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The Public Health Risk-to-Benefit Ratio of Vegetarian Diets: Changing Paradigms

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... The early model on the adequacy of vegetarian diets and public health risks and benefits (Fig. 2), which prevailed for the first part of the 20 th century, illustrated that if a population followed a vegetarian diet, that population would be more prone to develop nutri- ent deficiency diseases than those that followed a diet based on animal foods (Sabaté, 2001). This model was rightly termed the model on the adequacy of vegetarian diets because it was based on the available knowledge at a time of numerous nutrient deficiencies being recorded in clinical trials on vegetarians. ...
... The current model (Fig. 3), termed the model on the public health risks and benefits of vegetarian and meat-based diets, indicates the health risks and benefits of vegetarian and meat based diets (Sabaté, 2001). The area under each curve represents the proportion of the population for which a given diet pattern may be risky or beneficial to optimal health. ...
... Since a major public health educational objective is to bring about dietary changes to increase the plant based food in the American diet, a new model has been proposed (Fig.4) to indicate the public health risks and benefits of a plant-based and meat-based diet based on the epidemiological, clinical and basic science research on the potential health benefits of numerous plant foods and phytochemicals (Sabaté, 2001). This proposed new model attempts to capture the new understanding of the roles vegetarian and meat-based diets play in human health and disease. ...
Article
Vegetarianism dates back to a time before recorded history and, as many anthropologists believe, most early humans ate primarily plant foods, being more gatherers than hunters. Human diets may be adopted for a variety of reasons, including political, esthetic, moral, environmental and economic concerns, religious beliefs, and a desire to consume a more healthy diet. A major factor influencing the vegetarianism movement in the present time is primarily associated with better health. Epidemiologic data support the association between high intake of vegetables and fruit and low risk of chronic diseases and provide evidence to the profound and long-term health benefits of a primarily vegetarian diet. Vegetables and fruit are rich sources of nutrients, vitamins, minerals, and dietary fiber as well as biologically active nonnutrient compounds that have a complementary and often multiple mechanisms of actions, including antioxidant, anti-inflammatory, hypoglycemic, hypocholesterolemic, and hypolipidemic properties, and mechanisms that stimulate the human immune system. Because of the critical link established between diet and health, consumers have begun to view food as a means of self-care for health promotion and disease prevention. Functional foods are targeted to address specific health concerns, such as high cholesterol or high blood sugar levels, to obtain a desired health benefit. Functional properties identified in a number of plant species have led to a modern day renaissance for the vegetarian movement.
... Angka ini merupakan sebagian kecil dari jumlah penganut vegetarian yang sesungguhnya di Indonesia, karena tidak semua penganut vegetarian terdaftar sebagai anggota IVS. 1 Alasan kesehatan menjadi salah satu dari beberapa alasan utama yang menyebabkan pola hidup vegetarian semakin banyak diminati oleh masyarakat, terutama masyarakat pada kalangan usia dewasa. 2 Studi epidemiologi gizi menunjukkan bahwa diet vegetarian bermanfaat untuk mengurangi risiko serta angka kematian penyakit kronis degeneratif seperti penyakit kardiovaskuler, diabetes mellitus, dan kanker. 3 Suatu penelitian yang melakukan analisis kolaborasi dari lima hasil studi prospektif, dimana masing-masing studi tersebut mencakup jumlah subyek yang besar, juga menunjukkan bahwa vegetarian memiliki angka kematian penyakit jantung iskemik sebanyak 24% lebih rendah dibanding non-vegetarian. 4 Diet vegetarian yang dijalani oleh masyarakat terdiri dari beberapa tipe, dan setiap tipe dari diet tersebut dapat memberikan besar manfaat yang berbeda terhadap kesehatan. ...
Article
Background: Studies which investigated different risk for cardiovascular disease in vegetarian reported that each vegetarian diet type had different lipid serum level. Elevated LDL cholesterol level and reduced HDL cholesterol level are independent risk factors for coronary heart disease. This study was aimed to compare levels on LDL and HDL cholesterol between vegetarian vegan and non-vegan.Methods: Two groups of vegetarian women, 23 people in each group of vegan and non-vegan, participated in this cross-sectional study. The data taken of each subject were nutrient intakes (total fat, PUFA, MUFA, SFA, cholesterol, and total fiber), physical activity, body weight, height, LDL and HDL cholesterol serum levels. Data were analyzed by Shapiro-Wilk test, independent-t test, Mann-Whitney test and ANACOVA test.Results: There were no significant differences on LDL and HDL cholesterol serum levels between vegetarian vegan and non-vegan, both before and after variables i.e age, physical activity, body mass index (BMI), amount of total fat, PUFA, MUFA, SFA, cholesterol, and total fiber adjusted (p > 0,05). LDL cholesterol levels for vegetarian vegan and non-vegan were respectively: 97,8 ± 54,87 mg/dl and 112,6 ± 36,03 mg/dl, while for HDL cholesterol, those levels were 54,9 ± 11,15 mg/dl and 55,2 ± 10,82 mg/dl. In multivariant analysis, the most influential variables on LDL cholesterol serum level were age (p = 0,001) and physical activity (p = 0,010), while for HDL serum cholesterol were BMI (p = 0,010) and total fat (p = 0,012). This study also found the significant difference of BMI between vegetarian vegan and non-vegan (p = 0,011), whose for each of groups’ BMI, were respectively: 20,9 ± 3,08 kg/m2 and 23,5 ± 3,53 kg/m2. Conclusion: LDL and HDL cholesterol serum levels are not different between vegetarian vegan and non-vegan. BMI of both groups is different. Age and physical activity affect on LDL serum cholesterol level, while BMI and total fat affect on HDL serum cholesterol level. LDL cholesterol serum level and BMI in vegetarian vegan are lower than non-vegan. Key words: Vegetarian diet, vegan, non-vegan, LDL cholesterol, HDL cholesterol
... Finally, RBA related to diets, such as the Mediterranean diet (Brief Critical Reviews -Mediterranean Diet and Coronary Heart Disease: Are Antioxidants Critical?, 1999; Grosso et al., 2014), a raw diet (Cunningham, 2004), vegetarianism (Dagnelie, 2003;Sabate, 2001), and baby food infant formulae or breastfeeding (de Zegher et al., 2013;Fewtrell et al., 2013;Frank and Newman, 1993;Goldman et al., 2007;Harris and Highland, 1979;Mead, 2008;Serreau et al., 2011), could be of interest. ...
