Left ventricular diastolic abnormalities in vegetarians compared with non-vegetarians.

Vegetarians have less hypertension, diabetes mellitus and obesity, hence possibly lower risk of congestive heart failure (HF). We studied associations between vegetarian diets and echocardiographic markers of stage B HF. In a cross-sectional study, dietary pattern was ascertained by a validated FFQ. Echocardiograms were interpreted using standardised criteria. Participants were free-living subjects in Southern California who were older Adventist Health Study-2 cohort members. After exclusions, 133 subjects aged >60 years were enrolled. Their mean age was 72·7 (sd 8·7) years, 48·1 % were female, 32 % were African American and 71 % were vegetarian. Non-vegetarians had higher body weight (80·3 (sd 15·17) kg v. 71·3 (sd 16·2), P < 0·005), body surface area (1·92 (sd 0·24) m2v. 1·81 (sd 0·22) m2, P = 0·01) and prevalence of hypertension (63 % v. 47 %, P = 0·10). Adjusting for age, sex, race and physical activity, it is found that vegetarians had greater echocardiographic mitral annular e' velocity (a measure of left ventricular (LV) relaxation) 7·44 v. 6·48 (non-vegetarian) cm/s (P = 0·011) and a yet greater contrast when vegans (7·66 cm/s, P = 0·011) were the group of interest. The ratio mid-to-late-diastolic mitral flow velocity (E/A) was also higher in vegans compared with non-vegetarians (1·02 and 0·84, respectively, P = 0·008). Mediation analyses suggested these associations may be partly related to higher blood pressures and BMI in the non-vegetarians. We conclude that vegetarians, especially vegans, appear to have better LV relaxation and fewer diastolic abnormalities than others. As dietary exposure is modifiable, one may speculate pending further investigation about the potential for reduction of stage B HF and later mortality.

Dairy foods, calcium intakes, and risk of incident prostate cancer in Adventist Health Study-2.

BACKGROUND: Prostate cancer is the most common noncutaneous cancer in American males. Causal links between dairy, or dietary calcium, and this cancer are considered suggestive but limited. OBJECTIVES: To evaluate these associations in a large North American cohort, including many with no (or very low) dairy intake and much calcium from nondairy sources. METHODS: A prospective cohort study of 28,737 Seventh-day Adventist men in the United States and Canada, of whom 6389 were of black ethnicity. Diet was measured by FFQ, and 275 male participants also provided repeated 24-h dietary recalls as a calibration substudy. Incident cancers were mainly found by matching with cancer registries. Analyses used multivariable proportional hazards regressions and regression calibration for some analyses. RESULTS: In total, 1254 (190 advanced) incident prostate cancer cases were found during an average 7.8 y of follow-up. Men at the 90th percentile of dairy intake (430 g/d) compared with the 10th percentile (20.2 g/d) had higher prostate cancer risk (HR: 1.27; 95% CI: 1.12, 1.43). Similar findings, comparing the same g/d intakes, were demonstrated for advanced prostate cancers (HR: 1.38; 95% CI: 1.02, 1.88), for nonadvanced cases (HR: 1.27; 95% CI: 1.11, 1.45), in black participants (HR: 1.24; 95% CI: 0.98, 1.58), and when excluding vegan participants (HR: 1.22; 95% CI: 1.03, 1.43). Calibrated dairy (g/d) regressions (all participants and all prostate cancers), adjusting for dietary measurement error, found a HR of 1.75 (95% CI: 1.32, 2.32). Comparing 90th percentile intake to zero intakes (uncalibrated), the HR was 1.62 (95% CI: 1.26, 2.05). There was no evidence of an effect of higher (905 mg/d) compared with lower (349 mg/d) intakes of nondairy calcium (HR: 1.16; 95% CI: 0.94, 1.44). CONCLUSIONS: Men with higher intake of dairy foods, but not nondairy calcium, had a higher risk of prostate cancer compared with men having lower intakes. Associations were nonlinear, suggesting greatest increases in risk at relatively low doses.

The Biology of Veganism: Plasma Metabolomics Analysis Reveals Distinct Profiles of Vegans and Non-Vegetarians in the Adventist Health Study-2 Cohort.

