Insulin-like growth factors, insulin resistance and schizophrenia.
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Genomic Imprinting↗
Biomedical subjects
D Gunnell
Publications and source records attributed to D Gunnell.
Factors influencing the development and amelioration of suicidal thoughts in the general population. Cohort study.
BACKGROUND: The incidence of suicidal thoughts in the British population is unknown. AIMS: To determine the factors associated with the development of, and recovery from, suicidal thoughts. METHOD: An 18-month follow-up survey investigated 2404 of the adults who took part in the second National Psychiatric Morbidity Survey. RESULTS: The annual incidence of suicidal thoughts was 2.3%. Incidence was highest in women and among 16- to 24-year-olds. Increased incidence was associated with not being in a stable relationship, low levels of social support and being unemployed. Fifty-seven per cent of those with suicidal thoughts at baseline had recovered by the 18-month follow-up interview. CONCLUSIONS: Risk factors for suicidal thoughts are similar to those for completed suicide, although the age and gender patterning is different. Fewer than 1 in 200 people who experience suicidal thoughts go on to complete suicide. Further study into explanations for the differences in the epidemiology of suicidal thoughts and suicide is crucial to understanding the pathways (protective and precipitating) linking suicidal thoughts to completed suicide and should help inform effective prevention of suicide.
Adolescent↗
Do height-related variations in insulin-like growth factors underlie the associations of stature with adult chronic disease?
Tall people, particularly those with long legs, have an increased risk of developing cancer but a reduced risk of cardiovascular disease and type II diabetes. We examined associations of stature and body mass index with IGF-I, IGF-II, and IGF binding protein (IGFBP)-2 and IGFBP-3 in 274 men aged 50-70 yr to investigate whether variations in growth factor levels underlie associations of anthropometry with a number of adult diseases. Height and leg and trunk length were not strongly associated with circulating levels of IGF-I, IGF-II, or IGFBP-3. The molar ratio of IGF-I/IGFBP-3 increased with increases in the leg/trunk length ratio (P = 0.06). IGFBP-2 was positively associated with leg length and inversely associated with trunk length. Mean levels of IGFBP-2 (in nanograms per milliliter) across quartiles of increasing leg length were 504.4 493.6, 528.7, and 578.8 (P(trend) = 0.06), and for trunk length were 615.2, 507.2, 498.6, 488.5 (P(trend) < 0.01), suggesting that variations in IGFBP-2, or a factor influencing its levels in the circulation, may contribute to biological mechanisms underlying height-disease associations. We conclude that whereas growth-influencing exposures during childhood, which may operate through effects on IGF-I levels, have long-term influences on disease risk, they do not necessarily program IGF-I levels throughout life. The associations of anthropometry with IGFBP-2 merit additional investigation.
Aged↗
Associations of adult measures of childhood growth with breast cancer: findings from the British Women's Heart and Health Study.
Since the two components of adult height - leg length and trunk length - are poorly correlated with each other and appear to be influenced by different early life factors, examining their separate influence on breast cancer may provide additional insights into the mechanisms responsible for the positive association between adult height and breast cancer. In a cross-sectional study of 4286 women aged 60-79 years, in whom there were 170 cases of breast cancer, we found total height, leg length and trunk length were all modestly positively and linearly associated with breast cancer. The magnitudes of the associations of leg and trunk length were similar: fully adjusted odds ratio (95% confidence interval) of breast cancer for a one standard deviation (s.d.) increase in leg length 1.17 (0.98, 1.39) and for a 1 s.d. increase in trunk length 1.19 (0.99, 1.41). Self-reported birth weight (available on 33% of the sample) was positively and linearly associated with breast cancer: fully adjusted odds ratio of breast cancer for a 1 s.d. increase in birth weight 1.30 (0.93, 1.80). These associations were all independent of each other and other potential confounding factors and are likely to reflect different mechanisms by which factors operating prenatally and prepubertally influence breast cancer risk.
