s1 4 adventist health study

By: Stoy Proctor, MPH., M.Div.Associate Director

Health Ministries DepartmentGeneral Conference

Seventh-day Adventist ChurchAdjunct Professor

Loma Linda University July 2005

In 1974 a study involving 34,000 Adventists in California was

commenced. It was called the Californian Adventist Health

Study (Adventist Health Study I) and compared two groups of

Adventists the vegetarian group and the omnivorous group. It

attempted to see whether there were any associations between

the way people ate and the incidence of cancer and heart

disease.

In 1974 a study involving 34,000 Adventists in California was

commenced. It was called the Californian Adventist Health

Study (Adventist Health Study I) and compared two groups of

Adventists the vegetarian group and the omnivorous group. It

attempted to see whether there were any associations between

the way people ate and the incidence of cancer and heart

disease.

Healthiest Diets

• Whole grains- whole wheat, • yellow corn, brown and • red rice, oats, rye, buckwheat• and millet, bulgur, amaranth, • quinoa, kamut, triticale, spelt,• couscous, and buckwheat..

Go for the Gold- Golden Whole Grains

Nutrition of Whole Grains

• Complex carbohydrates• Soluble and insoluble fiber• Protein• Vitamin B, 1,2,3,6• Folate• Iron• Trace minerals• Magnesium• Polyphenoics

Whole Grains and Fatal and Non-Fatal IHD

Whole WhiteGrains Bread

Fatal IHD .89 1.00Non-fatal IHD .56 1.00

• 5-8 Servings Daily• 1 Slice of whole grain bread• ½ cup of whole gain cereal• 1 cup of dry whole grain cereal• ¼ cup of granola• ½ cup of pasta• 1 chapatti, tortilla• 3-4 whole grain crackers

Vote for the vegetables

• Onion

• Chives

• Leeks

• Basil

• Tarragon

• Dill

Green Super Herbs

AICR News Letter - Spring 1999*

• Parsley• Thyme• Cilantro• Coriander• Anise• Fennel

Kale, spinach, broccoli,

Bok choy, Collards,

Romaine

AJ Epid 1985, 119:775-787

Root Vegetables

• White potatoes

• Parsnips

• Rutabaga

• Beets

The Yellow-Orange Super’s Vegetables

• Carrots• Winter squash• Sweet potatoes• Pumpkin

The White Super’s

Food:1. Garlic, onions

• Death from all causes was associated with a low consumption of

green salads

Nutrition of Vegetables

• Complex carbohydrates

• Insoluble fiber

• Potassium

• Vitamin C

• Calcium

• Magnesium

• Flavonoids, Carot

• 4-6 Servings Daily• 1 cup vegetable salad

• ½ cup of cooked vegetables

• ¾ cup of vegetable juice

• 1 baked potato

Favor the Fruits

Papaya,

Mango

Cantaloupe

Apricots

Persimmon

Peaches

• Preventive Medicine, 1989, 18:732-739

The Orange Super Fruits

The Red Super’s

Food:1 Cranberries, strawberries,

cherries, raspberries, watermelon, apples, pink grape fruit and red grapes.

2 Tomatoes,

AJPH, 79, 1989, p. 1806-1819

Purple and Blue Super Foods

• Blueberries, blackberries,

• grapes, raisins, prunes,

• plums, and figs.

FigsBlueberries

Blackberries

Grapes

Raisins

Prunes

Eggplants

• Regular consumption of

dried fruit, legumes and tomatoes by

men was associated with

significantly decreased risk (40-

50%) of prostate cancer.

• Persons who consumed beans,

lentils, peas, dried fruit and vegetable

protein products more than 4 times a week had only

one-fifth the risk of pancreatic cancer.

Fruit and Cancer (AHS 1)

Cancer Site

Fruit Types

Frequency Relative Risk

Ovary All fruits <5/wk 1.00 1-2/day 1.24 >2/day 0.59

Pancreas

Raisins, dates, dried fruit

<1/month 1.00 > 3/wk 0.19

Prostate

Raisins, dates, dried fruit

<1/wk 1.00 1-4/wk 1.17 > 5/wk 0.62

Lung All fruits <3/wk 1.00 3-7/wk 0.30 >1/day 0.26

Tomatoes and Cancer (AHS 1 )

Tomato Frequency

Cancer Site <1/week 1-4 week

5 > / week

p values

Prostate 1.00 0.64 0.60 .10

Ovary 1.00 0.72 0.32 .001

Fruit and Cancer (AHS 1)

