Research Items (222)
Randomized controlled trials on diet and shortening of leukocyte telomere length (LTL) mostly focus on marine-derived n-3 polyunsaturated fatty acids (PUFA). Walnuts are a sustainable source of n-3 PUFA. We investigated whether inclusion of walnuts (15% of energy) in the diet for 2 years would maintain LTL in cognitively healthy elders (63–79 years old) compared to a control group (habitual diet, abstaining from walnuts). This opportunistic sub-study was conducted within the Walnuts and Healthy Aging study, a dual-centre (Barcelona, Spain and Loma Linda University, California) parallel trial. A sub-set of the Barcelona site participants were randomly assigned to the walnut (n = 80) or control group (n = 69). We assessed LTL at baseline and at 2 years and we conducted repeated-measures ANCOVA with 2 factors: time (baseline, 2 years) and group (control, walnut) and their interaction. Adjusted means (95% confidence interval) of LTL (in kb) in controls were 7.360 (7.084,7.636) at baseline and 7.061 (6.835,7.288) after 2 years; corresponding values in the walnut group were 7.064 (6.807,7.320) and 7.074 (6.864,7.284). The time × intervention interaction was nearly significant (p = 0.079), suggestive of a trend of walnut consumption in preserving LTL. This exploratory research finding should be confirmed in trials with adequate statistical power.
There is a significant and growing interaction between the transport sector and the food sector as globalized markets continue to increase the demand for ‘food miles’ i.e. the number of miles a food item travels throughout its life cycle. The concept of ‘food miles’ has become interesting to the public and policy makers as a way to assess the relative carbon footprint of food choices. However, there is currently a lack of information available about the transport-related greenhouse gas emissions that would allow to accurately differentiate between food items. To help address these current knowledge gaps, this paper presents a transferable methodological approach to estimating the transport related CO2 emissions of 10 popular food commodities transported from the farm gate to the retailer. The methodology combines GIS, data from the scientific literature and detailed commodity specific data from personal communication with one of the largest food retailers in California. To travel from the farm gate to the retailer, the amounts of CO2 emissions varied amongst the 10 foods, ranging from 47 g CO2/kg oranges, to 78 g CO2/kg almonds. While California was used as a case study, this method would be replicable across other locations and food life cycle assessments.
- Nov 2018
The 2015–2020 Dietary Guidelines for Americans (DGA) was issued in early 2016. It remains untested if adherence to these guidelines could reduce mortality risk. Using a modified version of the 2015 Dietary Guidelines for American Index (2015 DGAI), we investigated if adherence to the new DGA is associated with mortality in a Spanish (the Seguimiento Universidad de Navarra, SUN) cohort. We assessed the habitual diet of 16,866 participants of this cohort recruited between 1999 and 2014 and calculated their adherence scores to the new DGA using the modified 2015 DGAI (0–21points). Mortality data was determined from the yearly National Death Index reports. After adjusting for demographic and lifestyle confounders, high adherence scores (fourth quartile) were found to be associated with reduced all-cause, cardiovascular and cancer mortality risk, hazard ratios (HR) (95% confidence intervals [CI]) 0.42 (0.25–0.70), 0.30 (0.10–0.90) and 0.46 (0.22–0.96), respectively, compared to low adherence scores (first quartile). A 2-point increase in the 2015 DGAI score was linearly inversely associated with all-cause mortality (HR [95% CI] 0.78 [0.67–0.92]). Main sources of variability in the adherence scores were whole-fat dairy products, red/orange vegetables, fresh fruits, red meat, and dark green vegetables. In conclusion, higher adherence to 2015–2020 Dietary Guidelines for Americans was inversely associated with total, cardiovascular and cancer mortality risk in a Spanish cohort.
Background: Meat intake is associated with increased risk of type 2 diabetes (T2D). It is not clear if egg intake is associated with T2D risk because purported associations may be due to concurrent consumption of eggs with meat. Objective: Our aim was to differentiate any associations between meat and egg consumption and the risk of T2D. Design: In this longitudinal study, 55,851 participants of the Adventist Health Study 2 who were free of diabetes provided demographic, anthropometric, and dietary data at baseline. Meat and egg intakes were assessed with a validated quantitative food-frequency questionnaire. Responses to 2 follow-up questionnaires determined incident T2D cases. Multivariate-adjusted logistic regression was used to determine relations between meat and egg intake and incident T2D. Results: T2D cases identified during a mean 5.3 y of follow-up totaled 2772. Meat intake of >0 to <25 g/d, ≥25 to <70 g/d, and ≥70 g/d significantly increased the risk of T2D compared with no meat intake (OR: 1.29; 95% CI: 1.16, 1.44; OR: 1.42; 95% CI: 1.25, 1.61; and OR: 1.65; 95% CI: 1.39, 1.96, respectively; P-trend < 0.0001). Egg intake compared with no egg intake was not associated with T2D risk. A significant meat-egg interaction (P = 0.019) showed that within every category of egg intake, there was an incremental rise in T2D risk as meat intake increased. However, within categories of meat intake, increasing egg intake did not increase the risk of T2D except among nonmeat-eaters consuming ≥5 eggs/wk (OR: 1.52; 95% CI: 1.09, 2.12). Conclusions: Meat consumption, but not egg consumption, is independently associated with T2D risk. Egg intake seems not to increase T2D risk further with meat intake. Our findings suggest that the purported egg-T2D risk relation in US populations may be biased due to failure to investigate egg-meat interactions. Further investigations are needed to ascertain T2D risk among nonmeat-eaters with high egg intakes.
- Oct 2018
Knowledge in the role of plant-based diets on health had been shaped in part by cohort studies on vegetarians. We revisited publications from two ongoing longitudinal studies comprising large proportions of vegetarians—the Adventist Health Study-2 (AHS-2) and the European Prospective Investigation into Cancer and Nutrition-Oxford (EPIC-Oxford)—to describe the food and nutrient intake, health effects, and environmental sustainability outcomes of the dietary patterns identified in these studies. The vegetarian diet groups in both cohorts have essentially no meat intake, lower intake of fish and coffee, and higher intakes of vegetables and fruits compared to their non-vegetarian counterparts. In the AHS-2 cohort, vegetarians have higher intake of whole grains, legumes, nuts, and seeds. Vegans in AHS-2 have 16% reduced risk while vegans, vegetarians, and fish-eaters in EPIC-Oxford have 11–19% lower risk for all cancers compared to non-vegetarians. Pesco-vegetarians in the AHS-2 cohort had significantly lower mortality risk from all causes and ischemic heart disease while EPIC-Oxford fish-eaters had significantly lower all-cancers mortality risk than their non-vegetarians counterparts. Morbidity risks and prevalence rates for other chronic diseases were differentially reported in the two cohorts but vegetarians have lower risk than non-vegetarians. Greenhouse gas emissions of equicaloric diets are 29% less in vegetarian diet in AHS-2 and 47–60% less for vegetarian/vegan diets in EPIC-Oxford than non-vegetarian/meat-eating diets. The beneficial health outcomes and reduced carbon footprints make the case for adoption of vegetarian diets to address global food supply and environmental sustainability.
Objective: To assess the effects of chronic walnut consumption on body weight and adiposity in elderly individuals. Methods: The Walnuts and Healthy Aging study is a dual-center (Barcelona, Spain and Loma Linda University (LLU)), 2-year randomized parallel trial. This report concerns only the LLU cohort. Healthy elders (mean age 69 year, 67% women) were randomly assigned to walnut (n = 183) or control diets (n = 173). Subjects in the walnut group received packaged walnuts (28-56 g/day), equivalent to ≈15% of daily energy requirements, to incorporate into their habitual diet, while those in the control group abstained from walnuts. Adiposity was measured periodically, and data were adjusted for in-trial changes in self-reported physical activity. Results: After 2 years, body weight significantly decreased (p = 0.031), while body fat significantly increased (p = 0.0001). However, no significant differences were observed between the control and walnut groups regarding body weight (−0.6 kg and −0.4 kg, respectively, p = 0.67) or body fat (+0.9% and +1.3%, respectively, p = 0.53). Lean body mass, waist circumference, and waist-to-hip ratio remained essentially unchanged. Sensitivity analyses were consistent with the findings of primary analysis. Conclusion: Our findings indicate that walnuts can be incorporated into the daily diet of healthy elders without concern for adverse effects on body weight or body composition.
Objective: To assess the effects of chronic walnut consumption on body weight and adiposity in elderly individuals. Methods: The Walnuts And Healthy Aging study is a dual-center (Barcelona, Spain and Loma Linda University [LLU]), 2-year randomized parallel trial. This report concerns only the LLU cohort. Healthy elders (mean age 69 y, 67% women) were randomly assigned to walnut (n = 183) or control diets (n = 173). Subjects in the walnut group received packaged walnuts (28–56 g/d), equivalent to ≈15% of daily energy requirements, to incorporate into their habitual diet, while those in the control group abstained from walnuts. Adiposity was measured periodically, and data were adjusted for in-trial changes in self-reported physical activity. Results: After 2 years, body weight significantly decreased (P = 0.031), while body fat significantly increased (P = 0.0001). However, no significant differences were observed between the control and walnut groups regarding body weight (−0.6 kg and −0.4 kg, respectively, P = 0.67) or body fat (+0.9% and +1.3%, respectively, P = 0.53). Lean body mass, waist circumference and waist-to-hip ratio remained essentially unchanged. Sensitivity analyses were consistent with the findings of primary analysis. Conclusion: Our findings indicate that walnuts can be incorporated into the daily diet of healthy elders without concern for adverse effects on body weight or body composition.
The emphasis on health ministry within the Seventh-day Adventist (SDA) movement led to the development of sanitariums in mid-nineteenth century America. These facilities, the most notable being in Battle Creek, Michigan, initiated the development of vegetarian foods, such as breakfast cereals and analogue meats. The SDA Church still operates a handful of food production facilities around the world. The first Battle Creek Sanitarium dietitian was co-founder of the American Dietetics Association which ultimately advocated a vegetarian diet. The SDA Church established hundreds of hospitals, colleges, and secondary schools and tens of thousands of churches around the world, all promoting a vegetarian diet. As part of the ‘health message,’ diet continues to be an important aspect of the church’s evangelistic efforts. In addition to promoting a vegetarian diet and abstinence from alcohol, the SDA church has also invested resources in demonstrating the health benefits of these practices through research. Much of that research has been conducted at Loma Linda University in southern California, where there have been three prospective cohort studies conducted over 50 years. The present study, Adventist Health Study-2, enrolled 96,194 Adventists throughout North America in 2003–2004 with funding from the National Institutes of Health. Adventist Health Studies have demonstrated that a vegetarian diet is associated with longer life and better health.
- Aug 2018
Objective: To evaluate changes in postingestive gut hormone concentrations from the consumption of Hass avocado by addition or inclusion to lunch test meals, and to examine their association with measures of appetite sensation. Methods: A randomized 3 × 3 crossover study was conducted with 26 healthy overweight adults. Participants consumed one of three test meals: avocado-free control (C); isoenergic avocado inclusive (AI); and, energy increased avocado added (AA) one week apart. Ghrelin, peptide YY3-36 (PYY3-36), gastric inhibitory peptide (GIP) and glucagon-like peptide-1 (GLP-1) concentrations were measured at specific times before and following the test meals. Appetite sensations (Hunger, Fullness, Satisfied, Desire, How Much) were self-assessed using a visual analog scale (VAS) tool at matching time points and a Composite VAS score was computed. Mixed models and repeated measures analysis were used to compare differences among the test meals for VAS measurements and gut hormones, and their associations were evaluated using regression analysis. Results: A decrease in the 3-hour GLP-1 area under the curve (AUC) was observed in the AA meal compared to the C meal (P = 0.03). Negative associations were found for PYY3-36 and GIP for Hunger, Desire and How Much, and positive associations for Fullness, Satisfied and the Composite VAS score (all P < 0.001). For GLP-1, a negative association for Hunger and a positive association for Satisfied and the Composite VAS score (all P < 0.05) were noted. Conclusions: Postprandial responses to PYY3-36, GIP and GLP-1 concentrations were associated with VAS measures and the Composite VAS score following consumption of test meals in overweight adults.
There is compelling evidence showing that nut intake confers protection against cardiovascular disease (CVD). We conducted a review of the literature with respect to observational studies and randomized trials completed in the past ≈25 years that examined nut intake and CVD endpoints. We included findings from major cohort studies, a large intervention trial, and numerous smaller nut trials. Collectively, data from observational and intervention studies indicate strong and significant association between nut intake and decreased risk of fatal and non-fatal coronary heart disease, myocardial infarction, and sudden death; and somewhat weak association with stroke. The primary mechanism by which nuts protect against CVD is through the improvement of lipid and apolipoprotein profile. Increasing evidence also indicates that nut consumption may confer protection against CVD via lowering of oxidative stress, inflammation, and improvement in endothelial function. Nut components, such as unsaturated fatty acids, l-arginine, beneficial minerals, phenolic compounds and phytosterols, appear to be of paramount importance for their health effects.
Traditionally, healthful diets and lifestyles have been examined only in relation to single nutrients, foods, or food groups in terms of dietary exposure. An alternative approach is to conceptualize an index based on vegetarian food pyramid guidelines as a measure of overall diet and lifestyle quality. Our objectives were to: (1) develop the Vegetarian Lifestyle Index (VLI); and (2) evaluate adherence to the Vegetarian Food Guide Pyramid (VFGP) among a low-risk population of Adventists. The index was based on the operationalization of 14 dietary and lifestyle components. All components were equally weighted. Higher score reflected greater adherence to the VFGP. The analytic sample (n = 90,057) comprised 47.7% non-vegetarians, 5.6% semi-, 10.1% pesco-, and 29.0% lacto-ovo-vegetarians, and 7.7% vegans, of which 1.1% were current smokers and 9.9% were alcohol consumers. Population mean VLI score was 7.43 (SD = 1.75) ranging from 1 to 12.5. Non-vegetarians (6.14; 95% confidence interval (CI), 6.06–6.21) had a significantly lower mean compared to semi- (7.31; 95% CI, 7.22–7.40), pesco- (7.41; 95% CI, 7.32–7.49), and lacto-ovo-vegetarians (8.16; 95% CI, 8.08–8.24), as well as vegans (8.88; 95% CI, 8.78–8.96). Vegetarians scored on average 1.18 to 2.73 more points than their non-vegetarian counterparts. Results demonstrate that the index has strong discriminant ability across distinct dietary patterns. Additionally, the VLI provides a useful measure of diet and lifestyle adherence to further refine vegetarian food pyramid guidelines.
