N J Wareham
Biographic Data
| ID | 184118 |
|---|---|
| NAME | N J Wareham |
| GIVEN NAMES | N J |
| FAMILY NAME | Wareham |
| SIGNATURE | WAREHAM N J |
| AFFILIATIONS | University of Cambridge |
| ORCID | 0000-0003-1422-2993 |
| VERIFIED | Yes |
| TOTAL WORKS | 57 |
| TOTAL CITATIONS | 53 |
| AUTHOR COUNT | 57 |
| EDITOR COUNT | 0 |
| FIRST PUBLICATION YEAR | 1998 |
| LATEST PUBLICATION YEAR | 2026 |
| H-INDEX | 4 |
Assessment of individualised dynamic environmental exposures within The World Avatar
The environment in which people spend their lives influences their health behaviours and health outcomes. Traditional studies often use fixed descriptions and ad hoc analyses to characterise environmental exposures at static locations, relating a single environmental factor to one health aspect, even though both the environment and the exposures of people who move through it are dynamic. We introduce a digital twinning approach that semantically …
Examining causal relationships between educational attainment and type 2 diabetes using genetic analysis: Findings from the Epic-InterAct study through Mendelian randomisation
INTRODUCTION: Observational studies have shown that more educated people are at lower risk of developing type 2 diabetes (T2D). However, robust study designs are needed to investigate the likelihood that such a relationship is causal. This study used genetic instruments for education to estimate the effect of education on T2D using the Mendelian randomisation (MR) approach. METHODS: Analyses have been conducted in the European Prospective Investi…
The genetic landscape of neuro-related proteins in human plasma
Genome-wide analysis identifies genetic effects on reproductive success and ongoing natural selection at the Fads locus
The global diet and activity research (GDAR) network: A global public health partnership to address upstream NCD risk factors in urban low and middle-income contexts
Implications of Covid-19 control measures for diet and physical activity, and lessons for addressing other pandemics facing rapidly urbanising countries
At the time of writing, it is unclear how the COVID-19 pandemic will play out in rapidly urbanising regions of the world. In these regions, the realities of large overcrowded informal settlements, a high burden of infectious and non-communicable diseases, as well as malnutrition and precarity of livelihoods, have raised added concerns about the potential impact of the COVID-19 pandemic in these contexts. COVID-19 infection control measures have b…
Cross-sectional and prospective associations between active living environments and accelerometer-assessed physical activity in the Epic-Norfolk cohort
The environments in which young and middle-aged adults live may influence their physical activity (PA) behaviours. These associations are less clear among older adults. We estimated cross-sectional and prospective associations of population density, junction density, and land use mix and perceived active living environments with accelerometer-assessed PA in a cohort of older adults. Adults living in more dense and mixed neighbourhoods had less op…
Using natural experimental studies to guide public health action: Turning the evidence-based medicine paradigm on its head
Despite smaller effect sizes, interventions delivered at population level to prevent non-communicable diseases generally have greater reach, impact and equity than those delivered to high-risk groups. Nevertheless, how to shift population behaviour patterns in this way remains one of the greatest uncertainties for research and policy. Evidence about behaviour change interventions that are easier to evaluate tends to overshadow that for population…
Genome-wide association study identifies 48 common genetic variants associated with handedness
Handedness has been extensively studied because of its relationship with language and the over-representation of left-handers in some neurodevelopmental disorders. Using data from the UK Biobank, 23andMe and the International Handedness Consortium, we conducted a genome-wide association meta-analysis of handedness (N = 1,766,671). We found 41 loci associated (P < 5 × 10−8) with left-handedness and 7 associated with ambidexterity. Tissue-enrichmen…
World Health Organization cardiovascular disease risk charts: Revised models to estimate risk in 21 global regions
BACKGROUND: To help adapt cardiovascular disease risk prediction approaches to low-income and middle-income countries, WHO has convened an effort to develop, evaluate, and illustrate revised risk models. Here, we report the derivation, validation, and illustration of the revised WHO cardiovascular disease risk prediction charts that have been adapted to the circumstances of 21 global regions. METHODS: In this model revision initiative, we derived…
FEV1 and total Cardiovascular mortality and morbidity over an 18 years follow-up Population-Based Prospective Epic-Norfolk Study
