In the originally published version of this Article, the affiliation details for Santi González, Jian'an Luan and Claudia Langenberg were inadvertently omitted. Santi González should have been ...affiliated with 'Barcelona Supercomputing Center (BSC), Joint BSC-CRG-IRB Research Program in Computational Biology, 08034 Barcelona, Spain', and Jian'an Luan and Claudia Langenberg should have been affiliated with 'MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK'. Furthermore, the abstract contained an error in the SNP ID for the rare variant in chromosome Xq23, which was incorrectly given as rs146662057 and should have been rs146662075. These errors have now been corrected in both the PDF and HTML versions of the Article.
The role of dietary fat in the etiology of type 2 diabetes remains uncertain. The authors investigated the association between dietary fat composition and risk of clinical type 2 diabetes in the ...European Prospective Investigation of Cancer-Norfolk study and identified food consumption patterns associated with dietary fat composition. Diet was assessed at baseline (1993-1997) using a semiquantitative food frequency questionnaire. From multiple sources of information, 414 incident cases of diabetes were identified among 23,631 men and women aged 40-78 years during 3-7 years of follow-up. The capture-recapture ascertainment level was 99%. The energy-adjusted dietary polyunsaturated:saturated fat ratio was inversely associated with the risk of diabetes (odds ratio (OR) = 0.84 per standard deviation change, 95% confidence interval (CI): 0.75, 0.94). Adjustment for age, sex, family history of diabetes, smoking, physical activity, total fat, protein, and alcohol attenuated the association (OR = 0.88, 95% CI: 0.78, 0.99), and it was no longer statistically significant after including body mass index and the waist:hip ratio (OR = 0.91, 95% CI: 0.81, 1.03). This prospective study showed that an increased dietary polyunsaturated:saturated fat ratio was associated with a reduced risk of diabetes, independent of age, sex, family history of diabetes, and other lifestyle factors.
Plasma apolipoprotein C-III (apoC-III) levels are associated with coronary artery disease (CAD) risk.
To assess whether lipoprotein-associated apoC-III levels predict risk of CAD events.
apoC-III ...associated with apoB, apoAI, and Lp(a) (apoCIII-apoB, apoCIII-apoAI, and apoCIII-Lp(a), respectively) were measured using high-throughput chemiluminescent enzyme-linked immunoassays in 2711 subjects (1879 controls and 832 cases with CAD) in the European Prospective Investigation into Cancer and Nutrition-Norfolk prospective population study with 7.4 years of follow-up. These measures were correlated with a variety of lipid measurements and the presence of CAD. The indices of “total apoCIII-apoB” and “total apoCIII-apoAI” were derived by multiplying plasma apoB and apoAI, respectively.
apoCIII-apoB (P = .001), apoCIII-Lp(a) (P < .001), apoCIII-apoAI (P = .005) were higher in cases vs controls; tended to correlate positively with body mass index, hsCRP, apoC-III, low-density lipoprotein (LDL) cholesterol, triglycerides, remnant cholesterol, very low density lipoprotein, LDL and high-density lipoprotein particle number and very low density lipoprotein size; but negatively with LDL and high-density lipoprotein particle size (P < .001 for all). apoCIII-apoB, apoCIII-apoAI, apoCIII-Lp(a), total apoCIII-Lp(a), and total apoCIII-apoB were predictors of CAD after adjustment of age, sex, body mass index, smoking, diabetes, hypertensive and lipid-lowering drug use, but they lost their significance after further adjustment of lipid and lipoprotein variables.
This study suggests that enzyme-linked immunoassay–measured lipoprotein-associated apoC-III markers reflect atherogenic lipid particles but do not independently predict risk of CAD events.
•High-throughput enzyme-linked immunoassays were developed to measure lipoprotein-associated apolipoprotein C-III (apoC-III) levels.•apoCIII-apoB, apoCIII-Lp(a), and apoCIII-apoAI were measured in EPIC-Norfolk.•apoCIII-apoB, apoCIII-Lp(a), and apoCIII-apoAI reflect atherogenic lipid particles.•apoCIII-apoB, apoCIII-Lp(a), and apoCIII-apoAI do not independently predict risk of coronary artery disease events.•Their role in patients with prior history of coronary artery disease needs to be evaluated.
