Biomedical subjects

K Nanchahal

Publications and source records attributed to K Nanchahal.

At least 19 recordsLinked to original sources

PubMed2005

Coronary heart disease risk in men and the epidemic of overweight and obesity.

OBJECTIVE: To evaluate the contributions of socioeconomic, lifestyle, and body weight factors to predicted risk of coronary heart disease (CHD) in the population and thus provide a focus for policies on prevention. DESIGN: Prospective study and cross-sectional population health survey. SUBJECTS: In all, 3090 men in the Framingham study and 2571 men in the 1998 Health Survey for England (HSE) aged 35-74 y with no history of cardiovascular disease participated in the study. MEASUREMENTS: Data on sex, age, systolic blood pressure and antihypertensive medication, total and high-density lipoprotein cholesterol levels, diabetes, and their association with the incidence of myocardial infarction and fatal CHD in the Framingham study population were used to derive functions for predicting individual 10-y risk of CHD. These functions were applied to the same data on participants in the HSE. High risk was defined as 10-y CHD risk > or = 15%. The proportion of high risk in the English population attributable to each of the risk factors examined was assessed. RESULTS: In all, 32% of men in England had predicted 10-y CHD risk > or =15%. Such high risk was significantly associated with body mass index (BMI, kg/m2), waist:hip ratio (WHR), smoking, and levels of physical activity, educational attainment, and income (all P < or = 0.007). In this population, 47% of high CHD risk was attributable to excess body weight--BMI > or = 25 kg/m2 and/or WHR > or = 0.95--and 31% to the sum of the four other significant factors: lack of educational qualifications, low income, smoking, and physical inactivity. CONCLUSION: Overweight and obesity now dominate the standard risk factors of CHD in men and should be the focus of national policies for prevention.

Adult↗

PubMed2002

The accuracy of reported sensitive sexual behaviour in Britain: exploring the extent of change 1990-2000.

OBJECTIVES: The 1990-1 British national probability sample survey of sexual attitudes and lifestyles (Natsal 1990) was repeated in 1999-2001 (Natsal 2000) to update population estimates of risk behaviours, and assess change over time. We examine whether changes in prevalence estimates may partly result from changes in measurement accuracy. METHODS: Taking Natsal 2000 (11 161 respondents) and Natsal 1990 (13 765 respondents aged 16-44) we compared the response rate, sample representativeness, reporting of abortion last year (relative to official statistics), and selected attitudes. Among the common birth cohort eligible for both surveys (aged 16-34 Natsal 1990, 26-44 Natsal 2000), we compared reporting of experiences before 1990. RESULTS: The response rate (66.8% Natsal 1990, 65.4% Natsal 2000) and completeness of reporting abortion were unchanged (84% Natsal 1990, 86% Natsal 2000). Attitudes were significantly changed in Natsal 2000 relative to Natsal 1990--for example, increased tolerance of male homosexual sex, OR (95% CI) 2.10 (1.93-2.29) men and 2.95 (2.74 to 3.18) women. In the common birth cohort reporting of heterosexual intercourse before 16 (OR 1.15 (1.02 to 1.29) men, 1.49 (1.31 to 1.69) women), and homosexual experience (OR 1.80 (1.46 to 2.21) men, 2.00 (1.61 to 2.48) women) were significantly increased. CONCLUSIONS: The results are consistent with improved reporting accuracy for some sensitive behaviours in Natsal 2000, in line with greater social tolerance and improved survey methodology. However, the evidence is not conclusive, and may not be generalisable to all such behaviours. The increase found in the reported prevalence of STI risk behaviours between Natsal 1990 and Natsal 2000 is likely to be somewhat overstated.

Adolescent↗

PubMed2001

Sexual behaviour in Britain: partnerships, practices, and HIV risk behaviours.

