Publications
135 results found
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
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, Pages: 1-12, 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.
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
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
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.
Abu Hamad B, Jamaluddine Z, Safadi G, et al., 2022, The hypertension cascade of care in the midst of conflict: the case of the Gaza Strip, Journal of Human Hypertension, 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.
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, LANCET, Vol: 400, Pages: 31-31, 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 UK, 2008-17: a pooled cross-sectional study, LANCET, Vol: 400, Pages: 12-12, ISSN: 0140-6736
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.
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., Lancet, Vol: 400 Suppl 1
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
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
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., Lancet, Vol: 400 Suppl 1
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
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., 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 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
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), Publisher: OXFORD UNIV 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
Parnham JC, McKevitt S, Vamos EP, et al., 2022, Evidence use in the UK's COVID-19 free school meals policy: a thematic content analysis, Policy Design and Practice, 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.
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.
Jenkins RH, Vamos EP, Taylor-Robinson D, et al., 2022, Changes to local area public sector spending and food purchasing in England: a longitudinal ecological study, BMJ Nutrition, Prevention & Health, Vol: 5, Pages: 72-86, ISSN: 2516-5542
Objectives: Changes in public sector service spending may influence food consumption. We make use of changing local authority (LA) expenditure in England to assess impacts on food purchasing. We examine total LA service spending and explore two potential pathways: highways and transport spending which may affect access to food; and housing service expenditure which may affect household resources available to purchase foods. Design: Longitudinal panel survey at the LA level (2008-2015) using fixed effects linear regression. Setting: 324 LAs in England. Main exposure: Expenditure per capita on total LA services, highways and transport services, and housing services. Main outcome measures: LA area estimates of purchasing of fresh fruits and vegetables, high in fat, sugar and salt (HFSS) foods, and takeaways at home, expressed as a percentage of total food and drink expenditure. Results: Total LA service spending decreased by 17% on average between 2008 and 2015. A 10% decrease in total LA spending was associated with a 0.071 percentage point decrease in HFSS (95% CI -0.093 to -0.050) and a 0.015 percentage point increase in takeaways (95% CI 0.006 to 0.024). A 10% decrease in highways and transport expenditure was associated with a 0.006 percentage point decrease in fruit and vegetable purchasing (95% CI -0.009 to -0.002) and a 0.006 percentage point increase in takeaway purchasing (95% CI 0.001 to 0.010). These associations were seen in urban areas only when analyses were stratified by rural/urban area status. A 0.006 percentage point decrease in HFSS purchasing was also seen with a 10% decrease in housing expenditure (95% CI -0.010 to -0.002). Conclusion: Changes in LA spending may have impacts on food purchasing which are evident at the area level. This suggests that in addition to more prominent impacts such as foodbank use, austerity measures may have mixed impacts on food purchasing behaviours among the wider population.
Haney E, Parnham JC, Chang K, et al., 2022, Dietary quality of school meals and packed lunches: a national study of primary and secondary schoolchildren in the UK, PUBLIC HEALTH NUTRITION, ISSN: 1368-9800
Parnham JC, Chang K, Millett C, et al., 2022, The impact of the Universal Infant Free School Meal policy on dietary quality in English and Scottish primary school children: evaluation of a natural experiment, Nutrients, Vol: 14, ISSN: 2072-6643
The Universal Infant Free School Meal (UIFSM) policy was introduced in September 2014 in England and January 2015 in Scotland and offered all infant schoolchildren (ages 4-7 years) a free school lunch, regardless of income. Yet, impacts of UIFSM on dietary intakes and or social inequalities are not known. A difference-in-differences study using the National Diet and Nutrition Survey assessed pooled pre-UIFSM (2010-2014) and post-UIFSM (2014-2017) dietary data. English or Scottish infant schoolchildren (4-7 years; N=458) were the intervention group with junior schoolchildren (8-11 years; N=401) as controls. We found that implementation of UIFSM led to an increase in infant schoolchildren having a school meal. Impacts on key food groups such as fruit and vegetables or sweetened beverages were not seen. However, there was evidence that the UIFSM policy lowered consumption of foods associated with packed lunches, such as crisps, and some nutrients, such as total fat and sodium. Policy impacts differed by income group, with larger effect sizes in low-income children. In conclusion, evaluation of UIFSM demonstrated some improvements on dietary quality but the findings suggest school meal quality needs to be improved to fully realise the benefits of UIFSM.
