Height and risk of death among men and women: aetiological implications of associations with cardiorespiratory disease and cancer mortality

OBJECTIVES: Height is inversely associated with cardiovascular disease mortality risk and has shown variable associations with cancer incidence and mortality. The interpretation of findings from previous studies has been constrained by data limitations. Associations between height and specific causes of death were investigated in a large general population cohort of men and women from the West of Scotland. DESIGN: Prospective observational study. SETTING: Renfrew and Paisley, in the West of Scotland. SUBJECTS: 7052 men and 8354 women aged 45-64 were recruited into a study in Renfrew and Paisley, in the West of Scotland, between 1972 and 1976. Detailed assessments of cardiovascular disease risk factors, morbidity and socioeconomic circumstances were made at baseline. MAIN OUTCOME MEASURES: Deaths during 20 years of follow up classified into specific causes. RESULTS: Over the follow up period 3347 men and 2638 women died. Height is inversely associated with all cause, coronary heart disease, stroke, and respiratory disease mortality among men and women. Adjustment for socioeconomic position and cardiovascular risk factors had little influence on these associations. Height is strongly associated with forced expiratory volume in one second (FEV1) and adjustment for FEV1 considerably attenuated the association between height and cardiorespiratory mortality. Smoking related cancer mortality is not associated with height. The risk of deaths from cancer unrelated to smoking tended to increase with height, particularly for haematopoietic, colorectal and prostate cancers. Stomach cancer mortality was inversely associated with height. Adjustment for socioeconomic position had little influence on these associations. CONCLUSION: Height serves partly as an indicator of socioeconomic circumstances and nutritional status in childhood and this may underlie the inverse associations between height and adulthood cardiorespiratory mortality. Much of the association between height and cardiorespiratory mortality was accounted for by lung function, which is also partly determined by exposures acting in childhood. The inverse association between height and stomach cancer mortality probably reflects Helicobacter pylori infection in childhood resulting inor being associated withshorter height. The positive associations between height and several cancers unrelated to smoking could reflect the influence of calorie intake during childhood on the risk of these cancers

Relationship between cortisol and physical performance in older persons

Objective: Hypercortisolism is associated with muscle weakness. This study examines the relationship between cortisol and physical performance in older persons. Design/patients: The study was conducted within the Longitudinal Aging Study Amsterdam (LASA), an ongoing cohort study in a population-based sample of healthy older persons in the Netherlands. Data from the second (1995/1996) and fourth (2001/2002) cycle were used pertaining to 1172 (65-88 years) and 884 (65-94 years) men and women, respectively. Measurements: Physical performance was measured by adding up scores on the chair stands, tandem stand and walk test (range 0-12). In the second cycle serum total and calculated free cortisol were assessed; in the fourth cycle evening salivary cortisol was assessed. Regression analysis (stratified for sex, adjusted for age, body mass index, alcohol use, physical activity and region) was performed to examine the cross-sectional relationship between cortisol and physical performance. Results: Women with higher calculated free cortisol scored less well on physical performance (b = -0.28 per SD higher cortisol, P = 0.016), which was mainly explained by poorer performance on the tandem stand (OR = 1.32 for a lower score per SD higher cortisol, P = 0.003). Men with higher salivary cortisol scored less well on physical performance (b = -0.90 in the highest vs. the lowest quartile, P = 0.008), which was mainly explained by poorer performance on the chair stands and walk test (OR = 1.88, P = 0.020 and OR = 1.81, P = 0.027, respectively, in the highest vs. the lowest quartile). Conclusion: Physical performance is negatively associated with high cortisol levels in older persons. © 2007 The Authors

Migration and health: a study of effects of early life experiences and current socio-economic situation on mortality of immigrants in Sweden

Objectives. Previous research has demonstrated mortality differences between immigrants and natives living in Sweden. The aim of this study is to investigate the effects of early life conditions in the country of birth and current socio-economic conditions in adult life in Sweden on cardiovascular, cancer, all other cause and total mortality among immigrants and natives in Sweden. Design. The cohort data concerning individual demographic characteristics and socio-economic conditions stems from the Swedish Longitudinal Immigrant Database (SLI), a register-based representative database, and consists of individuals from 11 countries of birth, born between 1921 and 1939, who were residents in Sweden between 1980 and 2001. The associations between current socio-economic conditions as well as infant mortality rates (IMR) and Gross Domestic Product (GDP) per capita in the year and country of birth, and total, cardiovascular, cancer and 'all other' mortality in 1980-2001 were calculated by survival analysis using Cox proportional hazards regression to calculate hazard rate ratios. Results. The effects of current adult life socio-economic conditions in Sweden on mortality are both stronger and more straightforward than the effects of early life conditions in the sense that higher socio-economic status is significantly associated with lower mortality in all groups of diagnoses; however, we find associations between infant mortality rates (IMR) in the year and country of birth, and cancer mortality among men and women in the final model. Conclusions. Socioeconomic conditions in Sweden are more strongly associated with mortality than early life indicators IMR and GDP per capita in the year of birth in the country of origin. This finding has health policy and other policy implications

Commentary: Components in the interpretation of the high mortality in the county of Finnmark

The weather in Northern Norway is severe. Anders Forsdahl describes ‘polar nights, harsh cold and long winters’ that force people to spend much of their time indoors. He himself, however, put his long winters to good use, reflecting on why the adult population of Finnmark, far above the Arctic Circle, has such high death rates. He quickly disposed of smoking and genes as possible explanations. He concluded that since economic and social conditions in Finnmark were similar to those in other parts of Norway, its 25% higher adult mortality rates must be a legacy of its history, of events during the childhood or adolescence of the adult population. This was the first of two platforms on which he developed . .

