Height, wealth, and health: An overview with new data from three longitudinal studies

https://doi.org/10.1016/j.ehb.2009.06.004Get rights and content

Abstract

This overview, based on a literature review and new data from the three cohorts (Whitehall Studies I and II, and the Vietnam Experience Study), has four objectives: (a) to outline the major determinants of height, so providing an indication as to what exposures this characteristic may capture; (b) to summarise, by reviewing reports from large scale studies, the relation between adult height and a range of disease outcomes – both somatic and psychiatric – with particular emphasis on coronary heart disease (CHD) and stroke; (c) to discuss why these relationships may exist, in particular, the role, if any, of socioeconomic position in explaining the apparent associations; and, finally (d) to outline future research directions in this field.

The large majority of evidence for predictors of height, and its health consequences, comes from observational studies. While genetic predisposition is a major determinant of height, secular rises in childhood and adult stature across successive birth cohorts suggest that early life environment also has an important impact. Plausible non-genetic determinants of height include nutrition, illness, socioeconomic status, and psychosocial stress. Evidence for an association between height and a series of health endpoints is accumulating. Thus, shorter people appear to experience increased risk of CHD, and these associations appear to be independent of socioeconomic position and other potentially confounding variables. For stroke, and its sub-types, findings are less clear. In contrast to CHD, some cancers, such as carcinoma of the colorectum, prostate, breast (in women), central nervous system, skin, endometrium, thyroid and blood (haematopoietic) are more common in taller people. While height may be negatively related to the risk of completed suicide, conclusions about the links between stature and other health endpoints is problematic given the paucity of evidence, which should be addressed.

Ultimately, for want of better data, investigators in this area have used height as a proxy for a range of pre-adult exposures. In future, research should aim to explore the predictive capacity of direct measures of diet, psychosocial stress, childhood chronic illness and so on, rather than focus on height or its components. The problem is that extended follow-up of child cohorts with such data are required, and studies which hold these data are not currently available, although several are either maturing to the point where they offer sufficient clinical outcomes to facilitate analyses or are in the advanced planning stage.

Introduction

The characteristic of physical stature has been utilised for many years in the fields of economic history and development, anthropology, anthropometry and, more recently, epidemiology. Economists have typically regarded height as a marker of historical prosperity – one which conventional, contemporaneous indicators fail to capture – that may, in turn, reflect differences in health and longevity within and between countries. Anthropologists, on the other hand, have been more concerned with the influence of various nutritional privations on height.

Over the last two decades, epidemiologists have begun to take an interest in adult stature (Waaler, 1984, Walker et al., 1989, Gunnell, 2002, Batty et al., 2006a) as the volume of research into the early life origins of chronic disease, specifically cardiovascular disease, has increased exponentially. The use of stature in this manner has arisen out of the paucity of longitudinal studies which hold data on prospectively gathered early life factors and adult disease outcomes; that is, studies which follow population-based childhood groups for several decades through into middle- and older age when the majority of clinical events occur. Height, which may capture, amongst other insults, early life illness, socioeconomic disadvantage, sub-optimal nutrition, and psychosocial stress has the added advantage of varying little during adult years, although some “shrinkage” in trunk length owing to osteoporotic vertical collapse appears to occur (see later discussions).

Taking largely an epidemiological perspective, but aiming wherever possible to incorporate findings from the afore named fields, the objectives of this overview are fourfold: (a) to outline the major determinants of height, so providing an indication as to what exposures this characteristic may capture; (b) to review reports from large scale studies to summarise the relation between adult height and a range of disease outcomes – both somatic and psychiatric – with a particular emphasis on cardiovascular disease; (c) to discuss why these relationships may exist, in particular the role, if any, of socioeconomic position in explaining the apparent associations; and, finally, (d) to outline future research directions in this field. For the purpose of illustration, we introduce new data from other studies: the original Whitehall study of men (Reid et al., 1974), the second Whitehall study of men and women (Marmot and Brunner, 2005), and the Vietnam Experience Study of men (TCDCVES, 1987, Batty et al., 2008d).

