UK Women's Cohort Research Articles

Foods, Nutrients, and Risk of In-Hospital Frailty in Women: Findings from a Large Prospective Cohort Study.

Frailty is increasingly prevalent worldwide because of aging populations. Diet may play a role as a modifiable risk factor. This study aimed to investigate associations between dietary factors and risk of frailty in the UK Women's Cohort admitted to hospitals in England. Consumption of foods and nutrients was estimated using a validated 217-item food frequency questionnaire at baseline. Incident frailty was assessed via a hospital frailty risk score based on linkage with hospital episode statistics. Out of 25,186 participants admitted to hospitals, 6919 (27%) were identified with frailty and 10,562 (42%) with pre-frailty over a mean follow-up of 12.7 years. After adjustment for confounding, we observed a 12% increase in risk of frailty with each additional 10 g/MJ intake of total meat (HR = 1.12, 95%CI: 1.07, 1.17), with the highest risk observed for processed meats (HR = 1.45, 95%CI: 1.21, 1.73). Similar associations were observed with pre-frailty. Vegetable intake was associated with slightly lower risk of frailty (HR = 0.98, 95%CI: 0.97, 1.00). There was no evidence of association between most nutrient intakes and in-hospital frailty risk. Overall, our findings suggest that reducing consumption of meat, especially processed meat, in adults may be beneficial regarding the development of frailty.

Major dietary patterns in the United Kingdom Women's Cohort Study showed no evidence of prospective association with pancreatic cancer risk

Diet is a modifiable risk factor for pancreatic cancer. We hypothesized that specific dietary patterns would increase/decrease pancreatic cancer risk. We evaluated the association of dietary patterns with pancreatic cancer risk in the UK Women's Cohort Study. Dietary patterns were assessed at enrollment using: (1) self-reported practice of vegan/vegetarian dietary habits, (2) diet quality indices (World Health Organization Healthy Diet Indicator and Mediterranean Diet Score), and (3) principal component analysis-derived dietary patterns. The association of dietary patterns with pancreatic cancer incidence was quantified using Cox regression survival analysis. Over a median follow-up of 19 years of 35,365 respondents, there were 136 incident cases of pancreatic cancer. No association between dietary habits/quality and pancreatic cancer incidence was evident after adjustments (hazard ratio (95% confidence interval): self-reported omnivores vs vegan/vegetarian dietary habit: 1.13 (0.73-1.76); per-unit increase in World Health Organization Healthy Diet Indicator scores: 0.99 (0.91-1.09); per-unit increase in Mediterranean Diet Score: 0.92 (0.83-1.02). Similarly, no association of principal component analysis-derived dietary patterns with pancreatic cancer risk was evident ("prudent:" 1.02 [0.94-1.10]; ``meat-based:'' 1.00 [0.92-1.09]; ``fast-food, sugar-sweetened beverages, and carbohydrate-rich snacks:'' 0.96 [0.86-1.07]; ``cereal and dairy-rich:'' 1.04 [0.94-1.16], and ``low-diversity and lowfat:'' 1.00 [0.89-1.13]). In this prospective cohort of women, several major dietary patterns were of poor quality. There was no evidence of a prospective association between any of the dietary patterns explored and pancreatic cancer incidence.

Association between adherence to the Mediterranean Diet and the Eatwell Guide and changes in weight and waist circumference in post-menopausal women in the UK Women's Cohort Study.

This study investigated the associations between adherence to the Mediterranean Diet and the Eatwell Guide (EWG) and changes in weight and waist circumference in post-menopausal women. Post-hoc analysis of post-menopausal women from the UK Women's Cohort Study. Changes in weight, waist circumference and the risk of abdominal and general obesity. 4162 post-menopausal women were selected. Higher adherence to both the EWG and the Mediterranean Diet was associated with smaller increases in waist circumference over 4years (EWG: β -0.47, CI -0.75, -0.20 per 1 tertile increase in score), (Mediterranean Diet: β -0.29, CI -0.58, -0.01 per 1 tertile increase in score); and lower risk of abdominal obesity (EWG: OR 0.55, CI 0.43, 0.70 third versus the first tertile), (Mediterranean Diet: OR 0.60, CI 0.46, 0.76 third versus the first tertile), but was not associated with weight changes (EWG: β 0.14, CI -0.07, 0.36 per 1 tertile increase in score), (Mediterranean Diet: β 0.03, CI -0.19, 0.25 per 1 tertile increase in score) or risk of becoming overweight or obese (EWG: OR 1.09, CI 0.77, 1.52 third versus the first tertile), (Mediterranean Diet: OR 0.91, CI 0.65, 1.27 third versus the first tertile). The results suggest that adherence to either the Mediterranean Diet or the EWG can help to prevent abdominal obesity in post-menopausal women.