BACKGROUND: Sexual behaviour is a major determinant of sexual and reproductive health. We did a National Survey of Sexual Attitudes and Lifestyles (Natsal 2000) in 1999-2001 to provide population estimates of behaviour patterns and to compare them with estimates from 1990-91 (Natsal 1990). METHODS: We did a probability sample survey of men and women aged 16-44 years who were resident in Britain, using computer-assisted interviews. Results were compared with data from respondents in Natsal 1990. FINDINGS: We interviewed 11161 respondents (4762 men, 6399 women). Patterns of heterosexual and homosexual partnership varied substantially by age, residence in Greater London, and marital status. In the past 5 years, mean numbers of heterosexual partners were 3.8 (SD 8.2) for men, and 2.4 (SD 4.6) for women; 2.6% (95% CI 2.2-3.1) of both men and women reported homosexual partnerships; and 4.3% (95% CI 3.7-5.0) of men reported paying for sex. In the past year, mean number of new partners varied from 2.04 (SD 8.4) for single men aged 25-34 years to 0.05 (SD 0.3) for married women aged 35-44 years. Prevalence of many reported behaviours had risen compared with data from Natsal 1990. Benefits of greater condom use were offset by increases in reported partners. Changes between surveys were generally greater for women than men and for respondents outside London. INTERPRETATION: Our study provides updated estimates of sexual behaviour patterns. The increased reporting of risky sexual behaviours is consistent with changing cohabitation patterns and rising incidence of sexually transmitted infections. Observed differences between Natsal 1990 and Natsal 2000 are likely to result from a combination of true change and greater willingness to report sensitive behaviours in Natsal 2000 due to improved survey methodology and more tolerant social attitudes.

Adolescent↗

PubMed2001

Sexual behaviour in Britain: early heterosexual experience.

BACKGROUND: Relatively high rates of teenage conception and sexually transmitted infection among young people in Britain have focused attention on early sexual behaviour and its determinants. We report the results of the second National Survey of Sexual Attitudes and Lifestyles (Natsal 2000). METHODS: We did a probability sample survey between 1999 and 2001, of men and women aged 16-44 years in Britain. Participants were interviewed using a combination of computer-assisted face-to-face and self-completion questionnaires, and asked questions regarding first heterosexual intercourse, communication about sex, pregnancy, and sexually transmitted infections (STIs). FINDINGS: We recruited 11161 men and women to the survey (4762 men, 6399 women). The proportion of those aged 16-19 years at interview reporting first heterosexual intercourse at younger than 16 years was 30% for men and 26% for women; median age was 16 years. The proportion of women reporting first intercourse before 16 years increased up to, but not after, the mid-1990s. There has been a sustained increase in condom use and a decline in the proportion of men and women reporting no contraceptive use at first intercourse with decreasing age at interview. Among 16-24 year olds, non-use of contraception increased with declining age at first intercourse; reported by 18% of men and 22% of women aged 13-14 years at occurrence. Early age at first intercourse was significantly associated with pregnancy under 18 years, but not with occurrence of STIs. Low educational attainment was associated with motherhood before 18 years, but not abortion. INTERPRETATION: The increase in the proportion of women reporting first intercourse before age 16 years does not appear to have continued throughout the past decade. Only a small minority of teenagers have unprotected first intercourse, and early motherhood is more strongly associated with educational level than with family background. Factors most strongly associated with risk behaviour and adverse outcomes have considerable potential for preventive intervention.

Adolescent↗

PubMed2001

Sexual behaviour in Britain: reported sexually transmitted infections and prevalent genital Chlamydia trachomatis infection.

BACKGROUND: Studies of the epidemiology of sexually transmitted infections (STI) are largely based on surveillance data. As part of a national survey of sexual attitudes and lifestyles (Natsal 2000) in Britain, we estimated the frequency of self-reported STIs, and the prevalence of urinary Chlamydia trachomatis infection. METHODS: We did a stratified probability sample survey of 11161 men and women aged 16-44 years in Britain. Computer assisted self-interviews contained items on the nature and timing of previously diagnosed STIs. Half of all sexually experienced respondents aged 18-44 years were invited to provide a urine sample for ligase chain reaction testing for C trachomatis infection. FINDINGS: 10.8% of men and 12.6% of women reported ever having an STI, 3.6% of men and 4.1% of women reported ever being diagnosed with genital warts, and 1.4% of men and 3.1% of women reported previous infection with C trachomatis. 76% of men and 57% of women ever diagnosed with an STI had been to a GUM clinic. C trachomatis was found in 2.2% (95% CI 1.5-3.2) of men and 1.5% (95% CI 1.11-2.14) of women with age-specific prevalence being highest among men aged 25-34 (3.1%) and women aged 16-24 years (3.0%). Non-married status, age, and reporting partner concurrency or two or more sexual partners in the past year were independently associated with infection with C trachomatis. INTERPRETATION: We show substantial heterogeneity in distribution of reported STIs, and the demographic and behavioural determinants of prevalent genital chlamydial infection. The results have potentially wide application for proposed chlamydia screening programmes which, given the demonstrated prevalence, must now proactively seek to involve men.

