Welcome to the summer 2022 issue of epigram, the quarterly newsletter from the MRC Epidemiology Unit.

To receive it straight to your inbox, sign up at www.mrc-epid.cam.ac.uk/subscribe/

In this issue

• Active kids – anything but child’s play
• Wearable tech boosts research accuracy
• That’s a WRAP for weight loss study
• Lockdown learning – lessons from the pandemic
• Opportunities at the Unit
• Researcher voices
• Getting the word out
• Our latest publications

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Active kids – anything but child’s play

Nearly half of British six-year-olds don’t meet daily physical activity guidelines

Current UK physical activity guidelines recommend that children and young people aged between 5 and 18 years do an average of 60 minutes of moderate-to-vigorous physical activity – including activities such as brisk walking, swimming, dancing or football – per day across the week.

Children’s transition into formal schooling is an important opportunity to ensure many more achieve recommended levels of activity. To find out how much physical activity UK children at the beginning of formal schooling are actually achieving, researchers gave 712 UK six-year-olds accelerometers that they each wore continually for an average of six days.

The results showed that just over half of the children (53%) met the current UK recommended guidelines, with boys being more likely to reach the target than girls (63% of boys vs 42% of girls). The scientists recommend that new initiatives to promote physical activity should consider the lower activity levels in girls and at weekends. Read more.

The importance of professional development for school-based physical activity promotion

Schools have been the focus of the majority of government policies and researcher-led interventions aiming to increase children’s physical activity levels. However, the best available evidence suggests that they have largely failed to achieve their desired outcomes.

To investigate the reasons for these disappointing outcomes, researchers reviewed evidence from 19 countries to determine what staff training has been provided within the interventions, and then explored if specific training features were associated with either teachers implementing the new initiative as intended or an increase in student physical activity.

They identified specific training features which made it more likely that an intervention would be delivered to students as intended, including clear goals to work towards, the opportunity to practice the new teaching technique, regular evaluation and feedback, and resources such as sports equipment. Unfortunately these key ingredients for success were often missing from the training the teachers received. Read more.

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Wearable tech boosts research accuracy

Wearable device study in 88,000 people shows the heart health benefits of more intense physical activity

Increasing physical activity of any intensity is known to be beneficial for health, but a research team new led by scientists at the MRC Epidemiology Unit and University of Leicester wanted to find out if there is a greater reduction in cardiovascular disease risk when more of that activity is of at least moderate intensity.

Most large-scale physical activity research uses questionnaires, but physical activity intensity and duration is hard to recall accurately, especially when it comes to low intensity every day activities like housework or shopping. So the authors analysed wrist-worn accelerometer-measured physical activity data from more than 88,000 UK Biobank participants.

They found that, as expected, the total amount of physical activity a person does was strongly associated with a decrease in the risk of heart disease or stroke. But they also found that getting more of the total physical activity volume from moderate-to-vigorous physical activity was associated with a substantial additional reduction in cardiovascular risk. In other words, intensity of exercise does matter for health. Read more.

Unit joins collaboration developing better techniques to track people’s diets

Diets are currently measured by people trying to remember what they have eaten and then completing complex and time-consuming nutrition surveys. This can lead to unreliable results. In an effort to more accurately measure the UK’s eating habits and improve public health, scientists from the MRC Epidemiology Unit have joined a project that will soon begin testing new techniques including wearable cameras and urine and blood tests.

Volunteers will follow set meal plans representative of the UK diet under supervised conditions, wearing tiny cameras to film what they eat, as well as providing blood and urine samples. The images taken will be analysed using AI software and the results compared with measurement of chemical markers of food intake in the urine and blood to determine how accurately the approach can recognise foods eaten by the wearer.

This work has major implications for how researchers and policy makers assess the success of efforts to improve people’s health and give better dietary advice. It could also help in the monitoring needed to test new treatments for disease, such as the connection between eating patterns and cancer. Read more.

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That’s a WRAP for weight loss study

Assessing the long term impact of a commercial weight management programme

A study examining the long term effect of 12 and 52 week commercial weight management programmes shows that the 52 week programme was more effective over two years. After five years some weight loss was maintained, and over a lifetime both programmes are likely to be cost-saving for the NHS.

• Read more here 
• Watch a short video about the findings and download an infographic below:

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Lockdown learning – lessons from the pandemic

Pandemic widens inequalities in physical activity and diet 

The COVID-19 pandemic exposed clear inequalities in the UK, with people with existing health conditions and living in the poorest areas of the country more likely to die from COVID-19 than the wealthiest. The pandemic, and the restrictions brought in to control it, also had an impact on everyday life including how active people were, their diets, alcohol consumption, sleep and smoking.

