The EPIC-Norfolk prospective population study: biological and behavioural determinants of health and disease in an ageing population
Lead Research Organisation:
University of Cambridge
Department Name: Public Health and Primary Care
Abstract
The aim of the European Prospective Investigation into Cancer in Norfolk (EPIC-Norfolk) is to help us understand what we can do to improve health and prevent disease and disability in later life. There is a particular focus on patterns of diet and physical activity.
EPIC-Norfolk is a study of 30,000 men and women living in Norfolk who first agreed to take part in the study in 1993 when aged 40-79 years of whom 25,00 attended a detailed health examination and who have been followed up to the present for health. At the original health examination in 1993-1997 they gave detailed information on their health and lifestyle, including very detailed diet and physical activity records, medical and family history, had assessments of heart disease risk factors including blood cholesterol and blood pressure, and provided blood and urine samples for analysis. Participants have continued to take part in repeated health assessments with further measures to assess bone health, eye health and visual function, and physical and mental performance, the most recent being between 2006-2011, and answered further questionnaires about their health including psychosocial factors such as stress and anxiety, sleep patterns and quality of life. We have thus been able to track the health experiences over 20 years of this middle aged older population who are comparable to the British general population. We are able to obtain an understanding of the risk factors for important diseases such as heart diseases and strokes, individual cancers, osteoporotic fractures, arthritis and diabetes and what we can do to reduce risk of these diseases. As the population ages, there is increasing emphasis on outcomes relevant to older people, not just disease occurrence and death, but functional capacity including physical function, mental function, visual health as well as self perceived quality of life. The detailed data available enable us to understand not just how the mind and body age biologically, but behavioural factors such as diet and physical activity may affect this process and how wider environmental determinants such as socioeconomic status, residential deprivation and access to green space can influence our health.
This is an ongoing population study and have an active participants' panel that advises us on research questions of interest and future studies.
Results from the study have already contributed to health policy and recommendations including a Department of Health Public Health initiative"Small changes Big difference". We have now been able to conduct genetic profiling of the participants to enable us to identify how our genetic make up can influence risk of disease and will explore how environmental factors such as health behaviours may modify genetic susceptibility.
The current application is to maintain follow up of participants and assessments to understand how different individuals may age differently and further clarify what factors influence the ageing process and risk of disease and disability to enable interventions to improve health and quality of life.
EPIC-Norfolk is a study of 30,000 men and women living in Norfolk who first agreed to take part in the study in 1993 when aged 40-79 years of whom 25,00 attended a detailed health examination and who have been followed up to the present for health. At the original health examination in 1993-1997 they gave detailed information on their health and lifestyle, including very detailed diet and physical activity records, medical and family history, had assessments of heart disease risk factors including blood cholesterol and blood pressure, and provided blood and urine samples for analysis. Participants have continued to take part in repeated health assessments with further measures to assess bone health, eye health and visual function, and physical and mental performance, the most recent being between 2006-2011, and answered further questionnaires about their health including psychosocial factors such as stress and anxiety, sleep patterns and quality of life. We have thus been able to track the health experiences over 20 years of this middle aged older population who are comparable to the British general population. We are able to obtain an understanding of the risk factors for important diseases such as heart diseases and strokes, individual cancers, osteoporotic fractures, arthritis and diabetes and what we can do to reduce risk of these diseases. As the population ages, there is increasing emphasis on outcomes relevant to older people, not just disease occurrence and death, but functional capacity including physical function, mental function, visual health as well as self perceived quality of life. The detailed data available enable us to understand not just how the mind and body age biologically, but behavioural factors such as diet and physical activity may affect this process and how wider environmental determinants such as socioeconomic status, residential deprivation and access to green space can influence our health.
This is an ongoing population study and have an active participants' panel that advises us on research questions of interest and future studies.
Results from the study have already contributed to health policy and recommendations including a Department of Health Public Health initiative"Small changes Big difference". We have now been able to conduct genetic profiling of the participants to enable us to identify how our genetic make up can influence risk of disease and will explore how environmental factors such as health behaviours may modify genetic susceptibility.
The current application is to maintain follow up of participants and assessments to understand how different individuals may age differently and further clarify what factors influence the ageing process and risk of disease and disability to enable interventions to improve health and quality of life.
Technical Summary
The aim of the European Prospective Investigation into Cancer in Norfolk (EPIC-Norfolk) is to help us understand what we can do to improve health and prevent disease and disability in later life. There is a particular focus on patterns of diet and physical activity.