Lai H, Sharma A, Chang K, et al., 2022, Historical cardiometabolic trajectories in T2D patients by dementia status in England by sex, ethnicity, and deprivation, DUK, Publisher: ELSEVIER IRELAND LTD, ISSN: 0168-8227
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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Sharma A, Lai H, Chang K, et al., 2022, A 20-year follow-up of cardiometabolic trajectories amongst individuals with type 2 diabetes before dementia diagnosis by ethnic group, DUK, Publisher: WILEY, ISSN: 0742-3071
Zheng B, Su B, Udeh-Momoh C, et al., 2022, Associations of cardiovascular and non-cardiovascular comorbidities with dementia risk in patients with diabetes: results from a large UK cohort study, JPAD-JOURNAL OF PREVENTION OF ALZHEIMERS DISEASE, Vol: 9, Pages: 86-91, ISSN: 2274-5807
BackgroundType 2 diabetes (T2D) is an established risk factor for dementia. However, it remains unclear whether the presence of comorbidities could further increase dementia risk in diabetes patients.ObjectivesTo examine the associations between cardiovascular and non-cardiovascular comorbidities and dementia risk in T2D patients.DesignPopulation-based cohort study.SettingThe UK Clinical Practice Research Datalink (CPRD).Participants489,205 T2D patients aged over 50 years in the UK CPRD.MeasurementsMajor cardiovascular and non-cardiovascular comorbidities were extracted as time-varying exposure variables. The outcome event was dementia incidence based on dementia diagnosis or dementia-specific drug prescription.ResultsDuring a median of six years follow-up, 33,773 (6.9%) incident dementia cases were observed. Time-varying Cox regressions showed T2D patients with stroke, peripheral vascular disease, atrial fibrillation, heart failure or hypertension were at higher risk of dementia compared to those without such comorbidities (HR [95% CI] = 1.64 [1.59–1.68], 1.37 [1.34–1.41], 1.26 [1.22–1.30], 1.15 [1.11–1.20] or 1.10 [1.03–1.18], respectively). Presence of chronic obstructive pulmonary disease or chronic kidney disease was also associated with increased dementia risk (HR [95% CI] = 1.05 [1.01–1.10] or 1.11 [1.07–1.14]).ConclusionsA range of cardiovascular and non-cardiovascular comorbidities were associated with further increases of dementia risk in T2D patients. Prevention and effective management of these comorbidities may play a significant role in maintaining cognitive health in T2D patients.
Pearson-Stuttard J, Cheng Y, Bennett J, et al., 2022, Trends in leading causes of hospitalisation among adults with diabetes in England from 2003 to 2018: an epidemiological analysis of linked primary care records, The Lancet Diabetes and Endocrinology, Vol: 10, Pages: 46-57, ISSN: 2213-8595
BackgroundDiabetes mellitus (DM) leads to a wide range of established vascular and metabolic complications which has resulted in specific prevention programmes being implemented across high-income countries. DM has been associated with increased risk of a broader set of conditions including cancers, liver disease and common infections. We aimed to examine the trends in a broad set of cause-specific hospitalisations in individuals with DM in England from 2003-2018.MethodsWe identified 309,874 individuals with DM in the Clinical Practice Research Datalink, a well described primary care database, linked to Hospital Episode Statistics inpatient data from 2003-2018. We generated a mixed prevalence and incident DM study population through serial cross sections and follow-up over time. We used a discretised Poisson regression model to estimate annual cause-specific hospitalisation rates in men and women with DM across 17 cause groupings. We generated a 1:1 age and sex matched non-DM population to compare findings. FindingsHospitalisation rates were higher for all causes in persons with DM compared to those without throughout the study period. DM itself and Ischaemic Heart Disease (IHD) were the leading causes of excess hospitalisation in 2003, but by 2018, respiratory conditions, cancers and IHD were the most common causes of excess hospitalisation across men and women. Hospitalisation rates declined in almost all traditional DM complication groupings (IHD, stroke, DM, amputations) whilst generally increasing across broader conditions (cancers, infections, respiratory conditions). These differing trends resulted in a diversification in the cause of hospitalisation, such that the traditional DM complications accounted for more than 50% of hospitalisations in 2003, but only approximately 30% in 2018. In contrast, the portion of hospitalisations that broader conditions accounted for increased including respiratory infections being attributable for 12% of hospitalisations in 2
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