Publication: Diabetes Care

Frank Qian  Andres V. Ardisson Korat  Fumiaki Imamura, Matti Marklund, Nathan Tintle, Jyrki K. Virtanen,  Xia Zhou, Julie K. Bassett,  Heidi Lai, Yoichiro Hirakawa, Kuo-Liong Chien, Alexis C. Wood, Maria Lankinen, Rachel A. Murphy, Cecilia Samieri, Kamalita Pertiwi, Vanessa D. de Mello, Weihua Guan, Nita G. Forouhi, Nick Wareham, Frank B. Hu, Ulf Riserus, Lars Lind, William S. Harris, Aladdin H. Shadyab, Jennifer G. Robinson, Lyn M. Steffen, Allison Hodge, Graham G. Giles, Toshiharu Ninomiya, Matti Uusitupa, Jaakko Tuomilehto, Jaana Lindström, Markku Laakso, David S. Siscovick, Catherine Helmer, Johanna M. Geleijnse, Jason H.Y. Wu, Amanda Fretts, Rozenn N. Lemaitre, Renata Micha , Dariush Mozaffarian and Qi Sun

May 2021


Prospective associations between n-3 fatty acid biomarkers and type 2 diabetes (T2D) risk are not consistent in individual studies. We aimed to summarize the prospective associations of biomarkers of α-linolenic acid (ALA), eicosapentaenoic acid (EPA), docosapentaenoic acid (DPA), and docosahexaenoic acid (DHA) with T2D risk through an individual participant-level pooled analysis.

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Publication: Medicine & Science in Sports & Exercise

Winters-van Eekelen, Esther van der Velde, Jeroen H.P.M. Boone, Sebastiaan C.; Westgate, Kate; Brage, Søren, Lamb, Hildo J, Rosendaal, Frits R. de Mutsert, Renée1

28 May 2021


It remains unclear to what extent habitual physical activity and sedentary time are associated with visceral fat and liver fat.

Researchers studied substitution of sedentary time with time spent physically active and total body fat (TBF), visceral adipose tissue (VAT) and hepatic triglyceride content (HTGC) in middle-aged men and women.

Reallocation of time spent sedentary with time spent in moderate-to-vigorous physical activity, but not light physical activity, was associated with less total body fat, and visceral and liver fat. These findings contribute to the development of more specified guidelines on sedentary time and physical activity.

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Publication: Journal of Nutrition

Matthew Pearce, Anouar Fanidi, Tom R P Bishop, Stephen J Sharp, Fumiaki Imamura, Stefan Dietrich, Tasnime Akbaraly, Maira Bes-Rastrollo, Joline W J Beulens, Liisa Byberg, Scheine Canhada, Maria del Carmen B Molina, Zhengming Chen, Adrian Cortes-Valencia, Huaidong Du, Bruce B Duncan, Tommi Härkänen, Maryam Hashemian, Jihye Kim, Mi Kyung Kim, Yeonjung Kim, Paul Knekt, Daan Kromhout, Camille Lassale, Ruy Lopez Ridaura, Dianna J Magliano, Reza Malekzadeh, Pedro Marques-Vidal, Miguel Ángel Martínez-González, Gráinne O’Donoghue, Donal O’Gorman, Jonathan E Shaw, Sabita S Soedamah-Muthu, Dalia Stern, Alicja Wolk, Hye Won Woo, EPIC-InterAct Consortium, Nicholas J Wareham, Nita G Forouhi

11 May 2021


A healthy diet is one important way to prevent type 2 diabetes. Legumes such as beans, lentils, peas and soy are typically high in dietary fibre, protein, B vitamins, and minerals and have a low glycaemic index.

Legume consumption is promoted as part of a healthy diet in many countries, but research has shown inconsistent and inconclusive findings for any link with type 2 diabetes. Researchers planned to find out the nature of the association between the amount and type of legume consumption and the risk of developing type 2 diabetes over time and in different world regions.

The research included data from 27 existing studies in Europe (Finland, France, Germany, Italy, Netherlands, Spain, Sweden, Switzerland, UK), the Americas (Brazil, Mexico, Puerto Rico, USA), Eastern Mediterranean (Iran), and Western Pacific (Australia, China, South Korea).

They used data on more than 800,000 participants, among whom 42,473 participants developed type 2 diabetes over time.

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Publication: The American Journal of Clinical Nutrition

Gallant, J., Chan, K., Green, T., Wieringa, F., Leemaqz, S., Ngik, R., Measelle, J., Baldwin, D., Borath, M., Sophonneary, P., Yelland, L., Hampel, D., Shahab-Ferdows, S., Allen, L., Jones, K., Koulman, A., Parkington, D., Meadows, S., Kroeun, H. and Whitfield, K.

7 April 2021

Infantile beriberi–related mortality is still common in South and Southeast Asia. Interventions to increase maternal thiamine intakes, and thus human milk thiamine, are warranted; however, the required dose remains unknown.

In this study the researchers sought to estimate the dose at which additional maternal intake of oral thiamine no longer meaningfully increased milk thiamine concentrations in infants at 24 wk postpartum, and to investigate the impact of 4 thiamine supplementation doses on milk and blood thiamine status biomarkers.

Healthy mothers were recruited in Kampong Thom, Cambodia. At 2 wk postpartum, women were randomly assigned to consume 1 capsule, containing 0, 1.2 (estimated average requirement), 2.4, or 10 mg of thiamine daily from 2 through 24 weeks postpartum.

Human milk total thiamine concentrations were measured and maternal and infant blood thiamine biomarkers were also assessed.

The results showed that milk thiamine concentrations were significantly higher in all intervention groups compared with the placebo group and did not significantly differ from each other. Furthermore, 1.2 mg/d for 22 weeks was sufficient to increase milk thiamine concentrations to similar levels achieved by higher supplementation doses (2.4 and 10 mg/d), and comparable to those of healthy mothers in regions without beriberi.
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Publication: Nutrients

Danielle Jones, Emanuella De Lucia Rolfe, Kirsten L. Rennie, Linda M. Oude Griep, Laura C. Kusinski, Deborah J. Hughes, Soren Brage, Ken K. Ong, Kathryn Beardsall, Claire L. Meek

31 March 2021


Around 5-10% of pregnant women in the UK develop gestational diabetes, which arises during pregnancy and typically resolves after delivery. Mothers with gestational diabetes are at greater risk of diabetes in later life, and their babies are also more likely to develop short-term and long-term health complications.

Preventing childhood obesity is really important, and yet, we still have an incomplete understanding about why and how obesity develops in early life.  The aim of this study is to assess pregnancy and early postnatal factors which contribute to maternal and child obesity after gestational diabetes, and to identify if a reduced-calorie diet in pregnancy can reduced these risks.

This paper outlines our plans to follow-up mothers and babies after gestational diabetes, who participated in our DiGest trial. Researchers will collect information about changes in weight in mothers and babies for 3 years following birth and will also assess the importance of infant feeding, early life growth, maternal diet and physical activity upon weight and glucose tolerance.

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Publication: European Journal of Sport Science,

Eero A. Haapala ,Juuso Väistö ,Johanna K. Ihalainen ,Claudia Tomaselli González,Marja H. Leppänen ,Aapo Veijalainen ,Taisa Sallinen ,Aino-Maija Eloranta ,Ulf Ekelund ,Ursula Schwab ,Soren Brage ,Mustafa Atalay &Timo A. Lakka

14 March 2021


We investigated the associations of ST, screen time, PA at different intensities, and diet quality with biomarkers for inflammation, including hs-CRP, leptin, IL-6, adiponectin, TNF-α, and glycoprotein acetyls, in a population sample of children. We also investigated the modifying effect of BF% on these associations. Finally, we studied the modifying effect of diet quality on the associations of ST, screen time, and PA at different intensities with these biomarkers of inflammation.

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Publication: The Journal of Nutrition

Pearce, M., Fanidi, A., Bishop, T., Sharp, S., Imamura, F., Dietrich, S., Akbaraly, T., Bes-Rastrollo, M., Beulens, J., Byberg, L., Canhada, S., Molina, M., Chen, Z., Cortes-Valencia, A., Du, H., Duncan, B., Härkänen, T., Hashemian, M., Kim, J., Kim, M., Kim, Y., Knekt, P., Kromhout, D., Lassale, C., Ridaura, R., Magliano, D., Malekzadeh, R., Marques-Vidal, P., Martínez-González, M., O’Donoghue, G., O’Gorman, D., Shaw, J., Soedamah-Muthu, S., Stern, D., Wolk, A., Woo, H., Wareham, N. and Forouhi, N.

9 March 2021

The consumption of legumes is promoted as part of a healthy diet in many countries but associations of total and types of legume consumption with type 2 diabetes (T2D) are not well established. Analyses across diverse populations are lacking despite the availability of unpublished legume consumption data in prospective cohort studies.

In this study the researchers examined the prospective associations of total and types of legume intake with the risk of incident T2D.

Meta-analyses of associations between total legume, pulse, and soy consumption and T2D were conducted, using data from 807,785 adults without diabetes in 27 cohorts across the Americas, Eastern Mediterranean, Europe, and Western Pacific.

The findings suggest no evidence of an association of legume intakes with T2D in several world regions. The positive association observed in some European studies warrants further investigation relating to overall dietary contexts in which legumes are consumed, including accompanying foods which may be positively associated with T2D.

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Publication: American Journal of Preventive Medicine

Hajna, S., Sharp, S., Cooper, A., Williams, K., van Sluijs, E., Brage, S., Griffin, S. and Sutton, S.

1 March 2021

Around 23% of adults worldwide are insufficiently active. Wearable devices paired with virtual coaching software could increase physical activity. The effectiveness of 3 minimal contact interventions (paper-based physical activity diaries, activity trackers, and activity trackers coupled with virtual coaching) in increasing physical activity energy expenditure and cardiorespiratory fitness were compared over 12 weeks among inactive adults.

This was an open label, parallel-group RCT. Inactive adults were randomized to no intervention (Control; n=121), paper-based diary (Diary; n=124), activity tracker (Activity Band; n=122), or activity tracker plus virtual coaching (Activity Band PLUS; n=121) groups. Coprimary outcomes included 12-week changes in physical activity energy expenditure and fitness (May 2012–January 2014). Analyses were conducted in 2019–2020.

There were no differences between groups overall (physical activity energy expenditure: p=0.114, fitness: p=0.417). However, there was a greater increase in physical activity energy expenditure (4.21 kJ/kg/day, 95% CI=0.42, 8.00) in the Activity Band PLUS group than in the Diary group. There were also greater decreases in BMI and body fat percentage in the Activity Band PLUS group than in the Control group and in theActivity Band PLUS group than in the Diary group.

Coupling activity trackers with virtual coaching may facilitate increases in physical activity energy expenditure compared with a traditional paper‒based physical activity diary intervention and improve some secondary outcomes compared with a traditional paper‒based physical activity diary intervention or no intervention.

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Publication: The American Journal of Clinical Nutrition

Braithwaite, V., Mwangi, M., Jones, K., Demir, A., Prentice, A., Prentice, A., Andang’o, P. and Verhoef, H.

1 March 2021

Fibroblast growth factor-23 (FGF23) regulates body phosphate homeostasis primarily by increasing phosphaturia. It also acts as a vitamin D-regulating hormone. Maternal iron deficiency is associated with perturbed expression and/or regulation of FGF23 and hence might be implicated in the pathogenesis of hypophosphatemia-driven rickets in their offspring.

The researchers aimed to determine the effect of antenatal oral iron supplementation on FGF23 concentration and maternal and infant markers of bone-mineral regulation.

Rural Kenyan women with singleton pregnancies and hemoglobin concentrations ≥ 90 g/L were randomly allocated to daily, supervised supplementation with 60 mg elemental iron as ferrous fumarate or placebo from 13–23 weeks of gestation until 1 month postpartum.

The researchers reanalyzed all available plasma samples collected in 433 mothers and 414 neonates at birth and confirmed that iron supplementation can reverse elevated FGF23 production caused by iron deficiency in iron-deficient mothers and their neonates.

Further investigations are warranted to assess to what extent iron supplementation can prevent FGF23-mediated hypophosphatemic rickets or osteomalacia.

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Publication:  Journal of Human Nutrition and Dietetics,.

Lynsey N. Spillman, Arabella Melville-Claxton, Gillian A. Gatiss, Nicola Fernandez, Angela M. Madden

01 March 2021


Liver transplant recipients are given diet and physical activity advice to aid recovery and promote long-term health. The present study aimed to explore patients’ experiences of receiving and implementing diet and physical activity advice after liver transplant and identify barriers and facilitators to following recommendations.

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Publication: BMC Medicine

Burgoine, T., Monsivais, P., Sharp, S., Forouhi, N. and Wareham, N.