Participants with higher FEV1 levels had a lower risk of CVD and all-cause mortality. Measuring the FEV1 with a portable handheld spirometry measurement may be used as a surrogate marker for cardiovascular risk. Every effort should be made to identify those with poorer lung function even in the absence of cardiovascular disease as they are at greater risk of total and CV mortality
Gene discovery and polygenic prediction from a genome-wide association study of educational attainment in 1.1 million individuals
Here we conducted a large-scale genetic association analysis of educational attainment in a sample of approximately 1.1 million individuals and identify 1,271 independent genome-wide-significant SNPs. For the SNPs taken together, we found evidence of heterogeneous effects across environments. The SNPs implicate genes involved in brain-development processes and neuron-to-neuron communication. In a separate analysis of the X chromosome, we identify…
Large Scale Population Assessment of Physical Activity Using Wrist Worn Accelerometers: The UK Biobank Study
BACKGROUND: Physical activity has not been objectively measured in prospective cohorts with sufficiently large numbers to reliably detect associations with multiple health outcomes. Technological advances now make this possible. We describe the methods used to collect and analyse accelerometer measured physical activity in over 100,000 participants of the UK Biobank study, and report variation by age, sex, day, time of day, and season. METHODS: P…
Interplay of Socioeconomic Status and Supermarket Distance Is Associated with Excess Obesity Risk: A UK Cross-Sectional Study
U.S. policy initiatives have sought to improve health through attracting neighborhood supermarket investment. Little evidence exists to suggest that these policies will be effective, in particular where there are socioeconomic barriers to healthy eating. We measured the independent associations and combined interplay of supermarket access and socioeconomic status with obesity. Using data on 9702 UK adults, we employed adjusted regression analyses…
Longitudinal associations between built environment characteristics and changes in active commuting
Co-locating residential and employment centres as well as redesigning urban areas to improve safety for pedestrians and cyclists may encourage active commuting. Future evaluative studies should seek to assess the effects of redesigning the built environment on active commuting and physical activity
Sociodemographic, lifestyle and behavioural factors associated with consumption of sweetened beverages among adults in Cambridgeshire, UK: The Fenland Study
Objective We aimed to identify sociodemographic, lifestyle and behavioural determinants of consumption of sugar-sweetened beverages (SSB) and artificially sweetened beverages (ASB) among adults in Cambridgeshire, UK. Design Cross-sectional data were obtained from a cohort of 9991 adults born between 1950 and 1975. An FFQ was used to assess consumption of beverages and other dietary factors. Multivariable logistic regression was used to examine po…
Does neighborhood fast-food outlet exposure amplify inequalities in diet and obesity? A cross-sectional study
BACKGROUND: Greater exposures to fast-food outlets and lower levels of education are independently associated with less healthy diets and obesity. Little is known about the interplay between these environmental and individual factors. OBJECTIVE: The purpose of this study was to test whether observed differences in fast-food consumption and obesity by fast-food outlet exposure are moderated by educational attainment. DESIGN: In a population-based …
Neighbourhood greenspace is associated with a slower decline in physical activity in older adults: A prospective cohort study
Maintaining physical activity in later life is important for maintaining health and function. Activity outdoors, such as walking, jogging and cycling, may provide an accessible, sociable and practical solution, but maintaining outdoor mobility may be a challenge in later life. Providing green environments which are supportive of physical activity may facilitate this, yet research into how greenspace could be best used is inconclusive. This study …
Residential neighbourhood greenspace is associated with reduced risk of incident diabetes in older people: A prospective cohort study
Greener home neighbourhoods may protect against risk of diabetes in older adults, although this study does not support a mediation role for physical activity. Causal mechanisms underlying the associations require further investigation
A treelet transform analysis to relate nutrient patterns to the risk of hormonal receptor-defined breast cancer in the European Prospective Investigation into Cancer and Nutrition (Epic)