Thesis
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The objective of the present PhD project was to develop a conceptual and methodological framework to assess quantitatively the overall impact of food on human health, including microbiological, chemical and nutritional dimensions. This methodology was developed using a case study on infant milk-based diet (breast milk and infant formulas) taking into account the following selected factors: Cronobacter sakazakii, Cryptosporidium, arsenic, dioxin like polychlorinated biphenyls and docosahexaenoic acid. Five probabilistic mathematical models were developed to quantify risks / benefits associated with these factors. When possible, they were harmonised using a common public health indicator, the DALY. Results were obtained by second-order Monte Carlo simulation in order to quantify separately the uncertainty and the variability. Probabilistic techniques enabled to take into account on the one hand the biology related to variability (heterogeneity between individuals of the same population) and on the other hand the uncertainty linked to the lack of knowledge and data. In addition, separation of variability and uncertainty strengthened the evaluation by enabling a more accurate interpretation of results and by providing more comprehensive information for policy makers. The method used in this PhD thesis can be considered as a robust basis for other case studies and can be used to continue methodological development in risk-benefit assessment. This approach is also part of a broader area: the multi-criteria decision analysis of agronomic and food systems.
... Veel vegetariërs kiezen voor deze leefstijl (ook) vanwege de persoonlijke gezondheid of de gezondheid van de gezinsleden. Een wat oudere Amerikaanse studie uit 1992 laat zien dat 46% van de vegetariërs voor deze leefstijl koos vanuit gezondheidsmotieven, maar ook dat 15% ervoor koos vanwege dierenrechten, 5% vanuit ethische motieven en 4% vanwege milieuredenen (Pribis et al. 2010: 524;Sabaté 2001). Meestal spelen verschillende motieven naast elkaar een rol. ...
... Over recent years a number of epidemiological and clinical trials have established a strong link between the intake of fruit and vegetables and reducing the risk of several chronic diseases, cancer, and heart disease (Palaniswamy, 2003), for numerous plant foods and phytochemicals (Sabaté, 2001). ...
Article
Full-text available
The genetic and production improvement research programme for Gevuina avellana (Gevuin), a tree native to Chile, has developed high productivity and quality clones of edible nuts with interesting results with respect to nut characteristics, yield, nutrition and phytotherapy purposes. Total fat and fatty acids, and especially mono-unsaturated fatty acids, are very important in the antioxidant complex. During 2001 and 2002, nuts from nine selected clones were analyzed to determine their lipid composition and the degree of variability among clones. After oil Soxhlet extraction, fatty acid methyl esters (FAME) were prepared by reacting the oil in n-hexane with a methanolic solution. FAME were determined in a Hewlett Packard 5890 (II) with a flame ionization detector. Significant differences in kernel oil were found among clones with respect to total fat, total saturated fatty acids and the unsaturated/ saturated ratio. The greatest in terms of mean isomer quantity was oleic fatty acid (C18:1∆ 9 = 35.32%). The hexadecenoic fatty acid (C16:1) content was the only monounsaturated fatty acid that showed significant differences among clones, with values ranging between 21.73 to 23.72%. The highest clonal value of C 16:1 in 2001 year was 24.38%, and had the following isomer proportions: ∆ 11 (23.83%), ∆ 9 (0.50%) and a third undetermined (0.05%). Total fat in the pericarp (shell) was very much lower (0.91%) than in cotyledons (46.67%), and fatty acids were found in different proportions to those in the kernel. There was variability in the UV radiation absorbance of the kernel oil obtained using the cold extrusion process. The results show the importance of clonal selection in Gevuin because there was evidence of genetic variation among clones in relation to content and quality of total fat and fatty acids in kernel oil.
... Over recent years a number of epidemiological and clinical trials have established a strong link between the intake of fruit and vegetables and reducing the risk of several chronic diseases, cancer, and heart disease (Palaniswamy, 2003), for numerous plant foods and phytochemicals (Sabaté, 2001). ...
