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Objective: The European Society of Cardiology's prevention guideline suggests that the risk of total (fatal plus non-fatal) cardiovascular disease (CVD) may be calculated from the risk of CVD mortality using a fixed multiplier (3×). However, the proposed multiplier has not been validated. We investigated the ratio of total CVD to CVD mortality in a large population-based cohort.Methods: CVD mortality and total CVD (fatal plus non-fatal CVD requiring hospitalisation) were analysed using Kaplan-Meier estimates among 24 014 men and women aged 39-79 years without baseline CVD or diabetes mellitus in the prospective population-based European Prospective Investigation of Cancer and Nutrition-Norfolk cohort. CVD outcomes included death and hospitalisations for ischaemic heart disease, heart failure, cerebrovascular disease, peripheral artery disease or aortic aneurysm. The main study outcome was the ratio of 10-year total CVD to 10-year CVD mortality stratified by age and sex.Results: Ten year CVD mortality was 3.9% (900 CVD deaths, 95% CI 3.6% to 4.1%); the rate of total CVD outcomes was 21.2% (4978 fatal or non-fatal CVD outcomes, 95% CI 20.7% to 21.8%). The overall ratio of total CVD to CVD mortality was 5.4. However, we found major differences in this ratio when stratified by gender and age. In young women (39-50 years), the ratio of total CVD to CVD mortality was 28.5, in young men (39-50 years) 11.7. In the oldest age group, these ratios were considerably lower (3.2 in women and 2.4 in men aged 75-79 years).Conclusions: The relationship between 10-year total CVD and CVD mortality is dependent on age and sex, and cannot be estimated using a fixed multiplier. Using CVD mortality to estimate total CVD risk leads to serious underestimation of risk, particularly in younger age groups, and particularly in women. [ABSTRACT FROM AUTHOR]

Background: We investigate the association between occupational social class and self-rated health (SRH) at different ages in men and women.Methods: Cross sectional population study of 22,457 men and women aged 39-79 years living in the general community in Norfolk, United Kingdom, recruited using general practice age-sex registers in 1993-1997. The relationship between self-rated health and social class was examined using logistic regression, with a poor or moderate rating as the outcome.Results: The prevalence of poor or moderate (lower) self-rated health increased with increasing age in both men and women. There was a strong social class gradient: in manual classes, men and women under 50 years of age had a prevalence of lower self-rated health similar to that seen in men and women in non-manual social classes over 70 years old. Even after adjustment for age, educational status, and lifestyle factors (body mass index (BMI), smoking, physical activity and alcohol consumption) there was still strong evidence of a social gradient in self-rated health, with unskilled men and women approximately twice as likely to report lower self-rated health as professionals (OR(men) = 2.44 (95%CI 1.69, 3.50); OR(women) = 1.97 (95%CI 1.45, 2.68).Conclusion: There was a strong gradient of decreased SRH with age in both men and women. We found a strong cross-sectional association between SRH and social class, which was independent of education and major health related behaviors. The social class differential in SRH was similar with age. Prospective studies to confirm this association should explore social and emotional as well as physical pathways to inequalities in self reported health. [ABSTRACT FROM AUTHOR]

Background: Social inequalities in adult smoking and excessive alcohol intake may be associated with exposure to multiple childhood social risk factors across different domains of risk within the household. Methods: We used data from a cross-sectional cohort study of adults (40-75 years) in 1993-97 living in England (N = 19466) to examine the association between clusters of childhood social risks across different domains with adult smoking and excessive alcohol use. Participants reported exposure to six childhood social risk factors, current smoking behaviour and alcohol intake. Factor analysis was used to identify domains of social risk. We created a childhood cumulative domain social risk score (range 0-2) from summing the total number of domains. Results: Factor analysis identified two domains of childhood social risk within the household: maladaptive family functioning (parental unemployment, substance misuse, physical abuse) and parental separation experiences (maternal separation, divorce, being sent away from home). Compared to those children with risk exposure in no single domain, children with risk exposure in both domains (i.e. maladaptive family functioning, parental separation experiences) had a higher prevalence of adult smoking [men: Prevalence ratio (PR) = 1.74, 95% confidence intervals (CI): 1.35-2.26; women: PR = 1.71 95% CI: 1.34-2.18]. There was a trend association between the number of childhood social risk domains and adult smoking (both sexes: P < 0.001) and excessive alcohol use (men: P <0.008). Conclusions: Further work is needed to understand if addressing cumulative risk exposure to maladaptive family functioning and parental separation experiences can reduce social inequalities in adult smoking and excessive alcohol intake. [ABSTRACT FROM AUTHOR]

