On-line Supplemental Material

Generated Summary

This document presents findings from analyses of data collected within the Adventist Health Study-2 (AHS-2) cohort, focusing on cause-specific mortality in vegetarians compared to non-vegetarians. The study utilizes a competing-risks approach to examine the associations between dietary patterns and specific causes of death, including cancer, cardiovascular diseases, and other conditions. The research involves multivariate analyses to account for various covariates, such as gender, race, region of residence, marital status, education, body mass index, exercise, smoking habits, and alcohol consumption. The core methodology involves comparing hazard ratios (HRs) for different causes of death among individuals adhering to various dietary patterns. The study aims to provide insights into the impact of vegetarian diets on longevity and health outcomes. The analysis is stratified by age groups (65 and 85 years) to observe how these relationships vary with age. The document details subject exclusions, including prevalent diseases to ensure the reliability of cause-specific death models.

Key Findings & Statistics

• Table 1: Reported prevalent diseases at baseline by dietary category
• Vegan: 19.5% Black, 7.71% Respiratory Disease, 4.33% Cardiovascular Disease, 5.08% Stroke, 5.01% Diabetes, 0.368% Parkinson’s Disease, 0.0295% Multiple sclerosis, 0.0147% Renal Failure.
• Lacto: 12.5% Black, 8.67% Respiratory Disease, 4.22% Cardiovascular Disease, 6.46% Stroke, 5.57% Diabetes, 0.531% Parkinson’s Disease, 0.0156% Multiple sclerosis, 0.00782% Renal Failure.
• Pesco: 35.6% Black, 8.23% Respiratory Disease, 4.23% Cardiovascular Disease, 7.29% Stroke, 7.52% Diabetes, 0.283% Parkinson’s Disease, 0.0113% Multiple sclerosis, 0.0226% Renal Failure.
• Nonveg: 33.0% Black, 7.58% Respiratory Disease, 6.00% Cardiovascular Disease, 8.51% Stroke, 11.7% Diabetes, 0.373% Parkinson’s Disease, 0.0141% Multiple sclerosis, 0.0235% Renal Failure.
• Table 2 (Supplement 3): Associations between dietary patterns and all-cause mortality among 76,998 participants
• All Participants (Model 1): Vegetarian HR: 0.74 (0.69, 0.80). Non-vegetarian: 1 [Reference]
• Men (Model 1): Vegetarian HR: 0.69 (0.61, 0.78). Non-vegetarian: 1 [Reference]
• Women (Model 1): Vegetarian HR: 0.78 (0.71, 0.86). Non-vegetarian: 1 [Reference]
• Vegan (Model 1): HR: 0.86 (0.79,0.94)
• Lacto, ovo (Model 1): HR: 0.75 (0.69,0.82)
• Pesco (Model 1): HR: 0.76 (0.67,0.87)
• Semi (Model 1): HR: 0.92 (0.83,1.01)
• Table 2 (Supplement 3): Associations between dietary patterns and all-cause mortality among 20,512 black participants
• All Participants (Model 1): Vegetarian HR: 0.79 (0.71,0.88). Non-vegetarian: 1 [Reference]
• Men (Model 1): Vegetarian HR: 0.68 (0.56,0.82). Non-vegetarian: 1 [Reference]
• Women (Model 1): Vegetarian HR: 0.84 (0.74,0.96). Non-vegetarian: 1 [Reference]
• Vegan (Model 1): HR: 0.74 (0.59,0.92)
• Lacto, ovo (Model 1): HR: 0.79 (0.68,0.91)
• Pesco (Model 1): HR: 0.73 (0.61,0.86)
• Semi (Model 1): HR: 1.10 (0.85,1.42)
• Figure 1 (Supplement 3): Multivariate competing-risks analyses for specific causes of death (excluding participants with prevalent cardiovascular disease or cancer)
• Cancer: HR (65 years): 1.04 (0.92, 1.18), HR (85 years): 0.96 (0.86, 1.08)
• Renal Failure: HR (65 years): 0.55 (0.38, 0.78), HR (85 years): 0.64 (0.51, 0.79)
• Other Genitourinary: HR (65 years): 0.86 (0.46, 1.59), HR (85 years): 0.71 (0.53, 0.95)
• Infectious disease: HR (65 years): 0.57 (0.38, 0.85), HR (85 years): 0.88 (0.64, 1.20)
• Gastrointestinal: HR (65 years): 0.77 (0.56, 1.07), HR (85 years): 0.94 (0.73, 1.19)
• Respiratory: HR (65 years): 0.71 (0.51, 0.99), HR (85 years): 0.93 (0.80, 1.10)
• Diabetes: HR (65 years): 0.47 (0.29, 0.76), HR (85 years): 0.53 (0.38, 0.73)
• Select Cardiac: HR (65 years): 0.71 (0.61, 0.83), HR (85 years): 0.84 (0.78, 0.91)
• Ischemic Heart dis: HR (65 years): 0.70 (0.56, 0.87), HR (85 years): 0.80 (0.71, 0.91)
• Other CVD: HR (65 years): 0.76 (0.52, 1.10), HR (85 years): 1.04 (0.81, 1.35)
• Stroke: HR (65 years): 0.99 (0.72, 1.36), HR (85 years): 1.26 (1.07, 1.48)
• Dementia: HR (65 years): 1.27 (0.83, 1.93), HR (85 years): 1.16 (1.01, 1.33)
• Other Neurological: HR (65 years): 0.79 (0.57, 1.10), HR (85 years): 1.22 (0.95, 1.58)
• Parkinson’s disease: HR (65 years): 1.04 (0.34, 3.13), HR (85 years): 1.42 (0.96, 2.11)
• Figure 2 (Supplement 2): Multivariate competing-risks analyses for specific causes of death (vegetarian dietary patterns compared to non-vegetarians)
• Renal Failure: Vegan (65 years): 0.06 (0.01, 0.59), Vegan (85 years): 0.51 (0.24, 1.11), Lacto (65 years): 0.34 (0.16, 0.74), Lacto (85 years): 0.43 (0.28, 0.65), Pesco (65 years): 0.21 (0.05, 0.83), Pesco (85 years): 0.70 (0.40, 1.20)
• Infectious dis: Vegan (65 years): 0.54 (0.20, 1.42), Vegan (85 years): 1.02 (0.59, 1.76), Lacto (65 years): 0.59 (0.34, 1.02), Lacto (85 years): 0.84 (0.59, 1.20), Pesco (65 years): 0.39 (0.16, 0.98), Pesco (85 years): 0.92 (0.57, 1.49)
• Gastrointestinal: Vegan (65 years): 0.75 (0.33, 1.69), Vegan (85 years): 0.87 (0.51, 1.48), Lacto (65 years): 1.05 (0.68, 1.60), Lacto (85 years): 1.13 (0.84, 1.52), Pesco (65 years): 1.00 (0.53, 1.89), Pesco (85 years): 1.08 (0.72, 1.64)
• Select Cardiac: Vegan (65 years): 0.79 (0.57, 1.09), Vegan (85 years): 0.91 (0.78, 1.06), Lacto (65 years): 0.70 (0.57, 0.86), Lacto (85 years): 0.91 (0.82, 1.00), Pesco (65 years): 0.75 (0.57, 1.00), Pesco (85 years): 0.81 (0.70, 0.93)
• Ischemic Heart dis: Vegan (65 years): 0.68 (0.43, 1.07), Vegan (85 years): 0.78 (0.62, 0.98), Lacto (65 years): 0.74 (0.57, 0.97), Lacto (85 years): 0.88 (0.76, 1.00), Pesco (65 years): 0.65 (0.43, 0.99), Pesco (85 years): 0.74 (0.60, 0.91)
• Stroke: Vegan (65 years): 1.11 (0.63, 1.93), Vegan (85 years): 1.25 (0.98, 1.60), Lacto (65 years): 0.89 (0.61, 1.31), Lacto (85 years): 1.16 (0.99, 1.37), Pesco (65 years): 1.14 (0.70, 1.83), Pesco (85 years): 1.10 (0.88, 1.38)
• Dementia: Vegan (65 years): 1.76 (0.90, 3.41), Vegan (85 years): 1.28 (1.01, 1.61), Lacto (65 years): 0.90 (0.55, 1.46), Lacto (85 years): 1.05 (0.89, 1.24), Pesco (65 years): 1.37 (0.73, 2.60), Pesco (85 years): 1.14 (0.91, 1.42)
• Other Neurological: Vegan (65 years): 0.57 (0.24, 1.31), Vegan (85 years): 1.21 (0.77, 1.89), Lacto (65 years): 0.81 (0.52, 1.26), Lacto (85 years): 1.25 (0.93, 1.67), Pesco (65 years): 1.10 (0.62, 1.93), Pesco (85 years): 0.97 (0.63, 1.51)

