A Seventh-day Adventist Organization

Abstracts for The Adventist Health Study Bibliography

Abstracts for The Adventist Health Study bibliography

Ref #1 - Hardinge MG
SO: Am J Clin Nutr. 1954; 2: 73-82
No Abstract

Ref #2 - Hardinge MG
SO: Am J Clin Nutr. 1954; 2: 83-88
AB: In the United States the vegetarian groups afford a singular opportunity to compare dietary intakes and serum cholesterol concentrations with those of control groups. Eighty-six lacto-ovo-vegetarian, twenty-six "pure" vegetarian, and eighty-eight non-vegetarian adults, adolescents, and pregnant women were studied. Lacto-ovo-vegetarians include milk and eggs in their diet but do not eat flesh of animals (meat, poultry, fish). "Pure" vegetarians eat no foods of animal origin. Details regarding the selection and composition of these groups, together with a report on their dietary practices, physical condition, and laboratory findings are described in the preceding paper. This study discusses the cholesterol findings.

Ref #3 - Hardinge MG
SO: Am J Clin Nutr. 1958; 6: 523-525
AB: An investigation of the nutritional, physical, and laboratory findings, together with the dietary and serum levels of cholesterol, of 88 non-vegetarian, 86 lacto-ovo-vegetarian, and 26 "pure" vegetarian adults, adolescents, and pregnant women was reported earlier. Lacto-ovo-vegetarians include milk and eggs in their diet but do not eat flesh of animals (meat, poultry, fish). "Pure" vegetarians eat no food of animal origin. The details concerning the selection and composition of these groups are described in the preceding papers. The present study deals with the fiber content of the diets of these several groups.
The food composition tables of the U.S. Department of Agriculture provided most of the data for the computation of the fiber content of the foods consumed. In a few instances information was also obtained from other sources.

Ref #4 - Wynder EL
SO: Calif Med. 1958; 89: 267-272
No Abstract

Ref #5 - Downs RA
SO: Bull Amer Assoc Pub Health Dent. 1958; 18: 19-21
No Abstract

Ref #6 - Wynder EL
SO: Cancer. 1959; 12: 1016-1028
AB: Numerous statistical investigations have indicated that smoking and excess drinking play a role in the etiology in certain diseases. Smoking is considered to be one of the causes of cancer of the respiratory tract and is also suspected to increase the risk for myocardial infarction. Excessive drinking, mostly of hard liquors, has been found to affect the development of cancer of the mouth, larynx, and esophagus. In view of the available evidence, it was of interest to study the incidence of cancer and coronary artery disease among a population group consisting mainly of nonsmokers and nondrinkers. The Seventh-Day Adventists, a religious group of about 300,000 members in the United States, represent such a group of individuals since their religion prohibits smoking and drinking.
The purpose of this study was, first, to review admission records of Seventh-Day Adventist hospitals and to determine the relative admission rates of Seventh-Day Adventists with a given disease compared to all other admissions and, second, to obtain data on the past and present smoking and drinking habits, as well as other background data on Seventh-Day Adventists.

Ref #7 - Donnelly CJ
SO: Public Health Rep. 1961; 76:209-212
No Abstract

Ref #8 - Hardinge MG
SO: Am J Clin Nutr. 1962; 10: 516-524
AB: A nutritional study of eighty-six lacto-ovo-vegetarians, twenty-six "pure" vegetarians and eighty-eight nonvegetarians, including a description of the diets with various nutrient calculations, was published earlier. The serum cholesterol levels of these groups as related to fat intake and the fiber in the diet have also been reported.
This report presents the component fatty acids and the iodine values of fats consumed by these subjects, and their correlations with the serum cholesterol values. A table of fatty acids compiled by us and a more recent one by the Department of Agriculture were used as the basis for these calculations.

Ref #9 - Dysinger PW
SO: Dis Chest. 1963; 43: 17-26
No Abstract

Ref #10 - Larsson E
SO: Obstet Gynecol. 1963; 22: 630-635
No Abstract

Ref #11 - Hardinge MG
SO: J Am Dietet Assoc. 1963; 43: 545-549
No Abstract

Ref #12 - Hardinge MG
SO: J Am Dietet Assoc. 1963; 43: 550-558
No Abstract

Ref #13 - Hardinge MG
SO: J Am Dietet Assoc. 1963; 43: 537-542
No Abstract

Ref #14 - Walden RT
SO: Am J Med. 1964; 36: 269-276
AB: Ischemic heart disease is not only the most common cause of death among adult white Americans but has apparently increased in frequency in recent years. There is a growing belief that this is partially related to environmental factors peculiar to the so-called "highly-civilized" societies. Among isolated segments of the population, however, the environment differs from that which encompasses most Americans. One such segment is the Seventh-day Adventists, a denomination in which the maintenance of a healthy body is incorporated into religious dogma.
The external factors that influence the lives of the Seventh-day Adventists are different from those of the average American in several respects. As a group, Seventh-day Adventists use much less meat and fat of animal origin, and they do not use caffeine-containing beverages. With infrequent exceptions, they do not use tobacco or alcohol in any form. Stresses related to the rapid pace of American life, and self-imposed tensions incident to worry, ambition to competition may also be less, although objective proof of this is difficult to obtain.
Wynder and Lemon found that hospital admissions for coronary artery disease were approximately 40 per cent less among Seventh-day Adventist men than among men in the general population, only 15 per cent less than that expected among Seventh-day Adventist women. In the Seventh-day Adventists observed, the marked difference in the pattern of ischemic heart disease between men and women that is seen in the general white population was not evident; in fact, there was rather a striking similarity between men and women in terms of incidence and age distribution.
The present study attempts to clarify possible interrelationships between environmental factors, serum esterified fatty acids and the occurrence of ischemic heart disease by comparing a population living under "atypical environmental conditions" (the Seventh-day Adventists), with one sharing a standard American environment (white adults in New York City).

Ref #15 - Lemon FR
SO: Cancer. 1964; 17: 486-497
No Abstract

Ref #16 - Wynder EL
SO: Am Rev Resp Dis. 1965; 91: 679-700
No Abstract

Ref #17 - Hardinge MG
SO: J Am Diet Assoc. 1966; 48: 25-28
AB: In earlier publications, we presented nutritional studies of eighty-six lacto-ovo-vegetarians, twenty-six pure vegetarians, and eighty-eight nonvegetarians. These include a description of the diets, nutrient intakes, and health findings, serum cholesterol levels as related to fat consumption, the fiber content of the diet, and the dietary fatty acids in relation to the serum cholesterol.
This paper considers the essential plus two related amino acids of the dietary proteins of our subjects.

Ref #18 - Lemon FR
SO: J-Amer-Med-Assoc. 1966; 198:117-126.
AB: There were 850 deaths among 11,071 Seventh-Day Adventist (SDA) men from 1958 to 1962. The group was similar to other men in California except for occupation, and older age distribution, and much less tobacco exposure. The total number of deaths observed and death from respiratory disease were approximately one half and one fourth, respectively, of that expected at comparable ages for California men. In the SDA group, the 28 deaths contributed to by emphysema or lung cancer were concentrated in a minority with a history of heavy tobacco usage; only one such death occurred among 3,913 (35%) SDA "lifetime" members who had never smoked. The findings from this study are consistent with previous epidemiologic studies and predictions of a large reduction in lung cancer and other mortality in any nonsmoking US population. The findings support the causal relationship of cigarette smoking to lung cancer but discount the "selection or constitutional" theory.

Ref #19 - Glass RL
SO: J Dent Child. 1966; 33: 22-23
No Abstract

Ref #20 - Holmes CB
SO: J-Dent-Res. 1967 Jul-Aug; 46(4): 650-5
AB: The prevalence of dental caries and periodontal disease has been observed to vary widely in population groups in countries throughout the world and to vary within the same population groups of the same country. The efforts to determine factors that have a correlation with periodontal disease have shown that age and oral hygiene explain more than 90 percent of the variance in group periodontal index scores. The single factor with the most profound effect on the prevalence and pattern of dental caries is the ingestion of adequate amounts fluorides, although there is an association of sugar consumption and dental caries prevalence as determined by ICNND teams.
Three studies suggest a lower dental caries prevalence in children of Seventh-Day Adventist children. The present study was conducted in 1963 and 1964 to extend this comparison to older children and to include other variables, such as oral hygiene, periodontal status, dietary patterns as reflected in 1-day diet histories, salivary caries susceptibility tests as measured by the SLC tube test and Lactobacillus plate count, and reported number of daily tooth brushing frequency. This report is limited to nine variables of interest: decayed surfaces (DS), missing surfaces (MS), filled surfaces (FS), DMF surfaces (DMFS), oral hygiene index (OHI-S), debris index (DI-S), calculus index (CI-S), periodontal index (PI), and tooth brushing frequency (TBF) in four groups (two Adventist groups and two non-Adventist groups). Details of the methods used in collecting and processing this data obtained with the DMFS index, PI and OHI-S have been presented previously.

Ref #21 - Marsh AG
SO: J-Am-Diet-Assoc. 1967 Nov; 51(5): 441-6
No Abstract

Ref #22 - Mozar HN
SO: Med-Arts-Sci. 1967 May-Aug; 21(2): 59-63
AB: Seventh-day Adventists do not drink alcoholic beverages and do not smoke for reasons which they believe are founded on health and moral principles. Many prefer a lactovegetarian diet and drink no coffee, tea, or other beverages containing caffeine.
Under the social pressures of a nonabstentious, affluent society, the practice of multiple abstentions could be a frustrating experience. Therefore, a representative population of Seventh-day Adventists was studied in order to assess the mental health status of such a relatively abstemious group.
This paper presents the results of a mental health home survey in which questionnaire-guided interviews were held with 265 white Seventh-day Adventist church members and an equal number of white nonmembers.

Ref #23 - West RO
SO: Am-J-Clin-Nutr. 1968 Aug; 21(8): 853-62
AB: The serum cholesterol levels and the dietary habits of a voluntary study group of 466 Seventh-day Adventists in Washington, D.C., suburban area were compared to determine the influence of diet on serum cholesterol levels in an adult population whose only environmental differences related to dietary practices - adherence to vegetarianism. This study matched vegetarians with nonvegetarians from the same base population according to several physical and demographic variables - place of residence, age, sex, marital status, height, weight, and occupation - and examined the effects of various levels of meat, fish, and fowl consumption (degrees of nonvegetarianism) on serum cholesterol levels. With the exception of those under 25 years of age, the results showed that the nonvegetarians had higher serum cholesterol levels than the vegetarians.

Ref #24 - Amundsen W
SO: Am Ann Deaf. 1968 Sep; 113(4): 896-7
No Abstract

Ref 25 - Lemon FR
SO: Arch-Environ-Health. 1969;18:950-955.
AB: The mortality and survival of 34,217 Seventh-day Adventists (SDAs) from 1960 to 1962 has been subjected to a life table analysis and compared to similar data for the simultaneous California population. The preferential survival experience and life expectancy of the SDAs is of a very high order - considering the ages (35 and above) to which the analysis was limited. The life expectancy advantage of SDAs at age 35 and over exceed present California life expectancies by an amount greater than that gained in the US population during the past 40 or more years. On the basis of prior detailed studies of the mortality experience of SDAs, we postulate that the great preponderance of this preferential life expectancy is due to the SDA practice of abstinence from the use of tobacco. We reason, inversely, that one of the important, and recently measurable, biologic costs of cigarette smoking is a substantial reduction in life expectancy, notably among US men.

Ref #26 - Cohen CA
SO: Am-Rev-Respir-Dis. 1972 Feb; 105(2): 251-61
AB: A comparison of respiratory symptoms and pulmonary function tests in two similar groups of nonsmoking adults who were chronically exposed to essentially the same mean value but different peak values of oxidant air pollution did not show a difference in the prevalence of symptoms suggestive of pulmonary disease. Analysis of different ventilatory parameters measured by spirometry and maximal expiratory flow-volume curves also did not indicate significant differences between the two groups. The study, therefore, did not support the hypothesis that chronic exposure of nonsmokers to twofold differences in peak values of oxidant air pollution results in either increased incidence of symptoms of chronic lung disease or impairment of lung function as reflected by spirometry or flow-volume loops.

Ref #27 - Starr P
SO: Amer J Clin Path. 1971; 56: 515-522
No Abstract

Ref #28 - Dysinger PW
SO: Med-Arts-Sci. 1972; 26(3): 27-41
No Abstract

Ref #29 - Kuzma JW
SO: Accid Anal Prev. 1973; 5: 55-65
No Abstract

\\Ref #30 - Armstrong BK
SO: Am J Clin Nutr. 1974; 27:712-718
AB: Hematological, vitamin B12, and folate levels were measured in 562 members of the Seventh-day Adventist Church, of whom 431 were vegetarians. Vegetarians had a significantly higher mean serum folate than did non-vegetarians. Serum vitamin B12 levels correlated directly with both meat and egg intake. Subjects with a serum vitamin B12 level of <160 pg/ml had significantly higher mean MCV and MHC and lower mean total red and white cell counts and red cell folate than the rest of the group. Comparison of the vegetarians with the Busselton population showed similar differences. The prevalence of low hemoglobin levels was not significantly Different from that in the Busselton population, and there was no evidence of an excess of iron or folate deficiency among the Seventh-day Adventists. Only one volunteer was found to have suffered from symptomatic dietary vitamin B12 deficiency. A significant positive correlation among MCV, MHC, and age in men was found, apparently due to an increased sensitivity to vitamin B12 deficiency in older men. Young women also appeared more sensitive to the effects of vitamin B12 deficiency.

Ref #31 - Phillips RL
SO: Cancer-Res. 1975 Nov; 35(11 Pt. 2): 3513-22
AB: The Seventh-Day Adventist population abstains from smoking and drinking; about 50% follow a lacto-ovo-vegetarian diet; and most avoid the use of coffee, tea, hot condiments, and spices. Existing data on cancer mortality in Seventh-Day Adventists clearly document mortality rates that are 50 to 70% of general population rates for most cancer sites that are unrelated to smoking and drinking. Several approaches to determining whether this reduced risk is due to the unique Seventh-Day Adventist life-style or selective factors related to who choses to become and remain a Seventh-Day Adventist are described. A comparison of the mortality experience of Seventh-Day Adventist and non-Seventh-Day Adventist physicians shows equal cancer mortality, which is consistent with the hypothesis that the apparent reduced risk of cancer death in all Adventists may be due to selective factors. However, the results of a small case-control study of colon and breast cancer among Adventists show statistically significant relative risks for colon cancer of 2.8 for past use of meat. For current food use, the significant relative risks are 2.3 for beef, 2.7 for lamb, and 2.1 for a combined group of highly saturated fat foods. This strongly suggests that the lacto-ovo-vegetarian diet may protect against colon cancer. However, the evidence linking diet to breast cancer is less clear. Because of the marked variability in dietary habits within the Seventh-Day Adventist population, they will be a productive group for further study of diet and cancer.

Ref #32 - Ruys J
SO: Br Med J. 1976; 2: 87
AB: Vegetarians consume a diet free of or low in animal meat but containing, in addition to vegetable products, eggs and milk and their derivatives. The diet is low in saturated fats and high in polyunsaturated fats; it is also relatively high in beans and fiber, which may actively reduce serum cholesterol. Such diets would be expected to produce blood lipid levels lower than those found in the average population, and this has been confirmed in a few studies. Such studies have not been performed on adolescents or children. We report the results of a preliminary study of blood lipid levels in 183 Seventh Day Adventist (SDA) adolescents and compare them with the results of a previous study of adolescents from the general Australian population.

Ref #33 - Phillips RJ
SO: Am J Epidemiol. 1976; 104: 354-355
AB: The assessment of intake of specific nutrients is a challenging problem in epidemiologic studies. This study demonstrates how a food frequency questionnaire was used to obtain quantitative estimates of average individual intake of major nutrients. A self-administered 95-item food frequency questionnaire followed by five 24-hour recalls of food intake were obtained from a random sample of 75 vegetarian and 75 nonvegetarian Seventh-day Adventists. The 24-hour food recalls were obtained by telephone interview on five randomly selected days over a six-week period. Accuracy of estimating the food eaten was facilitated by providing participants with a book containing color life-size pictures of common foods. The average daily amount of major nutrients was computed from the 24-hour recall data. The reported frequency of use and average serving size of individual food items reported in the initial questionnaire were used as independent variables and the calculated intake of individual nutrients as the dependent variable in a stepwise multi-regression analysis. Prediction equations were obtained which estimate the amount of each person's intake of nine major nutrients. The last nutrient which contributed $ 0.015 to cumulative R2 value and had an F to enter of $ 4 was used as a cutoff point. The multiple R's attained were as follows (the number of independent variables used in the corresponding prediction equations are given in parentheses): saturated fat, .75 (13); unsaturated fat, .71 (11); fiber, .86 (12); animal protein, .76 (15); vegetable protein, .75 (10); calories, .77 (13); total sucrose, .66 (13); starch, .70 (10); and cholesterol, .66 (12). Several of the prediction equations include interesting unexpected food items. A total of 50 food items were used in one or more of the nine prediction equations. The prediction equations will be used in estimating major nutrient intake on a larger population of 60,000 Seventh-day Adventists from their reported usage of the 50 food items utilized in the prediction equations.

Ref #34 - Taylor CB
SO: Arterial Wall 1976 Oct; 3(4): 175-9
AB: Serum cholesterol levels and dietary habits were surveyed in 27 male and 34 female Seventh-day Adventist. All subjects studied were lacto-ovo-vegetarians and a few consumed some meat products. Their serum cholesterol levels, significantly lower than those of the United States general population, showed no sex difference but increased with age and were higher in overweight males. Their levels, however, were much higher than those of true vegetarians which was most likely attributable to their consumption, even though to a limited acount, of dairy foods.

Ref #35 - Walker AR
SO: Am-J-Clin-Nutr. 1976 Dec; 29(12): 1417-26
AB: Colon cancer, rare in the past, and in developing populations, currently accounts for 2 to 4% of all deaths in Western populations. Evidence suggests the primary cause to be changes in diet, which affect the bowel milieu interieur. It is possible that in sophisticated populations, the higher concentrations of fecal bile acids and sterols, and longer transit time, favor the production of potentially carcinogenic metabolites. Of secular changes in diet, evidence suggests that the following may have etiological importance: 1) the fall in intake of fiber-containing foods with its effects on bowel physiology, and 2) the decreased fiber but increased fat intakes, in their respective capacities to raise concentrations of fecal bile acids, sterols, and other noxious substances. For possible prophylaxis against colon cancer, recommendations for a lower fat intake, or a higher intake of fiber-containing foods (apart from fiber ingestion from bran) are extremely unlikely to be adopted. For future research, western populations with considerably lower than average mortality rates, e.g., Seventh-Day Adventists, Mormons, the rural Finnish population, as well as developing populations, demand intensive study. Also requiring elucidation are the respective roles of diet and of genetic constitution on concentrations of fecal bile acids, etc., and on transit time, in prone and nonprone populations.

Ref #36 - Phillips RL
SO: Natl-Cancer-Inst-Monogr. 1977 Dec; 47: 107-12
AB: Considerable evidence was found that Adventists are a low-risk population to develop cancer of many sites. Adventists have numerous unique life-style and dietary habits with great variability within the population in adherence to these practices as well as considerable variation in duration of exposure to these characteristics. Thus this study population will likely be extremely productive in identifying dietary habits or other life-style characteristics that are etiologically related to various cancer sites.

Ref #37 - Armstrong B
SO: Am-J-Epidemiol. 1977 May; 105(5): 444-9
The blood pressures (BP) in 418 vegetarian Seventh-day Adventist (SDA) volunteers in Western Australia were compared with those in 290 non-vegetarian volunteers in Narrogin, a Western Australian country town. The mean systolic and diastolic BPs in the SDAs, adjusted for age, sex, height and weight (128.7/76.2 mm of mercury) were significantly less than those in the Narrogin residents (139.3/84.5). It appeared unlikely that these differences could be explained by differences in alcohol, tobacco, tea, coffee or egg consumption, socioeconomic status or physical activity. There was, however, a gradient toward increasing BP with increasing egg intake in SDAs, and SDAs who drank tea or coffee had a higher mean diastolic BP than those who did not (mean difference of 4.2 mm of mercury). The possibility that selective bias or unmeasured environmental differences might explain the difference in BP between the two groups is discussed.

Ref #38 - Goldberg MJ
SO: Ann-Surg. 1977 Jul; 186(1): 97-100
Qualitative and quantitative fecal microflora was studied in a double blind fashion in 28 subjects. Fourteen were Seventh-Day Adventists, who were strict vegetarians, while the remaining 14 subjects were individuals consuming a general western diet. No statistically significant differences were identified in the fecal microflora of the two groups. The bacteriologic analysis included total aerobes and total anaerobes as well as each of the major fecal aerobes and anaerobes. This study seems to indicate that the dietary intake of animal fat and protein does not significantly alter the fecal microflora, a possibility which has previously been suggested as being part of the explanation for the higher incidence of colonic carcinoma in those who consume meat compared with vegetarians. It does not, however, invalidate the concept that dietary animal fat does increase bile acid degradation within the gastrointestinal tract, a factor which has been related to colon cancer. Future studies should be directed at identifying the factors that may be present in the gastrointestinal tracts of vegetarians which modify the ability of their colonic microflora to degrade bile acids, an essential step in the production of intraluminal carcinogens or co-carcinogens.

Ref #39 - Finegold SM
SO: Am-J-Clin-Nutr. 1977 Nov; 30(11): 1781-92
A comparison of 13 vegetarian Seventh Day Adventists with 14 nonvegetarian Adventists revealed relatively few statistically significant differences in fecal flora. A separate study involved a comparison of vegetarian Adventists (49 subjects), nonvegetarian Adventists (45), and non-Adventists on a conventional American diet (31) re: the incidence of the C. paraputrificum group in the fecal flora. The Adventist groups had significantly fewer C. septicum and C. tertium isolates than the non-Adventists. Reference to earlier diet studies done by our group revealed certain striking differences. Fusobacterium and C. perfringens counts were very low and lactobacillus counts very high in Adventists as compared with Japanese-Americans on either a Japanese or Western diet or Caucasian individuals on a conventional U.S. diet. Comparison of nonvegetarian Adventists with the other groups on a nonvegetarian Western diet also revealed several statistically significant differences. Finally, there were a number of significant differences in fecal flora when high risk groups (Japanese-Americans on Western diet and Caucasians on conventional U.S. diet) were compared with low risk groups (Japanese-Americans on a Japanese diet and Adventists).

Ref #40 - Phillips RL
SO: Am-J-Clin-Nutr. 1978 Oct; 31(10 Suppl): S191-S198
AB: Seventh-Day Adventists (SDAs) are a conservative religious denomination who abstain from tobacco and alcohol; approximately one-half follow a lacto-ovo-vegetarian diet. In this 6-year prospective study of 24,044 California SDAs age 35 and over, coronary heart disease (CHD) mortality rates for ages 35 to 64 and 65+ are 28% and 50% respectively, of the rates for the same age groups of the total California population. This reduced risk of CHD mortality among SDAs is partially due to abstinence from smoking; however, at least half the low risk among SDAs is likely attributable to other characteristics of the SDA lifestyle. The risk of fatal CHD among nonvegetarian SDA males, ages 35 to 64, is three times greater than vegetarian SDA males of comparable age (P less than 0.01), suggesting that the SDA diet may account for a large share of their low risk. This differential was much smaller for older SDA males and SDA females. Although the differential in risk of fatal CHD for male nonvegetarians versus vegetarians may be partially accounted for by other CHD risk factors, which are more frequent among nonvegetarians, a significant differential persists after adjustment for each of six other CHD risk factors.

Ref #41 - Macdonald IA
SO: Am-J-Clin-Nutr. 1978 Oct; 31(10 Suppl): S233-S238
AB: Cell-free extracts were prepared from mixed fecal anaerobic bacteria grown from stools of 14 vegetarian Seventh-Day Adventists, 16 omnivorous control subjects, and eight patients recently diagnosed with cancer of the large bowel. Preparations were assayed for NAD- and NADP-dependent 3alpha-, 7alpha- and 12alpha-hydroxysteroid dehydrogenases with bile salts and androsterone as substrates (eight substrate-cofactor combinations were tested). A significant intergroup difference was observed in the amounts of NAD- and NADP-dependent 7alpha-hydroxysteroid dehydrogenase produced: bowel cancer patients exceeded controls, and controls exceeded Seventh-Day Adventists. Other enzyme activity comparisons were not significant. The pH values of the stools were significantly higher in cancer patients compared to Seventh-Day Adventists; values were 7.03 +/- 0.60 and 6.46 +/- 0.58 respectively. The pH value for controls was 6.66 +/- 0.62. A plot of pH value versus NADP-dependent 7alpha-hydroxysteroid dehydrogenase tended to separate the cancer patients from the other groups. Comparative data suggest that much of the 3alpha-hydroxysteroid dehydrogenase active against bile salt is also active against androsterone.

Ref #42 - Finegold SM
SO: Am-J-Clin-Nutr. 1978 Oct; 31(10 Suppl): S116-S122
Although potent antimicrobial agents may effect rapid and significant changes in fecal microflora, changes in diet or dietary supplements usually produce modest changes by comparison. It may be, however, that even such minor changes may result in significant changes in metabolic activity, particularly in terms of production of possible carcinogens or cocarcinogens. It is clear that significant changes may occur in metabolic activity without major qualitative or quantitative changes in the fecal microflora. Other research that might help explain the epidemiological observations of the association between diet and colon cancer would be studies of the flora at different levels of the gastrointestinal tract (particularly the cecum and small bowel), studies of the mucosa-associated flora at different levels, and long-term dietary studies.

Ref #43 - Simons LA
SO: Am-J-Clin-Nutr. 1978 Aug; 31(8): 1334-9
AB: The influence of absorbed dietary cholesterol on plasma cholesterol concentration was studied in two populations, one Seventh Day Adventist (SDA) vegetarian and one nonvegetarian, representing a broad range of plasma cholesterol values and dietary cholesterol intakes. As a group, the SDA vegetarians had significantly lower levels of plasma cholesterol and triglycerides than did the nonvegetarians. This hypolipidemic pattern in the SDA vegetarians was apparently closely related to dietary habits, since another group of SDA who were nonvegetarian had significantly higher plasma cholesterol and triglyceride levels than their vegetarian counterparts. Both the dietary intake of cholesterol and the percentage absorption of cholesterol were lower in vegetarians than in nonvegetarians. The mass of cholesterol absorbed increased linearly with the mass of cholesterol ingested in all groups, but no relationship could be demonstrated between absorbed cholesterol and plasma cholesterol concentration.

Ref #44 - Trahms CM
SO: AM J Clin Nutr.1978; 31: 720
AB: The growth and food intakes of young children on meatless diets were compared to apparently healthy well-nourished children in the United States. Seventh Day Adventist preschool children (n=45) were evaluated with three day food records and standardized anthropometric measurements.
The one to three year olds consumed 99±22 kcal/kg/day of energy and 3.1±0.8 gm protein/kg/day. The four to six year olds consumed 90±19 kcal/kg/day of energy and 2.7±0.6 gm protein/kg/day. These intakes compared favorably to accepted standards.
Weight to height ratios of the children were compared to North Central Region (NCR) data. These ratios were found to be similar. The mean weight : height ratio of two to three year old males was 0.83 (NCR 0.87) and females 0.79 (NCR 0.85). The ratio for four to six year old males was 0.94 (NCR 0.97) and females 0.96 (NCR 0.96). Thus a meatless diet can support adequate growth and be an adequate dietary pattern for the preschool child when carefully formulated.

Ref #45 - Webster IW
SO: Med-J-Aust. 1979 May 19; 1(10): 417-20
AB: A comparison of health status between 779 Seventh-day Adventists, who have a strong commitment to heal-related life styles, and two other groups of people--8363 persons referred by general practitioners and 9825 volunteers--was made. The Seventh-day Adventists showed less impairment of systolic and diastolic blood pressures, of plasma cholesterol and plasma urate concentrations, and of lung ventilatory capacity; and less obesity at most specific ages. With increasing age, the level of breathlessness, reported heart disease, hypertension, and hypertensive and diuretic therapy in this sample approached that of the comparative groups, possibly because of natural attrition of high-risk persons in the latter. Depression, sleeplessness, use of sedatives and tranquillizers were lower in the Seventh-day Adventists; although, once again, a drawing together of the three groups in older age categories was evident. It is concluded that the life style of Seventh-day Adventists is conducive to lessened morbidity, delayed mortality, and decreased call on health services in comparison with the general population.

Ref #46 - Berkel J
Drukkerij Insulinde, Amsterdam/Netherlands, 1979

Ref #47 - Smith S
SO: Fed Proc. 1979; 38: 713
AB: Questionnaires on attitudes toward and knowledge of nutrition and its relationship to cancer (CA) were sent to 1000 randomly selected Oregon Seventh-day Adventists (SDA). Responses came from 208 of 500 females (F) and 123 of 500 males (M). A higher percentage of M (68%) than F (53%) were vegetarians (V). 61% of the respondents strongly agreed that there is a relation between nutrition and CA. From 90-95% of both M and F agreed that some foods contain CA causing substances. Lower percentage of respondents strongly agreed to more specific statements relating CA to nutritional (N) factors such as fiber (45%), fat (27%), obesity (22%) and protein (14%). A higher percent of F than M rated food choice factors of cost, N value, health and caloric content as very important. Caloric content of foods was more important to the non-V (NV) than V. 35% of the F took vitamins daily. VM (19%) were less likely to take vitamins daily than NVM (39%). More F (50%) than M (24%) studied nutrition in high school. More F (73%) than M (53%) said they knew the seven signs of CA. Of an additional 15 respondents who had CA, 7 of them were V. Responses from the CA subjects followed the general trends of the other respondents. Data suggests that SDA (88%) as a group agree that there is a relation between nutrition and cancer, but are less sure of the specific relationships. V more strongly agree than NV that there is a relationship and that specific nutrients are related to cancer risk. (No Refs)

Ref #48 - Entsrom JE
SO: CA-A Cancer Journal for Clinicians. 1979; 29: 352-361
AB: What can we learn by studying populations that develop chronic diseases at relatively low rates compared with the general population? Are there protective factors that minimize or delay an individual's risk of developing and dying from heart disease, cancer, diabetes? A number of epidemiologic studies have examined relatively low rates of disease around the world. These have been directed primarily at coronary heart disease. This approach is being applied more extensively to cancer. In studying cancer etiology, it is as important to identify populations at relatively low risk as it is to identify populations at relatively high risk. From those at low risk, clues to protective mechanisms emerge; from those at high risk, clues causative mechanisms emerge. Based on these findings, interventions may be introduced to challenge apparent risk factors.

Ref #49 - Armstrong B
SO: Am-J-Clin-Nutr. 1979 Dec; 32(12): 2472-6
Urinary sodium, potassium urea, creatinine, uric acid, plasma urea, creatinine, cholesterol, blood pressures, height, weight, and skinfold thickness were measured in some or all of 106 matched pairs of vegetarians (mainly Seventh-Day Adventists) and nonvegetarians. Mean blood pressures were lower in vegetarians (141.9/88.9 mm) than nonvegeterians (148.0/90.9 mm) but the urinary excretion of sodium was higher, although not significantly, in the vegetarians (mean of 169.7 compared with 161.2 mmole/day). The vegetarians also had a higher urinary potassium excretion (62.9 mmole/day) than the nonvegetarians (54.8 mmole/day) thus giving them a lower mean sodium to potassium ratio (3.0 compared with 3.3). Both systolic and diastolic blood pressures correlated positively with plasma cholesterol levels which were less in vegetarians (6.0 mmole/liter) than nonvegetarians (6.6 mmole/liter). They also correlated positively with the urinary sodium to potassium ratio, but only in nonvegetarians. It was concluded that dietary sodium does not explain the blood pressure differences between vegetarians and nonvegetarians.

Ref #50 - Simons L
Med J of Australia 1979; 2:148
Letter to the Editor

Ref #51 -Bachrach S
SO: Pediatrics. 1979 Dec; 64(6): 871-7
Nutritional, racial, cultural, and environmental factors have combined to produce a resurgence of vitamin D deficiency rickets in urban Philadelphia. Between January 1974 and June 1978, 24 cases were diagnosed at the Children's Hospital of Philadelphia. Patients' ages ranged from 4 to 58 months. Presenting complaints included seizures, swollen wrists, pathologic fractures, and developmental regression. Sixteen patients were below the third percentile for length and weight. Laboratory results indicated vitamin D deficiency in nursing mothers as well as in infants. All infants had been breast-fed and all were black. Ingestion of vitamin D was limited by exclusion of meat and/or dairy products in 21, and no infants had consistently taken supplemental vitamins. Nineteen were members of Muslim or Seventh Day Adventist faiths. Endogenous synthesis of vitamin D was limited by dark skin, by dressing in long garments with hoods and veils, and by air pollution in a densely populated northern city. The return to a more "natural" diet, free of food additives, has been accompanied by the return of a classic disease of industrial society. Effective management required patience and respect for religious convictions. With treatment, there was correction of chemical and skeletal abnormalities, but few patients showed catch-up growth.

Ref #52 - Gori GB
SO: Cancer. 1979 May; 43(5 Suppl): 2151-61
It has been estimated that 80--90% of the cancer rate in the U. S. can be attributed to environmental factors. For the last 20 years the role of smoking has been recognized by the scientific community. However it is only recently that the role of diet, i.e., food and beverages in carcinogenesis has begun to be recognized. It is likely that diet is more important than smoking in cancer causation. Both human and animal studies support this assumption. The study of special populations in the U. S. such as the Mormons and the Seventh Day Adventists also point to the potential of reducing U. S. cancer rates and individual risk factors through the modification of dietary habits. The major hypotheses of the role of dietary and nutritional factors in cancer etiology are examined in light of current scientific knowledge. General guideline for the reduction of risk from the major chronic diseases are also discussed.

Ref #53 - Marsh AG
SO: J-Am-Diet-Assoc. 1980 Feb; 76(2): 148-51
Lacto-ovo-vegetarian women fifty to eighty-nine years of age lost 18 per cent bone mineral mass while omnivorous women lost 35 per cent. This study established that this difference could not be explained by a greater bone density in the lacto-ovo-vegetarians during the third, fourth, and fifth decades of life. The possibility of higher sulfur content in the meat-containing diet, the effect of excess phosphorus, and the effect of an acid-ash diet are discussed. From the standpoint of a general survey, comsumption of calcium-containing foods was not appreciably different in the two groups. It is, therefore, concluded that lacto-ovo-vegetarian diet may be beneficial in extended protective health care in terms of defense against, or control of, bone mineral loss in the later years of a woman's life.

Ref #54 - Phillips RL
SO: J Environ Pathol Toxicol 1980; 3:157-69
No abstract

Ref #55 - Phillips RL
SO: Banbury Report 4. New York, 1980, Cold Spring Harbor Lab. Pp. 93-108
No abstract

Ref #56 - Phillips RL
SO: J-Natl-Cancer-Inst. 1980 Nov; 65(5): 1097-1107
AB: In previous reports concerning cancer among Seventh-Day Adventists (SDA), comparisons were made only with the general population. This report compared California SDA to a sample of non-SDA who were demographically similar to SDA. The study consisted of 17 years of follow-up (1960--76) on 22,940 white California SDA and 13 years of follow-up (1960--72) on 112,725 white California non-SDA. Both groups completed the same base-line questionnaire in 1960. Deaths were ascertained by annual contacts with each study member and by computer-assisted record linkage with the California State death certificate file. Results indicated that, with the exception of colon-rectal cancer and smoking-related cancers, the difference in risk of fatal cancer between SDA and non-SDA was substantially reduced when SDA were compared with a more socioeconomically similar population. The persistence of the low risk for colon-rectal cancer can probably be attributed to some aspect of the diet or life-style of the SDA.

Ref #57 - Phillips RL
SO: Am J Epidemiol 1980; 112:296-314
No abstract

Ref #58 - Reddy BS
SO: Mutat-Res. 1980 Aug; 72(3): 511-22
AB: Because of potential significance of fecal mutagens in the pathogenesis of colon cancer, the dietary pattern and fecal mutagens of 3 populations with distinct risk for the development of colon cancer, a high-risk population in New York Metropolitan area (non-Seventh-Day Adventists), a low-risk population of vegetarian Seventh-Day Adventists in New York Metropolitan area and a low-risk population in rural Kuopio, Finland were studied. The average daily intake of protein was the same in the 3 groups, but the sources were different, a greater portion coming from meat in the New York non-Seventh-Day Adventists and from vegetables in Seventh-Day Adventists. The intake of fat was lower in Seventh-Day Adventists and higher in Kuopio and in New York non-Seventh-Day Adventists. The intake of dietary fiber was high in Kuopio compared to other groups. Fecal samples collected for 2 days were freeze-dried extracted with peroxide-free diethyl ether, partially purified on a silica-gel column and assayed for mutagenicity using the Salmonella/mammalian microsome mutagenicity test. The mutagenic activity was observed with Salmonella typhimurium tester strain TA98 without microsomal activation and with TA100 with and without microsomal activation in high-risk subjects from New York consuming a high-fat, high-meat diet. The incidence of fecal mutagen activity was higher in volunteers from New York consuming a high-fat, high-meat diet compared to low-risk rural Kuopio population. None of the vegetarian Seventh-Day Adventists showed any mutagenic activity.

Ref #59 - Reddy BS
SO: Cancer-Lett. 1980 Aug; 10(2): 123-32
Dietary patterns and fecal mutagens of 2 population groups with a distinct risk for colon cancer, high-risk, non-Seventh-Day Adventists and a low-risk, vegetarian Seventh-Day Adventists, in the New York metropolitan area were studied. The diet histories indicate that the intake of protein was identical in the 2 groups; a greater portion coming from meat in non-Seventh-Day Adventists and from vegetables in the Seventh-Day Adventists. The intake of fat was lower in Seventh-Day Adventists. Fecal samples were extracted with dichloromethane, partially purified on silica and assayed for mutagenic activity using the Salmonella/mammalian microsome mutagenicity test. When tested alone, fecal extracts from both groups were non mutagenic in TA98 and TA100 strains. Fecal extracts of non-Seventh-Day Adventists and Seventh-Day Adventists enhanced the mutagenic activity induced by 2-AAF in TA98 and TA100 (co-mutagenic activity). However, non-Seventh-Day Adventists showed a significantly higher co-mutagenic activity in TA98 than did Seventh-Day Adventists.

Ref #60 - Kondo AT
SO: Dissertation - Univ. Microfilms International, Ann Arbor, MI

Ref #61 - Harris RD
SO: Am-J-Public-Health. 1981 Dec; 71(12): 1342-9
AB: Distribution of systolic and diastolic blood pressures (measured with an automated blood pressure recorder) of two large groups of children-3,159 from Seventh-Day Adventist (SDA) schools and 4,681 from non-SDA schools-are reported. They boys and girls were from four different ethnic groups and attended grades one through 10 in 29 Southern California schools. The analysis of the data failed to show significant differences in mean blood pressure levels between the two groups of children at all ages, despite marked differences in life-style between the two groups, and despite the fact that adults from the two population groups have marked differences in mortality from diseases associated with elevated blood pressure. A comparison between boys and girls showed significantly higher trends in mean systolic blood pressure for boys after age 12. Inter-ethnic comparisons of blood pressure revealed that Black children of both sexes had slightly higher mean blood pressure levels at all ages.

Ref #62 - Fraser GE
SO: J Chron Dis. 1981; 34: 487-501
AB: Although experimental work has supported the influence of diet on serum cholesterol levels, it has been puzzling that several large cross-sectional studies have failed to demonstrate such relationships. Five hundred and seventeen Seventh-day Adventist, who largely vegetarian, were investigated to obtain serum cholesterol levels and a food frequency dietary record. A stepwise multivariate analysis revealed significant relationships between diet and serum cholesterol in this cross-sectional study.
The analysis was split to Europeans and Polynesians and relationships were found for both groups between serum cholesterol and such variables as use of butter as a breadspread, use of margarine as a breadspread , a specific predetermined linear combination of saturated and polyunsaturated fats (2S-P). These relationships are consistent with the hypothesis that in these free-living people dietary fats influence serum cholesterol in the fashion predicted from previous experimental work.
Consideration is given to some of the difficulties in using stepwise regression programs with this type of data. This data did not clearly support the threshold hypothesis in relating diet to serum cholesterol.