Objective: The objective of the present study was to investigate associations between sugar intake and overweight using dietary biomarkers in the Norfolk cohort of the European Prospective Investigation into Cancer and Nutrition (EPIC-Norfolk).Design: Prospective cohort study.Setting: EPIC-Norfolk in the UK, recruitment between 1993 and 1997.Subjects: Men and women (n 1734) aged 39-77 years. Sucrose intake was assessed using 7 d diet diaries. Baseline spot urine samples were analysed for sucrose by GC-MS. Sucrose concentration adjusted by specific gravity was used as a biomarker for intake. Regression analyses were used to investigate associations between sucrose intake and risk of BMI>25·0 kg/m2 after three years of follow-up.Results: After three years of follow-up, mean BMI was 26·8 kg/m2. Self-reported sucrose intake was significantly positively associated with the biomarker. Associations between the biomarker and BMI were positive (β=0·25; 95 % CI 0·08, 0·43), while they were inverse when using self-reported dietary data (β=-1·40; 95 % CI -1·81, -0·99). The age- and sex-adjusted OR for BMI>25·0 kg/m2 in participants in the fifth v. first quintile was 1·54 (95 % CI 1·12, 2·12; P trend=0·003) when using biomarker and 0·56 (95 % CI 0·40, 0·77; P trend<0·001) with self-reported dietary data.Conclusions: Our results suggest that sucrose measured by objective biomarker but not self-reported sucrose intake is positively associated with BMI. Future studies should consider the use of objective biomarkers of sucrose intake. [ABSTRACT FROM AUTHOR]

Background Poor vision is associated with lower socioeconomic status, but less is known about its relationship to area deprivation. Methods The European Prospective Investigation into Cancer and Nutrition study Norfolk Eye Study was a cross-sectional study of 8563 participants with completed eye examinations. Logarithm of the minimum angle of resolution (logMAR) visual acuity (VA) was measured using standard protocols and low vision (LV) was defined as Snellen equivalent (VA) ?6/12 in the better eye. Uncorrected refractive error (URE) was defined as improvement of VA by 2 logarithm of the minimum angle of resolution lines with pinhole. The lowest 5% of index of multiple deprivation rank was used to define the most deprived areas. The index of multiple deprivation is a composite measure using routine data from seven domains of deprivation to identify the most disadvantaged areas in England. Logistic regression was used to examine univariable and multivariable associations with LV. Results Ninety-six participants with missing data were excluded, leaving 8467 for analysis (98.9%). The mean age of the study group was 68.7 years (SD=8.1, range=48-92), with 55.1% women. LV was present in 263 participants (3.1%, 95% CI 2.7 to 3.5%). LV was associated with deprivation after adjusting for age, sex, education, social class and cataract surgery (OR=1.7, 95% CI 1.1 to 2.6, p=0.03), but this effect was mitigated by additionally adjusting for URE (OR=1.5, 95% CI 1.0 to 2.4, p=0.09). Conclusions People with LV are more likely to live in the most deprived areas; this association was independent of socioeconomic status and partly mediated by URE. Targeting URE in deprived areas may reduce health inequalities associated with LV. [ABSTRACT FROM AUTHOR]

