The relationship between adult stature and longevity: Tall men are unlikely to outlive their short peers - Evidence from a study of all adult deaths in Poland in the years 2004-2008

Abstract

Early epidemiological studies demonstrated that short stature is associated with cardiovascular disease (CVD), diabetes, lower energy intake or food deprivation during growth, poor health, and increased all-cause mortality. Nevertheless, the links between adult height and longevity become tenuous if certain confounders (e.g. BMI, SES, educational attainment, etc.) are allowed for. Furthermore, numerous studies have found that like excess weight, tallness is costly in terms of longevity in late ontogeny, and shorter people tend to outlive their taller peers, especially if they are slim and maintain a healthy diet and lifestyle. Therefore, there is currently a lack of agreement in the literature as to whether and how body height and lifespan are linked. The objective of this study was to explore the relationship between adult stature and longevity on the basis of a large sample from a population-based cohort study. Data on declared height and exact dates of birth and death were available from 480,493 men and 364,666 women who died in the years 2004-2008 in Poland. To control for secular changes, the sample was divided into fifteen birth cohorts and each group was subsequently split into five height categories using pentiles, separately for both sexes. The analysis has revealed an inverse relationship between height and lifespan in men and women. However, after controlling for secular changes in height, the relationship turned out to be very weak and linear in men, and inverted U-shaped in women. In general, taller individuals had lower age at death compared to shorter ones, and this relationship was more pronounced and consistent in men. To sum up, these findings do not comport with the traditional belief that taller individuals live longer. The role of several possible biological mechanisms pertinent to enhanced longevity in smaller individuals was emphasized, and these biological factors were discussed.

Full text

AnthropologicAl review • Vol. 79(4), 439–460 (2016)
The relationship between adult stature and
longevity: tall men are unlikely to outlive their
short peers – evidence from a study of all adult
deaths in Poland in the years 2004–2008
Piotr Chmielewski
Department of Anatomy, Faculty of Medicine, Wrocław Medical University, Poland
AbstrAct: Early epidemiological studies demonstrated that short stature is associated with cardiovascular
disease (CVD), diabetes, lower energy intake or food deprivation during growth, poor health, and increased
all-cause mortality. Nevertheless, the links between adult height and longevity become tenuous if certain
confounders (e.g. BMI, SES, educational attainment, etc.) are allowed for. Furthermore, numerous studies
have found that like excess weight, tallness is costly in terms of longevity in late ontogeny, and shorter
people tend to outlive their taller peers, especially if they are slim and maintain a healthy diet and lifestyle.
Therefore, there is currently a lack of agreement in the literature as to whether and how body height and
lifespan are linked. The objective of this study was to explore the relationship between adult stature and
longevity on the basis of a large sample from a population-based cohort study. Data on declared height and
exact dates of birth and death were available from 480,493 men and 364,666 women who died in the years
2004–2008 in Poland. To control for secular changes, the sample was divided into fteen birth cohorts and
each group was subsequently split into ve height categories using pentiles, separately for both sexes. The
analysis has revealed an inverse relationship between height and lifespan in men and women. However,
after controlling for secular changes in height, the relationship turned out to be very weak and linear in
men, and inverted U-shaped in women. In general, taller individuals had lower age at death compared to
shorter ones, and this relationship was more pronounced and consistent in men. To sum up, these ndings
do not comport with the traditional belief that taller individuals live longer. The role of several possible
biological mechanisms pertinent to enhanced longevity in smaller individuals was emphasized, and these
biological factors were discussed.
Key words: aging, body height, life expectancy, lifespan, longevity, mortality, predictor
Introduction
A multitude of studies have shown that
short stature is associated with lower
energy intake during growth and devel-
opment, inadequate diet and nutrition,
poor health, low socioeconomic status
(SES), and increased risk of cardiovas-
cular disease (CVD), diabetes mellitus,
and premature death (for a review, see
Original Article Received: September 19, 2016; Accepted for publication: November 23, 2016
DOI: 10.1515/anre- 2016-0032
© 2016 Polish Anthropological Society
Piotr Chmielewski
Short stature is related to greater longevity
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440 Piotr Chmielewski
Austad 2010; Özaltin 2012; Perkins et al.
2016). Moreover, anthropological inves-
tigations have revealed that body height
correlates positively with social mobility,
SES, remuneration, educational attain-
ment, health, physical attractiveness in
men, and their reproductive success, at
least in Western societies (Kemkes-Grot-
tenthaler 2005; Sear 2006; Pawłowski
2012). For several decades, researchers
have been trying to ascertain whether
tallness is costly in later life in terms of
longevity, which would act as some type
of compensation, according to the hand-
icap principle. The nal results remain
mixed because the relationship between
adult height and longevity is weak and
tenuous and can be modied by numer-
ous factors, such as body mass index
(BMI), body fat percentage (BFP), SES,
causes of short stature, illness, etc.
