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Final-year medical students, Ibrahim and Alicia, share details of their Special Studies Module (SSM) project; carried out alongside Dr. David Nunan at the Centre for Evidence-Based Medicine.
COVID-19 and influenza vaccine uptake among pregnant women in national cohorts of England and Wales
Vaccines against COVID-19 and influenza can reduce the adverse outcomes caused by infections during pregnancy, but vaccine uptake among pregnant women has been suboptimal. We examined the COVID-19 and influenza vaccine uptake and disparities in pregnant women during the COVID-19 pandemic to inform vaccination interventions. We used data from the Oxford-Royal College of General Practitioners Research and Surveillance Centre database in England and the Secure Anonymised Information Linkage Databank in Wales. The uptake of at least one dose of vaccine was 40.2% for COVID-19 and 41.8% for influenza among eligible pregnant women. We observed disparities in COVID-19 and influenza vaccine uptake, with socioeconomically deprived and ethnic minority groups showing lower vaccination rates. The suboptimal uptake of COVID-19 and influenza vaccines, especially in those from socioeconomically deprived backgrounds and Black, mixed or other ethnic groups, underscores the necessity for interventions to reduce vaccine hesitancy and enhance acceptance in pregnant women.
Associations between dietary patterns and incident colorectal cancer in 114,443 individuals from the UK Biobank: a prospective cohort study.
BACKGROUND: Diet-disease association studies increasingly use dietary patterns (DPs) to account for the complexity of the exposure. We assessed if a DP associated with type 2 diabetes mellitus, CVD, and all-cause mortality is also associated with colorectal cancer (CRC). METHODS: We used reduced rank regression on 24-h recall data to identify DPs explaining the maximum variation in four nutrient-response variables: energy density, saturated fatty acids, free sugars and fibre density. Cox-proportional hazards models examined prospective associations between DP adherence (coded in a continuous scale as z-scores as well as in quintiles) and incident CRC. Subgroup analyses were conducted for tumour site, age, and sex. RESULTS: Post-exclusions, 1,089 CRC cases occurred in 114,443 participants over a median follow-up of 8.0 years. DP1 was characterised by increased intake of chocolate and confectionery, butter, low-fibre bread, red and processed meats and alcohol, as well as low fruit, vegetable, and high-fibre cereal intake. After accounting for confounders, including body mass, there were positive linear associations between DP1 and incident overall CRC (HR of quintile 5 vs. 1: 1.34, 95%CI 1.16-1.53, PTrend=0.005) and rectal cancer (HR of quintile 5 vs. 1: 1.58, 95%CI 1.27-1.96, PTrend=0.009), but not for proximal or distal colon cancers. No DP2-CRC association was observed. CONCLUSION: A DP previously associated with cardio-metabolic disease is also associated with incident CRC, especially rectal cancers. IMPACT: These consistent associations of particular food groups with both cardiometabolic disease and this diet-related cancer strengthen the evidence base for holistic population dietary guidelines to prevent ill-health.
Effects of environmental impact labels on the sustainability of food purchases: A randomised controlled trial in an experimental online supermarket
Providing consumers with product-specific environmental impact information for food products (ecolabels) may promote more sustainable purchasing, needed to meet global environmental targets. This UK study (N = 1051 participants) investigated the effectiveness of different ecolabels using an experimental online supermarket platform, comparing three labels against control (no label). Significant reductions were found in the environmental impact score (EIS) for all labels compared to control (labels presented: values for four environmental indicators [-3.9 percentiles, 95%CIs: -5.3, -2.6]; a composite score [taking values from A to E; -3.9, 95%CIs: -5.2,-2.5]; or both together [-3.2, 95%CIs: -4.5, -1.9]). Providing ecolabels is a promising intervention to promote the selection of more sustainable products.
