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

BMJ 2015; 351 doi: (Published 04 August 2015) Cite this as: BMJ 2015;351:h3942
  1. Jun Lv, associate professor1,
  2. Lu Qi, associate professor23,
  3. Canqing Yu, assistant professor1,
  4. Ling Yang, senior epidemiologist4,
  5. Yu Guo, director, CKB national coordinating center5,
  6. Yiping Chen, senior research fellow4,
  7. Zheng Bian, senior coordinator, CKB national coordinating center5,
  8. Dianjianyi Sun, PhD candidate1,
  9. Jianwei Du, director6,
  10. Pengfei Ge, vice director7,
  11. Zhenzhu Tang, director8,
  12. Wei Hou, chief9,
  13. Yanjie Li, investigator10,
  14. Junshi Chen, professor11,
  15. Zhengming Chen, professor4,
  16. Liming Li, professor15
  17. on behalf of the China Kadoorie Biobank collaborative group
  1. 1Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing 100191, People’s Republic of China
  2. 2Department of Nutrition, Harvard School of Public Health, Boston, MA, USA
  3. 3Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
  4. 4Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, UK
  5. 5Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
  6. 6Hainan Center for Disease Control and Prevention, Haikou, Hainan, People’s Republic of China
  7. 7Gansu Center for Disease Control and Prevention, Lanzhou, Gansu, People’s Republic of China
  8. 8Guangxi Center for Disease Control and Prevention, Liuzhou, Guangxi, People’s Republic of China
  9. 9Licang Center for Disease Control and Prevention, Qingdao, Shandong, People’s Republic of China
  10. 10Nangang Center for Disease Control and Prevention, Harbin, Heilongjiang, People’s Republic of China
  11. 11China National Center for Food Safety Risk Assessment, Beijing, People’s Republic of China
  1. Correspondence to: L Li lmlee{at}
  • Accepted 8 July 2015


Objective To examine the associations between the regular consumption of spicy foods and total and cause specific mortality.

Design Population based prospective cohort study.

Setting China Kadoorie Biobank in which participants from 10 geographically diverse areas across China were enrolled between 2004 and 2008.

Participants 199 293 men and 288 082 women aged 30 to 79 years at baseline after excluding participants with cancer, heart disease, and stroke at baseline.

Main exposure measures Consumption frequency of spicy foods, self reported once at baseline.

Main outcome measures Total and cause specific mortality.

Results During 3 500 004 person years of follow-up between 2004 and 2013 (median 7.2 years), a total of 11 820 men and 8404 women died. Absolute mortality rates according to spicy food consumption categories were 6.1, 4.4, 4.3, and 5.8 deaths per 1000 person years for participants who ate spicy foods less than once a week, 1 or 2, 3 to 5, and 6 or 7 days a week, respectively. Spicy food consumption showed highly consistent inverse associations with total mortality among both men and women after adjustment for other known or potential risk factors. In the whole cohort, compared with those who ate spicy foods less than once a week, the adjusted hazard ratios for death were 0.90 (95% confidence interval 0.84 to 0.96), 0.86 (0.80 to 0.92), and 0.86 (0.82 to 0.90) for those who ate spicy food 1 or 2, 3 to 5, and 6 or 7 days a week, respectively. Compared with those who ate spicy foods less than once a week, those who consumed spicy foods 6 or 7 days a week showed a 14% relative risk reduction in total mortality. The inverse association between spicy food consumption and total mortality was stronger in those who did not consume alcohol than those who did (P=0.033 for interaction). Inverse associations were also observed for deaths due to cancer, ischemic heart diseases, and respiratory diseases.

Conclusion In this large prospective study, the habitual consumption of spicy foods was inversely associated with total and certain cause specific mortality, independent of other risk factors of death.


  • We thank the participants, project staff, and China National Center for Disease Control and Prevention (CDC) and its regional offices for access to death and disease registries. The Chinese National Health Insurance scheme provides electronic linkage to all hospital treatment.