Using data from the Cambridgeshire-based Fenland Study and the Fenland COVID-19 Study, researchers compared measures of these behaviours taken on two occasions in the years before the pandemic (2005-2020) with the same measures taken on three occasions during the pandemic (2020-2021).

The amount of fruit and vegetables eaten as well as physical activity decreased during the pandemic period, with a much larger decrease among participants living in poorer areas of Cambridgeshire compared to those living in more affluent areas. These decreases were also greater in women compared to men. Additionally, larger decreases in home-, leisure- and work-based physical activity were seen in older age groups compared with those under 60 years old. Read more.

New analysis explains why some people suffer more from COVID-19 than others

Why is a COVID-19 infection more serious for some people than others? The human genome may hold a key. An international research team led by scientists from the MRC Epidemiology Unit and Berlin Institute of Health at Charité identified several variations in human genes that contribute to a higher risk of severe COVID-19.

By examining the levels of over 1,000 proteins in blood plasma, they found eight proteins for which differences between individuals in their levels were associated with differing infection severity, and linked these to variations in the genes that code for them.

The scientists hope that this knowledge can be used to develop effective therapies for COVID-19 infection, though not all the proteins are suitable targets due to the risk of side effects. One protein they identified G-CSF, is promising. COVID-19 patients who produce more G-CSF tend to experience a milder disease course, and as synthetic G-CSF is already used as a drug for other conditions it can potentially be repurposed as a treatment for COVID-19. Read more.

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Opportunities at the Unit

PhD Studentships in Epidemiology or Public Health Research 2023/24

We’re pleased to announce the availability of PhD student places to start in 2023/24. PhD students are encouraged to develop and conduct their own research relevant to any of the department’s nine research programmes. We invite applicants to contact potential supervisors directly to discuss your research interests. You are welcome to formulate your own PhD topic, coherent with the overall goal of the Unit and any of our programmes, or alternatively you may choose from our list of projects.

• Closing date 5 January 2023.
• Full details

Senior Programmer – Web Lead

An exciting opportunity has arisen for a Senior Programmer/Web Lead to join the Unit. Initially embedded in Data Management this role will transition to become part of the Digital Tools Team – a new team that will enable a step change in the development and application of digital technology to the Unit’s portfolio of research such as wearables and apps, working alongside the existing Data Management and IT teams. The post holder will work with a number of other specialists, including a number of Data Managers, Programers and IT Support Staff to deliver web-based applications for the Unit. You will work closely with the Communication Team where your technical expertise and understanding of websites will be integral to developing and maintaining the Unit’s web presence.

• Closing date 3 November 2022
• Full details

Get specific alerts about vacancies by amending your subscription preferences at www.mrc-epid.cam.ac.uk/subscribe

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Researchers Voices

The views of Unit researchers are often sought on issues related to their work. Here are a few example from the last few months, and you can find more on our Researcher Voices page

The “zero-chance” doctor who now advises government

In an interview with the University of Cambridge’s ‘This Cambridge Life’ feature, MRC Epidemiology Unit scientist Dr Raghib Ali describes how after growing up on free school meals at one of the lowest performing state schools in the country, he went on to become a leading epidemiologist and OBE awardee. Read more

The innovative doctor who treats cities

Unit scientist Dr Tolullah Oni, who leads our Global Diet and Physical Activity research group, was interviewed by South Africa’s Daily Maverick about how components of cities such as food environments, noise and air pollution contribute to different disease outcomes. She also gave a talk on ‘Public Health, Architecture and Urbanism’ to the African Futures Institute, which you can watch on YouTube.

Imagining a future beyond the car

In an analysis for the BMJ, Dr James Woodcock and colleagues argue that achieving a healthy and net zero transport system requires a transition away from the private car – whether electric of fossil fuelled – to a mix of other forms of transport. Read more.

BBC Food programme discusses processed food reformulation 

Professor Jean Adams examined the challenges of reformulating highly processed food to make it healthier in an interview for the Food Programme episode ‘Reformulation – a fix for the obesity crisis?’. Listen on BBC Sounds.

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Getting the word out

Big Biology Day 2022

Volunteers from the Unit were joined by colleagues from the IMS-Metabolic Research Laboratories on our Big Biology Day 2022 stand at Hills Road 6th Form College on Saturday 15 October. We were visited by more than 250 people of all ages who raced against the clock in our Sugar Cube Challenge, learned what biomarkers can tell us about diet and health with Fortune Telling Molecules, and discovered how our food environment influences what we chose to eat with the Snackingtons game.