It is unclear how vegetarian dietary patterns influence plasma metabolites involved in biological processes regulating chronic diseases. We sought to identify plasma metabolic profiles distinguishing vegans (avoiding meat, eggs, dairy) from non-vegetarians (consuming ≥28 g/day red meat) of the Adventist Health Study-2 cohort using global metabolomics profiling with ultra-performance liquid chromatography mass spectrometry (UPLC-MS/MS). Differences in abundance of metabolites or biochemical subclasses were analyzed using linear regression models, adjusting for surrogate and confounding variables, with cross-validation to simulate results from an independent sample. Random forest was used as a learning tool for classification, and principal component analysis was used to identify clusters of related metabolites. Differences in covariate-adjusted metabolite abundance were identified in over 60% of metabolites (586/930), after adjustment for false discovery. The vast majority of differentially abundant metabolites or metabolite subclasses showed lower abundance in vegans, including xanthine, histidine, branched fatty acids, acetylated peptides, ceramides, and long-chain acylcarnitines, among others. Many of these metabolite subclasses have roles in insulin dysregulation, cardiometabolic phenotypes, and inflammation. Analysis of metabolic profiles in vegans and non-vegetarians revealed vast differences in these two dietary groups, reflecting differences in consumption of animal and plant products. These metabolites serve as biomarkers of food intake, many with potential pathophysiological consequences for cardiometabolic diseases.

Ultra-processed food intake and animal-based food intake and mortality in the Adventist Health Study-2.

BACKGROUND: Both ultra-processed foods and animal-derived foods have been associated with mortality in some studies. OBJECTIVES: We aimed to examine the association of 2 dietary factors (ultra-processed foods and animal-based foods), adjusted for each other, with all-cause mortality. METHODS: The setting is an observational prospective cohort study in North America, recruited from Seventh-day Adventist churches, comprised of 95,597 men and women, yielding an analytic sample of 77,437 participants after exclusions. The exposure of interest was diet measured by FFQ, in particular 2 dietary factors: 1) proportion of dietary energy from ultra-processed foods (other processing levels and specific substitutions in some models) and 2) proportion of dietary energy from animal-based foods (red meat, poultry, fish, and eggs/dairy separately in some models). The main outcome was all-cause mortality. Mortality data through 2015 were obtained from the National Death Index. Analyses used proportional hazards regression. RESULTS: There were 9293 deaths. In mutually adjusted continuous linear models of both dietary factors (ultra-processed and animal-based foods), the HR for the 90th compared with the 10th percentile of the proportion of dietary energy from ultra-processed food was 1.14 (95% CI: 1.07, 1.21, comparing 47.7% with 12.1% dietary energy), whereas for animal-based food intake (meats, dairy, eggs) it was 1.01 (95% CI: 0.95, 1.07, comparing 25.0% with 0.4% dietary energy). There was no evidence of interaction (P = 0.36). Among animal-based foods, only red meat intake was associated with mortality (HR: 1.14; 95% CI: 1.08, 1.22, comparing 6.2% with 0% dietary energy). CONCLUSIONS: Greater consumption of ultra-processed foods was associated with higher all-cause mortality in this health-conscious Adventist population with many vegetarians. The total of animal-based food consumption (meat, dairy, eggs) was not associated with mortality, but higher red meat intake was. These findings suggest that high consumption of ultra-processed foods may be an important indicator of mortality.

Validity of FFQ Estimates of Total Sugars, Added Sugars, Sucrose and Fructose Compared to Repeated 24-h Recalls in Adventist Health Study-2 Participants.

Sugar intake is a potentially important aspect of diet which has not previously been validated in the Adventist Health Study-2 (AHS-2). We sought to validate the food frequency questionnaire (FFQ) measurement of total sugars, added sugars, sucrose, and fructose against multiple 24-h dietary recalls (recalls) in AHS-2 participants. Food consumption data from a self-administered FFQ and six recalls from 904 participants were combined with nutrient profile data to estimate daily sugar intake. Validity was evaluated among all participants and by race. FFQ and recall means were compared and correlation coefficients (Spearman's, energy-adjusted log-transformed Pearson's, deattenuated Pearson's) were calculated. Mean total energy, total sugars, and fructose intake were higher in the FFQ, whereas added sugars and sucrose were higher in recalls. The energy-adjusted (log-transformed) deattenuated correlations among all participants were: total sugars (r = 0.42, 95% CI 0.32-0.52), added sugars (r = 0.50, 95% CI 0.36-0.59), sucrose (r = 0.32, 95% CI 0.23-0.42), and fructose (r = 0.50, 95% CI 0.40-0.59). We observed moderate validity for added sugars and fructose and low-moderate validity for total sugars and sucrose measured by the AHS-2 FFQ in this population. Dietary sugar estimates from this FFQ may be useful in assessing possible associations of sugars intake with health outcomes.