15 February 2021

Characteristics of the built environment, such as neighbourhood fast-food outlet exposure, are increasingly recognised as risk factors for unhealthy diet and obesity. Obesity also has a genetic component, with common genetic variants explaining a substantial proportion of population-level obesity susceptibility. However, it is not known whether and to what extent associations between fast-food outlet exposure and body weight are modified by genetic predisposition to obesity.

We used data from the Fenland Study, a population-based sample of 12,435 UK adults (mean age 48.6 years). We derived a genetic risk score associated with BMI (BMI-GRS) from 96 BMI-associated single nucleotide polymorphisms. Neighbourhood fast-food exposure was defined as quartiles of counts of outlets around the home address. We used multivariable regression models to estimate the associations of each exposure, independently and in combination, with measured BMI, overweight and obesity, and investigated interactions.

We found independent associations between BMI-GRS and risk of overweight (RR = 1.34, 95% CI 1.23–1.47) and obesity (RR = 1.73, 95% CI 1.55–1.93), and between fast-food outlet exposure and risk of obesity (highest vs lowest quartile RR = 1.58, 95% CI 1.21–2.05). There was no evidence of an interaction of fast-food outlet exposure and genetic risk on BMI (P = 0.09), risk of overweight (P = 0.51), or risk of obesity (P = 0.27). The combination of higher BMI-GRS and highest fast-food outlet exposure was associated with 2.70 (95% CI 1.99–3.66) times greater risk of obesity.

Our study demonstrated independent associations of both genetic obesity risk and neighbourhood fast-food outlet exposure with adiposity. These important drivers of the obesity epidemic have to date been studied in isolation. Neighbourhood fast-food outlet exposure remains a potential target of policy intervention to prevent obesity and promote the public’s health.

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Publication: Osteoporosis International 

A.M. Constable, D. Vlachopoulos, A.R. Barker, S.A. Moore, S. Soininen, E.A. Haapala, J. Väistö, K. Westgate, S. Brage, A. Mahonen &  T.A. Lakka

5 February 2021


It is unclear how physical activity intensity and vitamin D status are related to bone health in prepubertal children. We found positive associations between vitamin D status and moderate-to-vigorous physical activity with bone in boys and girls. This highlights the importance of lifestyle factors for skeletal health prepuberty.

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Publication: EBioMedicine

Olga L, van Diepen J, Bobeldijk-Pastorova I, Gross G, Prentice P, Snowden S et al.

7 January 2021

Altered lipid metabolism in early life has been associated with subsequent weight gain and predicting this could aid in obesity prevention and risk management. Here, a lipidomic approach was used to identify circulating markers for future obesity risk in translational murine models and validate in a human infant cohort.

From murine models to human setting, the ratios of circulating lipid species indicating key desaturase activities in lipid metabolism were associated with subsequent body size increase, providing a potential tool to predict early life weight gain.

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Publication: BMJ Open

Saman Khalatbari-Soltani, Pedro Marques-Vidal, Fumiaki Imamura, G. Forouhi

22 December 2020


In an international study, with researchers from Cambridge and Switzerland, researchers reviewed a Mediterranean-style diet to see if it may lower the risk of developing fatty liver disease.

Fatty liver, defined as fat accumulation of more than 5% of liver volume, is common especially among obese and diabetic individuals. Fatty liver is the first stage for non-alcoholic fatty liver disease (NAFLD), which is a major cause of liver disease worldwide, and may also predispose to higher risk of cardiovascular diseases.

The Mediterranean diet is thought to be beneficial but research was limited to people with established fatty liver disease. Researchers

In 2288 study participants without NAFLD at baseline, when we assessed their dietary habits and scaled their levels of adherence to the well-established Mediterranean diet. After an average of 5.3-years of follow-up in the study, we tested for the presence of fatty liver disease based on two indices called “fatty liver index” and “NAFLD score”.

Results showed that those who adhered more to the Mediterranean diet had lower risk of developing new-onset fatty liver disease based on fatty liver index.

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Publication: AHA Stroke

Kathrine J. Vinknes, Helga Refsum, Cheryl Turner, Kay-Tee Khaw, Nicholas J. Wareham, Nita G. Forouhi, Fumiaki Imamura

22 December 2020

B-vitamin supplements lower circulating concentrations of homocysteine and may reduce stroke incidence. Homocysteine concentrations are associated with the incidence of stroke but other sulfur-containing compounds in the related metabolic pathway have not yet been investigated for an association with incident cerebrovascular diseases.

Nested within the EPIC (European Prospective Investigation Into Cancer and Nutrition)-Norfolk cohort, we established a case-control study with 480 incident cases of cerebrovascular diseases and 480 controls matched by age, sex, and year of baseline examination (1993–1997).

Using baseline plasma samples, we assayed sulfur-containing compounds including methionine, homocysteine, cystathionine, cysteine, glutathione, and taurine with liquid chromatography–tandem mass spectrometry. We examined the association of concentrations of each of the compounds and the ratio of methionine to homocysteine (representing activity of one-carbon metabolism) with risk of incident cerebrovascular diseases, adjusted for potential confounders.

Plasma methionine and the methionine/homocysteine ratio were inversely associated with risk of cerebrovascular diseases, with odds ratios per 1 SD of 0.83 and 0.82, respectively. The association of methionine remained significant after adjustment for homocysteine. None of the other examined compounds was significantly associated with incident cerebrovascular diseases.

Conclusions: These findings suggest that greater availability of methionine, an essential amino acid, may play a role in the prevention of cerebrovascular diseases and explain the previously recognized link between elevated homocysteine and stroke. Further research is needed to determine causation and the potential of circulating methionine as a target in cerebrovascular disease prevention.

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Publication: International Journal of Behavioral Nutrition and Physical Activity

Matthew Pearce, Tessa Strain, Youngwon Kim, Stephen J. Sharp, Kate Westgate, Katrien Wijndaele, Tomas Gonzales, Nicholas J. Wareham & Søren Brage

16 March 2020


Higher levels of physical activity have been shown to be associated with a lower risk of morbidity and mortality, but accurately assessing the dose of physical activity in large population studies remains challenging The baseline questionnaire includes items adapted from the International Physical Activity Questionnaire (IPAQ) [6] and the Recent Physical Activity Questionnaire (RPAQ).


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Publication: Annals of the New York Academy of Sciences

Kerry S. Jones, Damon A. Parkington, Lorna J. Cox, Albert Koulman

22 December 2020


Vitamin B1 (thiamine) is an essential nutrient required for energy metabolism and the nervous system.  Thiamine deficiency can cause infantile beriberi (a potential life-threatening condition that affects multiple parts of the body.) Populations particularly at risk of thiamine deficiency are breastfed infants of thiamine-deficient mothers in low-income countries, especially those where rice, which contains little thiamine, is the staple food. However, deficiency is associated with a range of non-specific clinical symptoms and can be difficult to diagnose. Evidence also exists to suggest that mild thiamine deficiency may have long-term effects on brain development and gross motor skills.

Biomarkers are compounds we can measure in blood that tell us about a person’s physiology and health. Biomarkers of thiamine status are essential to identify deficiency and improve understanding of the global prevalence of thiamine deficiency and of the links between thiamine and later health outcomes.

An important biomarker of thiamine status is the “erythrocyte transketolase activity coefficient” (ETKAC). ETKAC is a measure of the availability of thiamine available for use in in red blood cells (erythrocytes).

Researchers provided a step-by-step protocol to perform the ETKAC assay. It will facilitate harmonisation of the ETKAC assay. It provides a foundation for the establishment of the assay in new laboratories and supports the investigation of outstanding questions in thiamine biology contributing to the ultimate aim of developing strategies to control thiamine deficiency.

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Publication: Clinical Nutrition

Ghadeer S. Aljuraiban,Kamalita Pertiwi, Jeremiah Stamler, Queenie Chan, Johanna M. Geleijnse, Linda Van Horn, Martha L. Daviglus, Paul Elliott, Linda M. Oude Griep

22 January 2020


Previous studies have reported associations between higher potato intake and higher blood pressure (BP) and/or risk of hypertension and obesity. These studies rarely considered preparation methods of potatoes, overall dietary pattern or the nutrient quality of the meals. These factors may affect the association of potato intake with BP and body mass index (BMI). This study investigated potato consumption by amount, type of processing, overall dietary pattern, and nutrient quality of the meals in relation to BP and BMI.

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Publication: Journal of Clinical Densitometry

Watson, L., Carr, K., Orford, E. and Venables, M.

15 December 2020

Body composition is associated with many noncommunicable diseases.

The accuracy of many simple techniques used for the assessment of body composition is influenced by the fact that they do not take into account tissue hydration and this can be particularly problematic in paediatric populations.

This study looked at DXA systems for determining total and regional (arms, legs, trunk) fat, lean, and bone mass and compared lean soft tissue (LST) hydration correction methods in 124 children aged between 6 and 16 years old.

The study showed that care needs to be exercised when combining data from iDXA and Prodigy, as total and regional estimates of body composition can differ significantly.

Furthermore, tissue hydration should be taken into account when assessing body composition as it can vary considerably within a healthy paediatric population even within specific age and/or sex groups.

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Publication: Clinical Biochemistry

Paquette M, Gauthier D, Chamberland A, Prat A, De Lucia Rolfe E, Rasmussen J et al.

March 2020


The objective of this study is to investigate the association between circulating PCSK9 levels and the presence of hepatic steatosis, as well as with liver biomarkers in a cohort of healthy individuals.

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Publication: Diabetes Care

Ju-Sheng Zheng, Jian’an Luan, Eleni Sofianopoulou, Fumiaki Imamura, Isobel D. Stewart, Felix R. Day, Maik Pietzner, Eleanor Wheeler, Luca A. Lotta, Thomas E. Gundersen, Pilar Amiano, Eva Ardanaz, María-Dolores Chirlaque, Guy Fagherazzi, Paul W. Franks, Rudolf Kaaks, Nasser Laouali, Francesca Romana Mancini, Peter M. Nilsson, N. Charlotte Onland-Moret, Anja Olsen, Kim Overvad, Salvatore Panico, Domenico Palli, Fulvio Ricceri, Olov Rolandsson, Annemieke M.W. Spijkerman, María-José Sánchez, Matthias B. Schulze, Núria Sala, Sabina Sieri, Anne Tjønneland, Rosario Tumino, Yvonne T. van der Schouw, Elisabete Weiderpass, Elio Riboli, John Danesh, Adam S. Butterworth, Stephen J. Sharp, Claudia Langenberg, Nita G. Forouhi, Nicholas J. Wareham

17 November 2020


Type 2 is a condition with serious health problems. Previous research has shown higher blood levels of vitamin C were linked with lower future risk of type 2 diabetes and if this was proven, it could mean that giving vitamin C as a supplement may help in preventing the condition. Testing this theory is quite challenging due to finding the correct dose.

Researchers identified 11 genetic markers that can predict blood levels of vitamin C using a large sample of more than 50,000 adults. They tested the association of type 2 diabetes with genetically predicted vitamin C levels with a large sample size of more than 80,000 people with diabetes and up-to 840,000 people without diabetes.

They found a mismatch when comparing the link of diabetes with the genetically predicted vitamin C levels versus when used directly measured blood vitamin C levels. The researchers results for directly measured or genetically predicted blood vitamin C levels indicated that blood vitamin C is not likely to be a causal factor for the development of type diabetes. Therefore conclude that it is not justified to use vitamin C supplementation for the prevention of type 2 diabetes.

Researchers highlighted that the current research findings should be interpreted as showing no link of the micronutrient vitamin C with type 2 diabetes.

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Publication: PLoS Med

Zheng JS, Luan J, Sofianopoulou E, Sharp SJ, Day FR, Imamura F, Gundersen TE et al.

16 October 2020

Why was this study done?

There is ongoing uncertainty on whether the body’s vitamin D status indicated by blood 25-hydroxyvitamin D (25(OH)D) is relevant to the prevention of type 2 diabetes. There are conflicting findings from observational studies and a limited number of randomised controlled trials.

What did the researchers do and find?

The current research compared observational estimates of the association between 25(OH)D metabolites and incident type 2 diabetes with Mendelian randomisation estimates based on genetic instruments.

Using multiple data sources, we performed genome-wide association studies among 120,618 individuals for total 25(OH)D, and among 40,562 individuals for the other vitamin D metabolites. Among participants of European descent, 10 genetic loci were identified for total 25(OH)D, 7 loci for 25(OH)D3 and 3 loci for C3-epi-25(OH)D3.

In meta-analysis of observational studies, we found that each 1–standard deviation higher level of total 25(OH)D was associated with 20% lower risk of type 2 diabetes. The result was similar for 25(OH)D3, but for C3-epi-25(OH)D3, a positive association with type 2 diabetes was found.

