Socio-demographic influences on trends of fish consumption during later adult life in the Whitehall II study

Our aim was to investigate how socio-demographic factors influence trends and age-related trajectories of fish consumption. We examined consumption of total, fried and recommended fish (white and oily fish. and shellfish) in the Whitehall 11 study over I I years in participants aged 39-59 years at phase 3. The cohort included 8358 British civil servants who completed a FFQ at phase 3 (1991-3). phase 5 (1997-9. n 5430) and phase 7 (2002-4 n 5692). Occupational grade. ethnicity, marital and retirement status were collected at each phase. To analyse changes in age-related trends of fish intake over time according to socio-demographic characteristics. we applied a random mixed-effect model. Over the follow-up a significant increase in consumption of 'recommended' (mean: 1.85 to 2.22 portions/week) and total fish (mean: 2.32 to 2.65 portions/week) and a decreasing trend in fried-fish intake (mean: 0.47 to 0.43 portions/week) was observed. Recommended. fried and total fish consumption differed by occupational status, ethnicity. marital Status and sex. The trend of age-related fish intake diverged significantly by ethnicity. In South Asian participants (n 432). slope of recommended-fish consumption was significantly higher compared with white participants (0.077 v. 0.025 portions/week per year). For black participants (n 275) slope of fried-fish intake was significantly higher compared with white participants (0.0052 v. -0.0025 portions/week per year). In terms of public health. our descriptive and analytical work allows detailed Understanding of the impact of socio-demographic factors oil fish intake and its age-related trends. Such information is Valuable for food policies that seek to promote health equity

Social factors and cardiovascular morbidity

Recent progress in population health at aggregate level, measured by life expectancy, has been accompanied by lack of progress in reducing the difference in health prospects between groups defined by social status. Cardiovascular disease is an important contributor to this undesirable situation. The stepwise gradient of higher risk with lower status is accounted for partly by social gradients in health behaviors. The psychosocial hypothesis provides a stronger explanation, based on social patterning of living and working environments and psychological assets that individuals develop during childhood. Three decades of research based on Whitehall II and other cohort studies provide evidence for psychosocial pathways leading to cardiovascular morbidity and mortality. Job stress is a useful paradigm because exposure is long term and depends on occupational status. Studies of social-biological translation implicate autonomic and neuroendocrine function among the biological systems that mediate between chronic adverse psychosocial exposures and increased cardiometabolic risk and cardiovascular disease incidence

Prospective study of coffee and tea consumption in relation to risk of type 2 diabetes mellitus among men and women: The Whitehall II study

At least fourteen cohort studies have documented all inverse association between coffee consumption and risk of type 2 diabetes. We examined the prospective association between coffee and tea consumption and the risk of type 2 diabetes mellitus among British men (n 4055) and women (n 1768) from the Whitehall II cohort. During 11.7 years follow-up there were a total of 387 incident cases of diabetes confirmed by Self-report of doctor's diagnosis or glucose tolerance tests. Despite an inverse association between coffee intake and 2 h post-load glucose concentration at the baseline assessment, combined caffeinated and decaffeinated coffee (hazard ratio (HR) 0-80 95% CI 0.54, 1.18) or only decaffeinated coffee intake (HR 0.65: 95% CI 0.36, 1.16) was not significantly associated with diabetes risk at follow-up after adjustment for possible confounders. There was all association between tea intake and diabetes (HR 0.66: 95% CI 0.61, 1.22: P<0.05) after adjustment for age. gender. ethnicity and social status, which was not robust to further adjustments. There was. however, an association between combined intake of tea and coffee (two or more cups per clay of both beverage) and diabetes (HR 0.68: 95% CI 0.46, 0.99: P<0.05) after full adjustment. In conclusion, relatively moderate intake (more than three CLIPS per (lay) of coffee and tea were not prospectively associated with incidence of type 2 diabetes although there was evidence of a combined effect. The limited range of exposure and beverage consumption according to socio-economic class may explain these conflicting findings

Sugar intake from sweet food and beverages, common mental disorder and depression: prospective findings from the Whitehall II study