Validation of estimated glycaemic index and glycaemic load, stratified by race, in the Adventist Health Study-2 (AHS-2).

OBJECTIVE: Few studies have validated FFQ estimates of dietary glycaemic index (GI) and load (GL). We investigated how well our estimates of overall GI and GL from FFQs correlate with estimates from repeated 24 h recall data to validate overall GI and GL in the Adventist Health Study-2 (AHS-2). DESIGN: The AHS-2 is a prospective population-based cohort of 95 873 Seventh-day Adventist adult church members enrolled from 2002 to 2007 to investigate diet, cancer and mortality. SETTING: A 204-item FFQ was used to assess race- and gender-specific validity of GI and GL and 24 h recall data, from the calibration sub-study, were used as the reference. PARTICIPANTS: The 734 calibration study participants were randomly selected by church and included approximately equal numbers of blacks and whites but were otherwise similar to the whole cohort with respect to gender, age, education and vegetarian status. RESULTS: The deattenuated correlation coefficients for overall GI ranged from 0·19 (95 % CI -0·06, 0·53) in black men to 0·46 (95 % CI 0·40, 0·60) in black women, with both non-black men and women falling between those values (0·45 (95 % CI 0·35, 0·65) and 0·38 (95 % CI 0·27, 0·57), respectively). GL correlations were somewhat higher for all study participants. When looking at the entire cohort, the deattenuated validity correlation value for overall GI was (r 0·38, 95 % CI 0·36, 0·47) and GL was (r 0·39, 95 % CI 0·34, 0·49). CONCLUSIONS: Our findings support the cautious use of our FFQ in epidemiological studies when assessing associations of overall GI and GL with disease risk. However, observed differences by race should be considered when interpreting results.

DNA Methylation Profiles of Vegans and Non-Vegetarians in the Adventist Health Study-2 Cohort.

We sought to determine if DNA methylation patterns differed between vegans and non-vegetarians in the Adventist Health Study-2 cohort. Genome-wide DNA methylation derived from buffy coat was profiled in 62 vegans and 142 non-vegetarians. Using linear regression, methylation of CpG sites and genes was categorized or summarized according to various genic/intergenic regions and CpG island-related regions, as well as the promoter. Methylation of genes was measured as the average methylation of available CpG's annotated to the nominated region of the respective gene. A permutation method defining the null distribution adapted from Storey et al. was used to adjust for false discovery. Differences in methylation of several CpG sites and genes were detected at a false discovery rate < 0.05 in region-specific and overall analyses. A vegan diet was associated predominantly with hypomethylation of genes, most notably methyltransferase-like 1 (METTL1). Although a limited number of differentially methylated features were detected in the current study, the false discovery method revealed that a much larger proportion of differentially methylated genes and sites exist, and could be detected with a larger sample size. Our findings suggest modest differences in DNA methylation in vegans and non-vegetarians, with a much greater number of detectable significant differences expected with a larger sample.

Tomato consumption and intake of lycopene as predictors of the incidence of prostate cancer: the Adventist Health Study-2.

