News from the MRC Epidemiology Unit – Autumn 2021
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- Welcome – Prof Nick Wareham
- epigram is changing
- Genes – Time for a bigger picture
- Why we’re all different and why it matters
- Food for thought
- Progress on policy
- Global health challenges call for new solutions
- Responding to the COVID-19 pandemic
- Awards and accomplishments
- About epigram
Welcome – Prof Nick Wareham
Obesity and diabetes: facing the future
Welcome to epigram 2021.
The challenge of COVID-19 has focussed attention not only on our pandemic preparedness but also on inequalities and health conditions that make infection more likely and its complications more severe.
Chief among these are obesity and diabetes, and the pandemic is providing further impetus to efforts to respond to the rising levels around the world.
It is a response we need to make on all fronts: from the individual to the societal; from the local to the global. And it requires insight from genetics, behavioural science, epidemiology, and population health science. You can read in this issue about how we continue to bring all these disciplines – and more – to bear on the treatment and prevention of these diseases, their cause and their consequences.
You will also see below that epigram will be changing to a quarterly newsletter and incorporating CEDAR Bulletin. We feel it is a good time to be able to more regularly update you with all of our news, and bring together many of the different pieces in our scientific jigsaw. I very much hope you will continue to follow us on our research journey.
Finally, as always, thank you to all our researchers, staff, students, research participants, and partners in practice and policy. It is your individual and collective inputs and insights that sustain what we do, and help us make the differences to the world that we need.
With best wishes
Prof Nick Wareham
Director, Medical Research Council Epidemiology Unit
epigram is changing
From the beginning of 2022, epigram will be combining with CEDAR Bulletin so that there will be a single quarterly newsletter from the MRC Epidemiology Unit.
This will still cover all the news you are used to, but will better allow us to share the latest research and events across all our research programmes. As you’ll see from this packed issue, there is such a wealth of research happening at the Unit, and we would like to be able to update you more regularly.
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Genes – Time for a bigger picture
That our DNA influences our risk of developing obesity and health conditions is not news. But the influence and interaction of genetic variations is often subtle and hard to quantify. New technologies and techniques now mean we can analyse data from large and diverse populations to gain deeper understanding and help point the way to new approaches to treatment and prevention.
Small molecules with big impact
Blood metabolites are small circulating molecules, such as sugars, vitamins, or lipids, which reflect the influences of genetics, lifestyle, environment and medical treatment on human physiology. This year two innovative studies co-led by Dr Claudia Langenberg and Dr Maik Pietzner highlighted their potential to improve understanding of the causes of both rare and common diseases.
In the first study, researchers combined large-scale genetic analysis with measurements of levels of more than a hundred individual blood metabolites from over 85,000 people, which were originally obtained using several different technologies. This approach identified hundreds of gene variations not previously known to regulate blood metabolite levels. This work identified a strong link between high levels of the amino acid serine and protection from a rare eye disease called macular telangiectasia type 2, highlighting new therapeutic opportunities of their approach.
The second study of blood plasma metabolites in 11,000 EPIC-Norfolk study participants found that those with more than one chronic disease, known as multimorbidity, have a common genetic origins for these diseases. Two-thirds of the metabolites associated with disease were shared by multiple diseases. The researchers hope that future treatments targeting pathways shared by two or more of a patient’s conditions may be more effective and better at avoiding complications.
This work provides an unprecedented reference map of human metabolism, which the researchers have made freely available to the scientific community at Omicscience.org.
Diversity aids discovery of diabetes genes
Until recently, nearly 87% of human genome research has been conducted in people of European descent. By ensuring that 30% of the more than 280,00 people in a new study were individuals of East Asian, Hispanic, African-American, South Asian and sub-Saharan African origin, the international MAGIC collaboration identified 24 more regions of the genome linked to type 2 diabetes-related traits than if the research had been conducted in Europeans alone. Not all the regions were distributed evenly among all ancestries, and the authors, including Unit researchers Dr Claudia Langenberg and Dr Eleanor Wheeler, hope that this information will help to develop better genetic tools to weigh up an individual’s risk of diabetes. Read more.
Sequencing complete genomes identifies rare diabetes genes
Large scale genetic studies usually depend on ‘array genotyping’ methods, which are good at finding specific gene variations scattered across the whole genome, but may miss rare genetic variants. Recent technical advances have allowed the complete DNA sequences of over 20,000 genes that code for proteins in humans to be quickly and efficiently read. Unit scientists led by PhD student Yajie Zhao and Prof John Perry used this technology to study the DNA of more than 200,000 adults in UK Biobank. They identified rare genetic variants – carried by only one in 3,000 people – that have a larger impact on the risk of developing Type 2 diabetes than any previously identified variants. Read more.
