Publications
143 results found
Parnham JC, Chang K, Rauber F, et al., 2024, The Impact of the Universal Infant Free School Meals Policy on the Ultra-Processed Food Content of Children’s Lunchtime Intake in England and Scotland, European Nutrition Conference, Publisher: MDPI
Morales-Berstein F, Biessy C, Viallon V, et al., 2024, Ultra-processed foods, adiposity and risk of head and neck cancer and oesophageal adenocarcinoma in the European Prospective Investigation into Cancer and Nutrition study: a mediation analysis, European Journal of Nutrition, Vol: 63, Pages: 377-396, ISSN: 0044-264X
Purpose:To investigate the role of adiposity in the associations between ultra-processed food (UPF) consumption and head and neck cancer (HNC) and oesophageal adenocarcinoma (OAC) in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort.Methods:Our study included 450,111 EPIC participants. We used Cox regressions to investigate the associations between the consumption of UPFs and HNC and OAC risk. A mediation analysis was performed to assess the role of body mass index (BMI) and waist-to-hip ratio (WHR) in these associations. In sensitivity analyses, we investigated accidental death as a negative control outcome.Results:During a mean follow-up of 14.13 ± 3.98 years, 910 and 215 participants developed HNC and OAC, respectively. A 10% g/d higher consumption of UPFs was associated with an increased risk of HNC (hazard ratio [HR] = 1.23, 95% confidence interval [CI] 1.14–1.34) and OAC (HR = 1.24, 95% CI 1.05–1.47). WHR mediated 5% (95% CI 3–10%) of the association between the consumption of UPFs and HNC risk, while BMI and WHR, respectively, mediated 13% (95% CI 6–53%) and 15% (95% CI 8–72%) of the association between the consumption of UPFs and OAC risk. UPF consumption was positively associated with accidental death in the negative control analysis.Conclusions:We reaffirmed that higher UPF consumption is associated with greater risk of HNC and OAC in EPIC. The proportion mediated via adiposity was small. Further research is required to investigate other mechanisms that may be at play (if there is indeed any causal effect of UPF consumption on these cancers).
Bijlani C, Vrinten C, Junghans C, et al., 2024, Changes in diet and physical activity following a community-wide pilot intervention to tackle childhood obesity in a deprived inner-London ward, BMC Public Health, Vol: 24, ISSN: 1471-2458
BackgroundLocal authorities in England have an important role in shaping healthy local environments contributing to childhood obesity. This study examined changes in diet and physical activity in primary school children following a three-year, complex, community-based intervention in Golborne ward, the second most deprived ward in London.MethodsThe Go-Golborne intervention aimed to shape the local environment across multiple settings with the engagement of a large number of local government and community stakeholders in a joint approach. Activities focused on six co-created themes to make changes to local environments and reduce sugary snacks and beverage consumption, increase fruit and vegetable intake, promote healthy snacks, increase active play and travel, and reduce screen time. We analysed changes in self-reported diet and physical activity, collected annually between 2016 and 2019, from 1,650 children aged 6–11 years through six local schools, who all received the intervention. We used multilevel, linear and logistic random-slope regression models adjusted for time on study, baseline age, gender, ethnicity, deprivation quintile, school, and baseline weight status.ResultsAfter three years of follow-up, there were reductions in sugar-sweetened beverage consumption (adjusted beta -0·43 occasions/day, 95% CI -0·55 to -0·32), fruit and vegetable consumption (adjusted beta -0.22 portions, 95% CI -0.44 to 0.001) and car travel to and from school (adjusted OR 0·19, 95% CI 0·06 to 0·66), while screen time increased (high versus moderate/low: OR 2·30, 95% CI 1·36 to 3·90). For other behavioural outcomes, there was no statistically significant evidence of changes.ConclusionLocal authorities have substantial powers to make positive changes to the obesogenic environment but programmes remain under-evaluated. Results from the ambitious Go-Golborne intervention demonstrated mixed results in health behaviou
Vrinten C, Parnham JC, Radó MK, et al., 2023, Associations of social media use with smoking and e-cigarettes: a national longitudinal study., Lancet, Vol: 402 Suppl 1
BACKGROUND: Social media use is high among children and young people and might influence health behaviours. We examined social media use and use of tobacco and e-cigarettes in the UK. METHODS: We used data from participants aged 10-25 years from the UK Household Longitudinal Study (January 2015-January 2022). Participants were asked: "On a normal weekday, that is Monday to Friday, how many hours do you spend chatting or interacting with friends through a social website or app like that?". Specific social media platforms were not specified. Responses were none, less than 1 h, 1-3 h, 4-6 h, 7 h or more. Outcomes were current tobacco smoking and e-cigarette use. Generalised Estimating Equation (GEE) logistic regression models investigated associations of social media use with tobacco and e-cigarette use, and fixed