Adventist health study 2 vegan 30

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Vegetarian diets may result in differences in energy absorption and utilization that lead to differences in BMI. The results for diabetes mellitus reviewed here are interesting in that significant reductions in risk for vegetarians remained after BMI was controlled for. Some of this remaining effect may still be mediated by differences in adiposity not fully captured by BMI central adiposity, visceral adiposity ; however, mechanisms entirely independent of adiposity may also be in effect.

Differences in the intake of specific nutrients may mediate some of the effects of vegetarian dietary patterns. For example, vegetarians have higher intakes of potassium 3 , which is considered an important micronutrient for the prevention of hypertension. Tantamango-Bartley et al 9 provided a discussion of many possible mechanisms linking vegetarian dietary patterns to reduced cancer risk; in particular, they discussed the possibility that increased soy consumption among vegetarians could be relevant to their finding of a reduction in risk of female-specific cancers among vegans 9.

The primary aim of the AHS-2 is to investigate potential connections between dietary factors and the risk of specific cancers. To this end, we are attempting record linkages with the cancer registries of all 50 states and all Canadian provinces, something that, to our knowledge, has not previously been done.

This process is well advanced, and we anticipate important publications on the relation of diet to specific major cancers starting in We are hopeful that these ongoing and future analyses will add to our understanding of the relation of vegetarian dietary patterns to health and longevity. Neither of the authors declared a possible conflict of interest. Int J Epidemiol ; 37 : — 5. Google Scholar. Vegetarian dietary patterns and mortality in Adventist Health Study 2. J Acad Nutr Diet ; : — 9. Type of vegetarian diet, body weight, and prevalence of type 2 diabetes.

Diabetes Care ; 32 : — 6. Public Health Nutr ; 15 : — Vegetarian diets and cardiovascular risk factors in black members of the Adventist Health Study Vegetarian dietary patterns are associated with a lower risk of metabolic syndrome: the Adventist Health Study 2. Diabetes Care ; 34 : — 7. Vegetarian diets and incidence of diabetes in the Adventist Health Study Nutr Metab Cardiovasc Dis ; 23 : — 9.

Vegetarian diets and the incidence of cancer in a low-risk population. Cancer Epidemiol Biomarkers Prev ; 22 : — EPIC—Oxford: lifestyle characteristics and nutrient intakes in a cohort of 33 meat-eaters and 31 non meat-eaters in the UK. Public Health Nutr ; 6 3 : — Fraser GE. Associations between diet and cancer, ischemic heart disease, and all-cause mortality in non-Hispanic white California Seventh-day Adventists.

Protein consumption and bone fractures in women. Am J Epidemiol ; : — 9. Does dietary protein reduce hip fracture risk in elders? The Framingham Osteoporosis Study. Osteoporos Int ; 22 1 : — 9. Prospective study of dietary protein intake and risk of hip fracture in postmenopausal women. Am J Clin Nutr ; 69 : — A high ratio of dietary animal to vegetable protein increases the rate of bone loss and the risk of fracture in postmenopausal women.

Study of Osteoporotic Fractures Research Group. Am J Clin Nutr ; 73 : — The relation between dietary protein, calcium and bone health in women: results from the EPIC-Potsdam cohort. Ann Nutr Metab ; 49 : — 8. Nutrition ; 25 : — Effects of meat consumption and vegetarian diet on risk of wrist fracture over 25 years in a cohort of peri- and postmenopausal women. Public Health Nutr ; 11 : — Soy milk and dairy consumption is independently associated with ultrasound attenuation of the heel bone among postmenopausal women: the Adventist Health Study Nutr Res ; 31 : — Release Nutrient Data Laboratory Home Page.

Ten years of life: is it a matter of choice? Arch Intern Med ; : — A search for truth in dietary epidemiology. Primary prevention of cardiovascular disease with a Mediterranean diet. N Engl J Med ; : — Mediterranean diet, traditional risk factors, and the rate of cardiovascular complications after myocardial infarction. Circulation ; 99 : — A multicenter randomized controlled trial of a plant-based nutrition program to reduce body weight and cardiovascular risk in the corporate setting: the GEICO study.

Eur J Clin Nutr ; 67 : — Am J Health Promot ; 24 6 : — 7. A randomized clinical trial of a standard versus vegetarian diet for weight loss: the impact of treatment preference. Int J Obes Lond ; 32 : — A two-year randomized weight loss trial comparing a vegan diet to a more moderate low-fat diet. Obesity Silver Spring ; 15 : — Arch Intern Med ; 11 : — A low-fat vegan diet improves glycemic control and cardiovascular risk factors in a randomized clinical trial in individuals with type 2 diabetes.

