Transcript Document

The Adventist Health Studies: A contribution to
preventive medicine. 1958-2010
IAD Health Summit, 2013
Tricia Penniecook, MD, MPH
Dean, Loma Linda University
School of Public Health
Adventists – attractive to study
Wide range of lifestyle
• Exercise
• Diet (from average US to vegans).
~ Some with:
• High intake of soy, nuts, legumes
• Very high fruit/vegetable intake
• No meat/fish intake
• No dairy intake
• No confounding by smoking or alcohol
• Fairly homogenous on “other” factors
• church attendance, social support, etc.
»
Adventist Mortality Study, 1958
» Dr. Hardinge
» Prospective study of 22,940 California Adventists
» 5-year intensive follow-up and 25-year informal follow-up
» For first five years, American Cancer Society had similar study
with volunteers as well
» The similarities between the groups were important because it has been
found that individuals who volunteer for such studies tend to be healthier
than the general population, and those in the upper socio-economic
classes tend to have lower rates of disease overall. Thus, the Adventist
Mortality Study and the American Cancer Society Study provide a
reasonably fair comparison between Adventists and non-Adventists.
Findings of AHS-1 vs. ACS study
» Overall : 60% SDA men and 76% SDA women
» Lung cancer: 21%
» Colo-rectal cancer: 62%
» Breast cancer: 85%
» Prostate cancer: 92%
» Lymphoma or leukemia: 86% for men and 100% for women
» Coronary heart disease: 66% for men and 98% for women
» Stroke: 72% for men and 82% for women
» All deaths: 66% for men and 88% for women
Comparison between SDA’s and nonsmokers
All cancers: 85% for men and 78% for women
Lung cancer: 67% for men and 42% for women
Colo-rectal cancer: 67% for men and 42% for women
Breast cancer: 81%
Prostate cancer: 93%
Lymphoma and leukemia: 93% for men and 89% for women
Coronary heart disease: 76% for men, 101% for women
Stroke: 75% for men and 79% for women
All causes: 79% for men and 91% for women
Adventist Health Studies in other parts
of the world
» Norway, 1960, the national census in Norway showed an existing
population of 7,173 known Adventist. Studies compare them with other
nationals with follow-up till 1986.
» Adventist men were at 82 percent of the expected death rates for the
general population, and Adventist women were at 95 percent.
» Deaths due to cardiovascular disease in individuals less than 75 years of
age: Adventist men 65 % and Adventist women at 90%.
» Cancer deaths for Adventist men were at 78 percent and at 94 percent of
expectation for Adventist women.
More around the world…
» Dutch Adventists, 1968 - 1977, 4000 members (Berkel and deWaard).
» Compared to the total expected death rate, Dutch Adventists were at 45%.
» Cancer deaths—50%
» Breast cancer-- 50%; lung cancer --45%; colo-rectal cancer-- 43 %; and
stomach cancer-- 59%.
» Cardiovascular disease—41%
» Ischemic heart disease—43%; for stroke—54%.
Fundamental Weakness
» Nonfatal events were not measured
» What is it about the SDA lifestyle that enabled Adventists to live
longer?
» Would lifestyle differences among Adventists themselves produce
different risks for contract specific diseases-both fatal and
nonfatal?
» The Adventist Mortality Study raised a number of interesting questions.
What was it about the Adventist lifestyle that enabled Adventists to live
longer? Would lifestyle differences among Adventists themselves produce
different risks for contracting specific diseases-both fatal and nonfatal?
Adventist Health Study-1, 1974
» Which components of lifestyle are protectors
» Data reporting nonfatal events as well.
» More detailed investigation of diet.
» Started as primarily cancer investigation, cardiovascular
component was added in 1981
» Two questionnaires, two years apart: 75% from White Non
Hispanic subjects
» Incredible response rates of 90-99.5%
How the population was chosen
» The initial mailing of 63,530 census questionnaires was sent to every
Adventist household in California in an attempt to enroll every adult in these
households over the age of 25 years.
» Two years later, a second more extensive lifestyle questionnaire was sent
to those who had responded to the census questionnaire. This second
questionnaire included previous medical history, drug therapy, more than
60 dietary questions, a variety of psychosocial questions, and questions
about physical activity. The response rate from White non-Hispanic
subjects was the highest of any ethnic group at 75 percent, and numbered
34,198 individuals.