- Feb 2018
Background & aims: Shortening of leukocyte telomere length (LTL) is a biomarker of aging. Epidemiologic studies of LTL in relation to dietary fatty acids have reported conflicting results. The red blood cell (RBC) fatty acid status is a valid objective biomarker of long-term dietary intake of C18:2n-6, C18:3n-3 and long-chain n-3 polyunsaturated fatty acids (C20:5n-3 and C22:6n-3). In healthy older individuals, we investigated whether LTL relates to the RBC proportions of the main dietary polyunsaturated fatty acids (PUFA), and to the RBC proportion of arachidonic acid (C20:4n-6), a fatty acid that can generate pro-inflammatory lipid mediators once released from cell membranes. Design: Cross-sectional study in 344 subjects (mean age 68.8 y, 68.6% women) who participated in a randomized controlled trial testing whether a diet enriched in walnuts can delay the onset of age-related diseases (https://clinicaltrials.gov/ct2/show/NCT01634841). At baseline, we assessed LTL by high-throughput quantitative fluorescence and determined fatty acids in RBCs by gas chromatography. Results: In multivariate models adjusted for age and gender, the RBC proportions of dietary PUFA were unrelated to LTL. In contrast, the RBC proportion of arachidonic acid inversely related to LTL (regression coefficient [95% confidence interval], -0.10 (-0.19 to -0.01), P = 0.023). Conclusion: An increasing proportion of C20:4n-6 in RBCs is associated with shorter telomeres. Further research is needed to investigate the role of this fatty acid and its derived lipid mediators in the aging process.
- Jan 2018
Objective How food is produced and consumed has consequences for ecosystems, such as resource use and greenhouse gas (GHG) emission among others. The Mediterranean diet (MedDiet) was proposed as a sustainable dietary model, due to its nutritional, environmental, economic and sociocultural dimensions. However, further evidence is needed. Thus, our objective was to evaluate the impact on resource (land, water and energy) use and GHG emission of better adherence to the MedDiet in a Mediterranean Spanish cohort. Design We analysed the dietary pattern of participants through a validated FFQ. The outcomes were land use, water and energy consumption and GHG emission according to MedDiet adherence. The specific environmental footprints of food item production and processing were obtained from different available life-cycle assessments. Setting Spanish university graduates. Subjects Participants ( n 20 363) in the Seguimiento Universidad de Navarra (SUN) cohort. Results Better adherence to the MedDiet was associated with lower land use (−0·71 (95 % CI −0·76, −0·66) m ² /d), water consumption (−58·88 (95 % CI −90·12, −27·64) litres/d), energy consumption (−0·86 (95 % CI −1·01, −0·70) MJ/d) and GHG emission (−0·73 (95 % CI −0·78, −0·69) kg CO 2 e/d). A statistically significant linear trend ( P <0·05) was observed in all these analyses. Conclusions In this Mediterranean cohort, better adherence to the MedDiet was an eco-friendly option according to resource consumption and GHG emission.
- Jan 2018
- Pediatric Obesity
Childhood obesity can persist through adulthood with adverse lifelong consequences. Prevention of unnecessary weight gain and overweight/obesity during childhood could mitigate the difficulty of treating adult obesity and its comorbidities. Exposing children to plant-based or vegetarian diets at a relatively young age is a judicious approach that may have long-term beneficial effects in maintaining a healthy weight. The Academy of Nutrition and Dietetics states that “appropriately planned vegetarian, including vegan, diets are healthful, nutritionally adequate, and may provide health benefits for the prevention and treatment of certain diseases” for all life cycle stages. Vegetarian children are relatively leaner and less susceptible to cardio-metabolic risks compared to their non-vegetarian counterparts due to the nature of the foods that comprise their diet. Vegetarian diets are characteristically plant-based, allowing a synergy between nutrients and phytochemicals that confer health benefits. This chapter looks into how vegetarian diets can address pediatric obesity and how to ensure adequate nutrition for vegetarian children.
Although there is accumulating evidence for a protective role of n-3 polyunsaturated fatty acids (n-3 PUFAs) on bone health, there are limited studies that examine the effect of altering dietary n-6:n-3 PUFA ratio with plant and marine sources of n-3 PUFA on bone health. Healthy adults (n = 24) were randomized into an eight-week crossover study with a four-week washout between treatments, with each subject consuming three of four diets. The four diets differed in the dietary n-6:n-3 PUFA ratios and either had an algal oil supplement added or not: (Control diet (10:1); α-linolenic acid (ALA) diet (2:1); Eicosapentaenoic acid/Docosahexaenoic acid (EPA/DHA) diet (10:1 plus supplement (S) containing EPA/DHA; Combination diet (2:1 + S)). The supplement was microalgae oil that provided 1 g EPA + DHA/day. Flaxseed oil and walnuts provided 8.6 g of ALA/day in the 2:1 diets. Serum levels of c-telopeptide (CTX), procollagen Type I N-terminal peptide, and osteocalcin showed significant correlation with age but none of the bone markers or peroxisomal proliferator-activated receptor-γ mRNA expression was significantly different between the diets. Serum CTX was negatively associated with red blood cell membrane linoleic acid and ALA and positively associated with membrane DHA. Neither altering dietary n-6:n-3 PUFA ratio from a 10:1 to a 2:1 ratio nor adding EPA/DHA supplement significantly changed bone turnover in the short term in healthy adults.
Older adults tend to require fewer energy content and higher levels of nutrients to promote and maintain optimal health. Regrettably, dietary variety and quality are known to decline with advancing age. We conducted a 2-year prospective, randomised, dietary intervention trial where we asked free-living elderly subjects (63–79 years) on self-selected habitual diets to incorporate walnuts daily into their diet (15 % energy). We then compared their nutrient intake with that of a similar group of concurrent participants on self-selected habitual diets but abstaining from walnut consumption (control). No recipes or advice on use of nuts were provided. Dietary intake was assessed by multiple unannounced 24-h telephone dietary recalls. On average, walnut supplement consumption was 43 g/d or 1171·5 kJ (281 kcal). The mean daily energy intake was 954 kJ (228 kcal) higher in the walnut group than in the control group ( P <0·001). Compared with control, participants in the walnut group reported significantly higher intake of total protein, vegetable protein, total PUFA and n -3 and n -6 PUFA; and significantly lower intake of total carbohydrate, animal protein, SFA, and Na. An estimated 19 % of total energy and 25 % of total fat from other food sources was displaced. Displacement of MUFA and total PUFA was 21 and 16 %, respectively. Thus adding a daily supplement of walnuts to an ad libitum diet of older adults can induce favourable modifications to the nutrient profile in a way that addresses declining nutrient intake associated with aging.
Purpose: There is inconsistent evidence regarding the relationship between higher intake of nuts, being an energy-dense food, and weight gain. We investigated the relationship between nut intake and changes in weight over 5 years. Methods: This study includes 373,293 men and women, 25-70 years old, recruited between 1992 and 2000 from 10 European countries in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. Habitual intake of nuts including peanuts, together defined as nut intake, was estimated from country-specific validated dietary questionnaires. Body weight was measured at recruitment and self-reported 5 years later. The association between nut intake and body weight change was estimated using multilevel mixed linear regression models with center/country as random effect and nut intake and relevant confounders as fixed effects. The relative risk (RR) of becoming overweight or obese after 5 years was investigated using multivariate Poisson regressions stratified according to baseline body mass index (BMI). Results: On average, study participants gained 2.1 kg (SD 5.0 kg) over 5 years. Compared to non-consumers, subjects in the highest quartile of nut intake had less weight gain over 5 years (-0.07 kg; 95% CI -0.12 to -0.02) (P trend = 0.025) and had 5% lower risk of becoming overweight (RR 0.95; 95% CI 0.92-0.98) or obese (RR 0.95; 95% CI 0.90-0.99) (both P trend <0.008). Conclusions: Higher intake of nuts is associated with reduced weight gain and a lower risk of becoming overweight or obese.
Purpose: Isoflavones have estrogenic properties that may adversely affect pubertal development of boys. We examined if soy isoflavone consumption is associated with age at pubarche (first onset of pubic hair) in a male population with a wide range of soy intake. Methods: Boys aged 12-18 years (n = 248) who attended schools around Adventist universities in Southern California and Michigan self-reported their age at pubarche. Intake of soy isoflavones was assessed using a validated Web-based food frequency questionnaire; consumption levels were designated as low, moderate, and high. Descriptives, time-to-event analysis, and Cox proportional hazards regression that controlled for confounders were performed. Results: Energy-adjusted mean intakes were 0.8-54.9 mg/d for total isoflavones, 0.4-22.1 mg/d for daidzein, and 0.4-28.0 mg/d for genistein. Moderate and high total soy isoflavone intake were significantly associated with earlier adjusted median age at pubarche: 12.58 years [RR (95% CI): 1.58 (1.06, 2.36)] for moderate and 12.50 years [RR (95% CI): 1.63 (1.03, 2.60)] for high vs. 13.00 years for low consumers. Similarly, daidzein and genistein consumption was also significantly associated with age at pubarche. No significant associations were found for facial hair for any of the isoflavones. Conclusions: Age at pubarche in this male population widely exposed to soy is within the reported range for boys' pubarcheal age; moderate/high consumers tend to have it earlier compared to low consumers. Further studies are needed to ascertain that substantial exposure to soy isoflavones does not adversely affect pubertal development of boys.
Background: Traditionally, nutritional epidemiology examines diet and disease risks only in relation to a single nutrient, foods, or food groups as dietary exposures. An alternative and novel approach is to conceptualize a global scoring index based on vegetarian food pyramid guidelines as a method to assessing overall diet and lifestyle quality. Objective: Our objective is to evaluate the level of dietary and lifestyle adherence among vegetarian and non-vegetarian Adventists as measured by the Loma Linda University Vegetarian Lifestyle Index (LLU-VLI) among Adventist Health Study 2 (AHS-2) cohort, a population with unique and wide range of dietary patterns. Method: The score is based on the operationalization of multiple dietary and lifestyle components recommended by LLU Vegetarian Food Pyramid, using data from AHS-2 comprehensive questionnaires. All components were equally weighted. Higher scores reflect greater adherence. Results: Among an analytic sample of 90,057 participants, 42,954 (47.7%) were non-vegetarians, 5,007 (5.6%) were semi-vegetarians, 9,078 (10.1%) were pesco-vegetarians, 26,101 (29.0%) were lacto-ovo-vegetarians, and 6,917 (7.7%) were vegans. The mean score for our population was 7.43 (SD=1.75) ranging from 1 to 12.5. When adjusted for genetics, lifestyles and social-economic factors, non-vegetarians (6.07; 95% CI, 5.99-6.14) had significantly lower mean compared to the vegetarian groups including semi- (7.24; 95% CI, 7.15-7.33), pesco- (7.34; 95% CI, 7.26-7.42), lacto-ovo- (8.10; 95% CI, 8.02-8.18), vegan (8.80; 95% CI, 8.71-8.89). Vegetarians had a greater adherence to the LLU Vegetarian Food Pyramid, whose scores were on average 1.17 to 2.73 points higher than their non-vegetarian counterparts. Conclusion: The results demonstrate that the index has strong discriminant ability across distinct dietary patterns.
The objective of this study was to evaluate the greenhouse gas emissions (GHGEs) generated by the production of tofu. A partial life cycle assessment (LCA) was performed using SimaPro 8 software with a functional unit of 1 kg of packaged tofu and a farm to factory gate boundary. Original production data for the period of 1 year were obtained from a tofu manufacturer based in the United States and used with soybean production data from SimaPro 8 Ecoinvent 3.1 and U.S. Life Cycle Inventory databases to calculate the associated GHGEs as carbon dioxide equivalents (CO2e). The LCA calculations included resource inputs required to produce and package tofu: soybeans, water, electricity, natural gas, transportation, and packaging materials. The LCA boundary was from the cradle (i.e., soybean farm) to the factory exit gate (i.e., postpackaging). Uncertainty analyses were performed using Monte Carlo simulations. Total CO2e from packaged tofu were 982 g/kg, 9820 g/kg of protein, 1150 g/1000 calories, and 336 g/retail packet of 396 g. For 1 kg of packaged tofu, 16% of CO2e resulted from soybean production, 52% from tofu manufacturing, 23% from packaging, and 9% from transportation. Tofu, a protein-rich plant food, generates relatively low GHGEs.
Shifting dietary patterns for environmental benefits has long been advocated. In relation to mitigating climate change, the debate has been more recent, with a growing interest from policy makers, academics, and society. Many researchers have highlighted the need for changes to food consumption in order to achieve the required greenhouse gas (GHG) reductions. So far, food consumption has not been anchored in climate change policy to the same extent as energy production and usage, nor has it been considered within the context of achieving GHG targets to a level where tangible outputs are available. Here, we address those issues by performing a relatively simple analysis that considers the extent to which one food exchange could contribute to achieving GHG reduction targets in the United States (US). We use the targeted reduction for 2020 as a reference and apply published Life Cycle Assessment data on GHG emissions to beans and beef consumed in the US. We calculate the difference in GHGs resulting from the replacement of beef with beans in terms of both calories and protein. Our results demonstrate that substituting one food for another, beans for beef, could achieve approximately 46 to 74% of the reductions needed to meet the 2020 GHG target for the US. In turn, this shift would free up 42% of US cropland (692,918 km 2). While not currently recognized as a climate policy option, the Bbeans for beef^ scenario offers significant climate change mitigation and other environmental benefits, illustrating the high potential of animal to plant food shifts. Climatic Change
Background: High intakes of total and animal protein are associated with the risk of type 2 diabetes (T2D). The influence of protein type on insulin resistance, a key precursor of T2D, has not been extensively studied. Objective: The aim of this study was to determine the associations between dietary total, animal, and plant protein intakes as well as the animal-to-plant protein (AP) intake ratio with insulin resistance in middle-aged and older adults. Methods: This was a cross-sectional analysis in 548 participants (mean ± SD age: 66.2 ± 13.7 y) from the calibration substudy of the AHS-2 (Adventist Health Study 2) cohort. Participants consumed diets with a low AP intake ratio. Dietary intakes of total and particular types of protein were calculated from six 24-h dietary recalls. Participants completed a self-administered questionnaire on demographic, lifestyle, health, diet intake, and physical activity characteristics. Anthropometric variables including weight, height, and waist circumference were measured. Homeostasis model assessment of insulin resistance (HOMA-IR) was calculated by using fasting serum glucose and insulin. Multiple linear regression models were used to test the relations between total and specific protein intakes with insulin resistance. Results: The ranges of dietary intakes of animal and plant protein and the AP intake ratio were 0.4–87.4 and 14.0–79.2 g/d and 0.02–4.43, respectively. Dietary intakes per 10-g/d increments of total protein (β: 0.11; 95% CI: 0.02, 0.21) and animal protein (β: 0.11; 95% CI: 0.01, 0.20) and the AP intake ratio (β: 1.82; 95% CI: 0.80, 2.84) were positively related to HOMA-IR. Plant protein was not significantly related to insulin resistance. Conclusion: Total and animal protein intakes and the AP intake ratio were positively associated with HOMA-IR in adults with relatively a low intake of animal protein and a high consumption of plant protein.
