This website is intended for healthcare professionals only.
Take a look at a selection of our recent media coverage:
25th September 2023
Cancer screening is designed to detect the presence of disease at an early stage, but whether it actually has the desired effect of reducing mortality is up for debate. Clinical writer Rod Tucker investigates.
In medicine, screening is designed to identify the presence of a disease in healthy individuals who are not displaying any of the typical clinical signs or symptoms of a particular condition. Cancer screening, for instance, can therefore be considered to serve a dual purpose: on the one hand it is preventative, but it can also enable the early identification of cancer or precursor lesions and thus having the potential to improve prognosis.
Cancer screening is already well established for breast, prostate, lung, cervical and colorectal cancers, and many of the current tests are very accurate. For example, one novel prostate cancer screening test has an accuracy of 94%.
The fact that cancer screening has the potential to reduce cancer-related mortality and ultimately improve lifespan, has been the main focus in public health messaging. In the past, such messaging has been emotive, employing powerful and persuasive tools such as fear and guilt, engendering a sense of personal responsibility and convincing individuals to be screened.
And this approach has clearly worked. For instance, in a survey of 500 individuals that included women over 40 years of age and men over 50 years, without a history of cancer, the majority (87%) believed that routine cancer screening was almost always a good idea. In addition, 74% felt that finding a cancer early, through methods such as screening, saved lives most or all the time.
But does cancer screening actually extend lifetime? Five-year survival is often presented to the public as evidence of the value of early detection, but one analysis concluded that changes in five-year survival over time bear little relationship to changes in cancer mortality.
A recent meta-analysis attempted to shed further light on the relationship between cancer screening and all-cause mortality, which offered some surprising results.
Most randomised controlled trials of cancer screening focus on disease-specific mortality as the outcome of interest. However, the validity of this outcome is highly dependant on an accurate ascertainment of death, which is not always clear.
This was highlighted in an analysis of 12 published randomised trials of cancer screening for which disease-specific and all-cause mortality data were available. The researchers identified major inconsistencies in both disease-specific and all-cause mortality but concluded that since all-cause mortality is not affected by bias in classifying the cause of death, it should be used as the main outcome of interest for randomised trials looking at cancer screening.
The most recent study to examine of the impact of cancer screening on all-cause mortality was conducted by a team based at the Institute of Health and Society, which is part of the University of Oslo in Sweden. The researchers performed a systematic review and meta-analysis of randomised clinical trials that reported on all-cause mortality to estimate the potential lifetime gained for six commonly used cancer screening tests when compared to no screening.
They focused on mammography screening for breast cancer; colonoscopy, sigmoidoscopy or faecal occult blood testing (FOBT) for colorectal cancer; computed tomography screening for lung cancer in smokers and former smokers; and prostate-specific antigen (PSA) testing for prostate cancer.
The team included trials with 10 to 15 years of follow-up and set the primary outcome of interest as lifetime in the screened group compared to the non-screening group based on all-cause mortality. Using these differences, the researchers calculated the absolute lifetime gained in days.
With the inclusion of just over 2.1 million individuals in the analysis for the six different cancer screening trials, the only screening test with a significant lifetime gain of 110 days (95% CI 0 – 274) was sigmoidoscopy. However, the lower 95% confidence interval extended to zero, so the effect was just significant.
Although there were gains in lifetime accrued for prostate (37 days) and lung (107 days) cancer screening, these increases were not significant.
Despite these largely negative findings, the researchers were quick to point out that they did not actually favour abandoning screening, merely that the current evidence did not substantiate the claim that common cancer screening tests saved lives by extending lifetime.
Although all-cause mortality has been suggested as a better study endpoint, a problem with using this metric is that the impact of screening on all-cause mortality, depends largely on the level of underlying risk of death from different causes, such as heart disease, within the population being screened.
Consequently, while there are clearly some limitations from focusing solely on cancer-related deaths as an outcome, this may be preferable with the caveat that deaths from other causes are carefully reviewed to identify potential cases of harm.
Nonetheless, a 2015 analysis concluded that currently available screening tests for diseases where death is a common outcome, reductions in disease-specific mortality are uncommon and either very rare or non-existent for all-cause mortality.
