Grant title
Dairy, meat, linolenic acid and soy consumption as risk factors for prostate, colorectal and breast cancer in a cohort with a wide range of dietary habits: Adventist Health Study-2 (AHS-2)
Scientific abstract
Background and aim
The AHS-2 is a cohort comprising a special North American population (N=96,000) of whom half are vegetarian, and 25% are Black (African-American and West Indian). The average age at enrolment was 62 years and 65% of participants were female.
The main goals of this study were to capitalise on the unusual dietary characteristics of this population, of whom about half were vegetarian (including 8% vegan), and half of whom ate soy at Asian levels, and to relate the risk of breast, colorectal, and prostate cancers to different dietary habits taking advantage of the wide range of dietary exposure in this population.
This feature adds power and reduces the biasing effects of measurement error.
Methods
Participants were enrolled in the study by promotional efforts among 4,000 congregations across North America. Enrolment was concluded when they completed and mailed back a long questionnaire about dietary habits and other aspects of lifestyle and medical history.
New cancers were found by matching AHS-2 data with each state cancer registry. A major challenge in the US is to detect all incident cancer cases from a nationwide cohort. The WCRF grant has been most helpful in providing supplementary funds to enable us to successfully achieve the goal of matching with all US cancer registries (except in Maine), a task not previously accomplished by a research group.
Based on this, and again aided by some support from the WCRF grant, we have been able to pursue analyses and the production of manuscripts to address the main study goals.
Results
Results at present are as follows:
- As compared to non-vegetarians there is little difference in the cancer mortality of vegetarians; however the incidence of gastrointestinal cancers in vegetarians is reduced, as is the risk of cancers of female genital organs in females;
- Vegetarians have a significant 20% reduction in colorectal cancer, and it appeared that this was nearly 50% in pesco-vegetarians, although this difference from other vegetarians was not statistically significant;
- Vegans, as compared to non-vegetarians and other vegetarians, appear to have a significant 33% reduction in the risk of total prostate cancer, a reduction that is maintained in aggressive/advanced incident cases, although the smaller numbers of this endpoint do not achieve statistical significance. This remains after adjustment for differences in cancer screening habits in vegans;
- We could not demonstrate any significant reduction in risk of breast cancer among vegetarians, although a trend to lower risk (p=0.07) was seen in vegans;
- There appears to be about a 10% non-significant reduction in risk of prostate cancer when comparing raw tomato consumption 4+ times per week to rare consumption; however a similar comparison of intake of cooked/canned tomatoes (lycopene is more available) revealed a significant 28% protective effect;
- Comparing extreme quintiles of isoflavone consumption (half of Adventists eat this at Asian levels) found a 40% significant reduction in risk of breast cancer among the higher users in a calibrated regression;
- Comparing extreme quintiles of dairy consumption, the risk of colon cancer was non-significantly lower in the high dairy group by about 7%. However risk of rectal cancer was a significant 40%/30% lower in the high dairy protein/fat consumption groups. All these results have substantial multivariate adjustment.
Conclusion
The study found that although there was little difference in overall cancer mortality between vegetarians and non-vegetarians, vegetarians were found to have a significantly reduced risk of cancers of the gastrointestinal tract. Additionally, a vegan diet may confer lower risk for overall and female-specific cancer than other dietary patterns.
Plain language abstract
Background
The Adventist Health Study-2 (AHS-2) is a longitudinal study of 96,000 North American Seventh-day Adventists. About 50% of these subjects are vegetarian and 26% are Black. Thus there is a wide range of dietary habits that lends power to these investigations.
Aims and objectives
The overall goals of the AHS-2 research were to evaluate associations between several dietary items and risks of prostate, colorectal, and breast cancer. In particular we evaluated consumption of red meats, fish, n-3 fatty acids, soy products, cruciferous dairy products and tomatoes. Results in Black and non-Black subjects were compared.
The first aim was to help complete the major task of cancer case-finding as all states in the US have their own cancer registry requiring a separate agreement and payment. The second aim was to provide support for analyses and the writing of scientific papers that address the diet-cancer questions.
How the study was carried out
Participants were enrolled to the study by promotional efforts among 4,000 congregations across North America. Enrolment was concluded when they completed and mailed back a long questionnaire about dietary habits and other aspects of lifestyle and medical history. New cancers were found by matching AHS-2 data with each state cancer registry.
Key findings and conclusion
So far our conclusions in relation to cancer are:
- It is feasible for studies like AHS-2 to match with virtually all US cancer registries.
- As compared to non-vegetarians, vegetarians have modestly lower risk of cancer, but particularly gastro-intestinal cancers. However death rates from cancer are not lower among vegetarians.
- Vegans (strict vegetarians) appear to have lower risk of cancers of female organs and also prostate cancer.
- Vegetarians overall did not differ from non-vegetarians in their risk of breast cancer, though there was a trend to lower risk (p=0.07) among vegans.
- Higher consumption of cooked/canned tomatoes is associated with lower risk of prostate cancer, perhaps particularly the aggressive type of cancer. Evidence of lesser risk from consumption of raw tomatoes was not found, perhaps because their content of lycopene is in a form less readily absorbed.
- Vegans and other vegetarians (to a lesser extent) are less likely to follow screening recommendations for prostate cancer.
- Higher consumers of soy isoflavones had about a 22% lower risk of breast cancer, this in a western population where about half of subjects eat soy at Asian levels.
Grant publications
- Vegetarian diets and the incidence of cancer in a low-risk population
- Vegetarian dietary patterns and mortality in Adventist Health Study-2
- Nutrient profiles of vegetarian and non-vegetarian dietary patterns
- Utilization of prostate cancer screening according to dietary patterns and other demographic variables. The Adventist Health Study-2
- Vegetarian dietary patterns and the risk of colorectal cancers
- Are strict vegetarians protected against prostate cancer?
- Tomato consumption and intake of lycopene as predictors of the incidence of prostate cancer: the Adventist Health Study-2