MRC Unit for Lifelong Health and Ageing

London, United Kingdom

MRC Unit for Lifelong Health and Ageing

London, United Kingdom
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Maughan B.,King's College London | Stafford M.,MRC Unit for Lifelong Health and Ageing | Shah I.,MRC Unit for Lifelong Health and Ageing | Kuh D.,MRC Unit for Lifelong Health and Ageing
Psychological Medicine | Year: 2014

Background. Severe youth antisocial behaviour has been associated with increased risk of premature mortality in high-risk samples for many years, and some evidence now points to similar effects in representative samples. We set out to assess the prospective association between adolescent conduct problems and premature mortality in a population-based sample of men and women followed to the age of 65 years. Method. A total of 4158 members of the Medical Research Council National Survey of Health and Development (the British 1946 birth cohort) were assessed for conduct problems at the ages of 13 and 15 years. Follow-up to the age of 65 years via the UK National Health Service Central Register provided data on date and cause of death. Results. Dimensional measures of teacher-rated adolescent conduct problems were associated with increased hazards of death from cardiovascular disease by the age of 65 years in men [hazard ratio (HR) 1.17, 95% confidence interval (CI) 1.04-1.32], and of all-cause and cancer mortality by the age of 65 years in women (all-cause HR 1.16, 95% CI 1.07-1.25). Adjustment for childhood cognition and family social class did little to attenuate these risks. Adolescent conduct problems were not associated with increased risks of unnatural/substance-related deaths in men or women in this representative sample. Conclusions. Whereas previous studies of high-risk delinquent or offender samples have highlighted increased risks of unnatural and alcohol-or substance abuse-related deaths in early adulthood, we found marked differences in mortality risk from other causes emerging later in the life course among women as well as men. Copyright © Cambridge University Press 2013.

News Article | December 14, 2016

LUGANO-SINGAPORE, 14 December, 2016 - Around 20% of breast cancer patients do not complete prescribed endocrine therapy, researchers report at the ESMO Asia 2016 Congress in Singapore.1 The study in over 5,500 women found that younger patients and those who had taken hormone replacement therapy (HRT) were less likely to adhere to their medicine. "Adjuvant endocrine treatment such as tamoxifen prevents recurrence and improves absolute survival by 5-10% in patients with oestrogen receptor (ER) positive breast cancer, especially when taken long term (5-10 years)," said lead author Dr Wahyu Wulaningsih, research associate, MRC Unit for Lifelong Health and Ageing at University College London, UK and co-founder of Philippine and Indonesian Scholars (PILAR) Research and Education. "A substantial proportion of patients who start this treatment do not complete it," continued Wulaningsih. "There is evidence that failure to take the medicine could lead to worse survival. We therefore investigated the reasons for non-adherence so that targeted strategies could be developed." The study included 5,544 women with ER positive breast cancer who collected at least one prescription of aromatase inhibitors or tamoxifen and had five years of follow up data. Women were identified and prescription information was obtained from the regional registers of Uppsala-Örebro, Stockholm-Gotland, and Northern Sweden which cover around 60% of the Swedish population. The data was linked to Swedish national registers with information about factors which could influence adherence. Adherence was calculated from the drugs dispensed - patients were classified as non-adherent if they received less than 80% of the drugs needed over five years. During the five years, 20% of the women became non-adherent. In the multivariable analysis the strongest independent predictors of non-adherence were younger age, previous use of HRT, marital status, and socioeconomic status (measured by type of employment). Women less than 50 years of age were 50% more likely to be non-adherent than 50-65 year olds, with 5% of all non-adherent cases attributable to being in the younger age group. Women who had used HRT were 57% more likely to be non-adherent than those who had not. Unmarried women were 33% more likely to be non-adherent than married women. Regarding employment, unemployed women had 60% higher odds to be non-adherent compared to blue collar workers. White collar women were slightly less likely to adhere to endocrine treatment compared to blue collar patients, but the absolute difference was negligible. Wulaningsih said: "A proportion of breast cancer patients of reproductive age may be concerned about the potential impact of endocrine treatment on fertility which could explain why they are more likely to stop taking the drugs. Women who wish to have children after a breast cancer diagnosis need more information about their treatment options." "Research is needed to find out if there are any biological differences in women exposed to HRT before undergoing endocrine treatment for breast cancer," continued Wulaningsih. "It could be that they are more predisposed to side effects from endocrine treatment. Personalised approaches may improve adherence in these patients by, for example, tailoring the dosage." Wulaningsih speculated that unmarried patients might have less social and emotional support to continue taking endocrine therapy. She said: "Our study identified subgroups of patients who can be targeted with information on the benefits and consequences of endocrine treatment when it is first prescribed and at subsequent visits. Patient support groups could be strengthened, or developed, to help patients overcome the barriers to continuing treatment. Improving adherence should lead to better outcomes for these patients." Commenting on the findings, Dr Lim Siew Eng, senior consultant, Department of Haematology-Oncology, National University Cancer Institute, Singapore (NCIS), said: "Nonadherence to oral endocrine therapy is associated with higher recurrence rates, and is the most important modifiable risk factor that can affect breast cancer outcomes." She continued: "In this large study, mainly socioeconomic factors and not disease nor treatment factors were identified as risks for nonadherence. Pre-diagnostic use of HRT was also identified. These risk factors could pinpoint certain groups in which stricter compliance monitoring and better management of side effects might improve adherence rates.

