Imperial College London

Heather Ward

Faculty of MedicineSchool of Public Health

Honorary Research Fellow
 
 
 
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Contact

 

+44 (0)20 7594 5081heather.ward

 
 
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Location

 

150Norfolk PlaceSt Mary's Campus

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Summary

 

Publications

Publication Type
Year
to

73 results found

Ward HA, Wark PA, Muller DC, Steffen A, Johansson M, Norat T, Gunter MJ, Overvad K, Dahm CC, Halkjaer J, Tjønneland A, Boutron-Ruault MC, Fagherazzi G, Mesrine S, Brennan P, Freisling H, Li K, Kaaks R, Trichopoulou A, Lagiou P, Panico S, Grioni S, Tumino R, Vineis P, Palli D, Peeters PHM, Bueno-de-Mesquita HB, Weiderpass E, Agudo A, Ramon Quiros J, Larrañaga N, Ardanaz E, Huerta JM, Sánchez MJ, Laurell G, Johansson I, Westin U, Wallstrom P, Bradbury KE, Wareham NJ, Khaw KT, Pearson C, Boeing H, Riboli Eet al., 2017, Measured adiposity in relation to head and neck cancer risk in the European Prospective Investigation into Cancer and Nutrition, Cancer Epidemiology Biomarkers & Prevention, Vol: 26, Pages: 895-904, ISSN: 1538-7755

Background: Emerging evidence from cohort studies indicates that adiposity is associated with greater incidence of head and neck cancer (HNC). However, most studies have used self-reported anthropometry which is prone to error. Methods: Among 363 094 participants in the European Prospective Investigation into Cancer and Nutrition study (EPIC) with measured anthropometry, there were 837 incident cases of HNC. HNC risk was examined in relation to body mass index (BMI) [lean: < 22.5 kg/m2, normal weight (reference): 22.5-24.9 kg/m2, overweight 25-29.9 kg/m2, obese: > 30 kg/m2], waist circumference (WC), hip circumference (HC) and waist to hip ratio (WHR) using Cox proportional hazards models. Results: Among men, a BMI < 22.5 kg/m2 was associated with higher HNC risk [hazard ratio (HR) 1.62, 95% confidence interval (CI) 1.23 - 2.12)]; BMI was not associated with HNC among women. WC and WHR were associated with greater risk of HNC among women, (WC per 5 cm: HR 1.08, 95% CI 1.02 - 1.15; WHR per 0.1 unit: HR 1.64, 95% CI 1.38 - 1.93). After stratification by smoking status, the association for WHR was present only among smokers (p interaction 0.004). Among men, WC and WHR were associated with HNC only upon additional adjustment for BMI (WC per 5 cm: HR 1.16, 95% CI 1.07 - 1.26; WHR per 0.1 unit: HR 1.42, 95% CI 1.21 - 1.65). Conclusion: Central adiposity, particularly among women, may have a stronger association with HNC risk than previously estimated. Impact: Strategies to reduce obesity may beneficially impact HNC incidence.

Journal article

Molina-Montes E, Sánchez M, Buckland G, Bueno-de-Mesquita B, Weiderpass E, Amiano P, Wark PA, Kuhn T, Katzke V, Huerta JM, Ardanaz E, Ramón Quirós J, Affret A, His M, Boutron- Ruault M, Peeters PH, Ye W, Sund M, Boeing H, Iqbal K, Ohlsson B, Sonestedt E, Tjonneland A, Petersen KEN, Travis RC, Skeie G, Agnoli C, Agnoli C, Panico S, Palli D, Tumino R, Sacerdote C, Freisling H, Huybrechts I, Overvad K, Trichopoulou A, Bamia C, Vasilopoulou E, Wareham N, Khaw K, Cross AJ, Ward HA, Riboli E, Duell EJet al., 2017, Mediterranean Diet and risk of pancreatic cancer in the European Prospective Investigation into Cancer and Nutrition cohort, British Journal of Cancer, Vol: 116, Pages: 811-820, ISSN: 1532-1827

Background:The Mediterranean Diet (MD) has been proposed as a means for cancer prevention, but little evidence has been accrued regarding its potential to prevent pancreatic cancer. We investigated the association between the adherence to the MD and pancreatic cancer risk within the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. Methods: Over half a million participants from 10 European countries were followed-up for over11 years, after which 865 newly diagnosed exocrine pancreatic cancer cases were identified. Adherence to the MD was estimated through an adapted score without the alcohol component (arMED) to discount alcohol-related harmful effects. Cox proportional hazards regression models, stratified by age, sex and center, and adjusted for energy intake, body mass index (BMI), smoking status, alcohol intake and diabetes status at recruitment, were used to estimate hazardratios (HRs) associated with pancreatic cancer and their corresponding 95% confidence intervals 16 (CIs) . Results: Adherence to the arMED score was not associated with risk of pancreatic cancer (HR high versus low adherence = 0.99; 95% CI: 0.77-1.26, and HR per increments of 2 units in adherence to arMED = 1.00; 95% CI: 0.94-1.06). There was no convincing evidence for heterogeneity by smoking status, BMI, diabetes or European region. There was also no evidence of significant associations in analyses involving microscopically confirmed cases, plausible reporters of energy intake, or other definitions of the MD pattern.Conclusion: A high adherence to the MD is not associated with pancreatic cancer risk in the EPIC study.

