Vasant Hirani

Cohort Profile: The Health Survey for England

To monitor the health of the public in England, UK, the Central Health Monitoring Unit within the UK Department of Health commissioned an annual health examination survey, which became known as the Health Survey for England (HSE). The first survey was completed in 1991. The HSE covers all of England and is a nationally representative sample of those residing at private residential addresses. Each survey year consists of a new sample of private residential addresses and people. The HSE collects detailed information on mental and physical health, health-related behaviour, and objective physical and biological measures in relation to demographic and socio-economic characteristics of people aged 16 years and over at private residential addresses. There are two parts to the HSE; an interviewer visit, to conduct an interview and measure height and weight, then a nurse visit, to carry out further measurements and take biological samples. Since 1994, survey participants aged 16 years and over have been asked for consent to follow-up through linkage to mortality and cancer registration data, and from 2003, to the Hospital Episode Statistics database, thus converting annual cross-sectional survey data into a longitudinal study. Annual survey data (1994-2009) are available through the UK Data Archive.

Moderate-to-vigorous physical activity and sedentary behaviours in relation to body mass index-defined and waist circumference-defined obesity

The aim of the present study was to investigate the relationships of physical activity types and sedentary behaviour with BMI and waist circumference (WC). The sample comprised 6215 adults (2775 men, 3440 women) aged 16 years and over living in Scotland. Self-reported physical activity of moderate to vigorous intensity (MVIA) included domestic activity, walking, and sports and exercises. MVIA levels were classified as being inactive, being insufficiently active, being sufficiently active for general health benefits and being sufficiently active for obesity prevention. Sedentary time was defined as television and other screen-based entertainment time (TVSE). Dependent variables were BMI-defined obesity (BMI-OB) and WC-defined obesity (WC-OB). TVSE was positively related to both WC-OB (adjusted OR 1.69 (95 % CI 1.39, 2.05) for > or = 4 h of TVSE per d compared with < 2 h/d) and BMI-OB (OR 1.88; 95 % CI 1.51, 2.35) independently of MVIA. Those classified as most active who reported > or = 4 h/d of TVSE had higher prevalence of BMI-OB (18.9 v. 8.3 %; P < 0.05) and WC-OB (28.0 v. 10.0 %; P < 0.01) than those equally active with < 2 h/d of TVSE. Sports and walking were related inversely to WC-OB (OR for no time compared with > or = 30 min/d: 1.55 (95 % CI 1.24, 1.94); 2.06 (95 % CI 1.64, 2.58)), but only walking was related to BMI-OB (OR 1.94; 95 % CI 1.58, 2.37). Domestic physical activity was not related to BMI-OB or WC-OB. In conclusion, physical activity and sedentary behaviour are independently related to obesity. Public health recommendations should both promote physical activity and discourage engagement in sedentary pursuits.

Relationship between vitamin D levels and depressive symptoms in older residents from a national survey population.

Objective: To investigate the association between vitamin D deficiency and depressive symptoms in a national community sample of older people. Vitamin D deficiency is common in older people with potential effects on mood. Methods: Data were analyzed from 2070 participants aged ≥65 years who had participated in the 2005 Health Survey for England. Serum 25-hydroxy vitamin D (25(OH)D) levels and depressive symptoms (Geriatric Depression Scale) had been measured. Covariates included age, sex, social class, season of examination, and physical health status. Results: Depressive symptoms were associated with clinical vitamin D deficiency (25(OH)D levels <10 ng/mL; present in 9.8%) independent of other covariates but not with broader deficiency states. This association was not modified by season of examination. Conclusion: Vitamin D deficiency is associated with late-life depression in northern latitudes. 25(OH)D = 25-hydroxy vitamin D; HSE = Health Survey for England; GDS10 = 10-item Geriatric Depression Scale; BMI = body mass index; OR = odds ratio; CI = confidence interval.

Dental Health and Cognitive Impairment in an English National Survey Population

OBJECTIVES: To investigate the association between dental health and cognitive impairment and to examine the extent to which dental status accounts for the association between cognitive impairment and low body mass index (BMI) in a national survey sample.

