UK Biobank Prospective Cohort Study Research Articles

Types of diet, obesity, and incident type 2 diabetes: Findings from the UK Biobank prospective cohort study.

AimTo investigate the associations between types of diet and incident type 2 diabetes and whether adiposity mediated these associations.Materials and MethodsIn total, 203 790 participants from UK Biobank (mean age 55.2 years; 55.8% women) without diabetes at baseline were included in this prospective study. Using the dietary intake data self‐reported at baseline, participants were categorized as vegetarians (n = 3237), fish eaters (n = 4405), fish and poultry eaters (n = 2217), meat eaters (n = 178 004) and varied diet (n = 15 927). The association between type of diet and incident type 2 diabetes was investigated using Cox‐proportional hazards models with a 2‐year landmark analysis. The mediation role of adiposity was tested under a counterfactual framework.ResultsAfter excluding the first 2 years of follow‐up, the median follow‐up was 5.4 (IQR: 4.8‐6.3) years, during which 5067 (2.5%) participants were diagnosed with type 2 diabetes. After adjusting for lifestyle factors, fish eaters (HR 0.52 [95% CI: 0.39‐0.69]) and fish and poultry eaters (HR 0.62 [95% CI: 0.45‐0.88]) had a lower risk of incident type 2 diabetes compared with meat eaters. The association for vegetarians was not significant. Varied diet had a higher risk of type 2 diabetes. Obesity partially mediated the association of fish (30.6%), fish and poultry (49.8%) and varied (55.2%) diets.ConclusionsFish eaters, as well as fish and poultry eaters, were at a lower risk of incident type 2 diabetes than meat eaters, partially attributable to lower obesity risk.

Handgrip strength and all-cause dementia incidence and mortality: findings from the UK Biobank prospective cohort study.

BackgroundThis study aimed to investigate the associations of grip strength with incidence and mortality from dementia and whether these associations differ by sociodemographic and lifestyle factors.MethodsA total of 466 788 participants of the UK Biobank (median age 56.5 years, 54.5% women). The outcome was all‐cause dementia incidence and mortality and the exposure was grip strength. Grip strength was assessed using a Jamar J00105 hydraulic hand dynamometer.ResultsExcluding the first 2 years of follow‐up (landmark analysis), mean follow‐up was 9.1 years (inter‐quartile range: 8.3; 9.7) for incidence and 9.3 (inter‐quartile range: 8.7; 10.0) for mortality. During this time, 4087 participants developed dementia, and 1309 died from it. Lower grip strength was associated with a higher risk of dementia incidence and mortality independent of major confounding factors (P < 0.001). Individuals in the lowest quintile of grip strength had 72% [95% confidence interval (CI): 1.55; 1.92] higher incident dementia risk and 87% [95% CI: 1.55; 2.26] higher risk of dementia mortality compared with those in the highest quintile. Our PAF analyses indicate that 30.1% of dementia cases and 32.3% of dementia deaths are attributable to having low grip strength. The association between grip strength and dementia outcomes did not differ by lifestyle or sociodemographic factors.ConclusionsLower grip strength was associated with a higher risk of all‐cause dementia incidence and mortality, independently of important confounding factors.

Glycated haemoglobin and the risk of postoperative complications in people without diabetes: a prospective population-based study in UK Biobank.

