| 16) Key TJ (2009) | The EPIC-Oxford Study | 47,254 participants aged 20-89 without MI, stroke, or malignant cancer (including surviving participants in the Oxford Vegetarian Study).
(UK) | 1993-99 to 2007 | 159 | Death from cerebrosvascular disease | Vegetarianism |
DRR = 1.10 (0.77-1.58) for vegetarian vs nonvegetarian.
Fish eater
(113 cases): | Vegetarian or vegan
(140 cases): |
| DRR = 1.03 (0.62-1.71) for fish eaters (eating fish, but not meat) vs meat eaters.
|
DRR = 1.11 (0.76-1.62) for vegetarians (not eating fish) or vegans vs meat eaters.
|
No significant effect modification by sex was found (results not shown).Age, sex, smoking, and alcohol consumption. |
| 16) Key TJ (2003) | The EPIC-Oxford Study | 46,562 participants aged 20-89. | 5.9
(1993-99 to 2002) | 62 | Cerebrovascular disease death | Vegetarian status (not defined) | DRR = 1.13 (0.65-1.96) for vegetarians vs nonvegetarians. | Age, sex, and smoking. |
| 14) Qiu D (2003) | No cohort name defined | 50,069 participants (25,226 males and 24,843 females) aged ≥ 40 from Jiangxi Province without a history of CVD.
(China) | 1994-96 to 2000 | 632 | Cerebrovascular disease mortality (cerebral hemorrhage, cerebral infarction, and subarachnoid hemorrhage) | Meat (including chicken, pork, and beef) |
HR = 0.84 (0.66-1.06; P = 0.13) for the highest vs lowest quartile of consumption.
Amount specific data (frequency of intake):
Never or seldom: HR = 1.
1-2 times/month: HR = 0.75 (0.62-0.91).
> 1 time/week: HR = 0.84 (0.66-1.06). | Sex, area, age, cigarette smoking status, alcohol drinking status, blood pressure, BMI, marital status, liking fatty foods, liking salty foods, Chinese pickles, and sleeping hours. |
| 11) Key TJ (1999) | Collaborative analysis of 4 prospective studies over 5 follow-up periods. | 76,172 men and women aged 16-89. | Median 10.6
(5.6-18.4) | 909 | Cerebrovascular disease mortality | Vegetarianism |
INCLUDED STUDIES (Follow-up years/No. of cases).
- The Adventist Health Study. (1960-65/182)
Snowdon DA. Animal product consumption and mortality because of all causes combined, coronary heart disease, stroke, diabetes, and cancer in Seventh-day Adventists. Am J Clin Nutr. Full text
- The Health Food Shoppers Study. (1974-95/292)
Burr ML. Vegetarianism, dietary fiber, and mortality. Am J Clin Nutr. 1982 Nov;36(5):873-7. Full text
- The Adventist Health Study. (1976-88/317)
Beeson WL. Chronic disease among Seventh-day Adventists, a low-risk group. Rationale, methodology, and description of the population. Cancer. 1989 Aug 1;64(3):570-81. Abstract
- The Heidelberg Study Cohort. (1978-89/31)
Frentzel-Beyme R. Mortality among German vegetarians: first results after five years of follow-up. Nutr Cancer. 1988;11(2):117-26. Abstract
- The Oxford Vegetarian Study. (1981-95/87)
Thorogood M. Risk of death from cancer and ischaemic heart disease in meat and non-meat eaters. BMJ. 1994 Jun 25;308(6945):1667-70. Full text
RESULTS:
Stratified by sex:
| Both sexes | Men
(350 cases) | Women
(559 cases) |
| Death rate ratio = 0.93 (0.74-1.17) for vegetarians vs nonvegetarians.
|
Death rate ratio = 0.77 (0.57-1.02) for vegetarians vs nonvegetarians.
|
Death rate ratio = 0.98 (0.80-1.20) for vegetarians vs nonvegetarians.