EPIC-Norfolk is a study of 30,000 men and women living in Norfolk who first agreed to take part in the study in 1993 when aged 40-79 years of whom 25,623 attended a detailed health examination in 1993-1997 and who have been followed up to the present for health. This is a very well characterised population with extensive baseline data available on behavioural factors, health including medical and family history, and anthropometry, assessment of heart disease risk factors including blood cholesterol and blood pressure, and provided blood and urine samples for analysis and for establishment of a biological sample bank. Participants have continued to take part in repeated health assessments 1997-2000 and 2006-2011 with further Participants have continued to take part in repeated health assessments with further measures to assess bone health, eye health and visual function, and physical and mental performance, the most recent being between 2006-2011, and answered further questionnaires about their health including psychosocial factors such as stress and anxiety, sleep patterns and quality of life. All participants have been followed up to the present for health outcome including total mortality by cause and disease incidence through routine record linkage with health records. We are proposing to continue maintenance and follow up the cohort, including testing of new hypotheses relating to health and disease, and to resurvey the cohort to characterise longitudinal trajectories of objective physical and cognitive functional performance.
EPIC-Norfolk is a study of 30,000 men and women living in Norfolk who first agreed to take part in the study in 1993 when aged 40-79 years of whom 25,623 attended a detailed health examination in 1993-1997 and who have been followed up to the present for health. This is a very well characterised population with extensive baseline data available on behavioural factors, health including medical and family history, and anthropometry, assessment of heart disease risk factors including blood cholesterol and blood pressure, and provided blood and urine samples for analysis and for establishment of a biological sample bank. Participants have continued to take part in repeated health assessments 1997-2000 and 2006-2011 with further Participants have continued to take part in repeated health assessments with further measures to assess bone health, eye health and visual function, and physical and mental performance, the most recent being between 2006-2011, and answered further questionnaires about their health including psychosocial factors such as stress and anxiety, sleep patterns and quality of life. All participants have been followed up to the present for health outcome including total mortality by cause and disease incidence through routine record linkage with health records. We are proposing to continue maintenance and follow up the cohort, including testing of new hypotheses relating to health and disease, and to resurvey the cohort to characterise longitudinal trajectories of objective physical and cognitive functional performance.
Planned Impact
Understanding what we can do to improve health and prevent disease and disability in ageing populations will have benefits for society and the general public nationally and internationally. Results have already and will continue to contribute to health and clinical policy. Clarification of the mechanisms underlying diseases will enable us to understand pathophysiological processes to support better prevention and treatment, understanding the risk profile for diseases will enable more targeted screening and prevention programmes and understanding and quantifying specific behaviours that influence functional health and healthy ageing will enable us to improve the health experience and quality of life in populations as they age.
EPIC Investigators have contributed to national and international (e.g. WHO) clinical and public health guideline panels, Department of Health initiatives, and invited to provide evidence to Select Committees on health issues in the Houses of Parliament
Examples include:
Research from EPIC-Norfolk quantifying the association between four health behaviours (not smoking, modest alcohol intake, physical activity and consumption of 5 servings of fruit and vegetable intake) were associated with a 14 year difference in life expectancy. This directly influenced the Department of Health "Small change big difference" national public health campaign launched from Downing Street, underpinned regional initiatives to promote health behaviour change and has been taken up in national guidance. http://webarchive.nationalarchives.gov.uk/20080905235643/http://dh.gov.uk/en/Publichealth/Healthimprovement/Smallchangebigdifference/DH_4134042; http://learning.nhslocal.nhs.uk/features/making-every-contact-count/mecc-post-march-2013/mecc-case-studies-and-workshops. www.kingsfund.org.uk/sites/files/kf/field/field_publication_file/10PrioritiesFinal2.pdf
EPIC findings have been reported to meetings contributing European policies on ageing (invited presentations to the European Commission DG Health on Frailty in Old Age 2013) http://ec.europa.eu/dgs/health_consumer/dyna/enews/enews.cfm?al_id=1365
Results from EPIC have also contributed to clinical guidelines on screening for osteoporosis using heel ultrasound measures, a low cost and safe feasible assessment ( Lewiecki EM et al, Official Positions for FRAX Bone Mineral Density and FRAX simplification from Joint Official Positions Development Conference of the International Society for Clinical Densitometry and International Osteoporosis Foundation on FRAX. J Clin Densitom. 2011 Jul-Sep;14(3):226-36)
and to clinical guideline on the use of glycated haemoglobin in the diagnosis of diabetes. (RydenL et al, ESC Guidelines on diabetes, prediabetes and cardiovascular diseases in collaboration with the EASD- Summary. Eur Heart J 2013;34: 3035; Anderson T et al. 2012 update of the Canadian Cardiovascular Society guidelines for the diagnosis and treatment of dyslipidaemia for the prevention of cardiovascular disease in the adult. Can J Cardiol 2013;29:151-167.