Diabetes Care ; 29 : — Effects of plant-based diets on plasma lipids. Am J Cardiol ; : — Can lifestyle changes reverse coronary heart disease? Lancet ; : — Intensive lifestyle changes for reversal of coronary heart disease. JAMA ; 23 : — 7. Effect of a diet high in vegetables, fruit, and nuts on serum lipids. Metabolism ; 46 : — 7. Effectiveness of a low-fat vegetarian diet in altering serum lipids in healthy premenopausal women. Am J Cardiol ; 85 : — A low-fat vegan diet and a conventional diabetes diet in the treatment of type 2 diabetes: a randomized, controlled, wk clinical trial.

Toward improved management of NIDDM: a randomized, controlled, pilot intervention using a lowfat, vegetarian diet. Prev Med ; 29 : 87 — Vegetarian diets: what do we know of their effects on common chronic diseases? Craig WJ , Pinyan L. Nutrients of concern in vegetarian diets. Vegetarian nutrition. Google Preview. Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide.

Sign In or Create an Account. Sign In. ASN Journals. Advanced Search. Search Menu. Article Navigation. Close mobile search navigation Article Navigation. Volume Journal Article. Vegetarian diets in the Adventist Health Study 2: a review of initial published findings.

E-mail: morlich llu. Oxford Academic. Gary E Fraser. Select Format Select format. Permissions Icon Permissions. Open in new tab. Google Scholar Crossref. Search ADS. Google Scholar PubMed. Issue Section:. Download all slides. Views 8, More metrics information. Email alerts Article activity alert. Advance article alerts. New issue alert. Receive exclusive offers and updates from Oxford Academic. More on this topic Should dairy be recommended as part of a healthy vegetarian diet?

Vegetarian diets and children. Health aspects of vegetarian diets. Related articles in Web of Science Google Scholar. Related articles in PubMed Sexual and reproductive health education for patients with myelomeningocele.

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Search for terms. Save this study. Warning You have reached the maximum number of saved studies Plant-based Diets and Risk of Cancer in the Adventist Health Study-2 AHS-2 The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.

Federal Government. Read our disclaimer for details. Last Update Posted : November 14, View this study on Beta. Study Description.

The Adventist Health Study-2 is a long-term study, exploring the links between lifestyle, diet, and disease outcomes among Seventh-day Adventists. More than 96, church members from the U. Detailed Description:. The study is searching for associations between diet and risk of common and medium frequency cancers breast, prostate, colorectal, lung, uterus, pancreas, melanoma of skin.

This cohort is unusual in that about half are vegetarian, many eat soy at Asian levels, and many have very low or absent dairy intake while others eat normal amounts of dairy. Thus observations on these people, many of whom have contrasting dietary habits, may provide insights about diet and cancer, so supporting dietary changes that could be readily adopted by many. Outcome Measures.

Primary Outcome Measures : Incident cases of breast cancer among subjects with documented dietary habits. Eligibility Criteria. Information from the National Library of Medicine Choosing to participate in a study is an important personal decision. The sample includes Seventh-day Adventist church members living in the USA and Canada who are 30 years and older, and who are sufficiently fluent in English to complete the lengthy lifestyle questionnaire.

Incarcerated or institutionalized people Non-English speakers. Contacts and Locations. Information from the National Library of Medicine To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor. Please refer to this study by its ClinicalTrials.

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Residual methods were used to evaluate possible outliers and influential data points; no data points required removal. Multiple imputation of missing values was done for the small amount of missing data in the dietary variables used to calculate vegetarian status and for all covariates; a guided multiple-imputation approach was used when possible, 32 as we have evidence that many of the missing dietary data are true zeroes.

Guided multiple imputation was performed using R, version 2. Table 2 presents characteristics of the participants at baseline according to the 5 dietary patterns. Percentages and means were age-sex-race standardized as appropriate. Vegetarian groups tended to be older, more highly educated, and more likely to be married, to drink less alcohol, to smoke less, to exercise more, and to be thinner. The proportion of blacks was highest among pesco-vegetarians and lowest in lacto-ovo—vegetarians.