Associations between BMI and hospital resource use in patients hospitalised for COVID-19 in England: a community-based cohort study
Background: Excess weight is a major risk factor for severe disease after infection with SARS-CoV-2. However, the effect of BMI on COVID-19 hospital resource use has not been fully quantified. This study aimed to identify the association between BMI and hospital resource use for COVID-19 admissions with the intention of informing future national hospital resource allocation. Methods: In this community-based cohort study, we analysed patient-level data from 57 415 patients admitted to hospital in England with COVID-19 between April 1, 2020, and Dec 31, 2021. Patients who were aged 20–99 years, had been registered with a general practitioner (GP) surgery that contributed to the QResearch database for the whole preceding year (2019) with at least one BMI value measured before April 1, 2020, available in their GP record, and were admitted to hospital for COVID-19 were included. Outcomes of interest were duration of hospital stay, transfer to an intensive care unit (ICU), and duration of ICU stay. Costs of hospitalisation were estimated from these outcomes. Generalised linear and logit models were used to estimate associations between BMI and hospital resource use outcomes. Findings: Patients living with obesity (BMI >30·0 kg/m2) had longer hospital stays relative to patients in the reference BMI group (18·5–25·0 kg/m2; IRR 1·07, 95% CI 1·03–1·10); the reference group had a mean length of stay of 8·82 days (95% CI 8·62–9·01). Patients living with obesity were more likely to be admitted to ICU than the reference group (OR 2·02, 95% CI 1·86–2·19); the reference group had a mean probability of ICU admission of 5·9% (95% CI 5·5–6·3). No association was found between BMI and duration of ICU stay. The mean cost of COVID-19 hospitalisation was £19 877 (SD 17 918) in the reference BMI group. Hospital costs were estimated to be £2736 (95% CI 2224–3248) higher for patients living with obesity. Interpretation: Patients admitted to hospital with COVID-19 with a BMI above the healthy range had longer stays, were more likely to be admitted to ICU, and had higher health-care costs associated with hospital treatment of COVID-19 infection as a result. This information can inform national resource allocation to match hospital capacity to areas where BMI profiles indicate higher demand. Funding: National Institute for Health Research.
Association of gestational diabetes with long-term risk of premature mortality, and cardiovascular outcomes and risk factors: A retrospective cohort analysis in the UK Biobank
Aim: To investigate the association of gestational diabetes mellitus (GDM) with premature mortality and cardiovascular (CVD) outcomes and risk factors. Materials and Methods: Parous women recruited to the UK Biobank cohort during 2006-2010 were followed up from their first delivery until 31 October 2021. The data were linked to Hospital Episode Statistics and mortality registries. Multivariate Cox proportional hazard models investigated associations of GDM with all-cause mortality, CVD, diabetes, hypertension and dyslipidaemia. Results: The maximum total analysis time at risk and under observation was 9 694 090 person-years. Among 220 726 women, 1225 self-reported or had a recorded diagnosis of GDM. After adjusting for confounders and behavioural factors, GDM was associated with increased risk for premature mortality [hazard ratio (HR): 1.44, 95% confidence interval (CI): 1.12-1.86], particularly CVD-related death (HR: 2.38, 95% CI: 1.63-3.48), as well as incident total CVD (HR: 1.50, 95% CI: 1.30-1.74), non-fatal CVD (HR: 1.41, 95% CI: 1.20-1.65), diabetes (HR: 14.37, 95% CI: 13.51-15.27), hypertension (HR: 1.49, 95% CI: 1.38-1.60), and dyslipidaemia (HR: 1.30, 95% CI: 1.22-1.39). The total CVD risk was greater in women with GDM who did not later develop diabetes than in those with GDM and diabetes. Conclusions: Women with GDM are at increased risk of premature death and have increased CV risk, emphasizing the importance of interventions to prevent GDM. If GDM develops, the diagnosis represents an opportunity for future surveillance and intervention to reduce CVD risk factors, prevent CVD and improve long-term health.
Data from Prospective Analysis Reveals Associations between Carbohydrate Intakes, Genetic Predictors of Short-Chain Fatty Acid Synthesis, and Colorectal Cancer Risk
<div>Abstract<p>Whole grain and fiber intakes may decrease the risk of colorectal cancer. The interplay between host genetic factors, colonization of specific bacteria, production of short-chain fatty acids (SCFA), and intake of whole grains and fiber could alter the protective role of carbohydrates against colorectal cancer. Here, we assessed intakes of types and sources of carbohydrates in 114,217 UK Biobank participants with detailed dietary data (2–5 24-hour dietary assessments), and a host polygenic score (PGS) was applied to categorize participants as high or low for intraluminal microbial SCFA production, namely, butyrate and propionate. Multivariable Cox proportional hazards models were used to determine the associations of carbohydrates and SCFA with colorectal cancer incidence. During a median follow-up of 9.4 years, 1,193 participants were diagnosed with colorectal cancer. Risk was inversely associated with intakes of non-free sugar and whole grain fiber. Evidence of heterogeneity was observed by the butyrate PGS; consuming higher amounts of whole grain starch was only associated with a lower risk of colorectal cancer in those with predicted high SCFA production. Similarly, in additional analyses utilizing the larger UK Biobank cohort (<i>N</i> = 343,621) with less detailed dietary assessment, only individuals with a high genetically predicted butyrate production had a lower risk of colorectal cancer per 5 g/day intake of bread and cereal fiber. This study suggests that colorectal cancer risk varies by intake of carbohydrate types and sources, and the impact of whole grain intake may be modified by SCFA production.