effects analyses investigated changes in social media use with uptake of both products. Models included possible confounders such as age, sex, household income, ethnicity (White vs non-White) and use of tobacco or e-cigarettes by others within the home. All participants gave written informed consent. FINDINGS: The analytic sample included 10 808 participants with 27 962 observations (mean age 15·7 years [SD 3·8], 5080 [47%] male, 5728 [53%] female, and 7868 [73%] White). Current tobacco smoking was reported at one or more timepoints by 929 (8·6%) participants, and current e-cigarette use by 270 (2·5%) participants. In adjusted GEE models, all levels of social media use were associated with greater odds of current smoking than no use. This association was particularly apparent at higher levels of use adjusted odds ratio [aOR] 3·11, 95% CI 2·41-4·03 for ≥7 h use vs no use), with similar associations for e-cigarettes (aOR 3·04, 2·11-4·40 for ≥7 h use vs no use). Fixed effects analyses also found increased use of social media to be associated with increased uptake of both produc
Abu Hamad B, Jamaluddine Z, Safadi G, et al., 2023, The hypertension cascade of care in the midst of conflict: the case of the Gaza Strip, Journal of Human Hypertension, Vol: 37, Pages: 957-968, ISSN: 0950-9240
Although hypertension constitutes a substantial burden in conflict-affected areas, little is known about its prevalence, control, and management in Gaza. This study aims to estimate the prevalence and correlates of hypertension, its diagnosis and control among adults in Gaza. We conducted a representative, cross-sectional, anonymous, household survey of 4576 persons older than 40 years in Gaza in mid-2020. Data were collected through face-to-face interviews, anthropometric, and blood pressure measurements. Hypertension was defined in anyone with an average systolic blood pressure ≥140 mmHg or average diastolic blood pressure ≥90 mmHg from two consecutive readings or a hypertension diagnosis. The mean age of participants was 56.9 ± 10.5 years, 54.0% were female and 68.5% were Palestinian refugees. The prevalence of hypertension was 56.5%, of whom 71.5% had been diagnosed. Hypertension was significantly higher among older participants, refugees, ex-smokers, those who were overweight or obese, and had other co-morbidities including mental illnesses. Two-thirds (68.3%) of those with hypertension were on treatment with one in three (35.6%) having their hypertension controlled. Having controlled hypertension was significantly higher in females, those receiving all medications for high blood pressure and those who never or rarely added salt to food. Investing in comprehensive but cost-effective initiatives that strengthen the prevention, early detection and timely treatment of hypertension in conflict settings is critical. It is essential to better understand the underlying barriers behind the lack of control and develop multi-sectoral programs to address these barriers.
McKevitt S, White M, Petticrew M, et al., 2023, Characterizing restrictions on commercial advertising and sponsorship of harmful commodities in local government policies: a nationwide study in England, JOURNAL OF PUBLIC HEALTH, ISSN: 1741-3842
Lai HTM, Chang K, Sharabiani MTA, et al., 2023, Twenty-year trajectories of cardio-metabolic factors among people with type 2 diabetes by dementia status in England: a retrospective cohort study, European Journal of Epidemiology, Vol: 38, Pages: 733-744, ISSN: 0393-2990
To assess 20-year retrospective trajectories of cardio-metabolic factors preceding dementia diagnosis among people with type 2 diabetes (T2D). We identified 227,145 people with T2D aged > 42 years between 1999 and 2018. Annual mean levels of eight routinely measured cardio-metabolic factors were extracted from the Clinical Practice Research Datalink. Multivariable multilevel piecewise and non-piecewise growth curve models assessed retrospective trajectories of cardio-metabolic factors by dementia status from up to 19 years preceding dementia diagnosis (dementia) or last contact with healthcare (no dementia). 23,546 patients developed dementia; mean (SD) follow-up was 10.0 (5.8) years. In the dementia group, mean systolic blood pressure increased 16-19 years before dementia diagnosis compared with patients without dementia, but declined more steeply from 16 years before diagnosis, while diastolic blood pressure generally declined at similar rates. Mean body mass index followed a steeper non-linear decline from 11 years before diagnosis in the dementia group. Mean blood lipid levels (total cholesterol, LDL, HDL) and glycaemic measures (fasting plasma glucose and HbA1c) were generally higher in the dementia group compared with those without dementia and followed similar patterns of change. However, absolute group differences were small. Differences in levels of cardio-metabolic factors were observed up to two decades prior to dementia diagnosis. Our findings suggest that a long follow-up is crucial to minimise reverse causation arising from changes in cardio-metabolic factors during preclinical dementia. Future investigations which address associations between cardiometabolic factors and dementia should account for potential non-linear relationships and consider the timeframe when measurements are taken.