» When the gathering of follow-up data was officially concluded for the
Adventist Health Study, 32,000 hospitalizations were reported, representing
28,000 hospital charts on 18,053 different individuals. In California, 698
different hospitals were involved, and 960 hospitals out-of-state.
» Researchers from many studies of this type are pleased when they receive
a response rate of 50 percent. The rate of returns from the annual follow-up
questionnaires which asked about hospitalization, critical to the entire
research process, received response rates in excess of 90 percent, usually
above 95 percent. The final and most critical mailing received an incredible
99.5 percent response.
Descriptive data
» Average age: 51 years for men and 53 for women.
» Hypertension levels close to expected
» Virtually no smokers
» Two thirds women, well-educated
» Half ate meat less than once a week
AHS-1: Dietary findings
21% consume beef more than twice/week
10% ate fish once/week
35% drink coffee
77% consume primarily whole wheat bread
66% eat nuts at least once/week
24% eat nuts more than four times/week
81% eat fruit at least once a day, 49% eat fruit at least three times/day
Life Expectancy
AHS-1 1976-88
.Cal
81.2
Years
of life
SDA
Veg. SDA
83.9
83.3
79.5
73.9
Males
© 2004 Adventist Health
Study-2
Females
85.7
Fatal Heart Disease
Californians & Adventists 1976-88
Californians
SDA Males
SDA Females
45-54
55-59
60-64
Years
© 2004 Adventist Health
Study-2
65-69
70-74
Diet & Weight
AHS-1 1976-88
,Veg
.Semi Veg
183
169 176
Weight
in pounds
Male
© 2004 Adventist Health
Study-2
.Non Veg
152
145
139
Female
Weight Differences Between Vegetarians
and Non-Vegetarians
Vegan
Pounds
Lacto-ovo
Pesco-veg
Semi-veg
Non-veg
200
180
160
161
171
188
180
164
177
193
181
161
140 146
120
100
0
Female
5’ 6” tall
Male
5’ 10” tall
Relative Period Incidence of
Hypertension requiring Medication 196076 by Meat intake (AMS and AHS-1)
RR
2.5
2.24
2
1.82
1.5
1
1
0.5
0
Never
< 1/week
1+/week
Prevalent Treated High Blood Pressure and
Diet
% Reporting Hypertension
Vegan
25%
20%
15%
10%
5%
0%
Lacto-ovo
Pesco-veg
Semi-veg
Non-veg
AHS-1 Cancer findings
Fruit is protective-those who consume it more than once a day, 25% lung
cancer of those less than 3 times a week
Many-fold protection against stomach cancer
Legumes: 1/30th risk of pancreatic cancer
Dates, raisins and dried fruit: 1/5th risk of pancreatic cancer
Beans: 42% lower risk of colon cancer
Beef: more than two-fold risk of bladder cancer
Dried fruit: decrease prostate cancer by 40%
Meat intake and risk of different
incident cancers. AHS-1.
RR
2.5
P (t): 0.01
ns
<.01
0.02
2
1.5
Never
week/1 <
1
week/+1
0.5
0
Colon
Colon
Prostate
Postmenopausal
Ovary
Ovary
Ovary
Fruit & Lung Cancer
AHS-1 1976-88
wk/3<
Relative
Risk
© 2004 Adventist Health
Study-2
day/1<
day/1>
Meats & Colon Cancer
AHS-1 1976-88
Never
Relative
Risk
© 2004 Adventist Health
Study-2
wk/1<
wk/+1
Red Meat & Colon Cancer
AHS-1 1976-88
Never
Relative
Risk
© 2004 Adventist Health
Study-2
wk/1<
wk/+1
White Meat & Colon Ca
AHS-1 1976-88
Never
Relative
Risk
© 2004 Adventist Health
Study-2
wk/1<
wk/+1
Legumes & Colon Cancer
AHS-1 1976-88
wk/1<
Relative
Risk
© 2004 Adventist Health
Study-2
wk/1-2
wk/2>
Tomatoes & Prostate Ca
AHS-1 1976-88
wk/1<
Relative
Risk
© 2004 Adventist Health
Study-2
wk/1-4
wk/4>
Legumes & Prostate Ca
AHS-1 1976-88
wk/1<
Relative
Risk
© 2004 Adventist Health
Study-2
wk/1-2
wk/2>
Soy Milk & Prostate Ca
AHS-1 1976-88
Never
Relative
Risk
© 2004 Adventist Health
Study-2
day/1<
day/1
day/1>
Diabetes—Cases in the US
Associations between Vegetarian
Status and the Prevalence of Diabetes
in Adventists
MEN
Vegetarian
Status
WOMEN
Adjusted
95%
Adjusted
for Age Confidence for Age
and BMI
Interval
and BMI
95%
Confidence
Interval
Vegetarian
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
1.00
Prevalence of diabetes according to
dietary profile.
