In 2015 the MRC Epidemiology Unit successfully navigated its Quinquennial Review, securing funding for its core programmes from 2015-2020. The MRC Board recognised the Unit as a highly productive, strategically important and world leading centre of expertise for epidemiology, diabetes and associated metabolic disorders. The high quality of its scientific outputs were noted, together with a strong strategic vision, an excellent training environment and a comprehensive communications, public engagement and knowledge exchange programme.
Together with the Unit-led Centre for Diet and Activity Research (CEDAR), researchers are making important contributions to the development of public health practice and policy – from the development of interactive tools to support healthy neighbourhoods to Prof Nick Wareham’s invitation to give expert testimony to the House of Commons Health Committee.
The Unit continues to develop its research across its wide portfolio, with particular areas of focus for the future including:
––An expansion of the dietary public health portfolio as part of CEDAR, in order to build a greater understanding of
the influence and impact dietary behaviours to inform public policy and industry action.
––Development of ‘big data’ research, including the InterConnect initiative on gene-environment interaction in
diabetes and obesity, and collaborations with UK Biobank, which holds data on around half a million participants
from across the country.
––Contributing to the prevention and control of non-communicable disease in low and middle income countries, in
partnership with the Wellcome Trust Cambridge Centre for Global Health Research.
Growth and Development
Prevention and Diabetes
Diet and Global Health
Growth and development
Research using UK Biobank data has revealed that the timing of puberty has wide-ranging impacts on health in later life. The timing of puberty varies significantly between individuals, with the normal onset of puberty ranging from 8 to 13 in girls and from 9 to 14 in boys. Analysis of data from nearly half a million participants found that those in the earliest or latest 20% to go through puberty had higher risks for late life disease when compared to those in the middle 20%. The age at which both men and women begin puberty is associated with 48 different health conditions, from diabetes to depression (Day, FR et al, Scientific Reports, 2015).
Prevention and diabetes
Early detection and treatment of type 2 diabetes may reduce heart disease and mortality. Combining data from the ADDITION-Europe study with a computer simulation model of diabetes progression allowed researchers to estimate the impact of screening followed by treatment,
compared to no screening. The model predicted that for people with undiagnosed type 2 diabetes, screening would be associated with a 29% reduction in relative risk of a cardiovascular disease event over the next 10 years compared with a delay of six years in diagnosis and treatment. The comparable change in all-cause mortality was 20% relative risk.
In another study, a meta-analysis of 17 observational studies indicated that regular consumption of sugar sweetened drinks is positively associated with type 2 diabetes, independent of obesity status. The authors estimated that, over a 10 year period in the UK, about 79,000 cases of type 2 diabetes could be attributed to consumption of sugar sweetened beverages (Imamura, F et al, BMJ, 2015). Data from the EPICNorfolk study, meanwhile, found that drinking water or unsweetened tea or coffee in place of one sugary drink per day can reduce the risk of developing diabetes (O’Connor, L et al, Diabetologia, 2015). And EPIC-InterAct data showed that the consumption of dietary fibre is associated with a reduced risk of developing diabetes (The InterAct Consortium, Diabetologia, 2015).
Diet and global health
CEDAR research using data from Norfolk revealed that the number of takeaway food outlets has risen substantially over the past two decades, with a large increase seen in areas of socioeconomic disadvantage. And novel use of national UK data by CEDAR has shown a growing gap between the prices of more and less healthy foods between 2002 and 2012, with healthy foods in 2012 being three times more expensive per calorie than less healthy foods (Jones, NRV et al, PLOSE ONE, 2014).
Across the world, diet quality has declined, but with major differences across regions. The Global Burden of Diseases Nutrition and Chronic Diseases Expert Group reviewed dietary surveys that represented almost 90 percent of the world’s adult population, looking at trends from 1990 to 2010. Even as consumption of healthier foods has increased in many countries, unhealthy foods have outpaced this growth, especially in middle income countries (Imamura, F et al, The Lancet Global Health, 2015).
Greater adherence with a diet rich in vegetables, low fat dairy and whole grains would not only be good for health, but also for the planet. The Dietary Approaches to Stop Hypertension (DASH) diet is a proven way to prevent and control hypertension and other chronic disease – and new analysis has shown that this diet is also associated with lower emissions of climate-changing greenhouse gases (Monsivais, P et al, AJCN, 2015).
Lack of exercise may be responsible for twice as many deaths as obesity, according to an analysis of more than 300,000 participants in the EPIC study. The research found that while physical inactivity may contribute to an increased body mass index (BMI), the association between physical inactivity and mortality is independent of an individual’s BMI. The researchers estimated that for inactive people, doing exercise equivalent to just a 20 minute brisk walk each day could reduce relative risk of premature death by between 16-30% (Ekelund, U et al, AJCN, 2015).
Each hour per day spent watching TV, using the internet or playing computer games during Year 10 is associated with poorer grades at GCSE at age 16. Researchers also found that pupils doing an extra hour of daily homework and reading performed significantly better than their
peers. CEDAR researchers found that each hour per day of time spent in front of the TV or online at age 14.5 years was associated with 9.3 fewer GCSE points at age 16 years – the equivalent, for example, to two grades in one subject or one grade in each of two subjects (Corder, K et al, IJBNPA, 2015).
Encouraging people to switch from driving to work to walking, cycling or using public transport could help reduce the level of obesity in the population. CEDAR research from the University of East Anglia showed that switching from car commuting to active travel or public transport was associated with a reduction in body mass index (BMI), even over a relatively short time period of two years (Martin, A et al, J Epidemiol Community Health, 2015).
However, CEDAR analysis of the 2001 and 2011 Census data revealed that growing cycling levels have not been accompanied by greater age and gender diversity. In places where cycling to work has risen, cycle commuting has remained a disproportionately male activity, and has become even more skewed towards younger age groups. New strategies may be needed therefore to help more women and older people take up cycling (Aldred, R et al, Transport Reviews, 2015).