Adding salt to your food at the table is linked to higher risk of premature death

by European Society of Cardiology

The risk of premature death from adding salt to food. Credit: European Heart Journal

People who add extra salt to their food at the table are at higher risk of dying prematurely from any cause, according to a study of more than 500,000 people, published in the European Heart Journal today.

31 jul 2022--Compared to those who never or rarely added salt, those who always added salt to their food had a 28% increased risk of dying prematurely. In the general population about three in every hundred people aged between 40 and 69 die prematurely. The increased risk from always adding salt to food seen in the current study suggests that one more person in every hundred may die prematurely in this age group.

In addition, the study found a lower life expectancy among people who always added salt compared to those who never, or rarely added salt. At the age of 50, 1.5 years and 2.28 years were knocked off the life expectancy of women and men, respectively, who always added salt to their food compared to those who never, or rarely, did.

The researchers, led by Professor Lu Qi, of Tulane University School of Public Health and Tropical Medicine, New Orleans, U.S., say their findings have several public health implications.

"To my knowledge, our study is the first to assess the relation between adding salt to foods and premature death," he said. "It provides novel evidence to support recommendations to modify eating behaviors for improving health. Even a modest reduction in sodium intake, by adding less or no salt to food at the table, is likely to result in substantial health benefits, especially when it is achieved in the general population."

Assessing overall sodium intake is notoriously difficult as many foods, particularly pre-prepared and processed foods, have high levels of salt added before they even reach the table. Studies assessing salt intake by means of urine tests often only take one urine test and so do not necessarily reflect usual behavior. In addition, foods that are high in salt are often accompanied by foods rich in potassium, such as fruit and vegetables, which is good for us. Potassium is known to protect against the risk of heart diseases and metabolic diseases such as diabetes, whereas sodium increases the risk of conditions such as cancer, high blood pressure and stroke.

For these reasons, the researchers chose to look at whether or not people added salt to their foods at the table, independent of any salt added during cooking.

"Adding salt to foods at the table is a common eating behavior that is directly related to an individual's long-term preference for salty-tasting foods and habitual salt intake," said Prof. Qi. "In the Western diet, adding salt at the table accounts for 6-20% of total salt intake and provides a unique way to evaluate the association between habitual sodium intake and the risk of death."

The researchers analyzed data from 501,379 people taking part in the UK Biobank study. When joining the study between 2006 and 2010, the participants were asked, via a touch-screen questionnaire, whether they added salt to their foods (i) never/rarely, (ii) sometimes, (iii) usually, (iv) always, or (v) prefer not to answer. Those who preferred not to answer were not included in the analysis. The researchers adjusted their analyses to take account of factors that could affect outcomes, such as age, sex, race, deprivation, body mass index (BMI), smoking, alcohol intake, physical activity, diet and medical conditions such as diabetes, cancer and heart and blood vessel diseases. They followed the participants for a median (average) of nine years. Premature death was defined as death before the age of 75 years.

As well as finding that always adding salt to foods was linked to a higher risk of premature death from all causes and a reduction in life expectancy, the researchers found that these risks tended to be reduced slightly in people who consumed the highest amounts of fruit and vegetables, although these results were not statistically significant.

"We were not surprised by this finding as fruits and vegetables are major sources of potassium, which has protective effects and is associated with a lower risk of premature death," said Prof. Qi.

He added that "because our study is the first to report a relation between adding salt to foods and mortality, further studies are needed to validate the findings before making recommendations."

In an editorial to accompany the paper, Professor Annika Rosengren, a senior researcher and professor of medicine at the Sahlgrenska Academy, University of Gothenburg, Sweden, who was not involved with the research, writes that the net effect of a drastic reduction in salt intake for individuals remains controversial.

"Given the various indications that a very low intake of sodium may not be beneficial, or even harmful, it is important to distinguish between recommendations on an individual basis and actions on a population level," she writes.