Article
Full-text available
The genetic and production improvement research programme for Gevuina avellana (Gevuin), a tree native to Chile, has developed high productivity and quality clones of edible nuts with interesting results with respect to nut characteristics, yield, nutrition and phytotherapy purposes. Total fat and fatty acids, and especially mono-unsaturated fatty acids, are very important in the antioxidant complex. During 2001 and 2002, nuts from nine selected clones were analyzed to determine their lipid composition and the degree of variability among clones. After oil Soxhlet extraction, fatty acid methyl esters (FAME) were prepared by reacting the oil in n-hexane with a methanolic solution. FAME were determined in a Hewlett Packard 5890 (II) with a flame ionization detector. Significant differences in kernel oil were found among clones with respect to total fat, total saturated fatty acids and the unsaturated/ saturated ratio. The greatest in terms of mean isomer quantity was oleic fatty acid (C18:1∆ 9 = 35.32%). The hexadecenoic fatty acid (C16:1) content was the only monounsaturated fatty acid that showed significant differences among clones, with values ranging between 21.73 to 23.72%. The highest clonal value of C 16:1 in 2001 year was 24.38%, and had the following isomer proportions: ∆ 11
... Finally, RBA related to diets, such as the Mediterranean diet [122,123], a raw diet [124], vegetarianism [125,126], and baby food infant formulae or breastfeeding [127][128][129][130][131][132][133], could be of interest. ...
Article
Full-text available
Background: In the food safety field, risk assessment, including microbial and chemical components, has been applied for many years. However, a whole and integrated public health assessment also depends on the nutritional composition of food. While the fact that foods and diets can be a source of both risks and benefits now appears undisputed, carrying out a risk-benefit assessment (RBA) is still an emerging and challenging scientific subject. Aims: The purpose of the present review was to synthesize RBA studies associated with food consumption and to summarize the current methodological options and/or tendencies carried out in this field. Methods: The different data sources explored included around 20 accessible databases using the main terms “risk”, “benefit” and “food” as keyword enquiries in article title and full-text. The initial research process led to 3293 screened papers, 160 of which were examined in detail. Results: There were 126 articles dealing with RBA studies and 34 with the RBA methodological framework. Most of the available papers dealt with the comparison of nutritional beneficial effects
... This heralded the replacement of one conceptual world view by another, commonly called a paradigm shift. The recognition of this paradigm shift toward vegetarian diets was first documented by Joan Sabaté of Loma Linda University (10,11). This paradigm shift took place in various phases and was illustrated by Sabaté in 3 graphical models. ...
Article
Early human food cultures were plant-based. Major religions such as Hinduism and Buddhism have recommended a vegetarian way of life since their conception. The recorded history of vegetarian nutrition started in the sixth century bc by followers of the Orphic mysteries. The Greek philosopher Pythagoras is considered the father of ethical vegetarianism. The Pythagorean way of life was followed by a number of important personalities and influenced vegetarian nutrition until the 19th century. In Europe, vegetarian nutrition more or less disappeared during the Middle Ages. In the Renaissance era and in the Age of Enlightenment, various personalities practiced vegetarianism. The first vegetarian society was started in England in 1847. The International Vegetarian Society was founded in 1908 and the first vegan society began in 1944. Prominent vegetarians during this time included Sylvester Graham, John Harvey Kellogg, and Maximilian Bircher-Benner. A paradigm shift occurred at the turn of the 21st century. The former prejudices that vegetarianism leads to malnutrition were replaced by scientific evidence showing that vegetarian nutrition reduces the risk of most contemporary diseases. Today, vegetarian nutrition has a growing international following and is increasingly accepted. The main reasons for this trend are health concerns and ethical, ecologic, and social issues. The future of vegetarian nutrition is promising because sustainable nutrition is crucial for the well-being of humankind. An increasing number of people do not want animals to suffer nor do they want climate change; they want to avoid preventable diseases and to secure a livable future for generations to come.
... (Asymptotic is a curve whose distance to a given line tends to zero.) A review of the scientific literature of the last fifty years clearly shows that many nutrition concepts and ideas are coming progressively closer to the corresponding Adventist notions (Sabaté, 2001). This convergence is so evident in the last few years that one gets the impression that nutritionists are " catching up " with Adventists. ...
... Scientific progress in nutrition research leads to an improvement in the knowledge about vegetarian nutrition. In early nutrition studies, the potential health risks of vegetarian diets were often overestimated (Sabaté 2001). In the 1960s and 1970s nutrient deficiency diseases were more prevalent than nowadays. ...
