Height loss in middle age is linked to a heightened risk of early death

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Height loss in middle age is linked to a heightened risk of early death, primarily from heart disease or stroke – at least in Northern European women – suggests research published in the online journal BMJ Open.

But regular physical activity may help to stave off mid-life shrinkage, as well as lowering cardiovascular disease risk, the findings indicate.

People tend to start losing height once they reach their 50s, a process that speeds up during their 70s. Height loss is usually caused by vertebral disc shrinkage, spinal compression fractures, and changes in posture.

While some degree of height loss is associated with natural aging, previous research suggests that it may also be associated with an increased risk of death from heart disease.

Height loss in women has not been well studied, however, despite the fact that women tend to lose more height than men, say the researchers.

They therefore wanted to find out if mid-life height loss might predict death from all causes, and specifically death from heart disease/stroke, in 2406 Swedish and Danish women born between 1908 and 1952.

The 1147 Swedish women were all part of the Swedish Prospective Population Study of Women in Gothenburg while the 1259 Danish women were part of the MONItoring trends and determinants of CArdiovascular disease (MONICA) study.

Height was measured without shoes and in the morning, at entry to each of these studies, when the women were aged between 30 and 60 (two thirds were aged 38–52), and again between 10 and 13 years later.

Date and cause of death were monitored for 17 to 19 years after the second height measurement.

Potentially influential factors, including weight, smoking, leisure time physical activity, alcohol intake, and educational attainment, were all recorded.

The women lost an average of 0.8 cm between the first and second height measurements, but the amount ranged from 0 to 14 cm.

During the total monitoring period of 19 years, 625 of the women died from all causes. But during the 17 year period, cardiovascular disease was the primary cause of death in 157 women, which included 37 cases of stroke; 362 cases were due to other causes.

Each cm of height loss was associated with 14% and 21% greater odds of death from any cause among the Swedish and Danish women, respectively, after adjusting for potentially influential factors.

Short stature and high leisure time physical activity (including participation in competitive sports) at study entry were associated with less height loss, independent of age.

Major height loss, defined as more than 2 cm, was associated with 74% and 80% greater odds of death, respectively, among two groups of women.

Pooled analysis of the data showed that major height loss was associated with a more than doubling in the odds of death from stroke and all types of cardiovascular disease, and 71% greater odds of death from all other causes.

These findings held true even after factoring in age, time between height measurements, nationality, and baseline values of height, weight, educational attainment and lifestyle factors.

This is an observational study, and as such, can’t establish cause. And the researchers point out that the number of stroke deaths was small, suggesting that the findings should be interpreted with a degree of caution.

Other unmeasured factors may also have influenced the findings, they add. These include early life physical activity and exposure to tobacco (either through second-hand smoke or smoking themselves], peak bone mass, underlying health conditions and medical treatments.

Nevertheless, the findings prompt the researchers to conclude that mid-life height loss “is a risk marker for earlier mortality in northern European women.”

Specifically, the risk of cardiovascular disease is increased in women who lose height, with death from stroke a major contributor to this association, they add.

“These findings suggest the need for increased attention to height loss to identify individuals at increased [cardiovascular disease] risk. Moreover, regular physical activity may be beneficial not only in prevention of [cardiovascular disease], but also in prevention of height loss,” they write.


The British Regional Heart Study is a prospective study of CVD that involved 7735 men aged 40 to 59 years who were selected from the age-sex registers of 1 general practice in each of 24 British towns and who were screened between 1978 and 1980.17 From 1998 to 2000, after a 20-year interval, all surviving men, now aged 60 to 79 years, were invited for a follow-up examination. Ethics approval was provided by all relevant local research ethics committees.

All men provided informed written consent to the investigation, which was carried out in accordance with the Declaration of Helsinki. All men completed a questionnaire (Q), providing details of their medical history and lifestyle behavior. The men were then asked to fast for a minimum of 6 hours, during which they were instructed to drink only water and to attend for measurement at a specified time between 8 AM and 6 PM. A fasting blood sample was collected (Monovette; Sarstedt, Nurnbrecht, Germany), with 4252 men (77% of survivors) attending for examination.Anthropometric measures

Height and weight were measured both at baseline screening (Q1) and at the 20-year reexamination (Q20), with the subjects in light clothing without shoes. On both occasions, height was measured to the last complete 0.1 cm using the supported stretch technique with the same stadiometer (Harpenden; Holtrain Ltd, Crymych, Wales); weight was measured to the last complete 0.1 kg using externally calibrated digital electronic scales (Soehnle, Murrhardt, Germany).

