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Kay-Tee Khaw

Publications and source records attributed to Kay-Tee Khaw.

86 records · Page 5Linked to original sources
PubMed2004

Microalbuminuria, cardiovascular risk factors and cardiovascular morbidity in a British population: the EPIC-Norfolk population-based study.

BACKGROUND: Microalbuminuria is independently associated with increased cardiovascular risk and renal function deterioration in diabetes and hypertension, but the clinical relevance of raised albuminuria in the general population is less certain. We examined the prevalence of microalbuminuria and its relationship to cardiovascular risk factors and cardiovascular morbidity in the UK general population. METHODS: Cross-sectional population-based study of 23,964 individuals, aged 40-79 years recruited in 1993-1997 for the EPIC-Norfolk Study. Smoking status, prevalent physician diagnosed diabetes, hypertension, cardiovascular disease and cancer were derived from a health and lifestyle questionnaire. Albumin-to-creatinine ratios were estimated from random spot urine specimens collected at the survey visit, and using these ratios participants were categorized into normoalbuminuria, microalbuminuria (2.5-25 mg/mmol), and macroalbuminuria. RESULTS: The prevalence of microalbuminuria and macroalbuminuria was 11.8% and 0.9% respectively in the total population and significantly higher in women (14.4%) compared with men (8.9%) (P<0.001). Independent determinants of microalbuminuria were age, sex, systolic blood pressure and current smoking. Microalbuminuria was independently associated with cardiovascular morbidity, after adjusting for known cardiovascular risk factors, with odds ratio (95% confidence interval) for prevalent cardiovascular disease of 1.30 (1.12-1.51) in all men and women. CONCLUSION: Microalbuminuria was present in approximately 12% of this population. It was independently associated with cardiovascular risk factors and prevalent cardiovascular disease. Microalbuminuria may be a useful indicator of high absolute cardiovascular risk in the community but prospective data are needed to establish its independent predictive value for future events.

Adult↗
PubMed2004

Residential area deprivation predicts fruit and vegetable consumption independently of individual educational level and occupational social class: a cross sectional population study in the Norfolk cohort of the European Prospective Investigation into Cancer (EPIC-Norfolk).

STUDY OBJECTIVE: To investigate the independent association between individual and area based socioeconomic measures and fruit and vegetable consumption. DESIGN: Cross sectional population based study. SETTING AND PARTICIPANTS: 22,562 men and women aged 39-79 years living in the general community in Norfolk, United Kingdom, recruited using general practice age-sex registers. OUTCOME MEASURES: Fruit and vegetable intake assessed using a food frequency questionnaire. MAIN RESULTS: Being in a manual occupational social class, having no educational qualifications, and living in a deprived area all independently predicted significantly lower consumption of fruit and vegetables. The effect of residential area deprivation was predominantly in those in manual occupational social class and no educational qualifications. CONCLUSIONS: Understanding some of the community level barriers to changing health related behaviours may lead to more effective interventions to improving health in the whole community, particularly those who are most vulnerable.

Adult↗
PubMed2004

Phytoestrogen concentrations in serum and spot urine as biomarkers for dietary phytoestrogen intake and their relation to breast cancer risk in European prospective investigation of cancer and nutrition-norfolk.

Subjects of this study consisted of 333 women (aged 45-75 years) drawn from a large United Kingdom prospective study of diet and cancer, the European Prospective Investigation of Cancer and Nutrition-Norfolk study. Using newly developed gas chromatography/mass spectrometry and liquid chromatography/mass spectrometry methods incorporating triply (13)C-labeled standards, seven phytoestrogens (daidzein, genistein, glycitein, O-desmethylangolensin, equol, enterodiol, and enterolactone) were measured in 114 spot urines and 97 available serum samples from women who later developed breast cancer. Results were compared with those from 219 urines and 187 serum samples from healthy controls matched by age and date of recruitment. Dietary levels were low, but even so, mean serum levels of phytoestrogens were up to 600 times greater than postmenopausal estradiol levels. Phytoestrogen concentrations in spot urine (adjusted for urinary creatinine) correlated strongly with that in serum, with Pearson correlation coefficients > 0.8. There were significant relationships (P < 0.02) between both urinary and serum concentrations of isoflavones across increasing tertiles of dietary intakes. Urinary enterodiol and enterolactone and serum enterolactone were significantly correlated with dietary fiber intake (r = 0.13-0.29). Exposure to all isoflavones was associated with increased breast cancer risk, significantly so for equol and daidzein. For a doubling of levels, odds ratios increased by 20-45% [log(2) odds ratio = 1.34 (1.06-1.70; P = 0.013) for urine equol, 1.46 (1.05-2.02; P = 0.024) for serum equol, and 1.22 (1.01-1.48; P = 0.044) for serum daidzein]. These estimates of risk are similar to those established for estrogens and androgens in postmenopausal breast cancer but need confirmation in larger studies.