Foods, nutrients and hip fracture risk: A prospective study of middle-aged women

Hip fracture affects 1.6 million people globally each year, and increases morbidity and mortality. There is potential for risk reduction through diet modification, but prospective evidence for associations between intake of several foods and nutrients and hip fracture risk is limited. This study aimed to investigate associations between food and nutrient intakes and hip fracture risk in the UK Women's Cohort Study, and to determine the role of body mass index (BMI) as a potential effect modifier. Dietary, lifestyle, anthropometric, and socio-economic information of UK women, ages 35-69 years, were collected in a survey at recruitment (1995-1998), and included a validated 217-item food frequency questionnaire. Hip fracture cases were identified by linking participant data at recruitment with their Hospital Episode Statistics (HES) up to March 2019. Cox regression models were used to estimate associations between standard portions of food and nutrient intakes and hip fracture risk over a median follow-up time of 22.3 years. Among 26,318 women linked to HES data (556,331 person-years), 822 hip fracture cases were identified. After adjustment for confounders, every additional cup of tea or coffee per day was associated with a 4% lower risk of hip fracture (HR (95% CI): 0.96 (0.92, 1.00)). A 25g/day increment of dietary protein intake was also associated with a 14% lower risk of hip fracture (0.86 (0.73, 1.00)). In subgroup analyses, BMI modified linear associations between dietary intakes of protein, calcium, total dairy, milk, and tea and hip fracture risk (pinteraction=0.02, 0.002, 0.003, 0.001, and 0.003, respectively); these foods and nutrients were associated with a reduced risk of hip fracture in underweight but not healthy or overweight participants. In particular, risk of hip fracture in underweight participants (28 cases, 545 participants) was 45% lower for every 25g/day protein consumed (0.55 (0.38, 0.78)). This is the first prospective cohort study internationally of multiple food and nutrient intakes in relation to hip fracture risk by BMI using linkage to hospital records. Results suggest that the potential roles of some foods and nutrients in hip fracture prevention, particularly protein, tea and coffee in underweight women, merit confirmation. Clinicaltrials.gov NCT05081466.

Diet and hip fracture risk in the UK women's cohort study

Diet and hip fracture risk in the UK women's cohort study

Foods, nutrient intakes and Mediterranean dietary pattern in midlife are not associated with reaction times: a longitudinal analysis of the UK Women's Cohort Study.

Associations between dietary factors and general cognition in the elderly have been documented; however, little is known about reaction time ability in relation to midlife diet. The present study aimed to investigate associations between reaction time and midlife dietary factors, specifically foods, nutrients and Mediterranean diet (MeDi) pattern. The UK Women's Cohort Study collected dietary information from middle-aged women (52 (sd 9·4) years old) using a validated 217-item FFQ in 1995-1998. In 2010-2011, a sub-group of 664 participants completed online reaction time ability tests including simple reaction time (SRT) and choice reaction time; 503 participants were eligible for analysis. Participants were grouped into fast and slow groups by their median reaction time. The intake of particular foods, nutrients, adherence to the MeDi and cooking methods (roasting/baking, frying and barbecuing/grilling) were explored in relation to reaction times. We did not find any significant associations between reaction times and investigated foods, nutrients or adherence to the MeDi in adjusted models. However, consumers of roasted/baked fish and fried vegetables were associated with slower SRT (adjusted OR 1·46, 95 % CI 1·00, 2·13, P = 0·049; and adjusted OR 1·64, 95 % CI 1·12, 2·39, P = 0·010, respectively) compared with non-consumers of that particularly cooked food. Overall, our findings show no significant associations between midlife diet and reaction time ability 10-15 years later.

