Abstract
The relationship between body height and the risk of non‒communicable diseases such as cardiovascular disease and cancer has been the subject of much debate in the epidemiological literature. Concerns have recently arisen over spurious associations due to confounding factors like birth cohort, especially in the context of epidemiological transition. The population of Sardinia represents an interesting case study, as the average physical stature of inhabitants was the lowest recorded in Europe until a few decades ago. In this population we tested whether height is an independent risk factor for cardiovascular disease and cancer. We analysed the stature of 10,427 patients undergoing endoscopy for any reason, for whom a detailed clinical history of cardiovascular disease and/or malignancies had been documented. Poisson regression modelling was used to test the association between stature and disease risk. When patients were subdivided according to sex and height tertiles, the risk of cardiovascular disease proved significantly greater for subjects in the lowest tertile irrespective of sex (men: 1.87; 95%CI 1.41‒2.47; women: 1.23; 95%CI 0.92‒1.66) and smaller for those in the highest tertile (men: 0.51; 95%CI 0.35‒0.75; women: 0.41; 95%CI 0.27‒0.61). However, after adjusting the risk for birth cohort and established risk factors, it mostly resulted in non-significant values, although the overall trend persisted. Similar results were obtained for all-cancer risk (relative risk for men and women in the lowest tertile: 1.44; 95%CI 1.09–1.90 and 1.17; 95%CI 0.93–1.48, in the highest tertile: 0.51; 95%CI 0.36–0.72 and 0.62; 95%CI 0.47–0.81, respectively) as well as for some of the most common types of cancer. We concluded that the risk of developing cardiovascular disease and malignancies does not vary significantly with stature in the Sardinian population, after adjusting for birth cohort and more obvious risk factors.
Highlights
Several retrospective and prospective studies suggested that the risk of cardiovascular (CV) disease and cancer, the leading causes of morbidity and mortality worldwide, is affected by adult height, the magnitude and the precise direction of this association are quite controversial [1,2,3]
Investigations aimed at testing the hypothesis of an association between height and non–communicable disease risk should consider birth cohort and socio-economic status (SES) [27] as modifying variables, assuming that older, short-statured generations may have been less exposed to risk factors for CV disease and malignancies than younger, taller generations
Demographic information was recorded in a computerized system, including sex, year of birth, smoking habits, history of definitive CV disease and cancer, as well as established risk factors such as tobacco smoking, obesity, hypertension, diabetes mellitus and hypercholesterolemia
Summary
Several retrospective and prospective studies suggested that the risk of cardiovascular (CV) disease and cancer, the leading causes of morbidity and mortality worldwide, is affected by adult height, the magnitude and the precise direction of this association are quite controversial [1,2,3]. The relationship between stature and disease risk was investigated through Mendelian randomization, an innovative methodology combining both genetic and epidemiological analysis, and whose results are less likely influenced by confounding and reverse causation [15] This approach provided compelling evidence that genetically–determined taller height is associated with significant lower risk of CV disease [16] and higher risk of colorectal cancer [17] in accordance with previous observational studies. The slow rise in average stature over the past century – called secular trend – was documented in most developed populations, and was attributed to improvements in living standards and nutrition resulting from societal development over the last century This period has witnessed an increased risk of non–communicable diseases, due to changes in nutrition habits and the impact of environmental and food carcinogens, to which both developed and developing societies were heavily exposed. Because of the marked sexual dimorphism in height and because men and women are exposed to different risk for non– communicable diseases [28], sex should be considered both a potential confounder and effect modifier
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