Living Longer and Better:

The Health Experience of California Seventh-day Adventists.

Larry Beeson, DrPH Associate Professor School of Public Health Co-investigator, AHS-2

Adventist Health Study Background 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

Biomedical Research 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.

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 Prevention Public Health Service National Institutes of Health

Question 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) ?

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 and Bible 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 by Loma 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)

1950 Adventist Health Studies U.S.A. 1958-2012

25,153 SDA 25+ years California 1974

5,649 overlap

ARHS 2006 11,000 AHS-2 2002 97,000 SDA 30+ years USA & Canada

2000 2010 1960 12,000 overlap 1970 1980 1990

AHSMOG 1976-2006 6,328 SDA 25+ years California AHS-1 1974-2006 34,198 SDA 25+ years California

Dietary Assessment Increasing 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.page

Adventist 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 371 Available 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 Australia Canada Germany, Fed. Rep.

Hungary Japan Sweden United Kingdom United States California Adventist California Adventist Vegetarians To Age 65 74.7

75.1

73.4

60.9

80.8

78.7

75.0

72.0

86.7

89.2

To Age 85 17.6

19.6

14.2

8.2

23.6

20.4

14.5

19.5

41.0

48.6

To Age 65 86.4

86.3

85.8

79.3

89.5

88.4

84.6

84.1

89.3

94.1

To Age 85 38.4

40.0

31.7

21.0

41.1

39.8

32.7

39.3

54.4

60.1

An Extra 10 Years of Life

Adventist Health Study-1 demonstrated that 5 simple habits Adventists have promoted for over 100 years extend their life by as much as 10 years in both men and women      Regular exercise Eating plant-based diet Eating small amounts of nuts regularly Maintaining normal body weight Not smoking

Effects of Individual Risk Factors To Increase Life Expectancy Variable Vegetarianism Vigorous Exercise Frequent Nut Consumption Avoid High BMI Never Smoked Men 2.38 yrs 2.14 yrs 2.87 yrs 1.51 yrs 1.33 yrs Women 1.65 yrs 2.19 yrs 1.18 yrs 1.90 yrs 1.49 yrs

Health Habits and Life Expectancy in Adventists ‘Best’-Lifestyle 1

Men

87.0 years

Women

88.5 years ‘Converse’-Lifestyle 2 76.2 years Difference 10.8 years 79.8 years 8.7 years 1 Vegetarians 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).

Californians California Adventists Vegetarian Adventists Extra Years California Adventists Vegetarian Adventists

Men

43.9

51.2

53.3

7.3

9.4

Women

49.5

53.9

55.7

4.4

6.2

Different Types of ‘Vegetarians’ High lacto 1. Lacto-Ovo-vegetarians Low lacto 2. Fish-eating (pesco) ‘vegetarians’.

3. High and low processed food vegetarians.

4. Soy and non-soy vegetarians.

5. Vegans and Fruitarians.

Brief Introduction to Epidemiology 1) Measures of association between exposure and health outcome:  “Relative Risk” = “Risk Ratio” = “RR” 2) Statistical significance  Biologic significance ??

 “p-value”

The Relative Risk (RR)

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

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 % Men Cause of Death (%) Disease of the Heart Malignant Neoplasms (Cancer) Cerebrovascular Disease (Stroke) Unintentional Injuries COPD and Allied Conditions Pneumonia and Influenza Diabetes † 39.0

23.4

6.6

2.9

5.6

4.5

1.1

Age (Years) 75.7

71.2

79.4

59.5

76.3

81.8

73.0

% 40.4

19.0

††† 8.7

†† 3.5

2.5

††† 6.1

† 1.3

Age (Years) 82.9

††† 77.9

††† ††† 85.8

††† 69.6

82.6

††† 87.8

††† 81.6

†††

Effect of meat.

