Living Longer and Better: The Health Experience of California Seventh-day

Adventists.

Larry Beeson, DrPH Associate Professor

School of Public HealthCo-investigator, AHS-2

Adventist Health StudyBackground

More than 95% of the half-trillion health care dollars ($500,000,000,000) in the U.S. each year goes to treat rather than prevent disease

Issues in Science & Technology

Epidemiology: The study of the distribution (who, when, where) and causes (determinants) of health and disease in populations.

Nutritional Epidemiology: The study of diet as promoting or preventing the onset of disease.

Biomedical Research

Epidemiologic evidence suggests that choosing carefully and eating a well-balanced diet, you may reduce your cancer risk:

1. Eat a variety of foods every day

2. Include fresh fruits and vegetables, especially those high in vitamin A and C

3. Choose leafy green and yellow-orange vegetables

4. Keep intake of all fats low (both sat. & unsaturated)

5. Limit your use of butter, margarine, cream, shortening

6. Avoid hidden fats in salad dressing and snack foods

7. Choose lowfat or skim milk and lowfat cheeses

8. Choose fruit instead of high fat desserts

9. Eat foods with fiber for example:

a) Whole grain breads

b) Raw fruits and vegetables

c) Beans, Peas, Seeds

10. Do not drink alcohol in excess

11. Do not smoke

Cancer PreventionPublic Health ServiceNational Institutes of Health

Can we observe measurable health benefits in a people (e.g. SDAs) who have been practicing for more than 140 years the current recommendations of health-related organizations (ACS, AHA, CDC, NIH) ?

Question

Adventist Literature

“Animals are becoming more and more diseased, and it will not be long until animal food will be discarded by many besides Seventh-day Adventists … The Lord will teach many in all parts of the world to combine fruits, grains, and vegetables into foods that will sustain and will not bring disease.”

1902 - Vol 7, Testimonies, pg 124-6

Adventist Literature

“Seventh-day Adventists are handling momentous truths. More than forty years ago [<1869] the Lord gave us special light on health reform, but how are we walking in that light? … On the subject of temperance we should be in advance of all other people.”

1909 - Vol 9, Testimonies, pg 158

Adventist Literature

“In this age of the world the use of tobacco is almost universal. Women and children suffer from having to breathe the atmosphere that has been polluted by the pipe, the cigar, or … the tobacco-user. Those who live in this atmosphere will always be ailing.”

1882 - Vol 5, Testimonies, pg. 440

Adventist Literature

“The liability to take disease is increased tenfold by meat eating.”

1868 - Vol 2, Testimonies, pg 64

Adventist Literature

“Health is a treasure. Of all temporal possessions it is the most precious. Wealth, learning, and honor are dearly purchased at the loss of the vigor of health. None of these can secure happiness, if health is lacking.”

1890 - Christian Temperance andBible Hygiene, pg 150

Adventist Literature

“Fruits, grains, and vegetables, prepared in a simple way, free from spice and grease of all kinds, make … the most healthful diet.”

1870 - Vol 2, Testimonies, pg. 369

Adventist Literature

“It is a mistake to suppose that muscular strength depends on the use of animal food. The needs of the system can be better supplied, and more vigorous health can be enjoyed, without its use.”

1905 - Ministry of Healing, pg. 316

Adventist Literature

“Education in health principles was never more needed than now… Many transgress the laws of health through ignorance, and they need instruction. But the greater number know better than they do. They need to be impressed with the importance of making their knowledge a guide for life.”

1905 - Ministry of Healing, pg. 126

Seventh-day Adventists will continue to be a unique population

for epidemiologic study

1. They are interested in health, hence cost effective postal contacts are likely to

produce good response rates.

2. There are few subgroups in society that have the same range of exposures such as diet. This should increase statistical power in testing hypotheses.

3. The relative absence of cigarette smoking and alcohol consumption allow examination of the effects of other exposures (e.g. diet) without the potential confounding of tobacco and alcohol.