The use of all-cause mortality as a primary outcome may be more relevant for the multi-cancer early detection test, especially if deaths from the cancers targeted constitute a high proportion of expected deaths in the population recruited.
Perhaps the most important message from the recent cancer screening analysis is that in their discussions with patients, clinicians should no longer predicate the rationale for screening on the claim that it will both save lives and increase life expectancy. This may not always be the case.
11th August 2023
Elevated levels of cardiac troponin in those for whom there was no clinical indication for testing is independently associated with medium-term cardiovascular and non-cardiovascular mortality, according to a large study by researchers at the University of Southampton, UK.
Cardiac troponin (cTn) concentrations above the manufacturer recommended upper limit of normal (ULN) and without a clinical presentation consistent with type 1 myocardial infarction, has been linked to a 76% higher risk of death, the study found.
The prospective, observational study, published in the journal Heart, was designed to assess the relationship between medium-term mortality and cTn concentration in a large consecutive hospital population, regardless of whether there was a clinical indication for performing the test.
It‘s rationale was based on prior research showing how increased cTn levels were associated with an increased mortality risk. For example, even among patients with dyspnoea and without a cardiac cause, there is a three-fold higher risk of death when cardiac troponin levels are elevated.
The study included 20,000 hospital patients over the age of 18 years who underwent a troponin blood test for any reason between June and August 2017 at a large teaching hospital, regardless of the original clinical indication. Their average age was 61 and 53% were women.
In 91.4% of these patients, there was no clinical indication for cardiac troponin testing.
The mortality was significantly higher if the cTn concentration was above the ULN (45.3% vs 12.3% p < 0.001 log rank). Using multivariable Cox regression analysis, the log10 cTn concentration remained independently associated with mortality (Hazard ratio, HR = 1.76, 95% CI 1.65 – 1.89).
In addition, multivariable analysis revealed a significant and independent association between the log10cTn concentration with non-cardiovascular (HR =1.99, 95% CI 1.861 – 2.118) as well as cardiovascular mortality (HR = 2.53, 95% CI 2.198 – 2.90).
The researchers concluded on how ‘a snapshot cTn in a hospital population may represent a biomarker of overall medium-term mortality’.
30th May 2023
Consuming one to three serving of chocolate per week is enough to lower women’s risk of death, findings from a recent study suggest.
Focusing on post-menopausal women, free of cardiovascular disease (CVD) and cancer at baseline when enrolled in the study during 1993 through to 1998, the cohort were followed until March 2018. The outcomes of interest were all-cause mortality and cause-specific mortality from CVD, cancer and dementia.
Women’s intake of chocolate was categorised based on the intake frequency of a 1oz serving of chocolate as: none, less than one serving per week (<1 serving/wk), one to three serving per week (1-3 servings/wk), four to six servings per week (4-6 servings/wk) and more than one serving per day (≥1 serving/d).
Over 1,608,856 person-years of follow-up, there were a total of 25,388 deaths, which included 7,069 deaths from CVD, 7,030 from cancer and 3,279 from dementia. In multivariable adjusted analysis, compared to those who did not eat chocolate, the hazard ratio (HR) for all-cause mortality ranged from 0.95 (95% CI 0.92 – 0.98) for <1 serving/wk to 0.93 (95% CI 0.89 – 0.96) for 1-3 serving/wk (p for trend = 0.02).
For CVD mortality, the association was only significant for 1-3 servings/wk (HR = 0.88, 05% CI 0.82 – 0.95). In contrast, dementia mortality was significantly lower for both <1 serving/wk and 1-3 servings/wk.
Overall, there was no significant effect of chocolate intake on cancer mortality, but, in subgroup analysis, lung cancer mortality was significantly lower but only for 1-3 servings/wk (HR = 0.82, 95% CI 0.70 – 0.96).
The authors recognised how their analysis did not consider the different types of chocolate in their analysis, for example dark chocolate has purported health benefits, and this could have impacted on their findings. They also accepted that residual confounding could not be excluded, in other words, the findings could be due to other factors not considered.