Cancer Site

Fruit

Types

( Fruit Frequencies)/Risk Ratios

Ovary All fruits (<5/wk) 1.00; (1-2/day)1.24;

(>2/day) 0.59

Pancreas Raisins, dates, dried fruit

(<1/month) 1.00; (> 3/wk) 0.19

Prostate Raisins, dates, dried fruit

(<1/wk) 1.00; (1-4/wk) 1.17; (> 5/wk) 0.62

Lung All fruits (<3/wk) 1.00; (3-7/wk) 0.30; (>1/day) 0.26

Nutrition of Fruits

• Vitamin C

• Insoluble fiber

• Potassium

• Folate

• Magnesium

• Flavonoids

• Carotenoids

• 3-4 Servings Daily• 1 medium fresh fruit

• ¼ cup dried fruit

• ½ cup canned or frozen fruit

• ¾ cup fruit juice

Log on to Legumes

• Legumes –

• Beans

• Peas.

• Lentils

Power with Nuts

• WALNUTS ,ALMONDS, PEANUTS,

pecans• High in MUFAS

linoleic and linolenic.• BMJ 1998 Nov. 14,

317 (7169), 1341-5

Flax-highest in omega 3 fatty acids:

• Pumpkin Dill• Sesame Coriander• Sunflower Fenugreek• Watermelon Nutmeg• Lotus Poppy• Safflower Fennel• Anise• Cardamom

• Pictures of these seeds

0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

0.9

1

Nuts <1 time/ wk

Nuts 1-4 times/ wk

Nuts 5+ times/ wk

Nut Consumption and Coronary Heart

Disease (AHS 1)

Events 63 55 15 79 76 57

Non-Vegetarians Vegetarians

Rela

tive

Ris

k

P(t) <.05P<.05

P(t) <.001P<.001

0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

0.9

1

Nuts <1 time/ wk

Nuts 1-4 times/ wk

Nuts 5+ times/ wk

Nut Consumption and Coronary Heart

Disease

Events 65 85 34 77 47 38

Age <80 Age 80+

Rela

tive

Ris

k

P(t) <.05P<.05

P(t) <.001P<.001

• 3-4 Servings Daily• ½ cup cooked legumes

• ½ cup tofu

• 1/2 cup soy alternatives

• 1 egg

• 2 egg whites

Nutrition of Legumes

• Protein Niacin

• Zinc Linoleic acid

• Iron Linolenic acid

• Insoluble Fiber Calcium

• Vitamin B 6 Folate

Reported Benefits from orgaganics

• Healthier for the family andHealthier for the family and• farmer, Less pesticide and herbicides farmer, Less pesticide and herbicides • Lower nitrates= exposed to bess Better for the environment- Lower nitrates= exposed to bess Better for the environment-

water .air, and soilwater .air, and soil• Maybe higher in Vitamin C and phyto-chemicalsMaybe higher in Vitamin C and phyto-chemicals• In some studies organically grown food tasted betterIn some studies organically grown food tasted better• With the No-till methods of farming soil humus is similarWith the No-till methods of farming soil humus is similar• Organic maybe lower in mineralsOrganic maybe lower in minerals• Food may be more expensiveFood may be more expensive• Cannot feed the whole populationCannot feed the whole population• More labor intensiveMore labor intensive

• ¼ cup nuts

• 1/4 seeds

• 2 t. nut butter

Move more Milk to your Menu

Nutrition of Dairy Products

• Vitamin B 12• Calcium• Protein• Vitamin A and d• Iodine• Isoflavones in soy

• Frequent consumption of soy milk (more than once a day) was associated with a 70% reduction

of risk of prostate cancer.

0.9

0.7

0.3

0

1

Rela

tiv

e R

isk

Relative risk* of prostate cancer by intake of soy milk.

P(t) = .02

*Adjusted for age, BMI, consumption of coffee, whole milk, eggs and citrus fruit and age at first marriage.

*Adjusted for age, BMI, consumption of coffee, whole milk, eggs and citrus fruit and age at first marriage.