1.5

1 0.5

0 Meat intake and risk of different cancers.

RR 2.5

P (t): 0.01 ns <.01 0.02

2 Never < 1/week 1+/week

Ovary

Postmenopausal

RR 2 Total meat intake and risk of colon cancer P (trend)=0.01

1.5

1.85

(1.16-2.87) 1.5

(0.92-2.45) 1 1 0.5

0 Never < 1/week 1+/week

Red meat intake and risk of colon cancer, among those who eat white meat < 1x/week.

RR 2 P (trend) = 0.02

1.5

1.9

(1.16-3.11) 1 1.4

(0.87-2.25) 1 0.5

0 Never < 1/week 1+/week

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

RR 3.5

3 2.5

2 1.5

1 0.5

0 P (trend) = 0.006

1 1.55

(0.97-2.50) 3.29

(1.60-6.75) Never < 1/week 1+/week

Cancer Site Colon Prostate Ovary (Postmenopausal) Bladder Meat Consumption and Cancer Never Meat Frequency <1/week >1/week p values 1.00

1.00

1.00

1.00

<3/week 1.00

1.50

1.15

1.39

1.59

1.85

1.41

1.75

2.30

.01

NS* <0.10

0.02

>3/week 2.38

0.01

* Not statistically significant

Nut Consumption and Coronary Heart Disease P(t) <.001

P<.001

1 0.9

0.8

0.7

0.6

0.5

0.4

0.3

0.2

0.1

0 Definite Non-Fatal MI P(t) <.001

P<.001

Fatal Nuts <1 time/wk Nuts 1-4 times/wk Nuts 5+ times/wk

Nut Consumption and Coronary Heart Disease P(t) <.001

P<.001

P(t) <.001

P<.001

1 0.9

0.8

0.7

0.6

0.5

0.4

0.3

0.2

0.1

0 Events 66 85 33 66 85 33 Women Men Nuts <1 time/wk Nuts 1-4 times/wk Nuts 5+ times/wk

Nut Consumption and Coronary Heart Disease P(t) <.05

P<.05

1 0.9

0.8

0.7

0.6

0.5

0.4

0.3

0.2

0.1

0 Events 63 55 15 NonVegetarians P(t) <.001

P<.001

79 76 57 Vegetarians Nuts <1 time/wk Nuts 1-4 times/wk Nuts 5+ times/wk

Nut Consumption and Coronary Heart Disease P(t) <.05

P<.05

1 0.9

0.8

0.7

0.6

0.5

0.4

0.3

0.2

0.1

0 Events 65 85 34 Age <80 P(t) <.001

P<.001

77 47 38 Age 80+ Nuts <1 time/wk Nuts 1-4 times/wk Nuts 5+ times/wk

RR ‡ of F ATAL of W ATER in CHD M ALES according to Intake (n=11,257) 1.2

.001 .0002 .0004 .0003 p (trend) 1 1 1 1 1 0.8

0.6

.65

.60

.67

.64

0.4

0.2

.46

.38

.39

.33

0 Events 25 51 48 24 34 37 22 42 33 17 33 23 Glasses/day <=2 3 to 4 5+ ‡ Adustments: Age + Smoking, Ed, + Energy + Other BMI, BP Fluids

RR ‡ of F ATAL of W ATER in CHD according to Intake F EMALES (n=15,840) p(trends) NS 1.2

1 1 1 1 1 0.8

0.6

0.4

0.2

.54

.59

.57

.61

.41

.52

.44

.57

Glasses/day <=2 3 to 4 5+ 0 Events 23 40 52 18 34 43 13 17 26 13 17 26 ‡ Adustments: Age + Smoking, Ed, + Energy + Other BMI, BP Fluids

RR ‡ of F ATAL CHD according to W ATER I NTAKE Males & Females ( n= 27,342 ) Age & Sex Adjusted 1.6