Objective: The study sought to measure the effects of caffeinated and decaffeinated coffee on affective mood, sleep, and health-related quality of life (HRQL). Methods: Forty-nine healthy participants between the ages of 18 and 45 took part in a randomized, double-blind, longitudinal study with decaffeinated coffee as the control. The participants began with a 5-day washout period, followed by a 5-day treatment phase, and concluded with a 5-day washout phase. Data were analyzed with repeated-measures analysis of covariance and ordinary least-squares mediational analysis. Results: The caffeinated coffee treatment group showed significant direct effects on sleep, anxiety, and stress-based domains of HRQL. In addition, mediational analysis showed that the more global domains of HRQL were affected indirectly through reduced sleep quality/quantity and through increases in anxiety. No significant changes were noted in the decaffeinated treatment group. Conclusions: Given the strong effect of caffeine on sleep and anxiety, as well as the indirect effect on HRQL in this study, it might be beneficial for individuals with stress responsive illnesses to refrain from high doses of caffeine. Further studies should examine the effects of caffeine in individuals with various stress-related illnesses. The results of caffeine on depression are contrary to previous studies, and further evaluations should examine variations of effects based on dosages and different populations (major depression diagnoses as well as healthy populations).
Introduction: An unwanted consequence of population aging is the growing number of elderly at risk of neurodegenerative disorders, including dementia and macular degeneration. As nutritional and behavioral changes can delay disease progression, we designed the Walnuts and Healthy Aging (WAHA) study, a two-center, randomized, 2-year clinical trial conducted in free-living, cognitively healthy elderly men and women. Our interest in exploring the role of walnuts in maintaining cognitive and retinal health is based on extensive evidence supporting their cardio-protective and vascular health effects, which are linked to bioactive components, such as n-3 fatty acids and polyphenols. Methods: The primary aim of WAHA is to examine the effects of ingesting walnuts daily for 2 years on cognitive function and retinal health, assessed with a battery of neuropsychological tests and optical coherence tomography, respectively. All participants followed their habitual diet, adding walnuts at 15% of energy (≈30–60 g/day) (walnut group) or abstaining from walnuts (control group). Secondary outcomes include changes in adiposity, blood pressure, and serum and urinary biomarkers in all participants and brain magnetic resonance imaging in a subset. Results: From May 2012 to May 2014, 708 participants (mean age 69 years, 68% women) were randomized. The study ended in May 2016 with a 90% retention rate. Discussion: The results of WAHA might provide high-level evidence of the benefit of regular walnut consumption in delaying the onset of age-related cognitive impairment and retinal pathology. The findings should translate into public health policy and sound recommendations to the general population (ClinicalTrials.gov identifier NCT01634841).
- Dec 2016
Health benefits of vegetarian diets have emerged. The focus has shifted from nutrient adequacy to health and environmental impact of vegetarianism. This indicates growing awareness that vegetarian diets, despite marginal intake of a few nutrients, can provide ample health benefits to humans. Vegetarians worldwide display increased longevity but low rates of overweight and obesity, cardiovascular diseases, cancers, type II diabetes, kidney stones, gallstones, and diverticular disease. Observed health advantages are likely due to the protective effect of plant nutrients as well as reduced intake of meat components.
Background Dietary assessment during adolescence is crucial in determining how adolescents’ consumption habits potentially affect current and long-term health. However, assessment methods for adolescents need to be relevant to their emerging technological culture. We developed a web-based food frequency questionnaire (webFFQ) to assess the habitual soy isoflavones and nutrient intake of adolescents. Our purpose was to validate this webFFQ against multiple 1-day photograph-assisted food records (FR). Methods Adolescents aged 12–18 years (n = 70) attending middle and high schools completed the webFFQ and provided six 1-day FR. Fifteen participants were excluded due to improbable energy intake. Statistical agreements were determined using Wilcoxon signed-ranks test, Pearson’s bivariate correlations of normalized values with energy-adjustment and correction for attenuation, cross-classification, and Bland-Altman plots. Results Based on n = 55, the webFFQ had higher intake estimates for all isoflavones and most nutrients compared to the FR. Energy-adjusted and deattenuated correlations were moderately strong for total isoflavones (r = 0.67), daidzein (r = 0.63), genistein (r = 0.64), and glycitein (r = 0.54). They ranged from a high of 0.82 (animal proteins) to a low of 0.11 (vitamin B12) for nutrients. Cross-classification agreement up to within 1 quartile ranged from 99.0 % (vegetable protein) to 61.8 % (vitamin B12) with low gross misclassifications (0.0–12.7 %). Bland-Altman plots for the isoflavones showed consistent overestimation and wide variation but nevertheless good agreement between the two methods. Conclusions The webFFQ is relatively valid in ranking adolescents according to their isoflavones and nutrient intake. However, while it significantly overestimates the absolute intake of most nutrients, results are comparable to other food frequency questionnaires developed for adolescents.
Background: Traditional paper-based methods to assess food intake can be cumbersome for adolescents; use of mobile phones to track and photograph what they eat may be a more convenient, reliable, and compelling way to collect data. Objective: Our aims were to determine (1) the feasibility of using personal mobile phones to send food records with digital images (FRDIs) among free-living adolescents and (2) whether the quality of food records differed between a high-level intervention group (ie, face-to-face training plus real-time support) and a low-level intervention group (ie, telephone training plus next-day follow-up). Methods: Adolescents (N=42, 11 males and 31 females) aged 12-18 years who had a mobile phone with camera enrolled in the study via consecutive sampling. The first group (n=21) received face-to-face training while the second group (n=21) was trained via telephone. Participants received a fiducial marker (FM) and completed a 1-day FRDI using their mobile phones. At every eating occasion, participants were to (1) take clear images of their meals/food with a correctly placed fiducial marker before eating, (2) send the image immediately to a designated email address, (3) right after completing a meal, send a text message listing the time and name of the meal, foods eaten, and amounts eaten, and (4) before sleep, send an "end" text message to indicate completion of food recording. Those who received face-to-face training received real-time support during reporting; those trained by telephone received next-day follow-up. Descriptive statistics and comparison tests were used to determine performance of the groups. Results: All participants (N=42) who underwent training completed their 1-day FRDI. A significantly greater proportion of the low-level intervention group compared to the high-level intervention group placed their FM correctly in the image (95% vs 43%, P<.001), had complete information for each meal in their food record (95% vs 71%, P=.04), and had a higher overall score in meeting the criteria for food recording (4.3 vs 3.4 out of 5 points). Both groups had energy intake values that moderately correlated with their estimated energy requirements: low-intervention r=.55; high-intervention r=.51. Conclusions: Using personal mobile phones to report dietary intake via texting and digital images is feasible among free-living adolescents. Real-time support or high-level intervention does not guarantee better food recording quality among adolescents.
Childhood obesity is associated with a greater chance of a lifetime of obesity. Evidence suggests dairy at recommended levels could be beneficial in maintaining normal weight and body composition. We assessed whether dairy consumption is associated with anthropometric indicators of health (z-scores for weight-for-age (WAZ); height-for-age (HAZ) and body mass index (BMIZ); waist-to-height ratio (WHtR); fat-free mass (FFM); and fat mass (FM)) in adolescents. In a cross-sectional study, 536 males and females ages 12-18 completed a 151-item semi-quantitative web-based food frequency questionnaire that included 34 dairy-containing foods. Dairy foods were categorized into milk, cheese, sweetened dairy, and total dairy. Anthropometrics were measured during school visits. Total dairy intake was associated with WAZ (β = 0.25 (95% CI: 0.01, 0.49), p = 0.045) and HAZ (β = 0.28 (95% CI: 0.04, 0.52), p = 0.021). In boys, total dairy was associated with WHtR (β = 0.02 (95% CI: 0.00, 0.04), p = 0.039), FFM (β = 4.83 (95% CI: 1.79, 7.87), p = 0.002), and FM (β = 3.89 (95% CI: 0.58, 7.21), p = 0.021), and cheese was associated with FFM (β = 4.22 (95% CI: 0.98, 7.47), p = 0.011). Dairy consumption seems to influence growth in both genders, and body composition and central obesity in boys. Prospective studies are needed to identify how types of dairy relate to growth, body composition, and central obesity of adolescents.
Background Over the years, evidence has accumulated showing that consuming nuts in moderate amounts may reduce the risk of cardiovascular disease. However, nuts are known to be dense in energy providing 23.4 to 26.8 kJ/ per gram and thus it's consumption without regard to overall energy balance may potentially lead to weight gain. Study aim The aim of this study was to determine if habitual consumption of walnuts by free living older adults without additional dietary or lifestyle advice would result in increased risk of weight gain. Methods The Walnuts for Healthy Aging (WAHA) study is an ongoing, dual center clinical trial, examining the effects of a walnut diet on age related outcomes. At our center, we randomly assigned 355 participants (60% female), mean age 69 y, to a walnut or control group. Participants in both groups followed their habitual diet and lifestyle; the control group refrained from eating any walnuts, while walnut group were provided with packets of walnuts equivalent to 15% of their daily energy that they incorporated into the daily diet. No other dietary advice was provided to either groups. They were followed up once every two months by a dietitian. Compliance was assessed through unannounced 24-hour telephone diet recalls and by measuring changes in a-linolenic (ALA) in the erythrocyte membrane. Body weight, body fat, and waist and hip circumferences were obtained at baseline and after one year. Weight change over time and between the two groups was analyzed by repeated measures analysis of covariance (ANCOVA), adjusting for: age, gender, ethnicity, and additional baseline characteristics. Results There was slight decrease in mean body weight in both groups, decrease being higher in the control group (-1.05 kg) than in the walnut group (-0.29 kg) (P=0.082). Waist circumference increased marginally in both groups; by 0.76 cm in the walnut group and by 0.15 cm in the control group (P=0.620) . Body fat increased by 1% in both groups over time, the difference between the two groups was non-significant (P=0.792). Overtime, the walnut group reported higher mean energy intake (+1075kJ or 257 kcal) compared to the control group. Conclusion Daily consumption of 1-2oz of walnuts by free living older adults for a year does not result in body weight gain or significant change in other adiposity measures.
Food systems must operate within environmental constraints to avoid disastrous consequences for the biosphere. Such constraints must also take into account nutritional quality and health outcomes. Given the intrinsic relationships between the environmental sciences and nutritional sciences, it is imperative that public health embraces environmental nutrition as the new frontier of research and practice and begins a concerted focus on the new discipline of environmental nutrition, which seeks to comprehensively address the sustainability of food systems. We provide an overview to justify our proposition, outline a research and practice agenda for environmental nutrition, and explore how the complex relationships within food systems that affect public health could be better understood through the environmental nutrition model.
- Mar 2016
- Mediterranean Diet
Due to its increasing prevalence and associated health complications, Metabolic Syndrome (MetS) has become both a public health concern and a clinical challenge. Dietary approaches to prevention and treatment of MetS vary, yet nearly all experts agree that the clinical parameters of the syndrome are greatly improved through lifestyle changes including diet. Existing evidence suggest a positive link between adherence to diets with features resembling the principles of the traditional Mediterranean diet (MD) and improvement of metabolic abnormalities. Although, the overall evidence suggests such promising trend, discrepancy of the results can be attributed to factors such as quality, methodology, and the overall design of the studies. Not much clinical application can be instigated from the existing evidence unless several well-designed clinical trials are conducted to investigate the causal associations and potentially define the underlying mechanisms.
Background: There is emerging evidence of the beneficial effects of n-3 (ω-3) fatty acids (FAs) on cardiometabolic risk factors. Nevertheless, not much is known about the association between adipose tissue α-linolenic acid (ALA), eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA) and insulin resistance. Objective: We determined the association between adipose tissue n-3 FAs (total n-3 FAs, ALA, and EPA plus DHA) and insulin resistance in healthy adults. Design: In this cross-sectional study, multivariable analyses were used to assess the association between adipose tissue FAs (ALA, EPA plus DHA, and total n-3 FAs) and the homeostasis model assessment of insulin resistance (HOMA-IR) in a subset of adult participants (n = 716; mean age: 58 y) from the Adventist Health Study-2 (AHS-2) cohort. Results: Compared with the lowest tertile, the third tertile (β = -0.13; 95% CI: -0.24, -0.01) of adipose tissue ALA was inversely associated with the HOMA-IR. When stratified by waist circumference, ALA continued to be inversely associated [third tertile: β = -0.17 (95% CI: -0.31, -0.02)] with the HOMA-IR in subjects with a waist circumference ≤88 cm in women or ≤102 cm in men but not in those with a larger waist circumference. No significant association was noted between adipose tissue EPA plus DHA and HOMA-IR. Conclusions: Higher adipose tissue ALA was inversely associated with insulin resistance in this cohort of healthy adult men and women. This finding appears to be more pronounced in individuals with a normal waist circumference.