In the present study, we investigated the association between dietary intake of carbohydrates and the risk of type 2 diabetes. Incident cases of diabetes (n 749) were identified and compared with a randomly selected subcohort of 3496 participants aged 40–79 years. For dietary assessment, we used 7 d food diaries administered at baseline. We carried out modified Cox proportional hazards regression analyses and compared results obtained from the different methods of adjustment for total energy intake. Dietary intakes of total carbohydrates, starch, sucrose, lactose or maltose were not significantly related to diabetes risk after adjustment for confounders. However, in the residual method for energy adjustment, intakes of fructose and glucose were inversely related to diabetes risk. The multivariable-adjusted hazard ratios (HR) of diabetes comparing the extreme quintiles of intake were 0·79 (95 % CI 0·59, 1·07; P for trend = 0·03) for glucose and 0·62 (95 % CI 0·46, 0·83; P for trend = 0·01) for fructose. In the nutrient density method, only fructose was inversely related to diabetes risk (HR 0·65, 95 % CI 0·48, 0·88). The replacement of 5 % energy intake from SFA with an isoenergetic amount of fructose was associated with a 30 % lower diabetes risk (HR 0·69, 95 % CI 0·50, 0·96). Results of the standard and energy partition methods were similar to those of the residual method. These prospective findings suggest that the intakes of starch and sucrose are not associated, but that those of fructose and glucose are inversely associated with diabetes risk. Whether the inverse associations with fructose and glucose reflect the effect of substitution of these carbohydrate subtypes with other nutrients (i.e. SFA), their net higher intake or other nutrients associated with their intake remains to be established through further investigation. [ABSTRACT FROM PUBLISHER]

Chronic obstructive pulmonary disease is known to be associated with systemic inflammation. We examined the longitudinal association of C-reactive protein (CRP) and lung function in a cohort of 18,110 men and women from the European Prospective Investigation Into Cancer in Norfolk who were 40–79 years of age at baseline (recruited in 1993–1997) and followed-up through 2011. We assessed lung function by measuring forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1) at baseline, 4 years, and 13 years. Serum CRP levels were measured using a high-sensitivity assay at baseline and the 13-year follow up. Cross-sectional and longitudinal associations of loge-CRP and lung function were examined using multivariable linear mixed models. In the cross-sectional analysis, 1-standard-deviation increase in baseline loge-CRP (about 3-fold higher CRP on the original milligrams per liter scale) was associated with a −86.3 mL (95% confidence interval: −93.9, −78.6) reduction in FEV1. In longitudinal analysis, a 1-standard-deviation increase in loge-CRP over 13 years was also associated with a −64.0 mL (95% confidence interval: −72.1, −55.8) decline in FEV1 over the same period. The associations were similar for FVC and persisted among lifetime never-smokers. Baseline CRP levels were not predictive of the rate of change in FEV1 or FVC over time. In the present study, we found longitudinal observational evidence that suggested that increases in systemic inflammation are associated with declines in lung function. [ABSTRACT FROM PUBLISHER]

Objective: Supplement use has increased over time and measurements of supplement use are dependent on instruments chosen. Therefore, we investigated three different questionnaires to measure supplement use and whether these results were associated with age, year of recruitment (secular trend, 1993-1998), and seasonal trends. Design: The questionnaires were self-administered within a median time interval of 54 days and included a Health and Lifestyle Questionnaire (1-year recall), a Food Frequency Questionnaire (1-year recall), and a 7-day diet diary. Setting: Men and women, aged 40-79 years from the general population living in Norfolk (East Anglia, UK), recruited between 1993 and 1998 in the European Prospective Investigation into Cancer Study (EPIC-Norfolk). Results: The prevalence of supplement use estimated with different instruments ranged from 31.7% to 39.0% for men and 45.0% to 54.3% for women. Agreement was substantial with kappa-statistics between 0.72 and 0.81. Participants' age (men only) and recruitment year were independently associated with supplement use; season showed inconsistent results. Conclusions: The diary provides a good agreement as measured by the kappa-statistic, compared to more long-term measures of supplement use classification. The secular and seasonal trends in supplement use and type of assessment instrument need to be taken into account in studies on health and supplement use. [ABSTRACT FROM AUTHOR]

We investigated the association between psychological stress, emotional health, and relative mean telomere length in an ethnically homogeneous population of 4,441 women, aged 41–80 years. Mean telomere length was measured using high-throughput quantitative real-time polymerase chain reaction. Social adversity exposure and emotional health were assessed through questionnaire and covariates through direct measurement and questionnaire. This study found evidence that adverse experiences during childhood may be associated with shorter telomere length. This finding remained after covariate adjustment and showed evidence of a dose–response relationship with increasing number of reported childhood difficulties associated with decreasing relative mean telomere length. No associations were observed for any of the other summary measures of social adversity and emotional health considered. These results extend and provide support for some previous findings concerning the association of adverse experience and emotional health histories with shorter telomere length in adulthood. Replication of these findings in longitudinal studies is now essential. [ABSTRACT FROM PUBLISHER]