Intake of sweet food, beverages and added sugars has been linked with depressive symptoms in several populations. Aim of this study was to investigate systematically cross-sectional and prospective associations between sweet food/beverage intake, common mental disorder (CMD) and depression and to examine the role of reverse causation (influence of mood on intake) as potential explanation for the observed linkage. We analysed repeated measures (23,245 person-observations) from the Whitehall II study using random effects regression. Diet was assessed using food frequency questionnaires, mood using validated questionnaires. Cross-sectional analyses showed positive associations. In prospective analyses, men in the highest tertile of sugar intake from sweet food/beverages had a 23% increased odds of incident CMD after 5 years (95% CI: 1.02, 1.48) independent of health behaviours, socio-demographic and diet-related factors, adiposity and other diseases. The odds of recurrent depression were increased in the highest tertile for both sexes, but not statistically significant when diet-related factors were included in the model (OR 1.47; 95% CI: 0.98, 2.22). Neither CMD nor depression predicted intake changes. Our research confirms an adverse effect of sugar intake from sweet food/beverage on long-term psychological health and suggests that lower intake of sugar may be associated with better psychological health

Is There an Association between Work Stress and Diurnal Cortisol Patterns? Findings from the Whitehall II Study.

The evidence on whether there is work stress related dysregulation of the hypothalamic-pituitary-adrenal axis is equivocal. This study assessed the relation between work stress and diurnal cortisol rhythm in a large-scale occupational cohort, the Whitehall II study

Dietary pattern, inflammation and cognitive decline: The Whitehall II prospective cohort study

BACKGROUND & AIMS: Low-grade inflammation appears to play an etiological role in cognitive decline. However the association between an inflammatory dietary pattern and cognitive decline has not been investigated. We aimed to investigate dietary patterns associated with inflammation and whether such diet is associated with cognitive decline. METHODS: We analyzed 5083 participants (28.7% women) from the Whitehall II cohort study. Diet and serum interleukin-6 (IL-6) were assessed in 1991-1993 and 1997-1999. We used reduced rank regression methods to determine a dietary pattern associated with elevated IL-6. Cognitive tests were performed in 1997-1999 and repeated in 2002-2004 and 2007-2009. The association between dietary pattern and cognitive decline between ages 45 and 79 was assessed using linear mixed models. RESULTS: We identified an inflammatory dietary pattern characterized by higher intake of red meat, processed meat, peas and legumes, and fried food, and lower intake of whole grains which correlated with elevated IL-6 both in 1991-1993 and 1997-1999. A greater decline in reasoning was seen in participants in the highest tertile of adherence to the inflammatory dietary pattern (-0.37 SD; 95% confidence interval [CI] -0.40, -0.34) compared to those in the lowest tertile (-0.31; 95% CI -0.34, -0.28) after adjustment for age, sex, ethnicity, occupational status, education, and total energy intake (p for interaction across tertiles = 0.01). This association remained significant after multivariable adjustment. Similarly for global cognition, the inflammatory dietary pattern was associated with faster cognitive decline after multivariable adjustment (p for interaction across tertiles = 0.04). Associations were stronger in younger participants (<56 years), reducing the possibility of reverse causation. CONCLUSIONS: Our study found that a dietary pattern characterized as higher intake of red and processed meat, peas, legumes and fried food, and lower intake of whole grains was associated with higher inflammatory markers and accelerated cognitive decline at older ages. This supports the case for further research

Development of a novel walkability index for London, United Kingdom: cross-sectional application to the Whitehall II study