Adolescent↗

PubMed2001

Body mass index and metabolic risk factors for coronary heart disease in women.

AIMS: Prospective epidemiological studies demonstrate an increase in coronary heart disease mortality in women beginning at values of body mass index > or = 22 kg. m(-2). However, the metabolic basis for this observation has not been adequately studied in women. Our aim was to examine the association between body mass index, metabolic coronary heart disease risk factors and a predicted 10-year coronary heart disease risk score in a large occupational cohort of women in the U.K. METHODS AND RESULTS: We carried out a cross-sectional survey of cardiovascular risk factors in 14 077 women, aged 30-64 years. The main outcome measures were systolic and diastolic blood pressure, serum total cholesterol, HDL cholesterol, total cholesterol/HDL cholesterol ratio, LDL-cholesterol, triglycerides, apolipoprotein A1, apolipoprotein B, lipoprotein(a), fasting blood glucose and a predicted 10-year coronary risk score. Across seven categories of body mass index, i.e. < 20, 20-, 22-, 24-, 26-, 28- and > or = 30 kg. m(-2), there were highly significant age-adjusted increases in the risk factors (all P < 0.001), except for a decrease in HDL cholesterol and ApoA1 (all P<0.001) and no relationship with lipoprotein(a) (P = 0.05). Based on a multifactorial 10-year coronary heart disease risk estimate, odds ratios for being in the highest quintile of risk for each category of body mass index, were 1 (< 20 kg. m(-2)), 0.91, 1.56, 2.18, 2.97, 3.83 and 4.21 (> or = 30 kg. m(-2)). CONCLUSION: The significant rise in metabolic coronary heart disease risk at 22 kg. m(-2)observed in this study is consistent with prospective epidemiological studies in women which have reported an increase in coronary heart disease mortality starting at 22 kg. m(-2). However, body mass index was a poor discriminator of women at different levels of coronary heart disease risk. The primary goal of weight loss in individuals should be the correction of dysmetabolism, irrespective of the level of body mass index.

Adult↗

PubMed2001

Development and validation of a computerized South Asian Names and Group Recognition Algorithm (SANGRA) for use in British health-related studies.

BACKGROUND: Studies on ethnic variations in health have played an important role in aetiological and health services research. Most routine datasets, however, do not include information on ethnicity. South Asians, one of the largest minority ethnic groups in Britain, have distinctive names that also allow differentiation of the main sub-groups with their important differences in health-related exposures and disease risks. METHODS: A computerized name recognition algorithm (SANGRA) was developed incorporating directories of South Asian first names and surnames together with their religious and linguistic origin. SANGRA was validated using health-related data with self-ascribed information on ethnicity. RESULTS: SANGRA was successful in recognizing South Asian origin in reference datasets, with sensitivity of 89-96 per cent, specificity of 94-98 per cent, positive predictive value (PPV) of 80-89 per cent and negative predictive value (NPV) of 98-99 per cent. Religious origin was correctly assigned in the majority of cases: sensitivity, specificity and PPV were 94 per cent, 91 per cent and 90 per cent for Hindus; 90 per cent, 99 per cent and 98 per cent for Muslims; and 76 per cent, 99 per cent and 94 per cent for Sikhs. SANGRA correctly identified 76 per cent Gujerati and 70 per cent Punjabi names, although only 62 per cent of Gujerati names were sufficiently distinct to be allocated to the Gujerati-only category and only 53 per cent Punjabi names were allocated to the Punjabi-only category. However, specificity and PPV were high for both languages (respectively 97 per cent and 93 per cent for Gujerati, and 99 per cent and 97 per cent for Punjabi). CONCLUSIONS: SANGRA provides a practical and valid method of ascertaining South Asian origin by name and, to a lesser degree of accuracy, of differentiating between the main religious and linguistic subgroups living in Britain. This algorithm will be useful in health-related studies where information on self-ascribed ethnicity is not available or is of a limited nature.