Healthy dietary patterns from food diaries and FFQ are not associated with colorectal cancer risk: results from the UKWCS

AbstractDietary pattern analyses have most commonly used food frequency questionnaire (FFQ) data for large population studies, whilst food diaries (FD) tend to be used with smaller datasets and followed up for shorter terms, restricting the possibility of a direct comparison. Studies comparing dietary patterns derived from two different assessment methods, in relation to diet and disease are limited. The aims of this study are to assess the agreement between dietary patterns derived from FFQ and FDs and to compare the associations between the Mediterranean dietary pattern and the World Cancer Research Fund/American Institute of Cancer Research (WCRF/AICR) dietary pattern in relation to colorectal cancer incidence.The study population included 2276 healthy middle-aged women – participants of the UK Women's Cohort Study. Energy and nutrient intakes, derived from 4-day FDs and from a 217-item FFQ were compared. A 10 and an 8-component score indicating adherence to the Mediterranean diet and to the 2007 WCRF/AICR cancer prevention recommendations respectively were generated. Agreement was assessed by weighted Kappa statistics and the Bland-Altman method. Cox regression was used to estimate hazard ratios (HRs) for colorectal cancer risk for both the FD and the FFQ patterns, for each score separately.The Bland-Altman method showed that the FFQ gave a higher energy intake compared to the FD with a bias of -525 kcal (95% CI -556, -493) between the two methods. Agreement was slight for the Mediterranean diet score (Κ = 0.15; 95% CI: 0.14, 0.16) and fair for the WCRF/AICR score (Κ = 0.38; 95% CI: 0.37, 0.39). A total of 173 incident cases of colorectal cancer were documented. In the multi-variable adjusted models, the estimates for an association with colorectal cancer were weak: HR = 0.94 (95% CI: 0.83 to 1.06) for a 1-unit increment in the Mediterranean diet score using FD and HR = 1.01 (95% CI: 0.83 to 1.24) for a 1-unit increment in the WCRF/AICR score using FD. For scores derived from the FFQ, estimates were inverse, but weak (HR = 0.80 (95% CI: 0.90 to 1.00) for a 1-unit increment in the Mediterranean diet score using FFQ and HR = 0.84 (95% CI: 0.67 to 1.05) for a 1-unit increment in the WCRF/AICR score using FFQ.There is insufficient evidence of an association of colorectal cancer risk with the Mediterranean dietary pattern or with the WCRF/AICR cancer prevention recommendations, irrespective of the dietary assessment method in this sample. Further studies with larger sample sizes, using FD for diet assessment are warranted.

Is body mass index (BMI) associated with reaction time? Results from the UK Women's Cohort Study

Is body mass index (BMI) associated with reaction time? Results from the UK Women's Cohort Study

Bitter taste sensitivity, food intake, and risk of malignant cancer in the UK Women's Cohort Study.

There is variability in sensitivity to bitter tastes. Taste 2 Receptor (TAS2R)38 binds to bitter tastants including phenylthiocarbamide (PTC). Many foods with putative cancer preventive activity have bitter tastes. We examined the relationship between PTC sensitivity or TAS2R38 diplotype, food intake, and cancer risk in the UK Women's Cohort Study. PTC taste phenotype (n = 5500) and TAS238 diplotype (n = 750) were determined in a subset of the cohort. Food intake was determined using a 217-item food-frequency questionnaire. Cancer incidence was obtained from the National Health Service Central Register. Hazard ratios (HR) were estimated using multivariable Cox proportional hazard models. PTC tasters [HR 1.30, 95% confidence interval (CI) 1.04, 1.62], but not supertasters (HR 0.98, CI 0.76, 1.44), had increased cancer risk compared to nontasters. An interaction was found between phenotype and age for supertasters (p = 0.019) but not tasters (p = 0.54). Among women > 60years, tasters (HR 1.40, CI 1.03, 1.90) and supertasters (HR 1.58, CI 1.06, 2.36) had increased cancer risk compared to nontasters, but no such association was observed among women ≤ 60years (tasters HR 1.16, CI 0.84, 1.62; supertasters HR 0.54, CI 0.31, 0.94). We found no association between TAS2R38 diplotype and cancer risk. We observed no major differences in bitter fruit and vegetable intake. These results suggest that the relationship between PTC taster phenotype and cancer risk may be mediated by factors other than fruit and vegetable intake.