Kliemann N, Rauber F, Levy R, et al., 2023, Food processing and cancer risk in Europe: results from the prospective EPIC cohort study, The Lancet Planetary Health, Vol: 7, Pages: E219-E232, ISSN: 2542-5196
BackgroundFood processing has been hypothesised to play a role in cancer development; however, data from large-scale epidemiological studies are scarce. This study investigated the association between dietary intake according to amount of food processing and risk of cancer at 25 anatomical sites using data from the European Prospective Investigation into Cancer and Nutrition (EPIC) study.MethodsThis study used data from the prospective EPIC cohort study, which recruited participants between March 18, 1991, and July 2, 2001, from 23 centres in ten European countries. Participant eligibility within each cohort was based on geographical or administrative boundaries. Participants were excluded if they had a cancer diagnosis before recruitment, had missing information for the NOVA food processing classification, or were within the top and bottom 1% for ratio of energy intake to energy requirement. Validated dietary questionnaires were used to obtain information on food and drink consumption. Participants with cancer were identified using cancer registries or during follow-up from a combination of sources, including cancer and pathology centres, health insurance records, and active follow-up of participants. We performed a substitution analysis to assess the effect of replacing 10% of processed foods and ultra-processed foods with 10% of minimally processed foods on cancer risk at 25 anatomical sites using Cox proportional hazard models.Findings521 324 participants were recruited into EPIC, and 450 111 were included in this analysis (318 686 [70·8%] participants were female individuals and 131 425 [29·2%] were male individuals). In a multivariate model adjusted for sex, smoking, education, physical activity, height, and diabetes, a substitution of 10% of processed foods with an equal amount of minimally processed foods was associated with reduced risk of overall cancer (hazard ratio 0·96, 95% CI 0·95–0·9
Parnham JC, McKevitt S, Vamos EP, et al., 2023, Evidence use in the UK's COVID-19 free school meals policy: a thematic content analysis, Policy Design and Practice, Vol: 6, Pages: 328-343, ISSN: 2574-1292
Free school meals (FSM) are a well-recognized intervention for tackling food insecurity among school children. National school closures during the COVID-19 pandemic meant that there was a need to rapidly adapt the delivery of FSM. A range of food-assistance policies were implemented, but it is not clear if they were evidence-based. This study aimed to determine the transparency of evidence use and identify other competing influences in the UK’s FSM policy decisions. Thematic content analysis was used to review 50 publicly available policy documents and debate transcripts on FSM policy published between March 2020 and 2021. This period covered the first national school closures (March 2020–July 2020), school holidays, and the second national school closures (January 2021–March 2021). The Evidence Transparency Framework (ETF) was used to assess the transparency of evidence use in policy documents. We found that overall transparency of evidence use was poor but was better for the Holiday Activities and Food (HAF) program. The Government showed preference for replacing FSM with food parcels, rather than more agentic modes of food assistance, such as cash-vouchers. This preference appeared to be closely aligned with ideological views on the welfare state. With an absence of evidence, value-based reasoning took precedent and was polarized by social media. This article highlights the need for a formal review into FSM, one which includes a comparison of low and high agentic food assistance policies. Such a review would address the evidence gap, improve food assistance policy, and aid policymakers in future periods of uncertainty.
