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Consumption of spicy foods and total and cause specific mortality: Population based cohort study

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Objective To examine the associations between the regular consumption of spicy foods and total and cause specific mortality. Design Population based prospective cohort study. Setting China Kadoorie Biobank in which participants from 10 geographically diverse areas across China were enrolled between 2004 and 2008. Participants 199 293 men and 288 082 women aged 30 to 79 years at baseline after excluding participants with cancer, heart disease, and stroke at baseline. Main exposure measures Consumption frequency of spicy foods, self reported once at baseline. Main outcome measures Total and cause specific mortality. Results During 3 500 004 person years of follow-up between 2004 and 2013 (median 7.2 years), a total of 11 820 men and 8404 women died. Absolute mortality rates according to spicy food consumption categories were 6.1, 4.4, 4.3, and 5.8 deaths per 1000 person years for participants who ate spicy foods less than once a week, 1 or 2, 3 to 5, and 6 or 7 days a week, respectively. Spicy food consumption showed highly consistent inverse associations with total mortality among both men and women after adjustment for other known or potential risk factors. In the whole cohort, compared with those who ate spicy foods less than once a week, the adjusted hazard ratios for death were 0.90 (95% confidence interval 0.84 to 0.96), 0.86 (0.80 to 0.92), and 0.86 (0.82 to 0.90) for those who ate spicy food 1 or 2, 3 to 5, and 6 or 7 days a week, respectively. Compared with those who ate spicy foods less than once a week, those who consumed spicy foods 6 or 7 days a week showed a 14% relative risk reduction in total mortality. The inverse association between spicy food consumption and total mortality was stronger in those who did not consume alcohol than those who did (P=0.033 for interaction). Inverse associations were also observed for deaths due to cancer, ischemic heart diseases, and respiratory diseases. Conclusion In this large prospective study, the habitual consumption of spicy foods was inversely associated with total and certain cause specific mortality, independent of other risk factors of death.
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thebmj
BMJ
2015;351:h3942doi: 10.1136/bmj.h3942
RESEARCH
1
open access
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Correspondence to:
LLilmlee@vip.163.com
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Cite this as: BMJ ;:h
doi: 10.1136/bmj.h3942
Accepted: 8 July 2015
Consumption of spicy foods and total and cause specic
mortality: population based cohort study
Jun Lv,
1
Lu Qi,
2,
3
Canqing Yu,
1
Ling Yang,
4
Yu Guo,
5
Yiping Chen,
4
Zheng Bian,
5
Dianjianyi Sun,
1
Jianwei Du,
6
Pengfei Ge,
7
Zhenzhu Tang,
8
Wei Hou,
9
Yanjie Li,
10
Junshi Chen,
11
Zhengming Chen,
4
Liming Li
1
5
on behalf of the China Kadoorie Biobank collaborative group
ABSTRACT
OBJECTIVE
To examine the associations between the regular
consumption of spicy foods and total and cause
specic mortality.
DESIGN
Population based prospective cohort study.
SETTING
China Kadoorie Biobank in which participants from 10
geographically diverse areas across China were
enrolled between 2004 and 2008.
PARTICIPANTS
199 293 men and 288 082 women aged 30 to 79 years
at baseline aer excluding participants with cancer,
heart disease, and stroke at baseline.
MAIN EXPOSURE MEASURES
Consumption frequency of spicy foods, self reported
once at baseline.
MAIN OUTCOME MEASURES
Total and cause specic mortality.
RESULTS
During 3 500 004 person years of follow-up between
2004 and 2013 (median 7.2 years), a total of 11 820 men
and 8404 women died. Absolute mortality rates
according to spicy food consumption categories were
6.1, 4.4, 4.3, and 5.8 deaths per 1000 person years for
participants who ate spicy foods less than once a week,
1 or 2, 3 to 5, and 6 or 7 days a week, respectively. Spicy
food consumption showed highly consistent inverse
associations with total mortality among both men and
women aer adjustment for other known or potential
risk factors. In the whole cohort, compared with those
who ate spicy foods less than once a week, the
adjusted hazard ratios for death were 0.90 (95%
condence interval 0.84 to 0.96), 0.86 (0.80 to 0.92),
and 0.86 (0.82 to 0.90) for those who ate spicy food 1
or 2, 3 to 5, and 6 or 7 days a week, respectively.
Compared with those who ate spicy foods less than
once a week, those who consumed spicy foods 6 or 7
days a week showed a 14% relative risk reduction in
total mortality. The inverse association between spicy
food consumption and total mortality was stronger in
those who did not consume alcohol than those who did
(P=0.033 for interaction). Inverse associations were
also observed for deaths due to cancer, ischemic heart
diseases, and respiratory diseases.
CONCLUSION
In this large prospective study, the habitual
consumption of spicy foods was inversely associated
with total and certain cause specic mortality,
independent of other risk factors of death.
Introduction
Spices have been an integral part of culinary cultures
around the world and have a long history of use for
flavoring, coloring, and preserving food, as well as for
medicinal purposes. The increased use of spices as
flavorings in foods is a major trend worldwide.
1
2
In
China, chilli pepper is among the most popular spicy
foods consumed nationwide.
3
The beneficial eects of spices and their bioactive
ingredients such as capsaicin have long been docu
-
mented in experimental or small sized population stud-
ies. For example, an ecological study showed that
populations with a higher consumption of spices have a
lower incidence of cancer.
4
The ingestion of red pepper
was found to decrease appetite and energy intake in peo
-
ple of Asian origin and white people and might reduce
the risk of overweight and obesity.
5
6
In addition, the bio-
active agents in spices have also shown beneficial roles
in obesity, cardiovascular and gastrointestinal condi
-
tions, various cancers, neurogenic bladder, and derma-
tological conditions.
7-9
Moreover, spices exhibit
antibacterial activity and aect gut microbiota popula
-
tions, which in humans have been recently related to
risks of diabetes, cardiovascular disease, liver cirrhosis,
and cancer.
10-12
These data collectively suggest that spices
may have a profound influence on morbidities and mor
-
tality in humans; however, the evidence relating daily
consumption of spicy foods and total and disease spe
-
cific mortality from population studies is lacking.
We prospectively examined the associations of the
regular consumption of spicy foods in a daily diet with
total and cause specific mortality in the China Kadoorie
Biobank (CKB) study of 0.5 million adults.
13
14
Methods
Study population
The China Kadoorie Biobank is a prospective cohort
study of over 0.5 million adults from 10 geographically
WHAT IS ALREADY KNOWN ON THIS TOPIC
A benecial role of spices and their major bioactive components has been reported
in a variety of chronic disorders in experimental and small sized population studies
Evidence relating daily consumption of spicy foods to mortality from prospective
cohort studies is lacking
WHAT THIS STUDY ADDS
The habitual consumption of spicy foods was inversely associated with total and
certain cause specic mortality (cancer, ischemic heart diseases, and respiratory
diseases), independent of other risk factors of death
doi: 10.1136/bmj.h3942
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2015;351:h3942thebmj
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diverse areas across China; participants were enrolled
between 2004 and 2008 and have been followed up
ever since for morbidities and mortality. Further details
of the China Kadoorie Biobank study have been
described elsewhere.
13
14
Briefly, a total of 512 891 adults
aged 30-79 years had valid baseline data—that is,
completed questionnaire, physical measurements, and
a written informed consent form.
In the present study we excluded 2577 people with
cancer, 15 472 with heart disease, and 8884 with stroke
at baseline, as well as three people with a recorded
implausible censoring date for loss to follow-up. The
final analyses included 199 293 men and 288 082
women. All participants provided information on spicy
food consumption. All gave informed consent before
taking part.
Patient involvement
There was no patient involvement in this study.
Assessment of spicy food consumption
In the baseline questionnaire we asked the partici-
pants “During the past month, about how often did you
eat hot spicy foods?”: never or almost never, only occa
-
sionally, 1 or 2 days a week, 3 to 5 days a week, or 6 or 7
days a week. The participants who selected the last
three categories were further asked “When you eat
spicy foods, what are the main sources of spices usu
-
ally used?” (multiple choices allowed fresh chilli pep-
per, dried chilli pepper, chilli sauce, chilli oil, and
other or don’t know).
After completion of the baseline survey in July
2008, about 5% randomly chosen surviving partici
-
pants in 10 survey sites were resurveyed during
August and October of 2008.
14
To test the reproduc-
ibility of the frequency of spicy food consumption, we
included 1300 participants who completed the same
questionnaire twice at an interval of less than
1.5years (median 1.4 years). Spearman’s coecient
for the correlation between the two questionnaires
was 0.71, indicating that spicy food consumption was
reported consistently.
Assessment of covariates
We obtained covariates from the baseline question-
naire, including sociodemographic characteristics (age,
sex, education, occupation, household income, and
marital status), lifestyle behaviors (alcohol consump
-
tion, tobacco smoking, physical activity, and intakes of
red meat, fresh fruits, and vegetables), personal health
and medical history (hypertension, diabetes, chronic
hepatitis or cirrhosis, peptic ulcer, gallstones or chole
-
cystitis, and menopausal status for women only), and
information on family members, including biological
parents and siblings who had had cancer, heart attack,
stroke, or diabetes. The daily level of physical activity
was calculated by multiplying the metabolic equivalent
tasks (METs) value for a particular type of physical
activity by hours spent on that activity per day and
summing the MET hours for all activities. Habitual
dietary intake in the past year was assessed by a
qualitative food frequency questionnaire. A participant
was considered as having a family history of a particu
-
lar disease if they reported at least one first degree rela-
tive with the disease.
At baseline, trained sta measured body weight,
height, and blood pressure using calibrated instru
-
ments. Body mass index was calculated as weight (kg)/
(height (m)
2
. A stepwise on-site testing of plasma glu-
cose level was undertaken using the SureStep Plus
meter (LifeScan; Milpitas, CA). Prevalent hypertension
was defined as a measured systolic blood pressure of
140 mm Hg or more, a measured diastolic blood pres
-
sure of 90 mm Hg or more, self reported diagnosis of
hypertension, or self reported use of antihypertensive
drugs at baseline. Prevalent diabetes was defined as a
measured fasting blood glucose concentration of 7.0
mmol/L or more, a measured random blood glucose
concentration of 11.1 mmol/L or more, or self reported
diagnosis of diabetes.
