1. UNIVERSITY OF
CAMBRIDGE
Patterns and Predictions: The EPIC-Norfolk study Background General approaches Examples of some current issues: fat, vit D, genetics
Kay-Tee Khaw
CIPH 25 June 2014

2. EPIC*-Norfolk population study
Aims: to improve health through better understanding of the major determinants health in middle and later life
25,000 men and women years from GP age-sex registers in Norfolk, UK
Baseline survey
Extensive lifestyle and biologic information
Followed up for health endpoints to present
* Part of European Prospective Investigation into Cancer:
a 10 country collaboration with 450,000 participants

3. What influences our risk of health in later life?
Disease/disability
e.g. stroke, fractures,
dementia, cancer
functional health
e.g. lung function,
bone quality,
immune function,
blood vessel function
Physiological risk factors
e.g. diet, psychosocial,
physical activity,
infection, smoking
Exposure
genetic
environmental

4. Lower blood glucose levels Low levels of inflammation
Some simple low cost physiological measures predict subjective and objective health in men and women aged years
Good lung function
Low pulse rate
Good bone health
Lower blood glucose levels
Low levels of inflammation
FEV1 and lower hip fracture risk FEV1 and good physical function
Moayyeri A JCEM Myint P Eur Resp J 2005

5. 1 Alcohol >0 <14 units/wk 1 Not inactive
Four simple health behaviours and mortality by cause in men and women aged years, EPIC-Norfolk (multiple endpoints)
P<0.001
P<0.0001
P<0.001
1 Non smoker
1 Alcohol >0 <14 units/wk
1 Not inactive
1 Blood vitamin C >50 umol/l
(5 servings fruit and vegetable daily)
Score 0-4
Equivalent 14 years
Adjusted for age, BMI, social class
Khaw et al PLOS Medicine 2008

6. Active compared with inactive equivalent to 7 years in age
Physical activity patterns in predict physical performance* in and in men and women
Active compared with inactive equivalent to 7 years in age
P<0.01 for trend
*timed 5 chair stands adjusted for age and sex

7. Cognitive function (PAL) by age in men and women EPIC-Norfolk 2006-8
Mean errors Percent scoring Cantab15
Compared to no qualifications, finishing school equivalent to 9 years younger, tertiary education equivalent to 14 years younger cognitive performance
[E.g. Delay dementia onset by:- 2 yrs ↓ prevalence by 20%
- 5 yrs ↓ prevalence by 50%]

9. Age and sex adjusted odds ratios for CHD by fatty acid quartile, unadjusted and adjusted for other fatty acids in 2424 CHD cases and 4930 controls, men and women years, EPIC Norfolk
Khaw KT et al PLOS Med 2012

10. Implications
Different fatty acids differently related to CHD and overall balance critical Biomarkers of dietary intake/nutritional status and better dietary assessment tools may help clarify associations Future studies need to consider dietary patterns, foods as well as nutrients

11. Vitamin D and health: (to D or not to D?)

12. Relative risks* of incident diseases by vitamin D status in men and women years, EPIC Norfolk
*Adjusted for age, sex, month, body mass index, physical activity, smoking, alcohol, diabetes,
Vitamin C, history of cardiovascular disease, history of cancer, social class,& education

13. Survival between by baseline 25 OH vitamin D category in men and women, age, sex and month adjusted
Public health implications?
If everyone increased serum concentrations 20nmol/l (e.g IU daily)
Estimated theoretical population impact 12% lower mortality
p<0.05
1 <30nmol/l
<90 nmol/l
<120 nmol/l
4 >=120 nmol /l

14. Physical activity modifies the relationship between genetic predisposition and body mass index, EPIC-Norfolk
Li et al PLOS Med 2010

15. EPIC-Norfolk: Continuing challenges for population health
Disease/disability
Better assessment of relevant health outcomes: e.g. quality of life, function, service utilization
Better characterisation of physiology and phenotype e.g. gut microbiome
Physiological risk factors
Better characterisation
exposures e.g. diet,
physical activity, infection
Wider environmental
determinants e.g. pollution, social networks
genetic
environmental
Exposure

16. THANK YOU
We are most grateful to all participants, general practitioners and staff in EPIC-Norfolk who have given all their time and effort over the past 20 years
Funding support
Medical Research Council
Cancer Research UK
Stroke Association
Research Into Ageing
British Heart Foundation
Academy of Medical Science
Department of Health
Food Standards Agency
EU against Cancer