4. The church structure (i.e. “letters of transfer”)

facilitates the tracking of subjects who move after initial enrollment in a study thus minimizing lost-to-followup.

5. Marked tendency towards vegetarianism makes this population probably the closest of any subgroup to the lifestyle

recommendations of several official bodies seeking to prevent cancer and atherosclerotic vascular disease.

Research On Adventists byLoma Linda Epidemiologists

1. Adventist Mortality Study (1958 - 1985)

2. Adventist Health Study [ - 1] (1974 - 2006)

3. Adventist Health Study - 2 (2002 - future)

4. Adventist Health Study on Smog (AHSMOG) (1976 – future)

5. Adventist Health and Religion Study (AHRS)(2006 – future)

AHSMOG 1976-20066,328 SDA25+ yearsCalifornia

Adventist Health StudiesU.S.A. 1958-2012

1966 1974

1950 201020001990198019701960

AMS 1958-198525,153 SDA 25+ years California

AHS-1 1974-200634,198 SDA25+ yearsCalifornia

AHS-2 2002-97,000 SDA30+ yearsUSA & Canada

12,000overlap

5,649overlap

ARHS2006-11,000

Dietary AssessmentIncreasing Complexity

Adventist Mortality Study (1958 - 1980)• 4-page questionnaire• n = 25,153

Adventist Health Study-1 (1974 - 2006)• 20-page questionnaire• n = 34,198

Adventist Health Study-2 (2002 - ????)• 52-page questionnaire• n = 97,000

www.llu.edu/public-health/health/index.pageAdventist Health Study Home

About the Study

Enrollment Form

Common Questions

Progress of Enrollment

News and Events

Promotion Resources

The Research Team

Contact Us

Previous Studies

Selected references

Bibliography

Back

1. Hardinge MG, Stare FJ: Nutritional studies of vegetarians. I Nutritional, physical, and laboratory studies. Am J Clin Nutr

1954; 2:73-82.…303. Fraser GE, Shavlik DJ. Ten years of life. Is it a matter of choice? Arch Int Med 2001;161:1645-52.

308. Chan J, Knutsen SMF, Blix GG, Lee JW, Fraser GE. Water, other fluids and fatal coronary heart disease: The Adventist Health Study. Am J Epidemiol 2002; 155:827-33.

313. Singh PN, Sabaté J, Fraser GE. Does low meat consumption increase life expectancy in humans? Am J Clin Nutrit 2003; 78(suppl):526S-32S.

315. Willett W. Lessons from dietary studies in Adventists and questions for the future. Am J Clin Nutr 2003; 78:539S-43S.

Oxford Univ. Press, 2003, pp 371Available from Amazon.com

Areas with an unusual cluster of centenarians (age 100+):

1) Sardinia

2) Okinawa

3) Costa Rica

4) Loma Linda (only area in the United States) thanks to the AHS research team

Proportions of Life Table Subjects Surviving to Ages 65 Years and 85 Years.

Percentage of males surviving Percentage of females surviving

Country To Age 65

To Age 85

To Age 65

To Age 85

Australia 74.7 17.6 86.4 38.4

Canada 75.1 19.6 86.3 40.0

Germany, Fed. Rep. 73.4 14.2 85.8 31.7

Hungary 60.9 8.2 79.3 21.0

Japan 80.8 23.6 89.5 41.1

Sweden 78.7 20.4 88.4 39.8

United Kingdom 75.0 14.5 84.6 32.7

United States 72.0 19.5 84.1 39.3

California Adventist 86.7 41.0 89.3 54.4

California Adventist Vegetarians

89.2 48.6 94.1 60.1

An Extra 10 Years of Life

Regular exercise Eating plant-based diet Eating small amounts of nuts regularly Maintaining normal body weight Not smoking

Adventist Health Study-1 demonstrated that 5 simple habits Adventists have promotedfor over 100 years extend their life by as much as 10 years in both men and women

Effects of Individual Risk Factors To Increase Life Expectancy

Variable Men WomenVegetarianism 2.38 yrs 1.65 yrsVigorous Exercise 2.14 yrs 2.19 yrsFrequent Nut Consumption 2.87 yrs 1.18 yrsAvoid High BMI 1.51 yrs 1.90 yrsNever Smoked 1.33 yrs 1.49 yrs

Health Habits and Life Expectancy in Adventists

Men Women

‘Best’-Lifestyle1 87.0 years 88.5 years

‘Converse’-Lifestyle2 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.