She concludes that "classic epidemiology argues that a greater net benefit is achieved by the population-wide approach (achieving a small effect in many people) than from targeting high-risk individuals (a large effect but only achieved in a small number of people). The obvious and evidence-based strategy with respect to preventing cardiovascular disease in individuals is early detection and treatment of hypertension, including lifestyle modifications, while salt-reduction strategies at the societal level will lower population mean blood pressure levels, resulting in fewer people developing hypertension, needing treatment, and becoming sick. Not adding extra salt to food is unlikely to be harmful and could contribute to strategies to lower population blood pressure levels."

A strength of Prof. Qi's study is the large number of people included. It also has some limitations, which include: the possibility that adding salt to food is an indication of an unhealthy lifestyle and lower socio-economic status, although analyses attempted to adjust for this; there was no information on the quantity of salt added; adding salt may be related to total energy intake and intertwined with intake of other foods; participation in UK Biobank is voluntary and therefore the results are not representative of the general population, so further studies are needed to confirm the findings in other populations.

Prof. Qi and his colleagues will be carrying out further studies on the relation between adding salt to foods and various chronic diseases such as cardiovascular disease and diabetes. They also expect potential clinical trials to test the effects of a reduction in adding salt on health outcomes.

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More information: Hao Ma et al, Adding salt to foods and hazard of premature mortality, European Heart Journal (2022). DOI: 10.1093/eurheartj/ehac208

Annika Rosengren, Salt: the sweet spot?, European Heart Journal (2022). DOI: 10.1093/eurheartj/ehac336

Journal information: European Heart Journal 

 

Difference between retina's biological age and person's real age linked to heightened death risk

by British Medical Journal

Credit: Unsplash/CC0 Public Domain

The difference between the biological age of the retina, the light sensitive layers of nerve tissue at the back of the eye, and a person's real (chronological) age, is linked to their risk of death, finds research published online in the British Journal of Ophthalmology.

29 jan 2022--This 'retinal age gap' could be used as a screening tool, suggest the researchers.

A growing body of evidence suggests that the network of small vessels (microvasculature) in the retina might be a reliable indicator of the overall health of the body's circulatory system and the brain.

While the risks of illness and death increase with age, it's clear that these risks vary considerably among people of the same age, implying that 'biological aging' is unique to the individual and may be a better indicator of current and future health, say the researchers.

Several tissue, cell, chemical, and imaging-based indicators have been developed to pick up biological aging that is out of step with chronological aging. But these techniques are fraught with ethical/privacy issues as well as often being invasive, expensive, and time consuming, say the researchers.

They therefore turned to deep learning to see if it might accurately predict a person's retinal age from images of the fundus, the internal back surface of the eye, and to see whether any difference between this and a person's real age, referred to as the 'retinal age gap', might be linked to a heightened risk of death.

Deep learning is a type of machine learning and artificial intelligence (AI) that imitates the way people acquire certain types of knowledge. But unlike classic machine learning algorithms that are linear, deep learning algorithms are stacked in a hierarchy of increasing complexity.

The researchers drew on 80,169 fundus images taken from 46,969 adults aged 40 to 69, all of whom were part of the UK Biobank, a large, population-based study of more than half a million middle aged and older UK residents.

Some 19,200 fundus images from the right eyes of 11,052 participants in relatively good health at the initial Biobank health check were used to validate the accuracy of the deep learning model for retinal age prediction.

This showed a strong association between predicted retinal age and real age, with an overall accuracy to within 3.5 years.

The retinal age gap was then assessed in the remaining 35,917 participants during an average monitoring period of 11 years.

During this time, 1871(5%) participants died: 321(17%) of cardiovascular disease; 1018 (54.5%) of cancer; and 532 (28.5%) of other causes including dementia.

The proportions of 'fast agers'—those whose retinas looked older than their real age– with retinal age gaps of more than 3, 5, and 10 years were, respectively, 51%, 28%, and 4.5%.

Large retinal age gaps in years were significantly associated with 49%-67% higher risks of death, other than from cardiovascular disease or cancer.

