Effectiveness of a low-fat vegetarian diet in altering serum lipids in healthy premenopausal women. A vegetarian diet rich in soybean products compromises iron status in young students. Effect of dietary alpha-linolenic acid on thrombotic risk factors in vegetarian men. Serum fatty acid, lipid profile and dietary intake of Hong Kong Chinese omnivores and vegetarians Plasma concentrations of 25-hydroxyvitamin D in meat eaters, fish eaters, vegetarians and vegans: results from the EPIC-Oxford study. Toward improved management of NIDDM: A randomized, controlled, pilot intervention using a lowfat, vegetarian diet. The selective lipid-lowering effect of vegetarianism on low density lipoproteins in a cross-over experiment. Vegetarian diet, change in dietary patterns, and diabetes risk: a prospective study Plasma lipids and lipoproteins in vegetarians and controls. The influence of maternal vegetarian diet on essential fatty acid status of the newborn. Cardiovascular disease risk factors in free-living men: comparison of two prudent diets, one based on lactoovovegetarianism and the other allowing lean meat. Vitamin B-12 supplementation improves arterial function in vegetarians with subnormal vitamin B-12 status A Vegetarian Diet Is a Major Determinant of Gut Microbiota Composition in Early Pregnancy Folate status during pregnancy in women is improved by long-term high vegetable intake compared with the average western diet. 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 Vegetarianism, bone loss, fracture and vitamin D: a longitudinal study in Asian vegans and non-vegans Vegetarian dietary patterns and mortality in Adventist Health Study 2. A low-fat vegan diet and a conventional diabetes diet in the treatment of type 2 diabetes: a randomized, controlled, 74-wk clinical trial. Predominantly Vegetarian Diet in Patients with Incipient and Early Clinical Diabetic Nephropathy: Effects on Albumin Excretion Rate and Nutritional Status Effects of supplementing n-3 fatty acid enriched eggs and walnuts on cardiovascular disease risk markers in healthy free-living lacto-ovo-vegetarians: a randomized, crossover, free-living intervention study The Netherlands Cohort Study – Meat Investigation Cohort; a population-based cohort over-represented with vegetarians, pescetarians and low meat consumers Biochemical and neurohormonal responses to the introduction of a lacto-ovovegetarian diet Randomization to plant-based dietary approaches leads to larger short-term improvements in Dietary Inflammatory Index scores and macronutrient intake compared with diets that contain meat.
Few controlled trials have studied cholesterol-lowering diets in premenopausal women . None has examined the cholesterol-lowering effect of a low-fat vegetarian diet , which , in other population groups , leads to marked reductions in serum cholesterol concentrations and , in combination with other life-style changes , a regression of atherosclerosis . We tested the hypothesis that a low-fat , vegetarian diet significantly reduces serum total and low-density lipoprotein ( LDL ) cholesterol concentrations in premenopausal women . In a crossover design , 35 women , aged 22 to 48 , followed a low-fat vegetarian diet deriving approximately 10 % of energy from fat for 2 menstrual cycles . For 2 additional cycles , they followed their customary diet while also taking a " supplement " ( placebo ) pill .  Serum lipid concentrations were assessed at baseline and during each intervention phase . Mean serum LDL , high-density lipoprotein ( HDL ) , and total cholesterol concentrations decreased 16 . 9 % , 16.5 % , and 13.2 % , respectively , from baseline to the intervention diet phase ( p<0.001 ) , whereas mean serum triacylglycerol concentration increased 18.7 % ( p<0.01 ) . LDL/HDL ratio remained unchanged . Thus , in healthy premenopausal women , a low-fat vegetarian diet led to rapid and sizable reductions in serum total , LDL , and HDL cholesterol concentrations The iron status of young Chinese Buddhist vegetarians ( 23 men and 32 women ) and nonvegetarian students ( 20 men and 39 women from a medical college ) was investigated by dietary assessment of iron intake and hematological measurement of biochemical indices including hemoglobin , plasma iron , transferrin , transferrin saturation and plasma ferritin . A characteristic of the vegetarian diet in this study was the replacement of meat by soybean products . Results of the dietary assessment showed that the average iron density of the diets ranged from 1.9 to 2.2 mg/MJ , with no difference between the vegetarian and nonvegetarian diets . Daily iron intake was similar in both vegetarian and nonvegetarian men . However ,  iron intake was significantly higher in female vegetarians than nonvegetarians , averaging 104 and 78 % of the RDA , respectively . Results of blood analysis showed that , for both sexes , the median plasma ferritin concentration of the vegetarians ( male 47 micrograms/L and female 12 micrograms/L ) was about half the level of the nonvegetarians ( male 91 micrograms/L and female 27 micrograms/L ) . Occurrence and risk of iron deficiency are more prevalent in vegetarians . Correlation between plasma ferritin concentration and years of vegetarian practice in vegetarian