25
20
RR
15
Veg
Semi- Nonveg
veg
Veg
Semi- Nonveg
veg
10
5
0
Males
Females
Prevalent Treated Diabetes and Diet
% Reporting Type 2 Diabetes
Vegan
8%
6%
4%
2%
0%
Lacto-ovo
Pesco-veg
Semi-veg
Non-veg
AHS-1: Interesting dietary findings
» Nuts and whole wheat bread significantly reduce the risk of
coronary heart disease
» Beef significantly increases the risk of fatal coronary heart
disease
AHS-1: Findings for coronary heart
disease
» Lower cholesterol overall
» Exercise has not been studied well, however when asked, SDA’s
said 2.38X/week vs. 1.5X/week for their neighbors
» Double the risk of heart attacks for diabetics, three times the risk
for hypertensives, elevation of risk for current and past smokers
and more than double the risk for obese.
Beef & Fatal CHD Risk
AHS-1 1976-88
Never
wk/3<
wk/+3
Relative
Risk
Male
© 2004 Adventist Health
Study-2
Female
Fish & CHD Risk
AHS-1 1976-88
Never
Relative
Risk
© 2004 Adventist Health
Study-2
wk/1<
wk/+1
Bread & CHD Risk
AHS-1 1976-88
White
Relative
Risk
© 2004 Adventist Health
Study-2
Mixed
Whole
Nuts & CHD Risk
AHS-1 1976-88
wk/1<
wk/1-4
wk/4>
Relative
Risk
Male
© 2004 Adventist Health
Study-2
Female
Nuts & CHD Risk
AHS-1 1976-88
wk/1<
wk/1-4
wk/4>
Relative
Risk
Vegetarian
© 2004 Adventist Health
Study-2
Non-Vegetarian
AHS-1: Findings for nuts, 1992
» 1-4/week: 74% risk of nonfatal MI and 73% risk of fatal MI
» 5+/week: 52% risk of nonfatal MI and 62% risk of fatal MI
» Obese nut eaters had 46% risk of coronary heart disease
Exercise & All Deaths
AHS-1 1976-88
Low
Relative
Risk
© 2004 Adventist Health
Study-2
Medium
High
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
© 2004 Adventist Health
Study-2
Effects of Individual Risk Factors To
Increase Life Expectancy
Variable
Men
Women
Vegetarian diet
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
© 2004 Adventist Health
Study-2
» The study's strengths lie in the large size of the cohort group, the extensive
data gathered on each subject, the inclusion of both men and women from
a wide range of ages, and, perhaps most important, the wide range of nut
consumption among Adventists.
» In February of 1992, grant money was received to further examine the
existing data and address questions that have been raised about the
longevity of Adventists.
» Mortality follow-up of the 34,198 individuals from the original study through
1988, a time span of 12 years.
» Questions such as:
~ "Do diet or exercise patterns influence longevity?”
~ "Which dietary components are important?”
~ "If Adventists with particular habits live longer, is it due to the fact that
they tend to live closer to a certain maximum life span and die rapidly,
or is there an increase in the maximum life span and the entire
distribution of ages at death?”
» Certain factors are known to increase the risk of heart disease and cancer.
Of all Adventist deaths, 56.7 percent were from cardiovascular diseases
and 20.9 percent from cancer. These figures are quite similar to those of
the non-Adventist population.
Then, what is the difference?
The difference lies in the fact that Adventists develop these same problems
at a later age
Adventist Health Study-2
2002-Present
Demographics
About 96,000 subjects
More than 25,000 Black study members
Mean age at enrollment 58.7 years
Age range 30-110 years
35% male, 65% female
» AHS-2 is of the largest, and most exciting health studies of its kind ever
designed and will have national importance and international significance.
As one of the largest health studies of Black/African Americans, it aims to
help answer why Black/African Americans have a disproportionate amount
of cancers and heart disease. It is estimated that 40 percent of cancers
could be prevented by a proper diet. AHS-2 seeks to increase
understanding of the benefits of healthy eating.
» Every study member filled out a 50-page diet and lifestyle questionnaire at
the start of the study. Every two years after that, participants fill out hospital
history forms and list any hospitalizations and diagnoses of cancers, stroke,
heart attack and diabetes during the previous two years.