Algorithms↗

PubMed2001

National level promotion of physical activity: results from England's ACTIVE for LIFE campaign.

STUDY OBJECTIVE: To assess the impact of a national campaign on awareness of the campaign, change in knowledge of physical activity recommendations and self reported physical activity. DESIGN: three year prospective longitudinal survey using a multi-stage, cluster random probability design to select participants. SETTING: England. PARTICIPANTS: A nationally representative sample of 3189 adults aged 16-74 years. MAIN OUTCOME MEASURES: Awareness of the advertising element of the campaign, changes in knowledge of physical activity recommendations for health and self reported physical activity. RESULTS: 38% of participants were aware of the main advertising images, assessed six to eight months after the main television advertisement. The proportion of participants knowledgeable about moderate physical activity recommendations increased by 3.0% (95% CI: 1.4%, 4.5%) between waves 1 and 2 and 3.7% (95% CI: 2.1%, 5.3%) between waves 1 and 3. The change in proportion of active people between baseline and waves 1 and 2 was -0.02 (95% CI: -2.0 to +1.7) and between waves 1 and 3 was -9.8 (-7.9 to -11.7). CONCLUSION: The proportion of participants who were knowledgeable about the new recommendations, increased significantly after the campaign. There was however, no significant difference in knowledge by awareness of the main campaign advertisement. There is no evidence that ACTIVE for LIFE improved physical activity, either overall or in any subgroup.

Adolescent↗

PubMed2000

Alcohol consumption, metabolic cardiovascular risk factors and hypertension in women.

BACKGROUND: Low to moderate alcohol consumption is associated with reduced mortality, primarily due to a reduction in coronary heart disease (CHD). Conversely, heavy drinking increases mortality, mainly due to haemorrhagic stroke and non-cardiovascular diseases. It is important to identify the threshold of alcohol consumption above which the balance of risk and benefit becomes adverse. We examine the relationship between reported alcohol consumption, cardiovascular disease (CVD) risk factors, a 10-year CHD risk score and hypertension in women. METHODS: In all, 14 077 female employees aged 30-64 years, underwent screening for CVD risk factors. Information was available on a range of personal and lifestyle factors, including height, weight, blood pressure, lipids, lipoproteins, apolipoproteins and blood glucose. Age-adjusted means were computed for the risk factors in each of five groups of reported alcohol intake: <1 (non-drinkers), 1-7, 8-14, 15-21, > or = 22 units/week. The relationships between alcohol and a derived coronary risk score and hypertension were also examined. RESULTS: Increasing consumption was associated with an age-adjusted increase in high density lipoprotein cholesterol (HDL-C) and apolipoprotein A1 (both P < 0.001), a decline in body mass index, total cholesterol (TC), TC/HDL-C ratio, low density lipoprotein cholesterol (LDL-C) and apolipoprotein B (all P < 0.001), and no trend in triglycerides (P = 0.06), lipoprotein (a) (P = 0.09) or fasting glucose (P = 0.14). Except for LDL-C (P = 0.06) the relationships remained statistically significant after adjustment for possible confounders. Compared to non-drinkers, there was a decrease in 10-year CHD risk with increasing consumption, with the greatest reduction in risk in women consuming 1-7 units/week, odds ratio (OR) = 0.79, (95% CI: 0.72-0.87), and an increase in the prevalence of hypertension among those consuming 15-21 units/week, OR = 1.68, (95% CI: 1.14-2.46). CONCLUSIONS: This study provides biological support for an inverse association between alcohol intake and CHD in women, associated with favourable changes in lipid and lipoprotein risk factors. Women consuming 1-14 units/week had a reduction in CHD risk, but there was an increased prevalence of hypertension among those consuming > or = 15 units/week. These data suggest that, in terms of the reduced risk of CVD, women should be advised to restrict their alcohol consumption to < or = 14 units/week.