Of postmenopausal women, far fewer vegans were receiving hormone therapy. Mean reported duration of adherence to current dietary pattern not included in Table 2 was 21 years for vegans, 39 years for lacto-ovo—vegetarians, 19 years for pesco-vegetarians, 24 years for semi-vegetarians, and 48 years for nonvegetarians.

The mean SD follow-up time was 5. Table 3 gives the age-sex-race standardized mortality rates by dietary pattern. Vegans, lacto-ovo—vegetarians, and pesco-vegetarians had significantly lower mortality rates compared with nonvegetarians. Table 1 reports the comparison of multivariate-adjusted risk of death for all vegetarians combined with that for nonvegetarians.

Vegetarians had 0. In men, the hazard ratio HR was 0. For men, CVD mortality 0. In women, there were no significant reductions in these causal categories of mortality, although the effect estimates for IHD mortality, cancer mortality, and other mortality were moderately less than 1.

Table 4 reports the comparison of the multivariate-adjusted risk of death for 4 categories of vegetarians compared with nonvegetarians. In men and women combined, vegetarians had a significantly reduced risk of renal mortality HR, 0. Forty of 67 renal deaths were associated with renal failure for both sexes combined, HR, 0. Sixty-seven of endocrine deaths were associated with diabetes mellitus for both sexes combined, HR, 0. A sensitivity analysis in which body mass index was added to the model generally had only a modest effect on the results.

Overall HRs for vegetarians were then 0. The adjustment for body mass index did not consistently move results toward the null. Mortality results adjusted for body mass index affected statistical significance in the following instances. Additional adjustment by dietary energy intake resulted in negligible changes. These results demonstrate an overall association of vegetarian dietary patterns with lower mortality compared with the nonvegetarian dietary pattern. They also demonstrate some associations with lower mortality of the pesco-vegetarian, vegan, and lacto-ovo—vegetarian diets specifically compared with the nonvegetarian diet.

Some associations of vegetarian diets with lower cardiovascular mortality and lower noncardiovascular, noncancer mortality were observed.

Vegetarian diets have been associated with more favorable levels of cardiovascular risk factors, 17 , 22 - 25 , 36 , 37 and nutrient profiles of the vegetarian dietary patterns suggest possible reasons for reduced cardiovascular risk, such as lower saturated fat and higher fiber consumption.

These apparent protective associations seem consistent with previously published findings showing an association of vegetarian diets with reduced risk of incident diabetes 25 and of prevalent diabetes, hypertension, and metabolic syndrome. No significant associations with reduced cancer mortality were detected. The heterogeneous nature of cancer may obscure specific diet-cancer associations in analyses of combined cancer mortality, and lack of significance may reflect insufficient power to detect weaker associations at early follow-up.

Early analyses of vegetarian dietary patterns and cancer incidence in AHS-2 demonstrated significantly reduced risks of female-specific and gastrointestinal cancers. Effects were generally stronger and more significant in men than women. Previous studies 40 - 42 among Adventists have demonstrated effect modification by sex of the association of vegetarian diets with reduced ischemic heart disease mortality.

It is possible that within dietary groups the diets of men and women differ in important ways; however, a recent evaluation 38 of the nutrient profile of the dietary patterns in this cohort did not reveal striking differences. Alternatively, the biological effect of dietary factors on mortality may be different in men and women.

Future analysis will evaluate possible effect modification by sex for particular foods or nutrients, which may suggest sex-specific mechanisms. Strengths of this study include the large number of participants consuming various vegetarian diets; the diverse nature of this cohort in terms of sex, race, geography, and socioeconomic status, enhancing generalizability; the low use of tobacco and alcohol, making residual confounding from these unlikely; the shared religious affiliation of the cohort, which may lead to greater homogeneity across several possible unmeasured confounders, enhancing internal validity; and precise dietary pattern definitions based on measured food intake rather than self-identification of dietary patterns.

This analysis is limited by relatively early follow-up. If dietary patterns affect mortality, they may do so with moderate effect sizes, via complex pathways, and with long latency periods. Early follow-up analysis may thus have bias toward the null, and true associations may remain undetected. Observed mortality benefits may be affected by factors related to the conscious lifestyle choice of a vegetarian diet other than dietary components.

Potential for uncontrolled confounding remains. Dietary patterns may change over time, whereas the analysis relies on a single measurement of diet at baseline. Caution must be used in generalizing results to other populations in which attitudes, motivations, and applications of vegetarian dietary patterns may differ; dietary pattern definitions used may not reflect some common uses of these terms. Further study of the possible association with mortality of specific foods and nutrients that characterize the different diet-pattern groups is a major future goal of the AHS-2 study.

