Exciting news! EPIC-Norfolk has recently been shortlisted by the Novo Nordisk Foundation to take part in their Inter-SUSTAIN call.

There is now an opportunity for researchers to submit proposed research projects to compete for funding as the second part of this call. If a research project is successful then both the researcher and the study database will receive funding, helping to not only support the research project but also support improving and maintaining the study database. More information can be found on the Novo Nordisk Foundation website.

If you are a researcher considering submitting a data request, we would encourage you to take a look at the Novo Nordisk Foundation website and consider submitting a project proposal before the closing date of 10^th February 2026.

A new study led by Dr Robert Luben at the University of Cambridge, utilizing data from European and Asian studies including EPIC-Norfolk and UK Biobank, has identified genetic risk factors for primary angle-closure glaucoma (PACG) in European populations, shedding new light on the genetic underpinnings of this condition across different ancestry groups.

In PACG the eye’s drainage angle becomes blocked, leading to increased pressure in the eye and damage to the optic nerve. It is a leading cause of blindness in older adults, and while most cases are reported in East Asian populations, an estimated 2.6 million people of European ancestry have PACG. Previous genome-wide association studies (GWAS) identified eight genetic loci associated with PACG risk in Asian populations. However, the extent to which these genetic risk factors apply to other populations has remained unclear.

In this new study, researchers conducted a discovery GWAS for PACG in European populations using data from the UK Biobank, identifying five genomic regions that were associated with PACG, including two loci previously identified in Asian populations. They successfully replicated their findings in six independent European populations and then compared these results with data from 14 Asian population cohorts.

The meta-analysis that statistically combined data from the combined European and Asian populationcohorts identified six additional novel loci, all previously associated with refractive error, a common eye condition where the eye cannot focus light properly on the retina, leading to blurred vision

Using Mendelian randomisation, the study provided strong evidence for a causal role of shorter axial length of the eye and hypermetropic (farsighted) refractive error in the development of PACG. Furthermore, a polygenic risk score derived from the European ancestry meta-analysis showed significant associations with quantitative ocular traits, such as a shallower anterior chamber and higher intraocular pressure, in the EPIC-Norfolk eye cohort.

In a subsequent multi-ancestry meta-analysis of 21 European and Asian cohorts, the researchers identified 12 additional novel loci. Most notably, the study showed that genetic factors associated with a darker iris eye axial length and hypermetropia confer risk for primary angle-closure glaucoma. Genetic factors associated with a darker iris were associated with PACG in European but not Asian populations, potentially reflecting the more homogeneous eye colour in Asian populations, and eye colour may be a surrogate for other genetic risk factors such as iris thickness.

This research not only advances our understanding of the genetic basis of PACG, opening up the possibility of targeted screening efforts for this blinding disease, but also highlights the importance of considering genetic diversity across populations in the study of complex diseases.

Reference

• Robert N. Luben et al. GWAS for primary angle-closure glaucoma identifies loci related to ocular biometry and morphology. Nature Communications (2025). DOI:10.1038/s41467-025-64949-z

The latest datasets from the EPIC-Norfolk Study – specifically AHEI, FFQ3, FFQ4, and the 2024 Endpoint datasets – are now available for release. The Food Frequency Questionnaire (FFQ) datasets of FFQ3 and FFQ4 provide energy, nutrient and food group intakes, available from data collected at Health Check 3 and 5, respectively. This builds on the already available datasets of FFQ1 (Health Check 1) and FFQ2 (Health Check 2). The 2024 Endpoint dataset provides endpoints derived from mortality and hospital admissions data through data linkage, with follow-up now up to March 2024.

The Alternative Healthy Eating Index (AHEI) is now available for the EPIC-Norfolk Study for FFQ1, FFQ2, FFQ3 and FFQ4. The AHEI measures the adherence to dietary guidelines. Calculations based on the updated AHEI presented in ‘Alternative Dietary Indices Both Strongly Predict Risk of Chronic Disease’ (https://doi.org/10.3945/jn.111.157222) and generated using Food Frequency Questionnaire (FFQ) data.