Objective Pattern analysis has emerged as a tool to depict the role of multiple nutrients/foods in relation to health outcomes. The present study aimed at extracting nutrient patterns with respect to breast cancer (BC) aetiology. Design Nutrient patterns were derived with treelet transform (TT) and related to BC risk. TT was applied to twenty-three log-transformed nutrient densities from dietary questionnaires. Hazard ratios (HR) and 95 % confide…
Marital transitions and associated changes in fruit and vegetable intake: Findings from the population-based prospective Epic-Norfolk cohort, UK
Unhealthy changes to diet accompanying divorce, separation and becoming widowed may be more common among men than women. Moreover, deterioration in fruit and vegetable intakes was more apparent for variety rather than quantity consumed. Programmes to promote healthy eating among older adults need to recognise these social determinants of diet and consider prioritising people who live alone and in particular men who have recently left relationship…
Association of Cardiometabolic Multimorbidity With Mortality
IMPORTANCE The prevalence of cardiometabolic multimorbidity is increasing. OBJECTIVE To estimate reductions in life expectancy associated with cardiometabolic multimorbidity. DESIGN, SETTING, AND PARTICIPANTS Age-and sex-adjusted mortality rates and hazard ratios (HRs) were calculated using individual participant data from the Emerging Risk Factors Collaboration (689 300 participants; 91 cohorts; years of baseline surveys: 1960-2007; latest morta…
Genetic studies of body mass index yield new insights for obesity biology
Gender and the double burden of economic and social disadvantages on healthy eating: Cross-sectional study of older adults in the Epic-Norfolk cohort
A double burden of low economic resources and lack of social relationships suggested they are unique joint determinants, particularly in older men, and that public health efforts to improve healthy eating would offer most benefit to older adults with intersecting economic and social disadvantages
Patterns and correlates of objectively measured free-living physical activity in adults in rural and urban Cameroon
BACKGROUND: Urbanisation in sub-Saharan Africa is changing lifestyles and raising non-communicable disease burden. Understanding the underlying pattern of physical activity and its correlates may inform preventive interventions. We examined correlates of objectively-measured physical activity in rural and urban Cameroon. METHODS: Participants were 544 adults resident in rural (W-156, M-89) or urban (W-189, M-110) regions. Physical activity was me…
Social relationships and healthful dietary behaviour: Evidence from over-50s in the Epic cohort, UK
Social relationships are an important aspect of a person's social environment that can protect against a wide range of chronic conditions and facilitate recovery from disease. Social relationships have also been linked to dietary behaviour which may be an important pathway through which social circumstances exert their influence on health. Yet, questions remain about which structural aspects of social relationships most affect healthful dietary b…
Does the association between self-rated health and mortality vary by social class
Using natural experimental studies to guide public health action: Turning the evidence-based medicine paradigm on its head
Despite smaller effect sizes, interventions delivered at population level to prevent non-communicable diseases generally have greater reach, impact and equity than those delivered to high-risk groups. Nevertheless, how to shift population behaviour patterns in this way remains one of the greatest uncertainties for research and policy. Evidence about behaviour change interventions that are easier to evaluate tends to overshadow that for population…
Changes in household, transport and recreational physical activity and television viewing time across the transition to retirement: Longitudinal evidence from the Epic-Norfolk cohort
BACKGROUND: Retirement is associated with an increase in recreational physical activity but its impact on other domains of activity (at home, for transport) and sedentary behaviour, such as time spent watching television (TV) is unknown. We examined the association between retirement and changes in domain-specific and overall activity and TV viewing. METHODS: Data were derived from the population-based EPIC (European Prospective Investigation int…
Genome-wide analysis identifies genetic effects on reproductive success and ongoing natural selection at the Fads locus
Marital transitions and associated changes in fruit and vegetable intake: Findings from the population-based prospective Epic-Norfolk cohort, UK
Unhealthy changes to diet accompanying divorce, separation and becoming widowed may be more common among men than women. Moreover, deterioration in fruit and vegetable intakes was more apparent for variety rather than quantity consumed. Programmes to promote healthy eating among older adults need to recognise these social determinants of diet and consider prioritising people who live alone and in particular men who have recently left relationship…