The science of takeaway names

How often can you guess what kind of food a takeaway sells from the name alone? Chances are you can sometimes guess even when the food isn’t specified. In 2021 Unit researchers led who study neighbourhood exposure to takeaway outlets used machine learning to develop a model to automatically classify takeaway food outlets based on business name alone. They’ve now launched an online tool that anyone can use to classify outlets. Does it get your local takeaways right? 

Unit members across several of our programmes and teams have been given awards that recognise their work.

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Our latest publications

You can now find all publications from the MRC Epidemiology Unit at our new Publications Database: https://publications.mrc-epid.cam.ac.uk/ You can search by journal, year, study, programme, Unit author, and keywords in the title and abstract. Since the last issue of epigram, we have published the following papers:

• Awareness, use and understanding of nutrition labels among adults from five countries: findings from the 2018 – 2020 International Food Policy Study Acton R et al. Appetite
• Effectiveness and cost-effectiveness of referral to a commercial open group behavioural weight management programme in adults with overweight and obesity: 5-year follow-up of the WRAP trial Ahern AL et al. Lancet Public Health
• Making integration foundational in population health intervention research: why we need ‘Work Package Zero’ Alvarado M et al. Public Health
• Subclinical thyroid dysfunction and incident diabetes: a systematic review and an individual participant data analysis of prospective cohort studies Alwan H et al. Eur J Endocrinol
• The association between sleep duration and detailed measures of obesity: A cross sectional analysis in the ADDITION-PRO study Andersen MM et al. Obesity Science & Practice
• The Impact of Nutrition-Based Interventions on Nutritional Status and Metabolic Health in Small Island Developing States: A Systematic Review and Narrative Synthesis Augustus E et al. Nutrients
• Dietary Patterns, Food Insecurity, and Their Relationships with Food Sources and Social Determinants in Two Small Island Developing States Bhagtani D et al. Nutrients
• An investigation of factors affecting changes in health behaviours during the COVID-19 pandemic in a UK population-based cohort study Braithwaite VS et al. Public Health
• Metabolomic profiles predict individual multidisease outcomes Buergel T et al. Nat Med
• The dynamic changes and sex differences of 147 immune-related proteins during acute COVID-19 in 580 individuals Butler-Laporte G et al. Clin Proteomics
• Mortality from angiotensin-converting enzyme-inhibitors and angiotensin receptor blockers in people infected with COVID-19: a cohort study of 3.7 million people Dambha-Miller H et al. Family Practice
• Characterising trusted spokespeople in noncommunicable disease prevention: A systematic scoping review Demeshko A et al. Prev Med Rep
• UK government food strategy lacks ambition to achieve transformative food system change Doherty B et al. Nat Food
• A realist review of voluntary actions by the food industry and implications for public health and policy in low- and middle-income countries Erze A et al. Nature Food
• A Mixed-Methods Participatory Intervention Design Process to Develop Intervention Options in Immediate Food and Built Environments to Support Healthy Eating and Active Living among Children and Adolescents in Cameroon and South Africa Erzse A et al. Int J Environ Res Public Health
• Diabetes precision medicine: plenty of potential, pitfalls and perils but not yet ready for prime time Griffin SJ et al. Diabetologia
• Association between Legume Consumption and Risk of Hypertension in the European Prospective Investigation into Cancer and Nutrition (EPIC)-Norfolk Cohort Hartley M et al. Nutrients
• Activity behaviours in British 6-year-olds: cross-sectional associations and longitudinal change during the school transition Hesketh K et al. J Phys Act Health
• Monitoring the Nutrient Composition of Food Prepared Out-of-Home in the United Kingdom: Database Development and Case Study Huang Y et al. JMIR Public Health Surveill
• External validation of a prediction model for estimating fat mass in children and adolescents in 19 countries: individual participant data meta-analysis Hudda MT et al. BMJ
• Matching study using health and police datasets for characterising interpersonal violence in the community of Khayelitsha, South Africa 2013-2015 Jabar A et al. BMJ Open
• Developing and implementing 20-mph speed limits in Edinburgh and Belfast: mixed-methods study Jepson R et al. Southampton (UK): National Institute for Health and Care Research;
• Adolescents’ perspectives on soft drinks after the introduction of the UK Soft Drinks Industry Levy: a focus group study using reflexive thematic analysis Jones CP et al. Appetite
• Participants experiences of mental health during a COVID-19 tailored ACT-based behavioural weight management intervention: a qualitative study Jones R et al. Int J Qual Stud Health Well-being