Ref #63 - Insel PM
SO: J-Psychosom-Res. 1981; 25(6): 505-11
AB: Preliminary analyses of data relating blood pressure levels in children to psychosocial factors suggest there are small but significant and important associations between blood pressure and an adolescent lifestyle that emphasizes Control, Ambitiousness, Competitiveness, Order and Organization, Religious Orientation, and strong pressures to achieve. Seventh-day Adventist children compared to public school children perceive a stronger emphasis on Religious Orientation and Family Control.

Ref #64 - Kuzma JW
SO: Proc of the 19th Natl Mtg of the Public Health Conference on Records and Statistics, DHHS Publication No. (PHS) 81-1214, 1981.
No abstract

Ref #65 - Waaler H
SO: Tidsskr Nor Laegeforen. 1981; 101: 623-627
AB: Observation of 17 years mortality among Norwegian adventists shoes a clear low mortality for all age groups, most clearly for men. We have calculated that adventists have an increased life duration of approximately 4 and 2 years for men and women, respectively. This corresponds to the increases life duration one would obtain if the mortality due to ischemic heart disease were eliminated. The results are in good agreement with extensive investigations in the United States.

Ref #66 - Nestel PJ
SO: Metabolism. 1981 Oct; 30(10): 941-5
AB: Vegetarians have lower than average plasma lipid levels. Possible mechanisms were studied by measuring the kinetics of LDL-B protein and HDL-AI protein in 7 young male vegetarians and 6 omnivorous control subjects; sterol balances were also determined in a further study with the 6 additional control subjects whose intake of cholesterol was low. Plasma total cholesterol, LDL cholesterol and LDL-B protein were significantly lower in the vegetarians and plasma AI protein concentrations also tended to be lower. The flux or production of LDL was significantly lower, 9.1 +/- 2.3 mg/kg/d (mean +/- SD) compared to 11.8 +/- 0.6 mg/kg/d in the controls and appeared to explain the low levels of LDL. The fractional removal rate of HDL-AI protein was significantly greater in the vegetarians (0.043 +/- 0.011 versus 0.027 +/- 0.011 for the fractions of pool 1 cleared per hour) and appeared to account for the low plasma AI levels. In the second study, bile acid excretion was significantly lower in the vegetarians and estimated cholesterol synthesis was in the low normal range. Low rates of LDL-B protein formation have been reported in other subjects with low LDL cholesterol concentrations and in the vegetarians presumably reflect the composite of several dietary factors.

Ref #67 - Shultz TD
SO: Diss Abstr Int (B). 1981; 41(11): 4068-B
AB: Adult males and females were recruited from the Corvallis area, and the group was comprised of 51 Seventh-Day Adventist (SDA) vegetarians (SV), 16 SDA non-vegetarians (SNV), 53 non-vegetarians (NV), and 18 hormone dependent cancer subjects (HDCS). Approx 50% of the SDA population consume vegetarian diets, which may contain higher amounts of fiber than NV diets and may adversely affect their vitamin B-6 (B-6) and selenium (Se) status. The B-6 status of SV, SNV, NV, and HDCS as assessed by dietary B-6, plasma pyridoxal-phosphate (PLP), urinary 4-pyridoxic acid and total urinary B-6 did not differ; however, HDCS currently receiving chemotherapy had significantly lower PLP levels than non-therapeutic HDCS. Selenium levels of the SV, SNV, NV and HDCS were low and well below values reported elsewhere in the United States, but similar in all groups. SDA endocrine related cancer rates are lower than the general population. Investigation of the relationship between diet and plasma estrone (E1), estradiol (E2), estriol (E3), dehydroepiandrosterone sulfate (DHEA-S), and prolactin (PRL) levels for SV, SNV, NV, and HDCS was done. Also, estimation of dietary fat (F) intake from 32 F containing foods was determined from a questionnaire reflecting the dietary intakes of 14 SV and 9 NV premenopausal women during the past yr. The premenopausal SV were consuming approx 25% less F than NV, and used significantly less fried foods (P less than or equal to 0.01). Premenopausal NV plasma levels of E1 and E2, but not E3, were significantly greater than that of SV (P less than or equal to 0.02; P less than or equal to 0.05). Comparisons of the other male or female SV and NV groups E1, E2, E3, DHEA-S, and PRL levels were not different. Regression analysis of the questionnaire data revealed no significant positive correlations between F intake and SV or NV premenopausal levels of any of the three estrogens. However, according to regression analysis involving 3-day dietary intake av, premenopausal SV E2 and E3 levels were positively correlated with intakes of linoleic acid and protein (P less than or equal to 0.01; also, premenopausal NV prolactin levels were correlated with intakes of oleic and linoleic acid and total fat (p less than or equal to 0.005; P less than or equal to 0.02; P less than or equal to 0.01). Therefore, based on these findings and other current evidence, it may be wise to premenopausal women to reduce meat intake and other products of high fat content.

Ref #68 - Fraser GE
SO: Am-J-Clin-Nutr. 1981 Jul; 34(7): 1272-7
AB: Several previous studies have indicated that vegetables may lower serum total cholesterol. This study, using a Latin square experimental design, investigates the effect of three vegetable supplements (vegetable roots, vegetable leaves and stalks, whole grains) on serum lipoprotein cholesterol. The results from each vegetable supplement are compared to the results from a sucrose supplement of equal caloric content. Dietary fat, alcohol consumption, cigarette smoking, body weight, and physical activity are all controlled in the experimental design or the analysis. The results show that the effect of vegetables on serum cholesterol is not confined to one vegetable grouping or one type of lipoprotein cholesterol. Vegetable leaves and stalks are associated with lower values of very low-density lipoprotein cholesterol (and possibly low-density lipoprotein cholesterol) and total cholesterol. Whole grains are associated with lower values of low density lipoprotein cholesterol and total cholesterol. In addition to the actual cholesterol lowering effect compared to sucrose, the lack of an increase, suggests some advantage in the use of these vegetable groupings (even roots) as a replacement for fat in the diet, and vegetable leaves and whole grains as a replacement for sucrose.

Ref # 69 - Sanchez A
SO: Medical Hypotheses. 1981; 7: 1339-45
AB: Body size and body composition have been suggested as the best explanation for the temporal trend toward early menarche over the last 100 years. There is evidence from human and animal studies that indicates that body size is not the primary factor in influencing the occurrence of menarche. The data actually show that diet may be a primary environmental control mechanism of menarche especially since it alters hormone levels. We see diet as an etiological factor in both the long term and immediate control of menarche. In the long term it influences body size and development leading to menarche. In the short term it acts at a critical state to precipitate the onset of menarche and related physiological changes. This hypothesis does not exclude other less important factors associated with menarche. Our data shows that the present trend toward early menarche can be reversed when a balanced vegetarian diet is selected in place of the ordinary American diet.

Ref #70 - Armstrong BK
SO: J-Natl-Cancer-Inst. 1981 Oct; 67(4): 761-7
AB: In comparison with matched nonvegetarian women, postmenopausal vegetarian women were found to have lower urinary levels of estriol and total estrogens, lower plasma prolactin levels, and higher plasma sex hormone-binding globulin (SHBG) levels. These differences were not explained by differences in body weight or obesity. Plasma SHBG levels were highly correlated with plasma high-density lipoprotein cholesterol levels, which were also higher in vegetarians than in nonvegetarians. These hormonal differences may explain the lower rates of endometrial and possibly breast cancer that have been observed previously in vegetarian women.

.Ref #71 - Shultz TD
Book Chapter

Ref #72
SO: Sth African Med J. 1981; 59: 925
Editorial: Studies in English-speaking countries have established that those who belong to the Seventh-Day Adventist Church tend to be more healthy and to live longer than the average population. The latest study of this group comes from Norway, where Waaler and Hjort (T. Norske Laegeforen., 1981, 101, 623) discuss statistics for the period 1960-1977. The results must gladden the heart of any health educator, since it seems clear that the healthy lifestyle of these people is responsible for the fact that they live longer that anyone else. There are over 5000 of them in Norway and the reduction in mortality from the expected figure amounts to 72% for men and 83% for women. This means that on average the men live 4 years longer and the women 2 years longer than others. In order to achieve an increase in longevity of this magnitude in the entire population, ischemic heart disease would have to be eliminated for example.
The authors looked at the connection between longevity and health, and showed that for both ischemic heart disease and cancer the figures were lower for Adventists. Examination of the figures also suggests that there has been no genetic selection, a conclusion which American observers have also reached. Their longevity cannot be due to the fact that they belong to a privileged social class, since an examination of their distribution among social classes revealed no advantage over the general population. Nor could their geographic distribution in Norway explain the difference.
The likeliest explanation is the fact that they do not use tobacco, alcohol, coffee, tea or any drugs of addiction, and that they use fruit and vegetables freely (in fact, 50% are entirely vegetarian). They also encourage exercise, good working habits and regular sleep. It may well be that a better state of mental health helps to promote good health. Some light might be cast on this last point by a comparison with other religious groups who are not following the same lifestyle.
The authors comment that these natural experiments are much more instructive and reliable than experimental studies of the type of controlled clinical trials.

Ref #73 - Anderson BM
SO: Am-J-Clin-Nutr. 1981 Jun; 34(6): 1042-8
AB: Iron and zinc status of 56 Seventh-Day Adventist Canadian women (mean age 52.9 +/- 15.3 yr) following vegetarian diets for 19 +/- 17 yr were investigated. Energy, protein, iron, available iron, zinc, and total dietary fiber intakes were calculated from 3-day dietary records. Hemoglobin, serum iron, total iron binding capacity, serum and hair zinc concentrations were also determined. Plant products provided 92 and 77% of the total dietary iron and zinc intakes, respectively. Calculated mean daily intakes (+/- SD) for energy, protein, iron, zinc, and total dietary fiber were 1630 +/- 354 kcal, 58 +/- 14 g, 12.5 +/- 3.0 mg, 9.2 +/- 2.5 mg, and 30.9 +/- 11.0 g, respectively. Mean hemoglobin (13.1 +/- 1.0 g/dl), calculated serum transferrin saturation (37.5 +/- 12.9%), mean serum zinc (99 +/- 24 microgram/dl), and hair zinc concentrations (187 +/- 44 ppm) were all within the normal range. The iron and zinc status of these long-term Seventh-Day Adventist vegetarian women appeared adequate despite their low intake of readily absorbed iron and zinc from flesh foods and their high intake of total dietary fiber and phytate.

Ref #74 - Gray GE
SO: Prev Med. 1982; 11: 103-107
AB: Seventh-Day Adventist women in California have a decreased mortality rate from breast cancer. If this lower rate is due to the fact that many Adventists are lactoovovegetarians ("vegetarians") then one may find reduced levels of suggested risk factors for breast cancer in such Adventists. We studied this by comparing plasma and urine sex horrmone levels in Seventh-Day Adventist "vegetarian" and "nonvegetarian" girls aged 14 to 17. No differences were found between the two groups in Day 11 estrogens and prolactin, or in Day 22 estrogens, progesterone, and prolactin. Mean heights, weights, and ages at menarche were also similar. The Adventists were similar in height, weight, and age at menarche, and had similar plasma hormone levels, when compared with non-Adventist "control" girls.

Ref #75 - Snowdon DA
SO: Banbury Report 11, 1982
AB: Seventh-day Adventists (SDAs) are a religious group with low risk of death due to ischemic heart disease, cerebrovascular disease, cancer of the stomach, colon, prostate, breast, lung, and other cancer sites, as well as other diseases (Phillips et al. 1980a,b). The low risk of death from several of these diseases is probably due, in part, to the unique life-style that characterizes this religious group. Adventists generally avoid the use of tobacco, alcohol, spices, pork, and beverages containing caffeine. In addition, approximately 50% of all Adventists adhere to a lacto-ovo-vegetarian diet - a vegetarian diet that includes milk and egg products. Other behavioral and social components also characterize the SDA life-style.
Two principal questions will be addressed in this report. This first question is whether age at baptism is related to the risk of fatal ischemic disease. In other words, is the risk of ischemic heart disease in persons who join the Adventist religion as children different than the risk of those who convert to the Adventist religion as adults?
The second major question addressed in this report is whether the relationship between age at baptism and risk of ischemic heart disease differs among various subgroups of Adventists. These subgroups will include males, females, vegetarians, nonvegetarians, former cigarette smokers, and those who have never smoked.

Ref #76 - Turjman N
SO: Cold Spring Harbor Laboratory, New York, 1982
Book Chapter

Ref #77 -Rouse IL
SO: Clin-Exp-Pharmacol-Physiol. 1982 May-Jun; 9(3): 327-30
AB: 1. The association between vegetarianism and blood pressure was studied in relation to obesity, sex and aspects of lifestyle in 180 Seventh-day Adventists and 113 Mormons aged 25-44 y. 2. Volunteers completed a questionnaire, a 1-day diet record and submitted to standardized measurements of blood pressure, heart rate and body size. 3. Ninety-eight Adventist "vegetarians' were comparable to the 113 Mormon omnivores for strength of religious affiliation, consumption of alcohol, tea and coffee and use of tobacco, but were significantly less obese. 4. Obesity correlated positively with blood pressures in males and females of both diet classes. Age showed a positive correlation with blood pressure in females only. 5. Adjustment of blood pressures for age and Quetelet Index indicated that there is an additional blood pressure reducing effect associated with a vegetarian diet.

Ref #78 - Ferguson LR
SO: Alan R Liss, Inc., New York, 1982
Book Chapter

Ref # 79 - Nnakwe N
SO: Proc Nebraska Academy of Sciences and Affiliated Societies 1982; 92:29
AB: The objective of the project was to compare the calcium and phosphorus utilization of vegetarians and omnivores consuming either self-selected or laboratory controlled vegetarian diets. In Study A, 3-day dietary records of Seventh-Day Adventist omnivore and vegetarian students were collected. Students ate primarily in a lacto-ovo-vegetarian food service. Vegetarian students consumed significantly higher amounts of calcium and phosphorus than did omnivore students suggesting that under the conditions described the vegetarian students were making superior food pattern selections. No significant differences in blood serum calcium and phosphorus levels between these two groups were found. In Study B, vegetarian and omnivore students consumed laboratory controlled vegetarian diets. The vegetarian students excreted significantly less fecal calcium and, thus, exhibited better calcium utilization characteristics than did the omnivore subjects. This suggests that with time some adaptation to vegetarian diets may occur which results in improved calcium utilization. No statistically significant differences were demonstrated between the two groups attributable to phosphorus utilization.

Ref #80 - Miller-AB
SO: Cancer. 1982 Dec 1; 50(11 Suppl): 2533-40
AB: The incidence of gastrointestinal cancers differ greatly internationally. Blacks have higher rates than whites for esophagus, stomach, liver, and pancreatic cancer in the U.S. Differences also occur between other racial groups. Studies on migrants suggest environmental causes for these differences. Stomach cancer rates have fallen, intestine cancer is stable, pancreatic cancer rates rose, but are now falling in males. The incidence of colon, rectal, breast, corpus-uterus, ovary, and prostate cancer are positively correlated, but colon or rectal and stomach cancer are negatively correlated. Colon and rectal cancer mortality are positively and stomach cancer negatively associated with social class. Esophageal, liver, colon, and pancreatic cancer in males are higher in urban areas. Seventh Day Adventists and Mormons show a low risk of colon cancer. Internationally intake of fat is correlated with colon, rectal, and pancreatic cancer, and starch with stomach cancer.

Ref #81 - Fraser GE
SO: Circulation. 1983 Feb; 67(2): 405-12
AB: We studied the relationship between physical fitness and blood pressure in 228 school children. The data were collected as part of the Loma Linda Child-Adolescent Blood Pressure Study. Systolic and diastolic blood pressures were lower in children above average fitness than in children below average fitness among preadolescent and adolescent boys and girls. On multivariate analysis, adjusting for skinfold thickness, an index of lean arm mass, height and age, the relationship between fitness and systolic blood pressure was statistically significant for preadolescent boys and for adolescents of both sexes. The multivariate relationship was not clearly seen for diastolic blood pressure. Multivariate techniques showed that significant correlates of fitness were obesity in preadolescents, age in adolescent boys and height in adolescent girls. Predicted pulse rates for stages 6-10 of a modified Balke treadmill protocol are given in appendix 1 for preadolescent and adolescent boys and girls.

Ref #82 - Shultz TD
SO: Am-J-Clin-Nutr. 1983 Jan; 37(1): 114-8
AB: Human blood selenium (Se) levels have been related to the types of food consumed, bioavailability of Se, and various disease states, including cancer. Some of these interrelationships were investigated in this study in Corvallis, OR (a low soil-Se region) using adult vegetarian and omnivorous subjects, some of whom had hormone-dependent cancer. The study groups were comprised of 48 Seventh-day Adventist vegetarians, 16 Seventh-day Adventist nonvegetarians, 52 non-Seventh-day Adventist nonvegetarians, and 16 nonvegetarian hormone-dependent cancer subjects. Fasting blood samples and 3-days dietary intake information were obtained from each subject. Whole blood Se levels, measured fluorimetrically, correlated positively with dietary protein, riboflavin, niacin, and oleic and linoleic acids but not with 11 other nutrients. Due to limited literature values, dietary Se could not be assessed. There was no significant difference in blood Se values between the four groups (which ranged from 0.069 microgram Se/ml for Seventh-day Adventist nonvegetariants to 0.112 +/- 0.050 microgram Se/ml for non-Seventh-day Adventists nonvegetarians and nonvegetarian hormone-dependent cancer patients). All values were well below averages reported for other regions of the United States. These data suggest a relationship between blood Se and the consumption of meat, milk, and cereal products, but it is not simply a difference between the vegetarian and nonvegetarian diets.

Ref #83 - McEndree LS
SO: Nutr Rep Int 1983; 27:199-206
AB: The ability of vegetarian diets to provide adequate amounts of available iron to iron deficiency vulnerable groups has been questioned. Iron utilization has been shown to be inhibited by soy protein, milk protein, egg albumin, phytates and fiber, all of which are found in abundance in vegetarian diets. The primary objective of the current study was to determine iron intakes and iron nutritional status of lacto-ovo-vegetarian students and omnivore students eating in a lacto-ovo-vegetarian food service. In this survey, iron intakes of both groups were low, but intakes of omnivore subjects tended to be poorer than were those of the vegetarian subjects, suggesting that the omnivore subjects made poorer food choices than die the vegetarians. Biochemical indexes of iron nutritional status, however, did not indicate the omnivore subjects to be in poorer nutritional status than vegetarians. Hemoglobin, hematocrit and serum iron levels were not different between the two groups. One group of vegetarian students did have a statistically lower level of serum ferritin than did the omnivore counterparts. Both groups were not considered anemic, but neither did they have enough iron stores to cope with heavy menstrual losses or pregnancy without possible jeopardy to their iron nutritional status.

Ref #84 - Marsh AG
SO: Am-J-Clin-Nutr. 1983 Mar; 37(3): 453-6
AB: Past studies indicate postmenopausal women who eat meat may experience greater bone mineral loss than lacto-ovo-vegetarian women. The present study extends those findings by comparing bone mineral in adult lacto-ovo-vegetarian and omnivorous males. Bone mineral mass was determined by direct photon absorptiometry in 320 lacto-ovo-vegetarian and 320 omnivorous males 20 to 79 yr old. Lacto-ovo-vegetarians were Seventh-day Adventists committed to their diet for at least 20 yr. Measurements were made at a cortical site along the radius. No statistical differences were identified between bone mineral mass in the lacto-ovo-vegetarian and omnivorous males in any decade examined. When contrasted against significant differences between bone mineral mass in postmenopausal omnivores and lacto-ovo-vegetarians, the data presented here may be interpreted as indicating that some factor associated with meat consumption is increasing bone mineral losses in postmenopausal females while having no observable effect in males.

Ref #85 - Phillips RL
SO: Cancer-Res. 1983 May; 43(5 Suppl): 2403s-2408s
AB: Deaths from cancers of the large bowel, breast, and prostate were ascertained over a 21-year period among 21,295 white California Adventists. Compared to non-Adventists, the age-sex-adjusted mortality for large bowel cancer was substantially reduced among Adventists. Adventists also showed a minimum reduction in mortality for breast and prostate cancer. Fatal large bowel cancer within the Adventist group was unrelated to meat use. However, coffee use showed a substantial positive association with fatal large bowel cancer. Although this association may be indirect or spurious, it deserves further investigation. Weak nonsignificant associations were observed between cancers of the breast and prostate and meat use.

Ref #86 - Jensen OM
SO: J-Natl-Cancer-Inst. 1983 Jun; 70(6): 1011-4
AB: Cancer risk was studied in 781 male Seventh-Day Adventists (SDA) and 808 male members of other temperance societies. Standardized morbidity ratios for all cancers were 0.69 among SDA and 1.05 among other temperants. Significantly decreased risks of cancers were noted among SDA for cancer of the colon [observed/expected (O/E): 0.13], cancer of the respiratory system (O/E: 0.17), cancer of the lung (O/E: 0.15), and cancer of the bladder including papilloma (O/E: 0.13). No significant deviations from expectations were noted among members of other temperance societies. Thus risks of tobacco-associated cancers were markedly decreased among SDA. The risk of alcohol-associated cancers (cancers of the oral cavity, pharynx, esophagus, and larynx) taken together was also decreased (O/E: 0.7), although not significantly so. When the results were compared with those of a previous study of Danish brewery workers who had a high average daily beer intake, the present investigation provides further support that the alleged association between beer consumption and the occurrence of rectal cancer is of a noncausal nature. The explanation for the decreased risk of colon cancer should probably be sought in the dietary practices of SDA.

Ref #87 - Rouse IL
SO: J-Hypertens. 1983 Jun; 1(1): 65-71
AB: The association between blood pressure and a vegetarian diet was studied in relation to obesity, sex, age and lifestyle in 98 Seventh-day Adventist (SDA) lacto-ovo vegetarians, 82 SDA omnivores and 113 Mormon omnivores aged 25 to 44 years. Mean blood pressures adjusted for age, height and weight were significantly lower in SDA vegetarians than in Mormon omnivores (115.6/68.7 and 121.2/72.2, respectively, in males and 109.1/66.7 and 114.9/72.6, respectively, in females) and were not related to past or current use of alcohol, tobacco, tea and coffee, physical activity, personality or religious observance. Mean blood pressures in SDA omnivore males (121.7/71.7) were similar to those in Mormon males, while those in SDA omnivore females (109.9/67.4) were similar to SDA vegetarian females. Quetelet's Index in these subgroups demonstrated the same pattern as blood pressure and may reflect, in part, the high level of physical activity in female SDA omnivores. The prevalence of mild hypertension (greater than or equal to 140 mmHg systolic or greater than or equal to 90 mmHg diastolic) was 10 and 8.5% in Mormon and SDA omnivores, respectively, compared with 1 to 2% in SDA vegetarians. Analysis of diet records showed that vegetarians ate significantly more dietary fibre, polyunsaturated fat, magnesium and potassium and significantly less total fat, saturated fat and cholesterol than did Mormon omnivores. SDA omnivores had a dietary pattern which was less homogeneous, and which lay between those of the other groups. Which, if any, of these dietary differences were responsible for the blood pressure differences could not be determined in this study.

Ref #88 - Phillips RL
SO: Food and Nutrition Press, 1983
Environmental Aspects of Cancer - Book Chapter

Ref #89 - Shultz TD
SO: Nutr-Cancer. 1983; 4(4): 247-59
AB: The relationship between dietary nutrients and plasma estrone, estradiol-17 beta, estriol, dehydroepiandrosterone sulfate, and prolactin levels was investigated in 14 premenopausal Seventh-day Adventist vegetarian (SV) women and 9 premenopausal non-Seventh-day Adventist nonvegetarian (NV) women. The SV subjects consumed less fat, especially saturated fat, and used significantly less fried food than the NV subjects. Plasma levels of estrone and estradiol-17 beta in the SV subjects were significantly lower than in the NV subjects. SV estradiol-17 beta and estriol levels were positively correlated with linoleic acid and protein intake, while NV prolactin levels were significantly correlated with intakes of oleic and linoleic acids and total fat. The data suggest that specific dietary nutrients were related to the hormonal milieu of these SV and NV subjects.

Ref #90 - Snowdon DA
SO: Intervention in the Aging Process, 1983 Alan R. Liss, New York
Book Chapter

Ref #91 - Shultz TD
SO: J-Am-Diet-Assoc. 1983 Jul; 83(1): 27-33
AB: The dietary intakes of Seventh-day Adventist (SDA) vegetarians and nonvegetarians, as well as of non-SDA nonvegetarians, were generally adequate. However, even though iron and vitamin B6 intakes exceeded 100% and 90% of the RDAs for all men, 26% and 19% of the women were consuming less than 60% of the RDAs for iron and vitamin B6.

Ref #92 - Berkel J
SO: Int-J-Epidemiol. 1983 Dec; 12(4): 455-9
AB: The mortality pattern of Seventh-Day Adventists (SDAs) in the Netherlands was assessed during a ten-year study period, 1968-1977. Of 522 deceased SDAs the causes of death of 482 could be ascertained. Standardized Mortality Ratios (SMR) for total mortality (SMR = 0,45), cancer (SMR = 0,50) and cardiovascular diseases (SMR = 0,41) as well as for various subgroups differed significantly from the total Dutch population. Mean age at death as well as life-expectation at baptism were significantly higher in SDAs, both in males and females, as compared with Dutch males and females. A health survey among a sample of the total SDA population and a group of 'friend' controls' was done in order to try to explain the differences in mortality pattern and life expectancy. It is concluded that evidence was found for the thesis that abstinence from cigarette smoking is the main factor explaining the low mortality from ischaemic heart diseases among SDAs, while presumably an appropriate (prudent) diet confers additional benefit for example on colon cancer mortality.

Ref #93 - Semmens J
SO: Metabolism 1983; 32:428-32
AB: The significance of sex hormone levels in determining variation in high-density lipoprotein cholesterol (HDL-C) concentrations was studied in healthy Seventh-day Adventists (vegetarians) and Mormons. These groups were selected to avoid the confounding effects of alcohol consumption and cigarette smoking on HDL-C concentrations. Multivariate analysis showed that testosterone has a strong negative association with HDL-C in men (t=3.99, P<0.001) and women (t=2.04, P<0.05) when controlled for other variables including the concentration of sex-hormone-binding globulin (SHBG). Sex-hormone-binding globulin showed an independent positive association with HDL-C in men (P<0.001) and women (P<0.001). We postulate that the sex hormones affect HDL-C levels by regulating the activities of two important enzymes involved in the production and catabolism of HDL, namely, lipoprotein lipase and hepatic endothelial lipase. Other factors contributing independently to variation in HDL-C levels in this study were, in men, age and triglyceride, and in women, apoprotein-HDL, triglyceride, systolic blood pressure, heart rate, body mass index, and triceps skinfold thickness. Plasma estradiol concentrations were not significantly associated I either sex.

Ref #94 - Semmens JB
SO: Clin-Chim-Acta. 1983 Oct 14; 133(3): 295-300
AB: The associations between sex-hormone-binding globulin capacity (SHBG), age, body mass index (BMI), and physical fitness have been studied in 34 men and 36 women. Multivariate analysis was used to look for independent associations with SHBG. The data indicate that when controlled for a number of other factors SHBG levels are related, in men but not in women, to age (positively, p less than 0.001) and BMI (negatively, p less than 0.001).

Ref #95 - Jedrychowski W
SO: Polski Tygodnik Lekarski 1983; 32:14-7 (in polish)
AB: The study aimed at verifying an opinion that life duration parameters of the Adventist Church followers are higher than in the general population. The study included members of the Adventist Church in Krakow. Probability of survival in particular age groups of this population was determined with Tables of Life Duration, and the obtained results were compared to the parameters of the Polish Tables of Life Duration. Survival index of the Adventist Church followers over 40 years of life was markedly higher than that in the general population both males and females inhabiting large cities. In the general population, survival index was higher in females than in males. No such difference was noted in the Adventist Church followers. The study shows the important influence of lifestyle and health promoting behavior of life-span.

Ref #96 - Abu-Assal M
SO: Nutr Rep Int 1984; 29 (2):485-94
AB: The zinc status of 12 pregnant vegetarian and 17 pregnant nonvegetarian women, aged 23-36 years, was investigated. Fasting plasma samples were collected at a mean gestational age of 37 ± 2 weeks and a mean postpartum time of 11± 7 weeks. Dietary zinc intake, calculated from 3-day dietary records, was 10.5 ± 4.0 mg and 10.9 ± 3.0 mg for the vegetarians and nonvegetarians respectively. Dietary zinc intakes did not correlate with plasma zinc levels. Only one-half of the women in each group were consuming above 50% of the Recommended Dietary Allowance for zinc. Last trimester mean plasma zinc levels of the vegetarians and nonvegetarians were 47.9 ± 12.4 ug/dl and 42.9 ± 9.5 ug/dl respectively. While mean plasma zinc levels of the vegetarians rose only 24% (p<0.2) after term compared with an increase of 55% (p<0.001) in nonvegetarians after term, no significant difference was observed between the postpartum ainc measurements of the 2 groups. A lacto-ovo vegetarian diet did not appear to compromise the zinc status of pregnant women. The birthweights of infants born to the vegetarian mothers were negatively correlated with maternal plasma zinc levels.

Ref #97 - Davidson L
SO: Clin-Sci. 1984 Sep; 67(3): 347-52
AB: Resting and stimulated plasma noradrenaline and adrenaline concentration were compared in 45 females and 45 males of similar age who did not smoke, drink alcohol or caffeine-containing beverages. At rest plasma noradrenaline levels were consistently higher in females and adrenaline levels higher in males. These sex-related differences were maintained after isometric exercise, mental arithmetic and cold pressor testing. Resting noradrenaline concentration was negatively correlated with Quetelet index in males and positively correlated with age in females. These findings, based on precise catecholamine measurements under standardized conditions in subjects of similar age, reveal important sex-related differences which need to be taken into account in assessing sympatho-adrenal activity, particularly in relation to mechanisms in essential hypertension.

Ref #98 - Böing H
SO: Akt Ernähr 1983; 8:187-91
AB: Prospective epidemiological studies with Californian Seventh-day Adventists yielded lower standardized mortality ratios for some diseases for Adventists compared to the total population. These differences concern cardiovascular diseases, cerebrovascular diseases, but also cancer, in particular cancer of the colon and the lung, and they even remained when a control group was used resembling the Adventists in many features more closely than the general population. For some diseases, differences in the mortality rates with increasing adherence to the Adventist lifestyle were observed, while these findings were absent in women. So far, no conclusive explanations could be found for the differences in mortality. Results gained from other populations of vegetarians do, however, point to a possible nutritional influence.

Ref #99 - Rouse IL
SO: Aust-N-Z-J-Med. 1984 Aug; 14(4): 439-43
AB: This paper reviews the association between a vegetarian diet and a number of risk factors for cardiovascular disease investigated in a series of epidemiological and experimental studies. Ninety-eight Seventh-day Adventist "vegetarians" were similar to 113 Mormon omnivores for strength of religious affiliation, consumption of alcohol, tea and coffee and use of tobacco, but were significantly less obese and had significantly lower blood pressures adjusted for age, height and weight. A random sample of forty-seven Adventist vegetarians had significantly lower home blood pressures, serum cholesterol levels and blood pressure responses to a cold-pressor test than Mormon omnivores carefully matched for age, sex and Quetelet's index. In a controlled dietary intervention study mean systolic and diastolic blood pressures and serum cholesterol fell significantly during feeding with a vegetarian diet--an effect unrelated to changes in other lifestyle factors. Dietary analysis indicated that a vegetarian diet provided more polyunsaturated fat, fibre, vitamin C, vitamin E, magnesium, calcium and potassium and significantly less total fat, saturated fat and cholesterol than an omnivore diet. There was no evidence for a difference between vegetarians and omnivores in levels of catecholamines, plasma renin activity, angiotensin II, cortisol or serum and urinary prostanoids.

Ref #100 - Masarei-JR
SO: Aust-N-Z-J-Med. 1984 Aug; 14(4): 400-4
AB: Vegetarian diets produce moderate but appreciable changes in serum lipid levels. A six-week intervention study in which other aspects of life-style were kept constant showed that levels of total cholesterol, LDL-cholesterol and HDL-cholesterol fell 0.22, 0.19 and 0.07 mmol/l, respectively, while triglyceride levels increased non-significantly 0.12 mmol/l. The ratio of total cholesterol to HDL-cholesterol did not change. A comparison of groups of habitual vegetarians and omnivores matched for other aspects of lifestyle showed rather larger differences in atherogenic lipid levels: 0.71 and 0.67 mmol/l for total- and LDL-cholesterol; the difference in HDL-C levels was 0.04 mmol/l; triglyceride was 0.19 mmol/l greater in vegetarians. 92% of the variation in intakes of major nutrients was accounted for by three derived factors; changes in levels of most of the lipids were associated in each case with one of the factors. The resultant falls in the levels of total- and LDL-cholesterol in people adopting a vegetarian diet probably contribute to a reduction in cardiovascular risk.

Ref #101 - Shultz TD
SO: FASEB 1984
AB: Vitamin B-6 levels have been related to dietary intake and various disease states, including breast cancer (BCa). To explore this relationship, fasting blood and 24 h urines were obtained from 14 vegetarian (V), 16 non-vegetarian (NV), and 17 hormone dependent cancer subjects (HDCS) women 45-83 yr of age. All HDCS had been in clinical remission for at least 6 months. The 3 groups were subdivided into vitamin users (VU) and non-users. Dietary intake was estimated from a 3-day diet record. Plasma pyridoxal phosphate (PLP) was analyzed by an enzymatic method. Urinary B-6 (UB6) and 4-pyridoxic acid (4PA) were determined by microbiological and fluorimetric methods, respectively. B-6 intakes for V, NV and HDCS were similar providing 85% of the RDA for V and NV, and 75% for HDCS. There were no significant differences found for PLP, 4PA, and UB6 between nonvitamin user V, NV, and nontherapeutic HDCS or for age categories within groups; however, there were significant differences for mean PLP values (pmol/ml) between V (30.78±11,16; p#0.05), NV (39.32±16.34; p#0.025), nontherapeutic HDCS (35.60±6.88; p#0.005) and chemotherapeutic BCa, HDCS (13.59±8.66), respectively. In VU (1-2.6 mg/d), PLP, 4PA, and UB6 increased slightly, while with >5mg B-6/d a 4-6 fold increase was seen. Since dietary B-6 intakes were similar for all groups, it seems likely that the chemotherapeutic Bca HDCS low PLP values may be associated with impaired B-6 metabolism.

Ref #102 - Cooper R
SO: Am J Epidemiol 1984; 140:471-7
AB: The life-style of adolescents attending a Seventh-day Adventist boarding school was evaluated as it related to cardiovascular risk factors. The diet contained 34% calories as fat, with 11% derived from saturated fat. Total serum cholesterol levels were low (mean, standard deviation = 138±15 mg per dl), and apolipoprotein B level was low as well (46 ±9 mg per dl). The high-density lipoprotein cholesterol level was within the usual range (52.4±13.3 mg per dl). Mean blood pressures were also low (systolic, 104.1±9.6 mm of mercury; diastolic, 65.7±9.7 mm of mercury). There was no self-reported use of cigarettes. If this life-style were to continue through adulthood, the incidence of premature atherosclerotic disease, particularly coronary artery disease, for this group might well be reduced, compared with other North Americans, as suggested by findings from previous studies of adult Seventh-day Adventists.

Ref #103 - Zollinger TW
SO: Am-J-Epidemiol. 1984 Apr; 119(4): 503-9
AB: Survival rates were compared among 282 Seventh-day Adventists and 1675 other white female cancer cases following diagnosis during the 30-year period, 1946 to 1976, at two California hospitals owned and operated by the Seventh-day Adventist Church. The Adventist women had a more favorable 5-year relative survival pattern than the other women (69.7% vs. 62.9%) as well as a higher probability of not dying of breast cancer. The differences, however, were no longer significant when stage at diagnosis was taken into account. It seems likely that the lower breast cancer death rates reported among Seventh-day Adventist women as compared with the general population result in part from better survival patterns due to earlier diagnosis and treatment.

Ref #104 - Kahn HA
SO: Am-J-Epidemiol. 1984 May; 119(5): 775-87
AB: This report examines the association between mortality from all causes during a 21-year period and frequency of consumption of 28 specific foods among 27,530 adult California members of the Seventh-Day Adventist Church. Food consumption was measured at the beginning of the study (1960) by a self-administered questionnaire. Deaths were identified by computer-assisted matching of study subjects to the file of death certificates for all deaths that occurred in California during 1960-1980. All-cause mortality showed a significant negative association with green salad consumption and a significant positive association with consumption of eggs and meat. For green salad and eggs, the association was stronger for women; for meat, the association was stronger for men. All the observed associations were adjusted for age, sex, smoking history, history of major chronic disease, and age at initial exposure to the Adventist Church.

Ref #105 - Snowdon DA
SO: Am-J-Public-Health. 1984 Aug; 74(8): 820-3
AB: In 1960, the coffee consumption habits and other lifestyle characteristics of 23,912 white Seventh-day Adventists were assessed by questionnaire. Between 1960 and 1980, deaths due to cancer were identified. There were positive associations between coffee consumption and fatal colon and bladder cancer. The group consuming two or more cups of coffee per day had an estimated relative risk (RR) of 1.7 for fatal colon cancer and 2.0 for fatal bladder cancer, compared to the group that consumed less than one cup per day (RR = 1.0). These positive associations were apparently not confounded by age, sex, cigarette smoking, or meat consumption habits. In this study, there were no significant or suggestive associations between coffee consumption and fatal pancreatic, breast, and ovarian cancer, or a combined group of all other cancer sites.

Ref #106 - Snowdon DA
SO: Am-J-Epidemiol. 1984 Aug; 120(2): 244-50
AB: Findings described in this report are for 6,763 white male Seventh-day Adventists who completed a dietary questionnaire in 1960. Between 1960 and 1980 mortality data were collected on cohort members. Overweight men had a significantly higher risk of fatal prostate cancer than men near their desirable weight. The predicted relative risk of fatal prostate cancer was 2.5 for overweight men. Suggestive positive associations were also seen between fatal prostate cancer and the consumption of milk, cheese, eggs, and meat. There was an orderly dose-response between each of the four animal products and risk. The predicted relative risk of fatal prostate cancer was 3.6 for those who heavily consumed all four animal products. The results of this study and others suggest that animal product consumption and obesity may be risk factors for fatal prostate cancer.

Ref #107 - Calkins BM
SO: Am-J-Clin-Nutr. 1984 Oct; 40(4 Suppl): 887-95
AB: A study was designed to compare nutritional and metabolic parameters on subjects with a spectrum of vegetarian and nonvegetarian dietary patterns. The method of selection of the study population, the description of its characteristics, and the data collection protocol are described. Anthropometric measurements of vegetarians and nonvegetarians are reported and compared with previously reported measurements on similar populations.

Ref #108 - Calkins-BM
SO: Am-J-Clin-Nutr. 1984 Oct; 40(4 Suppl): 896-905
AB: A 3-day diary with portion sizes weighed by the subject and a 24-h recall were obtained on 50 sets of subjects: Seventh-day Adventist lacto-ovo-vegetarians and nonvegetarians, and general population nonvegetarians, matched on age (+/- 5 yr), sex, marital status, education, type of milk preferred, and an index of the frequency of dairy and egg product use. An additional 18 unmatched persons who follow a pure vegetarian dietary pattern (use no meat, fish, fowl, dairy, or egg products) were recruited into the study. The rational for the dietary methods used is presented and details of each of the methods used are given. The results of the nutrient analysis of the 24-h recall and 3-day diary are presented. The 3-day nutrient intake means for the four groups are compared to the sex-specific recommended daily allowance both with and without supplements. The contribution of nutritional supplements to the nutrient intake is discussed. All groups show adequate or excess intake levels of calories, protein, and fat when either the 24-h recall or the 3-day diary values are considered. The higher intake of calories noted among nonvegetarians can be explained by a higher intake of both fat and protein in these groups. A, B, and C vitamin levels (3-day dairy estimates) are adequate both with and without supplements. Calcium intake is much below recommended levels for pure vegetarian females. Iron intake is low for all females. A heme iron source does not improve the intake levels for nonvegetarian females. A comparison of these results with prior reports of nutrient intake among Seventh-day Adventists is presented.