</p>Significance:<p>Prospective population-level analyses provide evidence supporting the importance of butyrate production in reduction of colorectal cancer risk by whole grain consumption.</p></div>
Data from Prospective analysis reveals associations between carbohydrate intakes, genetic predictors of short-chain fatty acid synthesis, and colorectal cancer risk
<div>Abstract<p>Whole grain and fiber intakes may decrease the risk of colorectal cancer. The interplay between host genetic factors, colonization of specific bacteria, production of short-chain fatty acids (SCFA), and intake of whole grains and fiber could alter the protective role of carbohydrates against colorectal cancer. Here, we assessed intakes of types and sources of carbohydrates in 114,217 UK Biobank participants with detailed dietary data (2-5 24-hour dietary assessments), and a host polygenic score (PGS) was applied to categorize participants as high or low for intra-luminal microbial SCFA production, namely butyrate and propionate. Multivariable Cox proportional hazards models were used to determine the associations of carbohydrates and SCFA with colorectal cancer incidence. During a median follow-up of 9.4 years, 1,193 participants were diagnosed with colorectal cancer. Risk was inversely associated with intakes of non-free sugar and whole grain fiber. Evidence of heterogeneity was observed by the butyrate PGS; consuming higher amounts of whole grain starch was only associated with a lower risk of colorectal cancer in those with predicted high SCFA production. Similarly, in additional analyses utilizing the larger UK Biobank cohort (N=343,621) with less detailed dietary assessment, only individuals with a high genetically predicted butyrate production had a lower risk of colorectal cancer per 5 g/day intake of bread and cereal fiber. This study suggests that colorectal cancer risk varies by intake of carbohydrate types and sources, and the impact of whole grain intake may be modified by SCFA production.</p></div>
Table 1 from Prospective Analysis Reveals Associations between Carbohydrate Intakes, Genetic Predictors of Short-Chain Fatty Acid Synthesis, and Colorectal Cancer Risk
<p>Baseline characteristics by lowest and highest quartile of intake of whole grain starch, refined grain starch, and fiber in 114,217 UK Biobank participants.</p>
Figure 3 from Prospective Analysis Reveals Associations between Carbohydrate Intakes, Genetic Predictors of Short-Chain Fatty Acid Synthesis, and Colorectal Cancer Risk
<p>Multivariable-adjusted hazard ratios (95% CI) for intake of carbohydrates and fiber and colorectal cancer risk separated by genetically predicted host short-chain fatty acid production for butyrate (<b>A</b>) and propionate (<i>n</i> = 87,417; <b>B</b>). All models are stratified by sex, age at recruitment, adjusted for region of recruitment, first 10 genetic principal components, body mass index, height, physical activity, Townsend deprivation index, education, smoking, alcohol consumption, diabetes status, nonsteroidal anti-inflammatory drug use, red and processed meat intake, fruit and vegetable intake (except when fiber from vegetables and/or fruits, and non-free sugar intake was the exposure), energy intake, and female-specific covariates: menopausal hormone therapy use and menopausal status. Analyses are restricted to white British participants. χ<sup>2</sup> and <i>P</i> value represents improvement of fit obtained from likelihood ratio tests for including an interaction term between butyrate or propionate polygenic score and carbohydrate type/source (modeled as a 5% energy increment) or fiber source (modeled as a 5 gram/day increment) into the model.</p>
Figure 3 from Prospective Analysis Reveals Associations between Carbohydrate Intakes, Genetic Predictors of Short-Chain Fatty Acid Synthesis, and Colorectal Cancer Risk
<p>Multivariable-adjusted hazard ratios (95% CI) for intake of carbohydrates and fiber and colorectal cancer risk separated by genetically predicted host short-chain fatty acid production for butyrate (<b>A</b>) and propionate (<i>n</i> = 87,417; <b>B</b>). All models are stratified by sex, age at recruitment, adjusted for region of recruitment, first 10 genetic principal components, body mass index, height, physical activity, Townsend deprivation index, education, smoking, alcohol consumption, diabetes status, nonsteroidal anti-inflammatory drug use, red and processed meat intake, fruit and vegetable intake (except when fiber from vegetables and/or fruits, and non-free sugar intake was the exposure), energy intake, and female-specific covariates: menopausal hormone therapy use and menopausal status. Analyses are restricted to white British participants. χ<sup>2</sup> and <i>P</i> value represents improvement of fit obtained from likelihood ratio tests for including an interaction term between butyrate or propionate polygenic score and carbohydrate type/source (modeled as a 5% energy increment) or fiber source (modeled as a 5 gram/day increment) into the model.</p>
