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Risks of ischaemic heart disease and stroke in meat eaters, fish eaters, and vegetarians over 18 years of follow-up: results from the prospective EPIC-Oxford study.

ABSTRACT: OBJECTIVE:To examine the associations of vegetarianism with risks of ischaemic heart disease and stroke. DESIGN:Prospective cohort study. SETTING:The EPIC-Oxford study, a cohort in the United Kingdom with a large proportion of non-meat eaters, recruited across the country between 1993 and 2001. PARTICIPANTS:48 188 participants with no history of ischaemic heart disease, stroke, or angina (or cardiovascular disease) were classified into three distinct diet groups: meat eaters (participants who consumed meat, regardless of whether they consumed fish, dairy, or eggs; n=24 428), fish eaters (consumed fish but no meat; n=7506), and vegetarians including vegans (n=16 254), based on dietary information collected at baseline, and subsequently around 2010 (n=28 364). MAIN OUTCOME MEASURES:Incident cases of ischaemic heart disease and stroke (including ischaemic and haemorrhagic types) identified through record linkage until 2016. RESULTS:Over 18.1 years of follow-up, 2820 cases of ischaemic heart disease and 1072 cases of total stroke (519 ischaemic stroke and 300 haemorrhagic stroke) were recorded. After adjusting for sociodemographic and lifestyle confounders, fish eaters and vegetarians had 13% (hazard ratio 0.87, 95% confidence interval 0.77 to 0.99) and 22% (0.78, 0.70 to 0.87) lower rates of ischaemic heart disease than meat eaters, respectively (P<0.001 for heterogeneity). This difference was equivalent to 10 fewer cases of ischaemic heart disease (95% confidence interval 6.7 to 13.1 fewer) in vegetarians than in meat eaters per 1000 population over 10 years. The associations for ischaemic heart disease were partly attenuated after adjustment for self reported high blood cholesterol, high blood pressure, diabetes, and body mass index (hazard ratio 0.90, 95% confidence interval 0.81 to 1.00 in vegetarians with all adjustments). By contrast, vegetarians had 20% higher rates of total stroke (hazard ratio 1.20, 95% confidence interval 1.02 to 1.40) than meat eaters, equivalent to three more cases of total stroke (95% confidence interval 0.8 to 5.4 more) per 1000 population over 10 years, mostly due to a higher rate of haemorrhagic stroke. The associations for stroke did not attenuate after further adjustment of disease risk factors. CONCLUSIONS:In this prospective cohort in the UK, fish eaters and vegetarians had lower rates of ischaemic heart disease than meat eaters, although vegetarians had higher rates of haemorrhagic and total stroke.

SUBMITTER: Tong TYN

PROVIDER: S-EPMC6724406 | biostudies-other | 2019 Sep

REPOSITORIES: biostudies-other

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Risks of ischaemic heart disease and stroke in meat eaters, fish eaters, and vegetarians over 18 years of follow-up: results from the prospective EPIC-Oxford study.

Tong Tammy Y N TYN Appleby Paul N PN Bradbury Kathryn E KE Perez-Cornago Aurora A Travis Ruth C RC Clarke Robert R Key Timothy J TJ

BMJ (Clinical research ed.) 20190904

<h4>Objective</h4>To examine the associations of vegetarianism with risks of ischaemic heart disease and stroke.<h4>Design</h4>Prospective cohort study.<h4>Setting</h4>The EPIC-Oxford study, a cohort in the United Kingdom with a large proportion of non-meat eaters, recruited across the country between 1993 and 2001.<h4>Participants</h4>48 188 participants with no history of ischaemic heart disease, stroke, or angina (or cardiovascular disease) were classified into three distinct diet groups: mea ...[more]

