National Heart Forum e-Research Briefing
19 August 2010
In this week’s briefing...
Highlights in chronic disease prevention
 Asia-Pacific region: Body-mass index and cancer
mortality in the Asia-Pacific cohort studies
collaboration: pooled analyses of 424,519
participants
 Sweden: Forecast of future premature mortality as a
result of trends in obesity and smoking: nationwide
cohort simulation study
 USA: Diabetes and cancer: a consensus report
 UK: Cardiovascular effects of marine omega-3 fatty
acids
Nutrition
 UK: Developing a timeline for evaluating public health
nutrition policy interventions. What are the outcomes
and when should we expect to see them?
 Australia: The global context for public health
nutrition taxation
 Norway: Effect of the nationwide free school fruit
scheme in Norway
 UK: A comparison of British school meals and packed
lunches from 1990 to 2007: meta-analysis by lunch
type
 UK: Meat consumption and prospective weight
change in participants of the EPIC-PANACEA study
Physical activity
Obesity
 UK: Social mobility and social accumulation across the
 Finland: Leisure-time physical activity,
life course in relation to adult overweight and obesity:
cardiovascular risk factors and mortality during a 34the Whitehall II study
year follow-up in men
 Finland: Physical activity, morbidity and mortality in  Europe: The potential role of taxes and subsidies on
food in the prevention of obesity in Europe
twins: a 24-year prospective follow-up
 Norway: The association of metabolic clustering and
physical activity with cardiovascular mortality: the
HUNT study in Norway
Tobacco regulation
Public health and climate change
 USA: Tobacco control policy in developed countries:  Changes in residential proximity to road traffic and
Yesterday, today, and tomorrow
the risk of death from coronary heart disease
Highlights in chronic disease prevention
Asia-Pacific region: Body-mass index and cancer mortality in the Asia-Pacific cohort studies collaboration: pooled
analyses of 424,519 participants – The Lancet Oncology 2010; 11, 8: 741-752
Excess bodyweight is an established risk factor for several types of cancer, but there are sparse data from Asian
populations, where the proportion of overweight and obese individuals is increasing rapidly and adiposity can be
substantially greater for the same body-mass index (BMI) compared with people from Western populations.
Overweight and obese individuals in populations across the Asia-Pacific region have a significantly increased risk of
mortality from cancer. Strategies to prevent individuals from becoming overweight and obese in Asia are needed to
reduce the burden of cancer that is expected if the obesity epidemic continues.
See article abstract: http://bit.ly/ccWPzG
Sweden: Forecast of future premature mortality as a result of trends in obesity and smoking: nationwide cohort
simulation study – European Journal of Epidemiology 2010; 25, 8.
In many countries obesity has increased dramatically during the last decades, while there has been a parallel
decrease in smoking. The objective of the present study was to estimate the net effect on premature mortality of
these trends. A simulation model was developed to estimate the expected number of deaths between ages 19–56
years for cohorts of young men (n = 50,000), depending on inputs of obesity and smoking prevalence. The model
was populated with nationwide data of Swedish men performing mandatory military conscription tests between
1969 and 2005. This study shows that despite large increases in overweight and obesity, a continued decline in
premature deaths among Swedish males is expected due to reduced smoking during the last four decades.
See article abstract: http://bit.ly/d4cbMH
USA: Diabetes and cancer: a consensus report – CA: a journal for cancer clinicians 2010; 60, 4: 207-221
Epidemiologic evidence suggests that cancer incidence is associated with diabetes as well as certain diabetes risk
factors and treatments. This consensus statement of experts assembled jointly by the American Diabetes
Association and the American Cancer Society reviews the state of science concerning 1) the association between
diabetes and cancer incidence or prognosis; 2) risk factors common to both diabetes and cancer; 3) possible biologic
links between diabetes and cancer risk; and 4) whether diabetes treatments influence the risk of cancer or cancer
prognosis. In addition, key unanswered questions for future research are posed.
See article abstract: http://bit.ly/dabCgV
UK: Cardiovascular effects of marine omega-3 fatty acids - The Lancet 2010; 376, 9740: 540-550
Much evidence shows that the marine omega-3 fatty acids eicosapentaenoic acid and docosahexaenoic acid have
beneficial effects in various cardiac disorders, and their use is recommended in guidelines for management of
patients after myocardial infarction. However, questions have been raised about their usefulness alongside
optimum medical therapies with agents proven to reduce risk of cardiac events in high-risk patients. Additionally,
there is some evidence for a possible pro-arrhythmic effect in subsets of cardiac patients. Some uncertainly exists
about the optimum dose needed to obtain beneficial effects and the relative merit of dietary intake of omega-3
polyunsaturated fatty acids versus supplements. We review evidence for the effects of omega-3 polyunsaturated
fatty acids on various cardiac disorders and the risk factors for cardiac disease. We also assess areas of uncertainty
needing further research.