Body mass index (BMI [weight in kilograms divided by height in meters squared]) was calculated for each man. Height could not be measured in 17 of the 4252 men who attended reexamination. We excluded a further 22 men whose height appeared to have increased by more than 5 cm, as this increase in height is biologically implausible and may reflect invalid readings. Valid measures on height change were thus available in 4213 men.

Fat-free mass was calculated using bioelectric impedance analysis (Bodystat 500; Bodystat Ltd, Douglas, Isle of Man),18 applying the equation of Deurenberg et al,19 which has been validated in an elderly population. Measured weight loss was defined as a loss of 4% in weight.20 The men were also asked whether they had lost weight in the 3 years before reexamination (1998-2000) and whether this weight loss was intentional or unintentional.Cardiovascular risk factors

Details of measurement and classification methods for smoking status, physical activity, social class, alcohol intake, blood pressure, blood lipid levels, and lung function (forced expiratory volume in 1 second [FEV1] and forced vital capacity [FVC] in this cohort have been described elsewhere18,21,22; FEV1 and FVC were height standardized to the average height [1.73 m] in the study).23 Possible chronic obstructive pulmonary disease (COPD) was defined on the basis of an FEV1-FVC ratio of less than 70%.24Indicators of health status at reexamination

The men were asked to describe their present health status as excellent, good, fair, or poor. They were also asked whether a physician had ever told them that they had angina, myocardial infarction (heart attack or coronary thrombosis), stroke, diabetes, cancer, or a number of other cardiovascular conditions. Patient recall of a physician diagnosis of CVD has been shown to be a valid measure of recording diseases in this study population.25,26 The κ statistic comparing record review with patient recall of CHD was 0.82.25 The men were asked about regular treatment and were required to bring their medication to the examination session. The medications were classified according to the British National Formulary codes.27 The presence of musculoskeletal and joint diseases was inferred by the use of any drugs for the treatment of rheumatic diseases, neuromuscular disorder, and soft tissue inflammation (British National Formulary codes 10.1-10.3).Follow-up

All subjects were followed up from the initial examination (1978-1980) to December 2005 for all-cause mortality and to December 2004 for cardiovascular morbidity; follow-up was completed for 99% of the cohort.28 In the present analyses, all-cause mortality was based on follow-up from rescreening during 1998 to 2000, when the men were aged 60 to 79 years, with a mean follow-up period of 6 years (range, 5-7 years), and cardiovascular morbidity was based on a mean follow-up of 5 years (range, 4-6 years). Information on death was collected through the established “tagging” procedures provided by the National Health Service registers.

Fatal stroke episodes were defined as those coded 430 to 438 on the death certificate according to the International Classification of Diseases, Ninth Revision (ICD-9). Nonfatal stroke events were defined as those that produced a neurologic deficit that was present for more than 24 hours. Fatal CHD events were defined as death with CHD (ICD codes 410-414) as the underlying code. A nonfatal myocardial infarction was diagnosed according to World Health Organization criteria.29

 Cardiovascular deaths included all those with ICD codes 401 to 459. Evidence regarding nonfatal CHD and stroke was obtained from ongoing reports from general practitioners, from biennial reviews of the patients’ practice records (including hospital and clinic correspondence) throughout the study period, and from repeated personal questionnaires that were distributed to surviving subjects after the initial examination.Statistical analysis

The Cox proportional hazards model was used to assess the multivariate-adjusted relative risk (RR) for each height loss group compared with the reference group (height loss <1 cm). In the adjustment, smoking (never or long-term ex-smokers [>15 years], recent ex-smokers [<15 years], and current smokers), social class (7 groups), physical activity (4 groups), alcohol intake (5 groups), preexisting CHD (yes/no), stroke (yes/no), diabetes (yes/no), BMI (<25.0, 25.0-29.9, and ≥30.0), poor/fair health (yes/no), musculoskeletal problems (yes/no), and weight loss (yes/no) were fitted as categorical variables.