PURPOSE: Studies have controversially suggested that prostate cancer, the most common cancer among Western men, is less common among those with a high intake of tomato products and lycopene. We examine multivariable associations between the intake of tomatoes and lycopene, and risk of prostate cancer. METHODS: In a prospective study of 27,934 Adventist men without prevalent cancer, Cox proportional hazard regression analyses were used to address the objectives. Dietary measurement error was partially corrected with regression calibration. RESULTS: 1226 incident cases of prostate cancer, 355 of them aggressive, were identified during 7.9 years of follow-up. Consumption of canned and cooked tomatoes more than four times a week was associated with a HR = 0.72 (95% CI 0.55, 0.94, P = 0.02) comparing to risk in those never consuming this food. Treating this as a continuous variable, adjusting for confounders, produces a similar result, HR = 0.86 (95% CI 0.75, 0.99), comparing 64 g/day with zero intakes (questionnaire data). Regression calibration, although less precise, suggests a yet stronger and statistically significant inverse relationship, comparing a 24-h dietary recall intake of 71 g/day canned and cooked tomato product, with zero intake. Uncalibrated multivariable-adjusted competing risk analyses do not find differences in tomato associations between aggressive and non-aggressive prostate cancers although power for aggressive cancers is limited. CONCLUSION: Consumption of canned and cooked tomatoes may reduce the risk of prostate cancer. These products contain more available lycopene. However, an observational study cannot exclude confounding by some unidentified, prostate cancer preventive factor. Clinical Trial Registry: ClinicalTrials.gov Identifier: NCT03615599.

Dairy, soy, and risk of breast cancer: those confounded milks.

BACKGROUND: Associations between soy, dairy intakes and breast cancer risk are inconsistent. No studies exist with large numbers of dairy consumers and soy consumers to assess mutual confounding. METHODS: The study cohort contains 52 795 North American women, initially free of cancer, followed for 7.9 years (29.7% were Black). Dietary intakes were estimated from food frequency questionnaires and, for 1011 calibration study subjects, from six structured 24-h dietary recalls. Incident invasive breast cancers were detected mainly by matching with cancer registries. Analyses used multivariable proportional hazards regression. RESULTS: The participants (mean age of 57.1 years) experienced 1057 new breast cancer cases during follow-up. No clear associations were found between soy products and breast cancer, independently of dairy. However, higher intakes of dairy calories and dairy milk were associated with hazard ratios (HRs) of 1.22 [95% confidence interval (CI): 1.05-1.40] and 1.50 (95% CI 1.22-1.84), respectively, comparing 90th to 10th percentiles of intakes. Full fat and reduced fat milks produced similar results. No important associations were noted with cheese and yogurt. Substituting median intakes of dairy milk users by those of soy milk consumers was associated with HR of 0.68 (95% CI: 0.55-0.85). Similar-sized associations were found among pre- and post-menopausal cases, with CIs also excluding the null in estrogen receptor (ER+, ER-), and progesterone receptor (PR+) cancers. Less biased calibrated measurement-error adjusted regressions demonstrated yet stronger, but less precise, HRs and CIs that still excluded the null. CONCLUSIONS: Higher intakes of dairy milk were associated with greater risk of breast cancer, when adjusted for soy intake. Current guidelines for dairy milk consumption could be viewed with some caution.

Patterns of amino acid intake are strongly associated with cardiovascular mortality, independently of the sources of protein.

BACKGROUND: The intake of specific amino acids (AA) has been associated with cardiovascular health, but amino acids are consumed together as dietary protein. Here we investigated the association between identified patterns of amino acid intake and cardiovascular mortality. METHODS: A total of 2216 cardiovascular deaths among 79 838 men and women from the Adventist Health Study-2 were included in our analysis. Baseline dietary patterns based on the participants' amino acids intakes were derived by factor analysis. Using Cox regression analyses, we estimated multivariate-adjusted hazard ratios (HRs) adjusted for sociodemographic and lifestyle factors and other dietary components. RESULTS: Three patterns of amino acids were identified. Factor 1 was positively associated with cardiovascular disease (CVD) mortality [hazard ratio (HR)Q5-Q1: 1.62, 98.75% confidence interval (CI): 1.15, 2.28; P-trend <0.001]; and Factors 2 and 3 were inversely associated with CVD mortality (HR Q5-Q1 Factor 2: 0.74, 98.75% CI: 0.53, 1.04; P-trend <0.01 and HR Q5-Q1 Factor 3: 0.65, 98.75% CI: 0.44, 0.95; P-trend <0.05]. The associations with Factor 1 (with high loadings on indispensable amino acids such as branched chain amino acids, lysine, methionine) and Factor 3 (with high loadings on non-indispensable amino acids, namely arginine, glycine, aspartate+asparagine) remained significant after further adjustment for nutrient intake and for the five protein source patterns identified previously (HR Q5-Q1: 1.56 (0.99, 2.45) and 0.55 (0.35, 0.85); P-trends < 0.01). CONCLUSIONS: Indispensable AA have a positive and some non-indispensable AA have a negative, independent, strong association with the risk of cardiovascular mortality.

