Foods Nutrients Vegetarianism and Coronary Heart Disease

It is likely that the reduction in CHD among vegetarians is, at least partly, due to a lower serum cholesterol concentration caused by a lower dietary intake of saturated fat and cholesterol. Unfortunately, none of the five prospective studies of mortality in vegetarians has complete information on serum cholesterol concentrations in all subjects, therefore, it is currently impossible to investigate whether the difference in CHD between vegetarians and non-vegetarians can be statistically explained by the difference in cholesterol levels.

Some data are available, however, on the relationships of various foods to CHD within the cohort studies of vegetarians. Meat intake was strongly positively associated with CHD among male Seventh-Day Adventists in the two large prospective studies in California.49,77 There was also a positive, but weaker, association with meat intake among women in the earlier study,77 but not in the more recent study.49 Eggs, but not dairy products, were also associated with an increased risk of CHD among Seventh-Day Adventists.77 In the Oxford Vegetarian Study, the frequency of meat consumption was not significantly related to mortality from CHD, but consumption of cheese, eggs, total animal fat, and dietary cholesterol were each strongly associated with CHD mortality. Compared with those who ate relatively little of these foods, the death rate ratios in those who ate the most were 2.47 (95% CI 0.97-6.26) for cheese, 2.68 (95% CI 1.19-6.02) for eggs, 3.29 (95% CI 1.50-7.21) for total animal fat and 3.53 (95% CI 1.57-7.96) for dietary cholesterol (Figure 3.3).78 These observations might all be due to the effects of saturated animal fats on serum cholesterol.

In the Oxford Vegetarian Study, no foods that significantly reduced CHD risk were identified, but in the Adventist health study in California, eating whole-wheat bread and frequently consuming nuts were both associated with a reduction in risk.79,80 Similar associations have been observed in non-vegetarian populations for both fiber-rich foods81 and for nuts.82

Figure 3.3 Oxford Vegetarian Study: death rate ratios (& 95% confidence intervals) for CHD by dietary factor among subjects with no evidence of preexisting disease at the time of recruitment, adjusted for age, sex, smoking, and social class. (Adapted from Appleby et al.78)

There are currently insufficient data to establish the reasons for the reduction in risk of CHD associated with a vegetarian diet. Several mechanisms are possible, perhaps in combination.83 In our opinion, the simplest and perhaps most likely explanation is that the low intake of animal fats in vegetarians causes a lower serum cholesterol concentration and therefore, a reduced risk of CHD. Ongoing large prospective studies of vegetarians that include both assessment of diet and measurement of serum cholesterol concentrations should allow researchers to test this hypothesis.

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