Adult↗

PubMed2000

Association between blood pressure, the treatment of hypertension, and cardiovascular risk factors in women.

OBJECTIVE: To examine relationships of normal blood pressure (BP), hypertension and degree of BP control with cardiovascular disease (CVD) risk factors and predicted 10-year risks for coronary heart disease (CHD) and stroke. DESIGN: Cross-sectional survey. SETTING: 107 Marks and Spencer retail stores in the UK. PARTICIPANTS: 14,077 women, aged 30-64 years, screened for CVD risk factors between 1988 and 1991. MAIN OUTCOME MEASURES: Systolic (SBP) and diastolic (DBP) BP; total, high-(HDL) and low-density lipoprotein (LDL) cholesterol, ratio of total to HDL cholesterol (TC/HDL-C); triglycerides, apolipoprotein A1, apolipoprotein B, lipoprotein (a), glucose, body mass index, antihypertensive medication and predicted risks for CHD and stroke. Hypertension was defined as SBP > or = 140 mmHg and/or DBP > or = 90 mmHg and/or taking anti-hypertensive medication. Subjects were divided into normotensives with optimal (n = 6,599), normal (n = 3,170) and high normal (n = 2,184) BP levels, and hypertensives with adequate BP control (n = 228), untreated (n = 1,729) and inadequate BP control (n = 291). RESULTS: BP level was associated with other CVD risk factors among both normotensives and hypertensives. Women with inadequately controlled BP had the worst risk profile, followed by untreated hypertensives, those with adequately controlled BP and normotensives. Odds ratios for being in the top quintile of predicted 10-year CHD and stroke risks were 1, 2.7, 4.2, 8.5, 13.0, 18.9 for CHD; 1, 1.1, 5.8, 18.7, 20.6, 756 for stroke, for optimal, normal, high normal, adequate BP control, untreated and inadequate BP control groups respectively. CONCLUSIONS: Untreated hypertensives and women taking anti-hypertensive medication but with BP > or = 140/90 mmHg have the most atherogenic risk factor profiles. Effective management of BP and the associated CVD risk requires a multi-factorial approach, rather than addressing BP control in isolation.

Adult↗

PubMed2000

Leisure-time physical activity and coronary risk factors in women.

BACKGROUND: Evidence that physical activity is cardioprotective in women is not as strong as that observed in men. Furthermore, the extent to which exercise protects against coronary heart disease via its influence on classical risk factors remains unclear. This study examines the relationship between reported physical activity, a range of coronary heart disease risk factors and a 10-year predicted coronary heart disease risk score. METHODS: A cross-sectional study of 14,077 female employees aged 30-64 years who were screened between 1988 and 1991 was employed. Measurements included systolic and diastolic blood pressure, body mass index, serum total cholesterol, high-density lipoprotein cholesterol, total cholesterol:high-density lipoprotein cholesterol ratio, low-density lipoprotein cholesterol, triglycerides, apolipoprotein A1, apolipoprotein B, lipoprotein a and fasting blood glucose. Participants were divided into three groups according to reported average frequency of vigorous leisure-time physical activity, that is zero, one to two, or three or more episodes per week. RESULTS: Increasing activity frequency was associated with lower systolic and diastolic blood pressure, total cholesterol, total cholesterol:high-density lipoprotein cholesterol ratio, triglycerides and body mass index (all P < 0.001), low-density lipoprotein cholesterol (P = 0.003), apolipoprotein B (P = 0.04) and blood glucose (P = 0.01) and higher high-density lipoprotein cholesterol (P < 0.001) and apolipoprotein A1 (P = 0.03). There was no association with lipoprotein a. After controlling for possible confounders, these relationships remained statistically significant except for apolipoprotein B and glucose. The odds ratios for being in the top quintile of predicted 10-year coronary heart disease risk for individuals in each category of activity were 1.0 (inactive), 0.70 (one to two episodes of activity per week) and 0.77 (three or more episodes of activity per week). CONCLUSION: Women engaging in vigorous, leisure-time physical activity have a less atherogenic coronary heart disease risk factor profile than those who do not, which translates into a potential reduction of approximately 30% in coronary heart disease risk.