Lower rates of cancer and all-cause mortality in an Adventist cohort compared with a US Census population.

BACKGROUND: Previous research suggests that Adventists, who often follow vegetarian diets, live longer and have lower risks for many cancers than others, but there are no national data and little published comparative data for black subjects. METHODS: This study compared all-cause mortality and cancer incidence between the nationally inclusive Adventist Health Study 2 (AHS-2) and nonsmokers in US Census populations: the National Longitudinal Mortality Study (NLMS) and its Surveillance, Epidemiology, and End Results substudy. Analyses used proportional hazards regression adjusting for age, sex, race, cigarette smoking history, and education. RESULTS: All-cause mortality and all-cancer incidence in the black AHS-2 population were significantly lower than those for the black NLMS populations (hazard ratio [HR] for mortality, 0.64; 95% confidence interval [CI], 0.59-0.69; HR for incidence, 0.78; 95% CI, 0.68-0.88). When races were combined, estimated all-cause mortality was also significantly lower in the AHS-2 population at the age of 65 years (HR, 0.67; 95% CI, 0.64-0.69) and at the age of 85 years (HR, 0.78; 95% CI, 0.75-0.81), as was cancer mortality; this was also true for the rate of all incident cancers combined (HR, 0.70; 95% CI, 0.67-0.74) and the rates of breast, colorectal, and lung cancers. Survival curves confirmed the mortality results and showed that among males, AHS-2 blacks survived longer than white US subjects. CONCLUSIONS: Substantially lower rates of all-cause mortality and cancer incidence among Adventists have implications for the effects of lifestyle and perhaps particularly diet on the etiology of these health problems. Trends similar to those seen in the combined population are also found in comparisons of black AHS-2 and NLMS subjects.

Comparison of phytosterol intake from FFQ with repeated 24-h dietary recalls of the Adventist Health Study-2 calibration sub-study.

We evaluated the performance of an FFQ in estimating phytosterol intake against multiple 24-h dietary recalls (24HDR) using data from 1011 participants of the calibration sub-study of the Adventist Health Study-2 (AHS-2) cohort. Dietary assessments of phytosterol intake included a self-administered FFQ and six 24HDR and plasma sterols. Plasma sterols were determined using the GLC flame ionisation method. Validation of energy-adjusted phytosterol intake from the FFQ with 24HDR was conducted by calculating crude, unadjusted, partial and de-attenuated correlation coefficients (r) and cross-classification by race. On average, total phytosterol intake from the FFQ was 439·6 mg/d in blacks and 417·9 mg/d in whites. From the 24HDR, these were 295·6 mg/d in blacks and 351·4 mg/d in whites. Intake estimates of ß-sitosterol, stigmasterol, other plant sterols and total phytosterols from the FFQ had moderate to strong correlations with estimates from 24HDR (r 0·41-0·73). Correlations were slightly higher in whites (r 0·42-0·73) than in blacks (r 0·41-0·67). FFQ estimates were poorly correlated with plasma sterols as well as 24HDR v. plasma sterols. We conclude that the AHS-2 FFQ provided reasonable estimates of phytosterol intake and may be used in future studies relating phytosterol intake and disease outcomes.

Red and Processed Meat and Mortality in a Low Meat Intake Population.

