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

BMJ 2015; 351 doi: https://doi.org/10.1136/bmj.h3942 (Published 04 August 2015) Cite this as: BMJ 2015;351:h3942

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

The inverse association between consumption of spicy foods and mortality, reported by Lv and colleagues, is clearly an interesting finding. However, the authors, as well as the corresponding editorial and previous rapid responses, acknowledge residual confounding as possible explanation for the results. In my opinion, one strong contender for the confounding role is salt intake. While it has strong relationship with hypertension and the consequent CVD mortality (1), it is also possible that those who eat spicy food frequently have a lower sodium intake as they might use chili or other spice instead of salt.

Because of the difficulties in measuring salt intake accurately, this dietary factor may be a potential unmeasured confounder in not just this study but many other nutritional epidemiological analyses. Regarding the high salt and spice intake in China, this population would be especially suitable to clarify these dietary inter-relationships in future studies.

References
1. Aburto NJ, Ziolkovska A, Hooper L, Elliott P, Cappuccio FP, Meerpohl JJ. Effect of lower sodium intake on health: systematic review and meta-analyses. BMJ. 2013;346:f1326.

Competing interests: No competing interests

10 August 2015
Denes Stefler
PhD student
Department of Epidemiology and Public Health, University College London
1-19 Torrington Place, London, WC1E 6BT