Adult↗
PubMed2004

Preliminary communication: glycated hemoglobin, diabetes, and incident colorectal cancer in men and women: a prospective analysis from the European prospective investigation into cancer-Norfolk study.

BACKGROUND: Increasing evidence suggests that abnormal glucose metabolism may be associated with increased risk of colorectal cancer. METHODS: We examined the relationship between known diabetes and glycated hemoglobin (HbA1c) concentrations measured in 1995 to 1997 and subsequent incident colorectal cancer after 6 years follow-up in 9,605 men and women ages 45 to 79 years in the European Prospective Investigation into Cancer-Norfolk Study. RESULTS: Among individuals not known to have cancer at the baseline survey, there were 67 incident colorectal cancers. HbA1c concentration appeared continuously related to incident colorectal cancer risk, with lowest rates observed in those with HbA1c below 5%. Known diabetes was also associated with incident colorectal cancer, with relative risk (RR) 3.18 and 95% confidence interval (CI) 1.36-7.40 (P < 0.01) adjusting for age and sex and RR 2.78 and 95% CI 1.10-7.00 (P = 0.03) adjusting for age, sex, body mass index, and smoking compared with those without known diabetes. The RR (95% CI) of incident colorectal cancer per 1% absolute increase in HbA1c was 1.34 (1.12-1.59; P < 0.001). HbA1c concentrations appeared to explain the increased colorectal cancer risk associated with diabetes in multivariate models. CONCLUSIONS: Known diabetes was associated with approximately 3-fold risk of colorectal cancer in this analysis; this increased risk was largely explained by HbA1c concentrations, which appears continuously related to colorectal cancer risk across the population distribution.

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PubMed2003

Sense of coherence and mortality in men and women in the EPIC-Norfolk United Kingdom prospective cohort study.

This study tested the hypothesis that a personality disposition defined by a strong sense of coherence is associated with a reduced risk of mortality. The authors prospectively examined, for < or =6 years, the relation between a strong sense of coherence and mortality due to all causes, cardiovascular disease, and cancer among 20,579 participants aged 41-80 years from the European Prospective Investigation into Cancer (EPIC)-Norfolk Study in the United Kingdom. Data were collected in 1996-2002. Participants were recruited by post from general practice age-sex registers and subsequently completed a postal assessment of their sense of coherence. During follow-up, 1,024 deaths were recorded. A strong sense of coherence was associated with a 30% reduction in mortality from all causes (rate ratio=0.69, p<0.0001), cardiovascular disease (rate ratio=0.70, p=0.001), and cancer (rate ratio=0.74, p=0.003), independent of age, sex, and prevalent chronic disease. These associations were consistent by sex, except that no association was observed for cancer mortality in women. The association for all-cause mortality remained after adjustment for cigarette smoking history, social class, body mass index, systolic blood pressure, cholesterol, hostility, and neuroticism (rate ratio=0.76, p=0.002). Results suggest that a strong sense of coherence may confer some resilience to the risk of chronic disease.

Adult↗
PubMed2003

Are imprecise methods obscuring a relation between fat and breast cancer?

Pooled analyses of cohort studies show no relation between fat intake and breast-cancer risk. However, food-frequency questionnaire (FFQ) methods used in these studies are prone to measurement error. We assessed diet with an FFQ and a detailed 7-day food diary in 13070 women between 1993 and 1997. We compared 168 breast-cancer cases incident by 2000 with four matched controls. Risk of breast cancer was associated with saturated-fat intake measured with the food diary (hazard ratio 1.22 [95% CI 1.06-1.40], p=0.005, per quintile increase in energy-adjusted fat intake), but not with saturated fat measured with the FFQ (1.10 [0.94-1.29], p=0.23). Dietary measurement error might explain the absence of a significant association between dietary fat and breast-cancer risk in cohort studies.

Aged↗
PubMed2003

Smoking status and differential white cell count in men and women in the EPIC-Norfolk population.

