Obesity has many different metabolic effects, some of which would tend to increase the risk of CHD. In particular, obesity increases serum total cholesterol while reducing HDL cholesterol, raises blood pressure, and induces glucose intolerance.44 Data from prospective studies also indicate that obesity is an important risk factor for CHD.45,46

Numerous studies have consistently found that vegetarians are, on average, thinner than comparable non-vegetarians.21,47-49 The data from four large cohorts are shown in Figure 3.1. The average body mass index (BMI) varies substantially between cohorts (higher in the Seventh-Day Adventist cohorts in California than in the European cohorts), but, on average, vegetarians in each cohort have a BMI about 1 kg/m2 lower than that of non-vegetarians within the same cohort. The difference is similar in men and women, and is seen in all age groups. The lower mean BMI of vegetarians leads to a substantially lower prevalence of obesity.47

The reasons for this association have not been established. An analysis of data from 5,000 men and women in the Oxford Vegetarian Study suggested that the lower BMI of non-meat-eaters was partly due to a higher intake of dietary fiber and a lower intake of animal fat, and, in men only, a lower intake of alcohol. These factors, however, accounted for only one third of the observed difference in BMI.50

Figure 3.1 Mean body mass index in vegetarians and non-vegetarians in four large cohort studies. (Adapted from Key et al.48)
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