With up to 80,983 type 2 diabetes cases and 842,909 controls, we assessed the association of genetically predicted differences in total 25(OH)D and its metabolites with type 2 diabetes. Neither genetically predicted higher total 25(OH)D level nor genetically predicted higher levels of 25(OH)D metabolites were significantly associated with type 2 diabetes.

What do these findings mean?

There were conflicting findings for a link with type 2 diabetes for the observational analysis of biochemically measured 25(OH)D metabolites versus the genetically predicted levels of these metabolites.

The null findings based on Mendelian randomisation analysis indicate that blood levels of 25(OH)D or its metabolites are not likely to be causal factors for the development of type 2 diabetes.

The current findings together with other evidence from randomised controlled trials do not support the use of vitamin D supplementation for the prevention of type 2 diabetes.

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Publication: Nutrients

Birdem Amoutzopoulos, Toni Steer, Caireen Roberts, David Collins, Polly Page

1 February 2020


Monitoring dietary intake of sugars in the population’s diet has great importance in evaluating the efficiency of national sugar reduction programmes. The study objective was to provide a comprehensive assessment of dietary sources of added and free sugars to assess adherence to public health recommendations in the UK population and to consider the impact of different sugar definitions on monitoring.

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Publication: Nordic Journal of Psychiatry

Josefine Freyberg , Søren Brage , Lars Vedel Kessing & Maria Faurholt-Jepsen

14 October 2020


The subjective reporting of physical activity generally has low accuracy for quantifying energy expenditure, possibly due to problems of recall which may differ by mental health status.

This study compared the validity of self-reported physical activity (using International Physical Activity Questionnaire, IPAQ) in patients with bipolar disorder, unaffected relatives and healthy controls using combined heart rate and movement sensing as the objective criterion measure.

Correlations were positive but weak between IPAQ and sensor-based estimates for all groups combined, indicating IPAQ may be used to approximately rank individuals by activity level but there was no clear evidence that validity was any different in the bipolar patients as validity in the two comparison groups was higher (unaffected relatives) and lower (healthy controls).

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Publication: BMJ

Deschasaux, M, Huybrechts, I, Julia, C, Hercberg, S, Egnell, M, Srour, B, et al.

16 September 2020

This study looked to see if the Food Standards Agency nutrient profiling system (FSAm-NPS), which grades the nutritional quality of food products and is used to derive the Nutri-Score front-of-packet label to guide consumers towards healthier food choices, is associated with mortality, using the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort from 23 centres in 10 European countries.

More than 500,ooo participants’ dietary questionnaires were analysed to assess their usual dietary intakes. A FSAm-NPS score was calculated for each food item per 100 g content of energy, sugars, saturated fatty acids, sodium, fibre, and protein, and of fruit, vegetables, legumes, and nuts. An overall mean of all foods consumed was also calculated; the higher the score the lower the overall nutritional quality of the diet.

The results showed that consuming foods with a higher FSAm-NPS score (lower nutritional quality) was associated with a higher mortality for all causes and for cancer and diseases of the circulatory, respiratory, and digestive systems, supporting the relevance of FSAm-NPS to characterise healthier food choices in the context of public health policies (eg, the Nutri-Score) for European populations. This is important considering ongoing discussions about the potential implementation of a unique nutrition labelling system at the European Union level.

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Publication: Aging

Yerrakalva D, Hajna S, Wijndaele K, Westgate K, Khaw K, Wareham N et al.

12 September 2020

Development of effective strategies to reduce sedentary time among older adults necessitates understanding of its determinants but longitudinal studies of this utilising objective measures are scarce.

Among 1536 older adults (≥60 years) in the EPIC-Norfolk study, sedentary time was assessed for seven days at two time-points using accelerometers. We assessed associations of change in total and prolonged bouts of sedentary time (≥ 30 minutes) with change in demographic and behavioural factors using multi-level regression.

Over follow-up (5.3±1.9 years), greater increases in total sedentary time were associated with older age, being male, higher rate of increase in BMI, lower rate of increase in gardening (0.5 min/day/yr greater sedentary time per hour/week/yr less gardening, 95% CI 0.1, 1.0), a lower rate of increase in walking (0.2 min/day/yr greater sedentary time per hour/week/yr less walking, 95% CI 0.1, 0.3) and a higher rate of increase in television viewing. Correlates of change in prolonged sedentary bouts were similar.

Conclusion: Individuals in specific sub-groups (older, male, higher BMI) and who differentially participate in certain behaviours (less gardening, less walking and more television viewing) but not others increase their sedentary time at a higher rate than others; utilising this information could inform successful intervention content and targeting.

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Publication: European Journal of Preventive Cardiology

Sangeeta Lachman, S Matthijs Boekholdt, Robert N Luben, Stephen J Sharp, Soren Brage, Kay-Tee Khaw, Ron JG Peters, Nicholas J Wareham

29 August 2020


There is broad consensus that regular physical activity yields major health benefits. However, current guidelines on physical activity are mainly aimed at middle-aged adults. It is unclear whether physical activity also translates into cardiovascular health benefits in older adults.

Researchers analysed data from the EPIC Norfolk prospective population study. Cox proportional hazards models were used to analyse the association between physical activity levels and time to CVD events in three age categories (<55, 55–65 and >65 years). Interaction between age categories and physical activity levels was assessed.

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Publication: Nature Medicine

Strain, T., Wijndaele, K., Dempsey, P., Sharp, S., Pearce, M., Jeon, J., Lindsay, T., Wareham, N. and Brage, S.

17 August 2020

Use of wearable devices that monitor physical activity is projected to increase more than fivefold per half-decade. In this study the researchers investigated how device-based physical activity energy expenditure (PAEE) and different intensity profiles were associated with all-cause mortality.

96,476 UK Biobank participants (mean age 62 years, 56% female) were studied and followed up for 3.1 years. The research showed that higher PAEE was associated with a lower hazard of all-cause mortality for a constant fraction of moderate-to-vigorous-intensity physical activity (MVPA).

The results show that higher volumes of PAEE are associated with reduced mortality rates, and achieving the same volume through higher-intensity activity is associated with greater reductions than through lower-intensity activity. The linkage of device-measured activity to energy expenditure creates a framework for using wearables for personalized prevention.

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Publication: Cell Metabolism

Marenne, G., Hendricks, A., Perdikari, A., Bounds, R., Payne, F., Keogh, J., Lelliott, C., Henning, E., Pathan, S., Ashford, S., Bochukova, E., Mistry, V., Daly, A., Hayward, C., Wareham, N., O’Rahilly, S., Langenberg, C., Wheeler, E., Zeggini, E., Farooqi, I. and Barroso, I.

2 June 2020

Obesity is genetically heterogeneous with monogenic and complex polygenic forms. Using exome and targeted sequencing in 2,737 severely obese cases and 6,704 controls, the researchers identified three genes (PHIPDGKI, and ZMYM4) with an excess burden of very rare predicted deleterious variants in cases.

In cells, they showed that PHIP is involved in human energy homeostasis, which has potential diagnostic and therapeutic implications for patients with obesity and developmental delay.

Additionally, they found an excess burden of predicted deleterious variants involving genes nearest to loci from obesity genome-wide association studies.

Genes and gene sets influencing obesity with variable penetrance provide compelling evidence for a continuum of causality in the genetic architecture of obesity, and explain some of its missing heritability.

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Publication: Nutrients

Silvia Pastorino, Tom Bishop, Stephen J. Sharp, Matthew Pearce, Tasnime Akbaraly, Natalia B. Barbieri, Maira Bes-Rastrollo, Joline W. J. Beulens, Zhengming Chen, Huaidong Du, Bruce B. Duncan, Atsushi Goto, Tommi Härkänen, Maryam Hashemian, Daan Kromhout, Ritva Järvinen, Mika Kivimaki, Paul Knekt, Xu Lin, Eiliv Lund, Dianna J. Magliano, Reza Malekzadeh, Miguel Ángel Martínez-González, Gráinne O’Donoghue, Donal O’Gorman, Hossein Poustchi, Charlotta Rylander, Norie Sawada, Jonathan E. Shaw, Maria Schmidt, Sabita S. Soedamah-Muthu, Liang Sun, Wanqing Wen, Alicja Wolk, Xiao-Ou Shu, Wei Zheng, Nicholas J. Wareham, and Nita G. Forouhi

7 April 2020


Eating fish is generally considered part of a healthy diet. This is based on previous evidence from research that found benefits of consuming fish for heart disease. That is why there are various dietary guidelines that recommend that people should consume fish regularly.

Whether fish consumption also has a role in the prevention of type 2 diabetes is not clear. In previous research it was reported that the relationship between eating fish and developing type 2 diabetes may vary in different parts of the world.

To understand this better, we undertook research including data from studies in several world regions.  The InterConnect project enabled us to analyse data from nearly one million people from 28 studies across the world, among whom 48,000 people developed type 2 diabetes over time. Researchers analysed data on different types of fish, including shellfish, fatty fish, lean fish and fried fish.

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Publication: International Journal of Epidemiology

Brage S, Lindsay T, Venables M, Wijndaele K, Westgate K, Collins D, et al.

19 March 2020

This is the first nationally representative study of human energy expenditure, covering the UK in the period 2008-2015.

Key messages:

  • Total energy expenditure (MJ/day) increases steadily with age throughout childhood and adolescence, peaks in the 3rd decade of life in women and 4th decade of life in men, before decreasing gradually in old age.
  • Physical activity energy expenditure (kJ/day/kg or kJ/day/kg fat-free mass) declines steadily with age from childhood to old age, more steeply so in males.
  • Body-fat percentage is strongly inversely associated with physical activity energy expenditure.
  • We found little evidence that energy expenditure varied by geographical region, over time, or by dietary macronutrient composition.
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Publication: PLoS Med

Hardeman W, Mitchell J, Pears S, Van Emmenis M, Theil F, Gc VS, et al.

6 March 2020

The majority of people do not achieve recommended levels of physical activity. There is a need for effective, scalable interventions to promote activity. Self-monitoring by pedometer is a potentially suitable strategy. We assessed the effectiveness and cost-effectiveness of a very brief (5-minute) pedometer-based intervention (‘Step It Up’) delivered as part of National Health Service (NHS) Health Checks in primary care.

The Very Brief Intervention (VBI) Trial was a two parallel-group, randomised controlled trial (RCT) with 3-month follow-up, conducted in 23 primary care practices in the East of England.

Participants were 1,007 healthy adults aged 40 to 74 years eligible for an NHS Health Check. They were randomly allocated to either intervention (505) or control group (502), stratified by primary care practice. Control participants received the NHS Health Check only. Intervention participants additionally received Step It Up: a 5-minute face-to-face discussion, written materials, pedometer, and step chart. The primary outcome was accelerometer-based physical activity volume at 3-month follow-up adjusted for sex, 5-year age group, and general practice.


In this large well-conducted trial, we found no evidence of effect of a plausible very brief pedometer intervention embedded in NHS Health Checks on objectively measured activity at 3-month follow-up.

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Publication: European Heart Journal

Tammy Y N Tong, Paul N Appleby, Timothy J Key, Christina C Dahm, Kim Overvad, Anja Olsen, Anne Tjønneland, Verena Katzke, Tilman Kühn, Heiner Boeing, Anna Karakatsani, Eleni Peppa, Antonia Trichopoulou, Elisabete Weiderpass, Giovanna Masala, Sara Grioni, Salvatore Panico, Rosario Tumino, Jolanda M A Boer, W M Monique Verschuren, J Ramón Quirós, Antonio Agudo, Miguel Rodríguez-Barranco, Liher Imaz, María-Dolores Chirlaque, Conchi Moreno-Iribas, Gunnar Engström, Emily Sonestedt, Marcus Lind, Julia Otten, Kay-Tee Khaw, Dagfinn Aune, Elio Riboli, Nicholas J Wareham, Fumiaki Imamura, Nita G Forouhi, Emanuele di Angelantonio, Angela M Wood, Adam S Butterworth, Aurora Perez-Cornago

24 February 2020


This research looked at more than 418,000 people in nine European countries who were recruited to the European Prospective Investigation into Cancer and Nutrition (EPIC) study between 1992 and 2000. Researchers found that while higher intakes of fruit, vegetables, fibre, milk, cheese or yoghurt were each linked to a lower risk of ischaemic stroke, there was no significant association with a lower risk of haemorrhagic stroke.

As the study is observational, it cannot show that the foods studied cause an increase or decrease in risk of ischaemic or haemorrhagic stroke, only that they are associated with different risks.