Background Self-Rated Health (SRH) as assessed by a single-item measure is an independent predictor of health outcomes. However, it remains uncertain which elements of the subjective health experience it most strongly captures. In view of its ability to predict outcomes, elucidation of what determines SRH is potentially important in the provision of services. This study aimed to determine the extent to which dimensions of physical, mental and social functioning are associated with SRH. Methods We studied 20 853 men and women aged 39-79 years from a population-based cohort study (European Prospective Investigation of Cancer study) who had completed an SRH (Short Form (SF)-1) measure and SF-36 questionnaire. SF-36 subscales were used to quantify dimensions of health best predicting poor or fair SRH within a logistic regression model. Results In multivariate models adjusting for age, gender, social class, medical conditions and depression, all subscales of the SF-36 were independently associated with SRH, with the Physical Functioning subscale more strongly associated with poor or fair compared with excellent, very good or good health (OR 3.7 (95% CI 3.3 to 4.1)) than Mental Health (OR 1.4 (95% CI 1.2 to 1.5)) or Social Functioning subscales (OR 1.8 (95% CI 1.6 to 2.0)) for those below and above the median. Conclusion This study confirms that physical functioning is more strongly associated with SRH than mental health and social functioning, even where the relative associations between each dimension and SRH may be expected to differ, such as in those with depression. It suggests that the way people take account of physical, mental and social dimensions of function when rating their health may be relatively stable across groups. [ABSTRACT FROM AUTHOR]

Background: Screening for increased waist circumference and hypertriglyceridemia (the hypertriglyceridemic-waist phenotype) has been proposed as an inexpensive approach to identify patients with excess intra-abdominal adiposity and associated metabolic abnormalities. We examined the relationship between the hypertriglyceridemic-waist phenotype to the risk of coronary artery disease in apparently healthy individuals. Methods: A total of 21 787 participants aged 45-79 years were followed for a mean of 9.8 (standard deviation 1.7) years. Coronary artery disease developed in 2109 of them during follow-up. The hypertriglyceridemic-waist phenotype was defined as a waist circumference of 90 cm or more and a triglyceride level of 2.0 mmol/L or more in men, and a waist circumference of 85 cm or more and a triglyceride level of 1.5 mmol/L or more in women. Results: Compared with participants who had a waist circumference and triglyceride level below the threshold, those with the hypertriglyceridemic-waist phenotype had higher blood pressure indices, higher levels of apolipoprotein B and C-reactive protein, lower levels of high-density lipoprotein cholesterol and apolipoprotein A-I, and smaller low-density lipoprotein particles. Among men, those with the hypertriglyceridemic- waist phenotype had an unadjusted hazard ratio for future coronary artery disease of 2.40 (95% confidence interval [CI] 2.02-2.87) compared with men who did not have the phenotype. Women with the phenotype had an unadjusted hazard ratio of 3.84 (95% CI 3.20-4.62) compared with women who did not have the phenotype. Interpretation: Among participants from a European cohort representative of a contemporary Western population, the hypertriglyceridemic- waist phenotype was associated with a deteriorated cardiometabolic risk profile and an increased risk for coronary artery disease. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the role of the inflammatory biomarkers C-reactive protein (CRP), myeloperoxidase, paraoxonase, secretory phospholipase A2 group IIA (sPLA2), lipoprotein-associated phospholipase A2, fibrinogen, macrophage chemoattractant protein-1 and adiponectin, in predicting the risk of coronary heart disease (CHD) among people estimated to be at intermediate risk according to the Framingham Risk Score (FRS). Design: Prospective case-control study nested in EPIC-Norfolk cohort. Setting: Norfolk, UK. Patients: Apparently healthy men and women aged 45-79 years. Main outcome measures: Risk of future coronary artery disease. Results: For participants predicted to be at intermediate risk by the FRS, the highest c statistics were observed for FRS plus CRP (0.61, 95% CI 0.57 to 0.65) and for FRS plus sPLA2 (0.56, 95% CI 0.52 to 0.6). Net correct reclassification of cases and controls for each marker was assessed for people across the entire risk spectrum and again for people at intermediate risk only. The largest differences were observed for CRP, 12.0% net reclassification improvement in the entire risk spectrum and 28.4% net reclassification improvement in the intermediate-risk group and for sPLA2, the net reclassification improvement was 6.4% in the entire risk spectrum and 16.3% in the intermediate-risk group. Conclusions: The discriminatory potential of inflammatory biomarkers was substantially different when analysed across the entire risk spectrum compared with the subgroup of people at intermediate risk. [ABSTRACT FROM AUTHOR]

