s1 4 adventist health study
DESCRIPTION
Basado en investigaciones realizadas a los habitos de vida de miembros de la iglesia adventista.TRANSCRIPT
By: Stoy Proctor, MPH., M.Div.Associate Director
Health Ministries DepartmentGeneral Conference
Seventh-day Adventist ChurchAdjunct Professor
Loma Linda University July 2005
In 1974 a study involving 34,000 Adventists in California was
commenced. It was called the Californian Adventist Health
Study (Adventist Health Study I) and compared two groups of
Adventists the vegetarian group and the omnivorous group. It
attempted to see whether there were any associations between
the way people ate and the incidence of cancer and heart
disease.
In 1974 a study involving 34,000 Adventists in California was
commenced. It was called the Californian Adventist Health
Study (Adventist Health Study I) and compared two groups of
Adventists the vegetarian group and the omnivorous group. It
attempted to see whether there were any associations between
the way people ate and the incidence of cancer and heart
disease.
Healthiest Diets
• Whole grains- whole wheat, • yellow corn, brown and • red rice, oats, rye, buckwheat• and millet, bulgur, amaranth, • quinoa, kamut, triticale, spelt,• couscous, and buckwheat..
Go for the Gold- Golden Whole Grains
Nutrition of Whole Grains
• Complex carbohydrates• Soluble and insoluble fiber• Protein• Vitamin B, 1,2,3,6• Folate• Iron• Trace minerals• Magnesium• Polyphenoics
Whole Grains and Fatal and Non-Fatal IHD
Whole WhiteGrains Bread
Fatal IHD .89 1.00Non-fatal IHD .56 1.00
• 5-8 Servings Daily• 1 Slice of whole grain bread• ½ cup of whole gain cereal• 1 cup of dry whole grain cereal• ¼ cup of granola• ½ cup of pasta• 1 chapatti, tortilla• 3-4 whole grain crackers
Vote for the vegetables
• Onion
• Chives
• Leeks
• Basil
• Tarragon
• Dill
Green Super Herbs
AICR News Letter - Spring 1999*
• Parsley• Thyme• Cilantro• Coriander• Anise• Fennel
Kale, spinach, broccoli,
Bok choy, Collards,
Romaine
AJ Epid 1985, 119:775-787
Root Vegetables
• White potatoes
• Parsnips
• Rutabaga
• Beets
The Yellow-Orange Super’s Vegetables
• Carrots• Winter squash• Sweet potatoes• Pumpkin
The White Super’s
Food:1. Garlic, onions
• Death from all causes was associated with a low consumption of
green salads
Nutrition of Vegetables
• Complex carbohydrates
• Insoluble fiber
• Potassium
• Vitamin C
• Calcium
• Magnesium
• Flavonoids, Carot
• 4-6 Servings Daily• 1 cup vegetable salad
• ½ cup of cooked vegetables
• ¾ cup of vegetable juice
• 1 baked potato
Favor the Fruits
Papaya,
Mango
Cantaloupe
Apricots
Persimmon
Peaches
• Preventive Medicine, 1989, 18:732-739
The Orange Super Fruits
The Red Super’s
Food:1 Cranberries, strawberries,
cherries, raspberries, watermelon, apples, pink grape fruit and red grapes.
2 Tomatoes,
AJPH, 79, 1989, p. 1806-1819
Purple and Blue Super Foods
• Blueberries, blackberries,
• grapes, raisins, prunes,
• plums, and figs.
FigsBlueberries
Blackberries
Grapes
Raisins
Prunes
Eggplants
• Regular consumption of
dried fruit, legumes and tomatoes by
men was associated with
significantly decreased risk (40-
50%) of prostate cancer.
• Persons who consumed beans,
lentils, peas, dried fruit and vegetable
protein products more than 4 times a week had only
one-fifth the risk of pancreatic cancer.
Fruit and Cancer (AHS 1)
Cancer Site
Fruit 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
Tomatoes and Cancer (AHS 1 )
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 (AHS 1)
Cancer Site
Fruit
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
Nutrition of Fruits
• Vitamin C
• Insoluble fiber
• Potassium
• Folate
• Magnesium
• Flavonoids
• Carotenoids
• 3-4 Servings Daily• 1 medium fresh fruit
• ¼ cup dried fruit
• ½ cup canned or frozen fruit
• ¾ cup fruit juice
Log on to Legumes
• Legumes –
• Beans
• Peas.