Aged↗
Are diet-prostate cancer associations mediated by the IGF axis? A cross-sectional analysis of diet, IGF-I and IGFBP-3 in healthy middle-aged men.
We examined the association of diet with insulin-like growth factors (IGF) in 344 disease-free men. Raised levels of IGF-I and/or its molar ratio with IGFBP-3 were associated with higher intakes of milk, dairy products, calcium, carbohydrate and polyunsaturated fat; lower levels with high vegetable consumption, particularly tomatoes. These patterns support the possibility that IGFs may mediate some diet-cancer associations.
Adult↗
Association between psychotic disorder and urban place of birth is not mediated by obstetric complications or childhood socio-economic position: a cohort study.
BACKGROUND: Although urban place of birth has been identified as a risk factor for schizophrenia, the extent to which this association is mediated by socially patterned risk factors such as obstetric complications and childhood socio-economic position is unclear. The diagnostic specificity of the association within the clinical psychotic syndromes is also unclear. METHOD: A population cohort of 696025 males and females, born in Sweden between 1973 and 1980 and with linked birth and socio-economic data was followed up from age 16 for up to 9.8 years. Hospitalized cases of schizophrenia and other non-affective psychosis were identified from the Swedish Inpatient Discharge Register. We examined associations of these disorders with a three-level measure of urbanicity of birthplace before and after controlling for measures of foetal nutrition, obstetric complications and level of maternal education. RESULTS: Urban compared to rural birthplace was associated both with increased risk of adult onset schizophrenia (hazard ratio 1.34, CI 0.91-1.96) and other non-affective psychoses (hazard ratio 1.63, CI 1.18-2.26). None of these associations was greatly affected by adjustment for obstetric complications or maternal educational level. In the group of other non-affective psychoses urban-rural differences in disease risk were strongest among those born in the winter months. CONCLUSION: Urbanization of birthplace is associated with increased risk of non-affective psychosis but this is not confined to narrowly defined cases. The magnitude of the association in Sweden is lower than that reported in other studies. Causal factors underlying this association appear to operate independently of risks associated with obstetric complications and parental educational status.
Adolescent↗
Trends in body mass index from 1948 to 1968: results from the Glasgow Alumni Cohort.
Most published studies suggest that the rising prevalence of overweight and obesity is a recent phenomenon. We have investigated whether secular trends in body mass index (BMI) existed in the 1950s and 1960s, using data collected from young adults attending Glasgow University. Mean BMI increased from 1948 to 1968 in men, and decreased slightly in women. The proportion of men who were overweight increased, whereas that of women changed little. These data must be interpreted in light of the fact that the study participants were relatively affluent, and not representative of the whole population in terms of socioeconomic position in childhood. The increases of BMI in men evident from 1948 to 1968 suggest that recent changes in exercise and dietary patterns do not fully explain changes in body weight over time.
Adolescent↗
Body mass index in early and mid-adulthood, and subsequent mortality: a historical cohort study.