SummaryThe aim of our study was to clarify the association between glycated haemoglobin (HbA1c) and postoperative outcomes in people without an existing diagnosis of diabetes. Half a million adults were recruited into the UK Biobank prospective cohort study between March 2006 and October 2010. We divided participants into three groups: no diagnosis of diabetes and HbA1c < 42 mmol.mol−1; no diagnosis of diabetes and elevated HbA1c (≥ 42 mmol.mol−1 with no upper limit); and prevalent diabetes (regardless of HbA1c concentration) at recruitment. We followed up participants by linkage with routinely collected hospital data to determine any surgical procedures undertaken after recruitment and the associated postoperative outcomes. Our main outcome measure was a composite primary outcome of 30‐day major postoperative complications and 90‐day all‐cause mortality. We used logistic regression to estimate the odds of the primary outcome by group. We limited analyses to those who underwent surgery within one year of recruitment (n = 26,653). In a combined effects logistic regression model, participants not known to have diabetes with HbA1c ≥ 42 mmol.mol−1 had increased odds of the primary outcome (OR [95% CI] 1.43 [1.02–2.02]; p = 0.04), when compared with those without diabetes and HbA1c < 42 mmol.mol−1. This effect was attenuated and no longer statistically significant in a direct effects model with adjustment for hyperglycaemia‐related comorbidity (OR [95% CI] 1.37 [0.97–1.93]; p = 0.07). Elevated pre‐operative HbA1c in people without diabetes may be associated with an increased risk of complications, but the association is likely confounded by end‐organ comorbidity. In contrast to previous evidence, our findings suggest that to prevent adverse postoperative outcomes, optimisation of pre‐existing morbidity should take precedence over reducing HbA1c in people without diabetes.

Association of Serum 25-Hydroxyvitamin D With Cardiovascular Outcomes and All-Cause Mortality in Individuals With Prediabetes and Diabetes: Results From the UK Biobank Prospective Cohort Study.

To examine the associations of circulating 25-hydroxyvitamin D (25[OH]D) concentrations with cardiovascular disease (CVD) and all-cause mortality in individuals with prediabetes and diabetes from the large population-based UK Biobank cohort study. A total of 67,789 individuals diagnosed with prediabetes and 24,311 with diabetes who had no CVD or cancer at baseline were included in the current study. Serum 25(OH)D concentrations were measured at baseline. Cox proportional hazard models were used to calculate hazard ratios (HRs) and 95% CIs for cardiovascular outcomes and mortality after 10-14 years. After multivariable adjustment, higher serum 25(OH)D levels were significantly and nonlinearly associated with lower risk of cardiovascular outcomes and all-cause mortality among participants with prediabetes and diabetes (all P nonlinearity < 0.05). Compared with those in the lowest category of 25(OH)D levels (<25 nmol/L), participants with prediabetes in the highest category of 25(OH)D levels (≥75 nmol/L) had a significant association with lower risk of cardiovascular events (HR 0.78; 95% CI 0.71-0.86), coronary heart disease (CHD) (HR 0.79; 95% CI 0.71-0.89), heart failure (HR 0.66; 95% CI 0.54-0.81), stroke (HR 0.75; 95% CI 0.61-0.93), CVD mortality (HR 0.43; 95% CI 0.32-0.59), and all-cause mortality (HR 0.66; 95% CI 0.58-0.75). Likewise, these associations with cardiovascular events, CHD, heart failure, CVD mortality, and all-cause mortality were observed among participants with diabetes, except for stroke. These findings highlight the importance of monitoring and correcting vitamin D deficiency in the prevention of CVD and mortality among adults with prediabetes and diabetes.

Association of meat, vegetarian, pescatarian and fish-poultry diets with risk of 19 cancer sites and all cancer: findings from the UK Biobank prospective cohort study and meta-analysis.