A modest and inverse association between eating chocolate and mortality from all causes and cause-specific mortality from cardiovascular disease, cancer and dementia has previously been found in an analysis of data from Women’s Health Initiative (WHI) by US researchers.
Chocolate is known to contain a high content of the saturated fat, stearic acid and antioxidant flavonoids with the latter component likely responsible for a cardioprotective effect. Moreover, evidence from a meta-analysis of prospective studies, suggests that moderate consumption of chocolate is associated with a decreased risk of coronary heart disease (CHD), stroke and diabetes. But not all studies have concurred with this analysis. One, for instance, undertaken in women, was unable to find an association between chocolate intake and the risk of CHD and stroke. As well as potential cardiovascular benefits, it seems there is also an inverse relationship between regular intake of chocolate and a lower risk of cognitive decline.
25th April 2023
Data for 2021 suggests that globally, 537 million were living with diabetes. In addition cardiovascular disease (CVD) is the main cause of death in those with type 2 diabetes (T2D). Moreover, sugar-sweetened and artificially sweetened beverages increase all-cause and CVD-related mortality. Nevertheless, the effect of different beverages on either all-cause mortality or CVD risk in those with T2D is largely unknown. There is also a lack of clarity on whether changes to beverage intake following a T2D diagnoses effects CVD risk.
In a recent BMJ study, researchers set out to investigate the relationship between beverage intake and all-cause mortality in T2D. They also considered if a change in what people drank following their T2D diagnosis affected their subsequent CVD risk. Data were collected from two large US prospective studies (the Nurses’ Health Study and Health Professionals Follow-Up Study). The researchers set the primary outcome as all-cause mortality. Secondary outcome measures were CVD incidence and mortality.
Beverages and all-cause mortality
There were 15,486 men and women with a mean age of 61.3 years (73.6% female) who had a diagnosis of type 2 diabetes at baseline. These individuals were followed for an average of 18.5 years. During this time, 22.3% developed incident CVD and 49.3% died.
When comparing the highest and lowest drink intake, there was a 20% greater all-cause mortality risk for those drinking sugar-sweetened drinks (hazard ratio, HR = 1.20, 95% CI 1.04 – 1.37). In contrast, the all-cause mortality risk was significantly lower in those drinking higher amounts of coffee (HR = 0.74, 95% CI 0.63 – 0.86). This relationship was also apparent for tea (HR = 0.79), plain water (HR = 0.77) and low-fat milk (HR = 0.88). Higher intake of coffee also significantly lowered the risk of CVD incidence (HR = 0.82).
The researchers also considered the effect of changes to beverage intake after an individual had their T2D diagnosis. For example, replacing one serving/day of a sugar sweetened drink with coffee, gave rise to an 18% lower risk of all-cause mortality. Similar trends occurred with tea, plain water and low-fat milk.
24th January 2023
Treatment with the loop diuretic torsemide (TM) leads to a similar level of all-cause mortality and all-cause hospitalisations as furosemide (FM) following hospital discharge in patients with heart failure according to the findings of a randomised trial by US researchers.
Heart failure is growing public health concern with an estimated global prevalence exceeding 37.7 million people. Both fluid retention and congestion are key features of the condition which are treated with loop diuretics and this approach is recommended in therapy guidelines. Although furosemide is an established loop diuretic, another agent, torsemide, has both a longer half-life and greater oral bioavailability than furosemide. Moreover, some evidence points to a lower mortality in patients with congestive heart failure treated with torsemide compared to furosemide. However, studies have not been sufficiently powered to address mortality differences between the two agents.
In the present study, researchers undertook an open-label, randomised trial to examine the comparative effectiveness of TM and FM in patients discharged from hospital following an admission for heart failure, irrespective of their ejection fraction. The researchers hypothesised that torsemide would lower all-cause mortality by 20% compared to furosemide. Patients were eligible if they were hospitalised for either de novo heart failure or a worsening of chronic heart failure and randomised 1:1 to either furosemide or torsemide. The researchers set the primary effectiveness outcome as all cause mortality whereas one of the main secondary outcomes was all-cause hospitalisations.
Torsemide and all-cause mortality
A total of 2,859 patients with a mean age of 64.5 years (36.9% female) were randomised to either diuretic and followed for a median of 17.4 months.