Job-loss and weight gain in British adults: Evidence from two longitudinal studies
Overweight and obesity have been associated with unemployment but less is known about changes in weight associated with changes in employment. We examined weight changes associated with job-loss, retirement and maintaining employment in two samples of working adults in the United Kingdom. This was a prospective study of 7201 adults in the European Prospective Investigation of Cancer (EPIC)-Norfolk study (aged 39-76 years) and 4539 adults in the B…
Genome-wide association study identifies 48 common genetic variants associated with handedness
Handedness has been extensively studied because of its relationship with language and the over-representation of left-handers in some neurodevelopmental disorders. Using data from the UK Biobank, 23andMe and the International Handedness Consortium, we conducted a genome-wide association meta-analysis of handedness (N = 1,766,671). We found 41 loci associated (P < 5 × 10−8) with left-handedness and 7 associated with ambidexterity. Tissue-enrichmen…
Cross-sectional and prospective associations between active living environments and accelerometer-assessed physical activity in the Epic-Norfolk cohort
The environments in which young and middle-aged adults live may influence their physical activity (PA) behaviours. These associations are less clear among older adults. We estimated cross-sectional and prospective associations of population density, junction density, and land use mix and perceived active living environments with accelerometer-assessed PA in a cohort of older adults. Adults living in more dense and mixed neighbourhoods had less op…
The validation of physical activity instruments for measuring energy expenditure: Problems and pitfalls
Objective: To review and categorize the problems associated with undertaking physical activity validation studies and to construct a checklist against which any study could be compared. Results: The studies reviewed demonstrated problems in defining the dimension of physical activity that is of interest and in the selection of an appropriate comparison technique. Ideally this should be closely related to the true exposure of interest and assess t…
Nutritional methods in the European Prospective Investigation of Cancer in Norfolk
Objective: To describe methods and dietary habits of a large population cohort. Design: Prospective assessment of diet using diet diaries and food-frequency questionnaires, and biomarkers of diet in 24-h urine collections and blood samples. Setting: Free living individuals aged 45 to 75 years living in Norfolk, UK. Subjects: Food and nutrient intake from a food-frequency questionnaire on 23 003 men and women, and from a 7-day diet diary from 2117…
Physical activity of subjects aged 50–64 years involved in the European Prospective Investigation into Cancer and Nutrition (Epic)
Objective: To describe physical activity of participants in the European Prospective Investigation into Cancer and Nutrition (EPIC). Design: A cross-sectional analysis of baseline data of a European prospective cohort study. Subjects: This analysis was restricted to participants in the age group 50–64 years, which was represented in all EPIC centres. It involved 236 386 participants from 25 centres in nine countries. In each EPIC centre, physical…
Validity and repeatability of a simple index derived from the short physical activity questionnaire used in the European Prospective Investigation into Cancer and Nutrition (Epic) study
Objective: To assess the validity and repeatability of a simple index designed to rank participants according to their energy expenditure estimated by self-report, by comparison with objectively measured energy expenditure assessed by heart-rate monitoring with individual calibration. Design: Energy expenditure was assessed over one year by four separate episodes of 4-day heart-rate monitoring, a method previously validated against whole-body cal…
The ProActivetrial protocol – a randomised controlled trial of the efficacy of a family-based, domiciliary intervention programme to increase physical activity among individuals at high risk of diabet…
ProActive is the first efficacy trial of an intervention programme to promote physical activity in a defined high-risk group accessible through primary care. The intervention programme is based on psychological theory and evidence; it introduces and facilitates the use of self-regulatory skills to support behaviour change and maintenance. The trial addresses a range of methodological weaknesses in the field by careful specification and quality as…
Criterion-related validity of the last 7-day, short form of the International Physical Activity Questionnaire in Swedish adults