BackgroundThe associations of cancer with types of diets, including vegetarian, fish, and poultry-containing diets, remain unclear. The aim of this study was, therefore, to investigate the association of type of diet with all cancers and 19 site-specific incident cancers in a prospective cohort study and then in a meta-analysis of published prospective cohort studies.MethodsA total of 409,110 participants from the UK Biobank study, recruited between 2006 and 2010, were included. The outcomes were incidence of all cancers combined and 19 cancer sites. Associations between the types of diets and cancer were investigated using Cox proportional hazards models. Previously published prospective cohort studies were identified from four databases, and a meta-analysis was conducted using random-effects models.ResultsThe mean follow-up period was 10.6 years (IQR 10.0; 11.3). Compared with meat-eaters, vegetarians (hazard ratio (HR) 0.87 [95% CI: 0.79 to 0.96]) and pescatarians (HR 0.93 [95% CI: 0.87 to 1.00]) had lower overall cancer risk. Vegetarians also had a lower risk of colorectal and prostate cancers compared with meat-eaters. In the meta-analysis, vegetarians (Risk Ratio (RR): 0.90 [0.86 to 0.94]) and pescatarians (RR 0.91 [0.86; 0.96]) had lower risk of overall and colorectal cancer. No associations between the types of diets and prostate, breast, or lung cancers were found.ConclusionsCompared with meat-eaters, vegetarians and pescatarians had a lower risk of overall, colorectal, and prostate cancer. When results were pooled in a meta-analysis, the associations with overall and colorectal cancer persisted, but the results relating to other specific cancer sites were inconclusive.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12916-022-02257-9.

Associations of A Body Shape Index (ABSI) with Cancer Incidence, All-Cause, and at 23 Sites-Findings from the UK Biobank Prospective Cohort Study.

Few studies have explored the emerging adiposity marker A Body Shape Index (ABSI) with cancer risk. This study investigated the associations between ABSI and the incidence of cancer at 23 sites and all cancer combined. Data from 442,610 participants from the UK Biobank prospective study were included in this study. ABSI was used as the exposure. Incidence of cancer at 23 sites was the outcome. Cox proportional hazard models were performed to explore the association of ABSI, and combined ABSI and body mass index (BMI) with cancer risk, after adjusting for multiple testing. 36,961 individuals developed cancer during the 8.8 years median follow-up. In multivariable analyses, participants in the highest tertile of ABSI had higher risk of lung [HR, 1.58; 95% confidence interval (CI), 1.44-1.74], liver (HR, 1.45; 95% CI, 1.18-1.77), esophagus (HR, 1.32; 95% CI, 1.12-1.57), colorectal (HR, 1.19; 95% CI, 1.10-1.28), and breast (HR, 1.05; 95% CI, 1.04-1.17) cancers, and all cancers combined (HR, 1.11; 95% CI, 1.08-1.14) compared with the lowest tertile. These associations remained significant after adjustment for BMI. When ABSI was combined with BMI, participants in the highest ABSI who also had a BMI ≥ 25 kg/m2 were at higher risk of uterus, esophagus, liver, stomach, colorectal, and breast cancers, as well as all cancers combined, compared with those in the lowest ABSI tertile with a normal BMI. ABSI is associated with an increased risk of five cancers as well as all cancers combined, independently of BMI. ABSI is a useful marker for adiposity. However, cancer risk prediction improves with the combination of BMI.

Lower serum testosterone concentrations are associated with a higher incidence of dementia in men: The UK Biobank prospective cohort study.

The association of testosterone concentrations with dementia risk remains uncertain. We examined associations of serum testosterone and sex hormone-binding globulin (SHBG) with incidence of dementia and Alzheimer's disease. Serum total testosterone and SHBG were measured by immunoassay. The incidence of dementia and Alzheimer's disease (AD) was recorded. Cox proportional hazards regression was adjusted for age and other variables. In 159,411 community-dwelling men (median age 61, followed for 7 years), 826 developed dementia, including 288 from AD. Lower total testosterone was associated with a higher incidence of dementia (overall trend: P=.001, lowest vs highest quintile: hazard ratio [HR]=1.43, 95% confidence interval [CI]=1.13-1.81), and AD (P=.017, HR=1.80, CI=1.21-2.66). Lower SHBG was associated with a lower incidence of dementia (P<.001, HR=0.66, CI=0.51-0.85) and AD (P=.012, HR=0.53, CI=0.34-0.84). Lower total testosterone and higher SHBG are independently associated with incident dementia and AD in older men. Additional research is needed to determine causality.

