Adherence to the Eatwell Guide and population and planetary health: A Rank Prize Forum report.

This report summarises a Forum conducted in June 2023 to explore the current state of the knowledge around the Eatwell Guide, which is the UK government's healthy eating tool, in relation to population and planetary health. The 1.5-day Forum highlighted the limited, albeit promising evidence linking higher adherence to the Eatwell Guide with favourable health outcomes, including reduced overall mortality risk, lower abdominal obesity in post-menopausal women and improved cardiometabolic health markers. Similarly, evidence was presented to suggest that higher adherence to the Eatwell Guide is associated with reduced greenhouse gas emissions. Presentations were given around cultural adaptations of the Eatwell Guide, including African Heritage and South Asian versions, which are designed to increase the acceptability and uptake of the Eatwell Guide in these communities in the United Kingdom. Presentations highlighted ongoing work relevant to the applications of the Eatwell Guide in randomised controlled trials and public health settings, including the development of a screening tool to quantify Eatwell Guide adherence. The Forum ended with a World Café-style event, in which the strengths and limitations of the Eatwell Guide were discussed, and directions for future research were identified. This Forum report serves as a primer on the current state of the knowledge on the Eatwell Guide and population and planetary health and will be of interest to researchers, healthcare professionals and public health officials.

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.

OBJECTIVE: 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. STUDY DESIGN: Post-hoc analysis of post-menopausal women from the UK Women's Cohort Study. MAIN OUTCOME MEASURES: Changes in weight, waist circumference and the risk of abdominal and general obesity. RESULTS: 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 4 years (EWG: ß -0.47, CI -0.75, -0.20 per 1 tertile increase in score), (Mediterranean Diet: ß -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: ß 0.14, CI -0.07, 0.36 per 1 tertile increase in score), (Mediterranean Diet: ß 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). CONCLUSIONS: The results suggest that adherence to either the Mediterranean Diet or the EWG can help to prevent abdominal obesity in post-menopausal women.

Multi-laboratory Validation of a New Marine Biodegradation Screening Test for Chemical Persistence Assessment.

Current biodegradation screening tests are not specifically designed for persistence assessment of chemicals, often show high inter- and intra-test variability, and often give false negative biodegradation results. Based on previous studies and recommendations, an international ring test involving 13 laboratories validated a new test method for marine biodegradation with a focus on improving the reliability of screening to determine the environmental degradation potential of chemicals. The new method incorporated increased bacterial cell concentrations to better represent the microbial diversity; a chemical is likely to be exposed in the sampled environments and ran beyond 60 days, which is the half-life threshold for chemical persistence in the marine environment. The new test provided a more reliable and less variable characterization of the biodegradation behavior of five reference chemicals (sodium benzoate, triethanolamine, 4-nitrophenol, anionic polyacrylamide, and pentachlorophenol), with respect to REACH and OSPAR persistence thresholds, than the current OECD 306 test. The proposed new method provides a cost-effective screening test for non-persistence that could streamline chemical regulation and reduce the cost and animal welfare implications of further higher tier testing.

Nasal carriage of Staphylococcus aureus in healthy Aucklanders.

BACKGROUND: Studies have reported higher rates of diseases caused by Staphylococcus aureus (S. aureus) amongst Maori and Pacific people, compared with people of other ethnicities. AIM: We aimed to estimate the prevalence of nasal carriage and to explore demographic differences between S. aureus carriers and non-carriers in Auckland, New Zealand. MATERIALS AND METHODS: Nasal swab specimens were obtained from healthy population volunteers, who did not have recent healthcare contact. Each participant completed a short questionnaire. RESULTS: 78/424 (18%; 95%CI, 15-22) S. aureus carriers were identified. Female participants were less likely to be S. aureus carriers than males; but there were no differences in the ages or ethnic groups between S. aureus carriers and non-carriers. Socioeconomic deprivation, recent non-hospital healthcare contact and past history of S. aureus infection were not associated with S. aureus carriage. CONCLUSION: Ethnic variation in the prevalence of S. aureus nasal carriage does not contribute to an increased risk of disease caused by S. aureus.