Journal article

Udeh-Momoh CT, Price G, Su B, Benjamin M, O'Driscoll C, Robb C, Bassil D, Ward H, Perneczky R, Middleton Let al., 2016, THE CHARIOT COGNITIVE RESERVE COMPOSITE: A CONSTRUCT AND PREDICTIVE VALIDITY STUDY, The 13th International Conference on Alxheimer's and Parkinson's Disease

Conference paper

Fanidi A, Muller DC, Midttun Ø, Ueland PM, Vollset SE, Relton C, Vineis P, Weiderpass E, Skeie G, Brustad M, Palli D, Tumino R, Grioni S, Sacerdote C, Bueno-de-Mesquita HB, Peeters PH, Boutron-Ruault MC, Kvaskoff M, Cadeau C, Huerta JM, Sánchez MJ, Agudo A, Lasheras C, Quirós JR, Chamosa S, Riboli E, Travis RC, Ward H, Murphy N, Khaw KT, Trichopoulou A, Lagiou P, Papatesta EM, Boeing H, Kuehn T, Katzke V, Steffen A, Johansson A, Brennan P, Johansson Met al., 2016, Circulating vitamin D in relation to cancer incidence and survival of the head and neck and oesophagus in the EPIC cohort, Scientific Reports, Vol: 6, ISSN: 2045-2322

Experimental and epidemiological data suggest that vitamin D play a role in pathogenesis and progression of cancer, but prospective data on head and neck cancer (HNC) and oesophagus cancer are limited. The European Prospective Investigation into Cancer and Nutrition (EPIC) study recruited 385,747 participants with blood samples between 1992 and 2000. This analysis includes 497 case-control pairs of the head and neck and oesophagus, as well as 443 additional controls. Circulating 25(OH)D3 were measured in pre-diagnostic samples and evaluated in relation to HNC and oesophagus cancer risk and post-diagnosis all-cause mortality. After controlling for risk factors, a doubling of 25(OH)D3 was associated with 30% lower odds of HNC (OR 0.70, 95% confidence interval [95% CI] 0.56-0.88, Ptrend = 0.001). Subsequent analyses by anatomical sub-site indicated clear inverse associations with risk of larynx and hypopharynx cancer combined (OR 0.55, 95CI% 0.39-0.78) and oral cavity cancer (OR 0.60, 95CI% 0.42-0.87). Low 25(OH)D3 concentrations were also associated with higher risk of death from any cause among HNC cases. No clear association was seen with risk or survival for oesophageal cancer. Study participants with elevated circulating concentrations of 25(OH)D3 had decreased risk of HNC, as well as improved survival following diagnosis.

Journal article

Moskal A, Freisling H, Byrnes G, Assi N, Fahey MT, Jenab M, Ferrari P, Tjønneland A, Petersen KE, Dahm CC, Hansen CP, Affret A, Boutron-Ruault MC, Cadeau C, Kühn T, Katzke V, Iqbal K, Boeing H, Trichopoulou A, Bamia C, Naska A, Masala G, de Magistris MS, Sieri S, Tumino R, Sacerdote C, Peeters PH, Bueno-de-Mesquita BH, Engeset D, Licaj I, Skeie G, Ardanaz E, Buckland G, Castaño JM, Quirós JR, Amiano P, Molina-Portillo E, Winkvist A, Myte R, Ericson U, Sonestedt E, Perez-Cornago A, Wareham N, Khaw KT, Huybrechts I, Tsilidis KK, Ward H, Gunter MJ, Slimani Net al., 2016, Main nutrient patterns and colorectal cancer risk in the European Prospective Investigation into Cancer and Nutrition study, British Journal of Cancer, Vol: 115, Pages: 1430-1440, ISSN: 1532-1827

BACKGROUND: Much of the current literature on diet-colorectal cancer (CRC) associations focused on studies of single foods/nutrients, whereas less is known about nutrient patterns. We investigated the association between major nutrient patterns and CRC risk in participants of the European Prospective Investigation into Cancer and Nutrition (EPIC) study. METHODS: Among 477 312 participants, intakes of 23 nutrients were estimated from validated dietary questionnaires. Using results from a previous principal component (PC) analysis, four major nutrient patterns were identified. Hazard ratios (HRs) and 95% confidence intervals (CIs) were computed for the association of each of the four patterns and CRC incidence using multivariate Cox proportional hazards models with adjustment for established CRC risk factors. RESULTS: During an average of 11 years of follow-up, 4517 incident cases of CRC were documented. A nutrient pattern characterised by high intakes of vitamins and minerals was inversely associated with CRC (HR per 1 s.d.=0.94, 95% CI: 0.92-0.98) as was a pattern characterised by total protein, riboflavin, phosphorus and calcium (HR (1 s.d.)=0.96, 95% CI: 0.93-0.99). The remaining two patterns were not significantly associated with CRC risk. CONCLUSIONS: Analysing nutrient patterns may improve our understanding of how groups of nutrients relate to CRC.British Journal of Cancer advance online publication 20 October 2016; doi:10.1038/bjc.2016.334 www.bjcancer.com.