Why we’re all different and why it matters
Unit research is showing how our health and how we respond to healthcare as individuals is profoundly influenced by our genes, our environment and our personal histories.
Education and employment in early adulthood independently influence cardiovascular health in later life
Research by Dr Eleanor Winpenny and colleagues found that education and employment experiences in early adulthood contribute to cardiovascular health inequalities in later life. In a study of 12,000 people they found that those who spent longer in education, going onto professional or managerial roles during early adulthood, had better cardiovascular health more than 20 years later. Importantly this wasn’t just because of a higher income or higher level job in middle age. Read more.
Type 2 diabetes weight loss recommendations could be harmful for some, depending on BMI
In a study of 2,730 adults, Dr Jean Strelitz and colleagues found that over the five-year period after type 2 diabetes diagnosis a steady, moderate weight loss showed no effect on heart disease or mortality. And a large weight loss – more than 10% of body weight – led to no increased risk among people who had obesity. However, those who did not have obesity and experienced a large weight loss had more than three times the risk of death than someone who maintained their weight, leading the authors to recommend that weight loss advice for people with type 2 diabetes should be tailored to reflect that weight loss may affect patients differently. Read more.
The genetics of sex and reproduction
Sex and reproduction are key to human genetics, yet until now the influence of genetic variations on sexual and reproductive events has been limited. Recent analysis of data from hundreds of thousands of participants in UK Biobank and other large genetic studies is shedding light on the role of gene variants in the age at when people first have sex and become parents, and the age at which women go through natural menopause.
In the first study, an analysis of data from more than half a million UK Biobank participants, co-led by Unit scientist Dr Felix Day, discovered hundreds of genetic markers that influence the age at when people first have sex and become parents. The researchers did also find that these genetic traits are strongly moderated by social factors and the environment.
The second study, an international research collaboration involving more than 180 research institutions co-led by Unit scientist Professor John Perry, identified more than 200 gene variations that influence the age at natural menopause. Researchers hope these findings can be used to help predict which women are most likely to have menopause at a young age.
Food for thought
Diet has long been known to profoundly influence health. But to offer sound advice and implement policies that will support healthy diets, we need a good understanding of what we eat, and how it affects our bodies.
Legume study highlights complexity of dietary research
Legumes such as beans, lentils, peas and soy are typically high in dietary fibre, protein, B vitamins and minerals, and have a low glycaemic index. Consequently, their consumption is promoted as part of a healthy diet in many countries. But how healthy are they? A new analysis of both published and unpublished research led by Dr Matthew Pearce and Prof Nita Forouhi found the answer may depend on how they are eaten and what they are eaten with. Read more.
Replacing red and processed meat with cheese, yogurt or nuts may lower the risk of type 2 diabetes
After analysing data from a study comparing 11,741 new cases of type 2 diabetes with 14,719 matched individuals who remained free of diabetes, a research team co-led by Prof Nita Forouhi estimated that if all participants had replaced one serving per day of red and processed meat with one serving per day of cheese, yoghurt or nuts, almost one in 10 of the observed new diabetes cases could have been prevented. Read More.
National Diet and Nutrition Survey highlights a mixed picture
In December 2020, the latest report from the UK National Diet and Nutrition Survey Rolling Programme was published, covering the period from 2016 to 2019. The survey is carried out jointly by researchers at the Unit and NatCen Social Research. It found that while progress had been made in reducing sugar consumption, fruit and vegetable consumption had barely changed over the past decade. There were also concerning declines in folate levels in women of childbearing age and vitamin D levels in children. Read more.
Progress on policy
The obesity epidemic is shaped significantly by the quality and availability of the food that makes up our diets. Our researchers have continued to contribute to understanding these influence and helped shape and evaluate policy responses.
Sugar purchased in soft drinks falls 10% after levy introduced
A research team led by Dr Jean Adams and Dr David Pell reported that the amount of sugar purchased by households through soft drinks fell by 10% in the year following the introduction of the UK Soft Drinks Industry Levy in April 2018, although there was no change in the volume of soft drinks purchased. Read More.
Restricting junk food ads on TV
In June 2021 the UK Government announced that a ban on TV adverts for food high in sugar, salt and fat before 9 PM would be implemented from the end of 2022. This followed an analysis in October 2020 by Dr Oliver Mytton and colleagues indicating that unhealthy food advertising on television before the 9pm watershed is responsible for 1 in 22 cases of childhood obesity. They also showed that removing these adverts before 9pm has the potential to reduce the number of children with obesity by 40,000. Read more.