Osteoporosis and Its Association With Cardiovascular Disease, Respiratory Disease, and Cancer: Findings From the UK Biobank Prospective Cohort Study

ObjectiveTo investigate sex-specific associations of osteoporosis with incidence of and mortality from cardiovascular disease (CVD), respiratory disease, and cancer as well as with all-cause mortality. MethodsIn total, 305,072 participants (53% [161,383] women) of UK Biobank were included in this study (2007-2010). Self-reported diagnosis of osteoporosis at baseline was the exposure of interest. The outcomes were CVD, respiratory disease, chronic obstructive pulmonary disease (COPD), all cancer, and prostate and breast cancer incidence and mortality and all-cause mortality. Associations between osteoporosis and outcomes were investigated using Cox proportional hazards models. ResultsIn men, osteoporosis was associated with a higher incident risk of all respiratory diseases (hazard ratio [HR], 1.26; 95% CI, 1.06 to 1.50) including COPD (HR, 1.82; 95% CI, 1.38 to 2.40). Men with osteoporosis also had a higher mortality risk from all causes (HR, 1.71; 95% CI, 1.38 to 2.11), CVD (HR, 1.68; 95% CI, 1.19 to 2.37), respiratory disease (HR, 2.35; 95% CI, 1.70 to 3.24), and COPD (HR, 3.64; 95% CI, 2.24 to 5.91). These associations persisted after adjustment for age, body mass index, and comorbidities. Women with osteoporosis had a higher risk of incident CVD (HR, 1.24; 95% CI, 1.97 to 1.44), respiratory disease (HR, 1.23; 95% CI, 1.13 to 1.33), and COPD (HR, 1.29; 95% CI, 1.10 to 1.52). Women with osteoporosis also had a higher mortality risk from respiratory disease (HR, 1.31; 95% CI, 1.00 to 1.72) and breast cancer (HR, 1.60; 95% CI, 1.14 to 2.26). ConclusionCompared with women, men with osteoporosis had a higher risk of all-cause mortality, mortality from respiratory diseases including COPD, and cancer incidence. Osteoporosis was strongly associated with respiratory disease and COPD in both sexes, even after full adjustment for covariates, although men with osteoporosis experienced a higher risk of adverse outcomes.

Unhealthy Lifestyle, Genetics and Risk of Cardiovascular Disease and Mortality in 76,958 Individuals from the UK Biobank Cohort Study.

To examine associations of unhealthy lifestyle and genetics with risk of all-cause mortality, cardiovascular disease (CVD) mortality, myocardial infarction (MI) and stroke. We used data on 76,958 adults from the UK Biobank prospective cohort study. Favourable lifestyle included no overweight/obesity, not smoking, physical activity, not sedentary, healthy diet and adequate sleep. A Polygenic Risk Score (PRS) was derived using 300 CVD-related single nucleotide polymorphisms. Cox proportional hazard ratios (HR) were used to model effects of lifestyle and PRS on risk of CVD and all-cause mortality, stroke and MI. New CVD (n = 364) and all-cause (n = 2408) deaths, and stroke (n = 748) and MI (n = 1140) events were observed during a 7.8 year mean follow-up. An unfavourable lifestyle (0–1 healthy behaviours) was associated with higher risk of all-cause mortality (HR: 2.06; 95% CI: 1.73, 2.45), CVD mortality (HR: 2.48; 95% CI: 1.64, 3.76), MI (HR: 2.12; 95% CI: 1.65, 2.72) and stroke (HR:1.74; 95% CI: 1.25, 2.43) compared to a favourable lifestyle (≥4 healthy behaviours). PRS was associated with MI (HR: 1.35; 95% CI: 1.27, 1.43). There was evidence of a lifestyle-genetics interaction for stroke (p = 0.017). Unfavourable lifestyle behaviours predicted higher risk of all-cause mortality, CVD mortality, MI and stroke, independent of genetic risk.