While estimates of relative risks associated with risk factors such as age and bone mineral density (BMD) may be of interest for etiologic and comparative purposes, clinical questions such as who might benefit most from preventive interventions or BMD monitoring depend on estimates of absolute fracture risk. The European prospective investigation into cancer (EPIC)-Norfolk study included 25,311 participants (11,476 men) aged 4,079 years in 1993–1997. All participants were followed for osteoporotic fractures to March 2007. Ten-year absolute risk of fracture in men and women were calculated using the baseline survivor function in multivariable Cox proportional-hazards models adjusting for age, sex, history of fractures, body mass index, smoking, and alcohol intake. In comparison of those without history of fracture versus those with history of fracture, the 10-year absolute risk of any fracture in men ranged from 1.0 vs. 1.2% at age 40 years to 3.0 vs. 4.4% at age 75 years. The respective estimates in women ranged from 0.7 vs. 1.0% at age 40 years to 9.3 vs. 17.2% at age 75 years. Statistically significant interaction between age and sex was found ( P < 0.001), which contributed to the differences in predicted absolute fracture risks for men and women at different ages. Our study shows the need for population-specific data to develop efficient well calibrated algorithms for assessment of fracture risk. The interaction observed between sex and age points to the need for further prospective studies among men. [ABSTRACT FROM AUTHOR]

OBJECTIVE -- Accumulating evidence suggests that energy-dense foods predispose to obesity and that such foods may also be associated with an increased risk of type 2 diabetes, but there is limited evidence. Our aim was to investigate whether there is an independent association between dietary energy density and incidence of diabetes. RESEARCH DESIGN AND METHODS-- The European Prospective Investigation of Cancer (EPIC)-Norfolk Cohort Study was a population-based prospective study of individuals aged 40-79 years at baseline. We calculated energy density for overall diet (all solids and drinks) using food frequency questionnaires. During 12 years of follow-up, we documented 725 new-onset cases of diabetes among 21,919 participants without diabetes, cancer, or cardiovascular disease at baseline. RESULTS-- Baseline energy density (adjusted for age, sex, and baseline BMI) was higher in those who developed type 2 diabetes (mean 3.08 kJ/g [95% CI 3.03-3.13]) than in those who remained nondiabetic (3.01 kJ/g [3.00-3.02]) (P = 0.012). Energy density was positively associated with incident diabetes (odds ratio 1.21 per unit increase [95% CI 1.06-1.38]) adjusted for known risk factors. There was a 60% higher risk of diabetes (1.60 [1.19-2.16]) in the highest quintile of energy density (range 3.55-7.97 kJ/g) compared with the lowest quintile (1.04-2.43 kJ/g) in adjusted analysis. CONCLUSIONS -- This is the first large population-based prospective study to report that an energy-dense diet may be associated with increased risk of development of diabetes, independent of baseline obesity. The potential public health impact of a low-energy-dense diet on reducing the risk of diabetes deserves further study. [ABSTRACT FROM AUTHOR]

Objective:To investigate the intake of plant sterols and identify major dietary sources of plant sterols in the British diet.Subjects:A total of 24 798 men and women recruited during 1993–1997, participating in the European Prospective Investigation into Cancer (EPIC-Norfolk).Interventions:A database of the plant sterol (campesterol, β-sitosterol, stigmasterol, campestanol and β-sitostanol) content in foods, based on gas-liquid chromatography (GLC) analyses, was linked to nutritional intake data from food frequency questionnaires in the EPIC-Norfolk population.Results:The mean (s.d.) intake of total plant sterols was 300 (108) mg/d for men and 293 (100) mg/d for women. Bread and other cereals, vegetables and added fats were the three major food sources of plant sterols representing 18.6 (8.9), 18.4 (8.5) and 17.3 (10.4)% of the total plant sterol intake respectively. Women had a higher plant sterol density than men (36.4 vs 32.8 mg/1000 kJ, P<0.001) and in relation to energy intake higher intakes of plant sterols from vegetables, bread and other cereals, added fats, fruits and mixed dishes (all P<0.001), whilst men had higher intakes of plant sterols from cakes, scones and chocolate, potatoes (all P<0.001) and other foods (P<0.01).Conclusions:The intake of plant sterols in UK, mainly from bread, cereals, fats and vegetables, is much higher than previously reported but comparable to recent European studies.European Journal of Clinical Nutrition (2008) 62, 695–703; doi:10.1038/sj.ejcn.1602765; published online 18 April 2007 [ABSTRACT FROM AUTHOR]