Article
Das Ziel dieser Studie war eine Untersuchung des Ernährungszustands von buddhistischen Nonnen in Südkorea. Die Ergebnisse wurden mit Daten von koreanischen Mischköstlern verglichen. Gemäß den Einschlusskriterien, waren 54 vegetarische buddhistische Nonnen, 31 katholische Nonnen und 31 Studentinnen, die eine Mischkost verzehrten, in die Untersuchung eingebunden. Die Nährstoffaufnahme der buddhistischen Vegetarier war vergleichbar mit der von Mischköstlern, wobei die Aufnahme der meisten Nährstoffe bei den Vegetariern besser war als bei den Mischköstlern. Es gab keine Unterschiede bezüglich Körpergröße und Körpergewicht zwischen den drei Gruppen, dennoch hatten die Vegetarier ein signifikant höheres Körpergewicht, eine höhere fettfreie Körpermasse und einen höheren BMI (kg/m²) als beide Mischkostgruppen. Bei den Vegetariern war der Körperfettgehalt negativ mit der Dauer des Vegetarismus korreliert, die zwischen 3 bis 34 Jahren lag. Die buddhistischen Vegetarier hatten einen niedrigeren Gesamtcholesterin- und HDL-Cholesterin-Wert als beide Mischkostgruppen. Die Triglycerid-Werte der buddhistischen Vegetarier unterschieden sich nicht von denen der Mischkostgruppen. Es gab keine signifikanten Unterschiede bezüglich des LDL-Cholesterins und des LDL/HDL-Cholesterin-Quotienten zwischen den drei Gruppen. Keine Unterschiede hinsichtlich des Hämoglobinstatus zwischen den drei Gruppen wurden gefunden. Die Serum-Ferritin- und Hämatokrit-Werte der Vegetarier unterschieden sich nicht von den Werten der studentischen Mischköstler mit einer hohen Aufnahme tierischer Lebensmittel, aber einer geringen Aufnahme von Vitamin C. Bei den Vegetariern war die energieadjustierte Vitamin-C-Aufnahme sowohl mit der Serum-Ferritin als auch mit der Hämoglobin-Konzentration positiv korreliert. Obwohl die buddhistischen Vegetarier in dieser Studie eine sehr niedrige Aufnahme tierischer Lebensmittel hatten, war die Prävalenz von Eisen-, Vitamin B12- und Folatmangel bei den Vegetariern nicht höher als bei den Mischköstlern mit einer hohen Aufnahme tierischer Lebensmittel. Im Gegensatz zu westlicher vegetarischer Ernährung diente Seegemüse als diese Nährstoffquelle. Koreanischer Seetang stellt eine gute Quelle für Vitamin B12 für Vegetarier dar. Eine adäquate Aufnahme von Gemüse und Früchten spiegelte sich im guten Serum-Folat-Status wider. Schlussfolgernd sollten Ernährungsempfehlungen oder Richtlinien für koreanische Vegetarier entwickelt werden, die auf der koreanischen Esskultur basieren. Mit einer adäquaten Zusammenstellung und Zubereitung ihrer vegetarischen Kost können die Vegetarier die Vorteile dieser Ernährungsform sichern. The aim of this study was to determine the nutritional status of vegetarian Buddhist nuns to compare the results with omnivorous women in Korea. According to the inclusion criteria, 54 vegetarian Buddhist nuns, 31 omnivorous Catholic nuns, and 31 omnivorous college students were enrolled. The nutrient intakes of Buddhist vegetarians were comparable to those of omnivores, and the intake of some nutrients in vegetarians was even more favorable than in omnivores. There was no difference in body height and body fat between the dietary groups, but the vegetarians had a significantly higher body weight, fat free mass, and BMI than both omnivorous groups. Body fat was inversely correlated with the duration of vegetarianism, which ranged from 3 to 34 years. The Buddhist vegetarians had a lower total and HDL cholesterol blood level than both omnivorous groups. The triglyceride levels of Buddhist vegetarians did not differ from those of omnivorous groups. There was no significant difference in LDL-cholesterol and LDL/HDL cholesterol ratio between the groups. There was no difference in hemoglobin status among the dietary groups. The serum ferritin and hematocrit levels of vegetarians did not differ from those of omnivorous students with a high intake of animal source foods but a low intake of vitamin C. In vegetarians, the energy adjusted vitamin C intake showed a positive correlation with both serum ferritin and hemoglobin concentrations. Although the Buddhist vegetarians in this study had a very low intake of animal source foods, the serum vitamin B12 levels of all subjects except one vegetarian and the serum folate levels of all subjects except one omnivorous student fell within normal ranges. Unlike in Western vegetarian diets, sea vegetables contribute to the supply of these nutrients. Serum vitamin B12 of vegetarians was positively associated with laver intake. Korean laver can be a good source of vitamin B12 for vegetarians. Further, an adequate intake of vegetables and fruits was reflected in the good serum folate status. In conclusion, dietary guidelines for Korean vegetarians based on the Korean food culture should be developed. With adequate diet composition and food preparation, vegetarians can ensure the advantages of a vegetarian diet.
... This concept paper presents 3 models I recently developed for a book on vegetarian nutrition (4). The models depict the expected health risks and benefits of a population following either a vegetarian diet largely based on plant foods or a diet largely based on animal foods (meat-based diet). ...
Article
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Advances in nutrition research during the past few decades have changed scientists' understanding of the contribution of vegetarian diets to human health and disease. Diets largely based on plant foods, such as well-balanced vegetarian diets, could best prevent nutrient deficiencies as well as diet-related chronic diseases. However, restrictive or unbalanced vegetarian diets may lead to nutritional deficiencies, particularly in situations of high metabolic demand. If some vegetarian diets are healthier than diets largely based on animal products, this constitutes an important departure from previous views on dietary recommendations to prevent disease conditions. Based on different paradigms, 3 models are presented depicting the population health risks and benefits of vegetarian and meat-based diets. This series of models encapsulates the evolution of scientific understanding on the overall effects of these dietary patterns on human health. Recent scientific advances seem to have resulted in a paradigm shift: diets largely based on plant foods, such as well-balanced vegetarian diets, are viewed more as improving health than as causing disease, in contrast with meat-based diets.