Section snippets

Determinants of height

As evidenced by the classic studies demonstrating the predictive value of midparental height for offspring stature (Galton, 1885, Pearson and Lee, 1903), height is clearly under a large degree of genetic control. Indeed, estimates suggest that up to 80% of the phenotypic variation in height in a given population is determined by genetic factors (Carmichael and McGue, 1995, Silventoinen et al., 2003, Perola et al., 2007). However, for centuries it has also been recognised that environmental

Height as a determinant of chronic disease

Given that height may capture the afore-described pre-adult socioeconomic, nutritional, psychological, and infectious insults, it has been related to a series of morbidities to test the hypothesis that pre-adult exposures may have a long term impact on adult health. In the main, the outcomes considered have been all-cause mortality, cardiovascular disease – principally comprising coronary heart disease, stroke (including sub-types of haemorrhagic and ischaemic) – and cancer. A much smaller

Conclusions and future research directions

Although very few experimental studies have been conducted, there is good observational evidence to suggest that, while undoubtedly under a large degree of genetic control, height is also influenced by early life environmental factors, which include nutrition, psychosocial stress, chronic illness, and living circumstances. Height consistently reveals inverse relations with total mortality (weakly), CHD (more strongly) and possibly stroke, that appear to be robust to the adjustment of

Funding

The Medical Research Council (MRC) Social and Public Health Sciences Unit receives funding from the UK MRC and the Chief Scientist Office at the Scottish Government Health Directorates. David Batty is a Wellcome Trust Fellow (WBS U.1300.00.006.00012.01). Martin Shipley is supported by the British Heart Foundation, Mika Kivimaki by the Academy of Finland, and Rachel Huxley by a Career Development Award from the National Heart Foundation of Australia

References (162)

  • Actuarial Society of America and Association of Life Insurance Directors, 1932. Influence of Build on...
  • D. Albanes et al.

    Adult stature and risk of cancer

    Cancer Res.

    (1988)
  • D. Albanes et al.

    Are cell number and cell proliferation risk factors for cancer?

    J. Natl. Cancer Inst.

    (1988)
  • S.A. Ali et al.

    Giardia intestinalis

    Curr. Opin. Infect. Dis.

    (2003)
  • E. Arias Vallejo

    La dieta de hambre a días alternos en la alimentación de los viejos

    Revista Clínica Española

    (1956)
  • D.J.P. Barker

    Mothers, Babies and Health in Later Life

    (1998)
  • G.D. Batty et al.

    Socio-economic position and coronary heart disease risk factors in children and young people. Evidence from UK epidemiological studies

    Eur. J. Public Health

    (2002)
  • G.D. Batty et al.

    Socioeconomic position and coronary heart disease risk factors in children and young people

  • G.D. Batty

    Confounding effect of socioeconomic position in the study of height in relation to prostate cancer risk (letter)

    Br. J. Cancer

    (2004)
  • G.D. Batty et al.

    Adult height and lung function as markers of life course exposures: associations with risk factors and cause-specific mortality

    Eur. J. Epidemiol.

    (2006)
  • G.D. Batty et al.

    Pre-morbid intelligence, the metabolic syndrome and mortality: the Vietnam Experience Study

    Diabetologia

    (2008)
  • G.D. Batty et al.

    Cigarette smoking and site-specific cancer mortality: testing uncertain associations using extended follow-up of the original Whitehall study

    Ann. Oncol.

    (2008)
  • G.D. Batty et al.

    IQ in late adolescence/early adulthood, risk factors in middle age and later all-cause mortality in men: the Vietnam Experience Study

    J. Epidemiol. Commun. Health

    (2008)
  • G.D. Batty et al.

    IQ in late adolescence/early adulthood, risk factors in middle-age and later coronary heart disease mortality in men: the Vietnam Experience Study

    Eur. J. Cardiovasc. Prev. Rehabil.

    (2008)
  • Y. Ben Shlomo et al.