men was marginally significant ( r = -0.38 , P = 0.077 ) . We conclude that a vegetarian diet that is rich in soybean products and restricted in animal foods is limited in bioavailable iron and is not adequate for maintaining iron balance in men and women BACKGROUND Vegetarians have lower platelet and plasma concentrations of n-3 polyunsaturated fatty acids ( PUFAs ) than do omnivores . We recently showed that male vegetarians have higher platelet aggregability than do omnivores . OBJECTIVE We investigated whether male vegetarians ( n = 17 ) who consumed an increased amount of dietary alpha-linolenic acid ( ALA )  showed any changes in their tissue profile of PUFAs , plasma thromboxane concentrations , platelet aggregability , or hemostatic factors . DESIGN During the study , all subjects maintained their habitual vegetarian diets except that a proportion of dietary fat was replaced with vegetable oils and margarines that were provided . Initially , all subjects consumed a low-ALA diet ( containing safflower oil and safflower oil-based margarine ) for 14 d ; they then consumed either a moderate-ALA diet ( containing canola oil and canola oil-based margarine ) or a high-ALA diet ( containing linseed oil and linseed oil-based margarine ) for 28 d. Blood sample s were collected at day 0 ( baseline ) , day 14 , and day 42 . RESULTS Eicosapentaenoic acid , docosapentaenoic acid , total n-3 PUFAs , and the ratio of n-3 to n-6 PUFAs were significantly increased ( P < 0.05 ) , whereas the ratio of arachidonic acid to eicosapentaenoic acid was decreased ( P < 0.05 ) , in platelet phospholipids , plasma phospholipids , and triacylglycerols after either the moderate-ALA or high-ALA diet compared with the low-ALA diet . No significant differences were observed in thrombotic risk factors . CONCLUSION ALA from vegetable oils ( canola and linseed ) has a beneficial effect on n-3 PUFA concentrations of platelet phospholipids and plasma lipids in vegetarian males Objective : To examine the serum fatty acid and lipid profiles and dietary intake of  Hong Kong Chinese omnivores and vegetarians  with respect to cardiovascular health . Design : R and om population survey stratified by age and sex . Subjects : One-hundred and ninety-four omnivore subjects ( 81 men , 113 women ) age 25–70 y , and 60 ovo-lacto-vegetarian adults ( 15 men , 45 women ) age 30–55 y. Measurements : Nutrient quantitation was by a food frequency method . Serum fatty acids were analysed by  gas chromatography , and serum lipid  by st and ard laboratory methods . Results : Compared with omnivores , vegetarians had higher serum concentrations of polyunsaturated ( PUFA ) and monosaturated fatty acids ( MUFA ) , and lower saturated fatty acids ( SFA ) , long chain omega-3 and trans fatty acids ( TFA ) . They also had lower serum cholesterol and higher apoA-I concentrations , but the LDL/HDL ratio was not different . The ratio of polyunsaturated to saturated fatty acids intake was higher in vegetarians . Compared with results from population s with higher incidences of coronary heart disease , while lower myristic and palmitic acid concentrations and higher eicosapentaneoic ( EPA ) and docosahexanoic acid ( DHA ) may partly account for the difference in incidence , linoleic acid concentration was higher . Although the Chinese vegetarian diet may be beneficial for heart health in that antioxidant and fibre intakes are higher and saturated fat lower , the low EPA and DHA due to omission from dietary source and suppressed formation by high linoleic acid level , and the presence of TFA in the diet , may exert an opposite effect . Conclusion : There are some favourable features in the serum fatty acid profile in the Hong Kong Chinese population with respect to cardiovascular health , but the consumption of TFA is of concern . The Chinese vegetarian diet also contains some adverse features . Sponsorship : This study is partly sponsored by the Hong Kong Health Services Research Grant . European Journal Of Clinical Nutrition ( 2000 ) 24 , OBJECTIVE Vegetarians and vegans exclude certain food sources of vitamin D from their diet , but it is not clear to what extent this affects plasma concentrations of 25-hydroxyvitamin D ( 25(OH)D ) . The objective was to investigate differences in vitamin D intake and plasma concentrations of 25(OH)D among meat eaters , fish eaters , vegetarians and vegans . DESIGN A cross-sectional analysis . SETTING United Kingdom . SUBJECTS Plasma 25(OH)D concentrations were measured in 2107 white men and women ( 1388 meat eaters , 210 fish eaters , 420 vegetarians and eighty-nine vegans ) aged 20 - 76 years from the European Prospect i ve Investigation into Cancer and Nutrition (EPIC)-Oxford cohort . RESULTS Plasma 25(OH)D concentrations reflected the degree of animal product exclusion and , hence , dietary intake of vitamin D ; meat eaters had the highest mean intake of vitamin D ( 3·1 ( 95 % CI 3·0 , 3·2 ) μg/d ) and mean plasma 25(OH)D concentrations ( 77·0 ( 95 % CI 75·4 , 78·8 ) nmol/l ) and vegans the lowest ( 0·7 ( 95 % CI 0·6 , 0·8 ) μg/d and 55·8 ( 95 % CI 51·0 , 61·0 ) nmol/l , respectively ) . The magnitude of difference in 25(OH)D concentrations between meat eaters and vegans was smaller ( 20 % ) among those