Urgent action needed to improve vitamin D status among older people in England

BACKGROUND the importance of vitamin D for bone health is well known, but emerging evidence also suggests that adequate vitamin D status may also be protective against non-communicable diseases. In the UK, government initiatives highlighting the importance of adequate vitamin D among older people have been in place since 1998. OBJECTIVES the aim of this analysis is to assess vitamin D status in people aged > or =65, living in private households in England, 2005 and make comparisons with the Health Survey for England (HSE) 2000 and the National Diet and Nutrition Survey (NDNS), 1994. We also examine associations of hypovitaminosis D [serum 25(OH)D <50 nmol/l] with demographic, geographic, lifestyle and health risk factors. DESIGN AND SETTING a nationally representative sample of older people living in England in 2005. PARTICIPANTS 2,070 adults aged > or =65, living in private households taking part in the HSE 2005. RESULTS in the HSE 2005, mean serum 25(OH)D levels were 53 and 49 nmol/l in men and women, respectively, these levels are significantly lower than currently recommended at > or =75 nmol/l. Prevalence of vitamin D deficiency [25(OH)D <25 nmol/l] in people aged > or =65 in 2005 was 13% in women and 8% in men. Nearly two thirds (57%) of women and half of men (49%) had serum 25(OH)D <50 nmol/l. Only 16% of men and 13% of women aged > or =65 years had serum 25(OH)D levels > or =75 nmol/l. There is no improvement in vitamin D status in 2005 compared to 2000 and a significant decline in vitamin D status among men in 2005 in comparison to the 1994/1995 NDNS results. The odds of hypovitaminosis D increased by age group from those aged 75-79 to aged > or =85. Season of taking a blood sample, obesity, dark skin pigmentation, not taking vitamin supplements, cigarette smoking, poor general health and longstanding illness were all significant predictors (P < 0.05) of serum 25(OH)D status in adjusted regression models. CONCLUSIONS poor vitamin D status of older people continues to be a public health problem in England. Hypovitaminosis D is associated with many risk factors and poor health outcomes. There is now an urgent need for a uniform policy on assessment and dietary supplementation of vitamin D in older people to prevent poor vitamin D status and its negative consequences.

Generalised and abdominal obesity and risk of diabetes, hypertension and hypertension-diabetes co-morbidity in England

OBJECTIVES To look at trends in generalised (body mass index (BMI) >or=30 kg m(-2)) and abdominal (waist circumference (WC) >102 cm in men, >88 cm in women) obesity among adults between 1993 and 2003, and to evaluate their association with diabetes, hypertension and hypertension-diabetes co-morbidity (HDC) in England. DESIGN Analyses of nationally representative cross-sectional population surveys, the Health Survey for England (HSE). SUBJECTS Non-institutionalised men and women aged >or=35 years. MEASUREMENTS Interviewer-administered questionnaire (sociodemographic information, risk factors, doctor-diagnosed diabetes), measurements of height and weight to calculate BMI. WC and blood pressure measurements were taken by trained nurses. RESULTS Generalised obesity increased among men from 15.8% in 1993 to 26.3% in 2003, and among women from 19.3% to 25.8%. Abdominal obesity also increased in both sexes (men: 26.2% in 1993 to 39.0% in 2003; women: 32.4% to 47.0%). In 1994, 1998 and 2003, generalised and abdominal obesity were independently associated with risk of hypertension, diabetes and HDC. The odds of diabetes associated with generalised obesity in 1994, 1998 and 2003 were 1.62, 2.26 and 2.62, respectively, in women and 1.24, 1.82 and 2.10, respectively, in men. Similar differences were observed for hypertension and HDC. Men and women with abdominal obesity also showed a higher risk for diabetes, hypertension and HDC than those with a normal WC. CONCLUSIONS If current trends in obesity continue then the risk of related morbidities may also increase. This will impact on cardiovascular disease morbidity and mortality, with cost implications for the health service. Therefore there is an urgent need to control the epidemic of obesity.

Sarcopenia Is Associated With Incident Disability, Institutionalization, and Mortality in Community-Dwelling Older Men: The Concord Health and Ageing in Men Project

INTRODUCTION Sarcopenia is associated with an increased risk of adverse outcomes. The aim of this study was to explore the relationship between severity of sarcopenia and incident activities of daily living (ADL) disability, institutionalization, and all-cause mortality among community-dwelling older men participating in the Concord Health and Ageing in Men Project (CHAMP). METHODS Longitudinal analysis of 1705 participants aged 70 years or older at baseline (2005-2007) living in the community in Sydney, Australia. MEASUREMENTS The main outcome measures were incident ADL disability, institutionalization, and mortality. Of the 1705 participants who completed the baseline assessments, a total of 1678 men (mean age 77 years) had complete measures by dual-energy x-ray absorptiometry, to assess sarcopenia in terms of low appendicular lean mass (ALM), using the Foundation for the National Institutes of Health (FNIH) criteria. To differentiate between severity of sarcopenia we used low ALM alone (sarcopenia I), low ALM with weakness (sarcopenia II), and sarcopenia with weakness and poor gait speed (sarcopenia III). Cox proportional hazard models and logistic regression models were used to assess the risk of mortality and institutionalization, and incidence of ADL disability. RESULTS From baseline to follow-up, 103 (11.3%) men had incident ADL disability, 191 (11.2%) men were institutionalized, and 535 (31.9%) had died. At baseline, 14.2% had sarcopenia I, 5.3% had sarcopenia II, and 3.7% had sarcopenia III. Fully adjusted analysis (adjusted for demographics, lifestyle factors, comorbidities and health conditions, and blood measures) showed that sarcopenia I, II, and III were associated with increased risk of disability, institutionalization, and mortality. Associations between sarcopenia I, II, and III and risk of incident disability were as follows: odds ratio (OR) 2.77 95% confidence interval (CI) 1.30-5.87, OR 3.78 95% CI 1.23-11.64, and OR 4.53 95% CI 0.90-22.72; associations with institutionalization were hazard ratio (HR) 1.96 95% CI 1.14-3.35, HR 2.53 95% CI 1.31-4.90, and HR 2.27 95% CI 1.08-4.80; and with mortality were HR 1.65 95% CI 1.30-2.09, HR 1.50 95% CI 1.08-2.08, and HR 1.69 95% CI 1.17-2.44. CONCLUSIONS This study shows that, in community-dwelling older men, sarcopenia defined by the FNIH criteria is associated with increased risk of incident disability, institutionalization, and mortality.