Thus, in general, being tall and slim
has long been considered a superior
conguration for humans in terms of
healthspan and longevity, but it turns out
that data supporting this view come from
mortality studies that do not track the
entire cohort to death. As regards mor-
tality, ahost of studies have demonstrat-
ed that taller individuals outlive their
shorter peers (for a review, see Austad
2010; Özaltin 2012; Perkins et al. 2016),
especially when certain confounding fac-
tors, such as BMI, SES, and education-
al attainment, are not controlled in the
analysis. Nonetheless, after controlling
for such types of confounders, adult stat-
ure fails to predict CVD morbidity and
mortality in some populations (Liao et
al. 1996; Murray 1997; Sear 2006), and
after allowing for some CVD risk factors,
short stature alone is not linked to ele-
vated risk of all-cause or cardiovascular
mortality in either sex, though it is relat-
ed to increased risk of myocardial infarc-
tion in women but not in men (Kannam
et al. 1994). Moreover, it should be noted
that deaths before age 65 or 70 are pre-
mature, and thus such analyses do not
provide insights into what is benecial in
terms of longevity.
Likewise, the results of compara-
tive studies of the association between
body size and longevity in animals can
be misleading. Although large mammals
(e.g. whales, elephants) live signicant-
ly longer than small ones (e.g. pygmy
shrews, mice), numerous studies have
found that within the species the small-
er individuals have greater longevity, and
smaller mice, dogs, cows etc. live signi-
cantly longer than bigger ones (Miller et
al. 2002; Rollo 2002; Miller and Austad
2006; Bartke 2012). To date, the inverse
relationship between body size and lon-
gevity was conrmed in many different
mammalian species. Furthermore, more
recent studies suggest that higher rates
of growth and greater body size may be
costly in terms of longevity in humans
(Bartke 2012; He et al. 2014; Samaras
2014) despite the fact that during pro-
gressive ontogeny they can be used as
reliable proxies for environmental con-
ditions, standard of living, SES, lifestyle,
and general health status. The present
study aims to investigate whether lifes-
pan depends on adult stature within the
Polish population, and whether the as-
sociation between these two life history
parameters is positive or negative.
Materials and methods
To evaluate the relationship between
adult height and longevity in the Polish
population, data on adult stature and ex-
act dates of birth and death from 845,159
individuals, including 480,493 men and
364,666 women, were analyzed. The
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Short stature is related to greater longevity 441
study data were obtained from two elec-
tronic databases at the Ministry of Inter-
nal Affairs and Administration in War-
saw, Poland, i.e. the Universal Electronic
System for Registration of the Population
(sex, dates of birth and death), and from
the State Register of Issued and Invali-
dated Identity Cards (declared body
height), and concerned all adult deaths
in the years 2004–2008 in Poland.
The collected data have a number of
advantages. First, the study sample is
large and representative for the whole
studied population, which is crucial and
indispensible for the analysis of the stud-
ied relationship as gathering alarge sam-
ple that is representative for the whole
population of the country is a sine qua
non prerequisite in such studies. This is
necessary because body height is an eco-
sensitive feature, determined by many
biological and social factors, while the
variation in lifespan as well as in body
size in every human population is large
and signicant. Furthermore, there are
numerous dened or unknown selec-
tion factors which can easily inuence
the results of such investigations. Sec-
ond, the study sample is heterogeneous
and concerns typical causes of death, i.e.
the causes of death in the study sample
are the same as in the total population
(Chmielewski and Borysławski 2015).
Even randomly chosen data sets con-
cerning several thousand subjects are
described by some researchers as insuf-
ciently random and large as various lo-
cal factors, mainly the level of pollution,
smog, radiation, and climatic factors,
and above all different social and biolog-
ical factors can easily distort the image
of the investigated relationship. Despite
these reservations many epidemiologi-
cal and anthropological studies involve
data from small geographical areas, i.e.
cities or districts where the residents
are affected by specic local factors (e.g.
smog), obtained in a short period of
time, or concerning individuals who died
of a specic disease (CVD, myocardial
infarction, cancer, etc.), which is justied
for practical reasons but has anegative ef-
fect on the value of research and validity
of such conclusions. Third, an important
advantage of the analyzed study material
is the high reliability of data on dates of
birth and death, which were proven by
relevant documents. According to many
authors, the use of the declared body
height is justied, or at least acceptable,
in a situation when measurements can-
not be taken. This is because in young
and older adults, there is ahigh and sta-
tistically signicant correlation between
the self-reported and measured values of
body height, especially if height is given
for ofcial purposes, and not for matri-
monial ones. On the other hand, some
respondents tend to overestimate their
Table 1. Number of subjects in the consecutive
birth cohorts for both sexes.
Birth cohort N
Men Women Total
1896–1910 1762 5017 6779
1911–1915 8023 18557 26580
1916–1920 19989 34861 54850
1921–1925 51588 71157 122745
1926–1930 73138 70924 144062
1931–1935 73350 51055 124405
1936–1940 59876 33827 93703
1941–1945 41720 21094 62814
1946–1950 49156 22940 72096
1951–1955 40661 16150 56811
1956–1960 27135 9431 36566
1961–1965 13890 4299 18189
1966–1970 8634 2344 10978
1971–1975 6510 1684 8194
1976–1980 5061 1326 6387
Total 480493 364666 845159
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442 Piotr Chmielewski
body height (usually by 1-2 cm), and this
more frequently happens with young
men as well as with short individuals,
while very tall subjects usually indicate
slightly lower values of height than actu-
al (Brener et al. 2003; Sherry et al. 2007;
Danubio et al. 2008; Krul et al. 2010;
Bowring et al. 2012). There is another
salient criterion that should be included
in such investigations and that is met by
the study material, namely the research
should be based solely on data gathered
specically to clarify the effect of body
size, i.e. body height, on lifespan, and not
on the secondary use of material collect-
ed previously for another purposes, espe-
cially if the material is cross-sectional and
there is a high risk of the cohort effect
(Kościński et al. 2009). A disadvantage
of the collected data is that the analysis
Table 2. Body height values pertinent to centiles that were used to divide each birth cohort into ve height
categories in both sexes.