Data from Prospective Analysis Reveals Associations between Carbohydrate Intakes, Genetic Predictors of Short-Chain Fatty Acid Synthesis, and Colorectal Cancer Risk
<div>Abstract<p>Whole grain and fiber intakes may decrease the risk of colorectal cancer. The interplay between host genetic factors, colonization of specific bacteria, production of short-chain fatty acids (SCFA), and intake of whole grains and fiber could alter the protective role of carbohydrates against colorectal cancer. Here, we assessed intakes of types and sources of carbohydrates in 114,217 UK Biobank participants with detailed dietary data (2–5 24-hour dietary assessments), and a host polygenic score (PGS) was applied to categorize participants as high or low for intraluminal microbial SCFA production, namely, butyrate and propionate. Multivariable Cox proportional hazards models were used to determine the associations of carbohydrates and SCFA with colorectal cancer incidence. During a median follow-up of 9.4 years, 1,193 participants were diagnosed with colorectal cancer. Risk was inversely associated with intakes of non-free sugar and whole grain fiber. Evidence of heterogeneity was observed by the butyrate PGS; consuming higher amounts of whole grain starch was only associated with a lower risk of colorectal cancer in those with predicted high SCFA production. Similarly, in additional analyses utilizing the larger UK Biobank cohort (<i>N</i> = 343,621) with less detailed dietary assessment, only individuals with a high genetically predicted butyrate production had a lower risk of colorectal cancer per 5 g/day intake of bread and cereal fiber. This study suggests that colorectal cancer risk varies by intake of carbohydrate types and sources, and the impact of whole grain intake may be modified by SCFA production.</p>Significance:<p>Prospective population-level analyses provide evidence supporting the importance of butyrate production in reduction of colorectal cancer risk by whole grain consumption.</p></div>
Table 1 from Prospective Analysis Reveals Associations between Carbohydrate Intakes, Genetic Predictors of Short-Chain Fatty Acid Synthesis, and Colorectal Cancer Risk
<p>Baseline characteristics by lowest and highest quartile of intake of whole grain starch, refined grain starch, and fiber in 114,217 UK Biobank participants.</p>
Figure 4 from Prospective Analysis Reveals Associations between Carbohydrate Intakes, Genetic Predictors of Short-Chain Fatty Acid Synthesis, and Colorectal Cancer Risk
<p>Multivariable-adjusted hazard ratios (95% CI) for intake of fiber from breads and cereals from the touchscreen questionnaire and colorectal cancer risk by genetically predicted host short-chain fatty acid production for butyrate (<b>A</b>) and propionate (<i>n</i> = 343,621; <b>B</b>). Models stratified for sex and age at recruitment, and further adjusted for region, first 10 principal components, height, physical activity, Townsend deprivation index, education, employment, smoking, alcohol consumption measured at recruitment, diabetes status, nonsteroidal anti-inflammatory drug use, body mass index, processed and red meat intake, and female-specific covariates: menopausal hormone therapy use and menopausal status. Analyses are restricted to white British participants. χ<sup>2</sup> and <i>P</i> value represents improvement of fit obtained from likelihood ratio tests for including an interaction term between butyrate or propionate polygenic score and fiber from breads and cereals (modeled as a 5 gram/day increment) into the model. g/day, grams per day; <i>N</i>, number of participants; Q, quintile; ref, reference group.</p>
Figure 4 from Prospective Analysis Reveals Associations between Carbohydrate Intakes, Genetic Predictors of Short-Chain Fatty Acid Synthesis, and Colorectal Cancer Risk
<p>Multivariable-adjusted hazard ratios (95% CI) for intake of fiber from breads and cereals from the touchscreen questionnaire and colorectal cancer risk by genetically predicted host short-chain fatty acid production for butyrate (<b>A</b>) and propionate (<i>n</i> = 343,621; <b>B</b>). Models stratified for sex and age at recruitment, and further adjusted for region, first 10 principal components, height, physical activity, Townsend deprivation index, education, employment, smoking, alcohol consumption measured at recruitment, diabetes status, nonsteroidal anti-inflammatory drug use, body mass index, processed and red meat intake, and female-specific covariates: menopausal hormone therapy use and menopausal status. Analyses are restricted to white British participants. χ<sup>2</sup> and <i>P</i> value represents improvement of fit obtained from likelihood ratio tests for including an interaction term between butyrate or propionate polygenic score and fiber from breads and cereals (modeled as a 5 gram/day increment) into the model. g/day, grams per day; <i>N</i>, number of participants; Q, quintile; ref, reference group.</p>