Background: Accurate assessment of diet in study populations is still a challenge. Some statistical strategies that use biomarkers of dietary intake attempt to compensate for the biasing effects of reporting errors. Objective: The objective was to correlate biomarkers of dietary intake with 2 direct measures of dietary intake. Methods: Subjects provided repeated 24-h dietary recalls and 2 food-frequency questionnaires (FFQs) separated by ∼3 y. Correlations between biomarkers and reported dietary intakes as measured by the recalls and FFQs were de-attenuated for within-person variability. The Adventist Health Study-2 (AHS-2) has a large database of biomarkers of dietary intake (blood, urine, adipose tissue) from a calibration study (909 analytic subjects) representing the cohort. Participants were black and non-black Adventists in the United States and Canada. Results: Dietary items with higher-valued de-attenuated correlations (≥0.50) between biomarkers and recalls included some fatty acids (FAs), the non-fish meats, fruit (non-black subjects), some carotenoids, vitamin B-12 (non-black subjects), and vitamin E. Moderately valued correlations (0.30-0.49) were found for very long chain ω-3 (n-3) FAs, some carotenoids, folate, isoflavones, cruciferous vegetables, fruit (black subjects), and calcium. The highest correlation values in non-black and black subjects were 0.69 (urinary 1-methyl-histidine and meat consumption) and 0.72 (adipose and dietary 18:2 ω-6), respectively. Correlations comparing biomarkers with recalls were generally similar for black and non-black subjects, but correlations between biomarkers and the FFQ were slightly lower than corresponding recall correlations. Correlations between biomarkers and a single FFQ estimate (the usual cohort situation) were generally much lower. Conclusions: Many biomarkers that have relatively high-valued correlations with dietary intake were identified and were usually of similar value in black and non-black subjects. These may be used to correct effects of dietary measurement errors in the AHS-2 cohort, and in some cases they also provide evidence supporting the validity of the dietary data.
- Dec 2015
Aims: Coffee reduction has been a strategy to prevent urinary symptoms with conflicting evidence. We aimed to study the effects of regular and decaffeinated coffee on urinary symptoms among low and frequent coffee users, who were young and healthy. Methods: We conducted a double-blinded parallel study on subjects, who were restricted from consuming caffeinated items outside the study. After subjects completed 5 days of caffeine abstinence they consumed regular coffee (450 mg/d caffeine content) or decaffeinated coffee (12 mg/d caffeine content) for 5 days. Previous caffeine use and urinary symptoms were assessed by a diet survey, urogenital distress inventory, and interstitial cystitis problem and symptom indices (ICPI, ICSI). Results: Forty nine subjects completed the study. When assessing the submeasures "frequency" and "urgency" on ICPI and ICSI subjects drinking coffee reported a significant increase in urgency (P < 0.05) and frequency (P < 0.05), whereas subjects drinking decaffeinated coffee experienced no difference in those submeasures in comparison to no caffeine intake. However, previous "low coffee users" experienced the largest increase of urinary symptoms, whereas previous "frequent coffee users" showed fewer symptoms when exposed to regular coffee. Conclusions: The study suggests that avoiding high-dosage coffee consumption prevents urgency and frequency, which supports recommendations to limit caffeinated beverages. The study differentiates between subjects having a history of low and frequent coffee use. Subjects, who are not used to regular coffee consumption, seem to be more vulnerable to the effects of coffee on urinary symptoms. Better understanding of the effects of coffee on urinary symptoms may improve patients counseling. Neurourol. Urodynam. 9999:XX-XX, 2015. © 2015 Wiley Periodicals, Inc.
Background: According to the American Cancer Society, prostate cancer accounts for ∼27% of all incident cancer cases among men and is the second most common (noncutaneous) cancer among men. The relation between diet and prostate cancer is still unclear. Because people do not consume individual foods but rather foods in combination, the assessment of dietary patterns may offer valuable information when determining associations between diet and prostate cancer risk. Objective: This study aimed to examine the association between dietary patterns (nonvegetarian, lacto-ovo-vegetarian, pesco-vegetarian, vegan, and semi-vegetarian) and prostate cancer incidence among 26,346 male participants of the Adventist Health Study-2. Design: In this prospective cohort study, cancer cases were identified by matching to cancer registries. Cox proportional hazards regression analysis was performed to estimate HRs by using age as the time variable. Results: In total, 1079 incident prostate cancer cases were identified. Around 8% of the study population reported adherence to the vegan diet. Vegan diets showed a statistically significant protective association with prostate cancer risk (HR: 0.65; 95% CI: 0.49, 0.85). After stratifying by race, the statistically significant association with a vegan diet remained only for the whites (HR: 0.63; 95% CI: 0.46, 0.86), but the multivariate HR for black vegans showed a similar but nonsignificant point estimate (HR: 0.69; 95% CI: 0.41, 1.18). Conclusion: Vegan diets may confer a lower risk of prostate cancer. This lower estimated risk is seen in both white and black vegan subjects, although in the latter, the CI is wider and includes the null.
- Oct 2015
Introduction: Greenhouse gas emissions (GHGEs) and health outcomes are both major consequences of dietary choices. Assessments of dietary patterns that vary in their content of plant and animal contents are emerging at the intersection of nutrition, environment and public health. Objectives: Compare the GHGEs associated with a variety of dietary patterns consumed by a large population across North America and simultaneously assess mortality according to the same dietary patterns in the same population. Method/ Design: SimaPro Life Cycle Assessment software was used to calculate GHGEs for each of the 200+ food items in the food frequency questionnaire of the Adventist Health Study-2 cohort. GHGEs were then calculated for 5 dietary patterns derived from the food intake data of the cohort, which varied in the quantity and type of animal and plant foods: vegan, lacto-ovo vegetarian, pesco vegetarian, semi vegetarian, and non-vegetarian. All-cause mortality rates for the 73,000+ subjects were adjusted for a range of lifestyle and sociodemographic factors and estimated according to dietary pattern. Results: Using the non-vegetarian diet as a reference, the mean reductions in GHGEs for the semi vegetarian, pesco vegetarian, lacto-ovo vegetarian and vegan diets were 20%, 24%, 28% and 42% respectively. The age, gender and race adjusted mortality rates for nonvegetarian, semi vegetarian, pesco vegetarian, lacto-ovo vegetarian and vegan diets were 6.66 (6.26, 7.05), 6.18 (5.00, 7.37), 5.49 (4.80, 6.18), 5.60 (5.20, 5.99) and 5.38 (4.64, 6.12) deaths per 1000 person-years, respectively. The differences were significant. Conclusions: Moderate differences in the caloric intake of plant and animal products provided nontrivial reductions in GHGEs and health outcomes, as shown through the mortality analysis.
Abstract Objective: To investigate the resource efficiency and environmental impacts of producing one kilogram of edible protein from two plant- and three animalprotein sources. Design: Primary source data were collected and applied to commodity production statistics to calculate the indices required to compare the environmental impact of producing 1 kg of edible protein from kidney beans, almonds, eggs, chicken and beef. Inputs included land and water for raising animals and growing animal feed, total fuel, and total fertilizer and pesticide for growing the plant commodities and animal feed. Animal waste generated was computed for the animal commodities. Setting: Desk-based study at the Department of Nutrition and Department of Occupational and Environmental Health, Loma Linda University. Subjects: None. Results: To produce 1 kg of protein from kidney beans required approximately eighteen times less land, ten times less water, nine times less fuel, twelve times less fertilizer and ten times less pesticide in comparison to producing 1 kg of protein from beef. Compared with producing 1 kg of protein from chicken and eggs, beef generated five to six times more waste (manure) to produce 1 kg of protein. Conclusions: The substitution of beef with beans in meal patterns will significantly reduce the environmental footprint worldwide and should also be encouraged to reduce the prevalence of non-communicable chronic diseases. Societies must work together to change the perception that red meat (e.g. beef) is the mainstay of an affluent and healthy diet.
Nutrition professionals that have menu planning and disaster management responsibilities should consider factors that have transcended from ancient to current times, in addition to recognizing societal trends that have led to our current increased vulnerability in the event of a disaster. Hence, we proceeded to develop a set of "Disaster Response Diets" (DRDs) for use in urban societies inclusive of the aforementioned considerations. A three-phase multidimensional approach was used to identify food groups suitable for creating a set of DRDs. Phase One consisted of calculating the percent daily nutrient intake and Drewnowski's naturally nutrient rich (NNR) score for an individual or mean composite for one serving of food from 11 specific food groups. In Phase Two, in addition to nutrient density, the 11 food groups were evaluated and scored based on the following DRD planning criteria: storage and handling properties, preparation ease and, cultural acceptance/individual tolerance. During Phase Three, three DRDs were developed based upon the data retrieved from Phases one and two. In Phase One, the NNR scores ranged from 2.1 for fresh fruits to 28.1 for dry cereals, a higher score indicating a higher nutrient density. During Phase Two, a maximum score of 12 was possible based on appropriateness for a disaster situation. Five plant-based food groups (dry cereals, nuts, dried fruits, grains and legumes) achieved a score ranging between 7 and 12, whereas the five fresh food groups were deemed ineligible due to sanitation and perishability concerns. During Phase Three, three DRDs (milk-inclusive, milk-free and Grab-and-Go) were developed as benchmarks for disaster response planning. Plant-based DRDs are universally acceptable and tolerated across cultures and religions. Therefore, we suggest nutrition professionals consider using a plant-based approach for creating DRDs for public health institutions and organizations.
Prior reports indicated that subjective well-being, or self-reported satisfaction with life, is associated with positive health-related outcomes. For instance, individuals with higher levels of optimism have been shown to have a lower risk of heart disease, diabetes, and cancer in comparison to their pessimistic counterparts. In addition to protecting against disease, a sense of well-being has been associated with increased longevity, resilience, and healthy aging. Spirituality, or having a sense of purpose, meaning, or power from within or from a transcendent source, is another significant predictor of positive health outcomes. Spiritual well-being (SWB) is a novel concept developed to measure a dimension of spirituality that is linked to well-being. Prior researchers have found that social contact and having supportive relationships contribute to well-being. However, the impact of different sources of support on well-being has not been explored. Additionally, researchers have not currently examined predictors of SWB. Thus, the current study tested the influence of social activity and significant other, family, and friend support on SWB in healthy older adults. Participants were 365 adults ages 62-80 years (M = 69.57, SD = 3.90). The Spirituality Index of Well-Being measured SWB; the Social Activity Subscale of the Cognitive Reserve Questionnaire assessed level of involvement in social activities; and, the Multidimensional Scale of Perceived Social Support appraised three sources of social support: significant other, family, and friends. Regression analysis revealed that 20.6% of the variance in SWB was accounted for by social activity and significant other, family, and friend support, F(4, 329) = 21.32, p < .001. SWB was significantly predicted by social activity (β = .206, t = 3.94, p < .001) and family support (β = .306, t = 4.68, p < .001). Results revealed social activity and family support as new predictors of SWB, and confirmed prior findings indicating a relationship between social support and well-being. Outcomes from this study have major implications for healthcare providers and individuals, suggesting that social interventions may have a positive impact on SWB. Consequently, an increase in SWB may contribute to the prevention of illness in an aging population.
The vegetarian dietary pattern is traditionally a plant-based diet that includes fruits, vegetables, cereals, legumes, nuts, vegetable oils, soya, and possibly dairy products and/or eggs. Vegetarians and other populations who follow a plant-based dietary pattern enjoy longevity. Specifically, vegetarian dietary patterns have been associated with a lower risk for developing IHD, type 2 diabetes, hypertension, specific cancers, lower all-cause mortality and reduction in cause-specific mortality. The prevalence of the metabolic syndrome (MetS) in the USA is approximately 20 % and is currently increasing in developing countries in line with the obesity epidemic. The health care costs associated with the MetS are on a magnitude of 1·6 overall compared with healthy individuals, which makes it an important public health problem. Current evidence from several cross-sectional and case-control studies shows an association between consumption of a vegetarian dietary pattern and a reduced prevalence or risk of developing the MetS. There is a need for further research to be conducted, particularly prospective cohort studies to evaluate the effect of vegetarian dietary patterns on reducing the incidence of the MetS and, clinical trials should be designed to explore vegetarian dietary patterns for the reversal of the MetS in high-risk populations. This research could contribute to reduce the societal and economic burdens associated with the disorder.
Colorectal cancers are a leading cause of cancer mortality, and their primary prevention by diet is highly desirable. The relationship of vegetarian dietary patterns to colorectal cancer risk is not well established. To evaluate the association between vegetarian dietary patterns and incident colorectal cancers. The Adventist Health Study 2 (AHS-2) is a large, prospective, North American cohort trial including 96 354 Seventh-Day Adventist men and women recruited between January 1, 2002, and December 31, 2007. Follow-up varied by state and was indicated by the cancer registry linkage dates. Of these participants, an analytic sample of 77 659 remained after exclusions. Analysis was conducted using Cox proportional hazards regression, controlling for important demographic and lifestyle confounders. The analysis was conducted between June 1, 2014, and October 20, 2014. Diet was assessed at baseline by a validated quantitative food frequency questionnaire and categorized into 4 vegetarian dietary patterns (vegan, lacto-ovo vegetarian, pescovegetarian, and semivegetarian) and a nonvegetarian dietary pattern. The relationship between dietary patterns and incident cancers of the colon and rectum; colorectal cancer cases were identified primarily by state cancer registry linkages. During a mean follow-up of 7.3 years, 380 cases of colon cancer and 110 cases of rectal cancer were documented. The adjusted hazard ratios (HRs) in all vegetarians combined vs nonvegetarians were 0.78 (95% CI, 0.64-0.95) for all colorectal cancers, 0.81 (95% CI, 0.65-1.00) for colon cancer, and 0.71 (95% CI, 0.47-1.06) for rectal cancer. The adjusted HR for colorectal cancer in vegans was 0.84 (95% CI, 0.59-1.19); in lacto-ovo vegetarians, 0.82 (95% CI, 0.65-1.02); in pescovegetarians, 0.57 (95% CI, 0.40-0.82); and in semivegetarians, 0.92 (95% CI, 0.62-1.37) compared with nonvegetarians. Effect estimates were similar for men and women and for black and nonblack individuals. Vegetarian diets are associated with an overall lower incidence of colorectal cancers. Pescovegetarians in particular have a much lower risk compared with nonvegetarians. If such associations are causal, they may be important for primary prevention of colorectal cancers.