• Lentils
Power with Nuts
• WALNUTS ,ALMONDS, PEANUTS,
pecans• High in MUFAS
linoleic and linolenic.• BMJ 1998 Nov. 14,
317 (7169), 1341-5
Flax-highest in omega 3 fatty acids:
• Pumpkin Dill• Sesame Coriander• Sunflower Fenugreek• Watermelon Nutmeg• Lotus Poppy• Safflower Fennel• Anise• Cardamom
• Pictures of these seeds
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1
Nuts <1 time/ wk
Nuts 1-4 times/ wk
Nuts 5+ times/ wk
Nut Consumption and Coronary Heart
Disease (AHS 1)
Events 63 55 15 79 76 57
Non-Vegetarians Vegetarians
Rela
tive
Ris
k
P(t) <.05P<.05
P(t) <.001P<.001
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
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
Ris
k
P(t) <.05P<.05
P(t) <.001P<.001
• 3-4 Servings Daily• ½ cup cooked legumes
• ½ cup tofu
• 1/2 cup soy alternatives
• 1 egg
• 2 egg whites
Nutrition of Legumes
• Protein Niacin
• Zinc Linoleic acid
• Iron Linolenic acid
• Insoluble Fiber Calcium
• Vitamin B 6 Folate
Reported Benefits from orgaganics
• Healthier for the family andHealthier for the family and• farmer, Less pesticide and herbicides farmer, Less pesticide and herbicides • Lower nitrates= exposed to bess Better for the environment- Lower nitrates= exposed to bess Better for the environment-
water .air, and soilwater .air, and soil• Maybe higher in Vitamin C and phyto-chemicalsMaybe higher in Vitamin C and phyto-chemicals• In some studies organically grown food tasted betterIn some studies organically grown food tasted better• With the No-till methods of farming soil humus is similarWith the No-till methods of farming soil humus is similar• Organic maybe lower in mineralsOrganic maybe lower in minerals• Food may be more expensiveFood may be more expensive• Cannot feed the whole populationCannot feed the whole population• More labor intensiveMore labor intensive
• ¼ cup nuts
• 1/4 seeds
• 2 t. nut butter
Move more Milk to your Menu
Nutrition of Dairy Products
• Vitamin B 12• Calcium• Protein• Vitamin A and d• Iodine• Isoflavones in soy
• Frequent consumption of soy milk (more than once a day) was associated with a 70% reduction
of risk of prostate cancer.
0.9
0.7
0.3
0
1
Rela
tiv
e R
isk
Relative 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.
*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)
• 3 servings daily• 1 cup of low-fat milk• 1 cup fortified soy milk• 1 cup yogurt• ½ cup ricotta or cottage cheese• 1 oz. fresh cheese• 1 ½ T. cream cheese
• Oils: olive, canola, soy, walnut
• Olives, avocados,
• Flax seed and flax seed oils
• Olive increases elasticity of arteries. (MUFA)
• Sunflower oil reduces serum cholesterol. (Omega 6’s)
• Canola and flaxseed oil high in alpha linolenic acid (Omega 3’s)
• reduces clotting. *
• Nutr. Rev. 1998: 56: 142-147 *
Nutrition of Healthy Fats
• Vitamin E• Linoleic acid• Linolenic acid• Vitamin A and D in margarines• Recommended Servings 3-5 daily 1/3 avocado 2 t. nut butter 1 t. healthy plant oils 1 t. margarine
• Men drinking 1-2 cups of coffee a day had a 50% higher risk of
heart disease, while women had a 10-20% increase in risk.
Animal Protein and Fat
• You noticed that the higher the intake of whole grains, vegetables, fruits, legumes. Nuts, soy
• the lower the disease.
• Now notice what happens with disease as the consumption goes up.
• Data from the Adventist Health Study
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
0
0.5
1
1.5
2
2.5
3
3.5
Never < 1/week 1+/week
P (trend) = 0.006
(0.97-2.50)
(1.60-6.75)
RR
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
RR
1.43(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
Meat Consumption and Cancer
Meat 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/week
Bladder 1.00 2.38 0.01* Not statistically significant
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
Ris
k
Effects of Individual Risk Factors To Increase Life Expectancy
Variable Men Women
Vegetarianism 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
Health Habits and Life Expectancy in Adventists
Men Women
‘Best’-Behaved1 87.0 years 88.5 years
‘Worst’-Behaved2 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.
