Source: LOMA LINDA UNIVERSITY submitted to
NUTRITION, DIET AND LIFESTYLE RESEARCH
Sponsoring Institution
National Institute of Food and Agriculture
Project Status
TERMINATED
Funding Source
OTHER GRANTS
Reporting Frequency
Annual
Accession No.
0221662
Grant No.
2010-38938-20924
Project No.
CALW-2010-01510
Proposal No.
2010-01510
Multistate No.
(N/A)
Program Code
EE-E
Project Start Date
Jun 1, 2010
Project End Date
May 31, 2012
Grant Year
2010
Project Director
Fraser, G. E.
Recipient Organization
LOMA LINDA UNIVERSITY
(N/A)
LOMA LINDA,CA 92350
Performing Department
(N/A)
Non Technical Summary
The work proposed under this grant forms an important complement and aid to the on-going diet-chronic disease work among Adventists. Some of these results have been publicized in the National Geographic magazine, the recent "Blue Zones" book by Dan Buettner, and elsewhere. In addition there are over 350 published peer-reviewed reports about the health of Adventists. A nation-wide cohort, Adventist Health Study-2 (AHS-2) of 96,000 subjects has recently been assembled to extend this research, and has the main goal to evaluate diet-cancer associations. Associations between diet and other diseases will also be evaluated. This grant will achieve three main purposes: 1. To help further publicize the main findings from these studies. This information has the potential to improve the health of the nation. The extra years of life and lower rates of heart disease and cancer enjoyed by Adventists can almost certainly also be largely attained by others. Thus an Office of Publicity, staffed by a part-time writer/publicist and talented doctoral students, will be formed. Regular articles aimed at media outlets, popular magazines and professional journals will be produced. 2. To develop an educational and motivational program to encourage and aid African-Americans to live more healthfully. They have particular health challenges in relation to prostate cancer (men), obesity (women), hypertension, congestive heart failure, and higher mortality from several common cancers. They are also a group that received special emphasis in AHS-2 where there are 25,000 African-American study members. Thus a 6 month program will be developed, and pilot-tested in two local Black Adventist churches. There will be an evaluation component. The project will be structured with the clear goal in the next phase of moving beyond the Adventist environment. 3. To help ensure that there continues to be a vigorous team of talented academics at Loma Linda University to continue these studies. To this end, the grant will support post-doctoral and pre-doctoral research fellowships to help identify and train talented younger investigators. Initial efforts will publicize the fellowship opportunities in national professional and other magazines, and also particularly in the Schools of Medicine and Public Health at Loma Linda University. In addition, there are some funds budgeted to enhance the capacity of existing mid-career and senior investigators, by providing mini-sabbaticals (3 month) at centers of excellence related to this type of study. Connections formed with other experienced investigators will be most valuable.
Animal Health Component
40%
Research Effort Categories
Basic
(N/A)
Applied
40%
Developmental
60%
Classification

Knowledge Area (KA)Subject of Investigation (SOI)Field of Science (FOS)Percent
7031499101010%
7031499117010%
9011499101010%
9011499117010%
9031499101025%
9031499117035%
Knowledge Area
703 - Nutrition Education and Behavior; 901 - Program and Project Design, and Statistics; 903 - Communication, Education, and Information Delivery;

Subject Of Investigation
1499 - Vegetables, general/other;

