Vegetarian dietary patterns and mortality in Adventist Health Study 2
Open accessAbstract
IMPORTANCE: Some evidence suggests vegetarian dietary patterns may be associated with reduced mortality, but the relationship is not well established. OBJECTIVE: To evaluate the association between vegetarian dietary patterns and mortality. DESIGN: Prospective cohort study; mortality analysis by Cox proportional hazards regression, controlling for important demographic and lifestyle confounders. SETTING: Adventist Health Study 2 (AHS-2), a large North American cohort. PARTICIPANTS: A total of 96,469 Seventh-day Adventist men and women recruited between 2002 and 2007, from which an analytic sample of 73,308 participants remained after exclusions. EXPOSURES: Diet was assessed at baseline by a quantitative food frequency questionnaire and categorized into 5 dietary patterns: nonvegetarian, semi-vegetarian, pesco-vegetarian, lacto-ovo-vegetarian, and vegan. MAIN OUTCOME AND MEASURE: The relationship between vegetarian dietary patterns and all-cause and cause-specific mortality; deaths through 2009 were identified from the National Death Index. RESULTS: There were 2570 deaths among 73,308 participants during a mean follow-up time of 5.79 years. The mortality rate was 6.05 (95% CI, 5.82-6.29) deaths per 1000 person-years. The adjusted hazard ratio (HR) for all-cause mortality in all vegetarians combined vs nonvegetarians was 0.88 (95% CI, 0.80-0.97). The adjusted HR for all-cause mortality in vegans was 0.85 (95% CI, 0.73-1.01); in lacto-ovo-vegetarians, 0.91 (95% CI, 0.82-1.00); in pesco-vegetarians, 0.81 (95% CI, 0.69-0.94); and in semi-vegetarians, 0.92 (95% CI, 0.75-1.13) compared with nonvegetarians. Significant associations with vegetarian diets were detected for cardiovascular mortality, noncardiovascular noncancer mortality, renal mortality, and endocrine mortality. Associations in men were larger and more often significant than were those in women. CONCLUSIONS AND RELEVANCE: Vegetarian diets are associated with lower all-cause mortality and with some reductions in cause-specific mortality. Results appeared to be more robust in males. These favorable associations should be considered carefully by those offering dietary guidance.
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Prior studies have defined plant-based diets as vegetarian diets, which exclude some or all animal foods.
“With the exception of a recent investigation,(3) prior studies(4–9) have defined plant-based diets as ‘vegetarian’ diets, which constitute a family of dietary patterns that exclude some or all animal foods.”
From Healthful and Unhealthful Plant-Based Diets and the Risk of Coronary Heart Disease in U.S. Adults (2017) · cites this paper as [7]
Plant-based diets have been associated with a lower risk of various diseases, including coronary heart disease.
“Plant-based diets have been associated with a lower risk of various diseases,(1–3) including coronary heart disease (CHD),(4–9) the leading global cause of death.(10)”
From Healthful and Unhealthful Plant-Based Diets and the Risk of Coronary Heart Disease in U.S. Adults (2017) · cites this paper as [7]
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- [38]Rizzo NS Jaceldo-Siegl K Fraser GE Differences and similarities in dietary pattern and nutrient profiles between the sexes and blacks and whites: the Adventist Health Study 2 [abstract P077] Circulation 2012 125 10 suppl AP077 http://circ.ahajournals.org/cgi/content/meeting_abstract/125/10_MeetingAbstracts/AP077 Accessed December 1, 2012
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- Authors
- Orlich, M. J., Singh, P. N., Sabaté, J., Jaceldo-Siegl, K., Fan, J., Knutsen, S., Beeson, W. L., & Fraser, G. E.
- Affiliations
- Loma Linda University (US)
- ORCID
- Venue
- JAMA Internal Medicine
- Publisher
- American Medical Association (AMA)
- Published
- 2013-07-08
- Volume
- 173
- Issue
- 13
- Pages
- 1230
- ISSN
- 2168-6106 (ISSN-L)
- PMC
- PMC4191896
- OpenAlex
- W2154622069
- Cited by
- 607
- References
- 47
- Citations by year
- 2026: 33 · 2025: 50 · 2024: 45 · 2023: 47 · 2022: 59 · 2021: 59 · 2020: 61 · 2019: 66 · 2018: 44 · 2017: 32 · 2016: 41 · 2015: 26 · 2014: 37 · 2013: 6
- FWCI
- 37.40
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- JAMA Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Cancer Institute (U01CA152939)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
- Physical Sciences › Environmental Science › Ecology › Agriculture Sustainability and Environmental Impact
- Health Sciences › Medicine › Physiology › Dietary Effects on Health
- Keywords
- vegetarian diet, dietary habits, mortality, vegan diet, lacto-ovo-vegetarian diet, pesco-vegetarian diet, semi-vegetarian diet, all-cause mortality, cardiovascular mortality, renal mortality, Seventh-day Adventists, Adventist Health Study-2, sex differences, cause-specific mortality, lifestyle confounding, food frequency questionnaire
- MeSH terms
- Adult, Aged, Cause of Death, Diet, Female, Follow-Up Studies, Humans, Life Style, Male, Middle Aged, Neoplasms, North America, Nutritional Status, Prospective Studies, Sampling Studies, Diet, Vegetarian, Cohort Studies, Body Mass Index, Myocardial Ischemia, Protestantism
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