Sex Birth cohort NCentiles (cm)
20 40 60 80
Men
1896–1910 1762 160 165 170 173
1911–1915 8023 162 165 170 174
1916–1920 19989 164 168 170 175
1921–1925 51588 164 168 171 175
1926–1930 73138 165 170 172 175
1931–1935 73350 165 170 172 176
1936–1940 59876 165 170 172 176
1941–1945 41720 167 170 174 176
1946–1950 49156 168 170 175 177
1951–1955 40661 168 172 176 178
1956–1960 27135 170 173 176 180
1961–1965 13890 170 174 176 180
1966–1970 8634 170 175 177 181
1971–1975 6510 172 176 178 182
1976–1980 5061 172 176 180 183
Women
1896–1910 5017 150 155 158 160
1911–1915 18557 150 155 158 161
1916–1920 34861 152 156 160 163
1921–1925 71157 154 158 160 164
1926–1930 70924 155 158 160 164
1931–1935 51055 155 159 161 165
1936–1940 33827 156 160 162 165
1941–1945 21094 156 160 163 165
1946–1950 22940 158 160 164 165
1951–1955 16150 158 160 164 165
1956–1960 9431 158 160 164 167
1961–1965 4299 158 162 164 168
1966–1970 2344 159 163 165 168
1971–1975 1684 160 164 167 170
1976–1980 1326 160 164 167 170
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Short stature is related to greater longevity 443
did not consider potentially signicant
confounding factors which can affect the
investigated relationships and may mod-
ify them in various ways. Unfortunately,
it was not possible to compare people of
the same body weight or proportions be-
cause no such data (e.g. on somatotype,
BMI, body fat, etc.) were available for the
study sample. Likewise, the study did not
allow for health status, diet, nutrition,
SES, income, specic causes of death,
aging-associated alterations in height,
proximal causative factors proposed
in the literature, e.g. hormonal prole,
growth rate during progressive ontogeny,
detrimental effects of catch-up growth,
the place of residence (urban/rural), and
so forth. Nonetheless, it seems that the
relationship between adult height and
lifespan can be assessed based on the
study sample used for the analysis.
To control for the secular changes in
body height and the cohort effect, the
whole sample was divided into fteen
birth cohorts (Table 1), and subsequent-
ly each group was split into ve height
categories using centiles (pentiles): very
short (0–20), short (21–40), average
(41–60), tall (61–80), very tall (81–100)
(Table 2). Statistical analysis was per-
formed separately for both sexes. Cor-
relation analysis and ANOVA, including
the method of remnant variation, along
with Fisher’s Least Signicant Differ-
ence (LSD) test were run. The normality
of the data distribution was tested with
the goodness-of-t test for a normal
distribution.
Results
In the study sample, both height and
lifespan were normally distributed. In
general, men were taller than wom-
en (171.6±6.6 cm vs. 159.6±6.2 cm;
F=1.14; p<0.001) and lived signicantly
shorter (67.9±13.8 years vs. 75.0±12.7
years; F=1.19; p<0.001).
In the rst cohort, i.e. the group
concerning subjects born in the years
1896–1910 (1,762 men and 5,017 wom-
en), the differences in lifespan between
height categories were on the border of
statistical signicance in men (F=2.30;
p=0.057) and statistically signicant in
women (F=3.61; p=0.006). In both sex-
es, very short subjects had the highest
age at death, while tall subjects had the
lowest age at death (Fig. 1A).
In the next birth cohort (subjects
born in the years 1911–1915, 8,023 men
and 18,557 women), the differences in
lifespan were statistically signicant
in men (F=4.41; p=0.001) but not in
women (F=1.57; p=0.179). In men, very
short and short individuals lived signif-
icantly longer than the rest, while tall
subjects had the lowest age at death (Fig.
1B). In women, on the other hand, no
relationship between height and lifespan
was observed.
In the birth cohort 1916–1920
(19,989 men and 34,861 women), aclear
inverse relationship between adult
height and lifespan was observed in
men (F=17.39; p<0.001) and women
(F=20.07; p<0.001). In both sexes, very
short and short subjects had the highest
age at death, whereas the lowest age at
death was found for very tall men and
tall women (Fig. 1C). The differences
between tall and very tall subjects were
nonsignicant.
In the birth cohort 1921–1925 (51,588
men and 71,157 women), lifespan of both
sexes depends on adult height, and the
differences were statistically signicant
(F=9.66; p<0.001 for men; F=14.76;
p<0.001 for women). The highest age
at death was found for the categories of
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444 Piotr Chmielewski
very short stature, while the lowest age
at death occurred in the categories of tall
stature in both sexes (Fig. 1D).
The same pattern occurred in the
birth cohort 1926–1930 (73,138 men
and 70,924 women) and, thus, the dif-
ferences were statistically signicant
(F=10.90; p<0.001; F=16.32; p<0.001,
respectively), and very short individuals
lived, on average, longer than subjects
from other height categories (Fig. 2A).
