PMCC PMCC

Search tips
Search criteria

Advanced
Results 1-17 (17)
 

Clipboard (0)
None

Select a Filter Below

Journals
Year of Publication
1.  Cod Liver Oil Supplement Consumption and Health: Cross-sectional Results from the EPIC-Norfolk Cohort Study 
Nutrients  2014;6(10):4320-4337.
Supplement users (SU) make healthy lifestyle choices; on the other hand, SU report more medical conditions. We hypothesised that cod liver oil (CLO) consumers are similar to non-supplement users, since CLO use might originate from historical motives, i.e., rickets prevention, and not health consciousness. CLO consumers were studied in order to identify possible confounders, such as confounding by indication. The European Prospective Investigation into Cancer (EPIC) investigates causes of chronic disease. The participants were 25,639 men and women, aged 40–79 years, recruited from general practices in Norfolk, East-Anglia (UK). Participants completed questionnaires and a health examination between 1993 and 1998. Supplement use was measured using 7-day diet diaries. CLO was the most common supplement used, more prevalent among women and associated with not smoking, higher physical activity level and more favourable eating habits. SU had a higher occurrence of benign growths and bone-related diseases, but CLO was negatively associated with cardiovascular-related conditions. Although the results of SU characteristics in EPIC-Norfolk are comparable with studies worldwide, the CLO group is different from SU in general. Confounding by indication takes place and will need to be taken into account when analysing prospective associations of CLO use with fracture risk and cardiovascular diseases.
doi:10.3390/nu6104320
PMCID: PMC4210919  PMID: 25325252
dietary supplement; cod liver oil; socio-demographics; health; confounding; cardiovascular disease
2.  Breakfast consumption and daily physical activity in 9-10 year old British children 
Public health nutrition  2011;16(7):1281-1290.
Objective
To examine the association between breakfast consumption and physical activity in a well-characterised sample of English children.
Design
Cross sectional study using food diaries to record breakfast consumption and accelerometery to assess physical activity.
Setting
Norfolk county, England.
Subjects
1697 children aged 9-10yrs from the SPEEDY (Sport, Physical Activity and Eating behaviour: Environmental Determinants in Young people) study.
Results
Boys who consumed a poor quality breakfast based on dairy product, cereal and fruit intakes, spent approximately 7 minutes more time in moderate to vigorous (MVPA) during weekday afternoons and evenings compared to those who did not consume breakfast (p<0.05). On weekend days, boys who consumed a poor or good quality breakfast spent approximately 6 and 5 minutes respectively less time sedentary during the mornings compared to non-breakfast consumers (p<0.05). Boys who consumed a good quality breakfast spent almost 3 minutes more in MVPA during the morning on weekend days compared to non-consumers, and boys who consumed a poor or good quality breakfast were 22% and 16% more active overall respectively than non-breakfast consumers (p<0.05). During the rest of the day, boys who consumed a good quality breakfast spent around 11 minutes less time sedentary (p<0.05) and 7 minutes more time in MVPA (p<0.01).
Conclusion
Although some associations between breakfast consumption and physical activity were detected for boys, this study does not provide strong evidence that failing to consume breakfast, or having a low energy intake at breakfast time, is detrimental to children’s physical activity levels.
doi:10.1017/S1368980011002175
PMCID: PMC3667735  PMID: 21899790
3.  Availability of local food outlets is associated with weight status and dietary intake in 9-10 year olds 
Background
The rising rate of childhood obesity is a key public health issue worldwide. Limited evidence suggests that there may be interactions between environmental factors at a neighbourhood level and the development of obesity, with the availability and accessibility of foods outlets being potentially important.
Purpose
To examine how the weight status and dietary intake of 1669 9-10 year-olds was associated with neighbourhood food-outlets in a cross-sectional study.
Methods
Availability of food outlets was computed from GIS data for each child’s unique neighbourhood. Outlets were grouped into BMI-healthy, BMI-unhealthy or BMI-intermediate categories according to food-type sold. Weight status measurements were objectively collected and food intake was recorded using four-day food-diaries. Data was collected in 2007 and analysed in 2009.