The lack of similar findings in British vegetarians 28 remains interesting, and this difference deserves careful study. In both cohorts, the nonvegetarians are a relatively healthy reference group. In both studies, the nutrient profiles of vegetarians differ in important ways from those of nonvegetarians, with vegetarians especially vegans consuming less saturated fat and more fiber. We believe that perceived healthfulness of vegetarian diets may be a major motivator of Adventist vegetarians.

More important, other large cohort studies have linked increased red and processed meat consumption to higher mortality, 18 , 19 , 45 and our findings build on this work by demonstrating reduced mortality in those consuming low-meat dietary patterns. Notably, the findings of the present study are similar to those of prior North American Adventist cohorts, demonstrating a consistent association over several decades and replicating prior results in a population with greater geographic and ethnic diversity.

In conclusion, in a large American cohort, we found that vegetarian dietary patterns were associated with lower mortality. The evidence that vegetarian diets, or similar diets with reduced meat consumption, may be associated with a lower risk of death should be considered carefully by individuals as they make dietary choices and by those offering dietary guidance.

Corresponding Author: Michael J. Published Online: June 3, Author Contributions: Drs Orlich and Fraser had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Conflict of Interest Disclosures: Dr Orlich reports receiving a small honorarium from the Northern California Conference of Seventh-day Adventists to partially defray travel expenses for a speaking engagement at which he gave an overview and update of Adventist Health Studies research and a small honorarium from the Southern California Conference of Seventh-day Adventists for a speaking engagement at which he lectured on lifestyle approaches for chronic disease prevention.

The ideas and opinions expressed herein are those of the authors, and endorsement by the NCI, NIFA, or their contractors or subcontractors is not intended nor should it be inferred.

Previous Presentation: These findings were presented in a brief oral presentation at the Society for Epidemiologic Research annual meeting; June 28, ; Minneapolis, Minnesota. Table 1. View Large Download. Table 2. Table 3. Table 4. Table 5. Nut consumption, vegetarian diets, ischemic heart disease risk, and all-cause mortality: evidence from epidemiologic studies. Am J Clin Nutr. PubMed Google Scholar. Am J Epidemiol. PubMed Google Scholar Crossref. Consumption of polyunsaturated fatty acids, fish, and nuts and risk of inflammatory disease mortality.

Ten years of life: is it a matter of choice? Arch Intern Med. Differences in overall mortality in the elderly may be explained by diet. A prospective study of dietary patterns and mortality in Chinese women. Association between reported diet and all-cause mortality: twenty-one—year follow-up on 27, adult Seventh-day Adventists.

Adherence to a Mediterranean diet and survival in a Greek population. N Engl J Med. Comparison of three different dietary scores in relation to year mortality in elderly European subjects: the HALE project. Eur J Clin Nutr. Accruing evidence on benefits of adherence to the Mediterranean diet on health: an updated systematic review and meta-analysis.

Dietary patterns and survival in older Dutch women. Healthy food and nutrient index and all cause mortality. Eur J Epidemiol. Public Health Nutr. Low-carbohydrate diets and all-cause and cause-specific mortality: two cohort studies.

Ann Intern Med. Mortality in vegetarians and nonvegetarians: detailed findings from a collaborative analysis of 5 prospective studies. Fraser GE. Associations between diet and cancer, ischemic heart disease, and all-cause mortality in non-Hispanic white California Seventh-day Adventists. Meat intake and mortality: a prospective study of over half a million people.

Red meat consumption and mortality: results from 2 prospective cohort studies. How much should we eat? Hypertension and blood pressure among meat eaters, fish eaters, vegetarians and vegans in EPIC-Oxford.

Vegetarian dietary patterns are associated with a lower risk of metabolic syndrome: the Adventist Health Study 2. Although analyses were adjusted for race and other factors, it was not stated if this was true separately in black individuals.

This diet has a reduced amount of meat and more fruit, vegetables and whole grains than a typical US diet. Protective associations between vegetarian diets and high BP are consistent with studies of non-black populations. Several small experimental studies 39 — 42 and larger observational studies 43 , including white participants in AHS-2 14 , have generally found similar results to those that we report here in black North Americans.

Further, studies of non-vegetarians have often, in multivariate analyses, associated plant foods such as whole grains, fruits, etc. The mechanisms underlying the effect of vegetarian diets on hypertension are unclear.