This article deals with a study examining the relationship between hemoglobin A1c, cardiovascular disease, and total mortality. This study was performed on 4662 men and 5570 women who were 45 to 79 years of age and were residents of Norfolk, England. Hemoglobin A1c and cardiovascular disease risk factors were assessed from 1995 to 1997, and cardiovascular disease events and mortality were assessed during the follow-up period to 2003. It was found that in men and women, the relationship between hemoglobin A 1c and cardiovascular disease and between hemoglobin A1c and all-cause mortality was continuous and significant throughout the whole distribution. The relationship was apparent in persons without known diabetes. These findings support the need for randomized trials of interventions to reduce hemoglobin A1c concentrations in persons without diabetes.

Poor respiratory function and obesity are associated with all-cause and cardiovascular disease mortality. Obese persons may also have impaired lung function, but the mechanism is unclear. The authors investigated the relation between abdominal pattern of obesity and respiratory function in the European Prospective Investigation into Cancer and Nutrition–Norfolk (EPIC-Norfolk) cohort in Norfolk, United Kingdom. This analysis included 9,674 men and 11,876 women aged 45–79 years with no known preexisting serious illness who had complete anthropometric and respiratory function measures obtained at a health visit between 1993 and 1997. Waist:hip ratio was used to assess abdominal obesity, and forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC), obtained by spirometry, were used to assess respiratory function. Both FEV1 and FVC were linearly and inversely related across the entire range of waist:hip ratio in both men and women. This relation persisted after adjustment for age, body mass index, cigarette smoking, social class, physical activity index, prevalent bronchitis/emphysema, and prevalent asthma. The association remained significant among nonobese nonsmokers without preexisting respiratory disease. In the general adult population, abdominal fat deposition may play a role in the impairment of respiratory function among the abdominally obese. [ABSTRACT FROM AUTHOR]

Objective: To examine the seroprevalence, correlates, and characteristics of undetected coeliac disease in a large adult population sample in Cambridge, UK. Methods: The Cambridge General Practice Health Study invited individuals from 12 general practices, aged 45-76 years, to attend for a health survey that included a bone density measurement, between 1990 and 1995. A total of 7550 participants' serum samples were tested for antiendomysial antibody (EMA). Seroprevalence of undetected coeliac disease was based on EMA positivity. Differences between EMA positive and negative participants of various physiological correlates and reported characteristics were estimated by multivariate logistic and linear regression and adjusted for age, sex, social class, and smoking behaviour. Results: The seroprevalence of undetected coeliac disease in this general population sample aged 45-76 was 1.2% (95% confidence interval (CI) 0.9-1.4). EMA positive participants (n = 87) were on average slightly lighter by 2.2 kg (p = 0.08), were more likely to have reported their general health as being "good or excellent" (odds ratio (OR) 1.76 (95% CI 0.90-3.46)), and were less likely to report being a current smoker (OR for current versus never 0.36 (95% CI 0.14-0.90)) than EMA negative participants. EMA positivity was associated with an 8% reduction in mean serum cholesterol (0.5 mmol/l; p < 0.01) and reductions in mean haemoglobin (0.3 g/dl; p < 0.01), total protein (1.0 g/l; p < 0.05), and corrected serum calcium (0.02 mmol/l; p < 0.05). There was an increased risk of osteoporosis in EMA positive participants (OR 3.1 (95% CI 1.3-7.2)) and of mild anaemia (OR 4.6 (95% CI 2.5-8.2)) compared with EMA negative participants. Conclusions: Undetected coeliac disease is likely to affect approximately 1% of the population of England aged 45-76 years, a value similar to several other countries. Those affected report "better health" but they do have an increased risk of osteoporosis and mild anaemia. In contrast, they have a favourable cardiovascular risk profile that may afford protection from ischaemic heart disease and stroke. [ABSTRACT FROM AUTHOR]