BACKGROUND: The aim of this study was to investigate the associations between body mass index (BMI) in early and mid-adulthood, and BMI change between these ages, and mortality. METHODS: Historical cohort study of 629 men, who had height and weight measured at the Student Health Service of the University of Glasgow in 1948-1949 (median age 22 y) and who reported their weight in a postal questionnaire in 1963-1966 (median age 38 y). The participants were followed up until April 2002 (mean follow-up: 35 y). During this time, 124 men died, 68 of cardiovascular disease (CVD) and 33 of cancer. FINDINGS: Mean BMI increased from 21.4 kg/m(2) (standard deviation (s.d.): 2.2 kg/m(2)) in early adulthood to 24.2 kg/m(2) (s.d.: 3.0 kg/m(2)) in mid-adulthood. All-cause mortality was associated with being overweight (BMI> or =25 kg/m(2)) at age 22 but not at age 38, adjusted hazard ratio (HR): 1.85 (95% confidence interval (CI) 1.09-3.13) and 1.05 (95% CI: 0.73-1.52), respectively. BMI at age 22 y was more strongly associated with CVD mortality than was BMI at age 38 y, adjusted HR(22 y): 2.41 (95% CI: 1.26-4.60) and HR(38 y): 1.33 (95% CI: 0.82-2.16). There was no clear relationship between cancer mortality and BMI at either age: HR(22 y): 0.68 (95% CI: 0.16-2.91), HR(38 y): 0.90 (95% CI: 0.44-1.84), although relatively few men died of cancer in the follow-up period. Similar patterns were seen for obesity (BMI> or =30 kg/m(2)) as for being overweight. Analyses of weight patterns indicated particularly detrimental effects of overweight persisting from early to mid-adulthood. CONCLUSIONS: BMI in early adulthood is positively related to CVD mortality in later life in men. The risk associated with early adulthood adiposity appeared to be greater than that in mid-adulthood. We did not demonstrate an association between weight gain and later mortality. These results reinforce the need to stem the obesity epidemic in children and young adults.
Adult↗
An investigation of fetal, postnatal and childhood growth with insulin-like growth factor I and binding protein 3 in adulthood.
OBJECTIVE: Weight at birth and adult height are positively associated with cancer risk. These patterns may be mediated by the insulin-like growth factor (IGF) axis. We have examined whether pre- and postnatal growth patterns have a long-term influence on adult IGF-I and IGFBP-3 levels. DESIGN: A follow-up study of a randomized controlled trial of milk supplementation in pregnancy and childhood. SUBJECTS: A total of 951 individuals took part in a study of diet and growth in South Wales between 1972 and 1974 followed up from birth until their mid-20s. MEASUREMENTS: Anthopometric measures at birth, postnatally up to 5 years of age and in adulthood, and serum measures of IGF-I and IGF-I to IGFBP-3 ratio at mean age of 25 years. RESULTS: A total of 63 subjects (70%) provided blood for analysis. We found no association between birth dimensions and adult IGF-I. Subjects who exhibited 'catch-down growth' had lower IGF-I levels (P-value for trend 0.02). Adult height was positively related to IGF-I, for every one standard deviation increase in adult height, IGF-I increased by 3.75 ng/dl (95% CI 0.46-7.08, P = 0.03). Adiposity was inversely associated with the IGF-I and IGF-I to IGFBP-3 ratio and positively associated with IGFBP-3. The strength of the associations increased with age. Downward centile crossing at any time in childhood was associated with lower IGF-I whilst the highest levels were observed in subjects who were tall throughout their early life course. Adult height remained a significant predictor of IGF-I even after adjustment for earlier growth. CONCLUSIONS: Our results indicate that IGF-I levels in early adulthood are associated with patterns of childhood growth as well as adult stature and adiposity. These associations suggest the IGFs may contribute to anthropometric associations with cancer risk.
Adult↗
Temperament in young adulthood and later mortality: prospective observational study.