Results
Availability of BMI-healthy outlets in neighbourhoods was associated with lower body weight (1.3kg; p=0.03), BMI (0.5kg/m2; p=0.02), BMI z-score (0.20; p=0.02), waist circumference (1.3cm; p=0.02), and percentage body fat (1.1%; p=0.03) compared to no availability. In contrast, neighbourhood availability of BMI-unhealthy outlets was inversely associated with body weight (1.3kg; p=0.02), BMI (0.4kg/m2; p=0.05), BMI z-score (0.15; p=0.05), waist circumference (1.1cm; p=0.04), and percentage body fat (1.0%; p=0.03). Unhealthy food intake (fizzy drinks 15.3%; p=0.04, and non-carbonated ‘fruit’ drinks 11.8%; p=0.03) was also associated with availability of BMI-unhealthy food outlets.
Conclusions
This study suggests that features of the built environment relating to food purchasing opportunities are independent significant correlates of weight status in children.
doi:10.1016/j.amepre.2010.12.014
PMCID: PMC3773911  PMID: 21406273
4.  Food and drink consumption at school lunchtime: the impact of lunch type and contribution to overall intake in British 9–10-year-old children 
Public health nutrition  2011;16(6):1132-1139.
Objective
To examine the differences in dietary intakes of children consuming school meals and packed lunches, the contribution of lunchtime intake to overall dietary intake and how lunchtime intake relates to current food-based recommendations for school meals.
Design
Cross-sectional analysis of overall intake of macronutrients and food choice from 4-day food diaries and school lunchtime intake from the two diary days completed while at school.
Setting
Norfolk, UK
Subjects
One thousand six hundred and twenty six children (aged 9-10 years) attending 90 Norfolk primary schools
Results
At school lunchtime school meal eaters consumed more vegetables, sweet snacks, chips, starchy foods, and milk, and less squash/cordial, fruit, bread, confectionery and savoury snacks than packed lunch eaters. These differences were also reflected in the overall diet. On average school meal eaters met School Food Trust (SFT) food-based standards, while food choices among packed lunch eaters were less healthy. The contribution of food consumed at school lunchtime to overall diet varied by food and lunch type, ranging from 0.8% (milk intake in packed lunches) to 74.4% (savoury snack intake in packed lunches).
Conclusions
There were significant differences in the foods consumed by school meal and packed lunch eaters, with food choices among school meal eaters generally in line with SFT standards. The food choices made at school lunchtime make a significant contribution to overall diet.
doi:10.1017/S1368980011002321
PMCID: PMC3713402  PMID: 21936970
5.  Impact of neighbourhood food environment on food consumption in children aged 9–10 years in the UK SPEEDY (Sport, Physical Activity and Eating behaviour: Environmental Determinants in Young people) study 
Public health nutrition  2009;13(7):1022-1030.
Objective
Poor diet in childhood increases risk of obesity but the relationship between access to food and children’s food choice is underexplored. We determined relationships between distance to and density of food outlets on children’s food choice.
Design
Children (n 1721) aged 9–10 years who participated in a cross-sectional study from a sample of state and private schools across urban and rural areas. Food consumption was reported using a short validated FFQ. A Geographic Information System was used to determine proximity to local food outlets. Multivariable regression analyses were performed to determine associations between food consumption and distance to and density of local food outlets.
Setting
Norfolk, England.
Subjects
Boys (n 754) and girls (n 967) aged 9–10 years.
Results
The impact of distance to or density of food outlets on food choice was small after adjustment. Living further away from a supermarket increased portions of fruit (0·11 portions/week per 1 km increase in distance to nearest supermarket, P<0·05) and vegetables (0·11 portions/week, P<0·05) consumed. Living closer to convenience stores was also associated with an increased consumption of crisps, chocolate and white bread. Density of supermarkets was associated with both an increase in vegetable intake (0·31 portions/week, P<0·05) and unhealthy foods.
Conclusions
Distance to and density of food outlets are both associated with children’s food choice, although the impact appears to be small and the relationship is complex. However, the effects of individual foods combined could be important, particularly as even small differences in intake can impact on body weight over time.
doi:10.1017/S1368980009992035
PMCID: PMC3164802  PMID: 20082745
Children; Food; Environment
6.  Healthy lifestyle choices: could sense of coherence aid health promotion? 
Background
A research framework based on the personal characteristic defined by a sense of coherence (SOC) focuses on the effective use of resources to maintain good health.
Objectives
To test the hypothesis that individual differences in SOC are associated with healthier lifestyle choices independently of social class and education.
Design and setting
Cross sectional. Population based cohort study recruited through 35 general practice registers. Reported dietary intakes of alcohol, fruit and vegetables, fibre, saturated fat, non‐discretionary salt (sodium), and total sugars were assessed by food frequency questionnaire. Current cigarette smoking, physical inactivity, and SOC were assessed through questionnaires.