participants who had a blood sample collected during the summer months ( July-September ) compared with the winter months ( 38 % ; January-March ) . The prevalence of low plasma concentrations of 25(OH)D ( < 25 nmol/l ) during the winter and spring ranged from < 1 % to 8 % across the diet groups . CONCLUSIONS Plasma 25(OH)D concentrations were lower in vegetarians and vegans than in meat and fish eaters ; diet is an important determinant of plasma 25(OH)D in this British population OBJECTIVE To investigate whether glycemic and lipid control in patients with non-insulin-dependent diabetes ( NIDDM ) can be significantly improved using a low-fat , vegetarian ( vegan ) diet in the absence of recommendations regarding exercise or other lifestyle changes . METHODS Eleven subjects with NIDDM recruited from the Georgetown University Medical Center or the local community were r and omly assigned to a low-fat vegan diet ( seven subjects ) or a conventional low-fat diet ( four subjects ) . Two additional subjects assigned to the control group failed to complete the study . The diets were not design ed to be isocaloric . Fasting serum glucose , body weight , medication use , and blood pressure were assessed at baseline and biweekly thereafter for 12 weeks . Serum lipids , glycosylated hemoglobin , urinary albumin , and dietary macronutrients were assessed at baseline and 12 weeks . RESULTS Although the sample was intentionally small in accordance with the pilot study design , the 28 % mean reduction in fasting serum glucose of the experimental group , from 10.7 to 7.75 mmol/L ( 195 to 141 mg/dl ) , was significantly greater than the 12 % decrease , from 9.86 to 8.64 mmol/L ( 179 to 157 mg/dl ) , for the control group ( P < 0.05 ) . The mean weight loss was 7.2 kg in the experimental group , compared to 3 . 8 kg for the control group ( P < 0.005 ) . Of six experimental group subjects on oral hypoglycemic agents , medication use was discontinued in one and reduced in three . Insulin was reduced in both experimental group patients on insulin . No patient in the control group reduced medication use . Differences between the diet groups in the reductions of serum cholesterol and 24-h microalbuminuria did not reach statistical significance ; however , high-density lipoprotein concentration fell more sharply ( 0.20 mmol/L ) in the experimental group than in the control group ( 0.02 mmol/L ) ( P < 0.05 ) . CONCLUSION The use of a low-fat , vegetarian diet in patients with NIDDM was associated with significant reductions in fasting serum glucose concentration and body weight in the absence of recommendations for exercise . A larger study is needed for confirmation In a cross-over experiment the effect of  short-term vegetarianism  on serum lipids , lipoproteins and apoproteins was studied . The experimental diet was free of animal products , with the exception of skim milk , and consequently low in saturated fat and cholesterol . Fifteen free-living individuals were r and omly assigned to 3-week periods on either the experimental diet or a control diet which closely approximated the usual intake in the U.S.A. Significant reductions in total cholesterol ( 12.5 % ) , low density lipoprotein cholesterol ( 14.7 % ) , and apo B ( 13.2 % ) were observed , accompanied by a non-significant decrease in high density lipoprotein cholesterol ( 10 % ) , apo A-I ( 3 % ) and a non-significant increase in apo-II ( 4 % ) . These data suggest that a fat-modified diet low in total fat , saturated fat and cholesterol , and moderate ( not high ) in polyunsaturated fat may not lower HDL-C or its apoproteins as much as a diet high in polyunsaturated fat , while having similar effects on LDL-C , and would therefore be preferable as the basis for primary prevention of atherosclerosis Background / objectives Vegetarian diets are inversely associated with diabetes in Westerners but their impact on Asians — whose pathophysiology differ from Westerners — is unknown . We aim to investigate the association between a vegetarian diet , change in dietary patterns and diabetes risk in a Taiwanese Buddhist population . Methods We prospect ively followed 2918 non-smoking , non-alcohol drinking Buddhists free of diabetes , cancer , and cardiovascular diseases at baseline , for a median of 5 years , with 183 incident diabetes cases confirmed .  Diet was assessed through a vali date d food frequency question naire at baseline and a simple question naire during follow-ups .  