Overview

The institute was officially launched in 2021 as a multi-agency, multi-disciplinary research unit.

The Norwich Institute of Healthy Ageing (NIHA) develops and implements effective strategies to promote sustained population behaviour change, in order to improve physical and mental well-being.

Over 50% of our health status is determined by our lifestyle behaviours.

A core interest in NIHA is establishing the impact of nutrition, physical activity, sleep and smoking status on health outcomes, and how to deliver effective behaviour change interventions.

Our research contributes to the UK Healthy Ageing Grand Challenge to increase healthy life expectancy by 5 years by 2035, while narrowing the gap between the experience of the richest and poorest.

Key Themes

Theme 1 – Behaviour Inequalities and Health:

Currently, people in deprived communities live almost 20 years more in poor health compared to the wealthiest communities. In this theme we aim to address the inequalities in health behaviours that cause this chasm. We work with communities to support individuals to make positive behaviour changes by focusing on people’s priorities and unique challenges. Our current focus is on supporting multiple behaviour change and mental health, whole-diet interventions, and work with local foodbanks and social supermarkets. Co-production increases the chances that our research reaches people who can benefit the most, and influences practice and policy.

Theme 2 – Plant Foods and Health

In this theme we aim to deliver projects that will enable people to benefit from increasing their consumption of plant foods in their diet, which has a huge impact in maintaining good health. We work across the partners of the Norwich Institute of Healthy Ageing and with local communities to understand how the barriers to increasing plant food in the diet can be removed and why eating plant foods provides health benefits. Our aims align with the National Food Strategy which are to reduce inequality in diets and to increase fruit and vegetable consumption in low income communities.

Theme 3 – Cardiometabolic Health and Brain Ageing

In this theme we explore the link between a healthy heart and weight with having a healthier brain. We focus on how we can improve our heart health and weight in middle age to improve our brain health later in life. For our studies we use existing medication or lifestyle changes to improve heart health and weight in middle age.

Key Projects

MedEx UK Project (Theme 1 and 3):

Mediterranean Diet, Exercise and Dementia Risk Reduction Programme (MedEx-UK)

The main aim of the MedEx-UK study was to test if it was possible to run an intervention designed to change eating and activity behaviours over a short period of time (24 weeks) in the UK. The intervention was run across the three sites in Norwich, Newcastle, and Birmingham.

The targets were to improve Mediterranean diet scores by at least 3 points (on a 14-point scale) and increase levels of activity to 150 minutes of moderate, or 75 minutes of vigorous, per week.

For both the Mediterranean Diet and the Mediterranean Diet plus Physical Activity groups the intervention included three components to support behaviour change and maintenance over 24 weeks: a website (LEAP2), food delivery/supermarket vouchers, and group sessions.Those in the control group were asked not to change their diet or physical activity levels.

Following the initial 24-week intervention period several participants volunteered to enter a behavioural maintenance phase for a further 24 weeks. During this phase of the study, participants had continued access to the LEAP2 website but no longer received group support sessions or food vouchers.

The intervention was run in part during COVID-19 lockdown with social distancing restrictions, a hurdle we hadn’t expected to face. Despite this, the intervention was delivered as intended, with alterations for remote testing and group sessions where necessary.

Our results showed that it was possible to carry out this type of intervention in the UK, with participant recruitment and retention targets being met.Across the three sites, 104 participants were recruited, of which 99 completed the main 24-week intervention and 67 completed the 24 to 48-week maintenance phase.

Engagement and feedback on the group sessions and food provision was generally good. However, use of the website was low, feedback from participants highlighted this was due to the website being difficult to use which we plan to improve for future studies.

The intervention was successful in improving eating behaviour, with these changes sustained during the maintenance phase of the study (weeks 24-48). On average, participants in the intervention groups achieved a 3.7-point increase in Mediterranean Diet Adherence Score at 24-weeks, with a 2.7-point increase maintained at 48-weeks follow-up. Of the 14 Mediterranean targets, nuts, fish, sofrito and the ratio of white to red meat were the components most participants changed over the 24-week intervention.

Only modest increases in physical activity levels were observed in the Mediterranean Diet plus Physical Activity group of around 10 minutes per day. This was not entirely unexpected given that the study took place during COVID-19 lockdowns where activity opportunities were restricted. Of interest, studies have shown that increasing physical activity by 10 minutes per day can have positive effects on health and cognition.

The results from the 24-hour blood pressure monitors showed a reduction in pulse pressure variability and arterial stiffness in the Mediterranean Diet plus Physical Activity group.Stiff arteries have a negative effect on blood pressure which is linked to long-term cardiovascular risk.We also found that participants in the Mediterranean Diet groups performed better on the cognitive tests after the 24-week intervention, with an improvement in overall cognition, memory, and executive function (the mental processes that enable us to plan, multi-task, follow instructions and pay attention).

The CHarMINg Project (Theme 1):

The CHarMINg Project is a co-production of promising interventions to support multiple behaviour changes in socially deprived communities (funded through UEAHSCP).

Unhealthy behaviours place a heavy burden on regional health and social care services.

Physical inactivity, unhealthy diets, tobacco smoking, and excessive alcohol consumption are called the “big four” behaviours. People living in underrepresented communities are much more likely to engage in all four behaviours.

We still do not know how best to support change in multiple behaviours. our aims are to identify best practice examples and work together to produce promising interventions to support multiple behaviour change in underrepresented communities.

Our findings will inform innovation in practice and research.

The essence of this project is partnership working. The project brings together members of the public, practitioners, voluntary and community organisations, policy makers, and researchers from across the local area.

The UEA Health and Social Care #PowerofCollaborativeResearchFunding grant is supporting this project.

For further information please contact Prof Wendy Hardeman ([email protected]).

HRT and Dementia Risk in Women (Theme 3):

An observational study led by NIHA Director Prof Anne-Marie Minihane and a team of researchers from the University of East Anglia (Dr Rasha Saleh, Prof Michael Hornberger) and the University of Edinburgh (Prof Craig Ritchie) aimed to establish whether there is a link between hormone replacement therapy (HRT) and Alzheimer’s disease among high-risk women.

The study looked at data from 1,178 women involved in the European Prevention of Alzheimer's Dementia initiative, which studies participants' brain health over time. All women who took part in the European initiative were over 50 and had no dementia diagnosis when joining it. This study then looked at results of cognitive tests and brain volumes as recorded by MRI scans. The publication was published in the Alzheimer’s Research & Therapy journal.

The results concluded that HRT could reduce the risk of Alzheimer’s disease in high-risk women who carry the APOE4 gene. The new, early, research found HRT, which can help control menopause symptoms, was associated with better memory and larger brain volumes for those with the gene.

Whilst the research concluded it was too early to say for sure whether HRT reduced dementia risk in women, the results highlighted its potential importance in the face of limited dementia treatments.

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