Participants
7863 men and 10 424 women. Residents of Norfolk (UK).
Results
Compared with participants with the weakest SOC, those with the strongest were 28% less likely to be current smokers (odds ratio 0.72 (95% confidence interval (CI), 0.58 to 0.89)), 36% less likely to be physically inactive (0.64 (0.55 to 0.75)), and reportedly consumed on average 63 g/day more fruit and vegetables (95% CI, 46 to 80), and 1.2 g/day more fibre (0.8 to 1.6). These associations were independent of age, sex, social class, and education. For physical inactivity and consumption of fruit, vegetables, and fibre, these differences exceeded those observed between the extremes of social class and education.
Conclusions
Individual differences in SOC are associated with healthy lifestyle choices independently of social class and education, and may therefore aid the design of future health promotion interventions.
doi:10.1136/jech.2006.056275
PMCID: PMC2652963  PMID: 17873222
sense of coherence; smoking; physical activity; alcohol; diet
7.  Assessment of dietary intake: NuGO symposium report 
Genes & Nutrition  2010;5(3):205-213.
Advances in genomics science and associated bioinformatics and technology mean that excellent tools are available for characterising human genotypes. At the same time, approaches for characterising individual phenotypes are developing rapidly. In contrast, there has been much less investment in novel methodology for measuring dietary exposures so that there is now a significant gap in the toolkit for those investigating how diet interacts with genotype to determine phenotype. This symposium reviewed the strengths and limitations of current tools used in assessment of dietary intake and the potential to improve these tools through, for example, the use of statistical techniques that combine information from different sources (such as modelling and calibration methods) to ameliorate measurement error and to provide validity checks. Speakers examined the use of approaches based on technologies such as mobile ‘phones, digital cameras and Web-based systems which offer the potential for more acceptable (for study participants) and less laborious (for researchers and participants) routes to more robust data collection. In addition, the application of omics, especially metabolomics, tools to biofluids to identify new biomarkers of intake offers great potential to provide objective measures of food consumption with the advantage that data may be collected in forms that can be integrated readily with other high throughput (nutrigenomic) technologies.
doi:10.1007/s12263-010-0175-9
PMCID: PMC2935535  PMID: 21052527
Dietary intake; Assessment; Nutrigenomics; Phenotype; Exposure
8.  Assessment of dietary intake: NuGO symposium report 
Genes & Nutrition  2010;5(3):205-213.
Advances in genomics science and associated bioinformatics and technology mean that excellent tools are available for characterising human genotypes. At the same time, approaches for characterising individual phenotypes are developing rapidly. In contrast, there has been much less investment in novel methodology for measuring dietary exposures so that there is now a significant gap in the toolkit for those investigating how diet interacts with genotype to determine phenotype. This symposium reviewed the strengths and limitations of current tools used in assessment of dietary intake and the potential to improve these tools through, for example, the use of statistical techniques that combine information from different sources (such as modelling and calibration methods) to ameliorate measurement error and to provide validity checks. Speakers examined the use of approaches based on technologies such as mobile ‘phones, digital cameras and Web-based systems which offer the potential for more acceptable (for study participants) and less laborious (for researchers and participants) routes to more robust data collection. In addition, the application of omics, especially metabolomics, tools to biofluids to identify new biomarkers of intake offers great potential to provide objective measures of food consumption with the advantage that data may be collected in forms that can be integrated readily with other high throughput (nutrigenomic) technologies.
doi:10.1007/s12263-010-0175-9
PMCID: PMC2935535  PMID: 21052527
Dietary intake; Assessment; Nutrigenomics; Phenotype; Exposure
9.  Dietary habits in three Central and Eastern European countries: the HAPIEE study 
BMC Public Health  2009;9:439.
Background
The high cardiovascular mortality in Eastern Europe has often been attributed to poor diet, but individual-level data on nutrition in the region are generally not available. This paper describes the methods of dietary assessment and presents preliminary findings on food and nutrient intakes in large general population samples in Russia, Poland and the Czech Republic.
Methods
The HAPIEE (Health, Alcohol and Psychosocial factors In Eastern Europe) study examined random samples of men and women aged 45-69 years at baseline in Novosibirsk (Russia), Krakow (Poland) and six Czech urban centres in 2002-2005. Diet was assessed using a food frequency questionnaire (at least 136 items); complete dietary information was available for 26,870 persons.
