Why study Adventists? About 50% are vegetarians. About 25% are relagvely normal meat consumption. Demographics

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Jewel Benson
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Living Longer -- Living Better The Health Experience of Seventh-day Adventists Fred Hardinge, DrPH, RD Associate HM Director General Conference Data courtesy of Gary Fraser, MBBS, DrPH Director of

1 Living Longer -- Living Better The Health Experience of Seventh-day Adventists Fred Hardinge, DrPH, RD Associate HM Director General Conference Data courtesy of Gary Fraser, MBBS, DrPH Director of AHS Why study Adventists? If we believe lifestyle (especially diet) affects risk here is a populagon which contains the whole spectrum. About 50% are vegetarians About 25% are relagvely normal meat consumption Summary of AHS-1 AdvenGsts in California have a dramagc extension of life expectancy. AdvenGsts have lower rates of heart disease, most cancers, and a longer life expectancy. This relates to increased intake of fruits, vegetables, nuts, whole grains, soy, and less meat. The main effect appears to be a later age of death whatever the cause of death. LiQle impact on causes of death. A vegetarian diet, nut consumpgon, physical acgvity, absence of past smoking, medium body weight, each appear to contribute an extra 1 ½ to 2 ½ years Adventist Health Study-2 (AHS-2) Demographics About 96,000 subjects More than 25,000 Black study members Mean age at enrollment 58.7 years Age range years 35% male, 65% female What we look like 4 5 6

2 Smoking Status Alcohol Use AHS-2 Dietary Patterns Vegans 9,062(9.4%) Never Smoked Never 59.4 L- O vegetarians 30,103 (31.4%) Semi- vegetarians 4,801 (5.0%) less than 1x week Past Smoker Past Use 33.8 Pesco- vegetarians 9,793 (10.2%) Non- vegetarians 42,241 (44.0%) more than 1x week Current Smoker 1.50 Current Use Dietary Categories: Whites Dietary Categories: Blacks Dietary Status by Age Group 39.6% 9.7% 36.8% Vegan Lacto-Ovo Vegetarian Pesco-Vegetarian Semi-Vegetarian Non-Vegetarian 56.5% 8.7% 15.9% 15.6% Vegan Lacto-Ovo Vegetarian Pesco-Vegetarian Semi-Vegetarian Non-Vegetarian % 26% 39.2% 34.4% 47.4% 52.4% 5.6% 8.3% 3.3% 0% 25% 50% 75% 100% Vegan Lacto-Ovo Vegetarian Pesco-Vegetarian Semi-Vegetarian Non-Vegetarian

3 Daily Meat Intake Non-Vegetarians Dairy Intake Diet: Mean Servings Per Week Black Non- Vegetarians: 61.1 grams per day White Non- Vegetarians: 41.3 grams per day Vegan Lacto Pesco Semi Non Cruciferous Veg Fish Fruits Legumes Tomatoes Dairy Fat Dairy Protein Coffee Consumption Vitamin B 12 Intake (Including Supplements) Calcium Intake Never Cup or Less Per Day Cups Per Day Vegan Lacto Pesco Semi Non Vegan Lacto Pesco Semi Non Dietary Supplement

4 Diabetes Hypertension Overweight Hyperlipidemia Weight Differences Between Vegetarians and Non-Vegetarians Pounds Female 5 6 tall Male 5 10 tall Vegan Lacto-ovo Pesco-veg Semi-veg Non-veg Dietary Pattern and Number Treated for Hypertension % Reporting Hypertension 28% 0% Vegan Lacto-ovo Pesco-veg 1 Semi-veg Non-veg Dietary Pattern and Number with High Cholesterol % Reporting High Cholesterol Dietary Pattern and Treated for Diabetes % Reporting Type 2 Diabetes Diet and Total Mortality* 18% % Vegan Lacto- ovo Pesco % Vegan Lacto-ovo Pesco-veg 1 Semi-veg Non-veg Also supported by studies of non-adventist vegetarians 0% Vegan Lacto-ovo Pesco-veg 1 Semi-veg Non-veg Semi *Adjusted for Age, gender, and Ethnicity

5 Red Meat and Total Mortality* No red meat 1 oz/day (28 g) oz/day (56 g) oz/day (84 g) *Adjusted for Age, gender, and Ethnicity. Diet and CHD Mortality* Vegan Lacto- ovo Pesco Semi *Adjusted for Age, gender and ethnicity. Diet and Total Cancer* Vegan Lacto- ovo Pesco Semi *Adjusted for Age, gender and ethnicity Red Meat and Colon Cancer* No red meat 1 oz/day oz/day oz/day *Adjusted for Age, gender, and Ethnicity. 28 Diet and Breast Cancer* Vegan Lacto- ovo Pesco Semi *Adjusted for Age, gender and ethnicity. 29 The vegetarian advantage is very clear almost everywhere 30

What is the Optimum Vegetarian Diet So far pure vegetarians are looking very good, but not yet convincingly superior to lacto-ovo vegetarians. We need to keep looking as the data grows more robust.

6 What is the Optimum Vegetarian Diet So far pure vegetarians are looking very good, but not yet convincingly superior to lacto-ovo vegetarians. We need to keep looking as the data grows more robust. A Healthy Animal-free Vegetarian Diet Ensure ample grains, vegetables, legumes, fruits, nuts, seeds and berries; Avoid replacing animal foods by refined, sweet, faqy commercial products, even if from plant sources; Obtain adequate sunlight and emphasize high calcium vegetables, or supplement calcium; Consider algal supplements high in omega- 3 faqy acids; Supplement with vitamin B12. Overall Conclusions The health advantage experienced by the more conforming AdvenGsts over many years is remarkable. However, strong conclusions require strong evidence. AHS- 2 will provide this. We have data from 96,000 AdvenGsts across the U.S and Canada, a large number. This improves precision and helps rule out chance as an explanagon Practical Conclusion The evidence is right now sufficient to support a diet that: i) may sgll include some lacto- ovo foods; ii) is otherwise plant- based, or trends strongly in that direction. If you wait to modify your lifestyle ungl all the details are known- - for sure you will be dead 34

Making the case for vegetarian diets! Joan Sabaté, MD, DrPH

Making the case for vegetarian diets! Joan Sabaté, MD, DrPH! Vegetarian diets are ffffffffffffffff of eating. The roots of vegetarian diets can be traced back to the beginnings of recorded history. The