|
Stratified by age at death:
< 65 y
(62 cases) | 65-79 y
(371 cases) | 80-89 y
(476 cases) |
| Death rate ratio = 0.64 (0.35-1.17) for vegetarians vs nonvegetarians.
|
Death rate ratio = 0.90 (0.62-1.30) for vegetarians vs nonvegetarians.
|
Death rate ratio = 0.97 (0.81-1.17) for vegetarians vs nonvegetarians.
|
Stratified by duration of vegetarian diet:
| ≤ 5 y | > 5 y |
| Death rate ratio = 1.10 (0.68-1.77) for vegetarians vs nonvegetarians (18 vs 548 cases, respectively).
|
Death rate ratio = 0.92 (0.68-1.24) for vegetarians vs nonvegetarians (321 vs 548 cases, respectively).
|
Stratified by diet category (reference group = regular meat eaters [≥ 1 time/wk]):
| Occasional meat eaters [< 1 time/wk] | Fish eaters [never ate meat, but did eat fish] | Vegetarians [ate dairy products, eggs, or both] | Vegans [did not eat any animal products] |
| Death rate ratio = 0.97 (0.75-1.25) for occasional- vs regular meat eaters (92 vs 267 cases, respectively).
|
Death rate ratio = 1.04 (0.65-1.64) for fish eaters vs regular meat eaters (20 vs 267 cases, respectively).
|
Death rate ratio = 0.87 (0.66-1.13) for vegetarians vs regular meat eaters (234 vs 267 cases, respectively).
|
Death rate ratio = 0.70 (0.25-1.98) for vegans vs regular meat eaters (4 vs 267 cases, respectively).
|
Age, sex, and smoking status. |
| 8) Appleby PN (2002) | The Oxford Vegetarian Study | 11,045 subjects aged 16-89.
(UK) | 1980-84 to 2000 | 125 | Cerebrovascular disease death | Vegetarianism (not eating meat or fish) | DRR = 1.08 (0.75-1.54) for vegetarians vs nonvegetarians. | Age at entry, sex and smoking. |
| 5) Kinjo Y (1999) | No cohort name defined | 223,170 men and women aged 40-69, and without a history of diseases other than stomach disease.
(Japan) | 1966-1981 | See variables | Cerebrovascular disease mortality (Cerebral haemorrhage, cerebral embolism and thrombosis, subarachnoid haemorrhage, and other cerebrovascular disease) | Meat (not defined) |
All cerebrovascular disease
(11,030 cases) | Cerebral haemorrhage
(4,773 cases) | Cerebral embolism and thrombosis
(4,084 cases) |
RR = 0.78 (0.71-0.85) for the highest vs lowest tertile of consumption.
Amount specific data (Frequency of consumption/week):
< 1: RR = 1.
1-3: RR = 0.89 (0.85-0.93).
≥ 4: RR = 0.78 (0.71-0.85).
|
RR = 0.70 (0.60-0.81) for the highest vs lowest tertile of consumption.
Amount specific data (Frequency of consumption/week):
< 1: RR = 1.
1-3: RR = 0.88 (0.82-0.94).
≥ 4: RR = 0.70 (0.60-0.81).
|
RR = 0.81 (0.69-0.95) for the highest vs lowest tertile of consumption.
Amount specific data (Frequency of consumption/week):
< 1: RR = 1.
1-3: RR = 0.93 (0.86-1.00).
≥ 4: RR = 0.81 (0.69-0.95).
|
All cerebrovascular disease.
Meat consumption ≥ 1 vs < 1 time/week.
Joint effects with milk and fish consumption:
Low milk, low fish
(Milk < 1 time/week, and fish < 4 times/week) | Low milk, high fish
(Milk < 1 time/week, and Fish ≥ 4 times/week) | High milk, low fish
(Milk ≥ 1 time/week, and fish < 4 times/week) | High milk, high fish
(Milk ≥ 1 time/week, and fish ≥ 4 times/week) |
< 1: RR = 1.00 (Reference).
≥ 1: RR = 0.93 (0.87-0.99).
|
< 1: RR = 0.89 (0.81-0.97).