The total white blood cell (WBC) count is reported to be an independent predictor of mortality in several prospective studies. We investigated the association between total and differential WBC counts and cigarette smoking habit in a cross-sectional population-based study of 6902 men and 8405 women 39-79 years of age participating between July 1994 and 1997 in the European Prospective Investigation of Cancer (EPIC-Norfolk) study. Main outcome measures included WBC, granulocyte, lymphocyte and monocyte counts measured at a baseline health check and self-reported cigarette smoking habit. The age- and body mass index-adjusted mean total WBC counts were 7.8, 6.4, and 6.2x10(3) per ul (P<0.0001) among male current, former and never smokers, respectively, and 7.4, 6.3 and 6.2x10(3) per ul (P<0.0001), respectively, in women. The greatest absolute and percentage differences between smoking groups were observed for the granulocyte count. Current smoking habit had a stronger effect on mean total WBC counts than cumulative exposure as measured by pack years. Among former smokers mean age- and body mass index-adjusted WBC, granulocyte and lymphocyte counts were inversely related to duration of smoking cessation (P< or =0.02). Smokers who had given up less than 12 months previously had WBC counts substantially lower (6.7 and 6.9x10(3) per ul, respectively, in men and women) than current smokers. In conclusion, the total WBC count and its components (particularly the granulocyte count) are strongly associated with cigarette smoking habit. Smoking cessation may have an almost immediate impact at least on pathophysiologic processes such as inflammation that may be indicated by the WBC count. The apparent almost immediate reversibility of effects of smoking on inflammation, as indicated by the WBC count, may help motivate efforts to stop smoking.

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PubMed2003

Association of depression with peripheral leukocyte counts in EPIC-Norfolk--role of sex and cigarette smoking.

OBJECTIVE: To investigate the associations among depression, smoking behaviour and enumerative measures of immunity in a population-based cohort study. METHODS: Participants in the European Prospective Investigation into Cancer and Nutrition in Norfolk, England, aged 40-80 years, were identified through age-sex general practice registers. After exclusions for prevalent conditions, white blood cell (WBC) counts and a measure of depressive episode history were available from 11,367 participants and, after a mean interval of 44 months, from 11,857 at a second health check. The measure of depression was completed between health checks. RESULTS: Observed associations between leukocyte counts and depression for men were weakened following adjustment for cigarette smoking. There was an incremental elevation in age-smoking adjusted mean WBC count by recency of depression such that there was a 3.1% (P=.03) and 5.6% (P=.0004) difference across depression history subgroups (never, lifetime, current) at the first and second health checks, respectively. No age-smoking adjusted associations were observed for women. CONCLUSION: Following adjustment for age and cigarette smoking, these data provide evidence for an association between major depressive disorder and leukocyte counts for men, but not for women.

Adult↗
PubMed2003

Effects of gender, anthropometric variables, and aging on the evolution of hip strength in men and women aged over 65.

Although gender differences in fall rates may partly explain the higher prevalence of fractures in elderly women than men, male bones may also be intrinsically stronger or suffer less structural degradation with age than those of women. We used hip structural analysis (HSA) to study gender differences in hip geometry and bone mineral density (BMD) as they evolved over time in elderly white men and women with the aim of identifying candidate biological pathways leading to heightened risk of hip fracture. We recruited 443 women and 439 men aged 67-79 years from a diet and cancer prospective population-based cohort study to a study of hip bone loss. Hip BMD was measured on two occasions 2-5 years apart by dual-energy X-ray absorptiometry and HSA software used to derive BMD and structural parameters at the narrow neck (NN), the intertrochanter (IT), and the shaft (S) regions. Structural indices calculated in each region were cross-sectional area (CSA)-amount of bone surface area in the cross section after excluding soft tissue space; section modulus (Z)-an index of bending resistance, subperiosteal width, endocortical width, cortical thickness; and cortical buckling ratio (CBR)-a measure of cortical instability. Compared to men, women had lower values of BMD, CSA, Z, subperiosteal width, endocortical width, and cortical thickness in all regions, except S endocortical width, after adjusting for weight, height, and age (P < 0.0001). CBR was higher in women than in men (P < 0.0001) in all regions. Longitudinal analysis of rates of change revealed faster rates of BMD decline in women than in men at the Hologic total hip, Hologic femoral neck, and IT regions (P < 0.029). Women had faster rates of subperiosteal and endosteal expansion than men at the NN (P < 0.011) and IT (P < 0.049) and faster increase in Z at the NN (P = 0.029). At the IT region, cortical thinning was faster in women than in men (P = 0.037) and CBR increased at a faster rate in women (P = 0.011). In conclusion, Z is lower in women than in men and expansion of the proximal femur occurs in both sexes, being faster in women than in men. Z does not decline at the same rate as BMD, implying that part of the effect of aging on BMD is due to expansion of the bony envelope without loss of bone mineral content. Faster expansion in the female femoral neck may in turn lead to greater fragility if wider diameter and thinner cortices become locally unstable.