Chang C-M, Gunter M, Rauber F, et al., 2023, Ultra-processed food consumption, cancer risk and cancer mortality: a large-scale prospective analysis within the UK Biobank, EClinicalMedicine, Vol: 56, Pages: 1-12, ISSN: 2589-5370
BackgroundGlobal dietary patterns are increasingly dominated by relatively cheap, highly palatable, and ready-to-eat ultra-processed foods (UPFs). However, prospective evidence is limited on cancer development and mortality in relation to UPF consumption. This study examines associations between UPF consumption and risk of cancer and associated mortality for 34 site-specific cancers in a large cohort of British adults.MethodsThis study included a prospective cohort of UK Biobank participants (aged 40–69 years) who completed 24-h dietary recalls between 2009 and 2012 (N = 197426, 54.6% women) and were followed up until Jan 31, 2021. Food items consumed were categorised according to their degree of food processing using the NOVA food classification system. Individuals’ UPF consumption was expressed as a percentage of total food intake (g/day). Prospective associations were assessed using multivariable Cox proportional hazards models adjusted for baseline socio-demographic characteristics, smoking status, physical activity, body mass index, alcohol and total energy intake.FindingsThe mean UPF consumption was 22.9% (SD 13.3%) in the total diet. During a median follow-up time of 9.8 years, 15,921 individuals developed cancer and 4009 cancer-related deaths occurred. Every 10 percentage points increment in UPF consumption was associated with an increased incidence of overall (hazard ratio, 1.02; 95% CI, 1.01–1.04) and specifically ovarian (1.19; 1.08–1.30) cancer. Furthermore, every 10 percentage points increment in UPF consumption was associated with an increased risk of overall (1.06; 1.03–1.09), ovarian (1.30; 1.13–1.50), and breast (1.16; 1.02–1.32) cancer-related mortality.InterpretationOur UK-based cohort study suggests that higher UPF consumption may be linked to an increased burden and mortality for overall and certain site-specific cancers especially ovarian cancer in women.FundingThe Cancer Research UK and World Cancer Re
Chang K, Gunter MJ, Rauber F, et al., 2023, Ultra-processed food consumption, cancer risk and cancer mortality: a large-scale prospective analysis within the UK Biobank, ECLINICALMEDICINE, Vol: 56, Pages: 1-12
McKevitt S, White M, Petticrew M, et al., 2023, Typology of how ‘harmful commodity industries’ interact with local governments in England: a critical interpretive synthesis, BMJ Global Health, Vol: 8, Pages: 1-13, ISSN: 2059-7908
Introduction Industries that produce and market potentially harmful commodities or services (eg, tobacco, alcohol, gambling, less healthy foods and beverages) are a major influence on the drivers of behavioural risk factors for non-communicable diseases. The nature and impact of interactions between public bodies and ‘harmful commodity industries’ (HCIs) has been widely recognised and discussed at national and international levels, but to date little is known about such interactions at local or regional government levels. This study aimed to identify and characterise actual and potential interactions and proposes a typology of interactions between HCIs and English local authorities (LAs).Methods Five electronic databases covering international literature (PubMed, EBSCO, OVID, Scopus and Web of Science) were searched up to June 2021. We also performed online searches for publicly available, web-based grey literature and documented examples of interactions in an English LA context. We conducted a critical interpretive synthesis of the published and grey literature to integrate and conceptualise the data in the context of English LAs.Results We included 47 published papers to provide the frame for the typology, which was refined and contextualised for English LAs through the available grey literature. Three categories were developed, describing the medium through which interactions occur: (1) direct involvement with LAs, (2) involvement through intermediaries and (3) involvement through the local knowledge space. Within these, we grouped interactions into 10 themes defining their nature and identified illustrative examples.Conclusion Our typology identifies complex inter-relationships and characterises interactions between HCIs and LAs, with illustrative examples from English LAs. Drawn from well-established theories and frameworks in combination with contextual information on English LAs, this typology explores the LA perspective and could help local decis
Levy R, da Costa Louzada ML, Chang K, et al., 2023, ULTRA-PROCESSED FOODS VS. ANIMAL-BASED DIETARY PATTERNS AND CARDIOVASCULAR-RELATED MORTALITY, Archivos Latinoamericanos de Nutricion, Vol: 73, ISSN: 0004-0622
Introduction and Objective: Both ultra-processed foods (UPF) and animal-based foods have been associated with cardiovascular disease in some studies. Our study aims to examine the prospective association of two dietary factors (UPF and animal-based foods), adjusted for each other, with cardiovascular-related mortality using the UK Biobank cohort. Methods: Participants of the UK Biobank from England, Scotland, and Wales with at least two 24-h dietary recall completed between 2009 and 2012 were included. The exposure of interest was 2 dietary factors: 1) proportion of dietary energy from UPF and 2) proportion of dietary energy from animal-based foods (red meat, poultry/fish, and eggs/ dairy). The main outcome was cardiovascular-cause mortality, identified through data linkage to mortality registries. Prospective association was assessed using multivariable Cox proportional hazards models adjusted for baseline sociodemographic and lifestyle characteristics. Results: Among 126,639 participants followed for a mean of 9.2 years, there were 1,327 cardiovascular deaths. In mutually adjusted models o f both dietary factors (UPF and animal-based foods), the hazard ratio for the 5th compared with the 1st quintile of the proportion of dietary energy from UPF was 1.47 (95% Cl: 1.22,1.76, comparing 41.5% w ith 9.4% dietary energy), whereas for animal-based food intake (meats, dairy, eggs) it was 1.10 (95% Cl: 0.93,1.32, comparing 45.3% with 16.8% dietary energy). There was no evidence of interaction (P = 0.51). Among animalbased foods, none of the subgroups was associated with CVD mortality. Conclusion: Greater consumption of UPF was associated with higher cardiovascular-cause mortality in this UK population. The total of animal-based food consumption (meat, dairy, eggs) was not associated with cardiovascular mortality, neither red meat intake. These findings suggest th at the proportion of UPF in the diet maybe more important with respect to cardiovascular mortality than the pro
Parnham J, Millett C, Vamos E, 2023, School meals in the UK: ultra-processed, unequal, and inadequate, Public Health Nutrition, Vol: 26, Pages: 297-301, ISSN: 1368-9800
Recent research paints an alarming picture of the school food system in the UK. This commentary discusses the issues that undermine healthy school meals and considers the actions required to ensure the school food system can meet the challenges ahead.