Adventist Health Study-2
 Emphasis will be on effects of:






Soy
Meats
Dairy products
Linolenic acid
Particular families of vegetables
BMI/Body shape
 ON

Common cancers and other chronic diseases
 ALSO
 Diet and disease in African-Americans (N=25,000)
 Religiosity/psychosocial factors/Mortality/Quality of life
The Oldest-Old in AHS-2
» 90-99 years of age --- 1043 subjects
» 100+
---
46 subjects
They all completed a 50 page
questionnaire!!
» Our study is made up of 96,000 Adventists ages 30 to 112 from all 50 U.S.
states, as well as Canada. Enrollment occurred between 2001 and
2007. About 64% were members of the Adventist church by the age of 15
years. The study members are 65.1% female, with a mean age of 60.2 at
enrollment. Additionally, 65.3% of our study members are White (nonHispanic) and 26.9% of our study members are Black/African American.
Our study includes small numbers of other ethnic minorities. Only 1.1% of
our study members report being current smokers and 6.6% report current
alcohol use.
Questions AHS 2 is asking
» What specific foods enhance quality of life?
» Do soy products really help prevent breast and prostate cancer?
» What foods help prevent cancer, diabetes, heart disease, Alzheimer's, and
arthritis?
» Heredity or lifestyle – which is more important?
» Does faith contribute to a healthier life?
AHS 2 subjects
» 8% are vegan (No red meat, fish, poultry, dairy or eggs) - 28% are lactoovo vegetarian (Consume milk and/or eggs, but no red meat, fish or
poultry) - 10% are pesco-vegetarian (Eat fish, milk and eggs but no red
meat or poultry) - 6% are semi-vegetarian (Eat red meat, poultry and fish
less than once per week) - 48% are non-vegetarian (Eat red meat,
poultry, fish, milk and eggs more than once a week)
Education
No High School
Diploma
8.98%
High School
Diploma Only
53.07%
Bachelor's
Degree
20.63%
17.33%
Graduate Degree
0
10
20
30
40
50
60
Diet: Mean Servings Per Week
25
20.44
20
15
10
5
4.2
4.6
6.1
0.84
0
Cruciferous
Vegetables
Fish
Fruits
Legumes
Tomatoes
» Our data show a progressive weight increase from a total vegetarian diet
toward a non-vegetarian diet. For instance, 55-year-old male and female
vegans weigh about 30 pounds less than non-vegetarians of similar height.
Additionally, levels of cholesterol, diabetes, high blood pressure, and the
metabolic syndrome all had the same trend – the closer you are to being a
vegetarian, the lower the health risk in these areas. In the case of type 2
diabetes, prevalence in vegans and lacto-ovo vegetarians was half that of
non-vegetarians, even after controlling for socioeconomic and lifestyle
factors.
» Compared to non-vegetarians, vegans/vegetarians:
» - Watched less television - Slept more hours per night - Consumed more
fruits and vegetables - Consumed less saturated fat - Typically ate foods
with a low glycemic index, such as beans, legumes and nuts
Associations between Vegetarian Status and
the Prevalence of Hypertension in Adventists.
AHS-2
Men
Women
Diet
Adj. for
Age and
BMI
95%
Adj. for
95%
Confidence Age and Confidence
Interval
BMI
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
Weight Differences Between
Vegetarians and Non-Vegetarians
Vegan
Lacto-ovo
Pesco-veg
Semi-veg
Non-veg
200
Pounds
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
»Total Mortality
»Risk of Dying – Dividing to Different Ages
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.
»Coronary Heart Disease (CHD) Mortality
»Risk of Dying from CHD – Dividing to Different Ages
»Dietary Pattern & Prostate Screening Utilization
US Adventist vegetarians who increased their meat intake to
weekly consumption of meat over a 17-year interval
experienced a 3.6 year decrease in life expectancy
Increased
meat intake
Maintained
Zero Meat
Intake
Singh PN, Sabate J, Fraser GE. Does low meat consumption increase life expectancy in humans? Am J Clin Nutr 2003, 78(3):
526-532
From the 1st (1960) to the 2nd study (1976), some
Adventists changed from vegetarian diet to some meat.
Disease next 6 years (‘76-’82).
RR
(Singh et al.)
Also noteworthy is a pathway linking increased meat
intake in US Adventists to obesity, weight gain, and
the occurrence of diabetes*.
