Imperial College London

DrEszterVamos

Faculty of MedicineSchool of Public Health

Clinical Senior Lecturer
 
 
 
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Contact

 

+44 (0)20 7594 7457e.vamos

 
 
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Location

 

321Reynolds BuildingCharing Cross Campus

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Summary

 

Publications

Publication Type
Year
to

121 results found

Abu Hamad B, Jamaluddine Z, Safadi G, Ragi ME, Ahmad RES, Vamos E, Basu S, Yudkin J, Jawad M, Millett C, Ghattas Het al., 2022, The Hypertension Cascade of Care in the Midst of Conflict: The Case of the Gaza Strip, Journal of Human Hypertension

Journal article

Handakas E, Chang K, Khandpur N, Vamos EP, Millett C, Sassi F, Vineis P, Robinson Oet 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

Journal article

Parnham JC, Vamos EP, McKevitt S, Laverty AAet 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

Journal article

Parnham J, Millett C, Vamos E, 2022, School meals in the UK: ultra-processed, unequal, and inadequate, Public Health Nutrition, ISSN: 1368-9800

Journal article

Laverty A, Jenkins R, Millett C, Vamos E, Kate Met 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

Journal article

Vamos EP, Lai H, Sharabiani M, Gregg EW, Valabhji J, Middleton L, Millett C, Majeed A, Bottle A, Chang Ket 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

Conference paper

Parnham JC, McKevitt S, Vamos EP, Laverty AAet 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.

Journal article

Parnham J, Chang C-M, Rauber F, Levy RB, Millett C, Laverty AA, von Hinke S, Vamos EPet 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.

Journal article

Jenkins RH, Vamos EP, Taylor-Robinson D, Mason KE, Laverty AAet 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.

Journal article

Haney E, Parnham JC, Chang K, Laverty AA, von Hinke S, Pearson-Stuttard J, White M, Millett C, Vamos EPet 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

Journal article

Parnham JC, Chang K, Millett C, Laverty A, von Hinke S, Pearson-Stuttard J, de Vocht F, White M, Vamos EPet 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.

Journal article

Lai H, Sharma A, Chang K, Sharabiani M, Bottle A, Jonathan V, Middleton L, Majeed A, Millett C, Vamos Eet 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

Conference paper

Kliemann N, Al Nahas A, Vamos EP, Touvier M, Kesse-Guyot E, Gunter MJ, Millett C, Huybrechts Iet 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

Journal article

Sharma A, Lai H, Chang K, Sharabiani M, Bottle A, Valabhji J, Middleton L, Majeed A, Millett C, Vamos Eet 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

Conference paper

Zheng B, Su B, Udeh-Momoh C, Price G, Tzoulaki I, Vamos EP, Majeed A, Riboli E, Ahmadi-Abhari S, Middleton LTet 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.

Journal article

Pearson-Stuttard J, Cheng Y, Bennett J, Zhou B, Vamos E, Valabhji J, Cross A, Ezzati M, Gregg Eet 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

Journal article

Parnham J, Millett C, Chang K, Laverty A, von Hinke S, Pearson-Stuttard J, Vamos Eet al., 2021, Is the Healthy Start scheme associated with increased food expenditure in low-income families with young children in the United Kingdom?, BMC Public Health, Vol: 21, Pages: 1-11, ISSN: 1471-2458

Introduction: Healthy Start is a food assistance programme in the United Kingdom (UK) which aims to provide a nutritional safety-net and enable low-income families on welfare benefits to access a healthier diet through the provision of food vouchers. Healthy Start was launched in 2006 but remains under-evaluated. This study aims to determine whether participation in the Healthy Start scheme is associated with differences in food expenditure in a nationally representative sample of households in the UK. Methods: Cross-sectional analyses of the Living Costs and Food Survey dataset (2010-2017). All households with a child (0-3 years) or pregnant woman were included in the analysis (n=4,869). Multivariable quantile regression compared the expenditure and quantity of fruit and vegetables (FV), infant formula and total food purchases. Four exposure groups were defined based on eligibility, participation and income (Healthy Start Participating, Eligible Non-participating, Nearly Eligible low-income and Ineligible high-income households).Results: Of 876 eligible households, 54% participated in Healthy Start. No significant differences were found in FV or total food purchases between participating and eligible non-participating households, but infant formula purchases were lower in Healthy Start participating households. Ineligible higher-income households had higher purchases of FV. Conclusion: This study did not find evidence of an association between Healthy Start participation and FV expenditure. Moreover, inequalities in FV purchasing persist in the UK. Higher participation and increased voucher value may be needed to improve programme performance and counteract the harmful effects of poverty on diet.