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Publication: Food Science & Nutrition

Rachel M. Harris, Angela M. C. Rose, Nita G. Forouhi, Nigel Unwin

5 February 2020

The Caribbean island of Barbados has a high burden of diabetes and cardiovascular disease. Dietary habits were last described in 2005. A representative population-based sample provided two nonconsecutive 24-hr dietary recalls in this cross-sectional study. Mean daily nutrient intakes were compared with the Dietary Guidelines for Americans. Subgroup differences by age, sex, and educational level were examined using logistic regression. High sugar intakes exist for both sexes with 24% consuming less than the recommended <10% of energy from added sugars. Sugar-sweetened beverages provide 43% of total sugar intake. Inadequate dietary fiber intakes exist across all age groups. Inadequate micronutrient intake was found in women for calcium, folate, thiamine, zinc, and iron. Older persons (aged 45–64 years) were more likely to report adequacy of dietary fiber and iron than younger persons (aged 25–44). Older persons (aged 45–64 years) were less likely to have an adequate supply of riboflavin (OR = 0.4, 0.2, 0.6) than younger persons. Men were more likely to have adequate intakes of iron, folate, and thiamine than women. Education was not associated with nutrient intake. The Barbadian diet is characterized by high sugar intakes and inadequate dietary fiber; a nutrient profile associated with an increased risk of obesity, type 2 diabetes, and related noncommunicable diseases.

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Publication: Nutrition Reviews

Amoutzopoulos B, Page P, Roberts C, Roe M, Cade J, Steer T et al.

30 January 2020

Overestimation or underestimation of portion size leads to measurement error during dietary assessment.


To identify portion size estimation elements (PSEEs) and evaluate their relative efficacy in relation to dietary assessment, and assess the quality of studies validating PSEEs.

Data Selection and Extraction

Electronic databases, internet sites, and cross-references of published records were searched, generating 16 801 initial records, from which 334 records were reviewed and 542 PSEEs were identified, comprising 5% 1-dimensional tools (eg, food guides), 46% 2-dimensional tools (eg, photographic atlases), and 49% 3-dimensional tools (eg, household utensils). Out of 334 studies, 21 validated a PSEE (compared PSEE to actual food amounts) and 13 compared PSEEs with other PSEEs.


Quality assessment showed that only a few validation studies were of high quality. According to the findings of validation and comparison studies, food image–based PSEEs were more accurate than food models and household utensils. Key factors to consider when selecting a PSEE include efficiency of the PSEE and its applicability to targeted settings and populations.

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Publication: The American Journal of Clinical Nutrition

Trichia E, Luben R, Khaw K, Wareham NJ, Imamura F, Forouhi NG

8 January 2020

Background The consumption of some types of dairy products has been associated with lower cardiometabolic disease incidence. Knowledge remains limited about habitual dairy consumption and the pathways to cardiometabolic risk.

Objective We aimed to investigate associations of habitual consumption of total and types of dairy products with markers of metabolic risk and adiposity among adults in the United Kingdom.

Methods We examined associations of changes in dairy consumption (assessed with a food-frequency questionnaire) with parallel changes in cardiometabolic markers using multiple linear regression among 15,612 adults aged 40–78 y at baseline (1993–1997) and followed up over 1998–2000 (mean ± SD: 3.7±0.7 y) in the European Prospective Investigation into Cancer and Nutrition (EPIC)–Norfolk study.

Results For adiposity, an increase in fermented dairy products [yogurt (total or low-fat) or low-fat cheese] consumption was associated with a lower increase in body weight and body mass index (BMI). For example, over 3.7 y, increasing yogurt consumption by 1 serving/d was associated with a smaller increase in body weight by 0.23 kg (95% CI: −0.46, −0.01 kg). An increase in full-fat milk, high-fat cheese, and total high-fat dairy was associated with greater increases in body weight and BMI [e.g., for high-fat dairy: β = 0.13 (0.05, 0.21) kg and 0.04 (0.01, 0.07) kg/m2, respectively]. For lipids, an increase in milk (total and low-fat) or yogurt consumption was positively associated with HDL cholesterol. An increase in total low-fat dairy was negatively associated with LDL cholesterol (−0.03 mmol/L; −0.05, −0.01 mmol/L), whereas high-fat dairy (total, butter, and high-fat cheese) consumption was positively associated [e.g., 0.04 (0.02, 0.06) mmol/L for total high-fat dairy]. For glycemia, increasing full-fat milk consumption was associated with a higher increase in glycated hemoglobin (P = 0.027).

Conclusions The habitual consumption of different dairy subtypes may differently influence cardiometabolic risk through adiposity and lipid pathways.

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Publication: Endocrine Connections

Janus C, Vistisen D, Amadid H, Witte DR, Lauritzen T, Brage S, et al.

31 December 2019

The hormone glucagon-like peptide-1 (GLP-1) decreases blood glucose and appetite. Greater physical activity (PA) is associated with lower incidence of type 2 diabetes. While acute exercise may increase glucose-induced response of GLP-1, it is unknown how habitual PA affects GLP-1 secretion. We hypothesised that habitual PA associates with greater glucose-induced GLP-1 responses in overweight individuals.


Cross-sectional analysis of habitual PA levels and GLP-1 concentrations in 1326 individuals (mean (s.d.) age 66 (7) years, BMI 27.1 (4.5) kg/m2) from the ADDITION-PRO cohort. Fasting and oral glucose-stimulated GLP-1 responses were measured using validated radioimmunoassay. PA was measured using 7-day combined accelerometry and heart rate monitoring. From this, energy expenditure (PAEE; kJ/kg/day) and fractions of time spent in activity intensities (h/day) were calculated. Cardiorespiratory fitness (CRF; mL O2/kg/min) was calculated using step tests. Age-, BMI- and insulin sensitivity-adjusted associations between PA and GLP-1, stratified by sex, were evaluated by linear regression analysis.


In 703 men, fasting GLP-1 concentrations were 20% lower (95% CI: −33; −3%, P = 0.02) for every hour of moderate-intensity PA performed. Higher CRF and PAEE were associated with 1–2% lower fasting GLP-1 (P = 0.01). For every hour of moderate-intensity PA, the glucose-stimulated GLP-1 response was 16% greater at peak 30 min (1; 33%, P rAUC0-30 = 0.04) and 20% greater at full response (3; 40%, P rAUC0-120 = 0.02). No associations were found in women who performed PA 22 min/day vs 32 min/day for men.


Moderate-intensity PA is associated with lower fasting and greater glucose-induced GLP-1 responses in overweight men, possibly contributing to improved glucose and appetite regulation with increased habitual PA.

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Publication: The Journal of Nutrition

Jones KS, Meadows SR, Schoenmakers I, Prentice A, Moore SE

13 December 2019

Vitamin D is important to maternal, fetal, and infant health, but quality data on vitamin D status in low- and middle-income countries and response to cholecalciferol supplementation in pregnancy are sparse.

We characterized vitamin D status and vitamin D metabolite change across pregnancy and in response to cholecalciferol supplementation in rural Gambia.

This study was a secondary analysis of samples collected in a 4-arm trial of maternal nutritional supplementation [iron folic acid (FeFol); multiple micronutrients (MMN); protein energy (PE) as lipid-based supplement; PE + MMN]; MMN included 10 μg/d cholecalciferol. Plasma 25-hydroxycholecalciferol [25(OH)D3], 24,25-dihydroxycholecalciferol [24,25(OH)2D3], and C3-epimer-25-hydroxycholecalciferol [3-epi-25(OH)D3] were measured by LC-MS/MS in 863 women [aged 30 ± 7 y (mean ± SD)] in early pregnancy (presupplementation) and late pregnancy, (gestational age 14 ± 3 and 30 ± 1 wk). Changes in 25(OH)D3 and vitamin D metabolite concentrations and associations with pregnancy stage and maternal age and anthropometry were tested.

Early pregnancy 25(OH)D3 concentration was 70 ± 15 nmol/L and increased according to pregnancy stage (82 ± 18 and 87 ± 17 nmol/L in the FeFol and PE-arms) and to cholecalciferol supplementation (95 ± 19 and 90 ± 20 nmol/L in the MMN and PE + MMN-arms) (P < 0.0001). There was no difference between supplemented groups. Early pregnancy 25(OH)D3 was positively associated with maternal age and gestational age. Change in 25(OH)D3 was negatively associated with late pregnancy, but not early pregnancy, triceps skinfold thickness. The pattern of change of 24,25(OH)2D3 mirrored that of 25(OH)D3 and appeared to flatten as pregnancy progressed, whereas 3-epi-25(OH)D3 concentration increased across pregnancy.

This study provides important data on the vitamin D status of a large cohort of healthy pregnant women in rural Africa. Without supplementation, vitamin D status increased during pregnancy, demonstrating that pregnancy stage should be considered when assessing vitamin D status. Nutritionally relevant cholecalciferol supplementation further increased vitamin D status. These data are relevant to the development of fortification and supplementation policies in pregnant women in West Africa.

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Publication: International Journal of Behavioral Nutrition and Physical Activity

Lindsay T, Westgate K, Wijndaele K, Hollidge S, Kerrison N, Forouhi N, et al.

9 December 2019

Background Physical activity (PA) plays a role in the prevention of a range of diseases including obesity and cardiometabolic disorders. Large population-based descriptive studies of PA, incorporating precise measurement, are needed to understand the relative burden of insufficient PA levels and to inform the tailoring of interventions. Combined heart and movement sensing enables the study of physical activity energy expenditure (PAEE) and intensity distribution. We aimed to describe the sociodemographic correlates of PAEE and moderate-to-vigorous physical activity (MVPA) in UK adults.

Methods The Fenland study is a population-based cohort study of 12,435 adults aged 29–64 years-old in Cambridgeshire, UK. Following individual calibration (treadmill), participants wore a combined heart rate and movement sensor continuously for 6 days in free-living, from which we derived PAEE (kJ•day− 1•kg− 1) and time in MVPA (> 3 & > 4 METs) in bouts greater than 1 min and 10 min. Socio-demographic information was self-reported. Stratum-specific summary statistics and multivariable analyses were performed.

Results Women accumulated a mean (sd) 50(20) kJ•day− 1•kg− 1 of PAEE, and 83(67) and 33(39) minutes•day− 1 of 1-min bouted and 10-min bouted MVPA respectively. By contrast, men recorded 59(23) kJ•day− 1•kg− 1, 124(84) and 60(58) minutes•day− 1. Age and BMI were also important correlates of PA. Association with age was inverse in both sexes, more strongly so for PAEE than MVPA. Obese individuals accumulated less PA than their normal-weight counterparts, whether considering PAEE or allometrically-scaled PAEE (− 10 kJ•day− 1•kg− 1 or − 15 kJ•day− 1•kg-2/3 in men). Higher income and manual work were associated with higher PA; manual workers recorded 13–16 kJ•kg− 1•day− 1 more PAEE than sedentary counterparts. Overall, 86% of women and 96% of men accumulated a daily average of MVPA (> 3 METs) corresponding to 150 min per week. These values were 49 and 74% if only considering bouts > 10 min (15 and 31% for > 4 METs).

Conclusions PA varied by age, sex and BMI, and was higher in manual workers and those with higher incomes. Light physical activity was the main driver of PAEE; a component of PA that is currently not quantified as a target in UK guidelines.

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Publication: PLoS ONE

Sagelv EH, Ekelund U, Pedersen S, Brage S, Hansen BH, Johansson J, et al.

3 December 2019

Introduction Surveillance of physical activity at the population level increases the knowledge on levels and trends of physical activity, which may support public health initiatives to promote physical activity. Physical activity assessed by accelerometry is challenged by varying data processing procedures, which influences the outcome. We aimed to describe the levels and prevalence estimates of physical activity, and to examine how triaxial and uniaxial accelerometry data influences these estimates, in a large population-based cohort of Norwegian adults.

Methods This cross-sectional study included 5918 women and men aged 40–84 years who participated in the seventh wave of the Tromsø Study (2015–16). The participants wore an ActiGraph wGT3X-BT accelerometer attached to the hip for 24 hours per day over seven consecutive days. Accelerometry variables were expressed as volume (counts·minute-1 and steps·day-1) and as minutes per day in sedentary, light physical activity and moderate and vigorous physical activity (MVPA).

Results From triaxial accelerometry data, 22% (95% confidence interval (CI): 21–23%) of the participants fulfilled the current global recommendations for physical activity (≥150 minutes of MVPA per week in ≥10-minute bouts), while 70% (95% CI: 69–71%) accumulated ≥150 minutes of non-bouted MVPA per week. When analysing uniaxial data, 18% fulfilled the current recommendations (i.e. 20% difference compared with triaxial data), and 55% (95% CI: 53–56%) accumulated ≥150 minutes of non-bouted MVPA per week. We observed approximately 100 less minutes of sedentary time and 90 minutes more of light physical activity from triaxial data compared with uniaxial data (p<0.001).

