EPIC-Norfolk: The Third Health Check

Questionnaires

Participation in the Third Health Check will begin with a letter of invitation sent through the post. Participants will be contacted systematically as we approach each GP practice, one at a time. All participants will be sent a Health Questionnaire in the original invitation, to be filled out and returned before an appointment is scheduled. Some participants may choose only to fill out this questionnaire and to opt out of the health check at this time. A Food Frequency Questionnaire (FFQ) will be sent at the time of arranging the appointment, to be returned to the nurse at the health check. Finally, a seven-day food diary will be given to the participant by the nurse at the health check to be filled out and returned at their convenience. Filling out questionnaires is entirely anonymous and voluntary.

Eye Examination

Photographs of eyes will be taken using various digital imaging devices. The procedure will not involve dilation of the pupils, which means that there will be no after effects on the vision and participants will be able to drive to and from the clinic. In addidtion, visual acuity will be assessed and intraocular pressure will be measured using a non-contact Tonometer. These two examinations are carried out by all high street opticians as a part of a routine eye examination. All of these tests are currently regarded as an essential to detecting loss of vision or the presence of important, treatable eye diseases. For more information see Eye Examinations.

Cognitive Measures

Age associated decline in memory, name finding, complex decision-making and speed of information processing is common in middle-age and later life. These can have severe effects on decision making at this stage of life as well as cause problems that may lead to social withdrawal and depression. Other aspects of memory and executive function such as organisation, mental flexibility, numerical skills and quantitative reasoning also appear to show decline. As part of this study, specific cognitive measurements will be assessed using a number of validated cognitive tests.

Clinical Assessments:

Bloods

A maximum amount of 40ml of blood will be taken. Investigation will include a full blood count, measurement of glycated haemoglobin, lipid profile, C-Reactive protein using high sensitivity assay and vitamin C. A sample will also be stored for DNA extraction. Participants can contact EPIC to obtain their cholesterol results once they have been processed.

Physical Measures

The physical performance test constitutes of a combination of walking speed, chair stands, leg raises and balance tests to test general physical functioning.

Muscle Strength

Muscle strength will be measured by a hand-held dynamometer. Grip strength has been found to correlate with strength of other muscle groups and is a good indicator of overall strength. Poor muscle strength has been shown to be a very good long-term predictor of functional limitations and disability in old age.

Photographing Hands

The aim of this test is to analyse the hands. This includes observing the outward appearance of the skin as an indicator of ageing and measuring finger length as this is related to hormone exposure in the womb, which has been shown to be related to certain diseases. These photos will also be used to look for arthritis, which is indicated by thickening around joints.

Anthropometric measurements

Height and weight measurements are used to calculate body mass index (BMI) (Weight (Kg) /height (m)2 ). BMI is strongly related to morbidity and mortality. Anthropometric measurements are taken on individuals without their shoes and wearing light clothing.

Impedance or Body Fat

Measuring Impedance uses the BIA (Bioelectrical Impedance Analysis) technique to measure body fat by sending a low (safe) electrical signal through the body. This signal passes freely through the fluids contained in muscle tissue, but encounters resistance when passing through fatty tissue. This resistance is termed 'bioelectrical impedance'. When set against a person's height and weight, the body fat percentage can be calculated. The BIA technique will not be used if the participant is fitted with a pacemaker.

Waist-to-Hip Ratio

Where fat is distributed on the body can be a good indicator of overweight/obesity. A lot of fat deposited in the abdominal area can put someone at increased risk of obesity related diseases. The waist to hip ratio is determined by measuring the waist at the narrowest part - just above the navel and dividing that figure by the measurement of the hips at the widest possible part. Measurements will be carried out using the D loop tape measure.

Spirometric and Peak Flow Measurements

Spirometry provides an objective measurement of lung function. It will measure how well the lungs breathe out (exhale). The information collected during this test is useful in diagnosing certain types of lung diseases, but is most useful when assessing for obstructive lung diseases (especially asthma and chronic obstructive pulmonary disease, COPD). Participants will be asked to inhale deeply and then blow into the spirometer and exhale breath until lungs have completely emptied.

Blood Pressure Measurements

Two blood pressure measurements will be taken. The first will be in the arm (brachial) using an automatic sphygmomanometer (taken twice during the appointment, once at the beginning and a further measurement at the end). The next measurement will be taken in the ankle to ascertain the ankle-brachial systolic blood pressure index (ABI).

The Ankle-Brachial Systolic Blood Pressure Index

The Ankle-brachial systolic blood pressure index (ABI) is defined as the ratio of the average systolic blood pressure in the arm (brachial) divided by the average systolic blood pressure at the ankle. ABI correlates well with degree of stenosis in lower extremity arteries and is a very useful surrogate for more proximal atheroma and cardiovascular outcomes in the general population. A low ABI (<0.9) is an independent predictor of both all-cause and cardiovascular mortality. Patients with lower extremity arterial disease (asymptomatic and symptomatic) have significantly increased risks of stroke, myocardial infarction, and cardiovascular death.

Heel Ultrasound Measurements

Measurements of heel bone density will be taken using an ultrasound scanner. This test is used to assess for bone density and possible risk of fracture or osteoporosis. Measures will not taken from participants who have pins in their heels or if there is any swelling or pain in the legs or feet.

Results

Participants may be given the results of some of the measurements or observations of the Health Check if they so request. These include, blood pressure, anthropometric measurements (such as weight, height, impedance and waist and hip measurements), muscle grip strength and respiratory function. It is not possible to provide any feedback on the physical performance battery or the cognition tests, as these are still research tools and not diagnostic tests. The following measures will be reported to the participant's GP if they are found to be abnormal

• Blood pressure

• Total cholesterol

• Total HBA1C

• Haematology

• Heel bone ultrasound

• Eyes

Eye data will be examined by our collaborating ophthalmologist Dr Paul Foster who will recommend to you referrals to the Eye Clinic at the Norfolk and Norwich University Hospital. Participants with an intraocular pressure of greater than 39 mm Hg will be referred to the eye clinic on the same day of their health check by the EPIC nurses.

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