Past Government obesity policies were destined to fail
Unit PhD student Dolly Theis and Prof Martin White analysed three decades of Government obesity policies in England, finding that they had largely failed to achieve their aims because of problems with implementation and lack of learning from past successes or failures. Policies were also over-reliant on trying to persuade individuals to change their behaviour, rather than tackling unhealthy environments. Read more.
Mapping the UK’s disease prevention research landscape
Prof Nick Wareham and Prof Martin White were involved in detailed analysis of research in the prevention of non-communicable diseases like cancer, diabetes and heart disease in the UK, which is key to improving population health and reducing health inequalities. Their work highlights the growing challenge of worsening population health and persisting health inequalities, and makes a clear case for a step change in investment in UK prevention research. Read more.
Unit contributes to Broken Plate report and National Food Strategy
For the third year in a row, Unit researchers contributed in July to the Food Foundation’s annual Broken Plate Report, which showed that UK food environment is skewed towards less healthy options, and that healthier foods are much less accessible and affordable for those on lower incomes. And in the same month, the National Food Strategy, an independent review carried out for the Government by a team led by businessman and author Henry Dimbleby, was launched. It cited a range of research papers by Unit authors as well as referencing the National Diet and Nutrition Survey (NDNS) – co-led by the Unit in collaboration with NatCen Social Research. The report made 14 recommendations, including the introduction of a sugar and salt reformulation tax, similar to the levy introduces in 2018 for sugary soft drinks, the evaluation of which is being led by the Unit.
Global health challenges call for new solutions
The last eighteen months has shown more clearly than ever how interconnected the health of people around the world is. Unit scientists have been helping to understand this global picture, and apply innovative methods to address the varied challenges.
New funding for GDAR Network to explore interaction of non-communicable diseases, urbanisation and climate change
The Global Diet and Activity Research Network (GDAR), co-led by the Unit’s Dr Tolullah Oni, has secured funding from the NIHR Global Health Research initiative for four more years. The Network is working in Cameroon, South Africa, Kenya and Jamaica, as well as collaborating with universities in Nigeria and Brazil. In its new phase of funding, the Network is investigating the interaction of mass urbanisation, rapid climate change, and epidemics of poor diet and physical inactivity. The goal is to create effective and sustainable interventions to improve health in low and middle income countries. Among the research projects, the Network will look at the lesson learnt from responses to COVID-19. The pandemic has prompted policymakers from across sectors to work in ways previously considered challenging or impossible. This could sow the seeds for the radical action needed to tackle non-communicable diseases and sustainable growth. www.gdarnet.org
Unit scientists highlight need for action on global diabetes epidemic
In November 2020, Unit scientists were part of an international team calling for urgent action to address the global diabetes epidemic. Worldwide, more than 460 million people have diabetes, and in 2019 more than 4 million people died as a result of the condition and its complications. Eight out of ten diabetes cases are now in low-income and middle- income countries, and people with diabetes can be at more than twice the risk of severe disease and death from COVID-19 than the general population. In a report for The Lancet, the international team summarised the best evidence for effectively managing and preventing diabetes. This encompasses areas such as sustained weight reduction, reducing blood sugar, the use of risk-reducing drugs, better integrated care and structured lifestyle interventions. Read more.
Olympics provide reminder of need to improve physical activity worldwide
Unit researchers were among those contributing to The Lancet’s third Series on physical activity, launched ahead of the Tokyo Olympics and Paralympic. In the past decade, not enough progress has been made to improve physical activity worldwide. Overall deaths associated with inactivity remain at more than 5 million people per year. No progress has been made to improve adolescent physical activity since 2012, with eight out of ten people still not meeting WHO activity guidelines. The Olympics remains a missed opportunity to increase physical activity in host countries. The authors call for urgent efforts to improve physical activity in key populations, and recognise the potential to incorporate population health initiatives into future mass sporting events. Read more.
Seven is the magic number: global study identifies a threshold for gender equality in cycling
In many countries many fewer women than men cycle. Using data from 17 countries in six continents, researchers including the Unit’s Dr James Woodcock have identified a threshold above which we start to see at least as many women cycling as men. At a country level, this is 7% of all trips by bike, a tipping point that has been reached in the Netherlands, Japan, Germany, Finland and Switzerland. In Amsterdam in the Netherlands and Osaka in Japan, just under one in three trips are made by bike. But in cities with the lowest cycling levels it is less than one in a hundred. In Osaka almost two-thirds of bike trips are made by women. In London, only 3% of trips are made by bike, and this drops to 1% among women. Read more.