    An investigation of fetal, postnatal and childhood growth with insulin-like growth factor I and binding protein 3 in adulthood

    Clin. Endocrinol. (Oxf.)

    (2003)
  • W.Z. Billewicz et al.

    A longitudinal study of growth in Newcastle upon Tyne adolescents

    Ann. Hum. Biol.

    (1983)
  • O. Bjerkeset et al.

    Association of adult body mass index and height with anxiety, depression, and suicide in the general population: the HUNT study

    Am. J. Epidemiol.

    (2008)
  • T.K. Boehmer et al.

    Postservice mortality in Vietnam veterans: 30-year follow-up

    Arch. Intern. Med.

    (2004)
  • S. Brown

    Excess mortality of schizophrenia. A meta-analysis

    Br. J. Psychiatry

    (1997)
  • G.H. Brundtland et al.

    Height, weight and menarcheal age of Oslo schoolchildren during the last 60 years

    Ann. Hum. Biol.

    (1980)
  • C.M. Carmichael et al.

    A cross-sectional examination of height, weight, and body mass index in adult twins

    J. Gerontol. A: Biol. Sci. Med. Sci.

    (1995)
  • A.E. Cavelaars et al.

    Persistent variations in average height between countries and between socio-economic groups: an overview of 10 European countries

    Ann. Hum. Biol.

    (2000)
  • L. Cernerud

    Differences in height between socially more and less privileged 10 year old Stockholm children born in 1933–1963

    Scand. J. Soc. Med.

    (1992)
  • M. Champoux et al.

    Hormonal effects of early rearing conditions in the infant rhesus monkey

    Am. J. Primatol.

    (1989)
  • P.H. Chyou et al.

    A prospective study of weight, body mass index and other anthropometric measurements in relation to site-specific cancers

    Int. J. Cancer

    (1994)
  • G. Davey Smith et al.

    Height and mortality from cancer among men: prospective observational study

    BMJ

    (1998)
  • G. Davey Smith et al.

    Education and occupational social class: which is the more important indicator of mortality risk?

    J. Epidemiol. Commun. Health

    (1998)
  • G. Davey Smith et al.

    Height and risk of death among men and women: aetiological implications of associations with cardiorespiratory disease and cancer mortality

    J. Epidemiol. Commun. Health

    (2000)
  • G. Davey Smith et al.

    Leg length, insulin resistance, and coronary heart disease risk: the Caerphilly Study

    J. Epidemiol. Commun. Health

    (2001)
  • G. Davey Smith

    The conundrum of height and mortality

    West J. Med.

    (2002)
  • M. Dong et al.

    Insights into causal pathways for ischemic heart disease: adverse childhood experiences study

    Circulation

    (2004)
  • O. Duncan

    A Socioeconomic Index for all Occupations

    (1961)
  • P.C. Elwood et al.

    Growth of children from 0–5 years: with special reference to mother's smoking in pregnancy

    Ann. Hum. Biol.

    (1987)
  • J.E. Ferrie et al.

    Birth weight, components of height and coronary heart disease: evidence from the Whitehall II study

    Int. J. Epidemiol.

    (2006)
  • Floud, R., 2003. The dimensions of inequality: height and weight variation in Britain, 1700–2000. In: Berridge, V.,...
  • S. Frankel et al.

    Childhood energy intake and adult mortality from cancer: the Boyd Orr Cohort Study

    BMJ

    (1998)
  • S.C. Freni et al.

    Anthropometric measures and metabolic rate in association with risk of breast cancer (United States)

    Cancer Causes Control

    (1996)
  • C. Gale

    Commentary: height and intelligence

    Int. J. Epidemiol.

    (2005)
  • F. Galton

    Regression towards mediocrity in hereditary stature

    J. R. Anthropol. Inst.

    (1885)
  • M.M. Gertler et al.

    Young candidates for coronary heart disease

    J. Am. Med. Assoc.

    (1951)
  • Cited by (200)

    View all citing articles on Scopus
    View full text