See article abstract: http://bit.ly/bkybt9
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Nutrition
UK: Developing a timeline for evaluating public health nutrition policy interventions. What are the outcomes and
when should we expect to see them? – Public Health Nutrition 2010 (online first 16/08/10)
Concept mapping and a stakeholder-driven approach for developing an evaluation framework were used to
estimate the 'time to impact' for policy interventions. The Schools (Health Promotion and Nutrition) (Scotland) Act
2007 was used as the model to develop the evaluation timeline as it had typical characteristics of government
policy. Concept mapping requires stakeholders to generate a list of the potential outcomes, sort and rate the
outcomes. Multidimensional scaling and hierarchical cluster data analysis were used to develop an anticipated
timeline to impact for the policy. Developing an anticipated timeline provides a realistic framework upon which to
base an outcome evaluation for policy interventions and identifies positive and negative outcomes as well as
considering possible unintended consequences. It offers benefit to both policy makers and researchers in mapping
the progress expected towards long-term health goals and outcomes.
See article abstract: http://bit.ly/bW9Ipv
Australia: The global context for public health nutrition taxation – Public Health Nutrition 2010 (online first
16/08/10)
This study aimed to assess critically the scope for public health nutrition taxation within the framework of the global
tax reform agenda. The priorities of the global tax reform agenda relevant to public health nutrition taxation are
streamlining of taxes, adoption of value-added tax (VAT), minimisation of excise taxes (except to correct for
externalities) and removal of import taxes in line with trade liberalisation policies. Proposals consistent with the
global tax reform agenda have included excise taxes, extension of VAT to currently exempted (unhealthy) foods and
tariff reductions for healthy foods. Proposals for public health nutrition taxation should (i) use existing types and
rates of taxes where possible, (ii) use excise taxes that specifically address externalities, (iii) avoid differential VAT
on foods and (iv) use import taxes in ways that comply with trade liberalisation priorities.
See article abstract: http://bit.ly/aZ813T
Norway: Effect of the nationwide free school fruit scheme in Norway – British Journal of Nutrition 2010; 104: 589594
In Norway, children and adolescents consume only about half of the national five-a-day recommendation. There are
also rather large social inequalities in health, and in eating behaviours. In order to increase fruit and vegetable (FV)
intake, a subscription programme was initiated in 1996 and made nationwide in 2003, and a free programme
(without parental payment) has been implemented nationwide from 2007. The objective of the present study is to
evaluate the effect of these efforts. The increases in fruit intake at school were 0·49, 0·29 and 0·18 portions/school
day, respectively, for the Free Fruit 08, Subscription 08 and No Programme 08 schools (time × group P < 0·001), and
0·74, 0·39 and 0·16 portions/d for fruit intake all day (time × group P = 0·04). No group effect was observed for
vegetable intake. There has been an increase in pupils' fruit intake from 2001 to 2008 in Norway, and the school
fruit programmes seem to have been effective. A great challenge remains in increasing vegetable intake.
See article abstract: http://bit.ly/d5YOVW
UK: A comparison of British school meals and packed lunches from 1990 to 2007: meta-analysis by lunch type –
British Journal of Nutrition 2010; 104: 474-487
Primary school children in the UK have the choice of a school meal provided by the school or a packed lunch
provided from home. Currently, more than half of primary school children have a packed lunch. New food-based
standards for school meals were introduced in English primary schools in 2006, followed by nutrient-based
standards in 2008. No formal comparisons of primary school lunches by lunch type have been undertaken to date.
The present review identified seven studies from 1990 to 2007 measuring lunchtime nutrient intake in children
aged 5–11 years having a school meal and children having a packed lunch. The study found that the nutritional
quality of packed lunches is poor compared with school meals. The introduction of food-based standards for school
meals in 2006 has moderately improved the nutrient content of school meals, slightly widening the nutritional gap
between school meals and packed lunches.
See article abstract: http://bit.ly/cMspUW
UK: Meat consumption and prospective weight change in participants of the EPIC-PANACEA study - American
Journal of Clinical Nutrition 2010; 92, 2: 398-407
Meat intake may be related to weight gain because of its high energy and fat content. Some observational studies
have shown that meat consumption is positively associated with weight gain, but intervention studies have shown
mixed results. The study objective was to assess the association between consumption of total meat, red meat,
poultry, and processed meat and weight gain after 5 y of follow-up, on average, in the large European population
who participated in the European Prospective Investigation into Cancer and Nutrition-Physical Activity, Nutrition,
Alcohol, Cessation of Smoking, Eating Out of Home and Obesity (EPIC-PANACEA) project. The results suggest that a
decrease in meat consumption may improve weight management.
See article abstract: http://bit.ly/9UonKU
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Physical activity
Finland: Leisure-time physical activity, cardiovascular risk factors and mortality during a 34-year follow-up in men
– European Journal of Epidemiology 2010; 25, 8.