Life Expectancy at Age 30 years (1985).

Men WomenCalifornians 43.9 49.5California Adventists 51.2 53.9Vegetarian Adventists 53.3 55.7Extra YearsCalifornia Adventists 7.3 4.4Vegetarian Adventists 9.4 6.2

Different Types of ‘Vegetarians’

1. Lacto-Ovo-vegetarians

2. Fish-eating (pesco) ‘vegetarians’.

3. High and low processed food vegetarians.

4. Soy and non-soy vegetarians.

5. Vegans and Fruitarians.

High lacto

Low lacto

1) Measures of association between exposure and health outcome:

“Relative Risk” = “Risk Ratio” = “RR”

2) Statistical significance Biologic significance ??

“p-value”

Brief Introduction to Epidemiology

The Relative Risk (RR)

Incidence of disease (in those “exposed”)

Incidence of disease (in those “not exposed”)RR =

If: RR is less than (<) 1, then exposure is reduces risk of disease

If: RR is equal to (=) 1, then exposure is unrelated to disease

If: RR is greater than (>) 1, then exposure increases risk of disease

High

Lowor

Statistical Significance: (p-value)

p (probability)-value: The probability that an observed value from a statistical test (e.g. RR) could have occurred by chance, if the comparison groups were really alike.

In biomedical research (i.e. Epidemiology), we traditional say that if the p-value is less than (<) 5%, then another explanation (e.g. biology) is a better explanation of the observation than is chance alone.

Percentages Dying From the Named Causes and Average Ages at these Fatal Events: California non-Adventists and Adventists.

All Californians All Adventists

MenCause of Death (%)

% Age (Years)

% Age (Years)

Disease of the Heart 39.0 75.7 40.4 82.9Malignant Neoplasms (Cancer) 23.4 71.2 19.0 77.9Cerebrovascular Disease (Stroke) 6.6 79.4 8.7 85.8Unintentional Injuries 2.9 59.5 3.5 69.6COPD and Allied Conditions 5.6 76.3 2.5 82.6

Pneumonia and Influenza 4.5 81.8 6.1 87.8Diabetes 1.1 73.0 1.3 81.6

p<0.05; p<0.01; p<0.001† †† †††

†††

††

†††

†

†††

†††

†††

†††

†††

†††

†††

Effect of meat.

Meat intake and risk of different cancers.

0

0.5

1

1.5

2

2.5

Colon Ovary

Never< 1/ week1+/ week

Colon Prostate Ovary Ovary Postmenopausal

P (t): 0.01 ns <.01 0.02RR

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

00.5

11.5

22.5

33.5

Never < 1/week 1+/week

P (trend) = 0.006

(0.97-2.50)

(1.60-6.75)

RR

Meat Consumption and CancerMeat 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/weekBladder 1.00 2.38 0.01