Jacobsen et al,

(0.5-1.4)

Never < daily 1 x/day 2+ day# men 10,875 902 395 223

(0.4-1.4)

(0.1-0.9)

• 3 servings daily• 1 cup of low-fat milk• 1 cup fortified soy milk• 1 cup yogurt• ½ cup ricotta or cottage cheese• 1 oz. fresh cheese• 1 ½ T. cream cheese

• Oils: olive, canola, soy, walnut

• Olives, avocados,

• Flax seed and flax seed oils

• Olive increases elasticity of arteries. (MUFA)

• Sunflower oil reduces serum cholesterol. (Omega 6’s)

• Canola and flaxseed oil high in alpha linolenic acid (Omega 3’s)

• reduces clotting. *

• Nutr. Rev. 1998: 56: 142-147 *

Nutrition of Healthy Fats

• Vitamin E• Linoleic acid• Linolenic acid• Vitamin A and D in margarines• Recommended Servings 3-5 daily 1/3 avocado 2 t. nut butter 1 t. healthy plant oils 1 t. margarine

• Men drinking 1-2 cups of coffee a day had a 50% higher risk of

heart disease, while women had a 10-20% increase in risk.

Animal Protein and Fat

• You noticed that the higher the intake of whole grains, vegetables, fruits, legumes. Nuts, soy

• the lower the disease.

• Now notice what happens with disease as the consumption goes up.

• Data from the Adventist Health Study

Total meat intake and risk of colon cancer

1

1.5

1.85

0

0.5

1

1.5

2

Never < 1/week 1+/week

P (trend)=0.01

(0.92-2.45)

(1.16-2.87)

RR

Red meat intake and risk of colon cancer, among those who eat white

meat < 1x/week.

1

1.4

1.9

0

0.5

1

1.5

2

Never < 1/week 1+/week

P (trend) = 0.02

(0.87-2.25)

(1.16-3.11)

RR

White meat intake and risk of colon cancer, among those who eat red meat > 1x/week.

1

1.55

3.29

0

0.5

1

1.5

2

2.5

3

3.5

Never < 1/week 1+/week

P (trend) = 0.006

(0.97-2.50)

(1.60-6.75)

RR

Risk of prevalent rheumatoid arthritis and meat intake.

Females.

00.20.40.60.8

11.21.41.61.8

2

RR

1.49(1.31-1.7)

# Adjusted for age, BMI, education, oral contraceptive use, number of live births, smoking and alcohol intake.

1.26(1.21-1.43)

Meat intake: Never < 1x /wk 1+ /wk

Risk of prevalent rheumatoid arthritis and meat intake. Males.

00.20.40.60.8

11.21.41.61.8

2

RR

1.43(1.20-1.7)

# Adjusted for age, BMI, education, number of live births, smoking and alcohol intake.

1.19(1.05-1.34)

Meat intake: Never < 1x /wk 1+ /wk

Meat Consumption and Cancer

Meat Frequency

Cancer Site Never <1/week >1/week p values

Colon 1.00 1.50 1.85 .01

Prostate* 1.00 1.15 1.41 NS

Ovary 1.00 1.39 1.75 <0.10

(Postmenopausal) 1.00 1.59 2.30) 0.02

<3/week > 3/week

Bladder 1.00 2.38 0.01* Not statistically significant

0

0.5

1

1.5

2

2.5

Women Men

Vegetarian (meat<1/ wk)SemiVegetarian(meat 1-2x/ wk)NonVegetarian(meat 3+x/ wk)

Relative Risk of Incidence of HYPERTENSION Requiring Medication (1960-76) according to Vegetarian Status(Adventist Mortality and Adventist Health Studies)

All values significant.

Rela

tive

Ris

k

Effects of Individual Risk Factors To Increase Life Expectancy

Variable Men Women

Vegetarianism 2.38 yrs 1.65 yrs

Vigorous Exercise 2.14 yrs 2.19 yrs

Frequent Nut Consumption 2.87 yrs 1.18 yrs

Avoid High BMI 1.51 yrs 1.90 yrs

Never Smoked 1.33 yrs 1.49 yrs

Health Habits and Life Expectancy in Adventists

Men Women

‘Best’-Behaved1 87.0 years 88.5 years

‘Worst’-Behaved2 76.2 years 79.8 years

Difference 10.8 years 8.7 years

1Vegetarians who exercise vigorously at least 3 times weekly, eat nuts >4 times each week. BMI < 25.90 (males), <25.20 (females), never smokers.2 Converse of the above, including eating nuts <1/week, BMI greater than limits shown above.