• Perceived weight-related stigma, loneliness, and mental wellbeing during COVID-19 in people with obesity: A cross-sectional study from ten European countries. Jones RA et al. Int J Obesity
• Maternal Early-Life Risk Factors and Later Gestational Diabetes Mellitus: A Cross-Sectional Analysis of the UAE Healthy Future Study (UAEHFS) Juber NF et al. Int J Environ Res Public Health
• Investigating experiences of frequent online food delivery service use: a qualitative study in UK adults Keeble M et al. BMC Public Health
• The association of physical activity and cardiorespiratory fitness with β-cell dysfunction, insulin resistance, and diabetes among adults in north-western Tanzania: A cross-sectional study Kitilya B et al. Front Endocrinol (Lausanne)
• Physical behaviours and their association with type 2 diabetes mellitus risk markers in urban South African middle-aged adults: An isotemporal substitution approach Kufe CN et al. BMJ Open Diabetes Res Care
• HOTAIR interacts with PRC2 complex regulating the regional preadipocyte transcriptome and human fat distribution Kuo FC et al. Cell Rep
• Association between circulating 25-hydroxyvitamin D and cardiometabolic risk factors in adults in rural and urban settings Mba C et al. Nutr Diabetes
• Do not routinely test for vitamin D McChesney C et al. BMJ
• Reducing Sugar Intake in South Africa: Learnings from A Multilevel Policy Analysis on Diet and Noncommunicable Disease Prevention McCreedy N et al. Int J Environ Res Public Health
• Physical behaviors and their association with adiposity in men and women from a low-resourced African setting Mendham AE et al. J Phys Act Health
• Early weight gain influences duration of breast feeding: prospective cohort study Olga L et al. Arch Dis Child
• Lipid profiling analyses from mouse models and human infants Olga L et al. STAR Protoc
• Newborn body composition and child cardiovascular risk markers: a prospective multi-ethnic Asian cohort study Ong YY et al. Int J Epidemiol
• ELF5 is a potential respiratory epithelial cell-specific risk gene for severe COVID-19 Pietzner M et al. Nat Commun
• Developing a core outcome set for physical activity interventions in primary schools: a modified-Delphi study Ram B et al. BMJ Open
• A multi-layer functional genomic analysis to understand noncoding genetic variation in lipids Ramdas S et al. Am J Hum Genet
• Engagement with mHealth COVID-19 digital biomarker measurements in a longitudinal cohort study: a mixed methods evaluation Rennie KL et al. J Med Internet Res
• Features of effective staff training programmes within school-based interventions targeting student activity behaviour: a systematic review and meta-analysis Ryan M et al. Int J Behav Nutr Phys Act
• Towards Harmonization of Directly-Measured Free 25-Hydroxyvitamin D Using an Enzyme-linked Immunosorbent Assay Sempos CT et al. Anal Bioanal Chem
• Travel behaviour and barriers to active travel among adults in Yaoundé, Cameroon Tatah L et al. Sustainability
• The Relationship of Maternal Gestational Mass Spectrometry-Derived Metabolites with Offspring Congenital Heart Disease: Results from Multivariable and Mendelian Randomization Analyses Taylor K et al. J Cardiovasc Dev Dis
• Development, validation and item reduction of a food literacy questionnaire (IFLQ-19) with Australian adults Thompson C et al. Int J Behav Nutr Phys Act
• The Yorkshire Kidney Screening Trial (YKST): protocol for a feasibility study of adding non-contrast abdominal CT scanning to screen for kidney cancer and other abdominal pathology within a trial of community-based CT screening for lung cancer Usher-Smith JA et al. BMJ Open
• Genome-wide association analyses of physical activity and sedentary behavior provide insights into underlying mechanisms and roles in disease prevention Wang Z et al. Nat Genet
• Personalised prevention of type 2 diabetes Wareham NJ. Diabetologia
• A cluster randomised controlled trial of screening for atrial fibrillation in people aged 70 years and over to reduce stroke: protocol for the pilot study for the SAFER trial Williams K et al. BMJ Open
• Sex-specific associations between potassium intake, blood pressure, and cardiovascular outcomes: the EPIC-Norfolk study Wouda RD et al. Eur Heart J
• Impacts of new cycle infrastructure on cycling levels in two French cities: An interrupted time series analysis Xiao C et al. Int J Behav Nutr Phys Act
• Ethnicity and risks of severe COVID‐19 outcomes associated with glucose‐lowering medications: a cohort study Zaccardi F et al. Diabetes Obes Metab
• Factors associated with significant weight loss in hospitalised patients with COVID-19: a retrospective cohort study in a large teaching hospital Zannidi D et al. Nutrients

About epigram

epigram is the newsletter for everyone interested in work happening at the MRC Epidemiology Unit at the University of Cambridge.

We welcome your views on it. Email us at comms@mrc-epid.cam.ac.uk

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