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Food Intake Patterns of Self-identified Vegetarians Among the U.S. Population, 2007-2010

Authors:
Wenyen Juan at U.S. Food and Drug Administration
Wenyen Juan
Sedigheh Yamini
Sedigheh Yamini
Sedigheh Yamini
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Patricia Britten
Patricia Britten
Patricia Britten
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Abstract

Vegetarians’ food intake patterns vary in the extent that they exclude all or some animal products (e.g., meat, poultry, fish/ seafood, eggs, and dairy). We examined the differences of consumption of selected USDA Food Patterns food groups, subgroups, and food components, total calorie intake,and the number of food items between self-identified vegetarians and non-vegetarians in the U.S. population aged 1 year and older. Weighted reliable food consumption data from day 1 of the National Health and Nutrition Examination Survey, 2007-2010 and the USDA Food Patterns Equivalents Database, 2007-2010 were analyzed in the U.S. population (n=15,453) using SAS 9.3. Only 3% of the self-identified vegetarians (total 2.1%; n=323) did not consume any animal products. Compared to non-vegetarians, vegetarians consumed significantly fewer calories (1862 kcal vs. 2058 kcal; p<0.05) with the same number of food items (n=16) per day, and they consumed significantly less meat, poultry, solid fats and added sugars, and more soy, legumes, and whole grains than non-vegetarians. Both groups consumed about the same amounts of eggs, dairy, seafood, fruits, and vegetables. After energy adjustment, vegetarians consumed significantly more fruits, vegetables, whole grains, and total grains than non-vegetarians per 1000 kcal. Although a large proportion of self-identified vegetarians report consuming some type of animal products, such as meat, poultry and/or seafood, their dietary patterns contain more plant-based foods and whole grains with less solid fats and added sugars. Caution is needed in interpreting the term “vegetarian” from self-reports. Increasing fruit, vegetable, and whole grain consumption remains a targeted message for all populations.
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Procedia Food Science 4 ( 2015 ) 86 – 93
2211-601X Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license
(http://creativecommons.org/licenses/by-nc-nd/4.0/).
Peer-review under responsibility of the National Nutrient Databank Steering Committee
doi: 10.1016/j.profoo.2015.06.013
Available online at www.sciencedirect.com
ScienceDirect
38th National Nutrient Databank Conference
Food Intake Patterns of Self-identified Vegetarians
among the U.S. Population, 2007-2010
WenYen Juan
a,
*, Sedigheh Yamini
a
, Patricia Britten
b
a
b
Center for Nutrition Policy and Promotion, U.S. Department of Agriculture, 3101 Park Center Drive, Alexandria, 22302, USA
Office of Nutrition, Labeling and Dietary Supplements, Center for Food Safety and Applied Nutrition, U.S. Food and Drug Administration, 5100
Paint Branch Parkway, College Park, 20740, USA
Abstract
Vegetarians’ food intake patterns vary in the extent that they exclude all or some animal products (e.g., meat, poultry, fish/
seafood, eggs, and dairy). We examined the differences of consumption of selected USDA Food Patterns food groups, subgroups,
and food components, total calorie intake, and the number of food items between self-identified vegetarians and non-vegetarians
in the U.S. population aged 1 year and older. Weighted reliable food consumption data from day 1 of the National Health and
Nutrition Examination Survey, 2007-2010 and the USDA Food Patterns Equivalents Database, 2007-2010 were analyzed in the
U.S. population (n=15,453) using SAS 9.3. Only 3% of the self-identified vegetarians (total 2.1%; n=323) did not consume any
animal products. Compared to non-vegetarians, vegetarians consumed significantly fewer calories (1862 kcal vs. 2058 kcal;
p<0.05) with the same number of food items (n=16) per day, and they consumed significantly less meat, poultry, solid fats and
added sugars, and more soy, legumes, and whole grains than non-vegetarians. Both groups consumed about the same amounts of
eggs, dairy, seafood, fruits, and vegetables. After energy adjustment, vegetarians consumed significantly more fruits, vegetables,
whole grains, and total grains than non-vegetarians per 1000 kcal. Although a large proportion of self-identified vegetarians
report consuming some type of animal products, such as meat, poultry and/or seafood, their dietary patterns contain more plant-
based foods and whole grains with less solid fats and added sugars. Caution is needed in interpreting the term “vegetarian” from
self-reports. Increasing fruit, vegetable, and whole grain consumption remains a targeted message for all populations.
© 2015 The Authors. Published by Elsevier Ltd.
Peer-review under responsibility of the National Nutrient Databank Steering Committee.
Keywords: self-identified vegetarian; vegetarian food intake pattern; NHANES
* Corresponding author. Tel.: 240-402-1790; fax: 301-436-1191.
E-mail address: wenyen.juan@fda.hhs.gov
Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license
(http://creativecommons.org/licenses/by-nc-nd/4.0/).
Peer-review under responsibility of the National Nutrient Databank Steering Committee
87
WenYen Juan et al. / Procedia Food Science 4 ( 2015 ) 86 – 93
1. Introduction
Vegetarianism has become a popular and a potentially healthful eating practice for more than a decade in the
United States
1
. Generally, vegetarians are identified as individuals who do not consume any foods containing animal
flesh product
2
. There are different eating patterns among vegetarians: vegans are those who do not eat any animal
products including meat, fish/seafood, poultry, eggs, and dairy, while others may include dairy (lacto-vegetarians),
eg
gs (ovo-vegetarians), or both products (lacto-ovo-vegetarians) in their diets. The percent of individuals who are
id
entified as following a vegetarian diet varies, based on the specific survey and the way in which a vegetarian diet
is identified. Most recently, in a 2012 survey, about 4% of U.S. adults aged 18 years and older self-reported that
they were vegetarians, including about 1% that were vegans
3
. A similar prevalence in vegetarian and vegan children
aged 8-18 years old was reported in a 2014 survey
4
Other studies have reported that individuals who considered themselves vegetarians may also consume some
animal products (e.g., fish, chicken or red meat) as part of their daily diet
.
5,6
These individuals could be considered to
be “self-described” vegetarians, or “semi-vegetarians
2
. For example, in a British Columbia cross-sectional survey,
about 14 (16%) and 51 (57%) out of 90 self-identified vegetarian women aged 18 to 50 years reported occasional
con
sumption of chicken or fish, respectively
5
.A1994-1996 national study found that 2.5% of the U.S. population
aged 6 years and older considered themselves vegetarians, but about 36% of these self-reported vegetarians reported
con
suming meat products on the surveyed consumption day
6
.A1999-2004 population-based survey of the U.S.
adults aged 19 years and older found that 6% of the participants did not report eating any meat, poultry or fish on the
day of the survey
7
Despite the consumption of animal flesh products reported by the self-identified vegetarians, the dietary pattern
in general for vegetarians appears to indicate a more “healthful” dietary practice compared to non-vegetarians. In
ge
neral, self-identified vegetarians consumed more total fruits, total vegetables, especially dark green and deep
y
ellow vegetables, legumes, and less table fats than non-vegetarians; there were no differences in consumption of
m
ilk and cheese products compared to non-vegetarians
. Reported prevalence of a vegetarian eating pattern has varied in these studies, perhaps due to
w
hen the study was conducted, the specific population group, or the way in which a vegetarian eating pattern was
defined and assessed.