... This concept paper presents 3 models I recently developed for a book on vegetarian nutrition (4). The models depict the expected health risks and benefits of a population following either a vegetarian diet largely based on plant foods or a diet largely based on animal foods (meat-based diet). ...
Article
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Our knowledge is far from complete regarding the relationship between vegetarian diets and human health. However, scientific advances in the last decades have considerably changed the role that vegetarian diets may play in human nutrition. Components of a healthy vegetarian diet include a variety of vegetables, fruits, whole grain cereals, legumes and nuts. Numerous studies show important and quantifiable benefits of the different components of vegetarian diets, namely the reduction of risk for many chronic diseases and the increase in longevity. Such evidence is derived from the study of vegetarians as well as other populations. While meat intake has been related to increased risk for a variety of chronic diseases, an abundant consumption of vegetables, fruits, cereals, nuts, and legumes all have been independently related with a lower risk for several chronic degenerative diseases, such as ischemic heart disease, diabetes, obesity, and many cancers. Hence, whole foods of plant origin seem to be beneficial on their own merit for chronic disease prevention. This is possibly more certain than the detrimental effects of meats. Vegetarian diets, as any other diet pattern, have potential health risks, namely marginal intake of essential nutrients. However, from the public health viewpoint the health benefits of a well-planned vegetarian diet far outweigh the potential risks.
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This study was designed to assess the physical fitness and health status in 36 life-long vegetarians. Besides a general questionnaire a dietary diary was completed and several blood parameters were determined. Physical fitness profile was estimated by testing handgrip strength, leg explosive strength, dynamic abdominal muscle endurance and cardiorespiratory endurance capacity. Body mass and length were measured for the determination of the BMI. The general questionnaire revealed that most of the subjects had healthy lifestyles. Nutritional intakes were not optimal with excess of some nutrients, but equally with some intakes not reaching the recommended daily allowances. Blood profile was normal for all evaluated parameters. Physical performance capacity was rather weak for strength-oriented tasks while a normal cardiorespiratory endurance capacity was measured. Our results indicate that a vegetarian diet is not automatically a healthy diet. Proper food choices need to be made to assure the completeness and to avoid excesses or deficiencies in the diet.
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We examined the relation between Troutlets body mass index (BMI) and age-adjusted mortality risk from specific diseases in a 26-year prospective cohort study of 12,576 non-Hispanic white women who had never smoked. To account for effects due to antecedent disease, we focused on women surviving 15-26 years after their report of body weight. High BMI (>27 kg per m(2)) decreased the risk of fatal respiratory disease (hazard ratios of 0.7 for ages 30-54 years and 0.6 for ages 55-74 years) but increased risk in all other disease categories. Low BMI (<21 kg per m(2)) increased the risk of fatal respiratory disease (hazard ratios of 2.0 for ages 30-54 years and 1.4 for ages 55-74 years). Among middle-aged women (ages 30-54 years), we found that low BMI also increased the risk of certain fatal cardiovascular diseases (hazard ratios of 1.5 for cerebrovascular death and 2.5 for hypertensive and other cardiovascular deaths), but the increase in the risk of fatal cerebrovascular disease did not remain (hazard ratio of 0.4) after exclusion of subarachnoid and intraparenchymal hemorrhage deaths from the endpoint. Although the inverse relation between BMI and risk of fatal respiratory disease was also evident in the subset who reported body weight 17 years after baseline, further restriction of this subset to stable-weight women reporting no history of respiratory disease resulted in a U-shaped relation. Data from this subset also indicated that weight loss substantially increased the risk of fatal respiratory disease. these findings implicate high and low BMI as risk factors for fatal respiratory disease but suggest that the risk due to high BMI was obscured by weight loss that followed the onset of disease. The overall findings support an association between obesity and a higher risk of fatal disease but also raise the possibility that apparently healthy, never-smoking women can experience a higher long-term risk of fatal cardiovascular and respiratory diseases due to a lower body weight.
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Approximately 200 studies that examined the relationship between fruit and vegetable intake and cancers of the lung, colon, breast, cervix, esophagus, oral cavity, stomach, bladder, pancreas, and ovary are reviewed. A statistically significant protective effect of fruit and vegetable consumption was found in 128 of 156 dietary studies in which results were expressed in terms of relative risk. For most cancer sites, persons with low fruit and vegetable intake (at least the lower one-fourth of the population) experience about twice the risk of cancer compared with those with high intake, even after control for potentially confounding factors. For lung cancer, significant protection was found in 24 of 25 studies after control for smoking in most instances. Fruits, in particular, were significantly protective in cancers of the esophagus, oral cavity, and larynx, for which 28 of 29 studies were significant. Strong evidence of a protective effect of fruit and vegetable consumption was seen in cancers of the pancreas and stomach (26 of 30 studies), as well as in colorectal and bladder cancers (23 of 38 studies). For cancers of the cervix, ovary, and endometrium, a significant protective effect was shown in 11 of 13 studies, and for breast cancer a protective effect was found to be strong and consistent in a meta analysis. It would appear that major public health benefits could be achieved by substantially increasing consumption of these foods.