Ascertainment of deaths
We ascertained vital status by means of linkage with
local disease surveillance points system death regis
-
tries
15
and residential records. To minimize the
under-reporting of deaths and to identify participants
who had moved permanently out of the study areas,
we also carried out separate active follow-up annually
by reviewing residential records, visiting local com
-
munities, or directly contacting participants.
14
The
causes of death were sought chiefly from ocial death
certificates that were supplemented, if necessary, by a
review of the medical records or undertaking a verbal
autopsy using a validated instrument for those with
an ill defined or unknown cause of death reported.
The electronic linkage to the national health insur
-
ance claim databases started in 2011, which has
become an important means of follow-up and helped
to improve the accuracy of diagnosis and phenotyp
-
ing of reported conditions, outcome adjudication,
and further data collection. Linkage to local health
insurance databases has been achieved for about 95%
of the participants in 2013. Participants from both
urban and rural areas had similar proportions of suc
-
cessful linkage to health insurance databases. Link-
age to local health insurance database was renewed
annually. Participants who failed to be linked to local
health insurance database were actively followed
annually by sta to ascertain their status, including
hospital admission, death, and moving out of the
study area. Linkage to a local health insurance data
-
base has become an important supplementary way of
ascertaining deaths.
Trained sta blinded to baseline information clas
-
sified any deaths occurring among participants by
using ICD-10 codes (international classification of
diseases, 10th revision). The deaths were grouped
into seven categories: cancer (C00-C97), ischemic
heart diseases (I20-I25), cerebrovascular diseases
(I60-I69), diabetes mellitus (E10-E14), diseases of the
respiratory system (J00-J99), infections (A00-B99),
and all other causes. Losses to follow-up in this study
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refer to participants whose permanent registered res-
idence was no longer in the study area, who could not
be contacted after at least three reasonable eorts
within one year, or who could be contacted but their
new residence was out of the jurisdiction of the
regional coordinating center.
Statistical analysis
We measured person years from baseline (2004–08)
until the date of death, loss to follow-up, or 31 Decem
-
ber 2013, whichever occurred first. Cox proportional
hazards regression models were used to estimate the
hazard ratios and 95% confidence intervals of mortality
for spicy food consumption, with age as the underlying
time scale. We accounted for the group specific eect of
10 survey sites on the hazard function by stratifying on
the survey site variable in the Cox model.
Multivariate models were adjusted for established
and potential risk factors for death: age (continuous,
serving as the underlying timescale); sex (male or
female); level of education (no formal school, pri
-
mary school, middle school, high school, college, or
university or higher); marital status (married, wid
-
owed, divorced or separated, or never married); alco-
hol consumption (non-drinker, occasional drinker,
former drinker, or regular drinker); smoking status
(never smoker, occasional smoker, former smoker, or
regular smoker); physical activity in MET hours a day
(continuous); body mass index (continuous); intake
frequencies of red meat, fresh fruits, and vegetables
(daily, 4-6 days/wk, 1-3 days/wk, monthly, or rarely or
never); prevalent hypertension and diabetes at base
-
line (presence or absence); menopausal status (for
women only, premenopausal, perimenopausal, or
postmenopausal); and status of family history of can
-
cer, heart attack, stroke, or diabetes (presence or
absence). We adjusted for the family history variables
only in the corresponding analysis of cause specific
mortality.
To examine the robustness of our findings, we also
conducted several sensitivity analyses: additionally
adjusting for occupation and household income; addi
-
tionally adjusting for histories of chronic hepatitis or
cirrhosis, peptic ulcer, and gallstone or cholecystitis;
adjusting for a 13 level detailed smoking variable,
which incorporated the information on amount of
smoking in regular smokers and the time since quitting
in former smokers, instead of a four level smoking vari
-
able; excluding participants dying during the first two
years of follow-up; excluding participants who had
diabetes at baseline; excluding participants who
reported exclusive use of other spices instead of any
types of chilli; stratifying analyses by rural or urban
residence; and stratifying analyses by follow-up dura
-
tion (<3 or 3 years).
Subgroup analyses were conducted separately
among participants who did and did not report fresh
chilli pepper as one of their commonly used spices. We
compared both with those who ate spicy foods less than
once a week. We also examined the associations of
spicy food consumption with total mortality among
prespecified baseline subgroups based on age (<50, 50
to 59, or 60), smoking status (regular smoker, or not),
alcohol consumption (regular drinker, or not), level of
physical activity (categorized using tertile cut-os), and
body mass index (<24.0, 24.0 to 27.9, or 28.0). The tests
for interaction were performed by means of likelihood
ratio tests, which involved comparing models with and
without cross product terms between the baseline strat
-
ifying variable and spicy food consumption as an ordi-
nal variable.
The statistical analyses were performed with Stata
(version 13.1, Stata). All P values were two sided, and we
defined statistical significance as P<0.05.
Results
Spicy food consumption and lifestyle and dietary
factors
Table 1 presents the age and site adjusted baseline
characteristics of the participants according to the cat
-
egories of spicy food consumption. Compared with
participants who consumed spicy foods less fre
-
quently (3 to 5 days a week or less), those who con-
sumed spicy foods almost every day were more likely
to be rural residents, more likely to smoke tobacco and
consume alcohol, and more frequently to consume red
meat, vegetables, and fruits. Fresh and dried chilli
peppers were the most commonly used types of spices
in those who reported consuming spicy foods weekly
(table 1).
Spicy food consumption and total mortality
During a median follow-up of 7.2 years (interquartile
range 1.84 years; total person years 3 500 004), we doc
-
umented 11 820 deaths among men and 8404 deaths
among women. Absolute mortality rates according to
spicy food consumption categories were 6.1, 4.4, 4.3,
and 5.8 deaths per 1000 person years for participants
who ate spicy foods less than once a week and 1 or 2, 3
to 5, and 6 or 7 days a week, respectively. Age adjusted
and multivariate adjusted analyses showed a statisti
-
cally significant inverse association between spicy
food consumption and total mortality. In the whole
cohort, compared with participants who ate spicy
foods less than once a week, the adjusted hazard ratios
for death were 0.90 (95% confidence interval 0.84 to
0.96) for those who ate spicy foods 1 or 2 days a week,
0.86 (0.80 to 0.92) for 3 to 5 days a week, and 0.86 (0.82
to 0.90) for 6 or 7 days a week (table 2 ). Compared with
participants who ate spicy foods less than once a week,
those who consumed spicy foods 6 or 7 days a week
showed a 14% relative risk reduction in total mortality.
The multivariate adjusted hazard ratios for total mor
-
tality among men, compared with men who ate spicy
foods less than once a week, were 0.90 (0.83 to 0.98) for
those who ate spicy food 1 or 2 days a week, 0.90 (0.83
to 0.99) for 3 to 5 days, and 0.90 (0.85 to 0.96) for 6 or
7 days a week; the respective hazard ratios among
women were 0.88 (0.79 to 0.98), 0.78 (0.69 to 0.88), and
0.81 (0.75 to 0.87) (table 3). There was no heterogeneity
between men and women in any of the associations
(P=0.723).
doi: 10.1136/bmj.h3942
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Spicy food consumption and cause specic
mortality
After multivariate adjustment, spicy food consump-
tion was inversely associated with the risks of death
due to cancer, ischemic heart diseases, and respira
-
tory diseases in the whole cohort (table 2). No statisti-
cally significant heterogeneity was observed in the
associations between spicy food consumption and
cause specific mortality by sex (all P>0.05). Neverthe
-
less, the associations seemed to be less evident in
men than in women (table 3). In addition, more fre
-
quent consumption of spicy foods in women was also
significantly associated with a reduced risk of death
due to infections.
Sensitivity analyses
In the sensitivity analyses, the associations of spicy
food consumption with total and cause specific mortal
-
ity did not change appreciably with additional adjust-
ment for occupation and household income; or
additional adjustment for histories of chronic hepatitis
or cirrhosis, peptic ulcer, and gallstone or cholecystitis;
or adjustment for a 13 level detailed smoking variable
instead of a four level smoking variable; or excluding
participants dying during the first two years of fol
-
low-up; or excluding participants with prevalent diabe-
tes at baseline; or excluding participants with exclusive
use of other spices instead of any types of chilli (data
not shown). The associations of spicy food consump
-
tion with total and cause specific mortality were consis-
tently observed in participants from both rural and
urban areas and for dierent follow-up durations (<3 or
3 years).
Subgroup analyses
We further performed stratified analyses according to
whether the participants reported using fresh chilli
pepper as their predominant spice. We found that the
inverse associations of daily spicy food consumption
with death due to cancer, ischemic heart diseases, and
diabetes seemed stronger in the fresh chilli group than
in the non-fresh chilli group in the whole cohort of
women and men, and the results were statistically sig
-
nificant in the fresh chilli group (fig 1 and appendix
table 1).