6
. Self-identified vegetarians also reported consuming plant
protein sources at least weekly
5
Although the dietary patterns of vegetarians suggest healthful dietary practices, there has been inconsistent
evidence on the use of such dietary practices for weight loss or weight management purposes, which focus on the
red
uction of energy intake
.
8
. While some studies reported that vegetarians’ dietary patterns had been suggested as an
approach for weight reduction or weight management to improve health
7-9
, other studies found that there was no
difference in total energy intake between vegetarians and non-vegetarians
10, 11
. Energy reduction could be the result
of areduction of variety in the diet
12
2. Subjects and method
— in other words; it could be associated with the number of food items
c
onsumed per day. To our knowledge, no study has examined the differences in the number of food items consumed
per
day and only limited research has explored the differences in food intake patterns among self-identified
ve
getarians and non-vegetarians, especially in a nationally representative sample of the U.S. population. Therefore,
th
e main purpose of this study was to compare the types and quantities of food groups and subgroups, as well as the
average total energy intake and the number of food items consumed per day, in the dietary patterns of self-identified
vegetarian and non-vegetarians in the U.S. population during the years of 2007-2010.
F
or this study, we examined food consumption data from the combined survey years of 2007-2008 and 2009-
2010 National Health and Nutrition Examination Survey (
NHANES). NHANES uses a stratified, multiple-stage of
probability sampling method to collect health- and nutrition-related information from about 5,000 civilian, non-
institutionalized United States populations per year. The Diet Behavior and Nutrition component of the NHANES
survey includes a question (“Do you consider yourself to be a vegetarian”) asking participants (or their proxies)
aged 1 year and older their self-perception of vegetarian dietary practices. Only the definitive answers from the
participants as either “yes” (considered as the “self-identified vegetarian”) or “no” (considered as “self-identified
no
n-vegetarian” or “non-vegetarian”) were included in the data analysis for this study. The consumption data of the
88 WenYen Juan et al. / Procedia Food Science 4 ( 2015 ) 86 – 93
NHANES, called “What We Eat in America” (WWEIA) were collected by the United States Department of
Agriculture (USDA). Detailed information on two consumption days (day 1 and day 2) of the types and amounts of
food consumed in the past 24-hours was collected among participants of all ages. The first day (day 1) of the dietary
data
were collected during an in-person Mobile Examination Center (MEC) interview and the second day (day 2) of
t
he dietary data were collected 3 to 10 days later during a phone interview
13
We included only the reliable day 1 food consumption data from participants aged 1 and older in the study
(n=15,453). The amounts of intakes in WWEIA-NHANES were further estimated for the consumption of 37
com
ponents of food groups and subgroups, based on the ingredients of the foods. The consumption of food groups
and subgroups was estimated based on the Food Patterns Equivalents Database (FPED) 2007-2008 and 2009-2010
dev
eloped by the Food Surveys Research Group, Agricultural Research Service of USDA. The FPED is often used
to evaluate the dietary patterns of Americans in compliance with the recommendations from the Dietary Guidelines
for Americans (DGA)
.
14, 15
For this study, we examined the dietary patterns among the self-identified vegetarians based on consumption of
any amount of several major animal protein sources, such as meat, poultry, seafood, eggs, and dairy. Additionally,
we examined the differences in dietary patterns between the self-defined vegetarians and non-vegetarians based on
consumption of selected USDA Food Pattern food groups, subgroups, and FPED components: animal protein foods,
s
uch as meat, poultry, seafood, eggs, and dairy; fruits; vegetables; soy products; legumes; total grains and whole
grains; added sugars; and solid fats. The differences in consumption between self-identified vegetarians and non-
vegetarians were adjusted per 1000 calories for the same food group components to evaluate the diet quality
bet
ween those two subpopulations at the p<0.05 level. Weighted analyses were computed using SAS 9.3 (Statistical
Analysis System, Cary, NC) taking into account the survey design to produce the U.S. population representative
estimates.
. The major food groups in the FPED are: Fruits, Vegetables, and Dairy presented in cup
equivalents; and Grains and Protein foods presented in ounce equivalents. Additional food components in the FPED
are: number of Alcoholic drinks; teaspoon equivalents of Added Sugars; and gram equivalents of Solid Fats and
Oils. The major food groups, are further divided into subgroups (e.g., whole grain subgroup and refined grains
subgroup for the Grains food group), which can be used to examine the variety of the dietary patterns and
compliance with key recommendations from the DGA.
3. Results
As shown in Table 1, only 2.1% (n=323) of the U.S. population identified themselves as a vegetarian (the “self-
identified vegetarians”). Self-identified vegetarians were more likely than non-vegetarians to be females (68%). The
se
lf-identified vegetarians consumed significantly fewer average calories per day compared to non-vegetarians
(186
2 vs. 2058 kcal); however, there was no difference in the average total number of food items (about 16)
reported in a day between the two groups.
Table 1. Characteristics of self-identified vegetarians and non-vegetarians
Self-identified
veg
etarians
(n=323; 2.1%)
Se
lf-identified
no
n-vegetarians
(n
=15,130; 97.9%)
Age (years) 35.3 37.2
Sex
Males
Females
32%
68%
48%
52%
Average number of foods consumed /day
A
verage calories (kcal)/day
16.8
1862
16.4
2058*
*Significantly different between self-identified vegetarians and non-vegetarians at p<0.05.
89
WenYen Juan et al. / Procedia Food Science 4 ( 2015 ) 86 – 93
Very few (n=10; 3%) self-identified vegetarians reported consuming no animal protein foods at all on any given
consumption day (Figure 1). The majority of self-identified vegetarians reported consumption of dairy (93%), and
eg
gs (65%). In addition, more than one-fourth (27%) reported consumption of some type of red meat. When meat,
pou
ltry, and seafood were grouped, almost half (48%) of self-identified vegetarians reported consumption of some
f
ood from this combined grouping (Figure 1).
Fig.1. Percent of self-identified vegetarians consumed or did not consume animal protein food groups
Table 2 shows the average amounts of food groups, subgroups, and components consumed by self-identified
vegetarians and non-vegetarians. On average, self-identified vegetarians consumed significantly less meat, poultry,
s
olid fats and added sugars, but more legumes, soy, and whole grains per day compared to non-vegetarians. After
ad
justing the average daily consumption to amounts per 1000 kcal, to examine the diet quality between the self-
identified vegetarians and non-vegetarians, we found that compared to non-vegetarians, self-identified vegetarians
consumed significantly less meat, poultry, solid fats, and added sugars per 1000 kcal and more fruits, vegetables,
legumes, soy, whole grains, and total grains per 1000 kcal than non-vegetarians. The consumption of seafood, eggs,
and dairy did not differ between self-identified vegetarians and non-vegetarians whether adjusting for energy intake
or n
ot.
4. Discussion
A very small percentage (2.1%) of the U.S. population aged 1 year and older identified themselves as
vegetarians; and within this group, only about 3% were true vegans íWKH\GLGQRWUHSRUWFRQVXPLQJDQ\DQLPDO
protein sources on any given day. Almost all of the self-reported vegetarians included some type of animal product
in
their diet, most commonly dairy products and eggs which are considered acceptable foods for many vegetarians.