Ref #109 - Rider AA
SO: Am-J-Clin-Nutr. 1984 Oct; 40(4 Suppl): 906-13
AB: Data obtained from two vegetarian and two nonvegetarian populations by 24-h diet recall, 3-day weighed diet diary, analysis of 3-day composite food samples, and measurement of certain biochemical parameters were compared. Correlations for group means (both sexes combined) for values obtained by 24-h recall versus 3-day diet diary were protein, r = 0.96 and total calories r = 0.86. For 3-day diet diary with food analysis, protein r = 0.89, fat r = 0.90 and for reported protein intake with serum prealbumin r = 0.74, with urinary urea nitrogen r = 0.87. Correlations were low for comparisons of means of male groups for most parameters. Individual correlations for reported protein intake and biochemical parameters were lower for males than for females. This suggests that male subjects may require special attention to insure accuracy of reporting and specimen collection. These findings indicate comparability of data from 24-h recall and 3-day diary, and agreement of dietary records with certain biochemical parameters. Protein and fat intake as determined from chemical analysis of a composite food sample correlated well (r = 0.89; r = 0.90) with that calculated from food tables.

Ref #110 - Rider AA
SO: Am-J-Clin-Nutr. 1984 Oct; 40(4 Suppl): 914-6
AB: In a study designed to characterize dietary patterns of vegetarian and nonvegetarian populations, chemical analysis of 3-day composite food samples showed lower fat content of food of vegetarians than that of nonvegetarians; pure vegetarians had the lowest. Unsaturated fatty acids were highest in the food of the pure vegetarian group. No significant difference was seen in percentage protein of the food consumed by male vegetarians and nonvegetarians while the food of female vegetarians was of lower protein content than that of the nonvegetarians. The relationship of these findings to the lower incidence of colon cancer in vegetarian populations remains to be determined.

Ref #111 - Rider AA
SO: Am-J-Clin-Nutr. 1984 Oct; 40(4 Suppl): 917-20
AB: Selected biochemical parameters (serum protein, albumin, prealbumin, total retinol-binding protein, vitamins A and E, total carotenoids, and urinary urea and creatinine) were determined in healthy, free-living vegetarian and nonvegetarian subjects. The groups studied were composed of Seventh-day Adventist pure vegetarians, Seventh-day Adventist lacto-ovo vegetarians, Seventh-day Adventist nonvegetarians, and general population nonvegetarians. No values indicative of nutritional deficiencies were observed in any of the subjects. Serum carotenoid levels were significantly higher in Seventh-day Adventist pure vegetarians than in members of the other groups. Mean values for serum vitamin A showed no differences between the dietary groups, although 41% of general population nonvegetarian subjects (the group considered at highest risk for colon cancer) had serum vitamin A levels in the upper quartile of the distribution. From these data no conclusions can be drawn relating to the role of dietary habits as determinants of colon cancer risk.

Ref #112 - Kritchevsky D
SO: Am J Coin Nutr 1984; 40:921-6
AB: Serum cholesterol, high-density lipoprotein cholesterol, and triglycerides of three groups of Seventh-day Adventists (SDAs) - true vegetarians, lacto-ovo vegetarians, and nonvegetarians - and the general population were measured and related to age, sex, and diet. True vegetarian SDAs had the lowest cholesterol levels while cholesterol levels of the other three groups were similar. Triglyceride levels were highest in the true vegetarian SDAs and lowest in general population. Cholesterol levels rose with increasing age while percentage of high-density lipoprotein cholesterol fell. Female SDAs in all three dietary groups had higher cholesterol levels than males. In all four groups percentage of high-density lipoprotein cholesterol was higher in females than in males. In the male subjects, cholesterol levels varied linearly and inversely with carbohydrate intake. Protein and fat intake in true vegetarian SDAs and lacto-ovo vegetarian SDA groups were lower than in the nonvegetarian SDA and general population groups. The differences in protein and fat intake were reflected in elevations in serum cholesterol levels. In the female subjects, cholesterol levels were also inversely correlated with carbohydrate intake but not as distinctly as in the males. True vegetarian SDA females ingested less protein and fat than the other three groups and exhibited lower serum cholesterol levels. Cholesterol levels in lacto-ovo vegetarian SDA, nonvegetarian SDA, and general population female subjects were similar and did not reflect differences in protein or fat intake. The true vegetarian dietary lifestyle resulted in lowest cholesterol levels, however, if it was breeched to the least extent, cholesterol levels rose. Thus, intake of skim, low fat, or whole milk resulted in similar serum cholesterol levels as did low or high egg consumption.

Ref #113 - Nair PP
SO: Am-J-Clin-Nutr. 1984 Oct; 40(4 Suppl): 927-30
AB: Cholesterol and fat are implicated as dietary factors enhancing the risk for colon carcinogenesis. Plant sterols such as beta-sitosterol when added to diets of experimental animals treated with colon carcinogens reduce tumor yields and counteract the proliferative changes associated with carcinogenesis. The question of whether the diet of human populations at low risk for colon cancer is mirrored in their sterol composition is addressed in this study. Four study groups consisting of 18 Seventh-day Adventist (SDA) pure vegetarians, 50 SDA lacto-ovo vegetarians, 50 SDA nonvegetarians, and 50 general population nonvegetarians were selected from the greater Los Angeles basin, and 3-day composite diets were analyzed for their sterol composition. The most significant index of dietary sterol status is the ratio, beta-sitosterol + stigmasterol/cholesterol (plant sterol/cholesterol ratio). The values for the four groups ranged from 0.49 to 16.0 (general population nonvegetarians = 0.49; SDA-nonvegetarians = 0.98; SDA lacto-ovo vegetarians = 3.26; SDA pure vegetarians = 16.0). The data also show that the absolute amounts of cholesterol consumed as a factor by itself might not be as significant as its relationship to total plant sterols in the diet.

Ref #114 - Nair PP
SO: Am-J-Clin-Nutr. 1984 Oct; 40(4 Suppl): 931-6
AB: Cholesterol and its metabolites, together with bile acids, are implicated as risk factors in the genesis and progression of colon cancer. This study was designed to determine differences in the neutral sterol composition of stools from four different population groups differing in their dietary habits as well as in their expected rates for colon cancer. Four study groups consisting of 18 Seventh-day Adventist (SDA) pure vegetarians, 50 SDA lacto-ovo vegetarians, 50 SDA nonvegetarians, and 50 general population nonvegetarians were selected from the greater Los Angeles Basin area. Three-day composite stool samples were lyophilized and then analyzed for their neutral sterol composition. Cholesterol excretion values consistently showed an age-dependent peak in 46- to 50-yr age group for the total population, SDA lacto-ovo vegetarian and SDA-nonvegetarian subgroups being the principal contributors to this age-dependent phenomenon. The SDA pure vegetarians exhibited the lowest fecal concentrations and daily excretion of cholesterol as expected since their intake of dietary cholesterol is insignificant. Among the other SDA, regardless of whether they are lacto-ovo vegetarians or nonvegetarians, their cholesterol excretion patterns were similar but higher than in the nonvegetarians from the general population. Since dietary intakes of cholesterol are not significantly different among the two nonvegetarian groups, the differences in excretion values are attributable to differences in colonic metabolism. The ratio of cholesterol/cholesterol metabolites showed generally lower values among nonvegetarians compared to the matched group of lacto-ovo vegetarians. The observation was made that fecal cholesterol and its metabolites tend to be higher among nonvegetarians compared to those in the corresponding vegetarian groups.

Ref #115 - Turjman N
SO: Am-J-Clin-Nutr. 1984 Oct; 40(4 Suppl): 937-41
AB: High levels of fecal bile acids have been associated with populations at high risk for developing colon cancer. In this study, 168 subjects were drawn from populations that show low and high mortality from colon cancer [pure vegetarians, lacto-ovo vegetarians, and nonvegetarians Seventh-day Adventists (SDA) and demographically comparable group from the general population]. Lyophilized aliquots of 3-day stool samples were examined for levels of primary (cholic and chenodeoxycholic acids) and secondary (deoxycholic and lithocholic acids) bile acids. Total bile acids (mg/g lyophilized stools) were statistically different among dietary groups: SDA pure vegetarians 2.16 +/- 0.32, SDA lacto-ovo vegetarians 3.66 +/- 0.41, SDA nonvegetarians 4.39 +/- 0.44, general population nonvegetarians 6.04 +/- 0.75; but were similar when stool weights, body weights, and fat intake were taken into account. The most striking difference was evident in the ratio of secondary to primary bile acids: when compared to SDA pure vegetarians, both SDA lacto-ovo vegetarians and SDA nonvegetarians had twice the ratio while values for general population nonvegetarians were five to six times. The data indicate that these differences in excretion patterns among dietary groups reveal distinctly characteristic metabolic features associated with diet and lifestyle.

Ref #116 - Stich HF
SO: Int-J-Cancer. 1984 May 15; 33(5): 625-8
AB: The effect of dietary components on the levels of nitrosoproline ( NPRO ) excreted over a 24 h period in the urine was examined in volunteers ingesting known amounts of various food products. The ingestion of nitrite-preserved meats (85-170 g per meal), including canned, rolled or Yunnan ham, cured pork, luncheon meat, and various Chinese and European-style sausages, led to urinary NPRO excretion levels ranging from 2.5 to 78.5 micrograms/24 h, whereas the consumption of non-preserved meat and fish products, including chicken, herring, salmon, shrimp, ground beef (hamburger), pork chops and beef liver, led to relatively low NPRO excretion levels, ranging from 0.0 to 0.8 micrograms/24 h. The urinary NPRO levels of 22 vegetarians and 14 lacto-vegetarians averaged 0.8 and 1.4 micrograms/24 h, respectively. A change from a nitrite-preserved meat diet to a vegetarian diet was accompanied by an approximately six-fold reduction in urinary NPRO levels; however, these remained above control levels for at least 3 days following the dietary change. The relatively high NPRO levels following the ingestion of nitrite-preserved meats could not be reduced by nitrite-trapping chemicals, including ascorbic acid, ferulic acid, caffeic acid, or phenolic-containing mixtures such as coffee and tea, which were effective in suppressing endogenous NPRO formation following the intake of nitrate and proline. The high urinary NPRO levels after ingestion of preserved meat products appear to be due to the consumption of preformed NPRO . An understanding of the relative contribution of preformed and endogenously formed nitrosamines appears to be essential when designing dietary intervention programmes.

Ref #117 - Kurup PA
SO: Am-J-Clin-Nutr. 1984 Oct; 40(4 Suppl): 942-6
AB: The role of fiber in human diet in preventing a number of chronic diseases has been a widely debated topic in recent years. The claim that populations at low risk for colon cancer generally consume a more fiber-rich diet than those at high risk, has been used to postulate a protective role for this group of substances. In this study we asked the question whether populations leading different dietary lifestyles and who are at varying risks for colon cancer show marked differences in their dietary and fecal profiles of various fiber components. Four study groups consisting of Seventh-day Adventist (SDA) pure vegetarians, SDA lacto-ovo vegetarians, SDA nonvegetarians, and a group of general population nonvegetarians were selected from the greater Los Angeles Basin area. Three-day composite diets, and stools were analyzed for neutral detergent fiber (NDF), hemi-cellulose, lignin, cellulose, cutin + silica, and pectin. The percentage composition and the daily intake and output of each of these components were computed for each population group. The dietary profile revealed a trend (not statistically significant) toward generally higher daily intake values among the vegetarian subgroups, neutral detergent fiber values in g/day: SDA pure vegetarians, 63.0 +/- 7.9; SDA-lacto-ovo vegetarians, 55.8 +/- 3.5; SDA nonvegetarians, 57.2 +/- 3.5; general population nonvegetarians, 52.5 +/- 4.9), lignin, cellulose, and pectin being the major contributors to this difference.(ABSTRACT TRUNCATED

Ref #118 - Tepper SA
SO: Am-J-Clin-Nutr. 1984 Oct; 40(4 Suppl): 947-8
AB: The binding of glycocholic and glycochenodeoxycholic acids to dried defatted residues of homogenized diets consumed by four dietary groups has been measured. The four groups were true vegetarian Seventh-day Adventists (SDA), lacto-ovo vegetarian SDA, nonvegetarian SDA, and the general population. Glycocholic acid was bound to the same extent (7 to 9%) by all four dietary residues. The true vegetarian SDA residues bound significantly more glycochenode-oxycholic acid than those of either lacto-ovo vegetarian SDA (p less than 0.001) or non-vegetarian SDA (p less than 0.001). The general population residue bound significantly more glycochenodeoxycholic acid than did those of nonvegetarian SDA (p less than 0.001). Binding of glycochenodeoxycholic acid was significantly correlated with dietary neutral detergent fiber (p less than 0.001), hemicellulose (p less than 0.01) and cellulose (p = 0.01). There was no corre-lation between the binding of glycochenodeoxycholic acid and dietary lignin, pectin, or cutin.

Ref #119 - Goodman GT
SO: Am-J-Clin-Nutr. 1984 Oct; 40(4 Suppl): 949-51
AB: Elevated levels of serum hexosaminidase (beta-2-acetamido-2-deoxy-D-glucoside; N-acetamidodeoxy-D-glucohydrolase, EC have been found in patients with cancer. In view of the reported low levels of colon cancer among Seventh-day Adventists (SDA) we determined levels of total HEX, and its heat-labile (HEX-A) and heat-stable (HEX-B) isozymes in vegetarian SDA, lacto-ovo vegetarian SDA, nonvegetarian SDA, and the general public. Lowest levels of total HEX and highest percentage of HEX-B were found in vegetarian SDA. The levels in the other three groups were comparable, and these differences were seen at all age levels. Female subjects exhibited significantly lower total HEX levels than the males but the percentage of HEX-B was the same.

Ref #120 - Snowdon DA
SO: Prev-Med. 1984 Sep; 13(5): 490-500
AB: In 1960 the meat-consumption habits of 25,153 California Seventh-Day Adventists were assessed by questionnaire. Between 1960 and 1980 ischemic heart disease deaths were identified. Meat consumption was positively associated with fatal ischemic heart disease in both men and women. This association was apparently not due to confounding by eggs, dairy products, obesity, marital status, or cigarette smoking. The positive association between meat consumption and fatal ischemic heart disease was stronger in men than in women and, overall, strongest in young men. For 45- to 64-year-old men, there was approximately a threefold difference in risk between men who ate meat daily and those who did not eat meat. This is the first study to clearly show a dose-response relationship between meat consumption and ischemic heart disease risk.

Ref #121 - Howden GF
SO: P-N-G-Med-J. 1984 Sep-Dec; 27(3-4): 123-31
AB: The island of Aua 143 miles off the N.E. coast of Papua New Guinea has a population consisting of (41%) Roman Catholics who chew betel nut regularly and (59%) Seventh Day Adventists who do not. This provided an ideal opportunity to compare the effects of betel nut chewing on all aspects of dental health against an identical population who did not chew and therefore provided an excellent control. The results of this survey showed, for those of the population who had never lived away from the island, that for betel nut chewers the prevalence of dental caries was 23% whereas for non-chewers it was considerably and statistically significantly greater at 49%. The amount of dental caries as measured by DMFT was also considerably and statistically significantly greater for this group of non-chewers at 1.162 compared with 0.364 for chewers. The above findings confirmed the work of other investigators which at the time of this survey were not known to the author, and this led to a laboratory investigation of the possibility that the betel nut stain may mediate its effect by acting as a chemical or physical barrier against the acid attack of dental caries. Betel nut stained teeth from PNG, which had been extracted due to periodontal disease were prepared with "windows" of enamel from which the betel nut stain had been removed, and their roots were protected by layers of varnish. These teeth were maintained in an "Artificial Caries Medium" at pH's of 3.5, 4.0 and 4.5 for several months.(ABSTRACT TRUNCATED AT 250 WORDS)

Ref #122 - Nnakwe N
SO: Nut Rep Intl 1984; 29:365-9
AB: The objective of the project was to compare the calcium and phosphorus intakes and status of vegetarians and omnivores consuming self-selected diets in a lacto-ovo-vegetarian food service. For 3 days, Seventh-day Adventist omnivore and vegetarian students who ate primarily in a lacto-ovo-vegetarian food service kept dietary diaries. Samples of all foods served were collected and were analyzed for calcium and phosphorus content. Fasting blood samples were also drawn from the subjects and serums were analyzed for calcium and phosphorus content. Vegetarian students consumed significantly higher amounts of calcium and phosphorus than did omnivore students suggesting that under the conditions described the vegetarian students were making superior food pattern selections. No significant differences in blood serum calcium and phosphorus levels between these two groups were found.

Ref #123 - Snowdon D
SO: Am J Epidemiol 1984; 120:480
AB: In 1960, 7,036 white Seventh-day Adventist married couples were identified and, during the following 21 years, deaths were ascertained among 65-94-year-old members of this group. These married couples were a subgroup of a population of approximately 25,000 Adventists who completed a questionnaire at the beginning of the study in 1960. Risk of death among subjects who experienced bereavement due to the loss of their spouse during follow-up was compared to the risk among the subjects who remained married. Bereaved subjects experienced a significant excess risk of death from all causes combined, ischemic heart disease, and stroke. Bereaved and married subjects, however, had approximately the same risk of death from all cancers combined. The age- and sex-adjusted relative risk of death from all causes combined for bereaved subjects compared to the married subjects was 1.5 (95% confidence interval (CI) = 1.3-1.7) during the first five years of bereavement, and 1.7 (95% CI = 1.4-2.1) during the first year of bereavement, and 2.2 (95% CI = 1.5-3.3) during the first two months of bereavement. Other findings from this study indirectly suggest that involvement in church religious and social activities does not lower the excess risk of death among bereaved subjects.

Ref #124 - Hodgkin-JE
SO: Chest. 1984 Dec; 86(6): 830-8
AB: The prevalence of respiratory symptoms, as ascertained by questionnaire, was evaluated in 6,666 nonsmokers who had lived for at least 11 years in either a high photochemical pollution area (4,379 individuals) or a low photochemical pollution area (2,287 individuals). Of these, 5,178 had never smoked, and none was currently smoking. The risk estimate for "definite" COPD, as defined in this study, was 15 percent higher in the high pollution area (p = 0.03), after adjusting for sex, age, race, education, occupational exposure, and past smoking history. Past smokers had a risk estimate 22 percent higher than never smokers (p = 0.01). Multivariate analysis showed a significant effect of air pollution on the prevalence of "definite" COPD which univariate analysis failed to demonstrate.

Ref #125 - Modeste NN
SO: Intl Quarterly of Community Health Education 1984-85; 5(3):203-11
AB: This cross-sectional study presents an assessment of factors associated with elevated blood pressure in Seventh-day Adventists in the Caribbean. Four-hundred-thirty-three subjects were randomly selected from the English-speaking Caribbean population. Subjects ranged in age from twenty-one to sixty: 150 were males and 283 females. Eighty percent were Negroes of African descent, 12 percent mixed, 8 percent Indians of East Indian descent, and 3 percent of Spanish background. The study utilized the PRECEDE model developed by Green and associates to examine factors for hypertension. A positive correlation was found between body mass index (weight in Kg/height in M2) and hypertension in both sexes. Age was also significantly associated with hypertension. Normotensive females had a slightly higher intake of potassium than hypertensives, while hypertensive males tended to have higher levels of calcium. Other factors, such as parental history of blood pressure, vegetarian diet, sugar and fat intake, or Type A/B personality showed no relationship to hypertension. The vast majority of participants were Type B. This study provides baseline information for use in selecting those features which will be emphasized in a health education program, as well as baseline data for evaluation of health education in the Caribbean.

Ref. #126 - Spuehler J
SO: Federation Proc. 1985; 23:49-52
AB: Specific nutrients may modify hormonal balance and contribute to breast cancer etiology. This study investigated relationships between nine dietary nutrients and plasma and urine hormone levels. Ten SDA vegetarian (SV), and 10 SDA non-vegetarian (SNV) women were studied. For each 3-day study period, diet records, fasting midluteal bloods and 24 h urines were collected. All were similar as to age, height, weight, age at menarche, menstrual cycles, and body fat measures. Urinary unconjugated estrone, estradiol-17ß (E2) and estriol, as well as plasma E2, dehydroepiandroesterone-sulfate (DHEA-S), prolactin (Prl) and progesterone were determined by RIA. SNV consumed significantly more protein (p<0.025), total and saturated fats (p<0.02, p<0.005), oleic and linoleic acids (p<0.02, p<0.05), and cholesterol (p<0.001) than SV; SV consumed more crude fiber (p<0.05). Hormonal status of SV and SNV did not differ significantly. SV DHEA-S levels correlated positively with total and saturated fats, and cholesterol (r=0.66, p<0.025; r=0.68, p<0.025; r=0.64, p<0.025, respectively). SNF Prl levels were positively correlated with dietary protein, total and saturated fats (r=0.75, p<0.01; r=0.64, p<0.025; r=0.64, p<0.025, respectively). These data suggest a possible relationship between hormonal balance and dietary milieu.

Ref #127 - Jedrychowski-W
SO: Scand-J-Soc-Med. 1985; 13(2): 49-52
AB: The purpose of the work was to test the hypothesis that the survival rate is higher among the Seventh Day Adventists (SDA) than in the general population of Poland, because of the strictly respected customs adhered to by members of this church community, such as abstinence from smoking and from alcohol. The data on life expectancy in the SDA community covered a total of 236 members of this denomination in Krakow (86 males and 150 females). The survival probability rates were estimated by the life table method, for both men and women separately, and were subsequently compared with the corresponding parameters of the Polish Life Tables. Over a period of 10 years, in which these data were studied, there were 11 deaths in males and 24 deaths in females. Mean age at death was 71.9 years among men and 75.1 among women. The survival curves traced over the age groups of both sexes of SDA members were fairly similar, but they were markedly higher than in the general population of Poland. In the general population the survival rates for people over 40 years old were higher in females than in males, whereas no corresponding sex differences in rates concerning SDA members were observed. The greater benefit in life expectancy is gained in the SDA group in comparison with men in the general population. This is attributable to their abstinence from very harmful habits, otherwise more widespread in this sex group.

Ref #128 - Halvorsen GA
SO: Tidsskr Nor Laegeforen 1985; 24:1620-5
AB: In Norwegian

Ref #129 - Phillips RL
SO: J Natl Cancer Inst. 1985 Feb; 74(2): 307-17
AB: Associations between fatal colon or colorectal cancer and frequency of use of meat, cheese, milk, eggs, green salad, and coffee, as well as percent desirable weight, are described with the use of 21 years of follow-up for 25,493 white California Seventh-Day Adventists. Associations are presented in terms of relative risk (RR) of colorectal cancer for heavy or light exposure versus rare exposure. There were no clear relationships evident between colon or rectal cancer and meat, cheese, milk, or green salad use. Egg use was positively associated with risk of fatal colon cancer in both males (RR = 1.6) and females (RR = 1.7). Coffee use was positively associated with both colon and rectal cancer mortality in males and females, particularly for colon cancer during the last 11 years of follow-up (male RR = 3.5; female RR = 1.9). Overweight (percent of desirable weight greater than or equal to 125) was associated with an increased risk of fatal rectal cancer in both sexes combined (RR = 2.8) and colon cancer in males only (RR = 3.3). Furthermore, eggs, coffee, and overweight appear to be independently associated with risk of both colon and colorectal cancer. These three factors may explain a substantial portion of the colorectal cancer mortality differential between Adventists and U.S. whites (62% for males; 30% for females).

Ref #130 - Snowdon DA
SO: Am-J-Public-Health. 1985 May; 75(5): 507-12
AB: We propose the hypothesis that a vegetarian diet reduces the risk of developing diabetes. Findings that have generated this hypothesis are from a population of 25,698 adult White Seventh-day Adventists identified in 1960. During 21 years of follow-up, the risk of diabetes as an underlying cause of death in Adventists was approximately one-half the risk for all US Whites. Within the male Adventist population, vegetarians had a substantially lower risk than non-vegetarians of diabetes as an underlying or contributing cause of death. Within both the male and female Adventist populations, the prevalence of self-reported diabetes also was lower in vegetarians than in non-vegetarians. The associations observed between diabetes and meat consumption were apparently not due to confounding by over- or under-weight, other selected dietary factors, or physical activity. All of the associations between meat consumption and diabetes were stronger in males than in females.

Ref #131 - Lipkin M
SO: Cancer-Lett. 1985 Mar; 26(2): 139-44
AB: The proliferation of epithelial cells in colonic mucosa was studied in humans at varying degrees of risk for colon cancer. Seventh-Day Adventist vegetarians, known to have significantly lower mortality from colon cancer than the general U.S. population, had the most quiescent proliferative activity of mucosal epithelial cells. Increased replication and expansion of the proliferative compartment accompanied increased colon cancer risk. The analytical methods of this study may be useful in assessing the influence of dietary components involved in the initiation, promotion or inhibition of colon cancer, and in developing strategies for nutritional intervention.

Ref #132 - Howie BJ
SO: Am-J-Clin-Nutr. 1985 Jul; 42(1): 127-34
AB: The relationship between dietary nutrients and plasma testosterone, 5 alpha-dihydrotestosterone, estradiol-17 beta, luteinizing hormone, and prolactin levels was investigated in 12 Seventh-Day Adventist (SDA) vegetarian (SV), 10 SDA nonvegetarian (SNV), and 8 non-SDA nonvegetarian (NV) men. Fasting blood samples and 3-day dietary intake information were obtained from each subject. The SV subjects consumed significantly more crude and dietary fiber than the SNV and NV subjects, respectively. Plasma levels of testosterone and estradiol-17 beta were significantly lower in the SV than in the omnivores. Additionally, the plasma levels of testosterone and estradiol-17 beta of the combined groups (SV, SNV, and NV) revealed a significant negative relationship with their crude and dietary fiber intakes. These subjects hormonal milieu was related to specific dietary constituents, possibly leading to a decreased plasma concentration of androgen and estrogen in vegetarians. Implications include the possible modification of prostate cancer risk through dietary intervention.

Ref #133 - Mack TM
SO: Natl-Cancer-Inst-Monogr. 1985 Dec; 69: 235-45
AB: The patterns of cancer risk by religion in the large multidenominational population of Los Angeles County were examined with the method of proportional incidence. Risk estimates for individual cancers by religion were screened and those extreme but stable estimates found were reexamined in light of relative socioeconomic class, nativity, and ethnicity. Within Protestant denominations, gradients which can still best be attributed to religious preference were observed for leukemia, stomach, and cervix cancer. Roman Catholics tend to have high risks of stomach and gallbladder and a low risk of prostate cancer, whereas Eastern Orthodox women trade high risk of stomach cancer for low risk of endometrial and lung cancer. The most extreme pattern of risk, that for Jews, is comprised of lowered risk for cervical cancer and for most sites usually associated with smoking, plus consistently higher risk for lymphomas, thyroid cancer, and bladder cancer among males. Like Jews, Seventh-Day Adventists experience high risk for lymphoma and low risk for cervical and respiratory cancers. Risk to Mormons in Los Angeles differs from that of the standard Protestant population in only minor and inconsistent ways. Neither Mormons nor Adventists showed the previously reported deficits of colorectal or breast cancer. Although the method of proportional incidence may be partly responsible for our failure to confirm previous findings, nonreligious cultural or methodologic factors in the original investigations also provide plausible explanations. More generally, associations of the modest magnitude observed between cancer risk and religion in American populations should probably not be attributed to religious life-style, unless extraordinary circumstances permit the exclusion of other determinants.

Ref #134 - Repace JL
SO: Environment International 1985; 11:3-22.
AB: This work presents a quantitative assessment of nonsmokers' risk of lung cancer from passive smoking. The estimates given should be viewed as preliminary and subject to change as improved research becomes available. It is estimated that U.S. nonsmokers re exposed to from 0 to 14 mg of tobacco tar per day, and that the typical nonsmoker is exposed to 1.4 mg per day. A phenomenological exposure-response relationship is derived, yielding 5 lung cancer deaths per year per 100,000 persons exposed, per mg daily tar exposure. This relationship yields lung cancer mortality rates and mortality ratios for a U.S. cohort which are consistent to within 5% with the results of both of the large prospective epidemiological studies of passive smoking and lung cancer in the United States and Japan. Aggregate exposure to ambient tobacco smoke is estimated to produce about 5000 lung cancer deaths per year in U.S. nonsmokers aged $35 yr, with an average loss of life expectancy of 17 ± 9 yr per fatality. The estimated risk to the most-exposed passive smokers appears to be comparable to that from pipe and cigar smoking. Mortality from passive smoking is estimated to be about two orders of magnitude higher than that estimated for carcinogens currently regulated as hazardous air pollutants under the federal Clean Air Act.

Ref #135 - Snowdon DA
SO: Diet and ovarian cancer.
Letter to the Editor

Ref #136 - Register UD
SO: Frontiers in Longevity Research
Book Chapter

Ref #137 - Shultz TD
SO: Current Topics in Nutrition and Disease 1985; 13:419-27
AB: It has been estimated that as many as 50% of adult Americans use vitamin supplements regularly. Several reports have shown that 75% of Americans believe that the luxus consumption of vitamins is beneficial, no matter how adequate their diets. In recent years, the American public has been inundated by the claims of promoters that vitamin and mineral supplements will cure arthritis, cancer and heart disease. In the public's search to improve health and cure disease, over $1.5 billion is spent annually on supplements. Greengard has reported that no single class of drugs has been so misunderstood, misrepresented, and misused as vitamins. About 4,000 cases of vitamin poisoning occur each year. Nutritionists frequently alert the public to the inappropriate use of food supplements. The fact that several fat-soluble vitamins can be toxic has been well documented, but toxicity due to over-consumption of vitamin B-6 has received much less attention because of its presumed low toxicity. The objectives of this study were to assess vitamin B-6 intakes and plasma and urinary metabolite interrelationships I groups of users and non-users of vitamin supplements and to identify levels of supplemental vitamin B-6 intake in a free-living population.

Ref #138 - Fønnebø V
SO: Am J Epidemiol. 1985 Nov; 122(5): 789-93
AB: Seventh-day Adventists in Tromso showed a coronary risk factor pattern similar to Seventh-day Adventists in other parts of the world. Compared with non-Seventh-day Adventists, serum cholesterol was 1.35 mmol/liter (1974) and 0.83 mmol/liter (1979-1980) lower in males and 0.64 mmol/liter (1979-1980) lower in females. Blood pressure was lower in Seventh-day Adventist women. The religiously inactive Seventh-day Adventists had risk factor patterns more similar to non-Seventh-day Adventists.

Ref #139 - FitzSimmons SC
SO: Dissertation (University Microfilms International, Ann Arbor, MI

Ref #140 - Ferguson LR
SO: Nutr-Cancer. 1985; 7(1-2): 93-103
AB: Using repair-proficient and repair-deficient strains of E. coli, we investigated the application of a liquid incubation assay to measure the DNA-damaging activity of ethanol-soluble fecal extracts. This method appears to be suitable for the study of a wide range of sample types. It was used to measure the DNA-modifying activity of ethanol-soluble fecal extracts from a group of European colorectal cancer patients. Data were compared with those from Europeans of similar age and sex distribution who did not have bowel cancer. We also studied groups of Maoris, Samoans, and European Seventh-Day Adventists who followed an ovo-lacto vegetarian diet. There are significant levels of DNA-modifying materials in the feces of many Europeans on a mixed diet, regardless of whether or not they have cancer. The number of positive samples was less in the Polynesian groups, and there were no samples that could be unequivocally scored as positive in the Seventh-Day Adventist groups. We conclude that diet can significantly reduce the level of ethanol-soluble mutagens, at least in New Zealand Europeans. The data may provide an explanation for the reduced incidence of bowel cancer in Seventh-Day Adventist groups.

Ref #141 - Hirayama T
SO: Natl-Cancer-Inst-Monogr. 1985 Dec; 69: 143-53
AB: Using 16 years of follow-up results of a prospective cohort study for 122,261 men, 95% of the census population, aged 40 years and older in 29 Health Center Districts in Japan as subjects, we compared the age-standardized mortality rates for cancer of each site and other causes of death in Japanese with life-styles similar to those of Seventh-Day Adventists (SDA), i.e., no smoking, no drinking, no meat consumption daily and eating green and yellow vegetables daily, with those of Japanese with opposite life-styles. Compared with the latter Japanese, the risks were one-fifth or less in Japanese with SDA-like life-styles for cancers of the mouth, pharynx, esophagus, and lung, and subarachnoid hemorrhage. Risks were less than one-half for cancers of all sites, stomach, and liver, and for peptic ulcer and heart disease. As a single factor, the addition of daily smoking was observed to elevate the risk most strikingly in Japanese who followed SDA life patterns. Influences of further addition of habits of daily drinking of alcohol and dietary changes were significant for cancers of the esophagus, liver, and bladder and other selected diseases. Strategies for cancer prevention by means of life-style modification, e.g., increased consumption of green and yellow vegetables, were discussed.

Ref #142 - Melby CL
SO: Nutr Res 1985; 5:1077-82
AB: The purpose of this study was to examine the relationship between dietary status and blood pressure (BP) in a population of adult Seventh-day Adventists attending a statewide church conference. A total of 215 conferees (0 age = 52 yrs.) Volunteered to complete a lifestyle questionnaire (LSQ) designed to obtain information on selected demographic and psychosocial variables, medical history, and dietary and other health-related habits. Height and weight were measured, and a minimum of two blood pressure readings using a random baseline mercury sphygmomanometer were taken from each individual by observers blind to the participants' LSQ responses. Participants were divided into vegetarian and non-vegetarian categories based on self-reported dietary habits. Significantly fewer (x2 = 14.4, p<0.001) vegetarians (n=21, 14.0%) reported a history of physician-diagnosed hypertension compared to non-vegetarians (n=27). An analysis of variance showed that blood pressure of vegetarians (n=135, 0 = 114/71) was significantly lower (p<.05) than the BP of the non-vegetarians (n=53, 0 = 122/74). When blood pressures were adjusted for the covariates of age, sex, and body mass index, there was no significant difference in blood pressure between the two groups. Further analyses revealed that the lower BP in the vegetarians appeared to be best explained by their lower body mass index.

Ref #143 -Linkosalo E
SO: Scand-J-Dent-Res. 1985 Aug; 93(4): 304-8
AB: Twenty-eight lactovegetarians as well as age- and sex-matched controls were interviewed about their dietary habits, especially the frequency of ingesting acid fruits, drinks and foods, as well as their dental health habits. Samples of stimulated saliva were collected in connection with the clinical and radiologic study. Plaque, Gingival and Calculus Indices were not significantly different in lactovegetarians and controls. Of the lactovegetarians 76.9% and of the controls none had dental erosions on some tooth surfaces. In lactovegetarians the rate of flow of stimulated saliva was lower than in controls but did not decrease with advancing age as it did in controls. Salivary pH was lower in lactovegetarians than in controls.

Ref #144 - Stich HF
SO: Int-J-Cancer. 1986 Mar 15; 37(3): 389-93
AB: Beta-carotene was estimated in exfoliated oral mucosa cells in groups of individuals at various risks for oral cancer. Approximately 4 X 10(6) exfoliated cells were collected from each subject by brushing the oral mucosa. Cell pellets were hydrolyzed with pronase and then with KOH/methanol. Beta-carotene was extracted with hexane, separated by reverse-phase HPLC, and detected at 450 nm. Mean beta-carotene levels in exfoliated cells were 0.08 ng/10(6) cells for 56 heavy consumers of alcoholic beverages (150 g or more per week), 1.36 ng/10(6) cells for 28 Seventh Day Adventists (all abstainers from alcohol, tobacco and meat consumption), 1.39 ng/10(6) cells for 55 lacto-vegetarians of the International Society for Krishna Consciousness (ISKC) (abstainers from alcohol and tobacco), and 1.08 ng/10(6) cells for 61 representatives of a "Western" life-style pattern (64% consumed the equivalent of at least one bottle of wine or 7 bottles of beer per week, and all were non-smokers). If the heavy alcohol consumers (males) are matched to non-drinking males of comparable age, the mean beta-carotene values are 0.08 ng versus 1.24 ng/10(6) cells. The possible involvement of the low levels of beta-carotene in the mucosa of heavy alcohol drinkers in increased sensitivity towards the carcinogenic and genotoxic activity of cigarette smoking plus alcohol ingestion is discussed.

.Ref #145 - Wulf HC
SO: Mutat-Res. 1986 Aug; 162(1): 131-5
AB: 42 Seventh-Day Adventists (SDAs) and 42 controls matched for sex, age and occupation had their sister-chromatid exchange (SCE) examined in peripheral blood lymphocytes. This was done to examine if the SCE frequency was lower in this group of people, who are known to have a decreased cancer risk compared to the general population. The average SCE/cell in 30 cells from each person was 5.54 +/- 0.07 (mean +/- standard error of the mean) for the SDAs and 8.00 +/- 0.15 for the controls, the difference being statistically significant (p less than 0.00001). No difference in SCE frequency was found between SDAs eating only an ovo-lacto-vegetarian diet and those eating some fish or meat. The mitotic index (MI) was significantly higher and the replication index (RI) was significantly lower in SDAs than in controls. No correlation was found between gamma (a statistical transformation of SCEs/cell) and MI or RI within the groups of SDAs or controls. In the pooled data there was a negative correlation of gamma and MI and a positive correlation of gamma and RI. Of the interpersonal variation in gamma 8% and 14% could be explained by MI and RI. The finding of a lower SCE frequency in a group of SDAs who have a low risk of cancer might indirectly indicate a relation between SCE and cancer and encourages further studies of SCE and diet.

Ref #146 - Kuratsune M
SO: Environ-Health-Perspect. 1986 Aug; 67: 143-6
AB: To elucidate the effect of intake of mutagenic and/or carcinogenic pyrolysis products of proteins and amino acids on carcinogenesis in man, we have undertaken two epidemiologic cohort studies: one concerning the possible association of broiled fish consumption with cancer and the other concerning the cancer mortality among Japanese Seventh-Day Adventists. The main findings of these studies are described.

Ref #147 - Phillips RL
SO: Plant Proteins: Application, Biologic Effect, and Chemistry. 1986; pp 162-174.
AB: This report summarizes 21 years of mortality follow-up for 25,000 California members of the Seventh-day Adventist church. Compared to the general population, Adventists have an exceptionally low risk of fatal lung cancer which is clearly accounted for by their lack of cigarette smoking. They also have a marked reduction in risk of fatal large bowel cancer, coronary disease, stroke, diabetes and nontraffic accidents. Compared to Adventists who heavily use meat, the vegetarian Adventists have a substantially lower risk of fatal coronary disease, fatal diabetes and death from any cause, especially among men. Among Adventist men who use few animal products (meat, milk, cheese, eggs) the risk of fatal prostate cancer is one third that of Adventist men who heavily use such products. Moderate use of coffee is associated with an increased risk of fatal large bowel cancer among both sexes and an increased risk of coronary death and all-cause deaths among males. Since the amount of meat and coffee used by Adventists tends to reflect their overall adherence to the prudent practices advocated by the Adventist church, these findings suggest that the Adventist lifestyle may delay premature death from several major causes of death.