Non-linear isocaloric substitution analysis: an example using the UK Biobank prospective cohort study

BackgroundDiet is one of the major modifiable lifestyle risk factors of mortality. When total energy intake is held constant, isocaloric substitution of energy sources can also affect mortality risk. The assumption in conventional methods that this exposure-outcome relationship is linear has been found to be untrue in many scenarios. This paper explores non-linear isocaloric substitution analysis using the UK Biobank data. MethodsThis is a UK Biobank prospective cohort study including 195 658 participants from England, Scotland, and Wales with complete information in at least one dietary questionnaire. Baseline data were collected between 2007 and 2010. Participants who reported non-typical diets were excluded. The exposure variables were intakes of carbohydrates (including sugar, starch, fibre), fat (including monounsaturated, polyunsaturated, and saturated fat) and protein, assessed using a 24 h dietary recall. Prospective all-cause mortality, the outcome variable, was derived from linkage to death records. We did a non-linear isocaloric substitution analysis using penalised cubic splines in Cox proportional hazard models. This analysis provides effect sizes conditional on the current intake, whereas conventional analysis provides an average over the whole range of intake. Analyses were adjusted for sociodemographic and other lifestyle factors. This study was performed under generic ethics approval obtained by UK Biobank from the National Health Service National Research Ethics Service. Written consent was obtained from all participants. FindingsThe majority (187 549) of the participants were White and 55·9% were female. Five of nine of the associations between macronutrient intake (as percentage of total energy, %E) and all-cause mortality were non-linear. Conventional isocaloric substitution showed no difference in mortality risk when replacing sugar with starch. However, the non-linear method revealed that replacing sugar with starch was associated with approximately 10% higher risk per 5%E when the current starch intake was greater than 30% of total energy, and with approximately 7% lower risk per 5%E when current intake was less than 25%. InterpretationWhen the underlying exposure-outcome association is non-linear, a relevant non-linear isocaloric substitution analysis technique should be used. The approach described here could provide more meaningful individualised dietary advice in line with precision public health. FundingNone.

Repeat revascularisation following PCI in the UK Biobank prospective cohort study: incidence, independent predictors and prognostic impact

Abstract Introduction Data from the SYNTAX and EXCEL trials have previously demonstrated increased morbidity and mortality following repeat revascularisation (RR). However real-world RR rates following index PCI are poorly defined, particularly in the 'late' context of restenosis of bystander disease and de novo lesions. Purpose To identify independent predictors of RR and evaluate its prognostic impact in an unselected cohort of patients following first PCI. Methods The UK Biobank is a large prospective multicentre study which recruited over 500,000 participants in the UK aged 37–73 years at entry between 2006–2010. Data are derived from an array of physical measurements, self-reported measures and biological samples, together with longitudinal linkage to hospital inpatient records and death registries. Procedural codes (OPCS-4) were used to identify patients who had undergone first PCI from 2006 onwards. RR was defined as PCI or CABG occurring at least 9 months after the index PCI, in order to preclude instances of staged revascularisation and in-stent restenosis. Data were censored at January 2021 or date of death as appropriate. Non-parametric tests are used throughout. Results A total of 12,853 participants underwent a first PCI during the study period, with 1,394 (10.8%) requiring RR over a median follow-up of 6.5 years. Of these, 1188 underwent PCI whilst 206 were elected to CABG. The average age was 64 years in the RR cohort and 1117 (80%) were male. Univariate analyses confirmed a number of established associations with RR, including for example diabetes mellitus and hypertension. Median lipoprotein(a) concentrations were 27.6 vs. 30.3nmol/L in the RR group, p=0.066. Cox regression analyses incorporating 21 biometric and clinical parameters demonstrated that lipoprotein(a) was an independent predictor of time to RR, independent of other lipids (Table 1). The strength of this association persisted when the number of covariates was reduced to include only other lipids and classical cardiovascular risk parameters. In Kaplan-Meier analyses, RR was associated with lower all-cause mortality (Figure 1). Further multivariate time-to-event analyses confirmed this association (HR 0.59, 95% CI 0.47–0.75, p&amp;lt;0.001). In separate models examining PCI and CABG as distinct modalities of RR, both were independently associated with prognostic benefit (HR 0.61, p&amp;lt;0.001 and HR 0.48, p&amp;lt;0.05 respectively). Conclusions Lipoprotein(a) is identified as a major independent driver of RR. In contrast to recent trial data focussing on left main stem and multivessel disease, unselected patients undergoing RR 9 or more months following index PCI attain prognostic benefit as assessed in multivariate analyses. The findings support an invasive approach, whether with PCI or CABG, in progressive coronary artery disease following initial PCI. Funding Acknowledgement Type of funding sources: Other. Main funding source(s): 1. The Herefordshire Heart Fund, UK. 2. Postgraduate Medical Bursary, Wye Valley NHS Trust, UK. Table 1Figure 1