Journal article

Huseinovic E, Winkvist A, Slimani N, Park MK, Freisling H, Boeing H, Buckland G, Schwingshackl L, Weiderpass E, Rostgaard-Hansen AL, Tjønneland A, Affret A, Boutron-Ruault MC, Fagherazzi G, Katzke V, Kühn T, Naska A, Orfanos P, Trichopoulou A, Pala V, Palli D, Ricceri F, Santucci de Magistris M, Tumino R, Engeset D, Enget T, Skeie G, Barricarte A, Bonet CB, Chirlaque MD, Amiano P, Quirós JR, Sánchez MJ, Dias JA, Drake I, Wennberg M, Boer J, Ocké MC, Verschuren W, Lassale C, Perez-Cornago A, Riboli E, Ward H, Forslund HBet al., 2016, Meal patterns across ten European countries - results from the European Prospective Investigation into Cancer and Nutrition (EPIC) calibration study, Public Health Nutrition, Vol: 19, Pages: 2769-2780, ISSN: 1475-2727

OBJECTIVE: To characterize meal patterns across ten European countries participating in the European Prospective Investigation into Cancer and Nutrition (EPIC) calibration study. DESIGN: Cross-sectional study utilizing dietary data collected through a standardized 24 h diet recall during 1995-2000. Eleven predefined intake occasions across a 24 h period were assessed during the interview. In the present descriptive report, meal patterns were analysed in terms of daily number of intake occasions, the proportion reporting each intake occasion and the energy contributions from each intake occasion. SETTING: Twenty-seven centres across ten European countries. SUBJECTS: Women (64 %) and men (36 %) aged 35-74 years (n 36 020). RESULTS: Pronounced differences in meal patterns emerged both across centres within the same country and across different countries, with a trend for fewer intake occasions per day in Mediterranean countries compared with central and northern Europe. Differences were also found for daily energy intake provided by lunch, with 38-43 % for women and 41-45 % for men within Mediterranean countries compared with 16-27 % for women and 20-26 % for men in central and northern European countries. Likewise, a south-north gradient was found for daily energy intake from snacks, with 13-20 % (women) and 10-17 % (men) in Mediterranean countries compared with 24-34 % (women) and 23-35 % (men) in central/northern Europe. CONCLUSIONS: We found distinct differences in meal patterns with marked diversity for intake frequency and lunch and snack consumption between Mediterranean and central/northern European countries. Monitoring of meal patterns across various cultures and populations could provide critical context to the research efforts to characterize relationships between dietary intake and health.

Journal article

Ward HA, Norat T, Overvad K, Dahm CC, Bueno-de-Mesquita HB, Jenab M, Fedirko V, van Duijnhoven FJB, Skeie G, Romaguera-Bosch D, Tjonneland A, Olsen A, Carbonnel F, Affret A, Boutron-Ruault M-C, Katzke V, Kuehn T, Aleksandrova K, Boeing H, Trichopoulou A, Lagiou P, Bamia C, Palli D, Sieri S, Tumino R, Naccarati A, Mattiello A, Peeters PH, Weiderpass E, Asli LA, Jakszyn P, Ramon Quiros J, Sanchez M-J, Dorronsoro M, Huerta J-M, Barricarte A, Jirstrom K, Ericson U, Johansson I, Gylling B, Bradbury KE, Khaw K-T, Wareham NJ, Stepien M, Freisling H, Murphy N, Cross AJ, Riboli Eet al., 2016, Pre-diagnostic meat and fibre intakes in relation to colorectal cancer survival in the European Prospective Investigation into Cancer and Nutrition, British Journal of Nutrition, Vol: 116, Pages: 316-325, ISSN: 1475-2662