Ref #148 - Calkins BM
SO: Handbook of Dietary Fiber and Nutrition (Spiller G, ed.)
Book Chapter

Ref #149 - Fisher M
SO: Arch-Intern-Med. 1986 Jun; 146(6): 1193-7
AB: Vegetarians have an apparent diminished risk for the development of ischemic coronary heart disease. This may be secondary to dietary effects of plasma lipids and lipoproteins, but platelets, which may also play a role, have also been observed to have aberrant functions in vegetarians. We measured plasma lipid and lipoprotein levels, platelet function, platelet fatty acid levels, and platelet active prostaglandins in ten strict vegetarians (vegans), 15 lactovegetarians, and 25 age- and sex-matched omnivorous controls. The most striking observations were a highly significant rise in platelet linoleic acid concentration and a decline in platelet arachidonic acid concentration in both vegetarian subgroups as compared with omnivorous controls. Serum thromboxane and prostacyclin levels as well as results of platelet aggregation studies did not differ among the groups tested. Cholesterol levels were significantly lower in both vegetarian groups as compared with controls, but plasma high- and low-density lipoprotein levels were lower only in the vegan subgroup as compared with omnivores. If diet produces these changes in platelet fatty acid and plasma lipid levels it may contribute to the decreased risk of coronary heart disease and possibly atherosclerosis in vegetarians.

Ref #150 - Mills PK
SO: Dissertation (University Microfilms International, Ann Arbor, MI

Ref #151 - Chan JY
SO: Aust Fam Physician 1986; 15(9):1154
AB: Continuing the series on the relationship between medical and religious ethics, this publication is a personal view by John Y Chan, a Seventh-day minister. The article does not represent the official view of the church.

Ref #152 - Fraser GE
SO: Am-J-Epidemiol. 1987 Oct; 126(4): 638-46
AB: Seventh-day Adventists in California have much lower mortality from ischemic heart disease than do other Californians, but the risk factors have not been well documented previously for a representative sample. This study, conducted in 1982, chose a random sample of 160 Californian non-Hispanic white middle-aged Adventist men, 160 of their similar-aged male neighbors, and documented traditional ischemic heart disease risk factors. Results show major dietary differences between the two groups as expected, this being reflected in significant differences in consumption of total fat, saturated fat, dietary cholesterol, and crude fiber. Questionnaire data suggested that the Adventists also exercised 50% more, rarely smoked, but had identical Framingham Type A/B scores. There were no differences in obesity or blood pressure levels, but serum total cholesterol was significantly lower in the Adventists (190.1 vs. 203.5 mg/dl, p less than 0.001), as was low density lipoprotein cholesterol (125 vs. 134.0 mg/dl, p less than 0.03) and high density lipoprotein (HDL) cholesterol (42.3 vs. 46.0 mg/dl, p less than 0.005). Consequently, the ratio of total cholesterol/HDL cholesterol was virtually identical between the two groups. Possible explanations for some of these findings are discussed.

Ref #153 - Shultz TD
SO: Am-J-Clin-Nutr. 1987 Oct; 46(4): 647-51
AB: It has been hypothesized that the vitamin B-6 status of vegetarians and nonvegetarians may differ in relation to bioavailability of vitamin B-6. Fasting blood samples and 24-h urine collections were obtained from 13 Seventh-day Adventist (SDA) vegetarian and 16 non-SDA nonvegetarian women aged 50-83 y. The two groups were further subdivided into vitamin users and nonusers. Dietary intake was estimated from a 3-d diet record. Plasma pyridoxal 5'-phosphate (PLP) was measured by an enzymatic method. Vitamin B-6 intakes were similar and provided 85% of the RDA for both groups. The vegetarians consumed significantly more crude fiber than the nonvegetarians. No significant differences were found between the two groups for plasma PLP, urinary 4-pyridoxic acid, and urinary vitamin B-6 among vitamin nonusers or for age categories within groups. There appeared to be no adverse effect of fiber on the availability or metabolism of vitamin B-6 between these free-living groups.

Ref #154 - Beilin LJ
SO: Biblthca Cardiol 1987; 41:85-105
AB: An interest in the possible blood pressure lowering effect of a vegetarian diet dates back to the early part of this century when Hamman in 1917 concluded that meat was harmful for patients with hypertension. Subsequently Donaldson in 1926 reported that blood pressures of vegetarian college students increased significantly within 2 weeks of adding meat to their diet. Before viewing more recent studies which have attempted to explore the influence of a vegetarian diet on blood pressure, it is important to define the range of diets and populations involved. With few exceptions the vegetarian dietary pattern which has been studied is more correctly described as lacto-ovo-vegetarian, which in addition to the infrequent use of meat, fish and poultry is usually characterized by moderate use of eggs and dairy products and a relatively high intake of whole grain cereals, vegetables, fruit and vegetables.

Ref #155 - Beilin LJ
SO: Nephron. 1987; 47 Suppl 1: 37-41
AB: There is now convincing evidence from epidemiological studies and randomized controlled trials that adoption of an ovo-lacto vegetarian diet leads to blood pressure reduction in both normotensive and hypertensive subjects. This effect appears to be independent of both dietary sodium and weight loss but additive to effects of weight reduction. Long-term adherence to a vegetarian diet is associated with less of a rise of blood pressure with age and a decreased prevalence of hypertension. The nutrients responsible for these effects have not been clearly identified and the mechanisms involved are unknown. Resolution of these questions is needed to enable more widespread adoption of dietary changes which may reduce the prevalence of hypertension, reduce antihypertensive drug dependence and by effects on blood pressure and blood lipids ameliorate the natural history of hypertensive cardiovascular disease.

Ref #156 - Shultz TD
SO: Am-J-Clin-Nutr. 1987 Dec; 46(6): 905-11
AB: To investigate possible differences in tissue exposures to reproductive hormones and to determine hormone-nutrient interrelationships, we studied 10 vegetarian and 10 nonvegetarian premenopausal Seventh-day Adventist women. Over 3 d in each of three consecutive menstrual cycles, we collected diet records, fasting midluteal phase blood, and 24-h urine samples. During each study period, we measured plasma and urinary estrogens, plasma free and protein bound-estradiol-17 beta, the binding capacity of sex-hormone-binding globulin (SHBG), androgens, progesterone, and prolactin levels. The omnivores consumed significantly more protein, total and saturated fatty acids, oleic and linoleic acids, and cholesterol than did the vegetarians. Hormonal status and binding capacity of SHBG were similar in both groups. However, for nonvegetarians, prolactin levels were positively correlated with dietary energy, protein, total and saturated fatty acids, and oleic acid. Further study delineating the effects of specific dietary nutrients on the basal level of prolactin secretion is warranted.

Ref #157 - Ringstad J
SO: Ann-Clin-Res. 1987; 19(5): 351-4
AB: High serum selenium concentration may protect against cardiovascular disease and cancer. Seventh-Day Adventists have a low risk for these diseases. This study of 32 Seventh-Day Adventists and matched controls in Tromso shows that Seventh-Day Adventists have a lower serum selenium concentration (1.45 mumol/litre versus 1.58 mumol/litre, 99% confidence interval of the difference = 0.01-0.24). The difference in serum selenium levels was positively associated with difference in the consumption of fish (p = 0.05), but no association was found with other dietary items. Aspects other than serum selenium concentration must explain the lower incidence of cardiovascular disease and cancer among Seventh-Day Adventists.

Ref #158 - Scholfield DJ
SO: Am-J-Clin-Nutr. 1987 Dec; 46(6): 955-61
AB: Sixty-two Asian Indian and American vegetarians participated in a 3-h glucose tolerance test after an overnight fast to study clinical indices of glucose homeostasis. The Asian Indians had a higher (p less than 0.0035) insulinogenic score than the Americans. The Asian Indians had significantly higher insulin levels than the Americans at every sampling time during the glucose tolerance test except for the 3-h sample. The Indian men had significantly higher (p less than 0.05) plasma glucose than the other three groups at 2 h after the glucose load. American subjects had higher (p less than 0.0008) insulin binding to erythrocytes than the Asian Indian subjects. Scatchard analysis and competition-inhibition plots of the insulin-receptor data indicated that decreased binding in the Indian group results from a lowered number and decreased affinity of erythrocyte receptors. These results suggest that Asian Indians exhibit several clinical indications associated with an increased risk for the development of insulin-independent diabetes.

Ref #159 - Morgan JW
SO: Dissertation (University Microfilms International, Ann Arbor, MI

Ref #160 - King C
SO: Dissertation (University Microfilms International, Ann Arbor, MI

Ref #161 - Kissinger DG
SO: Nutr Res 1987; 7:471-9
AB: The relationship between dietary factors and the age of menarche (AOM) was investigated using prospective data. Dietary intake was assessed by multiple 24-hour recalls during 1 or more years immediately prior to menarche for each of 230 white, non-hispanic girls from Southern California. The study population was well nourished with an average intake of calories and 13 nutrients well within the recommended dietary allowances of the National Research Council. The data show a significant association between meat and age of menarche (p<0.025) resulting in a 6 month earlier AOM among meat users compared to vegetarians. Conversely, those using meat analogues had menarche 9 months later than those who did not use meat analogues (p<0.001). The use of grains, nuts, beans and other legumes is associated (p<0.025) with 5-6 months later AOM compared to a more restricted use of these foods. The upper quartile of intake of carbohydrate, thiamine, and iron is associated with a 7-8 month later AOM than those in the lowest quartile of intake of these nutrients. Total intake of protein or fat was not associated with AOM. These results are consistent with the hypotheses that diet affects the AOM. The present prospective data from well nourished girls support previous retrospective studies which associate meat use with earlier AOM. These data point to a vegetarian dietary lifestyle as an important factor in retarding the onset of menarche among well nourished girls.

Ref #162 - Sellers EEB
SO: Dissertation (University Microfilms International, Ann Arbor, MI

Ref #163 - Euler GL
SO: Arch-Environ-Health. 1987 Jul-Aug; 42(4): 213-22
AB: Risk of chronic obstructive pulmonary disease symptoms due to long-term exposure to ambient levels of total suspended particulates (TSP) and sulfur dioxide (SO2) symptoms was ascertained using the National Heart, Lung, and Blood Institute (NHLBI) respiratory symptoms questionnaire on 7,445 Seventh-Day Adventists. They were non-smokers, at least 25 yr of age, and had lived 11 yr or more in areas ranging from high to low photochemical air pollution in California. Participant cumulative exposures to each pollutant in excess of four thresholds were estimated using monthly residence zip code histories and interpolated dosages from state air monitoring stations. These pollutant thresholds were entered individually and in combination in multiple logistic regression analyses with eight covariables including passive smoking. Statistically significant associations with chronic symptoms were seen for: SO2 exposure above 4 pphm (104 mcg/m3), (p = .03), relative risk 1.18 for 500 hr/yr of exposure; and for total suspended particulates (TSP) above 200 mcg/m3, (p less than .00001), relative risk of 1.22 for 750 hr/yr.

Ref #164 - Hosken B
SO: RECORD, January 16, 1988
No Abstract

Ref #165 - Linkosalo E
SO: Dissertation 1988

Ref #166 - Mills PK
SO: Am-J-Epidemiol. 1988 Mar; 127(3): 440-53
AB: Seventh-day Adventist women experience lower mortality rates from breast cancer than other white females in the United States. To evaluate the role of diet in relation to breast cancer within this unique population (more than one-half of all Adventist women are lacto-ovo-vegetarians), a nested case-control study was conducted including 142 cases of fatal breast cancer and 852 matched controls among California Seventh-day Adventist women in 1960-1980. No significant relations between the consumption of animal products (meat, milk, cheese, and eggs) and breast cancer were evident. Odds ratios of 1.00, 1.22, and 1.03 were observed for meat consumption categories of none or occasional, 1-3 days/week, and 4+ days/week, respectively. However, among those women who experienced a relatively early age at natural menopause (less than or equal to 48 years), a suggestive though nonsignificant, positive association between meat consumption and risk was noted. These relations remained unchanged after simultaneously controlling for the effects of other covariates (menstrual characteristics and obesity) via conditional logistic regression analysis. Risk was not related to age at first exposure to the vegetarian lifestyle nor to duration of exposure to the vegetarian lifestyle.

Ref #167 - Fraser GE
SO: Am-J-Clin-Nutr. 1988 Sep; 48(3 Suppl): 833-6
AB: Most data from several countries shows Seventh-day Adventist men to have lower rates of ischemic heart disease (IHD) mortality. Similar data for women are somewhat conflicting. There is clear evidence that Adventists have lower serum total cholesterol and lower serum HDL cholesterol with the ratio of total cholesterol to HDL cholesterol being similar to that of non-Adventists. The risk relationships of this ratio may differ in different populations. There is a certain amount of evidence that vegetarians may have lower blood pressures but this is not clearly supported by data from Seventh-day Adventists. The lower risk for IHD in Adventist men, at least, is probably related to their dietary habits, nonsmoking status, possibly their better exercise habits, and greater social support.

Ref #168 - Linkosalo E
Proc Finn Dent Soc 1998; 84:279-89
AB: Dietary habits, dental status and salivary parameters of 123 life-long lactovegetarians (Seventh-day Adventists, SDAs) and their age- and sex-matched controls on omnivorous diet were studied and statistically analyzed to determine the explanatory factors most pertinent to dental health. The following factors were selected for analysis: DMFS-index, Gingival Bleeding Index (GBI), dental erosions and salivary potassium, inorganic phosphate, IgA and amylase. In the SDAs, the most important explanatory factors for the DMFS were levels of salivary magnesium (p<0.01), and the use of honey (p<0.05). In the controls, dental plaque (VPI) (p<0.001) was the most important explanatory factor for the DMFS-index. In both groups, buffering capacity of the stimulated whole saliva had the greatest protective effect. In the SDAs, GBI (p<0.001) and the levels of salivary magnesium (p<0.05) had positive association with VPI. In the SDAs the consumption of vegetables provided strong protection against gingival bleeding (p<0.001), whereas in the controls the negative correlation between GBI and vegetable consumption was weaker. In the SDAs, salivary amylase (p<0.05) was the factor accounting most for the presence of dental erosions but the intake of drinks (p<0.001) and the levels of salivary amylase (p<0.05) in the controls. Although changes were found in the composition of the stimulated whole saliva in lactovegetarians, only a few parameters analyzed were clearly connected with dietary habits. Honey was significant factor in explaining the presence of inorganic phosphate in the SDAs. Anylase apparently has a significant protective capacity against dental erosion, both in the SDAs and the controls, yet this requires further study.

Ref #169 - Mills PK
SO: Cancer. 1988 Jun 15; 61(12): 2578-85
AB: Epidemiologic studies of diet and pancreas cancer are few, and include ecologic comparisons and a limited number of prospective and case-control studies. Foods and/or nutrients that have been suggested to be associated with increased risk of this cancer include total fat intake, eggs, animal protein, sugar, meat, coffee and butter. Consumption of raw fruits and vegetables has been consistently associated with decreased risk. Dietary habits and medical history variables were evaluated in a prospective study of fatal pancreas cancer among 34,000 California Seventh-day Adventists between 1976 and 1983. Forty deaths from pancreas cancer occurred during the follow-up period. Compared to all US whites, Adventists experienced decreased risk from pancreas cancer death (standardized mortality ratio [SMR] = 72 for men; 90 for women), which was not statistically significant. Although there was a suggestive relationship between increasing meat, egg, and coffee consumption and increased pancreatic cancer risk, these variables were not significantly related to risk after controlling for cigarette smoking. However, increasing consumption of vegetarian protein products, beans, lentils, and peas as well as dried fruit was associated with highly significant protective relationships to pancreas cancer risk. A prior history of diabetes was associated with increased risk of subsequent fatal pancreas cancer, as was a history of surgery for peptic or duodenal ulcer. A history of tonsillectomy was associated with a slight, nonsignificant protective relationship as was history of various allergic reactions. These findings suggest that the protective relationships associated with frequent consumption of vegetables and fruits high in protease-inhibitor content are more important than any increase in pancreas cancer risk attendant on frequent consumption of meat or other animal products. Furthermore, the previously reported positive associations between diabetes and abdominal surgery and pancreas cancer risk are supported in these data.

Ref # 170 - Linkosalo E
SO: Proc Finn Dent Soc. 1988; 84:253-60
AB: Various constituents of stimulated whole saliva in 170 subjects on a temporary (n=21), short-term (n=26), and life-long (n=123) lactovegetarian diet as well as those of the same number of age and sex-matched controls were analyzed in order to determine whether there were any differences in saliva composition. The subjects on a life-long lactovegetarian diet were Seventh-Day Adventists, who are advised by their church to avoid consumption of meat, fish, coffee, tea and alcoholic beverages and to restrict their use of sugar, sweet desserts ans between-meal snacks. Short-term lactovegetarians had higher potassium and phosphate levels and a lower protein concentration. The only salivary difference in subjects following a temporary lactovegetarian diet was a lower pH value. In Seventh-Day Adventists, all salivary variables except calcium and chloride were different. Both elevated (sodium, potassium, phosphate and total IgA) and decreased (magnesium, total protein and amylase) values were recorded. When the salivary variables were related to the presence or absence of dental erosion, lower levels of protein and amylase were found in the subjects on life-long lactovegetarian diet, who had dental erosion. Protein and amylase were also lower in the subjects on a short-term lactovegetarian diet and with dental erosion, but only when the salivary constituents were expressed as µg or U/min, i.e. when the salivary output of these constituents was determined. The present study indicates that the diet regimens can have long-term effects on salivary composition.

Ref # 171 - Laidlaw SA
SO: Am-J-Clin-Nutr. 1988 Apr; 47(4): 660-3
AB: Plasma taurine levels and urinary taurine excretion were measured in 12 strict vegetarian (vegan) males who had maintained a vegan diet for 53 +/- 26 mo (SD) and in 14 male nonvegetarian control subjects. Plasma taurine levels differed (45 +/- 7 vs 58 +/- 16 mumol/L, respectively). Urinary taurine excretion was lower (266 +/- 279 vs 903 +/- 580 mumol/d), urinary N pi-methylhistidine was barely detectable, and urinary N tau-methylhistidine was significantly reduced (296 +/- 87 vs 427 +/- 19 mumol/d) in the vegans. Analysis of 3-d dietary diaries kept by the vegans indicated marginal to adequate intake of protein, carbohydrate, vitamin B-6, methionine, and cystine; inadequate intake of zinc; and negligible intake of taurine. Prolonged absence of dietary taurine intake causes decreased plasma taurine and severely restricted urinary taurine output.

Ref #172 - Euler GL.
SO: Arch-Environ-Health. 1988 Jul-Aug; 43(4): 279-85
AB: To assess the risk of chronic obstructive pulmonary disease symptoms due to long-term exposure to ambient levels of total oxidants and nitrogen dioxide (NO2), symptoms were ascertained using the National Heart, Lung, and Blood Institute (NHLBI) respiratory symptoms questionnaire. A total of 7,445 Seventh-day Adventist (SDA) nonsmokers who were 25 yr of age or older and had resided at least 11 yr in areas of California with high to low photochemical air pollution were included in this study. Cumulative exposures to each pollutant in excess of four thresholds were estimated for each participant, using zip codes for months of residence and interpolated dosages from state air-monitoring stations. Multiple logistic regression analyses were conducted individually and together for pollutants and included eight covariables, including passive smoking. A statistically significant association with chronic symptoms was seen for total oxidants above 10 pphm (196 mcg/m3) (p less than .004, relative risk of 1.20 for 750 hr/yr). Chronic respiratory disease symptoms were not associated with relatively low NO2 exposure levels in this population. When these pollutant exposures were studied with exposures to total suspended particulates (TSP) and sulfur dioxide (SO2), only TSP exposure above 200 mcg/m3 showed statistical significance (p less than .01). Exposure to TSP is either more strongly associated with symptoms of chronic obstructive pulmonary disease than the other measured exposures or is the best single surrogate representing the mix of pollutants present.

Ref #173 - Linkosalo E
SO: Proc Finn Dent Soc 1988; 84:31-8
AB: Buffering capacity, pH-values, and sucrose and glucose concentrations of 17 commercial beverages, six effervescent vitamin C preparations and seven kinds of berry were measured. Five of these products were selected for in vitro tests to determine their possible effects on enamel. Changes in enamel surface were evaluated using scanning electron microscopy (SEM), atomic absorption spectrophotometry and hardness measurements.
Severe dissolution of the enamel, as determined by SEM, was caused by grapefruit beverage and blackcurrant, moderate dissolution by effervescent vitamin C preparation and mild dissolution by potato and carrot beverages. Values for calcium release and softening of dental tissue were in agreement with SEM findings.

Ref #174 - Abbey DE
SO: JAPCA. 1989 Apr; 39(4): 437-45
AB: A method for setting air quality standards for long-term cumulative exposures of a population based on epidemiological studies has been developed. It uses exposure estimates interpolated from monitoring stations to zip code centroids, each month applied to zip code by month residence histories of the population. Two alternative cumulative exposure indices are used--hours in excess of a threshold, and the sum of concentrations above a threshold. The indices are then used with multiple logistic regression models for the health outcome data to form dose response curves for relative risk, adjusting for covariates. These curves are useful for determination of at what exposure amounts and threshold levels, effects which have both statistical and public health significance begin to occur. The method is applied to a ten year follow-up of a sub cohort of 7,343 members of the National Cancer Institute-funded Adventist Health Study. Up to 20 years of residence history was available. Analysis for prevalence of symptoms was conducted for four air pollutants--total oxidants, sulfur dioxide, nitrogen dioxide, and total suspended particulates. For each pollutant, cumulated exposures were calculated above each of five different thresholds. Statistically significant effects were noted for total suspended particulates, total oxidants, sulfur dioxide, past and passive smoking.

Ref #175 - Linkosalo E
SO: Proc Finn Dent Soc 1988; 84:109-15
AB: Although a vegetarian diet is usually regarded as healthy, harmful effects have recently also been reported. Because of these contradictory opinions, this study was aimed at further analysis of the effect of diet on dentition in subjects who have followed a life-long vegetarian diet. Seventh-Day Adventists (SDA) were selected as a study group, because they are the largest religious group practising lacto- or lacto-ovo-vegetarianism in Finland. A clinical examination was performed using an interview on 123 SDAs and their age- and sex-matched controls. Great differences in eating habits between the SDA group and the controls (p < 0.001) were found, especially in between-meal snacks and sugar consumption. These differences reflected in the better condition of dental health in the SDA group if evaluated by the number of teeth (p < 0.001) and by indices measuring the periodontal condition (p <0.001). The higher frequency of juice drinking in the SDA group introduced erosive defects, although these were less severe than indicated in our previous report.

Ref #176 - Snowdon DA
SO: Am-J-Clin-Nutr. 1988 Sep; 48(3 Suppl): 739-48
AB: This report reviews, contrasts, and illustrates previously published findings from a cohort of 27,529 California Seventh-day Adventist adults who completed questionnaires in 1960 and were followed for mortality between 1960 and 1980. Within this population, meat consumption was positively associated with mortality because of all causes of death combined (in males), coronary heart disease (in males and females), and diabetes (in males). Egg consumption was positively associated with mortality because of all causes combined (in females), coronary heart disease (in females), and cancers of the colon (in males and females combined) and ovary. Milk consumption was positively associated with only prostate cancer mortality, and cheese consumption did not have a clear relationship with any cause of death. The consumption of meat, eggs, milk, and cheese did not have negative associations with any of the causes of death investigated.

Ref #177 - Shultz TD
SO: Am J Clin Nutr 1988; 791-4
AB: To determine if dietary fat affects the bioactivity of circulating prolactin and growth hormone (lactogenic hormones), a controlled feeding study was conducted in six premenopausal women over two complete menstrual cycles. After an initial 7-10 day dietary adjustment, subjects were randomly assigned to either low-fat (25% of calories) or high-fat (46%) diets. The diets were similar in proportions of energy, protein, P:S ratio, and cholesterol. All subjects completed both diets in a crossover experimental design. Fasting blood samples were collected on alternate days throughout the study. Plasma hormone bioactivity was assayed by the Nb2 lymphoma cell method. Luteal-phase lactogenic hormone bioactivity appeared to be higher (averaging 28%; p less than 0.07) in response to high- rather than low-fat diets. No differences were seen in levels of radioimmunoreactiveprolactin or growth hormone. Substantial changes in short-term fat intake may alter the level of lactogenic hormone bioactivity in young women.

Ref #178 - Beilin LJ
SO: Am-J-Clin-Nutr. 1988 Sep; 48(3 Suppl): 806-10
AB: Evidence that nutrients other than the major cations may influence blood pressure levels stems from studies of acculturated vegetarians and from randomized controlled dietary trials. Earlier studies of vegetarians focused on religious groups and on vegans, making it difficult to know whether their lower blood pressures were due to diet per se or to other aspects of lifestyle. Seventh-day Adventist vegetarians showed significantly less hypertension and lower blood pressures compared with Mormon omnivores, effects which were independent of differences in obesity and not due to altered sodium intake. Subsequently, controlled dietary intervention studies in healthy normotensive omnivores provided more direct evidence for a blood pressure-lowering effect of a lactoovovegetarian diet with reversible changes of 5-6 mm Hg systolic and 2-3 mm Hg diastolic occurring over 6-wk periods. Similar dietary effects in mild hypertensive subjects provides impetus for identifying the responsible nutrients.

Ref #179 - Fønnebø V
SO: Am-J-Clin-Nutr. 1988 Sep; 48(3 Suppl): 826-9
Low values of cholesterol and blood pressure in Seventh-day Adventists has been suggested to be caused by selection bias. Seventh-day Adventists in the Tromso Heart Study have a diet that is low in the intake of coffee, ground meat, and fish. They have total serum cholesterol values 11-20% (p less than 0.01) lower than non-Seventh-day Adventists. Blood pressure is also lower in Seventh-day Adventists. Baptists and religiously nonactive Seventh-day Adventists had a dietary pattern very similar to the general population. Their serum cholesterol and blood pressure values were also similar to the general population. This indicates that the low levels of serum cholesterol and blood pressure in religiously active Seventh-day Adventists is not caused by selective or religious factors.

Ref #180 - Marsh AG
SO: Am-J-Clin-Nutr. 1988 Sep; 48(3 Suppl): 837-41
AB: The amount and type of dietary protein affect bone mineral loss after the menopause. This observation was substantiated in 10 y of studies by direct photon absorptiometry, four results of which follow. 1) Studies of 1600 women in southwestern Michigan revealed that those who had followed the lactoovovegetarian diet for at least 20 y had only 18% less bone mineral by age 80 whereas closely paired omnivores had 35% less bone mineral. 2) A study of self-selected weighed food intake showed no statistical difference in nutrient intakes but a difference in Ca:P ratio and acid-base formation of diet, each significant to p less than 0.001. 3) When sulfur intake of a fixed diet was increased, the titratable acidity of the urine increased proportionately. 4) Bone mineral densities of 304 older women from the continental United States closely paralleled those from earlier Michigan studies.

Ref #181 - Tylavsky FA
SO: Am-J-Clin-Nutr. 1988 Sep; 48(3 Suppl): 842-9
AB: The relationships between dietary factors and radial bone indices of omnivorous (n = 287) and lactoovovegetarian (n = 88) postmenopausal women were investigated. Bone mineral content (BMC) and bone density (BD) were determined at mid and distal radius sites using a Norland single-beam bone densitometer. A quantitative food frequency questionnaire assessed usual current and long-term intakes. Multiple regression analyses showed that 1) vegetarianism was a positive contributor (p less than 0.05) to Mid BMC, 2) protein was a positive contributor (p less than 0.02) to Mid and Distal BMC, 3) phosphorus was a negative contributor (p less than 0.10) to Mid and Distal BMC and Mid BD, and 4) current calcium was not a significant contributor to any of the bone indices after age, body mass index, energy, protein, P, and vegetarianism were accounted for in the models. Estimations of long-term Ca intake and other nutrients are necessary if relationships between diet and bone are to be identified at any age period using cross-sectional epidemiological methods.

Ref #182 - Hunt IF
SO: Am-J-Clin-Nutr. 1988 Sep; 48(3 Suppl): 850-1
AB: Dietary intake data were collected on Seventh-day Adventist vegetarian and Methodist omnivorous postmenopausal women living in the Los Angeles area: Both groups met the Recommended Dietary Allowances except for zinc, folate, vitamin B-6, and vitamin E. Vegetarians' diets had a somewhat higher nutrient density for folate, thiamin, vitamin C, and vitamin A; lower total fat, saturated fatty acids, and cholesterol; and higher dietary fiber. No correlation between dietary intake and bone mineral content was observed. These findings are compared with those in a study on Oregon vegetarian women.

Ref #183 - Kelsey JL
SO: Am-J-Clin-Nutr. 1988 Sep; 48(3 Suppl): 875-9
AB: Dietary intakes of two groups of vegetarians (of Asian Indian and of American origin) residing in the United States were compared with intakes of a group of nonvegetarians. Mineral intakes and balances were determined for all three groups for a 7-d period. The vegetarians had a significantly higher percent of energy intake from carbohydrate and significantly higher intakes of crude fiber (CF) and neutral detergent fiber (NDF) than did the nonvegetarians. The American vegetarians had significantly higher intakes of magnesium, iron, and copper than did the other groups. Manganese intakes were significantly higher for the two vegetarian groups than for the nonvegetarians. Calcium, iron, zinc, and copper balances were not significantly different among the groups. Magnesium and manganese balances were significantly more negative for the American vegetarians than for the other two groups. In general, the higher percent of carbohydrate intake or the higher level of fiber intake did not appear to affect mineral utilization by the vegetarians.

Ref #184 - Ringstad J
SO: Am J Clin Nutrit 1988; 48:925
AB: High serum selenium concentration has been proposed as protective with regard to cardiovascular disease and cancer. Seventh-day Adventists have been identified as a low-risk group with regard to the same diseases. This study of 32 Seventh-day Adventists and matched controls in Tromsø, Norway, shows that Seventh-day Adventists have a significantly lower serum selenium concentration (1.45 micromol/liter versus 1.58 micromol/liter, p<0.01). There was no correlation between serum selenium difference and difference in other cardiovascular disease risk factors. Serum selenium difference was associated with difference in intake of fish, but no association was found with other dietary items. It can thus be assumed that other aspects of the Seventh-day Adventist life style are more important than selenium intake with regard to the development of cancer and cardiovascular disease.

Ref #185 - Thomas EC
SO: Am J Clin Nutrit 1988; 48:925
AB: Twelve students were selected randomly from Oakwood College in Huntsville, Alabama. Six of the students were females and within the six, three were lacto-ovo-vegetarians and the other three were vegans. The remaining six students were males who were similarly divided.
Foods samples from breakfast, lunch, supper, and snacks were collected for three consecutive days in September, 1985, and repeated in October, 1985, on the same days. Composite samples of breakfast, lunch, supper, snacks, and beverages (including water) for each day were homogenized in a blender, weighed, and an aliquot was placed in an air-tight Rubbermaid container. The samples were then frozen and freeze-dried before analyzing for moisture and minerals. Sodium (NA), iron (Fe), and zinc (Zn) were determined on each food sample by Atomic Absorption Spectrophotometer. Results indicated that the mean sodium intake for the lacto-ovo-vegetarian diet (2974.9 mg.) and vegan diet (2807.9 mg.) were both within the estimated safe and adequate daily dietary range (1100 to 3300 mg.Na). The males consumed significantly more (3441.1 mg.) sodium than the females (2341.7 mg.). Since there was no table salt available, the variation in sodium intake is attributable to the levels of sodium present in the foods selected. Iron intakes of males (22.3 mg.) exceeded that of the females (11.8 mg.) and the Recommended Dietary Allowance (10 mg.). Results showed that the females were below the recommended amount, suggesting that they made poor food choices. A significant contribution to the females' dietary iron intakes could be made if they increase their consumption of cereals, legumes, and nuts. Low zinc intakes were found amongst the males (8.8 mg.) and females (5.3 mg.). intakes were below the recommended amount (15 mg.). Review of the food choices of males and females indicates that they did not select adequate amounts of legumes, whole grains and cheese (all foods high in zinc).
Both lacto-ovo-vegetarians and vegans can meet their mineral (sodium, iron, and zinc) needs if they give attention to the distribution of nutrients among different kinds of foods.

Ref #186 - Snowdon DA
SO: Am-J-Public-Health. 1989 Jun; 79(6): 709-14
AB: The relation between age at natural menopause and all-cause mortality was investigated in a sample of 5,287 White women, ages 55 to 100 years, naturally-postmenopausal, Seventh-day Adventists who had completed mailed questionnaires in 1976. The age-adjusted odds ratio of death during 1976-82 in women with natural menopause before age 40 was 1.95 (95% confidence interval = 1.24, 3.07), compared to the reference group of women reporting natural menopause at ages 50 to 54. Corresponding odds ratios of death were 1.39 (95% CI = 1.06, 1.81) for natural menopause at ages 40 to 44, and 1.03 (95% CI = 0.84, 1.25) for natural menopause at ages 45 to 49. Among 3,166 White, 55- to 100-year-old, surgically-postmenopausal, Adventist women, there was no relation between age at surgical menopause and mortality. Logistic regression analyses indicated that findings from this study were apparently not due to confounding by smoking, over- or underweight, reproductive history, or replacement estrogen use.

Ref #187 - Kuzma JW
SO: Nutr-Cancer. 1989; 12(2): 151-60
AB: This study sought to determine how well individuals are able to recall accurately their food habits of 24 years ago and identify those factors that are predictive of recall ability. We investigated the self-reported dietary intakes of 216 people, one-half of whom were vegetarians, including cancer cases and controls. We compared 21 key food items reported in 1960 with the same data reported in 1984. Recall ability was the highest for persons with stable diets. Vegetarian status, education, and church attendance were the other significant determinants of exact recall; age and church attendances were the only significant determinants of recall error. After excluding nonusers of particular foods, we found a positive correlation between frequency of use and recall ability.

Ref #188 - Lindsted KD
SO: Nutr-Cancer. 1989; 12(2): 135-49
The following two questions concerning diet recall were addressed when studying 117 incident cancer cases and 99 controls from the Adventist Mortality Study. Are recalls of past dietary habits reliable? Does recall ability differ between cancer cases and controls? Two sets of dietary data were compared using the American Cancer Society's food frequency questionnaire--as reported in 1960 and recalled in 1984. Ability to recall 21 key food items was evaluated both for individual foods and a combination of all foods by comparing recall scores. The comparison revealed that among food groups, 24-year recall ability varied greatly. There was no significant difference in recall ability between cancer incident cases and controls after controlling for factors that may be related to recall ability (e.g., age, education, and sex). Also, there was no significant difference in recall ability among subjects with or without other chronic diseases likely to affect diet pattern. The results revealed no significant differences in recall ability by sex and body mass index; however, significant differences by vegetarian status and diet stability were found. Significant differences by educational level were found only in univariate analysis.

Ref #189 - Fraser GE
SO: Am-J-Epidemiol. 1989 Nov; 130(5): 958-65
AB: In 1982, high density lipoprotein (HDL) cholesterol and factors known to be or suspected of being associated with HDL cholesterol were measured in 160 middle-aged Seventh-day Adventist men and 160 male neighbors of similar age residing in California. Fish and alcohol consumption, Quetelet index (weight (Ib)/height (in)2), exercise habits, and cigarette smoking were each significantly related to HDL cholesterol levels, in total explaining 17.5% of the variance in the total population and 18.0% of that in the neighbors. Inclusion of three terms representing effect modification between alcohol and exercise, alcohol and Quetelet index, and smoking and Quetelet index and HDL cholesterol increased the explained variance to 25.1% and 31.7% in the total population and in the neighbors alone, respectively. This increase in variance was equivalent to the effect of obesity in the main effects model of all participants or to the effect of obesity and fish consumption together when only the neighbors were considered. Since all product terms included either alcohol or smoking and since exposure to those variables in Adventists was minimal, conclusions were drawn from analyses of the neighbors only. All three product terms were statistically significant in the neighbors. The effect modification that is hence implied suggests that exercise has a particularly strong effect on HDL cholesterol levels in those who drink more alcohol; that alcohol has a greater effect in those who exercise more or who are relatively thin; that obesity may have a greater effect in those who drink more alcohol; that cigarette smoking has a greater effect in those who are relatively obese; and that obesity has a greater effect in those who smoke more cigarettes. In most cases, this suggests synergism between these pairs of variables.

Ref #190 - Beeson WL
SO: Cancer. 1989 Aug 1; 64(3): 570-81
AB: The Adventist Health Study is a prospective cohort study of 34,198 non-Hispanic white Seventh-day Adventists (13,857 men; 20,341 women, age 25-100 years) followed for 6 years (1977-1982). Within this population, 55.2% were lacto-ovovegetarian (consumed meat, poultry, or fish less than one time per week with no restrictions as to egg or dairy product consumption) in 1976 and most abstained from alcohol, tobacco, and pork products. Baseline data included demographic variables, information on current and past dietary habits, exercise patterns, use of prescription drugs, use of alcohol and tobacco, measures of religiosity, occupation and residential histories, anthropometric data, and menstrual and reproductive histories. Nonfatal case ascertainment was completed through review of self-reported hospitalizations obtained from annual self-administered mailed questionnaires and through computerized record linkage with two California population-based tumor registries. Fatal case ascertainment was completed via record linkage with computerized California state death certificate files, the National Death Index, and individual follow-up. During the 6 years of follow-up, 52.8% of the 34,198 study subjects reported at least one hospitalization. A total of 20,702 medical charts were reviewed for cancer and cardiovascular disease incidence and 1406 incident cancer cases and 2716 deaths from all causes were identified after baseline data collection.

Ref #191 - Mills PK
SO: Cancer. 1989 Aug 1; 64(3): 582-90
AB: Breast cancer incidence was monitored in a cohort of 20,341 California Seventh-day Adventist women who completed a detailed lifestyle questionnaire in 1976, and who were followed for 6 years. There were 215 histologically confirmed primary breast cancer detected among some 115,000 person-years of follow-up. Mean age at diagnosis was 66 years, indicating a primarily postmenopausal case series. Established risk factors for breast cancer showed strong relationships to risk in these data. Age at first live birth, maternal history of breast cancer, age at menopause, educational attainment, and obesity were all significantly related to risk. However, increasing consumption of high fat animal products was not associated with increased risk of breast cancer in a consistent fashion. Nor were childhood and early teenage dietary habits (vegetarian versus nonvegetarian) related to subsequent, adult risk of developing breast cancer. Also, a derived index of percent of calories from animal fat in the adult years was not significantly related to risk. These results persisted after simultaneously controlling for other, potentially confounding variables, utilizing Cox proportional hazard regression models.

Ref #192 - Mills PK
SO: Cancer. 1989 Aug 1; 64(3): 591-7
AB: Exogenous hormone use as either oral contraceptives (OC) or hormone replacement therapy (HRT) was evaluated in reference to subsequent breast cancer risk in a cohort study of 20,341 Seventh-day Adventist women, residing in California, who completed a detailed lifestyle questionnaire in 1976 and who were followed for 6 years. During the follow-up period, 215 histologically confirmed primary breast cancers were detected in the cohort. The mean age at diagnosis was 66 years, indicating a primarily postmenopausal case series. In this cohort, after taking into account potentially confounding variables, current use of HRT (in 1976) was associated with a 69% increase in breast cancer risk, which was statistically significant (RR = 1.69; CI = 1.12-2.55). However, there was no strong increase in risk with increasing duration of use of HRT. Subgroups of women who did experience HRT associated increases in breast cancer risk included those women who had ever used HRT (RR = 1.39; CI = 1.00-1.94) and those with no history of maternal breast cancer (RR = 1.45), those women with prior benign breast disease (RR = 2.80), and those women who experienced menopause at 44 years of age or later (RR = 1.56). There was no substantial increase in breast cancer risk associated with use of OC in this population, although among women with exposure to both OC and HRT there was a suggested increase in risk (RR = 1.42; CI = 0.71-2.85).