Results
Total energy intakes among men ranged between 8.7 MJ in the Czech sample and 11.7 MJ in the Russian sample, while among women, energy intakes ranged between 8.2 MJ in the Czech sample and 9.8 MJ in the Russian sample. A Healthy Diet Indicator (HDI), ranging from a score of 0 (lowest) to 7 (highest), was developed using the World Health Organisation's (WHO) guidelines for the prevention of chronic diseases. The mean HDI scores were low, ranging from 1.0 (SD = 0.7) among the Polish subjects to 1.7 (SD = 0.8) among the Czech females. Very few subjects met the WHO recommended intakes for complex carbohydrates, pulses or nuts; intakes of saturated fatty acids, sugar and protein were too high. Only 16% of Polish subjects met the WHO recommendation for polyunsaturated fat intake. Consumption of fruits and vegetables was lower than recommended, especially among those Russian subjects who were assessed during the low intake season. Fewer than 65% of subjects consumed adequate amounts of calcium, magnesium and potassium, when compared with the United Kingdom's Reference Nutrient Intake.
Conclusion
This first large scale study of individual-based dietary intakes in the general population in Eastern Europe implies that intakes of saturated fat, sugar and complex carbohydrates are a cause for concern. The development of country-specific nutritional tools must be encouraged and nutritional campaigns must undergo continuing development.
doi:10.1186/1471-2458-9-439
PMCID: PMC2791768  PMID: 19951409
10.  Socioeconomic position and risk of short-term weight gain: Prospective study of 14,619 middle-aged men and women 
BMC Public Health  2008;8:112.
Background
The association between socioeconomic position in middle age and risk of subsequent, short-term weight gain is unknown. We therefore assessed this association in a prospective population based cohort study in Norfolk, UK.
Methods
We analysed data on 14,619 middle-aged men and women (aged between 40–75 at baseline) with repeated objective measures of weight and height at baseline (1993–1997) and follow up (1998–2000).
Results
During follow up 5,064 people gained more than 2.5 kg. Compared with the highest social class, individuals in the lowest social class had around a 30% greater risk of gaining more than 2.5 kg (OR 1.29; 95% CI 1.11–1.51; p for trend = 0.002). This association remained statistically significant following adjustment for sex, age, baseline BMI, smoking, and follow up time (OR 1.25; CI 1.07–1.46; p for trend <0.001). We also found no material difference between unadjusted models and those including all confounders and potential mediators.
Conclusion
Individuals of low socioeconomic position are at greatest risk of gaining weight during middle age, which is not explained by classical correlates of socioeconomic position and risk factors for obesity.
doi:10.1186/1471-2458-8-112
PMCID: PMC2323377  PMID: 18400100
12.  Combined Impact of Health Behaviours and Mortality in Men and Women: The EPIC-Norfolk Prospective Population Study 
PLoS Medicine  2008;5(1):e12.
Background
There is overwhelming evidence that behavioural factors influence health, but their combined impact on the general population is less well documented. We aimed to quantify the potential combined impact of four health behaviours on mortality in men and women living in the general community.
Methods and Findings
We examined the prospective relationship between lifestyle and mortality in a prospective population study of 20,244 men and women aged 45–79 y with no known cardiovascular disease or cancer at baseline survey in 1993–1997, living in the general community in the United Kingdom, and followed up to 2006. Participants scored one point for each health behaviour: current non-smoking, not physically inactive, moderate alcohol intake (1–14 units a week) and plasma vitamin C >50 mmol/l indicating fruit and vegetable intake of at least five servings a day, for a total score ranging from zero to four. After an average 11 y follow-up, the age-, sex-, body mass–, and social class–adjusted relative risks (95% confidence intervals) for all-cause mortality(1,987 deaths) for men and women who had three, two, one, and zero compared to four health behaviours were respectively, 1.39 (1.21–1.60), 1.95 (1.70–-2.25), 2.52 (2.13–3.00), and 4.04 (2.95–5.54) p < 0.001 trend. The relationships were consistent in subgroups stratified by sex, age, body mass index, and social class, and after excluding deaths within 2 y. The trends were strongest for cardiovascular causes. The mortality risk for those with four compared to zero health behaviours was equivalent to being 14 y younger in chronological age.
Conclusions
Four health behaviours combined predict a 4-fold difference in total mortality in men and women, with an estimated impact equivalent to 14 y in chronological age.
