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

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.

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

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  1. 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

  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

  3. 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.

  4. 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

  5. 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

  6. 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) ?

  7. 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

  8. 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

  9. 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

  10. Adventist Literature “The liability to take disease is increased tenfold by meat eating.” 1868 - Vol 2, Testimonies, pg 64

  11. 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

  12. 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

  13. 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

  14. 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

  15. 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.

  16. 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.

  17. 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.

  18. 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.

  19. 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.

  20. Research On Adventists by Loma Linda Epidemiologists • 1. Adventist Mortality Study (1958 - 1985) • 2. Adventist Health Study [ - 1] (1974 - 2006) • Adventist Health Study - 2 (2002 - future) • Adventist Health Study on Smog (AHSMOG) (1976 – future) • 5. Adventist Health and Religion Study (AHRS) • (2006 – future)

  21. 1960 1970 1980 1990 2000 2010 1950 AHS-2 2002- 97,000 SDA 30+ years USA & Canada AHSMOG 1976-2006 6,328 SDA 25+ years California Adventist Health StudiesU.S.A. 1958-2012 ARHS 2006- 11,000 AMS 1958-1985 25,153 SDA 25+ years California 1966 1974 5,649 overlap 12,000 overlap AHS-1 1974-2006 34,198 SDA 25+ years California

  22. 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

  23. 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

  24. 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.

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

  26. 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

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

  28. 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

  29. Effects of Individual Risk Factors To Increase Life Expectancy

  30. Health Habits and Life Expectancy in Adventists 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.

  31. Life Expectancy at Age 30 years (1985).

  32. Different Types of ‘Vegetarians’ High lacto • Lacto-Ovo-vegetarians • Fish-eating (pesco) ‘vegetarians’. • High and low processed food vegetarians. 4. Soy and non-soy vegetarians. 5. Vegans and Fruitarians. Low lacto

  33. 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”

  34. The Relative Risk (RR) Incidence of disease (in those “exposed”) Incidence of disease (in those “not exposed”) High Low or 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

  35. 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.

  36. Percentages Dying From the Named Causes and Average Ages at these Fatal Events: California non-Adventists and Adventists. p<0.05; p<0.01; p<0.001

  37. Effect of meat.

  38. Meat intake and risk of different cancers. RR P (t): 0.01 ns <.01 0.02 Colon Prostate Ovary Ovary Postmenopausal

  39. Total meat intake and risk of colon cancer RR P (trend)=0.01 (1.16-2.87) (0.92-2.45) Never < 1/week 1+/week

  40. Red meat intake and risk of colon cancer, among those who eat white meat < 1x/week. RR P (trend) = 0.02 (1.16-3.11) (0.87-2.25) Never < 1/week 1+/week

  41. White meat intake and risk of colon cancer, among those who eat red meat < 1x/week. RR P (trend) = 0.006 (1.60-6.75) (0.97-2.50) Never < 1/week 1+/week

  42. Meat Consumption and Cancer Meat Frequency * Not statistically significant

  43. Nut Consumption and Coronary Heart Disease P(t) <.001 P<.001 P(t) <.001 P<.001 Relative Risk Definite Non-Fatal MI Fatal

  44. Nut Consumption and Coronary Heart Disease P(t) <.001 P<.001 P(t) <.001 P<.001 Relative Risk Events 66 85 33 66 85 33 Women Men

  45. Nut Consumption and Coronary Heart Disease P(t) <.05 P<.05 P(t) <.001 P<.001 Relative Risk Events63 55 1579 76 57 Vegetarians NonVegetarians

  46. Nut Consumption and Coronary Heart Disease P(t) <.05 P<.05 P(t) <.001 P<.001 Relative Risk Events65 85 3477 47 38 Age 80+ Age <80

  47. .001 .0002 .0004 .0003 p (trend) Relative Risk Glasses/day Events 25 51 48 24 34 37 22 42 33 17 33 23 RR‡ of FATALCHD according to Intake of WATER inMALES(n=11,257) ‡ Adustments: Age + Smoking, Ed, + Energy + Other BMI, BP Fluids

  48. p(trends) NS Relative Risk Glasses/day Events23 40 52 18 34 43 13 17 26 13 17 26 ‡ Adustments: Age + Smoking, Ed, + Energy + Other BMI, BP Fluids RR‡ of FATAL CHD according to Intake of WATER inFEMALES(n=15,840)

  49. RR‡ of FATAL CHD according to WATER INTAKE Males & Females (n= 27,342) Age & Sex Adjusted <.01 <.05 p (trend) RR Glasses/day Events 28 50 60 20 40 41 Normotensive Hypertensive

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