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Kay-Tee Khaw

U NIVERSITY 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. EPIC*-Norfolk population study.

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Kay-Tee Khaw

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  1. UNIVERSITY • OF • CAMBRIDGE Patterns and Predictions: The EPIC-Norfolk studyBackgroundGeneral approachesExamples 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 40-79 years from GP age-sex registers in Norfolk, UK • Baseline survey 1993-1997 • 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 • http://www.epic-norfolk.org.uk

  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 • genetic • environmental • Exposure

  4. Some simple low cost physiological measures predict subjective and objective health in men and women aged 40-79 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 2009 Myint P Eur Resp J 2005

  5. Four simple health behaviours and mortality by cause in 20244 men and women aged 40-79 years, EPIC-Norfolk 1993-2007 (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. Physical activity patterns in 1993-1997 predict physical performance* in 2007-8 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%]

  8. 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 40-79 years, EPIC Norfolk 1993-2009 • Khaw KT et al PLOS Med 2012

  9. 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

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

  11. Relative risks* of incident diseases by vitamin D status in 14641 men and women 42-82 years, EPIC Norfolk 1997-2012 • 3121 4469 2132 563 198 • *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

  12. Survival between 1997-2012 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. 1000 IU daily) • Estimated theoretical population impact 12% lower mortality • p<0.05 • 1 <30nmol/l • 2 30-<90 nmol/l • 3 90-<120 nmol/l • 4 >=120 nmol /l

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

  14. 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

  15. 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 • http://www.epic-norfolk.org.uk

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