Almoosawi S.,MRC Human Nutrition Research | Prynne C.J.,MRC Human Nutrition Research | Hardy R.,MRC Unit for Lifelong Health and Ageing | Stephen A.M.,MRC Human Nutrition Research
International Journal of Obesity | Year: 2013

Background:Diet is a key modifiable factor in the prevention and treatment of the metabolic syndrome. However, few studies have examined the prospective association between time-of-day of nutrient intake and the metabolic syndrome.Objective:To examine the association between time-of-day and nutrient composition of eating occasions and the long-term development of metabolic syndrome in the Medical Research Council (MRC) National Survey of Health and Development (NSHD; 1946 British birth cohort).Methods:The analysis comprised 1488 survey members who completed at least 3 days of estimated diet records at age 43 years (1989) and for whom data on metabolic syndrome at age 53 years (1999) were available. Dietary records were divided into seven meal slots: breakfast, mid-morning, lunch, mid-afternoon, dinner, late evening and extras. Metabolic syndrome was defined by the criteria of the adult treatment panel (ATPIII8), and was modified to include glycosylated haemoglobin instead of fasting glucose. Associations between time-of-day of nutrient intake at age 43 years and prevalence of metabolic syndrome at age 53 years were assessed using multivariate nutrient density logistic models after adjustment for sex, social class, smoking status, region, alcohol intake and recreational physical activity.Results:There were 390 cases of metabolic syndrome at age 53 years. Substituting 5% of energy from carbohydrate for a similar amount of energy from fat at breakfast (odds ratio=0.93; 95% confidence interval=0.89-0.98; P=0.002) and mid-morning at age 43 years (odds ratio=0.96; 95% confidence interval=0.93-0.99; P=0.011) was associated with lower odds of the metabolic syndrome at age 53 years. Carbohydrate intake at breakfast or mid-morning was particularly protective against abdominal obesity (P≤0.001). Increasing carbohydrate intake at breakfast while simultaneously decreasing fat intake was also negatively related to triacylglycerols (P≤0.001).Conclusions:Increasing carbohydrate intake in the morning while simultaneously reducing fat intake could be protective against long-term development of the metabolic syndrome and its components. © 2013 Macmillan Publishers Limited.