BACKGROUND: Physical activity is essential for health; walking is the easiest way to incorporate activity into everyday life. Previous studies report positive associations between neighbourhood walkability and walking but most focused on cities in North America and Australasia. Urban form with respect to street connectivity, residential density and land use mix-common components of walkability indices-differs in European cities. The objective of this study was to develop a walkability index for London and test the index using walking data from the Whitehall II Study.  METHODS: A neighbourhood walkability index for London was constructed, comprising factors associated with walking behaviours: residential dwelling density, street connectivity and land use mix. Three models were produced that differed in the land uses included. Neighbourhoods were operationalised at three levels of administrative geography: (i) 21,140 output areas, (ii) 633 wards and (iii) 33 local authorities. A neighbourhood walkability score was assigned to each London-dwelling Whitehall II Study participant (2003-04, N = 3020, mean ± SD age = 61.0 years ± 6.0) based on residential postcode. The effect of changing the model specification and the units of enumeration on spatial variation in walkability was examined. RESULTS: There was a radial decay in walkability from the centre to the periphery of London. There was high inter-model correlation in walkability scores for any given neighbourhood operationalisation (0.92-0.98), and moderate-high correlation between neighbourhood operationalisations for any given model (0.39-0.70). After adjustment for individual level factors and area deprivation, individuals in the most walkable neighbourhoods operationalised as wards were more likely to walk >6 h/week (OR = 1.4; 95 % CI: 1.1-1.9) than those in the least walkable. CONCLUSIONS: Walkability was associated with walking time in adults. This walkability index could help urban planners identify and design neighbourhoods in London with characteristics more supportive of walking, thereby promoting public health

Validity of Cardiovascular Disease Event Ascertainment Using Linkage to UK Hospital Records

BACKGROUND: Use of electronic health records for ascertainment of disease outcomes in large population-based studies holds much promise due to low costs, diminished study participant burden, and reduced selection bias. However, the validity of cardiovascular disease endpoints derived from electronic records is unclear. METHODS: Participants were 7860 study members of the UK Whitehall II cohort study. We compared cardiovascular disease ascertainment using linkage to the National Health Service's Hospital Episode Statistics database records (hereafter, 'HES-ascertainment') against repeated biomedical examinations - our gold-standard ascertainment method ('Whitehall-ascertainment'). Follow-up for both methods was from 1997 to 2013 for coronary heart disease and from 1997 to 2009 for stroke. RESULTS: We identified 950 prevalent or incident non-fatal coronary heart disease cases and 118 prevalent or incident non-fatal stroke cases using Whitehall-ascertainment. The corresponding figures for HES ascertainment were 926 and 107. For coronary heart disease, the sensitivity of HES-ascertainment was 70%, positive predictive value 72%, specificity 96%, and the negative predictive value 96%. The pattern of results for stroke was similar. These statistics did not differ in analyses stratified by age, sex, baseline risk factor status, or after exclusion of prevalent cases. Estimates of risk factor-disease associations were similar between the two ascertainment methods. Including fatal cardiovascular disease in the outcomes improved the agreement between the methods. CONCLUSION: Our analyses support the validity of cardiovascular disease ascertainment using linkage to the UK Hospital Episode Statistics database records by showing agreement with high resolution disease data collected in the Whitehall II cohort.This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited

A novel walkability index for London predicts walking time in adults

Objective: To develop a novel walkability index for London and test it through measurement of associations between neighbourhood walkability and walking among adults using data from the Whitehall II Study. Background: Physical activity is essential for health; walking is the easiest way to incorporate it into everyday life. Many studies have reported positive associations between neighbourhood walkability and walking but the majority have focused on cities in North America and Australasia. Urban form with respect to street connectivity, residential density and land use mix – common components of walkability indices – is likely to differ in European cities. Methods: A walkability index for the 633 spatially contiguous census area statistics wards of London was constructed, comprising three core dimensions associated with walking behaviours: residential dwelling density, street connectivity and land use mix. Walkability was expressed as quartile scores, with wards scoring 1 being in the bottom 25% in terms of walkability, and those scoring 4 in the top 25%. A neighbourhood walkability score was assigned to each London-dwelling Whitehall II Study participant (2003-04, N=3020, mean +/-SD age=61.0y +/-6.0) as the walkability score of the ward in which their residential postcode fell. Associations between neighbourhood walkability and weekly walking time were measured using multiple logistic regression. Results: After adjustment for individual level factors and area deprivation, people in the most walkable neighbourhoods were significantly more likely to spend ≥6hr/wk (Odds Ratio 1.4; 95%Confidence Interval 1.1-1.9), than those in the least walkable. Conclusions: The walkability index constructed can predict walking time in adults: living in a more walkable neighbourhood is associated with longer weekly walking time. The index may help urban planners identify and design neighbourhoods in London with characteristics that are potentially more supportive of walking and, thereby, promote public health