* Not statistically significant

00.10.20.30.40.50.60.70.80.9

1

Nuts <1 time/ wk

Nuts 1-4 times/ wk

Nuts 5+ times/ wk

Nut Consumption and Coronary Heart

Disease

FatalDefinite Non-Fatal MI

Rela

tive

Ri

sk

P(t) <.001P<.001

P(t) <.001P<.001

00.10.20.30.40.50.60.70.80.9

1

Nuts <1 time/ wk

Nuts 1-4 times/ wk

Nuts 5+ times/ wk

Nut Consumption and Coronary Heart

Disease

Events 66 85 33 66 85 33 MenWomen

Rela

tive

Ri

sk

P(t) <.001P<.001

P(t) <.001P<.001

00.10.20.30.40.50.60.70.80.9

1

Nuts <1 time/ wk

Nuts 1-4 times/ wk

Nuts 5+ times/ wk

Nut Consumption and Coronary Heart

Disease

Events 63 55 15 79 76 57 NonVegetarians Vegetarians

Rela

tive

Ri

sk

P(t) <.05P<.05

P(t) <.001P<.001

00.10.20.30.40.50.60.70.80.9

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

Ri

sk

P(t) <.05P<.05

P(t) <.001P<.001

RRRR‡‡ of of FFATALATAL CHDCHD according to according to Intake of Intake of WWATER ATER inin MMALESALES (n=11,257)(n=11,257)

‡‡ Adustments: Adustments: Age + Smoking, Ed, + Energy + Other Age + Smoking, Ed, + Energy + Other BMI, BPBMI, BP Fluids Fluids

1

.65

.46

1

.60

.38

1

.67

.39

1

.64

.33

0

0.2

0.4

0.6

0.8

1

1.2

<=23 to 45+

Rel

ativ

e R

isk

EventsEvents 25 51 48 24 34 37 22 42 33 17 33 23 25 51 48 24 34 37 22 42 33 17 33 23

.001 .0002 .0004 .0003 p (trend)

Glasses/day

RRRR‡‡ of of FFATALATAL CHD CHD according to according to Intake of Intake of WWATER ATER inin FFEMALESEMALES (n=15,840)(n=15,840)

‡‡ Adustments: Adustments: Age + Smoking, Ed, + Energy + Other Age + Smoking, Ed, + Energy + Other BMI, BPBMI, BP FluidsFluids

1

.54.59

1

.57.61

1

.41.52

1

.44.57

0

0.2

0.4

0.6

0.8

1

1.2

<=23 to 45+ R

elat

ive

Ris

k

EventsEvents 23 40 52 18 34 43 13 17 26 13 17 2623 40 52 18 34 43 13 17 26 13 17 26

p(trends) NS

Glasses/day

RRRR‡‡ of F of FATALATAL CHD according to CHD according to WWATERATER I INTAKE NTAKE Males & FemalesMales & Females ( (n= 27,342n= 27,342) )

1

0.54 0.52

1

0.620.50

00.20.40.60.8

11.21.41.6

<=23 to 45+

RR

EventsEvents 28 50 60 20 40 41 28 50 60 20 40 41

Glasses/day

Normotensive Hypertensive

<.01 <.05 p (trend)

Age & Sex Adjusted

RRRR‡‡ of FATAL CHD according to of FATAL CHD according to WATERWATER

INTAKE INTAKE Males & FemalesMales & Females ( (n= 27,342n= 27,342))

1

0.570.46

1

0.57 0.54

00.20.40.60.8

11.21.41.6

<=23 to 45+

RR

EventsEvents 23 52 58 24 35 37 23 52 58 24 35 37

Glasses/day

Meat <1/week Meat 1+/week

.003 .02 p (trend)

Age & Sex Adjusted

RRRR‡‡ of of FFATALATAL STROKE STROKE according to according to WATER WATER Intake in Intake in MM & & F F withwith Stroke Stroke HxHx

(n=614)(n=614)

1 .84

.55

1

.66

.43

1

.60 .45

1

.71

.47

00.20.40.60.8

11.21.41.6

1 to 23 to 45+

‡‡ Adj: (Adj: (Age & Sex) (+ BP, Smoking, (+ Ex ( + Other) Age & Sex) (+ BP, Smoking, (+ Ex ( + Other) Fl Fl BMI)BMI) or Diab) or Diab)

Rel

ativ

e R

isk

EventsEvents 15 37 27 15 28 21 13 26 21 9 20 1415 37 27 15 28 21 13 26 21 9 20 14

<.05 <.01 <.02 .08 p (trend)

Servings /day

0

0.10.20.30.40.50.60.70.80.9

1

Non-Fatal MI Fatal CHD

White

Mixed

WholeWheat

Whole Grain or White Bread and Coronary Heart

Disease

Rela

tive

Ris

k

0

0.10.20.30.40.50.60.70.80.9

1

Women Men

LowExercise

MediumExercise

HighExercise -significant

Relative Risk of fatal CHD according to Exercise StatusAge & Sex Adjusted

(Adventist Mortality and Adventist Health Studies)

Rela

tive

Ri

sk

Other diseases in Adventists:

Vegetarians vs Nonvegetarians.