Likewise, in the cohort 1931–1935
(73,350 men and 51,055 women), the
highest age at death had the shortest
subjects, while the lowest age at death
had the tallest men and tall women
(Fig. 2B). In both sexes, the differences
between means were statistically sig-
nicant (F=11.22; p<0.001 for men;
F=19.91; p<0.001 for women).
Also, an inverse and steady relation-
ship between adult stature and longev-
ity was observed in subjects born in
the years 1936–1940 (59,876 men and
33,827 women; Fig. 2C), with the dif-
ferences being statistically signicant
in men (F=2.90; p= 0.020) and women
(F=3.24; p=0.011).
The same pattern was found for the
birth cohort 1941–1945 (41,720 men
and 21,094 women). Thus, the arith-
metic means differed signicantly in
men (F=10.32; p<0.001) and women
(F=4.33; p=0.002), and the smallest
subjects had the greatest longevity (Fig.
2D).
Fig. 1. The association between adult height and lifespan in men and women born in the years 1896–1925
and categorized into ve height groups using pentiles; data for rst four birth cohorts (A–D) are shown
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Short stature is related to greater longevity 445
Similarly, the relationship between
adult height and longevity was negative
and linear in men from the birth cohort
1946–1950 (N=49,156), with the dif-
ferences being statistically signicant in
both sexes (F=8.01; p<0.001; F=3.46;
p=0.008, respectively). However, un-
expectedly, tall women had the highest
age at death, while women with short
and average stature had the lowest age at
death (Fig. 3A).
In the cohort 1951–1955 (40,661
men and 16,150 women), as in the pre-
vious birth cohort, the association be-
tween height and lifespan was linear
and inverse in men but tall women had
the highest age at death (Fig. 3B). The
analysis has revealed that the differenc-
es in mean lifespan were signicant in
men (F=20.74; p<0.001) and women
(F=3.46; p=0.008).
Once again, the typical pattern was
observed in the birth cohort 1956–1960
(27,135 men and 9,431 women) and,
thus, the smallest individuals of both
sexes had the greatest longevity (Fig.
3C), and the differences were statistical-
ly signicant in men (F=19.44; p<0.001)
as well as in women (F=15.31; p<0.001).
Also, in the birth cohort 1961–1965
(13,890 men and 4,299 women) the
differences were signicant (F=9.03;
p<0.001; F=4.26; p=0.002, respective-
ly), and the shortest men, as well as short
women, had the highest age at death (Fig.
3D), albeit the differences in lifespan
Fig. 2. The association between adult height and lifespan in men and women born in the years 1926–1945
and categorized into ve height groups using pentiles; data for next four birth cohorts (A–D) are shown
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446 Piotr Chmielewski
between the neighboring categories of
height in women were nonsignicant.
Likewise, an inverse relationship was
found for men who were born in the
years 1966–1970 (N=8,634), while there
were no statistically signicant differenc-
es in lifespan of women from ve cate-
gories, except for the tallest women who
lived signicantly shorter compared with
the other groups (Fig. 4A). In general,
the arithmetic means were signicantly
differentiated in men (F=2.91; p=0.020)
and women (F=3.23; p=0.012).
In the cohort 1971–1975 (6,510 men
and 1,684 women), ANOVA has revealed
statistically signicant differences in men
(F=11.12; p<0.001) but not in women
(F=0.44; p=0.777). The highest age at
death had the shortest men, whereas the
tallest ones had the lowest age at death.
In women, however, no directional asso-
ciation between adult height and lifespan
was found (Fig. 4B).
In the last cohort, i.e. the group con-
cerning the individuals born in the years
1976–1980 (5,061 men and 1,326 wom-
en), the arithmetic means are differen-
tiated in men (F=3.63; p=0.006) and
women (F=3.28; p=0.011). The highest
age at death was found for short men and
women, while the lowest age at death oc-
curred in the categories of average stat-
ure in both sexes (Fig. 4C).
Fig. 3. The association between adult height and lifespan in men and women born in the years 1946–1965
and categorized into ve height groups using pentiles; data for next four birth cohorts (A–D) are shown
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Short stature is related to greater longevity 447
As regards the analysis concerning
the association between stature and lon-
gevity in the oldest old subjects, i.e. 85
years of age and older, tallness was neg-
atively associated with lifespan in both
sexes. In men (N=39,191), the correla-
tion between adult height and longevi-
ty was very weak and negative (r=–0.1;
p<0.001), and after the elimination of
secular changes in body height it was
–0.03 and p<0.001, respectively (Fig. 5A
and 6A). In women (N=75,405), the re-
lationship turned out to be inverse and
very weak (r=–0.13; p<0.001), and after
adjusting for secular trends in height it
changed into –0.06 and p<0.001, respec-
tively (Fig. 5B and 6B).
Discussion
The science of aging seems to be fraught
with misinterpretations. For example,
the well-known dualism of stochastic
and programmed theories of aging is
in fact obsolete and discarded (Rattan
2006). Like the processes of graying hair
and wrinkle formation, lifespan does not
measure the rate of aging (Kowald 2002;
Heward 2010). The rates and measures
of survival, such as all-cause mortality,
life expectancy, and longevity, do not cor-
respond to each other and provide dif-
ferent information (Chmielewski et al.