Objective The progressive increases in life expectancy and dementia in the United Sates highlight the importance of preventative care and maintenance of physical and cognitive functions. Executive functioning (EF) represents the executive control center of the brain that affects behavior and cognition. EF impacts performance on all activities of everyday living such as walking, driving, and managing a household. Previous studies have reported a positive association between education and EF. Alternatively, prior research has shown that EF declines with age; thus, preserving EF is crucial in older adults. The impact of sociocultural factors, such as spirituality, on EF has not been examined in the current literature. This study tested the influence of age, education, and spiritual well-being on EF in healthy older adults. Participants and Method Participants were 365 adults ages 62-80 years (M = 69.57, SD = 3.90) with a high level of education (M = 15.65, SD = 2.40). The Trail Making Test, Part B measured EF and the Self-Efficacy and Life Schemes subscales of the Spirituality Index of Well-Being measured spiritual well-being. Regression analysis was conducted to examine age, education, and spiritual well-being as predictors of EF. Results The analysis revealed that 8.9% of the variance in EF was accounted for by age, education, and spiritual well-being, F(4, 343) = 8.40, p < .001. EF was significantly predicted by age (β = .124, t = 2.41, p < .05), education (β = -.125, t = -2.35, p < .05), and self-efficacy (β = -.238, t = -3.44, p < .01). Conclusions: Results revealed spiritual well-being as a new predictor of EF. Further, our findings support previously reported relationships between age, education, and EF. Outcomes from this study have major implications for older adults, suggesting that education and a sense of well-being and self-confidence may mitigate the effects of aging on cognitive functioning.
OBJECTIVE: To compare the use of water, energy, pesticides and fertilizer to produce commodities for two dietary patterns that vary in the content of plant and animal products. DESIGN: A unique analysis using 'real-world' data was performed, in contrast to previous analyses which applied simulated data. Consumption data from the Adventist Health Study were used to identify two dietary patterns with a markedly different consumption of several plant and animal products. State agricultural data were collected and applied to commodity production statistics. Indices were created to allow a comparison of the resource requirements for each dietary pattern. SETTING: California, USA. SUBJECTS: None. RESULTS: The diet containing more animal products required an additional 10 252 litres of water, 9910 kJ of energy, 186 g of fertilizer and 6 g of pesticides per week in comparison to the diet containing less animal products. The greatest contribution to the difference came from the consumption of animal products, particularly beef. CONCLUSIONS: Consuming a more plant-based diet could to an extent alleviate the negative environmental impacts related to food production. As a method to feed ourselves more sustainably, behavioural adjustments appear to be a very important tool.
Objective: To investigate the resource efficiency and environmental impacts of producing one kilogram of edible protein from two plant- and three animalprotein sources. Design: Primary source data were collected and applied to commodity production statistics to calculate the indices required to compare the environmental impact of producing 1 kg of edible protein from kidney beans, almonds, eggs, chicken and beef. Inputs included land and water for raising animals and growing animal feed, total fuel, and total fertilizer and pesticide for growing the plant commodities and animal feed. Animal waste generated was computed for the animal commodities. Setting: Desk-based study at the Department of Nutrition and Department of Occupational and Environmental Health, Loma Linda University. Subjects: None. Results: To produce 1 kg of protein from kidney beans required approximately eighteen times less land, ten times less water, nine times less fuel, twelve times less fertilizer and ten times less pesticide in comparison to producing 1 kg of protein from beef. Compared with producing 1 kg of protein from chicken and eggs, beef generated five to six times more waste (manure) to produce 1 kg of protein. Conclusions: The substitution of beef with beans in meal patterns will significantly reduce the environmental footprint worldwide and should also be encouraged to reduce the prevalence of non-communicable chronic diseases. Societies must work together to change the perception that red meat (e.g. beef) is the mainstay of an affluent and healthy diet.
Vegetarian dietary patterns have been reported to be associated with a number of favourable health outcomes in epidemiological studies, including the Adventist Health Study 2 (AHS-2). Such dietary patterns may vary and need further characterisation regarding foods consumed. The aims of the present study were to characterise and compare the food consumption patterns of several vegetarian and non-vegetarian diets. Dietary intake was measured using an FFQ among more than 89 000 members of the AHS-2 cohort. Vegetarian dietary patterns were defined a priori, based on the absence of certain animal foods in the diet. Foods were categorised into fifty-eight minor food groups comprising seventeen major food groups. The adjusted mean consumption of each food group for the vegetarian dietary patterns was compared with that for the non-vegetarian dietary pattern. Mean consumption was found to differ significantly across the dietary patterns for all food groups. Increased consumption of many plant foods including fruits, vegetables, avocados, non-fried potatoes, whole grains, legumes, soya foods, nuts and seeds was observed among vegetarians. Conversely, reduced consumption of meats, dairy products, eggs, refined grains, added fats, sweets, snack foods and non-water beverages was observed among vegetarians. Thus, although vegetarian dietary patterns in the AHS-2 have been defined based on the absence of animal foods in the diet, they differ greatly with respect to the consumption of many other food groups. These differences in food consumption patterns may be important in helping to explain the association of vegetarian diets with several important health outcomes.
This study explored the acceptability of pearl millet grain in rural Eastern Kenya. Ninety seven households accepted to plant pearl millet. These were the 37 who were part of the study and other 60 who were not part of the study. When requested to barter 2 kg pearl millet with maize, 33 (85%) out of 39bartered with maize, 2 (5%) with sorghum, 2 (5%) with chicken and 2 (5%) with money. The average score for skill attainment was 88% with 92.5% mothers readily gaining the skill to prepare and incorporate pearl millet into the daily diet of children. Children liked pearl millet when given with a low of 77.8% and a high of 93.2%. These findings suggest that policies or programs to promote cultivation, bartering, and consumption of pearl millet grain could be well acceptable in rural Eastern Kenya which could add to the nutritional content of local diets.
This study aimed to develop and validate a de novo food frequency questionnaire for self-defined vegans in the United States. Diet histories from pilot samples of vegans and a modified 'Block Method' using seven selected nutrients of concern in vegan diet patterns, were employed to generate the questionnaire food list. Food frequency responses of 100 vegans from 19 different U.S. states were obtained via completed mailed questionnaires and compared to multiple telephone-conducted diet recall interviews. Computerized diet analyses were performed. Correlation coefficients, t-tests, rank, cross-tabulations, and probability tests were used to validate and compare intake estimates and dietary reference intake (DRI) assessment trends between the two methods. A 369-item vegan-specific questionnaire was developed with 252 listed food frequency items. Calorie-adjusted correlation coefficients ranged from r = 0.374 to 0.600 (p < 0.001) for all analyzed nutrients except calcium. Estimates, ranks, trends and higher-level participant percentile placements for Vitamin B12 were similar with both methods. Questionnaire intakes were higher than recalls for most other nutrients. Both methods demonstrated similar trends in DRI adequacy assessment (e.g., significantly inadequate vitamin D intake among vegans). This vegan-specific questionnaire can be a useful assessment tool for health screening initiatives in U.S. vegan communities.
Background Early onset of menarche may negatively influence the future health of adolescent girls. Several factors affect the timing of menarche but it is not clear if soy foods consumption around pubertal years plays a role; thus, we examined its relation to age at onset of menarche (AOM) in a high soy-consuming population. Methods We conducted a cross-sectional study on 339 girls ages 12–18 years attending middle and high schools near two Seventh-day Adventist universities in California and Michigan using a web-based dietary questionnaire and physical development tool. Soy consumption (categorized as total soy, meat alternatives, tofu/traditional soy, and soy beverages) was estimated from the questionnaire, while AOM was self-reported. Data analyses included descriptive statistics, Cox proportional hazards ratios, Kaplan-Meier curves and Poisson regression with adjustment for relevant confounders. Results Mean (SD) intakes were: total soy,12.9 (14.4) servings/week; meat alternatives, 7.0 (8.9) servings/week; tofu/traditional soy foods, 2.1 (3.8) servings/week; soy beverages, 3.8 (6.3) servings/week. Mean AOM was 12.5 (1.4) y for those who reached menarche. Consumption of total soy and the 3 types of soy foods was not significantly associated with AOM and with the odds for early- or late-AOM. Adjustment for demographic and dietary factors did not change the results. Conclusion Soy intake is not associated with AOM in a population of adolescent girls who have a wide range of, and relatively higher, soy intake than the general US population. Our finding suggests that the increasing popularity of soy in the US may not be associated with AOM.
Plant-based diets in comparison to diets rich in animal products are more sustainable because they use many fewer natural resources and are less taxing on the environment. Given the global population explosion and increase in wealth, there is an increased demand for foods of animal origin. Environmental data are rapidly accumulating on the unsustainability of current worldwide food consumption practices that are high in meat and dairy products. Natural nonrenewable resources are becoming scarce, and environmental degradation is rapidly increasing. At the current trends of food consumption and environmental changes, food security and food sustainability are on a collision course. Changing course (to avoid the collision) will require extreme downward shifts in meat and dairy consumption by large segments of the world's population. Other approaches such as food waste reduction and precision agriculture and/or other technological advances have to be simultaneously pursued; however, they are insufficient to make the global food system sustainable. For millennia, meatless diets have been advocated on the basis of values, and large segments of the world population have thrived on plant-based diets. "Going back" to plant-based diets worldwide seems to be a reasonable alternative for a sustainable future. Policies in favor of the global adoption of plant-based diets will simultaneously optimize the food supply, health, environmental, and social justice outcomes for the world's population. Implementing such nutrition policy is perhaps one of the most rational and moral paths for a sustainable future of the human race and other living creatures of the biosphere that we share.
Nuts are rich in many bioactive compounds that can exert beneficial effects on cardiovascular health. We reviewed the evidence relating nut consumption and the metabolic syndrome (MetS) and its components. Nuts reduce the postprandial glycemic response; however, long-term trials of nuts on insulin resistance and glycemic control in diabetic individuals are inconsistent. Epidemiologic studies have shown that nuts may lower the risk of diabetes incidence in women. Few studies have assessed the association between nuts and abdominal obesity, although an inverse association with body mass index and general obesity has been observed. Limited evidence suggests that nuts have a protective effect on blood pressure and endothelial function. Nuts have a cholesterol-lowering effect, but the relation between nuts and hypertriglyceridemia and high-density lipoprotein cholesterol is not well established. A recent pooled analysis of clinical trials showed that nuts are inversely related to triglyceride concentrations only in subjects with hypertriglyceridemia. An inverse association was found between the frequency of nut consumption and the prevalence and the incidence of MetS. Several trials evaluated the effect of nuts on subjects with MetS and found that they may have benefits in some components. Compared with a low-fat diet, a Mediterranean diet enriched with nuts could be beneficial for MetS management. The protective effects on metabolism could be explained by the modulation of inflammation and oxidation. Further trials are needed to clarify the role of nuts in MetS prevention and treatment.
Background: Greenhouse gas emissions (GHGEs) are a major consequence of our dietary choices. Assessments of plant-based compared with meat-based diets are emerging at the intersection of public health, environment, and nutrition. Objectives: The objective was to compare the GHGEs associated with dietary patterns consumed in a large population across North America and to independently assess mortality according to dietary patterns in the same population. Design: Data from the Adventist Health Study 2 (AHS-2) were used to characterize the differential environmental and health impacts of the following 3 dietary patterns, which varied in the quantity of animal and plant foods: vegetarian, semivegetarian, and nonvegetarian. The GHGE intensities of 210 foods were calculated through life-cycle assessments and by using published data. The all-cause mortality rates and all-cause mortality HRs for the AHS-2 subjects were adjusted for a range of lifestyle and sociodemographic factors and estimated according to dietary pattern. Results: With the use of the nonvegetarian diet as a reference, the mean reductions in GHGEs for semivegetarian and vegetarian diets were 22% and 29%, respectively. The mortality rates for nonvegetarians, semivegetarians, and vegetarians were 6.66, 5.53, and 5.56 deaths per 1000 person-years, respectively. The differences were significant. Compared with nonvegetarians, mortality HRs were lower for semivegetarians (0.86) and vegetarians (0.91). Conclusions: Moderate differences in the caloric intake of meat products provided nontrivial reductions in GHGEs and improved health outcomes, as shown through the mortality analyses. However, this does not mean that diets lower in GHGEs are healthy.
Vegetarians, those who avoid meat, and vegans, additionally avoiding dairy and eggs, represent 5% and 2%, respectively, of the US population. The aim of this review is to assess the effects of vegetarian diets, particularly strict vegetarian diets (i.e., vegans) on health and disease outcomes. We summarized available evidence from three prospective cohorts of Adventists in North America: Adventist Mortality Study, Adventist Health Study, and Adventist Health Study-2. Non-vegetarian diets were compared to vegetarian dietary patterns (i.e., vegan and lacto-ovo-vegetarian) on selected health outcomes. Vegetarian diets confer protection against cardiovascular diseases, cardiometabolic risk factors, some cancers and total mortality. Compared to lacto-ovo-vegetarian diets, vegan diets seem to offer additional protection for obesity, hypertension, type-2 diabetes, and cardiovascular mortality. Males experience greater health benefits than females. Limited prospective data is available on vegetarian diets and body weight change. Large randomized intervention trials on the effects of vegetarian diet patterns on neurological and cognitive functions, obesity, diabetes, and other cardiovascular outcomes are warranted to make meaningful recommendations.
An increase in noncommunicable disease (NCD) in India has been attributed to an epidemiologic transition whereby, due to urbanization, there is an increase in traditional cardiovascular disease risk factors such as obesity. Accumulated biomarker data on the "Asian Indian phenotype" identify central obesity, which occurs at a lower body mass index (BMI), as a particularly potent risk factor in Asian Indians. A revised WHO case definition for obesity in India [BMI (in kg/m(2)) >25] has identified an obesity epidemic that exceeds 30% in some cities and rivals that in Western nations. This review summarizes 2 key lines of evidence: 1) the emergence of an obesity epidemic in urban and rural India and its contribution to the NCD burden and 2) the role of a "nutrition transition" in decreasing the whole plant food content of diets in India and increasing risk of obesity and NCDs. We then present new epidemiologic evidence from Asian Indians enrolled in the Adventist Health Study 2 that raises the possibility of how specific whole plant foods (eg, nuts) in a vegetarian dietary pattern could potentially prevent obesity and NCDs in a target population of >1 billion persons.