Weight Differences Between Vegetarians and Non-Vegetarians

100

120

140

160

180

200

Vegan Lacto-ovo Pesco-veg Semi-veg Non-vegPounds

=

Female Male0

146

161

193181

188177

161

180

164171

DIABETES Prevalence and diet

patterns.

Associations between Vegetarian Status and the Prevalence of Diabetes in

Adventists

MEN WOMEN

Vegetarian Status

Adjusted for Age and BMI

95% Confidence Interval

Adjusted for Age and

BMI

95% Confidence

Interval

Vegetarian 1.00 1.00

Semivegetarian

1.29 0.97-1.71 0.98 0.80-1.20

Nonvegetarian 1.72*** 1.36-2.19 1.60*** 1.36-1.88

*** p<.0001

ARTHRITIS Prevalence and diet

patterns.

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

RR1.43

(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

Selected Risk Factors in Adventists:

Vegetarians vs Nonvegetarians.

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

Ri

sk

Associations between Vegetarian Status and the Prevalence of Hypertension in Adventists.

Men WomenVegetarian

StatusAdjusted for Age and BMI

95% Confidence

Interval

Adjusted for Age and BMI

95% Confidence

Interval

Vegetarian 1.00 1.00

Semivegetarian 1.66 1.34-2.07 1.50 1.30-1.73

Nonvegetarian 2.26 1.87-2.73 2.31 2.04-2.61

Frequency of High Cholesterol by Dietary Status and Race

0%

5%

10%

15%

20%

Blacks Whites

Vegan Lacto-ovo Pesco-veg Semi-veg Non-veg

Fruit and CancerCancer

SiteFruit 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

SOY MILK

Soy Foods1. Reduces cholesterol2. Isoflavone phytoestrogens (Genistein, daidzein, equol)3. May affect risk of cancers, heart disease,

osteoporosis, and other disorders4. American Adventists consume a great deal

of soy as a non-meat complete protein

0.9

0.7

0.3

0

1

Relat

ive R

iskRelative 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.

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)

Tomatoes and Cancer

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 CancerCancer

SiteFruit 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

The Independent Effects of Traditional Lifestyle Risk Factors and Psychosocial and Religious Participation Variables on

Coronary Heart Disease (CHD) Mortality in California AdventistsALL VARIABLES

Variable Level Men Women CombinedGender Women

Men1.001.63***

Meat Vegetarian<1/wk>1/wk

1.001.56**1.59**

1.001.181.03

1.001.31**1.21**

Exercise LowMediumHigh

1.000.860.70**

1.000.840.73**

1.000.850.71***

Nuts <1/wk1-4/wk>5/wk

1.001.040.85

1.000.77*0.68**

1.000.870.73**

Smoking NeverPast

1.001.04

1.001.09

1.001.04

Church Attendance 3-4/mo1-2/mo<1/mo

1.000.761.55

1.001.701.38

1.001.231.58**

**p<0.01 *** p<0.001

The Independent Effects of Traditional Lifestyle Risk Factors and Psychosocial and Religious Participation Variables on

All-Cause Mortality in California AdventistsALL VARIABLES

Variable Level Men Women Combined

Sex WomenMen

1.001.50***

Meat Vegetarian<1/wk>1/wk

1.000.991.09

1.001.021.08

1.001.011.09*

Exercise LowMediumHigh

1.000.80***0.75***

1.000.81***0.81***

1.000.81***0.79***

Nuts <1/wk1-4/wk>5/wk

1.000.87*0.78***

1.000.89**0.88**

1.000.89***0.84***

Smoking NeverPast

1.001.09*

1.001.15*

1.001.13**

Church Attendance 3-4/mo1-2/mo<1/mo

1.000.991.32*

1.001.201.17

1.001.121.25**

*p<0.05 **p<0.01 ***p<0.001

Meat seems to be one of the “villains” associated with

• Coronary Heart Disease (CHD)• Colon cancer• Bladder cancer• Ovarian cancer

Summary1. As a group, risk of CHD is much lower in

Adventists but this is especially so below the age of 70 years.