2016a). Likewise, healthspan does not
correspond to lifespan. It is well estab-
lished that men are physically stronger
Fig. 4. The association between adult height and lifespan in men and women born in the years 1966–1980
and categorized into ve height groups using pentiles; data for last three birth cohorts (A–C) are shown
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448 Piotr Chmielewski
Fig. 5. The relationship between adult height and longevity in men (A) and women (B) from the oldest old
group (85 years of age and older)
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Short stature is related to greater longevity 449
Fig. 6. The relationship between adult height and longevity in men (A) and women (B) from the oldest old
group (85 years of age and older) after eliminating the secular changes in body height which interfered
with the observed relationship between adult stature and lifespan
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450 Piotr Chmielewski
than women and have relatively longer
healthspan (Eskes and Haanen 2007;
Møller et al. 2009), but women remain
less susceptible to many diseases and
signicantly less vulnerable to environ-
mental factors compared with men (Stini
1969; 1978; Stinson 1985). The genetic
and developmental stability in women is
increased presumably due to the homog-
ametic state (Austad 2006). In addition,
estrogens play an important protective
role, and in women mitochondria pro-
duce less reactive oxygen species (ROS).
Consequently, women tend to live longer
than men despite the fact that their
healthspan is relatively shorter (Stindl
2004; Austad 2006; Eskes and Haanen
2007; Møller et al. 2009; Caruso et al.
2013; Chmielewski et al. 2016c).
Similarly, the well-known inverse
relationship between adult height and
mortality, which has been demonstrated
in an abundance of studies, may be in
fact spurious, or at least conned to pop-
ulations with low SES and high mortality
rates, because nal adult stature strong-
ly depends on health, diet, nutrition,
energy intake, and SES during growth
and development. It is noteworthy that
excess weight, which is not infrequently
associated with lower mortality in such
populations, also seems to be apredic-
tor of longer life expectancy (Flegal et
al. 2005). However, it is unlikely that
overweight people have a longevity ad-
vantage over slim people. Thus, excess
weight as apredictor of longevity is most
likely an artifact that result from the fact
that slimmer individuals in some popu-
lations, and especially in those with low
SES and high mortality rates, tend to be
undernourished and ill (e.g. emaciation
and marasums due to extremely low
food energy consumption, cachexia due
to chronic diseases, etc.). It is notewor-
thy that most studies did not compare
tall and short individuals of similar body
proportions, and thus it is possible that
many ndings result from different types
of artifacts. Likewise, adjusting for risk
factors can be acrude and inexact pro-
cess. Poor health or factors like smoking
can easily affect the nal results. Year of
birth is often an important confounding
factor because younger birth cohorts are
taller and have longer life expectancy
compared to older cohorts. Another con-
founder can be the fact that those sub-
jects who have spent their entire lives in
the upper class are taller and have low-
er mortality than upper class men who
were born in lower classes and worked
up to the upper class. They are taller than
those who remained in the lower class-
es all their lives. Some insurance studies
have found that taller men have alower
mortality that shorter men. However,
the shorter subjects were more over-
weight than the taller ones. Wilhelmsen
et al. 2011 tracked agroup of 67-year old
Swedish men to 90 years of age, and this
investigation has revealed that men who
were shorter at baseline were more like-
ly to reach 90 years of age compared to
taller men.
It has previously been established
that body height is a good and reliable
proxy for health status at both progres-
sive and regressive stages of ontogeny,
and tallness is believed to be associated
with better health, higher SES, reduced
all-cause mortality, and longer life expec-
tancy (Waaler 1984; Nyström Peck and
Vågerö 1987; Holl et al. 1991; Allebeck
and Bergh 1992; Elo and Preston 1992;
Herbert et al. 1993; Power and Matthews
1997; Silventoinen et al. 1999; Cave-
laars et al. 2000; Jousilahti et al. 2000;
Lawlor et al. 2002; 2004; Engeland et al.
2003; Kemkes-Grottenthaler 2005; Song
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Short stature is related to greater longevity 451
and Sung 2008; Austad 2010; Kirkwood
2010; Özaltin 2012; Chmielewski et al.
2015a; 2015b; 2016a; 2016b; Perkins et
al. 2016). The better health status, nutri-
tion, environmental conditions, medical
care, and prophylaxis during the progres-
sive development, the taller the individ-
uals are in agiven population. For exam-
ple, arecent study of children in Tanzania
showed that children who lost a father
before the age of 15 tended to be sig-
nicantly shorter and lived shorter than
their peers who had afather (Kirkwood
2010). Interestingly, those children who
lost amother were even shorter and lived
shorter than their peers who had amoth-
er and than those who lost afather. Prob-
ably until late adulthood, height can be
used as areliable and genuine proxy for
health. Moreover, adult stature is pos-
itively associated with socioeconomic
status (SES), social mobility, educational
attainment, remuneration, and physical
attractiveness, especially in men in West-
ern countries, while it is inversely relat-
ed to mortality and risk of many diseas-
es (Sear 2006; Özaltin 2012; Pawłowski
2012). Furthermore, tallness may confer
protection against some types of cancer,
including mouth, esophagus, and gas-
tric (Leoncini et al. 2014; Perkins et al.