Improvements in colorectal cancer (CRC) detection and treatment have led to greater numbers of CRC survivors, for whom there is limited evidence on which to provide dietary guidelines to improve survival outcomes. Higher intake of red and processed meat and lower intake of fibre are associated with greater risk of developing CRC, but there is limited evidence regarding associations with survival after CRC diagnosis. Among 3789 CRC cases in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort, pre-diagnostic consumption of red meat, processed meat, poultry and dietary fibre was examined in relation to CRC-specific mortality (n 1008) and all-cause mortality (n 1262) using multivariable Cox regression models, adjusted for CRC risk factors. Pre-diagnostic red meat, processed meat or fibre intakes (defined as quartiles and continuous grams per day) were not associated with CRC-specific or all-cause mortality among CRC survivors; however, a marginal trend across quartiles of processed meat in relation to CRC mortality was detected (P 0·053). Pre-diagnostic poultry intake was inversely associated with all-cause mortality among women (hazard ratio (HR)/20 g/d 0·92; 95 % CI 0·84, 1·00), but not among men (HR 1·00; 95 % CI 0·91, 1·09) (Pfor heterogeneity=0·10). Pre-diagnostic intake of red meat or fibre is not associated with CRC survival in the EPIC cohort. There is suggestive evidence of an association between poultry intake and all-cause mortality among female CRC survivors and between processed meat intake and CRC-specific mortality; however, further research using post-diagnostic dietary data is required to confirm this relationship.

Journal article

Gallo V, Vanacore N, Bueno-de-Mesquita HB, Vermeulen R, Brayne C, Pearce N, Wark PA, Ward HA, Ferrari P, Jenab M, Andersen PM, Wennberg P, Wareham N, Katzke V, Kaaks R, Weiderpass E, Peeters PH, Mattiello A, Pala V, Barricante A, Chirlaque M-D, Travier N, Travis RC, Sanchez M-J, Pessah-Rasmussen H, Petersson J, Tjonneland A, Tumino R, Ramon Quiros J, Trichopoulou A, Kyrozis A, Oikonomidou D, Masala G, Sacerdote C, Arriola L, Boeing H, Vigl M, Claver-Chapelon F, Middleton L, Riboli E, Vineis Pet al., 2016, Physical activity and risk of Amyotrophic Lateral Sclerosis in a prospective cohort study, European Journal of Epidemiology, Vol: 31, Pages: 255-266, ISSN: 1573-7284

Previous case–control studies have suggested a possible increased risk of Amyotrophic Lateral Sclerosis (ALS) with physical activity (PA), but this association has never been studied in prospective cohort studies. We therefore assessed the association between PA and risk of death from ALS in the European Prospective Investigation into Cancer and Nutrition. A total of 472,100 individuals were included in the analysis, yielding 219 ALS deaths. At recruitment, information on PA was collected thorough standardised questionnaires. Total PA was expressed by the Cambridge Physical Activity Index (CPAI) and analysed in relation to ALS mortality, using Cox hazard models. Interactions with age, sex, and anthropometric measures were assessed. Total PA was weakly inversely associated with ALS mortality with a borderline statistically significant trend across categories (p = 0.042), with those physically active being 33 % less likely to die from ALS compared to those inactive: HR = 0.67 (95 % CI 0.42–1.06). Anthropometric measures, sex, and age did not modify the association with CPAI. The present study shows a slightly decreased—not increased like in case–control studies—risk of dying from ALS in those with high levels of total PA at enrolment. This association does not appear confounded by age, gender, anthropometry, smoking, and education. Ours was the first prospective cohort study on ALS and physical activity.

Journal article

Stepien M, Duarte-Salles T, Fedirko V, Trichopoulou A, Lagiou P, Bamia C, Overvad K, Tjonneland A, Hansen L, Boutron-Ruault M-C, Fagherazzi G, Severi G, Kuehn T, Kaaks R, Aleksandrova K, Boeing H, Klinaki E, Palli D, Grioni S, Panico S, Tumino R, Naccarati A, Bueno-de-Mesquita HB, Peeters PH, Skeie G, Weiderpass E, Parr CL, Ramon Quiros J, Buckland G, Molina-Montes E, Amiano P, Chirlaque M-D, Ardanaz E, Sonestedt E, Ericson U, Wennberg M, Nilsson LM, Khaw K-T, Wareham N, Bradbury KE, Ward HA, Romieu I, Jenab Met al., 2016, Consumption of soft drinks and juices and risk of liver and biliary tract cancers in a European cohort, EUROPEAN JOURNAL OF NUTRITION, Vol: 55, Pages: 7-20, ISSN: 1436-6207

Journal article

Al Kuwari H, Al Thani A, Al Marri A, Al Kaabi A, Abderrahim H, Afifi N, Qafoud F, Chan Q, Tzoulaki I, Downey P, Ward H, Murphy N, Riboli E, Elliott Pet al., 2015, The Qatar Biobank: background and methods, BMC Public Health, Vol: 15, ISSN: 1471-2458