PMID: 31484644

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Project description:BackgroundFollowing a vegetarian diet has become increasingly popular and some evidence suggests that being vegetarian may be associated with a lower risk of cancer overall. However, for specific cancer sites, the evidence is limited. Our aim was to assess the associations of vegetarian and non-vegetarian diets with risks of all cancer, colorectal cancer, postmenopausal breast cancer, and prostate cancer and to explore the role of potential mediators between these associations.MethodsWe conducted a prospective analysis of 472,377 UK Biobank participants who were free from cancer at recruitment. Participants were categorised into regular meat-eaters (n = 247,571), low meat-eaters (n = 205,385), fish-eaters (n = 10,696), and vegetarians (n = 8685) based on dietary questions completed at recruitment. Multivariable-adjusted Cox regressions were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for all cancer incidence and separate cancer sites across diet groups.ResultsAfter an average follow-up of 11.4 years, 54,961 incident cancers were identified, including 5882 colorectal, 7537 postmenopausal breast, and 9501 prostate cancers. Compared with regular meat-eaters, being a low meat-eater, fish-eater, or vegetarian were all associated with a lower risk of all cancer (HR: 0.98, 95% CI: 0.96-1.00; 0.90, 0.84-0.96; 0.86, 0.80-0.93, respectively). Being a low meat-eater was associated with a lower risk of colorectal cancer in comparison to regular meat-eaters (0.91, 0.86-0.96); however, there was heterogeneity in this association by sex (p = 0.007), with an inverse association across diet groups in men, but not in women. Vegetarian postmenopausal women had a lower risk of breast cancer (0.82, 0.68-0.99), which was attenuated and non-significant after adjusting for body mass index (BMI; 0.87, 0.72-1.05); in mediation analyses, BMI was found to possibly mediate the observed association. In men, being a fish-eater or a vegetarian was associated with a lower risk of prostate cancer (0.80, 0.65-0.99 and 0.69, 0.54-0.89, respectively).ConclusionThe lower risk of colorectal cancer in low meat-eaters is consistent with previous evidence suggesting an adverse impact of meat intake. The lower risk of postmenopausal breast cancer in vegetarian women may be explained by their lower BMI. It is not clear whether the other differences observed for all cancers and for prostate cancer reflect any causal relationships or are due to other factors such as residual confounding or differences in cancer detection.

Project description:Background An increasing number of people adhere to plant-based diets, and the market for plant-based meat and dairy substitute products has been expanding rapidly. Objective To examine total intake of macronutrients and salt in a sample of Norwegian vegans, vegetarians and pescatarians; the consumption frequency of plant-based meat and dairy substitutes and raw ingredients used in these products; and the contribution to total macronutrient and salt intake from these products. Design A cross-sectional design using single 24-h dietary recall to assess the intake of macronutrients, salt and substitute products that the participants (n = 158 Norway residents [age 18–60 years]: vegans [n = 83]; vegetarians [n = 47]; pescatarians [n = 28]) consumed. The chi-square test with pairwise comparisons and the Kruskal-Wallis test with post hoc test were used to compare differences between diet groups. Macronutrient and salt intake were assessed relative to the Nordic Nutrition Recommendations (NNR). Results Dietary macronutrient intake fell within NNR recommendations, with a favourable distribution of fatty acids and high levels of dietary fibre. Most of the vegans (90%), vegetarians (68%) and pescatarians (64%) consumed meat or dairy substitutes. The main raw ingredient in the substitute products was soy, followed by oats and peas. Overall, substitute products contributed to 12% of total energy and 16% of total salt intake. The substitute products contributed to higher saturated fatty acid (SFA) intake amongst vegans (27% of total SFA intake) compared with vegetarians (10%) and pescatarians (8%). Moreover, substitute products contributed to higher protein intake in vegans (19%) compared with pescatarians (7%). Conclusion Most participants consumed meat or dairy substitute products, suggesting that these products are included regularly in Norwegian plant-based diets. Furthermore, substitute products may contribute to dietary fat, SFA and protein intake amongst vegans.

Dataset Information

Risks of ischaemic heart disease and stroke in meat eaters, fish eaters, and vegetarians over 18 years of follow-up: results from the prospective EPIC-Oxford study.

Publications

Risks of ischaemic heart disease and stroke in meat eaters, fish eaters, and vegetarians over 18 years of follow-up: results from the prospective EPIC-Oxford study.

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