And each 1 year increase in the retinal age gap was associated with a 2% increase in the risk of death from any cause and a 3% increase in the risk of death from a specific cause other than cardiovascular disease and cancer, after accounting for potentially influential factors, such as high blood pressure, weight (BMI), lifestyle, and ethnicity.

The same process applied to the left eyes produced similar results.

This is an observational study, and as such, can't establish cause. The researchers also acknowledge that the retinal images were captured at one moment in time, and that the participants may not be representative of the UK population as a whole.

Nevertheless, they write: "Our novel findings have determined that the retinal age gap is an independent predictor of increased mortality risk, especially of non-[cardiovascular disease]/ non-cancer mortality. These findings suggest that retinal age may be a clinically significant biomarker of aging."

They add: "The retina offers a unique, accessible 'window' to evaluate underlying pathological processes of systemic vascular and neurological diseases that are associated with increased risks of mortality.

"This hypothesis is supported by previous studies, which have suggested that retinal imaging contains information about cardiovascular risk factors, chronic kidney diseases, and systemic biomarkers."

The new findings, combined with previous research, add weight to "the hypothesis that the retina plays an important role in the aging process and is sensitive to the cumulative damages of aging which increase the mortality risk," they explain.

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More information: Retinal age gap as a predictive biomarker for mortality risk, British Journal of Ophthalmology (2022). DOI: 10.1136/ bjophthalmol-2021-319807

More physical activity, higher intensity may significantly reduce risk of death in older women in the short term

More physical activity and at higher intensities could lead to a big drop in the risk of death in older women from any cause, according to new research in the American Heart Association's journal Circulation.

07 nov 2017--Researchers found the volume of light intensity physical activity or sedentary behavior was not associated with death rate. However, light intensity activity may be beneficial for other health outcomes not studied in this research.
Previous studies, which used self-reports, showed that active people have about 20 percent to 30 percent lower death rates compared to their least active counterparts.
This research, conducted from 2011 to 2015, is among the first to investigate physical activity, measured using a wearable device called a triaxial accelerometer, and a clinical outcome. The device is capable of measuring activity along three planes: up and down, front to back and side to side. These capabilities increase sensitivity to detect physical activity and allow for more precise measurements.
"We used devices to better measure not only higher intensity physical activities, but also lower intensity activities and sedentary behavior, which has become of great interest in the last few years," said I-Min Lee, M.B.B.S., Sc.D., the study's first author and professor of medicine and epidemiology at Harvard University's medical and public health schools in Boston, Massachusetts.
More than 17,700 women (average age 72) who were asked to wear the device for seven days, when awake, returned their devices. Data were analyzed from 16,741 compliant participants (i.e., their devices showed it was worn for at least 10 hours a day, on at least four days). During an average follow-up of approximately two-and-a-half years, 207 women died.
Researchers found:

• More moderate to vigorous intensity physical activity (such as brisk walking) was associated with roughly a 60 percent to 70 percent lower risk of death at the end of the study among the most active women, compared to the least active.
• More light intensity activity (such as housework and slow walking - e.g., window shopping in a mall), or more sedentary behavior was not independently associated with death risk at the study's end. Researchers stressed this finding does not mean light activity isn't beneficial for other health outcomes not studied here.

Researchers chose this study population to begin addressing knowledge gaps, said Lee who is also an associate epidemiologist at Brigham and Women's Hospital in Boston. "Younger people in their 20s and 30s generally can participate in vigorous intensity activities, such as running or playing basketball. But for older people, vigorous intensity activity may be impossible, and moderate intensity activity may not even be achievable. So, we were interested in studying potential health benefits associated with light intensity activities that most older people can do."
The study's participants, selected from the Women's Health Study, were relatively healthy, and mostly white women, therefore the findings may have limited generalizability to other groups of people.
The findings support 2008 federal guidelines and American Heart Association that suggest at least 150 minutes a week of moderate intensity or 75 minutes a week of vigorous-intensity aerobic physical activity (or a combination of the two) and muscle-strengthening exercises two or more days a week.
"We hope to continue this study in the future to examine other health outcomes, and particularly to investigate the details of how much and what kinds of activity are healthful. What is irrefutable is the fact that physical activity is good for your health," Lee said.