Other Important Findings

• The study also provides hazard ratios for various causes of death in vegetarians compared to non-vegetarians.
• There is a reduced risk of renal failure, infectious diseases, diabetes, and select cardiac diseases among vegetarians.
• The study included data on the prevalence of various diseases at baseline, such as cardiovascular disease and cancer.
• The study accounted for factors like sex, race, region of residence, marital status, education, body mass index, exercise, smoking, and alcohol consumption in their analyses.
• The study provides data on the prevalence of various diseases at baseline, such as cardiovascular disease and cancer for multiple dietary groups
• The data also reveals insights based on specific dietary patterns, including vegan, lacto-ovo, pesco, and semi-vegetarian diets.
• Additional data is presented in supplementary tables and figures, which provide a detailed analysis of the mortality rates, based on underlying causes.
• The research investigates the specific impact of vegetarian diets on several causes of death, including, dementia, neurological and other cardiovascular conditions.
• The analysis is presented separately for ages 65 and 85, which shows how these relationships shift as individuals age.

Limitations Noted in the Document

• The analysis in this document appears to be based on observational data. As such, there may be limitations, including the potential for unmeasured confounding factors.
• The document states that the analyses relied on self-reported dietary patterns, which may be subject to recall bias or inaccuracies.
• The generalizability of these findings could be limited, given the specific population studied (Adventist Health Study-2 participants).
• The study acknowledges that competing risks analyses were employed, which could introduce complexities in the interpretation of results.
• The study’s reliance on death certificate data for cause of death may have inherent limitations related to accuracy and consistency in recording disease causes.
• There is a lack of inclusion of semi-vegetarians for certain analyses, which means that the results could not include all the dietary groups.

Conclusion

The analysis suggests a potential association between vegetarian diets and decreased mortality from several causes. The results indicate reduced risks for conditions like renal failure, infectious diseases, and diabetes among vegetarians. The study’s findings have implications for understanding the connection between diet and longevity, highlighting the importance of dietary patterns in public health initiatives. The use of robust statistical methods, including competing-risks analyses and adjustment for a variety of covariates, contributes to the study’s rigor. Further research is warranted to confirm these findings and explore the mechanisms underlying the observed associations. The document underlines the importance of examining the impact of dietary choices on health outcomes and disease prevention. The study findings support the idea that vegetarian diets may be associated with reduced risks of death from multiple causes. The data provides insights that are relevant for promoting healthy eating habits and creating public health strategies to reduce mortality. The document underscores the importance of considering the diverse causes of death when assessing the health benefits of vegetarian diets, providing specific hazard ratios for various causes, and emphasizing the need for further research to strengthen these findings.