Ref #193 - Mills PK
SO: Cancer. 1989 Aug 1; 64(3): 598-604
AB: Dietary and lifestyle characteristics were evaluated in relation to subsequent prostatic cancer risk in a cohort of approximately 14,000 Seventh-day Adventist men who completed a detailed lifestyle questionnaire in 1976 and who were monitored for cancer incidence until the end of 1982. During the 6-year follow-up period, 180 histologically confirmed prostatic cancers were detected among some 78,000 man-years of follow-up. Increasing educational attainment was associated with significantly decreased risk of prostate cancer in this study; age at first marriage was also inversely associated with risk, although this was not significant. There was no relationship between body mass index (as measured by Quetelet's Index) and risk. A history of prostate "trouble" was associated with a 60% increase in risk which was highly significant. Although there were suggestive relationships between increasing animal product consumption and increased risk, these results did not persist after accounting for the influence of fruit and vegetable consumption. Nor was exposure to the vegetarian lifestyle during the childhood years associated with alterations in subsequent risk. However, increasing consumption of beans, lentils and peas, tomatoes, raisin, dates, and other dried fruit were all associated with significantly decreased prostate cancer risk.

Ref #194 - Sabaté J.
Dissertation - University Microfilms International, Ann Arbor, MI

Ref #195 - Mills PK
SO: Neuroepidemiology. 1989; 8(5): 266-75
AB: We studied the occurrence of tumors of the brain and cranial meninges in a cohort of 34,000 California Seventh-Day Adventists who completed a detailed life-style questionnaire in 1976 and who were followed for cancer incidence until the end of 1982. During the period of follow-up, 31 tumors were diagnosed in the cohort (21 gliomas, 10 meningiomas). Increased risk for glioma was associated with rural residence, history of a positive tuberculosis skin test and consumption of pork products; increased meningioma risk was associated with a positive reaction to a tuberculosis skin test, previous stroke, use of tranquillizers and a vegetarian life-style in childhood.

Ref #196 - Hunt IF
SO: Am-J-Clin-Nutr. 1989 Sep; 50(3): 517-23
AB: This cross-sectional study of bone mineral content (BMC)/bone width (BW) (BMC/BW, cortical radius) was conducted in elderly, free-living Methodist omnivores (n = 146) and Seventh-day Adventist vegetarians (n = 144) in southern California. The purpose was to investigate relationships between BMC/BW and dietary factors (primarily vegetarianism and intakes of protein and calcium) and use of prescribed drugs. BMC was measured by single-photon absorptiometry. Dietary intakes during current and early periods of life were assessed by 24-h dietary recall and frequency methods. Information about drug use was obtained by interview. BMC/BW was not different in omnivores vs vegetarians. There were no significant relationships or trends between current or early dietary intakes and BMC/BW in either group. In multiple-regression analysis, age, weight, and use of estrogen and thiazide diuretics were predictive of 31% of the variability in BMC/BW in the total group.

Ref #197 - Lombard KA
SO: Am-J-Clin-Nutr. 1989 Sep; 50(3): 486-90
AB: Urinary excretion of biotin (total avidin-binding substances) was measured in adults and children who were adhering to one of the following self-selected diets: strict vegetarian (vegan), lactoovovegetarian, or mixed (containing meat and dairy products as well as plant-derived foods). In a subset of subjects, plasma biotin concentrations were also measured. In adults the biotin excretion rate was significantly greater in the vegan group than in either the lactoovovegetarian or the mixed-diet groups; the latter were not significantly different from one another. In children the biotin excretion rates in both the vegan group and the lactoovovegetarin group were significantly greater than in the mixed-diet group. A similar trend (vegan greater than lactoovovegetarian greater than mixed) was detected in the plasma concentrations of biotin of adults and children but differences were not generally statistically significant. These observations provide evidence that the biotin nutritional status of vegans is not impaired.

Ref #198 - Nieman DC
SO: Int-J-Sports-Med. 1989 Aug; 10(4): 243-51
AB: The purpose of this study was to investigate hematological, anthropometric, and metabolic differences in elderly women who were similar in most respects except for choice of diet. Nineteen vegetarian (V) and 12 non-vegetarian (NV) elderly women (mean ages 72.3 +/- 1.4 and 69.5 +/- 1.0 years, respectively) were recruited based on several selection criteria including race, religion, education, Quetelet Index, absence of major chronic disease and use of medications, physical activity, and geographic area. Average years of adherence by V and NV groups to dietary regimens were 46.3 +/- 3.3 and 69.6 +/- 1.0, respectively; Hematological comparisons revealed that the V elderly women had significantly lower glucose (4.60 +/- 0.09 vs 5.13 +/- 0.11 mmol/L), low-density lipoprotein cholesterol (3.14 +/- 0.19 vs 4.09 +/- 0.27 mmol/L) and total cholesterol levels (5.41 +/- 0.20 vs 6.48 +/- 0.29 mmol/L) than the NV elderly women (P less than 0.01) for each. The V elderly women tended to have less body fat and mid-upper arm muscle area than the NV. No differences between groups were found in a variety of metabolic and electrocardiographic parameters during graded maximal treadmill testing except for lower heart rates in the V women. VO2max was not significantly different between the V and NV elderly women (23.8 +/- 1.5 vs 21.9 +/- 0.8 ml.kg-1.min-1, respectively). In summary, when healthy elderly V women are compared with closely matched NV peers, the vegetarian diet is associated with several benefits, primarily lower blood glucose and lipid levels, but not greater functional capacity.

Ref #199 - Nieman DC
SO: J-Am-Diet-Assoc. 1989 Dec; 89(12): 1763-9
The purpose of this study was to investigate nutrient intakes of Seventh-Day Adventist elderly women who were similar in many demographic and life-style factors except for choice of diet. Twenty-three vegetarian and 14 non-vegetarian elderly women (mean +/- standard error ages 72.2 +/- 1.3 and 71.1 +/- 1.4 years, respectively) were recruited on the basis of several selection criteria, including race, religion, education, geographic area, Quetelet index, self-reported absence of major chronic disease and use of medications, and physical activity. Average years +/- SE of adherence to dietary regimens were 47.0 +/- 2.9 and 71.2 +/- 1.4 in the vegetarian and non-vegetarian groups, respectively. Results from analysis of 7-day food records showed that vegetarians consumed significantly less cholesterol, saturated fatty acids, and caffeine but more carbohydrate, dietary fiber, magnesium, vitamins E and A, thiamin, pantothenic acid, copper, and manganese than non-vegetarians (p less than .05). On the basis of group means, 67% of the Recommended Dietary Allowance was met for all nutrients except zinc and vitamin D in both groups, and vitamins B-6, folacin, and vitamin E in the non-vegetarians. Compared with non-vegetarians, vegetarians had significantly lower serum glucose (5.18 +/- 0.11 vs. 4.65 +/- 0.09 mmol/L), low-density-lipoprotein cholesterol (4.08 +/- 0.25 vs. 3.34 +/- 0.19 mmol/L), and total cholesterol levels (6.46 +/- 0.27 vs. 5.62 +/- 0.21 mmol/L) (p less than .05). In summary, when healthy elderly vegetarian women were compared with closely matched non-vegetarian peers, the vegetarian diet was associated with improved nutrient intake and associated reductions in blood glucose and lipid levels.

Ref. #200 - Marsh AG
SO: Nutr Rep Intl 1989; 89:19-24
AB: The dietary intakes of ten post-menopausal lacto-ovo vegetarian women were compared with those of a similar group of ten omnivorous women. The seven-day food and beverage records showed significant dietary differences in their calcium to phosphorus ratio, calculated acid-base content, P:S ratio, and cholesterol content. These differences may explain some of the differences in bone mineral loss between post-menopausal women of these two groups.

Ref #201 - Melby CL
SO: Am-J-Public-Health. 1989 Sep; 79(9): 1283-8
AB: We examined the possible interaction of race and diet on blood pressure (BP) in volunteer Black Seventh Day Adventists compared to volunteer White church members. Height, weight, waist and hip circumference, and resting seated BP were recorded in Black vegetarians (n = 55; age: 54.7 +/- 16.9 yrs), Black nonvegetarians (n = 59; 56.1 +/- 14.1 yrs), White vegetarians (n = 164; 52.2 +/- 16.7 yrs), and White nonvegetarians (n = 100; 52.6 +/- 15.6 yrs) attending a regional conference. Forty-four percent of the Black nonvegetarians were medicated hypertensives, compared to only 18 percent of the Black vegetarians, 7 percent of the White vegetarians, and 22 percent of the White nonvegetarians. Black vegetarians exhibited lower age and sex-adjusted systolic BP (means = 122.9/74.4 mm Hg) than Black nonvegetarians (means = 132.2/75.9 mm Hg). After further adjusting BP for body mass index and waist/hip ratio, the systolic BP among Black vegetarians remained lower (122.8) than Black nonvegetarians (129.7) but higher than that of the Whites who showed no diet-related BP differences.

Ref #202 - Beeson WL
SO: DHHS publication No. (PHS)90-1214, 1990, pp. 196-201
INTRODUCTION: The Adventist Health Study (AHS) is a prospective cohort study of 34,198 non-Hispanic white Seventh-day Adventists (SDAs) followed for 6 years (1977-1982) for cancer incidence and all cause mortality. These study subjects were all California residents at the time the study began in August, 1974.
Previous reports have documented lower age-adjusted sex-specific mortality rates for cancer, cardiovascular disease, and several other chronic diseases among SDAs when compared to either the total United States white population or to a comparable population of nonsmoking whites living in California.
The primary aim of the AHS is to relate diet and other lifestyle characteristics to long-term (10-15 years) site-specific risk of cancer among the study population. During 1973 through 1988. The study has been funded by the National Cancer Institute.

Ref #203 - Ross JK
SO: Am-J-Clin-Nutr. 1990 Mar; 51(3): 365-70
AB: Dietary fiber intake and fecal fiber excretion were investigated in 53 Seventh-day Adventist men: 18 nonvegetarians (NVs), 20 lactoovovegetarians (LOVs), and 15 vegans (Vs). Three-day composite diets and stools were analyzed for neutral detergent fiber (NDF), hemicellulose, cellulose, lignin, and pectin. In vitro binding of estrone (E1), estradiol-17 beta (E2), and testosterone (T) to a water-insoluble fiber fraction obtained from these diets was correlated with the intake of specific dietary fiber components. Vs consumed and excreted significantly more of all fiber components than did LOVs or NVs. LOVs consumed more of all fiber components (except cellulose) than did omnivores and excreted more NDF, hemicellulose, and cellulose. Dietary lignin was positively correlated with T binding in the V group. There were significant relationships for all groups combined between lignin and water-insoluble fiber binding of E1, E2, and T. Further study is needed to clarify relationships between fiber components, steroid-hormone metabolism, and risk of prostate cancer.

Ref #204 - Pusateri DJ
SO: Am-J-Clin-Nutr. 1990 Mar; 51(3): 371-7
AB: Relationships between dietary nutrients and plasma and fecal estrone, estradiol-17 beta, testosterone, and plasma prolactin concentrations were studied in young Seventh-day Adventist men: 18 nonvegetarians (NVs), 20 lactoovovegetarians (LOVs), and 15 vegans (V). Blood samples and 3-d dietary records were obtained. Contemporaneously collected diet composites and stool samples were analyzed for fiber. Vs and LOVs consumed significantly more fiber than did the omnivores, whereas NVs and LOVs consumed more saturated fatty acids than did Vs. Although plasma steroid-hormone status did not differ, Vs had significantly higher fecal estrogen concentrations than did NVs or LOVs. Plasma prolactin concentrations were significantly higher in NVs and LOVs than in Vs. Significant relationships were observed for the combined groups between dietary and fecal fiber components and fecal, but not plasma, steroid hormones. For the combined groups, prolactin concentrations were positively correlated with saturated fatty acid intake. Further research on the effects of dietary nutrients on endocrine homeostasis in other age groups is warranted.

Ref #205 - Snowdon DA
SO: J-Am-Geriatr-Soc. 1990 Apr; 38(4): 402-8
AB: Menopause marks the beginning of a stage of life characterized by an increased susceptibility to diseases such as coronary heart disease and osteoporosis. It was therefore hypothesized that early age at natural menopause would lengthen the duration of the postmenopausal stage of life and thereby result in an earlier age at death. This study investigated the relations between age at natural menopause, duration of postmenopausal life (ie, life expectancy at menopause), and age at death (ie, age at menopause plus life expectancy at menopause). Data were derived from a study of 5,287 naturally postmenopausal Seventh-day Adventists observed during 1976-1982. Life expectancy was estimated by a mathematical model that used mortality ratios from the study and mortality rates from the US general population. For natural menopause before the age of 47 years, each one-year decrease in age at menopause was associated with a 0.53-year increase in postmenopausal life (P = .04) and a 0.47-year decrease in the age at death (P = .04). For natural menopause at the age of 47 years and older, however, each one-year decrease in age at menopause was associated with a 0.99-year increase in postmenopausal life (P = .03) and only a 0.01-year decrease in the age at death (P = .85). Overall, these findings argue against the possibility that the association between age at menopause and age at death in this study was due to the relation of age at menopause to the duration of postmenopausal life.

Ref #206 - Fraser GE
SO: Int-J-Epidemiol. 1990 Dec; 19(4): 832-8
AB: A longitudinal study of 34 198 non-Hispanic white California Seventh-day Adventists identified incident cases of renal carcinoma over six years of follow-up. The use of antihypertensive medications and self-reported hypertension had estimated age-sex adjusted incidence rate ratios of 4.51 and 2.90 respectively. These were relatively unchanged by stratifying on additional variables that may have been confounders. Cases diagnosed later during the follow-up period had the strongest association with hypertension, making the alternative explanation that the cancer may have caused the hypertension less likely. Being married in 1976 (amongst females at least) was also associated with a marked elevation of risk. Point estimates of effect suggested that frequent (greater than or equal to 3 week) consumption of fruit (RR = 0.21) and salad vegetables (RR = 0.34) may be protective for this cancer, although the 95% confidence interval did not quite exclude the null value.

Ref #207 - Hopkins RJ
SO: Arch-Intern-Med. 1990 Nov; 150(11): 2347-8
AB: To evaluate the possible role of diet in the transmission of Helicobacter pylori, we compared H pylori seroprevalence among Seventh-Day Adventists (who are vegetarian and abstain from alcohol, caffeine, and meat; n = 94) and two non-Seventh-Day Adventist control groups (n = 168). With the use of an enzyme-linked immunosorbent assay H pylori antigen prepared in a French pressure cell, we found no difference in seroprevalence among these groups; however, seropositivity strongly correlated with age and black race.

Ref #208 - Mills PK
SO: J-Natl-Cancer-Inst. 1990 Dec 5; 82(23): 1832-6
AB: The risks of leukemia and myeloma associated with cigarette smoking were evaluated in a cohort study of 34,000 Seventh-day Adventists. Although Seventh-day Adventists do not smoke by church proscription, many are adult converts who smoked cigarettes prior to their baptism into the church. In comparison with those who never smoked, ex-smokers experience a relative risk of 2.00 (95% confidence interval = 1.01-3.95) for leukemia and 3.01 (95% confidence interval = 1.13-8.05) for myeloma. Risks increased in a dose-response fashion with increasing numbers of cigarettes smoked daily for both leukemia (trend P = .009) and myeloma (trend P = .005). Also, the risks of both leukemia and myeloma increased with the total duration of cigarette smoking. The cigarette smoking-leukemia relationship was strongest for myeloid leukemia, for which ex-smokers experienced a relative risk of 2.24 (95% confidence interval = 0.91-5.53). These data lend support to the hypothesis that cigarette smoke may induce malignant degeneration in bone marrow and its products.

Ref #209 - Sumbureru D
SO: Dissertation - University Microfilms International, Ann Arbor, MI

Ref #210 - Sabaté J
SO: Am-J-Dis-Child. 1990 Oct; 144(10): 1159-63
AB: Height and weight data obtained from a 2-year longitudinal survey were analyzed for 2272 children aged 6 through 18 years who were attending public schools or Seventh-Day Adventist (SDA) schools in southern California. The SDAs do not use alcohol or tobacco, and many adhere to a lacto-ovovegetarian diet. For both sexes, in each school group, the mean height and weight were at or above national reference values. Age-adjusted regression analysis showed that SDA school-boys were 1.6 cm taller than public schoolboys. There were no significant differences in height for girls. After controlling for height, boys and girls in the SDA schools were found to be leaner than their public school peers, ie, 1.27 and 1.16 kg, respectively. These results suggest that a health-oriented life-style in childhood and adolescence, such as the one followed by SDAs, is compatible with adequate growth and associated with a lower weight for height.

Ref #211 - Barbosa JC
SO: Am-J-Clin-Nutr. 1990 May; 51(5): 798-803
AB: The relationships among anthropometric variables, dietary nutrients, and plasma steroid, polypeptide, and binding-protein hormone concentrations were investigated in 24 Seventh-day Adventist postmenopausal women, 12 vegetarian (SV) and 12 nonvegetarian (SNV). Fasting blood and 7-d dietary intake information were collected. SVs consumed significantly more crude and dietary fiber and fewer saturated fatty acids than did SNVs. The thigh and sum of three skinfold-thickness measurements were significantly greater for SNVs than for SVs. Plasma concentrations of estradiol-17 beta were significantly lower in SVs than in SNVs. Significant relationships were observed for the combined groups (SV and SNV) between estradiol-17 beta and triceps and suprailiac skinfold thickness and body fat. Plasma concentrations of estradiol-17 beta of the combined groups revealed a significant negative relationship between their crude and dietary fiber intakes. Further study delineating the effects of adiposity and dietary nutrients on basal concentrations of sex hormones is warranted.

Ref #212 - Lindsted K
SO: Nutr-Cancer. 1990; 13(3): 175-87
AB: Diet concordance and changes in dietary practices by surviving spouses of cancer cases were investigated by studying 69 husband-wife pairs during an eight-year period spanning the death from cancer of one spouse. The data base consisted of reports for each cancer case from the Adventist Health Study (AHS) where a surviving spouse was available. Two questions were addressed. 1. Do husbands and wives eat similar diets? 2. Did survivors change their diet practices during the eight-year period? Three sets of dietary data were compared with the AHS food frequency questionnaire: reports made in 1976 by cases; reports made in 1976 by their spouses (initial); and the spouses' reports in 1984 (current). Diet concordance and dietary changes for 35 key food groups were evaluated both for individual foods and across foods by computing recall scores. The results were analyzed with univariate and multivariate methods. Comparison of means and Spearman rank-order correlations revealed good initial concordance between the spouses, which was not significantly related to age, sex, or education. However, eight years later subsequent to the deaths of the cases, the agreement was poor because the surviving spouses had changed their diets. The changes in dietary practices were significantly related to education and body mass index in univariate analysis but not in analysis of covariance. These results indicate that retrospective recall by spouses for the cases rather than the spouses' own current reports should be used as an estimate for the deceased cases. Repeated recalls are necessary to increase reliability.

Ref #213 - Murphy FG
SO: Am J Public Health 1990; 80:984-5.
AB: Mortality information was gathered for 110 Black Seventh-day Adventist members of seven churches in Metropolitan Atlanta, Georgia during the period 1980-87. Seventh-seven percent of the deaths were due to cardiovascular diseases; 8 percent due to cancer, the second leading cause of death. The cancer rate is extremely low in comparison to the proportion of deaths due to cardiovascular diseases. Subsequent research on this population will take into consideration lifestyle factors which could contribute to this finding.

Ref. #214 - Mills PK
SO: Am-J-Epidemiol. 1991 Feb 1; 133(3): 230-9
AB: A cohort study of bladder cancer was conducted in a population of California Seventh-day Adventists. Most Seventh-day Adventists use neither tobacco nor alcohol yet experience a large degree of variation in dietary habits. Therefore, diet and other lifestyle habits were evaluated in this unique population. In 1976, 34,198 non-Hispanic white Seventh-day Adventists in California completed a detailed lifestyle questionnaire which included a 51-item food frequency section. This cohort was then followed until the end of 1982 during which time all newly diagnosed malignancies were detected. In order to evaluate the relation between several variables hypothesized to be associated with altered bladder cancer risk, age-, sex-, and smoking-adjusted relative risks (incidence rate ratios) were calculated using the method of Mantel-Haenszel adopted for person-time data. Multivariate analyses were conducted using the Cox Proportional Hazards Regression model. Between the return of the questionnaire and the end of follow-up, there were 52 histologically confirmed bladder cancers detected in the cohort. Increasing age, male gender, and a history of cigarette smoking were all significantly associated with increased bladder cancer risk. In addition, residence in a rural area was associated with significantly increased risk (relative risk (RR) = 1.80) as was high consumption of meat, poultry, and fish (RR = 2.57).

Ref #215 - Resnicow K
J-Am-Diet-Assoc. 1991 Apr; 91(4): 447-53
The lipid levels and dietary habits of 31 Seventh-Day Adventist vegan vegetarians (aged 5 to 46 years) who consume no animal products were assessed. Mean serum total cholesterol (3.4 mmol/L), low-density-lipoprotein cholesterol (1.8 mmol/L), and triglyceride (0.8 mmol/L) levels were lower than expected values derived from the Lipid Research Clinics Population Studies prevalence data. Mean high-density-lipoprotein cholesterol (1.3 mmol/L) was comparable to expected values. Analysis of quantitative food frequency data showed that vegans had a significantly lower daily intake of total energy, percentage of energy from fat (31% vs 38%), total fat, saturated fat, monounsaturated fatty acids, cholesterol, and protein and a significantly higher intake of fiber than a sample of matched omnivore controls. Vegans' food intake was also compared with expected values, matched for sex and age, derived from the second National Health and Nutrition Examination Survey and Continuing Survey of Food Intakes by Individuals 24-hour recall data. The vegan diet was characterized by increased consumption of almonds, cashews, and their nut butters; dried fruits; citrus fruits; soy milk; and greens. We conclude from the present study that a strict vegan diet, which is typically very low in saturated fat and dietary cholesterol and high in fiber, can help children and adults maintain or achieve desirable blood lipid levels.

Ref #216 - Lindsted KD
SO: J-Clin-Epidemiol. 1991; 44(4-5): 355-64
AB: The Adventist Mortality Study provides 26-year follow-up through 1985 for 9484 males who completed a lifestyle questionnaire in 1960. The relationship of self-reported physical activity and all cause and disease-specific mortality was examined by survival analysis and with the Cox proportional hazards model, controlling for demographic and lifestyle characteristics. Moderate activity was associated with a protective effect on cardiovascular and all cause mortality in both analyses. In the Cox model, age-specific estimates of relative risk (RR) were obtained for several endpoints due to a significant interaction between level of physical activity and attained age (age at death or end of follow-up). This model permits calculation of the age at which the RR = 1.0, or the age at crossover of risk. For moderate activity, this age was 95.6 years (95% confidence intervals, 81.7-109.4 years) for all cause mortality and 91.5 years (95% confidence intervals, 79.0-104.0 years) for cardiovascular mortality. While the protective effect on mortality associated with moderate activity decreased with increasing age, it remained significant to the verge of the present life span.

Ref #217 - Lindsted K
SO: Inter-J-Obesity. 1991; 15:397-406.
AB: This study examines the relationship between body mass index (BMI) and 26-year mortality among 8828 nonsmoking, nondrinking Seventh-day Adventist men, including 439 who were very lean (BMI < 20 kg/m2). The adjusted relative risk comparing the lowest BMI quintile (<22.3) to the highest (>27.5 kg/m2) was 0.70 (95 percent CI 0.63-0.78) for all cause mortality, 0.60 (96 percent CI 0.43-0.85) for cerebrovascular mortality, and 0.80 (95 percent CI 0.61-1.04) for cancer mortality. Very lean men did not show increased mortality. To assess whether the protective effect associated with low BMI is modified by increasing age, the product term between BMI and attained age (age at the end of follow-up or at death) was included as a time-dependent covariate. For ischemic heart disease mortality, age-specific estimates of the relative risk for the lowest quintile relative to the highest ranged from 0.32 (95 percent CI, 0.19-0.52) at age 50 to 0.71 (95 percent CI, 0.56-0.89) at age 90. Interaction was also seen for the next lowest quintile (22.4-24.2). There was a significant trend of increasing mortality with increasing BMI for all endpoints studied. For cancer and cerebrovascular mortality the P-values for trend were 0.0001 and 0.001 respectively. For the other endpoints the p-values were <0.0001. Thus, there was no evidence for a J-shaped relationship between BMI and mortality in males. While the protective effect associated with the lowest BMI quintile decreased with increasing age for ischemic heart disease mortality, it remained greater than one at all ages. The relatively large number of subjects who were lean by choice, rather than as a result of preclinical disease or smoking, may explain these findings

Ref #218 - Fraser GE
SO: Am-J-Epidemiol. 1991 Apr 1; 133(7): 683-93
AB: The Adventist Health Study, a cohort study of 34,198 California Seventh-day Adventists, identified 61 cases of new primary lung cancer over 6 years of follow-up (1977-1982). The population studied was unique in that only 4% admitted to current cigarette smoking and about half were lacto-ovovegetarians. A total of 36% of the lung tumors were adenocarcinomas, and 19% were squamous cell carcinomas. The expected associations with cigarette smoking were noted for Kreyberg group I tumors (squamous cell, large cell, and small cell carcinoma; relative risk (RR) = 53.2 for current smokers and 7.07 for past smokers), but much lesser associations were noted for Kreyberg group II tumors (adenocarcinoma and bronchoalveolar carcinoma; RR = 1.99 for current smokers and 1.59 for past smokers). In this study, fruit consumption was the dietary constituent that showed a strong, statistically significant protective association with lung cancer that was independent of smoking (fruit consumption less than 3 times/week, RR = 1.0; 3-7 times/week, RR = 0.30; greater than or equal to 2 times/day, RR = 0.26). This association was somewhat stronger for Kreyberg group II tumors, but similar trends were also noted for Kreyberg group I tumors. Confounding with smoking seems unlikely in a population with very few current smokers and where both stratification and Cox modeling methods of analysis led to similar conclusions.

Ref # 219 - Ullman D
SO: JAMA. 1991 May 8; 265(18): 2352-9
AB: We compare the mortality experience of medical school graduates from Loma Linda University (LLU [n = 4342]) and the University of Southern California (USC [n = 2832]) with each other and with that of contemporaneous, white, American men. When compared with US white men from the general population, both USC and LLU graduates had below expected deaths for all causes (USC, standardized mortality ratio [SMR] = 76; LLU, SMR = 56), although deaths due to cerebrovascular disease, airplane accidents, and suicides were elevated for USC (SMRs = 132, 360, and 218, respectively). The LLU graduates had a risk similar to that of the USC graduates for fatal cancer, with a mortality ratio (MR) of 0.92 (95% confidence interval, 0.67 to 1.26); but half the risk of fatal atherosclerotic disease, with MRs of 0.58 (0.46 to 0.73) and 0.66 (0.43 to 0.99) for coronary and cerebrovascular disease, respectively; and three times the risk of fatal airplane accidents. The overall mortality rate of LLU physicians was only 75% as high as that of the USC physicians and only 56% as high as that of the US male population at large. We attribute this reduced mortality mainly to the low cardiovascular mortality rates, which may be accounted for by the life-style of the substantial proportion of Seventh-day Adventists among LLU graduates.

Ref #220 - Sabaté J
SO: Eur-J-Clin-Nutr. 1991 Jan; 45(1): 51-8
AB: The relationship between diet and attained height was studied in children and adolescents in Southern California. Diet pattern was determined from an extensive food frequency questionnaire in 1765 Caucasian children of 7-18 years, attending state schools (452 m and 443 f) and Seventh-day Adventist schools (427 m and 443 f). The major difference in diet pattern between state and Adventist school children was in meat consumption. The Adventist children were split evenly between three categories of frequency in meat consumption (less than 1/week, 1/week-less than 1/d, and greater than or equal to 1/d), while 92 percent of state school children consumed meat daily. Vegetarians (those consuming meat less than 1/week) differed significantly in the consumption of other major food groups, such as fruit and vegetables. All school and diet subgroups were at or above the 50th percentile of the National Center for Health Statistics. Age-adjusted regression analysis showed that on average Adventist vegetarian children were taller than their meat-consuming classmates (2.5 and 2.0 cm for boys and girls, respectively). These results did not change materially when adjusting for other food groups. Nor did adjustment for parental height and socioeconomic factors in a sub-sample of 518 children. The results indicate that vegetarian children and adolescents on a balanced diet grow at least as tall as children who consume meat.

Ref #221 - Fønnebø V
SP: Cancer. 1991 Aug 1; 68(3): 666-71
AB: Standardized incidence ratio for cancer in Norwegian Seventh-Day Adventists compared with the general population was not significantly different from unity (men 91, women 97). Persons converting late in life had a higher incidence than those converting at an earlier age. Respiratory cancers (standardized incidence ratio [SIR] 59, 95% CI = 36 to 91) and cancers with an unspecified site (SIR 53, 95% CI = 25 to 97) were rarer and cancer of the uterine corpus (SIR 164, 95% CI = 109 to 237) was more common in Seventh-Day Adventists before the age of 75 years. Inclusion of all registered Seventh-Day Adventists regardless of religious activity and the relatively low cancer incidence rates in the Norwegian population could contribute to the nonsignificant result with regard to total cancer. Main etiologic factors in cancer development in Norway should be sought in areas where Seventh-Day Adventists do not differ from the general population.

Ref #222 - Abbey DE
SO: Environ-Health-Perspect. 1991 Aug; 94: 43-50
AB: Cancer incidence and mortality in a cohort of 6000 nonsmoking California Seventh-Day Adventists were monitored for a 6-year period, and relationships with long-term cumulative ambient air pollution were observed. Total suspended particulates (TSP) and ozone were measured in terms of numbers of hours in excess of several threshold levels corresponding to national standards as well as mean concentration. For all malignant neoplasms among females, risk increased with increasing exceedance frequencies of all thresholds of TSP except the lowest one, and those increased risks were highly statistically significant. For respiratory cancers, increased risk was associated with only one threshold of ozone, and this result was of borderline significance. Respiratory disease symptoms were assessed in 1977 and again in 1987 using the National Heart, Lung and Blood Institute respiratory symptoms questionnaire on a subcohort of 3914 individuals. Multivariate analyses which adjusted for past and passive smoking and occupational exposures indicated statistically significantly (p less than 0.05) elevated relative risks ranging up to 1.7 for incidence of asthma, definite symptoms of airway obstructive disease, and chronic bronchitis with TSP in excess of all thresholds except the lowest one but not for any thresholds of ozone. A trend association (p = 0.056) was noted between the threshold of 10 pphm ozone and incidence of asthma. These results are presented within the context of standards setting for these constituents of air pollution.

Ref #223 - Mills PK
SO: Arch-Environ-Health. 1991 Sep-Oct; 46(5): 271-80
AB: Cancer incidence and mortality in a cohort of 6,000 Seventh-day Adventist nonsmokers who were residents of California were monitored for a 6-y period, and relationships with long-term ambient concentrations of total suspended particulates (TSPs) and ozone (O3) were studied. Ambient concentrations were expressed as mean concentrations and exceedance frequencies, which are the number of hours during which concentrations exceeded specified cutoffs (e.g., federal and California air quality standards). Risk of malignant neoplasms in females increased concurrently with exceedance frequencies for all TSP cutoffs, except the lowest, and these increased risks were highly statistically significant. An increased risk of respiratory cancers was associated with only one cutoff of O3, and this result was of borderline significance. These results are presented in the context of setting standards for these two air pollutants.

Ref #224 - Melby CL
SO: Clin-Exp-Hypertens-A. 1991; 13(6-7): 1233-48
AB: Few studies have examined the relationship between exercise and BP in Black adults, a population with substantial risk for hypertension. This pilot study was undertaken to examine BP, anthropometric characteristics, dietary intake, and resting pulse rate by level of exercise participation in a group of Black Seventh Day Adventists. Subjects were classified as regular exercisers (n = 54, age = 54.6 yrs) if they reported at least two exercise sessions per week (x = 4.0 times per week) lasting a minimum of 20 minutes each, in which they engaged in vigorous exercise. Nonexercisers (n = 60, age = 56.2 yrs) were those who reported participation in such exercise no more than once per week (x = 0.1 times per week). There were no group differences in dietary intake of any macro or micronutrients, but exercisers exhibited significantly lower body mass index, waist circumference, triceps skinfold thickness, and resting pulse rate. Forty-two percent of the nonexercisers were confirmed hypertensives compared to only 20 percent of the exercisers. Age and gender-adjusted BP was significantly lower in the exercisers (BP = 123.8/73.4 mm Hg) compared to the nonexercisers (BP = 133.5/77.1 mm Hg). After adjustment for anthropometric differences, the systolic BP of the exercisers remained approximately 8 mm Hg lower than their nonexercising counterparts. These data suggest that participation in vigorous exercise is favorably related to blood pressure and may attenuate the risk of hypertension in Black Seventh Day Adventists.

Ref #225 - Editorial
SO: MMWR 1991;40:579-82
AB: Patterns of morbidity and mortality vary substantially among some religious groups in the United States. These variations may be associated with a wide range of factors, including lifestyle, acceptance of prevention measures (e.g. vaccination), and risks for injury. This report summarizes a study of mortality in cohorts of graduates from two colleges whose students are from different religious backgrounds.

Ref #226 - Kurata JH
SO: Gastroenterology. 1992 Mar; 102(3): 902-9
AB: Cross-sectional and prospective data were collected and analyzed to identify risk factors for the development of peptic ulcer disease in a population of 34,198 white, non-Hispanic Seventh-Day Adventists. On a life-style questionnaire administered in 1976, 3853 subjects reported ever having had a physician-diagnosed peptic ulcer for a lifetime prevalence of 13.5% for men and 11.0% for women. Odds ratios of greater than 2.0 (P less than 0.0001) were observed for use of "stronger pain relievers," current cigarette smoking, and history of rheumatism or other arthritis and coronary disease. For both sexes, lower but statistically significant odds ratios (P less than 0.05) were found for eating white bread, "snacking," ever having smoked cigarettes, low church involvement, poor dietary adherence, high blood pressure, rheumatoid arthritis, aspirin use, job frustration and dissatisfaction, having a "blue collar household," and having less education. During 3 years of follow-up, 154 incident cases of ulcer were identified. The average annual incidence was 1.7 per 1000. Multivariate adjusted relative risks were statistically significant for using stronger pain relievers (P less than 0.001), having rheumatic conditions (P = 0.006), and using aspirin (P = 0.013). These findings suggest that rheumatic disease and use of aspirin and stronger pain relievers are more important risk factors for development of peptic ulcer disease in certain populations than diet, life-style, or psychological or socioeconomic characteristics.

Ref #227 - Persky VW
SO: Cancer-Res. 1992 Feb 1; 52(3): 578-83
AB: Between September 1984 and June 1985, a total of 75 adolescent girls, 35 vegetarians residing in a Seventh-Day Adventist school and 40 nonvegetarians residing in a private non-Adventist boarding school, underwent measurement of their plasma hormone levels in the follicular and luteal phase of their menstrual cycles as well as dietary intake measured by 3-day food records, medical history, height, and weight. There were no significant differences between vegetarians and nonvegetarians in average age of the girls, weight, body mass index, age at menarche, years since the onset of menstruation, or percentage of girls with ovulatory cycles. Vegetarian girls had significantly higher levels of log follicular estradiol [2.00 +/- 0.27 (SD) versus 1.85 +/- 0.27 pg/ml, P less than or equal to 0.05] and luteal dehydroepiandrosterone sulfate (DHS) (1.88 +/- 0.71 versus 1.45 +/- 0.80 microgram/ml, P less than or equal to 0.05) than nonvegetarian girls. Follicular DHS was higher in vegetarians than in nonvegetarians (1.72 +/- 0.79 versus 1.45 +/- 0.95 microgram/ml), but the difference was not significant. The differences in follicular and luteal DHS, but not the difference in log estradiol, were significant (P less than or equal to 0.05) after controlling for ovulation, smoking, and alcohol intake with multivariable regression analysis. There were no significant differences in testosterone or in percentage free estradiol levels between vegetarians and nonvegetarians. Smoking was significantly associated with follicular and luteal DHS and with percentage free follicular estradiol, while alcohol use was significantly and inversely associated with percentage free follicular estradiol after controlling for other variables. The implications for breast cancer risk are discussed.

Ref #228 - Fraser GE
SO: Arch-Intern-Med. 1992 Jul; 152(7): 1416-24
AB: BACKGROUND--Although dietary factors are suspected to be important determinants of coronary heart disease (CHD) risk, the direct evidence is relatively sparse. METHODS--The Adventist Health Study is a prospective cohort investigation of 31,208 non-Hispanic white California Seventh-Day Adventists. Extensive dietary information was obtained at baseline, along with the values of traditional coronary risk factors. These were related to risk of definite fatal CHD or definite nonfatal myocardial infarction. RESULTS--Subjects who consumed nuts frequently (more than four times per week) experienced substantially fewer definite fatal CHD events (relative risk, 0.52; 95% confidence interval [CI], 0.36 to 0.76) and definite nonfatal myocardial infarctions (relative risk, 0.49; 95% CI, 0.28 to 0.85), when compared with those who consumed nuts less than once per week. These findings persisted on covariate adjustment and were seen in almost all of 16 different subgroups of the population. Subjects who usually consumed whole wheat bread also experienced lower rates of definite nonfatal myocardial infarction (relative risk, 0.56; 95% CI, 0.35 to 0.89) and definite fatal CHD (relative risk, 0.89; 95% CI, 0.60 to 1.33) when compared with those who usually ate white bread. Men who ate beef at least three times each week had a higher risk of definite fatal CHD (relative risk, 2.31; 95% CI, 1.11 to 4.78), but this effect was not seen in women or for the nonfatal myocardial infarction end point. CONCLUSION--Our data strongly suggest that the frequent consumption of nuts may protect against risk of CHD events. The favorable fatty acid profile of many nuts is one possible explanation for such an effect.

Ref #229 - Fraser GE
SO: Circulation. 1992 Aug; 86(2): 406-13
AB: BACKGROUND. California Seventh-Day Adventists have lower mortality rates from coronary heart disease (CHD) than other Californians. Associations between traditional risk factor and CHD events have not been reported previously for Adventists. METHODS AND RESULTS. A cohort study allowed 6 years of follow-up of 27,658 male and female California Seventh-Day Adventists. Data collected included age, sex, physician-diagnosed hypertension and diabetes mellitus, body height, weight, previous and current cigarette smoking habits, and current exercise habits. Incident cases of definite myocardial infarction (MI) and definite fatal CHD were diagnosed according to recognized criteria. Both stratified and proportional hazards analyses demonstrated that in this low-risk population, the above traditional coronary risk factors exhibit their usual associations with risk of CHD events. It was noted that exercise had a strong negative association with fatal CHD events (relative risks [RR], 1.0, 0.66, and 0.50 with increasing exercise) but no association with risk of MI (either nonfatal or all cases). Conversely, obesity was much more clearly associated with MI (RR, 1.0, 1.18, and 1.83 with increasing tertiles of obesity) than with fatal events. The importance of the risk factors was similar in both sexes, except that the effect of cigarette smoking seemed more pronounced in women. CONCLUSIONS. The epidemiology of coronary heart disease in this low-risk California population appears to be at least qualitatively similar to that seen in other groups. There was evidence that the effects of exercise and obesity may differ depending on whether fatal CHD and MI (either all MI or nonfatal alone) is the end point.

Ref #230 - Mills PK
SO: Am-J-Epidemiol. 1992 Aug 1; 136(3): 287-95
AB: The relation between allergy and risk of cancer was evaluated in a cohort study of 34,198 Seventh-day Adventists in California. Information on prevalence of asthma, hay fever, and reactions to chemicals, medications, bee stings, and poison oak (or ivy) was obtained by questionnaire in 1976. The reported allergies must have been serious enough to require treatment by a physician. The cohort was then followed for 6 years (1977-1982). Both stratified analysis and Cox proportional hazards regression analyses were utilized to evaluate the relation of allergy to cancer after taking into account several potentially confounding variables. For all cancer sites combined in males, there was a 33% increased risk associated with reaction to medications. In contrast, among females, reaction to medications was associated with a 21% decrease in risk. Both results were statistically significant. Prostate and breast cancer risk were elevated in persons who reported any type of allergic history, as was risk of lymphatic or hematopoietic cancers and sarcoma. For each of these types of cancer, risk increased with increasing numbers of allergies. However, ovarian cancer risk was decreased in persons with any allergic history and increasing numbers of allergies was associated with decreasing risk of this form of cancer. These results suggest that the association between allergy and cancer is complex and depends on the specific allergy and the specific organ site under consideration.