2016), which is consistent with many
previous investigations showing that
short stature reects childhood illness,
low energy intake, low SES, and poor
health outcomes in later life (Davey
Smith et al. 2000; Özaltin 2012; Perkins
et al. 2016). Therefore, height has long
been used as a crude indicator of the
nutritional health and disease exposure
in numerous human populations by ep-
idemiologists, demographers, anthropol-
ogists, physicians, and economists. As
aresult, the majority of researchers and
scholars still believe that taller individu-
als are generally healthier and less prone
to many diseases than their shorter peers
(Austad 2010). Other epidemiological,
biodemographic, and bioarcheological
studies have demonstrated that shorter
people have increased mortality, and con-
siderably lower age at death compared
to taller ones (Peck and Vågerö 1989;
Läärä and Rantakallio 1996; Lawlor et
al. 2002; 2004; Engeland et al. 2003;
Kemkes-Grottenthaler 2005; Song and
Sung 2008; Özaltin 2012), which seems
to be acoincidental rather than acausal
relationship, which means that in some
samples tallness is coincidentally linked
to better health and survival, but short-
ness alone does not predict shorter life
expectancy, especially when BMI, SES,
and educational attainment are allowed
for (Sear 2006; Samaras 2014).
Although early epidemiological stud-
ies have shown that short stature is as-
sociated with cardiovascular disease
(CVD), diabetes, lower energy intake
or food deprivation during growth, poor
health, and increased all-cause mortal-
ity, the link between adult height and
longevity becomes tenuous when cer-
tain confounding factors, such as BMI,
SES, and educational attainment, are
controlled for. Furthermore, more re-
cent studies have found that like excess
weight, tallness is costly in terms of lon-
gevity in late ontogeny (Gavrilov and
Gavrilova 2008), and shorter people tend
to outlive their taller peers, especially if
they are slim and maintain ahealthy diet
and lifestyle (Samaras 2014). Therefore,
there is currently a lack of agreement
in the literature as to whether and how
body height and lifespan are linked. Nu-
merous recent studies have challenged
the traditional view that tallness pre-
dicts greater longevity. It is now well
established that the association between
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452 Piotr Chmielewski
adult height and mortality is in fact het-
erogeneous and complicated, and several
large studies have found apositive asso-
ciation between height and, for instance,
some types of cancer (Dieckemann et al.
2008; Cairns and Green 2013; Kabat et
al. 2013a; 2013b; Wirén et al. 2014; Jiang
et al. 2015). Furthermore, dwarsm and
signicantly reduced levels of hormones
(e.g. GH and IGF-1) and other biological
factors that stimulate growth are associ-
ated with extended longevity in model
organisms such as mice (Bartke 2012).
Interestingly, diet-induced alterations in
the concentration of these factors can
confer survival advantage in both an-
imals and humans, and many studies
have found that smaller individuals out-
live their taller peers, especially if they
remain slim, and the BMI and SES of
compared individuals are commensurate
(Samaras 2014). It was also suggested
that smaller body size can offer advantag-
es in terms of healthy aging and longev-
ity in late ontogeny (Wilhelmsen et al.
2011; Salaris et al. 2012; He et al. 2014;
Samaras 2014). Therefore, although his-
torical demographers argue that smaller
individuals have increased mortality and
shorter life expectancy, biologists and
gerontologists contend that small body
size may be preferable for longevity, if
short stature does not result from illness
associated with retarded growth during
progressive ontogeny but from the type
of physical constitution. Gavrilova and
Gavrilov (2008) assert that “biologists
are rmly convinced that asmall body
size is preferable for longevity”. Moreo-
ver, this nding makes perfect sense in
the light of the hyperfunction theory of
aging (Blagosklonny 2013), as well as
some other molecular mechanisms relat-
ed to aging and longevity (Bartke 2012;
Bartke et al. 2013; He et al. 2014; Sa-
maras 2014).
Notwithstanding these ndings,
which seem compelling, many authors
do not agree that the traditional view,
according to which taller people are
healthier and live longer, is in fact inva-
lid or at least challenged. Austad (2010)
states explicitly that: “Economists and
historians often use height as an indica-
tor of the nutritional health and disease
exposure of human populations and as
such an indicator in dozens of studies,
greater height correlates with longer life.
Samaras, astrident advocate of the oppo-
site view that shorter humans live longer
than taller ones – reaches his conclusion
by comparing heights of different sexes
or different countries or ethnic groups
within acountry with one another. Due
to variation in hormonal milieu, diet,
lifestyle, and multiple other factors in his
analyses, it is difcult to evaluate these
claims in the face of amountain of oppos-
ing epidemiological evidence”. Also, oth-
er researchers maintain that amultitude
of studies have shown that adult height
correlates positively with health, wealth,
SES, social mobility, and life expectancy,
but if one compares different populations
(like e.g. Samaras et al. 2003), the re-
sults can be opposite to the results from
arelatively homogenous population. For
example, shorter, on average, Japanese
people tend to live longer than relatively
taller Europeans. This approach seems
inappropriate as it does not allow for ge-
netic differences associated with various
adaptations to different conditions of liv-
ing. An assessment of men’s health with-
in agiven ethnic group would be amuch
better approach. It should be remem-
bered that body height may be a very
indirect cause of differences in incidence
of different diseases and there are many
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Short stature is related to greater longevity 453
more important factors, such as diet, nu-
trition, and lifestyle, which have asignif-
icantly greater inuence on, for instance,
coronary heart disease (CHD) than body
height alone (Pawłowski 2009).