Does adherence to the World Cancer Research Fund/American Institute of Cancer Research cancer prevention guidelines reduce risk of colorectal cancer in the UK Women's Cohort Study?

Evidence on adherence to diet-related cancer prevention guidelines and associations with colorectal cancer (CRC) risk is limited and conflicting. The aim of this cohort analysis is to evaluate associations between adherence to the World Cancer Research Fund/American Institute of Cancer Research (WCRF/AICR) 2007 recommendations and incident CRC. The UK Women's Cohort Study comprises over 35 372 women who filled in a FFQ at baseline in 1995. They were followed up for CRC incidence for a median of 17·4 years, an individual score linking adherence to eight of the WCRF/AICR recommendations was constructed. Cox proportional hazards regression provided hazard ratios (HR) and 95 % CI for the estimation of CRC risk, adjusting for confounders. Following exclusions, 444 CRC cases were identified. In the multivariate-adjusted model, women within the second and third (highest) categories of the WRCF/AICR score had HR of 0·79 (95 % CI 0·62, 1·00) and 0·73 (95 % CI 0·48, 1·10), respectively, for CRC compared with those in the lowest, reference category. The overall linear trend across the categories was not significant (P=0·17). No significant associations were observed between the WCRF/AICR score and proximal colon, distal colon and rectal cancers separately. Of the individual score components, a BMI within the normal weight range was borderline significantly protective only for rectal cancer in the fully adjusted model. In view of the likely different causes of CRC subtypes, further research is needed to identify the optimal dietary patterns associated with reducing colon and rectal cancer risk, respectively.

Breastfeeding is associated with the risk of ovarian cancer in the UK Women's Cohort Study

Studies have found that longer breastfeeding duration is associated with the risk of having ovarian cancer and other hormonal related cancers(1). However, the evidence is still inconsistent with a limited number of prospective studies providing evidence(2). Therefore, this analysis aimed to explore the association between breastfeeding duration and the risks of ovarian cancer in a large prospective cohort of middle-aged women, the UK Women’s Cohort Study (UKWCS). The UKWCS participants were recruited in 1995–1998 at the age of 35–69 years(3). Cancer incidence was obtained from the Office of National Statistics (ONS). A baseline questionnaire was used to estimate breastfeeding duration, ranging from >0 months to >6 months. Patients with prevalent cancers were excluded. The relationship between breast feeding duration and incidence of ovarian cancer was tested using survival analysis adjusting for age, children, socio-economic class, menopausal status, smoking status, body mass index, energy intake and age at menarche. The total number of incident ovarian cancer cases was 224 over 16 years follow up. Mean age at recruitment was 54 years. Breastfeeding duration for each child shows that ever breastfeeding was associated with 6 % risk reduction of ovarian cancer, after adjustment for confounders (HR: 0·94; 95 % CI: 0·90 to 0·99). Further analysis on breastfeeding duration per child shows that the risk reduces by 43 % among those who breastfed for more than 6 months per child (HR: 0·57; 95 % CI: 0·35 to 0·95). Additional analysis was done on cumulative breastfeeding duration across all children, with ovarian cancer risk, which shows a 2 % risk reduction for every 1 month of breastfeeding (HR: 0·98; 95 % CI: 0·97 to 1·00). In conclusion, ever breastfeeding per child was associated with 6 % risk reduction of ovarian cancer in a fully adjusted model and those who were breastfeeding for more than 6-month benefit more with a high-risk reduction of ovarian cancer by 43 %. This finding supports the World Health Organisation (WHO) recommendation for women to breastfeed for at least 6 months for each child. Future studies are warranted to determine if the duration of breastfeeding per child provides more meaningful data than cumulative breastfeeding duration. The average duration of breastfeeding per child might have more public health applicability than total duration and is a better reflection of lactation amenorrhea(1). 1. Luan NN, Wu QJ, Gong TT et al. (2013) Breastfeeding and ovarian cancer risk: a meta-analysis of epidemiologic studies.AmJ Clin Nutr 98, 1020–31. 2. Feng LP, Chen HL & Shen MY (2014) Breastfeeding and the risk of ovarian cancer: a meta-analysis. J Midwifery Womens Health 59, 428–37. 3. Cade JE, Burley VJ, Alwan NA et al. (2017) Cohort Profile: The UK Women’s Cohort Study (UKWCS). Int J Epidemiol 46, e11.

