Supercentenarians and the oldest-old are concentrated into regions with no birth certificates and short lifespans

[BrianR]

Some reasons to doubt the veracity of blue zone longevity reports (and thus conclusions about the impact of nutritional practices on lifespan/healthspan in those areas).

Open access: https://www.biorxiv.org/content/10.1101/704080v1

Supercentenarians and the oldest-old are concentrated into regions with no birth certificates and short lifespans
Saul Justin Newman
DOI: 10.1101/704080

Abstract
The observation of individuals attaining remarkable ages, and their concentration into geographic sub-regions or ‘blue zones’, has generated considerable scientific interest. Proposed drivers of remarkable longevity include high vegetable intake, strong social connections, and genetic markers. Here, we reveal new predictors of remarkable longevity and ‘supercentenarian’ status. In the United States, supercentenarian status is predicted by the absence of vital registration. The state-specific introduction of birth certificates is associated with a 69-82% fall in the number of supercentenarian records. In Italy, which has more uniform vital registration, remarkable longevity is instead predicted by low per capita incomes and a short life expectancy. Finally, the designated ‘blue zones’ of Sardinia, Okinawa, and Ikaria corresponded to regions with low incomes, low literacy, high crime rate and short life expectancy relative to their national average. As such, relative poverty and short lifespan constitute unexpected predictors of centenarian and supercentenarian status, and support a primary role of fraud and error in generating remarkable human age records.

[donbob]

These authors lost me at the Okinawa comment. My observation is Okinawa society is characterized with good birth records, low crime rate, and literacy typical of a highly functioning well organized first world country. Perhaps the abstract is incomplete.

[BrianR]

These authors lost me at the Okinawa comment. My observation is Okinawa society is characterized with good birth records, low crime rate, and literacy typical of a highly functioning well organized first world country. Perhaps the abstract is incomplete.

Note that the authors used the past tense, apparently referring primarily to the period 1880-1900, when current and recent "supercentenarians" were born. That said, since I don't have any expertise to evaluate their claims for that time and place, I'll defer to yours.

[BGTex]

Isn’t Loma Linda a blue zone?

[xactly]

Isn’t Loma Linda a blue zone?

Yes, Loma LInda, California is a Blue Zone. They have good birth records and a median income above the US average.

[MarcR]

Abstracts are brief summaries and are therefore "incomplete" by definition. If we click the Full Text tab below the title, we can read the full paper.

With respect to Okinawa, Newman has this to say:

Okinawa has the highest number of centenarians per capita of any Japanese prefecture and remains world-famous for remarkable longevity. Okinawa also has the highest murder rate per capita, the worst over-65 dependency ratio, the second-lowest median income, and the lowest median lifespan of all 47 Japanese prefectures [23].

Like the ‘blue zone’ islands of Sardinia and Ikaria, Okinawa also represents the shortest-lived and second-poorest region of a rich high-welfare state. These regions may have higher social connections and vegetable intakes, yet they also rank amongst the least educated and poorest regions of their respective countries. The hypothesis that these relatively low literacy rates and incomes are generating age-reporting errors and pension fraud, and therefore remarkable age records, seems overlooked.

Note that this aspect of the hypothesis rests on current societal status rather than that of the 1880-1900 period.

When coupled with Sally Fallon's observations about gross inaccuracy in the reporting of the dietary patterns of all five areas ...

Sardinia
Okinawa
Costa Rica
Ikaria, Greece
Loma Linda

... I see little reason to accord any credibility to Buettner's book.

[Julie G]

The paper raises some interesting points about record keeping, but I have to admit getting stuck on Okinawa too.

Okinawa has the highest number of centenarians per capita of any Japanese prefecture and remains world-famous for remarkable longevity. Okinawa also has the highest murder rate per capita, the worst over-65 dependency ratio, the second-lowest median income, and the lowest median lifespan of all 47 Japanese prefectures [23]

.
The claim that Okinawa has the LOWEST median life expectancy of all Japanese prefectures is contradicted by their own reference. The most recent statistics (2015) for females can be found here and males here. While average male life expectancy is lower for males, 80.27 vs. 86.88 for females, the shortest median life expectancy for both sexes is found in the prefecture of Aomori... not Okinawa. Additionally, when averaged together, those from the island of Okinawa still have among the highest median life expectancy of anywhere in the world lending to the credulity of Okinawan supercentenarians.