However, the greater intakes of K, other minerals and fibre in vegetarian diets have been postulated to reduce BP 44 , as have higher intakes of the minerals, Ca, K, Mg and P It is possible that meat appears to increase the risk of hypertension because of its association with fewer vegetables and fruits.

As found by others 43 , it also seems clear in our data that a large part of this effect is related to the lower BMI among vegetarians. Plant foods are also known to protect against insulin resistance which in turn is related to hypertension and other risk factors for heart disease In black participants from the parent AHS-2 cohort, Tonstad et al.

A few other cohorts have found that certain foods, often those preferentially consumed by vegetarians, were associated with lower risk of diabetes in black individuals.

The ARIC Atherosclerosis Risk in Communities study found a protective association between cereal fibre and diabetes risk in both white and black participants, but this was not statistically significant among the blacks However, in the CARDIA study where half of the subjects were black those following the Dietary Guidelines for Americans had increased insulin resistance compared with others in this population Studies of vegetarian diets from other populations, and risk of diabetes in black or non-black individuals, are rare, although much is known of the use of such diets in the treatment and control of diabetes A previous cohort of US Adventists has provided strong positive associations between intake of meat and incidence of diabetes Several mechanisms are postulated for the beneficial effects of the vegetarian diet on diabetes risk.

Undoubtedly the most important is the lower rates of overweight associated with these diets, and in our data, the magnitude of the effect is diminished after adjustment for BMI. Vegetarian diets usually also have lower glycaemic load, which is known to decrease risk of diabetes Red meats increase insulin resistance, an effect possibly mediated by saturated fats In addition, fruit and vegetable intake is associated with reduced oxidative stress and inflammation, possible precursors of diabetes Other studies of effects of vegetarian diets on lipid levels in black populations are rare.

Toohey et al. In our study, because of the small number of vegans, we combined these two dietary patterns. Melby et al. Very similar results were demonstrated by Famodu et al. Dietary fibre and phytosterols, found only in plant foods, also have a well-established but modest effect to lower serum cholesterol 60 , whereas red meat raises it Thus there is every reason to expect a more favourable lipid profile among vegetarians, which has usually been found 61 — The risk of abdominal adiposity was similarly much reduced in both vegetarian dietary patterns.

Brathwaite et al. That vegetarians are less overweight has been shown in several non-black research populations 53 , 64 , The mechanisms are unclear but probably include the higher energy density of meats and characteristics of plant foods that replace them in a vegetarian diet. We adjusted for differences in physical activity in the present study. Differences in energy intake by dietary pattern appear to be small This is because drug treatment lowers values to an unpredictable extent, perhaps to below normal values in some cases, thus potentially obscuring any dietary effect within the normal range.

Even with this exclusion, differences between dietary patterns may be diminished as individuals with more severe abnormality are often excluded. Smaller numbers of participants may also impact statistical significance. The study has the weakness of being cross-sectional, which does not establish causality. However, most Adventists with health problems will most likely change towards vegetarianism rather than in the opposite direction because of church recommendations on lifestyle. This is indicated by data from AHS-2 M Martins and GE Fraser, unpublished results that show strong within-subject trends towards lower animal food intake with ageing.

Such dietary changes due to poor health would bias our findings towards the null. A strength of the study is the relatively large sample size of black participants with high-quality dietary data and the careful risk factor assessment.

In summary, we provide evidence that black vegetarians show less hazardous values of several established cardiovascular risk factors when compared with non-vegetarians. This would be expected to translate into reduced risk of heart attack, stroke and renal failure. Being cross-sectional, our results do not prove a causal association with vegetarianism, but provide some evidence for this.

Conflict of interest: None of the authors has a conflict of interest to report. Knutsen contributed to the study design, assisted with data collection and reviewed the manuscript. Katuli wrote part of the manuscript and reviewed the manuscript. Jing Fan contributed to the data analysis and reviewed the manuscript. Public Health Nutr. Author manuscript; available in PMC Feb 1. Author information Copyright and License information Disclaimer.

Copyright notice. The publisher's final edited version of this article is available at Public Health Nutr. Abstract Objective To compare cardiovascular risk factors between vegetarians and non-vegetarians in black individuals living in the USA. Conclusions As with non-blacks, these results suggest that there are sizeable advantages to a vegetarian diet in black individuals also, although a cross-sectional analysis cannot conclusively establish cause. Keywords: Vegetarian diet, Cardiovascular risks, Blacks, Adventists.