We also analyzed the associations between spicy
food consumption and total mortality according to
other potential baseline risk factors for death; the
Table  | Baseline characteristics of the study participants according to weekly spicy food consumption. Values are numbers (percentages) of
participants unless stated otherwise
Characteristics
Men (n=  ) Women (n= )
Less than
once a week  or  days - days  or  days
Less than
once a week  or  days - days  or  days
No of participants 110 995 14 217 12 732 61 349 167 496 17 523 15 817 87 246
Mean age (years) 52.9 49.3 49.2 51.1 51.9 48.1 48.1 48.8
Rural area 53 076 (47.8) 5847 (41.2) 5089 (40.0) 50 360 (82.1) 76 404 (46.0) 7588 (42.7) 6889 (43.0) 71 982 (82.3)
Married 103 512 (92.6) 13 387 (93.0) 11 998 (93.2) 56 406 (93.4) 147 937 (89.3) 15 780 (88.7) 14 258 (88.7) 79 663 (90.0)
Middle school and higher 65 920 (56.5) 9491 (59.6) 8640 (59.9) 31 102 (59.0) 71 789 (41.5) 9238 (45.5) 8573 (46.8) 34 921 (45.3)
Mean body mass index 23.2 23.5 23.6 23.6 23.6 23.7 23.9 24.1
Diabetes 6483 (5.1) 761 (5.1) 669 (5.0) 2226 (5.1) 10 842 (5.5) 862 (5.5) 765 (5.5) 3554 (5.7)
Hypertension 43 038 (34.7) 5074 (37.1) 4431 (37.2) 19 031 (37.9) 59 239 (31.8) 4777 (31.7) 4216 (31.7) 24 532 (33.2)
Postmenopausal 93 125 (51.2) 7254 (50.7) 6485 (50.2) 39 292 (50.0)
Family medical history:
Cancer 24 557 (19.7) 2941 (20.2) 2675 (20.9) 9827 (20.7) 35 063 (18.5) 3372 (19.1) 3184 (20.3) 12 440 (19.0)
Stroke 24 243 (20.3) 3014 (20.5) 3003 (22.7) 11 402 (21.9) 34 886 (19.2) 3682 (20.3) 3621 (22.1) 15 022 (20.9)
Heart attack 7259 (6.3) 911 (6.4) 833 (6.5) 4093 (7.1) 9798 (5.5) 1047 (5.8) 1050 (6.4) 4608 (6.2)
Diabetes 11 620 (9.7) 1571 (10.2) 1416 (10.3) 5252 (10.5) 17 427 (9.2) 2033 (10.7) 1882 (11.1) 6400 (10.1)
Regular smoker 62 767 (57.0) 9255 (63.1) 8534 (65.6) 43 225 (70.4) 2715 (1.8) 383 (2.1) 444 (2.7) 3048 (3.0)
Regular drinker 33 788 (27.0) 5778 (36.6) 5588 (40.6) 22 486 (47.2) 2171 (1.2) 444 (2.3) 500 (2.9) 2888 (3.8)
Mean physical activity (MET h/day) 22.6 22.3 22.6 22.7 20.6 20.9 21.2 21.1
Average weekly consumption*:
Red meat (day) 3.8 3.9 3.9 4.2 3.4 3.4 3.5 3.7
Fresh vegetables (day) 6.8 6.5 6.7 7.0 6.8 6.4 6.7 7.0
Fresh fruits (day) 2.0 2.0 1.9 2.2 2.4 2.6 2.5 2.9
Commonly used types of spices†:
Fresh chilli pepper 8904 (76.3) 8743 (79.4) 54 546 (84.4) 10 745 (73.4) 10 768 (77.3) 76 819 (84.9)
Dried chilli pepper 5852 (55.8) 6223 (62.5) 48 486 (75.4) 6067 (50.0) 7082 (58.3) 67 372 (74.2)
Chilli sauce 6106 (39.2) 5921 (40.9) 25 406 (44.7) 7609 (40.2) 7278 (41.6) 37 621 (45.6)
Chilli oil 6959 (40.5) 6923 (42.6) 25 160 (46.2) 8553 (41.1) 8517 (43.5) 38 226 (47.8)
Other or don’t know 3735 (18.7) 3375 (19.6) 13 886 (27.0) 4176 (16.9) 374 6 (17.5) 20 091 (26.7)
MET=metabolic equivalent of task.
All variables were adjusted for age and survey sites, as appropriate. All exposures were associated with spicy food consumption, with P<0.001 for trends across categories, except for diabetes
(men: P= 0.872; women: P=0.186), family history of cancer in women (P= 0.002), and physical activity in men (P=0.546). Tests for linear trend across categories were performed by assigning the
midpoint values of each spicy food consumption category and treating the variable as continuous in a separate regression model.
*Average weekly consumptions of red meat, fresh vegetables, and fruits were calculated by assigning participants to the midpoint of their consumption category.
†Among those eating spicy foods at least once a week.
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5
inverse associations between spicy food consumption
and total mortality were generally similar across sub
-
groups stratified according to age, smoking status,
level of physical activity, and body mass index (all P
values for interaction >0.05) (fig 2 and appendix
table2). Significant dierences across stratums were
observed for alcohol consumption, with a stronger
inverse association among participants who did not
consume alcohol than those who did (P=0.033 for
interaction).
Discussion
In this large prospective study, we observed an inverse
association between consumption of spicy foods and
total mortality, after adjusting for potential confound
-
ers. Compared with those who ate spicy foods less than
once a week, those who consumed spicy foods almost
every day had a 14% lower risk of death. Inverse associ
-
ations were also observed for deaths due to cancer,
ischemic heart diseases, and respiratory diseases. The
associations were consistent in men and women.
Table  |Association of weekly spicy food consumption with total and cause specic mortality among  participants. Values are hazard ratios
(% CIs) unless stated otherwise
Cause of death No of participants
Frequency of spicy food consumption
Less than once a week*  or  days - days  or  days
No of participants 487375 278491 31740 28549 148595
No of person years 3500004 1990589 228112 204972 1076330
All causes:
No of deaths† 20224 12145 1014 876 6189
Model 1 1.00 0.90 (0.84 to 0.96) 0.85 (0.79 to 0.91) 0.83 (0.79 to 0.86)
Model 2 1.00 0.89 (0.83 to 0.95) 0.84 (0.79 to 0.90) 0.82 (0.79 to 0.86)
Model 3 1.00 0.90 (0.84 to 0.96) 0.86 (0.80 to 0.92) 0.86 (0.82 to 0.90)
Cancer:
No of deaths† 7256 4636 378 349 1893
Model 1 1.00 0.96 (0.86 to 1.07) 1.01 (0.90 to 1.13) 0.95 (0.88 to 1.03)
Model 2 1.00 0.91 (0.81 to 1.01) 0.95 (0.85 to 1.06) 0.89 (0.83 to 0.96)
Model 3 1.00 0.92 (0.83 to 1.03) 0.97 (0.87 to 1.08) 0.92 (0.85 to 0.99)
Ischemic heart diseases:
No of deaths† 2302 1406 109 93 694
Model 1 1.00 0.83 (0.68 to 1.01) 0.75 (0.60 to 0.93) 0.73 (0.64 to 0.84)
Model 2 1.00 0.84 (0.69 to 1.03) 0.76 (0.61 to 0.94) 0.75 (0.65 to 0.86)
Model 3 1.00 0.82 (0.67 to 1.00) 0.75 (0.61 to 0.94) 0.78 (0.67 to 0.89)
Cerebrovascular diseases:
No of deaths† 4024 2217 215 170 1422
Model 1 1.00 1.01 (0.88 to 1.17) 0.84 (0.72 to 0.99) 0.92 (0.83 to 1.01)
Model 2 1.00 1.03 (0.89 to 1.19) 0.86 (0.73 to 1.01) 0.94 (0.85 to 1.04)
Model 3 1.00 1.03 (0.89 to 1.20) 0.86 (0.73 to 1.01) 0.96 (0.87 to 1.07)
Diabetes:
No of deaths† 569 328 30 17 194
Model 1 1.00 0.77 (0.52 to 1.13) 0.46 (0.28 to 0.75) 0.59 (0.46 to 0.76)
Model 2 1.00 0.87 (0.59 to 1.27) 0.52 (0.32 to 0.86) 0.70 (0.55 to 0.90)
Model 3 1.00 0.94 (0.64 to 1.40) 0.60 (0.36 to 0.99) 0.82 (0.63 to 1.05)
Respiratory diseases:
No of deaths† 1996 1203 77 70 646
Model 1 1.00 0.60 (0.48 to 0.76) 0.59 (0.46 to 0.76) 0.57 (0.50 to 0.66)
Model 2 1.00 0.64 (0.51 to 0.81) 0.62 (0.49 to 0.80) 0.63 (0.55 to 0.72)
Model 3 1.00 0.67 (0.53 to 0.85) 0.65 (0.51 to 0.83) 0.71 (0.62 to 0.81)
Infections:
No of deaths† 336 187 20 15 114
Model 1 1.00 0.87 (0.54 to 1.39) 0.68 (0.40 to 1.17) 0.71 (0.51 to 0.98)
Model 2 1.00 0.90 (0.56 to 1.45) 0.72 (0.42 to 1.23) 0.77 (0.55 to 1.06)
Model 3 1.00 0.91 (0.56 to 1.48) 0.74 (0.43 to 1.28) 0.83 (0.60 to 1.15)
All other causes:
No of deaths† 3741 2168 185 162 1226
Model 1 1.00 0.90 (0.77 to 1.05) 0.89 (0.75 to 1.04) 0.81 (0.73 to 0.90)
Model 2 1.00 0.89 (0.76 to 1.04) 0.88 (0.75 to 1.04) 0.81 (0.73 to 0.91)
Model 3 1.00 0.89 (0.77 to 1.04) 0.89 (0.75 to 1.05) 0.86 (0.77 to 0.95)
Multivariate models were adjusted for: model 1: age (years); model 2: additionally included sex (male or female); level of education (no formal school, primary school, middle school, high
school, college, or university or higher); marital status (married, widowed, divorced or separated, or never married); alcohol consumption (non-drinker, occasional drinker, former drinker,
orregular drinker); smoking status (never smoker, occasional smoker, former smoker, or regular smoker); physical activity (MET (metabolic equivalent of task) h/day); model 3: additionally
included body mass index; intake frequencies of red meat, fruits, and vegetables (daily, 4 to 6 days/wk, 1 to 3 days/wk, monthly, or rarely or never); prevalent hypertension and diabetes at
baseline (presence or absence); and family history of cancer, heart attack, stroke, or diabetes (presence or absence, only adjusted for in corresponding analysis of cause specic mortality).
*Reference group.
†During follow-up.