Associations of low-to-moderate consumption of red and processed meat with mortality would add to the evidence of possible adverse effects of these common foods. This study aims to investigate the association of red and processed meat intake with mortality. The Adventist Health Study-2 (AHS-2) is a prospective cohort study of ~96,000 Seventh-day Adventist men and women recruited in the US and Canada between 2002 and 2007. The final analytic sample after exclusions was 72,149. Cox proportional hazards regression was used and hazard ratios (HR) and confidence intervals (CI) were obtained. Diet was assessed by a validated quantitative food frequency questionnaire (FFQ), calibrated using six 24-h dietary recalls. Mortality outcome data were obtained from the National Death Index. During a mean follow-up of 11.8 years, there were 7961 total deaths, of which 2598 were Cardiovascular diseases (CVD) deaths and 1873 were cancer deaths. Unprocessed red meat was associated with risk of all-cause mortality (HR: 1.18; 95% CI: 1.07⁻1.31) and CVD mortality (HR: 1.26; 95% CI: 1.05⁻1.50). Processed meat alone was not significantly associated with risk of mortality. The combined intake of red and processed meat was associated with all-cause mortality (HR: 1.23; 95% CI: 1.11⁻1.36) and CVD mortality (HR: 1.34; 95% CI: 1.12⁻1.60). These findings suggest moderately higher risks of all-cause and CVD mortality associated with red and processed meat in a low meat intake population.

Patterns of plant and animal protein intake are strongly associated with cardiovascular mortality: the Adventist Health Study-2 cohort.

Background: Current evidence suggests that plant and animal proteins are intimately associated with specific large nutrient clusters that may explain part of their complex relation with cardiovascular health. We aimed at evaluating the association between specific patterns of protein intake with cardiovascular mortality. Methods: We selected 81 337 men and women from the Adventist Health Study-2. Diet was assessed between 2002 and 2007, by using a validated food frequency questionnaire. Dietary patterns based on the participants' protein consumption were derived by factor analysis. Cox regression analysis was used to estimate multivariate-adjusted hazard ratios (HRs) adjusted for sociodemographic and lifestyle factors and dietary components. Results: There were 2276 cardiovascular deaths during a mean follow-up time of 9.4 years. The HRs for cardiovascular mortality were 1.61 [98.75% confidence interval (CI), 1.12 2.32; P-trend < 0.001] for the 'Meat' protein factor and 0.60 (98.75% CI, 0.42 0.86; P-trend < 0.001) for the 'Nuts & Seeds' protein factor (highest vs lowest quintile of factor scores). No significant associations were found for the 'Grains', 'Processed Foods' and 'Legumes, Fruits & Vegetables' protein factors. Additional adjustments for the participants' vegetarian dietary pattern and nutrients related to cardiovascular disease outcomes did not change the results. Conclusions: Associations between the 'Meat' and 'Nuts & Seeds' protein factors and cardiovascular outcomes were strong and could not be ascribed to other associated nutrients considered to be important for cardiovascular health. Healthy diets can be advocated based on protein sources, preferring low contributions of protein from meat and higher intakes of plant protein from nuts and seeds.

A New Approach to Assess Lifetime Dietary Patterns Finds Lower Consumption of Animal Foods with Aging in a Longitudinal Analysis of a Health-Oriented Adventist Population.

Life-course diet patterns may impact risk of disease, but little is known about dietary trends with aging. In a retrospective longitudinal analysis we estimated lifetime intake of animal products and adherence to vegetarian dietary patterns among 51,082 Adventist Health Study-2 (AHS-2) subjects using data from a reliable life-course dietary (meats, dairy, eggs) questionnaire. Results showed a marked tendency to consume fewer animal products (in total) in older years and to reduce consumption of meat, poultry and fish, but not eggs or dairy. Among the 29% of elderly subjects who during their lifetime kept the same dietary pattern (LTS) were: LTS-vegans (1.1%), LTS-lacto-ovo vegetarians (31.2%), LTS-pesco vegetarians (0.49%), LTS-semi vegetarians (3.7%), and LTS-non-vegetarians (63.5%). Among the 71% of switchers were "Converters" (59.7%) who moved towards and "Reverters" (9.1%) who moved away from vegetarian diets, and Multiverters (31.2%), who had moved in both directions. LTS-non-vegetarians, and also reverters, were more overweight and showed a less healthy lifestyle than others. We conclude that the dietary patterns are dynamic with strong trends to reduce animal foods and to adopt more vegetarian patterns with aging. The disease experience of subjects with different lifetime dietary patterns can be compared.

Meal Frequency and Timing Are Associated with Changes in Body Mass Index in Adventist Health Study 2.