In addition general findings from EPIC-Norfolk have informed publications from charities (e.g. Cancer Research UK, British Heart Foundation, Stroke Association, AgeUK) on disease prevention and maintenance of health.
EPIC Investigators have contributed to national and international (e.g. WHO) clinical and public health guideline panels, Department of Health initiatives, and invited to provide evidence to Select Committees on health issues in the Houses of Parliament
Examples include:
Research from EPIC-Norfolk quantifying the association between four health behaviours (not smoking, modest alcohol intake, physical activity and consumption of 5 servings of fruit and vegetable intake) were associated with a 14 year difference in life expectancy. This directly influenced the Department of Health "Small change big difference" national public health campaign launched from Downing Street, underpinned regional initiatives to promote health behaviour change and has been taken up in national guidance. http://webarchive.nationalarchives.gov.uk/20080905235643/http://dh.gov.uk/en/Publichealth/Healthimprovement/Smallchangebigdifference/DH_4134042; http://learning.nhslocal.nhs.uk/features/making-every-contact-count/mecc-post-march-2013/mecc-case-studies-and-workshops. www.kingsfund.org.uk/sites/files/kf/field/field_publication_file/10PrioritiesFinal2.pdf
EPIC findings have been reported to meetings contributing European policies on ageing (invited presentations to the European Commission DG Health on Frailty in Old Age 2013) http://ec.europa.eu/dgs/health_consumer/dyna/enews/enews.cfm?al_id=1365
Results from EPIC have also contributed to clinical guidelines on screening for osteoporosis using heel ultrasound measures, a low cost and safe feasible assessment ( Lewiecki EM et al, Official Positions for FRAX Bone Mineral Density and FRAX simplification from Joint Official Positions Development Conference of the International Society for Clinical Densitometry and International Osteoporosis Foundation on FRAX. J Clin Densitom. 2011 Jul-Sep;14(3):226-36)
and to clinical guideline on the use of glycated haemoglobin in the diagnosis of diabetes. (RydenL et al, ESC Guidelines on diabetes, prediabetes and cardiovascular diseases in collaboration with the EASD- Summary. Eur Heart J 2013;34: 3035; Anderson T et al. 2012 update of the Canadian Cardiovascular Society guidelines for the diagnosis and treatment of dyslipidaemia for the prevention of cardiovascular disease in the adult. Can J Cardiol 2013;29:151-167.
In addition general findings from EPIC-Norfolk have informed publications from charities (e.g. Cancer Research UK, British Heart Foundation, Stroke Association, AgeUK) on disease prevention and maintenance of health.
Publications
Lu Y
(2020)
Identification of Novel Loci and New Risk Variant in Known Loci for Colorectal Cancer Risk in East Asians.
in Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology
Lu Y
(2017)
Dietary Polyphenols in the Aetiology of Crohn's Disease and Ulcerative Colitis-A Multicenter European Prospective Cohort Study (EPIC).
in Inflammatory bowel diseases
Lu Y
(2021)
Association of Genetic Variants Affecting microRNAs and Pancreatic Cancer Risk.
in Frontiers in genetics
Lu Y
(2021)
Identification of Recessively Inherited Genetic Variants Potentially Linked to Pancreatic Cancer Risk.
in Frontiers in oncology
Luben R
(2020)
Usual physical activity and subsequent hospital usage over 20 years in a general population: the EPIC-Norfolk cohort
in BMC Geriatrics
Luben R
(2018)
Alcohol consumption and future hospital usage: The EPIC-Norfolk prospective population study.
in PloS one
Lécuyer L
(2022)
Inflammatory potential of the diet and association with risk of differentiated thyroid cancer in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort.
in European journal of nutrition
Lécuyer L
(2023)
Associations between dietary inflammatory scores and biomarkers of inflammation in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort.