Conclusion The prevalence estimates of sufficiently active adults and elderly are more than three times higher (22% vs. 70%) when comparing triaxial bouted and non-bouted MVPA. Physical activity estimates are highly dependent on accelerometry data processing criteria and on different definitions of physical activity recommendations, which may influence prevalence estimates and tracking of physical activity patterns over time.

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Publication: Diabetologia

Olov Rolandsson, Christiane S. Hampe, Nicholas J. Wareham et al

11 November 2019

Type 1 and type 2 diabetes differ with respect to pathophysiological factors such as beta cell function, insulin resistance and phenotypic appearance, but there may be overlap between the two forms of diabetes.

However, there are relatively few prospective studies that have characterised the relationship between autoimmunity and incident diabetes. The researchers investigated associations of antibodies against the 65 kDa isoform of GAD (GAD65) with type 1 diabetes and type 2 diabetes genetic risk scores and incident diabetes in adults in European Prospective Investigation into Cancer and Nutrition (EPIC)-InterAct, a case-cohort study nested in the EPIC cohort.

GAD65 antibodies were analysed in EPIC participants (over 40 years of age and free of known diabetes at baseline) by radioligand binding assay in a random subcohort (n = 15,802) and in incident diabetes cases (n = 11,981). Type 1 diabetes and type 2 diabetes genetic risk scores were calculated. Associations between GAD65 antibodies and incident diabetes were estimated using Prentice-weighted Cox regression.

GAD65 antibody positivity at baseline was associated with development of diabetes during a median follow-up time of 10.9 years (HR for GAD65 antibody positive vs negative 1.78; 95% CI 1.43, 2.20) after adjustment for sex, centre, physical activity, smoking status and education. The genetic risk score for type 1 diabetes but not type 2 diabetes was associated with GAD65 antibody positivity in both the subcohort (OR per SD genetic risk 1.24; 95% CI 1.03, 1.50) and incident cases (OR 1.97; 95% CI 1.72, 2.26) after adjusting for age and sex. The risk of incident diabetes in those in the top tertile of the type 1 diabetes genetic risk score who were also GAD65 antibody positive was 3.23 (95% CI 2.10, 4.97) compared with all other individuals, suggesting that 1.8% of incident diabetes in adults was attributable to this combination of risk factors.

This study indicates that incident diabetes in adults has an element of autoimmune aetiology. Thus, there might be a reason to re-evaluate the present subclassification of diabetes in adulthood.

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Publication: The Journal of Nutrition

Tong TYN, Koulman A, Griffin JL, Wareham NJ, Forouhi NG, Imamura F

26 October 2019

Cardiometabolic benefits of the Mediterranean diet have been recognized, but underlying mechanisms are not fully understood.

We aimed to investigate how the Mediterranean diet could influence circulating metabolites and how the metabolites could mediate the associations of the diet with cardiometabolic risk factors.

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Publication: PLoS ONE

Yerrakalva D, Wijndaele K, Hajna S, Westgate K, Khaw K, Wareham N, et al.

25 October 2019

Compensatory behaviours may be one of the reasons for the limited success of sedentary time interventions in older adults, but this possibility remains unexplored.

Activity compensation is the idea that if we change activity levels at one time we compensate for them at a later time to maintain a set point. We aimed to assess, among adults aged ≥60 years, whether sedentary time and time spent in prolonged sedentary bouts (≥30 mins) on one day were associated with sedentary time and time spent in prolonged sedentary bouts (≥30 mins) on the following day. We also sought to determine whether these associations varied by sociodemographic and comorbid factors.

Sedentary time was assessed for seven days using hip-worn accelerometers (ActiGraph GT1M) for 3459 adults who participated in the EPIC-Norfolk Study between 2004 and 2011. We assessed day-to-day associations in total and prolonged bouts of sedentary time using multi-level regressions. We included interaction terms to determine whether associations varied by age, sex, smoking, body mass index, social class, retirement, education and comorbid factors (stroke, diabetes, myocardial infarction and cancer).

Participants (mean age = 70.3, SD = 6.8 years) accumulated 540 sedentary mins/day (SD = 80.1). On any given day, every 60 minutes spent in sedentary time was associated with 9.9 extra sedentary minutes on the following day (95% CI 9.0, 10.2). This association was greater in non-retired compared to retired participants (non-retired 2.57 extra minutes, p = 0.024) and in current compared to former and never-smokers (5.26 extra mins for current vs former; 5.52 extra mins for current vs never, p = 0.023 and 0.017, respectively). On any given day, every 60 minutes spent in prolonged bouts was associated with 7.8 extra minutes in these bouts the following day (95% CI 7.6, 8.4). This association was greater in older individuals (0.18 extra minutes/year of age, 95% CI 0.061, 0.29), and for retired versus non-retired (retired 2.74 extra minutes, 95% CI 0.21, 5.74).

Conclusion Older adults did not display day-to-day compensation. Instead, individuals demonstrate a large stable component of day-to-day time spent sedentary and in prolonged bouts with a small but important capacity for positive variation. Therefore older adults appear to be largely habitual in their sedentary behaviour. Strategies to augment these patterns may be possible, given they may differ by age, smoking, and working status.

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Publication: Journal of the American Geriatrics Society

Bielemann RM, LaCroix AZ, Bertoldi AD, Tomasi E, Demarco FF, Gonzalez MC, et al.

8 October 2019

Use of objectively measured physical activity (PA) in older adults to assess relationship between PA and risk of all-causes mortality is scarce. This study evaluated the associations of PA based on accelerometry and a questionnaire with the risk of mortality among older adults from a city in Southern Brazil.

Overall physical activity (mg), light physical activity (LPA), and moderate to vigorous physical activity (MVPA) were estimated by raw accelerometer data. The International Physical Activity Questionnaire estimated leisure time and commuting PA. Hazard ratios (excluding deaths in the first 6 mo) stratified by sex were estimated by Cox regression analysis considering adjustment for confounders.

From the 1451 older adults interviewed in 2014, 145 died (10%) after a follow-up of an average 2.6 years. Men and women in the highest tertile of overall PA had on average a 77% and 92% lower risk of mortality than their less active counterparts. The highest tertile of LPA was also related to a lower risk of mortality in individuals of both sexes. MVPA statistically reduced the risk of mortality only among women. Self-reported leisure-time PA was statistically associated with a lower risk of mortality only among men. Women in the highest tertiles of commuting PA showed a lower risk of mortality than those in the reference group.

CONCLUSION Accelerometry-based PA was associated with a lower risk of mortality among Brazilian older adults. Older individuals should practice any type of PA.

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Publication: Metabolomics

Furse S, Billing G, Snowden SG, Smith J, Goldberg G, Koulman A.

25 September 2019

This study was motivated by the report that infant development correlates with particular lipids in infant plasma.

The hypothesis was that the abundance of these candidate biomarkers is influenced by the dietary intake of the infant.

A cohort of 30 exclusively-breastfeeding mother–infant pairs from a small region of West Africa was used for this observational study. Plasma and milk from the mother and plasma from her infant were collected within 24 h, 3 months post partum. The lipid, sterol and glyceride composition was surveyed using direct infusion MS in positive and negative ion modes. Analysis employed a combination of univariate and multivariate tests.

The lipid profiles of mother and infant plasma samples are similar but distinguishable, and both are distinct from milk. Phosphatidylcholines (PC), cholesteryl esters (CEs) and cholesterol were more abundant in mothers with respect to their infants. A latent structure model showed that four lipids in infant plasma previously shown to be biomarkers clustered with cholesteryl esters in the maternal circulation.

This study found evidence that the abundance of individual lipid isoforms associated with infant development are associated with the abundance of individual molecular species in the mother’s circulation.

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Publication: European Journal of Applied Physiology

Veijalainen A, Haapala EA, Väistö J, Leppänen MH, Lintu N, Tompuri T, et al.

18 September 2019

The researchers looked at the associations of physical activity (PA), sedentary time (ST), and cardiorespiratory fitness (CRF) with heart rate variability (HRV) in children.

The participants were a population sample of 377 children aged 6–9 years (49% boys). ST, light PA (LPA), moderate PA (MPA), vigorous PA (VPA), and moderate-to-vigorous PA (MVPA), and PA energy expenditure (PAEE) were assessed using a combined heart rate and movement sensor, maximal power output per kilograms of lean body mass as a measure of CRF by maximal cycle ergometer exercise test, and HRV variables (SDNN, RMSSD, LF, and HF) using 5 min resting electrocardiography. Data were analysed by linear regression adjusted for years from peak height velocity.

In boys, ST was inversely associated and MVPA, VPA, PAEE, and CRF were directly associated with HRV variables. CRF was directly associated with all HRV variables and PAEE was directly associated with RMSSD after mutual adjustment for ST, PAEE, and CRF.

In girls, ST was inversely associated and LPA, MPA, VPA, MVPA, and PAEE were directly associated with HRV variables. After mutual adjustment for ST, PAEE, and CRF, only the inverse associations of ST with HRV variables remained statistically significant.

Higher ST and lower PA and CRF were associated with poorer cardiac autonomic nervous system function in children. Lower CRF in boys and higher ST in girls were the strongest correlates of poorer cardiac autonomic function.

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Publication: Scientific Reports

Ottaviani JI, Fong R, Kimball J, Ensunsa JL, Gray N, Vogiatzoglou A, et al.

11 September 2019

Data from dietary intervention studies suggest that intake of (−)-epicatechin mediates beneficial vascular effects in humans. However, population-based investigations are required to evaluate associations between habitual intake and health and these studies rely on accurate estimates of intake, which nutritional biomarkers can provide.

Here, we evaluate a series of structurally related (−)-epicatechin metabolites (SREM), particularly (−)-epicatechin-3′-glucuronide, (−)-epicatechin-3′-sulfate and 3′-O-methyl-(−)-epicatechin-5-sulfate (SREMB), as flavan-3-ol and (−)-epicatechin intake. SREMB in urine proved to be a specific indicator of (−)-epicatechin intake, showing also a strong correlation with the amount of (−)-epicatechin ingested (R2: 0.86 (95% CI 0.8l; 0.92).

The median recovery of (−)-epicatechin as SREMB in 24 h urine was 10% (IQR 7–13%) and we found SREMB in the majority of participants of EPIC Norfolk (83% of 24,341) with a mean concentration of 2.4 ± 3.2 µmol/L.

Our results show that SREMB are suitable as biomarker of (−)-epicatechin intake. According to evaluation criteria from IARC and the Institute of Medicine, the results obtained support use of SREMB as a recovery biomarker to estimate actual intake of (−)-epicatechin.

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Publication: Journal of Nutritional Science

Foster E, Lee C, Imamura F, Hollidge SE, Westgate KL, Venables MC, et al.

30 August 2019

Online self-reported 24-h dietary recall systems promise increased feasibility of dietary assessment. Comparison against interviewer-led recalls established their convergent validity; however, reliability and criterion-validity information is lacking.

The validity of energy intakes (EI) reported using Intake24, an online 24-h recall system, was assessed against concurrent measurement of total energy expenditure (TEE) using doubly labelled water in ninety-eight UK adults (40–65 years). Accuracy and precision of EI were assessed using correlation and Bland–Altman analysis. Test–retest reliability of energy and nutrient intakes was assessed using data from three further UK studies where participants (11–88 years) completed Intake24 at least four times; reliability was assessed using intra-class correlations (ICC).

Compared with TEE, participants under-reported EI by 25 % (95 % limits of agreement −73 % to +68 %) in the first recall, 22 % (−61 % to +41 %) for average of first two, and 25 % (−60 % to +28 %) for first three recalls. Correlations between EI and TEE were 0·31 (first), 0·47 (first two) and 0·39 (first three recalls), respectively. ICC for a single recall was 0·35 for EI and ranged from 0·31 for Fe to 0·43 for non-milk extrinsic sugars (NMES). Considering pairs of recalls (first two v. third and fourth recalls), ICC was 0·52 for EI and ranged from 0·37 for fat to 0·63 for NMES. EI reported with Intake24 was moderately correlated with objectively measured TEE and underestimated on average to the same extent as seen with interviewer-led 24-h recalls and estimated weight food diaries.

Online 24-h recall systems may offer low-cost, low-burden alternatives for collecting dietary information.

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Publication: PLOS ONE

Cullerton K, Adams J, Francis O, Forouhi N, White M.

22 August 2019

Key to scientific integrity is ensuring that research findings are considered credible by scientific peers, practitioners, policymakers and the public.

Industry sponsorship of nutritional research can result in bias and raises significant professional, public and media concern. Yet, there is no international consensus on how to prevent or manage conflicts of interest for researchers considering engaging with the food industry.

This study aimed to determine internationally agreed principles to guide interactions between population health researchers and the food industry to prevent or manage conflicts of interest. We used a two-stage, online Delphi study for researchers, and an online survey for stakeholders. High levels of agreement on principles were achieved for both groups (researchers 68%; stakeholders 65%). Highest levels of agreement were with principles concerning research methods and governance.