To access EPIC-Norfolk data, please fill in a data request form.

A diet high in whole grains, fruits and vegetables and low in animal products and sugary drinks is more sustainable and linked to a lower risk of type 2 diabetes than a diet that skimps on plant foods and is rich in items such as red meat.

Dr Solomon Sowah and colleagues at the MRC Epidemiology Unit scored the diets of 23,700 participants in the EPIC-Norfolk study to see how well they adhered to the planetary health diet, a plant-heavy regimen that was developed in 2019 to reduce the risk of conditions like type 2 diabetes, while also lowering emission of greenhouse gasses such as methane and CO2.

The scientists tracked how many study participants developed type 2 diabetes over the next 20 years, finding that nearly 3,500 participants developed the disease. Those in the top 20% of diet adherence had a 32% lower incidence of type 2 diabetes than those in the bottom 20%, and their greenhouse gas emissions were estimated to be 18% lower.

The authors conclude that promoting adherence to the planetary health diet in the general population should be considered as part of strategies aimed at the prevention of type 2 diabetes, and for simultaneously reducing the adverse environmental impact linked to food production. However, they acknowledge that their observational findings do not show that lack of adherence to the planetary healthdiet causes type 2 diabetes.

Reference

• Solomon A. Sowah, Fumiaki Imamura, Daniel B. Ibsen, Pablo Monsivais, Nicholas J. Wareham, Nita G. Forouhi. The association of the planetary health diet with type 2 diabetes incidence and greenhouse gas emissions: findings from the EPIC-Norfolk Prospective Cohort Study; PLOS Medicine. 16 October 2025; DOI: 10.1371/journal.pmed.1004633

Today ITV Anglia reported on new results from the EPIC-Norfolk study that examined the impact of changes in diet and physical activity over more than a decade on the risk of developing heart disease and type 2 diabetes.

ITV Anglia reporter Andy Ward spoke with study participants Helen Jackson and Paul Smith about what it’s like to be part of the EPIC-Norfolk study for 30 years, and what they feel they have contributed, gained and learned from their participation.

Dr Shayan Aryannezhad, who led this research while a PhD candidate at the MRC Epidemiology Unit, was also interviewed by ITV Anglia about the findings, which are published today in Scientific Reports.

The researchers from the MRC Epidemiology Unit analysed data from more than nine thousand EPIC-Norfolk participants whose physical activity energy expenditure and Mediterranean diet score were derived from repeated measurements between 1993 and 2004. They found that both those who started the study with healthy habits, and those who improved their physical activity and diet over time, had a lower risk of developing heart disease and type 2 diabetes over the 30 years of the study. Assuming a cause-and-effect relationship, they estimate that 16% of heart disease and stroke, and 22% of type 2 diabetes cases could have been prevented if everyone had maintained healthier levels of both activity and diet throughout the study.

Dr Aryannezhad comments:

We found that while physical activity and diet quality each help prevent major diseases, their combination offers significantly greater protection. Improving just one habit is beneficial, but it doesn’t fully compensate for the other being poor. The greatest impact came from focusing on both. Importantly, it’s never too late to start—our findings show meaningful benefits even when changes are made in late adulthood. That said, earlier and sustained healthy behaviours lead to the greatest gains.”

The EPIC-Norfolk study recruited 25,639 men and women aged 40-79 years at baseline between 1993 and 1998 from 35 participating general practices in Norfolk, and many of these continued to provide follow up data and attend up to four additional health checks over 30 years. EPIC-Norfolk participants continue to be followed through health records linkage, led by Professor Nick Wareham, Director of the MRC Epidemiology Unit.

Professor Nita Forouhi of the MRC Epidemiology Unit, an EPIC-Norfolk Co-Principal Investigator and senior author on the new paper, said:

Our findings demonstrate that improvements to diet and physical activity levels that are achievable for most people can make a meaningful difference to preventing heart disease, diabetes, and other long-term illnesses, even when started later in life. 