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Table  |Association of weekly spicy food consumption with total and cause specic mortality by sex. Values are hazard ratios (% CIs) unless stated
otherwise
Cause of death
Frequency of spicy food consumption
Less than once a week*  or  days - days  or  days
Men
No of participants 110 995 14 217 12 732 61 349
No of person years 783 656 101 892 90 478 440 002
All causes:
No of deaths† 6872 606 545 3797
Multivariate adjusted hazard ratio (95% CI) 1.00 0.90 (0.83 to 0.98) 0.90 (0.83 to 0.99) 0.90 (0.85 to 0.96)
Cancer:
No of deaths† 2769 230 236 1188
Multivariate adjusted hazard ratio (95% CI) 1.00 0.88 (0.77 to 1.01) 1.05 (0.92 to 1.21) 0.94 (0.85 to 1.04)
Ischemic heart diseases:
No of deaths† 745 66 60 417
Multivariate adjusted hazard ratio (95% CI) 1.00 0.87 (0.67 to 1.13) 0.85 (0.65 to 1.11) 0.85 (0.70 to 1.02)
Cerebrovascular diseases:
No of deaths† 1199 117 85 821
Multivariate adjusted hazard ratio (95% CI) 1.00 1.00 (0.82 to 1.22) 0.77 (0.62 to 0.97) 0.95 (0.83 to 1.09)
Diabetes:
No of deaths† 116 13 7 95
Multivariate adjusted hazard ratio (95% CI) 1.00 1.10 (0.60 to 2.01) 0.71 (0.33 to 1.55) 0.99 (0.67 to 1.46)
Respiratory diseases:
No of deaths† 706 51 38 422
Multivariate adjusted hazard ratio (95% CI) 1.00 0.79 (0.59 to 1.06) 0.61 (0.44 to 0.86) 0.81 (0.67 to 0.97)
Infections:
No of deaths† 116 13 11 82
Multivariate adjusted hazard ratio (95% CI) 1.00 0.91 (0.50 to 1.65) 0.83 (0.44 to 1.58) 0.99 (0.67 to 1.48)
All other causes:
No of deaths† 1221 116 108 772
Multivariate adjusted hazard ratio (95% CI) 1.00 0.92 (0.75 to 1.11) 0.97 (0.79 to 1.19) 0.89 (0.78 to 1.03)
Women
No of participants 167 496 17 523 15 817 87 246
No of person years 1 206 933 126 220 114 494 636 329
All causes:
No of deaths† 5273 408 331 2392
Multivariate adjusted hazard ratio (95% CI) 1.00 0.88 (0.79 to 0.98) 0.78 (0.69 to 0.88) 0.81 (0.75 to 0.87)
Cancer:
No of deaths† 1867 148 113 705
Multivariate adjusted hazard ratio (95% CI) 1.00 0.97 (0.82 to 1.15) 0.82 (0.68 to 1.00) 0.87 (0.77 to 0.99)
Ischemic heart diseases:
No of deaths† 661 43 33 277
Multivariate adjusted hazard ratio (95% CI) 1.00 0.74 (0.54 to 1.02) 0.63 (0.44 to 0.90) 0.70 (0.56 to 0.86)
Cerebrovascular diseases:
No of deaths† 1018 98 85 601
Multivariate adjusted hazard ratio (95% CI) 1.00 1.08 (0.87 to 1.34) 0.96 (0.76 to 1.21) 0.98 (0.85 to 1.14)
Diabetes:
No of deaths† 212 17 10 99
Multivariate adjusted hazard ratio (95% CI) 1.00 0.87 (0.52 to 1.46) 0.54 (0.28 to 1.04) 0.72 (0.52 to 1.01)
Respiratory diseases:
No of deaths† 497 26 32 224
Multivariate adjusted hazard ratio (95% CI) 1.00 0.51 (0.34 to 0.76) 0.69 (0.48 to 1.00) 0.62 (0.51 to 0.76)
Infections:
No of deaths† 71 7 4 32
Multivariate adjusted hazard ratio (95% CI) 1.00 0.86 (0.38 to 1.96) 0.55 (0.19 to 1.56) 0.55 (0.31 to 0.99)
All other causes:
No of deaths† 947 69 54 454
Multivariate adjusted hazard ratio (95% CI) 1.00 0.85 (0.66 to 1.10) 0.76 (0.58 to 1.02) 0.82 (0.69 to 0.96)
Multivariate models were adjusted for several baseline factors: age (years); level of education (no formal school, primary school, middle school, high school, college, or university or higher);
marital status (married, widowed, divorced or separated, or never married); alcohol consumption (non-drinker, occasional drinker, former drinker, or regular drinker); smoking status (never
smoker, occasional smoker, former smoker, or regular smoker); physical activity (MET (metabolic equivalent of task) h/day); body mass index; intake frequencies of red meat, fruits, and
vegetables (daily, 4 to 6 days/wk, 1 to 3 days/wk, monthly, or rarely/never); prevalent hypertension and diabetes at baseline (presence or absence); family history of cancer, heart attack, stroke,
or diabetes (presence or absence, only adjusted for in corresponding analysis of cause specic mortality); and menopausal status (premenopausal, perimenopausal, or postmenopausal, for
women only).
*Reference group.
†During follow-up.
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7
Strengths and limitations of this study
The strengths of this study include a large sample size,
a prospective cohort design, and careful control for
established and potential risk factors for death. This
study does have a few limitations. Consumption of
spicy foods may be correlated with other dietary habits
and lifestyle behaviors. For example, in Chinese cui
-
sine the cooking of chilli pepper and the production of
chilli sauce and oil usually requires more oil, and
intake of pungent foods may be accompanied by an
increased intake of carbohydrate-rich foods such as
rice to relieve the burning sensation. However, the lack
of detailed dietary information in this study limited our
ability to comprehensively adjust for total energy
intake and other specific dietary factors. In addition,
spicy food consumption may be correlated with socio
-
economic status,
16
which we partly controlled for in
our analyses. Residual confounding by other unmea
-
sured or unknown biological and social factors was
still possible, although we carefully adjusted for sev
-
eral established and potential risk factors for death.
However, residual confounding by the aforementioned
or other confounding factors might have attenuated
the inverse associations between spicy food consump
-
tion and mortality toward the null. Although chilli pep-
per was the most commonly used spice in our
population, the use of other types of spices usually
increases as the use of chilli pepper increases. Thus the
health benefits of these spices apart from chilli pepper
may also contribute to the observed inverse associa
-
tions. Reverse causality is another possible explana-
tion for our findings because people with chronic
disease might abstain from spicy foods. However, we
excluded participants who had cancer, heart disease,
or stroke at baseline. Moreover, the results remained
largely unchanged when we excluded participants
dying during the first two years of follow-up from anal
-
yses or additionally adjusted for several major diges-
tive system diseases that might deter people from
consuming spicy foods.
Although we employed multiple ways to maximize
death ascertainment of participants, under-reporting
All causes
Any type
Fresh chilli pepper
Non-fresh chilli pepper
Cancer
Any type
Fresh chilli pepper
Non-fresh chilli pepper
Ischemic heart diseases
Any type
Fresh chilli pepper
Non-fresh chilli pepper
Cerebrovascular diseases
Any type
Fresh chilli pepper
Non-fresh chilli pepper
Diabetes
Any type
Fresh chilli pepper
Non-fresh chilli pepper
Respiratory diseases
Any type
Fresh chilli pepper
Non-fresh chilli pepper
Infections
Any type
Fresh chilli pepper
Non-fresh chilli pepper
All other causes
Any type
Fresh chilli pepper
Non-fresh chilli pepper
0.86 (0.82 to 0.90)
0.84 (0.80 to 0.88)
0.89 (0.82 to 0.96)
0.92 (0.85 to 0.99)
0.89 (0.81 to 0.97)
0.99 (0.87 to 1.12)
0.78 (0.67 to 0.89)
0.75 (0.65 to 0.88)
0.84 (0.65 to 1.09)
0.96 (0.87 to 1.07)
0.97 (0.86 to 1.08)
0.97 (0.82 to 1.15)
0.82 (0.63 to 1.05)
0.70 (0.53 to 0.94)
1.02 (0.70 to 1.47)
0.71 (0.62 to 0.81)
0.70 (0.60 to 0.81)
0.68 (0.55 to 0.85)
0.83 (0.60 to 1.15)
0.88 (0.62 to 1.25)
0.62 (0.32 to 1.20)
0.86 (0.77 to 0.95)
0.86 (0.76 to 0.96)
0.84 (0.70 to 1.01)
0.4 0.8 1 1.5 0.4 0.8 1 1.5 0.4 0.8 1 1.5
Hazard ratio
(95% CI)
Men WomenDeath by type of chilli pepper Total
Fig  | Subgroup analysis of associations between consumption of spicy foods  days a week and total and cause specic
mortality according to consumption of fresh chilli pepper. Hazard ratios for death from all causes and from specic causes
are for comparison of men and women who ate spicy foods  days a week with those who ate spicy foods less than once
a week. Appendix table  shows the risk estimates for other categories of spicy food consumption. Horizontal lines
represent % condence intervals
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8
of deaths might have occurred. However, the propor-
tion of participants under-reported on death status
would not depend on the levels of spicy food consump
-
tion. Considering that specificity of outcome detection
is nearly perfect and sensitivity is lower than 100% in
both exposure groups, outcome misclassification
would produce little bias in estimating hazard ratio.
17
The consumption of spicy foods was self reported;
therefore, some measurement error is inevitable. The
questionnaire on spicy food consumption used in our
study has not yet been validated directly; however, pre
-
vious studies have shown that using similar food fre-
quency questionnaires could produce valid estimates
of food consumption in a Chinese population.
18
In
addition, in a prospective study design, measurement
errors may be non-dierential and the measure of asso
-
ciation is more likely to be biased toward the null. The
consumption of spicy foods reported for a short period
may not necessarily reflect the long term patterns of
consumption. However, repeated collections of dietary
information averaged 1.4 years in our cohort and have
shown that the reported intakes of dietary factors
including spicy foods were highly consistent over time.
In addition, information was not available on how
spicy foods were prepared and cooked. Such informa
-
tion would have enabled us to perform further analyses
on the relation between spicy food consumption and
mortality more extensively.
Comparison with other studies and potential
mechanism
Our study is the first to analyze the association between
daily consumption of spicy foods and mortality in a
prospective cohort. Our findings are in line with previ
-
ous evidence showing potential protective eects of
spicy foods on human health. Capsaicin is the main
active component of chilli pepper. The beneficial roles
of capsaicin have been extensively reported in relation
to anti-obesity, antioxidant, anti-inflammatory, anti
-
cancer, and antihypertensive eects, and in improving
glucose homeostasis, largely in experimental or small
sized population studies.
7-9
Additionally, the antimi-
crobial function of spices, including chilli pepper, has
long been recognized,
3
19
and such a property may have
an important eect on the gut microbiota in humans.
In recent years, rapidly emerging evidence has impli
-
cated gut microbiota as a novel and important meta-
bolic factor that aects the health of the host,
20
and
several studies in humans have related abundance,
composition, and metabolites of gut microbiota to risk
of obesity,
21
22
23
diabetes,
12
24
liver cirrhosis,
11
and car-
diovascular disease.
10
25
However, how spicy foods and
their bioactive ingredients may aect the composition
and activity of gut microbiota has yet to be further
investigated. In addition, our study suggested a thresh
-
old of around 1 or 2 days a week of spicy food consump-
tion, beyond which the risk for mortality did not
decrease further. Possible mechanisms might involve
the bioaccessibility and bioavailability of bioactive
ingredients and nutrients of spicy foods
26
; but further
studies are needed to verify our findings. Our study
indicated that spicy food consumption was particu
-
larly related to the reduced risk of mortality due to can-
cer, ischemic heart diseases, and respiratory diseases.