During follow-up, death occurred in 26.1% of the TM group and 26.2% of the FM group and this difference was not significant (hazard ratio, HR = 1.02, 95% CI 0.89 – 1.18, p = 0.76). In addition, all-cause mortality or all-cause hospitalisations occurred in 47.3% of those assigned to TM and 49.3% of patients in the FM group (HR = 0.92, 95% CI 0.83 – 1.02). There were also no significant differences in any of the subgroups analysed, including patients with differing levels of ejection fractions.
Although there were no significant differences between the two loop diuretics, the researchers did acknowledge at least two potentially important study limitations including treatment discontinuation (9.5% of any agent at 6 months) and cross-over (7% for TM to FM) between the two agents could have had an effect.
They concluded that while torsemide did not lower all-cause mortality compared to furosemide, these findings should be interpreted with caution given the rates of discontinuation and cross-over.
Citation
Mentz RJ et al. Effect of torsemide vs furosemide after discharge on all-cause mortality in patients hospitalized with heart failure: The TRANSFORM-HF randomized clinical trial. JAMA 2023
9th January 2023
A large prospective study by Chinese researchers has found that both separately and combined, coffee and tea consumption is inversely associated with a reduced cardiovascular disease (CVD) and all-cause mortality, highlighting the potential importance of incorporating both into an individual’s diet, provided that these observed associations are causal.
Long-term and moderate consumption of coffee is known to be significantly and inversely associated with cardiovascular disease risk, with the greatest reduction seen with 3 to 5 cups per day. In addition, evidence from China also suggests that daily green tea consumption is associated with a lower risk of incident type 2 diabetes and a lower risk of all-cause mortality in diabetics though the associations for other types of tea is less clear. Nevertheless, emerging data suggests that higher green tea and coffee consumption is inversely associated with a lower risk of cardiovascular disease and stroke in the general population. To date, however, only one study has examined the mortality benefit from coffee and tea consumption, finding that higher consumption of both was associated with reduced all-cause mortality, although the study was restricted to patients with type 2 diabetes. Consequently, it remains unclear whether the benefits of consuming both drinks are more generalisable. In the present study, the Chinese researchers aimed to examine the separate and combined associations of consuming the two beverages, with total and cause-specific mortality (including cardiovascular disease, CVD, respiratory and digestive disease using data from a population-based longitudinal cohort of individuals registered with the UK Biobank.
Intake of coffee and tea were assessed at baseline using a self-reported questionnaire but the researchers also collected information on a range of factors including age, gender, sociodemographic, behavioural (e.g., smoking, exercise, alcohol intake and dietary intake). Intake of both drinks categorised as coffee: none, < 1–2, 3–4 and ≥ 5 cups/day and tea: none, < 1–1, 2–4 and ≥ 5 cups/day.
Coffee and tea intake and mortality outcomes
A total of 498,158 participants with a median age of 58 years (54% female) were included in the analysis. These individuals were followed up for a median of 12.1 years, during which time 34,699 deaths were identified.
In a separate analysis and after adjusting for potential confounders, drinking less than 1 – 2 cups/day of coffee, was inversely associated with a lower risk of all the health outcomes assessed. For example, a 9% lower risk for all-cause mortality (hazard ratio, HR = 0.91, 95% CI 0.88–0.93)and a 6% reduced risk for cardiovascular mortality (HR = 0.94, 95% CI 0.88–1.00). Among those drinking tea, 2 – 4 cups/day was associated with a lower risk for all-cause (HR = 0.86, 95% CI 0.83–0.88) as well as CVD mortality (HR = 0.88 95% CI 0.81–0.94).
However, in joint analyses and compared to those who did not drink either beverage, the combination of < 1 – 2 cups/day of coffee and 2 – 4 cups/day of tea, significantly lowered all-cause mortality (HR = 0.78 95% CI 0.73-0.85) and CVD mortality (HR = 0.76 95% CI 0.64-0.91). Interestingly, the lowest mortality occurred for gastrointestinal disease from drinking both < 1 – 2 cup/day of coffee and ≥ 5 cups/day of tea (HR = 0.42, 95% CI 0.34-0.53).