Objective To examine the validity of the short, last 7-day, self-administered form of the International Physical Activity Questionnaire (IPAQ). Design All subjects wore an accelerometer for seven consecutive days and completed the IPAQ questionnaire on the eighth day. Criterion validity was assessed by linear regression analysis and by modified Bland–Altman analysis. Specificity and sensitivity were calculated for classifying respondents accordin…
Habitual fish consumption and risk of incident stroke: The European Prospective Investigation into Cancer (Epic)–Norfolk prospective population study
Objectives To examine the association between fish consumption and stroke risk. Design Prospective population cohort study. Setting Norfolk, UK cohort of the European Prospective Investigation into Cancer (EPIC–Norfolk). Subjects Subjects were 24 312 men and women aged 40–79 years who had no previous history of stroke at baseline. Methods Fish consumption was assessed using a food-frequency questionnaire at baseline in 1993–1997 and stroke incide…
A Common Variant in the FTO Gene Is Associated with Body Mass Index and Predisposes to Childhood and Adult Obesity
Obesity is a serious international health problem that increases the risk of several common diseases. The genetic factors predisposing to obesity are poorly understood. A genome-wide search for type 2 diabetesâ susceptibility genes identified a common variant in the FTO (fat mass and obesity associated) gene that predisposes to diabetes through an effect on body mass index (BMI). An additive association of the variant with BMI was replicated in 1…
Self-Reported Mental Health-Related Quality of Life and Mortality in Men and Women in the European Prospective Investigation into Cancer (Epic-Norfolk): A Prospective Population Study
Objective: To explore the relationship between self-reported mental functional health and mortality. Methods: Participants included 17,777 men and women aged 40 to 79 years at baseline who lived in Norfolk, UK, and had no known cardiovascular disease or cancer, and completed the anglicized Short Form 36-item questionnaire (UK SF-36) during 1996 to 2000 in the European Prospective Investigation into Cancer-Norfolk prospective population study. We …
Fruit and vegetable consumption and self-reported functional health in men and women in the European Prospective Investigation into Cancer–Norfolk (Epic–Norfolk): A population-based cross-sectional st…
Objectives To investigate the association between fruit and vegetable consumption and self-reported physical and mental functional health measured by an anglicised short-form 36-item questionnaire (UK SF-36). Design Population-based cross-sectional study. Setting General community in Norfolk, UK. Subjects A total of 16 792 men and women aged 40–79 years recruited from general practice population registers as part of the European Prospective Inves…
Combined Impact of Health Behaviours and Mortality in Men and Women: The Epic-Norfolk Prospective Population Study
BACKGROUND: There is overwhelming evidence that behavioural factors influence health, but their combined impact on the general population is less well documented. We aimed to quantify the potential combined impact of four health behaviours on mortality in men and women living in the general community. METHODS AND FINDINGS: We examined the prospective relationship between lifestyle and mortality in a prospective population study of 20,244 men and …
Major Depression, C-Reactive Protein, and Incident Ischemic Heart Disease in Healthy Men and Women
Objective: To investigate how C-reactive protein (CRP) and major depressive disorder (MDD) relate to each other and to incident ischemic heart disease (IHD). Studies have shown that both depression and raised CRP concentration predict IHD and that elevated CRP is linked with increased risk of depression. Methods: A prospective case-control study of healthy men and women, aged 45 to 79 years, was undertaken within the United Kingdom European Prosp…
Social inequalities in self-rated health by age: Cross-sectional study of 22 457 middle-aged men and women
There was a strong gradient of decreased SRH with age in both men and women. We found a strong cross-sectional association between SRH and social class, which was independent of education and major health related behaviors. The social class differential in SRH was similar with age. Prospective studies to confirm this association should explore social and emotional as well as physical pathways to inequalities in self reported health
Physical activity and dietary behaviour in a population-based sample of British 10-year old children: The SPEEDY study (Sport, Physical activity and Eating behaviour: Environmental Determinants in You…
Results indicate that almost 70% of children meet national PA guidelines, indicating that a prevention of decline, rather than increasing physical activity levels, might be an appropriate intervention target. Promotion of daily fruit and vegetable intake in this age group is also warranted, possibly focussing on children from lower socioeconomic backgrounds