Sometimes, individuals may become vegetarians by gradually eliminating meat and poultry from their diets, and
further reducing dairy products and eggs as suggested by a previous study
5
. However, since this is a cross-
0
10
20
30
40
50
60
70
80
90
100
Percent
Foods from one or more of these Food Groups
Ate
Did not eat
90 WenYen Juan et al. / Procedia Food Science 4 ( 2015 ) 86 – 93
sectional study, it is impossible to know whether individuals who reported consuming animal proteins were trending
towards eliminating those protein sources from their diet. The duration of practicing vegetarianism may be an
important factor to consider in examining the dietary patterns of individuals.
Table 2. Average consumption for selected food groups, subgroups, and components among self-identified vegetarians and non-vegetarians
Food groups and subgroups
(measurement unit)
Self-identified
veg
etarians
Mean
SE
Self-identified
no
n-vegetarians
Mean
SE
Meat (oz equiv.)
Poultry (oz equiv.)
Seafood (oz equiv.)
Eggs (oz equiv.)
Dairy (cup equiv.)
Fruits (cup equiv.)
Vegetables (cup equiv.)
Legumes (cup equiv.)
Soy (oz equiv.)
Grains (oz equiv.)
Whole grains (oz equiv.)
Solid fats (grams)
Added sugars (grams)
0.67*
0.68*
0.42
0.41
1.65
1.21
1.49
0.2*
0.32*
7.05
1.23*
28.9*
63.2*
0.2
0.1
0.1
0.1
0.1
0.1
0.1
0.04
0.07
0.4
0.2
1.9
4.4
2.57
1.45
0.53
0.47
1.79
1.05
1.4
0.1
0.1
6.43
0.7
38.13
76.9
0.05
0.04
0.03
0.01
0.04
0.03
0.03
0.01
0.01
0.07
0.03
0.5
1.6
Food groups and subgroups
(measurement unit/1000 kcal)
Meat (oz equiv./1000 kcal)
Poultry (oz equiv./1000 kcal)
Seafood (oz equiv./1000 kcal)
Eggs (oz equiv./1000 kcal)
Dairy (cup equiv./1000 kcal)
Fruits (cup equiv./1000 kcal)
Vegetables (cup equiv./1000 kcal)
Legumes (cup equiv./1000 kcal)
Soy (oz equiv./1000 kcal)
Grains (oz equiv./1000 kcal)
Whole grains (oz equiv./1000 kcal)
Solid fats (grams/1000 kcal)
Added sugars (grams/1000 kcal)
0.38*
0.38*
0.28
0.21
0.88
0.77*
0.87*
0.09*
0.2*
3.78*
0.74*
14.7*
32.3*
0.09
0.07
0.09
0.05
0.05
0.09
0.06
0.02
0.05
0.2
0.1
0.8
1.97
0.73
0.74
0.26
0.23
0.9
0.57
0.72
0.05
0.03
3.15
0.38
17.9
36.7
0.03
0.03
0.01
0.007
0.02
0.02
0.01
0.003
0.004
0.03
0.01
0.16
0.75
*Significantly different between self-identified vegetarians and non-vegetarians at p<0.05.
Vegetarian dietary patterns have been suggested for weight management or weight reduction purposes. To use a
dietary pattern for the weight reduction purpose, it is often suggested to reduce the total daily energy intake by 500
calories per day for adults
16
. In this study, we found that self-identified vegetarians (some of whom included animal
91
WenYen Juan et al. / Procedia Food Science 4 ( 2015 ) 86 – 93
proteins in their diet) consumed significantly less average daily total calories than non-vegetarians (about 200
calories, p<0.05). A similar study that defined vegetarians as respondents who did not include any animal proteins in
t
heir diet on the consumption day of the survey
7
, found that vegetarians consumed about 363 fewer calories
compared to non-vegetarians. This suggests the potential usefulness of a vegetarian dietary pattern to promote
w
eight loss. Even though the majority of the self-identified vegetarians in our study were women, who typically
n
eed and consume fewer calories than men, a 200 calorie deficit could make a meaningful contribution to weight
loss over time
16
Although self-identified vegetarians consumed significantly lower average calories per day compared to non-
vegetarians, this difference was due to the amounts and types of food consumed, rather than the number of foods.
While about half of self-identified vegetarians consumed some meat and poultry products, compared to non-
vegetarians, they consumed more meat alternative products made of legumes and soy. Some meat alternative
produ
cts contain fewer calories per 100 grams compared to meat or poultry products (e.g., beef hot dog, 322
kcals/100 g vs. meatless hot dog, 233 kcals/100 g), which could contribute to lower calorie consumption. On a per
1000 calorie basis, they also consumed more fruits, vegetables, and whole grains and less empty calories (calories
from solid fats and added sugars) compared to non-vegetarians. Since almost two-thirds of the study sample of self-
identified vegetarians were female, it is also possible that t
he calorie difference is due to the lower calorie needs per
day of females. Females also were more likely to consider themselves as vegetarians compared to males in a
previous study
.
11
A vegetarian dietary pattern might affect nutrient density more than energy reduction
. However, we could not examine the impact of gender due to the small sample size of the self-
identified vegetarians. Future studies examining the gender effect on the vegetarian dietary pattern, numbers of food
ite
ms consumed, and calorie consumption are warranted.
7
. When examining the
types and amounts of food groups and subgroups consumed between self-identified vegetarians and non-vegetarians,
we found that among the self-identified vegetarians, almost all (97%) reported consuming some types of animal
protein sources (such as meat, poultry, seafood, eggs, or dairy); and about half of them consumed some meat,
poultry, and/or seafood. This finding is similar to previous studies, which reported that self-identified vegetarians
included those who reduced the consumption of red meat, or occasionally ate chicken or fish
5, 9, 11
. It appears that
self-defined vegetarians may have different dietary practices compared to the dietary patterns that are generally
recog
nized as vegetarianism. Therefore, caution is needed when interpreting vegetarian dietary practices based on
self-reports. Additionally, a consistent characterization of vegetarian dietary patterns should be carefully developed
and examined in research studies
17
Self-identified vegetarians in this study, reported per 1000 kcal consuming more fruits, vegetables, and whole
grains and less empty calories (calories from solid fats and added sugars) compared to non-vegetarians. Similar
f
indings were found in a previous study
.
7
. We did not find any differences in consumption of seafood, eggs, and
dairy whether adjusting by energy or not, which was different than a previous study which found that vegetarians
had higher intake of dairy but no difference in consumption of eggs compared to non-vegetarians
7
Although self-identified vegetarians appear to have a somewhat more healthful intake pattern compared to non-
vegetarians, with higher consumption of fruits, vegetables and whole grains, these intake levels remain below the
recom
mendations based on the 2010 DGA as measured by Healthy Eating Index-2010 (HEI-2010) standards
.
18
. The
maximum scoring standards for the components of the HEI-2010 are often used to assess diet quality and
con
formance to the key recommendations from the 2010 DGA
18
. Fruits, vegetables, and whole grains are some of
the components of the HEI-2010. The HEI-2010 standards set the consumption amount of 
FXS 00 kcal for
total fruits, FXSHTXLYDOHQWVNFDOIRUWRWDOYHJHWDEOHVDQGRXQFHHTXLYDOHQWVNFDORIZKROH
grains to receive the maximum component scores
18
Additionally, the consumption of solid fats and added sugars per 1000 kcal for self-identified vegetarians was
significantly less than non-vegetarians; however, it was still higher than the recommended limit based on the HEI-
2010 standard (Table 3). While the total consumption of calories from these two components are not directly
comparable to the “empty calories” component of HEI-2010 (which includes the total calories from solid fats,
. O
n average, the self-identified vegetarians consumed about 0.8
cup equivalents, 0.9 cup equivalents, and 0.7 ounce equivalents of fruits, vegetables, and whole grains per 1000
kcal, respectively (Table 3). These amounts, except for fruits, are less than the standards set for the HEI-2010.