The authors concluded that consumption of both drinks were both separately and jointly, inversely associated with all-cause and cause-specific mortality.
Citation
Chen Y et al. Consumption of coffee and tea with all-cause and cause-specific mortality: a prospective cohort study. BMC Med 2022
2nd December 2022
An olive oil intake of around 20g/day is associated with a reduced risk of both cardiovascular and all-cause mortality according to the results of a meta-analysis of prospective studies by Greek and Chinese researchers.
Olive oil contains a number of plant polyphenols that have health benefits including anti-mutagenic, anti-inflammatory, anti-thrombotic, anti-atherogenic, and anti-allergic effects. In addition, the monounsaturated fatty acids present in olive oil and in particular, oleic acid, might have positive impacts on lipid peroxidation. In fact, a 2019 network meta-analysis examining the role of olive oil in the modification of metabolic factors such as glucose and circulating lipids, found that olive oil polyphenols increased HDL-cholesterol and that overall, the beneficial effect of olive oil were more pronounced in subjects with an established metabolic syndrome or other chronic conditions/diseases. Furthermore, while some analyses indicate that a higher olive oil intake is associated with lower risk of coronary heart disease, other studies that have examined the link between dietary fat intake (including olive oil) and cardiovascular disease (CVD) events, have found no association.
Trying to provide more definitive evidence, in the present study, researchers performed a meta-analysis of prospective cohort studies to investigate the relationship between olive oil consumption and risk of CVD and all-cause mortality. The team included studies in which the exposure of interest was olive oil consumption and where the recorded outcomes were total CVD or all-cause mortality.
Olive oil intake and cardiovascular and all-cause mortality outcomes
A total of 13 prospective cohort studies were included and the duration of follow-up ranged from 4 to 28 years. Most of the studies collected the dietary data on olive oil intake from food-frequency questionnaires.
In an assessment of CVD risk, the pooled relative risk (RR) for the highest versus the lowest olive oil intake was 0.85 (95% CI 0.77 – 0.93, p < 0.001). In subgroup analysis, this relationship was independent of the region of study, sample size, follow-up duration, sex, or even the type of olive oil.
In terms of all-cause mortality and again comparing the highest and the lowest levels of intake, there was a significant reduction in all-cause mortality (RR: 0.83, 95% CI 0.77 –0.90, p < 0.001). As with CVD risk, there was no significant impact of any of the examined factors in subgroup analysis.
When the researchers looked at the amount of olive oil consumed, the relative risk for CVD for each 5g/day increment was 0.96 (95% CI 0.93 – 0.99, p = 0.005) and this was a similar order of magnitude for all-cause mortality. Interestingly, the reduction in CVD risk was largely attenuated with an intake above 20 g/day and there were also no preventive mortality effects when intake exceeded 20 g/day.
The authors concluded that consuming up to 20g/day of olive oil was associated with a reduced CVD and all-cause mortality risk but that there were no apparent benefits from exceeding this amount.
Citation
Xia M et al. Olive oil consumption and risk of cardiovascular disease and all-cause mortality: A meta-analysis of prospective cohort studies. Front Nutr 2022
18th July 2022
‘Weekend warriors’ who restrict physical activity to just one or two sessions per week appear to have similar levels of all-cause and cause-specific mortality compared to those who are regularly active, i.e., spread their physical activity over several days. This was the conclusion of a large, prospective cohort study by an international group of researchers.
Physical activity guidelines for Americans (and which are broadly similar across the world) recommend that adults should do at least 150 to 300 minutes a week of moderate-intensity, or 75 to 150 minutes a week of vigorous-intensity aerobic physical activity. In addition, the guidelines advocate muscle strengthening activities of moderate or greater intensity on two days or more each week.
Furthermore, the evidence to date suggests that when adults engage in the recommended levels of physical activity, there is a greatly reduced risk of all-cause and cause specific mortality. Only a single study has examined the mortality benefits achieved by weekend warriors and suggested that it may be sufficient to reduce all-cause mortality risks, in comparison to those who are insufficiently active.
However, it is less clear whether concentrating the recommended amounts of physical exercise into one or two sessions (e.g., weekend warriors) provides the same mortality benefits as observed by those who are physically active throughout the week.