We wouldn’t have been able to demonstrate these important findings without the extraordinary dedication of thousands of EPIC-Norfolk study volunteers like Helen and Paul, who have given so much to the study over three decades. We are extremely grateful to them for their contribution to our research and to improving health, and we look forward to working with them for many years to come.”

Reference

• Aryannezhad, S, et al. Combined associations of physical activity, diet quality and their trajectories with incidence of diabetes and cardiovascular diseases in the EPIC-Norfolk Study. Scientific Reports; 16 April 2025; DOI: 10.1038/s41598-025-93679-x

Image

• Image credit: Still from ITV Anglia footage, reproduced with their consent. From left to right. EPIC-Norfolk volunteer Helen Jackson, Dr Shayan Aryannezhad, ITV Anglia reporter Andy Ward, EPIC-Norfolk volunteer Paul Smith.

In a video recorded for the MRC Max Perutz Prize, MRC Epidemiology Unit PhD student Dr Shayan Aryannezhad discussed his research using data from the EPIC-Norfolk study to understand how the combined associations of diet quality, physical activity, and their changes over time, are associated with cardiometabolic risk and mortality.

Read more about Shayan’s work in: Aryannezhad S et al. Combined associations of physical activity, diet quality and their changes over time with mortality: findings from the EPIC-Norfolk study, United Kingdom. BMC Medicine (2024)

Open Science is an increasingly important movement across many disciplines. It involves initiatives and resources that make scientific research – including data, publications and software – freely accessible not just to researchers but to society as a whole.

The MRC Epidemiology Unit is committed to Open Science as a means to make our research more accessible, equitable, transparent and reproducible, and to the development of standards and platforms to facilitate this.

The Omicscience webserver is one of the Unit’s Open Science initiatives. Omicscience is a publicly available web resource that was set up in 2020 by Professor Claudia Langenberg and Dr Maik Pietzner at the MRC Epidemiology Unit, along with Dr Gabi Kastenmüller at Helmholtz Munich. Omicscience promotes clinical translation through rapid open access to results and resources from large scale proteomics, genomics and metabolomics studies. These range from the genetic architecture of human proteins that interact with the COVID-19 virus, to human genome variants that are associated with changes in the levels of individual metabolites (substances made or used when the body breaks down food, chemicals, or its own tissue).

A recent Science paper that used data from an MRC Epidemiology Unit study provides a good example of how Open Science platforms can support innovative research in practice.

Can taurine slow aging?

Earlier this month an international team of scientists led by Dr Vijay Yada at Columbia University in New York published a paper in Science reporting that studies in mice and monkeys indicate supplementation of the diet with taurine – an amino acid used in many energy drinks – may slow the aging process. Their findings received international media coverage, including in the Guardian, Time Magazine, The New York Times, El Pais, NBC News, and Hindustan Times, and provoked a lot of discussion.

But do their findings in animals apply to humans? One important question the authors asked was if there was any evidence that circulating taurine levels in humans are associated with age-related health conditions.

Examining the link between taurine and aging in EPIC-Norfolk

To examine this question the authors of the Science paper needed to access data from a large study where not only circulating levels of taurine and its metabolites have been measured, but also clinical risk factors such as BMI, waist-hip-ratio, type 2 diabetes prevalence and measures of inflammation and liver function.

They were able to analyse this data in almost 12,000 participants from the EPIC-Norfolk Study, a large epidemiological study established almost thirty years ago and now run by the MRC Epidemiology Unit. The researchers found that higher levels of circulating taurine and taurine metabolites were associated with several important biological markers of aging in EPIC-Norfolk, results that were consistent with taurine deficiency contributing to aging in humans.

Omicscience is Open Science

It is often still the case that researchers who want to analyse data from large epidemiological studies or clinical trials have to apply to the organisations who manage those studies, specifying what data they wish to analyse and what analyses they will run. The application is then reviewed and if approved the data is made available, taking care to ensure that the privacy and personal data of study participants is protected. This process can be time consuming for all parties involved.

