Patterns and Predictions: The EPIC-Norfolk study

BackgroundGeneral approachesExamples of some current issues: fat, vit D, genetics

Kay-Tee Khaw

UNIVERSITY OF

CAMBRIDGE

CIPH 25 June 2014

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

Exposure

Physiological risk factors

Disease/disability

genetic environmental

e.g. diet, psychosocial,physical activity, infection, smoking

e.g. lung function, bone quality, immune function, blood vessel function

e.g. stroke, fractures, dementia, cancerfunctional health

What influences our risk of health in later life?

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

0

0.2

0.4

0.6

0.8

1

1.2

1.4

1.6

1.8

1 2 3 4 5

Sex soecifc quintile of FEV1

Od

ds

ratio

for

hig

h P

CS

sco

re

Men

Women

0

0.2

0.4

0.6

0.8

1

1.2

1 2 3 4

Quartiles of FEV1

Rela

tive

ris

k o

f h

ip f

ractu

re

Women

Men

FEV1 and lower hip fracture risk FEV1 and good physical functionMoayyeri A JCEM 2009 Myint P Eur Resp J 2005

Four simple health behaviours and mortality by cause in 20244 men and women aged 40-79 years, EPIC-Norfolk

1993-2007 (multiple endpoints)

1 Non smoker1 Alcohol >0 <14 units/wk1 Not inactive1 Blood vitamin C >50 umol/l (5 servings fruit and vegetable daily)

P<0.0001

Score 0-4

Equivalent 14 years

Khaw et al PLOS Medicine 2008 Adjusted for age, BMI, social class

P<0.001

0

1

2

3

4

5

6

0 1 2 3 4

Number of health behaviours

Relat

ive ri

sk o

f mor

talit

y All causes

CVD

Cancer

P<0.001

Physical activity patterns in 1993-1997 predict physical performance* in 2007-8 and in men and women

0

0.5

1

1.5

2

Inactive Moderatelyinactive

Moderatelyactive

Active

Physical activity in 1993-1997

Odd

s ra

tio fo

r <1

2 se

c

10.5

11

11.5

12

12.5

Mea

n tim

e in

sec

onds

OR <12 sec

Mean

Active compared with inactive equivalent to 7 years in ageP<0.01 for trend*timed 5 chair stands adjusted for age and sex

Cognitive function (PAL) by age in men and women EPIC-Norfolk 2006-8

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%]

Mean errors Percent scoring Cantab15

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

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

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

Relative risks* of incident diseases by vitamin D status in 14641 men and women 42-82 years, EPIC Norfolk 1997-2012

*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

3121 4469 2132 563 198

Survival between 1997-2012 by baseline 25 OH vitamin D

category in men and women, age, sex and month adjusted

1 <30nmol/l2 30-<90 nmol/l3 90-<120 nmol/l 4 >=120 nmol /l

p<0.05

Public health implications?

If everyone increased serum concentrations 20nmol/l (e.g. 1000 IU daily)

Estimated theoretical population impact 12% lower mortality

Physical activity modifies the relationship between genetic predisposition and body

mass index, EPIC-Norfolk

Li et al PLOS Med 2010

Exposure

Physiological risk factors

Disease/disability

genetic environmental

Better characterisation exposures e.g. diet,physical activity, infectionWider environmental determinants e.g. pollution, social networks

Better characterisation of physiology and phenotype e.g. gut microbiome

Better assessment of relevant health outcomes: e.g. quality of life, function, service utilization

EPIC-Norfolk: Continuing challenges for population health

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

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

Funding supportMedical Research Council

Cancer Research UKStroke Association

Research Into AgeingBritish Heart Foundation

Academy of Medical ScienceDepartment of Health

Food Standards AgencyEU against Cancer