Background: The Qatar Biobank aims to collect extensive lifestyle, clinical, and biological information from up to60,000 men and women Qatari nationals and long-term residents (individuals living in the country for ≥15 years)aged ≥18 years (approximately one-fifth of all Qatari citizens), to follow up these same individuals over the longterm to record any subsequent disease, and hence to study the causes and progression of disease, and diseaseburden, in the Qatari population.Methods: Between the 11th-December-2012 and 20th-February-2014, 1209 participants were recruited into the pilotstudy of the Qatar Biobank. At recruitment, extensive phenotype information was collected from each participant,including information/measurements of socio-demographic factors, prevalent health conditions, diet, lifestyle,anthropometry, body composition, bone health, cognitive function, grip strength, retinal imaging, total body dualenergy X-ray absorptiometry, and measurements of cardiovascular and respiratory function. Blood, urine, and salivawere collected and stored for future research use. A panel of 66 clinical biomarkers was routinely measured onfresh blood samples in all participants. Rates of recruitment are to be progressively increased in the coming periodand the recruitment base widened to achieve a cohort of consented individuals broadly representative of theeligible Qatari population. In addition, it is planned to add additional measures in sub-samples of the cohort,including Magnetic Resonance Imaging (MRI) of the brain, heart and abdomen.Results: The mean time for collection of the extensive phenotypic information and biological samples from eachparticipant at the baseline recruitment visit was 179 min. The 1209 pilot study participants (506 men and 703women) were aged between 28–80 years (median 39 years); 899 (74.4 %) were Qatari nationals and 310 (25.6 %)were long-term residents. Approximately two-thirds of pilot participants were educated to graduate leve

Journal article

Kyro C, Zamora-Ros R, Scalbert A, Tjonneland A, Dossus L, Johansen C, Bidstrup PE, Weiderpass E, Christensen J, Ward H, Aune D, Riboli E, His M, Clavel-Chapelon F, Baglietto L, Katzke V, Kuehn T, Boeing H, Floegel A, Overvad K, Lasheras C, Travier N, Sanchez M-J, Amiano P, Chirlaque M-D, Ardanaz E, Khaw K-T, Wareham N, Perez-Cornago A, Trichopoulou A, Lagiou P, Vasilopoulou E, Masala G, Grioni S, Berrino F, Tumino R, Sacerdote C, Mattiello A, Bueno-de-Mesquita HBA, Peeters PH, van Gils C, Borgquist S, Butt S, Zeleniuch-Jacquotte A, Sund M, Hjartaker A, Skeie G, Olsen A, Romieu Iet al., 2015, Pre-diagnostic polyphenol intake and breast cancer survival: the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort., Breast Cancer Research and Treatment, Vol: 154, Pages: 389-401, ISSN: 0167-6806

The aim was to investigate the association between pre-diagnostic intakes of polyphenol classes (flavonoids, lignans, phenolic acids, stilbenes, and other polyphenols) in relation to breast cancer survival (all-cause and breast cancer-specific mortality). We used data from the European Prospective Investigation into Cancer and Nutrition cohort. Pre-diagnostic usual diet was assessed using dietary questionnaires, and polyphenol intakes were estimated using the Phenol-Explorer database. We followed 11,782 breast cancer cases from time of diagnosis until death, end of follow-up or last day of contact. During a median of 6 years, 1482 women died (753 of breast cancer). We related polyphenol intake to all-cause and breast cancer-specific mortality using Cox proportional hazard models with time since diagnosis as underlying time and strata for age and country. Among postmenopausal women, an intake of lignans in the highest versus lowest quartile was related to a 28 % lower risk of dying from breast (adjusted model: HR, quartile 4 vs. quartile 1, 0.72, 95 % CI 0.53; 0.98). In contrast, in premenopausal women, a positive association between lignan intake and all-cause mortality was found (adjusted model: HR, quartile 4 vs. quartile 1, 1.63, 95 % CI 1.03; 2.57). We found no association for other polyphenol classes. Intake of lignans before breast cancer diagnosis may be related to improved survival among postmenopausal women, but may on the contrary worsen the survival for premenopausal women. This suggests that the role of phytoestrogens in breast cancer survival is complex and may be dependent of menopausal status.

Journal article

Romaguera D, Ward H, Wark PA, Vergnaud A-C, Peeters PH, van Gils CH, Ferrari P, Fedirko V, Jenab M, Boutron-Ruault M-C, Dossus L, Dartois L, Hansen CP, Dahm CC, Buckland G, Sanchez MJ, Dorronsoro M, Navarro C, Barricarte A, Key TJ, Trichopoulou A, Tsironis C, Lagiou P, Masala G, Pala V, Tumino R, Vineis P, Panico S, Bueno-de-Mesquita HB, Siersema PD, Ohlsson B, Jirstrom K, Wennberg M, Nilsson LM, Weiderpass E, Kuehn T, Katzke V, Khaw K-T, Wareham NJ, Tjonneland A, Boeing H, Quiros JR, Gunter MJ, Riboli E, Norat Tet al., 2015, Pre-diagnostic concordance with the WCRF/AICR guidelines and survival in European colorectal cancer patients: a cohort study, BMC Medicine, Vol: 13, ISSN: 1741-7015

Journal article

Ekelund U, Ward H, Luan J, Sharp SJ, Brage S, Wareham NJet al., 2015, Regular physical activity: a little is good, but is it good enough? Reply, Publisher: OXFORD UNIV PRESS