However, rather than having to seek permission to access EPIC-Norfolk data, the researchers in this study were able to download summary statistics from the Omicscience webserver. This allowed them to quickly analyse profiles of circulating metabolites, and the links between them and markers of aging, among the 11,966 participants.  They did not need to ask us if they could download this data: all we asked is that they cite the associated Nature Medicine paper by Maik Pietzner et al.

Open Science at the MRC Epidemiology Unit

Professor Nick Wareham, Director of the MRC Epidemiology Unit, comments:

We believe that by making our research findings available in this way we can accelerate scientific discovery and the development of innovative therapies.”

Omicscience is not the Unit’s only Open Science initiative. Others include the Measurement Toolkit, providing resources or measurement of dietary intake, physical activity and energy expenditure, and anthropometry and body composition; and the Propensity to Cycle Tool (PCT), which provides an evidence base to inform cycling investment. And more than 95% of Unit-led publications are open access.

You can find links to several of our Open Science resources here.

Researchers have developed a novel way to detect whether a person follows a Mediterranean diet using a blood test and used it to show that a Mediterranean diet is associated with lower risk of type 2 diabetes. Unit PhD student Jakub Sobiecki and colleagues present their findings today in the open access journal PLOS Medicine.

Why measure the Mediterranean diet objectively?

The Mediterranean diet is a dietary pattern typically characterised by high consumption of vegetables, legumes, fruit, nuts, grains, fish and seafood, virgin olive oil, and moderate intake of meat, dairy, and wine. Earlier research has shown that people who self-report that they follow a diet that is closely aligned with the principles of the Mediterranean diet have a modestly lower risk of type 2 diabetes.

However, the subjectivity of self-reports makes that link uncertain, as other dietary research indicates that most people struggle to remember precisely and correctly report what and how much they normally eat and drink. Until now, the potential link between a Mediterranean diet and type 2 diabetes risk has not been evaluated using objective biological indicators—biomarkers—of adherence to the diet.

To address this senior authors Professor Nita Forouhi and Professor Nick Wareham at the MRC Epidemiology Unit led a team from Europe and Australia that developed a novel biomarker-based indicator of a Mediterranean diet.

Objective measurement of the Mediterranean Diet on an EPIC scale

There is no single biomarker that can be used to measure adherence to dietary patterns such as the Mediterranean diet, instead multiple biomarkers – for example vitamins or fatty acids circulating in the blood – must be analysed.

Unit PhD student Jakub Sobiecki, who was first author on the paper, said:

Investigations of the links between diet and risk of diseases can often be enhanced by using objectively measured biomarkers to address the limitations of using dietary intakes self-reported by study participants. Some nutrients and foods have specific blood or urinary analytes which can be used for this purpose. However, it has been less clear how to apply biomarkers to study overall diets. 

Our research offers a novel approach to combine multiple biomarkers as a measure of following the Mediterranean diet. It enabled us to study the link between this dietary pattern and the risk of new-onset type 2 diabetes in a more robust manner than in prior research.”

The researchers first analysed blood samples from the Medley clinical trial of 128 people in Australia who had been assigned at random to follow either their usual diet or the Mediterranean diet for six months. They found that a composite score derived from the blood levels of 24 fatty acids and 5 carotenoids could be applied to predict whether participants were assigned to and following a Mediterranean diet.

Next, the biomarker score of adherence to the Mediterranean diet pattern was applied in the EPIC-InterAct study living in eight European countries, which includes EPIC-Norfolk study participants. They specifically looked at 9,453 participants who developed type 2 diabetes during follow-up and had relevant biomarkers measured. Comparing them with 12,749 participants who remained free of type 2 diabetes, the researchers found that people whose biomarker score indicated greater adherence to a Mediterranean diet were less likely to develop type 2 diabetes.

Have the benefits of the Mediterranean diet been underestimated?

For comparison, the researchers also asked participants to self-report their diet. They found that using the biomarker score identified a stronger link between the Mediterranean diet and reduced risk of type 2 diabetes than when self-report was used. This suggests that previous self-report-based studies may have under-estimated the association.