More information: Circulation (2017). DOI: 10.1161/CIRCULATIONAHA.117.031300


Provided by American Heart Association

Elevated blood pressure not a high mortality risk for elderly with weak grip

A study of nearly 7,500 Americans age 65 or older suggests that elevated blood pressure is not related to high mortality risk among people in that age group with weak grip strength.

New research by Oregon State University builds on an earlier OSU study that showed the relationship between high blood pressure and risk of death is largely dependent on elders' frailty status as measured by walking speed.

29 mar 2017--The findings are important because they suggest that treating high blood pressure in older patients should not follow a one-size-fits-all approach. When an older person is still functioning at a high level physically, high blood pressure indicates mortality risk; however, when the person is not physically robust, high blood pressure is not a marker for mortality risk.
"If people are very frail, they typically don't respond well to anti-hypertensive therapy and they are not benefiting from having a low blood pressure," said lead author Chenkai Wu, a graduate student in OSU's College of Public Health and Human Sciences. "The research is basically saying older adults are not one single group, they're very different in terms of their health status, and drugs may not have the same benefits for everyone. This is consistent with the idea of precision medicine, where you don't just look at age, you look at other things like functional status."
Measured in millimeters of mercury, blood pressure is the force of blood against the vessel walls. Systolic blood pressure, the higher number, is the force during a heartbeat, and diastolic refers to when the heart is at rest.
Most people's diastolic blood pressure goes down with age. Systolic blood pressure, though, tends to rise, and high blood pressure - hypertension - can put extra strain on the heart and arteries, causing greater risk of heart attack and stroke.
But as Wu's research suggests, an elderly patient's level of physical functionality should be considered in determining whether anti-hypertensive therapy is warranted.
Grip strength, easily measured by an inexpensive device known as a dynamometer, is a common way to gauge functionality in the elderly. Another often-used measuring stick is walking speed.
Wu looked at data from 7,492 people age 65 or older who had taken part in the nationally representative Health and Retirement Study. Six years after being surveyed, 25 percent of those people had died.
The study showed that elevated systolic blood pressure (150 or greater) and diastolic blood pressure (90 or greater) correlated with a substantially higher likelihood of dying for those with normal grip strength, which is 26 kilograms or more for men and 16 kilograms or more for women.
"We did three analyses," Wu said. "One was to look at gait speed to separate people into two groups, normal and slow. The second part was grip strength - weak grip and normal grip. Third, we looked at the combinations, and the strongest inverse association between high blood pressure and mortality was for slow walkers with weak grip strength.
"Both measures are markers of functional status, a multidimensional concept. Considering both might be better than considering each measure alone for identifying subgroups of elders for whom high blood pressure is potentially beneficial."
OSU public health epidemiologist Michelle Odden, senior author on the study and the lead author on the earlier gait-speed research, explained how high blood pressure might actually help in some cases.
"As we age, our blood vessels lose elasticity and become stiff," said Odden, an assistant professor in the College of Public Health and Human Sciences. "Higher blood pressure could be a compensatory mechanism to overcome this loss of vascular elasticity and keep fresh blood pumping to the brain and heart.
"And everyone ages differently - there is a profound difference between the physiological age of an 80-year-old man who golfs every day and someone who needs a walker to get around. So with fast walkers, high blood pressure may be more indicative of underlying disease and not just a symptom of the aging process."
In addition to the connection with weak grip strength, Wu said there was a "very clear" inverse association between high blood pressure and mortality among those who weren't physically able to finish the gait-speed test in the latest study, measured over a 98.5-inch walk.
Put another way, among those who couldn't walk a little over 8 feet, high blood pressure was associated with less mortality risk.
"It's a small group but not negligible - 6 percent - of people who were not able to complete the test," he said. "Compared to grip strength, it's a harder test to complete, an integration of a lot of physiological systems: balance, vision, lower-extremity muscle strength, etc."
The findings were recently published in the Journal of the American Geriatrics Society.

