Key Findings to Date

One of the main findings to emerge from the prospective cohort is support for the hypothesised role of early-life undernutrition in CVD risk. Arterial stiffness, and possibly carotid intima-media thickness (see published work, data on a sub-group only), was found to be lower in the intervention arm in adolescence, and in early-adulthood (unpublished data) despite similar levels of conventional risk factors. These data provide novel mechanistic insights: increased CVD risk associated with early undernutrition may act through direct effects on developing vasculature, rather than conventional risk factors as thought previously.

Preliminary examination of data on adult participants also shows a strong correlation between urbanicity (using satellite-assessed night-light intensity as a proxy for urbanicity) and chronic disease risk factors in APCAPS villages, with effects varying by risk factors, although our current sample size noticeably limits our ability to examine several of these effects robustly. Our detailed profiling of the physical and social environment linked to an expanded sample should provide us with much greater resolution and study power to deconstruct the role of key components of urban environment.

Finally, data from APCAPS has also allowed us to critically examine the causal role of several existing risk factors (e.g. central adiposity, lean mass, leg length and childhood socio-economic position) that have mainly been examined in high-income countries, highlighting the importance of replicating epidemiological findings in settings with different confounding structures (for a list of APCAPS publications, click here).