More contentious were principles that required values-based decision-making, such as determining which elements of the commercial sector are acceptable to interact with. These results provide the basis for developing internationally-agreed guidelines for population health researchers governing interactions with the food industry.

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Publication: Advances in Nutrition

Aljuraiban G, Gibson R, Oude Griep L, Okuda N, Steffen L, Van Horn L et al.

18 June 2019

Healthy dietary habits are the cornerstone of cardiovascular disease (CVD) prevention.

Numerous researchers have developed diet quality indices to help evaluate and compare diet quality across and within various populations.

The availability of these new indices raises questions regarding the best selection relevant to a given population.

In this perspective, we critically evaluate a priori–defined dietary indices commonly applied in epidemiological studies of CVD risk and mortality.

A systematic literature search identified 59 observational studies that applied a priori–defined diet quality indices to CVD risk factors and/or CVD incidence and/or CVD mortality.

Among 31 different indices, these scores were categorized as follows: 1) those based on country-specific dietary patterns, 2) those adapted from distinct dietary guidelines, and 3) novel scores specific to key diet-related factors associated with CVD risk.

The strengths and limitations of these indices are described according to index components, calculation methods, and the application of these indices to different population groups. Also, the importance of identifying methodological challenges faced by researchers when applying an index are considered, such as selection and weighting of food groups within a score, since food groups are not necessarily equivalent in their associations with CVD.

The lack of absolute cutoff values, emphasis on increasing healthy food without limiting unhealthy food intake, and absence of validation of scores with biomarkers or other objective diet assessment methods further complicate decisions regarding the best indices to use.

Future research should address these limitations, consider cross-cultural and other differences between population groups, and identify translational challenges inherent in attempting to apply a relevant diet quality index for use in CVD prevention at a population level.

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Publication: The Journal of Endocrinology & Medicine

Martineau AR, Thummel KE, Wang Z, Jolliffe DA, Boucher BJ, Griffin SJ, et al.

14 June 2019

Vitamin D2 and vitamin D3 have been hypothesized to exert differential effects on vitamin D metabolism.

The objective of this study was to compare the influence of administering vitamin D2 vs vitamin D3 on metabolism of vitamin D3.

The researchers measured baseline and 4-month serum concentrations of vitamin D3, in 52 adults randomized to receive a total of four oral bolus doses of 2.5 mg vitamin D2 or vitamin D3 over four months. Metabolite-to-parent compound ratios were calculated to estimate hydroxylase activity. Pairwise before vs after comparisons were made to evaluate effects of vitamin D2 and vitamin D3 on metabolism of vitamin D. Mean postsupplementation metabolite-to-parent ratios were then compared between groups.

The researchers concluded that bolus-dose vitamin D2 is less effective than bolus-dose vitamin D3 in elevating total serum 25(OH)D concentration.

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Publication: Nutrients

Furse S, Koulman A.

20 May 2019

We tested the hypothesis that the lipid composition of infant formula is consistent between manufacturers, countries and target demographic. We developed techniques to profile the lipid and glyceride fraction of milk and formula in a high throughput fashion. Formula from principal brands in the UK (2017–2019; bovine-, caprine-, soya-based), the Netherlands (2018; bovine-based) and South Africa (2018; bovine-based) were profiled along with fresh British animal and soya milk and skimmed milk powder.

We found that the lipid and glyceride composition of infant formula differed by region, manufacturer and date of manufacture. The formulations within some brands, aimed at different target age ranges, differed considerably where others were similar across the range. Soya lecithin and milk lipids had characteristic phospholipid profiles. Particular sources of fat, such as coconut oil, were also easy to distinguish. Docosahexaenoic acid is typically found in triglycerides rather than phospholipids in formula.

The variety by region, manufacturer, date of manufacture and sub-type for target demographics lead to an array of lipid profiles in formula. This makes it impossible to predict its molecular profile. Without detailed profile of the formula fed to infants, it is difficult to characterise the relationship between infant nutrition and their growth and development.

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Publication: The Lancet

Forouhi NG, Unwin N

11 May 2019

Few, if any, would contest that diet and nutrition have a crucial and substantial impact on human health. But the devil is in the details. Common questions include: is there such a thing as an optimal diet? What is suboptimal? Which dietary components matter most? And given the necessity to take action on climate change and planetary health, what should the world eat?

The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) contributes towards answering these questions by estimating the burden of mortality and disability attributable to specific dietary risks, within a comparative risk assessment framework that currently considers 84 behavioural, environmental, occupational, and metabolic risks across 195 countries and territories.

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Publication: The Journal of Nutrition

Jannasch F, Kröger J, Agnoli C, Barricarte A, Boeing H, Cayssials V, et al.

24 April 2019

The aim of this study was to derive country-specific exploratory dietary patterns, investigate their association with type 2 diabetes incidence, and replicate diabetes-associated dietary patterns in other countries.

Dietary intake data were used, assessed by country-specific questionnaires at baseline of 11,183 incident diabetes cases and 14,694 subcohort members (mean age 52.9 y) from 8 countries, nested within the European Prospective Investigation into Cancer and Nutrition study (mean follow-up time 6.9 y).

Exploratory dietary patterns were derived by principal component analysis. HRs for incident type 2 diabetes were calculated by Prentice-weighted Cox proportional hazard regression models. Diabetes-associated dietary patterns were simplified or replicated to be applicable in other countries. A meta-analysis across all countries evaluated the generalizability of the diabetes-association.

Only few country/center-specific dietary patterns (3 of 18) were statistically significantly associated with diabetes incidence in this multicountry European study population. One pattern, whose association with diabetes was confirmed across other countries, showed overlaps in the food groups potatoes and processed meat with identified diabetes-associated dietary patterns from other studies. The study demonstrates that replication of associations of exploratory patterns with health outcomes is feasible and a necessary step to overcome population-specificity in associations from such analyses.

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Publication: The American Journal of Clinical Nutrition

Zheng J, Imamura F, Sharp SJ, Koulman A, Griffin JL, Mulligan AA, et al.

17 April 2019

Little is known about changes in blood fatty acid compositions over time and the correlates of any changes in a general population.

The aim of this study was to estimate changes in 27 individual plasma phospholipid fatty acids and fatty acid groups over time, and to identify potential correlates of these changes, using profiles from 722 participants in the European Prospective Investigation into Cancer and Nutrition-Norfolk Study, UK.

Changes in fatty acid levels were associated with consumption of different food groups. For example, a mean 100 g/d increase in fatty fish intake was associated with a 19.3% greater annual increase in marine n–3 PUFAs.

Even-chain SFAs and TFAs declined and marine n–3 PUFAs increased over time. These changes were partially explained by changes in dietary habits, and could potentially help interpret associations of baseline fatty acid composition with future disease risk.

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Publication: The American Journal of Clinical Nutrition

Fretts AM, Imamura F, Marklund M, Micha R, Wu JHY, Murphy RA, et al.

15 April 2019

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Publication: International Journal of Obesity

White T, Westgate K, Hollidge S, Venables M, Olivier P, Wareham N,

2 April 2019

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Publication: Nature Communications

Wittemans LBL, Lotta LA, Oliver-Williams C, Stewart ID, Surendran P, Karthikeyan S, et al.

5 March 2019

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Publication: Diabetes Care

Vissers LET, Sluijs I, van der Schouw YT, Forouhi NG, Imamura F, Burgess S, et al.

6 February 2019

Eating healthily on a daily basis is a major step to prevent development of type 2 diabetes. Higher intake of dairy products has been associated with a lower risk of diabetes in a meta-analysis of observational studies. Yogurt and cheese intake particularly were associated with lower diabetes risk, whereas milk intake was not, with substantial heterogeneity for most dairy products.

However, potential confounding and reverse causation cannot be excluded. Owing to these limitations, the causal role of dairy products in diabetes prevention remains debatable.

The relationship between dairy products and risk of diabetes could be investigated by applying a Mendelian randomization (MR) approach, using genetic variability in the MCM6 gene associated with lactase persistence (LP) in adults as an instrumental variable (IV).

Lactase is necessary to break down the sugars that are found in dairy products, i.e., lactose. Single nucleotide polymorphisms (SNPs) in the MCM6 region have been associated with LP (6). rs4988235 (LCT-12910C>T) has been associated with LP in European populations and has been associated with a higher intake of milk in European cohorts, albeit not in all.

Previous MR studies reported no association between LP-associated milk intake and diabetes. However, variation in the MCM6 gene is likely to lead to population stratification, which would introduce bias to an MR analysis, and previous MR studies did not sufficiently adjust for population substructure. Also, previous studies did not investigate whether rs4988235 was specifically associated with dairy product intake after adjusting for population substructure.

We therefore investigated whether rs4988235 associated with intake of dairy products and other foods in a pan-European study in eight countries with different dietary habits. We adjusted for genetic principal components (PCs) and study center to adjust for population substructure (16). Next, we used rs4988235 in an IV analysis to investigate whether there is a causal relationship between the LP-associated exposure and risk of diabetes.

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Publication: Nutrition Bulletin

Hengist A, Perkin O, Gonzalez JT, Betts JA, Hewison M, Manolopoulos KN, Jones KS, et al.

3 February 2019

Vitamin D is lipophilic and accumulates substantially in adipose tissue. Even without supplementation, the amount of vitamin D in the adipose of a typical adult is equivalent to several months of the daily reference nutrient intake (RNI).

Paradoxically, despite the large amounts of vitamin D located in adipose tissue, individuals with obesity are often vitamin D deficient according to consensus measures of vitamin D status (serum 25-hydroxyvitamin D concentrations).

Thus, it appears that vitamin D can become ‘trapped’ in adipose tissue, potentially due to insufficient lipolytic stimulation and/or due to tissue dysfunction/adaptation resulting from adipose expansion.

Emerging evidence suggests that exercise may mobilise vitamin D from adipose (even in the absence of weight loss). If exercise helps to mobilise vitamin D from adipose tissue, then this could have important ramifications for practitioners and policymakers regarding the management of low circulating levels of vitamin D, as well as chronically low levels of physical activity, obesity and associated health conditions.

This perspective led us to design a study to examine the impact of exercise on vitamin D status, vitamin D turnover and adipose tissue vitamin D content (the VitaDEx project). The VitaDEx project will determine whether increasing physical activity (via exercise) represents a potentially useful strategy to mobilise vitamin D from adipose tissue.

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Publication: BMC Medicine

Khalatbari-Soltani S, Imamura F, Brage S, De Lucia Rolfe E, Griffin SJ, Wareham NJ, et al.

24 January 2019

The risk of hepatic steatosis may be reduced through changes to dietary intakes, but evidence is sparse, especially for dietary patterns including the Mediterranean diet. Here the researchers investigated the association between adherence to the Mediterranean diet and prevalence of hepatic steatosis.

Cross-sectional analysis of data from two population-based adult cohorts: the Fenland Study (England, n = 9645, 2005–2015) and CoLaus Study (Switzerland, n = 3957, 2009–2013).

Habitual diet was assessed using cohort-specific food frequency questionnaires. Mediterranean diet scores (MDSs) were calculated in three ways based on adherence to the Mediterranean dietary pyramid, dietary cut-points derived from a published review, and cohort-specific tertiles of dietary consumption.

Hepatic steatosis was assessed by abdominal ultrasound and fatty liver index (FLI) in Fenland and by FLI and non-alcoholic fatty liver disease (NAFLD) score in CoLaus. FLI includes body mass index (BMI), waist circumference, gamma-glutamyl transferase, and triglyceride; NAFLD includes diabetes, fasting insulin level, fasting aspartate-aminotransferase (AST), and AST/alanine transaminase ratio. Associations were assessed using Poisson regression.

In Fenland, the prevalence of hepatic steatosis was 23.9% and 27.1% based on ultrasound and FLI, respectively, and in CoLaus, 25.3% and 25.7% based on FLI and NAFLD score, respectively.

In Fenland, higher adherence to pyramid-based MDS was associated with lower prevalence of hepatic steatosis assessed by ultrasound. This association was attenuated after adjustment for body mass index (BMI). Associations of similar magnitude were found for hepatic steatosis assessed by FLI in Fenland and in CoLaus, and these were also attenuated after adjustment for BMI. Findings were similar when the other two MDS definitions were used.

Greater adherence to the Mediterranean diet was associated with lower prevalence of hepatic steatosis, largely explained by adiposity. These findings suggest that an intervention promoting a Mediterranean diet may reduce the risk of hepatic steatosis.

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Publication: JAMA Network

Lotta LA, Wittemans LBL, Zuber V, Stewart ID, Sharp SJ, Luan J, et al.