Therefore, the self-identified vegetarians would not receive the maximum score for vegetables and whole grains
com
ponent.
92 WenYen Juan et al. / Procedia Food Science 4 ( 2015 ) 86 – 93
alcohol, and added sugars), the calories from just these two components exceeds the recommended limit. The mean
calorie intake from both solid fats and added sugars among self-identified vegetarians was about 27.5% of energy,
which was higher than the standard for the maximum score of the empty calories component of HEI-2010 (RI
energy), but lower than the non-vegetarians (31.6%). Therefore, the self-identified vegetarians would not receive the
m
aximum score for this HEI component amount. In other words, for both food group intakes and limits on empty
cal
ories, their consumption did not fully meet recommendations based on the 2010 DGA.
Table 3. Mean intakes and Healthy Eating Index-2010 (HEI-2010) standards for self-identified vegetarians and non-vegetarians
Component
HEI-2010
standard for maximum
co
mponent score
Self-identified
vegetarians
Self-identified
non-vegetarians
Fruits (cup equiv./1000 kcal)  0.77 0.57
Vegetables (cup equiv./1000 kcal)  0.87 0.72
Whole grains (oz equiv./1000 kcal)  0.74 0.38
Empty calories (% of kcal) 19 27.5* 31.6*
*Percent of energy intake from solid fats and added sugars.
5. Conclusion
Almost all self-identified vegetarians consumed some type of animal protein products. Among these self-
identified vegetarians, almost half reported consumption of meat, poultry, or seafood. Dairy and eggs were the most
com
monly consumed animal protein products, and are considered acceptable in many vegetarian dietary patterns.
Therefore, caution is needed in interpreting the dietary pattern based on the term “vegetarian” from self-reports.
Vegetarian dietary patterns as seen in this sample appear to have better diet quality with lower energy intake
w
hen compared to the non-vegetarian dietary pattern. When planned carefully, it may be useful for weight reduction
o
r weight management without lessening the quality of the diet.
Vegetarian dietary patterns based on self-report included more fruits, vegetables, and whole grains; and less solid
fats and added sugars than non-vegetarians. However, the consumption amounts are still below the
recom
mendations based on the 2010 DGA. Practitioners and future researchers should examine the types and
amounts of foods that are consumed by individuals that identify themselves as vegetarians when assessing if
nutrients that might be of concern in a vegetarian dietary pattern in general, such as protein, iron, vitamin B12, and
zin
c, are inadequate.
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... [52]. In an analysis of food intake based on data from NHANES, 2007-2010, and the USDA Food Patterns Equivalents Database, 2007-2010, vegetarians consumed 1862 kcal, whereas nonvegetarians consumed 2058 kcal [53]. A 2019 review listed the driving forces behind the increase in CRC as obesity, a sedentary lifestyle, and red meat, alcohol, and tobacco consumption. ...
Cancer Incidence Rates in the US in 2016–2020 with Respect to Solar UVB Doses, Diabetes and Obesity Prevalence, Lung Cancer Incidence Rates, and Alcohol Consumption: An Ecological Study
Article
Full-text available
  • May 2024
This article reports the results of an ecological study of cancer incidence rates by state in the US for the period 2016–2020. The goals of this study were to determine the extent to which solar UVB doses reduced cancer risk compared to findings reported in 2006 for cancer mortality rates for the periods 1950–1969 and 1970–1794 as well as cancer incidence rates for the period 1998–2002 and to determine which factors were recently associated with cancer risk. The cancer data for non-Hispanic white (European American) men and women were obtained from the Centers for Disease Control and Prevention. Indices were obtained for solar UVB at the surface for July 1992, and alcohol consumption, diabetes, and obesity prevalence near the 2016–2020 period. Lung cancer incidence rates were also used in the analyses as a surrogate for smoking, diet, and air pollution. The cancers for which solar UVB is significantly associated with reduced incidence are bladder, brain (males), breast, corpus uteri, esophageal, gastric, non-Hodgkin’s lymphoma, pancreatic, and renal cancer. Lung cancer was significantly associated with colorectal, laryngeal, and renal cancer. Diabetes was also significantly associated with breast, liver, and lung cancer. Obesity prevalence was significantly associated with breast, colorectal, and renal cancer. Alcohol consumption was associated with bladder and esophageal cancer. Thus, diet has become a very important driver of cancer incidence rates. The role of solar UVB in reducing the risk of cancer has been reduced due to people spending less time outdoors, wearing sunscreen that blocks UVB but not UVA radiation, and population increases in terms of overweight and obese individuals, which are associated with lower 25-hydroxyvitamin D concentrations and the generation of systemic inflammation, which is a risk factor for cancer. A dietary approach that would reduce the risk of diabetes, obesity, lung cancer, and, therefore, cancer, would be one based mostly on whole plants and restrictions on red and processed meats and ultraprocessed foods. Solar UVB exposure for a few minutes before applying sunscreen and taking vitamin D supplements would also help reduce the risk of cancer.
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... [46]. In an analysis of food intake based on data from NHANES, 2007-2010, and the USDA Food Patterns Equivalents Database, 2007-2010, vegetarians consumed 1862 kcal, whereas nonvegetarians consumed 2058 kcal [47]. A 2019 review listed the driving forces behind the increase in CRC as obesity, sedentary lifestyle, red meat consumption, alcohol, and tobacco Studies of changes in cancer rates in countries that experienced the nutrition transition to the Western dietary pattern in the past half-century offer more support for diet's role in cancer risk. ...
Cancer Incidence Rates in the US in 2016–2020 with Respect to Solar UVB Doses, Diabetes and Obesity Prevalence, Lung Cancer Incidence Rates, and Alcohol Consumption: An Ecological Study
Preprint
Full-text available
  • May 2024
This article reports the results of an ecological study of cancer incidence rates by state in the US for the period 2016-2020. The goals of this study were to determine the extent to which solar UVB doses still reduced cancer risk compared to findings reported in 2006 for cancer mortality rates for the periods 1950–1969 and 1970-1794 as well as cancer incidence rates for the period 1998–2002 and to determine which factors were recently associated with cancer risk. The cancer data for non-Hispanic white (European American) men and women were obtained from the Centers for Disease Control and Prevention. Indices were obtained for solar UVB at the surface for July 1992, and alcohol consumption, and diabetes and obesity prevalence near the 2016–2020 period. Lung cancer incidence rates were also used in the analyses as a surrogate for smoking, diet, and air pollution. The cancers for which solar UVB is significantly associated with reduced incidence are bladder, brain (males), breast, corpus uteri, esophageal, gastric, non-Hodgkin’s lymphoma, pancreatic, and renal cancer. Lung cancer was significantly associated with colorectal, laryngeal, and renal cancer. Diabetes was also significantly associated with breast, liver, and lung cancer. Obesity prevalence was significantly associated with breast, colorectal and renal cancer. Alcohol consumption was associated with bladder and esophageal cancer. Thus diet has become a very important driver of cancer incidence rates. The role of solar UVB in reducing risk of cancer has been reduced due to people spending less time outdoors, wearing sunscreen that blocks UVB but not UVA radiation, and population increases in overweight and obesity, which lowers 25-hydroxyvitamin D concentrations and generates systemic inflammation, a risk factor for cancer. The dietary approach that would reduce the risk of diabetes, obesity, lung cancer, and, therefore cancer, would be one based mostly on whole-plants and restrictions on red and processed meats and ultraprocessed foods. Solar UVB exposure for a few minutes before applying sunscreen and taking vitamin D supplements would also help reduce risk of cancer.Keywords: alcohol consumption; cancer incidence;
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... [42]. In an analysis of food intake based on data from NHANES, 2007-2010, and the USDA Food Patterns Equivalents Database, 2007-2010, vegetarians consumed 1862 kcal, whereas nonvegetarians consumed 2058 kcal [43]. A 2019 review listed the driving forces behind the increase in CRC as obesity, sedentary lifestyle, red meat consumption, alcohol, and tobacco Studies of changes in cancer rates in countries that experienced the nutrition transition to the Western dietary pattern in the past half-century offer more support for diet's role in cancer risk. ...