The biologic factors (serum high-density lipoprotein cholesterol, serum total cholesterol, blood pressure, serum albumin, and FEV1) were fitted as continuous variables. Tests for trend were carried out across the height-loss groups. Analysis of covariance was used to obtain age-adjusted mean levels of the biologic factors for the 4 height-loss groups. Direct standardization was used to obtain age-adjusted rates for the indicators of ill health. Logistic regression was used to obtain the age-adjusted odds ratio for prevalent disease.Results

In the 4213 men with valid measure of height change, the mean height loss from Q1 to Q20 was 1.67 cm (SD, 1.79 cm). Figure 1 shows the distribution of height loss. Height loss was significantly correlated with age (r = 0.20; P<.001). Mean height loss increased with increasing age from 1.2 to 1.6 cm to 2.0 and 2.3 cm in men initially aged 40 to 44 years, 45 to 49 years, 50 to 54 years, and 55 to 59 years, respectively. During the mean follow-up period of 5 years, there were 760 deaths from all causes.Height loss and risk factors

The men were divided into 4 groups on the basis of height change (<1.0 cm, 1.0-1.9 cm, 2.0-2.9 cm, and ≥3.0 cm). Table 1 shows the mean anthropometric factors, lifestyle characteristics, and biologic risk factors by the 4 height-loss groups. Increasing height loss was inversely associated with adiposity measures (BMI and waist circumference) and fat-free mass (muscle mass) and was positively associated with weight loss, physical inactivity, and nondrinking status at the 20-year follow-up examination.

No significant association was seen with smoking or social class. Height loss was inversely related to the FEV1-FVC ratio (an indicator of chronic obstructive pulmonary function) and total serum cholesterol and serum albumin levels and was positively associated with high-density lipoprotein cholesterol levels.Height loss and indicators of health status at q20

Age-adjusted prevalence of poor/fair health, mobility problems, musculoskeletal and joint problems, and COPD (as measured by the FEV1-FVC ratio <70%) tended to increase with increasing height loss, with risk substantially increased in those with a height loss of 3.0 cm or more (Table 2). Little association was seen between height loss and CVD, type 2 diabetes, and prevalent cancer.Mortality

Figure 2 shows age-adjusted mortality rates by the 4 height-loss groups. All-cause mortality increased with increasing height and was substantially increased in men with a height loss of 3.0 cm or more. The excess deaths were largely attributable to CVD and respiratory and other noncardiovascular, noncancer causes (Figure 2 and Table 3). No significant excess death was seen for cancer causes (age-adjusted RR, 1.28; 95% confidence interval [CI], 0.88-1.85). Initial height did not predict total mortality followed up from the 20-year reexamination (Q20).

A height loss of 3 cm or more was associated with significantly increased mortality even after adjustment for potential confounders and cardiovascular risk factors, including age, social class, smoking, alcohol intake, physical activity, BMI, preexisting CHD, stroke, diabetes, systolic blood pressure, serum total cholesterol, high-density lipoprotein cholesterol, and FEV1-FVC ratio (Table 3).

Further adjustment for poor/fair health, presence of musculoskeletal problems, and serum albumin levels (a marker of poor nutrition) attenuated the association slightly, but the increased risk seen for CVD mortality and other noncardiovascular, noncancer deaths remained significant (P = .03 and P = .001, respectively). The association between height loss and respiratory death was greatly attenuated after these adjustments, largely because of the lower FEV1-FVC ratio.Height loss and weight loss over 20 years

Height loss was significantly correlated with 20-year weight loss (Q1-Q20) (r = 0.20; P<.001) Further adjustment for weight loss attenuated the increased mortality risks, but the associations with total mortality (P = .002) and other noncardiovascular, noncancer deaths (P = .002) remained significant (Table 3). However, the increased risk of CVD mortality became of marginal significance.Exclusion of men with substantial height loss

The significantly increased risk of all-cause mortality in men with a height loss of 3.0 cm or more was observed even after exclusion of men with a height loss of 4.0 cm or more (n = 283) (adjusted RR, 1.48; 95% CI, 1.12-1.95). Thus, the increased mortality risk was already seen in men with a height loss in the range of 3.0 to 4.0 cm and was not solely attributable to extreme height loss. Indeed, we observed no further increase in mortality risk in those with a height loss of 4.0 cm or more after adjustment.Incidence of cvd

A height loss of 3.0 cm or more was associated with a significant increase in risk of major incident CHD events after adjustment for preexisting CVD and CVD risk factors (P = .03) (Table 4). Further adjustment for albumin, poor/fair health, musculoskeletal problems, and weight loss made small differences, but the difference between men with a height loss of 3.0 cm or more compared with those with a height loss of less than 1.0 cm became of marginal significance (P = .07). However, men with a height loss of 3.0 cm or more had a significantly higher CHD risk than all men with a height loss of less than 3.0 cm combined (adjusted RR, 1.42; 95% CI, 1.02-1.98). No association was seen between height loss and risk of stroke.

reference link: https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/769543


More information: Loss of height predicts total and cardiovascular mortality: a cohort study of northern European women, BMJ Open (2021). DOI: 10.1136/bmjopen-2021-049122

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