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
Chaker L
(2016)
Thyroid Function Within the Reference Range and the Risk of Stroke: An Individual Participant Data Analysis.
in The Journal of clinical endocrinology and metabolism
Caleyachetty R
(2016)
Cumulative social risk exposure in childhood and smoking and excessive alcohol use in adulthood.
in European journal of public health
Brunner C
(2016)
Alcohol consumption and prostate cancer incidence and progression: A Mendelian randomisation study
in International Journal of Cancer
Wentzensen N
(2016)
Ovarian Cancer Risk Factors by Histologic Subtype: An Analysis From the Ovarian Cancer Cohort Consortium
in Journal of Clinical Oncology
Beal J
(2016)
Reproducibility of Fluorescent Expression from Engineered Biological Constructs in E. coli.
in PloS one
Khawaja AP
(2016)
Associations with intraocular pressure across Europe: The European Eye Epidemiology (E3) Consortium.
in European journal of epidemiology
Hughes DJ
(2016)
Prediagnostic selenium status and hepatobiliary cancer risk in the European Prospective Investigation into Cancer and Nutrition cohort.
in The American journal of clinical nutrition
Ward H
(2016)
Pre-diagnostic meat and fibre intakes in relation to colorectal cancer survival in the European Prospective Investigation into Cancer and Nutrition
in British Journal of Nutrition
Chuang SC
(2016)
Cellular immune activity biomarker neopterin is associated hyperlipidemia: results from a large population-based study.
in Immunity & ageing : I & A
Dewi N
(2016)
Anthropometry and the Risk of Lung Cancer in EPIC
in American Journal of Epidemiology
Gusev A
(2016)
Atlas of prostate cancer heritability in European and African-American men pinpoints tissue-specific regulation.
in Nature communications
Del Gobbo LC
(2016)
?-3 Polyunsaturated Fatty Acid Biomarkers and Coronary Heart Disease: Pooling Project of 19 Cohort Studies.
in JAMA internal medicine
Van Wijk DF
(2016)
C-Reactive Protein Identifies Low-Risk Metabolically Healthy Obese Persons: The European Prospective Investigation of Cancer-Norfolk Prospective Population Study.
in Journal of the American Heart Association
Castellano-Pozo M
(2016)
Correction: The Caenorhabditis elegans THO Complex Is Required for the Mitotic Cell Cycle and Development.
in PloS one
Terry KL
(2016)
A Prospective Evaluation of Early Detection Biomarkers for Ovarian Cancer in the European EPIC Cohort.
in Clinical cancer research : an official journal of the American Association for Cancer Research
Khankari NK
(2016)
Polyunsaturated fatty acids and prostate cancer risk: a Mendelian randomisation analysis from the PRACTICAL consortium.
in British journal of cancer
Forouhi NG
(2016)
Association of Plasma Phospholipid n-3 and n-6 Polyunsaturated Fatty Acids with Type 2 Diabetes: The EPIC-InterAct Case-Cohort Study.
in PLoS medicine
Zhang M
(2016)
Three new pancreatic cancer susceptibility signals identified on chromosomes 1q32.1, 5p15.33 and 8q24.21.
in Oncotarget
Wu Y
(2016)
Weather, day length and physical activity in older adults: Results from the EPIC Norfolk cohort
in European Journal of Public Health
Conklin AI
(2016)
Dietary Diversity, Diet Cost, and Incidence of Type 2 Diabetes in the United Kingdom: A Prospective Cohort Study.
in PLoS medicine
Dunning A
(2016)
Breast cancer risk variants at 6q25 display different phenotype associations and regulate ESR1, RMND1 and CCDC170
in Nature Genetics
Machiela MJ
(2016)
Female chromosome X mosaicism is age-related and preferentially affects the inactivated X chromosome.
in Nature communications
Saunders EJ
(2016)
Gene and pathway level analyses of germline DNA-repair gene variants and prostate cancer susceptibility using the iCOGS-genotyping array.
in British journal of cancer
Duarte-Salles T
(2016)
Circulating Osteopontin and Prediction of Hepatocellular Carcinoma Development in a Large European Population
in Cancer Prevention Research
Zanoni P
(2016)
Rare variant in scavenger receptor BI raises HDL cholesterol and increases risk of coronary heart disease.
in Science (New York, N.Y.)
Bull CJ
(2016)
Blood lipids and prostate cancer: a Mendelian randomization analysis.
in Cancer medicine
Chamnan P
(2016)
Repeat Cardiovascular Risk Assessment after Four Years: Is There Improvement in Risk Prediction?
in PloS one
Pinnock C
(2016)
Topical Beta-Blockers and Cardiovascular Mortality: Systematic Review and Meta-Analysis with Data from the EPIC-Norfolk Cohort Study.
in Ophthalmic epidemiology
Wu YT
(2016)
Perceived and Objectively Measured Environmental Correlates of Domain-Specific Physical Activity in Older English Adults.
in Journal of aging and physical activity
Mitry D
(2016)
The Accuracy and Reliability of Crowdsource Annotations of Digital Retinal Images.
in Translational vision science & technology
Bonilla C
(2016)
Assessing the role of insulin-like growth factors and binding proteins in prostate cancer using Mendelian randomization: Genetic variants as instruments for circulating levels.
in International journal of cancer
NCD Risk Factor Collaboration (NCD-RisC)
(2016)
A century of trends in adult human height.
in eLife
Leng Y
(2016)
Daytime napping, sleep duration and increased 8-year risk of type 2 diabetes in a British population.
in Nutrition, metabolism, and cardiovascular diseases : NMCD
Lassale C
(2016)
Diet Quality Scores and Prediction of All-Cause, Cardiovascular and Cancer Mortality in a Pan-European Cohort Study
in PLOS ONE
Opstelten J
(2016)
Dairy Products, Dietary Calcium, and Risk of Inflammatory Bowel Disease Results From a European Prospective Cohort Investigation
in Inflammatory Bowel Diseases
Fanidi A
(2016)
Circulating vitamin D in relation to cancer incidence and survival of the head and neck and oesophagus in the EPIC cohort.
in Scientific reports
Zhang W
(2016)
Genome-wide association reveals that common genetic variation in the kallikrein-kinin system is associated with serum L-arginine levels.
in Thrombosis and haemostasis
Huseinovic E
(2016)
Meal patterns across ten European countries - results from the European Prospective Investigation into Cancer and Nutrition (EPIC) calibration study
in Public Health Nutrition
Basu N
(2016)
Fatigue is associated with excess mortality in the general population: results from the EPIC-Norfolk study.
in BMC medicine
Navarrete-Muñoz EM
(2016)
Sweet-beverage consumption and risk of pancreatic cancer in the European Prospective Investigation into Cancer and Nutrition (EPIC).
in The American journal of clinical nutrition
| 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 |