25 December 2018

The distribution of body fat is associated with the propensity of overweight individuals to manifest insulin resistance and its associated metabolic and cardiovascular complications.

The waist-to-hip ratio (WHR) is a widely used, convenient, and robustly validated indicator of fat distribution and is linked to the risk of type 2 diabetes and coronary disease independently of body mass index (BMI).

This observation has been used to infer that accumulation of fat in the abdominal cavity is an independent causal contributor to cardiometabolic disease. While many studies support this assertion and plausible mechanisms have been proposed, WHR can also be increased by a reduction in its denominator, the hip circumference.

Evidence from several different forms of partial lipodystrophy and functional studies of peripheral adipose storage compartments suggests that a primary inability to expand gluteofemoral or hip fat can also underpin subsequent cardiometabolic disease risk.

Emerging evidence from the analysis of common genetic variants associated with greater insulin resistance but lower levels of hip fat suggests that similar mechanisms may also be relevant to the general population.

In this study, large-scale human genetic data were used to investigate whether genetic variants related to body fat distribution via lower levels of gluteofemoral (hip) fat or via higher levels of abdominal (waist) fat are associated with type 2 diabetes or coronary disease risk.

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Publication: American Journal of Human Biology

Lee JC, Westgate K, Boit MK, Mwaniki DL, Kiplamai FK, Friis H, et al.

10 December 2018

Physical activity is beneficial for metabolic health but the extent to which this may differ by ethnicity is still unclear. Here, the objective was to characterize the association between physical activity energy expenditure (PAEE) and cardiometabolic risk among the Luo, Kamba, and Maasai ethnic groups of rural Kenya.

In a cross-sectional study of 1084 rural Kenyans, free-living PAEE was objectively measured using individually-calibrated heart rate and movement sensing. A clustered metabolic syndrome risk score (zMS) was developed by averaging the sex-specific z-scores of five risk components measuring central adiposity, blood pressure, lipid levels, glucose tolerance, and insulin resistance.

zMS was 0.08 (−0.09; −0.06) SD lower for every 10 kJ/kg/day difference in PAEE after adjustment for age and sex; this association was modified by ethnicity (interaction with PAEE P < 0.05).

When adjusted for adiposity, each 10 kJ/kg/day difference in PAEE was predicted to lower zMS by 0.04 (−0.05, −0.03) SD, without evidence of interaction by ethnicity. The Maasai were predicted to have higher cardiometabolic risk than the Kamba and Luo at every quintile of PAEE, with a strong dose-dependent decreasing trend among all ethnicities.

Free-living PAEE is strongly inversely associated with cardiometabolic risk in rural Kenyans. Differences between ethnic groups in this association were observed but were explained by differences in central adiposity. Therefore, targeted interventions to increase PAEE are more likely to be effective in subgroups with high central adiposity, such as Maasai with low levels of PAEE.

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Publication: International Journal of Behavioral Nutrition and Physical Activity

Hajna S, White T, Brage S, van Sluijs EMF, Westgate K, Jones AP, et al.

27 November 2018

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Publication: Public Health Nutrition

Dao MC, Subar AF, Warthon-Medina M, Cade JE, Burrows T, Golley RK, et al.

15 November 2018

A wide variety of methods are available to assess dietary intake, each one with different strengths and weaknesses. Researchers face multiple challenges when diet and nutrition need to be accurately assessed, particularly in the selection of the most appropriate dietary assessment method for their study. The goal of this collaborative work is to present a collection of available resources for dietary assessment implementation.

As a follow-up to the 9th International Conference on Diet and Physical Activity Methods held in 2015, developers of dietary assessment toolkits agreed to collaborate in the preparation of the present paper, which provides an overview of each toolkit.

The toolkits presented include: the Diet, Anthropometry and Physical Activity Measurement Toolkit (DAPA; UK); the National Cancer Institute’s (NCI) Dietary Assessment Primer (USA); the Nutritools website (UK); the Australasian Child and Adolescent Obesity Research Network (ACAORN) method selector (Australia); and the Danone Dietary Assessment Toolkit (DanoneDAT; France). An at-a-glance summary of features and comparison of the toolkits is provided.

The present review contains general background on dietary assessment, along with a summary of each of the included toolkits, a feature comparison table and direct links to each toolkit, all of which are freely available online.

This overview of dietary assessment toolkits provides comprehensive information to aid users in the selection and implementation of the most appropriate dietary assessment method, or combination of methods, with the goal of collecting the highest-quality dietary data possible.

View publication

Publication: The Journal of Clinical Endocrinology & Metabolism

Zheng JS, Imamura F, Sharp SJ, van der Schouw YT, Sluijs I, Gundersen TE, et al.

9 November 2018

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Publication: Nutrients

Jenkins B, Aoun M, Feillet-Coudray C, Coudray C, Ronis M, Koulman A.

3 November 2018

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Publication: Current Gerontology and Geriatrics Research

Hartley P, Keevil VL, Westgate K, White T, Brage S, Romero-Ortuno R, et al. Curr Gerontol Geriatr Res.

18 October 2018

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Publication: PLOS Medicine

Imamura F, Fretts A, Marklund M, Ardisson Korat AV, Yang WS, Lankinen M, et al.

10 October 2018

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Publication: JAMA Cardiology

Lotta LA, Stewart ID, Sharp SJ, Day FR, Burgess S, Luan J, et al.

19 September 2018

Are genetically determined differences in lipoprotein lipase (LPL)–mediated lipolysis and low-density lipoprotein cholesterol (LDL-C)–lowering pathways independently associated with risk of coronary disease and diabetes?

In this genetic association study including 392 220 people, triglyceride-lowering alleles in LPL or its inhibitor ANGPTL4 were associated with lower risk of coronary artery disease and type 2 diabetes in a consistent fashion across quantiles of the population distribution of LDL-C–lowering alleles.

For a given genetic difference in LDL-C, the association with lower risk of coronary disease conveyed by rare loss-of-function variants in ANGPTL3, which are associated with lower LDL-C levels and enhanced LPL lipolysis, was greater than that conveyed by other LDL-C–lowering genetic mechanisms.

Meaning LPL-mediated lipolysis and LDL-C–lowering mechanisms independently contribute to the risk of coronary disease and diabetes, which supports the development of LPL-enhancing agents for use in the context of LDL-C–lowering therapy.

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Publication: International Journal of Obesity

Tarp J, Child A, White T, Westgate K, Bugge A, Grontved A, et al.

13 July 2018

In this study the researchers wanted to determine the role of physical activity intensity and bout-duration in modulating associations between physical activity and cardiometabolic risk markers.

Cardiovascular disease accounted for 17.6 million deaths worldwide in 2016, making it the leading cause of non-communicable disease mortality. While the disease is generally a concern in adulthood, cardiometabolic risk factors may be present from a much earlier age, for example endothelial damage that leads to atherosclerosis can develop during adolescence. In addition, previous evidence suggests cardiometabolic risk factors may track from childhood and adolescence into adulthood. This makes it important to understand the modifiable determinants of cardiometabolic risk factors in young people. One such determinant is participation in physical activity.

Current national and international physical activity guidelines recommend adults should accumulate moderate-to-vigorous physical activity (MVPA) or vigorous physical activity in bouts of at least 10 min duration. For children and adolescents, a daily total of at least 60 min of MVPA is recommended but many countries (including the U.S., U.K., Australia, and Canada) do not specify any minimum bout-duration for MVPA.

Providing the optimal guidance on how to perform health-enhancing physical activity is important for authorities and clinicians. However, whether short bouts of activity confer similar benefits to longer durations remains unclear and available evidence on this issue remains scarce in young people. Accelerometry is currently the de facto standard of objective physical activity assessment in large-scale epidemiological studies. It is well-established that accelerometry-determined MVPA levels are highly influenced by the choice of intensity threshold but it has not been sufficiently explored how varying the intensity threshold impacts on associations with cardiometabolic risk factors.

Further, whether higher (or lower) intensity physical activity may be particularly beneficial for cardiometabolic risk factors at longer bout-durations has yet to be examined.

Therefore, the purpose of this study was to assess how physical activity of different intensities and accumulated in bouts of varying duration relates to cardiometabolic health in young people.

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Publication: International Journal of Behavioral Nutrition and Physical Activity

Alessandra Prioreschi, Soren Brage, Kate Westgate & Lisa K. Micklesfield

25 June 2018


Evidence for the importance of accumulating sufficient physical activity in the early years is mounting. This study aimed to determine the relationship between maternal and infant objectively measured physical activity, and to examine the diurnal interactions between these behaviours while accounting for potential covariates.

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Publication: Genome Biology

Sanders FWB, Acharjee A, Walker C, Marney L, Roberts LD, Imamura F, et al.

20 June 2018

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Publication: European Journal of Epidemiology

Kim Y, White T, Wijndaele K, Westgate K, Sharp SJ, Helge JW, et al.

28 March 2018

Little is known about the combined associations of cardiorespiratory fitness (CRF) and hand grip strength (GS) with mortality in general adult populations.

The purpose of this study was to compare the relative risk of mortality for CRF, GS, and their combination. In UK Biobank, a prospective cohort of > 0.5 million adults aged 40–69 years, CRF was measured through submaximal bike tests; GS was measured using a hand-dynamometer.

This analysis is based on data from 70,913 men and women who provided valid CRF and GS data, and with no history of heart attack/stroke/cancer at baseline.

CRF and GS are both independent predictors of mortality. Improving both CRF and muscle strength, as opposed to either of the two alone, may be the most effective behavioral strategy to reduce all-cause and cardiovascular mortality risk.

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Publication: British Journal of Nutrition

Tammy Y. N. Tong, Fumiaki Imamura, Pablo Monsivais, Søren Brage, Simon J. Griffin, Nicholas J. Wareham and Nita G. Forouhi

19 March 2018


High cost of healthy foods could be a barrier to healthy eating. Researchers aimed to examine the association between dietary cost and adherence to the Mediterranean diet in a non-Mediterranean country.

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Publication: Diabetologia

Sherly X. Li, Fumiaki Imamura, Matthias B. Schulze, Jusheng Zheng, Zheng Ye, Antonio Agudo, Eva Ardanaz, Dagfinn Aune, Heiner Boeing, Miren Dorronsoro, Courtney Dow, Guy Fagherazzi, Sara Grioni, Marc J. Gunter, José María Huerta, Daniel B. Ibsen, Marianne Uhre Jakobsen, Rudolf Kaaks, Timothy J. Key, Kay-Tee Khaw, Cecilie Kyrø, Francesca Romana Mancini, Elena Molina-Portillo, Neil Murphy, Peter M. Nilsson, N. Charlotte Onland-Moret, Domenico Palli, Salvatore Panico, Alaitz Poveda, J. Ramón Quirós, Fulvio Ricceri, Ivonne Sluijs, Annemieke M. W. Spijkerman, Anne Tjonneland, Rosario Tumino, Anna Winkvist, Claudia Langenberg, Stephen J. Sharp, Elio Riboli, Robert A. Scott, Nita G. Forouhi & Nicholas J. Wareham

17 March 2018


Researchers investigated the influence of interactions between genetic risk scores (GRSs) for type 2 diabetes, insulin resistance and BMI and macronutrient intake on the development of type 2 diabetes in the European Prospective Investigation into Cancer and Nutrition (EPIC)-InterAct, a prospective case-cohort study across eight European countries (N = 21,900 with 9742 incident type 2 diabetes cases).

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Publication: Pilot and Feasibility Studies

Alessandra Prioreschi, Thomas Nappey, Kate Westgate, Patrick Olivier, Soren Brage & Lisa Kim Micklesfield

01 March 2018


It is important to be able to reliably and feasibly measure infant and toddler physical activity in order to determine adherence to current physical activity guidelines and effects on early life development, growth and health. This study aimed to describe the development of an infant wearable wrist-worn band for the measurement of physical activity; to determine the feasibility of the device data for observational measurement of physical activity and to determine the caregiver reported acceptability of the infant wearable wrist band.

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Publication: Diabetes Care

Karina Meidtner, Clara Podmore, Janine Kröger, Yvonne T. van der Schouw, Benedetta Bendinelli, Claudia Agnoli, Larraitz Arriola, Aurelio Barricarte, Heiner Boeing, Amanda J. Cross, Courtney Dow, Kim Ekblom, Guy Fagherazzi, Paul W. Franks, Marc J. Gunter, José María Huerta, Paula Jakszyn, Mazda Jenab, Verena A. Katzke, Timothy J. Key, Kay Tee Khaw, Tilman Kühn, Cecilie Kyrø, Francesca Romana Mancini, Olle Melander, Peter M. Nilsson, Kim Overvad, Domenico Palli, Salvatore Panico, J. Ramón Quirós, Miguel Rodríguez-Barranco, Carlotta Sacerdote, Ivonne Sluijs, Magdalena Stepien, Anne Tjonneland, Rosario Tumino, Nita G. Forouhi, Stephen J. Sharp, Claudia Langenberg, Matthias B. Schulze, Elio Riboli and Nicholas J. Wareham

February 2018


Meat intake has been consistently shown to be positively associated with incident type 2 diabetes. Part of that association may be mediated by body iron status, which is influenced by genetic factors. Researchers aimed to test for interactions of genetic and dietary factors influencing body iron status in relation to the risk of incident type 2 diabetes.