STUDY OBJECTIVE: To determine the association between a clinician assessment of temperament in early adulthood and cause specific mortality. DESIGN: Prospective observational study. SETTING: Glasgow University. PARTICIPANTS: 9239 male former students aged 16-30 (mean 20.5) years who participated in an ongoing health survey from 1948-68. A physician recorded free text assessment of temperament, which seemed to capture aspects of personality (trait) and mental health (state), was coded into: stable, anxious, schizoid, hypomanic, odd, depressed, immature, hypochondriacal, unstable, and obsessive. Associations between temperament and mortality were investigated using Cox proportional hazards models. MAIN RESULTS: There were 878 deaths. Most students-8342 (90.3%)-were assessed as stable, the remaining 897 (9.7%) having at least one, and 103 (1.1%) having more than one, temperament type. The second most common temperament was anxiety, recorded in 520 (5.6%) students. In multivariable analyses, having at least one temperament type was associated with increased all cause and stroke mortality, hazard ratios (95% confidence intervals): 1.23 (1.01 to 1.50) and 1.95 (1.06 to 3.59) respectively, compared with stable students. Students with more than one temperament type had higher risk of death from: all causes, 2.05 (1.36 to 3.09); stroke, 3.26 (1.01 to 10.56); and cancer, 2.90 (1.62 to 5.20). Anxiety was positively associated with all cause and cancer mortality, respective hazard ratios: 1.36 (1.07 to 1.72) and 1.51 (1.04 to 2.20). Men labelled hypomanic had increased cardiovascular mortality risk, 1.90 (1.05 to 3.44). CONCLUSIONS: Markers of early adult psychological distress are associated with increased mortality. Mechanisms underlying these associations require investigation.
Adolescent↗
Associations of height, leg length, and lung function with cardiovascular risk factors in the Midspan Family Study.
BACKGROUND: Taller people and those with better lung function are at reduced risk of coronary heart disease (CHD). Biological mechanisms for these associations are not well understood, but both measures may be markers for early life exposures. Some studies have shown that leg length, an indicator of pre-pubertal nutritional status, is the component of height most strongly associated with CHD risk. Other studies show that height-CHD associations are greatly attenuated when lung function is controlled for. This study examines (1) the association of height and the components of height (leg length and trunk length) with CHD risk factors and (2) the relative strength of the association of height and forced expiratory volume in one second (FEV(1)) with risk factors for CHD. SUBJECTS AND METHODS: Cross sectional analysis of data collected at detailed cardiovascular screening examinations of 1040 men and 1298 women aged 30-59 whose parents were screened in 1972-76. Subjects come from 1477 families and are members of the Midspan Family Study. SETTING: The towns of Renfrew and Paisley in the West of Scotland. RESULTS: Taller subjects and those with better lung function had more favourable cardiovascular risk factor profiles, associations were strongest in relation to FEV(1). Higher FEV(1) was associated with lower blood pressure, cholesterol, glucose, fibrinogen, white blood cell count, and body mass index. Similar, but generally weaker, associations were seen with height. These associations were not attenuated in models controlling for parental height. Longer leg length, but not trunk length, was associated with lower systolic and diastolic blood pressure. Longer leg length was also associated with more favourable levels of cholesterol and body mass index than trunk length. CONCLUSIONS: These findings provide indirect evidence that measures of lung development and pre-pubertal growth act as biomarkers for childhood exposures that may modify an individual's risk of developing CHD. Genetic influences do not seem to underlie height-CHD associations.
Adult↗
Fruit, vegetables, and antioxidants in childhood and risk of adult cancer: the Boyd Orr cohort.
STUDY OBJECTIVE: To examine associations between food and nutrient intake, measured in childhood, and adult cancer in a cohort with over 60 years follow up. DESIGN AND SETTING: The study is based on the Boyd Orr cohort. Intake of fruit and vegetables, energy, vitamins C and E, carotene, and retinol was assessed from seven day household food inventories carried out during a study of family diet and health in 16 rural and urban areas of England and Scotland in 1937-39. PARTICIPANTS: 4999 men and women, from largely working class backgrounds, who had been children in the households participating in the pre-war survey. Analyses are based on 3878 traced subjects with full data on diet and social circumstances. MAIN RESULTS: Over the follow up period there were 483 incident malignant neoplasms. Increased childhood fruit intake was associated with reduced risk of incident cancer. In fully adjusted logistic regression models, odds ratios (95% confidence intervals) with increasing quartiles of fruit consumption were 1.0 (reference), 0.66 (0.48 to 0.90), 0.70 (0.51 to 0.97), 0.62 (0.43 to 0.90); p value for linear trend=0.02. The association was weaker for cancer mortality. There was no clear pattern of association between the other dietary factors and total cancer risk. CONCLUSIONS: Childhood fruit consumption may have a long term protective effect on cancer risk in adults. Further prospective studies, with individual measures of diet are required to further elucidate these relations.