Background: Scientific evidence for the optimal number, timing, and size of meals is lacking.Objective: We investigated the relation between meal frequency and timing and changes in body mass index (BMI) in the Adventist Health Study 2 (AHS-2), a relatively healthy North American cohort.Methods: The analysis used data from 50,660 adult members aged ≥30 y of Seventh-day Adventist churches in the United States and Canada (mean ± SD follow-up: 7.42 ± 1.23 y). The number of meals per day, length of overnight fast, consumption of breakfast, and timing of the largest meal were exposure variables. The primary outcome was change in BMI per year. Linear regression analyses (stratified on baseline BMI) were adjusted for important demographic and lifestyle factors.Results: Subjects who ate 1 or 2 meals/d had a reduction in BMI per year (in kg · m-2 · y-1) (-0.035; 95% CI: -0.065, -0.004 and -0.029; 95% CI: -0.041, -0.017, respectively) compared with those who ate 3 meals/d. On the other hand, eating >3 meals/d (snacking) was associated with a relative increase in BMI (P < 0.001). Correspondingly, the BMI of subjects who had a long overnight fast (≥18 h) decreased compared with those who had a medium overnight fast (12-17 h) (P < 0.001). Breakfast eaters (-0.029; 95% CI: -0.047, -0.012; P < 0.001) experienced a decreased BMI compared with breakfast skippers. Relative to subjects who ate their largest meal at dinner, those who consumed breakfast as the largest meal experienced a significant decrease in BMI (-0.038; 95% CI: -0.048, -0.028), and those who consumed a big lunch experienced a smaller but still significant decrease in BMI than did those who ate their largest meal at dinner.Conclusions: Our results suggest that in relatively healthy adults, eating less frequently, no snacking, consuming breakfast, and eating the largest meal in the morning may be effective methods for preventing long-term weight gain. Eating breakfast and lunch 5-6 h apart and making the overnight fast last 18-19 h may be a useful practical strategy.

Independent associations of dairy and calcium intakes with colorectal cancers in the Adventist Health Study-2 cohort.

OBJECTIVE: Results associating dairy and Ca intakes with colorectal cancer (CRC) risk have been mixed. Most previous analyses have suffered from confounding between dairy and Ca intakes. We examined independent associations between these variables, also dairy foods, and CRC incidence in a population with a large range of dairy intakes. DESIGN: Adventist Health Study-2 is a cohort study where subjects were enrolled 2002-2007. Proportional hazard regression analyses were performed to estimate hazard ratios (HR). Regression calibration was used to correct for dietary measurement error. SETTING: The population lived in all states of the USA. SUBJECTS: There were 77712 analytic subjects, all of whom were Seventh-day Adventists. Much of their dietary Ca came from non-dairy sources. SUBJECTS: During a mean follow-up of 7·8 years, 380 incident colon cancer and 111 incident rectal cancer cases were observed. RESULTS: Comparing extreme quintiles of intake in measurement error-corrected analyses, dairy intake (HR=0·31; 95 % CI 0·09, 0·88), independent of total Ca, was inversely related with risk of rectal cancer but gave little indication of association with colon cancer. However, total Ca intake (independent of dairy) was associated with risk of colon cancer (HR=0·55; 95 % CI 0·28, 0·98) and there was little indication of association with rectal cancer. Traditional regression analyses and associations with macronutrients from dairy generally supported these results. Milk intake was also negatively associated with CRC (HR=0·63; 95 % CI 0·43, 0·89). CONCLUSIONS: Dairy intake may decrease the risk of rectal cancer, and Ca may reduce risk of colon cancer and CRC.

Variations in dietary intake and plasma concentrations of plant sterols across plant-based diets among North American adults.