Cancer Incidence Rates for nonHispanic White Men and Women in the US in 2016–2020 with Respect to Solar UVB Doses, Diabetes and Obesity Prevalence, Lung Cancer Incidence Rates, and Alcohol Consumption: An Ecological Study
Preprint
Full-text available
  • Apr 2024
This article reports the results of an ecological study of cancer incidence rates by state in the US for the period 2016-2020. The goals of this study were to determine the extent to which solar UVB doses still reduced cancer risk compared to findings reported in 2006 for cancer mortality rates for the periods 1950–1969 and 1970-1794 as well as cancer incidence rates for the period 1998–2002 and to determine which factors were recently associated with cancer risk. The cancer data were obtained from the Centers for Disease Control and Prevention. Indices were obtained for solar UVB at the surface for July 1992, and alcohol consumption, and diabetes and obesity prevalence near the 2016–2020 period. Lung cancer incidence rates were also used in the analyses. The cancers for which solar UVB is significantly associated with reduced incidence are bladder, brain (males), breast, corpus uteri, esophageal, gastric, non-Hodgkin’s lymphoma, pancreatic, and renal cancer. Lung cancer was significantly associated with colorectal, laryngeal, and renal cancer. Diabetes was also significantly associated with breast, liver, and lung cancer. Obesity prevalence was significantly associated with breast, colorectal and renal cancer. Alcohol consumption was associated with bladder and esophageal cancer. Thus diet has become a very important driver of cancer incidence rates. The dietary approach that would reduce the risk of diabetes, obesity, lung cancer, and, therefore cancer, would be one based mostly on whole-plants and restrictions on red and processed meats and ultraprocessed foods.
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... This is just under twice the estimated percentage globally (e.g. Juan et al. 2015;Craig 2009). An increase in veganism highlights an anti-dairy identity, which the Vegan Society Aotearoa attributes to environmental factors, specifically climate change (Ibid.). ...
The ‘Good Kiwi’ and the ‘Good Environmental Citizen’?: Dairy, national identity and complex consumption-related values in Aotearoa New Zealand
Article
Full-text available
  • Mar 2024
  • AGR HUM VALUES
Alongside concerns for animal welfare, concerns for land, water, and climate are undermining established food identities in many parts of the world. In Aotearoa New Zealand, agrifood relations are bound tightly into national identities and the materialities of export dependence on dairying and agriculture more widely. Dairy/ing identities have been central to national development projects and the politics that underpin them for much of New Zealand’s history. They are central to an intransigent agrifood political ontology. For the last decade, however, they have been challenged by the identity politics of ethical food consumption. This paper explores the ensuing contests and asks how they are reshaping agrifood identities. We draw on interviews with 15 participants in Aotearoa New Zealand who have made dietary transitions that reduce or exclude dairy products. Our aim is not to identify a new post-dairying identity or claim a reconfigured national identity, but to examine the collision of production-consumption values in the context of a dominant place-based food identity. We ask how participants navigate contradictory commitments to becoming ‘good environmental citizens’ whilst remaining ‘good national citizens’. The paper offers insights for examining similar struggles elsewhere and the potential to shift agrifood relations and undermine entrenched political ontologies through ethical food consumption values.
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... The specific sampling methods used in these market research polls are not clear. In addition, the questions used in the surveys ask people to self-identify as vegetarian/vegan or mostly vegetarian/vegan, which will overestimate prevalence compared with asking people about the food groups that they consume or exclude (15). ...
The prevalence of vegetarians, vegans and other dietary patterns that exclude some animal-source foods in a representative sample of New Zealand adults
Article
Full-text available
  • Dec 2023
  • PUBLIC HEALTH NUTR
Objective This study aimed to estimate the prevalence of vegetarians, vegans and other dietary patterns that exclude some animal-source foods in New Zealand adults. We also examined sociodemographic and lifestyle correlates of these dietary patterns. Design The New Zealand Health Survey is a representative rolling cross-sectional survey of New Zealanders; data from the 2018/19 and 2019/20 waves were used for this analysis. Participants were asked if they completely excluded red meat, poultry, fish/shellfish, eggs, or dairy products from their diet. Setting New Zealand. Participants Adults, aged ≥15 years (n=23,292). Results The prevalence of red-meat excluders (2.89%), pescatarians (1.40%), vegetarians (2.04%), and vegans (0.74%) was low. After adjustment for sociodemographic and lifestyle factors, women (Odds Ratio (OR)=1.54, 95% CI: 1.22-1.95), Asian people (OR=2.56, 95% CI: 1.96-4.45), people with tertiary education (OR=1.71, 95% CI: 1.18-2.48), and physically active people (OR=1.36, 95% CI: 1.04-1.76) were more likely to be vegetarian/vegan. Those aged ≥75 years (OR=0.28, 95% CI: 0.14-0.53) and current smokers (OR=0.42, 95% CI:0.23-0.76) were less likely to be vegetarian/vegan. Similar associations were seen between sociodemographic and lifestyle factors and the odds of being a red-meat excluder/pescatarian. Conclusions Approximately 93% of New Zealand adults eat red-meat and a very small number exclude all animal products from their diets. The Eating and Activity Guidelines for New Zealand adults recommend a plant-based diet with moderate amounts of animal-source foods. A comprehensive national nutrition survey would provide detailed information on the amount of red meat and other animal-source foods that the New Zealand population currently consumes.
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... This definition limited the applicability of study findings in US populations given the fact less than 3% of US population are vegetarians. 8 Dietary indices that can evaluate the gradients of adherence to a plant-based diet are warranted to study the health effects of this dietary pattern in general populations. ...