Experimental methods Four hundred and seven black women and black men were selected for the present study, which is nested within the Adventist Health Study-2 AHS-2 cohort. Data analysis The odds ratios of prevalent hypertension, diabetes, larger WC and high lipid levels, comparing dietary patterns, were estimated by the use of logistic regression.

Results The baseline demographics of the participants, stratified by dietary pattern, are summarized in Table 1. Table 1 Relationship of selected demographic factors to dietary patterns among black participants in the Adventist Health Study-2 AHS Open in a separate window.

Hypertension and diet Of the participants, were classified as hypertensive and of these were taking anti-hypertensive medications. Diabetes and diet Of participants, eighty-five were classified as diabetic and fifty-six of these were taking diabetic medications.

BMI, waist circumference and diet Results are computed separately for males and females as we found that the average BMI in females was significantly higher than that of males. Discussion We found that black vegans and lacto-ovo-vegetarians as a combined category had significantly lower prevalences of major CVD risk factors compared with non-vegetarian black Adventists. Conclusion In summary, we provide evidence that black vegetarians show less hazardous values of several established cardiovascular risk factors when compared with non-vegetarians.

Footnotes Conflict of interest: None of the authors has a conflict of interest to report. References 1. Deaths: final data for Natl Vital Stat Rep.

Global burden of cardiovascular diseases. National Association for the Advancement of Colored People. Kannel WB. Blood pressure as a cardiovascular risk factor: prevention and treatment. Watson KE. Cardiovascular risk reduction among African Americans: a call to action. J Natl Med Assoc.

Willett WC. Dietary fats and coronary heart disease. J Intern Med. Reduction in blood pressure associated with high polyunsaturated fat diets that reduce blood cholesterol in man. Prey Med.

Scoring systems for evaluating dietary pattern effect on serum cholesterol. Prev Med. Oliver MF. It is more important to increase the intake of unsaturated fats than to decrease the intake of saturated fats: evidence from clinical trials relating to ischemic heart disease. Am J Clin Nutr. Diet, nutrition and the prevention of hypertension and cardiovascular diseases. Dietary patterns and cardiovascular disease.

Proc Nutr Soc. Fraser GE. Vegetarian diets and incidence of diabetes in the Adventist Health Study Nutr Metab Cardiovasc Dis. Vegetarian diets: what do we know of their effects on common chronic diseases? Craig WJ. Nutrition concerns and health effects of vegetarian diets.

Nutr Clin Pract. Blood pressure in Seventh-day Adventist vegetarians. Am J Epidemiol. Blood pressure and blood lipids among vegetarian, semivegetarian, and nonvegetarian African Americans. Blood pressure differences in older black and white long-term vegetarians and nonvegetarians. J Am Coll Nutr. Blood pressure and blood lipid levels among vegetarian, semi-vegetarian, and non-vegetarian native Africans.

Clin Biochem. The influence of a vegetarian diet on haemostatic risk factors for cardiovascular disease in Africans. Tbromb Res. Kulkani KD. Food, culture, and diabetes in the United States. Clin Diabetes. Prevalence and trends in obesity among US adults, — Recruiting black Americans in a large cohort study: the Adventist Health Study-2 AHS-2 design, methods and participant characteristics.

Etbn Dis. Blood Press Monit. Fraser G, Yan R. Guided multiple imputation of missing data: using a subsample to strengthen the missing-at-random assumption.

Nutrient profiles of vegetarian and nonvegetarian dietary patterns. J Acad Nutr Diet.

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It is possible that within dietary groups the diets of men and women differ in important ways; however, a recent evaluation 38 of the nutrient profile of the dietary patterns in this cohort did not reveal striking differences. Alternatively, the biological effect of dietary factors on mortality may be different in men and women.

Future analysis will evaluate possible effect modification by sex for particular foods or nutrients, which may suggest sex-specific mechanisms. Strengths of this study include the large number of participants consuming various vegetarian diets; the diverse nature of this cohort in terms of sex, race, geography, and socioeconomic status, enhancing generalizability; the low use of tobacco and alcohol, making residual confounding from these unlikely; the shared religious affiliation of the cohort, which may lead to greater homogeneity across several possible unmeasured confounders, enhancing internal validity; and precise dietary pattern definitions based on measured food intake rather than self-identification of dietary patterns.

