Vegetarian Epidemiology: Review and Discussion of Findings from Geographically Diverse Cohorts

doi:10.1093/advances/nmy109

Review

. 2019 Nov 1;10(Suppl_4):S284-S295.

doi: 10.1093/advances/nmy109.

Vegetarian Epidemiology: Review and Discussion of Findings from Geographically Diverse Cohorts

Michael J Orlich¹, Tina H T Chiu^{2

3}, Preet K Dhillon⁴, Timothy J Key⁵, Gary E Fraser¹, Krithiga Shridhar⁴, Sutapa Agrawal⁴, Sanjay Kinra⁶

Affiliations

¹ Schools of Medicine and Public Health, Loma Linda University, Loma Linda, CA.
² Department of Nutrition Therapy, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan.
³ College of Medicine, Tzu Chi University, Hualien, Taiwan.
⁴ Centre for Chronic Conditions and Injuries (CCCI), Public Health Foundation of India, Gurugram, India.
⁵ Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.
⁶ London School of Hygiene and Tropical Medicine, London, United Kingdom.

PMID: 31728496
PMCID: PMC6855947
DOI: 10.1093/advances/nmy109

Review

Vegetarian Epidemiology: Review and Discussion of Findings from Geographically Diverse Cohorts

Michael J Orlich et al. Adv Nutr. 2019.

. 2019 Nov 1;10(Suppl_4):S284-S295.

doi: 10.1093/advances/nmy109.

Authors

Michael J Orlich¹, Tina H T Chiu^{2

3}, Preet K Dhillon⁴, Timothy J Key⁵, Gary E Fraser¹, Krithiga Shridhar⁴, Sutapa Agrawal⁴, Sanjay Kinra⁶

Affiliations

¹ Schools of Medicine and Public Health, Loma Linda University, Loma Linda, CA.
² Department of Nutrition Therapy, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan.
³ College of Medicine, Tzu Chi University, Hualien, Taiwan.
⁴ Centre for Chronic Conditions and Injuries (CCCI), Public Health Foundation of India, Gurugram, India.
⁵ Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.
⁶ London School of Hygiene and Tropical Medicine, London, United Kingdom.

PMID: 31728496
PMCID: PMC6855947
DOI: 10.1093/advances/nmy109

Abstract

Epidemiologic cohort studies enrolling a large percentage of vegetarians have been highly informative regarding the nutritional adequacy and possible health effects of vegetarian diets. The 2 largest such cohorts are the European Prospective Investigation into Cancer and Nutrition-Oxford (EPIC-Oxford) and the Adventist Health Study-2 (AHS-2). These cohorts are described and their findings discussed, including a discussion of where findings appear to diverge. Although such studies from North America and the United Kingdom have been important, the large majority of the world's vegetarians live in other regions, particularly in Asia. Findings from recent cohort studies of vegetarians in East and South Asia are reviewed, particularly the Tzu Chi Health Study and Indian Migration Study. Important considerations for the study of the health of vegetarians in Asia are discussed. Vegetarian diets vary substantially, as may associated health outcomes. Cohort studies remain an important tool to better characterize the health of vegetarian populations around the globe.

Keywords: Adventist Health Study; EPIC-Oxford; Indian Migration Study; Tzu Chi Health Study; chronic disease risk; epidemiologic studies; plant-based diet pattern; vegetarians.

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Figures

**FIGURE 1**
Comparisons of selected findings from Oxford cohorts and AHS-2. (A) BMI: EPIC-Oxford from (10); AHS-2 from (27). Note: no 95% CIs available for AHS-2. (B) Colorectal cancer: EPIC-Oxford and OVS from (17); AHS-2 from (29). (C) Breast cancer: EPIC-Oxford and OVS from (17); AHS-2 from (32). (D) Prostate cancer: EPIC-Oxford and OVS from (17); AHS-2 from (31). (E) All cancers: EPIC-Oxford and OVS from (17); AHS-2 from (28). (F) All-cause mortality: EPIC-Oxford and OVS from (16); AHS-2 from (27). AHS-2, Adventist Health Study—2; EPIC-Oxford, European Prospective Investigation into Cancer and Nutrition—Oxford; OVS, Oxford Vegetarian Study.

