Transcript Living Longer: Living Better. The Experience of California

Gary E. Fraser MB ChB, PhD, FACC, FRACP
Professor of Medicine
Professor of Epidemiology
Loma Linda University
The Adventist Health Studies: A
contribution to preventive
medicine.
1958-2010
2001 – 2011+
 Our sincere thanks to the many of you who are
members of AHS-2.
 Please remember to return the short biennial
questionnaire about any hospitalizations
About 96,000 subjects
More than 25,000 Black study members
Mean age at enrolment 58.7 years
Age range 30-110 years
35% male, 65% female
Subjects by Age
25
Percentage
20
15
10
5
0
30-39
40-49
50-59
60-69
Ages
70-79
80-89
90-99
100+
Black Subjects by Age
Percentage
45
40
35
30
25
20
15
10
5
0
30-44
45-49
60-74
Ages
75+
The Oldest-Old in AHS-2
 90-99 years of age --- 1043 subjects
 100+
---
46 subjects
They all completed a 50 page
questionnaire!!
Education
No High School
Diploma
8.98%
High School
Diploma Only
53.07%
Bachelor's
Degree
20.63%
Graduate Degree
17.33%
0
10
20
30
40
50
60
Religion at Age 15
Unkown
5.74%
Other
34.32%
59.94%
Adventist
Smoking Status
80.06%
Never Smoked
Past Smoker
18.79%
Current Smoker
1.15%
0
20
40
60
80
100
Alcohol Use
59.43%
Never
Past Use
33.82%
6.75%
Current Use
0
10
20
30
40
50
60
70
Religion Sub-study Population
 10988 members enrolled
 3764 are Black subjects
 These were an approximate 11% sample of all Adventist
Health study-2 members
 1/3 attend churches <100 members
 1/10 attend churches >1000 members
Frequency of Church Attendance
More than once
per week
42%
Once per week
48.3%
A few times a
month
5.7%
Less than once
per month
3.9%
0
10
20
30
40
50
60
Family
 Of 6,872 married subjects who were active Adventists,
10.4% had non-SDA or inactive SDA spouses
 Of their 26,614 children:
• 51% are active Adventists
• 61% spent at least some time at Adventist schools
Social Circle:
Of the people you socialize with, what percentage are Adventist?
66-100% SDA
51.1%
26-65% SDA
20.1%
0-25% SDA
28.3%
0
20
40
60
80
100
Percentage of Adventists Reporting for Each Category
20% of Adventists reported approx. 100% of their social circle was Adventist
Church:
Do people whom you worship with make you feel loved and cared for?
Always
25.1%
Fairly or very
often
59.2%
Never or once in
a while
15.7%
0
10
20
30
40
50
60
70
Church:
How often are people whom you worship with critical of you?
Never
56.1%
Once in a while
38.3%
Fairly or very
often
5.6%
0
20
40
60
80
100
Church Size
<100
Yes to the question
White
Black
51%
50%
100-1000
41%
46%
>1000
24%
47%
Church size
<100
“At Least Fairly Often”
White
Black
42%
42%
100-1000
36%
39%
>1000
27%
37%
On Sabbath I feel relieved from
tensions that I normally experience
Very True
72.7%
Somewhat True
22.1%
Not True
5.2%
0
10
20
30
40
50
60
70
80
Bible Study:
How often do you spend time in private Bible study?
At least daily
47.1%
2-6 times per week
31.3%
A few times a month to once
per week
14.2%
Less than monthly
7.4%
0
10
20
30
40
50
Belief:
Do you feel punished by God for a lack of devotion?