  • China Kadoorie Biobank collaborative group: International steering committee: Liming Li (PI), Junshi Chen, Rory Collins, Richard Peto, Zhengming Chen (PI). Study coordinating centers: International Co-ordinating Center, Oxford: Zhengming Chen, Garry Lancaster, Xiaoming Yang, Alex Williams, Margaret Smith, Ling Yang, Yumei Chang, Iona Millwood, Yiping Chen, Sarah Lewington. National coordinating center, Beijing: Yu Guo, Jun Lv, Zheng Bian, Peng Liu, Canqing Yu, Pei Pei, Huiyan Zhou, Yunlong Tan, Can Hou, Lei Guo, Bingyang Han, Shuzhen Qu, Ge Chen. Regional coordinating centers, 10 areas in China: Qingdao CDC: Zengchang Pang, Shutao Pang, Shaojie Wang, Yongmei Liu, Ranran Du, Yajing Zang, Liang Cheng. Licang CDC: Silu Lv, Junzheng Wang, Wei Hou. Heilongjiang Provincial CDC: Jiyuan Yin, Shumei Liu, Zhigang Pang, Xue Zhou, Huijun Wang. Nangang CDC: Liqiu Yang, Bo Yu, Yanjie Li, Jing Qi, Huaiyi Mu, Qin’ai Xu, Meiling Dou. Hainan Provincial CDC: Jianwei Du, Shanqing Wang, Ximin Hu, Hongmei Wang, Jinyan Chen, Yan Fu, Zhenwang Fu, Xiaohuan Wang, Hua Dong. Meilan CDC: Min Weng, Xiangyang Zheng, Yijun Li, Huimei Li. Jiangsu Provincial CDC: Ming Wu, Jinyi Zhou, Ran Tao, Jie Yang. Suzhou CDC: Jie Shen, Yihe Hu, Yan Lu, Yan Gao, Liangcai Ma, Aiyu Tang, Shuo Zhang, Jianrong Jin. Guangxi Provincial CDC: Zhenzhu Tang, Naying Chen, Ying Huang. Liuzhou CDC: Mingqiang Li, Jinhuai Meng, Rong Pan, Qilian Jiang, Jingxin Qin, Weiyuan Zhang, Yun Liu, Liuping Wei, Liyuan Zhou, Ningyu Chen, Jun Yang, Hairong Guan. Sichuan Provincial CDC: Xianping Wu, Ningmei Zhang, Xiaofang Chen, Xuefeng Tang. Pengzhou CDC: Guojin Luo, Jianguo Li, Xiaofang Chen, Jian Wang, Jiaqiu Liu, Qiang Sun. Gansu Provincial CDC: Pengfei Ge, Xiaolan Ren, Caixia Dong. Maiji CDC: Hui Zhang, Enke Mao, Xiaoping Wang, Tao Wang. Henan Provincial CDC: Guohua Liu, Baoyu Zhu, Gang Zhou, Shixian Feng, Liang Chang, Lei Fan. Huixian CDC: Yulian Gao, Tianyou He, Li Jiang, Huarong Sun, Pan He, Chen Hu, Qiannan Lv, Xukui Zhang. Zhejiang Provincial CDC: Min Yu, Ruying Hu, Le Fang, Hao Wang. Tongxiang CDC: Yijian Qian, Chunmei Wang, Kaixu Xie, Lingli Chen, Yaxing Pan, Dongxia Pan. Hunan Provincial CDC: Yuelong Huang, Biyun Chen, Donghui Jin, Huilin Liu, Zhongxi Fu, Qiaohua Xu. Liuyang CDC: Xin Xu, Youping Xiong, Weifang Jia, Xianzhi Li, Libo Zhang, Zhe Qiu.

  • Contributors: JL and LQ are joint first authors. LL and ZC obtained funding. LL, ZC, and JC designed the study. YG, ZB, JD, PG, ZT, WH, YL, and ZC collected the data. LY and YC were involved in data cleaning, mortality follow-up, and verification. JL, CY, and DS analyzed the data. JL drafted the manuscript. LQ and LL contributed to the interpretation of the results and critical revision of the manuscript for important intellectual content and approved the final version of the manuscript. All authors have read and approved the final manuscript. LL and ZC are the study guarantors.

  • Funding: This study was supported by grants from the National Natural Science Foundation of China (81390541, 81390544), National Key Technologies research and development programme in the 12th five-year plan, Chinese Ministry of Science and Technology (2011BAI09B01, 2012-14), Wellcome Trust in the UK (088158/Z/09/Z), and Kadoorie Charitable Foundation in Hong Kong. LQ is supported by National Institutes of Health grants from the National Heart, Lung, and Blood Institute (HL071981, HL034594, HL126024), National Institute of Diabetes and Digestive and Kidney Diseases (DK091718, DK100383, DK078616), Boston Obesity Nutrition Research Center (DK46200), and United States-Israel Binational Science Foundation (grant 2011036). LQ was a recipient of the American Heart Association scientist development award (0730094N). The funders had no role in the study design, data collection, data analysis and interpretation, writing of the report, or the decision to submit the article for publication.

  • Competing interests: All authors have completed the ICMJE uniform disclosure form at and declare: no support from any organization for the submitted work; no financial relationships with any organization that might have an interest in the submitted work in the previous three years, no other relationships or activities that could appear to have influenced the submitted work.

  • Ethical approval: This study was approved by the ethical review committee of the Chinese Center for Disease Control and Prevention (Beijing, China) and the Oxford Tropical Research Ethics Committee, University of Oxford (UK).

  • Data sharing: The access policy and procedures are available at

  • Transparency: The lead authors (LL and ZC) affirm that the manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies are disclosed.

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