Food intake of vegetarians in the US has been evaluated, however, data on foods consumed by vegetarian adolescents is limited. The aim of this research was to compare the food intake of adolescent vegetarians and non-vegetarians. A cross-sectional study was conducted among adolescents ages 12 to 18 years (312 females, 241 males, mean [SD] age =15.0 [1.7] years) from 10 schools in southern California and Michigan. Dietary intake was determined by a web-based 150-item food frequency questionnaire. Vegetarian was defined a priori as combined intake of meats and fish < 1 serving/week. Differences were analyzed using ANCOVA adjusting for age, gender, ethnicity, BMI z-scores, and exercise. Vegetarians accounted for 18.6% of the study sample. Compared with non-vegetarians, vegetarians consume significantly less servings of eggs, dairy, soda/sweetened drinks, pastries, and coffee/tea (all p's < 0.01) but eat significantly more meat alternatives, fruits, soy beverages, cereals, legumes, and nuts (all p's < 0.01). Intake of vegetables, bread/grains/pasta, pastries, and chips were similar for both groups. In this adolescent population, vegetarians consume more plant-based foods and less sugar-sweetened and caffeinated beverages than their non-vegetarian counterparts. Displacement of dietary animal products results in greater consumption of meat analogs and soy products, but not eggs and dairy among the vegetarians. Funded by WhiteWave Foods Abstract • Cross-sectional analysis. • Study population: 312 females, 241 males ages 12 to 18 from 10 schools in Southern California and Michigan. • Semi-quantitative web-based food frequency questionnaire composed of 151 food items used to assess dietary intake. • Anthropometric measurements collected at school sites. • Data analyzed using SPSS. METHODS RESULTS OBJECTIVE Teen Food and Development Study (TeenFADS) Web-based Questionnaire Program #1024.12 Abstract #4907 To compare the food intake of adolescent vegetarians attending Adventist schools to the food intake of their non-vegetarian counterparts.
Objective: To examine the link between nuts intake and both insulin resistance (IR) and inflammation as measured by C- reactive protein (CRP). Methods: Data on 773 participants (571 females and 285 males), with a mean age of 58 years from the Adventist Health Study-2 cohort were Cross-sectionally analyzed. Total nuts intake, including peanuts was obtained from six unannounced telephone-based 24-hour dietary recalls and subjects were classified by tertiles of intake. IR was determined by Homeostasis Model Assessment (HOMA-IR), > 1.7. Multivariate logistic regression was used to compute the odds ratios (ORs) while adjusting for relevant demographic, dietary and lifestyle factors. Results: The odds of IR lowered with increased nuts intake. Compared with the lowest tertile the medium and high nut intake tertiles had an OR of 0.587 (95% CI 0.406-0. 847, P, 0.004) and an OR of 0.523 (95% CI 0.360-0.762, P, 0.001) respectively. This observed association was attenuated when additionally adjusting for BMI. High nut intake was linked to lower levels of CRP (OR 0.629, 95% CI 0.420-0.960, P, 0.014, comparing higher versus lower nut intake tertiles). However, further adjustment for BMI resulted in loss of the statistical significance. Conclusion: High nut intake favorably relates to insulin sensitivity and lower inflammatory status. BMI seems to modulate some of these effects.
The US Census Bureau projects that the population age 65 and older will more than double in the next 50 years. Age-related dementias, such as Alzheimer’s disease, are predicted to increase at the same rate. Cognitive decline is a key component in neurodegenerative diseases and can include memory loss, speech impairment, and inability to perform daily tasks. Premorbid intelligence (PI) is a determinant of cognitive decline and health behaviors. Researchers have found that PI is influenced by sociocultural factors including physical activity and education. The link between physical activity, education, and spirituality has not been examined. Thus, this study tested the impact of physical activity, education, and spirituality on PI in healthy older adults. Participants were 129 adults ages 64-75 years (M = 69.01, SD = 3.04). The American version of the National Adult Reading Test measured PI, the Physical Activity subscale of the Cognitive Reserve Questionnaire measured physical activity, and the Spirituality Index of Well-Being assessed spirituality. Regression analysis was conducted to test physical activity, years of education, and spirituality as predictors of PI. The analysis revealed that 57.3% of the variance in PI was accounted for by physical activity, education, spirituality, and the interaction between the variables, F(9, 111) = 16.54, p < .001. Premorbid intelligence was significantly predicted by education (β = 2.81, t = 9.00, p < .001), spirituality (β = -2.85, t = -7.55, p < .001), and the interactions between physical activity, education, and spirituality, p < .001. Results introduce spirituality as a new predictor of PI. Furthermore, our findings support previously reported relationships between physical activity, education, and PI. This study highlights the importance of using an integrative approach towards healthcare in a healthy, aging population.
The lacto-ovo-vegetarian (LOV) dietary regimen allows eggs, which are a rich source of choline. Consumption of eggs by LOV women may be especially important during pregnancy and lactation when demand for choline is high. The aim of this single blind, randomized, crossover-feeding study was to determine how near-daily egg consumption influenced biomarkers of choline metabolism in healthy LOV women of reproductive age (n=15). Because long-chain n-3 fatty acids could influence choline metabolism, the effect of n-3-enriched vs nonenriched eggs on choline metabolites was also investigated. Three 8-week dietary treatments consisting of six n-3-enriched eggs per week, six nonenriched eggs per week, and an egg-free control phase were separated by 4-week washout periods. Choline metabolites were quantified in fasted plasma collected before and after each treatment and differences in posttreatment choline metabolite concentrations were determined with linear mixed models. The n-3-enriched and nonenriched egg treatments produced different choline metabolite profiles compared with the egg-free control; however, response to the eggs did not differ (P>0.1). Consumption of the n-3-enriched egg treatment yielded higher plasma free choline (P=0.02) and betaine (P<0.01) (vs egg-free control) concentrations, whereas consumption of the nonenriched egg treatment yielded borderline higher (P=0.06) plasma phosphatidylcholine (vs egg-free control) levels. Neither egg treatment increased levels of plasma trimethylamine oxide, a gut-flora-dependent oxidative choline metabolite implicated as a possible risk factor for cardiovascular disease. Overall these data suggest that egg fatty-acid composition modulates the metabolic use of choline.
Background: Early onset of menarche may negatively influence the future health of adolescent girls. Several factors affect the timing of menarche but it is not clear if soy foods consumption around pubertal years plays a role; thus, we examined its relation to age at onset of menarche (AOM) in a high soy-consuming population. Methods: We conducted a cross-sectional study on 339 girls ages 12–18 years attending middle and high schools near two Seventh-day Adventist universities in California and Michigan using a web-based dietary questionnaire and physical development tool. Soy consumption (categorized as total soy, meat alternatives, tofu/traditional soy, and soy beverages) was estimated from the questionnaire, while AOM was self-reported. Data analyses included descriptive statistics, Cox proportional hazards ratios, Kaplan-Meier curves and Poisson regression with adjustment for relevant confounders.
BACKGROUND: Soy intake is associated with reduced chronic disease risk. Obesity and overweight during adolescence can affect lifelong health; however, research on the impact of soy intake in growth and development of teens is limited. OBJECTIVE: The purpose of this investigation was to determine if regular soy consumption is associated with indicators of overweight/obesity-BMI z-score (BMIZ), waist-to-height ratio (WHtR), and waist circumference (WC)-in adolescents. METHOD: In a cross-sectional study, 549 adolescents (310 females, 239 males) ages 12-18 years old recruited from 10 schools filled out a web-based food frequency questionnaire to report usual soy intake. Anthropometric measurements were taken during school visits. Associations between soy intake and BMIZ, WHtR and WC were analyzed using ANOVA, ANCOVA, and linear regression while controlling for relevant confounders. RESULTS: Average soy intake was 1.7 ± 1.9 servings per day (s/d), broken down as: meat analog (0.9 ± 1.1 s/d), soy beverages (0.5 ± 1.0 s/d), and tofu products (0.3 ± 0.6 s/d). Asians had a significantly greater intake of soy relative to Caucasians (p= 0.02). A greater proportion of adolescents who were mixed-fed (28.4%) or formula-fed (27.3%) as infants had higher BMIZ compared to those who were breastfed (21.8%). Total soy intake and each of the soy food types were not significantly associated with increased BMIZ, WHtR, or WC. CONCLUSION: In this population, regular soy consumption has a neutral effect on the risk of obesity.
Most convenience foods are characterized as energy dense, highly processed, and of poor nutrient quality. The aim of our study was to determine if the consumption of “meal-type” convenience foods (CF) is associated with the risk of overweight/obesity among adolescents. In a cross-sectional study, 308 females and 237 males ages 12-18 years from 10 schools in southern California and Michigan reported their usual food intake during the past month using a web-based food frequency questionnaire. Anthropometric measurements were obtained during school visits. BMI z-scores (BMIZ), waist circumference (WC), and waist-to-height ratio (WHtR) were used as overweight/obesity indicators. Intake of meal-type CF was classified either as meat-containing or meatless. Data was analyzed using frequency distributions, ANOVA, and multivariate tests. 418 participants had normal BMIZ and 128 were overweight/obese. Ethnicity was a significant predictor of BMIZ, WC, and WHtR. Controlling for age, gender, ethnicity, total energy intake, and exercise, increased consumption of meat-containing CF was significantly associated with increased BMIZ (p=.03), WHtR (p=0.04) and WC (p=.04). Intake of meatless CF was not significantly associated with BMIZ, WC, and WHtR. The consumption of meal- type CF among adolescents, those containing meat but not the meatless varieties may increase risk of obesity.
Plant and marine n-3 fatty acids (FA) may favorably modify select markers of cardiovascular disease risk. Whether supplementing the habitual diet of lacto-ovo-vegetarians (LOV) with walnuts (containing alpha-linolenic acid, ALA) and n-3 FA enriched eggs (containing primarily docosahexaenoic acid, DHA and ALA) would have equivalent effects on CVD risk factors is explored in this study. In this study, 20 healthy free-living LOVs following their habitual diet were randomly assigned in a crossover design to receive one of three supplements: n-3 FA enriched egg (6/week), walnuts (28.4 g, 6/week) or a standard egg, 6/week (control) for 8 weeks each with 4-wk washout between treatments. Erythrocyte membrane fatty acids, serum lipids and inflammatory markers were measured at the end of each treatment. Dietary compliance was observed by an expected increase in erythrocyte membrane ALA following the walnut treatment and in DHA following the n-3 FA enriched egg treatment. Walnut treatment lowered serum triacylglycerol, total cholesterol and Apo B (p < 0.05) compared to the standard egg but not the n-3 FA enriched egg treatment. However, walnut treatment significantly reduced total: HDL cholesterol ratio compared to both egg treatments. There were no differences between treatments for any of the inflammatory markers. For LOV, a direct source of DHA such as n-3 FA enriched eggs seems necessary to increase membrane levels of DHA. However for producing an overall favorable blood lipid profile, daily consumption of a handful of walnuts rich in ALA may be a preferred option for lacto-ovo vegetarian.
Objective: The US Census Bureau predicts that between 2012 and 2060, the population age 65 and older is expected to increase from 43.1 million to 92.0 million, representing over 20% of the total population. The Bureau projects the labor force participation rates for those 65 years and older will continue to rise emphasizing the importance of health maintenance in older adults. Researchers have shown that cognitive reserve, the brain’s ability to cope with damage, may be a protective factor against neurodegenerative diseases such as Alzheimer’s. Previous studies have found that sociocultural factors including spirituality and education may reduce the impact of cognitive decline. However, the link between education and spirituality has not yet been examined. This study tested the impact of age, education, and spirituality on cognitive reserve in healthy older adults. Participants and Method: Participants were 129 adults ages 64-75 years (M = 69.01, SD = 3.04) with a high level of education (M = 15.91, SD = 2.65) and who slept an average of 6.84 hours per night (SD = 1.22). Cognitive reserve was measured using the Cognitive Reserve Index questionnaire and spirituality was measured using the Spirituality Index of Well-Being. Regression analysis was conducted to test the impact of age, education, and spirituality on cognitive reserve. Results: Regression analysis revealed that 23% of the variance in cognitive reserve was accounted for by age, education, spirituality, and the interaction between the variables, F(4, 122) = 9.12, p < .001. Cognitive reserve was significantly predicted by education (β = .42, t = 5.18, p < .001) and spirituality (β = .19, t = 2.39, p < .05). Conclusions: Results were consistent with prior findings that show spirituality and education may mitigate the effects of aging-related cognitive deficits. Outcomes from this study have major implications for healthcare providers, suggesting that an integrative approach to healthcare is imperative for a healthy, aging population. Additionally, older adults have options to actively help preserve their intellectual capacity.
- Feb 2014
Background Differences in nutrient profiles between vegetarian and nonvegetarian dietary patterns reflect nutritional differences that can contribute to the development of disease. Objective Our aim was to compare nutrient intakes between dietary patterns characterized by consumption or exclusion of meat and dairy products. Design We conducted a cross-sectional study of 71,751 subjects (mean age¼59 years) from the Adventist Health Study 2. Data were collected between 2002 and 2007. Participants completed a 204-item validated semi-quantitative food frequency questionnaire. Dietary patterns compared were nonvegetarian, semi-vegetarian, pesco vegetarian, lacto-ovo vegetarian, and strict vegetarian. Analysis of covariance was used to analyze differences in nutrient intakes by dietary patterns and was adjusted for age, sex, and race. Body mass index and other relevant demographic data were reported and compared by dietary pattern using c 2 tests and analysis of variance. Results Many nutrient intakes varied significantly between dietary patterns. Non-vegetarians had the lowest intakes of plant proteins, fiber, beta carotene, and magnesium compared with those following vegetarian dietary patterns, and the highest intakes of saturated, trans, arachidonic, and docosahexaenoic fatty acids. The lower tails of some nutrient distributions in strict vegetarians suggested inadequate intakes by a portion of the subjects. Energy intake was similar among dietary patterns at close to 2,000 kcal/day, with the exception of semi-vegetarians, who had an intake of 1,707 kcal/ day. Mean body mass index was highest in nonvegetarians (mean¼28.7 [standard deviation¼6.4]) and lowest in strict vegetarians (mean¼24.0 [standard deviation¼4.8]). Conclusions Nutrient profiles varied markedly among dietary patterns that were defined by meat and dairy intakes. These differences are of interest in the etiology of obesity and chronic diseases.
