Search

Past dietary patterns may be more important than recent dietary patterns in the aetiology of chronic diseases because of the long latency in their development. We developed an instrument to recall vegetarian dietary patterns during the lifetime and examined its reliability of recall over 5·3 and 32·6 years on average. The short-term/5-year recall ability study (5-RAS) was done using 24 690 participants from the cohort of the Adventist Health Study-2 (mean age 62·2 years). The long-term/33-year recall ability study (33-RAS) included an overlap population of 1721 individuals who joined the Adventist Health Study- 1 and Adventist Health Study-2 (mean age 72·5 years). Spearman correlation coefficients for recall of vegetarian status were 0·78 and 0·72 for the 5-RAS and 33-RAS, respectively, when compared with 'reference' data. For both time periods sensitivity and positive predictive values were highest for the lactoovo-vegetarian and non-vegetarian patterns (vegans, lacto-ovo-vegetarians, pesco-vegetarians, semi-vegetarians and non-vegetarians). In the 5-RAS analyses, male, non-black, younger, and more educated participants, lifetime Adventists, and those with more stability of consumption of animal products generally showed higher recall ability. Somewhat similar tendencies were shown for the 33-RAS analyses. Our findings show that the instrument has higher reliability for recalled lacto-ovo-vegetarian and non-vegetarian than for vegan, semi- and pesco-vegetarian dietary patterns in both short- and long-term recalls. This is in part because these last dietary patterns were greatly contaminated by recalls that correctly would have belonged in the adjoining category that consumed more animal products. [ABSTRACT FROM AUTHOR]

The article discusses a study which aims to examine body mass index and pancreatic cancer mortality in African Americans. Topics discussed include association of obesity with increased pancreatic cancer mortality in African Americans, association of cigarette smoking and diabetes with pancreatic cancer, and data from cohort studies related to exposures before diagnosis of pancreatic cancer.

ObjectiveIn 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.DesignA prospective cohort of Adventist Health Study-2 (AHS-2) enrollees who completed a comprehensive lifestyle and dietary questionnaire between 2002 and 2007.SettingEvery two years after enrolment, a short questionnaire on hospitalizations and selected disease outcomes including hip fractures was sent to these members.SubjectsRespondents (n 33 208) to a baseline and a follow-up questionnaire.ResultsIn 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.ConclusionsHip 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. [ABSTRACT FROM AUTHOR]

Multiple myeloma ( MM) is a rare but highly fatal malignancy. High body weight is associated with this cancer, but several questions remain regarding the aetiological relevance of timing and location of body weight. To address these questions, we conducted a pooled analysis of MM mortality using 1·5 million participants (including 1388 MM deaths) from 20 prospective cohorts in the National Cancer Institute Cohort Consortium. Proportional hazards regression was used to calculate pooled multivariate hazard ratios ( HRs) and 95% confidence intervals ( CIs). Associations with elevated MM mortality were observed for higher early-adult body mass index ( BMI; HR = 1·22, 95% CI: 1·09-1·35 per 5 kg/m2) and for higher cohort-entry BMI ( HR 1·09, 95% CI: 1·03-1·16 per 5 kg/m2) and waist circumference ( HR = 1·06, 95% CI: 1·02-1·10 per 5 cm). Women who were the heaviest, both in early adulthood ( BMI 25+) and at cohort entry ( BMI 30+) were at greater risk compared to those with BMI 18·5 ≤ 25 at both time points ( HR = 1·95, 95% CI: 1·33-2·86). Waist-to-hip ratio and height were not associated with MM mortality. These observations suggest that overall, and possibly also central, obesity influence myeloma mortality, and women have the highest risk of death from this cancer if they remain heavy throughout adulthood. [ABSTRACT FROM AUTHOR]

The Adventist Health Study 2 is a large cohort that is well suited to the study of the relation of vegetarian dietary patterns to health and disease risk. Here we review initial published findings with regard to vegetarian diets and several health outcomes. Vegetarian dietary patterns were associated with lower body mass index, lower prevalence and incidence of diabetes mellitus, lower prevalence of the metabolic syndrome and its component factors, lower prevalence of hypertension, lower all-cause mortality, and in some instances, lower risk of cancer. Findings with regard to factors related to vegetarian diets and bone health are also reviewed. These initial results show important links between vegetarian dietary patterns and improved health. [ABSTRACT FROM AUTHOR]