From a large prospective population study, Kay-Tee Khaw and colleagues estimate the combined impact of four behaviors--not smoking, not being physically inactive, moderate alcohol intake, and at least five vegetable servings a day--amounts to 14 additional years of life.
Editors' Summary
Background.
Every day, or so it seems, new research shows that some aspect of lifestyle—physical activity, diet, alcohol consumption, and so on—affects health and longevity. For the person in the street, all this information is confusing. What is a healthy diet, for example? Although there are some common themes such as the benefit of eating plenty of fruit and vegetables, the details often differ between studies. And exactly how much physical activity is needed to improve health? Is a gentle daily walk sufficient or simply a stepping stone to doing enough exercise to make a real difference? The situation with alcohol consumption is equally confusing. Small amounts of alcohol apparently improve health but large amounts are harmful. As a result, it can be hard for public-health officials to find effective ways to encourage the behavioral changes that the scientific evidence suggests might influence the health of populations.
Why Was This Study Done?
There is another factor that is hindering official attempts to provide healthy lifestyle advice to the public. Although there is overwhelming evidence that individual behavioral factors influence health, there is very little information about their combined impact. If the combination of several small differences in lifestyle could be shown to have a marked effect on the health of populations, it might be easier to persuade people to make behavioral changes to improve their health, particularly if those changes were simple and relatively easy to achieve. In this study, which forms part of the European Prospective Investigation into Cancer and Nutrition (EPIC), the researchers have examined the relationship between lifestyle and the risk of dying using a health behavior score based on four simply defined behaviors—smoking, physical activity, alcohol drinking, and fruit and vegetable intake.
What Did the Researchers Do and Find?
Between 1993 and 1997, about 20,000 men and women aged 45–79 living in Norfolk UK, none of whom had cancer or cardiovascular disease (heart or circulation problems), completed a health and lifestyle questionnaire, had a health examination, and had their blood vitamin C level measured as part of the EPIC-Norfolk study. A health behavior score of between 0 and 4 was calculated for each participant by giving one point for each of the following healthy behaviors: current non-smoking, not physically inactive (physical inactivity was defined as having a sedentary job and doing no recreational exercise), moderate alcohol intake (1–14 units a week; a unit of alcohol is half a pint of beer, a glass of wine, or a shot of spirit), and a blood vitamin C level consistent with a fruit and vegetable intake of at least five servings a day. Deaths among the participants were then recorded until 2006. After allowing for other factors that might have affected their likelihood of dying (for example, age), people with a health behavior score of 0 were four times as likely to have died (in particular, from cardiovascular disease) than those with a score of 4. People with a score of 2 were twice as likely to have died.
What Do These Findings Mean?
These findings indicate that the combination of four simply defined health behaviors predicts a 4-fold difference in the risk of dying over an average period of 11 years for middle-aged and older people. They also show that the risk of death (particularly from cardiovascular disease) decreases as the number of positive health behaviors increase. Finally, they can be used to calculate that a person with a health score of 0 has the same risk of dying as a person with a health score of 4 who is 14 years older. These findings need to be confirmed in other populations and extended to an analysis of how these combined health behaviors affect the quality of life as well as the risk of death. Nevertheless, they strongly suggest that modest and achievable lifestyle changes could have a marked effect on the health of populations. Armed with this information, public-health officials should now be in a better position to encourage behavior changes likely to improve the health of middle-aged and older people.
Additional Information.
Please access these Web sites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.0050012.
The MedlinePlus encyclopedia contains a page on healthy living (in English and Spanish)
The MedlinePlus page on seniors' health contains links to many sites dealing with healthy lifestyles and longevity (in English and Spanish)
The European Prospective Investigation into Cancer and Nutrition (EPIC) study is investigating the relationship between nutrition and lifestyle and the development of cancer and other chronic diseases; information about the EPIC-Norfolk study is also available
The US Centers for Disease Control and Prevention provides information on healthy aging for older adults, including information on health-related behaviors (in English and Spanish)
The UK charity Age Concerns provides a fact sheet about staying healthy in later life
The London Health Observatory, which provides information for policy makers and practitioners about improving health and health care, has a section on how lifestyle and behavior affect health
doi:10.1371/journal.pmed.0050012
PMCID: PMC2174962  PMID: 18184033
13.  Measurement of Fruit and Vegetable Consumption with Diet Questionnaires and Implications for Analyses and Interpretation 
American journal of epidemiology  2005;161(10):987-994.