Ref #231 - Fønnebø V
SO: J-Clin-Epidemiol. 1992 Feb; 45(2): 157-67
AB: The standardized mortality ratio (SMR) was studied in Norwegian Seventh-Day Adventists, a religious group practising a life-style regarded as protective against cancer and cardiovascular disease. Persons converting before the age of 19 had a SMR of 69 (men) and 59 (women). This was both significantly lower than the general population and those converting at age 35 or above. The site mainly responsible for the low SMR in young converts was cardiovascular disease (men, 44; women, 52). Overall SMR in Seventh-Day Adventists compared to the general population was 82 (95% CI: 77-88, p less than 0.001) in men and 95 (95% CI: 91-100, NS) in women. SMR for cancer was significantly lower only in men before the age of 75 (SMR: 78, 95% CI: 61-99, p less than 0.05). Adopting a healthful lifestyle early in life seems to be of decisive importance with regard to mortality, later lifestyle changes have a smaller effect on death risk.

Ref #232 - Fønnebø V
Am-J-Epidemiol. 1992 Mar 1; 135(5): 504-8
Coronary risk factors in Seventh-day Adventists were compared with those in non-Seventh-day Adventist matched controls in the Norwegian Cardiovascular Disease Studies, 1973-1987. Only 10% of the Seventh-day Adventists were smokers (p less than 0.001) and serum cholesterol was 0.86 mmol/liter (95% confidence interval (CI) 0.59-1.13) lower in men and 0.48 mmol/liter (95% CI 0.25-0.71) lower in women. Blood pressure was significantly lower only in women. Ex-members of the Seventh-day Adventist Church and members who did not comply with the recommended life-style had a risk factor level significantly higher than Seventh-day Adventists who complied with the life-style.

Ref #233 - Sabaté J
SO: J-Am-Diet-Assoc. 1992 Oct; 92(10): 1263-4
AB: There is increasing interest in the vegetarian diet, particularly because of its potential benefits in reduction of chronic degenerative diseases in adult life (1,2). Concerns arise, however, about the value of the vegetarian diet for growing children. Some studies (3-7), but not all (8,9), indicate that some types of vegetarian diets may delay linear growth in infants and preschool children. There is limited information in the literature relating vegetarian diets to attained height in older children (10,11). Tayter and Stanek (12) compared the height of 11- to 12-year-old lacto-ovovegetarian children attending Seventh-Day Adventist schools with that of omnivore children attending non-church-affiliated schools. There was no difference in mean height between the two groups of boys, but lacto-ovovegetarian girls were 3.5 cm shorter than the omnivore girls. This large mean difference was not statistically significant, but this was undoubtedly due to the small sample size (9 lacto-ovovegetarians and 10 omnivores; Table 1, Sample C).
We have reported (13,14) anthropometric data from the Loma Linda Child Adolescent Study (15), a large epidemiological study that investigated the determinants of blood pressure in children aged 7 to 18 years who were attending Seventh-Day Adventist and public schools in southern California. The results of Tayter and Stanek (12) prompted us to reanalyze the height data of our population using their approach. This article reports the association between vegetarian life-styles and height of children during preadolescence - ages 11 to 12 years.

Ref #234 - Lindsted KD
SO: J-Clin-Epidemiol. 1992 Jul; 45(7): 733-42
AB: The relationship between reported coffee consumption and specific causes of death was examined in 9484 males enrolled in the Adventist Mortality Study in 1960 and followed through 1985. Coffee consumption was divided into three levels: less than 1 cup per day, 1-2 cups per day, and greater than or equal to 3 cups per day. Approximately one third of the subjects did not drink coffee. Cause-specific mortality rates were compared using survival analysis including Cox's proportional hazard model, and controlling for potential confounders such as body mass index, heart disease and hypertension at baseline, race, physical activity, marital status, educational level, smoking history, and dietary pattern. Inclusion of interaction terms between coffee consumption and attained age as time-dependent covariates allowed the hazard ratio to vary with age. Univariate analyses showed a statistically significant association (p less than 0.05) for coffee consumption and mortality for most endpoints. Multivariate analyses showed a small but statistically significant association between coffee consumption and mortality from ischemic heart disease, other cardiovascular diseases, all cardiovascular diseases, and all causes of death. For the major causes of death, the hazard ratios decreased from about 2.5 at 30 years of age to 1.0 around 95 years of age. These results indicate that abstinence from coffee leads to compression of mortality rather than an increase in lifespan.

Ref #235 - Giem P
SO: Neuroepidemiology. 1993; 12(1): 28-36
AB: We investigated the relationship between animal product consumption and evidence of dementia in two cohort substudies. The first enrolled 272 California residents matched for age, sex, and zip code (1 vegan, 1 lacto-ovo-vegetarian, and 2 'heavy' meat eaters in each of 68 quartets). This design ensured a wide range of dietary exposure. The second included 2,984 unmatched subjects who resided within the Loma Linda, California area. All subjects were enrolled in the Adventist Health Study. The matched subjects who ate meat (including poultry and fish) were more than twice as likely to become demented as their vegetarian counterparts (relative risk 2.18, p = 0.065) and the discrepancy was further widened (relative risk 2.99, p = 0.048) when past meat consumption was taken into account. There was no significant difference in the incidence of dementia in the vegetarian versus meat-eating unmatched subjects. There was no obvious explanation for the difference between the two substudies, although the power of the unmatched sub-study to detect an effect of 'heavy' meat consumption was unexpectedly limited. There was a trend towards delayed onset of dementia in vegetarians in both substudies.

Ref #236 - Abbey DE
SO: Arch-Environ-Health. 1993 Jan-Feb; 48(1): 33-46
AB: Seventh-day Adventist nonsmokers, who, subsequent to 1966, had resided within 8 km (5 miles) of their 1977 residence (N = 3,914), completed the National Heart and Lung Institute (NHLI) respiratory symptoms questionnaire in 1977 and again in 1987. For each participant, cumulative ambient concentrations of total suspended particulates (TSP), ozone, and sulfur dioxide (SO2) in excess of several cutoff levels were estimated by month and by interpolating ambient concentrations from state air-monitoring stations to their residential and workplace zip codes for the month. Statistically significant relationships between ambient concentrations of TSP and ozone, but not SO2, were found with several respiratory disease outcomes. Multivariate analyses adjusted for past and passive smoking and occupational exposures. Results are discussed within the context of standards setting for TSP and ozone.

Ref #237 - Melby CL
SO: J-Am-Coll-Nutr. 1993 Jun; 12(3): 262-9
AB: The vegetarian diet has been associated with lower blood pressure (BP) in elderly white Americans. This study was undertaken to determine whether or not long-term adherence (at least 5 years) to a plant-based diet is similarly related to lower BP in older black Americans, a group exhibiting significant risk for hypertension (HT). Anthropometric characteristics, nutrient intake, and resting systolic and diastolic BP were measured in older black vegetarians (n = 27, age = 69.3 +/- 1.7 years), black nonvegetarians (n = 37, age = 65.4 +/- 1.2 years), white vegetarians (n = 85, age = 66.7 +/- 1.0 years), and white nonvegetarians (n = 54, age = 65.2 +/- 0.9 years). Older black vegetarians were significantly leaner and exhibited lower average systolic BP (131.4/76.8 mm Hg) and less hypertension than the black omnivores (141.6/76.2 mm Hg), but had significantly higher average BP than either dietary group of older white adults (vegetarians: 120.9/66.7 mm Hg; nonvegetarians: 122.8/67.6 mm Hg). These data suggest that long-term adherence to a vegetarian diet by older black Americans may afford some protection against hypertension, but in comparison to older white adults, does not completely offset their apparently greater susceptibility to untoward elevation of BP.

Ref #238 - Sabaté J
SO: Eur-J-Clin-Nutr. 1993 Sep; 47 Suppl 1: S71-5
AB: Nuts are part of the Mediterranean tradition. For millennia, tree nuts have been in the region. Results of an epidemiological study conducted among California Adventists provide strong evidence that frequent consumption of nuts have a protective effect on both fatal and non-fatal ischaemic heart disease events. The unique nutrient composition of nuts makes it plausible that nuts favourably affect heart disease risk factors and interfere with the process of atherogenesis. Results of recently conducted human nutritional studies, with varying degrees of methodological rigour, all seem to indicate that eating nuts lowers serum cholesterol and favourably modifies the lipoprotein profile. The effects of nut consumption on other cardiovascular disease risk factors deserve further exploration.

Ref #239 - Sabaté J
SO: Primary Cardiology. 1993; 19:65-72.
AB: Recent studies suggest that the frequent consumption of nuts provides protection against both fatal and nonfatal coronary heart disease events. Nuts are high in unsaturated fats, and nutritional analyses seem to indicate that eating nuts lowers serum cholesterol and has a favorable effect on the lipoprotein profile.

Ref #240 - Richter A
SO: Cancer-Lett. 1993 Oct 15; 74(1-2): 65-8
AB: Measurements of intermediate biomarkers have recently increased, attempting to provide useful information about cancer risk. We report morphological findings in rectal mucosal biopsies from patients at low risk and at high risk for colorectal cancer. Rectal biopsies were analyzed from fourteen Seventh-Day Adventist (SDA) subjects at low risk and from twenty-seven members of families with hereditary nonpolyposis colonic cancer (HNPCC) at higher risk. The following measurements were made on rectal crypts: length of crypts, numbers of cells, diameter of the surface, middle and base of the crypts and infiltration of inflammatory cells into the lamina propria. Findings indicated morphological differences in normal-appearing rectal mucosa of individuals in the HNPCC group compared with SDA subjects (P < 0.05). They included shorter crypts with fewer epithelial cells and increased cellular infiltration in the mucosa of HNPCC subjects compared with SDA subjects, suggesting minimal inflammation, and an early stage of crypt atrophy in the rectal mucosa of subjects at higher risk for colonic neoplasia.

Ref #241 - Sorkin JD
Int-J-Obes-Relat-Metab-Disord. 1994 Nov; 18(11): 752-4
The aim of this work was to determine if the relationship between weight-adjusted-for-height (expressed as body mass index or BMI) using the BMI-at-entry and age-at-entry as opposed to BMI at entry and age-at-event (i.e. death, loss to follow-up, or end of the study) would alter the results previously reported from a population of Seventh-day Adventist men. The subjects were 8828 non-smoking, non-drinking Seventh-day Adventist men, ages 30-89 and older on entry, mean follow-up 15 years (maximum 26 years). The BMI and age reported by subjects when they were enrolled into the study were used to calculate the relationship between BMI and mortality. Mortality rates in each of five BMI quintiles were computed by dividing the number of deaths in each quintile by the number of person years of follow-up in the quintile. Rate ratios were computed by dividing each mortality rate by the rate in the reference quintile. The mortality rate ratios were then adjusted for the age difference between each quintile and the reference quintile. Calculations based upon age-at-enrollment rather than 'age-at-event' (as used in the original paper) demonstrate no increase in mortality until a BMI of 27.5 kg/m2 or greater is reached rather than a progressive increase in mortality with increasing BMI.

Ref #242 - Reed JA
Am-J-Clin-Nutr. 1994 May; 59(5 Suppl):
A 5-y prospective study of the changes in radial-bone mineral density (BMD) of elderly white women (mean age, 81 y) living in four residential communities, including 49 Seventh-day Adventist lacto-ovovegetarians and 140 omnivores, was undertaken to determine the potential effects of usual dietary calcium in preventing the loss of BMD, measured by single-photon absorptiometry, at two radial sites. Changes in BMD and other variables from baseline (1983) to follow-up (1988) were: 1) mean calcium intakes in 1988 of 996 mg/d for omnivores and 733 mg/d for lacto-ovovegetarians changed little from 1983, 2) all women lost BMD (P < 0.05) over the 5 y period, 3) the annual BMD loss rates were approximately 1% at each site, 4) BMD loss was independent of calcium intake, 5) BMD loss rates were similar in both lacto-ovovegetarians and omnivores, and 6) the greater the loss of lean body mass, the greater the BMD loss (P < 0.05).

Ref #243 - Melby CL
SO: Am-J-Clin-Nutr. 1994 Jan; 59(1): 103-9
AB: Blood pressure (BP) and serum lipids were compared among three dietary groups of Seventh-day Adventist (SDA) African-American adults: vegetarians (VEGs: no consumption of animal flesh, n = 66), semivegetarians (SEMIVEGs: one to three servings of animal flesh per week, n = 56), and nonvegetarians (NONVEGs: daily consumption of animal flesh, n = 45). VEGs had a lower mean waist-to-hip ratio (WHR) and lower dietary intakes of protein, saturated fat, and cholesterol compared with the NONVEGs. Only 16% of the VEGs were confirmed to be hypertensive compared with 35.7% of the SEMIVEGs and 31.1% of the NONVEGs. Independent of differences in WHR, the VEGs had significantly lower concentrations of serum total cholesterol (STC), LDL-C, triglycerides, STC/HDL-C, and LDL-C/HDL-C than the NONVEGs. The SEMIVEGs had lipid values intermediate to the VEG and NONVEG groups. Among African-American SDAs, a vegetarian diet is associated with lower cardiovascular disease risk factors than is an omnivorous diet.

Ref #244 - Fraser GE
SO: Am-J-Clin-Nutr. 1994 May; 59(5 Suppl): 1117S-1123S
AB: Traditionally, the effects of diet on coronary heart disease have been attributed to the effects of medium-chain fatty acids, soluble fiber, and dietary cholesterol on serum low-density-lipoprotein (LDL) cholesterol concentrations. We review evidence here that many other dietary substances may affect risk, often via mechanisms not involving LDL-cholesterol concentrations directly. Such substances include phytosterols, tocotrienols, arginine, and antioxidant vitamins. The effects of diet on high-density-lipoprotein-cholesterol concentrations, triglycerides (fasting and postprandial), oxidized LDL particles, prostaglandins, and endothelium-derived relaxing factor are described. Finally, an illustration of some epidemiologic associations between diet and coronary disease events is made from the Adventist Health Study data.

Ref #245 - Sabaté J
SO: Current Opinion in Lipidology. 1994; 5:11-16.
AB: Recent epidemiological findings indicate that frequent nut consumption offers protection from fatal and non-fatal coronary heart disease events. Although human nutrition studies seem to indicate that nut consumption lowers total and LDL cholesterol, the unique nutrient composition of nuts invites speculation on other mechanisms of protection.

Ref #246 - Mills PK
SO: Am-J-Clin-Nutr. 1994 May; 59(5 Suppl): 1136S-1142S
AB: Cancer incidence was monitored in a population of 34,000 Seventh-day Adventists in California. By religious belief, Adventists do not consume tobacco, alcohol, or pork and approximately one-half adhere to a lacto-ovovegetarian lifestyle. Only a small percentage are pure vegetarians. Comparisons of cancer-incidence rates in this population with an external reference population were completed by calculating standardized morbidity ratios (SMRs) for all cancer sites. Also, within the population, relative risks were calculated by using data obtained from a detailed lifestyle questionnaire that members of the study population completed. For all cancer sites combined in males, the SMR was lower in the Adventists (SMR = 0.73). The SMR was also lower in males for most individual cancer sites. However, prostate cancer risk was higher. For females, the all-cancer SMR was lower but not significantly so (SMR = 92). Most site-specific SMRs were lower, although not as much as the male SMRs. The SMR for endometrial cancer was significantly higher in female Adventists.

Ref #247 - Knutsen SF
SO: Am-J-Clin-Nutr. 1994 May; 59(5 Suppl): 1171S-1175S
AB: In 1976, 27,766 Seventh-day Adventists answered questions on diet, medications, use of health services, and prevalence of disease. Approximately 55% (n = 15,228) were vegetarians. Compared with vegetarian females, nonvegetarian females reported significantly more overnight hospitalizations and surgeries during the past year and nonvegetarian males reported more overnight hospitalizations and x-rays. The average numbers of chronic diseases were 1.24 in nonvegetarian females and 1.03 in vegetarian females compared with 0.93 and 0.79 in nonvegetarian and vegetarian males, respectively. Nonvegetarian females also reported more chemical allergy (rate ratio (RR) = 1.30), asthma (RR = 1.24), drug allergy (RR = 1.17), beesting allergy (RR = 1.17), and hayfever (RR = 1.15). Only chemical and drug allergy were more prevalent in nonvegetarian males. Medication use was increased by 70-115% in nonvegetarian females and more than doubled in nonvegetarian males. We conclude that a vegetarian diet may decrease the prevalence of chronic disease, medication use, and health service use, and thus, potentially, health care costs.

Ref #248 Fønnebø V
Am-J-Clin-Nutr. 1994 May; 59(5 Suppl): 1124S-1129S
The health effect of being a Seventh-day Adventist was studied by computer-linking the official church rosters with National Health Registries. Birth weight in children born by Seventh-day Adventist mothers was 99 g higher (P < 0.001) than that of matched control subjects. Total cholesterol was 0.86 mmol/L lower in the Seventh-day Adventist men (P < 0.001) and 0.48 mmol/L lower in women (P < 0.001). Cancer incidence was not significantly lower in Seventh-day Adventists [standardized incidence ratio (SIR) in men, 91; women, 97]. Total mortality was significantly lower only in Seventh-day Adventist men [standardized mortality ratio (SMR), 82; P < 0.001], especially cardiovascular mortality. Entering the church at an early age had a large effect on later mortality. The study supports previous findings in Seventh-day Adventists, with the exception of cancer incidence and mortality. An early establishment of a healthy lifestyle seems to be of decisive importance in the risk of later disease.

Ref #249 - Kuczmarski RJ
SO: J-Am-Coll-Nutr. 1994 Apr; 13(2): 165-73
OBJECTIVE: This comparative study was designed to discover early determinants of systolic (S) and diastolic (D) blood pressure (BP) elevations in 138 Seventh-Day Adventist (SDA) and 89 non-SDA male and female adolescents (median age, 17 years) living at three residential secondary schools in North Carolina. METHODS: Measurements were made of blood pressure, body weight, and height, and information was collected on lifestyle factors, dietary intake, and other behaviors, including exercise, religiosity, Type A behavior, and anger, by questionnaire. Multiple stepwise regression analyses were performed with BP, either SBP or DBP, as the independent variable. RESULTS: A significant direct association was found only between body weight and BP, but weak associations were shown between BP and other variables, including exercise, diet, religiosity, Type A behavior, and anger. Male and female SDA students showed significantly higher SBPs and DBPs than did non-SDA adolescents though the differences were small (approximately 5 mm for each sex). CONCLUSIONS: These findings suggest that the higher BP values of SDA adolescents, who were all practicing lacto-ovo-vegetarians, compared to similarly aged health-conscious non-SDAs, are determined more by eating behaviors that contribute to gains in body weight than by any other lifestyle variable. Furthermore, these data support the notion that the BP-protective effects of the vegetarian diet may not emerge in these SDA youth until early adulthood.

Ref #250 - Beilin LJ
SO: Am-J-Clin-Nutr. 1994 May; 59(5 Suppl): 1130S-1135S
AB: Although much of the attention on diet and hypertension has centered around the rule of specific nutrients such as sodium, potassium, and alcohol, it has become evident that certain complex dietary patterns have a blood pressure-lowering effect and may help protect against the development of hypertension. It remains to be seen whether these effects on blood pressure require complex but specific combinations of nutrients or, alternatively, are due to hitherto unrecognized single nutrients with antihypertensive properties. The issues are difficult to resolve because people eat foods, not single nutrients, and there is a high degree of association between different nutrients in foods and patterns of food intake, as well as potentially confounding effects of other factors associated with eating habits such as age, body fat distribution, physical activity, alcohol consumption, tobacco use, and psychosocial stress.

Ref #251 - Abbey DE
SO: Arch-Environ-Health. 1995 Mar-Apr; 50(2): 139-52
AB: Site- and season-specific regressions of particulates less than 10 mu in diameter (PM10) on total suspended particulates (TSPs) were formed throughout California during years when both were monitored. The regressions were then applied to monitored TSPs for the years 1973 to 1987, and indirect estimates of PM10 were formed. These estimates of PM10 were validated by interpolating them to other monitoring stations. The split-halves correlation between the estimated and monitored mean concentrations, obtained when both were first cumulated for a 2-y period, was .86. Indirect estimates of PM10 at monitoring stations were interpolated, by month, to zip code centroids of home and work location and were cumulated for a cohort of 3,914 California Seventh-day Adventist (SDA) nonsmokers. Multivariate analyses, adjusted for several covariates, showed statistically significant (p < .05), but small, positive associations between PM10 and development of (a) definite symptoms of overall airway obstructive disease, (b) chronic productive cough, and (c) increased severity of airway obstructive disease and asthma. The relative risk (RR) associated with 1,000 h/y (42 d) exposure to concentrations of PM10 that exceeded 100 micrograms/m3 for development of airway obstructive disease was 1.17 (95% confidence interval [CI]: 1.02, 1.33); for development of productive cough, the RR was 1.21 (CI 1.02, 1.44); and for development of asthma, the RR was 1.30 (CI, 0.97, 1.73). Stronger associations were observed for those who were exposed occupationally to dusts and fumes. The RR of developing airway obstructive disease as an adult for those who had airway obstructive disease as a child was 1.66 (CI 1.15, 2.33).

Ref #252 - Abbey DE
SO: Inhalat Toxicol 1995;7:19-34
AB: A cohort of 6340 nonsmoking California Seventh-day Adventists (SDAs) who had resided within 5 miles of their present residence for the past 10 yr has been followed since 1977 for incidence of cancer and myocardial infarction (MI) through 1982; development of definite symptoms of, and increasing severity of, airway obstructive disease (AOD), chronic bronchitis, and asthma through 1987; and all natural cause mortality through 1987. Cumulative ambient concentrations of specific pollutants have been estimated for study participants from 1967 to 1987 by interpolating monthly statistics from statewide air monitoring stations to ZIP codes of residence and work location. Statistics include excess concentrations and exceedance frequencies above a number of cutoffs as well as mean ambient concentration and mean ambient concentration adjusted for time spent indoors. Indoor sources or nitrogen (NO2), and of particulate pollution such as environmental tobacco smoke, both at home and at work, as well as occupational dusts and fumes, have been adjusted for in multivariate statistical models. Particulates included total suspended particulates (TSP), monitored from 1973 to 1987; inhalable particulates less than 10 Fm in diameter (PM-10), estimated from site/seasonal-specific regressions on TSP for 1973-1987; fine particulates less than 2.5 Fm in diameter estimated from airport visibility data for 1967-1987; and suspended sulfates (SO4). Monitored from 1977 to 1987. A direct measure of visibility, and gaseous pollutants - ozone, sulfur dioxide (SO2), and (NO2) - monitored from 1973 to 1987 were also included in analyses. No statistically significant associations between any of the disease outcomes studied and NO2 or SO2 were found in this cohort. None of the pollutants studied showed statistically significant associations with all natural cause mortality or incidence of all malignant neoplasms in males. Statistically significant associations were observed between elevated ambient concentrations of one or more particulate pollutants and each of the other disease outcomes. In addition, ozone was significantly associated with increasing severity of asthma, and with the development of asthma in males. Multipolutant analyses indicated that none of the associations between particulate pollutants and disease outcomes were due to correlations with gaseous pollutants studied except possibly for PM 2.5 and increasing severity of asthma, which could be due to a correlation with ozone. Observed associations between disease outcomes and PM2.5 or PM-10 could be biased toward the null because of increased measurement error due to their indirect methods of estimation.

Ref #253 - Morgan JW
SO: Nutr-Cancer. 1995; 23(3): 247-57
AB: Using 63 healthy subjects, we conducted an observational study to assess associations between colonic epithelial cell proliferation and dietary intake of selected nutrients. Study subjects exhibited no personal or family history of colon carcinoma, familial polyposis coli, sporadic adenomas, or chronic inflammatory bowel diseases. In this study population, a negative association between the tritiated thymidine-labeling index and dietary intake of calcium (p < 0.003) was found after the effects of age, sex, body mass index (kg/m2), dietary fat, and total energy were controlled in a linear regression model. The association for calcium indicated that a daily calcium intake of 1,200 mg was associated with a predicted thymidine-labeling index of 6%. In the same model, a positive association with the thymidine-labeling index was found for body mass index (p < 0.002) and was suggested for female gender (p < 0.09). No association was found between the thymidine-labeling index and intake of fat, protein, carbohydrate, retinol, ascorbic acid, phosphorus, or iron. Repeat measures of diet in this investigation were used to estimate a subject's daily intake of selected nutrients.

Ref #254 - Fraser GE
SO: Am-J-Epidemiol. 1995 Oct 1; 142(7): 746-58
AB: The effect of traditional coronary heart disease risk factors on lifetime risk, age at onset, and survival free of coronary disease has not been extensively studied. The authors have used the cohort data from 27,321 California Seventh-day Adventists who had no known heart disease in 1976 to investigate these questions. Multiple decrement life tables incorporating non-parametric estimates of conditional probabilities for both coronary disease and all other competing endpoints were used to estimate these survival outcomes. Variance estimators are provided in an appendix. Persons characterized by being either past smokers, diabetic, hypertensive, physically, non-vegetarian, or infrequent consumers of nuts often showed substantial differences in these survival outcomes. Statistically significant results include earlier age at onset of coronary disease at between 4 and 10 years, reduced life expectancy free of the disease between 5 and 9 years, and increased lifetime risk between 8% and 16%, when comparing groups with and without adverse values for different risk factors. The presence of adverse levels of two risk factors predicted even greater differences in these endpoints. These important effects are easily understood by the layman or non-epidemiologist professional, which is often not true of a relative risk. This should increase the effectiveness of such results when promoting behavioral change.

Ref #255 - Persky V
SO: J-Nutr. 1995 Mar; 125(3 Suppl): 709S-712S
AB: Previous epidemiologic studies of the effects of soy protein on cancer risk have been limited by small variations in soy intake, inability to separate soy from other dietary variables and difficulties inherent in relating dietary intake to the development of cancer several decades later. As a result, although existing data suggest that soy protein may be protective for cancer risk, results are overall inconclusive. There is also evidence that soy products may affect risk factors for cancer, such as endogenous hormone levels. Preliminary data from our group indicate that young Adventist women who are vegetarians with high soy intake and a lower risk of breast cancer may have higher levels of an adrenal androgen, dehydroepiandrosterone sulfate. Other groups have noted that soy protein may be associated with alterations in the regulation and binding of ovarian hormones. Additional studies examining effects of soy protein on risk factors for cancer would help, not only in delineating mechanisms of cancer development, but also in designing dietary programs aimed at cancer prevention.

Ref #256 - Toohey
SO: J-Nutr. 1996 Jan; 126(1): 121-8
AB: This study was undertaken to examine relationships among blood pressure, blood lipids, and plasma concentrations of ascorbic acid and malondialdehyde (MDA) equivalents (indicative of lipid peroxidation) in adult African-Americans. Subjects (n = 172, mean age = 48.0 y) were recruited from among the memberships of several Seventh-Day Adventist Churches. Plasma ascorbic acid and MDA equivalents were inversely correlated (r = -0.44, P < 0.0001). There were significant inverse correlations between plasma ascorbic acid levels and both systolic (r = -0.39, P < 0.0001) and diastolic blood pressure (r = -0.25, P < 0.03), and between plasma ascorbic acid and serum total cholesterol (r = -0.25, P < 0.03), LDL-cholesterol (LDL-C) (r = -0.33, P < 0.004), and the ratio of LDL-cholesterol to HDL-cholesterol (LDL-C/HDL-C) (r = -0.32, P < 0.004). Serum HDL-cholesterol was positively related to plasma ascorbic acid (r = 0.22, P < 0.05). The correlations for MDA equivalents and the blood pressure and blood lipid variables were of similar magnitude to those of plasma ascorbic acid, but were in the opposite direction. Multiple regression analysis revealed ascorbic acid to be a significant independent contributor to the prediction of blood pressure and LDL-C concentration. These data suggest that plasma concentrations of ascorbic acid and MDA equivalents are related to several cardiovascular risk indicators in black Americans.

Ref #257 - McAnulty J
SO: Ethn-Health. 1996 Sep; 1(3): 187-95
AB: OBJECTIVES: To examine relationships between body mass index (BMI) and cardiovascular risk factors in 279 Europeans and 231 Polynesian Pacific Islanders in New Zealand. METHODS: Participants were recruited from Seventh-Day Adventist church meetings or camps, and were surveyed by self-administered questionnaire. Blood pressure, weight and height were measured. Fasting blood samples were analysed for lipids, glucose and fructosamine. RESULTS: Age-adjusted BMI was higher in Pacific Islanders than in Europeans: 32.8(0.3) versus 25.6(0.3); means(SE); p = 0.0001). In Europeans, BMI was positively associated with systolic and diastolic blood pressures, triglycerides, total cholesterol, LDL cholesterol and fasting blood glucose, and negatively associated with HDL cholesterol. In Pacific Islanders, BMI was associated only with systolic and diastolic blood pressures, and with HDL cholesterol. These associations were stronger in Europeans than in Pacific Islanders. CONCLUSIONS: In this group of Pacific Islanders, the association between BMI and cardiovascular risk factors was weaker than in Europeans. This suggests that either BMI is a poor measure of adiposity in Pacific Islanders, or that adiposity may be less strongly linked to cardiovascular disease in Pacific Islanders.

Ref #258 - Sabaté J
SO: Handbook of Lipids in Human Nutrition (G. Spiller, Ed) CRC Press, 1996
INTRODUCTION: Although the majority of the literature connecting diet to coronary heart disease (CHD) and serum lipids has focused on nutrient intake, recent studies have emphasized the effect of individual foods on serum lipids and the risk of CHD. Because foods are unique combinations of nutrient and non-nutrient chemicals with many unknown biological actions, it is important to study the effects of natural foods on risk factors and the risk of chronic disease. Epidemiological research on nutrients is often translated into dietary recommendations for the general population. It is important for such research to evaluate foods as well as nutrients, however, since most individuals and institutions will change their nutrient intake largely by their choice of foods.

Ref #259 - Hunter DJ
SO: N-Engl-J-Med. 1996 Feb 8; 334(6): 356-61
AB: BACKGROUND. Experiments in animals, international correlation comparisons, and case-control studies support an association between dietary fat intake and the incidence of breast cancer. Most cohort studies do not corroborate the association, but they have been criticized for involving small numbers of cases, homogeneous fat intake, and measurement errors in estimates of fat intake. METHODS. We identified seven prospective studies in four countries that met specific criteria and analyzed the primary data in a standardized manner. Pooled estimates of the relation of fat intake to the risk of breast cancer were calculated, and data from study-specific validation studies were used to adjust the results for measurement error. RESULTS. Information about 4980 cases from studies including 337,819 women was available. When women in the highest quintile of energy-adjusted total fat intake were compared with women in the lowest quintile, the multivariate pooled relative risk of breast cancer was 1.05 (95 percent confidence interval, 0.94 to 1.16). Relative risks for saturated, monounsaturated, and polyunsaturated fat and for cholesterol, considered individually, were also close to unity. There was little overall association between the percentage of energy intake from fat and the risk of breast cancer, even among women whose energy intake from fat was less than 20 percent. Correcting for error in the measurement of nutrient intake did not materially alter these findings. CONCLUSIONS. We found no evidence of a positive association between total dietary fat intake and the risk of breast cancer. There was no reduction in risk even among women whose energy intake from fat was less than 20 percent of total energy intake. In the context of the Western lifestyle, lowering the total intake of fat in midlife is unlikely to reduce the risk of breast cancer substantially.

Ref #260 - Lindsted KD
SO: J-Clin-Epidemiol. 1996 Jul; 49(7): 783-90
AB: The healthy volunteer effect was studied by comparing 6 years of mortality data for 31,124 participants from the Adventist Health Study (AHS) who responded to both a relatively brief census questionnaire (CQ) in 1974 and a detailed life-style questionnaire (LQ) in 1976 (responders), to mortality data for 8,762 individuals who did not respond to the second questionnaire. The rate ratio (RR) comparing LQ nonresponders to responders for all cause mortality decreased from 2.5 (2.2-2.9) in 1977 to 1.4 (1.2-1.7) in 1982 (p for trend = 0.02); for ischemic heart disease mortality from 2.3 (1.8-3.0) to 1.3 (1.0-1.7); and for all sites cancer mortality from 1.8 (1.3-2.5) to 1.5 (1.1-2.0). The death rate decreased markedly among nonresponders and increased slightly among responders during the study. Similar results were seen for age and gender subgroups. Multivariate analysis controlling for confounding variables confirms these results, except that the apparent effect of education is probably due to effect modification by age. The RR decreased to about one after 3 years of follow-up in young subjects but remained elevated (> 2) in older subjects. Available sociodemographic information reveals that a higher proportion of responders are married, have college education, are SDA church members, and use medical services less than nonresponders during the previous year. Because the risk remains elevated at the end of the study in some but not all subgroups, it seems reasonable that the elevated risk in nonresponders may be due in part to a less healthy life style and in part to exclusion of individuals who did not feel well during enrollment. The results suggest that for internal comparisons no bias is likely to occur; but descriptive statistics for certain subgroup comparisons, and external comparisons, may be biased by the healthy volunteer effect.

Ref #261 - Collaborative Group on Hormonal Factors in Breast Cancer
SO: Lancet. 1996 Jun 22; 347(9017): 1713-27
AB: BACKGROUND The Collaborative Group on Hormonal Factors in Breast Cancer has brought together and reanalysed the worldwide epidemiological evidence on the relation between breast cancer risk and use of hormonal contraceptives. METHODS Individual data on 53 297 women with breast cancer and 100 239 women without breast cancer from 54 studies conducted in 25 countries were collected, checked, and analysed centrally. Estimates of the relative risk for breast cancer were obtained by a modification of the Mantel-Haenszel method. All analyses were stratified by study, age at diagnosis, parity, and, where appropriate, the age a woman was when her first child was born, and the age she was when her risk of conception ceased. FINDINGS The results provide strong evidence for two main conclusions. First, while women are taking combined oral contraceptives and in the 10 years after stopping there is a small increase in the relative risk of having breast cancer diagnosed (relative risk [95 percent CI] in current users 1.24 [1.15-1.33], 2p<0.00001; 1-4 years after stopping 1.16 [1.08-1.23], 2p=0.00001; 5-9 years after stopping 1.07 [1.02-1.13], 2p=0.009). Second, there is no significant excess risk of having breast cancer diagnosed 10 or more years after stopping use (relative risk 1.01 [0.96-1.05], NS). The cancers diagnosed in women who had used combined oral contraceptives were less advanced clinically than those diagnosed in women who had never used these contraceptives for ever-users compared with never-users, the relative risk for tumours that had spread beyond the breast compared with localised tumours was 0.88 (0.81-0.95; 2p=0.002). There was no pronounced variation in the results for recency of use between women with different background risks of breast cancer, including women from different countries and ethnic groups, women with different reproductive histories, and those with or without a family history of breast cancer. The studies included in this collaboration represent about 90 percent of the epidemiological information on the topic, and what is known about the other studies suggests that their omission has not materially affected the main conclusions. Other features of hormonal contraceptive use such as duration of use, age at first use, and the dose and type of hormone within the contraceptives had little additional effect on breast cancer risk, once recency of use had been taken into account. Women who began use before age 20 had higher relative risks of having breast cancer diagnosed while they were using combined oral contraceptives and in the 5 years after stopping than women who began use at older ages, but the higher relative risks apply at ages when breast cancer is rare and, for a given duration of use, earlier use does not result in more cancers being diagnosed than use beginning at older ages. Because breast cancer incidence rises steeply with age, the estimated excess number of cancers diagnosed in the period between starting use and 10 years after stopping increases with age at last use: for example, among 10 000 women from Europe or North America who used oral contraceptives from age 16 to 19, from age 20 to 24, and from age 25 to 29, respectively, the estimated excess number of cancers diagnosed up to 10 years after stopping use is 0.5 (95 percent CI 0.3-0.7), 1.5 (0.7-2.3), and 4.7 (2.7-6.7). Up to 20 years after cessation of use the difference between ever-users and never-users is not so much in the total number of cancers diagnosed, but in their clinical presentation, with the breast cancers diagnosed in ever-users being less advanced clinically than those diagnosed in never-users. The relation observed between breast cancer risk and hormone exposure is unusual, and it is not possible to infer from these data whether it is due to an earlier diagnosis of breast cancer in ever-users, the biological effects of hormonal contraceptives, or a combination of reasons...

Ref #262 - Singh PN
SO: Med-Sci-Sports-Exerc. 1996 Aug; 28(8): 1026-37
AB: The validity and reliability of selected physical activity questions were assessed in both Seventh-day Adventist (N = 131) and non-Adventist (N = 101) study groups. Vigorous activity questions similar to those used by others and new questions that measured moderate and light activities were included. Validation was external, comparing questionnaire data with treadmill exercise time, resting heart rate, and body mass index (kg.m-2), and internal, comparing data with other similar questions. Both Adventist and non-Adventist males showed significant age-adjusted correlations between treadmill time and a "Run-Walk-Jog Index" (R = 0.28, R = 0.48, respectively). These correlations increased substantially when restricting analysis to exercise speeds exceeding 3 mph (R = 0.39, R = 0.71, respectively). Frequency of sweating and a vigorous physical activity index also correlated significantly with treadmill time in males. Correlations were generally weaker in females. Moderate- and light-intensity questions were not correlated with physical fitness. Internal correlations R = 0.50-0.78) between the above three vigorous activity questions were significant in all groups, and correlations (R = 0.14-0.60) for light and moderate activity questions were also documented. Test-retest reliability coefficients were high for vigorous activity questions (R = 0.48-0.85) and for one set of moderate activity questions (R = 0.43-0.75). No important differences in validity and reliability were found between Adventist and non-Adventists, but the validity of vigorous activity measures was generally weaker in females.

Ref #263 - Fraser GE
SO: Am-J-Epidemiol. 1996 Jun 15; 143(12): 1181-90
AB: From a cohort of white, non-Hispanic California Seventh-day Adventists, 99 subjects over age 75 years in 1991 were randomly selected. Dietary habits and educational status had been measured in 1976. Subjects completed the Mini-Mental State Examination (MMSE) in 1991, and at that time, they or caregivers also gave information on current medical problems and drug therapy. Those who ate more calories in 1976 had lower MMSE scores in 1991 (p = 0.03), an association strengthened by excluding those with previous stroke or Parkinson's disease by 1991. This raises the possibility that higher consumption of calories in middle age may accelerate the decline in cognitive function seen with aging, as apparently occurs in some animals. Less-educated subjects had lower MMSE scores, especially among the very elderly. The statistical model predicts that the negative association between use of psychotropic drugs and MMSE score (p = 0.004) is particularly potent in those cognitively impaired for other reasons. If causal, this suggests that physicians should use these agents very cautiously in such subjects.