Increased Meat Intake
74% increase in risk
of Diabetes
Half of the Risk Produced
is mediated by a pathway
involving obesity (>30 kg/m2)
And weight gain of 10 kg or more
Vang A, Singh PN, Lee JW, Haddad E, Brinegar C. Meats, Processed Meats, Obesity, Weight
Gain, and the Occurrence of Diabetes among Adults: Findings from the Adventist Health
Studies. Ann Nutr Metab 2008.
Among Adventist vegetarians,
cessation of a faith-based
vegetarian diet pattern produced a
decrease in life expectancy that
was primarily attributable to
higher rates of stroke, coronary
heart disease, and diabetes.
Important questions for future
research
»
»
What are the advantages and risks of soy consumption (if any)?
Do all meats increase risk of CHD, colon cancer, and
possibly other chronic diseases equally? Do processed meats have greater
effects?
»
The decreased risk of several chronic diseases in
vegetarians is probably not only due to reduced or absent meat
consumption. The possible effects of particular families of vegetables, fruit,
nuts, and grains should be evaluated to gain greater specificity.
»
Report descriptive details of vegetarian diets in different
countries. Are these diets comparable, and how are pooled analyses best
conducted?
AHS-2--wrist fractures
» Thorpe et al examined diet practices and wrist fracture numbers over a 25year period of 1,865 women who participated in AHS-1 and AHS-2.
Women who reported fractures were more likely:
To be older
To have a history of fractures
To report low or no vigorous physical activity
To have experienced menopause more than 15
years earlier
To have never used hormones
AHS-2
African-American Cohort
» Almost 26,000 Black participants
» Help answer why Blacks have different risks of certain diseases.
» Examine how best to overcome historical barriers in working with the Black
community in a research setting.
Descriptive information
African-American Cohort AHS-2
» Compared to the rest of the AHS-2 study members, the Black cohort included
more females and younger individuals. Fewer were currently married and
more were never married, divorced or separated.
» - The average age of baptism was 24.3 years.
» - Compared to non-Adventist Blacks, rates of smoking, drinking and meat
consumption were lower, and rates of vegetarianism and water consumption
were higher for Black study members.
» - The education level was higher for Black study members (35% hold a
bachelor’s degree or higher) than for Blacks nationally (15% hold a bachelor’s
degree or higher).
Descriptive information
African-American Cohort AHS-2
» Compared to other Adventists, Black Adventists have more cases of type 2
diabetes, stroke and high blood pressure, but fewer cases of emphysema,
myocardial infarction, heart attacks, fibromyalgia and high cholesterol.
» - Black females had significantly less cancer than did non-Black females.
» - Black males had 47% higher prevalence of prostate cancer than did nonBlack males.
» - Obesity was more prevalent among Blacks than non-Blacks (35% vs.
22%). For Body Mass Index (BMI), 42% of non-Blacks had normal weight,
and 28% of Blacks had normal weight.
Descriptive information
African-American Cohort AHS-2
» 53% of Blacks reported sleeping six or fewer hours per night.
» -Overall, Black Adventist study participants reported better physical and
mental quality of life than the U.S. norm.
» Cases of hypertension and diabetes were lower for Black Adventists than
comparable national rates for both Blacks and non-Blacks, a noteworthy
finding. This may be explained by the fact that Black Adventists reported
better health habits than Black non-Adventists.
Why there is underrepresentation of
Blacks in scientific studies
» Blacks have been under-represented in scientific studies for several
reasons. From the Black community’s fear of exploitation based on
mistreatment in the past, to researchers’ failure to recruit Blacks through
targeted strategies, much work is needed to improve the representation of
Blacks in medical/scientific research. AHS-2 has documented the methods
involved in recruiting 26,000 Black Adventists in order for future
researchers to achieve better representation also.
What we have learned about research
with Blacks from AHS-2
» The local Adventist churches were the main area for recruitment to AHS-2,
as this is the center for community life and activity.
» - Focus groups in three churches revealed several areas of concern,
including:
» Confidentiality
» Use of Social Security numbers
» Respectful and culturally appropriate treatment
» Meaningful and motivating incentives
» On-going sharing of results
Adventist Health and Smog Study:
1976-Present
AHSMOG is made up of 7,000 participants from the first Adventist Health
Study. Through funding by the Environmental Protection Agency, Dr. David
Abbey of the Center for Health Research and fellow investigators are in the
midst of studying the effects of various air pollutants--both indoor and
outdoor--on lung function. The EPA has been especially interested in the
Adventist population because nearly all abstain from smoking. Testing of the
1,500 participants at more than 30 locations throughout California has been
completed. The data is now being analyzed by the researchers.