Pierce M.B.,MRC Unit for Lifelong Health and Ageing | Kuh D.,MRC Unit for Lifelong Health and Ageing | Hardy R.,MRC Unit for Lifelong Health and Ageing
Annals of Epidemiology | Year: 2010

Purpose: Why early puberty is associated with worse cardiovascular outcomes is unknown. The relationship between puberty and lipids is unclear. Our aim was to assess whether age at puberty was associated with triglyceride and total low-density lipoprotein and high-density lipoprotein cholesterol at age 53 years. Methods: Participants in a national birth cohort were examined at 15 years, when pubertal stage for boys was assessed and age at menarche reported by the girls' mothers. At 53 years, 3035 were interviewed in their homes by research nurses, where blood was taken. Results: There was a significant inverse relationship in women but not men between age at puberty (in years) and triglycerides (regression coefficient -0.2.9, 95% confidence interval -5.5, to -0.04, p = .02), age at puberty, and age at puberty and adult body mass index (BMI; p < .001). Relationships between puberty and lipids were completely explained by BMI or waist circumference at 53 years. Conclusions: In both sexes earlier maturation was associated with greater BMI and waist circumference in later life, which resulted in greater triglycerides and cholesterol in women. We suggest that intervention after puberty to help avoid obesity in early maturing women may improve their later cardiovascular health. © 2010 Elsevier Inc.

Byford M.,University College London | Kuh D.,MRC Unit for Lifelong Health and Ageing | Richards M.,MRC Unit for Lifelong Health and Ageing
International Journal of Epidemiology | Year: 2012

Background: Cognitive ability is an important contributor to life chances, with implications for cycles of advantage or disadvantage across generations. Parenting practices are known to influence offspring cognitive development, but the extent to which these mediate intergenerational continuities and discontinuities in cognitive ability has not been adequately studied. Methods: We used factor analysis to derive summary measures of parenting practices, and regression analyses and path modelling to test associations between these and cognitive function at age 8 years in 1690 first offspring of the British 1946 birth cohort. Analyses allowed for direct and indirect effects of parental original and achieved social circumstances, educational attainment and own childhood cognitive ability. Additional covariates were provided by indicators of parental physical and mental health. Results: Regression analyses revealed that three aspects of parenting, intellectual home environment, parental aspiration and cognitive stimulation, were positively and independently associated with offspring childhood cognitive ability, whereas coercive discipline was negatively and independently associated. Path modelling was appropriate for intellectual environment, which also revealed direct and indirect effects of parental cognitive ability and educational and occupational attainment on offspring cognitive ability. Conclusion: Parenting practices, particularly provision of an intellectual environment, were directly associated with offspring cognitive development. These data add to the relatively few studies that examine intergenerational continuity and discontinuity in cognitive ability. Published by Oxford University Press on behalf of the International Epidemiological Association © The Author 2011; all rights reserved.

Stafford M.,MRC Unit for Lifelong Health and Ageing | Mcmunn A.,University College London | De Vogli R.,University College London
Ageing and Society | Year: 2011

This prospective study examines the relationship between aspects of the neighbourhood social environment and subsequent depressive symptoms in over 7,500 participants of the English Longitudinal Study of Ageing (ELSA). Neighbourhood social environment at baseline was operationalised using four items capturing social cohesion and three items capturing perceived safety and associations with the Center for Epidemiologic Studies Depression Scale (CES-D) at two-year follow-up were assessed. Friendship quality and personal sense of control were tested as mediators of this relationship using structural equation modelling. Neighbourhood social cohesion was found to be associated with reporting fewer depressive symptoms independent of demographic and socioeconomic factors and baseline depressive symptoms. Friendship quality and sense of control mediated this association. The study highlights that greater personal sense of control, higher quality friendships and fewer depressive symptoms are found in neighbourhoods seen to be characterised by higher social cohesion. © Copyright Cambridge University Press 2011.

