Benefits independent of the Mediterranean diet, researchers say
Eating more chili peppers is linked to lower risk of dying, researchers found in a Mediterranean cohort study.
People who ate chili peppers regularly had less mortality over a median 8.2 years compared to peers who didn't eat them or only rarely did so. This was observed after adjustment for age, sex, and caloric intake:
- All-cause mortality: HR 0.77 (95% CI 0.66-0.90)
- Cardiovascular disease (CVD) mortality: HR 0.66 (95% CI 0.50-0.86)
- Ischemic heart disease mortality: HR 0.56 (95% CI 0.35-0.87)
- Cerebrovascular death: HR 0.39 (95% 0.20-0.75)
Notably, cancer deaths weren't lower with more consumption of chili peppers, according to investigators led by Marialaura Bonaccio, PhD, of IRCCS Neuromed in Pozzilli, Italy, reporting in the Dec. 24 issue of the Journal of the American College of Cardiology.
The lower risk of total and CVD death was independent of CVD risk factors or adherence to a Mediterranean diet in the large adult Mediterranean population studied. The researchers said this supports "the notion that minor dietary changes, such as adding chilies to usual diet, could be valuable measures for improving health, especially cardiovascular health, independent of overall diet quality."
Yet J. David Spence, MD, of the Stroke Prevention and Atherosclerosis Research Centre in London, Ontario, advocated caution in an accompanying editorial.
"Should we all begin taking tablets of capsaicin and dousing our food with hot sauce? The history of food supplements suggests that we should wait for randomized trials," he wrote. He cited a 2018 meta-analysis showing that only folic acid and vitamin B complex supplements can be tied to reduced CVD or stroke risk.
"What appears to be most beneficial is the eating pattern, rather than any one food. The Mediterranean diet, which is high in whole grains, fruits, vegetables, and legumes, is high in beneficial phytochemicals. Because it is a 'mainly vegetarian diet,' the Mediterranean diet is also low in cholesterol and saturated fat. As the fat intake is high (40% of calories from fat, mainly olive oil), the diet also has a low glycemic index," Spence noted.
"Thus, adopting the Cretan Mediterranean diet would be much more likely to reduce cardiovascular risk than adding Tabasco sauce to the unhealthy American diet."
The prospective Moli-sani Study had 22,811 men and women randomly recruited from Molise, Italy. Mortality data were retrieved from an Italian mortality registry and validated by death certificates.
Participants had their chili pepper intake estimated by a food frequency questionnaire, with regular consumption defined as four times a week or more.
Overall, the findings of the Mediterranean cohort study showed a greater risk reduction attributed to chili peppers than reported before, according to Spence.
A Chinese study from 2015 reported that eating spicy food almost daily was associated with a 14% reduction of total mortality and a 22% reduction of death from ischemic heart disease. Similarly, there was a 13% drop in total mortality associated with hot chili pepper consumption in a 2017 analysis of the U.S. National Health and Nutrition Examination Survey.
"Health benefits of chili peppers have been ascribed to capsaicin, its major pungent compound, which has been observed to favorably improve cardiovascular function and metabolic regulation in experimental and population studies. In addition to its anti-inflammatory and analgesic properties and atheroprotective effects, capsaicin reportedly induces apoptosis of the tumor cells," the authors noted.
However, none of the biological mechanisms they tested were able to explain the health benefits associated with chilies.
"Established biomarkers of CVD did not substantially modify the relation between chili pepper and mortality, although a marginal role was played by serum vitamin D levels and biomarkers of lipid metabolism, explaining 6.1% and 5.3% of the association with all-cause mortality, respectively," the authors wrote.
On the other hand, hypertension did interact with the relationship such that the purported survival benefit of chili peppers appeared stronger in people without high blood pressure (P=0.021 for interaction).
The observational nature of the study meant the investigators could not draw causal conclusions from their results and that the data may be subject to residual confounding despite statistical adjustment.
Bonaccio and colleagues had found that, among other baseline differences, regular chili pepper eaters were more likely to be men and slightly older. They also tended to report higher educational level and occupation, have a higher prevalence of CVD risk factors, and better adhere to the Mediterranean diet.
The study was funded by research grants from Pfizer, the Italian Ministry of University and Research, Instrumentation Laboratory, the Italian Ministry of Health, the Italian Association for Cancer Research, and the European Commission Seventh Framework Programme.
Bonaccio was supported by a Fondazione Umberto Veronesi Fellowship.
Spence is a consultant for Amgen and Orphan Technologies, is an officer of Vascularis, and has received lecture fees from Pfizer and Bristol-Myers Squibb.
Journal of the American College of Cardiology
Source Reference: Bonaccio M, et al "Chili pepper consumption and mortality in Italian adults" J Am Coll Cardiol 2019; DOI: 10.1016/j.jacc.2019.09.068.
Journal of the American College of Cardiology
Source Reference: Spence JD "Chili pepper consumption and cardiovascular mortality" J Am Coll Cardiol 2019; DOI: 10.1016/j.jacc.2019.08.1071.
Read the original article on Medpage Today: Hot Peppers May Be the Spice of (Long) Life and Healthy Heart