1.4

1.2

1 RR 0.8

0.6

0.4

0.2

0 Events <.01

1 0.54

0.52

<.05

1 0.62

0.50

28 50 60 20 40 41 Normotensive Hypertensive p (trend) Glasses/day <=2 3 to 4 5+

1.6

1.4

1.2

1 RR 0.8

0.6

0.4

0.2

RR ‡ of FATAL CHD according to WATER INTAKE Males & Females ( n= 27,342 ) Age & Sex Adjusted .003

1 0.57

0.46

.02

1 0.57

0.54

p (trend) Glasses/day <=2 3 to 4 5+ 23 52 58 24 35 37 Meat <1/week Meat 1+/week

RR ‡ of F ATAL STROKE WATER Intake in M & according to

F with Stroke Hx

(n=614) 1.6

1.4

<.05 <.01 <.02 .08 p (trend) 1.2

1 0.8

1 .84

1 1 1 0.6

0.4

0.2

.55

.66

.43

.60

.45

.71

.47

Servings /day 1 to 2 3 to 4 5+ 0 Events 15 37 27 15 28 21 13 26 21 9 20 14 ‡ Adj: ( Age & Sex) (+ BP, Smoking, (+ Ex ( + Other) Fl BMI) or Diab)

1 0.9

0.8

0.7

0.6

0.5

0.4

0.3

0.2

0.1

0 Non-Fatal MI Whole Grain or White Bread and Coronary Heart Disease Fatal CHD White Mixed Whole Wheat

1 0.9

0.8

0.7

0.6

0.5

0.4

0.3

0.2

0.1

0 Women Relative Risk of fatal CHD according to Exercise Status Age & Sex Adjusted (Adventist Mortality and Adventist Health Studies) Men Low Exercise Medium Exercise High Exercise significant

Other diseases in Adventists: Vegetarians vs Nonvegetarians.

Weight Differences Between Vegetarians and Non-Vegetarians

Pounds 200 Vegan Lacto-ovo Pesco-veg Semi-veg Non-veg 180 160

161 171 164 180 161 177 188 181 193

140

146

120 100

=

0 Female Male

DIABETES Prevalence and diet patterns .

Associations between Vegetarian Status and the Prevalence of Diabetes in Adventists Vegetarian Status Vegetarian Semivegetarian MEN Adjusted for Age and BMI 95% Confidence Interval WOMEN Adjusted for Age and BMI 95% Confidence Interval 1.00

1.00

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.

RR 2 1.8

1.6

1.4

1.2

1 0.8

0.6

0.4

1.26

(1.21-1.43) 1.49

(1.31-1.7) 0.2

0 Meat intake: Never < 1x /wk 1+ /wk # Adjusted for age, BMI, education, oral contraceptive use, number of live births, smoking and alcohol intake.

Risk of prevalent rheumatoid arthritis and meat intake. Males.

RR 2 1.8

1.6

1.4

1.2

1 0.8

0.6

0.4

1.19

(1.05-1.34) 1.43

(1.20-1.7) 0.2

0 Meat intake: Never < 1x /wk 1+ /wk # Adjusted for age, BMI, education, number of live births, smoking and alcohol intake.

Selected Risk Factors in Adventists:

Vegetarians vs Nonvegetarians.

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

2.5

2 1.5

1 0.5

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

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

Vegetarian Status Men Adjusted for Age and BMI 95% Confidence Interval Women Adjusted for Age and BMI 95% Confidence Interval Vegetarian Semivegetarian 1.00

1.66

1.34-2.07

1.00

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

Vegan 20% Lacto-ovo Pesco-veg Semi-veg Non-veg 15% 10% 5% 0% Blacks Whites

Fruit and Cancer

Cancer Site Ovary Fruit Types All fruits Pancreas Raisins, dates, dried fruit Prostate Raisins, dates, dried fruit Lung All fruits Frequency Relative Risk <5/wk 1.00