Explaining Ethnic Differentials in COVID-19 Mortality: A Cohort Study.

Ethnic inequalities in coronavirus disease 2019 (COVID-19) hospitalizations and mortality have been widely reported, but there is scant understanding of how they are embodied. The UK Biobank prospective cohort study comprises approximately half a million people who were aged 40–69 years at study induction, between 2006 and 2010, when information on ethnic background and potential explanatory factors was captured. Study members were prospectively linked to a national mortality registry. In an analytical sample of 448,664 individuals (248,820 women), 705 deaths were ascribed to COVID-19 between March 5, 2020, and January 24, 2021. In age- and sex-adjusted analyses, relative to White participants, Black study members experienced approximately 5 times the risk of COVID-19 mortality (odds ratio (OR) = 4.81, 95% confidence interval (CI): 3.28, 7.05), while there was a doubling in the South Asian group (OR = 2.05, 95% CI: 1.30, 3.25). Controlling for baseline comorbidities, social factors (including socioeconomic circumstances), and lifestyle indices attenuated this risk differential by 34% in Black study members (OR = 2.84, 95% CI: 1.91, 4.23) and 37% in South Asian individuals (OR = 1.57, 95% CI: 0.97, 2.55). The residual risk of COVID-19 deaths in ethnic minority groups may be ascribed to a range of unmeasured characteristics and requires further exploration.

Associations between grip strength and incident type 2 diabetes: findings from the UK Biobank prospective cohort study

IntroductionGrip strength has been associated with chronic diseases and mortality. However, current evidence of the association between grip strength and incident type 2 diabetes mellitus (T2DM) is controversial. The aim...

Quantifying and Understanding the Higher Risk of Atherosclerotic Cardiovascular Disease Among South Asian Individuals: Results From the UK Biobank Prospective Cohort Study.

Individuals of South Asian ancestry represent 23% of the global population, corresponding to 1.8 billion people, and have substantially higher risk of atherosclerotic cardiovascular disease compared with most other ethnicities. US practice guidelines now recognize South Asian ancestry as an important risk-enhancing factor. The magnitude of enhanced risk within the context of contemporary clinical care, the extent to which it is captured by existing risk estimators, and its potential mechanisms warrant additional study. Within the UK Biobank prospective cohort study, 8124 middle-aged participants of South Asian ancestry and 449 349 participants of European ancestry who were free of atherosclerotic cardiovascular disease at the time of enrollment were examined. The relationship of ancestry to risk of incident atherosclerotic cardiovascular disease-defined as myocardial infarction, coronary revascularization, or ischemic stroke-was assessed with Cox proportional hazards regression, along with examination of a broad range of clinical, anthropometric, and lifestyle mediators. The mean age at study enrollment was 57 years, and 202 405 (44%) were male. Over a median follow-up of 11 years, 554 of 8124 (6.8%) individuals of South Asian ancestry experienced an atherosclerotic cardiovascular disease event compared with 19 756 of 449 349 (4.4%) individuals of European ancestry, corresponding to an adjusted hazard ratio of 2.03 (95% CI, 1.86-2.22; P<0.001). This higher relative risk was largely consistent across a range of age, sex, and clinical subgroups. Despite the >2-fold higher observed risk, the predicted 10-year risk of cardiovascular disease according to the American Heart Association/American College of Cardiology Pooled Cohort equations and QRISK3 equations was nearly identical for individuals of South Asian and European ancestry. Adjustment for a broad range of clinical, anthropometric, and lifestyle risk factors led to only modest attenuation of the observed hazard ratio to 1.45 (95% CI, 1.28-1.65, P<0.001). Assessment of variance explained by 18 candidate risk factors suggested greater importance of hypertension, diabetes, and central adiposity in South Asian individuals. Within a large prospective study, South Asian individuals had substantially higher risk of atherosclerotic cardiovascular disease compared with individuals of European ancestry, and this risk was not captured by the Pooled Cohort Equations.

