Center for Complementary Medicine, Department of Medicine II, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg, Germany.
Translational Complementary Medicine, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland.
Ann Med. 2023;55(2):2269969. doi: 10.1080/07853890.2023.2269969. Epub 2023 Oct 18.
BACKGROUND/OBJECTIVE: Plant-based diets reduce the risk of cardiovascular disease but also increase the risk of certain micronutrient deficiencies, particularly, of vitamin B12 (B12). The extent to which the unsupervised use of oral nutrient supplements is sufficient to prevent these deficiencies is not well established. We analyzed nutrient intake, laboratory biomarkers, supplementation behavior, and B12 status adequacy amongst young, healthy, physically active omnivores, lacto-ovo-vegetarians and vegans from Germany.
We recruited 115 participants ( = 40 omnivores; = 37 lacto-ovo-vegetarians, and = 38 vegans) with comparable age, sex, marital status, physical activity and educational levels through online advertisements and local newspapers in Freiburg, Germany.
Energy intake and macronutrient distribution were comparable across diets. Major differences included intake of fiber, cholesterol, and several vitamins. Vegans had the lowest intake of B12 from foods (0.43 (0.58) µg/d), compared to omnivores (2.14 (2.29) µg/d) and lacto-ovo-vegetarians (0.98 (1.34) µg/day). Multivariate analysis of 36 blood biomarkers revealed that three major classes of biomarkers contributed the most to the clustering of individuals by dietary group, namely, biomarkers of B12 status (B12, holoTC, Hcy), iron (iron, ferritin, transferrin) and lipid metabolism (vitamin A, HDL, LDL, total cholesterol, TAG). This suggests that nutrients that modify the metabolic pathways represented by these biomarkers have the most penetrating effect on health status across diets. Analysis of B12 status (including 4cB12) revealed adequacy in omnivores and vegans, and a poorer B12 status amongst lacto-ovo-vegetarians. Fewer lacto-ovo-vegetarians used B12 supplements compared to vegans (51% versus 90%).
Even amongst homogeneously healthy Germans, each diet manifested with measurable differences in dietary intakes and biomarkers of health. Plant-based diets, in particular the vegan diet, exhibited the most favorable patterns of lipid metabolism and glycemic control, but the lowest food intake of B12. Supplementation of healthy vegans with B12 (median 250 µg B12/day, over 2 years) secured an adequate B12 status that was comparable to that of healthy omnivores. German Clinical Trial register number: DRKS00027425.
背景/目的：植物性饮食可降低心血管疾病的风险，但也会增加某些微量营养素缺乏的风险，特别是维生素 B12（B12）。未经监督使用口服营养补充剂在多大程度上足以预防这些缺乏症尚不清楚。我们分析了德国年轻、健康、身体活跃的杂食者、乳蛋素食者和素食者的营养素摄入、实验室生物标志物、补充行为和 B12 状态充足情况。
我们通过德国弗赖堡的在线广告和当地报纸招募了 115 名参与者（=40 名杂食者；=37 名乳蛋素食者和=38 名素食者），他们在年龄、性别、婚姻状况、身体活动和教育水平方面具有可比性。
不同饮食的能量摄入和宏量营养素分布相似。主要差异包括纤维、胆固醇和几种维生素的摄入量。与杂食者（2.14（2.29）μg/d）和乳蛋素食者（0.98（1.34）μg/d）相比，素食者从食物中摄入的 B12 最少（0.43（0.58）μg/d）。对 36 种血液生物标志物的多元分析表明，有三大类生物标志物对按饮食组聚类的个体贡献最大，即 B12 状态生物标志物（B12、全钴胺素、Hcy）、铁（铁、铁蛋白、转铁蛋白）和脂质代谢（维生素 A、HDL、LDL、总胆固醇、TAG）。这表明，改变这些生物标志物所代表的代谢途径的营养素对各种饮食中的健康状况具有最深远的影响。B12 状态分析（包括 4cB12）显示杂食者和素食者的 B12 状态充足，乳蛋素食者的 B12 状态较差。与素食者相比，乳蛋素食者使用 B12 补充剂的比例较低（51%对 90%）。
即使在同质健康的德国人中，每种饮食也表现出饮食摄入和健康生物标志物的可衡量差异。植物性饮食，特别是素食饮食，表现出最有利的脂质代谢和血糖控制模式，但 B12 的食物摄入量最低。健康素食者补充 B12（中位数 250μg B12/天，持续 2 年）可确保充足的 B12 状态，与健康杂食者相当。德国临床试验注册号：DRKS00027425。
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