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Presentation on theme: "UNIVERSITY OF CAMBRIDGE"— Presentation transcript:

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


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