: In a pooled analysis of 20 prospective studies, Cari Kitahara and colleagues find that class III obesity (BMI of 40–59) is associated with excess rates of total mortality, particularly due to heart disease, cancer, and diabetes. Please see later in the article for the Editors' Summary [ABSTRACT FROM AUTHOR]

Background. In samples of African Americans and the elderly adults, obesity is often not found to be a risk factor for mortality. These data contradict the evidence linking obesity to chronic disease in these groups. Our objective was to determine whether obesity remains a risk factor for mortality among long-lived black adults. Methods. The Adventist Health Study 2 is a large prospective cohort study of Seventh-day Adventist church members who are encouraged by faith-based principles to avoid tobacco, alcohol, and meat consumption. We conducted an attained age survival analysis of 22,884 U.S. blacks of the cohort—half of whom attained an age of 58–108 years during the follow-up (adult life expectancy of 84 years in men, 89 years in women). Results. Women in the highest body mass index quintile (>33.8) experienced a significant 61% increase (hazard ratio [95% CI] = 1.62 [1.23, 2.11] relative to the middle quintile) in mortality risk and a 6.2-year (95% CI = 2.8–10.2 years) decrease in life expectancy. Men in the highest body mass index quintile (>30.8) experienced a significant 87% increase (hazard ratio [95% CI] = 1.87 [1.28, 2.73] relative to the middle quintile) in mortality risk and 5.9-year (95% CI = 2.1– 9.5 years) decrease in life expectancy. Obesity (>30) was a significant risk factor relative to normal weight (18.5–24.9) in never-smokers. Instantaneous hazards indicated excess risk from obesity was evident through at least age 85 years. The nonobese tended to follow plant-based diets and exercise vigorously. Conclusions. Avoiding obesity promotes gains in life expectancy through at least the eighth decade of life in black adults. Evidence for weight control through plant-based diets and active living was found in long-lived nonobese blacks. [ABSTRACT FROM PUBLISHER]

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. Prospective cohort study. The Adventist Health Study and Adventist Mortality Study in California. Six thousand thirty adults aged 25 to 82 who had never smoked and had no history of coronary heart disease, cancer, or stroke. 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. Instantaneous hazard plots indicated that men with a body mass index (BMI) greater than 22.3 kg/m and women with a BMI greater than 27.4 kg/m 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/m 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/m; HR=2.00, 95% CI=1.01-3.97 for BMI>27.3 kg/m; reference, BMI≤22.3 kg/m). For women aged 75 to 99 who maintained stable body weight, a BMI greater than 27.4 kg/m 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/m; HR=1.41, 95% CI=1.05-1.89 for BMI>27.4 kg/m; reference, BMI 20.6-27.4 kg/m). Excess body fat maintained after the seventh decade decreases life expectancy but appears to be less lethal in women. [ABSTRACT FROM AUTHOR]

To identify correlates of perceived pain-related restrictions in a community sample of women with fibromyalgia. The fibromyalgia group was composed of white women with a self-reported, physician-given fibromyalgia diagnosis ( N = 238) from the Biopsychosocial Religion and Health Study (BRHS). BRHS respondents had participated in the larger Adventist Health Study-2. To identify associations with pain-related restrictions, we used hierarchical linear regression. The outcome measure was subjects' pain-related restrictions (one SF-12 version 2 item). Predictors included age, education, body mass index (BMI), sleep apnea, and fibromyalgia treatment in the last year, as well as standardized measures for trauma, major life stress, depression, and hostility. To better interpret the findings, pain-related restrictions also were predicted in women with osteoarthritis and no fibromyalgia. Women with fibromyalgia reporting the more severe pain-related restrictions were those who had experienced trauma accompanied by physical pain, were older, less educated, more depressed, more hostile, had high BMI scores, and had been treated for fibromyalgia in the last 12 months (adjusted R = 0.308). Predictors in women with osteoarthritis were age, BMI, treatment in the last 12 months, experience of a major life stressor, and greater depression symptom severity (adjusted R = 0.192). In both groups, age, BMI, treatment in the last 12 months, and depression predicted pain-related restrictions. Experience of a traumatic event with physical pain was the strongest predictor in the fibromyalgia group. These findings may be useful in constructing novel treatments and prevention strategies for pain-related morbidity in fibromyalgia patients. [ABSTRACT FROM AUTHOR]