2. Risk of many cancers is also much lower, and this is not all explained by the absence of cigarette smoking in Adventists.

3. Adventist men and women in California live much longer that other Californians, this being especially true of the vegetarians.

4. Adventists often have unusual dietary habits that trend toward vegetarianism.

5. Age at virtually all common causes of death is greater by several years.

Summary Cont’d

6. Individual foods that change risk are technically difficult to identify, but the following are probable associations.a) Nuts, and whole grain bread consumption decrease risk

of coronary heart disease (CHD). b) Meat consumption probably increases risk of CHD particularly in younger and middle-aged subjects. c) Fruits, legumes (including soy-products), and tomatoes probably decrease risk of several cancers. d) Meat consumption probably increases risk of colon, ovary, bladder and perhaps other cancers. e) This list by no means exhausts the possibilities.

CONCLUSIONThe studies on Adventists in California suggest that a vegetarianlifestyle reduces the risk of many chronic diseases such as:

• CHD• Cancer• Obesity• Arthritis• Diabetes

SummaryAHS “Firsts”

1. The AHS was the first epidemiologic study to demonstrate that men who consumed tomatoes & tomato products frequently, importantly reduced their risk of prostate cancer. (Is it licopenes alone or the complexity of the food ???)

SummaryAHS “Firsts”

2. The AHS was the first study to demonstrate that eating nuts 5 or more times per week appears to significantly reduce the risk of definite fatal CHD and definite nonfatal myocardial infarction compared to eating nuts less than once a week. Similar findings were seen for eating whole wheat bread.

SummaryAHS “Firsts”

3. AHS was the first to demonstrate that intake of adequate amounts of water each day may significantly reduce the risk of fatal coronary heart disease (CHD). This observed protection in both males and females was independent of other established CHD risk factors.

Summary

4. Those who consume a wide range of fruits, vegetables, seeds, whole grains, and nuts have less disease than those who follow a typical American diet.

Summary

5. Vegetarians appear to be at lower risk than omnivores for several fatal chronic diseases:

a) Cancers of the colon, breast, prostate

b) Cardiovascular disease

c) Diabetes

Summary

6. Vegetarians have more favorable heart disease risk profiles:

a) Decreased blood pressure

b) Decreased serum cholesterol

c) Decreased prevalence of obesity

Summary

7. Cancer risk may be lower because of several factors:

a) Increased plant sterol/cholesterol ratio in the diet

b) Decreased primary/secondary bile acids ratio

c) Favorable dietary factors, including more fiber and less fat

Our Oldest Old1,765 - aged 90 years +

99 - over 100 years

Lydia Newton 112 years

Our Centenarians

Marge Jetton 101(turned 105 on 9/29/09)

Marguerite 90, Lydia 112(Lydia’s daughter)

Description of the AHS-1 Study

Beeson WL, Mills PK, Phillips RL, Andress M, Fraser GE: Chronic disease among Seventh-day Adventists, A low risk group. Rationale, Methodology and description of the population. Cancer 1989;64:570-581.

Description of the AHS-2 Study

Butler TL, Fraser GE, Beeson WL, Knutsen SF, Herring RP, Chan J, Sabate J, Montgomery S, Haddad E, Preston-Martin S, Bennett H, Jaceldo-Siegl K. Cohort profile: The Adventist Health Study-2 (AHS-2). Int J Epidemiol 2007; Aug 27:[Epub ahead of print]

THANK YOU!

And for those who answered our AHS

questionnaires as your voice is being heard around the world !www.llu.edu/public-health/health/index.page

(AHS web page)