Accelerometer-derived physical activity and risk of atrial fibrillation.

Physical activity may be an important modifiable risk factor for atrial fibrillation (AF), but associations have been variable and generally based on self-reported activity. We analysed 93669 participants of the UK Biobank prospective cohort study without prevalent AF who wore a wrist-based accelerometer for 1 week. We categorized whether measured activity met the standard recommendations of the European Society of Cardiology, American Heart Association, and World Health Organization [moderate-to-vigorous physical activity (MVPA) ≥150 min/week]. We tested associations between guideline-adherent activity and incident AF (primary) and stroke (secondary) using Cox proportional hazards models adjusted for age, sex, and each component of the Cohorts for Heart and Aging Research in Genomic Epidemiology AF (CHARGE-AF) risk score. We also assessed correlation between accelerometer-derived and self-reported activity. The mean age was 62 ± 8 years and 57% were women. Over a median of 5.2 years, 2338 incident AF events occurred. In multivariable adjusted models, guideline-adherent activity was associated with lower risks of AF [hazard ratio (HR) 0.82, 95% confidence interval (CI) 0.75-0.89; incidence 3.5/1000 person-years, 95% CI 3.3-3.8 vs. 6.5/1000 person-years, 95% CI 6.1-6.8] and stroke (HR 0.76, 95% CI 0.64-0.90; incidence 1.0/1000 person-years, 95% CI 0.9-1.1 vs. 1.8/1000 person-years, 95% CI 1.6-2.0). Correlation between accelerometer-derived and self-reported MVPA was weak (Spearman r = 0.16, 95% CI 0.16-0.17). Self-reported activity was not associated with incident AF or stroke. Greater accelerometer-derived physical activity is associated with lower risks of AF and stroke. Future preventive efforts to reduce AF risk may be most effective when targeting adherence to objective activity thresholds.

Associations of six adiposity-related markers with incidence and mortality from 24 cancers\u2014findings from the UK Biobank prospective cohort study

BackgroundAdiposity is a strong risk factor for cancer incidence and mortality. However, most of the evidence available has focused on body mass index (BMI) as a marker of adiposity. There is limited evidence on relationships of cancer with other adiposity markers, and if these associations are linear or not. The aim of this study was to investigate the associations of six adiposity markers with incidence and mortality from 24 cancers by accounting for potential non-linear associations.MethodsA total of 437,393 participants (53.8% women; mean age 56.3 years) from the UK Biobank prospective cohort study were included in this study. The median follow-up was 8.8 years (interquartile range 7.9 to 9.6) for mortality and 9.3 years (IQR 8.6 to 9.9) for cancer incidence. Adiposity-related exposures were BMI, body fat percentage, waist-hip ratio, waist-height ratio, and waist and hip circumference. Incidence and mortality of 24 cancers sites were the outcomes. Cox proportional hazard models were used with each of the exposure variables fitted separately on penalised cubic splines.ResultsDuring follow-up, 47,882 individuals developed cancer and 11,265 died due to cancer during the follow-up period. All adiposity markers had similar associations with overall cancer incidence. BMI was associated with a higher incidence of 10 cancers (stomach cardia (hazard ratio per 1 SD increment 1.35, (95% CI 1.23; 1.47)), gallbladder (1.33 (1.12; 1.58)), liver (1.27 (1.19; 1.36)), kidney (1.26 (1.20; 1.33)), pancreas (1.12 (1.06; 1.19)), bladder (1.09 (1.04; 1.14)), colorectal (1.10 (1.06; 1.13)), endometrial (1.73 (1.65; 1.82)), uterine (1.68 (1.60; 1.75)), and breast cancer (1.08 (1.05; 1.11))) and overall cancer (1.03 (1.02; 1.04)). All these associations were linear except for breast cancer in postmenopausal women. Similar results were observed when other markers of central and overall adiposity were used. For mortality, nine cancer sites were linearly associated with BMI and eight with waist circumference and body fat percentage.ConclusionAdiposity, regardless of the marker used, was associated with an increased risk in 10 cancer sites.