This analysis is limited by relatively early follow-up. If dietary patterns affect mortality, they may do so with moderate effect sizes, via complex pathways, and with long latency periods. Early follow-up analysis may thus have bias toward the null, and true associations may remain undetected. Observed mortality benefits may be affected by factors related to the conscious lifestyle choice of a vegetarian diet other than dietary components.

Potential for uncontrolled confounding remains. Dietary patterns may change over time, whereas the analysis relies on a single measurement of diet at baseline. Caution must be used in generalizing results to other populations in which attitudes, motivations, and applications of vegetarian dietary patterns may differ; dietary pattern definitions used may not reflect some common uses of these terms.

Further study of the possible association with mortality of specific foods and nutrients that characterize the different diet-pattern groups is a major future goal of the AHS-2 study. The lack of similar findings in British vegetarians 28 remains interesting, and this difference deserves careful study. In both cohorts, the nonvegetarians are a relatively healthy reference group. In both studies, the nutrient profiles of vegetarians differ in important ways from those of nonvegetarians, with vegetarians especially vegans consuming less saturated fat and more fiber.

We believe that perceived healthfulness of vegetarian diets may be a major motivator of Adventist vegetarians. More important, other large cohort studies have linked increased red and processed meat consumption to higher mortality, 18 , 19 , 45 and our findings build on this work by demonstrating reduced mortality in those consuming low-meat dietary patterns. Notably, the findings of the present study are similar to those of prior North American Adventist cohorts, demonstrating a consistent association over several decades and replicating prior results in a population with greater geographic and ethnic diversity.

In conclusion, in a large American cohort, we found that vegetarian dietary patterns were associated with lower mortality. The evidence that vegetarian diets, or similar diets with reduced meat consumption, may be associated with a lower risk of death should be considered carefully by individuals as they make dietary choices and by those offering dietary guidance. Corresponding Author: Michael J. Published Online: June 3, Author Contributions: Drs Orlich and Fraser had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Conflict of Interest Disclosures: Dr Orlich reports receiving a small honorarium from the Northern California Conference of Seventh-day Adventists to partially defray travel expenses for a speaking engagement at which he gave an overview and update of Adventist Health Studies research and a small honorarium from the Southern California Conference of Seventh-day Adventists for a speaking engagement at which he lectured on lifestyle approaches for chronic disease prevention.

The ideas and opinions expressed herein are those of the authors, and endorsement by the NCI, NIFA, or their contractors or subcontractors is not intended nor should it be inferred.

Previous Presentation: These findings were presented in a brief oral presentation at the Society for Epidemiologic Research annual meeting; June 28, ; Minneapolis, Minnesota. Table 1. View Large Download.

Table 2. Table 3. Table 4. Table 5. Nut consumption, vegetarian diets, ischemic heart disease risk, and all-cause mortality: evidence from epidemiologic studies. Am J Clin Nutr. PubMed Google Scholar. Am J Epidemiol.

PubMed Google Scholar Crossref. Consumption of polyunsaturated fatty acids, fish, and nuts and risk of inflammatory disease mortality. Ten years of life: is it a matter of choice? Arch Intern Med. Differences in overall mortality in the elderly may be explained by diet.

A prospective study of dietary patterns and mortality in Chinese women. Association between reported diet and all-cause mortality: twenty-one—year follow-up on 27, adult Seventh-day Adventists.

Adherence to a Mediterranean diet and survival in a Greek population. N Engl J Med. Comparison of three different dietary scores in relation to year mortality in elderly European subjects: the HALE project. Eur J Clin Nutr. Accruing evidence on benefits of adherence to the Mediterranean diet on health: an updated systematic review and meta-analysis.

Dietary patterns and survival in older Dutch women. Healthy food and nutrient index and all cause mortality. Eur J Epidemiol. Public Health Nutr. Low-carbohydrate diets and all-cause and cause-specific mortality: two cohort studies. Ann Intern Med. Mortality in vegetarians and nonvegetarians: detailed findings from a collaborative analysis of 5 prospective studies.

Fraser GE. Associations between diet and cancer, ischemic heart disease, and all-cause mortality in non-Hispanic white California Seventh-day Adventists. Meat intake and mortality: a prospective study of over half a million people. Red meat consumption and mortality: results from 2 prospective cohort studies. How much should we eat? Hypertension and blood pressure among meat eaters, fish eaters, vegetarians and vegans in EPIC-Oxford.

