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Objective: In contrast to non-vegetarians, vegetarians consume more legumes and meat analogues as sources of protein to substitute for meat intake. The present study aimed to assess the association between foods with high protein content (legumes, meat, meat analogues) by dietary pattern (vegetarians, non-vegetarians) and hip fracture incidence, adjusted for selected lifestyle factors., Design: A prospective cohort of Adventist Health Study-2 (AHS-2) enrollees who completed a comprehensive lifestyle and dietary questionnaire between 2002 and 2007., Setting: Every two years after enrolment, a short questionnaire on hospitalizations and selected disease outcomes including hip fractures was sent to these members., Subjects: Respondents (n 33,208) to a baseline and a follow-up questionnaire., Results: In a multivariable model, legumes intake of once daily or more reduced the risk of hip fracture by 64% (hazard ratio = 0·36, 95% CI 0·21, 0·61) compared with those with legumes intake of less than once weekly. Similarly, meat intake of four or more times weekly was associated with a 40% reduced risk of hip fracture (hazard ratio = 0·60, 95% CI 0·41, 0·87) compared with those whose meat intake was less than once weekly. Furthermore, consumption of meat analogues once daily or more was associated with a 49 % reduced risk of hip fracture (hazard ratio = 0·51, 95% CI 0·27, 0·98) compared with an intake of less than once weekly., Conclusions: Hip fracture incidence was inversely associated with legumes intake and, to a lesser extent, meat intake, after accounting for other food groups and important covariates. Similarly, a high intake of meat analogues was associated with a significantly reduced risk of hip fracture.

Objectives: To determine whether the attenuation in risk of death due to excess body fat seen in most studies of older adults may be due to confounding, the relationship between adiposity and mortality was examined in adults who never smoked, were free of major chronic diseases, and maintained stable weight over long periods., Design: Prospective cohort study., Setting: The Adventist Health Study and Adventist Mortality Study in California., Participants: Six thousand thirty adults aged 25 to 82 who had never smoked and had no history of coronary heart disease, cancer, or stroke., Measurements: During 29 years of follow-up, anthropometric data were collected at baseline and 17 years later, and mortality surveillance continued for 12 years thereafter. Data were analyzed using survival analysis with attained age as the time variable., Results: Instantaneous hazard plots indicated that men with a body mass index (BMI) greater than 22.3 kg/m2 and women with a BMI greater than 27.4 kg/m2 had a greater mortality risk through the ninth decade than those with lower BMI. For men aged 75 to 99 who maintained stable body weight, a BMI greater than 22.3 kg/m2 was associated with a 3.7-year (95% confidence interval (CI)=1.1-6.3) shorter life expectancy and significantly greater mortality (hazard ratio (HR)=1.88, 95% CI=1.16-3.04, for BMI=22.3-27.3 kg/m2; HR=2.00, 95% CI=1.01-3.97 for BMI>27.3 kg/m2; reference, BMI≤22.3 kg/m2). For women aged 75 to 99 who maintained stable body weight, a BMI greater than 27.4 kg/m2 was associated with a 2.1-year (95% CI=0.5-3.8) shorter life expectancy and significantly greater mortality (HR=1.12, 95% CI=0.80-1.58 for BMI<20.6 kg/m2; HR=1.41, 95% CI=1.05-1.89 for BMI>27.4 kg/m2; reference, BMI 20.6-27.4 kg/m2)., Conclusion: Excess body fat maintained after the seventh decade decreases life expectancy but appears to be less lethal in women., (© 2011, Copyright the Authors. Journal compilation © 2011, The American Geriatrics Society.)