According to the American Diabetes Association (ADA), the nutritional goals for patients with type 2 diabetes (T2D) are to achieve an optimal nutrient intake to maintain normal blood glucose levels and a lipid profile. Peanuts are nutrient dense foods that contain high levels of monounsaturated fat (MUFA) and are a natural source of arginine, fiber, phytosterols, resveritrol, niacin, folate, vitamin E and magnesium, which have the potential for improving blood lipids and glycemic control. This study sought to evaluate the effect of a peanut enriched ADA meal plan on the nutrient profile of the total diet and cardiometabolic parameters in adults with T2D. This was a randomized, prospective 24-week parallel-group clinical trial with 60 adults with T2D [age range 34-84 years; body mass index (BMI) range 17.2-48.7 kg/m2]. Subjects consumed an ADA meal plan containing ~20% of energy from peanuts (peanut group) or a peanut-free ADA meal plan (control group). Weight, BMI, waist circumference (WC) and nutrient intake from 24-hour recalls were measured every 4 weeks and fasting blood glucose (FBG), HbA1c and blood lipids were measured every 12 weeks. A mixed-model repeated-measures analysis of covariance was performed to assess the significance of changes in the cardiometabolic parameters. A higher polyunsaturated fat (PUFA) to saturated fat diet ratio and higher intake of MUFA, PUFA, alpha-tocopherol, niacin and magnesium was observed in the peanut group as compared to the control group (P < 0.01-P = 0.04). Both groups experienced mild reductions in weight, BMI, and WC during the study (P = 0.01-P = 0.03), however there were no differences between the two groups in these measurements or in FBG, HbA1c or blood lipids. For each kilogram of weight loss in the entire cohort there were associations for reductions in WC of 0.48 cm (P < 0.01), FBG of 0.11 mmol/l (P = 0.01) and HbA1c of 0.07% (P < 0.01). Daily consumption of a peanut enriched (46 g/d) ADA meal plan over 24-weeks improves the nutrient profile of the total diet and is compatible with weight management and improvement in specific blood lipids.Trial registration: ClinicalTrials.gov NCT00937222.
In vitro studies rank walnuts (Juglans regia) among the plant foods high in antioxidant capacity, but whether the active constituents of walnuts are bioavailable to humans remains to be determined. The intention of this study was to examine the acute effects of consuming walnuts compared to refined fat on meal induced oxidative stress. At issue is whether the ellagitannins and tocopherols in walnuts are bioavailable and provide postprandial antioxidant protection. A randomized, crossover, and controlled-feeding study was conducted to evaluate a walnut test meal compared to one composed of refined ingredients on postprandial serum antioxidants and biomarkers of oxidative status in healthy adults (n = 16) with at least 1 week between testing sessions. Following consumption of a low phenolic diet for one day and an overnight fast, blood was sampled prior to the test meals and at intervals up to 24 hours post ingestion and analyzed for total phenols, malondiadehyde (MDA), oxidized LDL, ferric reducing antioxidant power (FRAP), hydrophilic and lipophilic oxygen radical absorbance capacity (ORAC), uric acid, catechins and urinary excretion of phenylacetate metabolites and of urolithin A. Mixed linear models demonstrated a diet effect (P < 0.001) for plasma gamma-tocopherol but not for alpha-tocopherol with the walnut meal. Following the walnut test meal, the incremental 5 hour area under the curve (AUC0-5h) was reduced 7.4% for MDA, increased 7.5% for hydrophilic and 8.5% for lipophilic ORAC and comparable for total phenols, FRAP and uric acid. Oxidized LDL was reduced at 2 hours after the walnut meal. Plasma concentrations of gallocatechin gallate (GCG), epicatechin gallate (ECG) and epicallocatechin gallate (EGCG) increased significantly at 1 hour after the walnut test meal. Quantities of urolithin-A excreted in the urine were significantly higher following the walnut meal. Compared to the refined control meal, the walnut meal acutely increased postprandial gamma-tocopherol and catechins and attenuated some measures of oxidative stress.
To examine the relationships of nut consumption, metabolic syndrome (MetS), and obesity in the Adventist Health Study-2, a relatively healthy population with a wide range of nut intake. Cross-sectional analysis was conducted on clinical, dietary, anthropometric, and demographic data of 803 adults. MetS was defined according to the American Heart Association and the National Heart, Lung, and Blood Institute diagnostic criteria. We assessed intake of total nuts, tree nuts and peanuts, and also classified subjects into low tree nut/low peanut (LT/LP), low tree/high peanut (LT/HP), high tree nut/high peanut (HT/HP), and high tree/low peanut (HT/LP) consumers. Odds ratios were estimated using multivariable logistic regression. 32% of subjects had MetS. Compared to LT/LP consumers, obesity was lower in LT/HP (OR = 0.89; 95% CI = 0.53, 1.48), HT/HP (OR = 0.63; 95% CI = 0.40, 0.99) and HT/LP (OR = 0.54; 95% CI = 0.34, 0.88) consumers, p for trend = 0.006. For MetS, odds ratios (95% CI) were 0.77 (0.47, 1.28), 0.65 (0.42, 1.00) and 0.68 (0.43, 1.07), respectively (p for trend = 0.056). Frequency of nut intake (once/week) had significant inverse associations with MetS (3% less for tree nuts and 2% less for total nuts) and obesity (7% less for tree nuts and 3% less for total nuts). Tree nuts appear to have strong inverse association with obesity, and favorable though weaker association with MetS independent of demographic, lifestyle and dietary factors.
The leading cause of morbidity and mortality in highly developed and low- and middle-income nations is cardiovascular disease (CVD). The establishment of healthy dietary patterns is one of the cornerstones of CVD prevention, and nuts have emerged as favorable components of dietary patterns associated with reducing the CVD epidemic. The etiological connection between nuts for the prevention of CVD is based upon several lines of evidence. First, nuts are nutrient-dense whole foods that contain a distinctive mix of macronutrients, specific micronutrients and non-nutrients that have been associated with cardioprotection. Second, numerous human feeding trials have demonstrated that nut intake improves the serum lipid profile, reduces oxidation and inflammation, and improves vascular reactivity. Third, nut consumption is consistently associated with a reduced risk of CVD in many epidemiological studies. Lastly, a recent large randomized clinical trial conducted in Spain demonstrated that consuming mixed nuts daily lowers CVD risk by 30 %.
The behavioral outcome of food ingestion is a complex process that involves psychological and biological factors. Avocados are nutrient dense with properties that may favorably impact energy balance. This study sought to evaluate if incorporating approximately one half of a Hass avocado by addition or inclusion into a lunch meal will influence post-ingestive satiety, glucose and insulin response, and subsequent energy intake among overweight adults. This was a randomized 3x3 single-blind crossover design study with 26 healthy overweight adults (mean +/-SD age 40.8+/-11.0 years and BMI 28.1+/-2.4 kg/m2). Participants consumed a standardized breakfast followed by 1 of 3 lunch test meals [Control (C), avocado-free; Avocado Inclusive (AI); and, Avocado Added (AA)]. Participants rated five appetite sensations using a visual analog scale (VAS) before lunch and at specific intervals over 5 hours following the start of the test meal. Blood glucose and insulin were measured before lunch and at specific intervals over 3 hours following the start of the test meal. Mixed models were used to compare differences among the 3 test meals, and the area under the curve (AUC0-xh) was computed for the VAS and biological measures. There were significant differences in the AUC(0-5h) for the self-reported feelings of satisfaction (P=0.04) and desire to eat (P=0.05) in the mixed model analysis. Compared to the C test meal, the AA test meal increased satisfaction by 23% (P=0.05) and decreased the desire to eat by 28% (P=0.04) for the AUC(0-5h) . For the AUC(0-3h), the AA test meal increased satisfaction by 26% (P=0.02) and decreased the desire to eat by 40% (P=0.01) as compared to the C test meal. Compared to the AI meal, the AUC(0-3h) for blood insulin was higher in the C and AA meals (P=0.04 and P=0.05, respectively). The addition of approximately one half of a Hass avocado at a lunch meal can influence post-ingestive satiety over a subsequent 3 and 5 hour period in overweight adults. A caveat to these findings is that the avocado contained an additional 112 kcal, which may have accounted for the observed increase in satisfaction and decreased desire to eat. Future trials are warranted to evaluate the effects of avocado intake on weight management in adults of varying BMIs and among insulin resistant individuals.
- Aug 2013
Differences in nutrient profiles between vegetarian and nonvegetarian dietary patterns reflect nutritional differences that can contribute to the development of disease. Our aim was to compare nutrient intakes between dietary patterns characterized by consumption or exclusion of meat and dairy products. We conducted a cross-sectional study of 71,751 subjects (mean age=59 years) from the Adventist Health Study 2. Data were collected between 2002 and 2007. Participants completed a 204-item validated semi-quantitative food frequency questionnaire. Dietary patterns compared were nonvegetarian, semi-vegetarian, pesco vegetarian, lacto-ovo vegetarian, and strict vegetarian. Analysis of covariance was used to analyze differences in nutrient intakes by dietary patterns and was adjusted for age, sex, and race. Body mass index and other relevant demographic data were reported and compared by dietary pattern using χ(2) tests and analysis of variance. Many nutrient intakes varied significantly between dietary patterns. Nonvegetarians had the lowest intakes of plant proteins, fiber, beta carotene, and magnesium compared with those following vegetarian dietary patterns, and the highest intakes of saturated, trans, arachidonic, and docosahexaenoic fatty acids. The lower tails of some nutrient distributions in strict vegetarians suggested inadequate intakes by a portion of the subjects. Energy intake was similar among dietary patterns at close to 2,000 kcal/day, with the exception of semi-vegetarians, who had an intake of 1,707 kcal/day. Mean body mass index was highest in nonvegetarians (mean=28.7 [standard deviation=6.4]) and lowest in strict vegetarians (mean=24.0 [standard deviation=4.8]). Nutrient profiles varied markedly among dietary patterns that were defined by meat and dairy intakes. These differences are of interest in the etiology of obesity and chronic diseases.
Importance Some evidence suggests vegetarian dietary patterns may be associated with reduced mortality, but the relationship is not well established.Objective To evaluate the association between vegetarian dietary patterns and mortality.Design Prospective cohort study; mortality analysis by Cox proportional hazards regression, controlling for important demographic and lifestyle confounders.Setting Adventist Health Study 2 (AHS-2), a large North American cohort.Participants A total of 96 469 Seventh-day Adventist men and women recruited between 2002 and 2007, from which an analytic sample of 73 308 participants remained after exclusions.Exposures Diet was assessed at baseline by a quantitative food frequency questionnaire and categorized into 5 dietary patterns: nonvegetarian, semi-vegetarian, pesco-vegetarian, lacto-ovo–vegetarian, and vegan.Main Outcome and Measure The relationship between vegetarian dietary patterns and all-cause and cause-specific mortality; deaths through 2009 were identified from the National Death Index.Results There were 2570 deaths among 73 308 participants during a mean follow-up time of 5.79 years. The mortality rate was 6.05 (95% CI, 5.82-6.29) deaths per 1000 person-years. The adjusted hazard ratio (HR) for all-cause mortality in all vegetarians combined vs nonvegetarians was 0.88 (95% CI, 0.80-0.97). The adjusted HR for all-cause mortality in vegans was 0.85 (95% CI, 0.73-1.01); in lacto-ovo–vegetarians, 0.91 (95% CI, 0.82-1.00); in pesco-vegetarians, 0.81 (95% CI, 0.69-0.94); and in semi-vegetarians, 0.92 (95% CI, 0.75-1.13) compared with nonvegetarians. Significant associations with vegetarian diets were detected for cardiovascular mortality, noncardiovascular noncancer mortality, renal mortality, and endocrine mortality. Associations in men were larger and more often significant than were those in women.Conclusions and Relevance Vegetarian diets are associated with lower all-cause mortality and with some reductions in cause-specific mortality. Results appeared to be more robust in males. These favorable associations should be considered carefully by those offering dietary guidance.
Background: In samples of African Americans and the elderly adults, obesity is often not found to be a risk factor for mortality. These data contradict the evidence linking obesity to chronic disease in these groups. Our objective was to determine whether obesity remains a risk factor for mortality among long-lived black adults. Methods: The Adventist Health Study 2 is a large prospective cohort study of Seventh-day Adventist church members who are encouraged by faith-based principles to avoid tobacco, alcohol, and meat consumption. We conducted an attained age survival analysis of 22,884 U.S. blacks of the cohort-half of whom attained an age of 58-108 years during the follow-up (adult life expectancy of 84 years in men, 89 years in women). Results: Women in the highest body mass index quintile (>33.8) experienced a significant 61% increase (hazard ratio [95% CI] = 1.62 [1.23, 2.11] relative to the middle quintile) in mortality risk and a 6.2-year (95% CI = 2.8-10.2 years) decrease in life expectancy. Men in the highest body mass index quintile (>30.8) experienced a significant 87% increase (hazard ratio [95% CI] = 1.87 [1.28, 2.73] relative to the middle quintile) in mortality risk and 5.9-year (95% CI = 2.1- 9.5 years) decrease in life expectancy. Obesity (>30) was a significant risk factor relative to normal weight (18.5-24.9) in never-smokers. Instantaneous hazards indicated excess risk from obesity was evident through at least age 85 years. The nonobese tended to follow plant-based diets and exercise vigorously. Conclusions: Avoiding obesity promotes gains in life expectancy through at least the eighth decade of life in black adults. Evidence for weight control through plant-based diets and active living was found in long-lived nonobese blacks.