Percentages Dying From the Named Causes and Average Ages at these Fatal Events: California

Adventists and non-Adventists.All Californians All Adventists

Men

Cause of Death (%)

% Age (Years)

% Age (Years)

Disease of the Heart 39.0 75.7 40.4 82.9

Malignant Neoplasms (Cancer)

23.4 71.2 19.0 77.9

Cerebrovacular Disease (Stroke)

6.6 79.4 8.7 85.8

Unintentional Injuries 2.9 59.5 3.5 69.6

COPD and Allied Conditions 5.6 76.3 2.5 82.6

Pneumonia and Influenza 4.5 81.8 6.1 87.8

Diabetes 1.1 73.0 1.3 81.6 p<0.05; p<0.01; p<0.001† †† †††

†††

††

†††

†

†††

†††

†††

†††

†††

†††

†††

• Non-vegetarians were two and a half times more likely to be obese

than vegetarians.

• Non-vegetarians had a risk of fatal stroke that was 20-30%

higher than vegetarians.

• Vegetarians had a delayed onset of dementia.

• Eating meat doubles the risk of dementia.

• Increased consumption of meat, poultry and fish is associated with

an increased risk of bladder cancer.

• The risk of prostate cancer is increased two and a half times

and the risk of colon cancer is 3-fold greater in the overweight

person.

• 30 year old women with a BMI above the 50th percentile had a

57% greater lifetime risk of breast cancer.

• Women who exercised

infrequently had a 27% higher

lifetime risk and an age at

diagnosis of breast cancer 6.6 years

younger than other women.

• Total vegetarian men had less than 20% of the expected rate of fatal heart

attacks compared to the general population.

•Total vegetarian women had higher than the expected rate of lacto-ovo-

vegetarians

• Lacto-ovo vegetarian men had about 40% of the expected rate of

fatal heart attacks compared to the general population.

• Men who adopted a vegetarian diet early in life (before age 20) had only

one-half the risk of fatal heart disease compared to those who did not adopt

a vegetarian lifestyle until after 50 years of age.

• Those who adopted a vegetarian diet in their thirties had 30% less

fatal heart disease than those who adopted the diet in their

fifties.

• Regular exercise reduced the risk of fatal coronary

heart disease by 50%.

• There were four main factors that added 10-12 years to life compared with the general population, with each factor contributing 3-4 years. • They were:

• Not smoking • Maintenance of a healthy weight• An exercise program• A vegetarian lifestyle• Especially, lots of Vegetables, fruits, legumes, whole grains-and little or no meat.

Predicted Age of Death of California Adventist

• Men 77.4 81.8

• Women 81.8 84.5

• 17 % of men survive past 90

• 24 % of women survive past 90

MBD – Meat-Based DietPBD – Plant-Based Diet

MBD – Meat-Based DietPBD – Plant-Based Diet

Risk ofDeficiency

Risk ofExcess

Optimal

MBD

PBD

• ‘‘It is the position of the ADA and Dietitians of Canada that appropriately planned vegetarian diets are healthful, nutritionally adequate, and provide health benefits on the prevention and treatment of certain diseases.”

American Dietetic Association• Vegetarians have lower body

mass indices than non-vegetarians, as well as lower blood cholesterols, lower rates of blood pressure, ischemic heart disease, hypertension, type 2 diabetes, prostate and colon cancer.

• P. 748 JADA June 2003 Vol. 103, • # 6

• Vegetarian Choices• “Vegetarians of all types can

achieve recommended nutrient intakes through careful selection of foods.

• If avoiding milk products, these individuals should give special attention to their intakes of protein, iron, vitamin B 12, as well as calcium and vitamin D”

• “Christian behavior… means that because our bodies are the temples of the Holy Spirit, we are to care for them intelligently. Along with adequate exercise and rest, we are to adopt the most healthful diet possible and abstain from the unclean foods identified in the Scriptures.

SDA Believe-27

• 21th Fundamental Beliefs• “The original diet. The Bible does

not condemn the eating of clean animals. But God’s original diet for man did not include flesh foods because He did not envision the taking of any animals life and because a balanced vegetarian diet is the best for health-a fact for which science offers mounting evidence”

• “The diet God ordained in the Garden of Eden-the vegetarian diet-is the ideal, but sometimes we cannot have the ideal. In those circumstances, in any given situation or locale, those who wish to stay in optimum health, will eat the best food that they can obtain.”

