背景:在将素食饮食模式与全因和特定于原因的死亡率相关联时,国际上报道的结果参差不齐。
目的:通过评估来扩展我们以前的结果,死亡人数较多(N=12515),特定原因的死亡率将不同的素食类型与非素食者进行比较。
方法:这项前瞻性研究使用了复临安息日会健康研究2队列的数据。死亡率在研究基线之间确定,2002-2007年和2015年的后续行动。使用经过验证的定量食物频率问卷在基线时收集饮食数据,然后将其分为五种饮食模式:非素食,半素食,pesco-素食主义者,lacto-ovo-素食主义者,和素食主义者。主要结果和措施包括使用Cox比例风险回归模型和竞争风险方法的全因死亡率和特定原因死亡率。
结果:分析样本包括88400名参与者,他们提供了971424人年的随访。我们报告的结果估计年龄65和85岁由于年龄依赖性的许多危险比(HR\s)。与非素食者相比,素食者的死亡率风险较低(65岁时的HR和95%置信区间-95%CI;括号中的85岁时相同),总体(0.89[0.83,0.95];0.98[0.91,1.04]),从肾功能衰竭(0.52[0.38,0.70];0.65[0.55,0.76]),传染病(0.57[0.40,0.82];0.90[0.70,1.17]),糖尿病(0.51[0.33,0.78];0.69[0.53,0.88]),选择心脏(0.75[0.65,0.87];0.89[0.83,0.95]),和缺血性心脏病的原因(0.730.59,0.90];0.84[0.75,0.94])。素食者,还观察到乳-卵-素食者和pesco-素食者的总死亡率和几种类似的特定原因死亡率的风险较低。然而,在老年素食者中观察到更高的特定原因的神经系统死亡率(估计年龄为85岁),特别是中风(HR=1.17[1.02,1.33]),痴呆(HR=1.13[1.00,1.27]),和帕金森病(HR=1.37[0.98,1.91])。黑人受试者素食/非素食比较的结果在很大程度上遵循相同的趋势,但由于数字较小,HR的精确度较低。
结论:素食与全因死亡率和许多特定原因死亡率的较低风险相关,尤其是男性和年轻受试者。然而,老年素食者患中风和痴呆的风险较高.这些结果需要进一步的支持和调查。
BACKGROUND: There have been mixed results reported internationally when associating vegetarian dietary patterns with all-cause and cause-specific mortalities.
OBJECTIVE: To extend our previous results by evaluating, with a larger number of deaths (N=12515), cause-specific mortalities comparing different vegetarian types to non-vegetarians.
METHODS: 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 five dietary patterns: non-vegetarian, semi-vegetarian, pesco-vegetarian, lacto-ovo-vegetarian, and vegan. Main outcomes and measures include all-cause and cause-specific mortalities using Cox proportional hazards regression models and competing risk methods.
RESULTS: The analytic sample included 88400 participants who provided 971424 person-years of follow-up. We report results as estimated at ages 65 and 85 years due to age-dependence of many hazard ratios (HR\'s). Compared to non-vegetarians, vegetarians had lower risks of mortality (HR\'s and 95% confidence interval - 95% CI at age 65; followed by same at age 85 years in parentheses), overall (0.89[0.83,0.95];0.98[0.91,1.04]), from renal failure (0.52[0.38,0.70]; 0.65[0.55,0.76]), infectious disease (0.57[0.40,0.82];0.90[0.70,1.17]), diabetes (0.51[0.33,0.78]; 0.69[0.53,0.88]), select cardiac (0.75[0.65,0.87]; 0.89[0.83,0.95]), and ischemic heart disease causes (0.730.59,0.90]; 0.84[0.75,0.94]). Vegans, lacto-ovo-vegetarians and pesco-vegetarians were also observed to have lower risks of total mortality and several similar cause-specific mortalities. However, higher cause-specified neurological mortalities were observed among older vegetarians (estimated at age 85 years), specifically stroke (HR=1.17[1.02,1.33]), dementia (HR=1.13[1.00,1.27]), and Parkinson\'s Disease (HR=1.37[0.98,1.91]). Results in Black subjects for vegetarian/nonvegetarian comparisons largely followed the same trends, but HR\'s were less precise due to smaller numbers.
CONCLUSIONS: 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 were observed among older vegetarians for stroke and dementia. These results need further support and investigation.