Objectives To estimate the current prevalence of family history and associated risk of prevalent colorectal cancer among middle aged and older British adults. Methods Cross sectional analysis of colorectal cancer and self reported family history based on data from a large population based study in Norfolk, United Kingdom. Results Of the 30 353 participants, 2069 (6.8%) participants had reported a family history of colorectal cancer in at least one first degree relative. The prevalence of colorectal cancer in those with a family history was 1% and 0.5% in those without. Of the 151 participants with prevalent colorectal cancer, 14.6% reported a family history of the disease. Also, a family history of colorectal cancer in first degree relatives was significantly associated with an increased risk of prevalent colorectal cancer (multivariate odds ratio (OR) 2.32 (95% confidence interval (95% CI) 1.43 to 3.76). For those with one affected relative below the age of 45, and for those with two affected relatives the multivariate ORs were 5.29 (1.63 to 17.17) and 4.93 (1.17 to 20.70), respectively. Conclusions Although positive family history may identify a group with increased likelihood of colorectal cancer, screening strategies targeted solely at people with a family history will have limited impact on reducing mortality from colorectal cancer at the population level. [ABSTRACT FROM AUTHOR]

cThe article provides information on the initiation of the European Prospective Investigation of Cancer (EPIC) in 1989 in Norfolk, England. The Norfolk-EPIC study aims to evaluate the public health impact of lifestyle intervention based on observational epidemiological data. It also explains the relationship between diet and the risk of developing cancer. The study identifies a cohort of 25,000 men and women age 45 to 74 from the general population in the Health Survey of England.

Focuses on the function of the opthalmic accident and emergency department of Southamptom Eye Hospital in England. Provision of services far in excess of the department's defined functions; Advantage of opthalmic nurse in the department; Enhancement of doctor's efficiency in handling complex clinical problems.

To investigate the association between percentage of total daily energy intake consumed at breakfast and weight change in middle-aged men and women, the authors analyzed data from a prospective population-based cohort study from Norfolk, United Kingdom. Participants were 6,764 men and women aged 40–75 years at baseline (1993–1997). Participants completed a 7-day food diary at baseline, and objective measurements of height and weight were carried out at baseline and follow-up (1998–2000). Mean baseline body mass index (weight (kg)/height (m)2) was lowest among persons in the highest quintile of percentage of daily energy consumed at breakfast (mean values were 26.0 in the highest quintile and 26.3 in the lowest quintile), despite higher daily total energy intake in this group. Although all participants gained weight, increased percentage of daily energy consumed at breakfast was associated with relatively lower weight gain (adjusted β coefficient = −0.021, 95% confidence interval: −0.035, −0.007; p = 0.004). The association between percentage of daily energy intake consumed at breakfast and weight gain was independent of age, sex, smoking, total energy intake, macronutrient intake, social class, and physical activity. Redistribution of daily energy intake, so that more energy is consumed at breakfast and less energy is consumed later in the day, may help to reduce weight gain in middle-aged adults. [ABSTRACT FROM AUTHOR]

Objectives: To examine whether anticholinergic medication exposure in middle and late life is associated with physical capability.Study Design: We used data from 8477 men and women who had enrolled in the European Prospective Investigation of Cancer-Norfolk study at baseline (1HC; 1993-1997) and who had attended its third health examination (3HC; 2004-2010). Medication history at the 1HC and 3HC was used to score participants according to the Anticholinergic Cognitive Burden (ACB) Scale at baseline and 3HC; participants were categorised as ACB = 0, ACB = 1, ACB>2.Main Outcome Measure: At 3HC, physical capability was objectively measured by: usual walking speed, maximum grip strength, timed chair stands speed (TCSS) and standing balance. Linear and logistic regression models examined prospective and cross-sectional associations between ACB and physical capability, controlling for co-morbidity, sociodemographic and lifestyle factors.Results: The analyses included 3386 men and 4110 women who were 56.4 (SD 7.9) and 55.0 (7.7) years old respectively at baseline and 69.4 (8.1) and 67.9 (8.0) years old at follow-up. Significant cross-sectional and prospective relationships were observed for all physical capability measures in women, except grip strength. For example, women with ACB ≥ 2 compared with ACB = 0 at baseline had 0.07 m/s (95 % CI -0.11, -0.03) slower usual walking speed, 2.61 stands/min (-4.17, -1.05) slower TCSS and higher odds of being unable to complete a tandem stand (odds ratio 2.40, 95 % CI 1.53, 3.76). These trends were observed in men but were less consistent in prospective analyses.Conclusion: Exposure to anticholinergic medication predicts poor physical capability and is a potentially reversible risk factor. [ABSTRACT FROM AUTHOR]