Other

Ekelund U, Ward HA, Norat T, Luan J, May AM, Weiderpass E, Sharp SJ, Overvad K, Ostergaard JN, TjOnneland A, Johnsen NF, Mesrine S, Foamier A, Fagherazzi G, Trichopoulou A, Lagiou P, Trichopoulos D, Li K, Kaaks R, Ferrari P, Licaj I, Jenab M, Bergmann M, Boeing H, Palli D, Sieri S, Panico S, Tumino R, Vineis P, Peeters PH, Monnikhof E, Bueno-de-Mesquita HB, Ramon Quiros J, Agudo A, Sanchez M-J, Maria Huerta J, Ardanaz E, Arriola L, Hedblad B, Wirfalt E, Sand M, Johansson M, Key TJ, Travis RC, Khaw K-T, Brage S, Wareham NJ, Riboli Eet al., 2015, Physical activity and all-cause mortality across levels of overall and abdominal adiposity in European men and women: the European Prospective Investigation into Cancer and Nutrition Study (EPIC), American Journal of Clinical Nutrition, Vol: 101, Pages: 613-621, ISSN: 0002-9165

Background: The higher risk of death resulting from excess adiposity may be attenuated by physical activity (PA). However, the theoretical number of deaths reduced by eliminating physical inactivity compared with overall and abdominal obesity remains unclear.Objective: We examined whether overall and abdominal adiposity modified the association between PA and all-cause mortality and estimated the population attributable fraction (PAF) and the years of life gained for these exposures.Design: This was a cohort study in 334,161 European men and women. The mean follow-up time was 12.4 y, corresponding to 4,154,915 person-years. Height, weight, and waist circumference (WC) were measured in the clinic. PA was assessed with a validated self-report instrument. The combined associations between PA, BMI, and WC with mortality were examined with Cox proportional hazards models, stratified by center and age group, and adjusted for sex, education, smoking, and alcohol intake. Center-specific PAF associated with inactivity, body mass index (BMI; in kg/m2) (>30), and WC (≥102 cm for men, ≥88 cm for women) were calculated and combined in random-effects meta-analysis. Life-tables analyses were used to estimate gains in life expectancy for the exposures.Results: Significant interactions (PA × BMI and PA × WC) were observed, so HRs were estimated within BMI and WC strata. The hazards of all-cause mortality were reduced by 16–30% in moderately inactive individuals compared with those categorized as inactive in different strata of BMI and WC. Avoiding all inactivity would theoretically reduce all-cause mortality by 7.35% (95% CI: 5.88%, 8.83%). Corresponding estimates for avoiding obesity (BMI >30) were 3.66% (95% CI: 2.30%, 5.01%). The estimates for avoiding high WC were similar to those for physical inactivity.Conclusion: The greatest reductions in mortality risk were observed between the 2 lowest activity groups across levels of general and abdominal adi

Journal article

Ward HA, Kuhnle GGC, 2014, Phytoestrogen consumption and association with breast, prostate and colorectal cancer in EPIC Norfolk (vol 501, pg 170, 2010), ARCHIVES OF BIOCHEMISTRY AND BIOPHYSICS, Vol: 562, Pages: 123-123, ISSN: 0003-9861

Journal article

Engeset D, Braaten T, Teucher B, Kuhn T, Bueno-de-Mesquita HB, Leenders M, Agudo A, Bergmann MM, Valanou E, Naska A, Trichopoulou A, Key TJ, Crowe FL, Overvad K, Sonestedt E, Mattiello A, Peeters PH, Wennberg M, Jansson JH, Boutron-Ruault M-C, Dossus L, Dartois L, Li K, Barricarte A, Ward H, Riboli E, Agnoli C, Maria Huerta J, Sanchez M-J, Tumino R, Altzibar JM, Vineis P, Masala G, Ferrari P, Muller DC, Johansson M, Luisa Redondo M, Tjonneland A, Olsen A, Olsen KS, Brustad M, Skeie G, Lund Eet al., 2014, Fish consumption and mortality in the European Prospective Investigation into Cancer and Nutrition cohort, European Journal of Epidemiology, Vol: 30, Pages: 57-70, ISSN: 1573-7284

Fish is a source of important nutrients and may play a role in preventing heart diseases and other health outcomes. However, studies of overall mortality and cause-specific mortality related to fish consumption are inconclusive. We examined the rate of overall mortality, as well as mortality from ischaemic heart disease and cancer in relation to the intake of total fish, lean fish, and fatty fish in a large prospective cohort including ten European countries. More than 500,000 men and women completed a dietary questionnaire in 1992–1999 and were followed up for mortality until the end of 2010. 32,587 persons were reported dead since enrolment. Hazard ratios and their 99 % confidence interval were estimated using Cox proportional hazard regression models. Fish consumption was examined using quintiles based on reported consumption, using moderate fish consumption (third quintile) as reference, and as continuous variables, using increments of 10 g/day. All analyses were adjusted for possible confounders. No association was seen for fish consumption and overall or cause-specific mortality for both the categorical and the continuous analyses, but there seemed to be a U-shaped trend (p < 0.000) with fatty fish consumption and total mortality and with total fish consumption and cancer mortality (p = 0.046).