Hurst L.,University College London | Stafford M.,MRC Unit for Lifelong Health and Ageing | Cooper R.,MRC Unit for Lifelong Health and Ageing | Hardy R.,MRC Unit for Lifelong Health and Ageing | And 2 more authors.
American Journal of Public Health | Year: 2013

Objectives. We examined the relationship between childhood and adult socioeconomic position (SEP) and objectively assessed, later-life functioning. Methods. We used the Medical Research Council's National Survey of Health and Development data to examine performance at 60 to 64 years (obtained in 2006-2011) for a representative UK sample. We compared 9 physical and cognitive performance measures (forced expiratory volume, forced vital capacity, handgrip strength, chair rise time, standing balance time, timed get up and go speed, verbal memory score, processing speed, and simple reaction time) over the SEP distribution. Results. Each performance measure was socially graded. Those at the top of the childhood SEP distribution had between 7% and 20% better performance than those at the bottom. Inequalities generally persisted after adjustment for adult SEP. When we combined the 9 performance measures, the relative difference was 66% (95% confidence interval = 53%, 78%). Conclusions. Public health practice should monitor and target inequalities in functional performance, as well as risk of disease and death. Effective strategies will need to affect the social determinants of health in early life to influence inequalities into old age.

Frayling T.M.,University of Exeter | Ong K.,Addenbrookes Hospital | Ong K.,MRC Unit for Lifelong Health and Ageing
Genome Biology | Year: 2011

Two recent studies of the FTO gene provide more information on how it affects body mass index. © 2011 BioMed Central Ltd.

Power C.,University College London | Kuh D.,MRC Unit for Lifelong Health and Ageing | Morton S.,University of Auckland
Annual Review of Public Health | Year: 2013

Maturation of long-running birth cohort studies has fostered a life course approach to adult health, function, and disease and related to conceptual frameworks. Using broad concepts of human development including physical, cognitive, and emotional function, birth cohorts provide insights into the processes across the life course and between generations that link to adult outcomes. We discuss findings on the determinants and health consequences of lifetime trajectories of body size, cognitive and emotional function, and socioeconomic position. Findings from the studies suggest that, for some adult health outcomes, explanations will be incomplete unless exposures and processes from across the life course are taken into account. New birth cohort studies are poised to delineate further the nature and timing of life course relationships in contemporary generations of children. © 2013 by Annual Reviews. All rights reserved.

Pierce M.B.,MRC Unit for Lifelong Health and Ageing | Kuh D.,MRC Unit for Lifelong Health and Ageing | Hardy R.,MRC Unit for Lifelong Health and Ageing
Diabetic Medicine | Year: 2012

Aims Previous research showing an inverse association between age of menarche and adult diabetes relied on recalled age at menarche and did not adjust for BMI across the life course. We investigated the relationship between age at menarche and diabetes, and whether childhood, adolescent or adult BMI attenuates this relationship. Methods We used data from the Medical Research Council National Survey of Health and Development, a British birth cohort study of men and women born in 1946, with contemporaneous recording of the age of menarche, BMI at 2, 7, 15 and 20-53years and diabetes status to 53years. Results A significant inverse relationship between age at menarche and diabetes [hazard ratio=0.73 per year older age at menarche (95%CI 0.56-0.96), P=0.02] was attenuated by adjustment for adult BMI [hazard ratio0.85 (95%CI 0.65-1.10), P=0.2]. The effect of age at menarche on Type2 diabetes was very similar to that for all types of diabetes. Attenuation of the association between age at menarche and diabetes was also observed with BMI at 15years, but less so with BMI measured earlier in childhood. Conclusions Earlier age at menarche is associated with a higher risk of diabetes, and specifically Type2 diabetes, in later life, which is most strongly attenuated by adolescent and adult adiposity. Early menarche may be clinically useful in identifying women who are at risk of later adiposity and so of developing Type2 diabetes. © 2011 The Authors. Diabetic Medicine © 2011 Diabetes UK.

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