Objective: To examine the relationship between the Short-Form Six-Dimension (SF-6D) and mortality.Study Design and Setting: Participants were 17,736 men and women aged 40-79 years at baseline who lived in Norfolk, UK, and had no known cardiovascular disease or cancer, and completed the anglicized Short-Form 36 (SF-36)-item during 1996-2000 in the European Prospective Investigation into Cancer-Norfolk prospective population study. The SF-36 data were converted to SF-6D. The relationship between SF-6D and all-cause and cause-specific mortality were examined.Results: One thousand and seventy deaths occurred during a total of 115,255 person years of follow-up (mean 6.5 years). Lower SF-6D was associated with increased risk of all-cause mortality in men and women. A decrease of 1 standard deviation (0.12 point) in SF-6D was associated with a 35% increase in all-cause mortality (hazards ratio = 1.35; 95% CI: 1.26, 1.45) after controlling for age, gender, body mass index, systolic blood pressure, cholesterol, diabetes, smoking, and social class. Similar results were observed for cardiovascular, cancer, and other causes of deaths.Conclusion: Poor health utility measured by the SF-6D predicted increased risk of all-cause and cause-specific mortality in men and women. The present study provides the first evidence of the sensitivity of the SF-6D in predicting mortality in an apparently healthy population. [ABSTRACT FROM AUTHOR]

Background: The relationship between different social-economic indices and physical and mental functional health of older people compared with younger people is unclear. Objective: To examine the effect of age and sex on the relationship between various social-economic indices and self-reported functional health. Methods: A population-based cross-sectional study was conducted in 19,088 participants of European Prospective Investigation into Cancer (EPIC)-Norfolk, UK, ages 40–79 years at baseline. The independent relationships between three different socioeconomic indices; occupational social class, education and residential area deprivation, and functional health measured by anglicized version of 36-item short form questionnaire (UK SF-36), were compared between older (≥65 years) and younger (<65 years) men and women. Results: Residential area deprivation was significantly associated with poor physical and mental functional health independent of social class and education, and consistent in both age groups in men and women. A low level of education in younger men and being in low social class in younger women were associated with poorer physical functional health compared with their respective older counterparts. Social class had a significantly greater effect in older women compared with younger women. Conclusion: Commonly used socioeconomic indices have differing associations with functional health depending the age and sex of an individual. Residential area deprivation predicts poor functional health in all age and sex groups. This may have implications for health policy. [Copyright &y& Elsevier]

Abstract: Bowel habit has been associated with colorectal carcinogenesis; however, findings from epidemiologic studies have been limited and inconsistent. The aim of this study was to explore the association between bowel habit and colorectal cancer (CRC) risk in the UK-Norfolk arm of the European Prospective Investigation Into Cancer and Nutrition (EPIC-Norfolk), a study of 25,663 men and women aged 45–79 years at entry. Having loose stools compared to soft stools was associated with an approximately 3-fold increased risk, and the association remained significant when lifestyle factors and bowel habit variables were included as covariates in the model (odds ratio (OR), 2.80; 95% confidence interval (CI), 1.41–5.56). The significantly elevated risk estimate persisted when we further excluded CRC cases within 3 years of follow-up. Frequency of bowel movement, stool quantity, feeling discomfort and laxative use was not overall associated with CRC risk. These findings suggest that having loose stools may be an indicator of colorectal cancer risk. [Copyright &y& Elsevier]

The article presents a study on the relationship between subdomains of total physical activity and mortality. The study aims to describe the association of physical activity on all-cause and cardiovascular mortality. It investigates the uncertainty that such association varies according to the domain of life in which the activity takes place. It examined 14,903 participants from England and accounted that 1128 deaths with 370 from cardiovascular disease happened in a span of seven years. The result indicated that physical activities at home and during exercise are related to lower risk of mortality.