Adult↗
Background influences on dietary choice in early old age.
The contemporary increase in life expectancy is opening up a new stage in the Life course--early old age. Diet during early old age makes an important contribution to disease prevention, the management of established disease and postponing the onset of physical dependency. Despite its importance, few specifically medical, dietary interventions have been designed for this age group. The presently reported study aims to supply background information for such an endeavour. Qualitative interviews have been conducted with people in early old age, sampled purposively from members of a longitudinal study cohort. A number of background influences on the dietary choices of the interviewees have been identified. Some of these influences are specific to the present generation of people in early old age, such as eating in NAAFI canteens during National Service. However, the more general categories of which they are a part will have enduring usefulness. The findings are discussed in relation to: future dietary advice; the potential for interventions in primary care; enhancing the policy of free school fruit and research on the next age cohort to enter early old age.
Aged↗
Breast density: agreement of measures from film and digital image.
Mammographic density, in particular density from digital images, is increasingly used in breast cancer research. We investigated the concordance between density assigned by the same radiologist to a mammogram film and a digital image of the same mammogram. Two density measures were investigated, Wolfe parenchymal patterns and a six category classification (SCC) system of density. Included in the study were 78 women, 528 mammograms. Crude and weighted Kappa statistics were used to estimate agreement between the density assigned from the film and the image. Kappa for Wolfe measures was 71%, p<0.001 and for SCC measures was 54%, p<0.001. Weighted Kappa values were 79%, p<0.001 and 77%, p<0.001, respectively. There was some evidence to suggest that the digitized image may be assigned a higher Wolfe but not numerical category than the original film, and the magnitude of these differences was small. Neither age nor mammogram view (craniocaudal or mediolateral oblique) were related to the likelihood of agreement of the two density measurements. This evidence justifies the use of digital images in the visual assessment of breast density in research studies.
Breast Neoplasms↗
Gender differences in self-reported minor mental disorder and its association with suicide. A 20-year follow-up of the Renfrew and Paisley cohort.
BACKGROUND: Suicide rates are around three times higher in men than women; in contrast women have a higher prevalence of community-diagnosed depression. To investigate this paradox we examined the association of General Health Questionnaire (GHQ)-caseness (score > or = 4), a measure of possible minor mental disorder, with suicide risk in a general population cohort. METHODS: Data were derived from a cohort study based on the 8,466 men and women in the Renfrew and Paisley cohort who completed a 30-item GHQ in the period from 1972 to 1976 and who were followed up to 1995 for all-cause and suicide mortality. RESULTS: The long-term suicide risk associated with possible minor mental disorder was higher in men [hazard ratio 6.78 (1.36-33.71)] than women [hazard ratio 1.66 (0.43-6.45)]; test for interaction between gender and GHQ with respect to suicide risk: p = 0.09. CONCLUSION: These findings indicate either that the long-term risk of suicide in the context of a past episode of minor mental disorder is higher in males than females or that there are sex differences in the validity of responses to mental health screening questionnaires. Further research is required to replicate our finding in larger studies and, if confirmed, clarify which explanation underlies it.
Adolescent↗
Do patients who self-harm consult their general practitioner soon after hospital discharge? A cohort study.