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To investigate the health consequences of a vegetarian diet by examining the 12 year mortality of non-meat eaters and meat eating controls. Prospective observational study in which members of the non-meat eating cohort were asked to nominate friends or relatives as controls. United Kingdom. 6115 non-meat eaters identified through the Vegetarian Society of the United Kingdom and the news media (mean (SD) age 38.7 (16.8) years) and 5015 controls who were meat eaters (39.3 (15.4) years). Standardised mortality ratios for cancer, ischaemic heart disease, and total mortality in the two cohorts and death rate ratio in the non-meat eaters compared with meat eaters after adjustment for potentially confounding variables. Standardised mortality ratios (taking the value among the general population as 100) for ischaemic heart disease were 51 (95% confidence interval 38 to 66) for meat eaters and 28 (20 to 38) for non-meat eaters (P < 0.01). Values for all cancers were 80 (64 to 98) and 50 (39 to 62) for meat eaters and non-meat eaters respectively. After adjustment for the effects of smoking, body mass index, and socioeconomic status death rate ratios in non-meat eaters compared with meat eaters were 0.72 (0.47 to 1.10) for ischaemic heart disease and 0.61 (0.44 to 0.84) for all cancers. The reduced mortality from cancer among those not eating meat is not explained by lifestyle related risk factors, which have a low prevalence among vegetarians. No firm conclusion can be made about deaths from ischaemic heart disease. These data do not justify advice to exclude meat from the diet since there are several attributes of a vegetarian diet apart from not eating meat which might reduce the risk.
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To examine the associations of diet and other lifestyle factors with body mass index (BMI) using data from the Oxford Vegetarian Study. 1914 male and 3378 female non-smokers aged 20-89 y at recruitment to the study. All subjects completed a diet/lifestyle questionnaire at recruitment giving details of their usual diet and other characteristics including height and weight, smoking and drinking habits, amount of exercise, occupation and reproductive history. Answers to the food frequency questionnaire were used to classify subjects as either meat eaters or non-meat eaters, and to estimate intakes of animal fat and dietary fibre. Subjects were further classified according to their alcohol consumption, exercise level, social class, past smoking habits and parity. Mean BMI was lower in non-meat eaters than in meat eaters in all age groups for both men and women. Overall age-adjusted mean BMIs in kg/m2 were 23.18 and 22.05 for male meat eaters and non-meat eaters respectively (P < 0.0001) and 22.32 and 21.32 for female meat eaters and non-meat eaters respectively (P < 0.0001). In addition to meat consumption, dietary fibre intake, animal fat intake, social class and past smoking were all independently associated with BMI in both men and women; alcohol consumption was independently associated with BMI in men, and parity was independently associated with BMI in women. After adjusting for these factors, the differences in mean BMI between meat eaters and non-meat eaters were reduced by 36% in men and 31% in women. Non-meat eaters are thinner than meat eaters. This may be partly due to a higher intake of dietary fibre, a lower intake of animal fat, and only in men a lower intake of alcohol.
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To examine the relation between nut consumption and risk of coronary heart disease in a cohort of women from the Nurses' Health Study. Prospective cohort study. Nurses' Health Study. 86 016 women from 34 to 59 years of age without previously diagnosed coronary heart disease, stroke, or cancer at baseline in 1980. Major coronary heart disease including non-fatal myocardial infarction and fatal coronary heart disease. 1255 major coronary disease events (861 cases of non-fatal myocardial infarction and 394 cases of fatal coronary heart disease) occurred during 14 years of follow up. After adjusting for age, smoking, and other known risk factors for coronary heart disease, women who ate more than five units of nuts (one unit equivalent to 1 oz of nuts) a week (frequent consumption) had a significantly lower risk of total coronary heart disease (relative risk 0.65, 95% confidence interval 0.47 to 0.89, P for trend=0.0009) than women who never ate nuts or who ate less than one unit a month (rare consumption). The magnitude of risk reduction was similar for both fatal coronary heart disease (0.61, 0.35 to 1.05, P for trend=0.007) and non-fatal myocardial infarction (0.68, 0.47 to 1.00, P for trend=0.04). Further adjustment for intakes of dietary fats, fibre, vegetables, and fruits did not alter these results. The inverse association persisted in subgroups stratified by levels of smoking,use of alcohol, use of multivitamin and vitamin E supplements, body mass index, exercise, and intake of vegetables or fruits. Frequent nut consumption was associated with a reduced risk of both fatal coronary heart disease and non-fatal myocardial infarction. These data, and those from other epidemiological and clinical studies, support a role for nuts in reducing the risk of coronary heart disease.