Not at all
73.5%
A little
15.8%
Somewhat to a
great deal
10.7%
0
20
40
60
80
Actions:
When coping, I have expressed anger at God for letting terrible things happen
Not at all
77.4%
Somewhat to a
little
19.8%
Quite a bit to a
great deal
2.9%
0
20
40
60
80
100
God: Saving vs. Damning
100
94.9%
50
4.8%
0.3%
0
1
Saving
2 to 4
5 to 7
Damning
Approving – Disapproving God
75%
80
60
40
11.9%
20
6.9%
3.4%
2
3
0.8%
0.6%
1.4%
5
6
7
0
1
Approving
4
Disapproving
A sense of justice is more on my mind
than God’s mercy
80
62%
60
40
14.2%
20
4.8%
11.4%
2.1%
2.2%
3.3%
5
6
7
0
1
Not True
2
3
4
Somewhat True
Very True
Stress: Traumatic Events
 We asked subjects the number of serious physical or
emotional traumas they have experienced.
 Examples:
 Serious illness (cancer, AIDS, leukemia)
 Miscarriage or abortion
 Family member murdered
 Homelessness
 Unwanted sexual contact
Stress:
Number of Traumas Experienced
20
18
Percentage
16
14
12
10
8
6
4
2
0
0
1
2
3
4
5
Physical or Emotional Traumas
6
7 to 15
Quality of Life in Black and
White Adventists compared to
Others
Physical and Mental Health
Figure 2. Physical and Mental Health based on SF-12 composite scores
for Seventh-day Adventist Blacks and Whites and for SF-12 national
norms (38). Numbers are scale scores (mean 50, SD 10) for individuals
over 35 years of age.
Depression
14.2% of subjects reported feeling somewhat or very
depressed
Other
Depressed
AHS-2 Counts of vegetarians
 Vegans
9,062(9.4%)
 L-O vegetarians
30,103 (31.4%)
 Semi-vegetarians
4,801 (5.0%)
 Pesco-vegetarians
9,793 (10.2%)
 Non-vegetarians
42,241 (44.0%)
Dietary Categories: Whites
9.7%
39.6%
5.6%
36.8%
8.3%
Vegan
Lacto-Ovo Vegetarian
Pesco-Vegetarian
Semi-Vegetarian
Non-Vegetarian
Dietary Categories: Blacks
8.7%
15.9%
56.5%
15.6%
3.3%
Vegan
Lacto-Ovo Vegetarian
Pesco-Vegetarian
Semi-Vegetarian
Non-Vegetarian
Dietary Status by Age Group
39.2%
76+
50-75
34.4%
25.7%
47.4%
26%
30-49
0%
20%
Vegan
Semi-Vegetarian
52.4%
40%
60%
Lacto-Ovo Vegetarian
Non-Vegetarian
80%
100%
Pesco-Vegetarian
Daily Meat Intake – Non-Vegetarians
 AHS-2 Results:
 Black Non-Vegetarians:
61.1 grams per day
 White Non-Vegetarians:
41.3 grams per day
Daily Meat Intake – Grams per Day
Black Non-Vegetarian
White Non-Vegetarian
30
20
10
0
Fish
Poultry
Red Meat
Dairy Intake
16
14
12
10
8
6
4
2
0
Vegan
Lacto
Dairy Fat
Pesco
Semi
Dairy Protein
Non
Diet: Mean Servings Per Week
25
20.44
20
15
10
5
4.27
4.69
6.16
0.84
0
Cruciferous
Vegetables
Fish
Fruits
Legumes
Tomatoes
Coffee Consumption
Never
69.03%
1 Cup or Less
Per Day
22.48%
8.49%
2+ Cups Per Day
0
20
40
60
80
Vitamin B12 Intake (Including Supplements)
24
20
16
12
8
4
0
Vegan
Lacto
Pesco
Semi
Non
Calcium Intake
1000
800
600
400
200
0
Vegan
Lacto
Dietary
Pesco
Semi
Supplement
Non
Long chain n-3 acids
0.3
0.2
0.1
0
Blacks
Whites
Diabetes
Hypertension
Overweight
Hyperlipidemia
Weight Differences Between Vegetarians
and Non-Vegetarians
Vegan
Pounds
Lacto-ovo
Pesco-veg
Semi-veg
Non-veg
200
180
160
188
180
171
161
164
177
193
181
161
140 146
120
100
0
Female
5’ 6” tall
Male
5’ 10” tall
Prevalent Treated High Blood Pressure and Diet
% Reporting Hypertension
Vegan
25%
20%
15%
10%
5%
0%
Lacto-ovo
Pesco-veg
Semi-veg
Non-veg
Prevalent Treated High Cholesterol
and Diet
% Reporting High Cholesterol
Vegan
Lacto-ovo
Pesco-veg
Semi-veg
Non-veg
15%
10%
5%
0%
Also supported by studies of non-Adventist vegetarians
Prevalent Treated Diabetes and Diet
% Reporting Type 2 Diabetes
Vegan
8%
6%
4%
2%
0%
Lacto-ovo
Pesco-veg
Semi-veg
Non-veg
Examining the risk of major causes of death
in California Adventists
 A. Total Mortality
 B. Heart disease
 C. Cancer
 D. Colon, Breast, Prostate cancers
1.