A placement effect on activity measures from movement sensors has been reported during treadmill and free-living activity. Positioning of electrodes may impact on movement artifact susceptibility as ...well as surface ECG waveform amplitudes and thus potentially on the precision by which heart rate (HR) is ascertained from such ECG traces. The purpose of this study was to examine the extent to which placement of the combined HR and movement sensor, Actiheart, influences measurement of HR and movement, and estimates of energy expenditure. A total of 24 participants (20-39 years, 45-109 kg, 1.54-2.05 m, 19-29 kg m(-2)) were recruited. Whilst wearing two monitors, one placed at the level of the third intercostal space (upper position) and one just below the apex of the sternum (lower position), study participants performed level walking, incline walking, and level running on treadmill, and completed at least one day of free-living monitoring. Placement differences in HR data quality, movement counts, and energy expenditure (estimated from combined HR and movement) were analyzed with regression techniques. Quality of HR data was generally higher when monitors were placed in the lower position. This effect was more pronounced in men during both treadmill activity (relative risk, RR 95% CI of noisy HR data in upper vs. lower position, RR=1.30.3; 5.6 in women, RR=17414; 2,156 in men) and during free-living (RR=1.20.4; 3.3 in women, RR=259.6; 67 in men). There were minor placement differences (< or =8%) in movement counts only in women during incline walking and running. During free-living, no placement effect on counts was observed. In all test scenarios, estimates of energy expenditure from the two positions were not significantly different. Positioning the Actiheart at the level below the sternum may yield cleaner HR data. Regardless of which position is used, this has little or no effect on movement counts and energy expenditure estimates, which is encouraging for studies where research participants may have to position the monitors themselves.
Abstract Objective The objective of this study was to investigate the associations between psychosocial factors and asthma in a population-based cohort study of older adults. Methods A total of ...20,888 participants in the Norfolk cohort of the European Prospective Investigation into Cancer study completed assessments that included details of lifetime self-reported doctor-diagnosed asthma, mood disorder history, social adversity experience, and social support. Results Doctor-diagnosed asthma was reported by 1699 (8.1%) participants. After adjusting for age, sex, preexisting myocardial infarction, stroke, diabetes, cancer, cigarette smoking, social class, and area deprivation, the psychosocial factors most strongly (and independently) associated with asthma were major depressive disorder ( P =.0001), adverse childhood circumstances ( P =.005), reported impact of life events experienced in adulthood ( P =.003), long-term difficulties in adulthood ( P =.04), and negative aspects of confidant support ( P =.002). Conclusion These results demonstrate that adverse psychosocial factors cluster among older adults with asthma. These findings may have implications for guiding improvements in asthma management.
Eur J Clin Invest 2010; 40 (12): 1081–1093
Background Although the total to high‐density lipoprotein cholesterol ratio (TC/HDL‐C) has been used for decades to identify individuals at risk for ...coronary heart disease (CHD), apolipoprotein‐based (apolipoprotein B/apolipoprotein A‐I apoB/apoA‐I) and nuclear magnetic resonance spectroscopy (NMR)‐based lipoprotein concentrations (low‐density lipoproteinNMR/high‐density lipoproteinNMR LDLNMR/HDLNMR) may also be useful for CHD risk stratification.
Materials and methods In a case–control study conducted within the European Prospective Investigation into Cancer and Nutrition (EPIC)‐Norfolk study population, 870 individuals who developed CHD during a 6‐year follow‐up were matched to 1659 controls on the basis of gender, age and enrolment time. LDLNMR and HDLNMR were measured by proton NMR spectroscopy.
Results After adjusting for traditional CHD risk factors, men in the top quintile of the various lipoprotein ratios proved to be at increased CHD risk (OR = 2·59 95% IC, 1·76–3·83 for TC/HDL‐C ratio, 2·59 1·75–3·83 for apoB/apoA‐I ratio and 2·78 1·86–4·17 for LDLNMR/HDLNMR ratio) compared with men in the bottom quintile. Similar associations were observed in women (OR = 2·86 1·71–4·80 for TC/HDL‐C ratio, 2·94 1·74–4·97 for apoB/apoA‐I ratio and 2·03 1·21–3·43 for LDLNMR/HDLNMR ratio). Compared with participants with only one component of the metabolic syndrome, those who had five had an increased TC/HDL‐C ratio (73·0% and 80·4% in men and women respectively), apoB/apoA‐I ratio (58·0% and 62·9% in men and women respectively) and for LDLNMR/HDLNMR ratio (52·6% and 54·1% in men and women respectively).
Conclusion In this European study population, the TC/HDL‐C, apoB/apoA‐I and LDLNMR/HDLNMR ratios were similarly associated with components of the metabolic syndrome and CHD risk.
Objectives To summarise the methods of the European Prospective Investigation of Cancer (EPIC)-Norfolk Eye Study, and to present data on the prevalence of visual impairment and associations with ...visual impairment in the participants. Design A population-based cross-sectional study nested within an on-going prospective cohort study (EPIC). Setting East England population (the city of Norwich and its surrounding small towns and rural areas). Participants A total of 8623 participants aged 48–92 years attended the Eye Study and underwent assessment of visual acuity, autorefraction, biometry, tonometry, corneal biomechanical measures, scanning laser polarimetry, confocal scanning laser ophthalmoscopy, fundal photography and automated perimetry. Outcome measures Visual impairment was defined according to the WHO classification and the UK driving standard, and was based on presenting visual acuity. Summary measures of other ophthalmic measurements are also presented. Results The prevalence (95% CI) of WHO-defined moderate-to-severe visual impairment and blindness was 0.74% (0.55% to 0.92%). The prevalence (95% CI) of presenting visual acuity worse than the UK driving standard was 5.87% (5.38% to 6.37%). Older age was significantly associated with visual impairment or blindness (p<0.001). Presenting visual acuity worse than UK driving standard was associated with older age (p<0.001), female sex (p=0.005) and lower educational level (p=0.022). Conclusions The prevalence of blindness and visual impairment in this selected population was low. Visual impairment was more likely in older participants, women and those with a lower educational level.