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bkground.— Although dietary factors are suspected to be important determinants of coronary heart disease (CHD) risk, the direct evidence is relative-lse.Methods.— The Adventist Health Study is a prospective cohort investigation of 31 208 non-Hispanic white California Seventh-Day Adventists. Extensive dietary information was obtained at baseline, along with the values of traditional coronary risk factors. These were related to risk of definite fatal CHD or definite nonfatal- dial infarction.Results.— Subjects who consumed nuts frequently (more than four times per week) experienced substantially fewer definite fatal CHD events (relative risk, 0.52; 95% confidence interval [CI], 0.36 to 0.76) and definite nonfatal myocardial infarctions (relative risk, 0.49; 95% CI, 0.28 to 0.85), when compared with those who consumed nuts less than once per week. These findings persisted on covariate adjustment and were seen in almost all of 16 different subgroups of the population. Subjects who usually consumed whole wheat bread also experienced lower rates of definite nonfatal myocardial infarction (relative risk, 0.56; 95% CI, 0.35 to 0.89) and definite fatal CHD (relative risk, 0.89; 95% CI, 0.60 to 1.33) when compared with those who usually ate white bread. Men who ate beef at least three times each week had a higher risk of definite fatal CHD (relative risk, 2.31; 95% CI, 1.11 to 4.78), but this effect was not seen in women or for the nonfatal myocardial infarction end point.Conclusion.— Our data strongly suggest that the frequent consumption of nuts may protect against risk of CHD events. The favorable fatty acid profile of many nuts is one possible explanation for such an effect.(Arch Intern Med. 1992;152:1416-1424)
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The epidemiologic literature on the relationship between vegetable and fruit consumption and human cancer at a variety of sites is reviewed systematically. A total of 13 ecologic studies, nine cohort studies, and 115 case-control studies are included. Cancer of all sites, cancers of lung, breast, colon, rectum, esophagus, larynx, oral cavity and pharynx, stomach, pancreas, prostate, bladder, ovary, endometrium, cervix, and thyroid, as well as mesothelioma and gestational trophoblastic disease, are considered. Relevant data from clinical trials, animal, and in vitro studies are included. It is concluded that consumption of higher levels of vegetables and fruit is associated consistently, although not universally, with a reduced risk of cancer at most sites. The association is most marked for epithelial cancers--particularly those of the alimentary and respiratory tracts--and, currently, is weak to nonexistent for hormone-related cancers. The association exists for a wide variety of vegetables and fruit with some suggestion that raw forms are associated most consistently with lower risk. Possible mechanisms by which vegetable and fruit intake might alter risk of cancer and possible adverse effects of vegetable and fruit consumption will be considered in Part II of this review.
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We propose the hypothesis that a vegetarian diet reduces the risk of developing diabetes. Findings that have generated this hypothesis are from a population of 25,698 adult White Seventh-day Adventists identified in 1960. During 21 years of follow-up, the risk of diabetes as an underlying cause of death in Adventists was approximately one-half the risk for all US Whites. Within the male Adventist population, vegetarians had a substantially lower risk than non-vegetarians of diabetes as an underlying or contributing cause of death. Within both the male and female Adventist populations, the prevalence of self-reported diabetes also was lower in vegetarians than in non-vegetarians. The associations observed between diabetes and meat consumption were apparently not due to confounding by over- or under-weight, other selected dietary factors, or physical activity. All of the associations between meat consumption and diabetes were stronger in males than in females.
Article
In 1960 the meat-consumption habits of 25,153 California Seventh-Day Adventists were assessed by questionnaire. Between 1960 and 1980 ischemic heart disease deaths were identified. Meat consumption was positively associated with fatal ischemic heart disease in both men and women. This association was apparently not due to confounding by eggs, dairy products, obesity, marital status, or cigarette smoking. The positive association between meat consumption and fatal ischemic heart disease was stronger in men than in women and, overall, strongest in young men. For 45- to 64-year-old men, there was approximately a threefold difference in risk between men who ate meat daily and those who did not eat meat. This is the first study to clearly show a dose-response relationship between meat consumption and ischemic heart disease risk.
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Essential trace elements are required by man in amounts ranging from 50 micrograms to 18 milligrams per day. Acting as catalytic or structural components of larger molecules, they have specific functions and are indispensable for life. Research during the past quarter of a century has identified as essential six trace elements whose functions were previously unknown. In addition to the long-known deficiencies of iron and iodine, signs of deficiency for chromium, copper, zinc, and selenium have been identified in free-living populations. Four trace elements were proved to be essential for two or more animal species during the past decade alone. Marginal or severe trace element imbalances can be considered risk factors for several diseases of public health importance, but proof of cause and effect relationships will depend on a more complete understanding of basic mechanisms of action and on better analytical procedures and functional tests to determine marginal trace element status in man.
Article
The effect of traditional coronary heart disease risk factors on lifetime risk, age at onset, and survival free of coronary disease has not been extensively studied. The authors have used the cohort data from 27,321 California Seventh-day Adventists who had no known heart disease in 1976 to investigate these questions. Multiple decrement life tables incorporating non-parametric estimates of conditional probabilities for both coronary disease and all other competing endpoints were used to estimate these survival outcomes. Variance estimators are provided in an appendix. Persons characterized by being either past smokers, diabetic, hypertensive, physically, non-vegetarian, or infrequent consumers of nuts often showed substantial differences in these survival outcomes. Statistically significant results include earlier age at onset of coronary disease at between 4 and 10 years, reduced life expectancy free of the disease between 5 and 9 years, and increased lifetime risk between 8% and 16%, when comparing groups with and without adverse values for different risk factors. The presence of adverse levels of two risk factors predicted even greater differences in these endpoints. These important effects are easily understood by the layman or non-epidemiologist professional, which is often not true of a relative risk. This should increase the effectiveness of such results when promoting behavioral change.