Handakas E, Chang K, Khandpur N, et al., 2022, Metabolic profiles of ultra-processed food consumption and their role in obesity risk in British children, Clinical Nutrition, Vol: 41, Pages: 2537-2548, ISSN: 0261-5614
Background & aimsHigher consumption of ultra-processed foods (UPF) has been associated with childhood obesity, but underlying mechanisms remain unclear. We investigated plasma nuclear magnetic resonance metabolic profiles of higher UPF consumption and their role in obesity risk in the British ALSPAC cohort.MethodsWe performed cross-sectional and prospective metabolome wide association analyses of UPF, calculated from food diaries using the NOVA classification. In cross-sectional analysis, we tested the association between UPF consumption and metabolic profile at 7 years (N = 4528), and in the prospective analysis we tested the association between UPF consumption at 13 years and metabolic profile at 17 years (N = 3086). Effects of UPF-associated metabolites at 7 years on subsequent fat mass accumulation were assessed using growth curve models.ResultsAt 7 years, UPF was associated with 115 metabolic traits including lower levels of branched-chain and aromatic amino acids and higher levels of citrate, glutamine, and monounsaturated fatty acids, which were also associated with greater fat mass accumulation. Reported intake of nutrients mediated associations with most metabolites, except for citrate.ConclusionsUPF consumption among British children is associated with perturbation of multiple metabolic traits, many of which contribute to child obesity risk.
Parnham JC, Chang K, Rauber F, et al., 2022, The ultra-processed food content of school meals and packed lunches in the UK, 2008-17: a pooled cross-sectional study.
BACKGROUND: British children have the highest ultra-processed food (UPF) intake in Europe, concerning as UPF is linked to adverse health outcomes. Schools are a potential setting for intervention, yet the rate of UPFs consumed at schools is currently unknown. This study aimed to describe the UPF content of school food in the UK and to explore differences in UPF content by meal type (school meals and packed lunches [food from home]) and children's household income. METHODS: We performed a pooled cross-sectional analysis of 1895 primary school children (aged 4-11 years) and 1408 secondary school children (aged 11-18 years) using data from the UK's National Diet and Nutrition Survey (from Feb, 2008, to June, 2017). Student's meal type was recorded using food diaries. UPF intake was defined using the NOVA food classification system. Income was measured through interview. We used quantile regression models to assess the association between meal type and lunchtime UPF intake (by both the percentage of calories and weight). We stratified models by school phase (primary or secondary) and interacted meal type with income. FINDINGS: The majority of schoolchildren's lunch was defined as UPFs, with secondary school children having higher median intakes of UPFs than primary school children (78% kcal [IQR 58-95] vs 73% kcal [55-86). School meals were associated with a lower median UPF intake than packed lunches for primary school children (61% kcal [IQR 44-75] vs 81% kcal [71-91]) and for secondary school children (70% kcal [IQR 48-89] vs 84% kcal [65-99]). Results were similar when UPFs were analysed as a percentage of the total weight of lunch. Overall, income was inversely associated with UPF lunch content. However, in primary school children, there was no significant association between percentage of UPF content of school meals by weight. INTERPRETATION: In the first nationally representative study, we showed that UK school children have a high intake of UPFs at lunch. UPF in
Parnham JC, Vamos EP, McKevitt S, et al., 2022, The UK's Free School Meals policy during the pandemic: a thematic content analysis of policy documents and debates., Lancet, Vol: 400 Suppl 1
BACKGROUND: A Free School Meals (FSM) policy is a well recognised intervention for tackling food insecurity among children (up to the age 18 years) whose parents receive state benefits. National school closures during the COVID-19 pandemic resulted in the need to rapidly adapt the delivery of FSM to protect the most disadvantaged children in the UK from increased food insecurity. A range of food assistance policies were implemented, but whether they were evidence-based is unclear. The aim of study was to establish the transparency of evidence use behind FSM policy decisions in the UK during the COVID-19 pandemic and to identify other factors influencing decision making. METHODS: We used thematic content analysis to analyse publicly available policy documents and parliamentary debate transcripts relating to FSM published in the first year of the COVID-19 pandemic in the UK (March, 2020, to March, 2021). This period covered the first national school closures (March, 2020, to July, 2020), all school holidays, and the second national school closures (January, 2021, to March, 2021). The evidence transparency framework was used to evaluate transparency of evidence-use in policy decisions. FINDINGS: We analysed 50 documents and debates. Overall transparency of evidence-use was low, but more evident for the Holiday Activities and Food programme than for the FSM programme. Replacing FSM with food parcels was favoured by the UK Government over more agentic modes of food assistance, such as cash vouchers. This preference seemingly aligned with politicians' ideological views on the welfare state, influenced by social media, as assessed from the analysis of available policy documents and parliamentary debate transcripts. Other influences on decision making included policy delivery and responding to increased public attention. INTERPRETATION: Evidence use behind the deployment of FSM was not transparent. Overall, value-based reasoning took precedent over evidence and was polarise
Chang K, Millett C, Rauber F, et al., 2022, Ultra-processed food consumption, cancer risk, and cancer mortality: a prospective cohort study of the UK Biobank, Annual National Conference on Public Health Science dedicated to New Research in UK Public Health, Publisher: ELSEVIER SCIENCE INC, Pages: 31-31, ISSN: 0140-6736
Parnham JC, Vamos EP, McKevitt S, et al., 2022, The UK's Free School Meals policy during the pandemic: a thematic content analysis of policy documents and debates., Lancet, Vol: 400 Suppl 1
BACKGROUND: A Free School Meals (FSM) policy is a well recognised intervention for tackling food insecurity among children (up to the age 18 years) whose parents receive state benefits. National school closures during the COVID-19 pandemic resulted in the need to rapidly adapt the delivery of FSM to protect the most disadvantaged children in the UK from increased food insecurity. A range of food assistance policies were implemented, but whether they were evidence-based is unclear. The aim of study was to establish the transparency of evidence use behind FSM policy decisions in the UK during the COVID-19 pandemic and to identify other factors influencing decision making. METHODS: We used thematic content analysis to analyse publicly available policy documents and parliamentary debate transcripts relating to FSM published in the first year of the COVID-19 pandemic in the UK (March, 2020, to March, 2021). This period covered the first national school closures (March, 2020, to July, 2020), all school holidays, and the second national school closures (January, 2021, to March, 2021). The evidence transparency framework was used to evaluate transparency of evidence-use in policy decisions. FINDINGS: We analysed 50 documents and debates. Overall transparency of evidence-use was low, but more evident for the Holiday Activities and Food programme than for the FSM programme. Replacing FSM with food parcels was favoured by the UK Government over more agentic modes of food assistance, such as cash vouchers. This preference seemingly aligned with politicians' ideological views on the welfare state, influenced by social media, as assessed from the analysis of available policy documents and parliamentary debate transcripts. Other influences on decision making included policy delivery and responding to increased public attention. INTERPRETATION: Evidence use behind the deployment of FSM was not transparent. Overall, value-based reasoning took precedent over evidence and was polarise
Bijlani C, Vrinten C, Chang K, et al., 2022, Changes in diet and physical activity after a pilot intervention to tackle childhood obesity in a deprived inner-London community: an observational cohort study., Lancet, Vol: 400 Suppl 1
BACKGROUND: Local authorities in England are uniquely positioned to modify obesogenic local environments contributing to childhood obesity. Evaluating the effects of local authority-led, community-wide approaches is challenging. This study examines changes in diet and physical activity in children aged 6-11 years after a 4-year, complex, community-based, pilot intervention in Golborne, one of the most deprived areas in London. METHODS: The Go-Golborne intervention aimed to shape the local environment by building on local assets, connecting stakeholders in local government and the community, and synchronising existing activities. Activities focused on six themes to make changes to local environments and reduce the consumption of sugary snacks and beverages, increase fruit and vegetable intake, promote healthy snacks, increase active play and travel, and reduce screen time. We analysed changes in self-reported diet and physical activity, collected annually in 2016-19, from children from six local schools. Results were compared with the data collected at baseline. We used multilevel, linear (for dietary outcomes), and logistic (for physical activity) random-slope regression models to examine changes in diet and physical activity by time on study, adjusting for baseline age, sex, ethnicity, deprivation quintile, school, and baseline weight status. Dietary outcomes were calculated by summing the total occasions a participant indicated they ate or drank a certain food or drink (reported as portions per day, expressed as a β coefficient). The physical activity outcomes were developed by creating six binary variables to distinguish those who were most active from those who were least active. FINDINGS: 1650 children (mean age 7·9 years [SD:1·6]; 808 [49%] girls and 842 [51%] boys) were included. After 3 years of follow-up, we noted reductions in sugary beverage consumption (adjusted β -0·43 portions [95% CI -0·55 to -0·32]; p<0