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Publication: Nature

Anthony P. Coll, Michael Chen, Stephen O’Rahilly et al

25 December 2019

Cambridge scientists have discovered that metformin causes the cells of the intestine to make large amounts of a hormone, called GDF15, and secrete it into the bloodstream.

The high blood levels of GDF15 are sensed by a highly specific area of the brain where they suppress hunger and reduce food intake. When GDF15 is blocked, metformin has no effect on body weight.

The work was undertaken in the MRC Metabolic Diseases Unit at the University of Cambridge with collaborators at NGM Biopharmaceuticals, the University of Glasgow and elsewhere.

Dr Tony Coll, a lead author, said “We usually think that drugs have to pass through the intestine to have their effects in the body. In this case, though, the cells of the intestine themselves respond to the drug to create a hormonal signal which does the work.”

Metformin has been used to treat Type 2 diabetes for over 60 years and is the world’s most commonly prescribed anti-diabetic drug. It can also prevent the onset of diabetes in those at risk, doing so by helping people to lose and keep off weight. However, how metformin reduces body weight has been a mystery.

Professor Stephen O’Rahilly said: “How metformin keeps body weight down has been a mystery. This work shows that all of this effect is down to GDF15 acting on a tiny number of cells in the brain.”

These findings are supported  by an independent study from McMaster University published in Nature Metabolism  and should stimulate research into the use of GDF15 itself as an anti-obesity agent.


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Publication: Pediatric Diabetes

Claire M Nightingale, Alicja R Rudnicka, Sarah R Kerry-Barnard, Angela S Donin, Soren Brage, Kate L Westgate, Ulf Ekelund, Derek G Cook, Christopher G Owen, Peter H Whincup

07 February 2018


The relationship between physical fitness and risk markers for type 2 diabetes (T2D) in children and the contribution to ethnic differences in these risk markers have been little studied. Researchers examined associations between physical fitness and early risk markers for T2D and cardiovascular disease in 9- to 10-year-old UK children.

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Publication: European Journal of Epidemiology

Nicholas R. V. Jones,  Nita G. Forouhi, Kay-Tee Khaw,  Nicholas J. Wareham &  Pablo Monsivais

9 January 2018


The dietary approaches to stop hypertension (DASH) diet could be an important population-level strategy to reduce cardiovascular disease (CVD) in the UK, but there is little UK-based evidence on this diet pattern in relation to CVD risk.

Researchers tested whether dietary accordance with DASH was associated with risk of CVD in a population-based sample of 23,655 UK adults.

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Publication: PLOS Medicine

Oliver T. Mytton, Nita G. Forouhi, Peter Scarborough, Marleen Lentjes, Robert Luben, Mike Rayner, Kay Tee Khaw, Nicholas J. Wareham, Pablo Monsivais

4 January 2018


In the United Kingdom, the Food Standards Agency-Ofcom nutrient profiling model (FSA-Ofcom model) is used to define less-healthy foods that cannot be advertised to children. However, there has been limited investigation of whether less-healthy foods defined by this model are associated with prospective health outcomes. The objective of this study was to test whether consumption of less-healthy food as defined by the FSA-Ofcom model is associated with cardiovascular disease (CVD)

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Publication: International Journal of Behavioral Nutrition and Physical Activity

Alessandra Prioreschi, Soren Brage, Kylie D. Hesketh, Jill Hnatiuk, Kate Westgate & Lisa K. Micklesfield

22 December 2017


Physical activity is considered to have health benefits across the lifespan but levels, patterns, and correlates have not been well described in infants and toddlers under the age of two years. This study aimed to describe objectively and subjectively measured physical activity in a group of South African infants aged 3- to 24-months.

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Publication: Trop Medicine International Health

Esther Babirekere-Iriso, Maren Johanne Heilskov Rytter, Hanifa Namusoke, Ezekiel Mupere, Kim F. Michaelsen, Ken D. Stark, Lotte Lauritzen, André Briend, Henrik Friis, Søren Brage, Daniel Faurholt-Jepsen

13 December 2017


To assess the level and predictors of physical activity at discharge among children recovering from severe acute malnutrition (SAM).


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Publication: Lancet Diabetes Endocrinology

Jason H Y Wu, Matti Marklund,  Fumiaki Imamura, Nathan Tintle, Andres V Ardisson Korat, Janette de Goede,  Xia Zhou,  Wei-Sin Yang,  Marcia C de Oliveira Otto,  Janine Kröger, Waqas Qureshi,  Jyrki K Virtanen,  Julie K Bassett,  Alexis C Frazier-Wood,  Maria Lankinen,  Rachel A Murphy,  Kalina Rajaobelina,  Liana C Del Gobbo,  Nita G Forouhi,  Robert Luben,  Kay-Tee Khaw, Nick Wareham, Anya Kalsbeek, ,Jenna Veenstra, Juhua Luo,  Frank B Hu,  Hung-Ju Lin,  David S Siscovick,  Heiner Boeing,  Tzu-An Chen,  Brian Steffen,  Lyn M Steffen,  Allison Hodge,  Gudny Eriksdottir,  Albert V Smith,  Vilmunder Gudnason,  Tamara B Harris,  Ingeborg A Brouwer,  Claudine Berr,  Catherine Helmer,  Cecilia Samieri,  Markku Laakso,  Michael Y Tsai,  Graham G Giles,  Tarja Nurmi,  Lynne Wagenknecht, Matthias B Schulze, Rozenn N Lemaitre,  Kuo-Liong Chien,  Sabita S Soedamah-Muthu,  Johanna M Geleijnse,  Qi Sun,  William S Harris,  Lars Lind,  Johan Ärnlöv,  Ulf Riserus, Renata Micha,  Dariush Mozaffarian,  for theCohorts for Heart and Aging Research in Genomic Epidemiology (CHARGE) Fatty Acids and Outcomes Research Consortium (FORCE)

01 December 2017


The metabolic effects of omega-6 polyunsaturated fatty acids (PUFAs) remain contentious, and little evidence is available regarding their potential role in primary prevention of type 2 diabetes. We aimed to assess the associations of linoleic acid and arachidonic acid biomarkers with incident type 2 diabetes.

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Publication: BMC Medicine

Ju-Sheng Zheng, Stephen J. Sharp, Fumiaki Imamura, Albert Koulman, Matthias B. Schulze, Zheng Ye, Jules Griffin, Marcela Guevara, José María Huerta, Janine Kröger, Ivonne Sluijs, Antonio Agudo, Aurelio Barricarte, Heiner Boeing, Sandra Colorado-Yohar, Courtney Dow, Miren Dorronsoro, Pia T. Dinesen, Guy Fagherazzi, Paul W. Franks, Edith J. M. Feskens, Tilman Kühn, Verena Andrea Katzke, Timothy J. Key, Kay-Tee Khaw, Maria Santucci de Magistris, Francesca Romana Mancini, Elena Molina-Portillo, Peter M. Nilsson, Anja Olsen, Kim Overvad, Domenico Palli, Jose Ramón Quirós, Olov Rolandsson, Fulvio Ricceri, Annemieke M. W. Spijkerman, Nadia Slimani, Giovanna Tagliabue, Anne Tjonneland, Rosario Tumino, Yvonne T. van der Schouw, Claudia Langenberg, Elio Riboli, Nita G. Forouhi & Nicholas J. Wareham

17 November 2017


Accumulating evidence suggests that individual circulating saturated fatty acids (SFAs) are heterogeneous in their associations with cardio-metabolic diseases, but evidence about associations of SFAs with metabolic markers of different pathogenic pathways is limited. We aimed to examine the associations between plasma phospholipid SFAs and the metabolic markers of lipid, hepatic, glycaemic and inflammation pathways.

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Publication: PLoS Med

Imamura F, Sharp SJ, Koulman A, Schulze MB, Kroger J, Griffin JL, et al.

11 Oct 2017


Combinations of multiple fatty acids may influence cardiometabolic risk more than single fatty acids. The association of a combination of fatty acids with incident type 2 diabetes (T2D) has not been evaluated.

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Publication: Clinical Nutrition Journal

Laura O’Connor, Fumiaki Imamura, Soren Brage, Simon J. Griffin, Nicholas J. Wareham, Nita G. Forouhi

June 2017


Associations of dietary sugars with metabolic and inflammatory markers may vary according to the source of the sugars. The aim of this study was to examine the association of dietary sugars from different sources [beverages (liquids), foods (solids), extrinsic (free) or intrinsic (non-free)] with metabolic and inflammatory markers.

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Publication: The American Journal of Clinical Nutrition,

Sherly X Li, Fumiaki Imamura, Zheng Ye, Matthias B Schulze, Jusheng Zheng, Eva Ardanaz, Larraitz Arriola, Heiner Boeing, Courtney Dow, Guy Fagherazzi, Paul W Franks, Antonio Agudo, Sara Grioni, Rudolf Kaaks, Verena A Katzke, Timothy J Key, Kay Tee Khaw, Francesca R Mancini, Carmen Navarro, Peter M Nilsson, N Charlotte Onland-Moret, Kim Overvad, Domenico Palli, Salvatore Panico, J Ramón Quirós, Olov Rolandsson, Carlotta Sacerdote, María-José Sánchez, Nadia Slimani, Ivonne Sluijs, Annemieke MW Spijkerman, Anne Tjonneland, Rosario Tumino, Stephen J Sharp, Elio Riboli, Claudia Langenberg, Robert A Scott, Nita G Forouhi, Nicholas J Wareham

7 June 2017


Gene-diet interactions have been reported to contribute to the development of type 2 diabetes (T2D). However, to our knowledge, few examples have been consistently replicated to date.

Researchers aimed to identify existing evidence for gene-macronutrient interactions and T2D and to examine the reported interactions in a large-scale study.

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Publication: Nutrition Journal 

Oonagh Markey, Dafni Vasilopoulou, Kirsty E. Kliem, Albert Koulman, Colette C. Fagan, Keith Summerhill, Laura Y. Wang, Alistair S. Grandison, David J. Humphries, Susan Todd, Kim G. Jackson, David I. Givens & Julie A. Lovegrove

23 May 2017


Dairy products are a major contributor to dietary SFA. Partial replacement of milk SFA with unsaturated fatty acids (FAs) is possible through oleic-acid rich supplementation of the dairy cow diet.

To assess adherence to the intervention of SFA-reduced, MUFA-enriched dairy product consumption in the RESET (REplacement of SaturatEd fat in dairy on Total cholesterol) study using 4-d weighed dietary records, in addition to plasma phospholipid FA (PL-FA) status.


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Publication: PloS one

Doherty A, Jackson D, Hammerla N, Plotz T, Olivier P, Granat MH, et al.

1 February 2017


Physical activity has not been objectively measured in prospective cohorts with sufficiently large numbers to reliably detect associations with multiple health outcomes. Technological advances now make this possible.

Participants were approached by email to wear a wrist-worn accelerometer for seven days that was posted to them. Physical activity information was extracted from 100Hz raw triaxial acceleration data after calibration, removal of gravity and sensor noise, and identification of wear / non-wear episodes.

We report age- and sex-specific wear-time compliance and accelerometer measured physical activity, overall and by hour-of-day, week-weekend day and season.


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Publication: PLoS Med

Lotta L.A, Scott R.A, Sharp S.J, Burgess, S. Luan, J. Tillin, T, et al.

29 November 2016

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Publication: JAMA

Lotta L. A, Sharp S. J, Burgess S, Perry J. R, Stewart, I. D, et al.

4 October 2016

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Publication: Nature

Horikoshi M, Beaumont R. N, Day F. R, Warrington N. M., Kooijman M. N, et al.

13 October 2016

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Publication: Nature

Fuchsberger C, Flannick J, Teslovich T. M, Mahajan A, Agarwala, V, et al.

11 July 2016

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Publication: PLoS Medicine

Forouhi N. G, Imamura F, Sharp, S. J, Koulman A, Schulze, M. B, et al.

19 July 2016

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Publication: Nature Genetics

Day F. R, Helgason H, Chasman D. I, Rose L. M, Loh P. R, et al.

June 2016

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Publication: PLoS Medicine

Conklin A. I, Monsivais P, Khaw K. T, Wareham N. J, and Forouhi N. G.

19 July 2016

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