More information: Chenkai Wu et al, Functional Status Modifies the Association of Blood Pressure with Death in Elders: Health and Retirement Study, Journal of the American Geriatrics Society (2017). DOI: 10.1111/jgs.14816


Provided by Oregon State University

Regular consumption of spicy foods linked to lower risk of death

Chile pepper (Capsicum annuum).

Eating spicy food more frequently as part of a daily diet is associated with a lower risk of death, suggests a new study published in The BMJ this week. The association was also found for deaths from certain conditions such as cancer, and ischaemic heart and respiratory diseases.

06 aug 2015--This is an observational study so no definitive conclusions can be drawn about cause and effect, but the authors call for more research that may "lead to updated dietary recommendations and development of functional foods."

Previous research has suggested that beneficial effects of spices and their bioactive ingredient, capsaicin, include anti-obesity, antioxidant, anti-inflammation and anticancer properties.

So an international team led by researchers at the Chinese Academy of Medical Sciences examined the association between consumption of spicy foods as part of a daily diet and the total risk and causes of death.

They undertook a prospective study of 487,375 participants, aged 30-79 years, from the China Kadoorie Biobank. Participants were enrolled between 2004-2008 and followed up for morbidities and mortality.

All participants completed a questionnaire about their general health, physical measurements, and consumption of spicy foods, and red meat, vegetable and alcohol.

Participants with a history of cancer, heart disease, and stroke were excluded from the study, and factors such as age, marital status, level of education, and physical activity were accounted for.

During a median follow-up of 7.2 years, there were 20,224 deaths.

Compared with participants who ate spicy foods less than once a week, those who consumed spicy foods 1 or 2 days a week were at a 10% reduced risk of death (hazard ratios for death was 0.90). And those who ate spicy foods 3 to 5 and 6 or 7 days a week were at a 14% reduced risk of death (hazard ratios for death 0.86, and 0.86 respectively).*

In other words, participants who ate spicy foods almost every day had a relative 14% lower risk of death compared to those who consumed spicy foods less than once a week.

The association was similar in both men and women, and was stronger in those who did not consume alcohol.

Frequent consumption of spicy foods was also linked to a lower risk of death from cancer, and ischaemic heart and respiratory system diseases, and this was more evident in women than men.

Fresh and dried chilli peppers were the most commonly used spices in those who reported eating spicy foods weekly, and further analysis showed those who consumed fresh chilli tended to have a lower risk of death from cancer, ischaemic heart disease, and diabetes.

Some of the bioactive ingredients are likely to drive this association, the authors explain, adding that fresh chilli is richer in capsaicin, vitamin C, and other nutrients. But they caution against linking any of these with lowering the risk of death.

Should people eat spicy food to improve health? In an accompanying editorial, Nita Forouhi from the University of Cambridge says it is too early to tell, and calls for more research to test whether these associations are the direct result of spicy food intake or whether this is a marker for other dietary or lifestyle factors.

More information: Consumption of spicy foods and total and cause specific mortality: population based cohort study, www.bmj.com/cgi/doi/10.1136/bmj.h3942

* A hazard ratio is a measure of how often a particular event happens in one group compared to how often it happens in another group, over time. 

Provided by British Medical Journal

New tool predicts your risk of death

Credit: Peter Griffin/public domain

Researchers from Uppsala University have studied the risk of dying over the next five years. They have developed a unique health-risk calculator by using one of the world's largest study material, UK Biobank, containing data from nearly half a million people. The results are expected to have large areas of application both in the clinical setting, public health policy and in research.

05 jun 2015--'We show that, using a few simple questions, one can predict the risk of dying within five years with greater reliability than in any other way we know today. We think our study and the associated risk calculator will become an important tool for a wide range of researchers, but also for doctors, decision-makers and the public,' says Erik Ingelsson, a professor at Uppsala University who headed the study that has now been published in The Lancet.