Field Of Science
1170 - Epidemiology; 1010 - Nutrition and metabolism;
Goals / Objectives
The overall objective for this grant is to further enhance the Lifestyle Medicine Institute at Loma Linda University (LLU) that will provide in many complementary ways important support to the ongoing but separately-funded NIH research on lifestyle, health and life expectancy. This research is nearly unique with a more than 50-year record of federal funding. The planned support functions include a) a professional education and training component which involves the identification and training of potential new investigators as pre- and post-doctoral fellows, and enhancement of skills of existing more senior investigators; b) promotion of healthier lifestyles in the community. Specific Objectives A) To provide a pool of qualified and experienced investigators at Loma Linda University so ensuring a continued strong research base for lifestyle research at this institution in the future. The Adventist population is a remarkable research resource that has provided information important for all Americans, a benefit that will continue as a result of this grant. However, there are special challenges in finding and developing talented young people who can effectively continue this work over the coming years. This objective will be implemented by the provision of a small number of pre- and post-doctoral fellowships to well-screened candidates. B) To further increase the experience and skills of faculty at Loma Linda University who already have a reputation in the area of lifestyle research. This objective will be implemented by the provision of a small number of i) research seed-money awards, and ii) awards providing the opportunity of mini-sabbaticals at renowned institutions of higher learning. C) To develop materials and methods to promote change to healthier dietary patterns in the general population, and particularly among those at high risk of vascular disease and cancer. Although we propose one focus on African-American subjects in this grant application, attention will also be given to other ethnicities. The main themes will be those where our past research has provided break-through guidance, specifically on the use of plant-based dietary, and the highly probable benefits of moderate nut and whole grain consumption. There are two main parts to this objective: i) To disseminate new research findings using appropriate organizational and communications outlets, including the mass media. Our work relating to plant-based vegetarian diets, or diets that trend in this direction, is almost unique in the U.S. Our ultimate goal is to shift the culture of the nation to a greater awareness, appreciation, and adherence to a proven, healthier diet. ii) To develop educational and promotional materials of particular relevance to African-American persons, along with programs in which to use these materials and methods. In our current research work (Adventist Health Study-2) there is a focus on African-Americans, a group well-known to have several special health challenges.
Project Methods
a) Dissemination of Research Findings. We plan to hire a part-time writer/publicist who will work closely with us and selected graduate students to provide reports for news outlets, for popular magazines, and for professional reviews. The goal is to provide at least one such article each month. b) An Intervention Program for African-American Community Groups. Drs Patti Herring and Fraser will work with a part-time nurse and graduate students to design and implement a 6 month education and intervention program for African-Americans. The focus will be on diet, exercise, and problems of body weight, and cardiovascular risk factors. This will be pilot-tested in two Seventh-day Adventist churches initially, although others from the community will be invited. Advertizing will be community-wide. An assessment protocol will be implemented to evaluate the success of educational efforts, behavior change, risk factor change and also to gather opinions about the program. We have a relationship with a number of churches in the local area as there was intensive promotion of enrolment to the AHS-2 cohort in the local African-American community. The program that will be implemented will be designed so that the next phase would be its export to non-Adventist churches and possible non-church community organizations. c) Training of New Investigators at Loma Linda University to Continue Lifestyle Research. Funding is provided to support a small number of post-doctoral fellows in Epidemiology. These will be both 12 months and also 4-6 three month fellowships. The data from the AHS-2 cohort offers rich opportunities for training, for gaining experience, and publication potential. Fellows will be both MD and Dr PH graduates. Senior AHS-2 investigators will mentor these fellows. Some support is provided for this mentoring. In addition a limited number of 3 month pre-doctoral fellowships will be offered. These students will be both MD and Dr PH students. d) Enhancing Skills of Existing Epidemiologic Investigators. Seed money for small research studies can provide very important preliminary data to enhance larger research applications. Competitive awards of such funding will be provided to accompany a larger application that is already in preparation. Finally, the opportunity for experienced faculty to spend up to three months working at another institution of recognized excellence in the area of lifestyle population research is of great value to their continued professional development. Loma Linda is a medium-sized private institution and general does not provide these opportunities. New ideas and new associations with recognized experts will usually result from such mini-sabbaticals.