Percentages Dying From the Named Causes and Average Ages at these Fatal Events: California
Adventists and non-Adventists.All Californians All Adventists
Men
Cause of Death (%)
% Age (Years)
% Age (Years)
Disease of the Heart 39.0 75.7 40.4 82.9
Malignant Neoplasms (Cancer)
23.4 71.2 19.0 77.9
Cerebrovacular Disease (Stroke)
6.6 79.4 8.7 85.8
Unintentional Injuries 2.9 59.5 3.5 69.6
COPD and Allied Conditions 5.6 76.3 2.5 82.6
Pneumonia and Influenza 4.5 81.8 6.1 87.8
Diabetes 1.1 73.0 1.3 81.6 p<0.05; p<0.01; p<0.001† †† †††
†††
††
†††
†
†††
†††
†††
†††
†††
†††
†††
• Non-vegetarians were two and a half times more likely to be obese
than vegetarians.
• Non-vegetarians had a risk of fatal stroke that was 20-30%
higher than vegetarians.
• Vegetarians had a delayed onset of dementia.
• Eating meat doubles the risk of dementia.
• Increased consumption of meat, poultry and fish is associated with
an increased risk of bladder cancer.
• The risk of prostate cancer is increased two and a half times
and the risk of colon cancer is 3-fold greater in the overweight
person.
• 30 year old women with a BMI above the 50th percentile had a
57% greater lifetime risk of breast cancer.
• Women who exercised
infrequently had a 27% higher
lifetime risk and an age at
diagnosis of breast cancer 6.6 years
younger than other women.
• Total vegetarian men had less than 20% of the expected rate of fatal heart
attacks compared to the general population.
•Total vegetarian women had higher than the expected rate of lacto-ovo-
vegetarians
• Lacto-ovo vegetarian men had about 40% of the expected rate of
fatal heart attacks compared to the general population.
• Men who adopted a vegetarian diet early in life (before age 20) had only
one-half the risk of fatal heart disease compared to those who did not adopt
a vegetarian lifestyle until after 50 years of age.
• Those who adopted a vegetarian diet in their thirties had 30% less
fatal heart disease than those who adopted the diet in their
fifties.
• Regular exercise reduced the risk of fatal coronary
heart disease by 50%.
• There were four main factors that added 10-12 years to life compared with the general population, with each factor contributing 3-4 years. • They were:
• Not smoking • Maintenance of a healthy weight• An exercise program• A vegetarian lifestyle• Especially, lots of Vegetables, fruits, legumes, whole grains-and little or no meat.
Predicted Age of Death of California Adventist
• Men 77.4 81.8
• Women 81.8 84.5
• 17 % of men survive past 90
• 24 % of women survive past 90
MBD – Meat-Based DietPBD – Plant-Based Diet
MBD – Meat-Based DietPBD – Plant-Based Diet
Risk ofDeficiency
Risk ofExcess
Optimal
MBD
PBD
• ‘‘It is the position of the ADA and Dietitians of Canada that appropriately planned vegetarian diets are healthful, nutritionally adequate, and provide health benefits on the prevention and treatment of certain diseases.”
American Dietetic Association• Vegetarians have lower body
mass indices than non-vegetarians, as well as lower blood cholesterols, lower rates of blood pressure, ischemic heart disease, hypertension, type 2 diabetes, prostate and colon cancer.
• P. 748 JADA June 2003 Vol. 103, • # 6
• Vegetarian Choices• “Vegetarians of all types can
achieve recommended nutrient intakes through careful selection of foods.
• If avoiding milk products, these individuals should give special attention to their intakes of protein, iron, vitamin B 12, as well as calcium and vitamin D”
• “Christian behavior… means that because our bodies are the temples of the Holy Spirit, we are to care for them intelligently. Along with adequate exercise and rest, we are to adopt the most healthful diet possible and abstain from the unclean foods identified in the Scriptures.
SDA Believe-27
• 21th Fundamental Beliefs• “The original diet. The Bible does
not condemn the eating of clean animals. But God’s original diet for man did not include flesh foods because He did not envision the taking of any animals life and because a balanced vegetarian diet is the best for health-a fact for which science offers mounting evidence”
• “The diet God ordained in the Garden of Eden-the vegetarian diet-is the ideal, but sometimes we cannot have the ideal. In those circumstances, in any given situation or locale, those who wish to stay in optimum health, will eat the best food that they can obtain.”