Socioeconomic position and risk of short-term weight gain: Prospective study of 14,619 middle-aged men and women
Individuals of low socioeconomic position are at greatest risk of gaining weight during middle age, which is not explained by classical correlates of socioeconomic position and risk factors for obesity
A translational framework for public health research
We propose a research agenda to advance the field and argue that resources for 'applied' or 'translational' public health research should be deployed across the framework, not reserved for 'dissemination' or 'implementation
The Addition-Cambridge trial protocol: A cluster – randomised controlled trial of screening for type 2 diabetes and intensive treatment for screen-detected patients
Current Controlled trials ISRCTN86769081
Self-rated health does not explain the socioeconomic differential in mortality: A prospective study in the Epic-Norfolk cohort: Table 1
BACKGROUND: Self-rated health (SRH), a subjective measure of health, is strongly predictive of mortality, independently of objective measures of health status and existing known disease. There is a strong social gradient in SRH. An investigation was carried to determine whether SRH can explain the well-known socioeconomic gradient in mortality. METHODS: The effect of adjusting for SRH on the socioeconomic differential in mortality was examined in…
Does the association between self-rated health and mortality vary by social class
Protocol for the Addition-Plus study: A randomised controlled trial of an individually-tailored behaviour change intervention among people with recently diagnosed type 2 diabetes under intensive UK ge…
The ADDITION-Plus trial will establish the medium-term effectiveness and cost-effectiveness of adding an externally facilitated intervention tailored to support change in multiple behaviours among intensively-treated individuals with recently diagnosed type 2 diabetes in primary care. Results will inform policy recommendations concerning the management of patients early in the course of diabetes. Findings will also improve understanding of the fa…
The association of education with body mass index and waist circumference in the Epic-Panacea study
In this European cohort, there is an inverse association between higher BMI as well as higher WC and lower education level. Public Health Programs that aim to reduce overweight and obesity should primarily focus on the lower educated population
CHD risk in relation to alcohol intake from categorical and open-ended dietary instruments
Objective To examine the risk of CHD in relation to alcohol intake from three different instruments. Design In the European Prospective Investigation into Cancer in Norfolk study, weekly alcohol intake was estimated from a single question in a mail-in health and lifestyle questionnaire (HLQ), a semi-quantitative FFQ, and a 7 d diet diary (7DD). Information on smoking status, physical activity, disease history, social class and medication use was …
O2-2.5 Lifestyle exposure measurement in cohort studies
Previous cohort studies have demonstrated associations between lifestyle factors and chronic disease outcomes. However, for many of these factors such as physical activity, the exposure measurement has been relatively imprecise. The development of newer questionnaires that assess different domains of activity (transportation, work, domestic life and recreation) and inactivity (specific sedentary activities) may allow the associations between diff…
Cardiorespiratory fitness and physical activity in Luo, Kamba, and Maasai of rural Kenya
BACKGROUND: Although habitual physical activity energy expenditure (PAEE) and cardio-respiratory fitness (CRF) are now well-established determinants of metabolic disease, there is scarcity of such data from Africa. The aim of this study was to describe objectively measured PAEE and CRF in different ethnic populations of rural Kenya. METHODS: A cross-sectional study was done among 1,099 rural Luo, Kamba, and Maasai of Kenya. Participants were 17-6…
Socioeconomic status, financial hardship and measured obesity in older adults: A cross-sectional study of the Epic-Norfolk cohort
Obesity in British over-50s was more likely in study participants who reported greater financial hardship, even after education, social class and home ownership were taken into account. Public health policies need to consider the hitherto neglected role of financial hardship in older people, especially difficulty paying bills, as part of strategies to prevent or reduce obesity
Medicine (50 works) · Environmental health (38 works) · Demography (33 works) · Population (30 works) · Gerontology (26 works) · Demography (22 works) · Internal Medicine (22 works) · Obesity, Physical Activity, Diet (20 works) · Prospective cohort study (18 works) · Public health (17 works)