UK Biobank contains data on as many as 655 variables, collected from around half a million British people aged 40–70. Studies of the associations between one or a few risk factors and future mortality risk have been carried out previously in smaller studies, but none has been based on such extensive data material. Erik Ingelsson and his colleague Andrea Ganna at Karolinska Institute made a series of interesting discoveries:

1. The variables with the best capacity to predict the risk of dying were, surprisingly enough, not primarily biological measured values but self-rated factors, like self-reported health status or walking speed. The risk of dying in the next five years was, for example, 3.7 times higher for subjects with low than with normal walking speed; and the risk of dying was clearly elevated for those who did not possess a car, which is interpreted as being due to socioeconomic causes.
2. The variables that best predicted risk were not the same in men and women, and the reliability of the prediction was generally greater for men.
3. When healthy individuals only were studied, smoking was found to be the strongest predictor of death within five years.
4. The risk of dying from external causes, such as suicide or accidents (data on causes of death were also collected), was best predicted by means of socioeconomic and psychological factors.
5. Prediction was generally less reliable for older than for younger people.

The researchers proceeded by using a computer algorithm to pick out the combination of questionnaire items with the highest accuracy. The outcome was 13 questions for men and 11 for women, and on the basis of the replies to these questions a person's 'Ubble age' can be calculated. If this is lower than the actual age, it means that the person's risk of dying is lower than the average for people of the same sex and age, and vice versa. The researchers have been working with web technicians and designers to develop a simple, user-friendly tool for visualizing all results, and enabling five-year mortality risk and Ubble age to be calculated.

'We see a large number of people who may find this useful. Researchers can use it to arrive at hypotheses for follow-up studies, doctors for identifying high-risk patients, decision-makers for making the right health investments, and the public for learning more about health,' says the other author of the study, Andrea Ganna.

The authors emphasises, however, that the study shows only statistical associations, and underlines the fact that this is not a matter of whether the different variables cause death. One should also be careful to avoid drawing sweeping conclusions about individuals, since what the results show is average risk and prediction results like these are never deterministic. But the large scale of the study is important not least in the light of all the alarming reports about health risks based on studies of associations, which are usually too small to yield reliable information.

This tool can no doubt be useful for journalists in assessing the news value of a new piece of research, since it enables them to compare the results with a large set of data material. The hope is that small studies will thus be discarded from the news flow, instead of unnecessarily causing concern.

More information: Test yourself with the Ubble (UK Longevity Explorer) health tool: www.ubble.co.uk

Provided by Uppsala University

Nutrition, mobility predict early death in elderly cancer patients

Low nutritional assessment scores, poor mobility, and advanced disease predict early death after chemotherapy initiation among elderly patients with cancer, according to a study published online April 16 in the Journal of Clinical Oncology.

18 april 2012-- Low nutritional assessment scores, poor mobility, and advanced disease predict early death after chemotherapy initiation among elderly patients with cancer, according to a study published online April 16 in the Journal of Clinical Oncology.

To investigate factors that predict death within six months of chemotherapy initiation, Pierre Soubeyran, M.D., Ph.D., of the Bordeaux Segalen University in France, and colleagues studied 348 elderly cancer patients (median age, 77.45 years) who had not had previous cancer treatment. Participants were evaluated at baseline using the abbreviated comprehensive geriatric assessment (aCGA), including the Mini-Mental State Exam, Timed Get Up and Go (GUG), Activities of Daily Living (ADL), Instrumental Activities in Daily Living (IADL), Mini Nutritional Assessment (MNA), Geriatric Depression Scale (GDS15), and comorbidities index (Cumulative Index Rating Scale-Geriatric).

The researchers found that 18.1 percent of participants had abnormal aCGA scores on the ADL, as did 73.0 percent on the IADL, 24.1 percent on the GUG, 19.0 percent on the MMS, 44.0 percent on the GDS15, and 64.9 percent on the MNA. Higher risk of early death was associated with advanced disease (odds ratio [OR], 3.9), a low MNA score (OR, 2.77), male gender (OR, 2.40), and long GUG (OR, 2.55).