Several previous epidemiological studies have suggested
protective eects of capsaicin consumption on stomach
or gallbladder cancer,
7
9
27
although such eects were not
consistently observed. The cardiovascular system is
All
Age at baseline
<50 years
50 to <60 years
≥60 years
Smoking status
Not current
Current
Alcohol consumption
Not current
Current
Physical activity (MET h/day)
<12.29
12.29 to <25.31
≥25.31
Body mass index
<24
24-<28
≥28
0.708
0.814
0.033
0.258
0.510
0.50.8 11.2
P value for
interaction
Subgroup
Total
0.477
0.807
0.514
0.221
0.522
0.50.8 11.2
P value for
interaction
Women
0.500
0.195
0.050
0.527
0.742
0.50.8 11.2
P value for
interaction
Men
Fig  | Subgroup analysis of associations between consumption of spicy foods  days a week and total mortality
according to potential baseline risk factors. Hazard ratios for total mortality are for comparison of men and women who
ate spicy foods  days a week with those who ate spicy foods less than once a week. Risk estimates for other categories
of spicy food consumption are shown in appendix table . Horizontal lines represent % condence intervals
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RESEARCH
9
richin capsaicin sensitive sensory nerves, which have
an extensive role in regulating cardiovascular func
-
tion.
28
The antioxidant and antiplatelet properties of
capsaicin and the important role of capsaicin in regu
-
lating energy metabolism may also contribute to its
beneficial eects on the cardiovascular system.
7
9
28-32
Less well known are the possible mechanisms underly
-
ing the potentially beneficial eect of spicy foods on
respiratory diseases. However, the anti-obesity, antiox
-
idant, anti-inflammatory, and antihypertensive eects
of spicy foods would generally protect all these specific
systems. Because the number of deaths from infections
was relatively small, our study might not have had
enough statistical power to rule out a possible relation
between spicy food consumption and infections spe
-
cific mortality.
Compared with non-fresh spicy foods such as dried
chilli pepper, chilli sauce, or chilli oil, fresh chilli pep
-
per is richer in bioactive ingredients, including capsa-
icin, vitamin C, and other nutrients such as vitamin A,
K, and B6, and potassium. In our stratified analyses
we found that the inverse associations of spicy food
consumption with certain cause specific deaths (can
-
cer, ischemic heart disease, and diabetes) seemed to
be stronger in those who consumed fresh chilli pepper
than those who consumed non-fresh spicy foods.
These data suggest that some of the bioactive ingredi
-
ents are likely to be eective in driving the observed
associations. Interestingly, a statistically significant
inverse association between the daily consumption of
spicy foods and diabetes, which was not observed in
the whole cohort, was found in the subgroup that con
-
sumed fresh chilli pepper. This was consistent with
previous evidence showing that dietary capsaicin may
provide beneficial eects on glucose homeostasis.
33
However, it remains unclear whether other nutrients
abundant in fresh chilli pepper also have roles in low
-
ering the risk of mortality. Intriguingly, we found that
the inverse association was stronger in those who did
not than did drink alcohol. Alcohol consumption has
been related to an increased risk of mortality in some
but not all previous studies.
34-36
Even though moderate
alcohol consumption has been related to a reduced
risk of certain chronic diseases such as diabetes, mod
-
erately high alcohol consumption may increase energy
intake
37
and has been associated with increased mor-
tality.
38
In addition, alcohol intake also aects the
metabolism of gut microbiota.
39
40
Even though the
precise mechanism remains unclear, the interaction
between spicy foods and alcohol intake is biologically
possible. We acknowledge that disease status might
aect both alcohol and spicy food intakes, and we
excluded participants with chronic diseases such as
cancer, heart disease, or stroke at baseline from our
analyses. Further investigations are warranted to vali
-
date our findings and explore the mechanisms.
Conclusion
Our analyses showed significant inverse associations
between spicy food consumption and total and certain
cause specific mortality (cancer, ischemic heart
diseases, and respiratory diseases). None the less,
given the observational nature of this study, it is not
possible to make a causal inference. Further prospec
-
tive studies in other populations would be essential to
demonstrate generalizability of these findings. More
evidence will lead to updated dietary recommenda
-
tions and development of functional foods, such as
herbal supplements.
AUTHOR AFFILIATIONS
1
Department of Epidemiology and Biostatistics, School of Public Health,
Peking University Health Science Center, Beijing 100191, People’s
Republic of China
2
Department of Nutrition, Harvard School of Public Health, Boston,
MA, USA
3
Channing Division of Network Medicine, Department of Medicine,
Brigham and Women’s Hospital and Harvard Medical School, Boston,
MA, USA
4
Clinical Trial Service Unit and Epidemiological Studies Unit, Nueld
Department of Population Health, University of Oxford, UK
5
Chinese Academy of Medical Sciences, Beijing, People’s Republic
of China
6
Hainan Center for Disease Control and Prevention, Haikou, Hainan,
People’s Republic of China
7
Gansu Center for Disease Control and Prevention, Lanzhou, Gansu,
People’s Republic of China
8
Guangxi Center for Disease Control and Prevention, Liuzhou,
Guangxi, People’s Republic of China
9
Licang Center for Disease Control and Prevention, Qingdao,
Shandong, People’s Republic of China
10
Nangang Center for Disease Control and Prevention, Harbin,
Heilongjiang, People’s Republic of China
11
China National Center for Food Safety Risk Assessment, Beijing,
People’s Republic of China
We thank the participants, project sta, and China National Center for
Disease Control and Prevention (CDC) and its regional oces for
access to death and disease registries. The Chinese National Health
Insurance scheme provides electronic linkage to all hospital treatment.
China Kadoorie Biobank collaborative group: International
steering committee: Liming Li (PI), Junshi Chen, Rory Collins, Richard
Peto, Zhengming Chen (PI). Study coordinating centers: International
Co-ordinating Center, Oxford: Zhengming Chen, Garry Lancaster,
Xiaoming Yang, Alex Williams, Margaret Smith, Ling Yang, Yumei
Chang, Iona Millwood, Yiping Chen, Sarah Lewington. National
coordinating center, Beijing: Yu Guo, Jun Lv, Zheng Bian, Peng Liu,
Canqing Yu, Pei Pei, Huiyan Zhou, Yunlong Tan, Can Hou, Lei Guo,
Bingyang Han, Shuzhen Qu, Ge Chen. Regional coordinating centers,
10 areas in China: Qingdao CDC: Zengchang Pang, Shutao Pang,
Shaojie Wang, Yongmei Liu, Ranran Du, Yajing Zang, Liang Cheng.
Licang CDC: Silu Lv, Junzheng Wang, Wei Hou. Heilongjiang Provincial
CDC: Jiyuan Yin, Shumei Liu, Zhigang Pang, Xue Zhou, Huijun Wang.
Nangang CDC: Liqiu Yang, Bo Yu, Yanjie Li, Jing Qi, Huaiyi Mu, Qin’ai
Xu, Meiling Dou. Hainan Provincial CDC: Jianwei Du, Shanqing Wang,
Ximin Hu, Hongmei Wang, Jinyan Chen, Yan Fu, Zhenwang Fu,
Xiaohuan Wang, Hua Dong. Meilan CDC: Min Weng, Xiangyang Zheng,
Yijun Li, Huimei Li. Jiangsu Provincial CDC: Ming Wu, Jinyi Zhou, Ran
Tao, Jie Yang. Suzhou CDC: Jie Shen, Yihe Hu, Yan Lu, Yan Gao,
Liangcai Ma, Aiyu Tang, Shuo Zhang, Jianrong Jin. Guangxi Provincial
CDC: Zhenzhu Tang, Naying Chen, Ying Huang. Liuzhou CDC:
Mingqiang Li, Jinhuai Meng, Rong Pan, Qilian Jiang, Jingxin Qin,
Weiyuan Zhang, Yun Liu, Liuping Wei, Liyuan Zhou, Ningyu Chen, Jun
Yang, Hairong Guan. Sichuan Provincial CDC: Xianping Wu, Ningmei
Zhang, Xiaofang Chen, Xuefeng Tang. Pengzhou CDC: Guojin Luo,
Jianguo Li, Xiaofang Chen, Jian Wang, Jiaqiu Liu, Qiang Sun. Gansu
Provincial CDC: Pengfei Ge, Xiaolan Ren, Caixia Dong. Maiji CDC: Hui
Zhang, Enke Mao, Xiaoping Wang, Tao Wang. Henan Provincial CDC:
Guohua Liu, Baoyu Zhu, Gang Zhou, Shixian Feng, Liang Chang,
LeiFan. Huixian CDC: Yulian Gao, Tianyou He, Li Jiang, Huarong Sun,
Pan He, Chen Hu, Qiannan Lv, Xukui Zhang. Zhejiang Provincial CDC:
Min Yu, Ruying Hu, Le Fang, Hao Wang. Tongxiang CDC: Yijian Qian,
Chunmei Wang, Kaixu Xie, Lingli Chen, Yaxing Pan, Dongxia Pan.
Hunan Provincial CDC: Yuelong Huang, Biyun Chen, Donghui Jin,
Huilin Liu, Zhongxi Fu, Qiaohua Xu. Liuyang CDC: Xin Xu, Youping
Xiong, Weifang Jia, Xianzhi Li, Libo Zhang, Zhe Qiu.
RESEARCH
No commercial reuse: See rights and reprints http://www.bmj.com/permissions Subscribe: http://www.bmj.com/subscribe
Contributors: JL and LQ are joint rst authors. LL and ZC obtained
funding. LL, ZC, and JC designed the study. YG, ZB, JD, PG, ZT, WH, YL,
and ZC collected the data. LY and YC were involved in data cleaning,
mortality follow-up, and verication. JL, CY, and DS analyzed the data.
JL draed the manuscript. LQ and LL contributed to the interpretation
of the results and critical revision of the manuscript for important
intellectual content and approved the nal version of the manuscript.
All authors have read and approved the nal manuscript. LL and ZC
are the study guarantors.
Funding: This study was supported by grants from the National Natural
Science Foundation of China (81390541, 81390544), National Key
Technologies research and development programme in the 12th
ve-year plan, Chinese Ministry of Science and Technology
(2011BAI09B01, 2012-14), Wellcome Trust in the UK (088158/Z/09/Z),
and Kadoorie Charitable Foundation in Hong Kong. LQ is supported by
National Institutes of Health grants from the National Heart, Lung, and
Blood Institute (HL071981, HL034594, HL126024), National Institute of
Diabetes and Digestive and Kidney Diseases (DK091718, DK100383,
DK078616), Boston Obesity Nutrition Research Center (DK46200), and
United States-Israel Binational Science Foundation (grant 2011036). LQ
was a recipient of the American Heart Association scientist
development award (0730094N). The funders had no role in the study
design, data collection, data analysis and interpretation, writing of the
report, or the decision to submit the article for publication.