Incident cases of diabetes were ascertained through follow-up question naires , fasting glucose and HbA1C . Stratified Cox Proportional Hazards Regression was used to assess the effect of diets on risk of diabetes . Results Consistent vegetarian diet was associated with 35 % lower hazards ( HR : 0.65 , 95 % CI : 0.46 , 0.92 ) , while converting from a nonvegetarian to a vegetarian pattern was associated with 53 % lower hazards ( HR : 0.47 , 95 % CI : 0.30 , 0.71 ) for diabetes , comparing with nonvegetarians while adjusting for age , gender , education , physical activity , family history of diabetes , follow-up methods , use of lipid-lowering medications , and baseline BMI . Conclusion Vegetarian diet and converting to vegetarian diet may protect against diabetes independent of BMI among Taiwanese The possible effect of diet on plasma lipids was investigated in a group of vegetarians . Seventy-three men and 43 women who had adhered to a vegetarian diet for an average of three years were studied in the fasting state and compared with a r and omly selected group of controls matched for age and sex . Mean cholesterol levels in milligrams per deciliter for vegetarians and controls , respectively , were 126 and 184 ; low-density lipoprotein , 73 and 118 ; very-low-density lipoprotein , 11.8 and 17.2 ; high-density lipoproteins , 42 and 49 ; and mean triglyceride levels 59 and 86 . Mean weight and subscapular skinfold thicknesses were 58 kg and 6 mm for vegetarians and 73 kg and 17 mm for controls . Similar differences in lipid levels were found between subgroups of 42 vegetarians and controls with identical mean weights . Multiple regression analyses showed that consumption of dairy foods and eggs , but not body weight , was associated with the lipoprotein and cholesterol findings OBJECTIVES To evaluate whether a  maternal vegetarian diet influences the essential fatty acid status of the newborn and whether this is related to outcome of pregnancy . DESIGN  Dietary intake  and the fatty acid composition of plasma phospholipids were determined in 24 South Asian vegetarian and 24 white omnivore non-pregnant premenopausal women r and omly selected from the general population of North London . Umbilical cords and cord blood were collected at delivery from 48 South Asian vegetarian women and 98 white omnivores from the same catchment area along with details of antenatal history and the outcome of pregnancy . The fatty acid composition of the cord arteries and that of cord plasma phospholipids were analysed in a subset of 32 pairs of subjects , who were matched for maternal age , gestational age , parity and sex of infant . RESULTS Intakes of linoleic acid  ( 18:2n-6 ) expressed as proportion of the dietary energy and the ratio of linoleic to alpha-linolenic acid ( 18:3n-3 ) were higher in the vegetarian women , and eicosapentaenoic acid ( EPA , 20:5n-3 ) and docosahexaenoic acid ( DHA , 22:6n-3 ) were absent from their diets . The proportion of linoleic acid , as well as the absolute concentration , was greater and those of EPA and DHA were lower in plasma phospholipids , plasma free fatty acid and total plasma lipids of the vegetarians compared with the white subjects . The proportion of DHA was lower ( P > 0.001 ) but that of docosapentaenoic acid ( 22:5n-6 ) was greater ( P < 0.001 ) in cord those from the omnivores . The ratio of 20:3n-9/20:4n-6 was elevated in cord artery but not in cord plasma phospholipids in both groups . Early onset of labour and the duration of gestation was 5.6 days shorter . Birth weight , head circumference and length were lower in the infants born to South Asian vegetarians even after adjusting for maternal height , duration of gestation , parity , gender of infants and smoking habits . Multivariate analysis did not reveal any relationship between the proportions of DHA in plasma or cord artery phospholipids and the birthweight or head circumference of the infants . CONCLUSION This study demonstrates that vegetarians give birth to infants with less DHA in their plasma and cord artery phospholipids but this did not appear to be independently related to the outcome of pregnancy In general , vegetarians have lower serum lipids and blood pressures than omnivores have . We tested the blood pressure and serum lipid lowering effects of two fat-modified diets differing primarily in their source of protein . Twenty-six men were r and omized in an incomplete block design to two of three diets : a high-fat diet , a fat-modified lactoovovegetarian diet ( LOV ) and a diet in which 60 % of plant protein in the LOV was replaced with lean meat ( LM ) . Compared with the high-fat diet both prudent diets significantly lowered blood pressure , serum total cholesterol ( TC ) , and LDL cholesterol but significantly increased serum triglycerides . The LOV diet had a significantly greater cholesterol-lowering effect than did the LM diet ( 10 % vs 5 % decrease ) but blood pressure reductions were similar . The partial substitution of lean meat for plant protein in a fat-modified diet did not negate the overall cardiovascular-risk lowering of the lactoovovegetarian diet Objective Vegetarians are more vascular-healthy but those with subnormal vitamin B-12 status have impaired arterial endothelial function and increased intima-media thickness . We aim ed to study the impact of vitamin B-12 supplementation on these markers , in the vegetarians . Design Double-blind , placebo controlled , r and omised crossover study . Setting Community dwelling vegetarians . Participants Fifty healthy vegetarians ( vegetarian diet for at least 6 years ) were recruited . Intervention : Vitamin B-12 ( 500µg/day ) or identical placebo were given for 12 weeks with 10 weeks of placebo-washout before crossover ( n=43 ) , and then open label vitamin B-12 for additional 24 weeks (n=41).MeasurementHow-mediated dilation of brachial artery ( FMD ) and intima-media thickness ( IMT ) of carotid artery were measured by ultrasound . Results The mean age of the subjects was 45 + 9 years and 