"We recommend that the MNA and GUG, performed by a trained nurse, be maintained as part of routine pretreatment work-up in these patients to identify at-risk patients and to inform the decision-making process for chemotherapy," the authors write.

Several authors disclosed financial relationships with pharmaceutical companies, many of which funded the study.

More information: Abstract

Elderly women with 'dowager's hump' may be at higher risk of earlier death

Hyperkyphosis, or "dowager's hump" — the exaggerated forward curvature of the upper spine seen commonly in elderly women — may predict earlier death in women whether or not they have vertebral osteoporosis, UCLA researchers have found.

22 may 2009--In a study published in the May 19 issue of Annals of Internal Medicine, researchers found that older white women with both vertebral fractures and the increased spinal curvature that results in the bent-over posture characteristic of hyperkyphosis had an elevated risk for earlier death. The finding was independent of other factors that included age and underlying spinal osteoporosis.

Women who had only hyperkyphosis, without vertebral fractures, did not show an increased risk for premature death.

Hyperkyphosis can be caused by a number of factors besides osteoporosis, including habitual poor posture and degenerative diseases of the muscles and intervertebral discs.

"Just being bent forward may be an important clinical finding that should serve as a trigger to seek medical evaluation for possible spinal osteoporosis, as vertebral fractures more often than not are a silent disease," said Dr. Deborah Kado, an associate professor of orthopedic surgery and medicine at the David Geffen School of Medicine at UCLA and the study's primary investigator. "We demonstrated that having this age-related postural change is not a good thing. It could mean you're likely to die sooner."

For the study, the researchers reviewed data on 610 women, age 67 to 93, from a cohort of 9,704 participants in the Study of Osteoporotic Fractures. The participants were recruited between 1986 and 1988 in Baltimore, Md.; Minneapolis, Minn.; Portland, Ore.; and Pennsylvania's Monongahela Valley. Researchers measured spinal curvature with a flexicurve and assessed vertebral fractures from spinal radiographs; they assessed mortality based on follow-ups averaging 13.5 years.

Adjusting for age, as well as osteoporosis-related factors such as low bone density, moderate and severe vertebral fractures, and the number of prevalent vertebral fractures, the researchers found that women with previous vertebral fractures and increasing degrees of spinal curvature were at increased mortality risk from the spinal condition, regardless of age, smoking, spinal bone-mineral density, or the number and severity of their spinal fractures.

These study findings provide evidence that it is not just vertebral fracture alone but the associated increased spinal curvature that may be most predictive of adverse health outcomes. Other studies linking hyperkyphosis to poor health, such as impaired physical function, increased fall risk, fractures and mortality, have been unable to exclude the possibility that vertebral fractures alone were the underlying explanation for the findings.

The researchers note several caveats. This study focused on women, though hyperkyphosis also affects men; measurements for vertebral fractures were based only on height ratios, which could lead to misclassification of other causes of height ratio decreases, such as Scheuermann disease; and the timing of the assessments could have affected the results, though it's unlikely to have made much difference.

However, this study demonstrates a possible association between hyperkyphosis and increased risk for earlier death independent of the number and severity of vertebral fractures or osteoporosis in older women, the researchers write.

"These results add to the growing literature that suggests that hyperkyphosis is a clinically important finding. Because it is readily observed and is associated with ill health in older persons, hyperkyphosis should be recognized as a geriatric syndrome — a 'multifactorial health condition that occurs when the accumulated effect of impairments in multiple systems renders a person vulnerable to situational challenges.'"

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Study co-authors include Arun S. Karlamangla of UCLA; Li-Yung Lui and Steven R. Cummings of the California Pacific Medical Center Research Institute; and Kristine E. Ensrud and Howard A. Fink of the University of Minnesota.

The National Institute of Arthritis and Musculoskeletal and Skin Diseases and the National Institute on Aging funded this study.