Ref #264 - Collaborative Group on Hormonal Factors in Breast Cancer
SO: Contraception. 1996 Sep; 54(3 Suppl): 1S-106S
AB: The Collaborative Group on Hormonal Factors in Breast Cancer has brought together and reanalysed the worldwide epidemiological evidence on breast cancer risk and use of hormonal contraceptives. Original data from 54 studies, representing about 90% of the information available on the topic, were collected, checked and analysed centrally. The 54 studies were performed in 26 countries and include a total of 53,297 women with breast cancer and 100,239 women without breast cancer. The studies were varied in their design, setting and timing. Most information came from case-control studies with controls chosen from the general population; most women resided in Europe or North America and most cancers were diagnosed during the 1980s. Overall 41% of the women with breast cancer and 40% of the women without breast cancer had used oral contraceptives at some time; the median age at first use was 26 years, the median duration of use was 3 years, the median year of first use was 1968, the median time since first use was 16 years, and the median time since last use was 9 years. The main findings, summarised elsewhere, are that there is a small increase in the risk of having breast cancer diagnosed in current users of combined oral contraceptives and in women who had stopped use in the past 10 years but that there is no evidence of an increase in the risk more than 10 years after stopping use. In addition, the cancers diagnosed in women who had used oral contraceptives tended to be less advanced clinically than the cancers diagnosed in women who had not used them. Despite the large number of possibilities investigated, few factors appeared to modify the main findings either in recent or in past users. For recent users who began use before age 20 the relative risks are higher than for recent users who began at older ages. For women whose use of oral contraceptives ceased more than 10 years before there was some suggestion of a reduction in breast cancer risk in certain subgroups, with a deficit of tumors that had spread beyond the breast, especially among women who had used preparations containing the highest doses of oestrogen and progestogen. These findings are unexpected and need to be confirmed. Although these data represent most of the epidemiological evidence on the topic to date, there is still insufficient information to comment reliably about the effects of specific types of oestrogen or of progestogen. What evidence there is suggests, however, no major differences in the effects for specific types of oestrogen or of progestogen and that the pattern of risk associated with use of hormonal contraceptives containing progestogens alone may be similar to that observed for preparations containing both oestrogens and progestogens. On the basis of these results, there is little difference between women who have and have not used combined oral contraceptives in terms of the estimated cumulative number of breast cancers diagnosed during the period from starting use up to 20 years after stopping. The cancers diagnosed in women who have used oral contraceptives are, however, less advanced clinically than the cancers diagnosed in never users. Further research is needed to establish whether the associations described here are due to earlier diagnosis of breast cancer in women who have used oral contraceptives, to the biological effects of the hormonal contraceptives or to a combination of both. Little information is as yet available about the effects on breast cancer risk of oral contraceptive use that ceased more than 20 years before and as such data accumulate it will be necessary to re-examine the worldwide evidence.

Ref #265 - Pribi_ P. Association between nutrient intake and risk of coronary heart disease in SO: Dissertation, Univ. Microfilms International, Ann Arbor, MI

Ref #266 - Fraser GE.
SO: Epidemiology. 1997 Mar; 8(2): 168-74
AB: We evaluated dietary and other risk factors in a black California cohort. Baseline data were gathered in 1974 and 1976, and mortality follow-up continued through 1985. A study census questionnaire was returned from 3,299 subjects who lived in a household containing at least one Seventh-Day Adventist. Of these, 1,668 subjects also completed a detailed life-style and dietary questionnaire in 1976. Vital status was ascertained using church records and the California State death tapes. Mortality hazard ratios (HR; both sexes combined) across three increasing consumption levels were determined for nuts (1.00, 0.60, 0.56), fruits (1.00, 0.38, 0.57), and green salads (1.00, 0.54, 0.65). Consumption of meats appeared more hazardous for women, although there was no dose-response relation. Education (HR = 1.00, no college; 0.74, some college; 0.42, college graduate), male gender (HR = 1.55), diabetes mellitus (HR = 1.77), and hypertension (HR = 2.52) were independently associated with mortality, as was obesity, which had a curvilinear association in women and a linear association in men. Exercise was not associated with mortality after excluding those with morbidity at baseline. In summary, traditional risk factors operated with similar force in this black population. In addition, the frequent consumption of nuts, fruits, and green salads appears protective.

Ref #267 - Lindsted KD
SO: Am-J-Epidemiol. 1997 Jul 1; 146(1): 1-11
AB: The authors have examined the relation between the Quetelet body mass index (BMI) and 26-year risk of all-cause mortality in a population of 12,576 non-Hispanic while, Seventh-day Adventist women (ages 30-74 years) who never smoked. Mortality risk for each BMI quintile (I, < 21.3 kg/m2; II, 21.3-22.9 kg/m2; III, 23.0-24.8 kg/m2; IV, 24.9-27.4 kg/m2; and V, > 27.4 kg/m2) was determined from a proportional hazard regression with adjustment for age and other covariables. In this population, the overall BMI-mortality relation showed dependence on age, duration of follow-up, and baseline indicators of preexisting illness (weight fluctuation, history of major chronic disease, and severe physical complaints). Therefore, the analysis focused on women with no indicators of preexisting illness, and risk estimates were stratified by age at baseline and duration of follow-up. Among middle-aged women (ages 30-54 years), the authors found a weak linear relation during years 1-8 (median attained age, 51 years), a significant linear relation during years 9-14 (median attained age, 57 years), and a significant nonlinear (U-shaped) relation during years 15-26 (median attained age, 68 years). Among older women (ages 55-74 years), they found a significant nonlinear (U-shaped) relation during years 1-8 (median attained age, 71 years) and significant linear relations during years 9-14 (median attained age, 77 years) and years 15-26 (median attained age, 87 years). These findings implicate overweight as a risk factor for fatal disease among women throughout adulthood and raise the possibility that lean, apparently healthy, middle-aged women may experience a higher risk of death during old age due to their lower body weight.

Ref #268 - Fraser GE
SO: Ann-Epidemiol. 1997 Aug; 7(6): 375-82
AB: PURPOSE: We evaluated the relationship between exposure variables and both lifetime risk and mean age at diagnosis of breast cancer in subjects from the Adventist Health Study who developed breast cancer before the age of 91 years. METHODS: Multiple decrement life-table analysis was used. This study provided data from 20,341 women followed for 6 years. RESULTS: In the total population, 30-year-old women with a parental history of any cancer or a maternal history of breast cancer had, respectively, 72% (P < 0.002) and 98% (P < 0.03) higher lifetime risks of breast cancer. Thirty-year-old women who had their first delivery after age 24 years or body mass indices above the 50th percentile had, respectively, 53% (P < 0.007) or 57% (P = 0.01) greater lifetime risk of breast cancer. Women who exercised infrequently had a 27% higher life-time risk (P = 0.09) and an age at diagnosis of breast cancer 6.6 years younger (P < 0.005) than other women. CONCLUSIONS: Standard risk factors account for substantial increases in lifetime risk of breast cancer and may be associated with differences in age at diagnosis.

Ref #269 - Fraser GE
SO: J Religion & Health 1997;36:231-9
AB: Certain structural and functional aspects of social networks and support were compared among 157 middle-aged Seventh-day Adventists and male neighbors of the same age range. The Adventist men were 11.2% more likely to be married (p<0.05), had 15% more trusted friends (p<0.10) and 31% more trusted relatives (p<0.005) than their neighbors. Of the Adventists and neighbors, 74% and 52% respectively reported feeling frequently cared for by others (p<0.001). At least weekly church attendance was practiced by 84% of the Adventists and 30% of the neighbors (p<0.001). It is speculated that some of the favorable mortality experience of Adventists may be causally related to these increased levels of social support.

Ref #270 - Fraser GE
SO: Arch Intern Med. 1997 Oct 27; 157(19): 2249-58
AB: BACKGROUND: The oldest-old population (> or = 84 years of age) is growing rapidly and consumes a disproportionate amount of health care dollars. Risk factors for disease have not been extensively studied in this group. METHODS: A cohort study of non-Hispanic white Seventh-Day Adventists from California allowed follow-up for mortality from 1976 through 1988. Associations between traditional risk factors, consumption of selected foods, and both coronary heart disease (CHD) and all-cause mortality were evaluated in the oldest-old portion of this population, using proportional hazards regression analyses. RESULTS: We observed 364 cases of CHD and 1387 total deaths during 11,828 person-years of follow-up. Men had higher risk of both all-cause mortality and mortality from CHD. The relative risks (RRs) associated with diabetes mellitus were 1.51 (95% confidence interval [CI], 1.24-1.84; P < .001) for all deaths and 1.95 (95% CI, 1.38-2.76; P < .001) for mortality from CHD. The apparent effects of hypertension were small unless subjects were currently taking antihypertensive medications. Compared with those with no regular vigorous activity, subjects who exercised at least 3 times each week had RRs of death of 0.80 (95% CI, 0.70-0.91; P < .001) and 0.74 (95% CI, 0.56-0.97; P < .05) for mortality from CHD. Subjects who consumed nuts 5 times per week had RRs of death of 0.82 (95% CI, 0.70-0.96; P < .01) and 0.61 (95% CI, 0.45-0.83; P < .001) for death from CHD compared with those consuming nuts less than weekly. In men, regular consumption of donuts appeared hazardous for both all-cause mortality (RR, 1.40; 95% CI, 1.05-1.88) and mortality from CHD (RR, 2.10; 95% CI, 1.15-3.81), and consumption of beef 4 times weekly was associated with a 2-fold RR for CHD compared with vegetarians, but there was no increase in risk for women. CONCLUSIONS: Even in the oldest-old, certain traditional risk factors and dietary habits are associated with mortality.

Ref #271 - Collaborative Group on Hormonal Factors in Breast Cancer
SO: Lancet. 1997 Oct 11; 350(9084): 1047-59
AB: BACKGROUND: The Collaborative Group on Hormonal Factors in Breast Cancer has brought together and reanalysed about 90% of the worldwide epidemiological evidence on the relation between risk of breast cancer and use of hormone replacement therapy (HRT). METHODS: Individual data on 52,705 women with breast cancer and 108,411 women without breast cancer from 51 studies in 21 countries were collected, checked, and analysed centrally. The main analyses are based on 53,865 postmenopausal women with a known age at menopause, of whom 17,830 (33%) had used HRT at some time. The median age at first use was 48 years, and 34% of ever-users had used HRT for 5 years or longer. Estimates of the relative risk of breast cancer associated with the use of HRT were obtained after stratification of all analyses by study, age at diagnosis, time since menopause, body-mass index, parity, and the age a woman was when her first child was born. FINDINGS: Among current users of HRT or those who ceased use 1-4 years previously, the relative risk of having breast cancer diagnosed increased by a factor of 1.023 (95% CI 1.011-1.036; 2p=0.0002) for each year of use; the relative risk was 1.35 (1.21-1.49; 2p=0.00001) for women who had used HRT for 5 years or longer (average duration of use in this group 11 years). This increase is comparable with the effect on breast cancer of delaying menopause, since among never-users of HRT the relative risk of breast cancer increases by a factor of 1.028 (95% CI 1.021-1.034) for each year older at menopause. 5 or more years after cessation of HRT use, there was no significant excess of breast cancer overall or in relation to duration of use. These main findings did not vary between individual studies. Of the many factors examined that might affect the relation between breast cancer risk and use of HRT, only a woman's weight and body-mass index had a material effect: the increase in the relative risk of breast cancer associated with long durations of use in current and recent users was greater for women of lower than of higher weight or body-mass index. There was no marked variation in the results according to hormonal type or dose but little information was available about long durations of use of any specific preparation. Cancers diagnosed in women who had ever used HRT tended to be less advanced clinically than those diagnosed in never-users. In North America and Europe the cumulative incidence of breast cancer between the ages of 50 and 70 in never-users of HRT is about 45 per 1000 women. The cumulative excess numbers of breast cancers diagnosed between these ages per 1000 women who began use of HRT at age 50 and used it for 5, 10, and 15 years, respectively, are estimated to be 2 (95% CI 1-3), 6 (3-9), and 12 (5-20). Whether HRT affects mortality from breast cancer is not known. INTERPRETATION: The risk of having breast cancer diagnosed is increased in women using HRT and increases with increasing duration of use. This effect is reduced after cessation of use of HRT and has largely, if not wholly, disappeared after about 5 years. These findings should be considered in the context of the benefits and other risks associated with the use of HRT.

Ref #272 - Hopkins GL
SO: Dissertation, Univ. Microfilms International, Ann Arbor, MI

Ref #273 - Murphy FG
SO: Am J Health Behav 1997; 21(1):43-50
AB: Differences in morbidity, mortality, and life expectancy between African-Americans and white Americans are well known, as are reduced disease-specific mortality rates among certain religious groups whose lifestyle practices protect them from various risk factors. This manuscript specifically, looks at health values and practices among African-American Seventh-day Adventists.

Ref #274 - Key TJ
SO: Public Health Nutr 1998;1:33-41
AB: Objective: To compare the mortality rates of vegetarians and non-vegetarians.
Design: Collaborative analysis using original data from five prospective studies. Death rate ratios for vegetarians compared to non-vegetarians were calculated for ischaemic heart disease, cerebrovascular disease, cancers of the stomach, large bowel, lung, breast and prostate, and for all causes of death. All results were adjusted for age, sex and smoking. A random effects model was used to calculate pooled estimates of effect for all studies combined.
Setting: USA, UK and Germany.
Subjects: 76,172 men and women aged 16-89 years at recruitment. Vegetarians were those who did not eat any meat or fish (n=27,808). Non-vegetarians were from a similar background to the vegetarians within each study.
Results: After a mean of 10.6 years of follow-up there were 8330 deaths before the age of 90 years, including 2264 deaths from ischaemic heart disease. In comparison with non-vegetarians, vegetarians had a 24% reduction I mortality from ischaemic heart disease (death rate ratio 0.76, 95% CI 0.62-0.94). The reduction in mortality among vegetarians varied significantly with age at death: rate ratios for vegetarians compared to non-vegetarians were 0.55 (95% CI 0.35-0.85), 0.69 (95% CI 0.53-0.90) and 0.92 (95% CI 0.73-1.16) for deaths from ischaemic heart disease at ages <65, 65-79 and 80-89 years, respectively. When the non-vegetarians were divided into regular meat eaters (who ate meat at least once a week) and semi-vegetarians (who ate fish only or ate meat leass than once a week), the ischaemic heart disease death rate ratios compared to regular meat eaters were 0.78 (95% CI 0.68-0.89) in semi-vegetarians and 0.66 (95% CI 0.53-0.83) in vegetarians (test for trend P<0.001). There were no significant differences between vegetarians and non-vegetarians in mortality from the other causes of death examined.
Conclusion: Vegetarians have a lower risk of dying from ischaemic heart disease than non-vegetarians.

Ref #275 - Singh PN
SO: Epidemiology. 1998 May; 9(3): 246-54
AB: We examined the relation between Quetelet's body mass index (BMI) and age-adjusted mortality risk from specific diseases in a 26-year prospective cohort study of 12,576 non-Hispanic white women who had never smoked. To account for effects due to antecedent disease, we focused on women surviving 15-26 years after their report of body weight. High BMI (>27 kg per m2) decreased the risk of fatal respiratory disease (hazard ratios of 0.7 for ages 30-54 years and 0.6 for ages 55-74 years) but increased risk in all other disease categories. Low BMI (<21 kg per m2) increased the risk of fatal respiratory disease (hazard ratios of 2.0 for ages 30-54 years and 1.4 for ages 55-74 years). Among middle-aged women (ages 30-54 years), we found that low BMI also increased the risk of certain fatal cardiovascular diseases (hazard ratios of 1.5 for cerebrovascular death and 2.5 for hypertensive and other cardiovascular deaths), but the increase in the risk of fatal cerebrovascular disease did not remain (hazard ratio of 0.4) after exclusion of subarachnoid and intraparenchymal hemorrhage deaths from the endpoint. Although the inverse relation between BMI and risk of fatal respiratory disease was also evident in the subset who reported body weight 17 years after baseline, further restriction of this subset to stable-weight women reporting no history of respiratory disease resulted in a U-shaped relation. Data from this subset also indicated that weight loss substantially increased the risk of fatal respiratory disease. These findings implicate high and low BMI as risk factors for fatal respiratory disease but suggest that the risk due to high BMI was obscured by weight loss that followed the onset of disease. The overall findings support an association between obesity and a higher risk of fatal disease but also raise the possibility that apparently healthy, never-smoking women can experience a higher long-term risk of fatal cardiovascular and respiratory diseases due to a lower body weight.

Ref #276 - Singh PN
SO: Am-J-Epidemiol. 1998 Oct 15; 148(8): 761-74
AB: In a 6-year prospective study, the authors examined the relation between diet and incident colon cancer among 32,051 non-Hispanic white cohort members of the Adventist Health Study (California, 1976-1982) who, at baseline, had no documented or reported history of cancer. The risk of colon cancer was determined from proportional hazards regression with adjustment for age and other covariates. The authors found a positive association with total meat intake (risk ratio (RR) for > or =1 time/week vs. no meat intake = 1.85, 95% confidence interval (CI) 1.19-2.87; p for trend = 0.01) and, among subjects who favored specific types of meat, positive associations with red meat intake (RR for > or =1 time/week vs. no red meat intake = 1.90, 95% CI 1.16-3.11; p for trend = 0.02) and white meat intake (RR for > or =1 time/week vs. no white meat intake = 3.29, 95% CI 1.60-6.75; p for trend = 0.006). An inverse association with legume intake (RR for >2 times/week vs. <1 time/week = 0.53, 95% CI 0.33-0.86; p for trend = 0.03) was observed. Among men, a positive association with body mass index was observed (relative to the RR for tertile III (>25.6 kg/m2) vs. tertile I (<22.5 kg/m2) = 2.63, 95% CI 1.12-6.13; p for trend = 0.05). A complex relation was identified whereby subjects exhibiting a high red meat intake, a low legume intake, and a high body mass experienced a more than threefold elevation in risk relative to all other patterns based on these variables. This pattern of putative risk factors would likely contribute to increases in both insulin resistance (high body mass, high red meat intake) and glycemic load (low legume intake), a synergism that, if causal, implicates hyperinsulinemic exposure in colon carcinogenesis. The overall findings from this cohort identify both red meat intake and white meat intake as important dietary risk factors for colon cancer and raise the possibility that the risk due to red meat intake reflects a more complex etiology.

Ref #277 - Famodu AA
SO: Clin Biochem. 1998 Oct; 31(7): 545-9
AB: BACKGROUND: Several epidemiological studies have implicated hypercholesterolemia and hypertriglyceridaemia as a dietary risk factor in the etiology of vascular disease. To date, there are virtually no blood lipid data available for Negroid Black African Seventh-Day Adventist vegetarians. This study was undertaken to gain a preliminary and better understanding of the relationships between BP, blood lipids, and diets in adults at the Seventh-Day Adventist Seminary of West Africa, Ilisan-Remo, Nigeria. METHODS: Three randomly selected groups of the Nigerian populace with different dietary habits were investigated. The Seventh-Day Adventist Seminary of West Africa was the study area. Anthropometric measurements, blood pressure, serum cholesterol, triglycerides, and serum glucose were estimated using standard methods. FINDINGS: The vegetarians (VEGs) had significantly lower body weight 75.0 +/- 1.9 kg than the semi-vegetarians (SEMI-VEGs) 77.3 +/- 1.8 kg (p < 0.05). There was no significant difference between the blood pressure (BP) of the three groups studied, although the VEGs exhibited lower systolic BP. The VEGs had significantly lower serum total cholesterol and triglycerides (p < 0.05), than non-vegetarians (NON-VEGs). The SEMI-VEGs had blood triglycerides values in between NON-VEGs and VEGs levels but these were not significant. There were no differences in blood glucose in the three groups. CONCLUSIONS: The vegetarian diet as well as the African natural diet are associated with lower levels of important cardiovascular disease risk factors. The significantly lower cardiovascular disease risk factors in vegetarian African Adventists could be a protective measure against the development of premature IHD and CVD incidence.

Ref #278 - Lindsted KD
SO: Int-J-Obes-Relat-Metab-Disord. 1998 Jun; 22(6): 544-8
AB: OBJECTIVE: To re-analyse the previously reported linear relation between Quetelet's body mass index (BMI) and mortality, among men from the Adventist Mortality Study after accounting for effects due to age at measurement of BMI, smoking history and race. DESIGN: Prospective cohort study. To specifically account for effects due to age at measurement of BMI, smoking history and race, our methodology includes: 1, computing hazard ratios for BMI quintiles from a proportional hazard regression, with 'time on study' as the time variable, and age at baseline as a covariate; 2, conducting separate analyses of middle-aged (age 30-54y) and older (age 55-74y) men; and 3, restriction of the analyses to never-smoking, non-Hispanic white males. SUBJECTS: 5062 men (age: 30-74 y, BMI: 14-44 kg/m2) from the Adventist Mortality Study. MEASUREMENTS: Subjects reported data on anthropometric, demographic, medical, dietary and lifestyle characteristics at baseline and were enrolled in mortality surveillance during a 26y study period (1960-1985). RESULTS: During the early years of follow-up (years 1-8, 9-14), we found some evidence of excess risk among the leanest men that was probably due to the effects of antecedent illness. During the later years of follow-up (years 15-26), effects due to antecedent illness were not apparent and a significant positive, linear relation between BMI and all-cause mortality was consistently found among middle-aged (30-54 y) and older (55-74 y) men. Disease-specific analyses of the later follow-up (years 15-26) revealed that the positive linear trends with all-cause mortality, were primarily due to excess risk of cardiovascular disease and cancer among the heavier men. Among older men, a significant inverse relation between BMI and respiratory disease mortality risk was identified during later follow-up (years 15-26), but this effect attenuated after restriction of the analyses to men with no baseline history of respiratory disease. CONCLUSIONS: The re-analysis confirms the findings of a positive, linear relation between BMI and all-cause mortality, reported in the original study.

Ref #279 - Harman SK
SO: N-Z-Med-J. 1998 Mar 27; 111(1062): 91-4
AB: AIM: To determine whether adult non-vegetarian Seventh-day Adventists differ in selected nutrition related health aspects from adult vegetarian Seventh-day Adventists. METHODS: One hundred and forty-one Seventh-day Adventist church members responded to a general health questionnaire. Forty-seven sex and age matched subjects (23 non-vegetarians and 24 vegetarians) were selected for further investigation. Blood lipids, serum vitamin B12, folate, haemoglobin and ferritin levels were measured along with stature, weight and blood pressure. A quantitative 7-day diet record was also completed. RESULTS: Body mass index was similar between the non-vegetarian and vegetarian groups but diastolic blood pressure was higher for non-vegetarian than vegetarian males. Even though the dietary vitamin B12 intake was significantly lower (p < 0.01) in the vegetarian group both vegetarians and non-vegetarians recorded similar serum vitamin B12 levels. The vegetarian and non-vegetarian groups had similar haemoglobin concentrations. While dietary iron intake was higher in the female vegetarian group, though predominantly in the non-haem form, the difference was not significant. Low serum ferritin levels were found in both female dietary groups even though the vegetarian group had a significantly (p < 0.05) higher vitamin C intake. Blood lipid levels were similar in the two diet groups even though the vegetarian group had a lower percentage energy contribution from total and saturated fat (p < 0.01) and consumed significantly less cholesterol. CONCLUSION: Both non-vegetarian and vegetarian Seventh-day Adventists appear likely to enjoy a lower risk of nutrition related chronic degenerative disease than the average New Zealander and have a satisfactory iron and vitamin B12 status.

Ref #280 - Hopkins GL
SO: J Sch Health. 1998 Apr; 68(4): 141-5
AB: In 1995, a survey was conducted among students attending 69 Seventh-day Adventist (SDA) high schools within the United States and Canada. The survey assessed the extent that these students practiced sexual and drug-use behaviors which place them at risk for contracting or transmitting the human immunodeficiency virus (HIV). A total of 1,748 respondents enrolled in grades 9 through 12 completed questionnaires similar to the instrument used in the 1993 Youth Risk Behavior Survey (YRBS). Data were collected and compared to results from the 1993 YRBS. Students who attended SDA parochial schools reported lower rates of sexual intercourse compared to YRBS school counterparts (16.3% vs. 53.1%) and lower rates of all substances measured. Furthermore, respondents were more likely to engage in substance use and sexual intercourse if they had at least one parent who used tobacco, alcohol, or marijuana, as reported by the students.

Ref #281 - Fraser GE
SO: Am J Epidemiol. 1998 Oct 15; 148(8): 810-8
AB: Past dietary habits are etiologically important to incident disease. Yet the validity of such measurements from the previous 10-20 years is poorly understood. In this study, the authors correlated food frequency results that were obtained in 1994-1995 but pertained to recalled diet in 1974 with the weighted mean of five random 24-hour dietary recalls obtained by telephone in 1974. The subjects studied were 72 Seventh-day Adventists who lived within 30 miles of Loma Linda, California; had participated in a 1974 validation study; were still alive; and were willing to participate again in 1994. A method was developed to allow correction for random error in the reference data when these data had differentially weighted components. The results showed partially corrected correlation coefficients of greater than 0.30 for coffee, whole milk, eggs, chips, beef, fish, chicken, fruit, and legumes. Higher correlations on average were obtained when the food frequencies were scored simply 1-9, reflecting the nine frequency categories. The 95% confidence intervals for 15 of the 28 correlations excluded zero. Incorporation of portion size information was unhelpful. The authors concluded that in this population, data recalled from 20 years ago should be treated with caution but, for a number of important foods, that the degree of validity achieved approached that obtained when assessing current dietary habits.

Ref #282 - Jacobsen BK
SO: Cancer-Causes-Control. 1998 Dec; 9(6): 553-7
AB: OBJECTIVES: Recent experimental studies have suggested that isoflavones (such as genistein and daidzein) found in some soy products may reduce the risk of cancer. The purpose of this study was to evaluate the relationship between soy milk, a beverage containing isoflavones, and prostate cancer incidence. METHODS: A prospective study with 225 incident cases of prostate cancer in 12,395 California Seventh-Day Adventist men who in 1976 stated how often they drank soy milk. RESULTS: Frequent consumption (more than once a day) of soy milk was associated with 70 per cent reduction of the risk of prostate cancer (relative risk = 0.3, 95 percent confidence interval 0.1-1.0, p-value for linear trend = 0.03). The association was upheld when extensive adjustments were performed. CONCLUSIONS: Our study suggests that men with high consumption of soy milk are at reduced risk of prostate cancer. Possible associations between soy bean products, isoflavones and prostate cancer risk should be further investigated.

Ref #283 - Hopkins GL
SO: J Res Christian Educ 1998; 7:91-120
AB: During the school year of 1994-1995 students (n=1611) attending Seventh-day Adventist high schools in the United States of America completed questionnaires designed to assess their HIV/AIDS-related knowledge and behaviors. AIDS-related behavioral intentions, attitudes, subjective norms, and perceived control were also assessed according to the Theory of Planned Behavior (Ajzen, 1989). The rates of the sexual and drug-use behaviors measured in this population are lower than for students who attend public high schools. Increased risk for participating in sexual intercourse, the key AIDS-risk behavior in youth, was associated with the students' substance use and also by their parents' use of substances. Measurements designed in accord with the Theory of Planned Behavior revealed that students most relied on spiritual strength and encouragement from teachers to manage their control over premarital sexual intercourse.

Ref #284 - Beeson WL
SO: Environ Health Perspect 1998; 106:813-23
AB: The purpose of this study was to evaluate the relationship of long-term concentrations of ambient air pollutants and risk of incident lung cancer in nonsmoking California adults. A cohort study of 6,338 nonsmoking, non-Hispanic, white Californian adults, ages 27-95, was followed from 1977 to 1992 for newly diagnosed cancers. Monthly ambient air pollution data were interpolated to zip code centroids according to home and work location histories, cumulated, and then averaged over time. The increased relative risk (RR) of incident lung cancer in males associated with an interquartile range (IQR) increase in 100 ppb ozone (O3) was 3.56 [95% confidence interval (CI), 1.35-9.42]. Incident lung cancer in males was also positively associated with IQR increases for mean concentrations of particulate matter <10 microm (PM10; RR = 5.21; CI, 1.94-13.99) and SO2 (RR = 2.66; CI, 1.62-4.39). For females, incident lung cancer was positively associated with IQR increases for SO2 (RR = 2.14; CI, 1.36-3.37) and IQR increases for PM10 exceedance frequencies of 50 microg/m3 (RR = 1.21; CI, 0.55-2.66) and 60 microg/m3 (RR = 1.25; CI, 0.57-2.71). Increased risks of incident lung cancer were associated with elevated long-term ambient concentrations of PM10 and SO2 in both genders and with O3 in males. The gender differences for the O3 and PM10 results appeared to be partially due to gender differences in exposure.

Ref #285 - Toohey ML; Harris-MA; DeWitt-W; Foster-G; Schmidt-WD; Melby-CL
SO: J-Am-Coll-Nutr. 1998 Oct; 17(5): 425-34
AB: OBJECTIVE: This study was undertaken to determine if African-American strict vegetarians (vegans) exhibit lower blood pressure (BP) and a more favorable serum lipid profile than their lacto-ovo vegetarian (LOV) counterparts, and if plasma ascorbic acid (AA) concentrations could explain any group differences in these cardiovascular disease (CVD) risk factors. METHODS: Habitual dietary intake, anthropometric characteristics, blood pressure, and blood lipids and ascorbic acid concentrations were determined in African-American study participants (male vegans, n = 14, age = 45.6 years; male LOV, n = 49, age = 49.8; female vegans, n = 31, age = 51.1, female LOV, n = 94, age = 52.1) recruited from Seventh-Day Adventist Churches in several cities in the northeastern United States. RESULTS: Body mass index (BMI) was significantly lower in the vegans (24.7 +/- 1.9 kg/m2) compared to LOV (26.4 +/- 0.45 kg/m2). There were no diet or gender differences in BP. Serum total cholesterol (3.75 +/- 0.12 vs. 4.51 +/- 0.10 mmol/L), LDL-cholesterol (2.06 +/- 0.13 vs. 2.65 +/- 0.09 mmol/l), and triglycerides (0.94 +/- 0.07 vs. 1.17 +/- 0.04 mmol/L) were significantly (p < 0.05) lower in vegans compared to LOV, but there were no dietary group differences in HDL-C. The ratio of total to HDL-cholesterol was significantly lower in vegans than in LOV (3.0 +/- 0.13 vs. 3.7 +/- 0.13). There were no dietary group differences in plasma AA concentrations. However, in the entire sample, plasma AA was inversely associated with BP (SBP: r = -0.46, p < 0.001, DBP: r = -0.32, p < 0.001), but unrelated to the serum lipid concentrations. CONCLUSION: African-American vegans exhibit a more favorable serum lipid profile than lacto-ovo-vegatarians and plasma AA is inversely related to BP in African-American vegetarians but does not explain any of the differences in CVD risk factors between vegans and lacto-ovo vegetarians.

Ref #286 -Fraser GE
SO: Stat-Med. 1999 Feb 28; 18(4): 397-410
AB: Readily grasped concepts such as lifetime risk of, and expected age at onset of, a disease, cannot be easily estimated by the relative risk methods commonly used in epidemiology. Here we develop a method for estimating these quantities with confidence intervals, where the likelihood is a multivariate function of exposure variables. The model is basically non-parametric, except for a proportional hazards assumption on exposures, and except for the youngest data-poor ages, where an exponential model in age is assumed. Tests of goodness-of-fit of the model are described, these allowing for product terms between exposures and age. Application of the method is made to the Adventist Health Study cohort, where the independent effects of several exposures on these outcomes are demonstrated.

Ref #287 - Jacobsen BK
SO: J Clin Epidemiol. 1999 Apr; 52(4): 303-7
AB: We studied the relationship between age at natural menopause and total mortality as well as mortality from ischemic heart disease in a cohort of 6182 California Seventh-Day Adventist women who reported a natural menopause. During follow-up from 1976 through 1988, there were 1831 deaths. A total of 308 deaths due to ischemic heart disease occurred in women who denied ischemic heart disease at start of follow-up. An early menopause was associated with increased total mortality (P value for linear trend <0.001) and ischemic heart disease mortality (P value for linear trend = 0.03). This relationship could not be explained by possible confounding variables. Our results support the hypothesis that an early natural menopause (35-40 years old) increases the risk of ischemic heart disease. There is, however, also some evidence of increased risk of ischemic heart disease in women with a very late menopause (>55 years), particularly in women who never have used postmenopausal estrogens.

Ref #288 - Fraser GE
SO: Clin Cardiol. 1999; 22(Suppl III):III-11-III-15.
AB: In the past, many have avoided nuts because of their high fat content. The Dietary Approaches to Stop Hypertension (DASH) diet, however, recommends regular consumption of this food along with seeds and dried beans (4-5 servings per week) as part of a diet to control hypertension. Nuts are nutrient-dense and most of their fat is unsaturated. They are also perhaps the best natural source of vitamin E and are relatively concentrated repositories of dietary fiber, magnesium, potassium, and arginine, the dietary precursor of nitric oxide. Human feeding studies have demonstrated reductions of 8-12% in low-density lipoprotein (LDL) cholesterol when almonds and walnuts are substituted for more traditional fats. Other studies show that macadamias and hazelnuts appear at least as beneficial as fats in commonly recommended diets. Whether consuming modest quantities of nuts daily may promote weight gain is not known with certainty, but preliminary data suggest that this is unlikely. Four of the best and largest cohort studies in nutritional epidemiology have now reported that eating nuts frequently is associated with a decreased risk of coronary heart disease of the order of 30-50%. The findings are very consistent in subgroup analyses and unlikely to be due to confounding. Possible mechanisms include reduction in LDL cholesterol, the antioxidant actions of vitamin E, and the effects on the endothelium and platelet function of higher levels of nitric oxide. Although nuts may account for a relatively small percentage of dietary calories, the potential interacting effects of these factors on disease risk may be considerable.

Ref #289 - Sabaté J.
SO: Am J Clin Nutr. 1999; 70(suppl):500S-3S.
AB Perhaps one of the most unexpected and novel findings in nutritional epidemiology in the past 5 y has been that nut consumption seems to protect against ischemic heart disease (IHD). Frequency and quantity of nut consumption have been documented to be higher in vegetarian than in non-vegetarian populations. Nuts also constitute an important part of other plant-based diets, such as Mediterranean and Asian diets. In a large, prospective epidemiologic study of Seventh-day Adventists in California, we found that frequency of nut consumption had a substantial and highly significant inverse association with risk of myocardial infarction and death from IHD. The Iowa Women's Health Study also documented an association between nut consumption and decreased risk of IHD. The protective effect of nuts on IHD has been found in men and women and I the elderly. Importantly, nuts have similar associations in both vegetarians and nonvegetarians. The protective effect of nut consumption on IHD is not offset by increased mortality from other causes. Moreover, frequency of nut consumption has been found to be inversely related to all-cause mortality in several population groups such as whites, blacks, and the elderly. Thus, nut consumption may not only offer protection against IHD, but also increase longevity.

Ref #290 - Key TJ
SO: Am J Clin Nutr. 1999; 70(suppl):516S-24S.
AB We combined data from 5 prospective studies to compare the death rates from common diseases of vegetarians with those of nonvegetarians with similar lifestyles. A summary of these results was reported previously: we report here more details of the findings. Data for 76,172 men and women were available. Vegetarians were thos who did not eat any meat of fish (n=27,808). Death rate ratios at ages 16-89 y were calculated by Poisson regression and all results were adjusted for age, sex, and smoking status. A random-effects model was used to calculate pooled estimates of effect for all studies combined. There were 8,330 deaths after a mean of 10.6 y of follow-up. Mortality from ischemic heart disease was 24% lower in vegetarians than in nonvegetarians (death rate ratio: 0.76; 95% CI: 0.62, 0.94; P<0.01). The lower mortality from ischemic heart disease among vegetarians was greater at younger ages and was restricted to those who had followed their current diet for >5 y. Further categorization of diets showed that, in comparison with regular meat eaters, mortality from ischemic heart disease was 20% lower in occasional meat eaters, 34% lower in people who ate fish but no meat, 34% lower in lactoovovegetarians, and 26% lower in vegans. There were no significant differences between vegetarians and nonvegetarians in mortality from cerebrovascular disease, stomach cancer, colorectal cancer, lung cancer, breast cancer, prostate cancer, or all other causes combined.

Ref #291 - Fraser GE
SO: Am J Clin Nutr. 1999; 70(suppl):532S-8S.
AB: Results associating diet with chronic disease in a cohort of 34,192 California Seventh-day Adventists are summarized. Most Seventh-day Adventists do not smoke cigarettes or drink alcohol, and there is a wide range of dietary exposures within the population. About 50% of those studied ate meat products <1 time/wk or not at all, and vegetarians consumed more tomatoes, legumes, nuts, and fruit, but less coffee, doughnuts, and eggs than did non-vegetarians. Multivariate analyses showed significant associations between beef consumption and fatal ischemic heart disease (IHD) in men [relative risk (RR) =2.31 for subjects who ate beef $3 times/wk compared with vegetarians], significant protective associations between nut consumption and fatal and non-fatal IHD in both sexes (RR ~ 0.5 for subjects who ate nuts $5 times/wk compared with those who ate nuts <1 time/wk), and a reduced risk of IHD in subjects preferring whole grain to white bread. The lifetime risk of IHD was reduced by ~ 31% in those who consumed nuts frequently and by 37% in male vegetarians compared to non-vegetarians. Cancers of the colon and prostate were significantly more likely in non-vegetarians (RR's of 1.88 and 1.54, respectively), and frequent beef consumers also had a higher risk of bladder cancer. Intake of legumes was negatively associated with risk of colon cancer in nonvegetarians, and risk of pancreatic cancer. Higher consumption of all fruit or dried fruit was associated with lower risks of lung, prostate, and pancreatic cancers. Cross-sectional data suggest vegetarian Adventists have lower risks of diabetes mellitus, hypertension, and arthritis than non-vegetarians. Thus, among Seventh-day Adventists, vegetarians are healthier than nonvegetarians but this cannot be ascribed only to the absence of meat.

Ref #292 - Hokin BC
SO: Am J Clin Nutr. 1999; 70(suppl):576S-8S.
AB As part of the Adventist Ministers' Health Study, a series of cross-sectional surveys conducted in 1992, 1994, and 1997, the serum vitamin B-12 status of 340 Australian Seventh-day Adventist ministers was assessed in 1997. The ministers in the study participated voluntarily. Of this group, 245 were either lactoovovegetarians or vegans who were not taking vitamin B-12 supplements. Their mean vitamin B-12 concentration was 199 pmol/L (range: 58-538 pmol/L), 53% of whom had values below the reference range for the method used (171-850 pmol/L) and 73% of whom had values <221 pmol/L, the lower limit recommended by Herbert. Dual-isotope Schillings test results in 36 lactoovovegetarians with abnormally low vitamin B-12 concentrations indicated that dietary deficiency was the cause in 70% of cases. Data from the dietary questionnaires supported dietary deficiency as the cause of low serum vitamin B-12 in this population of lactoovovegetarians and vegans, 56 (23%) of whom consumed sufficient servings of vitamin B-12-containing foods to obtain the minimum daily maintenance allowance of the vitamin (1 Fg).

Ref #293 - Singh PN
SO: Am J Epidemiol 1999;150:1152-64.
AB: In a 12-year prospective study, the authors examined the relation between body mass index (BMI) and mortality among the 20,346 middle-aged (25-54 years) and older (55-84 years) non-Hispanic white cohort members of the Adventist Health Study (California, 1976-1988) who had never smoked cigarettes and had no history of coronary heart disease, cancer, or stroke. In analyses that accounted for putative indicators (weight change relative to 17 years before baseline, death during early follow-up) of pre-existing illness, the authors found a direct positive relation between BMI and all-cause mortality among middle-aged men (minimum risk at BMI (kg/m2) 15-22.3, older men (minimum risk at BMI 13.5-22.3), middle-aged women (minimum risk at BMI 13.9-20.6), and older women who had undergone postmenopausal hormone replacement (minimum risk at BMI 13.4-20.6). Among older women who had not undergone postmenopausal hormone replacement, the authors found a J-shaped relation (minimum risk at BMI 20.7-27.4) in which BMI <20.7 was associated with a twofold increase in mortality risk (hazard ratio (HR) = 2.2, 95% confidence interval (CI) 1.3, 3.5) that was primarily due to cardiovascular and respiratory disease. These findings not only identify adiposity as a risk factor among adults, but also raise the possibility that very lean older women can experience an increased mortality risk that may be due to their lower levels of adipose tissue-derived estrogen.