• SDA Bible Commentary
• “The GCNC recommends that all fish, fowl and meat be gradually eliminated from the diet, and the use of egg yolks be limited to three or less per week. Red meats of animal origin are no longer viewed as dominant items in a healthy diet. General Conference Nutrition Council (GCNC)
The End July 2005
0
10
20
30
40
50
FruitServings/Day
Less thanone
One 2 - 3 4 or more
PE
RC
EN
T
Female Male
0
10
20
30
40
50
VegetablesServings/Day
Less than one One 2 or more
PE
RC
EN
T
Female Male
0
10
20
30
40
50
60
70
80
No Yes
PE
RC
EN
TEat Vegetarian Protein Food
Female Male
0
5
10
15
20
25
30
35
EggsTimes/Week
Never Less than Once Once 2 or more
PE
RC
EN
T
Female Male
0
10
20
30
40
50
CheeseTimes/Week
Never Less than Once Once 2 or more
PE
RC
EN
T
Female Male
0
10
20
30
40
50
MeatTimes/Week
Never Less than Once 1 - 4 5 or more
PE
RC
EN
T
Female Male
0
10
20
30
40
50
60
LegumesTimes/Week
Less thanOnce
Once 2 - 6 Times 7 or more
PE
RC
EN
T
Female Male
0
5
10
15
20
25
30
35
40
NutsTimes/Week
Never Once or Less 2 - 6 7 or more
PE
RC
EN
T
Female Male
0
10
20
30
40
50
Soy/Rice MilkTimes/Week
Never Less than Once 1 - 4 5 or more
PE
RC
EN
T
SOY
Female Male
0
10
20
30
40
50
60
70
80
CoffeeDrinks/Week
Never Less than One 1 - 4 5 or more
PE
RC
EN
T
Female Male
0
20
40
60
80
100
De-Caf CoffeeDrinks/Week
Never Less than One 1 - 4 5 or more
PE
RC
EN
T
Female Male
0
10
20
30
40
50
60
70
80
WaterCups/Day
One or Less 2 - 3 4 or more
PE
RC
EN
T
Female Male
Female Male
0
5
10
15
20
25
30
35
40
ExerciseTimes/Week
Never One or Less 2 - 4 5 or more
PE
RC
EN
T
Female Male
0
5
10
15
20
25
30
35
TelevisionHours/Day
Never One or Less 2 3 or more
PE
RC
EN
T
0
10
20
30
40
50
60
70
Drinking Alcohol
Never Past Drinker Current Drinker
PE
RC
EN
T
Female Male
Female Male
0
10
20
30
40
50
60
70
SleepHours/Night
5 - Less 6 - 7 8 or more
PE
RC
EN
T
Female Male
0
10
20
30
40
50
Eating Fast FoodTimes/Week
Never Once or Less 2 or more
PE
RC
EN
T
Female Male
0
20
40
60
80
100
Smoking Tobacco
Never Past Smoker Current Smoker
PE
RC
EN
T
Female Male
0
10
20
30
40
50
60
70
Restaurant DiningTimes/Week
Never Once or Less 2 or more
PE
RC
EN
T
• ‘‘It is the position of the ADA and Dietitians of Canada that appropriately planned vegetarian diets are healthful, nutritionally adequate, and provide health benefits on the prevention and treatment of certain diseases.”
American Dietetic Association• Vegetarians have lower body
mass indices than non-vegetarians, as well as lower blood cholesterols, lower rates of blood pressure, ischemic heart disease, hypertension, type 2 diabetes, prostate and colon cancer.
• P. 748 JADA June 2003 Vol. 103, • # 6
• Vegetarian Choices• “Vegetarians of all types can
achieve recommended nutrient intakes through careful selection of foods.
• If avoiding milk products, these individuals should give special attention to their intakes of protein, iron, vitamin B 12, as well as calcium and vitamin D”
• “Christian behavior… means that because our bodies are the temples of the Holy Spirit, we are to care for them intelligently. Along with adequate exercise and rest, we are to adopt the most healthful diet possible and abstain from the unclean foods identified in the Scriptures.
SDA Believe-27
• 21th Fundamental Beliefs• “The original diet. The Bible does
not condemn the eating of clean animals. But God’s original diet for man did not include flesh foods because He did not envision the taking of any animals life and because a balanced vegetarian diet is the best for health-a fact for which science offers mounting evidence”
• “The diet God ordained in the Garden of Eden-the vegetarian diet-is the ideal, but sometimes we cannot have the ideal. In those circumstances, in any given situation or locale, those who wish to stay in optimum health, will eat the best food that they can obtain.”
• “The GCNC recommends that all fish, fowl and meat be gradually eliminated from the diet, and the use of egg yolks be limited to three or less per week. Red meats of animal origin are no longer viewed as dominant items in a healthy diet. General Conference Nutrition Council (GCNC)