In the present analysis, researchers examined the all-cause and cause-specific mortality between weekend warriors and those who were regularly active using data from the US National Health Interview Survey from 1997 to 2013 and linked this information to a national death index.
They classified individuals as physically active (150 minutes of activity/week) or inactive (< 150 minutes/week). Among those deemed physically active, individuals were sub-divided into weekend warriors (1 – 2 sessions/week) or regularly active (> 3 sessions/week).
The main outcomes of interest were all-cause, cardiovascular and cancer-related mortality. In regression models, adjustments were made for several factors including age, gender, ethnicity and various lifestyle factors such as smoking status, alcohol intake and co-morbidities.
Weekend warriors and all-cause mortality
A total of 350978 individuals with a mean age of 41.1 years (50.8% women) were followed-up for a median of 10.4 years. More than half (52.5%) were deemed physically inactive, 3% weekend warriors and the remaining 44.5% regularly active. During the period of follow-up there were 21 898 deaths including 4130 from cardiovascular disease and 6034 from cancer.
When compared to those deemed physically inactive, the adjusted hazard ratio (HR) for all-cause mortality was 0.92 (95% CI, 0.83 – 1.02) for weekend warriors and 0.85 (95% CI 0.83 – 0.88) for regularly active participants. The HR for cardiovascular disease mortality were also similar for weekend warriors (HR = 0.87) and and those who were regularly active (HR = 0.77), as were the cancer-related HRs.
But when researchers compared mortality between weekend warriors and those who were regularly active, the all-cause, cardiovascular and cancer-related mortality hazard ratios, were also very similar, even after adjustment for the amount and intensity of physical activity undertaken.
The authors concluded that there were no significant differences for any cause mortality among those who were physically active, irrespective of whether the sessions were undertaken throughout the week or concentrated into one or two sessions.
Citation
dos Santos M et al. Association of the “Weekend Warrior” and Other Leisure-time Physical Activity Patterns With All-Cause and Cause-Specific Mortality: A Nationwide Cohort Study JAMA Intern Med 2022
14th July 2022
Individuals who frequently add salt to food have a higher risk of a premature death and a lower life expectancy according to an analysis of data in the UK Biobank by a group of US researchers from Boston.
According to the World Health Organization, the intake of dietary salt (sodium chloride) is an important determinant of blood pressure, hypertension and overall cardiovascular risk and the organisation recommends a salt intake of less than 5 grams (approximately 2g sodium) per day, for the prevention of cardiovascular diseases.
However, several studies examining the relationship between salt intake and cardiovascular disease are conflicting.
For example, one study concluded that there was an increased risk of mortality for high-sodium intake even at the lowest levels of sodium intake. In contrast, another reported that changes in systolic but not diastolic pressure over time aligned with change in sodium excretion, but this did not translate into a higher risk of hypertension or cardiovascular disease complications.
Similarly, in a study of older adults salt intake, the authors concluded that food frequency questionnaire-assessed sodium intake was not associated with 10-year mortality, incident cardiovascular disease or incident heart failure, adding that consuming greater than 2300 mg/d of sodium was associated with a non-significantly higher mortality in adjusted models.
The reason for these discrepant findings are unclear though in a 2014 advisory from the American Heart Association, it was suggested that methodological issues may account for the inconsistent findings in currently available observational studies relating sodium to cardiovascular disease.
While salt is present in many foods, adding salt to food is a common eating behaviour and a single study has suggested that adding salt to food was strongly positively associated with all-cause, cancer-related, but not cardiovascular-related mortality.
Thus in the present study, the US team wanted to get a better understanding of whether the frequency of adding salt to food influenced the risk of premature death but also if other dietary effects such as fruit and vegetable intake might affect this risk.
Using a questionnaire that asked ‘do you add salt to your foods?‘, the researchers categorised intake as either never/rarely, sometimes, usually and always. They were also able to access data on random urine samples collected at baseline to measure sodium and potassium levels and also collected information on intake of fruits and vegetables (from the questionnaire) as well as lifestyle and clinical factors such as smoking status, physical activity, body mass index etc.