Bijlani C, Vrinten C, Chang K, et al., 2022, Changes in diet and physical activity after a pilot intervention to tackle childhood obesity in a deprived inner-London community: an observational cohort study., The Lancet, Vol: 400, Pages: S22-S22, ISSN: 0140-6736
BACKGROUND: Local authorities in England are uniquely positioned to modify obesogenic local environments contributing to childhood obesity. Evaluating the effects of local authority-led, community-wide approaches is challenging. This study examines changes in diet and physical activity in children aged 6-11 years after a 4-year, complex, community-based, pilot intervention in Golborne, one of the most deprived areas in London. METHODS: The Go-Golborne intervention aimed to shape the local environment by building on local assets, connecting stakeholders in local government and the community, and synchronising existing activities. Activities focused on six themes to make changes to local environments and reduce the consumption of sugary snacks and beverages, increase fruit and vegetable intake, promote healthy snacks, increase active play and travel, and reduce screen time. We analysed changes in self-reported diet and physical activity, collected annually in 2016-19, from children from six local schools. Results were compared with the data collected at baseline. We used multilevel, linear (for dietary outcomes), and logistic (for physical activity) random-slope regression models to examine changes in diet and physical activity by time on study, adjusting for baseline age, sex, ethnicity, deprivation quintile, school, and baseline weight status. Dietary outcomes were calculated by summing the total occasions a participant indicated they ate or drank a certain food or drink (reported as portions per day, expressed as a β coefficient). The physical activity outcomes were developed by creating six binary variables to distinguish those who were most active from those who were least active. FINDINGS: 1650 children (mean age 7·9 years [SD:1·6]; 808 [49%] girls and 842 [51%] boys) were included. After 3 years of follow-up, we noted reductions in sugary beverage consumption (adjusted β -0·43 portions [95% CI -0·55 to -0·32]; p<0
Parnham JC, Vamos EP, McKevitt S, et al., 2022, The UK's Free School Meals policy during the pandemic: a thematic content analysis of policy documents and debates, LANCET, Vol: 400, Pages: 62-62, ISSN: 0140-6736
Chang K, Millett C, Rauber F, et al., 2022, Ultra-processed food consumption, cancer risk, and cancer mortality: a prospective cohort study of the UK Biobank.
BACKGROUND: Dietary patterns worldwide are increasingly displaced by many cheap, highly palatable, and ready-to-eat ultra-processed foods (UPFs). Higher UPF consumption has been linked to increased risk for obesity and cardiometabolic diseases, but prospective evidence is limited on cancer outcomes. This study aimed to examine the association between UPF consumption and risk for overall and site-specific cancer incidence and cancer mortality using the UK Biobank cohort. METHODS: 197 426 participants of the UK Biobank from England, Scotland, and Wales with 24-h dietary recall completed between 2009 and 2012 were included. Incident cancer cases were identified through data linkage to national cancer and mortality registries. Food items consumed were categorised according to their degree of food processing using the NOVA classification system. Individual UPF consumption were derived as a percentage of daily food intake. Prospective association was assessed using multivariable Cox proportional hazards models adjusted for baseline sociodemographic and lifestyle characteristics. For female-specific cancers, menopausal status, use of oral contraceptives, hormone replacement therapy, and parity were additionally adjusted. FINDINGS: Mean age was 58·0 years (SD 8·0); 54·6% of participants were women. During a median follow-up time of 9·8 years (IQR 9·4-10·6), 15 921 (8·1%) of 197 426 individuals developed cancer and 4009 (2·0%) cancer deaths were encountered. Consumption of UPFs was associated with a higher incidence of overall cancer (hazard ratio per 10% increment in UPF consumption was 1·02 [95% CI 1·01-1·04]; p=0·005) and ovarian cancer in females (1·19 [1·08-1·30]; p<0·001). Positive associations were identified for mortality of overall, breast, and ovarian cancers. INTERPRETATION: This large UK cohort study presents evidence of positive associations between