For comparative purposes, mean
lifespan of subjects who differed in body
height, and who were thus classied into
ve height categories, was used in the
present study. The relationship between
adult stature and longevity was evaluat-
ed within one population, and therefore
the results are unlikely to be encumbered
with effects of genetic or ethnic differ-
ences. The analysis concerning longevi-
ty was conned to subjects aged 85 and
above. These two approaches may seem
straightforward but are useful, and they
have been employed in numerous pre-
vious studies. In the rst type of analy-
sis, lifespan of subjects who differed in
height was compared only within con-
secutive birth cohorts, where the dif-
ferences in lifespan were limited. Thus,
the well-known problem of considerable
variability in human lifespan, which is
often raised, was curbed. The results of
this analysis unambiguously show that
shorter men tend to live longer, but the
relationship between adult stature and
lifespan in women is tenuous. In the
studied population, the negative asso-
ciation between height and lifespan is
more pronounced in men than in wom-
en, which may be attributable to great-
er ecosensitivity of the male sex (Stini
1969; 1978; Stinson 1985). Interesting-
ly, the links between height and lifespan
are more tenuous in individuals under
the age of 85 compared with individuals
aged 85 and over. This observation lends
credence to the hypothesis that longev-
ity depends on adult height and shorter
individuals tend to live longer than tall-
er ones as the negative association be-
tween height and lifespan is young and
middle-aged people is unanticipated.
Thus, in young and middle-aged peo-
ple, lifespan usually does not depend on
adult stature, mainly due to the fact that
deaths before age 65 are premature. By
contrast, deaths after age 85 are closely
related to the ravages of the aging pro-
cess, and longevity may favor smaller and
slimmer individuals (Bartke 2012).
There are at least two causes of the
observed inverse correlation between
height and lifespan, which could explain
the ndings and which do not pertain to
biological mechanisms responsible for
greater longevity of smaller individuals.
First, individuals born earlier were signif-
icantly shorter than those who were born
later (the secular changes in height), and
the latter lived signicantly shorter than
the former (the cohort effect) because the
lifetime of each subject lasted until the
xed limit of the years 2004–2008. Sec-
ond, long-lived subjects are also shorter,
on average, than their short-lived peers
as they experience the regressive chang-
es in body height for arelatively longer
time (Sorkin et al. 1999; Chmielewski
et al. 2015a; 2015b; 2016b). Although
only the rst effect was controlled in
the present study, the second one is un-
likely to blur the longevity picture. The
age-related changes in height consist in
decrease and not increase in height and
therefore such aging-associated changes
can enhance the studied association, i.e.
shorter stature in older individuals, but
cannot distort it.
There are several possible biological
mechanisms pertinent to enhanced lon-
gevity in smaller individuals (Table 3).
Smaller individuals have reduced DNA
damage as molecular damage increas-
es with taller stature (Giovannelli et al.
2002). Some studies have found that
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454 Piotr Chmielewski
body size is inversely related to telomere
length, and shorter people tend to have
longer telomeres (Maier et al. 2008). Pre-
sumably longer telomeres and a slower
rate of shortening in telomere length, as
well as lower level of oxidative damage
are associated with increased longevity
and decreased risk of some aging-asso-
ciated diseases such as CVD (Samaras
2014). Interestingly, hypertension is as-
sociated with increased oxidative stress
(Baradaran et al. 2014), and is also ama-
jor risk factor of atherosclerosis, stroke,
chronic kidney failure (CKF), coronary
heart disease (CHD), heart failure, and
myocardial infarction. Thus, higher arte-
rial blood pressure is astrong predictor
of ashortened life expectancy (Chobani-
an et al. 2003; Franco et al. 2005). Some
authors claim that lower blood pressure,
which is associated with decreased risk
of CVD, CHD, myocardial infarction,
stroke, and premature death, can be at-
tributed to biological mechanisms that
are responsible for greater longevity in
smaller individuals (Samaras 2014).
Shorter and slimmer people have lower
insulin and IGF-1 levels, which are re-
lated to greater longevity. Furthermore,
increased insulin, insulin-like growth
factor 1 (IGF-1), growth hormone
(GH), mechanistic target of rapamycin
(mTOR), adiponectin, C-reactive protein
(CRP), some binding proteins such as
IGFBP-1, and sex hormone binding glob-
ulin (SHBG) have anegative impact on
longevity in humans and tend to increase
with body size, i.e. body height, weight,
BMI, or with all three. As regards cellular
aspects of senescence, some studies have
suggested that shorter and slimmer in-
dividuals have signicantly reduced free
Table 3. Selected biological factors and mechanisms providing smaller individuals with longevity advan-
tages.
Biological factors Explanation
Reduced molecular damage
and lower level of oxidative
stress due to lower ROS
generation
Lower risk of many diseases, including CVD and cancer.
For example, hypertension is strongly associated with high level of oxi-
dative damage. Increased generation of ROS and high level of molecular
damage are closely related to higher risk of cancer and premature death.
Longer telomeres and slower
rate of telomere attrition It has been established that telomere length, which can be affected by var-
ious lifestyle factors, can affect the pace of aging as well as the onset of
aging-associated diseases. In general, shorter telomeres and faster process
of telomere shortening are associated with poor health and shorter life
expectancy.