Journal article

Vamos E, Khunti K, 2021, The indirect effects of the COVID-19 pandemic on people with type 2 diabetes - time to urgently move into a recovery phase, BMJ Quality & Safety, Vol: 7, ISSN: 2044-5415

Journal article

Jenkins RH, Mason KE, Vamos EP, Taylor-Robinson D, Laverty AAet al., 2021, Impacts of local area public sector spending and food purchasing in England: a panel study, Publisher: OXFORD UNIV PRESS, ISSN: 1101-1262

Conference paper

Chang K, Khandpur N, Neri D, Touvier M, Huybrechts I, Millett C, Vamos EPet al., 2021, Childhood consumption of ultra-processed foods and adiposity trajectories: a UK birth cohort study, Publisher: OXFORD UNIV PRESS, ISSN: 1101-1262

Conference paper

Jawad M, Hone T, Vamos EP, Cetorelli V, Millett Cet al., 2021, Implications of armed conflict for maternal and child health: A regression analysis of data from 181 countries for 2000-2019, PLoS Medicine, Vol: 18, ISSN: 1549-1277

BACKGROUND: Armed conflicts have major indirect health impacts in addition to the direct harms from violence. They create enduring political instability, destabilise health systems, and foster negative socioeconomic and environmental conditions-all of which constrain efforts to reduce maternal and child mortality. The detrimental impacts of conflict on global maternal and child health are not robustly quantified. This study assesses the association between conflict and maternal and child health globally. METHODS AND FINDINGS: Data for 181 countries (2000-2019) from the Uppsala Conflict Data Program and World Bank were analysed using panel regression models. Primary outcomes were maternal, under-5, infant, and neonatal mortality rates. Secondary outcomes were delivery by a skilled birth attendant and diphtheria, pertussis, and tetanus (DPT) and measles vaccination coverage. Models were adjusted for 10 confounders, country and year fixed effects, and conflict lagged by 1 year. Further lagged associations up to 10 years post-conflict were tested. The number of excess deaths due to conflict was estimated. Out of 3,718 country-year observations, 522 (14.0%) had minor conflicts and 148 (4.0%) had wars. In adjusted models, conflicts classified as wars were associated with an increase in maternal mortality of 36.9 maternal deaths per 100,000 live births (95% CI 1.9-72.0; 0.3 million excess deaths [95% CI 0.2 million-0.4 million] over the study period), an increase in infant mortality of 2.8 per 1,000 live births (95% CI 0.1-5.5; 2.0 million excess deaths [95% CI 1.6 million-2.5 million]), a decrease in DPT vaccination coverage of 4.9% (95% CI 1.5%-8.3%), and a decrease in measles vaccination coverage of 7.3% (95% CI 2.7%-11.8%). The long-term impacts of war were demonstrated by associated increases in maternal mortality observed for up to 7 years, in under-5 mortality for 3-5 years, in infant mortality for up to 8 years, in DPT vaccination coverage for up to 3 years, and in

Journal article

Misra S, Barron E, Vamos E, Thomas S, Dhatariya K, Kar P, Young B, Khunti K, Valabhji Jet al., 2021, Temporal trends in emergency admissions for diabetic ketoacidosis in people with diabetes in England before and during the COVID-19 pandemic: a population-based study, The Lancet Diabetes and Endocrinology, ISSN: 2213-8595