Parnham JC, Chang K, Rauber F, et al., 2022, The ultra-processed food content of school meals and packed lunches in the UK, 2008-17: a pooled cross-sectional study, Annual National Conference on Public Health Science dedicated to New Research in UK Public Health, Publisher: ELSEVIER SCIENCE INC, Pages: 12-12, ISSN: 0140-6736
Parnham JC, Chang K, Rauber F, et al., 2022, The ultra-processed food content of school meals and packed lunches in the United Kingdom (2008-2017), 15th European Public Health Conference Strengthening health systems, Publisher: Oxford University Press, ISSN: 1101-1262
Laverty A, Jenkins R, Millett C, et al., 2022, Local area public sector spending and nutritional anaemia hospital admissions in England: a longitudinal ecological study, BMJ Open, Vol: 12, Pages: 1-14, ISSN: 2044-6055
Introduction: Reductions in local government spending may have impacts on diets and health which increase the risk of hospital admissions for nutritional anaemias. Mechanisms include potential impacts of changes to local authority (LA) services (e.g. housing services) on personal resources and food access, availability, and provision. We therefore investigated the association between changes in LA spending and nutritional anaemia related hospital admissions. Specifically we address whether greater cuts to LA spending were linked to increased hospital admissions for nutritional anaemia.Design: Longitudinal analysis of LA panel data using Poisson fixed effects regression models.Setting: 312 LAs in England (2005-2018). Main exposure: Total LA service expenditure per capita per year.Main outcome: Principal and total nutritional anaemia hospital admissions, for all ages and stratified by age (0-14, 15-64, 65+). Results: LA service expenditure increased by 9% between 2005 and 2009 then decreased by 20% between 2010 and 2018. Total nutritional anaemia hospital admissions increased between 2005 and 2018 from 173 to 633 admissions per 100,000 population. A £100 higher LA service spending was associated with a 1.9% decrease in total nutritional anaemia hospital admissions (adjusted Incidence Rate Ratio: 0.98, 95% CI 0.96 to 0.99). When stratified by age, this was seen only in adults. A £100 higher LA service spending was associated with a 2.6% decrease in total nutritional anaemia hospital admissions in the most deprived LAs (aIRR: 0.97, 95% CI: 0.95 to 1.0). Conclusion: Increased LA spending was associated with reduced hospital admissions for nutritional anaemia. Austerity related reductions had the opposite effect, increasing admissions, with greater impacts in more deprived areas. This adds further evidence to the potential negative impacts of austerity policies on health and health inequalities. Re-investing in LA services may prevent hospital admissions assoc
Vamos EP, Lai H, Sharabiani M, et al., 2022, Cardio-metabolic factors and risk of dementia in people with type 2 diabetes in England: a large retrospective cohort study, DUK, Publisher: SPRINGER, Pages: S402-S403, ISSN: 0012-186X
Lai H, Sharma A, Chang K, et al., 2022, COMPARISON OF SEX-SPECIFIC HISTORICAL CARDIOMETABOLIC TRAJECTORIES IN T2D PATIENTS BY DEMENTIA STATUS IN ENGLAND, DUK, Publisher: BMJ PUBLISHING GROUP, Pages: A1-A2, ISSN: 0143-005X
Parnham J, Chang C-M, Rauber F, et al., 2022, The ultra-processed food content of school meals and packed lunches in the United Kingdom, Nutrients, Vol: 14, Pages: 1-14, ISSN: 2072-6643
British children have the highest levels of ultra-processed food (UPF) consumption in Europe. Schools are posited as a positive setting for impacting dietary intake but the level of UPFs consumed at schools is currently unknown. This study determined the UPF content of school food in the UK. We conducted a pooled cross-sectional analysis of primary (4-11 years, n=1,895) and secondary schoolchildren (11-18 years, n=1,408) from the UK’s National Diet and Nutrition Survey (2008-2017). Multivariable quantile regression models determined the association between meal-type (school meal or packed lunch) and lunchtime UPF intake (NOVA food classification system). We showed that on average UPF intake was high in both primary (72.6% total lunch Kcal) and secondary schoolchildren (77.8 % total lunch Kcal). Higher UPF intakes were observed in packed lunch consumers, secondary schoolchildren, and those in lower income households. This study highlights the need for a renewed focus on school food. Better guidance and policies which consider levels of industrial processing in food served in schools is needed to ensure the dual benefit of encouraging school meal uptake and equitably improving children’s diet.
Kliemann N, Al Nahas A, Vamos EP, et al., 2022, Ultra-processed foods and cancer risk: from global food systems to individual exposures and mechanisms, BRITISH JOURNAL OF CANCER, Vol: 127, Pages: 14-20, ISSN: 0007-0920
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