Plant-based diets and the incidence of cardiovascular disease: the Million Veteran Program
Article
Full-text available
  • Oct 2023
Background A healthful plant-based diet was associated with lower risks of coronary heart disease and type 2 diabetes, and a favourable profile of adiposity-associated biomarkers, while an unhealthful plant-based diet was associated with elevated risk of cardiometabolic disease in health professional populations. However, little is known about the associations between plant-based dietary patterns and risk of cardiovascular disease (CVD) in US veterans. Methods The study population consisted of 148 506 participants who were free of diabetes, CVD and cancer at baseline in the Veterans Affairs (VA) Million Veteran Program. Diet was assessed using a Food Frequency Questionnaire at baseline. We calculated an overall Plant-Based Diet Index (PDI), a healthful PDI (hPDI) and an unhealthful PDI (uPDI). The CVD endpoints included non-fatal myocardial infarction (MI) and acute ischaemic stroke (AIS) identified through high-throughput phenotyping algorithms approach and fatal CVD events identified by searching the National Death Index. Results With up to 8 years of follow-up, we documented 5025 CVD cases. After adjustment for confounding factors, a higher PDI was significantly associated with a lower risk of CVD (HR comparing extreme quintiles=0.75, 95% CI 0.68 to 0.82, P trend <0.0001). We observed an inverse association between hPDI and the risk of CVD (HR comparing extreme quintiles=0.71, 95% CI 0.64 to 0.78, P trend <0.001), whereas uPDI was positively associated with the risk of CVD (HR comparing extreme quintiles=1.12, 95% CI 1.02 to 1.24, P trend <0.001). We found similar associations of hPDI with subtypes of CVD; a 10-unit increment in hPDI was associated with HRs (95% CI) of 0.81 (0.75 to 0.87) for fatal CVD, 0.86 (0.79 to 0.94) for non-fatal MI and 0.86 (0.78 to 0.95) for non-fatal AIS. Conclusions Plant-based dietary pattern enriched with healthier plant foods was associated with a substantially lower CVD risk in US veterans.
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... Recent literature suggests that individual diet and taste sensitivity may have a reciprocal relationship, with evidence highlighting that specific diets can alter taste sensitivities [2][3][4]. In recent years, the number of people following vegetarian or vegan diets has rapidly increased, with approximately 14% of the world population now following one of these diets (e.g., [5][6][7][8][9]). Internationally, young Western females have been reported to be the most likely group to reduce animal products from their diet [10,11]. ...
Comparing Taste Detection Thresholds across Individuals Following Vegan, Vegetarian, or Omnivore Diets
Article
Full-text available
  • Nov 2021
Taste perception plays an undisputed role in food choice, preference, and intake. Recent literature suggests that individual diet and taste sensitivity may have a reciprocal relationship, with evidence highlighting that specific diets can alter taste sensitivities. Commensurate with an increase in the prevalence of plant-based diets is the importance of investigating if following a vegetarian or vegan diet is associated with altered taste sensitivities. In this study, the taste detection thresholds for six compounds (i.e., sweet-sucrose, salty-sodium chloride, sour-citric acid, umami-monosodium glutamate, MSG, bitter-caffeine, and metallic-iron II sulphate heptahydrate) were measured for a total of 80 healthy, New Zealand European females aged 18-45 years old, who were categorised as 22 vegans, 23 vegetarians, and 35 omnivores. Each participant's detection thresholds to these compounds were measured across two sessions, using an ascending Method of Limits with two-alternative-forced-choice presentations. The threshold data were analysed using both multivariate (i.e., principal component analysis) and univariate (i.e., ANCOVA) techniques to assess differences across the three types of diet. Multivariate analysis suggested that the omnivore group had distinct taste sensitivity patterns across the six compounds compared to the vegetarian or vegan group, which were characterised by relatively heightened sensitivity to metallic and lowered sensitivity to sweetness. Furthermore, the vegetarian group was shown to have a significantly lower detection threshold to bitterness (i.e., caffeine) relative to the other two groups (p < 0.001). While future study is required to investigate the cause-effect relationship between individual diet and taste sensitivities, the present study provides a systematic evaluation of taste sensitivities of individuals following distinct diets. This information may be valuable to future gustatory research as well as to food manufacturers.
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... Previous studies [58][59][60] have reported a significant mismatch between self-reported dietary pattern and the food groups being consumed. For example, in the current study, 16% of vegans were found to have reported consuming dairy products "at least once a day" while 4% reported consuming eggs "at least once a day" (Appendix A Table A4). ...
Identifying Novel Data-Driven Dietary Patterns via Dimensionality Reduction and Associations with Socioeconomic Profile and Health Outcomes in Ireland
Article
Full-text available
  • Jul 2023
Dietary patterns and body mass index (BMI) play a significant role in the development of non-communicable diseases (NCDs), which are the leading cause of mortality worldwide, including Ireland. A cross-sectional survey was conducted across Ireland to collate respondents’ socioeco-nomic profiles, health status, and dietary patterns with a representative sample size of 957 adult respondents. Principal component analysis (PCA) and statistical analyses were subsequently em-ployed. To the author’s knowledge, this is the first study to use recent (2021) nationally repre-sentative data to characterise dietary patterns in Ireland via dimensionality reduction. Five distinct dietary patterns (“meat-focused”, “dairy/ovo-focused”, “vegetable-focused”, “seafood-focused”, and “potato-focused”) were identified and statistically characterised. The “potato-focused” group exhibited the highest mean BMI (26.88 kg/m2), while the “vegetable-focused” group had the lowest (24.68 kg/m2). “Vegetable-focused” respondents were more likely to be associated with a categor-ically healthy BMI (OR = 1.90) and urban residency (OR = 2.03). Conversely, “meat-focused” re-spondents were more likely to have obesity (OR = 1.46) and rural residency (OR = 1.72) along with the “potato-focused” group (OR = 2.15). Results show that data-derived dietary patterns may better predict health outcomes than self-reported dietary patterns, and transitioning to diets focusing on vegetables, seafood, and lower meat consumption may improve health.
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Vegetarian diets and risk of nonalcoholic fatty liver disease: An observational study of National Health and Nutrition Examination Survey 2005-2018 using propensity score methods
Article
  • Feb 2024
  • J HUM NUTR DIET
Background Studies on the association between vegetarian diets and nonalcoholic fatty liver disease (NAFLD) are limited and have inconsistent results. This study aims to explore the association between vegetarian diets and NAFLD and compare the stage of fibrosis between vegetarians and nonvegetarians in a US representative sample. Methods Cross‐sectional data from 23,130 participants aged ≥20 years were obtained from the National Health and Nutrition Examination Survey, 2005–2018. Vegetarian status was classified based on two 24‐h dietary recalls. We examined the association between vegetarian diets and the risk of NAFLD using the propensity score weighting method. Results Vegetarian diets were significantly associated with decreases in hepatic steatosis index (HSI), US fatty liver index and nonalcoholic fatty liver disease fibrosis score with mean differences of −2.70 (95% confidence interval [CI]: −3.69, −1.70), −3.03 (95% CI: −7.15, −0.91) and −0.12 (95% CI: −0.26, −0.01), respectively. While modelling the risk of NAFLD, we estimated that vegetarians were 53% less likely to have NAFLD assessed by HSI (odds ratios [OR]: 0.47; 95% CI: 0.34, 0.65). The effect of vegetarian diets was higher among individuals with lower waist circumferences (OR: 0.20) than among those with higher waist circumferences (OR: 0.53, = 0.004). However, the association was largely attenuated after adjusting for body mass index and diabetes status. No significant association was identified between vegetarian diets and advanced fibrosis. Conclusions Vegetarian diets were associated with a lower prevalence of NAFLD among US adults, and the association appeared to be stronger in people with lower waist circumferences. Further studies are warranted to replicate our findings.