BACKGROUND: Diabetic ketoacidosis (DKA) has been reported to be increasing in frequency during the COVID-19 pandemic. We aimed to examine the rates of DKA hospital admissions and the patient demographics associated with DKA during the pandemic compared with in prepandemic years. METHODS: Using a comprehensive, multiethnic, national dataset, the Secondary Uses Service repository, we extracted all emergency hospital admissions in England coded with DKA from March 1 to June 30, 2020 (first wave of the pandemic), July 1 to Oct 31, 2020 (post-first wave), and Nov 1, 2020, to Feb 28, 2021 (second wave), and compared these with DKA admissions in the equivalent periods in 2017-20. We also examined baseline characteristics, mortality, and trends in patients who were admitted with DKA. FINDINGS: There were 8553 admissions coded with DKA during the first wave, 8729 during the post-first wave, and 10 235 during the second wave. Compared with preceding years, DKA admissions were 6% (95% CI 4-9; p<0·0001) higher in the first wave of the pandemic (from n=8048), 6% (3-8; p<0·0001) higher in the post-first wave (from n=8260), and 7% (4-9; p<0·0001) higher in the second wave (from n=9610). In the first wave, DKA admissions reduced by 19% (95% CI 16-21) in those with pre-existing type 1 diabetes (from n=4965 to n=4041), increased by 41% (35-47) in those with pre-existing type 2 diabetes (from n=2010 to n=2831), and increased by 57% (48-66) in those with newly diagnosed diabetes (from n=1072 to n=1681). Compared with prepandemic, type 2 diabetes DKA admissions were similarly common in older individuals and men but were higher in those of non-White ethnicities during the first wave. The increase in newly diagnosed DKA admissions occurred across all age groups and these were significantly increased in men and people of non-White ethnicities. In the post-first wave, DKA admissions did not return to the baseline level of previous years; DKA admissions w

Journal article

Lai H, Chang K, Sharabiani M, Valabhji J, Middleton L, Majeed A, Millett C, Bottle A, Vamos Eet al., 2021, 19-YEAR TRAJECTORIES OF CARDIO-METABOLIC FACTORS AMONG PATIENTS WITH TYPE 2 DIABETES BY DEMENTIA STATUS IN ENGLAND, EDC, Publisher: BMJ PUBLISHING GROUP, Pages: A12-A12, ISSN: 0143-005X

Conference paper

Chang K, Khandpur N, Neri D, Touvier M, Huybrechts I, Millett C, Vamos Eet al., 2021, CHILDHOOD CONSUMPTION OF ULTRA-PROCESSED FOODS AND LONG-TERM ADIPOSITY TRAJECTORIES: FINDINGS FROM A UK BIRTH COHORT STUDY, Publisher: BMJ PUBLISHING GROUP, Pages: A17-A18, ISSN: 0143-005X

Conference paper

Chang K, Khandpur N, Neri D, Touvier M, Huybrechts I, Millett C, Vamos Eet al., 2021, Association between childhood consumption of ultraprocessed food and adiposity trajectories in the Avon Longitudinal Study of Parents and Children birth cohort, JAMA Pediatrics, Vol: 175, ISSN: 2168-6211

Importance Reports of associations between higher consumption of ultraprocessed foods (UPF) and elevated risks of obesity, noncommunicable diseases, and mortality in adults are increasing. However, associations of UPF consumption with long-term adiposity trajectories have never been investigated in children.Objective To assess longitudinal associations between UPF consumption and adiposity trajectories from childhood to early adulthood.Design, Setting, and Participants This prospective birth cohort study included children who participated in the Avon Longitudinal Study of Parents and Children (ALSPAC) in Avon County, southwest England. Children were followed up from 7 to 24 years of age during the study period from September 1, 1998, to October 31, 2017. Data were analyzed from March 1, 2020, to January 31, 2021.Exposures Baseline dietary intake data were collected using 3-day food diaries. Consumption of UPF (applying the NOVA food classification system) was computed as a percentage of weight contribution in the total daily food intake for each participant and categorized into quintiles.Main Outcomes and Measures Repeated recordings of objectively assessed anthropometrics (body mass index [BMI; calculated as weight in kilograms divided by height in meters squared], weight, and waist circumference) and dual-energy x-ray absorptiometry measurements (fat and lean mass indexes [calculated as fat and lean mass, respectively, divided by height in meters squared] and body fat percentage). Associations were evaluated using linear growth curve models and were adjusted for study covariates.Results A total of 9025 children (4481 [49.7%] female and 4544 [50.3%] male) were followed up for a median of 10.2 (interquartile range, 5.2-16.4) years. The mean (SD) UPF consumption at baseline was 23.2% (5.0%) in quintile 1, 34.7% (2.5%) in quintile 2, 43.4% (2.5%) in quintile 3, 52.7% (2.8%) in quintile 4, and 67.8% (8.1%) in quintile 5. Among those in the highest quintile of UPF