Measurement error can have an important impact on the estimation of the true relation between diet and disease. The authors examined the performance of models regressing plasma vitamin C level on fruit and vegetable consumption and the effect of categorization of fruit and vegetable consumption on the association with plasma vitamin C. They used diet information reported by 4,487 participants in the Norfolk, United Kingdom, portion of the European Prospective Investigation into Cancer and Nutrition by means of a 7-day diet diary and a food frequency questionnaire (FFQ) (1993–1998). The authors found substantial differences in mean fruit and vegetable consumption assessed by the two diet instruments. Consumption estimated with the FFQ was about twice as high as that obtained with the 7-day diary, and the ranking of individuals according to estimates of fruit and vegetable consumption from the 7-day diary and the FFQ differed substantially. When fruit and vegetable consumption were categorized into quintiles, the two questionnaires produced similar associations of relative intake with plasma vitamin C, but estimation of the association of absolute intake with plasma vitamin C differed.
doi:10.1093/aje/kwi115
PMCID: PMC1909917  PMID: 15870164
bias (epidemiology); data collection; diet; food; nutrition assessment; questionnaires; regression analysis
14.  Self-reported parkinsonian symptoms in the EPIC-Norfolk cohort 
BMC Neurology  2005;5:15.
Background
Parkinsonian symptoms have been associated with increased morbidity and mortality. Several studies have reported on the prevalence of signs and symptoms. Symptoms questionnaires can identify potential PD cases for further neurological examination to save resources. They can also provide information about how much of the population reports specific signs and symptoms. The objective of the study was to determine the self-reported prevalence of parkinsonian symptoms from a questionnaire, and to examine their association with age and self-reported Parkinson's disease in a large cohort.
Methods
A cross-sectional study was conducted within a sub-cohort of the EPIC-Norfolk (European Prospective Investigation of Cancer) cohort study.
Results
The prevalence of six self-reported parkinsonian symptoms are reported for 11539 individuals who answered all symptoms questions (62% of sub-cohort): rest tremor (4%), difficulty starting to walk (4%), difficulty getting out of a chair (6%), slower walking (34%), smaller handwriting (micrographia- 9%), and less acute sense of smell (olfactory dysfunction- 9%). The presence of individual symptoms increased with age except for difficulty getting out of a chair.
Conclusion
The results support previous findings that the presence of self-reported parkinsonian symptoms is strongly associated with age and self-reported PD diagnosis. The data also provide information regarding the prevalence of symptoms in a large, younger population of adults than previously reported in the literature.
doi:10.1186/1471-2377-5-15
PMCID: PMC1208899  PMID: 16120210
15.  Frequency of eating and concentrations of serum cholesterol in the Norfolk population of the European prospective investigation into cancer (EPIC-Norfolk): cross sectional study 
BMJ : British Medical Journal  2001;323(7324):1286.
Objectives
To examine the relation between self reported eating frequency and serum lipid concentrations in a free living population.
Design
Cross sectional population based study.
Setting
Norfolk, England.
Participants
14 666 men and women aged 45-75 years from the Norfolk cohort of the European prospective investigation into cancer (EPIC-Norfolk).
Main outcome measures
Concentrations of blood lipids.
Results
Mean concentrations of total cholesterol and low density lipoprotein cholesterol decreased in a continuous relation with increasing daily frequency of eating in men and women. No consistent relation was observed for high density lipoprotein cholesterol, body mass index, waist to hip ratio, or blood pressure. Mean cholesterol concentrations differed by about 0.25 mmol/l between people eating more than six times a day and those eating once or twice daily; this difference was reduced to 0.15 mmol/l after adjustment for possible confounding variables, including age, obesity, cigarette smoking, physical activity, and intake of energy and nutrients (alcohol, fat, fatty acids, protein, and carbohydrate).
Conclusions
Concentrations of total cholesterol and low density lipoprotein cholesterol are negatively and consistently associated with frequency of eating in a general population. The effects of eating frequency on lipid concentrations induced in short term trials in animals and human volunteers under controlled laboratory conditions can be observed in a free living general population. We need to consider not just what we eat but how often we eat.