22 ( 44 % ) were male . Thirty-five subjects ( 70 % ) had serum B-12 levels < 150pmol/l . Vitamin B-12 supplementation significantly increased serum vitamin B-12 levels ( p<0.0001 ) and lowered plasma homocysteine ( p<0.05 ) . After vitamin B-12 supplementation but not placebo , significant improvement of brachial FMD ( 6.3±1.8 % to 6.9±1.9 % ; p<0.0001 ) and in carotid IMT ( 0.69±0.09 mm to 0.67±0.09 mm , p<0.05 ) were found , with further improvement in FMD ( to 7.4±1.7 % ; p<0.0001 ) and IMT ( to 0.65±0.09 mm ; p<0.001 ) after 24 weeks open label vitamin B-12 . There were no significant changes in blood pressures or lipid profiles . On multivariate analysis , changes in B-12 ( β=0.25 ; p=0.02 ) but not homocysteine were related to changes in FMD , ( R=0.32 ; F value=3.19 ; p=0.028 ) . Conclusions Vitamin B-12 supplementation improved arterial function in vegetarians with subnormal vitamin B-12 levels , proposing a novel strategy for atherosclerosis prevention The composition of the gut microbiota can be influenced by dietary composition . In pregnancy , the maternal gut microbiome has associations with maternal and infant metabolic status . There is little known regarding the impact of a vegetarian diet in pregnancy on maternal gut microbiota . This study explored the gut microbiota profile in women who were vegetarian or omnivorous in early gestation . Women were selected from participants in the Study of PRobiotics IN Gestational diabetes ( SPRING ) r and omised controlled trial . Nine women identified as vegetarians were matched to  omnivorous women in a 1:2 ratio . Microbiota analyses were performed using 16S rRNA gene amplicon sequencing and analysed using the Quantitative Insights Into Microbial Ecology ( QIIME ) and Calypso software tools . There was no difference in alpha diversity , but beta diversity was slightly reduced in vegetarians . There were differences seen in the relative abundance of several genera in those on a vegetarian diet , specifically a reduction in Collinsella , Holdemania , and increases in the relative abundances of Roseburia and Lachnospiraceae . In this sub- analysis of gut microbiota from women in early pregnancy , a vegetarian as compared to omnivorous diet , was associated with a different gut microbiome , with features suggesting alterations in fermentation end products from a mixed acid fermentation towards more acetate/butyrate The effect of increasing dietary folate on folate status during pregnancy is controversial . The aim of this study was to compare folate intake and folate status during pregnancy of women with high long-term vegetable intake and those eating an average Western diet .  In a prospect i ve study that included 109 participants , pregnant women adhering to a predominant vegetarian diet with high vegetable intake for 8 + /- 0.5 y with subgroups of ovo-lacto vegetarians ( n = 27 ) and low meat eaters ( n = 43 ) and women eating an average Western diet ( control group , n = 39 ) were compared with regard to dietary intake and plasma and red blood cell ( RBC ) folate concentrations during wk 9 - 12 , 20 - 22 and 36 - 38 of gestation . Plasma and RBC folate concentrations were highest in ovo-lacto vegetarians , followed by low meat eaters and lowest in the controls . Ovo-lacto vegetarians and low meat eaters showed a lower risk for folate deficiency , with RBC folate concentrations of < 320 nmol/L result ing in odds ratios of 0.10 ( 95 % confidence interval , 0.01 - 0.56 ) and 0.52 ( 95 % confidence interval , 0.20 - 1.34 ) , respectively . In ovo-lacto vegetarians , the RBC folate concentration was positively related to the intake of vitamin B-12 ( r = 0.51 , P : < 0.0001 ) . The results of the study suggest that long-term high vegetable intake favorably affects plasma folate as well as RBC folate concentrations throughout pregnancy and reduces the risk of folate deficiency if an adequate vitamin B-12 supply is ensured Background / Objectives : Vegans , and to a lesser extent vegetarians , have low average circulating concentrations of vitamin B12 ; however , the relation between factors such as age or time on these diets and vitamin B12 concentrations is not clear . The objectives of this study were to investigate differences in serum vitamin B12 and folate concentrations between  omnivores , vegetarians and vegans  and to ascertain whether vitamin B12 concentrations differed by age and time on the diet . Subjects/ Methods : A cross-sectional analysis involving 689 men ( 226 omnivores , 231 vegetarians and 232 vegans ) from the European Prospect i ve Investigation into Cancer and Nutrition Oxford cohort . Results : Mean serum vitamin B12 was highest among omnivores ( 281 , 95 % CI : 270–292 pmol/l ) , intermediate among vegetarians ( 182 , 95 % CI : 175–189 pmol/l ) and lowest among vegans ( 122 , 95 % CI : 117–127 pmol/l ) . In all , 52 % of vegans , 7 % of vegetarians and one omnivore were classified as vitamin B12 deficient ( defined as serum vitamin B12 < 118 pmol/l ) . There was no significant association between age or duration of adherence to a vegetarian or a vegan diet and serum vitamin B12 . In contrast , folate concentrations were highest among vegans , intermediate among vegetarians and lowest among omnivores , but only two men ( both omnivores ) were categorized as folate deficient ( defined as serum folate < 6.3 nmol/l ) . Conclusion :  Vegans  have lower vitamin B12 concentrations , but higher folate concentrations , than vegetarians and omnivores . Half of the vegans were categorized as vitamin B12 deficient and would be expected to have a higher risk of developing clinical symptoms related to vitamin B12 deficiency Background / Objectives : The effect of vegan diet on bone loss has not been studied . The aim of this study was to examine the association between veganism and bone loss in postmenopausal women . Subjects/ Methods : The study was design ed as a prospect i ve longitudinal investigation with 210 women , including 105 vegans and 105 omnivores . Femoral neck ( FN ) bone mineral density ( BMD ) was measured in 2008 and 2010 by dual-energy X-ray absorptiometry ( Hologic QDR4500 ) . The incidence of vertebral fracture was ascertained by X-ray report . Serum levels of C-terminal telopeptide of type I collagen ( βCTX ) and N-terminal propeptide of type I procollagen ( PINP ) were measured by Roche Elecsys assays . Serum concentration of 25-hydroxyvitamin D and parathyroid hormone were measured by electrochemiluminescence . Results : Among the 210 women who initially participated in the study in 2008 , 181 women had completed the study and 29 women were lost to follow-up . The rate of loss in FN BMD was −1.91±3.45%/year in omnivores and −0.86±3.81%/year ( P=0.08 ) in vegans . Lower body weight , higher intakes of animal protein and lipid , and corticosteroid use were associated with greater rate of bone loss . The 2-year incidence of fracture was 5.7 % ( n=5/88 ) in vegans , which was not significantly different from omnivores ( 5.4 % , n=6/93 ) . There were no significant differences in βCTX and PINP between vegans and omnivores . The prevalence of vitamin D insufficiency in vegans was higher than in omnivores ( 73 % versus 46 % ; P=0.0003 ) . Conclusions : Vegan diet did not have adverse effect on bone loss and fracture . Corticosteroid use and high intakes of animal protein and animal lipid were negatively associated with bone loss IMPORTANCE Some evidence suggests vegetarian dietary patterns may be associated with reduced mortality , but the relationship is not well established . OBJECTIVE To evaluate the association between vegetarian dietary patterns and mortality . DESIGN Prospect i ve cohort study ; mortality analysis by Cox proportional hazards regression , controlling for important demographic and lifestyle confounders . SETTING Adventist Health Study 2 ( AHS-2 ) , a large North American cohort . PARTICIPANTS A total of 96,469 Seventh-day Adventist men and women recruited between 2002 and 2007 , from which an analytic sample of 73,308 participants remained after exclusions . EXPOSURES Diet was assessed at baseline by a quantitative food frequency question naire and categorized into 5 dietary patterns : nonvegetarian , semi-vegetarian , pesco-vegetarian , lacto-ovo-vegetarian , and vegan . MAIN OUTCOME AND MEASURE The relationship between vegetarian dietary patterns and all-cause and cause-specific mortality ; deaths through 2009 were identified from the National Death Index . RESULTS There were 2570 deaths among 73,308 participants during a mean follow-up time of 5.79 years . The mortality rate was 6.05 ( 95 % CI , 5.82 - 6.29 ) deaths per 1000 person-years . The adjusted hazard ratio ( HR ) for all-cause mortality in all vegetarians combined vs nonvegetarians was 0.88 ( 95 % CI , 0.80 - 0.97 ) . The adjusted HR for all-cause mortality in vegans was 0.85 ( 95 % CI , 0.73 - 1.01 ) ; in lacto-ovo-vegetarians , 0.91 ( 95 % CI , 0.82 - 1.00 ) ; in pesco-vegetarians , 0.81 ( 95 % CI , 0.69 - 0.94 ) ; and in semi-vegetarians , 0.92 ( 95 % CI , 0.75 - 1.13 ) compared with nonvegetarians . Significant associations with vegetarian diets were detected for cardiovascular mortality , noncardiovascular noncancer mortality , renal mortality , and endocrine mortality . Associations in men were larger and more often significant than were those in women . CONCLUSIONS AND RELEVANCE Vegetarian diets are associated with lower all-cause mortality and with some reductions in cause-specific mortality . Results appeared to be more robust in males . These favorable associations should be considered carefully by those offering dietary guidance BACKGROUND Low-fat vegetarian and vegan diets are associated with weight loss , increased insulin sensitivity , and improved cardiovascular health . OBJECTIVE We compared the effects of a low-fat vegan diet and conventional diabetes diet recommendations on glycemia , weight , and plasma lipids . DESIGN Free-living individuals with type 2 diabetes were r and omly assigned to a low-fat vegan diet ( n = 49 ) or a diet following 2003 American Diabetes Association guidelines ( conventional , n = 50 ) for 74 wk . Glycated hemoglobin ( Hb A(1c ) ) and plasma lipids were assessed at weeks 0 , 11 , 22 , 35 , 48 , 61 , and 74 . Weight was measured at weeks 0 , 22 , and 74 . RESULTS Weight loss was significant within each diet group but not significantly different between groups ( -4.4 kg in the vegan group and -3.0 kg in the conventional diet group , P = 0.25 ) and