Journal article

Cordova R, Kliemann N, Huybrechts I, Rauber F, Vamos EP, Levy RB, Wagner K-H, Viallon V, Casagrande C, Nicolas G, Dahm CC, Zhang J, Halkjær J, Tjønneland A, Boutron-Ruault M-C, Mancini FR, Laouali N, Katzke V, Srour B, Jannasch F, Schulze MB, Masala G, Grioni S, Panico S, van der Schouw YT, Derksen JWG, Rylander C, Skeie G, Jakszyn P, Rodriguez-Barranco M, Huerta JM, Barricarte A, Brunkwall L, Ramne S, Bodén S, Perez-Cornago A, Heath AK, Vineis P, Weiderpass E, Monteiro CA, Gunter MJ, Millett C, Freisling Het al., 2021, Consumption of ultra-processed foods associated with weight gain and obesity in adults: A multi-national cohort study, Clinical Nutrition, Vol: 40, Pages: 5079-5088, ISSN: 0261-5614

BackgroundThere is a worldwide shift towards increased consumption of ultra-processed foods (UPF) with concurrent rising prevalence of obesity. We examined the relationship between the consumption of UPF and weight gain and risk of obesity.MethodsThis prospective cohort included 348 748 men and women aged 25–70 years. Participants were recruited between 1992 and 2000 from 9 European countries in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. Two body weight measures were available, at baseline and after a median follow-up time of 5 years. Foods and drinks were assessed at baseline by dietary questionnaires and classified according to their degree of processing using NOVA classification. Multilevel mixed linear regression was used to estimate the association between UPF consumption and body weight change (kg/5 years). To estimate the relative risk of becoming overweight or obese after 5 years we used Poisson regression stratified according to baseline body mass index (BMI).ResultsAfter multivariable adjustment, higher UPF consumption (per 1 SD increment) was positively associated with weight gain (0·12 kg/5 years, 95% CI 0·09 to 0·15). Comparing highest vs. lowest quintile of UPF consumption was associated with a 15% greater risk (95% CI 1·11, 1·19) of becoming overweight or obese in normal weight participants, and with a 16% greater risk (95% CI 1·09, 1·23) of becoming obese in participants who were overweight at baseline.ConclusionsThese results are supportive of public health campaigns to substitute UPF for less processed alternatives for obesity prevention and weight management.

Journal article

Valabhji J, Barron E, Vamos EP, Dhatariya K, Game F, Kar P, Weaver A, Verma S, Young B, Khunti Ket al., 2021, Temporal Trends in Lower-Limb Major and Minor Amputation and Revascularization Procedures in People With Diabetes in England During the COVID-19 Pandemic, DIABETES CARE, Vol: 44, Pages: E133-E135, ISSN: 0149-5992

Journal article

McKay AJ, Gunn LH, Nugawela MD, Sathish T, Majeed A, Vamos E, Molina G, Sivaprasad Set al., 2021, Associations between attainment of incentivized primary care indicators and incident sight-threatening diabetic retinopathy in England: A population-based historical cohort study, Diabetes, Obesity and Metabolism: a journal of pharmacology and therapeutics, Vol: 23, Pages: 1322-1330, ISSN: 1462-8902

AimTo examine the impact of attainment of primary care diabetes clinical indicators on progression to sight‐threatening diabetic retinopathy (STDR) among those with mild non‐proliferative diabetic retinopathy (NPDR).Materials and MethodsAn historical cohort study of 18,978 adults (43.63% female) diagnosed with type 2 diabetes before 1 April 2010 and mild NPDR before 1 April 2011 was conducted. The data were obtained from the UK Clinical Practice Research Datalink during 2010‐2017, provided by 330 primary care practices in England. Exposures included attainment of the Quality and Outcomes Framework HbA1c (≤59 mmol/mol [≤7.5%]), blood pressure (≤140/80 mmHg) and cholesterol (≤5 mmol/L) indicators in the financial year 2010‐2011, as well as the number of National Diabetes Audit processes completed in 2010‐2011. The outcome was time to incident STDR. Nearest neighbour propensity score matching was undertaken, and univariable and multivariable Cox proportional hazards models were then fitted using the matched samples. Concordance statistics were calculated for each model.ResultsA total of 1037 (5.5%) STDR diagnoses were observed over a mean follow‐up of 3.6 (SD 2.0) years. HbA1c, blood pressure and cholesterol indicator attainment were associated with lower rates of STDR (adjusted hazard ratios [95% CI] 0.64 [0.55‐0.74; p < .001], 0.83 [0.72‐0.94; p = .005] and 0.80 [0.66‐0.96; p = .015], respectively).ConclusionsOur findings provide support for meeting appropriate indicators for the management of type 2 diabetes in primary care to bring a range of benefits, including improved health outcomes—such as a reduction in the risk of STDR—for people with type 2 diabetes.