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References

1. Davey GK, Spencer EA, Appleby PN, Allen NE, Knox KH, Key TJ. EPIC-Oxford: lifestyle characteristics and nutrient intakes in a cohort of 33 883 meat-eaters and 31 546 non meat-eaters in the UK. Public Health Nutr. 2003;6(3):259–69. - PubMed
1. Appleby PN, Thorogood M, Mann JI, Key TJ. The Oxford Vegetarian Study: an overview. Am J Clin Nutr. 1999;70(3 Suppl):525S–31S. - PubMed
1. Key TJ, Appleby PN, Spencer EA, Travis RC, Roddam AW, Allen NE. Mortality in British vegetarians: results from the European Prospective Investigation into Cancer and Nutrition (EPIC-Oxford). Am J Clin Nutr. 2009;89(5):1613S–19S. - PubMed
1. Rosell MS, Lloyd-Wright Z, Appleby PN, Sanders TA, Allen NE, Key TJ. Long-chain n-3 polyunsaturated fatty acids in plasma in British meat-eating, vegetarian, and vegan men. Am J Clin Nutr. 2005;82(2):327–34. - PubMed
1. Gilsing AM, Crowe FL, Lloyd-Wright Z, Sanders TA, Appleby PN, Allen NE, Key TJ. Serum concentrations of vitamin B12 and folate in British male omnivores, vegetarians and vegans: results from a cross-sectional analysis of the EPIC-Oxford cohort study. Eur J Clin Nutr. 2010;64(9):933–9. - PMC - PubMed

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[1] Davey GK, Spencer EA, Appleby PN, Allen NE, Knox KH, Key TJ. EPIC-Oxford: lifestyle characteristics and nutrient intakes in a cohort of 33 883 meat-eaters and 31 546 non meat-eaters in the UK. Public Health Nutr. 2003;6(3):259–69. - PubMed

[2] Davey GK, Spencer EA, Appleby PN, Allen NE, Knox KH, Key TJ. EPIC-Oxford: lifestyle characteristics and nutrient intakes in a cohort of 33 883 meat-eaters and 31 546 non meat-eaters in the UK. Public Health Nutr. 2003;6(3):259–69. - PubMed

[3] Appleby PN, Thorogood M, Mann JI, Key TJ. The Oxford Vegetarian Study: an overview. Am J Clin Nutr. 1999;70(3 Suppl):525S–31S. - PubMed

[4] Appleby PN, Thorogood M, Mann JI, Key TJ. The Oxford Vegetarian Study: an overview. Am J Clin Nutr. 1999;70(3 Suppl):525S–31S. - PubMed

[5] Key TJ, Appleby PN, Spencer EA, Travis RC, Roddam AW, Allen NE. Mortality in British vegetarians: results from the European Prospective Investigation into Cancer and Nutrition (EPIC-Oxford). Am J Clin Nutr. 2009;89(5):1613S–19S. - PubMed

[6] Key TJ, Appleby PN, Spencer EA, Travis RC, Roddam AW, Allen NE. Mortality in British vegetarians: results from the European Prospective Investigation into Cancer and Nutrition (EPIC-Oxford). Am J Clin Nutr. 2009;89(5):1613S–19S. - PubMed

[7] Rosell MS, Lloyd-Wright Z, Appleby PN, Sanders TA, Allen NE, Key TJ. Long-chain n-3 polyunsaturated fatty acids in plasma in British meat-eating, vegetarian, and vegan men. Am J Clin Nutr. 2005;82(2):327–34. - PubMed

[8] Rosell MS, Lloyd-Wright Z, Appleby PN, Sanders TA, Allen NE, Key TJ. Long-chain n-3 polyunsaturated fatty acids in plasma in British meat-eating, vegetarian, and vegan men. Am J Clin Nutr. 2005;82(2):327–34. - PubMed

[9] Gilsing AM, Crowe FL, Lloyd-Wright Z, Sanders TA, Appleby PN, Allen NE, Key TJ. Serum concentrations of vitamin B12 and folate in British male omnivores, vegetarians and vegans: results from a cross-sectional analysis of the EPIC-Oxford cohort study. Eur J Clin Nutr. 2010;64(9):933–9. - PMC - PubMed

[10] Gilsing AM, Crowe FL, Lloyd-Wright Z, Sanders TA, Appleby PN, Allen NE, Key TJ. Serum concentrations of vitamin B12 and folate in British male omnivores, vegetarians and vegans: results from a cross-sectional analysis of the EPIC-Oxford cohort study. Eur J Clin Nutr. 2010;64(9):933–9. - PMC - PubMed

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Vegetarian Epidemiology: Review and Discussion of Findings from Geographically Diverse Cohorts

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Vegetarian Epidemiology: Review and Discussion of Findings from Geographically Diverse Cohorts

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