Journal article

Aleksandrova K, Pischon T, Jenab M, Bueno-de-Mesquita HB, Fedirko V, Norat T, Romaguera D, Knueppel S, Boutron-Ruault M-C, Dossus L, Dartois L, Kaaks R, Li K, Tjonneland A, Overvad K, Quiros JR, Buckland G, Sanchez MJ, Dorronsoro M, Chirlaque M-D, Barricarte A, Khaw K-T, Wareham NJ, Bradbury KE, Trichopoulou A, Lagiou P, Trichopoulos D, Palli D, Krogh V, Tumino R, Naccarati A, Panico S, Siersema PD, Peeters PHM, Ljuslinder I, Johansson I, Ericson U, Ohlsson B, Weiderpass E, Skeie G, Borch KB, Rinaldi S, Romieu I, Kong J, Gunter MJ, Ward HA, Riboli E, Boeing Het al., 2014, Combined impact of healthy lifestyle factors on colorectal cancer: a large European cohort study, BMC Medicine, Vol: 12, ISSN: 1741-7015

Background: Excess body weight, physical activity, smoking, alcohol consumption and certain dietary factors areindividually related to colorectal cancer (CRC) risk; however, little is known about their joint effects. The aim of thisstudy was to develop a healthy lifestyle index (HLI) composed of five potentially modifiable lifestyle factors –healthy weight, physical activity, non-smoking, limited alcohol consumption and a healthy diet, and to explore theassociation of this index with CRC incidence using data collected within the European Prospective Investigation intoCancer and Nutrition (EPIC) cohort.Methods: In the EPIC cohort, a total of 347,237 men and women, 25- to 70-years old, provided dietary and lifestyleinformation at study baseline (1992 to 2000). Over a median follow-up time of 12 years, 3,759 incident CRC caseswere identified. The association between a HLI and CRC risk was evaluated using Cox proportional hazardsregression models and population attributable risks (PARs) have been calculated.Results: After accounting for study centre, age, sex and education, compared with 0 or 1 healthy lifestyle factors,the hazard ratio (HR) for CRC was 0.87 (95% confidence interval (CI): 0.44 to 0.77) for two factors, 0.79 (95% CI: 0.70to 0.89) for three factors, 0.66 (95% CI: 0.58 to 0.75) for four factors and 0.63 (95% CI: 0.54 to 0.74) for five factors;P-trend <0.0001. The associations were present for both colon and rectal cancers, HRs, 0.61 (95% CI: 0.50 to 0.74; Pfor trend <0.0001) for colon cancer and 0.68 (95% CI: 0.53 to 0.88; P-trend <0.0001) for rectal cancer, respectively(P-difference by cancer sub-site = 0.10). Overall, 16% of the new CRC cases (22% in men and 11% in women) wereattributable to not adhering to a combination of all five healthy lifestyle behaviours included in the index.Conclusions: Combined lifestyle factors are associated with a lower incidence of CRC in European populationscharacterized by western lifestyles. Prevention str

Journal article

Chowdhury R, Warnakula S, Kunutsor S, Crowe F, Ward HA, Johnson L, Franco OH, Butterworth AS, Forouhi NG, Thompson SG, Khaw K-T, Mozaffarian D, Danesh J, Di Angelantonio Eet al., 2014, Association of Dietary, Circulating, and Supplement Fatty Acids With Coronary Risk A Systematic Review and Meta-analysis, ANNALS OF INTERNAL MEDICINE, Vol: 160, Pages: 398-+, ISSN: 0003-4819

Journal article

Ekelund U, Ward H, Luan J, Norat T, Brage S, Riboli E, Wareham Net al., 2013, Physical Activity, General and Abdominal Obesity and Mortality in European Men and Women, Scientific Sessions and Resuscitation Science Symposium of the American-Heart-Association, Publisher: LIPPINCOTT WILLIAMS & WILKINS, ISSN: 0009-7322

Conference paper

Zamora-Ros R, Ferrari P, Gonzalez CA, Tjonneland A, Olsen A, Bredsdorff L, Overvad K, Touillaud M, Perquier F, Fagherazzi G, Lukanova A, Tikk K, Aleksandrova K, Boeing H, Trichopoulou A, Trichopoulos D, Dilis V, Masala G, Sieri S, Mattiello A, Tumino R, Ricceri F, Bueno-de-Mesquita HB, Peeters PHM, Weiderpass E, Skeie G, Engeset D, Menendez V, Travier N, Molina-Montes E, Amiano P, Chirlaque M-D, Barricarte A, Wallstrom P, Sonestedt E, Sund M, Landberg R, Khaw K-T, Wareham NJ, Travis RC, Scalbert A, Ward HA, Riboli E, Romieu Iet al., 2013, Dietary flavonoid and lignan intake and breast cancer risk according to menopause and hormone receptor status in the European Prospective Investigation into Cancer and Nutrition (EPIC) Study, BREAST CANCER RESEARCH AND TREATMENT, Vol: 139, Pages: 163-176, ISSN: 0167-6806