The inverse relationship between physical activity and mortality may be confounded by socioeconomic factors,
cardiovascular risk factors and inverse causality. We investigated long-term association between self-reported
regular physical activity and mortality in a socioeconomically homogeneous, initially healthy middle-aged (mean age
47) male cohort (the Helsinki Businessmen Study). In 1974, the men were assessed with questionnaires, clinical and
laboratory examinations. During the 34-year follow-up, leisure-time physical activity in initially healthy middle-aged
men had a graded association with reduced mortality that was independent of CVD risk, glucose and BMI.
See article abstract: http://bit.ly/9RI3mu
Finland: Physical activity, morbidity and mortality in twins: a 24-year prospective follow-up – European Journal of
Epidemiology 2010; 25, 8.
The aim of this study was to find out whether persistent leisure-time physical activity, adjusted for genetic liability
and childhood experiences, protect against occurrence of specific chronic diseases and all-cause mortality. This
study supports the earlier findings that physical activity is associated with reduced mortality. However the
difference was seen only in DZ pairs and therefore some residual genetic confounding effects on mortality cannot
be excluded.
See article abstract: http://bit.ly/dfC0cf
Norway: The association of metabolic clustering and physical activity with cardiovascular mortality: the HUNT
study in Norway – Journal of Epidemiology and Community Health 2010; 64: 690-695
In asymptomatic populations, physical activity is inversely associated with the risk of cardiovascular death, but it is
not known if physical activity compensates for adverse effects of multiple cardiovascular risk factors. The aim of this
study was to assess if the positive association of a clustering of cardiovascular risk factors (CRFs) with cardiovascular
disease (CVD) mortality could be weakened by exercise training. This study shows that individuals with CRF are at
greater risk of premature cardiovascular death compared to people without CRF, and that the risk of people with
CRF who were physically active appears to be comparable to that of inactive individuals without CRF.
See article abstract: http://bit.ly/d3mzeT
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Obesity
UK: Social mobility and social accumulation across the life course in relation to adult overweight and obesity: the
Whitehall II study – Journal of Epidemiology and Community Health 2010; 64: 714-719
Social mobility (movement up or down the social hierarchy) and social accumulation (accumulating social advantage
or disadvantage) across the life course have been shown to affect adult health. There is no evidence on how these
processes simultaneously affect adult overweight and obesity. This study involved a cross-sectional analysis using
data from phase 5 of the Whitehall II study (1997–1999), including retrospective information on past socioeconomic
position (SEP) for 4598 participants (44–69 years). The effect of social mobility and social accumulation, from
childhood social class to educational attainment to current employment grade, on prevalent adult overweight and
obesity was examined. Social mobility and social accumulation can operate simultaneously across the life course.
Prevention of downward social mobility and social accumulation of disadvantage could reduce the overall
prevalence of adult overweight and obesity.
See article abstract: http://bit.ly/cjsCGE
Europe: The potential role of taxes and subsidies on food in the prevention of obesity in Europe – Journal of
Epidemiology and Community Health 2010; 64, 8: 696-704
Obesity implies costs not only for the individual but also for society. The authors explore the opinions of
stakeholders on the potential of taxes or subsidies, as measures for tackling obesity in Europe. Taxation and
subsidies were poorly appraised compared with other policy measures, with stakeholders expressing reservations
mainly focussed on the practicalities and cost of introducing such measures. Although applying taxes/subsidies
could be useful to combat obesity, the study suggests that most stakeholders still need to be convinced of their
viability and acceptability when compared with other measures.
See article abstract: http://bit.ly/b4MWe6
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Tobacco regulation
USA: Tobacco control policy in developed countries: Yesterday, today, and tomorrow – Nicotine & Tobacco
Research 2010 (online first 11/08/10)
Tobacco control policies have contributed to dramatic declines in smoking in the developed nations. However, the
circumstances under which these policies altered the smoking landscape have changed and are likely to change
further. As well, decreases in smoking prevalence may have "stalled" at current levels. Because today's smokers
differ significantly from yesterday's and the environment in which smokers consume their cigarettes has changed, it
is plausible that several of the evidence-based tobacco control policies soon will have run their course in the most
advanced tobacco control environments. This articles asks what developed nations can expect of these policies in
the future and what novel policy measures may be needed to continue the assault on tobacco. Without substantial
innovation in tobacco control policy, further reductions in smoking in developed nations will come frustratingly
slowly. Needed policy innovations might be quite radical, such as legislating entirely smoke-free outdoor
environments or regulators reducing allowable nicotine in cigarettes to non-addicting levels.
See article abstract: http://bit.ly/aJbCrD
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Climate change and public health
Changes in residential proximity to road traffic and the risk of death from coronary heart disease – Epidemiology
2010; 21, 5: 642-649
Residential proximity to road traffic is associated with increased coronary heart disease (CHD) morbidity and mortality. It is
unknown, however, whether changes in residential proximity to traffic could alter the risk of CHD mortality. This study showed
that living close to major roadways was associated with increased risk of coronary mortality, whereas moving away from major
roadways was associated with decreased risk.
See article abstract: http://bit.ly/bxQyw4
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