Vegetarian dietary patterns are associated with a lower risk of metabolic syndrome: the Adventist Health Study 2. Diabetes Care. Type of vegetarian diet, body weight, and prevalence of type 2 diabetes. Vegetarian diets and incidence of diabetes in the Adventist Health Study Nutr Metab Cardiovasc Dis. Diet and the risk of coronary heart disease. In: Fraser GE, ed. Diet, Life Expectancy, and Chronic Disease.

Chronic disease among Seventh-day Adventists, a low-risk group: rationale, methodology, and description of the population. Int J Epidemiol. Google Scholar. Fraser GE, Yan R. Guided multiple imputation of missing data: using a subsample to strengthen the missing-at-random assumption.

Missing data in a long food frequency questionnaire: are imputed zeroes correct? Team RDC. R: a language and environment for statistical computing. Accessed April 29, Hmisc: Harrell Miscellaneous. Health benefits of a vegetarian diet. Proc Nutr Soc. Differences and similarities in dietary pattern and nutrient profiles between the sexes and blacks and whites: the Adventist Health Study 2 [abstract P].

Accessed December 1, Vegetarian diets and the incidence of cancer in a low-risk population [published online November 20, ]. Cancer Epidemiol Biomarkers Prev. Diet as primordial prevention in Seventh-day Adventists. Prev Med. A possible protective effect of nut consumption on risk of coronary heart disease: the Adventist Health Study. Meat consumption and fatal ischemic heart disease. EPIC-Oxford: lifestyle characteristics and nutrient intakes in a cohort of 33 meat-eaters and 31 non meat-eaters in the UK.

Vegetarian diets: what do we know of their effects on common chronic diseases? Diet, other risk factors, and aging. Does low meat consumption increase life expectancy in humans?

Lack of Adjustment for Body Mass Index. Save Preferences. Privacy Policy Terms of Use. This Issue. Views , The study has the weakness of being cross-sectional, which does not establish causality. However, most Adventists with health problems will most likely change towards vegetarianism rather than in the opposite direction because of church recommendations on lifestyle.

This is indicated by data from AHS-2 M Martins and GE Fraser, unpublished results that show strong within-subject trends towards lower animal food intake with ageing.

Such dietary changes due to poor health would bias our findings towards the null. A strength of the study is the relatively large sample size of black participants with high-quality dietary data and the careful risk factor assessment.

In summary, we provide evidence that black vegetarians show less hazardous values of several established cardiovascular risk factors when compared with non-vegetarians. This would be expected to translate into reduced risk of heart attack, stroke and renal failure.

Being cross-sectional, our results do not prove a causal association with vegetarianism, but provide some evidence for this. Conflict of interest: None of the authors has a conflict of interest to report. Knutsen contributed to the study design, assisted with data collection and reviewed the manuscript. Katuli wrote part of the manuscript and reviewed the manuscript.

Jing Fan contributed to the data analysis and reviewed the manuscript. Public Health Nutr. Author manuscript; available in PMC Feb 1. Author information Copyright and License information Disclaimer. Copyright notice. The publisher's final edited version of this article is available at Public Health Nutr. Abstract Objective To compare cardiovascular risk factors between vegetarians and non-vegetarians in black individuals living in the USA.

Conclusions As with non-blacks, these results suggest that there are sizeable advantages to a vegetarian diet in black individuals also, although a cross-sectional analysis cannot conclusively establish cause. Keywords: Vegetarian diet, Cardiovascular risks, Blacks, Adventists. Experimental methods Four hundred and seven black women and black men were selected for the present study, which is nested within the Adventist Health Study-2 AHS-2 cohort. Data analysis The odds ratios of prevalent hypertension, diabetes, larger WC and high lipid levels, comparing dietary patterns, were estimated by the use of logistic regression.

Results The baseline demographics of the participants, stratified by dietary pattern, are summarized in Table 1. Table 1 Relationship of selected demographic factors to dietary patterns among black participants in the Adventist Health Study-2 AHS Open in a separate window. Hypertension and diet Of the participants, were classified as hypertensive and of these were taking anti-hypertensive medications. Diabetes and diet Of participants, eighty-five were classified as diabetic and fifty-six of these were taking diabetic medications.

BMI, waist circumference and diet Results are computed separately for males and females as we found that the average BMI in females was significantly higher than that of males. Discussion We found that black vegans and lacto-ovo-vegetarians as a combined category had significantly lower prevalences of major CVD risk factors compared with non-vegetarian black Adventists. Conclusion In summary, we provide evidence that black vegetarians show less hazardous values of several established cardiovascular risk factors when compared with non-vegetarians.

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