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Genetics of vegetarianism: A genome-wide association study
Article
Full-text available
A substantial body of evidence points to the heritability of dietary preferences. While vegetarianism has been practiced for millennia in various societies, its practitioners remain a small minority of people worldwide, and the role of genetics in choosing a vegetarian diet is not well understood. Dietary choices involve an interplay between the physiologic effects of dietary items, their metabolism, and taste perception, all of which are strongly influenced by genetics. In this study, we used a genome-wide association study (GWAS) to identify loci associated with strict vegetarianism in UK Biobank participants. Comparing 5,324 strict vegetarians to 329,455 controls, we identified one SNP on chromosome 18 that is associated with vegetarianism at the genome-wide significant level (rs72884519, β = -0.11, P = 4.997 x 10 ⁻⁸ ), and an additional 201 suggestively significant variants. Four genes are associated with rs72884519: TMEM241 , RIOK3 , NPC1 , and RMC1 . Using the Functional Mapping and Annotation (FUMA) platform and the Multi-marker Analysis of GenoMic Annotation (MAGMA) tool, we identified 34 genes with a possible role in vegetarianism, 3 of which are GWAS-significant based on gene-level analysis: RIOK3 , RMC1 , and NPC1 . Several of the genes associated with vegetarianism, including TMEM241 , NPC1 , and RMC1 , have important functions in lipid metabolism and brain function, raising the possibility that differences in lipid metabolism and their effects on the brain may underlie the ability to subsist on a vegetarian diet. These results support a role for genetics in choosing a vegetarian diet and open the door to future studies aimed at further elucidating the physiologic pathways involved in vegetarianism.
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Davey GK, Spencer EA, Appleby PN, Allen NE, Knox KH, Key TJEPIC-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 6: 259-269
Article
Full-text available
  • Jun 2003
To describe the lifestyle characteristics and nutrient intakes of the Oxford cohort of the European Prospective Investigation into Cancer and Nutrition (EPIC). Cohort of men and women recruited through general practices or by post to include a high proportion of non meat-eaters. Dietary, anthropometric and lifestyle data were collected at baseline and four diet groups were defined. United Kingdom. In total, 65 429 men and women aged 20 to 97 years, comprising 33 883 meat-eaters, 10 110 fish-eaters, 18 840 lacto-ovo vegetarians and 2596 vegans. Nutrient intakes and lifestyle factors differed across the diet groups, with striking differences between meat-eaters and vegans, and fish-eaters and vegetarians usually having intermediate values. Mean fat intake in each diet group was below the UK dietary reference value of 33% of total energy intake. The mean intake of saturated fatty acids in vegans was approximately 5% of energy, less than half the mean intake among meat-eaters (10-11%). Vegans had the highest intakes of fibre, vitamin B1, folate, vitamin C, vitamin E, magnesium and iron, and the lowest intakes of retinol, vitamin B12, vitamin D, calcium and zinc. The EPIC-Oxford cohort includes 31 546 non meat-eaters and is one of the largest studies of vegetarians in the world. The average nutrient intakes in the whole cohort are close to those currently recommended for good health. Comparisons of the diet groups show wide ranges in the intakes of major nutrients such as saturated fat and dietary fibre. Such variation should increase the ability of the study to detect associations of diet with major cancers and causes of death.
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Vegetarian diets: Position of the American Dietetic Association and dietitians of Canada
Article
  • Jun 2003
It is the position of the American Dietetic Association and Dietitians of Canada that appropriately planned vegetarian diets are healthful, nutritionally adequate, and provide health benefits in the prevention and treatment of certain diseases. Approximately 2.5% of adults in the United States and 4% of adults in Canada follow vegetarian diets. A vegetarian diet is defined as one that does not include meat, fish, or fowl. Interest in vegetarianism appears to be increasing, with many restaurants and college foodservices offering vegetarian meals routinely. Substantial growth in sales of foods attractive to vegetarians has occurred, and these foods appear in many supermarkets. This position paper reviews the current scientific data related to key nutrients for vegetarians, including protein, iron, zinc, calcium, vitamin D, riboflavin, vitamin B-12, vitamin A, n-3 fatty acids, and iodine. A vegetarian, including vegan, diet can meet current recommendations for all of these nutrients. In some cases, use of fortified foods or supplements can be helpful in meeting recommendations for individual nutrients. Well-planned vegan and other types of vegetarian diets are appropriate for all stages of the life cycle, including during pregnancy, lactation, infancy, childhood, and adolescence. Vegetarian diets offer a number of nutritional benefits, including lower levels of saturated fat, cholesterol, and animal protein as well as higher levels of carbohydrates, fiber, magnesium, potassium, folate, and antioxidants such as vitamins C and E and phytochemicals. Vegetarians have been reported to have lower body mass indices than nonvegetarians, as well as lower rates of death from ischemic heart disease; vegetarians also show lower blood cholesterol levels; lower blood pressure; and lower rates of hypertension, type 2 diabetes, and prostate and colon cancer. Although a number of federally funded and institutional feeding programs can accommodate vegetarians, few have foods suitable for vegans at this time. Because of the variability of dietary practices among vegetarians, individual assessment of dietary intakes of vegetarians is required. Dietetics professionals have a responsibility to support and encourage those who express an interest in consuming a vegetarian diet. They can play key roles in educating vegetarian clients about food sources of specific nutrients, food purchase and preparation, and any dietary modifications that may be necessary to meet individual needs. Menu planning for vegetarians can be simplified by use of a food guide that specifies food groups and serving sizes. J Am Diet Assoc. 2003;103:748-765.
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Nutritional adequacy of plant-based diets for weight management: Observations from the NHANES
Article
  • May 2014
  • AM J CLIN NUTR
Observational studies have shown that body mass indexes of vegetarians are lower than those of nonvegetarians and that caloric intake of vegetarians is typically lower than that of nonvegetarians, suggesting that a vegetarian diet could be an approach for weight management. However, vegetarians may be at risk of inadequate intakes of certain vitamins and minerals. Population-based studies indicate that vegetarians have lower mean intakes of vitamin B-12 and zinc and higher intakes of fiber, magnesium, and vitamins A, C, and E than do nonvegetarians. Usual intake data suggest a similar prevalence of inadequacy between vegetarians and nonvegetarians for magnesium and vitamins A, C, and E, with both groups at high risk of inadequate intakes of these nutrients. These same data report that vegetarians have a higher prevalence of inadequacy for iron, vitamin B-12, protein, and zinc than do nonvegetarians. Although mean intake data suggest that a vegetarian diet may be a useful approach for weight management, combined with energy restriction it may have a detrimental effect on diet quality. Mean intakes of fiber, vitamins A and C, magnesium, and iron were significantly lower for vegetarians with energy intakes ≥500 kcal below Estimated Energy Requirements compared with vegetarians who did not restrict energy. Vegetarian diets should be recommended for weight management; however, care should be taken to optimize food intake to provide adequate intakes of nutrients of concern when energy restriction is used in conjunction with a vegetarian dietary pattern. At any caloric amount, vegetarians should optimize intakes of vitamin B-12, zinc, and protein; and both vegetarians and nonvegetarians need to increase intakes of calcium, magnesium, fiber, and vitamins A, C, and E.