Predictors of 25-hydroxyvitamin D status among adults in two British national surveys.

Several recent reports have found a high prevalence of vitamin D deficiency in the adult British population. The present paper investigates the associations of low income/material deprivation and other predictors of serum 25-hydroxyvitamin D (25(OH)D) status in two surveys: The National Diet and Nutrition Survey (NDNS) of the population aged 19-64 years in mainland Britain and the Low Income Diet and Nutrition Survey (LIDNS) of adults aged > or = 19 years in all regions of the UK who were screened to identify low-income/materially deprived households. A valid serum 25(OH)D sample was obtained in 1297 and 792 participants from the NDNS and LDNS respectively. The NDNS participants who were not receiving benefits (n 1054) had a mean 25(OH)D of 50.1 nmol/l, which was higher than among NDNS participants receiving benefits (n 243) with a mean 25(OH)D of 43.0 nmol/l (P < 0.001) and the LIDNS sample (46.5 nmol/l; P < 0.05). For all three samples, the season of drawing blood, skin colour, dietary intake of vitamin D, and intake of dietary supplements were significant predictors (P < 0.05) of serum 25(OH)D status in mutually adjusted regression models. National prevention and treatments strategies of poor vitamin D status need to be targeted to include the adult population, particularly deprived populations, in addition to the elderly and ethnic minorities.

Relationship Between Depressive Symptoms, Anemia and Iron Status in Older Residents From a National Survey Population

Objective To investigate the association between iron deficiency status and depressive symptoms in a national community sample of older people. Methods Cross-sectional data were analyzed from 1875 participants 65 years and older who had participated in the 2005 Health Survey for England. Serum hemoglobin (Hb), ferritin, and transferrin receptor levels and depressive symptoms (Geriatric Depression Scale) had been measured. Covariates included age, sex, occupation, multivitamin intake, smoking status, body mass index, hypertension, heart disease, stroke, diabetes, and cancer. Results Depressive symptoms were associated with anemia (Hb <12.0 g/dL for women and <13.0 g/dL for men; present in 10.8%; odds ratio [OR] = 1.53 [95% confidence interval = 1.08–2.18]) after adjustment for age, sex, social class, multivitamin intake, smoking status, and body mass index, but this association was reduced substantially after further adjustment for physical health status (OR = 1.14). Low serum ferritin level (<45 ng/mL; present in 21.6%) was associated with depressive symptoms after full adjustment (OR = 1.37 [95% confidence interval = 1.03–1.81]). Linear models, however, revealed significant associations between higher number of depressive symptoms and lower Hb level and higher serum transferrin receptor level but not with ferritin levels. Conclusions Iron deficiency commonly co-occurs with depressive symptoms in older people, although the association with anemia is accounted for by physical health status and may primarily reflect anemia of chronic disease.

Associations Between Frailty and Serum 25-Hydroxyvitamin D and 1,25-Dihydroxyvitamin D Concentrations in Older Australian Men: The Concord Health and Ageing in Men Project

BACKGROUND Poor vitamin D status and frailty are common in older people and associated with adverse health outcomes. The aim of this study was to examine the associations between serum 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D levels and frailty and components of frailty in older Australian men. METHODS Cross-sectional analysis of the Concord Health and Ageing in Men Project, a large epidemiological study conducted in Sydney, Australia, between January 2005 and May 2007. Participants included 1,659 community-dwelling men. Main outcome measurements were frailty (assessed using the Cardiovascular Health Study), frailty criteria comprising five core components: weight loss; reduced muscular strength/weakness; slow walking speed; exhaustion; and low activity level, and the separate components of frailty. Covariates included serum 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D levels measured by radioimmunoassay, age, country of birth, season of blood collection, sun exposure, body mass index, vitamin D supplement use, income, measures of health, parathyroid hormone, estimated glomerular function. RESULTS Frailty was present in 9.2% of the sample. Low serum 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D levels were independently associated with frailty and with four of the five components of frailty (except weight loss). CONCLUSIONS 1,25-dihydroxyvitamin D and 25-hydroxyvitamin D levels were independently associated with frailty in older men. This suggests that there might be a number of different biological mechanisms for how low vitamin D status might contribute to the frailty syndrome. In addition, the possibility that improving vitamin D status may specifically influence the incidence and progression of frailty needs to be explored.