Ref #294 - Fraser GE.
SO: Preventive Medicine 1999;29 (Suppl.):S18-S23.
AB: Epidemiologic studies of Seventh-day Adventists have clearly shown that dietary habits are associated with risk of coronary heart disease (CHD) and other chronic diseases. However, a few surprising results emerge. Meat consumption is clearly hazardous for Adventist men by raising CHD mortality. However, no such effect was seen in women. Possible reasons are discussed. Our data, and that of others, strongly support the role of a fatty food, specifically nuts, as protective for CHD. The possible implications of this result for fat intake as a risk factor for CHD are discussed. In particular, it may be that consumption of modest quantities of certain fats is beneficial, rather than hazardous. The lower risk of CHD in Adventists probably has a complicated explanation and certainly cannot be entirely explained by their non-smoking status or a superior serum lipid profile. Adventists are unique in that the majority of this group have adopted a dietary habit that is either vegetarian or tending in this direction. The power of incorporating health into a system of religious belief is discussed. Possibly others can also implement such a model to their advantage.

Ref #295 - Key TJ
SO: Proc Nutr Soc 1999; 58:271-5
AB: Compared with non-vegetarians, Western vegetarians have a lower mean BMI (by about 1 kg/m2), a lower mean plasma total cholesterol concentration (by about 0.5 mmol/l), and a lower mortality from IHD (by about 25%). They may also have a lower risk for some other diseases such as constipation, diverticular disease, gallstones and appendicitis. No differences in mortality from common cancers have been established. There is no evidence of adverse effects on mortality. Much more information is needed, particularly on other causes of death, other morbidity including osteoporosis, and long-term health in vegans. The evidence available suggests that widespread adoption of a vegetarian diet could prevent approximately 40,000 deaths from IHD in Britain each year.

Ref #297 - Famodu AA
SO: Thromb Res 1999; 95:31-6
AB: Dietary habits have been implicated in the occurrence of cardiovascular diseases. Elevated plasma fibrinogen levels and decreased fibrinolytic activity have been identified as major independent cardiovascular risk factors. In this study, we compared the blood pressure, plasma fibrinogen concentration, and fibrinolytic activity of 40 nonvegetarians (NON-VEGs) with 36 vegetarians (8 VEGs and 28 SEMI-VEGs). The latter group consisted of students and lecturers of the Adventist Seminary Institute of West Africa, Ilishan Remo. All subjects had blood pressures below 140/90 mmHg, no underlying haemostatic disorders and were not on any medical treatment. The NON-VEGs had significantly decreased fibrinolytic activity (p<0.001) and increased plasma fibrinogen levels (p<0.001) compared with the SEMI-VEGs and VEGs. There were no significant differences between the blood pressure levels of the three groups, although the NON-VEGs had lower diastolic blood pressures. It is concluded that black African Seventh-Day Adventists who follow a vegetarian diet may be protected against premature cardiovascular disease because of beneficial dietary effects on plasma fibrinogen levels and fibrinolytic activity.

Ref #298 - van den Brandt PA.
SO: Am J Epidemiol 2000; 152:514-27.
AB: The association between anthropometric indices and the risk of breast cancer was analyzed using pooled data from seven prospective cohort studies. Together, these cohorts comprise 337,819 women and 4,385 incident invasive breast cancer cases. In multivariate analyses controlling for reproductive, dietary, and other risk factors, the pooled relative risk (RR) of breast cancer per height increment of 5 cm was 1.02 (95% confidence interval (CI): 0.96, 110) in premenopausal women and 1.07 (95% CI: 1.03, 1.12) in postmenopausal women. Body mass index (BMI) showed significant inverse and positive associations with breast cancer among pre-and postmenopausal women, respectively; these associations were nonlinear. Compared with premenopausal women with a BMI of less than 21 kg/m2, women with a BMI exceeding 31 kg/m2 had an RR of 0.54 (95% CI: 0.34, 0.85). In postmenopausal women, the RRs did not increase further when BMI exceeded 28 kg/m2; the RR for these women was 1.26 (95% CI: 1.09, 1.46). The authors found little evidence for interaction with other breast cancer risk factors. Their data indicate that height is an independent risk factor for postmenopausal breast cancer; in premenopausal women, this relation is less clear. The association between BMI and breast cancer varies by menopausal status. Weight control may reduce risk among postmenopausal women.

Ref #299 - Myint T
SO: Am J Epidemiol 2000; 152:752-5.
AB: Meat consumption predicts risk of several chronic diseases. The authors validate the accuracy of meat consumption reported by food frequency questionnaires and the mean of eight 24-hour recalls, using urinary methylhistidine excretion, in 55 Black and 71 White Adventist subjects in Los Angeles and San Diego, California, in 1994-1997. 1-Methylhistidine excretion predicts vegetarian status in Black (p = 0.02) and in White (p = 0.005) subjects. Spearman's correlation coefficients between 1-methylhistidine and estimated meat consumption were usually between 0.4 and 0.6 for both food frequency questionnaires and 24-hour recall data. This is despite the chance collection of dietary recalls and urines from omnivores on meatless days.

Ref #300 - Singh PN
SO: Med & Science in Sports & Exercise 2001; 33:468-75
AB: Physical activity has been identified as an important predictor of chronic disease risk in numerous studies in which activity levels were measured by questionnaire. Although the validity of physical activity questionnaires has been documented in a number of studies of U.S. adults, few have included a validation analysis among blacks. We have examined the validity and reliability of a physical activity questionnaire that was administered to 165 black Seventh-day Adventists from Southern California.
METHODS: Subjects completed a self-administered physical activity questionnaire and then "reference" measures of activity (7-d activity recalls, pedometer readings) and fitness (treadmill test) were completed in subsets of this population.
RESULTS: The authors found that 7-d recall activity levels correlated well with the corresponding questionnaire indices among women (total activity, r = 0.65; vigorous, r = 0.85;
moderate, r = 0.44; inactivity, r = 0.59; sleep duration, r = 0.52) and men (total activity, r = 0.51; vigorous, r = 0.65; moderate, r = 0.53; inactivity, r = 0.69; sleep duration, r = 0.39). Vigorous activity from 7-d recalls was best measured by gender-specific indices that included only recreational activities among men and emphasized nonrecreational activities among women.
Correlations between questionnaire data and the other "reference" measures were lower. Test-retest correlations of questionnaire items over a 6-wk interval were high (r = 0.4-0.9).
CONCLUSION: Simple questions can measure activities of different intensity with good validity and reliability among black Adventist men and women.

Ref # 301 - Smith-Warner SA
SO: Int J Cancer 2001; 92:676-74
AB: Recently, there has been interest in whether intakes of specific types of fat are associated with breast cancer risk independently of other types of fat, but results have been inconsistent. We
identified 8 prospective studies that met predefined criteria and analyzed their primary data using
a standardized approach. Holding total energy intake constant, we calculated relative risks for
increments of 5% of energy for each type of fat compared with an equivalent amount of energy
from carbohydrates or from other types of fat. We combined study-specific relative risks using a
random effects model. In the pooled database, 7,329 incident invasive breast cancer cases
occurred among 351,821 women. The pooled relative risks (95% confidence intervals [CI]) for
an increment of 5% of energy were 1.09 (1.00-1.19) for saturated, 0.93 (0.84-1.03) for
monounsaturated and 1.05 (0.96-1.16) for polyunsaturated fat compared with equivalent energy
intake from carbohydrates. For a 5% of energy increment, the relative risks were 1.18 (95% CI
0.99-1.42) for substituting saturated for monounsaturated fat, 0.98 (95% CI 0.85-1.12) for
substituting saturated for polyunsaturated fat and 0.87 (95% CI 0.73-1.02) for substituting
monounsaturated for polyunsaturated fat. No associations were observed for animal or vegetable
fat intakes. These associations were not modified by menopausal status. These data are
suggestive of only a weak positive association with substitution of saturated fat for carbohydrate
consumption; none of the other types of fat examined was significantly associated with breast
cancer risk relative to an equivalent reduction in carbohydrate consumption

Ref #302 - Smith-Warner SA
SO: JAMA 285:769-76.
AB: Some epidemiologic studies suggest that elevated fruit and vegetable consumption is associated with a reduced risk of breast cancer. However, most have been case-control studies
in which recall and selection bias may influence the results. Additionally, publication bias may
have influenced the literature on associations for specific fruit and vegetable subgroups.
OBJECTIVE: To examine the association between breast cancer and total and specific fruit and
vegetable group intakes using standardized exposure definitions. DATA SOURCES/STUDY
SELECTION: Eight prospective studies that had at least 200 incident breast cancer cases,
assessed usual dietary intake, and completed a validation study of the diet assessment method or
a closely related instrument were included in these analyses. DATA EXTRACTION: Using the
primary data from each of the studies, we calculated study-specific relative risks (RRs) that were
combined using a random-effects model. DATA SYNTHESIS: The studies included 7377
incident invasive breast cancer cases occurring among 351 825 women whose diet was analyzed
at baseline. For comparisons of the highest vs lowest quartiles of intake, weak, nonsignificant
associations were observed for total fruits (pooled multivariate RR, 0.93; 95% confidence
interval [CI], 0.86-1.00; P for trend =.08), total vegetables (RR, 0.96; 95% CI, 0.89-1.04; P
for trend =.54), and total fruits and vegetables (RR, 0.93; 95% CI, 0.86-1.00; P for trend =.12).
No additional benefit was apparent in comparisons of the highest and lowest deciles of intake.
No associations were observed for green leafy vegetables, 8 botanical groups, and 17 specific
fruits and vegetables. CONCLUSION: These results suggest that fruit and vegetable
consumption during adulthood is not significantly associated with reduced breast cancer risk.

Ref #303 -Fraser GE
SO: Arch Intern Med 2001;161:1645-52.
AB: Background: Relative risk estimates suggest that effective implementation of behaviors commonly advocated in preventive medicine should increase life expectancy, although there is little direct evidence.
Objective: To test the hypothesis that choices regarding diet, exercise and smoking influence life expectancy.
Methods: A total of 34,192 California Seventh-day Adventists (75% of those eligible) were enrolled in a cohort and followed up from 1976 to 1988. A mailed questionnaire provided dietary and other exposure information at study baseline. Mortality for all subjects was ascertained by matching to state death tapes and the National Death Index.
Results: California Adventists have higher life expectancies at the age of 30 years than other white Californians by 7.28 years (95% confidence interval, 6.59-7.97 years) in men and by 4.42 years (95% confidence interval, 3.96-4.88 years) in women, giving them perhaps the highest life expectancy of any formally described population. Commonly observed combinations of diet, exercise, body mass index, past smoking habits and hormone replacement therapy (in women) can account for differences of up to 10 years of life expectancy among Adventists. A comparison of life expectancy when these factors take high-risk compared with low-risk values shows independent effects that vary between 1.06 and 2.74 years for different variables. The effect of each variable is assessed with all others at either medium- or high-risk levels.
Conclusions: Choices regarding diet, exercise, cigarette smoking, body weight and hormone replacement therapy, in combination, appear to change life expectancy by many years. The longevity experience of Adventists probably demonstrates the beneficial effects of more optimal behaviors.

Ref #304 - Knutsen SF
SO: Ann Epidemiol. 2001;11:406-16.
AB: PURPOSE: To assess intake of several vitamins in preparation for a large cohort study investigating the effect of diet on risk of colon and prostate cancer.
METHODS: The dietary intake of several vitamins were assessed using eight different 24-hour recalls and a 200-item food frequency questionnaire (FFQ) from each subject. Participants also attended a clinic where blood was drawn and body composition, weight, height, and blood pressure were measured. A total of 97 black and 96 nonhispanic white subjects participated. The levels of alpha-tocopherol, carotene, folate, and vitamin C in the blood were correlated with the dietary intakes as measured by both 24-hour recalls and FFQ.
RESULTS: Correlations between blood levels and energy-adjusted dietary intake assessed by 24-hour recalls (with supplements) were as follows: carotene (adjusted for serum cholesterol): 0.47 and 0.55 in black and white subjects, respectively; alpha-tocopherol (adjusted for serum cholesterol): 0.61 (blacks) and 0.50 (whites); vitamin C: 0.22 (blacks) and 0.17 (whites); folate: 0.54 (blacks) and 0.55 (whites). Correlations between blood levels and FFQ indices were smaller in magnitude: 0.34 and 0.28 for carotene in black and white subjects, respectively, 0.37 and 0.56 for alpha-tocopherol (adjusted for serum cholesterol), 0.20 and 0.03 for vitamin C and 0.24 and 0.32 for folate. CONCLUSIONS: The correlations observed were generally of modest to moderate size and were similar to or larger than those reported by others. This is despite variations in absorption, metabolism, and excretion of the vitamins and suggests that both the 24-hour recalls and the FFQ contain valid information.

Ref #305 - Singh PN
SO: J North Am Menopause Soc. 2001;8:314-20.
AB: OBJECTIVE: To examine the effect of menopause on the relation between weight gain and all-cause mortality.
DESIGN: Prospective cohort study of 6,030 adults (ages 25-82 years) who never smoked cigarettes, had no history of coronary heart disease, cancer, or stroke, and were enrolled in a 29-year follow-up in which anthropometric data were given at baseline and at 17 years after baseline.
RESULTS: Weight gain that occurred over a 17-year interval (baseline to 17 years after baseline) increased the mortality risk of men and middle-aged women, but decreased the mortality risk of older women. Further study of the women revealed that a strong protective effect of weight gains was only evident among the leanest (25 kg/m2) postmenopausal women [HR (95% CI) = 0.81 (0.41, 1.58)] or for premenopausal women [HR (95% CI) = 1.05 (0.49, 2.25) for 25 kg/m2]. We found that the protective effect of weight gain among the leanest postmenopausal women was primarily due to a more than threefold decrease in cardiovascular disease mortality risk. One possible explanation for these findings is that weight gain increases the level of adipose-tissue-derived estrogen among lean postmenopausal women. CONCLUSION: Moderate menopausal weight gain may be well tolerated in lean women.

Ref #306 - Fraser GE
SO: Am J Epidemiol. 2001;154:836-44.
AB: Regression calibration is a technique that corrects biases in regression results in situations where exposure variables are measured with error. The existence of a calibration substudy, where accurate and crude measurement methods are related by a second regression analysis, is assumed. The cost of measurement error in multivariate analyses is loss of statistical power. In this paper, calibration data from California Seventh-day Adventists are used to simulate study populations and new calibration studies. Applying regression calibration logistic analyses, the authors estimate power for pairs of nutritional variables. The results demonstrate substantial loss of power if variables measured with error are strongly correlated. Biases in estimated effects in cases where regression calibration is not performed can be large and are corrected by regression calibration. When the true coefficient has zero value, the corresponding coefficient in a crude analysis will usually have a nonzero expected value. Then type I error probabilities are not nominal, and the erroneous appearance of statistical significance can readily occur, particularly in large studies. Major determinants of power with use of regression calibration are collinearity between the variables measured with error and the size of correlations between crude and corresponding true variables. Where there is important collinearity, useful gains in power accrue with calibration study size up to 1,000 subjects.

Ref #307 - Missmer SA
SO: Int J Epidemiol. 2002;31:78-85.
AB: BACKGROUND: More than 20 studies have investigated the relation between meat and dairy food consumption and breast cancer risk with conflicting results. Our objective was to evaluate the risk of breast cancer associated with meat and dairy food consumption and to assess whether non-dietary risk factors modify the relation. METHODS: We combined the primary data from eight prospective cohort studies from North America and Western Europe with at least 200 incident breast cancer cases, assessment of usual food and nutrient intakes, and a validation study of the dietary assessment instrument. The pooled database included 351,041 women, 7379 of whom were diagnosed with invasive breast cancer during up to 15 years of follow-up. RESULTS: We found no significant association between intakes of total meat, red meat, white meat, total dairy fluids, or total dairy solids and breast cancer risk. Categorical analyses suggested a J-shaped association for egg consumption where, compared to women who did not eat eggs, breast cancer risk was slightly decreased among women who consumed < 2 eggs per week but slightly increased among women who consumed > or = 1 egg per day.
CONCLUSIONS: We found no significant associations between intake of meat or dairy products and risk of breast cancer. An inconsistent relation between egg consumption and risk of breast cancer merits further investigation.

Ref #308 - Chan J
SO: Am J Epidemiol. 2002;155:827-33.
AB: 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.

Ref #309 - Smith-Warner SA
SO: Cancer Epidemiol Biomarkers Prev. 2002;11:987-92.
AB: Lung cancer rates are highest in countries with the greatest fat intakes. In several case-control studies, positive associations have been observed between lung cancer and intakes of total and saturated fat, particularly among nonsmokers. We analyzed the association between fat and cholesterol intakes and lung cancer risk in eight prospective cohort studies that met predefined criteria. Among the 280,419 female and 149,862 male participants who were followed for up to 6-16 years, 3,188 lung cancer cases were documented. Using the Cox proportional hazards model, we calculated study-specific relative risks that were adjusted for smoking history and other potential risk factors. Pooled relative risks were computed using a random effects model. Fat intake was not associated with lung cancer risk. For an increment of 5% of energy from fat, the pooled multivariate relative risks were 1.01 [95% confidence interval (CI), 0.98-1.05] for total, 1.03 (95% CI, 0.96-1.11) for saturated, 1.01 (95% CI, 0.93-1.10) for monounsaturated, and 0.99 (95% CI, 0.90-1.10) for polyunsaturated fat. No associations were observed between intakes of total or specific types of fat and lung cancer risk among never, past, or current smokers. Dietary cholesterol was not associated with lung cancer incidence [for a 100-mg/day increment, the pooled multivariate relative risk was 1.01 (95% CI, 0.97-1.05)]. There was no statistically significant heterogeneity among studies or by sex. These data do not support an important relation between fat or cholesterol intakes and lung cancer risk. The means to prevent this important disease remains avoidance of smoking.

Ref #310 - Collaborative Group on Hormonal Factors in Breast Cancer
SO: Brit J Cancer 2002; 87:1234-1245
AB: Alcohol and tobacco consumption are closely correlated and published results on their association with breast cancer have not always allowed adequately for confounding between these exposures. Over 80% of the relevant information worldwide on alcohol and tobacco consumption and breast cancer were collated, checked and analysed centrally. Analyses included 58 515 women with invasive breast cancer and 95 067 controls from 53 studies. Relative risks of breast cancer were estimated, after stratifying by study, age, parity and, where appropriate, women's age when their first child was born and consumption of alcohol and tobacco. The average consumption of alcohol reported by controls from developed countries was 6.0 g per day, i.e. about half a unit/drink of alcohol per day, and was greater in ever-smokers than never-smokers, (8.4 g per day and 5.0 g per day, respectively). Compared with women who reported drinking no alcohol, the relative risk of breast cancer was 1.32 (1.19-1.45, P<0.00001) for an intake of 35-44 g per day alcohol, and 1.46 (1.33-1.61, P<0.00001) for 45 g per day alcohol. The relative risk of breast cancer increased by 7.1% (95% CI 5.5-8.7%; P<0.00001) for each additional 10 g per day intake of alcohol, i.e. for each extra unit or drink of alcohol consumed on a daily basis. This increase was the same in ever-smokers and never-smokers (7.1% per 10 g per day, P<0.00001, in each group). By contrast, the relationship between smoking and breast cancer was substantially confounded by the effect of alcohol. When analyses were restricted to 22 255 women with breast cancer and 40 832 controls who reported drinking no alcohol, smoking was not associated with breast cancer (compared to never-smokers, relative risk for ever-smokers=1.03, 95% CI 0.98-1.07, and for current smokers=0.99, 0.92-1.05). The results for alcohol and for tobacco did not vary substantially across studies, study designs, or according to 15 personal characteristics of the women; nor were the findings materially confounded by any of these factors. If the observed relationship for alcohol is causal, these results suggest that about 4% of the breast cancers in developed countries are attributable to alcohol. In developing countries, where alcohol consumption among controls averaged only 0.4 g per day, alcohol would have a negligible effect on the incidence of breast cancer. In conclusion, smoking has little or no independent effect on the risk of developing breast cancer; the effect of alcohol on breast cancer needs to be interpreted in the context of its beneficial effects, in moderation, on cardiovascular disease and its harmful effects on cirrhosis and cancers of the mouth, larynx, oesophagus and liver.

Ref #311 - Knutsen SF
SO: Ann Epidemiol. 2003;13:119-27.
AB: PURPOSE: To calibrate and compare intake of different fats and individual fatty acids as assessed with a food frequency questionnaire (FFQ) against that estimated with (i) a series of dietary recalls and; (ii) the relative fat concentration in an adipose tissue biopsy. The FFQ was specially designed for use in a cohort of Seventh-day Adventists. In preparation for a large cohort study investigating the effect of diet on risk of colon, prostate and breast cancer.
METHODS: The association of adipose tissue fatty acids and dietary fat intake was assessed in 49 black and 72 white Seventh-day Adventists subjects using 8 different 24-hour recalls, a 200-item food frequency questionnaire (FFQ) and adipose tissue biopsies from each subject.
RESULTS: Pearson correlation between fatty acids in adipose tissue and dietary intake as assessed by multiple 24-hour recalls were as follows: Linoleic acid: 0.77 in black and 0.71 in white subjects, respectively; Linolenic acid: 0.68 (blacks) and 0.62 (whites); Total Polyunsaturated fat (PUFA): 0.78 (blacks) and 0.70 (whites); Total Monounsaturated fat (MUFA): 0.35 (blacks) and 0.03 (whites); Total Saturated fat (SFA): 0.46 (blacks) and 0.56 (whites). Correlations between fatty acids in adipose tissue and dietary intake as assessed by FFQ were: Linoleic acid: 0.61 (blacks) and 0.52 (whites), respectively; Linolenic acid: 0.29 (blacks) and 0.49 (whites); PUFA: 0.62 (blacks) and 0.53 (whites); MUFA: 0.07 (blacks) and 0.31 (whites), SFA: 0.21 (blacks) and 0.31 (whites). CONCLUSIONS: Our study confirms findings of others that 24-hour recalls are valid for assessing dietary intake of different types of fat. The FFQ we developed and used in this study gave reasonably valid measures of fatty acid intake in our population and is thus suitable for use in large cohort studies. It had validity comparable to that observed for other FFQs.

Ref #312 - Brathwaite N
SO: Ethn Dis. 2003;13:34-9.
AB: A population-based sample of Seventh-Day Adventists was studied to determine the relationship between vegetarian status, body mass index (BMI), obesity, diabetes mellitus (DM), and hypertension, in order to gain a better understanding of factors influencing chronic diseases in Barbados. A systematic sampling from a random start technique was used to select participants for the study. A standard questionnaire was used to collect data on demographic and lifestyle characteristics, to record anthropometrics and blood pressure measurements, and to ascertain the hypertension and diabetes status of participants. The sample population consisted of 407 Barbadian Seventh-Day Adventists (SDAs), who ranged in age from 25 to 74 years. One hundred fifty-three (37.6%) participants were male, and 254 (62.4%) were female, and 43.5% were vegetarians. The prevalence rates of diabetes and hypertension were lower among long-term vegetarians, compared to non-vegetarians, and long-term vegetarians were, on average, leaner than non-vegetarians within the same cohort. A significant association was observed between a vegetarian diet and obesity (vegetarian by definition P=.04, self-reported vegetarian P=.009) in this population. Other components of the study population lifestyle should be further analyzed to determine the roles they may plan in lessening the prevalence rates of obesity, diabetes, and hypertension.

Ref #313 - Singh PN
SO: Am J Clin Nutr. 2003;78(3 Suppl):526S-532S.
AB: BACKGROUND: Since meat products represent a major source of protein in the Western diet, findings on whether meat intake significantly contributes to the burden of fatal disease have important clinical and public health implications.
OBJECTIVE: The objective was to examine whether a very low meat intake (less than weekly) contributes to greater longevity.
DESIGN: We reviewed data from 6 prospective cohort studies and report new findings on the life expectancy of long-term vegetarians from the Adventist Health Study. RESULTS: Our review of the 6 studies found the following trends: 1) a very low meat intake was associated with a significant decrease in risk of death in 4 studies, a nonsignificant decrease in risk of death in the fifth study, and virtually no association in the sixth study; 2) 2 of the studies in which a low meat intake significantly decreased mortality risk also indicated that a longer duration (>/= 2 decades) of adherence to this diet contributed to a significant decrease in mortality risk and a significant 3.6-y (95% CI: 1.4, 5.8 y) increase in life expectancy; and 3) the protective effect of a very low meat intake seems to attenuate after the ninth decade. Some of the variation in the survival advantage in vegetarians may have been due to marked differences between studies in adjustment for confounders, the definition of vegetarian, measurement error, age distribution, the healthy volunteer effect, and intake of specific plant foods by the vegetarians.
CONCLUSION: Current prospective cohort data from adults in North America and Europe raise the possibility that a lifestyle pattern that includes a very low meat intake is associated with greater longevity.

Ref #314 - Smith-Warner SA
SO: Int J Cancer. 2003;107:1001-11.
AB: Inverse associations between fruit and vegetable consumption and lung cancer risk have been consistently reported. However, identifying the specific fruits and vegetables associated with lung cancer is difficult because the food groups and foods evaluated have varied across studies. We analyzed fruit and vegetable groups using standardized exposure and covariate definitions in 8 prospective studies. We combined study-specific relative risks (RRs) using a random effects model. In the pooled database, 3,206 incident lung cancer cases occurred among 430,281 women and men followed for up to 6-16 years across studies. Controlling for smoking habits and other lung cancer risk factors, a 16-23% reduction in lung cancer risk was observed for quintiles 2 through 5 vs. the lowest quintile of consumption for total fruits (RR = 0.77; 95% CI = 0.67-0.87 for quintile 5; p-value, test for trend < 0.001) and for total fruits and vegetables (RR = 0.79; 95% CI = 0.69-0.90; p-value, test for trend = 0.001). For the same comparison, the association was weaker for total vegetable consumption (RR = 0.88; 95% CI = 0.78-1.00; p-value, test for trend = 0.12). Associations were similar between never, past, and current smokers. These results suggest that elevated fruit and vegetable consumption is associated with a modest reduction in lung cancer risk, which is mostly attributable to fruit, not vegetable, intake. However, we cannot rule out the possibility that our results are due to residual confounding by smoking. The primary focus for reducing lung cancer incidence should continue to be smoking prevention and cessation.

Ref #315 - Willett W
SO: Am J Clin Nutr. 2003;78:539S-543S.
AB: Comparisons of diets and disease rates between Adventists and non-Adventists, and prospective cohort studies among Adventists, have contributed greatly to our general understanding of nutrition and health. The most fundamental conclusion drawn from the Adventist Health Studies has been that maintaining a lean body weight throughout life is central for optimal health. Other contributions have included the value of nut consumption for prevention of coronary artery disease, and the roles of red meat and dairy products in the etiologies of cardiovascular disease and cancer. Although much progress has been made, many issues remain unresolved. In particular, rates of breast and prostate cancers remain high among Adventist populations despite an overall healthy lifestyle and long life expectancy. There is even some suggestion that risk of breast cancer may increase with duration of being a vegetarian. One topic that may be uniquely studied among an Adventist population is the effect of soy phytoestrogens in disease prevention. Although soy consumption has been hypothesized to contribute to the low rates of breast cancer in Asian populations, several intervention studies using high doses of soy estrogens have shown changes in breast nipple fluid that would predict higher rates of breast cancer. Also, high dairy product consumption has been associated with risk of prostate and ovarian cancers in some but not all studies. The unusually wide range of milk consumption in Adventists will be particularly informative with regard to these relations. Resolution of these issues is needed to provide optimal guidance regarding healthy diets, and the newly funded Adventist Health Study will contribute importantly in this effort.

Ref #316 – Fraser GE
SO: Ann Epidemiol. 2004 Apr;14(4):287-95.
AB: 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.
Ref #317 – Herring P
SO: Ethn Dis. 2004 Summer;14(3):423-30.
AB: This paper presents findings from formative research exploring Black Seventh-day Adventist church members' attitudes about Black non-participation in past studies, and suggestions for recruiting 45,000 Blacks to an upcoming longitudinal cohort study. Data were collected in California and Pennsylvania, using 15 key informant interviews and 6 focus groups. Key findings supported and elucidated existing literature on the barriers to minority recruitment, and included: a general mistrust of the medical/scientific community; a perception that providing informed consent relinquishes, rather than protects, an individual's rights; a perception of being "studied" rather than "studying," due to the paucity of Black investigators; and a perceived lack of cultural sensitivity in the recruitment of Blacks, and in the conduct of the research itself. Building trust throughout the process, from clearly demonstrating the benefits of participation, at the individual and community level, to including Blacks in the study design from conceptualization to data analysis and presentation, emerged as a critical component in garnering Black participation in future studies.
Ref #318 – Cho E
SO: J Natl Cancer Inst. 2004 Jul 7;96(13):1015-22.
AB: BACKGROUND: Studies in animals have suggested that calcium may reduce the risk of colorectal cancer. However, results from epidemiologic studies of intake of calcium or dairy foods and colorectal cancer risk have been inconclusive. METHODS: We pooled the primary data from 10 cohort studies in five countries that assessed usual dietary intake by using a validated food frequency questionnaire at baseline. For most studies, follow-up was extended beyond that in the original publication. The studies included 534 536 individuals, among whom 4992 incident cases of colorectal cancer were diagnosed between 6 and 16 years of follow-up. Pooled multivariable relative risks for categories of milk intake and quintiles of calcium intake and 95% confidence intervals (CIs) were calculated. All statistical tests were two-sided. RESULTS: Milk intake was related to a reduced risk of colorectal cancer. Compared with the lowest category of intake (<70 g/day), relative risks of colorectal cancer for increasing categories (70-174, 175-249, and > or =250 g/day) of milk intake were 0.94 (95% CI = 0.86 to 1.02), 0.88 (95% CI = 0.81 to 0.96), and 0.85 (95% CI = 0.78 to 0.94), respectively (P(trend)<.001). Calcium intake was also inversely related to the risk of colorectal cancer. The relative risk for the highest versus the lowest quintile of intake was 0.86 (95% CI = 0.78 to 0.95; P(trend) =.02) for dietary calcium and 0.78 (95% CI = 0.69 to 0.88; P(trend)<.001) for total calcium (combining dietary and supplemental sources). These results were consistent across studies and sex. The inverse association for milk was limited to cancers of the distal colon (P(trend)<.001) and rectum (P(trend) =.02). CONCLUSION: Higher consumption of milk and calcium is associated with a lower risk of colorectal cancer.
Ref #319 – Knekt P
SO: Am J Clin Nutr. 2004 Dec;80(6):1508-20.
AB: BACKGROUND: Epidemiologic studies have suggested a lower risk of coronary heart disease (CHD) at higher intakes of fruit, vegetables, and whole grain. Whether this association is due to antioxidant vitamins or some other factors remains unclear. OBJECTIVE: We studied the relation between the intake of antioxidant vitamins and CHD risk. DESIGN: A cohort study pooling 9 prospective studies that included information on intakes of vitamin E, carotenoids, and vitamin C and that met specific criteria was carried out. During a 10-y follow-up, 4647 major incident CHD events occurred in 293 172 subjects who were free of CHD at baseline. RESULTS: Dietary intake of antioxidant vitamins was only weakly related to a reduced CHD risk after adjustment for potential nondietary and dietary confounding factors. Compared with subjects in the lowest dietary intake quintiles for vitamins E and C, those in the highest intake quintiles had relative risks of CHD incidence of 0.84 (95% CI: 0.71, 1.00; P=0.17) and 1.23 (1.04, 1.45; P=0.07), respectively, and the relative risks for subjects in the highest intake quintiles for the various carotenoids varied from 0.90 to 0.99. Subjects with higher supplemental vitamin C intake had a lower CHD incidence. Compared with subjects who did not take supplemental vitamin C, those who took >700 mg supplemental vitamin C/d had a relative risk of CHD incidence of 0.75 (0.60, 0.93; P for trend <0.001). Supplemental vitamin E intake was not significantly related to reduced CHD risk. CONCLUSIONS: The results suggest a reduced incidence of major CHD events at high supplemental vitamin C intakes. The risk reductions at high vitamin E or carotenoid intakes appear small.
Ref #320 - Fraser GE
SO: J Nutr Health & Aging 2005; 9:53-58
No abstract
Ref # 321 – Koushik A
SO: Cancer Epidemiol Biomarkers Prev. 2005 Sep;14(9):2160-7.
AB: Because fruits and vegetables are rich in bioactive compounds with potential cancer-preventive actions, increased consumption may reduce the risk of ovarian cancer. Evidence on the association between fruit and vegetable intake and ovarian cancer risk has not been consistent. We analyzed and pooled the primary data from 12 prospective studies in North America and Europe. Fruit and vegetable intake was measured at baseline in each study using a validated food-frequency questionnaire. To summarize the association between fruit and vegetable intake and ovarian cancer, study-specific relative risks (RR) were estimated using the Cox proportional hazards model, and then combined using a random-effects model. Among 560,441 women, 2,130 cases of invasive epithelial ovarian cancer occurred during a maximum follow-up of 7 to 22 years across studies. Total fruit intake was not associated with ovarian cancer risk-the pooled multivariate RR for the highest versus the lowest quartile of intake was 1.06 [95% confidence interval (95% CI), 0.92-1.21; P value, test for trend = 0.73; P value, test for between-studies heterogeneity = 0.74]. Similarly, results for total vegetable intake indicated no significant association (pooled multivariate RR, 0.90; 95% CI, 0.78-1.04, for the highest versus the lowest quartile; P value, test for trend = 0.06; P value, test for between-studies heterogeneity = 0.31). Intakes of botanically defined fruit and vegetable groups and individual fruits and vegetables were also not associated with ovarian cancer risk. Associations for total fruits and vegetables were similar for different histologic types. These results suggest that fruit and vegetable consumption in adulthood has no important association with the risk of ovarian cancer.
Ref #322 – Bell LS
SO: Ann Epidemiol. 2005 Oct;15(9):667-72.
AB: PURPOSE: To determine whether follow-up phone calls improve response rates to a long questionnaire among black and white subjects. METHODS: Forty black and 39 white Seventh-day Adventist churches were randomized to experimental or control status in a 2:1 ratio favoring the intervention, which is a follow-up phone call to certain church members. Subjects selected from each church were those who had signed up for the Adventist Health Study-2 but not returned a questionnaire 3 months after promotion began. Further returns from a church over the next 3 months, and this increment as a proportion of baseline response, were assessed using t-tests and Poisson regression, respectively. RESULTS: Comparing black experimental and control churches, the mean difference was 5.5 returned questionnaires per church (p < 0.01). Among white churches the mean difference was 3.0 (ns). The baseline-adjusted increment, however, was greater by a factor of 3.37 (95% confidence interval, 1.92, 5.93) in the black experimental relative to control churches, but among white experimental churches was 13% (ns) lower than controls. This difference in response by ethnic group was statistically significant (p < 0.01). CONCLUSION: Follow-up phone calls improved response rates among black subjects only.
Ref #323 – Fraser GE
SO: Ann Epidemiol. 2005 Aug;15(7):509-18.
AB: 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).
Ref #324 – Hailu A
SO: J Nutr Health Aging. 2006 Jan-Feb;10(1):7-14.
AB: OBJECTIVE: To examine associations between the prevalence of degenerative arthritis and soft tissue disorders and consumption of meat and other foods among participants in the Adventist Health Study. METHODS: Unconditional logistic regression analysis is used to examine cross-sectional associations, adjusting for the effects of age, smoking, alcohol consumption, body mass index, use of sex hormones and parity. RESULTS: The prevalence of degenerative arthritis and soft tissue disorders was 22.60 percent. Women had a higher prevalence than men and prevalence increased greatly with age. Smoking, higher body mass index, never use of contraceptive pills, and current hormone replacement therapy are associated with a higher prevalence of these disorders on multivariate analysis. Multivariate OR's comparing consumption of meat < 1/week; >or= 1/week; with the reference being no meat, were 1.31(95% CI: 1.21,1.43) and 1.49(1.31, 1.70) in women; and 1.19 (95% CI: 1.05,1.34) and 1.43(1.20, 1.70) in men. Dairy fat and fruit consumption were weakly associated with increased risk. There were protective associations with nut and salad consumption. CONCLUSIONS: Greater meat consumption is associated with a higher prevalence of degenerative arthritis and soft tissue disorders in both male and female subjects of this population, as is hormone replacement therapy in women.
Ref #325 – Kiani F
SO: Cancer Causes Control. 2006 Mar;17(2):137-46.
AB: Few prospective studies have reported dietary risk factors for ovarian cancer. A total of 71 histologically confirmed epithelial ovarian cancers occurred among 13,281 non-Hispanic white California Seventh-day Adventist women during follow-up. Participants were part of the Adventist Health Study (AHS) and had no history of cancer or hysterectomy at baseline in 1976 when they completed a detailed lifestyle questionnaire including a dietary assessment. The association of dietary variables with either all ovarian cancer cases or postmenopausal cases was tested using proportional hazards regression with adjustment for age and other covariates. The strongest hazardous risk factor associations among the food variables were found for meat intake with a risk ratio (RR) of 2.42 for intake > or = 1 time/week versus no meat (p for trend = 0.006), and cheese intake with a RR of 2.02 for intake of > 2 time/week versus < 1 per week (p for trend = 0.10), both of these being in postmenopausal cases. We found significantly reduced risk of all ovarian cancer with higher tomato consumption (RR = 0.32) comparing intakes > or = five times/week versus never to < 1 time/week (p for trend = 0.002), and also with higher fruit consumption (p < 0.01). A weak protective association was found with low fat, but not whole milk. Little confounding was observed between these foods.
Ref #326 – Genkinger JM
SO: Cancer Epidemiol Biomarkers Prev. 2006 Feb;15(2):364-72.
AB: BACKGROUND: Dairy foods and their constituents (lactose and calcium) have been hypothesized to promote ovarian carcinogenesis. Although case-control studies have reported conflicting results for dairy foods and lactose, several cohort studies have shown positive associations between skim milk, lactose, and ovarian cancer. METHODS: A pooled analysis of the primary data from 12 prospective cohort studies was conducted. The study population consisted of 553,217 women among whom 2,132 epithelial ovarian cases were identified. Study-specific relative risks and 95% confidence intervals were calculated by Cox proportional hazards models and then pooled by a random-effects model. RESULTS: No statistically significant associations were observed between intakes of milk, cheese, yogurt, ice cream, and dietary and total calcium intake and risk of ovarian cancer. Higher lactose intakes comparing > or = 30 versus <10 g/d were associated with a statistically significant higher risk of ovarian cancer, although the trend was not statistically significant (pooled multivariate relative risk, 1.19; 95% confidence interval, 1.01-1.40; P(trend) = 0.19). Associations for endometrioid, mucinous, and serous ovarian cancer were similar to the overall findings. DISCUSSION: Overall, no associations were observed for intakes of specific dairy foods or calcium and ovarian cancer risk. A modest elevation in the risk of ovarian cancer was seen for lactose intake at the level that was equivalent to three or more servings of milk per day. Because a new dietary guideline recommends two to three servings of dairy products per day, the relation between dairy product consumption and ovarian cancer risk at these consumption levels deserves further examination.
Ref #327 – Genkinger JM
SO: Cancer Causes Control. 2006 Apr;17(3):273-85.
AB: Fat and cholesterol are theorized to promote ovarian carcinogenesis by increasing circulating estrogen levels. Although case-control studies have reported positive associations between total and saturated fat intake and ovarian cancer risk, two cohort studies have observed null associations. Dietary cholesterol and eggs have been positively associated with ovarian cancer risk. A pooled analysis was conducted on 12 cohort studies. Among 523,217 women, 2,132 incident epithelial ovarian cancer cases were identified. Study-specific relative risks (RR) and 95% confidence intervals (CI) were calculated by Cox proportional hazards models, and then pooled using a random effects model. Total fat intake was not associated with ovarian cancer risk (pooled multivariate RR = 1.08, 95% CI 0.86-1.34 comparing > or =45 to 30-<35% of calories). No association was observed for monounsaturated, polyunsaturated, trans-unsaturated, animal and vegetable fat, cholesterol and egg intakes with ovarian cancer risk. A weakly positive, but non-linear association, was observed for saturated fat intake (pooled multivariate RR = 1.29, 95% CI: 1.01-1.66 comparing highest versus lowest decile). Results for histologic subtypes were similar. Overall, fat, cholesterol and egg intakes were not associated with ovarian cancer risk. The positive association for saturated fat intake at very high intakes merits further investigation.