1-2/day 1.24

>2/day 0.59

<1/month 1.00 > 3/wk 0.19

<1/wk 1.00

1-4/wk 1.17

> 5/wk 0.62

<3/wk 1.00

3-7/wk 0.30

>1/day 0.26

SOY MILK

Soy Foods

1. Reduces cholesterol 2. Isoflavone phytoestrogens (Genistein, daidzein, equol) 3. May affect risk of cancers, heart disease, osteoporosis, and other disorders 4. American Adventists consume a great deal of soy as a non-meat complete protein

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

1 0.9

(0.5-1.4) P(t) = .02

0.7

(0.4-1.4) 0.3

(0.1-0.9) 0 Never < daily 1 x/day 2+ day # men 10,875 902 395 223 *Adjusted for age, BMI, consumption of coffee, whole milk, eggs and citrus fruit and age at first marriage

.

Jacobsen et al,

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 Cancer Cancer Site Ovary Pancreas Fruit Types All fruits Raisins, dates, dried fruit ( Fruit Frequencies)/Risk Ratios (<5/wk) 1.00

; (1-2/day) 1.24

; (>2/day) 0.59

(<1/month) 1.00

; (> 3/wk) 0.19

Prostate Lung Raisins, dates, dried fruit (<1/wk) 1.00

; (1-4/wk) 1.17

; (> 5/wk) 0.62

All fruits (<3/wk) 1.00

; (3-7/wk) 0.30

; (>1/day) 0.26

Variable Gender Meat Exercise Nuts The Independent Effects of Traditional Lifestyle Risk Factors and Psychosocial and Religious Participation Variables on Coronary Heart Disease (CHD) Mortality in California Adventists ALL VARIABLES Smoking Church Attendance Level Women Men Vegetarian <1/wk >1/wk Low Medium High <1/wk 1-4/wk >5/wk Never Past 3-4/mo 1-2/mo <1/mo Men 1.00

1.56** 1.59** 1.00

0.86

0.70** 1.00

1.04

0.85

1.00

1.04

1.00

0.76

1.55

Women 1.00

1.18

1.03

1.00

0.84

0.73** 1.00

0.77* 0.68** 1.00

1.09

1.00

1.70

1.38

Combined 1.00

1.63*** 1.00

1.31** 1.21** 1.00

0.85

0.71*** 1.00

0.87

0.73** 1.00

1.04

1.00

1.23

1.58** **p<0.01 *** p<0.001

Variable The Independent Effects of Traditional Lifestyle Risk Factors and Psychosocial and Religious Participation Variables on All-Cause Mortality in California Adventists Level Men ALL VARIABLES Women Combined Sex Meat Exercise Women Men Vegetarian <1/wk >1/wk Low Medium High 1.00

0.99

1.09

1.00

0.80*** 0.75*** 1.00

1.02

1.08

1.00

0.81*** 0.81*** 1.00

1.50*** 1.00

1.01

1.09* 1.00

0.81*** 0.79*** Nuts Smoking Church Attendance <1/wk 1-4/wk >5/wk Never Past 3-4/mo 1-2/mo <1/mo 1.00

0.87* 0.78*** 1.00

1.09* 1.00

0.99

1.32* 1.00

0.89** 0.88** 1.00

1.15* 1.00

1.20

1.17

1.00

0.89*** 0.84*** 1.00

1.13** 1.00

1.12

1.25** *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

1.

2.

3.

4.

5.

Summary As a group, risk of CHD is much lower in Adventists but this is especially so below the age of 70 years.

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

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

Adventists often have unusual dietary habits that trend toward vegetarianism.

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.

CONCLUSION The studies on Adventists in California suggest that a vegetarian lifestyle reduces the risk of many chronic diseases such as: • CHD • Cancer • Obesity • Arthritis • Diabetes

Summary AHS “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 ???)

Summary AHS “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

.

Summary AHS “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 Old 1,765

- aged 90 years +

99 - over 100 years

Lydia Newton 112 years

Our Centenarians Marguerite 90, Lydia 112 (Lydia’s daughter) Marge Jetton 101 (turned 105 on 9/29/09)

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)