Abstract 14826: Increased Risk of Coronary Artery Disease Among South Asians in a National Biobank

Background: Individuals of South Asian ancestry represent 23% of the world population and experience substantially increased risk of coronary artery disease (CAD) compared to most other ethnicities. AHA/ACC practice guidelines recognize South Asian ancestry as an important ‘risk-enhancing’ factor. The magnitude of increased risk despite contemporary care, extent to which it is captured by existing risk estimators, and its potential mechanisms warrant further study. Methods: We studied 9,310 individuals of South Asian ancestry and 456,454 individuals of European ancestry free of baseline CAD from the UK Biobank prospective cohort study. Results: Over a median follow-up of 8.1 years, we confirm a striking increase in incident CAD events in individuals of South Asian ancestry, occurring in 352 (3.8%) of South Asians versus 10,165 (2.2%) of European ancestry individuals. After adjusting for age, sex, and enrollment site, this corresponded to a hazard ratio of 2.25 (95% CI 2.02 - 2.52; p&lt;0.001). Importantly, this increased risk was not predicted by the AHA/ACC Pooled Cohorts Equation, which estimates similar 10-year risk for South Asians and European ancestry individuals. Adjustment for a broad range of clinical, anthropometric, and lifestyle risk factors led to modest attenuation of the hazard ratio to 1.73 (95% CI 1.43 - 2.09; p&lt;0.001). By analyzing the population attributable fractions (PAF) of various risk factors, we observe that diabetes accounts for an outsized proportion of risk in South Asians (PAF 0.20, 95% CI 0.14 - 0.25 vs. 0.07, 95% CI 0.06 - 0.08 in European ancestry individuals) and current smoking accounted for a higher proportion of risk in individuals of European ancestry (PAF of 0.08, 95% CI 0.07 - 0.09 vs. 0.02, 95% CI -0.02 - 0.05 in South Asians). Conclusion: In the largest prospective study to date, we confirm and extend prior observations of a substantially increased risk of CAD among South Asians that is not captured by current clinical risk estimators.

Meat, plant, and fish-based diets and its associations withincident type 2 diabetes: Findings from the UK biobank prospective cohort Study

Meat, plant, and fish-based diets and its associations withincident type 2 diabetes: Findings from the UK biobank prospective cohort Study

The combined associations of walking pace and obesity with diabetes incidence: Findings from the UK biobank prospective cohort study

Rationale: Both obesity and walking pace are associated with health outcomes. However, evidence regarding their combined association on type 2 diabetes mellitus (T2DM) risk is limited. Therefore, this study aimed to investigate the joint association of walking pace and obesity with incident T2DM.

Modifiable and non-modifiable risk factors for COVID-19, and comparison to risk factors for influenza and pneumonia: results from a UK Biobank prospective cohort study

ObjectivesWe aimed to investigate demographic, lifestyle, socioeconomic and clinical risk factors for COVID-19, and compared them to risk factors for pneumonia and influenza in UK Biobank.DesignCohort study.SettingUK Biobank.Participants49–83 year olds...