Journal article

Rohrmann S, Linseisen J, Nothlings U, Overvad K, Egeberg R, Tjonneland A, Boutron-Ruault MC, Clavel-Chapelon F, Cottet V, Pala V, Tumino R, Palli D, Panico S, Vineis P, Boeing H, Pischon T, Grote V, Teucher B, Khaw K-T, Wareham NJ, Crowe FL, Goufa I, Orfanos P, Trichopoulou A, Jeurnink SM, Siersema PD, Peeters PHM, Brustad M, Engeset D, Skeie G, Duell EJ, Amiano P, Barricarte A, Molina-Montes E, Rodriguez L, Tormo M-J, Sund M, Ye W, Lindkvist B, Johansen D, Ferrari P, Jenab M, Slimani N, Ward H, Riboli E, Norat T, Bueno-de-Mesquita HBet al., 2013, Meat and fish consumption and risk of pancreatic cancer: Results from the European Prospective Investigation into Cancer and Nutrition, INTERNATIONAL JOURNAL OF CANCER, Vol: 132, Pages: 617-624, ISSN: 0020-7136

Journal article

Ward HA, Ekelund U, Norat T, Luan J, May AM, Weiderpass E, Wareham NJ, Riboli Eet al., 2013, PHYSICAL ACTIVITY, OBESITY, AND ALL-CAUSE MORTALITY IN THE EPIC STUDY

Poster

Romaguera D, Ward H, Wark PA, Vergnaud AC, Peeters PH, van Gils CH, Fedirko V, Jenab M, Riboli E, Norat Tet al., 2013, LIFESTYLE RECOMMENDATIONS FOR CANCER PREVENTION AND SURVIVAL AFTER DIAGNOSIS OF COLORECTAL CANCER: RESULTS FROM THE EPIC STUDY, Publisher: KARGER, Pages: 204-205, ISSN: 0250-6807

Conference paper

Chowdhury R, Stevens S, Gorman D, Pan A, Warnakula S, Chowdhury S, Ward H, Johnson L, Crowe F, Hu FB, Franco OHet al., 2012, Association between fish consumption, long chain omega 3 fatty acids, and risk of cerebrovascular disease: systematic review and meta-analysis, BMJ-BRITISH MEDICAL JOURNAL, Vol: 345, ISSN: 0959-535X

Journal article

Chowdhury R, Stevens S, Ward H, Chowdhury S, Sajjad A, Franco OHet al., 2012, Circulating vitamin D, calcium and risk of cerebrovascular disease: a systematic review and meta-analysis, EUROPEAN JOURNAL OF EPIDEMIOLOGY, Vol: 27, Pages: 581-591, ISSN: 0393-2990

Journal article

Duran OHF, Chowdhury R, Stevens S, Ward H, Chowdhury S, Sajjad Aet al., 2012, Association of circulating vitamin D and calcium levels with risk of cerebrovascular disease: systematic review and meta-analysis, Congress of the European-Society-of-Cardiology (ESC), Publisher: OXFORD UNIV PRESS, Pages: 1059-1059, ISSN: 0195-668X

Conference paper

Ward HA, Keogh R, Lentjes M, Luben RN, Wareham NJ, Khaw K-Tet al., 2012, Fibre intake in relation to serum total cholesterol levels and CHD risk: a comparison of dietary assessment methods, EUROPEAN JOURNAL OF CLINICAL NUTRITION, Vol: 66, Pages: 296-304, ISSN: 0954-3007

Journal article

Kuhnle GGC, Ward HA, Vogiatzoglou A, Luben RN, Mulligan A, Wareham NJ, Forouhi NG, Khaw K-Tet al., 2011, Association between dietary phyto-oestrogens and bone density in men and postmenopausal women, BRITISH JOURNAL OF NUTRITION, Vol: 106, Pages: 1063-1069, ISSN: 0007-1145

Journal article

Illner A-K, Harttig U, Tognon G, Palli D, Salvini S, Bower E, Amiano P, Kassik T, Metspalu A, Engeset D, Lund E, Ward H, Slimani N, Bergmann M, Wagner K, Boeing Het al., 2011, Feasibility of innovative dietary assessment in epidemiological studies using the approach of combining different assessment instruments, PUBLIC HEALTH NUTRITION, Vol: 14, Pages: 1055-1063, ISSN: 1368-9800

Journal article

Ward H, Luben RN, Wareham NJ, Khaw K-Tet al., 2011, CHD risk in relation to alcohol intake from categorical and open-ended dietary instruments, PUBLIC HEALTH NUTRITION, Vol: 14, Pages: 402-409, ISSN: 1368-9800

Journal article

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