ACCESSION NO: 0221662  SUBFILE: CRIS 

PROJ NO: CALW-2010-01510 AGENCY: NIFA CALW 

PROJ TYPE: OTHER GRANTS PROJ STATUS: TERMINATED 
CONTRACT/GRANT/AGREEMENT NO: 2010-38938-20924 PROPOSAL NO: 2010-01510 
START: 01 JUN 2010 TERM: 31 MAY 2012 
GRANT AMT: $865,800 GRANT YR: 2010
INITIAL AWARD YEAR: 2010

INVESTIGATOR: Fraser, G. E.; Herring, R. P.

PERFORMING INSTITUTION: 
LOMA LINDA UNIVERSITY 
LOMA LINDA, CALIFORNIA 92350

NUTRITION, DIET, AND LIFESTYLE RESEARCH FOR LONGEVITY AND HEALTHY AGING

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.

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.

APPROACH: 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: 2010/06 TO 2012/05
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. PARTICIPANTS:
Individuals: Gary E. Fraser (P.I. and Post-Doc Mentor) Developed guidelines for the various fellowships - Mentored
three Post-Doctoral Fellows - advertised and reviewed Seed Money grant applications - worked with Dr. Patti Herring
in developing the intervention program for minority subjects Rosa (Patti) Herring (Health Promotion Specialist) -
developed health promotion materials directed at the African-American population - developed an intervention
program that created community gardens at African-American church sites and oversaw its implementation - oversaw
collection of biological data Karen Jaceldo-Siegl (Post-Doc Mentor) - mentored two Post-Doctoral Fellows Synnove
Knutsen (Post-Doc Mentor) - mentored one Post-Doctoral Fellow Karen Breyer (Project Director) - oversaw
community garden project - coordinated with churches to arrange space and dates for intervention program -
coordinated project staff - conducted health education programs (with Masters students) Hannelore Bennett
(administrator) - facilitated advertising of fellowships and seed money grants - handled all personnel issues -
managed financial matters, including procurement of supplies for community gardens project, and oversight of budget
Jennifer Frehn (Year 01) and Barry Manembu (Year 02) (both Graphic Designers/Publicists) - wrote articles for
publication in popular magazines - assisted Project Director with design and procurement of promotional material for
the Community Gardens project and photographed and recorded its progress - coordinated interviews with the press
(local, TV, radio) Yessenia Tantamango-Bartley (Post-Doc) Sherma Charlemagne (Post-Doc) Yermek Ibrayev (Post-
Doc) Marcia Martins (Post-Doc) Michael Orlich (Post-Doc) Nico Rizzo (Post-Doc) Produce papers for publication
(See published abstracts and papers). Keep informed about epidemiologic literature. David Busolo (Grad. Asst.
Masters) Sozina Katuli (Grad. Asst. Doctoral) John Kebaso (Grad. Asst. Masters) La'Shaun McClinton (Grad. Asst.
Masters) La'Shay McClinton (Grad. Asst.Masters) Chuula Monga (Grad. Asst. Masters) Pamela Mukaire (Grad. Asst.
Doctoral) - worked with African-American churches in implementing community gardens - instructed community on
planting, maintaining and harvesting - assisted with cooking demonstrations and healthy living education - took
clinical measurements - performed data entry of clinical measurements and lab reports Partner Organizations Four
(4) churches-- 1. 16th Street SDA Church 1601 W. 16th Street San Bernardino, CA 92411 2. Juniper Ave. SDA
Church 7347 Juniper Ave Fontana, CA 92336-2022 3. Perris Fifth Street SDA Church 300 E. 5th St. Perris, CA
92570 4. Greater Faith Grace Bible Church 249 E. Randall Ave Rialto, CA 92376 One organization for disadvantaged
& under-served youth: PAL Center Center for Provisional Accelerated Learning 2450 Blake Street Muscoy, CA 92407
And....2 health health care 1. SAC Health Systems (SACHS) 1455 E. 3rd St. San Bernardino, CA 92408 2. Helping
Hands Pantry Distribution Food Center for the needy Located at the SACHS Clinic Finally, Loma Linda University
Grounds Dept Anderson St, Loma Linda, CA 92350 TARGET AUDIENCES: The target audiences of this project
were: a) Under-served minorities in San Bernardino County; the general public; Seventh-day Adventists; young early
career investigators who applied for fellowships; established investigators with interesting ideas and opportunities to
advance knowledge and their skills with small seed-grants. PROJECT MODIFICATIONS: This project was initially
submitted as a congressional appropriation, and was largely designed as a dissemination/training/demonstration
project. Once it was administratively assigned to the USDA, we were asked to strengthen the research component,
specifically that part of the project dealing with the under-served minorities. This we did, as far as was possible with
the resources allocated to that portion of the total award. This limitation did mean that although useful data was
collected, our ability to ensure that the same people attended the follow-up sessions six months later was inadequate,
so that numbers with before and after data were suboptimal. In addition the subjects who participated in gardens,
attended educational sessions, and the clinics, were often moderately different sub-sets of people. Nevertheless, it
was a valuable feasibility and developmental project, that we expect to build on further in the future.

IMPACT: 2010/06 TO 2012/05
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 (not previously reported): 2010/06 TO 2012/05

1. 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.
2. 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.
3. 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
4. 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.
5. 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).
6. April 2012 Blacks are more prone to inflammatory diseases compared to Whites, yet vegetarian diet and exercise
may counteract effects of disparities Press release
7. February 2012 Soy milk has similar benefits to dairy products in reducing the risk of osteoporosis among
postmenopausal women Press release
8. January 2012 Vegetarians have lower measured blood pressures and less hypertension than non-vegetarians
Press release
9. November 2011 NAACP branch recognizes AHS for minority health research Press release
10. October 2011 Vegetarian diet, physical activity protect against diabetes in Black population (Adventist Health
Study-2) Press release
11. August 2011 Contrary to past findings, excess body fat in elderly decreases life expectancy (Adventist Health
Study-2) Press release
12. July 2011 Adventist Health Study-2 awarded $5.5M grant from National Institutes of Health (Adventist Health
Study-2) Press release
13. July 2011 Cooked green vegetables, brown rice linked to reduced risk of colon cancer (Adventist Health Study-2)
Press release
14. June 2011 Black Adventists defy health disparities (Adventist Health Study-2) Press release
15. June 2011 Black physical/mental quality of life (Adventist Health Study-2) Press release
16. June 2011 Adventist Religion and Health Study shows connection between mental, physical health (Loma Linda
University) Press release
17. May 2011 The Contribution of Dietary Studies in Seventh-day Adventists to Vegetarian Nutrition (Vegetarian
Nutrition Update) Press release
18. April 2011 Vegetarians may be at a lower risk of heart disease, diabetes, stroke (Loma Linda University)Press
release
19. April 2011 Two Adventist churches to begin community gardens (Adventist Health Study-2) Press release
20. Frehn J. 2011. LLU Research: Excess body fat in elderly decreases life expectancy. Pacific Union Recorder,
November
21. Frehn J. 2011. NAACP recognizes Adventist Health Studies for minority health research, Dec
22. Manembu B. 2012. AHS-2 researchers share study results at camp-meeting. Southern Tidings, August
23. Manembu B, Fraser G. 2012 AHS-2 Newsletters adventisthealthstudy.org