Progress 06/01/10 to 05/31/12

Outputs
Outputs A. A major activity was innovative educational/community gardens programs at four churches and a community-based organization in San Bernardino for disadvantaged/underserved largely minority populations (African-American and Hispanic). Two container gardening programs were initiated at SACHS Clinic and the Helping Hands Pantry in San Bernardino, both servicing underserved, disadvantaged and homeless populations. This grant provided significant start-up funds for gardens; fencing/ground preparation, irrigation, and we mandated some contribution by the churches and the organizations. Accompanying this was a short series of educational lectures, a short health assessment survey, cooking demonstrations, and clinics where blood pressure, body weight, BMI, and blood were obtained. Serum lipids and hemoglobin A1c were estimated. These results were returned to participants with appropriate comments and appropriate recommendations. Each educational session was accompanied by a simple pre-/post-session questionnaire. After about 6 months participants were invited back for repeat clinical measures, and change was assessed. In total this has impacted about 330 participants (mostly African-American and Hispanic), although many unfortunately did not complete questionnaires. Also six graduate students were organizers/presenters. B. We hired a writer/publicist who was successful in a number of ways. She redesigned the Adventist Health Study (AHS-2) website, which is now attractive, and a resource to which we continually refer AHS-2 cohort members, other academics, and the news media. It summarizes all research on the health of Seventh-day Adventists over a 50 year period, includes copies of all questionnaires that have been used, lists of all publications, and recent news releases. About 12 news releases have occurred which were widely disseminated by electronic and print media, and about 6 articles were printed in Adventist church publications. Partly as a response to this, co-investigator Dr Patti Herring was honored by the local NAACP chapter for the Community Gardens project. C. This award allowed identification and support of five post-doctoral fellows. This productive, eclectic group has prepared several papers for publication on topics ranging from diet and cancer; cancer screening among vegetarians and non-vegetarians; diet and total mortality; foods and nutrients consumed by subjects subscribing to different dietary patterns; methods of measuring and describing lifetime diet; diet and prevalence of metabolic syndrome. One goal was to identify and train future research leaders, and we have a very good start in that direction. D. There were seven seed-money research awards. The topics include Catechol assays to assess allostatic load; Urinary cortisol assays to assess allostatic load; Lp(a) and serum homocysteine in relation to vegetarian dietary patterns; Lp-PLA2 activity in relation to vegetarian diets; Predictive value positive of self-reported rheumatoid arthritis; Telomere length in relation to diet and physical activity; Exploration of a new way to evaluate components of a survival curve.

Impacts
We divide these to changes in knowledge resulting from the programs at Black churches, changes in knowledge that resulted for readers of the press releases about results from AHS-2, the changes in knowledge resulting from the analyses and manuscripts produced by fellows, and finally the research funded by the seed-money awards. Changes in knowledge clearly resulted among participants of the educational/clinic programs held at minority churches/clinics. Subject scores improved greatly on items such as "How minutes/day should you exercise", "What is a good glycemic index for healthy eating" etc. Evaluating changes in habits, blood pressure, BMI, lipids and hemoglobin A1c among those who returned for follow-up testing showed evidence of significant increase in total exercise time. Changes in eating habits and cardiovascular risk factors were generally not statistically significant in the small (and probably non-representative) data samples that we were able to collect. As a result the investigators have learned much about the mechanics of promoting, conducting, and evaluating such programs, also the need to collect evaluation data that includes motivation, opportunity, skills, as well as changes in knowledge. A grant application is in draft form that will continue and expand this program. Changes in knowledge that have depended on the work of the fellows are briefly : Vegetarian Adventists have substantially lower risk of metabolic syndrome than non-vegetarians; Vegetarian Adventists (especially vegans) are substantially less likely to participate in recommended cancer screening tests; Vegetarians have a modest but significant total mortality advantage over non-vegetarian Adventists; Overall, vegetarians have about an 8% significant reduction in incident cancer events. However lacto-ovo vegetarians have about a 30% reduction in risk of gastro-intestinal cancers, and vegans about a 50% reduction in risk of cancers of female genital organs; Differences in intake of major nutrients, vitamins and minerals between vegans, lacto-ovo vegetarians, pesco vegetarians and non-vegetarians are now well-described; Vegetarians and Black subjects use supplements less than others, and females supplement much more than males; We now know the proportions of subjects who are lifelong adherents to a particular dietary pattern, and those who are "switchers". Algorithms have been developed to describe the percentage of the lifetime that subjects adhered to particular patterns and at what periods during the lifecycle. These will be important when relating diet to disease events. The reproducibility of self-report on dietary pattern has also been established for intervals of both 5 years and 30 years. Changes in knowledge will also come from seed-money research by faculty that generally is not yet concluded. One conclusion already available, while "negative", has nevertheless been very useful, is that self-reported diagnoses of rheumatoid arthritis in AHS-2 are mostly incorrect, with a positive predictive value of only about 25%. This has already led to changes in new questionnaires that now incorporate questions about medications.