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Update of the Healthy Eating Index: HEI-2010
Article
  • Feb 2013
The Healthy Eating Index (HEI) is a measure of diet quality in terms of conformance with federal dietary guidance. Publication of the 2010 Dietary Guidelines for Americans prompted an interagency working group to update the HEI. The HEI-2010 retains several features of the 2005 version: (a) it has 12 components, many unchanged, including nine adequacy and three moderation components; (b) it uses a density approach to set standards, eg, per 1,000 calories or as a percentage of calories; and (c) it employs least-restrictive standards; ie, those that are easiest to achieve among recommendations that vary by energy level, sex, and/or age. Changes to the index include: (a) the Greens and Beans component replaces Dark Green and Orange Vegetables and Legumes; (b) Seafood and Plant Proteins has been added to capture specific choices from the protein group; (c) Fatty Acids, a ratio of polyunsaturated and monounsaturated to saturated fatty acids, replaces Oils and Saturated Fat to acknowledge the recommendation to replace saturated fat with monounsaturated and polyunsaturated fatty acids; and (d) a moderation component, Refined Grains, replaces the adequacy component, Total Grains, to assess overconsumption. The HEI-2010 captures the key recommendations of the 2010 Dietary Guidelines and, like earlier versions, will be used to assess the diet quality of the US population and subpopulations, evaluate interventions, research dietary patterns, and evaluate various aspects of the food environment.
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Can limiting dietary variety assist with reducing energy intake and weight loss?
Article
  • Mar 2012
Due to the high prevalence of overweight and obesity, developing strategies to improve weight loss and weight loss maintenance is imperative. One dietary environmental variable that has received little attention in being targeted in an intervention to assist with obesity treatment is dietary variety. Experimental research has consistently shown that greater dietary variety increases consumption, with the effect of variety on consumption hypothesized to be a consequence of the differential experience of the more varied sensory properties of food under those conditions with greater dietary variety. As reduced energy intake is required for weight loss, limiting variety, particularly in food groups that are high in energy-density and low in nutrient-density, may assist with reducing energy intake and improving weight loss. A series of investigations, both observational and experimental, were conducted to examine if limiting variety in an energy-dense, non-nutrient-dense food group, snack foods (i.e., cookies, chips), assisted with reducing energy intake of the food group and improving weight loss. Results of the investigations suggest that a prescription for limiting variety in a food group can be implemented during obesity treatment, limiting variety is associated with the occurrence of monotony, and that reducing food group variety is related to decreased consumption of that food group. Future research is needed to ascertain the long-term effect of prescriptions targeting dietary variety on weight loss and weight loss maintenance.
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A Vegetarian Dietary Pattern as a Nutrient-Dense Approach to Weight Management: An Analysis of the National Health and Nutrition Examination Survey 1999-2004
Article
  • Jun 2011
Population-based studies have shown that vegetarians have lower body mass index than nonvegetarians, suggesting that vegetarian diet plans may be an approach for weight management. However, a perception exists that vegetarian diets are deficient in certain nutrients. To compare dietary quality of vegetarians, nonvegetarians, and dieters, and to test the hypothesis that a vegetarian diet would not compromise nutrient intake when used to manage body weight. Cross-sectional analysis of National Health and Nutrition Examination Survey (1999-2004) dietary and anthropometric data. Diet quality was determined using United States Department of Agriculture's Healthy Eating Index 2005. Participants included adults aged 19 years and older, excluding pregnant and lactating women (N = 13,292). Lacto-ovo vegetarian diets were portrayed by intakes of participants who did not eat meat, poultry, or fish on the day of the survey (n = 851). Weight-loss diets were portrayed by intakes of participants who consumed 500 kcal less than their estimated energy requirements (n = 4,635). Mean nutrient intakes and body mass indexes were adjusted for energy, sex, and ethnicity. Using analysis of variance, all vegetarians were compared to all nonvegetarians, dieting vegetarians to dieting nonvegetarians, and nondieting vegetarians to nondieting nonvegetarians. Mean intakes of fiber, vitamins A, C, and E, thiamin, riboflavin, folate, calcium, magnesium, and iron were higher for all vegetarians than for all nonvegetarians. Although vegetarian intakes of vitamin E, vitamin A, and magnesium exceeded that of nonvegetarians (8.3 ± 0.3 vs 7.0 ± 0.1 mg; 718 ± 28 vs 603 ± 10 μg; 322 ± 5 vs 281 ± 2 mg), both groups had intakes that were less than desired. The Healthy Eating Index score did not differ for all vegetarians compared to all nonvegetarians (50.5 ± 0.88 vs 50.1 ± 0.33, P = 0.6). These findings suggest that vegetarian diets are nutrient dense, consistent with dietary guidelines, and could be recommended for weight management without compromising diet quality.
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Relative Weight, Weight Loss Efforts and Nutrient Intakes among Health-Conscious Vegetarian, Past Vegetarian and Nonvegetarian Women Ages 18 to 50.
Article
  • Dec 2000
To compare relative weight, weight loss efforts and nutrient intakes among similarly health-conscious vegetarian, past vegetarian and nonvegetarian premenopausal women. Demographic data, lifestyle practices and weight loss efforts (by questionnaire), body mass index (BMI;kg/m2) and dietary intake (via multiple-pass 24-hour diet recall) were compared in a convenience sample of 90 current vegetarians, 35 past vegetarians and 68 nonvegetarians. Age (31.9 +/- 8.8), educational attainment, smoking status, alcohol use, physical activity and perceived health status were similar among the three groups of women. BMI did not differ by dietary pattern and averaged 23.7 +/- 4.7 for all women combined. Participants had intentionally lost > or = 10 pounds a mean of 2.1 times, and 39% of women perceived themselves to be overweight; again, no differences were observed among dietary groups. Dietary intakes of vegetarians and current nonvegetarians were consistent with current recommendations for macronutrient composition (< 30% fat, < 10% saturates). Compared to current nonvegetarians, current vegetarians had lower intakes of protein, saturated fat, cholesterol, niacin, vitamins B12 and D, and higher fiber and magnesium intakes. Vegetarians' mean vitamin B12 and D intakes were well below recommendations. Relative weight and weight loss efforts do not differ by dietary pattern among similarly health-conscious vegetarian and nonvegetarian women. The only differences in nutrient intake with potential health implications were vitamins D and B12.
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Perceptions and practices of self-defined current vegetarian, former vegetarian, and nonvegetarian women
Article
  • Apr 2002
  • J AM DIET ASSOC
To assess the diversity of vegetarians' dietary practices and how they change over time, and to explore perceptions of meat and dairy products among vegetarians, former vegetarians, and nonvegetarians. Cross-sectional survey; qualitative interviews with a subsample. Ninety self-defined current vegetarian, 35 former vegetarian and 68 nonvegetarian women in Vancouver, British Columbia. A subsample of 15 subjects completed qualitative interviews. Group comparisons using 1-way analysis of variance with post-hoc testing for continuous variables, chi2 for categorical variables. Of 90 current vegetarians, 51 and 14 reported occasional use of fish or chicken respectively. Fifty-six vegetarians, including 4 of 6 vegans, reported that their diets had become more restrictive over time, and 48 planned additional changes, most frequently a reduction in dairy product use. Reasons cited by former vegetarians for resuming omnivorous diets included: not feeling healthy, concern about their nutritional status, a change in living situation, or missing the taste of meat. Perceptions of meat and dairy products differed significantly by dietary pattern: nonvegetarians and former vegetarians were more likely than current vegetarians to agree with statements inferring positive attributes (eg, nutrient content). In contrast, more current and former vegetarians than nonvegetarians agreed with statements inferring negative attributes (eg, presence of contaminants). Dietitians who counsel women need to be aware of the heterogeneity of dietary practices and beliefs regarding use of animal products to provide advice appropriate to each individual. At a broader level, addressing women's food safety and animal welfare concerns will likely require collaboration among food industry and government, health, and consumer agencies.
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