SCOPE: Phytosterols are bioactive compounds in plants with similar cholesterol-lowering properties as vegetarian diets. However, information on phytosterol intake and plasma plant sterols among vegetarians is sparse. METHODS AND RESULTS: We examined dietary intake and plasma concentration of plant sterols and cholesterol across five dietary patterns in the Adventist Health Study-2 Calibration Sub-study (n = 861, 66% females, average age 61 years). To measure intake and plasma concentrations of these compounds, we used 24-h dietary recalls and gas-liquid chromatography-flame ionization detection, respectively. Mean (SD) total phytosterol and cholesterol intake were 363 (176) mg/day and 131 (111) mg/day; plasma ß-sitosterol, campesterol, and cholesterol were 3.3 (1.7) µg/mL, 4.2 (2.3) µg/mL, and 1.9 (0.4) mg/mL, respectively. Total phytosterol intake was lowest among non-vegetarians (263 mg/day) and highest among vegans (428 mg/day) (p < 0.0001). Cholesterol intake was lowest among vegans (15.2 mg/day) and highest among non-vegetarians (124.6 mg/day) (p < 0.0001). Plasma plant sterols and cholesterol did not differ by diet. Cholesterol-adjusted plasma ß-sitosterol and campesterol were significantly higher in Blacks than Whites, though no ethnic differences were observed in dietary intake of these plant sterols. CONCLUSION: Dietary intake but not plasma concentration of plant sterols and cholesterol varies across distinct plant-based diets.

[Frequency and timing of meals and changes in body mass index: Analysis of the data from the Adventist Health Study-2]. / Frekvence a nacasování jídel a zmeny v body mass indexu: analýza dat z Adventist Health Study-2.

GOAL: Our study focuses on examining the relationship between the frequency and timing of meals and changes in BMI in the Adventist Health Study-2 (AHS-2) which represents a relatively healthy population in North America. METHODOLOGY: A longitudinal analysis was undertaken using data from 48 673 individuals monitored over an average period of 7.43 ± 1.24 years. The number of meals per day, length of nighttime fasting, eating breakfast and timing of the largest meal of the day (breakfast 5-11 a.m., lunch noon-4 p.m. or supper/dinner 5-11 p.m.) were used as independent variables. The primary output was the change in body mass index (BMI) once in a year. Linear regression analyses were adjusted for all important demographic factors and lifestyle factors. RESULTS: Consumption of 1 and 2 meals a day was associated with decrease in BMI (-0.04; 95% CI -0.06 to -0.03 and -0.02; 95% CI -0.03 to -0,01 kg.m-2 per year, respectively). On the other hand, consumption of 3 or more meals a day was associated with increase in BMI, in a linear relation (p < 0.001). BMI of those who skipped breakfast increased (0.029; 95% CI 0.021-0.037 kg.m-2 per year; p = 0.002) as compared to no BMI change in those who had breakfast (-0.0002; 95% CI -0.005 to + 0.004 kg.m-2 per year). Those, whose largest meal of the day was breakfast, recorded no significant change in BMI (-0.002 95% CI -0.008 to +0.004 kg.m-2 per year). On the contrary, the largest supper was associated with the greatest increase in BMI (0.034; 95% CI 0.029-0.040 kg.m-2 per year). CONCLUSION: Our results indicate that eating less frequently, consuming breakfast and having the largest meal in the morning hours may be effective measures to prevent weight gain.Key words: body mass index (BMI) - frequency and timing of meals - body mass regulation - breakfast.

Protease inhibition by oleic acid transfer from chronic wound dressings to albumin.

High elastase and cathepsin G activities have been observed in chronic wounds to inhibit healing through degradation of growth factors, cytokines, and extracellular matrix proteins. Oleic acid is a non-toxic elastase inhibitor. Cotton wound dressing material was characterized as a transfer carrier for affinity uptake of oleic acid by albumin under conditions mimicking chronic wounds. The mechanism of oleic acid uptake from cotton and binding by albumin was examined with both intact dressings and cotton fiber-designed chromatography. Raman spectra of the albumin-oleic acid complexes under liquid equilibrium conditions revealed fully saturated albumin-oleic acid complexes with a 1:1 weight ratio of albumin:oleic acid. Liquid-solid equilibrium conditions revealed oleic acid transfer from cotton to albumin at 27 mole equivalents of oleic acid per mole albumin. Comparing oleic acid formulated wound dressings for dose dependent ability to lower elastase activity, we found cotton gauze>hydrogel>hydrocolloid. In contrast, the cationic serine protease cathepsin G was inhibited by oleic acid within a narrow range of oleic acid-cotton formulations. 2% albumin was sufficient to transfer quantities of oleic acid necessary to achieve a significant elastase-lowering effect. Oleic acid bound to cotton wound dressings may have promise in the selective lowering of cationic serine protease activity useful in topical application for chronic inflammatory pathogenesis.