Confounding—a confusion in causality.
2. Imprecision—Is it just chance?
3. Complicated associations that differ by gender, age
etc
4. Dietary and disease outcome measurement errors
Identified New Cancers---2700
Available New Cancers---3600
Required for analyses---5500
Identified Deaths (all causes)– 3300
Available Deaths (all causes)--4200
Diet and Total Mortality*
Risk Factor
RR
95% Confidence Intervals
Nonvegetarian
1.00
Vegan
0.81
0.71-- 0.93
Lacto-ovo-
0.89
0.82 – 0.96
Pesco-
0.78
0.69 – 0.88
Semi-
0.92
0.80—1.06
*Adjusted for Age, gender, and Ethnicity.
Diet and Total Mortality at
Different Ages (RR’s)*
Risk
55 years 65 years 80 years 90 years
Factor
Non1.00
1.00
1.00
1.00
vegetarian
Vegan
0.66
0.72
0.81
0.88
Lacto-ovo- 0.44
0.57
0.82
1.05
Pesco-
0.76
0.77
0.80
0.81
Semi-
0.47
0.60
0.87
1.10
*Adjusted for Age, gender and ethnicity.
Diet and Total Mortality at
Different Ages (RR’s)*
Risk
Factor
55 years 65 years 80 years 90 years
Non1.00
vegetarian
1.00
1.00
1.00
Vegetarian 0.53
0.63
0.83
0.99
*Adjusted for Age, gender and ethnicity.
Red Meat and Total
Mortality*
Risk Factor
RR
95% Confidence Intervals
No red meat
1.00
1 oz/day
1.27
1.19– 1.35
2 oz/day
1.61
1.42 – 1.83
3 oz/day
2.05
1.70 – 2.47
*Adjusted for Age, gender, and Ethnicity.
Red Meat and Total Mortality
at Different Ages (RR’s)*
Risk
Factor
55 years 65 years 80 years 90 years
None
1.00
1.00
1.00
1.00
1 oz/day
1.44
1.34
1.21
1.13
2 oz/day
2.07
1.80
1.46
1.28
3 oz/day
2.97
2.42
1.77
1.44
*Adjusted for Age, gender and ethnicity.
Dairy Fat and Total
Mortality*
Risk Factor
RR
95% Confidence Intervals
No dairy
1.00
5 g/day
1.08
1.04– 1.11
10 g/day
1.16
1.09 – 1.23
15 g/day
1.25
1.14 – 1.37
*Adjusted for Age, gender and ethnicity.
Diet and CHD Mortality*
Risk Factor
RR
95% Confidence Intervals
Nonvegetarian
1.00
Vegan
0.86
0.67– 1.10
Lacto-ovo-
0.95
0.80 – 1.12
Pesco-
0.82
0.64 – 1.05
Semi-
0.79
0.58—1.07
*Adjusted for Age, gender and ethnicity.
Diet and CHD Mortality at
Different Ages (RR’s)*
Risk
Factor
55 years 65 years 80 years 90 years
Non1.00
vegetarian
1.00
1.00
1.00
Vegetarian 0.44
0.55
0.79
0.99
*Adjusted for Age, gender and ethnicity.