Article
The incidence rates of colon cancer are high in North America and northern Europe, lower in southern Europe, and much lower in Asia and Africa. It is widely believed that environmental factors, particularly dietary patterns, account for most of this marked variation in rates. Over the past decade, a large number of case-control and cohort studies have added a substantial body of evidence regarding our understanding of the causes of colon cancer. Although the data are not entirely consistent, several important risk factors have emerged. The epidemiological evidence that physical inactivity or excess energy intake relative to requirements increases risk of this malignancy is quite strong. Intake of red meat appears to increase risk, but protein-rich sources other than red meat probably do not elevate risk and may even reduce the occurrence of colon cancer. Dietary fat, at least that from sources other than red meat, does not appear to increase risk appreciably. High consumption of vegetables and fruits and the avoidance of highly refined sugar containing foods are likely to reduce risk of colon cancer, although the responsible constituents remain unclear. Alcohol intake may enhance risk of cancers of the distal colorectum, although the evidence is not entirely consistent. The influence of alcohol may be particularly strong when combined with a diet low in methionine and folate, suggesting that the effect of alcohol may be through antagonism of methyl-group metabolism. The combined effect of these dietary factors, as well as modifiable non-dietary factors such as cigarette smoking, suggest that the majority of cases of colon cancer are preventable.
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There has been little research concerning the health effects of whole grain intake in humans. We have synthesized 15 american and European case-control and prospective studies of whole grain intake. Most subjects were middle aged or older. The studies employed disparate dietary methods, and the foods referred to and quantities eaten are ill defined. Nevertheless there is a striking consistency in reduced risk for colorectal and gastric cancers associated with intake of whole grain, also found in isolated studies of endometrial cancer and coronary heart disease. Because reduced risk was not associated with refined grain intake, these findings do not appear to be confounded by participant confusion concerning refined vs. whole grains. The independence of these findings from reduced risk associated with fruit and vegetable intake is not established. There should be further research to establish whether whole grain intake is protective against chronic disease.
Article
To examine prospectively the relationship between dietary fiber and risk of coronary heart disease. Cohort study. In 1986, a total of 43,757 US male health professionals 40 to 75 years of age and free from diagnosed cardiovascular disease and diabetes completed a detailed 131-item dietary questionnaire used to measure usual intake of total dietary fiber and specific food sources of fiber. Fatal and nonfatal myocardial infarction (MI). During 6 years of follow-up, we documented 734 cases of MI (229 were fatal coronary heart disease). The age-adjusted relative risk (RR) for total MI was 0.59 (95% confidence interval [CI], 0.46 to 0.76) among men in the highest quintile of total dietary fiber intake (median, 28.9 g/d) compared with men in the lowest quartile (median, 12.4 g/d). The inverse association was strongest for fatal coronary disease (RR, 0.45; 95% CI, 0.28 to 0.72). After controlling for smoking, physical activity and other known nondietary cardiovascular risk factors, dietary saturated fat, vitamin E, total energy intake, and alcohol intake, the RRs were only modestly attenuated. A 10-g increase in total dietary fiber corresponded to an RR for total MI of 0.81 (95% CI, 0.70 to 0.93). Within the three main food contributors to total fiber intake (vegetable, fruit, and cereal), cereal fiber was most strongly associated with a reduced risk of total MI (RR, 0.71; 95% CI, 0.55 to 0.91 for each 10-g increase in cereal fiber per day). Our results suggest an inverse association between fiber intake and MI. These results support current national dietary guidelines to increase dietary fiber intake and suggest that fiber, independent of fat intake, is an important dietary component for the prevention of coronary disease.
Article
EDITOR,—Britain is failing to meet targets that have been set for reducing obesity.1 One of the aims of the Health of the Nation strategy is to reduce the percentages of men and women who are obese to 6% and 8%, respectively, by 2005,2 but the Health Survey for England 1994 shows that the prevalence of obesity had increased to 13.2% among men and 16.0% among women by 1994.3 This increase is probably partly due to a reduction in physical activity; the importance of the composition of the diet is not …
Article
A recent review of epidemiologic literature found consistently reduced cancer and heart disease rates in persons with high compared with low whole-grain intakes. We hypothesized that whole-grain intake was associated with a reduced risk of ischemic heart disease (IHD) death. We studied 34,492 postmenopausal women aged 55-69 y and free of IHD at baseline in 1986. There were 438 IHD deaths between baseline and 1995. Usual dietary intake was determined with use of a 127-item food-frequency questionnaire. Whole-grain intake in median servings/d was 0.2, 0.9, 1.2, 1.9, and 3.2 for quintiles of intake. The unadjusted rate of IHD death was 2.0/1 x 10(3) person-years in quintile 1 and was 1.7, 1.2, 1.0, and 1.4 IHD deaths/1 x 10(3) person-years in succeeding quintiles (P for trend < 0.001). Adjusted for demographic, physiologic, behavioral, and dietary variables, relative hazards were 1.0, 0.96, 0.71, 0.64, and 0.70 in ascending quintiles (P for trend = 0.02). The lower risk with higher whole-grain intake was not explained by intake of fiber or several other constituents of whole grains. A clear inverse association between whole-grain intake and risk of IHD death existed. A causal association is plausible because whole-grain foods contain many phytochemicals, including fiber and antioxidants, that may reduce chronic disease risk. Whole-grain intake should be studied further for its potential to prevent IHD and cancer.