BACKGROUND: Deliberate self-harm (DSH, attempted suicide) is one of the most common reasons for emergency hospital admission in Great Britain. Approximately 20 % of patients repeat self-harm in the 12 months after admission. The GP's role in DSH aftercare and the prevention of repeat episodes is unclear. METHODS: The data were obtained from a 12-month follow-up of a series of 968 consecutive patients from 49 practices who attended an accident and emergency (A&E) department in Bristol or Bath, UK, following an episode of self-harm between 26(th) May 1997 and 1(st) March 1999. RESULTS: Information on consultation patterns were available for 681 (70 %) of the patients. Two hundred and fourteen (31 %) of these consulted their GP in the week following the episode, 360 (53 %) within 4 weeks. Of the subjects, 44 % were discharged directly from A & E; these patients were more likely to consult their GP in the 4 weeks after the episode. Over the 12-month follow-up, 117 (17 %) attended hospital for a repeat episode of DSH; 9 % of these repeats occurred within 1 week and 28 % within 4 weeks of the index event. Although few (2 out of 11 patients--18 %) of those repeating in the first week after the index episode consulted their GP prior to repeating, 50 % (11/22) of those who repeated in the 1-4 weeks after an episode did so. CONCLUSIONS: Consultation patterns indicate that most people who deliberately self-harm consult their GP soon after the episode. This consultation may provide an opportunity for preventing repeat DSH and suicide.
Adolescent↗
Neurotic symptoms, stress, or deprivation: which is most closely associated with incidence of suicide? An ecological study of English Health Authorities.
BACKGROUND: Suicide rates, anxiety/depression scores and stress scores are routinely used as mental health indicators in populations, but their inter-relationships have not been explored. Our aim was to explore the association of suicide rates with anxiety/depression and stress scores, while also referring to deprivation scores, which are known to be linked to suicide rates. METHODS: We undertook an ecological analysis of English Health Authorities, regressing suicide rates (1993-1994), on General Health Questionnaire and stress scores (1994), and also on Jarman deprivation scores (1991). RESULTS: Overall, Jarman deprivation score was a better predictor of suicide rate than the psychological distress measures. There were no statistically significant associations between suicide rates and GHQ scores, although there was a weak association between suicide rate and mean stress level in women. CONCLUSIONS: Suicide rates, though important in themselves, are not reliable indicators of the levels of neurotic symptoms or stress in populations. Suicide rates are more strongly associated with area-based measures of social disadvantage, though a possible stress-suicide relationship in women could be investigated further.
Adolescent↗
Association between breast feeding and growth: the Boyd-Orr cohort study.
OBJECTIVE: To investigate the association of breast feeding with height and body mass index in childhood and adulthood. DESIGN: Historical cohort study, based on long term follow up of the Carnegie (Boyd-Orr) survey of diet and health in pre-war Britain (1937-1939). SETTING: Sixteen urban and rural districts in Britain. SUBJECTS: A total of 4999 children from 1352 families were surveyed in 1937-1939. Information on infant feeding and childhood anthropometry was available for 2995 subjects. MAIN OUTCOME MEASURES: Mean differences in childhood and adult anthropometry between breast and bottle fed subjects. RESULTS: Breast feeding was associated with the survey district, greater household income, and food expenditure, but not with number of children in the household, birth order, or social class. In childhood, breast fed subjects were significantly taller than bottle fed subjects after controlling for socioeconomic variables. The mean height difference among boys was 0.20 standard deviation (SD) (95% confidence interval (CI) 0.07 to 0.32), and among girls it was 0.14 SD (95% CI 0.02 to 0.27). Leg length, but not trunk length, was the component of height associated with breast feeding. In males, breast feeding was associated with greater adult height (difference: 0.34 SD, 95% CI 0.13 to 0.55); of the two components of height, leg length (0.26 SD, 95% CI 0.02 to 0.50) was more strongly related to breast feeding than trunk length (0.16 SD, 95% CI -0.04 to 0.35). Height and leg length differences were in the same direction but smaller among adult females. There was no association between breast feeding and body mass index in childhood or adulthood. CONCLUSIONS: Compared with bottle fed infants, infants breast fed in the 1920s and 1930s were taller in childhood and adulthood. As stature is associated with health and life expectancy, the possible long term impact of infant feeding on adult mortality patterns merits further investigation.
Adolescent↗