Adult↗

PubMed1999

Mortality attributable to drinking, drinking too much, or drinking too little: a comparison of methods.

BACKGROUND: The existence of a U-shaped relationship between alcohol consumption and all-cause mortality complicates the calculation and interpretation of mortality attributable to alcohol consumption. METHODS: We used the relationships between all-cause mortality and alcohol consumption from four British cohort studies. For each study we defined a 'sensible drinking level' asthe level with lowest observed mortality. We estimated the fractions of deaths that were attributable to (1) any drinking (compared with not drinking), (2) drinking more than the 'sensible level', and (3) drinking less than the 'sensible level'. RESULTS: Data from the Doctors' study suggest that on balance 22.3 per cent of deaths are prevented by alcohol consumption, yet the fractions of deaths attributable to drinking more than 8-14 units per week and less than 8-14 units per week are nearly equal (6.5 per cent and 6.4 per cent, respectively). In a sensitivity analysis we show that it is possible for alcohol consumption to prevent deaths overall yet for more deaths to be attributable to drinking above a sensible level than are attributable to drinking below the sensible level. CONCLUSIONS: The balance of deaths attributable to or prevented by alcohol consumption provides no information about the deaths attributable to drinking above or below sensible levels. Using all-cause data in this way is likely to exaggerate the protective effect of alcohol consumption, so our results are only illustrative.

Alcohol Drinking↗

PubMed1998

Long-term results of RITA-1 trial: clinical and cost comparisons of coronary angioplasty and coronary-artery bypass grafting. Randomised Intervention Treatment of Angina.

BACKGROUND: Percutaneous transluminal coronary angioplasty (PTCA) and coronary-artery bypass grafting (CABG) are both effective intervention strategies for patients with coronary heart disease. We report comparative long-term clinical and health-service cost findings for these interventions in the first Randomised Intervention Treatment of Angina (RITA-1) trial. METHODS: 1011 patients with coronary heart disease (45% single-vessel, 55% multivessel) were randomly assigned initial treatment strategies of PTCA or CABG. Information on clinical events, subsequent intervention, symptomatic status, exercise testing, and use of health-care resources is available for a median 6.5 years of follow-up. Analyses were by intention to treat. FINDINGS: The predefined primary endpoint of death or nonfatal myocardial infarction occurred in 87 (17%) PTCA-group patients and 80 (16%) CABG-group patients (p=0.64). Similarly, there was no significant treatment difference in deaths alone (39 PTCA, 45 CABG), of which 46% were cardiac related. In both groups, the risk of cardiac death or myocardial infarction was more than five times higher in the first year than in subsequent years of follow-up. 26% of patients assigned PTCA subsequently also had CABG, and a further 19% required additional nonrandomised PTCA. Most of these reinterventions occurred within a year of randomisation, and from 3 years onwards the reintervention rate averaged 4% per year. In the CABG group the reintervention rate averaged 2% per year. The prevalence of angina was consistently higher in the PTCA group, with an absolute average 10% excess compared with the CABG group (p<0.001). Total health-service costs over 5 years showed no significant difference between initial strategies of PTCA and CABG (mean difference pounds sterling 426 [95% Cl -pounds sterling 383 to pounds sterling 1235]; p=0.30). The clinical and cost comparisons showed similar patterns for patients with single-vessel and multivessel disease. INTERPRETATION: Initial strategies of PTCA and CABG led to similar long-term results in terms of survival and avoidance of myocardial infarction and to similar long-term health-care costs. Choice of approach, therefore, rests on weighing the more invasive nature of CABG against the greater risk of recurrent angina and reintervention over many years after PTCA.

Adult↗

PubMed1998

Childhood obesity and adult cardiovascular mortality: a 57-y follow-up study based on the Boyd Orr cohort.