• SDA Bible Commentary

• “The GCNC recommends that all fish, fowl and meat be gradually eliminated from the diet, and the use of egg yolks be limited to three or less per week. Red meats of animal origin are no longer viewed as dominant items in a healthy diet. General Conference Nutrition Council (GCNC)

The End July 2005

0

10

20

30

40

50

FruitServings/Day

Less thanone

One 2 - 3 4 or more

PE

RC

EN

T

Female Male

0

10

20

30

40

50

VegetablesServings/Day

Less than one One 2 or more

PE

RC

EN

T

Female Male

0

10

20

30

40

50

60

70

80

No Yes

PE

RC

EN

TEat Vegetarian Protein Food

Female Male

0

5

10

15

20

25

30

35

EggsTimes/Week

Never Less than Once Once 2 or more

PE

RC

EN

T

Female Male

0

10

20

30

40

50

CheeseTimes/Week

Never Less than Once Once 2 or more

PE

RC

EN

T

Female Male

0

10

20

30

40

50

MeatTimes/Week

Never Less than Once 1 - 4 5 or more

PE

RC

EN

T

Female Male

0

10

20

30

40

50

60

LegumesTimes/Week

Less thanOnce

Once 2 - 6 Times 7 or more

PE

RC

EN

T

Female Male

0

5

10

15

20

25

30

35

40

NutsTimes/Week

Never Once or Less 2 - 6 7 or more

PE

RC

EN

T

Female Male

0

10

20

30

40

50

Soy/Rice MilkTimes/Week

Never Less than Once 1 - 4 5 or more

PE

RC

EN

T

SOY

Female Male

0

10

20

30

40

50

60

70

80

CoffeeDrinks/Week

Never Less than One 1 - 4 5 or more

PE

RC

EN

T

Female Male

0

20

40

60

80

100

De-Caf CoffeeDrinks/Week

Never Less than One 1 - 4 5 or more

PE

RC

EN

T

Female Male

0

10

20

30

40

50

60

70

80

WaterCups/Day

One or Less 2 - 3 4 or more

PE

RC

EN

T

Female Male

Female Male

0

5

10

15

20

25

30

35

40

ExerciseTimes/Week

Never One or Less 2 - 4 5 or more

PE

RC

EN

T

Female Male

0

5

10

15

20

25

30

35

TelevisionHours/Day

Never One or Less 2 3 or more

PE

RC

EN

T

0

10

20

30

40

50

60

70

Drinking Alcohol

Never Past Drinker Current Drinker

PE

RC

EN

T

Female Male

Female Male

0

10

20

30

40

50

60

70

SleepHours/Night

5 - Less 6 - 7 8 or more

PE

RC

EN

T

Female Male

0

10

20

30

40

50

Eating Fast FoodTimes/Week

Never Once or Less 2 or more

PE

RC

EN

T

Female Male

0

20

40

60

80

100

Smoking Tobacco

Never Past Smoker Current Smoker

PE

RC

EN

T

Female Male

0

10

20

30

40

50

60

70

Restaurant DiningTimes/Week

Never Once or Less 2 or more

PE

RC

EN

T

• ‘‘It is the position of the ADA and Dietitians of Canada that appropriately planned vegetarian diets are healthful, nutritionally adequate, and provide health benefits on the prevention and treatment of certain diseases.”

American Dietetic Association• Vegetarians have lower body

mass indices than non-vegetarians, as well as lower blood cholesterols, lower rates of blood pressure, ischemic heart disease, hypertension, type 2 diabetes, prostate and colon cancer.

• P. 748 JADA June 2003 Vol. 103, • # 6

• Vegetarian Choices• “Vegetarians of all types can

achieve recommended nutrient intakes through careful selection of foods.

• If avoiding milk products, these individuals should give special attention to their intakes of protein, iron, vitamin B 12, as well as calcium and vitamin D”

• “Christian behavior… means that because our bodies are the temples of the Holy Spirit, we are to care for them intelligently. Along with adequate exercise and rest, we are to adopt the most healthful diet possible and abstain from the unclean foods identified in the Scriptures.

SDA Believe-27

• 21th Fundamental Beliefs• “The original diet. The Bible does

not condemn the eating of clean animals. But God’s original diet for man did not include flesh foods because He did not envision the taking of any animals life and because a balanced vegetarian diet is the best for health-a fact for which science offers mounting evidence”

• “The diet God ordained in the Garden of Eden-the vegetarian diet-is the ideal, but sometimes we cannot have the ideal. In those circumstances, in any given situation or locale, those who wish to stay in optimum health, will eat the best food that they can obtain.”

• “The GCNC recommends that all fish, fowl and meat be gradually eliminated from the diet, and the use of egg yolks be limited to three or less per week. Red meats of animal origin are no longer viewed as dominant items in a healthy diet. General Conference Nutrition Council (GCNC)