Adventist Health Study, Research Affairs, Loma Linda University, Loma Linda, CA, United States; Center for Nutrition, Healthy Lifestyles and Disease Prevention, School of Public Health, Loma Linda University, Loma Linda, CA, United States.
School of Public Health, Loma Linda University, Loma Linda, CA, United States.
Am J Clin Nutr. 2024 Oct;120(4):907-917. doi: 10.1016/j.ajcnut.2024.07.028. Epub 2024 Aug 2.
There have been mixed results reported internationally when associating vegetarian dietary patterns with all-cause and cause-specific mortalities.
This study aimed to extend our previous results by evaluating, with a larger number of deaths (N = 12,515), cause-specific mortalities comparing different vegetarian types with nonvegetarians.
This prospective study used data from the Adventist Health Study-2 cohort. Mortality was ascertained between study baseline, 2002-2007, and follow-up through 2015. Dietary data were collected at baseline using a validated quantitative food frequency questionnaire and then categorized into 5 dietary patterns: nonvegetarian, semivegetarian, pescovegetarian, lacto-ovovegetarian, and vegan. Main outcomes and measures include all-cause and cause-specific mortalities using Cox proportional hazards regression models and competing risk methods.
The analytic sample included 88,400 participants who provided 971,424 person-years of follow-up. We report results pairwise as estimated at ages 65 and 85 y owing to age dependence of many hazard ratios (HRs). Compared with nonvegetarians, vegetarians had lower risks of mortality, overall (HR: 0.89; 95% confidence interval [CI]: 0.83, 0.95; HR: 0.98; 95% CI: 0.91, 1.04), from renal failure (HR: 0.52; 95% CI: 0.38, 0.70; HR: 0.65; 95% CI: 0.55, 0.76), infectious disease (HR: 0.57; 95% CI: 0.40, 0.82; HR: 0.90; 95% CI: 0.70, 1.17), diabetes (HR: 0.51; 95% CI: 0.33, 0.78; HR: 0.69; 95% CI: 0.53, 0.88), select cardiac (HR: 0.75; 95% CI: 0.65, 0.87; HR: 0.89; 95% CI: 0.83, 0.95), and ischemic heart disease causes (HR: 0.73; 95% CI: 0.59, 0.90; HR: 0.84; 95% CI: 0.75,0.94). Vegans, lacto-ovovegetarians, and pescovegetarians were also observed to have lower risks of total mortality and several similar cause-specific mortalities. However, higher cause-specified neurologic mortalities were observed among older vegetarians (estimated at age 85 y), specifically stroke (HR: 1.17; 95% CI: 1.02, 1.33), dementia (HR: 1.13; 95% CI: 1.00, 1.27), and Parkinson's disease (HR: 1.37; 95% CI: 0.98, 1.91). Results in Black subjects for vegetarian/nonvegetarian comparisons largely followed the same trends, but HRs were less precise owing to smaller numbers.
Vegetarian diets are associated with lower risk for all-cause and many cause-specific mortalities, especially among males and in younger subjects. However, higher risks are observed among older vegetarians for stroke and dementia. These results need further support and investigation.
国际上有关素食模式与全因和特定原因死亡率的关联结果不一。
本研究旨在通过评估更多的死亡人数（N=12515），比较不同素食类型与非素食者的特定原因死亡率，扩展我们之前的结果。
这项前瞻性研究使用了 Adventist Health Study-2 队列的数据。在研究基线（2002-2007 年）和 2015 年的随访期间，通过生存分析确定了死亡率。使用经过验证的定量食物频率问卷收集基线时的饮食数据，并将其分为 5 种饮食模式：非素食、半素食、鱼素食、乳素食和纯素食。主要结局和测量指标包括使用 Cox 比例风险回归模型和竞争风险方法评估全因和特定原因死亡率。
分析样本包括 88400 名参与者，提供了 971424 人年的随访。由于许多危险比（HR）随年龄而变化，我们报告了在 65 岁和 85 岁时的估计结果。与非素食者相比，素食者的死亡率总体较低（HR：0.89；95%置信区间[CI]：0.83，0.95；HR：0.98；95%CI：0.91，1.04），包括肾衰竭（HR：0.52；95%CI：0.38，0.70；HR：0.65；95%CI：0.55，0.76）、传染病（HR：0.57；95%CI：0.40，0.82；HR：0.90；95%CI：0.70，1.17）、糖尿病（HR：0.51；95%CI：0.33，0.78；HR：0.69；95%CI：0.53，0.88）、特定心脏病（HR：0.75；95%CI：0.65，0.87；HR：0.89；95%CI：0.83，0.95）和缺血性心脏病原因（HR：0.73；95%CI：0.59，0.90；HR：0.84；95%CI：0.75，0.94）。观察到纯素食者、乳素食者和鱼素食者的全因死亡率和几种类似的特定原因死亡率也较低。然而，在年龄较大的素食者中观察到更高的特定原因神经死亡率，特别是中风（HR：1.17；95%CI：1.02，1.33）、痴呆（HR：1.13；95%CI：1.00，1.27）和帕金森病（HR：1.37；95%CI：0.98，1.91）。素食/非素食者比较的黑人群体结果大致相同，但由于人数较少，HR 不太精确。
素食与全因和许多特定原因死亡率降低有关，特别是在男性和年轻人群中。然而，在年龄较大的素食者中，中风和痴呆的风险较高。这些结果需要进一步的支持和研究。