Associations between dietary patterns and age at natural menopause in the UK Women's Cohort Study

Previous studies have demonstrated an association between a later menopause and reduced risk of cardiovascular diseases and osteoporosis, and a higher risk for endometrial, ovarian and breast cancer(1). It is hypothesized that diet can influence the timing of natural menopause(2). Yet, evidence linking diet and age at natural menopause is still sparse and inconsistent. This study aimed to investigate the prospective association between dietary patterns derived from two different methods and age at natural menopause. Menopausal status was reported at two time points 4 years apart in the UK Women’s Cohort Study. Diet of participants were measured using a 217-item food frequency questionnaire at baseline. Principal component analysis (PCA) and reduced ranked regression (RRR) were used to derive dietary patterns for 13,916 women. Cox proportional hazards regression models were used to estimate hazard ratios (HR) and 95 % confidence intervals (CI) for each pattern in relation to increasing age at natural menopause at follow-up, adjusting for potential confounders. Five patterns were identified from the PCA, which we labelled: ‘vegetables and legumes’, ‘animal proteins’, ‘fruits’, ‘fats and sweets’ and ‘low-fat products’. Three patterns were derived from RRR: ‘sweets, pastries and puddings’, ‘low-fat dairy and meat’, and ‘red meat and processed meat’. Women who scored higher on the ‘animal proteins’ pattern were 6 % less likely to have gone through a natural menopause (HR: 0.94, 95 % CI: 0.90 to 0.97) compared to those who scored lower. The ‘red meat and processed meat’ pattern predicted a 7 % higher risk for a later natural menopause (HR: 0.93, 95 % CI: 0.87 to 1.00). No evidence of an association was observed between the other dietary patterns and incidence of being naturally menopausal. This is the first study ever investigating the associations between dietary patterns and age at natural menopause. Both PCA and RRR are useful in deriving dietary patterns which can influence the onset of natural menopause. These findings will contribute to an improved understanding of the timing of natural menopause in relation to diet, which may also have implications associated with longer term health outcomes in post-menopausal women. This work was supported by the Commonwealth Scholarships, UK. 1. Gold EB (2011) Obstet Gynecol Clin North Am 38, 425–440. 2. Nagata C, Takatsuka N, Inaba S et al. (1998) Maturitas 29, 105–113.

Associations between Nut Consumption and Health Vary between Omnivores, Vegetarians, and Vegans.

Regular nut consumption is associated with reduced risk factors for chronic disease; however, most population-based studies lack consideration of effect modification by dietary pattern. The UK Women’s Cohort Study (UKWCS) provides an ideal opportunity to examine relationships between nut consumption and chronic disease risk factors in a large sample with diverse dietary patterns. Nut and nutrient intake from 34,831 women was estimated using a food frequency questionnaire among self-identified omnivores, vegetarians and vegans. In this cross-sectional analysis, higher nut consumption was associated with lower body weight (difference between highest and lowest consumption categories from adjusted model: 6.1 kg; 95% CI: 4.7, 7.6) body mass index (BMI, 2.4 units difference; 95% CI: 1.9, 2.9), and waist circumference (2.6 cm difference; 95% CI: 1.4, 3.8) (all p for linear trend < 0.001). Higher nut consumption was also associated with reduced prevalence of high cholesterol and high blood pressure; having a history of heart attack, diabetes and gallstones; and markers of diet quality (all adjusted p for linear trend ≤ 0.011). Higher nut consumption appeared overall to be associated with greater benefits amongst omnivores compared to vegetarians and vegans. Findings support existing literature around beneficial effects of nut consumption and suggest that benefits may be larger among omnivores. Nut promotion strategies may have the highest population impact by specifically targeting this group.