Few studies have examined associations between childhood overweight and adult disease. We examined the relation between BMI measured in childhood and adult all-cause and cardiovascular mortality in a 57-y follow-up of a cohort study based on the Carnegie (Boyd Orr) Survey of Family Diet and Health in prewar Britain (1937-1939). Complete baseline and follow-up data were available for 1165 males and 1234 females who were aged between 2 y and 14 y 9 mo when they were examined. All-cause and cardiovascular mortality were associated with higher childhood BMIs. Compared with those with BMIs between the 25th and 49th centiles, the hazard ratio (95% CI) for all-cause mortality in those above the 75th BMI centile for their age and sex was 1.5 (1.1, 2.2) and for ischemic heart disease it was 2.0 (1.0, 3.9). There was also a suggestion of a nonlinear association with overall mortality; those in the 25-49th centile of the BMI distribution had the lowest mortality rates. The linear associations may be due in part to the tracking of BMI between childhood and adulthood. High BMI in adults is known to be associated with raised blood pressure and abnormal lipid profiles. The relative contributions of adult and childhood overweight to the observed mortality patterns are uncertain. From the public health perspective, strategies aimed at reducing weight in childhood are important but may only affect adult health if such weight reduction persists into adulthood.

Adolescent↗

PubMed1998

Childhood leg length and adult mortality: follow up of the Carnegie (Boyd Orr) Survey of Diet and Health in Pre-war Britain.

OBJECTIVE: To investigate the relation between childhood height, its components--leg length and trunk length--and mortality in adulthood. DESIGN: Cohort study based on the Carnegie (Boyd Orr) Survey of diet and health in pre-war Britain, 1937-9. SETTING: The 14 centres in England and Scotland that participated in the Carnegie Survey and where children were examined. Scottish centres: Aberdeen, Dundee, West Wemyss, Coaltown of Wemyss, Hopeman, Methlick, Tarves, Barthol Chapel. English Centres: Liverpool, York-shire, Barrow in Furness, Wisbech, Fulham, and Bethnal Green. SUBJECTS: 2990 boys and girls aged between 2 years and 14 years 9 months when they were examined in 1937-9. These children were drawn from 1134 families who underwent a one week assessment of family diet and home circumstances. Of these, 2547 (85%) have been traced and flagged using the NHS Central Register. MAIN OUTCOME MEASURES: Age adjusted overall, coronary heart disease, and cancer mortality in men and women in relation to age and sex specific z scores for height, leg length, and trunk length. All analyses were adjusted for the possible confounding effects of childhood and adult socioeconomic circumstances and childhood diet. RESULTS: Leg length was the component of childhood height most strongly associated with socioeconomic and dietary exposures. There was no significant relation between childhood height and overall mortality. Height-mortality relations were observed in relation to both coronary heart disease (CHD) and cancer. Leg length was the component of height most strongly related to cause specific mortality. In men and women CHD mortality increased with decreasing childhood leg length. Men in the lowest leg length quintile had a relative risk (RR) of 2.5 (95% CI 1.0 to 6.2) compared to those with the longest legs (linear trend p = 0.14). Similarly, women in the lowest leg length quintile had a RR of 3.9 (95% CI 0.8 to 19.0; linear trend p < 0.01). Adjustment for childhood and adult socioeconomic circumstances had little effect on these trends. In men, but not women, those who as children had long legs experienced increased cancer mortality. The significant relations between anthropometry and both CHD and cancer mortality were restricted to those aged < 8 years when measured. CONCLUSIONS: These findings suggest that adverse diet and living conditions in childhood, for which leg length seems to be a particularly sensitive indicator, are associated with increased risk of CHD in adulthood and possibly reduced cancer risk. It is likely that these influences operate after birth, during the first few years of life.

Adolescent↗

PubMed1997

Social inequality in coronary risk: central obesity and the metabolic syndrome. Evidence from the Whitehall II study.