Outdoor NOx and stroke mortality: adjusting for small area level smoking prevalence using a Bayesian approach.

There is increasing evidence, mainly from daily time series studies, linking air pollution and stroke. Small area level geographical correlation studies offer another means of examining the air pollution-stroke association. Populations within small areas may be more homogeneous than those within larger areal units, and census-based socioeconomic information may be available to adjust for confounding effects. Data on smoking from health surveys may be incorporated in spatial analyses to adjust for potential confounding effects but may be sparse at the small area level. Smoothing, using data from neighbouring areas, may be used to increase the precision of smoking prevalence estimates for small areas. We examined the effect of modelled outdoor NOx levels on stroke mortality using a Bayesian hierarchical spatial model to incorporate random effects, in order to allow for unmeasured confounders and to acknowledge sampling error in the estimation of smoking prevalence. We observed an association between NOx and stroke mortality after taking into account random effects at the small area level. We found no association between smoking prevalence and stroke mortality at the small area level after modelling took into account imprecision in estimating smoking prevalence. The approach we used to incorporate smoking as a covariate in a single large model is conceptually sound, though it made little difference to the substantive results.

Bayesian approaches to multiple sources of evidence and uncertainty in complex cost-effectiveness modelling.

Increasingly complex models are being used to evaluate the cost-effectiveness of medical interventions. We describe the multiple sources of uncertainty that are relevant to such models, and their relation to either probabilistic or deterministic sensitivity analysis. A Bayesian approach appears natural in this context. We explore how sensitivity analysis to patient heterogeneity and parameter uncertainty can be simultaneously investigated, and illustrate the necessary computation when expected costs and benefits can be calculated in closed form, such as in discrete-time discrete-state Markov models. Information about parameters can either be expressed as a prior distribution, or derived as a posterior distribution given a generalized synthesis of available data in which multiple sources of evidence can be differentially weighted according to their assumed quality. The resulting joint posterior distributions on costs and benefits can then provide inferences on incremental cost-effectiveness, best presented as posterior distributions over net-benefit and cost-effectiveness acceptability curves. These ideas are illustrated with a detailed running example concerning the cost-effectiveness of hip prostheses in different age-sex subgroups. All computations are carried out using freely available software for conducting Markov chain Monte Carlo analysis.

The relationship between water concentrations and individual uptake of chloroform: a simulation study.

We simulated the relationship between water chloroform concentrations and chloroform uptake in pregnant women to assess the potential extent of exposure measurement error in epidemiologic studies of the health effects of exposure to water disinfection by-products. Data from the literature were used to assign statistical distributions to swimming pool chloroform concentrations, frequency and duration of swimming, showering and bathing, and average tap water consumption. Measured increases in blood chloroform concentrations after these activities were used to estimate average uptake per microgram per liter chloroform in the water, per minute spent in the activity or per liter consumed. Given average tap water chloroform concentrations from a U.K. epidemiologic study, an average daily uptake over 90 days was simulated for 300,000 mothers. The correlation between simulated uptakes and home tap chloroform concentration was 0.6. Mothers who swam regularly received far greater doses than did nonswimmers. Results suggest there will be considerable attenuation in risk estimates and/or power loss in epidemiologic studies if the putative agent is chloroform.

Description of trihalomethane levels in three UK water suppliers.

Samples of drinking water are routinely analysed for four trihalomethanes (THMs), which are indicators of by-products of disinfection with chlorine, by UK water suppliers to demonstrate compliance with regulations. The THM data for 1992-1993 to 1997-1998 for three water suppliers in the north and midlands of England were made available for a UK epidemiological study of the association between disinfection by-products and adverse birth outcomes. This paper describes the THM levels in these three supply regions and discusses possible sources of variation. THM levels varied between different suppliers' water, and average THM levels were within the regulatory limits. Chloroform was the predominant THM in all water types apart from the ground water of one supplier. The supplier that distributed more ground and lowland surface water had higher dibromochloromethane (DBCM) and bromoform levels and lower chloroform levels than the other two suppliers. In the water of two suppliers, seasonal fluctuations in bromodichloromethane (BDCM) and DBCM levels were found with levels peaking in the summer and autumn. In the other water supplier, chloroform levels followed a similar seasonal trend whereas BDCM and DBCM levels did not. For all three water suppliers, chloroform levels declined throughout 1995 when there was a drought period. There was a moderate positive correlation between the THMs most similar in their structure (chloroform and BDCM, BDCM and DBCM, and DBCM and bromoform) and a slight negative correlation between chloroform and bromoform levels.