Background The measurement of energy intake in epidemiological studies is difficult. However, it is important that energy intake is assessed if epidemiological analyses are to correspond to ...isocaloric experiments. The aim of this study was to compare self-reported energy intake, physical activity, and body weight with energy expenditure measured by 4 days of heart rate monitoring with individual calibration of the relationship between heart rate and oxygen consumption. Methods Volunteer sub-study of 97 men and women (mean ages 54 and 51 years respectively) within the European Investigation into Cancer (EPIC) study in Norfolk (UK). Dietary assessment of energy intake and physical activity was by self-report and weight was measured using standard techniques. Energy expenditure was assessed objectively by recording heart rate for 4 days following a calibration of the relationship between heart rate and oxygen consumption. Results Self-reported energy intake by 7-day diary (mean 8.5 MJ/day) and food frequency questionnaire (FFQ) (mean 8.8 MJ/day) were significantly lower than objectively measured total energy expenditure (mean 11.2 MJ/day). The deattenuated partial correlations between total energy expenditure were 0.33 (7-day diary), 0.34 (FFQ), 0.50 (physical activity), and 0.56 (weight). Weight accounted for 31% (deattenuated) of the sum of squares about the mean of true energy intake after adjusting for age and sex. With the addition of self-reported physical activity, the model was significantly improved (R2 = 0.57). Adding energy either assessed by the diary or FFQ did not improve the model. Conclusions The results presented here indicate that to adjust for energy intake, for the purpose of replicating an isocaloric experiment in an observational epidemiological study, one would do considerably better adjusting for weight and physical activity, than adjusting for energy intake estimated from an FFQ.
Objective To estimate the potential population impact of different screening strategies for identifying and treating people at high risk of cardiovascular disease, including strategies using routine ...data for cardiovascular risk stratification, in light of the UK government’s recommended national strategy to screen all adults aged 40-74 for cardiovascular risk.Design Modelling study using data from a prospective cohort, EPIC-Norfolk (European Prospective Investigation of Cancer-Norfolk).Setting An English county.Participants 16 970 men and women aged 40-74 and free from cardiovascular disease and diabetes at baseline.Main outcome measures The main outcomes were the population attributable fraction, the number needed to screen to prevent one new case of cardiovascular disease, the number needed to treat to prevent one new case of cardiovascular disease, and the number of new cardiovascular events that could be prevented. Relative risk reductions for estimated treatment effects were derived from meta-analyses of clinical trials or guidelines from the National Institute for Health and Clinical Excellence.Results 1362 cardiovascular events occurred over 183 586 person years of follow-up. Compared with the recommended government strategy, a stepwise screening approach using a simple risk score incorporating routine data could prevent a similar number (lower to upper estimates) of new cardiovascular events annually in the United Kingdom (26 789, 20 778 to 36 239) and 25 134 (19 450 to 34 134), respectively) but requiring only 60% of the population to be invited to attend a vascular risk assessment. A similar number of cardiovascular events (25 016, 19 563 to 33 372) could also be prevented by inviting everyone aged 50-74 for a vascular assessment. Using a participant completed Finnish diabetes risk score questionnaire or anthropometric cut-off points for risk prestratification was less effective.Conclusions Compared with the UK government’s recommended national strategy to screen all adults aged 40-74 for cardiovascular risk, an approach using routine data for cardiovascular risk stratification before inviting people at high risk for a vascular risk assessment may be similarly effective at preventing new cases of cardiovascular disease, with potential cost savings.
Abstract Objective Test the hypothesis that considering leisure-time and work-related physical activity habits in addition to the Framingham risk score (FRS) would result into better classification ...of coronary heart disease (CHD) risk than FRS alone. Methods Prospective, population-based study of 9564 men and 12165 women aged 45–79 years followed for an average of 11.4 years. A modified FRS which takes into account physical activity (evaluated using a validated lifestyle questionnaire taking into account leisure-time and work-related physical activity) was computed. Results During follow-up, 2191 CHD events occurred. Among 3369 men who were classified as intermediate risk (event rate of 12.4%) according to the FRS, 413 were reclassified into the low-risk category and 279 were reclassified into the high-risk category after modification of the FRS. After reclassification of these men, CHD event rate was of 5.3% and 18.6%, respectively for men classified at low and high CHD risk. Among 4766 women initially classified as intermediate risk (event rate of 8.4%), 1282 were reclassified into the low-risk category whereas 1071 women were reclassified into the high-risk category. After reclassification of these women, CHD event rate was of 6.8% and 12.2%, respectively for women classified at low and high CHD risk. Conclusions Results of the present study suggest that asking simple questions about leisure-time and work-related physical activity which can be rapidly obtained by any physician at no cost could be helpful in the estimation of patients’ CHD risk.
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