This report describes the social distribution of central obesity and the metabolic syndrome at the Whitehall II study phase 3 examination, and assesses the contribution of health related behaviours to their distribution. Cross-sectional analyses were conducted utilising data collected in 1991-1993 from 4978 men and 2035 women aged 39-63 years who completed an oral glucose tolerance test. There was an inverse social gradient in prevalence of the metabolic syndrome. The odds ratio (95% confidence interval) for having the metabolic syndrome comparing lowest with highest employment grade was: men 2.2 (1.6-2.9), women 2.8 (1.6-4.8). Odds ratios for occupying the top quintile of the following variables, comparing lowest with highest grade, were, for waist-hip ratio: men 2.2 (1.8-2.8), women 1.6 (1.1-2.4); post-load glucose: men 1.4 (1.1-1.8), women 1.8 (1.2-2.6); triglycerides: men 1.6 (1.2-2.0), women 2.2 (1.5-3.3); fibrinogen: men 1.7 (1.4-2.3), women 1.9 (1.2-2.8). Current smoking status, alcohol consumption and exercise level made a small contribution (men 11%, women 9%) to the inverse association between socioeconomic status and metabolic syndrome prevalence. In conclusion, central obesity, components of the metabolic syndrome and plasma fibrinogen are strongly and inversely associated with socioeconomic status. Our findings suggest the metabolic syndrome may contribute to the biological explanation of social inequalities in coronary risk. Health related behaviours appear to account for little of the social patterning of metabolic syndrome prevalence.

Adult↗

PubMed1997

Reference values for alpha-tocopherol and beta-carotene in the Whitehall II Study.

Plasma alpha-tocopherol, beta-carotene, serum lipids and their derived ratios were determined in British Civil Servants (n = 7177) at the second medical examination of the Whitehall II Study, a longitudinal study of cardiovascular disease. For plasma alpha-tocopherol the non-parametric 95% reference interval (90% confidence limits) for the total population was: 11.1 (10.9-11.3)-51.5 (50.6-52.7) mumol/l. For plasma beta-carotene the non-parametric reference interval for the total population was: 0.05 (0.05-0.05)-2.14 (2.08-2.21) mumol/l. The latter interval was wider than those previously published with a higher mean (0.61 mumol/l) and median (0.75 mumol/l). Plasma beta-carotene concentrations were higher in women than men with age-adjusted means of 0.70 and 0.57 mumol/l respectively (p < 0.001). This may reflect differences in diet, lifestyle and metabolism between the sexes. The alpha-tocopherol/cholesterol ratio, as in other surveys, did not vary with age. Among men, current- and ex-smokers had a higher alpha-tocopherol/cholesterol ratio than never-smokers with age-adjusted means of 4.18, 4.19 mumol/mmol and 4.05 mumol/mmol respectively. This difference is as yet unexplained. Follow-up of these subjects will help to clarify the role of antioxidant nutrients as protective factors for cardiovascular disease and cancer.

Adult↗

PubMed1996

Lifecourse exposure and later disease: a follow-up study based on a survey of family diet and health in pre-war Britain (1937-1939).

There is an increasing interest in the origins of adult disease in early life. The elucidation of such explanations of current morbidity and mortality must depend upon the follow-up of previously established cohorts. This paper describes the design of and background to such a follow-up of one of the richest data sources for this type of research: Sir John Boyd Orr's survey of diet and health in pre-war Britain. 1,352 families from 16 centres in England and Scotland were surveyed; 3,762 children aged up to 19 years from these families were examined. Socio-economic information and detailed one week dietary diary records are available for all families. Detailed medical examinations (including anthropometry) were undertaken on children in 14 of the centres. Most of the information is cross-sectional although 1,322 children were examined on two or more occasions one year apart to assess the effects of dietary supplementation. Dietary records were retrieved for 1,343 (99.3%) of the families. Medical examination records were found for 3,560 (94.6%) of the children who were examined in the survey and attempts have been made to trace 4,973 children who were either examined or whose family participated in the dietary survey. The data demonstrate relationships between family food expenditure and height in childhood and housing conditions. Eighty-five per cent (4211/4973) of the children have been traced and flagged on the National Health Service Central Register, Southport. The characteristics of those traced do not differ significantly from those we have been unable to trace although untraced females were slightly heavier. To date 696 (16.5%) of the cohort have died. The cohort will be used to investigate the relationship between diet, nutritional status (height, weight, cristal height), health and social circumstances in childhood, and mortality and morbidity in adulthood.

Adolescent↗