Competing interests: All authors have completed the ICMJE uniform
disclosure form at http://www.icmje.org/coi_disclosure.pdf and
declare: no support from any organization for the submitted work; no
nancial relationships with any organization that might have an
interest in the submitted work in the previous three years, no other
relationships or activities that could appear to have influenced the
submitted work.
Ethical approval: This study was approved by the ethical review
committee of the Chinese Center for Disease Control and Prevention
(Beijing, China) and the Oxford Tropical Research Ethics Committee,
University of Oxford (UK).
Data sharing: The access policy and procedures are available at www.
ckbiobank.org.
Transparency: The lead authors (LL and ZC) arm that the manuscript
is an honest, accurate, and transparent account of the study being
reported; that no important aspects of the study have been omitted;
and that any discrepancies are disclosed.
This is an Open Access article distributed in accordance with the terms
of the Creative Commons Attribution (CC BY 4.0) license, which
permits others to distribute, remix, adapt and build upon this work, for
commercial use, provided the original work is properly cited. See:
http://creativecommons.org/licenses/by/4.0/.
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Supplementary table 1: association of weekly spicy
food consumption with total and cause specific
mortality according to consumption of fresh chilli
pepper

Supplementary resource (1)

... Nonetheless, the mortality rate among chili-eaters (21.6%) was clearly superior to that (33.6%) of the non-eaters. The Chinese study [55] enrolled close to half-million people and reported BMI values (kg/m 2 ) of 23.2, 23.5, 23.6, and 23.6, respectively, in groups that consumed less than 1, 1 to 2, 3 to 5, or 6 to 7 weekly spice meals. Interestingly, this study also reported a health benefit for chili eaters, for example, lower cancer and ischemic heart disease rates. ...
... In conclusion, capsaicin effects on appetite are modest and their long-term influence on body weight is questionable. Indeed, no significant difference in BMI was found between chili-eaters and non-eaters [54,55]. ...
... Based on the available literature, one may conclude that spicy food (culinary capsaicin), though it may suppress appetite in the short run, does not protect against obesity in the long run. Indeed, two large epidemiological studies found no significant difference in BMI between chili eaters and non-eaters [54,55]. This is hardly unexpected since capsaicin effects are known to undergo desensitization upon repeated challenge [4,68]. ...
Article
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Medical management of obesity represents a large unmet clinical need. Animal experiments suggest a therapeutic potential for dietary capsaicin, the pungent ingredient in hot chili peppers, to lose weight. This is an attractive theory since capsaicin has been a culinary staple for thousands of years and is generally deemed safe when consumed in hedonically acceptable, restaurant-like doses. This review critically evaluates the available experimental and clinical evidence for and against capsaicin as a weight control agent and comes to the conclusion that capsaicin is not a magic “exercise in a pill”, although there is emerging evidence that it may help restore a healthy gut microbiota.
... Spiciness or pungency was regarded as one of the basic tastes in ancient Asia, especially in India and China (16,17). It is reported that more than 30% of adults eat spicy food every day in China (18). As a mid-west city famous for its hot pot and spicy Sichuan cooking style, pepper's annual consumption per capita is up to 96.5 kg in Chongqing (19). ...
Article
Full-text available
Hyperuricemia is associated with substantial health and economic burden all over the world. Dietary habits are an important influencing factor of hyperuricemia. This study aimed to investigate the relationship between spicy food intake and hyperuricemia based on a large population. A total of 22,125 individuals aged 30–79 were enrolled in China Multi-Ethnic Cohort (CMEC), Chongqing region. Spicy food intake information was collected by a standardized questionnaire. The association between spicy food intake and hyperuricemia was estimated by multivariable logistic regression models and multiple linear regression models. Additionally, we explored these relations in subgroups stratified by sex and age. Furthermore, sensitivity analyses were conducted to verify the stability of current findings. After controlling for potential confounders, compared with participants who never consumed spicy food and consumed less hot, participants who ate 3–5 days per week and very hot had the highest risk of hyperuricemia; the ORs (95% CIs) were 1.28 (1.09, 1.5) and 1.22 (0.92, 1.63), respectively. Additionally, the corresponding ORs (95% CIs) for each level increment in the frequency and degree of pungency in spicy food intake were 1.04 (1.01, 1.07) (P trend = 0.009) and 1.15 (1.04, 1.26) (P trend = 0.004). Further in sex-stratified and age-stratified analysis, similar positive associations were observed among men and those aged 30–59, but no significant association was found among women and those aged 60–79. In the linear regression models, 3–5 days per week and moderate pungency in spicy food intake were associated with 5.21 μmol/L (95% CI: 1.72, 8.70) and 4.69 μmol/L (95% CI: 1.93, 7.45) higher serum urate level. Results in further subgroup analysis were generally consistent with the logistic regression models. This study suggests that spicy food intake may be a risk factor for hyperuricemia, especially in men and younger people, and more studies are warranted to verify the causal associations.
... For example, the China Kadoorie Biobank (CKB) study shows that high levels of spicy food intake are associated with a lower risk of certain gastrointestinal cancers in Chinese adults [10]. Previous studies describing the association between spicy foods intake and the risk of CVD showed inconsistent results [11][12][13][14]. Some studies found that spicy food consumption was associated with lower risks of hypertension [15,16], obesity [17] and diabetes [18], and lower levels of lipids [8,19]. ...
Article
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Background Evidence regarding the association of spicy foods intake with cardiovascular disease (CVD) risk factors was less clear, especially in those with diabetes. We hereby examined the association of spicy foods intake with CVD risk factors in older Chinese. Methods Thirty thousand three hundred twenty-five participants (72.34% women) aged 50+ years were recruited in the Guangzhou Biobank Cohort Study from 2003 to 2008. Information of spicy foods intake and disease history was collected by face-to-face interview. CVD risk factors were measured and treated as continuous variables. Diabetes was defined by a fasting plasma glucose (FPG) ≥7.0 mmol/L and/or self-reported physician-diagnosed diabetes. Results Of 30,325 participants, 12.9% consumed spicy foods regularly. After adjusting for multiple confounders, participants who consumed spicy foods of 5–7 days/week, versus none, had higher body mass index (1.18, 95% confidence interval (CI) 0.95 to 1.42 kg/m²), waist circumference (2.80, 95% CI 2.18–3.41 cm), waist-to-hip ratio (0.010, 95% CI 0.006 to 0.015), systolic blood pressure (2.44, 95% CI 0.92 to 3.97 mmHg), diastolic blood pressure (1.94, 95% CI 1.14 to 2.73 mmHg), FPG (0.310, 95% CI 0.188 to 0.432 mmol/L), triglycerides (0.185, 95% CI 0.096 to 0.273 mmol/L), and lower high-`density lipoprotein cholesterol (− 0.040, 95% CI − 0.069 to − 0.012 mmol/L). Similar results were found for the associations of spicy foods strength with CVD risk factors. The results attenuated slightly but not substantially across diabetes groups. Conclusions Our study showed that higher frequency and strength of spicy foods intake were associated with unfavorable cardiovascular disease risk profile in older people, and such associations did not vary by diabetes status. Whether the results were causal needs to be determined in further studies.
... Prevalent hypertension, diabetes, and COPD at baseline were defined based on the self-reported clinician diagnosis and baseline physical measurements. 21,22 During long-term follow-up, the disease status of the abovementioned ten underlying conditions was updated through established registries and the HI claim system. ...
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Background Pneumonia represents a public health problem of substantial health and economic burden. However, the evidence on the burden of adult pneumonia is limited in China. Methods The China Kadoorie Biobank recruited 512,725 participants aged 30–79 years from five urban and five rural areas during 2004–2008. The current analyses included 506,086 participants who were alive in 2009. Pneumonia hospitalizations were ascertained through the health insurance system until December 31, 2017. Generalized linear models were used to examine the secular trends and regional and population variations in pneumonia hospitalization rate, mean length of hospital stay (LOS), and 30-day case fatality rate (CFR). Findings A total of 27,879 participants with 36,567 pneumonia hospitalizations were identified with a mean follow-up time of 8·9 years. The unadjusted hospitalization rate was 8·4 (95% confidence interval [CI]: 8·3, 8·6) per 1000 person-years, with an increase of 15·5% annually from 4·2 (3·9, 4·4) in 2009 to 10·9 (10·6, 11·3) in 2017, after adjusting for age, sex, study area. The mean LOS was 8·8 (95% CI: 8·7, 8·9) days, with a slight decrease of 1·0% annually from 2009 to 2017. The average 30-day CFR remained practically unchanged at 2·4 (95% CI: 2·2, 2·5) deaths per 100 admissions. A clear seasonal pattern of pneumonia hospitalization rate was observed, and the hospitalization rate and CFR differed across regions and subpopulations of different ages and underlying conditions. Interpretation There was an increasing hospitalization burden of pneumonia in Chinese adults, especially for adults aged ≥60 years or those with underlying conditions. Funding The National Natural Science Foundation of China, the Kadoorie Charitable Foundation, the National Key R&D Program of China, the Chinese Ministry of Science and Technology. Translated abstract in Chinese This translation in Chinese was submitted by the authors and we reproduce it as supplied. It has not been peer reviewed. Our editorial processes have only been applied to the original abstract in English, which should serve as reference for this manuscript. 摘要 背景:肺炎是一个重要的公共卫生问题, 威胁人群健康的同时还造成沉重的经济负担.然而, 基于人群研究的中国成年人肺炎住院负担的研究证据十分有限. 方法:中国慢性病前瞻性研究(China Kadoorie Biobank)于2004-2008年募集了来自5个城市和5个农村地区的50余万30-79岁的成年人.本研究纳入506,086名在2009年1月1日仍存活的研究对象.研究通过链接医保数据库获取研究对象2009年1月1日至2017年12月31日的肺炎住院数据.采用广义线性模型分析肺炎住院率,肺炎住院患者的住院时长及30天病死率的长期趋势及其地区,人群分布情况. 结果:在平均8.9年的随访期内, 27,879名研究对象发生肺炎住院, 合计发生肺炎住院36,567人次.研究期间内肺炎的粗住院率为8.4 (95% CI:8.3, 8.6)/1000人年, 在调整年龄,性别和地区后, 由2009年的4.2 (3.9, 4.4)增长至2017年的10.9 (10.6, 11.3), 平均年增长率为15.5%.研究期间肺炎住院患者平均住院时长为8.8(95% CI:8.7, 8.9)天, 平均年缩短率为1.0%.肺炎住院患者的30天病死率没有明显改变, 研究期间粗病死率为2.4(95% CI:2.2, 2.5)/100例肺炎住院.本研究还发现肺炎住院率存在明显的季节性;不同地区,年龄和基础疾病的患者, 肺炎住院率和30天病死率都存在差异. 解读:中国成年人中肺炎住院负担重且呈现增长趋势, 尤其是在≥60岁或存在基础疾病的研究对象中.