Based on these findings the researchers argue that even a modest improvement in people’s adherence to a Mediterranean diet could meaningfully reduce the incidence of type 2 diabetes. However, they also point out that additional research will be needed to confirm and extend these new findings since currently it is unknown to what extent the biomarker score is specific for the Mediterranean diet.

Professor Forouhi said:

Our research combining information from a dietary clinical trial and a large cohort study to identify and apply blood biomarkers for a dietary pattern is exciting and should stimulate development of improved methods to study diet-disease associations which are typically limited by reliance on subjective recall of eating.”

Read more

• Sobiecki, JG  et al. A nutritional biomarker score of the Mediterranean diet and incident type 2 diabetes: Integrated analysis of data from the MedLey randomised controlled trial and the EPIC-InterAct case-cohort study. PLOS Medicine; 27 April 2023; DOI:10.1371/journal.pmed.1004221

New research has identified hundreds of proteins that might contribute to the onset of common, chronic metabolic diseases such as type 2 diabetes, and consequently pathways to potential treatments.

The study, published in Nature Metabolism, was led by an international research team from the MRC Epidemiology Unit, the Precision Healthcare University Research Institute (PHURI) at Queen Mary University of London, and the Berlin Institute of Health at Charité (BIH) at Universitätsmedizin Berlin in Germany.

The risk of most human diseases increases or decreases with natural changes in the genome, but in many cases the mechanism through which this occurs is not known. Professor Claudia Langenberg, director of the Precision Healthcare University Research Institute (PHURI) at Queen Mary University of London and MRC Investigator and program lead at the MRC Epidemiology Unit at the time of the study, said:

Thousands of regions in our genome have been identified to increase our risk for developing different diseases, but for most of them we have a poor understanding of why this is. 

“By measuring and integrating information on thousands of proteins in human plasma, we were able to create robust links between the genes that encode these proteins to many different diseases and demystify about 200 regions. This really narrows down the potential therapeutic targets at each genomic region, often a bottleneck for translation of genomic discoveries.”

The in order to precisely determine the amounts of proteins in the blood the team analysed 1,180 blood samples from the EPIC-Norfolk study using a new protein measurement method combines a large number of antibodies. The EPIC-Norfolk study has been following a total of 30,000 subjects for over 25 years and collected information on diet, lifestyle and health, but also analysed the genomes of all participants.

They then combined this with genome sequencing technologies to successfully link more than 900 regions in the human genome to almost 3,000 proteins in our blood, including many not previously identified.  Using existing genetic studies on diseases, they found more than 500 connections between genes, proteins and diseases.

For example, the team showed for the first time that people with high levels of a hormone called GRP are less likely to develop type 2 diabetes, most likely because it decreases the chances of becoming overweight. This ‘proteogenomic’ evidence supports GRP as a potential target for the prevention and/or treatment of diabetes.

The study has led to a greater scientific understanding of hundreds of genome regions, which open the door to more targeted and ultimately successful treatment options in the future as proteins are essential functional units of the human body and the most common target of drugs that exist today.

Senior author Professor Maik Pietzner, Professor at the PHURI and visiting scientist at the MRC Epidemiology Unit, said:

In an additional promising example, we identified a protein, called DKKL1, to be involved in multiple sclerosis that reinforces the depletion of certain immune cells – B-cells – as intervention. 

“These early-stage results are exciting and show the potential of such technologies for drug discovery, not just for metabolic diseases.”

Mine Koprulu, lead author of the study, Gates scholar and PhD student at the MRC Epidemiology Unit, said:

The biological mechanisms underlying diseases are not always very well understood. To address this issue, we systematically linked genetic variation, blood protein levels and disease risks in this study to be able to differentiate proteins which are likely to cause a disease, for example diabetes, from those which may only be a result of diseases. Identifying causal proteins is important because only interventions on causal proteins will lead to safe and effective treatments. We are hugely grateful to the EPIC Norfolk volunteers and team who made this research possible.”

The scientists are pleased with these early results and see their hope of discovering new target molecules for drugs or preventive measures through the gene-protein-disease connection as confirmed. “Because the lack of effect of drugs in studies on humans is still the biggest factor that causes new therapies to fail” explains Maik Pietzner.