Purpose: We describe a new application of the method of triads that allows an estimate of the correlation between a dietary questionnaire measure (Q) and true intake (T)., Methods: Three surrogate variables Q, M, and P are observed where M and P are both instrumental (often biological) variables. A reference dietary method (R) is not required. The variables M and P may be concentration rather than recovery biomarkers. Estimating equations produce Corr(Q,T), Corr(M,T), Corr(P,T), conditional on assumptions about error correlations. Correlations between errors in both Q and a reference dietary measure can also be estimated if R is available. A small validation study of California Seventh-day Adventists provided food frequency, repeated 24-hour dietary recalls (R), and biological data (blood, overnight urines, and subcutaneous fat)., Results: Values of Corr(Q,T) ranged between 0.40 and 0.66. Values of Corr(R,T) were higher, between 0.48 and 0.83. Estimated correlations between errors in R and Q were all positive., Conclusions: When carefully chosen, M and P, rather than M and R, should better satisfy assumptions about error correlations. Food frequency data and repeated 24-hour recalls both provide estimates of T, but the latter has greater validity. Standard errors suggest that for good precision Corr(Q,T) requires large validation studies (2000-3000 subjects).

Objective: Members of the Seventh-day Adventist Church generally adopt a healthy lifestyle, which is reflected by favorable mortality rates. The purpose of this study was to estimate relative mortality rates among persons joining the church in adult life compared with members of the same age who joined in childhood., Study Design and Setting: A cohort of 29,871 Seventh-day Adventist church members in California was followed for 12 years. A total of 5,109 deaths occurred during follow-up., Results: In men, the relative mortality at the time of entry into the church showed a curvilinear relation with age, with a maximum of about 2 for entry at age 50-60. For most ages at entry, the relative mortality first declined with increasing membership duration but later stabilized. Men joining at age 50 experienced a 15-25% reduction in relative mortality after 10 years of membership. Women joining after age 50 had a somewhat higher mortality than those who joined in childhood, with no subsequent short-term change., Conclusion: The pronounced drop in relative mortality among men entering the church may reflect the adoption of a healthy lifestyle.

Purpose: It is unclear how well questionnaire or so-called reference methods of dietary assessment correlate with true dietary intake. We develop a method to estimate such correlations., Methods: An error model is described that uses data from a food frequency questionnaire (Q), a reference method (R), and a biological marker (M). The model does not assume the classical error model for either R or M, or that the correlation between errors in the questionnaire and reference data is zero. Credible intervals can be placed about correlations between R, Q, M and true dietary data (T), also about the correlations between errors in reference and questionnaire data., Results: Application of this model to a validation data set mainly found correlations in the range 0.4 to 0.8, and that correlations (R,T) generally exceeded correlations (Q,T), providing evidence that R is more valid than Q. Estimated correlations between errors in R and Q were often far from zero suggesting that regression calibration to imperfect reference data is problematic unless these error correlations can be estimated., Conclusion: A biological marker in addition to dietary data, allows calculation of correlations between estimated and true dietary intakes under reasonable assumptions about errors. However, sensitivity analyses are necessary on one variable.

Whole blood viscosity, plasma viscosity, hematocrit, and fibrinogen are considered independent risk factors for coronary heart disease and can be elevated by dehydration. The associations between fatal coronary heart disease and intake of water and fluids other than water were examined among the 8,280 male and 12,017 female participants aged 38-100 years who were without heart disease, stroke, or diabetes at baseline in 1976 in the Adventist Health Study, a prospective cohort study. A total of 246 fatal coronary heart disease events occurred during the 6-year follow-up. High daily intakes of water (five or more glasses) compared with low (two or fewer glasses) were associated with a relative risk in men of 0.46 (95% confidence interval (CI): 0.28, 0.75; p trend = 0.001) and, in women, of 0.59 (95% CI: 0.36, 0.97). A high versus low intake of fluids other than water was associated with a relative risk of 2.47 (95% CI: 1.04, 5.88) in women and of 1.46 (95% CI: 0.7, 3.03) in men. All associations remained virtually unchanged in multivariate analysis adjusting for age, smoking, hypertension, body mass index, education, and (in women only) hormone replacement therapy. Fluid intake as a putative coronary heart disease risk factor may deserve further consideration in other populations or using other study designs.