related significantly to Hb A(1c ) changes ( r = 0.50 , P = 0.001 ) . Hb A(1c ) changes from baseline to 74 wk or last available values were -0.34 and -0.14 for vegan and conventional diets , respectively ( P = 0.43 ) . Hb A(1c ) changes from baseline to last available value or last value before any medication adjustment were -0.40 and 0.01 for vegan and conventional diets , respectively ( P = 0.03 ) . In analyses before alterations in lipid-lowering medications , total cholesterol decreased by 20.4 and 6.8 mg/dL in the vegan and conventional diet groups , respectively ( P = 0.01 ) ; LDL cholesterol decreased by 13.5 and 3.4 mg/dL in the vegan and conventional groups , respectively ( P = 0.03 ) . CONCLUSIONS Both diets were associated with sustained reductions in weight and plasma lipid concentrations . In an analysis controlling for medication changes , a low-fat vegan diet appeared to improve glycemia and plasma lipids more than did conventional diabetes diet recommendations . Whether the observed differences provide clinical benefit for the macro- or microvascular complications of diabetes remains to be established . This trial was registered at clinical trials.gov as NCT00276939 Several studies have suggested that dietary protein quality may be an important determinant in the natural history of renal disease . We have therefore studied the effects of a predominantly vegetarian diet in eight patients with Type 1 diabetes mellitus and an albumin excretion rate ( AER ) in excess of 30 μg min−1 . The AER was measured after an 8‐week run‐in period on the patient 's usual diet , and again after 8 weeks of a predominantly vegetarian diet in which the proportion of vegetable protein was supplemented in order to minimize the reduction in total dietary protein intake . The median fractional albumin clearance fell during the study from an initial value of 188 times 10−4 ( range 58–810 times 10−4 ) at the end of the run‐in period to 87 times 10−4 ( 23–829 times 10−4 ) at the end of the period on low animal protein diet ( difference 79 times 10−4 ( 95 % Cl 9–149 times 10−4 ) , p < 0.05 ) . The AER then returned to values similar to those obtained at the beginning of the study after a further 8 weeks in those patients returning to their usual diet . No significant changes in blood glucose control or in arterial pressure were observed . A predominantly vegetarian diet may therefore have important beneficial effects on diabetic nephropathy without the need for a heavily restricted total protein intake Background Plant and marine n-3 fatty acids ( FA ) may favorably modify select markers of cardiovascular disease risk . Whether supplementing the habitual diet of lacto-ovo-vegetarians ( LOV ) with walnuts ( containing α-linolenic acid , ALA ) and n-3 FA enriched eggs ( containing primarily docosahexaenoic acid , DHA and ALA ) would have equivalent effects on CVD risk factors is explored in this study . Methods In this study , 20 healthy free-living LOVs following their habitual diet were r and omly assigned in a crossover design to receive one of three supplements : n-3 FA enriched egg ( 6/week ) , walnuts ( 28.4 g , 6/week ) or a st and ard egg , 6/week ( control ) for 8 weeks each with 4-wk washout between treatments . Erythrocyte membrane fatty acids , serum lipids and inflammatory markers were measured at the end of each treatment . Results Dietary compliance was observed by an expected increase in erythrocyte membrane ALA following the walnut treatment and in DHA following the n-3 FA enriched egg treatment . Walnut treatment lowered serum triacylglycerol , total cholesterol and Apo B ( p < 0.05 ) compared to the st and ard egg but not the n-3 FA enriched egg treatment . However , walnut treatment significantly reduced total : HDL cholesterol ratio compared to both egg treatments . There were no differences between treatments for any of the inflammatory markers . Conclusions For LOV , a direct source of DHA such as n-3 FA enriched eggs seems necessary to increase membrane levels of DHA . However for producing an overall favorable blood lipid profile , daily consumption of a h and ful of walnuts rich in ALA may be a preferred option for lacto-ovo vegetarian Background Vegetarian diets have been associated with lower risk of chronic disease , but little is known about the health effects of low meat diets and the reliability of self-reported vegetarian status . We aim ed to establish an analytical cohort over-represented with vegetarians , pescetarians and 1 day/week meat consumers , and to describe their lifestyle and dietary characteristics . In addition , we were able to compare self-reported vegetarians with vegetarians whose status has been confirmed by their response on the extensive food frequency question naire ( FFQ ) . Study methods Embedded within the Netherl and s Cohort Study ( n = 120,852 ; including 1150 self-reported vegetarians ) , the NLCS-Meat Investigation Cohort ( NLCS-MIC ) was defined by combining all FFQ-confirmed-vegetarians ( n = 702 ) , pescetarians ( n = 394 ) , and 1 day/week meat consumers ( n = 1,396 ) from the total cohort with a r and om sample of 2–5 days/week- and 6–7 days/week meat consumers ( n = 2,965 and 5,648 , respectively ) . Results Vegetarians , pescetarians , and 1 day/week meat consumers had more favorable dietary intakes ( e.g. higher fiber/vegetables ) and lifestyle characteristics ( e.g. lower smoking rates ) compared to regular meat consumers in both sexes . Vegetarians adhered to their diet longer than pescetarians and 1 day/week meat consumers . 