in Clinical nutrition (Edinburgh, Scotland)
Macciotta A
(2024)
Examining causal relationships between educational attainment and type 2 diabetes using genetic analysis: findings from the EPIC-InterAct study through Mendelian randomisation
in Journal of Epidemiology and Community Health
Machiela MJ
(2016)
Female chromosome X mosaicism is age-related and preferentially affects the inactivated X chromosome.
in Nature communications
Madjedi KM
(2022)
The Association between Serum Lipids and Intraocular Pressure in 2 Large United Kingdom Cohorts.
in Ophthalmology
Mahamat-Saleh Y
(2023)
Baseline and lifetime alcohol consumption and risk of skin cancer in the European Prospective Investigation into Cancer and Nutrition cohort (EPIC).
in International journal of cancer
Malachin G
(2017)
Loss of prion protein induces a primed state of type I interferon-responsive genes.
in PloS one
Malihi Z
(2019)
Monthly high-dose vitamin D3 supplementation and self-reported adverse events in a 4-year randomized controlled trial.
in Clinical nutrition (Edinburgh, Scotland)
Malihi Z
(2019)
Monthly high-dose vitamin D supplementation does not increase kidney stone risk or serum calcium: results from a randomized controlled trial.
in The American journal of clinical nutrition
Malihi Z
(2020)
Risk factors for reporting adverse events and for study withdrawal in a population-based trial of vitamin D supplementation.
in The Journal of steroid biochemistry and molecular biology
Mancuso N
(2018)
Large-scale transcriptome-wide association study identifies new prostate cancer risk regions.
in Nature communications
Mao Z
(2023)
Prediagnostic serum glyceraldehyde-derived advanced glycation end products and mortality among colorectal cancer patients.
in International journal of cancer
Marklund M
(2019)
Biomarkers of Dietary Omega-6 Fatty Acids and Incident Cardiovascular Disease and Mortality.
in Circulation
Martin-Grace J
(2022)
Corticosteroid Suppression in Patients Receiving Inhaled Glucocorticoids: Time to Reassess Risk?
in The Journal of clinical endocrinology and metabolism
Matejcic M
(2018)
Germline variation at 8q24 and prostate cancer risk in men of European ancestry.
in Nature communications
Matejcic M
(2019)
Author Correction: Germline variation at 8q24 and prostate cancer risk in men of European ancestry.
in Nature communications
Matsumoto M
(2018)
Aging of hospital physicians in rural Japan: A longitudinal study based on national census data.
in PloS one
Mauschitz MM
(2023)
Association of lipid-lowering drugs and antidiabetic drugs with age-related macular degeneration: a meta-analysis in Europeans.
in The British journal of ophthalmology
Mayén AL
(2024)
Hepatic steatosis, metabolic dysfunction and risk of mortality: findings from a multinational prospective cohort study.
in BMC medicine
McLachlan F
(2023)
Glycated Haemoglobin (HbA1c) and Future Physical and Mental Functional Health in the European Prospective Investigation into Cancer (EPIC)-Norfolk Population-Based Study.
in Journal of personalized medicine
Medina-Gomez C
(2018)
Life-Course Genome-wide Association Study Meta-analysis of Total Body BMD and Assessment of Age-Specific Effects.
in American journal of human genetics
Meidtner K
(2018)
Interaction of Dietary and Genetic Factors Influencing Body Iron Status and Risk of Type 2 Diabetes Within the EPIC-InterAct Study.
in Diabetes care
Melaiu O
(2020)
Common gene variants within 3'-untranslated regions as modulators of multiple myeloma risk and survival
in International Journal of Cancer
Meuwese CL
(2019)
Low thyroid function is not associated with an accelerated deterioration in renal function.
in Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association
Minato Y
(2018)
Mutual potentiation drives synergy between trimethoprim and sulfamethoxazole.
in Nature communications
Mitry D
(2016)
The Accuracy and Reliability of Crowdsource Annotations of Digital Retinal Images.
in Translational vision science & technology
Mok A
(2019)
Physical activity trajectories and mortality: population based cohort study.
in BMJ (Clinical research ed.)