Publications

  • Rizzo NS, Sabate J, Jaceldo-Siegl K, Fraser GE. 2011. Vegetarian dietary patterns are associated with a lower risk of metabolic syndrome: the Adventist Health Study 2. Diabetes Care. 34(5):1225-7. Epub 2011 Mar 16.
  • Tantamango-Bartley Y, Jalcedo-Siegl K, Fraser G. 2011. Does it matter which meat when talking of cancer. AICR Annual Research Conference, Washington, DC, Nov 3-5, 2011.
  • Jalcedo-Siegl K, Tantamango-Bartley Y, Fraser G. 2011. Dietary Patterns and Cancer incidence in a low-risk population. 2011 AICR Annual Research Conference, Washington, Nov 3-5, 2011
  • Orlich MJ, Singh PN, Sabate J, Fan J, Fraser GE. 2012. Vegetarian Diet Patterns and Mortality: Early Findings from Adventist Health Study 2. Society for Epidemiologic Research. http://www.epiresearch.org/meeting_12/online/abstract_detail.phpi=ed 26962c71d801abf129937d729437d7.
  • Rizzo NS, Jaceldo-Siegl K, Fraser GE. 2012. Abstract P077: Differences and Similarities in Dietary Pattern and Nutrient Profiles between the Sexes and Blacks and Whites. The Adventist Health Study 2. Circulation. 125(10 supplement).
  • April 2012 Blacks are more prone to inflammatory diseases compared to Whites, yet vegetarian diet and exercise may counteract effects of disparities Press release
  • February 2012 Soy milk has similar benefits to dairy products in reducing the risk of osteoporosis among postmenopausal women Press release
  • January 2012 Vegetarians have lower measured blood pressures and less hypertension than non-vegetarians Press release
  • November 2011 NAACP branch recognizes AHS for minority health research Press release
  • October 2011 Vegetarian diet, physical activity protect against diabetes in Black population (Adventist Health Study-2) Press release
  • August 2011 Contrary to past findings, excess body fat in elderly decreases life expectancy (Adventist Health Study-2) Press release
  • July 2011 Adventist Health Study-2 awarded $5.5M grant from National Institutes of Health (Adventist Health Study-2) Press release
  • July 2011 Cooked green vegetables, brown rice linked to reduced risk of colon cancer (Adventist Health Study-2) Press release
  • June 2011 Black Adventists defy health disparities (Adventist Health Study-2) Press release
  • June 2011 Black physical/mental quality of life (Adventist Health Study-2) Press release
  • June 2011 Adventist Religion and Health Study shows connection between mental, physical health (Loma Linda University) Press release
  • May 2011 The Contribution of Dietary Studies in Seventh-day Adventists to Vegetarian Nutrition (Vegetarian Nutrition Update) Press release
  • April 2011 Vegetarians may be at a lower risk of heart disease, diabetes, stroke (Loma Linda University)Press release
  • April 2011 Two Adventist churches to begin community gardens (Adventist Health Study-2) Press release
  • Frehn J. 2011. LLU Research: Excess body fat in elderly decreases life expectancy. Pacific Union Recorder, November
  • Frehn J. 2011. NAACP recognizes Adventist Health Studies for minority health research, Dec
  • Manembu B. 2012. AHS-2 researchers share study results at camp-meeting. Southern Tidings, August
  • Manembu B, Fraser G. 2012 AHS-2 Newsletters adventisthealthstudy.org