Fetal Origins Of Adult Health. Commentary: Developmental origins of raised serum cholesterol

Human beings are plastic during development, and a single genotype can produce more than one alternative form of structure or physiological state in response to environmental conditions.1 There is now a considerable body of evidence that coronary heart disease (CHD) originates in developmental plasticity.2 That being the case environmental conditions during development should be linked to the major biological risk factors for the disease

Developmental origins of adult health and disease

The aim of this glossary is to define some key terms used in the field of developmental and life course epidemiology

Fetal and infant origins of adult disease

Background. Many human fetuses and infants have to adapt to a limited supply of nutrients, and in doing so they permanently change their physiology and metabolism. These programmed changes may be the origins of a number of diseases in later life, including coronary heart disease, stroke, diabetes and hypertension.Coronary heart disease. We have become accustomed to the idea that coronary heart disease, the commonest cause of death in the Western world, may result from the “unhealthy” lifestyle that is associated with increasing affluence. The influences of this “unhealthy” lifestyle (e. g. obesity, cigarette smoking, dietary fat, stress), however, go only a small way towards explaining why increasing affluence in the Third world is so regularly followed by epidemics of the disease, or why in the Western world these epidemics have risen steeply to become the commonest cause of death but thereafter have declined. Neither do they explain why the highest rates of coronary heart disease in Western countries occur among the poor?Fetal origins. Answers to these questions may come from an understanding of how the structure of the heart and processes such as blood pressure regulation and the way the body handles sugar and fat are established in the womb. The “fetal origins” hypothesis states that coronary heart disease and the disorders related to it – hypertension, adult-onset diabetes and stroke – originate through adaptations that the fetus makes when it is under-nourished. Unlike adaptations made in adult life those made during early development tend to have permanent effects on the body's structure and function – a phenomenon sometimes referred to as programming. They allow the fetus to survive and continue to grow but at the price of a shortened life.ZusammenfassungHintergrund. Viele Säuglinge und Kinder müssen sich an ein limitiertes Nahrungsangebot anpassen, wobei sie ständig ihre Physiologie und ihren Stoffwechsel verändern. Diese programmierten Änderungen sind möglicherweise der Grund von verschiedenen Erkrankungen des Erwachsenenalters wie koronarer Herzkrankheit, Schlaganfall, Diabetes Typ II und Bluthochdruck.Koronare Herzkrankheit. Allgemein wird angenommen, dass koronare Herzkrankheit, die häufigste Todesursache in der westlichen Welt, eine Folge des “ungesunden” Lebensstils ist, der mit steigendem Wohlstand einhergeht. Die Einflüsse dieses Lebensstils (z. B. Adipositas, Zigarettenrauchen, diätetische Fettaufnahme, Stress) erklären jedoch kaum, warum steigender Wohlstand in der Dritten Welt regelmäßig von Epidemien der koronaren Herzerkrankung gefolgt ist oder warum die Häufigkeit dieser Erkrankung in der westlichen Welt zunächst steil anstieg, bis sie zur häufigsten Todesursache geworden war, nun aber abfällt. Sie erklären auch nicht, warum die höchsten Raten der koronaren Herzkrankheit in der westlichen Welt bei der sozial schwachen Bevölkerung gefunden werden.Ursprünge im fetalen Alter. Antworten auf diese Fragen geben uns möglicherweise Erkenntnisse darüber, wie die Struktur des Herzens und Prozesse wie die Blutdruckregulation und die Verwertung von Zucker und Fett im Körper bereits im Mutterleib festgelegt werden. Die Hypothese des “fetalen Ursprungs” geht davon aus, dass koronare Herzkrankheit und die mit ihr verbundenen Funktionsstörungen – Bluthochdruck, Diabetes Typ II und Schlaganfall – aus Anpassungsvorgängen des Fetus an Unterernährung resultieren. Im Gegensatz zu Anpassungsvorgängen im Erwachsenenalter haben Anpassungsvorgänge der frühen Entwicklung eher permanente Effekte auf die Struktur und Funktion des Körpers, ein Phänomen, das manchmal mit Programmierung umschrieben wird. Diese Anpassungsvorgänge erlauben es dem Fetus, zu überleben und weiter zu wachsen, allerdings um den Preis eines verkürzten Lebens.<br/

A new model for the origins of chronic disease

Living things are often plastic during their early development and are moulded by the environment. Many human fetuses have to adapt to a limited supply of nutrients, and in doing so they permanently change their physiology and metabolism. These programmed changes may be the origins of a number of diseases in later life, including coronary heart disease, stroke, diabetes and hypertension

Low birth weight, early growth and chronic disease in later life

Low birth weight is now known to be associated with increased rates of coronary heart disease and the related disorders stroke, hypertension and non-insulin dependent diabetes. These associations have been extensively replicated in studies in different countries and are not the result of confounding variables. They extend across the normal range of birth weight and depend on lower birth weights in relation to the duration of gestation rather than the effects of premature birth. The associations are thought to be consequences of developmental plasticity, the phenomenon by which one genotype can give rise to a range of different physiological or morphological states in response to different environmental conditions during development. Recent observations have shown that impaired growth in infancy and rapid childhood weight gain exacerbate the effects of impaired prenatal growth. This is an important finding for pediatric health professionals given that promoting weight gain during infancy is standard practice