The Mediterranean diet and risk of colorectal cancer in the UK Women’s Cohort Study

Evidence from epidemiological studies investigating associations between adherence to the Mediterranean diet and colorectal cancer is inconsistent. The aim of this study is to assess in the UK Women's Cohort Study whether adherence to the Mediterranean dietary pattern is associated with reduced incidence of cancers of the colon and rectum. A total of 35 372 women were followed for a median of 17.4 years. A 10-component score indicating adherence to the Mediterranean diet was generated for each cohort participant, using a 217-item food frequency questionnaire. The Mediterranean diet score ranged from 0 for minimal adherence to 10 for maximal adherence. Cox proportional hazards regression was used to provide adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for colon and rectal cancer risk. A total of 465 incident colorectal cancer cases were documented. In the multivariable adjusted model, the test for trend was positive (HR = 0.88, 95% CI: 0.78 to 0.99; Ptrend = 0.03) for a 2-point increment in the Mediterranean diet score. For rectal cancer, a 2-point increment in the Mediterranean diet score resulted in an HR (95% CI) of 0.69 (0.56 to 0.86), whereas a 62% linear reduced risk (HR 0.38; 95% CI: 0.20 to 0.74; Ptrend < 0.001) was observed for women within the highest vs the lowest category of the MD score. Estimates for an association with colon cancer were weak (Ptrend = 0.41). Findings suggest that women adhering to a Mediterranean dietary pattern may have a lower risk of colorectal cancer, especially rectal cancer.

Does dietary intake affect age at natural menopause in the UK Women's Cohort Study?

Does dietary intake affect age at natural menopause in the UK Women's Cohort Study?

Breastfeeding and incidence of breast cancers in the UK Women's Cohort Study

Breastfeeding and incidence of breast cancers in the UK Women's Cohort Study

Sleep duration is associated with daily consumption of fruits and vegetables in British women from The UK Women's Cohort Study

Sleep duration is associated with daily consumption of fruits and vegetables in British women from The UK Women's Cohort Study

Dietary pattern by menopausal status in the UK Women's Cohort Study

Dietary pattern by menopausal status in the UK Women's Cohort Study

Fruit intake and cardiovascular disease mortality in the UK Women's Cohort Study.

In observational studies, fruit intake is associated with a reduced risk of cardiovascular disease (CVD), though fruit type has been less frequently explored. The aim of the current study was to explore the association between total fruit and fruit subgroup intake according to polyphenol content and CVD mortality in the UK Women's Cohort Study. Total fruit intake (g/day) derived from a 217-item food frequency questionnaire was obtained from 30,458 women (aged 35-69 years) at baseline from 1995-1998. Fruit intakes were sub-categorised according to similarities in polyphenol profile from Phenol Explorer, including berries, citrus, drupes, pomes and tropical fruits. Mortality events were derived from the NHS Central Register. During the mean follow-up period of 16.7 years, 286 fatal CVD deaths [138 coronary heart disease (CHD), 148 stroke] were observed. Survival analysis was conducted using participants free from history of CVD at baseline. Total fruit intake was associated with lower risk of CVD and CHD mortality, with a 6-7 % reduction in risk for each 80 g/day portion consumed (99 % CI 0.89, 1.00 and 0.85, 1.01 respectively). Concerning particular fruit types, the direction of the associations tended to be inverse, but point estimates and tests for trend were not generally statistically significant. However, women in the highest intake group of grapes and citrus experienced a significant reduction in risk of CVD and stroke respectively compared with non-consumers [HR 0.56 (99 % CI 0.32, 0.98) and 0.34 (0.14, 0.82) respectively]. These findings support promoted guidelines encouraging fruit consumption for health in women, but do not provide strong evidence to suggest that fruit type is as important.

Spatial variations in dietary fibre intake among women in England from the UK Women's Cohort Study

Spatial variations in dietary fibre intake among women in England from the UK Women's Cohort Study