A population-based case-control study for examining early life influences on geographical variation in adult mortality in England and Wales using stomach cancer and stroke as examples.

BACKGROUND: Geographical variation in mortality is influenced by factors operating in early life and in adulthood. The relative contributions of these factors may be examined by comparing the extent to which adult mortality is related to places of residence in early life and at death. We describe a population-based case-control design, in which all deaths are used as cases and the Office for National Statistics (ONS) Longitudinal Study (LS) survivors are used as controls. METHODS: Cases were all deaths from stomach cancer and stroke in England and Wales 1993-1995 amongst people born between January 1930 and September 1939 and for whom place of enumeration in 1939 could be imputed from the first three characters of their National Health Service number. Controls were all LS members born in the same period, enumerated in the 1991 census, resident in England and Wales in mid-1994 and for whom place of enumeration in 1939 could be similarly imputed. Logistic regression was used, adjusting for birth year, sex and social class. A previous mapping exercise by ONS generated comparable geographical units (counties) for 1939 enumeration and area of residence in 1991 or at death. 'Non-migrant' (i.e. 1939 'county' the same as county in 1991 or at death) case:control ratios were calculated to indicate background mortality risk in counties, with adjustment for imprecision using Bayesian smoothing methods. These ratios were then used in modelling risk for inter-county migrants. RESULTS: There were 2590 stomach cancer and 7778 stroke deaths and 28,400 men and 28,180 women as controls. For men, 64%, 61% and 67% of stomach cancer deaths, stroke deaths and controls respectively could be assigned a county of enumeration in 1939. The corresponding percentages for women were 76%, 72% and 75%. For stomach cancer, after adjustment for county of enumeration in 1939, a significant association with the non-migrant case:control ratio for county of residence in 1991 or at death was observed (P= 0.010), indicating an association between current area of residence and stomach cancer mortality. There was no evidence of an independent effect of county of enumeration in 1939. For stroke, there was a highly significant trend in relation to 1939 county (P = 0.0004)and a less significant association with county of residence in 1991 or at death(P = 0.016). CONCLUSIONS: The method described is able to detect the effect of place of residence in early life on geographical variation in adult mortality and will be useful for investigating specific characteristics of areas of enumeration in 1939 in relation to subsequent risk of mortality from a range of diseases.

A Bayesian approach to estimate the prevalence of low height-for-age from the prevalence of low weight-for-age

Victora et al. (1998) propuseram o uso de estimativas de prevalência de baixo peso para idade para a estimaçäo de déficit de altura para idade em crianças brasieiras, em virtude da necessidade de simplificar métodos usados em programas de saúde comunitária. Tenta aprofundar o referido estudo ao propor uma aordagem Bayesiana com base no método de Simulaçäo Estocástica via Cadeia de Markov (SEvCM), para lidar com questöes de imprecisäo ligadas à modelagem de estimaçäo do déficit de estatura. Para evitar valores inválidos de prevalência estimados pelo modelo linear sugerido originalmente, propöem-se duas alternativas: um truncamento dos valores que extrapolem os limites plausíveis de prevalência ou uma transformaçäo logito das prevalências. A abordagem Bayesiana é ilustrada com um exemplo de um estudo comunitário. Imprecisöes oriundas da complexidade do desenho desse estudo também säo contornadas com a abordagem Bayesiana, ao se introduzir uma estrutura hierárquica ou multinível. Já que o déficit de crescimento foi efetivamente observado no exemplo, também serve como instância de validaçäo para o procedimento proposto por Victora et al.