Responding to the COVID-19 pandemic
Just as we have adapted how we have conducted our science in the face of COVID-19 restrictions and changes, our researchers have also been studying COVID-19 and its impacts.
Open platform developed to help discover COVID-19 drugs
An international consortium led by Unit scientists Dr Claudia Langenberg and Dr Maik Pietzner has developed an open access platform to help prioritise drug discovery and repurposing efforts for the COVID-19 pandemic. The platform provides information on the genetic variation of host proteins involved in SARS-CoV-2 infection, based on analysis of genetic and proteomic data from 10,708 participants in the Unit-run Fenland Study. Read more.
COVID-19 pandemic led to nearly 1 million extra deaths in 29 high income countries in 2020
An international scientific collaboration, led by researchers at the Nuffield Department of Population Health at the University of Oxford, and including the Unit’s Prof Martin White, calculated that approximately one million excess deaths occurred in 2020 across 29 high income countries. They found that in most countries the estimated number of excess deaths was greater than the number of reported COVID-19 deaths; 33% higher for the United Kingdom and over 50% higher for some countries. Read more.
Fenland COVID-19 Study completes data collection
On 30 April 2021 the Fenland COVID-19 study completed data collection. The study, which sought to determine how many people in the Fenland study have had COVID-19 and identify predictors of early asymptomatic infection, recruited nearly 4,000 participants, and collected more than 500,000 measurements an a mobile app used by participants. Unit researchers are now analysing this data in preparation for publication. On 29 March Unit scientist Dr Kirsten Rennie discussed the Fenland COVID-19 study in a Cambridge Festival event that you can watch on YouTube.
Assessing the impact of COVID-19 on diet, nutrition and physical activity in the UK
In September Public Health England (PHE) published the report ‘Diet, Nutrition and Physical Activity in 2020: a follow up study during COVID-19’, which aimed to describe and assess the impact of the pandemic on the diet and physical activity of people in the UK by following up participants who had previously taken part in the National Diet and Nutrition Survey Rolling Programme. The report’s results were mixed, but among the key findings was that households with worries about not being able to afford food in the next month consumed less fruit and vegetables, less fish, and more sugar sweetened soft drinks than those from unworried households. Read more.
Awards and accomplishments
The past year has seen several important achievements and new initiatives by teams and individuals at the MRC Epidemiology Unit, which highlight out involvement in the wider community of Cambridge and beyond.
American Diabetes Association presents prestigious award to Unit Prof Nick Wareham
Unit Director Professor Nick Wareham received the2021 Kelly West Award for Outstanding Achievement in Epidemiology at this year’s American Diabetes Association (ADA) National Scientific and Health Care Achievement Awards. Announcing the awards, the ADA noted that they “recognize academics, health care providers and educators who have contributed to tangible advances in the field of diabetes care and research. Each of these leaders have unwavering dedication to achieving the mission of the ADA: life free of diabetes and all its burdens.” Read more.
MRC Epidemiology Unit receives Green Impact Platinum Award for 2020-21
The Unit was awarded the Green Impact Platinum Award in 2020-21, the first time that the Unit has achieved this award. Green Impact is a part of The Cambridge Green Challenge, the University of Cambridge’s environmental accreditation scheme, which supports and encourages departments and colleges across the university in reducing their environmental impact. Read more.
Unit takes part in Health Data Research UK’s Black internship programme
The Unit welcomed Elizabeth Oduala as part of the Health Data Research UK (HDR UK) Black internship programme. Elizabeth is studying for a degree in Applied AI & Data Analytics at the University of Bradford, and during her internship Elizabeth worked under the supervision of Dr SM Labib and Dr James Woodcock. Through the Black internship programme, HDR UK hopes to help tackle the underrepresentation of Black people within the STEM community by transforming the prospects of and providing the opportunities for young Black people in the UK to flourish in their future STEM careers. Read more.
Unit public engagement goes online and outdoors
The Covid pandemic has meant that many traditional science outreach activities have not been possible, but that hasn’t stopped our members getting out there. Our scientists and students took part in the inaugural Cambridge Festival, held online in March and April 2021. In the autumn we took part in Open Cambridge, with an event exploring how the UK’s diet has changed in recent years.
In the summer we joined our colleagues from the Wellcome-MRC Institute of Metabolic Science Metabolic Research Laboratories at community events organised by Cambridge City Council’s Children and Young People’s Participation Service (ChYpPS) and the North Cambridge Community Partnership.
Over the past year we’ve also continued our series of free online research talks and seminars. Our website has information about upcoming events, and you can also sign up to receive emails about them.
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