Abstract: The purpose of the study was to investigate the association between incident self-reported fibromyalgia (FM) and prior somatic diseases, lifestyle factors, and health behaviors among 3,136 women who participated in 2 cohort studies 25 to 26 years apart (the Adventist Health Study 1 and 2). The women completed a comprehensive lifestyle and medical history questionnaire at baseline in 1976. Information on new diagnosis of doctor-told FM was obtained at the second survey in 2002. A total of 136 women reported a diagnosis of FM during 25 years of follow-up, giving a period incidence of 43/1,000 or 1.72/1000 per year. In multivariable logistic regression analyses, a significant, dose-response association was found with number of allergies with OR of 1.61 (95% CI: .92–2.83) and 3.99 (95% CI: 2.31–6.88), (P[trend] < .0001), respectively, for 1 and 2 or more allergies versus none. A history of hyperemesis gravidarum was also associated with FM with OR of 1.32 (95% CI: .75–2.32) and 1.73 (95% CI: .99–3.03), (P[trend] < .05), respectively, for some or all pregnancies versus none. A positive association with smoking was also found with OR of 2.37 (95% CI: 1.33–4.23) for ever smokers versus never smokers. No significant association was found with number of surgeries, history of peptic ulcer, or taking medications to control various symptoms. Perspective: Smoking as well as prevalent allergies, and a history of hyperemesis gravidarum, seem to predict development of FM in women during 25 years of follow-up. This information may help in identifying persons at high risk of developing FM and thus initiate effective prevention strategies. [ABSTRACT FROM AUTHOR]

Objective: The goal of the prospective Adventist Health Study-2 (AHS-2) was to examine the relationship between diet and risk of breast, prostate and colon cancers in Black and White participants. This paper describes the study design, recruitment methods, response rates, and characteristics of Blacks in the AHS-2, thus providing insights about effective strategies to recruit Blacks to participate in research studies.Design: We designed a church-based recruitment model and trained local recruiters who used various strategies to recruit participants in their churches. Participants completed a 50-page self-administered dietary and lifestyle questionnaire.Participants: Participants are Black Seventh-day Adventists, aged 30-109 years, and members of 1,209 Black churches throughout the United States and Canada.Results: Approximately 48,328 Blacks from an estimated target group of over 90,000 signed up for the study and 25,087 completed the questionnaire, comprising about 26% of the larger 97,000 AHS-2-member cohort. Participants were diverse in age, geographic location, education, and income. Seventy percent were female with a median age of 59 years.Conclusion: In spite of many recruitment challenges and barriers, we successfully recruited a large cohort whose data should provide some answers as to why Blacks have poorer health outcomes than several other ethnic groups, and help explain existing health disparities. [ABSTRACT FROM AUTHOR]

Objective: To validate a 204-item quantitative FFQ for measurement of nutrient intake in the Adventist Health Study-2 (AHS-2). Design: Calibration study participants were randomly selected from the AHS-2 cohort by church, and then subject-within-church. Each participant provided two sets of three weighted 24 h dietary recalls and a 204-item FFQ. Race-specific correlation coefficients (r), corrected for attenuation from within-person variation in the recalls, were calculated for selected energy-adjusted macro- and micronutrients. Setting: Adult members of the AHS-2 cohort geographically spread throughout the USA and Canada. Subjects: Calibration study participants included 461 blacks of American and Caribbean origin and 550 whites. Results: Calibration study subjects represented the total cohort very well with respect to demographic variables. Approximately 33% were males. Whites were older, had higher education and lower BMI compared with blacks. Across fifty-one variables, average deattenuated energy-adjusted validity correlations were 0·60 in whites and 0·52 in blacks. Individual components of protein had validity ranging from 0·40 to 0·68 in blacks and from 0·63 to 0·85 in whites; for total fat and fatty acids, validity ranged from 0·43 to 0·75 in blacks and from 0·46 to 0·77 in whites. Of the eighteen micronutrients assessed, sixteen in blacks and sixteen in whites had deattenuated energy-adjusted correlations ≥0·4, averaging 0·60 and 0·53 in whites and blacks, respectively. Conclusions: With few exceptions validity coefficients were moderate to high for macronutrients, fatty acids, vitamins, minerals and fibre. We expect to successfully use these data for measurement error correction in analyses of diet and disease risk. [ABSTRACT FROM AUTHOR]