Diet and Total Cancer*
Risk Factor
RR
95% Confidence Intervals
Nonvegetarian
1.00
Vegan
0.78
0.65-- 0.93
Lacto-ovo-
0.92
0.83 – 1.02
Pesco-
0.95
0.82 – 1.11
Semi-
0.80
0.66—0.97
*Adjusted for Age, gender and ethnicity.
Diet and Colon Cancer*
Risk Factor
RR
95% Confidence Intervals
Nonvegetarian
1.00
Vegan
0.79
0.43– 1.46
Lacto-ovo-
0.76
0.53 – 1.09
Pesco-
0.43
0.21 – 0.88
Semi-
0.58
0.27—1.24
*Adjusted for Age, gender and ethnicity.
Red Meat and Colon Cancer*
Risk Factor
RR
95% Confidence Intervals
No red meat
1.00
1 oz/day
1.35
1.07– 1.71
2 oz/day
1.83
1.14 – 2.93
3 oz/day
2.48
1.22 – 5.03
*Adjusted for Age, gender, and Ethnicity.
Diet and Breast Cancer*
Risk Factor
RR
95% Confidence Intervals
Nonvegetarian
1.00
Vegan
0.56
0.36-- 0.88
Lacto-ovo-
0.89
0.70 – 1.13
Pesco-
0.81
0.57 – 1.16
Semi-
0.76
0.49—1.19
*Adjusted for Age, gender and ethnicity.
Diet and Prostate Cancer*
Risk Factor
RR
95% Confidence Intervals
Nonvegetarian
1.00
Vegan
0.68
0.44– 1.05
Lacto-ovo-
0.99
0.83 – 1.18
Pesco-
0.94
0.64 – 1.38
Semi-
0.93
0.61—1.43
*Adjusted for Age, gender and ethnicity.
Calcium intake and Prostate
Cancer*
Risk Factor
RR
600 mg/day
1.00
95% Confidence Intervals
1000 mg/day 0.78
0.63– 0.96
1500 mg/day 0.57
0.41 – 0.78
2000 mg/day 0.42
0.27 – 0.64
*Adjusted for Age, gender, and Ethnicity.
A Healthy Dairy-free Vegetarian Diet
 Quality depends on the overall character of the
diet, not just the absence of animal products.
 To obtain calories vegans usually eat more fruit,
vegetables, legumes, seeds, nuts, and berries—
packed with healthy phyto-chemicals.
 What about vegan diets where this is NOT so?
Exposed to “downsides” but not the “upsides” of
the animal-free diet.
If no dairy
a) Ensure ample grains, vegetables, legumes, fruits,
nuts, seeds and berries;
b) Avoid replacing animal foods by refined, sweet,
fatty commercial products, even if from plant
sources;
c) Obtain adequate sunlight and emphasize high
calcium vegetables, or supplement calcium;
d) Consider algal supplements high in omega-3
fatty acids;
e) Supplement with vitamin B12.
1.
The Optimum Vegetarian
Diet!
I don’t know!
So far vegans are looking very good, but
not yet convincingly superior to lactoovo vegetarians.
We will keep looking as the data grows
more robust.
Overall Conclusions
 The health advantage experienced by the more
conforming Adventists over many years is
remarkable.
 However, strong conclusions require strong
evidence.
 AHS-2 will provide this. We have data from 96,000
Adventists across the U.S and Canada, a large
number. This improves precision and helps rule
out chance as an explanation.
Practical Conclusion
 The evidence is right now sufficient to support a
diet that:
i) may still include some lacto-ovo foods;
ii) is otherwise plant-based, or trends
strongly in that direction.
 If you wait to modify your lifestyle till all the details are
known, for sure you will be dead!
For AHS-2 this is just the
beginning, and a small fraction of
what will be possible.
The main results will be available in 2-3 years.
We are very grateful for your support and interest as
influential members of the Adventist community.