Journal article

Rauber F, Chang K, Vamos E, da Costa Louzada ML, Monteiro C, Millett C, Levy Ret al., 2021, Ultra-processed food consumption and risk of obesity: a prospective cohort study of UK Biobank, European Journal of Nutrition, Vol: 60, Pages: 2169-2180, ISSN: 0044-264X

Objective: To examine the associations between ultra-processed food consumption and risk of obesity among UK adults. Methods: Participants aged 40-69 years at recruitment in the UK Biobank (2006-2019) with dietary intakes collected using 24-hour recall and repeated measures of adiposity - body mass index (BMI), waist circumference (WC) and percentage of body fat (% BF) - were included (N=22,659; median follow-up: 5 years). Ultra-processed foods were identified using the NOVA classification and their consumption was expressed as a percentage of total energy intake. Multivariable Cox proportional hazards regression models were used to estimate hazard ratios (HR) of several indicators of obesity according to ultra-processed food consumption. Models were adjusted for sociodemographic and lifestyle characteristics.Results: 947 incident cases of overall obesity (BMI≥30 kg/m2) and 1,900 incident cases of abdominal obesity (men: WC≥102cm, women: WC≥88cm) were identified during follow-up. Participants in the highest quartile of ultra-processed food consumption had significantly higher risk of developing overall obesity (HR: 1.79; 95%CI: 1.06─3.03) and abdominal obesity (HR: 1.30; 95%CI: 1.14─1.48). They had higher risk of experiencing a ≥5% increase in BMI (HR: 1.31; 95%CI: 1.20─1.43), WC (HR: 1.35; 95%CI: 1.25─1.45) and %BF (HR: 1.14; 95%CI: 1.03─1.25), than those in the lowest quartile of consumption.Conclusions: Our findings provide evidence that higher consumption of ultra-processed food is strongly associated with a higher risk of multiple indicators of obesity in the UK adult population. Policy makers should consider actions that promote consumption of fresh or minimally processed foods and reduce consumption of ultra-processed foods.

Journal article

Levy RB, Rauber F, Chang K, Louzada MLDC, Monteiro CA, Millett C, Vamos EPet al., 2021, Ultra-processed food consumption and type 2 diabetes incidence: A prospective cohort study., Clinical Nutrition, Vol: 40, Pages: 3608-3614, ISSN: 0261-5614

BACKGROUND: Ultra-processed foods account for more than 50% of daily calories consumed in several high-income countries, with sales of ultra-processed foods soaring globally, especially in middle-income countries. The objective of this study is to investigate the association between ultra-processed food (UPF) consumption and risk of type 2 diabetes (T2D) in a UK-based prospective cohort study. METHODS: Participants of the UK Biobank (2007-2019) aged 40-69 years without diabetes at recruitment who provided 24-h dietary recall and follow-up data were included. UPFs were defined using the NOVA food classification. Multivariable Cox proportional hazards regression models were used to evaluate the association between UPF consumption and the risk of T2D adjusting for socio-demographic, anthropometric and lifestyle characteristics. RESULTS: A total of 21,730 participants with a mean age of 55.8 years and mean UPF intake of 22.1% at baseline were included. During a mean follow-up of 5.4 years (116,956 person-years), 305 incident T2D cases were identified. In the fully adjusted model, compared with the group in the lowest quartile of UPF intake, the hazard ratio for T2D was 1.44, 1.04-2.02 in the group with the highest quartile of UPF consumption. A gradient of elevated risk of T2D associated with increasing quartiles of UPF intake was consistently observed (p value for trend < 0.028). A significantly increased risk of T2D was observed per 10 percentage points increment in UPF consumption ([adjusted HR]: 1.12, 95% confidence interval [CI]: 1.04-1.20). CONCLUSIONS: Our findings demonstrate that a diet high in UPFs is associated with a clinically important increased risk of T2D. Identifying and implementing effective public health actions to reduce UPF consumption in the UK and globally are urgently required.

Journal article

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