The average female life expectancy is longest in Okinawa with 86.88 years. This is 2.08 years longer than the average female life expectancy in Aomori. 2.08 years is smaller than the difference between the longest and shortest average male life expectancy which is 3.57 years, and thus it can be said that there is less regional difference compared to the average male life expectancy. [Emphasis mine.]

The validation of Okinawan supercentenarians hasn't gone without scrutiny as you can see here, with a more in-depth look here. From reading the various papers, it's clearly difficult to fully validate age when spanning more than a century, but I've not found any reports of outright fraud in Okinawa.

When coupled with Sally Fallon's observations about gross inaccuracy in the reporting of the dietary patterns of all five
areas...

FWIW, I agree that Buettner has propagandized Blue Zone data with a decidedly plant-focused perspective, but Sally Fallon is likely guilty of the same with an animal-focused emphasis. After all, the current "Spam" popularity (circa 1996) in Okinawa likely plays a small role when examining the contributions of lifelong diet for supercentenarians. Its pretty clear that Okinawans traditionally did eat some animals, fish and pork (nose-to-tail) with a lot of plants, especially sweet potatoes and seaweed. I also suspect that the traditional practice of "hara hachi bu" (only eating till 80% full) has also been a big contributor to their longevity with the average BMI for centenarians being 20.4.

[BrianR]

Some interesting historical notes which might affect considerations of Okinawan data. The Japanese annexed Okinawa in the late 1800s. I don't have any evidence, but I suspect that record keeping was less than pristine for some time thereafter. Also, the internet tells me that about 1/3 of the native Okinawan population died during the WW2 battle on the island. I wouldn't expect that to have a systemic affect on longevity, but it seems like we might not want to extrapolate from the Okinawan experience into our own practices.

[MarcR]

FWIW, I agree that Buettner has propagandized Blue Zone data with a decidedly plant-focused perspective, but Sally Fallon is likely guilty of the same with an animal-focused emphasis. After all, the current "Spam" popularity (circa 1996) in Okinawa likely plays a small role when examining the contributions of lifelong diet for supercentenarians. Its pretty clear that Okinawans traditionally did eat some animals, fish and pork (nose-to-tail) with a lot of plants, especially sweet potatoes and seaweed. I also suspect that the traditional practice of "hara hachi bu" (only eating till 80% full) has also been a big contributor to their longevity with the average BMI for centenarians being 20.4.

I agree with all of this and especially the last sentence (emphasis added). Fallon's credibility with me is no higher than Buettner's, but sharing her articles is a convenient way to expose Buettner's ideological bias and push back against the "but what about Blue Zones?" shorthand sometimes used here as primary justification for a dietary pattern that I believe is not supported well by actual science.

[Julie G]

Some interesting historical notes which might affect considerations of Okinawan data. The Japanese annexed Okinawa in the late 1800s. I don't have any evidence, but I suspect that record keeping was less than pristine for some time thereafter. Also, the internet tells me that about 1/3 of the native Okinawan population died during the WW2 battle on the island. I wouldn't expect that to have a systemic affect on longevity, but it seems like we might not want to extrapolate from the Okinawan experience into our own practices.

Thanks, Brian. Important perspective. In terms of directly extrapolating from this (or any) Blue Zone region, I agree. I'm more interested in the bigger commonalities like: lots of movement, low stress, daily down time, a sense of purpose, faith, family, friends, community, eating less from a primarily seasonal whole food omnivorous diet.

Fallon's credibility with me is no higher than Buettner's, but sharing her articles is a convenient way to expose Buettner's ideological bias and push back against the "but what about Blue Zones?" shorthand sometimes used here as primary justification for a dietary pattern that I believe is not supported well by actual science.

Fair enough. Good to know you're not buying Fallon hook, line, and sinker. FWIW, when I refer to Blue Zones, I'm also not relying on Beuttner's interpretation but rather using the best primary evidence I can find about traditional diets from the various regions. Nose-to-tail use of animals are almost always included... with Loma Linda being the exception (? ) Trying to extract from epidemiological evidence is imprecise and intrinsically subject to bias. Thanks for keeping us honest, Marc.