... With information on the genetic contribution to the behaviour of consuming mustard oil, the circulating metabolic response to eating mustard oil or even the component parts of mustard oil (i.e., levels of sanguinarine or diethyl nitrosamine), MR analyses could test whether consuming mustard oil or exposure to its components has a causal impact on gallbladder cancer in Indian populations. Similarly, knowing more about the genetic contribution to preference and consumption of spicy foods may enable further causal analyses of the observational relationship between consumption of spicy foods and mortality found across geographically diverse areas of China [161]. ...
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Dietary factors are assumed to play an important role in cancer risk, apparent in consensus recommendations for cancer prevention that promote nutritional changes. However, the evidence in this field has been generated predominantly through observational studies, which may result in biased effect estimates because of confounding, exposure misclassification, and reverse causality. With major geographical differences and rapid changes in cancer incidence over time, it is crucial to establish which of the observational associations reflect causality and to identify novel risk factors as these may be modified to prevent the onset of cancer and reduce its progression. Mendelian randomization (MR) uses the special properties of germline genetic variation to strengthen causal inference regarding potentially modifiable exposures and disease risk. MR can be implemented through instrumental variable (IV) analysis and, when robustly performed, is generally less prone to confounding, reverse causation and measurement error than conventional observational methods and has different sources of bias (discussed in detail below). It is increasingly used to facilitate causal inference in epidemiology and provides an opportunity to explore the effects of nutritional exposures on cancer incidence and progression in a cost-effective and timely manner. Here, we introduce the concept of MR and discuss its current application in understanding the impact of nutritional factors (e.g., any measure of diet and nutritional intake, circulating biomarkers, patterns, preference or behaviour) on cancer aetiology and, thus, opportunities for MR to contribute to the development of nutritional recommendations and policies for cancer prevention. We provide applied examples of MR studies examining the role of nutritional factors in cancer to illustrate how this method can be used to help prioritise or deprioritise the evaluation of specific nutritional factors as intervention targets in randomised controlled trials. We describe possible biases when using MR, and methodological developments aimed at investigating and potentially overcoming these biases when present. Lastly, we consider the use of MR in identifying causally relevant nutritional risk factors for various cancers in different regions across the world, given notable geographical differences in some cancers. We also discuss how MR results could be translated into further research and policy. We conclude that findings from MR studies, which corroborate those from other well-conducted studies with different and orthogonal biases, are poised to substantially improve our understanding of nutritional influences on cancer. For such corroboration, there is a requirement for an interdisciplinary and collaborative approach to investigate risk factors for cancer incidence and progression.
... Although eating a spicy meal is not always harmful to one's health, it might cause problems and trigger symptoms in those who suffer from chronic illnesses. According to certain research, chilies and spices provide health benefits such as reduced cancer incidence, hunger, obesity and cardiovascular disease (CVD) (Nilius and Appendino, 2013;Sharma et al. 2013;Lv, et al. 2015). Spices also have antibacterial properties and impact gut microbes, which have lately been linked to diabetes, heart and liver disease, and cancer in humans (Qin et al. 2012;Tang et al. 2013;Qin et al. 2014). ...
Article
Full-text available
Chili peppers are commonly used around the world to make a desirable taste for food, particularly fast food like spicy chicken. Studies indicate that red chili pepper makes some alterations in liver enzymes and lipid profiles. The goal of this study was to see how hypercholesterolemic rats changed their lipid profiles (Cholesterol, Triglycerides, HDL, VLDL, LDL) as well as some liver enzymes (ALP, GPT, and GOT) were evaluated in hypercholesterolemic rats. Thirty-five male rats were separated into seven groups, each with the same number of rats. First group was treated as a control negative group with no changes, while the other six groups were fed an extra 2% cholesterol for two weeks to induce hypercholesterolemia. Then there are two hypercholesterolemic groups were fed different doses of red chili pepper (RCP) extract (10, 20 and 40 mg/kg body weight (B.Wt.)), two were fed 30% (fried chicken and chicken burgers), and one remained on standard diet only (control positive). The impact of RCP on liver function and alterations in lipid profiles was investigated. The oral dose of 2% cholesterol for two weeks caused hypercholesterolemia in rats, according to our findings. The findings suggested that taking enough RCP orally as part of a standard/healthy diet or as a fast food component improves lipid profiles and liver function test values.
... Additionally, CG-intake significantly improved chemotaxis behavior (Fig. 2D). Previous studies reported that consumption of hot-red chili peppers could enhance human lifespan [18,19], our results showed a non-significant increase in survival of CG-treated worms (50 µg/ml) by 4.87%, as compared to control worms (0.1% DMSO) under normal condition ( Fig. 3A and Table S2, Supplementary material), but significantly enhanced the survival of wild type N2 worms under hydrogen peroxide by 43.51% compared to control worms ( Fig. 3B and Table S2, Supplementary material). ...
Article
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In this study, capsaicin-glucoside and dihydro-capsaicin-glucoside derived from fresh hot-red pepper were isolated and identified using UPLC-ESI-Q-TOF–MS/PDA. Synchronized worms were treated with capsaicinoid-glucosides (CG), and then lifespan and stress resistance were examined. The 50 µg/ml concentration of CG-intake could effectively protect the Caenorhabditis elegans (C. elegans) against stresses factors including oxidation and heat as well as reactive oxygen species (ROS), thereby enhancing the survival of CG-treated worms under stress. Enhancing stress resistance in CG-treated worms could be due to the increased expressions of stress-related genes in C. elegans such as daf-16, skn-1 and their downstream target genes (sod-3, hsp-16.2, gst-4 and gcs-1). Lifespan study of different C. elegans strains and RT-PCR showed that the CG-mediated lifespan extension was dependent on DAF-16/FOXO and SKN-1/Nrf2 transcription factors. The study is a step forward in exploring the stress resistance and anti-aging properties of this beneficial extract. Thus, this study will be useful in formulating remedies for stresses factors and age associated disorders.
Article
The aim of this study was to test whether personality traits influenced liking and choice of pungent foods such as cig kofte for Turkish population. In addition, we explored the role of demographic variables (gender and regions of Türkiye) and various concentration of capsaicin in cig kofte on the relation between personality traits and the frequency of annual cig kofte intake and liking of a spicy meal. Data of 316 participants from different region of Türkiye (47% women and 53% men) were examined. Participants were categorized for demographics, region, and personality traits (sensitivity seeking (AISS), sensitivity to reward (SR) and sensitivity to punishment (SP). They tasted cig kofte including various concentrations of capsaicin (trans-8-methyl-N-vanillyl-6-nonenamide; 50, 75, 100, and 150 μM) and then evaluated liking and perceived intensity in it. A significant positive correlation was found between the liking of a spicy meal and frequency of annual cig kofte intake. Although a significant negative correlation was observed between the liking of a spicy meal and each concentration of capsaicin in cig kofte, no correlation was seen between the frequency of annual cig kofte intake and each concentration of capsaicin. In addition, the liking of a spicy meal was only associated with a personality trait, AISS, but the frequency of annual cig kofte intake was related to personality traits, AISS and SR. Besides, the relations between the frequency of annual cig kofte intake, liking of a spicy meal, personality traits (AISS, SR, and SP) and various concentration of capsaicin were influenced by both gender and region. Finally, no clear relationship was observed between liking and perceived intensity in cig kofte.
Article
Chili pepper and its major active compound capsaicin have long been used not only a daily food additive but also medication worldwide. Like in other human organs and systems, capsaicin has multiple actions in gastrointestinal (GI) physiology and pathology. Numerous studies have revealed that capsaicin acts on GI tract in TRPV1-dependent and –independent manners, mostly depending on its consumption concentrations. In this review, we will focus on the beneficial role of capsaicin in GI tract, a less highlighted aspect, in particular how dietary capsaicin affects GI health, the mechanisms of actions and its preventive/therapeutic potentials to several GI diseases. Dietary capsaicin affects GI tract not only via TRPV1-derpendent and independent manners, but also via acute and chronic effects. Although high dose intake of dietary capsaicin is harmful to human health sometimes, current literatures suggest that appropriate dose intake is likely beneficial to GI health and is preventive/therapeutic to GI disease in most cases as well. With extensive and intensive studies on its GI actions, capsaicin, as a daily consumed food additive, has potential to become a safe drug for the treatment of several GI diseases.
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Assessment and characterization of gut microbiota has become a major research area in human disease, including type 2 diabetes, the most prevalent endocrine disease worldwide. To carry out analysis on gut microbial content in patients with type 2 diabetes, we developed a protocol for a metagenome-wide association study (MGWAS) and undertook a two-stage MGWAS based on deep shotgun sequencing of the gut microbial DNA from 345 Chinese individuals. We identified and validated approximately 60,000 type-2-diabetes-associated markers and established the concept of a metagenomic linkage group, enabling taxonomic species-level analyses. MGWAS analysis showed that patients with type 2 diabetes were characterized by a moderate degree of gut microbial dysbiosis, a decrease in the abundance of some universal butyrate-producing bacteria and an increase in various opportunistic pathogens, as well as an enrichment of other microbial functions conferring sulphate reduction and oxidative stress resistance. An analysis of 23 additional individuals demonstrated that these gut microbial markers might be useful for classifying type 2 diabetes.