- Apr 2013
This study aimed to investigate health belief as a major motive for diet and lifestyle behaviors of 100 vegans in the United States; and to determine congruence with selected health and nutrition outcomes. Response data from an administered questionnaire was analyzed. Statistical analyses determined the most common factors influencing diet choice; the number of vegans practicing particular lifestyle behaviors; body mass index; and prevalence of self-reported chronic disease diagnoses. Nutrient intakes were analyzed and assessed against Dietary Reference Intakes. Health was the most reported reason for diet choice (47%). In the health belief, animal welfare, and religious/other motive categories, low percentages of chronic disease diagnoses were reported: 27%, 11%, and 15%, respectively. There were no significant differences in health behaviors and indices among vegan motive categories, except for product fat content choices. Within the entire study population, health-related vegan motive coincided with regular exercise; 71% normal BMI (mean=22.6); minimal alcohol and smoking practices; frequently consumed vegetables, nuts, and grains; healthy choices in meal types, cooking methods, and low-fat product consumption; and adequate intakes for most protective nutrients when compared to reference values. But incongruence was found with 0% intake adequacy for vitamin D; and observation of excessive sodium use.
The healthy cities movement has made significant progress to integrate health criteria into city planning. In fact, there is increasing recognition of synergy between Public Health and Urban Planning. However, there appears to be a gap between the value of healthy food environments and the implementation of policies that would ensure optimal food environments. This case study presents a city that has been recognized internationally as the only Blue Zone in North America for its high life expectancy and how it has sought to go beyond its healthy city reputation to codify and ensure a purposeful approach to upholding its healthy nature. What started as a resistance to a proposed McDonald's restaurant in the city resulted in broader health policy efforts. Methods: citizens and public health professionals engaged local government leadership in dialogue to encourage healthy city by design decision-making; reviewed best practices; formed a coalition; and used media advocacy to impact the policies and design of the city's food environment. Findings: Lessons learned include: the importance of navigating political philosophies around choice and food regulation; the impact of media with its successes and challenges; the importance of partnering with a broad set of stakeholders to maximize results. Implications: The lessons learned discussed here can be applied to other communities, customizing existing best practices to a local context. More discussions should follow on how these efforts have been, and can be, implemented in communities with varying socio-economic realities who seek to take an active role in designing their food environment.
Background: The prevalence of the metabolic syndrome (MetS) is increasing worldwide. In the US it is approaching 30%. The identification of dietary factors that may help in the prevention of the MetS becomes thus an important goal. Objective: The purpose of the study was to investigate associations between dietary patterns specified by meat and dairy intake with the MetS and its component factors. Methods: Cross-sectional analysis of 1278 subjects (mean age 63 years) with a complete set of data from the Adventist Health Study 2. Subjects were classified as non-vegetarian, semi vegetarian, pesco vegetarian, lacto-ovo vegetarian and strict vegetarian. ANCOVA was used to determine associations between dietary pattern and metabolic risk factors (HDL, triglycerides, glucose, blood pressure, and waist circumference) while controlling for relevant co-factors. Logistic regression was used in calculating odds ratios (OR) for MetS and its component factors. Results: The OR for high waist circumference was halved for pesco vegetarians (OR=0.49, CI=0.32-0.73) and semi vegetarians (OR=0.49, CI=0.36-0.67) and reduced by two thirds for strict vegetarians (OR=0.32, CI=0.19-0.55). The OR for high blood pressure was reduced by half for lacto-ovo vegetarians (OR=0.53, CI=0.39-0.72) and the OR of high glucose levels was significantly reduced in lacto-ovo vegetarians (OR=0.64, CI=0.45-0.92) and strict vegetarians (OR=0.42, CI=0.22-0.78). Strict vegetarian had the lowest risk for MetS (OR=0.33, CI=0.17-0.61) followed by lacto-ovo vegetarians (OR=0.65, CI=0.47-0.90). Conclusions: Dietary patterns characterized by lower intakes of animal products are associated with a lower metabolic risk profile and may thus contribute in the prevention of the MetS.
Race-specific validation of food intake obtained from a comprehensive food frequency questionnaire: Adventist Health Study-2 – Corrigendum - Volume 15 Issue 11 - Karen Jaceldo-Siegl, Jing Fan, Joan Sabaté, Synnove F Knutsen, Ella Haddad, W Lawrence Beeson, R Patti Herring, Terrence L Butler, Hannelore Bennett, Gary E Fraser
- Jul 2012
Vegetarian diets of varying degrees of restriction may be adopted for cultural, religious, or health reasons. In 2003, an estimated 2.8% of adults in the United States reported no consumption of meat, poultry, or seafood and thus could be described as vegetarian, while 1.8% omitted all animal-derived products (including milk, eggs, and honey) and could be described as vegan . The official position statement of the American Dietetic Association and Dietitians of Canada states that: “Appropriately planned vegetarian diets are healthful and nutritionally adequate, and provide health benefits in the prevention and treatment of certain diseases” . Specifically, vegetarian diets have been linked with a decrease in the risk of ischemic heart disease [3,4] and other obesity-related disorders . The topic of vegetarian diets and obesity has been reviewed by one of the authors and others; in general, body mass index (BMI) has been found to be lower in both men and women in vegetarians vs. non-vegetarians [3,4,6,7]. The discussion that follows in this chapter emphasizes results published within the last 5 years. This chapter first describes observational studies of populations who have self-selected either vegetarian or non-vegetarian diets, then factors that might affect the outcome of these observational Vegetarian diets of varying degrees of restriction may be adopted for cultural, religious, or health reasons. In 2003, an estimated 2.8% of adults in the United States reported no consumption of meat, poultry, or seafood and thus could be described as vegetarian, while 1.8% omitted all animal-derived products (including milk, eggs, and honey) and could be described as vegan . The official position statement of the American Dietetic Association and Dietitians of Canada states that: “Appropriately planned vegetarian diets are healthful and nutritionally adequate, and provide health benefits in the prevention and treatment of certain diseases” . Specifically, vegetarian diets have been linked with a decrease in the risk of ischemic heart disease [3,4] and other obesity-related disorders . The topic of vegetarian diets and obesity has been reviewed by one of the authors and others; in general, body mass index (BMI) has been found to be lower in both men and women in vegetarians vs. non-vegetarians [3,4,6,7]. The discussion that follows in this chapter emphasizes results published within the last 5 years. This chapter first describes observational studies of populations who have self-selected either vegetarian or non-vegetarian diets, then factors that might affect the outcome of these observational 300 Obesity: Epidemiology, Pathophysiology, and Prevention studies. Subsequently, intervention studies of vegetarian diets are discussed, followed by an elaboration of potential mechanisms by which vegetarian diets might affect body weight.
Objective: To validate a 204-item quantitative FFQ for measurement of nutrient intake in the Adventist Health Study-2 (AHS-2). Design: Calibration study participants were randomly selected from the AHS-2 cohort by church, and then subject-within-church. Each participant provided two sets of three weighted 24 h dietary recalls and a 204-item FFQ. Race-specific correlation coefficients (r), corrected for attenuation from within-person variation in the recalls, were calculated for selected energy-adjusted macro- and micronutrients. Setting: Adult members of the AHS-2 cohort geographically spread throughout the USA and Canada. Subjects: Calibration study participants included 461 blacks of American and Caribbean origin and 550 whites. Results: Calibration study subjects represented the total cohort very well with respect to demographic variables. Approximately 33% were males. Whites were older, had higher education and lower BMI compared with blacks. Across fifty-one variables, average deattenuated energy-adjusted validity correlations were 0.60 in whites and 0.52 in blacks. Individual components of protein had validity ranging from 0.40 to 0.68 in blacks and from 0.63 to 0.85 in whites; for total fat and fatty acids, validity ranged from 0.43 to 0.75 in blacks and from 0.46 to 0.77 in whites. Of the eighteen micronutrients assessed, sixteen in blacks and sixteen in whites had deatttenuated energy-adjusted correlations >= 0.4, averaging 0.60 and 0.53 in whites and blacks, respectively. Conclusions: With few exceptions validity coefficients were moderate to high for macronutrients, fatty acids, vitamins, minerals and fibre. We expect to successfully use these data for measurement error correction in analyses of diet and disease risk.
Walnuts contain a number of potentially neuroprotective compounds like vitamin E, folate, melatonin, several antioxidative polyphenols and significant amounts of n-3 α-linolenic fatty acid. The present study sought to determine the effect of walnuts on verbal and non-verbal reasoning, memory and mood. A total of sixty-four college students were randomly assigned to two treatment sequences in a crossover fashion: walnuts-placebo or placebo-walnuts. Baseline data were collected for non-verbal reasoning, verbal reasoning, memory and mood states. Data were collected again after 8 weeks of intervention. After 6 weeks of washout, the intervention groups followed the diets in reverse order. Data were collected once more at the end of the 8-week intervention period. No significant increases were detected for mood, non-verbal reasoning or memory on the walnut-supplemented diet. However, inferential verbal reasoning increased significantly by 11·2 %, indicating a medium effect size (P = 0·009; d = 0·567). In young, healthy, normal adults, walnuts do not appear to improve memory, mood or non-verbal reasoning abilities. However, walnuts may have the ability to increase inferential reasoning.
- Sep 2011
Colorectal cancer (CRC) is a leading cause of cancer death in the United States. Most cases of CRC arise in adenomatous polyps. It has been estimated that 25%-35% of colon adenoma risk could be avoidable by modification of dietary and life-style habits. We estimated the association between total dietary fiber and fiber intake from fruits, vegetables, and grains, and the risk of physician-diagnosed colon polyps among 2818 men and women who had undergone colonoscopy. Data were drawn from 2 cohort studies-the Adventist Health Study-1 (AHS-1) of 1976 and the Adventist Health Study-2 (AHS-2) conducted from 2002 to 2005. Dietary information was obtained from the self-administered questionnaire from AHS-1, while outcome was assessed from AHS-2 data. Multivariate logistic regression analysis was used to estimate the period risk of incident cases of polyps. A total of 441 incident cases of colon polyps were identified. After adjusting for age, sex, body mass index, physical activity, education, and alcohol and meat consumption, total fiber intake was inversely associated with the risk of colon polyps (odds ratio [OR] for highest vs lowest quartile = 0.71, 95% confidence interval [CI] 0.51-0.99). This association showed a dose-response effect (p = .04). Analyses of various sources of fiber showed the most clear effect of fiber from vegetables including legumes (OR for highest vs lowest quartile = 0.65; 95% CI 0.47-0.90; p = .02). In this population comprising a high proportion of vegetarians, persons who consumed low amounts of fiber, especially fiber contained in vegetables, had a higher risk of developing colon polyps.
- Sep 2011
- International Society for Environmental Epidemiology
To investigate the association between the risk of overweight and the consumption of food groups in children and adolescents. We studied 1764 healthy children and adolescents (age 6-19y) attending 16 Seventh-Day Adventist schools and 13 public schools using a 106-item non-quantitative food frequency questionnaire from the late 1980 Child-Adolescent Blood Pressure Study. Logistic regression models were used to compute the risk of overweight according to consumption of grains, nuts, vegetables, fruits, meats/fish/eggs, dairy, and, low nutrient-dense foods (LNDF). The frequency of consumption of grains, nuts, vegetables and LNDF were inversely related to the risk of being overweight and dairy increased the risk. Specifically, the odds ratio (95% CI) for children in the highest quartile or tertile of consumption compared with the lowest quartile or tertile were as follows: grains 0.59(0.41-0.83); nuts 0.60(0.43-0.85); vegetables 0.67(0.48-0.94); LNDF 0.43(0.29-0.63); and, dairy 1.36(0.97, 1.92). The regular intake of specific plant foods may prevent overweight among children and adolescents.
- Jun 2011
Short-term (4-9 weeks) human feeding trials have shown nut consumption to reduce serum total cholesterol (TC) and LDL-cholesterol (LDL). We hypothesized that individual levels of BMI, LDL, TC and triglycerides modify the cholesterol-lowering effect of almonds in a 24-week almond supplementation trial in a free-living population. We performed secondary analysis on data from a previously published study. Using a sequential study design, all participants followed their habitual diets during the first six months (control), and then consumed an almond-supplemented diet (habitual + almonds) for another six months. 100 adults enrolled; 19 were lost to attrition. Those who completed the study were men (n = 43) and women (n = 38) with mean (SD) age 49.4 (13.6) years. During almond supplementation, we found statistically significant changes in TC (-0.22 mmol/L), LDL (-0.22 mmol/L), TC:HDL (-0.35), and LDL:HDL (-0.28) in participants with baseline LDL levels ≥ 3.30 mmol/L, but not among normocholesterolemic individuals. Direction and magnitude of change were similar among individuals with TC ≥ 5.20 mmol/L but not in the lower strata. Tests of interaction (diet × TC and diet × LDL) were significant. Reductions in the ratios TC:HDL, and LDL:HDL were significant among those with BMI < 25 kg/m(2), but not in heavier individuals; however, formal tests of interaction did not reach significance. We provide strong evidence that the cholesterol-lowering effect of almonds is responsive among hypercholesterolemic individuals, and weak evidence that BMI modifies the effect of almonds on serum lipids.
To assess race-specific validity of food and food group intakes measured using an FFQ. Calibration study participants were randomly selected from the Adventist Health Study-2 (AHS-2) cohort by church, and then by subject-within-church. Intakes of forty-seven foods and food groups were assessed using an FFQ and then compared with intake estimates measured using six 24 h dietary recalls (24HDR). We used two approaches to assess the validity of the questionnaire: (i) cross-classification by quartile and (ii) de-attenuated correlation coefficients. Seventh-day Adventist church members geographically spread throughout the USA and Canada. Members of the AHS-2 calibration study (550 whites and 461 blacks). The proportion of participants with exact quartile agreement in the FFQ and 24HDR averaged 46 % (range: 29-87 %) in whites and 44 % (range: 25-88 %) in blacks. The proportion of quartile gross misclassification ranged from 1 % to 11 % in whites and from 1 % to 15 % in blacks. De-attenuated validity correlations averaged 0·59 in whites and 0·48 in blacks. Of the forty-seven foods and food groups, forty-three in whites and thirty-three in blacks had validity correlations >0·4. The AHS-2 questionnaire has good validity for most foods in both races; however, validity correlations tend to be higher in whites than in blacks.