Lower total number of cells
and a greater mitotic poten-
tial of cells
Reduced cell replication and telomere attrition due to lower life-long
maintenance requirements; presumably lower risk of cancer at different
anatomic sites. Moreover, lower blood glucose level, insulin, and IGF-1;
presumably reduced oxidative damage and improved survival. CR is as-
sociated with lower blood pressure and lower risk of many age-related
diseases, including CVD and cancer.
Lower blood pressure Longer life expectancy and lower risk of renal failure, left ventricular hy-
pertrophy, and other consequences of high blood pressure.
Relatively lower BMI Increasing BMI promotes some chronic diseases, including diabetes, CVD,
and cancer.
Lower intake of toxins Shorter and slimmer people tend to have lower food energy intake and
water consumption.
Lower levels of insulin, GH,
IGF-1, SHBP, CRP, mTOR They increase with greater cell growth and taller stature at the organismal
level and are also related to shorter life expectancy.
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Short stature is related to greater longevity 455
radical generation. Moreover, lower cell
number in shorter subjects, relatively
lower need for new cells of the shorter or-
ganism compared to taller one, and low-
er level of ROS generation is associated
with slower aging and decreased risk of
cancer and other aging-associated diseas-
es such as CVD. In shorter individuals,
the size of some internal organs, such as
the liver, kidneys, and brain, is relative-
ly larger, and larger organs have greater
functional capacity. There can be many
other biological factors that favor small-
er individuals in terms of healthspan and
longevity. For example, He et al. 2014
found that shorter American men of Jap-
anese ancestry have ahigher expression
of FOXO3 gene, which is related to im-
proved survival and greater longevity.
In addition to the supports provided
by biological factors for the greater lon-
gevity of shorter people, evidence from
eight different types of studies supports
the advantages of smaller body size.
These include (Samaras 2014): (1) ex-
tensive research involving animal and
human subjects shows that within aspe-
cies, the smaller individuals tend to live
longer. (2) Hundreds of animal studies
show that caloric restriction reduces body
size and increases longevity; it seems
that both caloric restriction and small-
er body size contribute independently
to greater longevity. (3) Females are, on
average, smaller than males and have en-
hanced longevity; e.g. U.S. males are 9%
taller than females and have a9% shorter
life expectancy. In this study, men aver-
aged 8% taller and had a10% shorter life
expectancy. Interestingly, other studies
have also found that among nonhuman
species, larger females do not live as long
as smaller males within the same spe-
cies, and therefore sexual dimorphism in
lifespan can be associated with the differ-
ences in body size of both sexes and oth-
er related factors (e.g. the rate of growth
and development, GH, the insulin/IGF-1
signaling pathway, mTOR, etc.) within
agiven species. (4) Ethnic groups within
the U.S. show a progressive increase in
age-adjusted mortality with the increase
in average height of each ethnic group,
and these include results based on about
18 million deaths over a15-year period.
This advantage is strongest in the rst
generation of Latinos and declines, or
even disappears, with subsequent gen-
erations since they are often taller and
heavier than the rst generation. (5) Old
age survival studies show that shorter
people are more likely to reach advanced
ages compared to taller people (e.g. Wil-
helmsen et al. 2011). (6) The relation-
ship between shorter height and greater
longevity has been found among vari-
ous races and ethnic groups, independ-
ent of the nation’s economic status. (7)
In general, life expectancy is greater for
shorter nations when both taller (e.g. the
Dutch people, Norwegians, and Finns)
and shorter nations (e.g. the mainland
Japanese people, Okinawans, the people
of Andorra, and so forth) are developed.
(8) By and large, ahost of studies have
shown that centenarians and supercente-
narians tend to be short and light.
Conclusions
A growing body of evidence suggests
that shorter and slimmer individuals live
longer that taller ones, if they maintain
healthful diet, nutrition, and lifestyle.
Although body height is denitely not
a major factor for exceptional longevity
(height is probably only 5–10% of the
longevity picture, and genetic inheritance
along with lifestyle are the most impor-
tant factors which constitute the rest
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456 Piotr Chmielewski
of the longevity picture), more recent
studies have challenged the traditional
belief that taller people have a longevi-
ty advantage over shorter people. There
are several plausible biological mecha-
nisms that are responsible for enhanced
longevity in smaller individuals, such as
reduced DNA damage, longer telomeres
and slower rate of telomere attrition,
greater functional capacity of some or-
gans, lower levels of insulin, IGF-1, GH,
mTOR, SHBG, CRP, and so forth. Al-
though earlier studies demonstrated that
taller individuals have lower mortality,
higher SES, better health, and longer life
expectancy, evidence from novel data in-
dicates now that smaller body size is an
advantage under prosperous and similar
environmental conditions, lifestyles, and
medical care.
Acknowledgements
The author would like to thank the ano-
nymous reviewers for very helpful and
insightful suggestions for improving the
paper.
Conict of interest
The author declares that there is no con-
ict of interest.
Corresponding author
Piotr Chmielewski, Department of Anat-
omy, Faculty of Medicine, Wrocław Med-
ical University, ul. T. Chałubińskiego 6a,
50-368 Wrocław, Poland.
e-mail address:
piotr.chmielewski@umed.wroc.pl
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