Objective: To develop algorithms predicting serum 25 hydroxyvitamin D [s25(OH)D] for a large epidemiological study whose subjects come from large geographic areas, are racially diverse and have a wide range in age, skin types, and month of blood sample collection. This will allow a regression calibration approach to determine s25(OH)D levels replacing the more costly method of collection and analysis of blood samples.Study Design and Setting: Questionnaire data from a subsample of 236 non-Hispanic whites (whites) and 209 blacks from the widely dispersed Adventist Health Study-2 (n = 96,000) were used to develop prediction algorithms for races separately and combined. A single blood sample was collected from each subject, at different times throughout the year.Results: Models with independent variables age, sex, BMI, skin type, UV season, erythemal zone, total dietary vitamin D intake, and sun exposure factor explained 22 and 31% of the variance of s25(OH)D levels in white and black populations, respectively (42% when combined). UV season and erythemal zone determined from measured UV radiation produced models with higher R (2) than season and latitude.Conclusion: Combining races with a term for race and using variables with measured UV radiation capture the variance in s25(OH)D levels better than analyzing races separately. [ABSTRACT FROM AUTHOR]

Sporadic intake and short half-lives of serum or urinary biomarkers may make serum and urinary isoflavones quite unreliable indicators of longer-term dietary soy intake. In 26 participants in the Adventist Health Study-2 (AHS-2) we obtained two measures of fasting morning serum isoflavones, 1–2 years apart. In another 76 subjects we obtained an overnight urine sample and six 24-h dietary recalls over a period encompassing the time of the urine sample. Intraclass correlations (ICC) values for serum isoflavones were 0.11 (log(daidzein)) and 0.28 (log(genistein)). Assuming that the correlation (true dietary intake, true urinary excretion) <0.90, it is shown that this implies an ICC for urinary estimates that exceeds 0.56. As expected, the previous day’s soy intake, and its timing, influenced the next morning’s serum levels. These results suggest that fasting morning serum isoflavone estimates will provide a poor index of long-term soy intake, but that overnight urinary estimates perform much better. [ABSTRACT FROM AUTHOR]

The article details the biopsychosocial religion and health study (BRHS). The study aims to examine how religious experience affects the impact of cumulative risk exposure on quality of life, health and mortality and the mechanisms by which these religious manifestations might operate. In this study, 20,000 Adventist Health Study (AHS)-2 participants were sampled. The study found that Adventists and non-Adventists have the same levels of mental health in the age group of 35-44 and Black and White Adventists have better mental health in older age groups.

Objective: To identify the attitudes and perceptions of Black Seventh-day Adventists regarding health research and the healthcare system in two regions of the United States.Design: Church members were selected from those who participated in the Adventist Health Study-2 (AHS-2) and those who chose not to participate. Participants were selected from two regions of the United States.Setting: Participants were interviewed in their churches, in their homes, and in the research study office at Loma Linda University. Interviews were done in the Western and Southern regions of the United States.Participants: 384 Black Seventh-day Adventists, aged >30 years.Main Outcome Measures: Responses to the structured interviews from those in the Western region were compared to those in the Southern region.Results: Those in the Southern region included more elderly subjects; they were more likely to own their home despite earning less; and were more likely to be married. Compared to the Western region participants, we found Southern participants to have greater participation in church activities, greater mistrust of the healthcare system and particular concerns about racial inequalities in care. In contrast, they also reported more positive experiences with their personal healthcare provider than Western participants. Southerners felt that they had greater control over their own health, perhaps in part due to a greater identification with the health teachings of the Adventist church.Conclusions: A number of clear differences were found between Black Adventist subjects living in either the Western or Southern regions of the United States. These factors should be considered carefully when planning the promotion for a research study. [ABSTRACT FROM AUTHOR]