75 % of vegetarians with a prevalent cancer at baseline had changed to this diet after diagnosis . 50 % of self-reported vegetarians reported meat or fish consumption on the FFQ . Although the misclassification that occurred in terms of diet and lifestyle when merely relying on self-reporting was relatively small , the impact on associations with disease risk remains to be studied . Conclusion We established an analytical cohort over-represented with persons at the lower end of the meat consumption spectrum which should facilitate prospect i ve studies of major cancers and causes of death using ≥20.3 years of follow-up Objective : To assess the mechanisms of the blood pressure-lowering effect of a vegetarian diet in the early and later stages of dietary intervention Design : After 2 weeks without intervention ( baseline ) , 20 normotensive men were matched for age and body mass index and r and omly allocated to an omnivorous ( control ) or a lacto-ovovegetarian diet for 6 weeks in a parallel trial Methods : Ambulatory blood pressures were recorded between 0800 and 1700 h on alternate days during the first week of intervention , twice in the second week and weekly thereafter . Blood sample s collected after a st and ard breakfast were analysed for plasma noradrenaline , adrenaline , atrial natriuretic peptide ( ANP ) , renin , aldosterone , glucose and insulin . Factor and multiple regression analyses were used to assess the association among neurohormonal factors , blood pressures and diet . Results were analysed for the first week of the diet and for the entire 6 weeks Results : Ambulatory blood pressures at work were lower on the vegetarian diet than in the controls . This blood pressure decrease was associated with a factor representing lower plasma catecholamine and renin activity levels throughout the study , and a factor representing reduced plasma glucose and insulin levels in week 1 of intervention only . Plasma ANP levels were significantly higher during week 1 of the vegetarian diet Conclusions : A blood pressure lowering effect of a vegetarian diet during normal working activity was shown . Using factors derived from the biochemical variables , results were in keeping with the hypothesis that these effects may be mediated by reduced sympatho-adrenal activity consequent to altered glucose and insulin h and ling . An early increase in plasma ANP may contribute to the blood pressure Studies have examined nutrient differences among people following different plant-based diets . However , all of these studies have been observational . The aim of the present study was to examine differences in nutrient intake and Dietary Inflammatory Index ( DII ) scores among overweight and obese ( body mass index 25.0 - 49.9 kg/m(2 ) ) adults r and omized to receive dietary instruction on a vegan ( n = 12 ) , vegetarian ( n = 13 ) , pescovegetarian ( n = 13 ) , semivegetarian ( n = 13 ) , or omnivorous ( n = 12 ) diet during a 6-month r and omized controlled trial . Nutrient intake , nutrient adequacy , and DII score were assessed via two 24-hour dietary recalls ( Automated Self-Administered 24-Hour Dietary Recall ) at baseline and at 2 and 6 months . Differences in nutrient intake and the DII were examined using general linear models with follow-up tests at each time point . We hypothesized that individuals r and omized to the vegan diet would have lower DII scores and greater improvements in fiber , carbohydrate , fat , saturated fat , and cholesterol at both 2 and 6 months as compared with the other 4 diets . Participants r and omized to the vegan diet had significantly greater changes in most macronutrients at both time points , including fat and saturated fat , as well as cholesterol and , at 2 months , fiber , as compared with most of the other diet groups ( Ps < .05 ) . Vegan , vegetarian , and pescovegetarian participants all saw significant improvements in the DII score as compared with semivegetarian participants at 2 months ( Ps < .05 ) with no differences at 6 months . Given the greater impact on macronutrients and the DII during the short term , finding ways to provide support for adoption and maintenance of plant-based dietary approaches , such as vegan and vegetarian diets , should be given consideration
Conclusions This systematic review and meta‐ analysis provides evidence that vegetarian diets effectively lower blood concentrations of total cholesterol , low‐density lipoprotein cholesterol , high‐density lipoprotein cholesterol , and non – high‐density lipoprotein cholesterol .
Such diets could be a useful nonpharmaceutical means of managing dyslipidemia , especially hypercholesterolemia
Background Vegetarian diets exclude all animal flesh and are being widely adopted by an increasing number of people ; however , effects on blood lipid concentrations remain unclear .
This meta‐ analysis aim ed to quantitatively assess the overall effects of  vegetarian diets on blood lipids .