Molina-Montes E
(2016)
Flavonoid and lignan intake and pancreatic cancer risk in the European prospective investigation into cancer and nutrition cohort.
in International journal of cancer
Molina-Montes E
(2017)
Mediterranean diet and risk of pancreatic cancer in the European Prospective Investigation into Cancer and Nutrition cohort.
in British journal of cancer
Moore SC
(2016)
Association of Leisure-Time Physical Activity With Risk of 26 Types of Cancer in 1.44 Million Adults.
in JAMA internal medicine
| Title | Additional file 1 of Lifestyle correlates of eight breast cancer-related metabolites: a cross-sectional study within the EPIC cohort |
| Description | Additional file 1: Associations between metabolites and all variables tested as correlates, in discovery set and, for significant associations, in validation set (Supplementary Table 1); Stratified analyses by BMI, menopausal status, and fasting status at blood collection, for metabolites and variables showing a P-int < 0.20 after correction for multiple testing, in discovery set (Supplementary Table 2). Abbreviations: AICR American Institute for Cancer Research; Asn asparagine; BMI body mass index; C2 acetylcarnitine; HLI Healthy lifestyle index; PC aa phosphatidylcholine diacyl; PC ae phosphatidylcholine acyl-alkyl; SD Standard deviation; SE: Standard error of estimate; WCRF World Cancer Research Fund. (XLS 177 kb) |
| Type Of Material | Database/Collection of data |
| Year Produced | 2021 |
| Provided To Others? | Yes |
| URL | https://springernature.figshare.com/articles/dataset/Additional_file_1_of_Lifestyle_correlates_of_ei... |
| Title | Additional file 1 of Lifestyle correlates of eight breast cancer-related metabolites: a cross-sectional study within the EPIC cohort |
| Description | Additional file 1: Associations between metabolites and all variables tested as correlates, in discovery set and, for significant associations, in validation set (Supplementary Table 1); Stratified analyses by BMI, menopausal status, and fasting status at blood collection, for metabolites and variables showing a P-int < 0.20 after correction for multiple testing, in discovery set (Supplementary Table 2). Abbreviations: AICR American Institute for Cancer Research; Asn asparagine; BMI body mass index; C2 acetylcarnitine; HLI Healthy lifestyle index; PC aa phosphatidylcholine diacyl; PC ae phosphatidylcholine acyl-alkyl; SD Standard deviation; SE: Standard error of estimate; WCRF World Cancer Research Fund. (XLS 177 kb) |
| Type Of Material | Database/Collection of data |
| Year Produced | 2021 |
| Provided To Others? | Yes |
| URL | https://springernature.figshare.com/articles/dataset/Additional_file_1_of_Lifestyle_correlates_of_ei... |
| Description | Laboratory sample analyses |
| Organisation | University of Exeter |
| Department | School of Psychology |
| Country | United Kingdom |
| Sector | Academic/University |
| PI Contribution | Collection of data and samples |
| Collaborator Contribution | Analysis of urine samples Analysis of biological samples |
| Impact | Sample analyses ongoing |
| Start Year | 2009 |
| Description | Laboratory sample analyses |
| Organisation | University of Reading |
| Department | Department of Food and Nutritional Sciences |
| Country | United Kingdom |
| Sector | Academic/University |
| PI Contribution | Collection of data and samples |
| Collaborator Contribution | Analysis of urine samples Analysis of biological samples |
| Impact | Sample analyses ongoing |
| Start Year | 2009 |
| Title | Dietary assessment tool: FFQ |
| Description | This is a freely available downloadable programme for analysis of dietary intake using food frequency questionnaires. |
| Type Of Technology | Software |
| Year Produced | 2014 |
| Open Source License? | Yes |
| Impact | This is now being used by researchers. As far as we know, this is the only freely available analytic programme for dietary intake assessment |
| URL | http://www.srl.cam.ac.uk/epic/epicffq/websitedocumentation.html |
| Description | Cambridge Science Festival |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | Local |
| Primary Audience | Public/other audiences |
| Results and Impact | Talks to and activities in the Cambridge Science Festival which stimulated interest in the topics e.g. healthy ageing, use of supplements, dietary recommendations |
| Year(s) Of Engagement Activity | 2013,2014,2015,2016 |
| Description | EPIC Participants Advisory Panel |
| Form Of Engagement Activity | A formal working group, expert panel or dialogue |
| Part Of Official Scheme? | No |
| Geographic Reach | Local |
| Primary Audience | Study participants or study members |
| Results and Impact | The EPIC Participants Advisory Panel was established to enable a formal process by which participants in the study were able to provide input into study design, suggest questions for future study, advise on questionnaires and test study protocols, as well as to advise on dissemination of findings |
| Year(s) Of Engagement Activity | 2013,2014,2015,2016,2017,2018 |