What is already known on this topicStudies in animals and small human trials indicate that eating frequency is inversely related to serum lipid concentrationsFew studies have examined this in a free living population under no dietary restrictionsWhat this study addsIn a free living population increased eating frequency was negatively and significantly associated with concentrations of total cholesterol and low density lipoprotein cholesterolThis association was still present after adjustment for body mass index, physical activity, cigarette smoking, and dietary intakeMean age adjusted cholesterol concentrations differed by 0.25 mmol/l between people eating more than six times a day and those eating less than twice daily
PMCID: PMC60303  PMID: 11731392
16.  Patterns of physical activity and ultrasound attenuation by heel bone among Norfolk cohort of European Prospective Investigation of Cancer (EPIC Norfolk): population based study 
BMJ : British Medical Journal  2001;322(7279):140.
Objectives
To study associations between patterns of physical activity and ultrasound attenuation by the heel bone in men and women.
Design
Cross sectional, population based study.
Setting
Norfolk.
Participants
2296 men and 2914 women aged 45-74 registered with general practices participating in European Prospective Investigation into Cancer (EPIC Norfolk).
Results
Self reported time spent in high impact physical activity was strongly and positively associated with ultrasound attenuation by the heel bone, independently of age, weight, and other confounding factors. Men who reported participating in ⩾2 hours/week of high impact activity had 8.44 dB/MHz (95% confidence interval 4.49 to 12.40) or 9.5%, higher ultrasound attenuation than men who reported no activity of this type. In women, the difference in ultrasound attenuation between those reporting any high impact activity and those reporting none was 2.41 dB/MHz (0.45 to 4.37) or 3.4% higher. In women this effect was similar in size to that of an age difference of four years. Moderate impact activity had no effect. However, climbing stairs was strongly independently associated with ultrasound attenuation in women (0.64 dB/MHz (0.19 to 1.09) for each additional five flights of stairs). There was a significant negative association in women between time spent watching television or video and heel bone ultrasound attenuation, which decreased by 0.08 dB/MHz (0.02 to 0.14) for each additional hour of viewing a week.
Conclusions
High impact physical activity is independently associated with ultrasound attenuation by the heel bone in men and women. As low ultrasound attenuation has been shown to predict increased risk of hip fracture, interventions to promote participation in high impact activities may help preserve bone density and reduce the risk of fracture. However, in older people such interventions may be inappropriate as they could increase the likelihood of falls.
PMCID: PMC26592  PMID: 11159572
17.  Glycated haemoglobin, diabetes, and mortality in men in Norfolk cohort of European Prospective Investigation of Cancer and Nutrition (EPIC-Norfolk) 
BMJ : British Medical Journal  2001;322(7277):15.
Objective
To examine the value of glycated haemoglobin (HbA1c) concentration, a marker of blood glucose concentration, as a predictor of death from cardiovascular and all causes in men.
Design
Prospective population study.
Setting
Norfolk cohort of European Prospective Investigation into Cancer and Nutrition (EPIC-Norfolk).
Subjects
4662 men aged 45-79 years who had had glycated haemoglobin measured at the baseline survey in 1995-7 who were followed up to December 1999.
Main outcome measures
Mortality from all causes, cardiovascular disease, ischaemic heart disease, and other causes.
Results
Men with known diabetes had increased mortality from all causes, cardiovascular disease, and ischaemic disease (relative risks 2.2, 3.3, and 4.2, respectively, P <0.001 independent of age and other risk factors) compared with men without known diabetes. The increased risk of death among men with diabetes was largely explained by HbA1c concentration. HbA1c was continuously related to subsequent all cause, cardiovascular, and ischaemic heart disease mortality through the whole population distribution, with lowest rates in those with HbA1c concentrations below 5%. An increase of 1% in HbA1c was associated with a 28% (P<0.002) increase in risk of death independent of age, blood pressure, serum cholesterol, body mass index, and cigarette smoking habit; this effect remained (relative risk 1.46, P=0.05 adjusted for age and risk factors) after men with known diabetes, a HbA1c concentration ⩾7%, or history of myocardial infarction or stroke were excluded. 18% of the population excess mortality risk associated with a HbA1c concentration ⩾5% occurred in men with diabetes, but 82% occurred in men with concentrations of 5%-6.9% (the majority of the population).
Conclusions
Glycated haemoglobin concentration seems to explain most of the excess mortality risk of diabetes in men and to be a continuous risk factor through the whole population distribution. Preventive efforts need to consider not just those with established diabetes but whether it is possible to reduce the population distribution of HbA1c through behavioural means.
PMCID: PMC26599  PMID: 11141143

Results 1-17 (17)