Religion and Health Studies
» What specific aspects of religion account for better or worse health?
» What are the biopsychosocial pathways to health?
Religion and Health Study, 2006Present
» In 2006 and 2007, 10,988 Adventists from Adventist Health Study-2 filled
out a questionnaire about religious beliefs and practices, stressful life
experiences, psychological characteristics and social life. A smaller group
who live in Southern California gave blood and urine samples at a clinic
and underwent physical performance testing (e.g., grip strength) and
memory testing, and also allowed us to measure blood pressure, weight,
body fat, and waist and hip circumference. In 2009, we sent out a second
questionnaire to 7,000 participants to see how responses had changed. In
2010-2011 many of the original clinic members returned to a second clinic.
ARHS Findings
Overall, Adventists report better physical and mental health than comparable
non-Adventists.
»The advantage Adventists have over non-Adventists for mental health is
bigger in older age groups than in younger age groups.
»Individuals who experienced childhood poverty are more religious.
However, childhood poverty also relates to more abusive and conflicted
families in childhood, particularly in White participants. Those who
experienced an abusive home as a child are less likely to be religious.
ARHS Findings
» Religious individuals have less negative emotions and those who
experienced an abusive home have more negative emotions. These
negative emotions predict worse physical health.
» Some blood markers for inflammation were higher among Blacks than
Whites, older than younger and non-vegetarians compared to vegetarians.
» Individuals who engaged in secular activities on Sabbath had poorer
reported physical health. Those who said Sabbath relieved tensions and
promoted feelings of calm and peace reported better mental health.
ARHS Findings
» Not surprisingly, divorced individuals had more depressive symptoms than
non-divorced individuals, but divorced individuals who used positive
religious coping had fewer depressive symptoms than those who did not
use positive religious coping. The three types of positive religious coping
that were inversely associated with depressive symptoms were:
» Collaborative religious coping: Defined as forming a problem-solving
relationship with God. This kind of coping is not a solitary process, but is
aided by a caring and powerful God who is active in each person's life.
» Benevolent religious reappraisals: Problems are reinterpreted as part of
a divine plan or as an opportunity for growth.
» Seeking spiritual comfort from God: Defined as engaging God through
prayer or other devotional practices. This type of coping had the strongest
inverse association with depressive symptoms.
Perceived Physical Health - Females
U.S. Norm
Black SDA
White SDA
Percentile
60
55
50
45
40
35
35-44
45-54
55-64
Age
65-74
>74
Perceived Physical Health - Males
U.S. Norm
Black SDA
White SDA
60
Percentile
55
50
45
40
35
35-44
45-54
55-64
Age
65-74
>74
Perceived Mental Health - Females
U.S. Norm
Black SDA
White SDA
Percentile
60
55
50
45
40
35
35-44
45-54
55-64
Age
65-74
>74
Perceived Mental Health - Males
U.S. Norm
Black SDA
White SDA
Percentile
60
55
50
45
40
35
35-44
45-54
55-64
Age
65-74
>74
Vegetariansim and Vitamin D
» Vitamin D is an important hormone in the prevention of osteoporosis and
rickets but beyond that has major functions in the prevention of heart
disease, cancers, diabetes and in the regulation of the immune system.
Foods naturally rich in vitamin D are all from animal sources: cod liver oil,
finfish, and shellfish. The only naturally occurring plant sources of vitamin D
are certain mushrooms, in which it is present in only small amounts. There
has been concern that vegetarians would have lower blood levels of
vitamin D than non-vegetarians.
» AHS-2 looked at the vitamin D status of vegetarians, partial vegetarians
and non-vegetarians. The results demonstrated that a vegetarian diet was
not associated with lower levels of vitamin D. Other factors, such as vitamin
D supplementation, degree of skin pigmentation, and amount and intensity
of sun exposure had a greater influence on vitamin D levels in blood than
diet.
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.
The Optimum Vegetarian
Diet!
We don’t know!
So far vegans are looking very good,
but not yet convincingly superior to
lacto-ovo 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
that direction.
strongly in
 If you wait to modify your lifestyle till all the details are known, for sure you
will be dead!
Final Thoughts
Heal me, Lord, and I will
be healed;
save me
and I will be saved,
for
you are the one I praise.
Jeremiah 17:14