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Liver cirrhosis occurs as a consequence of many chronic liver diseases that are prevalent worldwide. Here we characterize the gut microbiome in liver cirrhosis by comparing 98 patients and 83 healthy control individuals. We build a reference gene set for the cohort containing 2.69 million genes, 36.1% of which are novel. Quantitative metagenomics reveals 75,245 genes that differ in abundance between the patients and healthy individuals (false discovery rate < 0.0001) and can be grouped into 66 clusters representing cognate bacterial species; 28 are enriched in patients and 38 in control individuals. Most (54%) of the patient-enriched, taxonomically assigned species are of buccal origin, suggesting an invasion of the gut from the mouth in liver cirrhosis. Biomarkers specific to liver cirrhosis at gene and function levels are revealed by a comparison with those for type 2 diabetes and inflammatory bowel disease. On the basis of only 15 biomarkers, a highly accurate patient discrimination index is created and validated on an independent cohort. Thus microbiota-targeted biomarkers may be a powerful tool for diagnosis of different diseases.
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Herbs and spices have a traditional history of use, with strong roles in cultural heritage, and in the appreciation of food and its links to health. Demonstrating the benefits of foods by scientific means remains a challenge, particularly when compared with standards applied for assessing pharmaceutical agents. Pharmaceuticals are small-molecular-weight compounds consumed in a purified and concentrated form. Food is eaten in combinations, in relatively large, unmeasured quantities under highly socialised conditions. The real challenge lies not in proving whether foods, such as herbs and spices, have health benefits, but in defining what these benefits are and developing the methods to expose them by scientific means. CULTURAL ASPECTS: The place of herbs and spices in the diet needs to be considered in reviewing health benefits. This includes definitions of the food category and the way in which benefits might be viewed, and therefore researched. Research may focus on identifying bioactive substances in herbs and spices, or on their properties as a whole food, and/or be set in the context of a dietary cuisine. THE ROLE OF HERBS AND SPICES IN HEALTH: The antioxidant properties of herbs and spices are of particular interest in view of the impact of oxidative modification of low-density lipoprotein cholesterol in the development of atherosclerosis. There is level III-3 evidence (National Health and Medical Research Council [NHMRC] levels of evidence) that consuming a half to one clove of garlic (or equivalent) daily may have a cholesterol-lowering effect of up to 9%. There is level III-1 evidence that 7.2 g of aged garlic extract has been associated with anticlotting (in-vivo studies), as well as modest reductions in blood pressure (an approximate 5.5% decrease in systolic blood pressure). A range of bioactive compounds in herbs and spices have been studied for anticarcinogenic properties in animals, but the challenge lies in integrating this knowledge to ascertain whether any effects can be observed in humans, and within defined cuisines. Research on the effects of herbs and spices on mental health should distinguish between cognitive decline associated with ageing and the acute effects of psychological and cognitive function. There is level I and II evidence for the effect of some herbal supplements on psychological and cognitive function. There is very limited scientific evidence for the effects of herbs and spices on type 2 diabetes mellitus, with the best evidence being available for the effect of ginseng on glycaemia, albeit based on four studies. More research is required, particularly examining the effects of chronic consumption patterns. With increasing interest in alternatives to non-steroidal anti-inflammatory agents in the management of chronic inflammation, research is emerging on the use of food extracts. There is level II evidence for the use of ginger in ameliorating arthritic knee pain; however, the improvement is modest and the efficacy of ginger treatment is ranked below that of ibuprofen. More definitive research is required. PUBLIC HEALTH AND DIETARY IMPLICATIONS: Recommendations for intakes of food in the Australian guide to healthy eating do not yet include suggested intakes of herbs and spices. Future consideration should be given to including more explicit recommendations about their place in a healthy diet. In addition to delivering antioxidant and other properties, herbs and spices can be used in recipes to partially or wholly replace less desirable ingredients such as salt, sugar and added saturated fat in, for example, marinades and dressings, stir-fry dishes, casseroles, soups, curries and Mediterranean-style cooking. Vegetable dishes and vegetarian options may be more appetising when prepared with herbs and spices. FUTURE DIRECTIONS: As several metabolic diseases and age-related degenerative disorders are closely associated with oxidative processes in the body, the use of herbs and spices as a source of antioxidants to combat oxidation warrants further attention. Immediate studies should focus on validating the antioxidant capacity of herbs and spices after harvest, as well as testing their effects on markers of oxidation. This will work in parallel with clinical trials that are aiming to establish antioxidants as mediators of disease prevention. From a dietary perspective, the functionality of herbs and spices will be exposed through consideration of their properties as foods. As with most foods, the real benefits of including them in the diet are likely to emerge with a better understanding of the attributes of health that are best supported by food, and in methodological developments addressing the evidence base for their effects. These developments are well underway through evidence-based frameworks for substantiating health claims related to foods. At present, recommendations are warranted to support the consumption of foods rich in bioactive components, such as herbs and spices. With time, we can expect to see a greater body of scientific evidence supporting the benefits of herbs and spices in the overall maintenance of health and protection from disease.
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The authors recently described a potential role of the phosphatidylcholine metabolic pathway involving gut flora in contributing to the pathogenesis of atherosclerotic coronary disease in an animal model (Wang Z et al, Nature 2011;472:57-63). TMAO is an intestinal flora-dependent metabolite of the choline group of phosphatidylcholine that is excreted in the urine (Simenhoff ML et al, Lancet 1976;2:818-21). The major dietary source of choline is lecithin, a part of the B-complex vitamin family. Choline and its metabolites, such as betaine, can serve as a source of the methyl groups required for proper metabolism of amino acids such as homocysteine and methionine (Zeisel AQ et al, Annu Rev Nutr 2006;26:229-50). Diets rich in phosphatidylcholine (those containing eggs, liver, beef, and pork) can contribute to the formation of the metabolite trimethylamine, with conversion to TMAO. TMAO production may be facilitated by intestinal microflora, thereby, potentially, providing a link between atherogenic diets, intestinal microflora, and atherosclerotic disease. The authors investigated the relationship of intestinal microflora-dependent metabolism of dietary phosphatidylcholine, TMAO levels, and cardiovascular events in humans. Plasma and urinary levels of TMAO and plasma choline and betaine levels were measured with liquid chromatography and gas spectrometry after a phosphatidylcholine challenge (two hard-boiled eggs with deuterium [d9]-labeled phosphatidylcholine) in healthy participants before and after suppression of intestinal microbiota with oral broad-spectrum antibiotics. Fasting plasma levels of TMAO were also examined in conjunction with incident major adverse cardiovascular events (death, myocardial infarction, or stroke) during 3 years of follow-up in 4007 patients undergoing elective coronary angiography. The authors found time-dependent increases in levels of TMAO and its [d9] isotopologue, as well as other choline metabolites, after the phosphatidylcholine challenge. TMAO plasma levels were suppressed after administration of antibiotics and reappeared after withdrawal of antibiotics. Increased plasma levels of TMAO were associated with an increased risk of major adverse cardiovascular events (hazard ratio for highest vs lowest TMAO quartile, 2.54; 95% confidence interval, 1.96-3.28; P < .001). After adjustment for traditional cardiovascular risk factors, an elevated TMAO level predicted an increased risk of major cardiovascular events (P < .001).
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With non-communicable conditions accounting for nearly two-thirds of deaths worldwide, the emergence of chronic diseases as the predominant challenge to global health is undisputed. In the USA, chronic diseases are the main causes of poor health, disability, and death, and account for most of health-care expenditures. The chronic disease burden in the USA largely results from a short list of risk factors-including tobacco use, poor diet and physical inactivity (both strongly associated with obesity), excessive alcohol consumption, uncontrolled high blood pressure, and hyperlipidaemia-that can be effectively addressed for individuals and populations. Increases in the burden of chronic diseases are attributable to incidence and prevalence of leading chronic conditions and risk factors (which occur individually and in combination), and population demographics, including ageing and health disparities. To effectively and equitably address the chronic disease burden, public health and health-care systems need to deploy integrated approaches that bundle strategies and interventions, address many risk factors and conditions simultaneously, create population-wide changes, help the population subgroups most affected, and rely on implementation by many sectors, including public-private partnerships and involvement from all stakeholders. To help to meet the chronic disease burden, the US Centers for Disease Control and Prevention (CDC) uses four cross-cutting strategies: (1) epidemiology and surveillance to monitor trends and inform programmes; (2) environmental approaches that promote health and support healthy behaviours; (3) health system interventions to improve the effective use of clinical and other preventive services; and (4) community resources linked to clinical services that sustain improved management of chronic conditions. Establishment of community conditions to support healthy behaviours and promote effective management of chronic conditions will deliver healthier students to schools, healthier workers to employers and businesses, and a healthier population to the health-care system. Collectively, these four strategies will prevent the occurrence of chronic diseases, foster early detection and slow disease progression in people with chronic conditions, reduce complications, support an improved quality of life, and reduce demand on the health-care system. Of crucial importance, with strengthened collaboration between the public health and health-care sectors, the health-care system better uses prevention and early detection services, and population health is improved and sustained by solidifying collaborations between communities and health-care providers. This collaborative approach will improve health equity by building communities that promote health rather than disease, have more accessible and direct care, and focus the health-care system on improving population health.
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Background Inflammation might play a role in the development of several psychiatric diseases. However, the origins of processes that mediate inflammation remain unknown. We previously reported, in alcohol-dependent (AD) subjects, increased intestinal permeability, elevated blood lipopolysaccharides (LPS) levels, and low-grade systemic inflammation associated with psychological symptoms of alcohol dependence. In this study, we tested during detoxification peripheral blood mononuclear cells (PBMCs) inflammatory responses to gut-derived bacterial products and its relation to alcohol-craving. Methods Sixty-three actively-drinking non-cirrhotic AD subjects were tested at the beginning (day 2) and end (day 18) of alcohol detoxification and compared with 14 healthy subjects. Activation of various intracellular signaling pathways by gut-derived bacterial products was analyzed by qPCR, Western blotting and DNA binding assays (for transcription factors). Toll-like receptors activation was assessed by cell cultures. Results In addition to LPS, we showed that peptidoglycans (PGN) may also cross the gut barrier to reach the systemic circulation. Both activate their respective Toll-like receptors in PBMCs. Chronic alcohol consumption inhibited the nuclear factor kappa B pro-inflammatory cytokine pathway, but activated the mitogen-activated protein kinase/activator protein 1 pathway, together with the inflammasome complex. This resulted in increased mRNA and plasma levels of interleukin (IL)-8, IL-1β, and IL-18. Activated pro-inflammatory pathways, in particular IL-8 and IL-1β, were positively correlated with alcohol consumption and alcohol-craving scores. Short-term alcohol withdrawal was associated with the recovery of LPS- but not PGN-dependent receptors. Conclusions LPS and PGN from the gut microbiota stimulate specific inflammatory pathways in PBMCs that are correlated with alcohol craving.