Adding salt to food and mortality
Data were available for a total of 501, 379 individuals with a mean age of 56.5 years (45.6% male). During a follow up period of 9 years, there were 18,474 cases of all-cause premature deaths recorded.
Not surprisingly, there was a graded relationship between the urinary sodium concentration and self-reported adding of salt to food.
In terms of mortality, there was an increasing risk with higher levels of reported addition of salt to food. For those who always added salt to food, there was a 28% higher risk (hazard ratio, HR = 1.28, 95% CI 1.20 – 1.35). In fully adjusted models, the risk of cardiovascular disease mortality was significantly elevated for those who always added salt to food (HR = 1.36, 95% CI 1.21 – 1.54, ptrend < 0.001) and for cancer-related death (HR = 1.64). Interestingly, however, a higher intake of fruit and vegetables attenuated the risk of premature all-cause premature mortality (HR = 0.97, 95% CI 0.69 – 1.37, p = 0.90).
The authors calculated that for a woman aged 50 who always added salt to food, had an average 1.5 lower years of life expectancy and this was higher for men (2.28 years).
They concluded that while always using salt at the table was associated with a higher risk of all-cause premature mortality, higher intake of fruits and vegetables may attenuate this risk.
Citation
Ma H et al. Adding salt to foods and hazard of premature mortality Eur Heart J 2022
27th June 2022
Being able to stand on one leg for only 10 seconds is associated with mortality benefits according to the findings of a study by an international team of researchers.
Ageing is known to be associated with a decline in physical fitness yet exercise capacity has been shown, at least in men, to be a more powerful predictor of mortality than other established risk factors for cardiovascular disease.
Most aspects of fitness such as aerobic capacity, strength and flexibility will decline with advancing age, although balance tends to be maintained much longer and health-related fitness can be assessed by asking individuals to stand on one leg with their eyes open.
Nevertheless, the ability to perform a unipedal stance test has also been found to reduce with age although whether the ability to stand on one leg – which provides a measure of fitness – is associated with a mortality benefit is uncertain.
In the present study, the research team examined if an individual’s ability to stand on one leg for 10 seconds was independently associated with all-cause mortality in a group of middle-aged and older adults. They also explored if the capacity to perform the 10 second unipedal stance added further prognostic value beyond that based on anthropometric and clinical data in mortality risk models.
Anthropometric data such as skin fold thickness and waist girth were measured and clinical data were derived from patient’s medical history. For the unipedal stance, individuals were asked to stand on one leg for at least 10 seconds and then categorised as ‘yes’ where the test could be performed or ‘no’ where individuals were unable to perform the test.
Using Cox modelling, the researchers assessed survival curves and the risk of death according to whether an individual could successfully perform the unipedal standing test.
Ability to stand on one leg and overall mortality
A total of 1702 individuals with a mean age of 61.7 years (68% women) were included in the study and followed for a median of 7 years.
A total of 20.4% of individuals failed the test, 4.7% of those aged 51 – 55 years and with the proportion rising to 36.8% of those aged 66 – 70 years.
During the follow-up period, 123 participants (7.2%) died, due to cancer (32%), cardiovascular causes (30%) and respiratory disease (9%).
Using a model adjusted for age and other co-morbidities, the risk of death, was significantly higher among those who were unable to perform a stand on one leg for 10 seconds (hazard ratio, HR = 1.84, 95% CI 1.23 – 2.78, p < 0.001).
Using an all-cause mortality model that made use of established risk factors, the C-index was 0.799. However, after addition of the ability to perform the 10 second standing on one leg, the C-index increased to 0.80 (p for comparison = 0.002). In other words, adding the ability to successfully perform the test improved the mortality prediction risk of the model.
The authors concluded that the ability to stand on one leg for at least 10 seconds is independently associated with a reduced risk of all-cause mortality.Citation
Araujo CG et al. Successful 10-second one-legged stance performance predicts survival in middle-aged and older individuals BJSM 2022
IMPORTANT LINKS
MORE FROM COGORA
© Cogora 2025
Cogora Limited. 1 Giltspur Street, London EC1A 9DD
Registered in the United Kingdom. Reg. No. 2147432