Read more

• Koprulu, M et al. Proteogenomic links to human metabolic diseases. Nature Metabolism; 23 February 2023; DOI:10.1038/s42255-023-00753-7

An international collaboration led by scientists from the University of Cambridge and Berlin Institute of Health at Charité (BIH) has discovered more than 300 regions in the genome that contribute to each person’s individual chemical fingerprint. Their results, published today in Nature Medicine, show how variations between individuals at these regions affect how our body reacts to external influences, which diseases we are susceptible to and how severe an illness will be.

Our body continuously processes thousands of small molecules such as fats, proteins and sugars as part of our normal metabolism, and the levels of these metabolites vary from person to person.  Small changes in this individual chemical fingerprint can cause or reflect illness, and potentially provide useful information about a person’s health. The scientists discovered both rare and common changes in the genetic code that influence this personal chemical fingerprint and an individual’s disease profile. ”

Professor Claudia Langenberg, Professor at the Berlin Institute of Health, and was an MRC investigator and programme leader at the MRC Epidemiology Unit when this work was done commented:

With our study, we are finally illuminating the genetic control of our metabolism based on many hundreds of small metabolites, which has never been shown in such detail. This means we now better understand how and why genetic differences contribute to the development of diseases.”

The scientists measured the amount of more than 900 small molecules in blood samples from over 14,000 participants in two large UK population studies – the INTERVAL study and the EPIC-Norfolk study – whose genetic code had also been analysed. They identified 330 regions in the genome that are linked to the levels of 646 different metabolites, with most regions linked to several metabolites, and vice versa.

Professor Langenberg said.

These metabolic ‘hotspots’ in the genome have helped us to better understand which genes are relevant to the changing amounts of molecules in the blood, with these new findings, we were then able to show which changes in metabolism contribute to the development of individual diseases, such as breast cancer”

Among the examples of the influence of metabolites on disease that they identified was an association between an increased levels of the modified amino-acid homoarginine and an increased risk of chronic renal failure. Homoarginine is currently in clinical trials for the prevention of cardiovascular disease, so special attention should therefore be paid to monitoring and maintaining kidney function in trial participants.

In addition to a role in healthy metabolism or disease, the scientists identified variations in the metabolic ‘hotspots’ in the genome that affect how effective drugs are, and the severity of their harmful effects. For example, the scientists found that about one fifth of the study participants had variations in the genetic code close to the DPYD gene. DPYD encodes for an enzyme that is responsible for breaking down certain common cancer chemotherapy drugs, and people these genetic variants are at an increased risk of accumulating elevated levels of these drugs and consequently more severe effects.

Professor Langenberg commented.

Variations near genes that are also the target of drugs can give us clues about possible unwanted side effects. For example, we were able to show that drugs that reduce the conversion of steroid hormones in the body and thus counteract male hair loss and prostate enlargement may increase the risk of depression, which is consistent with reports from drug studies”

The paper is the result of many years of cooperation between scientists at the University of Cambridge and BIH, as well as colleagues from all over the world including the Helmholtz Centre in Munich, Weill Cornell Medicine – Qatar, Pfizer, and Health Data Research UK. The team has made the summary statistics from their work publicly available to the scientific community through the interactive webserver omicscience.org, and the metabolite raw relative abundances for this paper are available in the MetaboLights database.

Information about an individual’s chemical fingerprint and the genomic variations that underpin it could help clinicians to more effectively tailor treatments to individual patients, and Professor Langenberg is already leading a new initiative to support this, saying:

We need larger studies that better map the genetic diversity of different populations to understand the biological and clinical effect of genetic variations that differ between certain populations.”

Read more

• Praveen Surendran, Isobel D. Stewart, Victoria P. W. Au Yeung, Maik Pietzner et al. Rare and common genetic determinants of metabolic individuality and their effects on human health. Nature Medicine 10 November 2022. DOI: 10.1038/s41591-022-02046-0