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PubMed2003

Functional health status, chronic medical conditions and disorders of mood.

BACKGROUND: Understanding of the impact of depressive and anxiety disorders on functional health status in the context of chronic medical illness has been gained almost exclusively from the study of patient populations. AIMS: To compare the impact of major depressive and generalised anxiety disorder with that of chronic medical conditions on functional health in a UK resident population. METHOD: The functional health of 20,921 study participants was assessed using the Medical Outcomes Study Short Form 36 questionnaire. Depressive and anxiety disorder episode histories and chronic medical conditions were assessed using independent self-completed questionnaires. RESULTS: The degree of physical functional impairment associated with mood disorders was of equivalent magnitude to that associated with the presence of chronic medical conditions or with being some 12 years older. CONCLUSIONS: Depressive and anxiety disorders have a profound impact on functional health that is independent of chronic medical illness. Chronic anxiety is associated with physical health limitations in excess of those associated with chronic depression or any of the physical health conditions considered, except for stroke.

Adult↗
PubMed2003

Adverse experience in childhood as a developmental risk factor for altered immune status in adulthood.

Compelling evidence is now available that adverse childhood experiences are associated with adult pathology. However, understanding of the pathways and mechanisms underlying these associations is limited. Participants in the European Prospective Investigation into Cancer and Nutrition in Norfolk, UK (EPIC-Norfolk), aged 40 to 80 years, provided an opportunity to investigate the hypothesis that adverse experience in childhood is associated with peripheral leukocyte count in adulthood in the context of a large-scale population-based cohort study. White blood cell counts were available from 11,367 participants and, after a mean interval of 44 months, from 11,857 at a second health check. A self-completion questionnaire that included the assessment of adverse experience during childhood was administered during the interval between health checks. Associations were observed between early adverse experiences and lymphocyte counts at both health checks. Lifestyle factors accounted for about half of this association. Caution is needed in the interpretation of these findings that require replication but they may be seen to aid understanding of the mechanisms through which early environmental exposures act.

Adult↗
PubMed2002

Physical inactivity is associated with lower forced expiratory volume in 1 second : European Prospective Investigation into Cancer-Norfolk Prospective Population Study.

Forced expiratory volume in 1 second (FEV(1)) is a strong risk factor for cardiovascular disease, stroke, lung cancer, and all-cause mortality. One possible explanation for this association is that FEV(1) is a marker of other determinants of mortality risk, such as obesity and physical inactivity. In a population-based cohort study of 12,283 men and women aged 45-74 years from the European Prospective Investigation into Cancer-Norfolk Study recruited in 1993-1997, the cross-sectional association between physical activity and FEV(1) and that between physical activity and change in FEV(1) were analyzed. Indices of physical activity, including participation in vigorous recreational activity, stair climbing, and television viewing, were assessed with a validated questionnaire designed to assess activity in the previous year. Television viewing was negatively associated with FEV(1) in men and women (p < 0.001), whereas stair climbing and participation in vigorous leisure time activities were positively associated with FEV(1) in men and women (p < 0.001). The associations remained after adjustment for known confounders, including age, height, vitamin C, and smoking. Climbing more stairs and participating in vigorous leisure-time activity predicted a slower rate in annual percent decline in FEV(1) (p < 0.004 and p < 0.002, respectively). In conclusion, physical activity is associated with higher levels of FEV(1), whereas television viewing is associated with lower levels.

Aged↗
PubMed2002

Self-reported birth weight and subsequent risk of colorectal cancer.

Case series data suggest that high birth weight and neonatal macrosomia in offspring are associated with an increased risk of colorectal cancer in parents. We therefore conducted a prospective analysis investigating the association among self-reported birth weight, neonatal macrosomia, and incident colorectal cancer in a population-based study of men and women. Participants were drawn from a cohort of men and women ages between 45 and 79 years: the European Prospective Investigation of Cancer in Norfolk study. A total of 4532 men and 7325 women who reported their birth weight were followed up between 1993 and 1999. The relation between birth weight and incident colorectal cancer was assessed using Cox's proportional hazards model. All Ps are two-sided. The association between self-reported birth weight and risk of incident colorectal cancer was nonlinear. Relative to individuals born weighing 2500-3249 g, the adjusted hazard ratio for people born with neonatal macrosomia was 2.57 (95% confidence interval = 1.15-5.74). There was also some evidence that low birth weight babies were at increased risk of colorectal cancer relative to the referent category. These risks were essentially unaltered after adjustment for potential confounders. There is a J-shape relation between self-reported birth weight and subsequent risk of colorectal cancer. Babies born with macrosomia appear to have the greatest risk.

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