≥ 1: RR = 0.86 (0.80-0.92).
|
< 1: RR = 0.92 (0.82-1.02).
≥ 1: RR = 0.80 (0.74-0.86).
|
< 1: RR = 0.84 (0.73-0.95).
≥ 1: RR = 0.68 (0.63-0.74).
|
Cerebral haemorrhage.
Meat consumption ≥ 1 vs < 1 time/week.
Joint effects with milk and fish consumption:
Low milk, low fish
(Milk < 1 time/week, and fish < 4 times/week) | Low milk, high fish
(Milk < 1 time/week, and Fish ≥ 4 times/week) | High milk, low fish
(Milk ≥ 1 time/week, and fish < 4 times/week) | High milk, high fish
(Milk ≥ 1 time/week, and fish ≥ 4 times/week) |
< 1: RR = 1.00 (Reference).
≥ 1: RR = 0.94 (0.85-1.03).
|
< 1: RR = 0.95 (0.82-1.09).
≥ 1: RR = 0.84 (0.75-0.93).
|
< 1: RR = 0.89 (0.75-1.05).
≥ 1: RR = 0.79 (0.70-0.87).
|
< 1: RR = 0.73 (0.58-0.91).
≥ 1: RR = 0.63 (0.55-0.70).
|
Cerebral embolism and thrombosis.
Meat consumption ≥ 1 vs < 1 time/week.
Joint effects with milk and fish consumption:
Low milk, low fish
(Milk < 1 time/week, and fish < 4 times/week) | Low milk, high fish
(Milk < 1 time/week, and Fish ≥ 4 times/week) | High milk, low fish
(Milk ≥ 1 time/week, and fish < 4 times/week) | High milk, high fish
(Milk ≥ 1 time/week, and fish ≥ 4 times/week) |
< 1: RR = 1.00 (Reference).
≥ 1: RR = 0.95 (0.85-1.05).
|
< 1: RR = 0.90 (0.78-1.05).
≥ 1: RR = 0.94 (0.84-1.06).
|
< 1: RR = 0.92 (0.77-1.10).
≥ 1: RR = 0.84 (0.74-0.94).
|
< 1: RR = 0.98 (0.79-1.19).
≥ 1: RR = 0.79 (0.70-0.89).
|
Effect modification: The results from separate analyses for men and women, non-smokers and smokers, and rural and urban areas were similar (data not shown).Sex, attained age, follow-up interval, prefecture, alcohol drinking, smoking and occupation. |
| 5) Hirayama T (1990) | Not defined | 265,118 adults (122,261 men, 142,857 women) aged ≥ 40 from 6 prefectures in Japan. | 17
(1966-1982) |
Cerebrovascular disease mortality: (Number of cases not clearly defined).
Subarachnoid haemorrhage mortality: (211? men, and 277? women).
Cerebral haemorrhage mortality: (3,556? men, and 2,811? women).
Cerebral embolism mortality: (3,380? men, and 2,497? women).
| Cerebrovascular disease mortality | Meat (beef, pork, chicken, ham/sausages, and other) |
| Men & Women | Men | Women |
Cerebrovascular disease mortality: RR = 0.83 (0.79-0.88; No P-value) for consumption ≥ 4 vs ≤ 3 times/wk.
Cerebral haemorrhage mortality: RR = 0.74 (90% CI = 0.68-0.81; No P-value) for consumption ≥ 4 vs ≤ 3 times/wk.
Cerebral embolism mortality: RR = 0.80 (90% CI = 0.74-0.89; No P-value) for consumption ≥ 4 vs ≤ 3 times/wk.
Subarachnoid haemorrhage mortality: RR = 1.38 (1.08-1.77; No P-value) for consumption ≥ 4 vs ≤ 3 times/wk.
|
Cerebrovascular disease mortality: RR = 1.78 (90% CI = 1.58-2.01; No P-value) for the lowest vs highest quartile of consumption.
Amount specific data (Frequency of consumption):
≥ 4 times/wk: RR = 1.
1-3 times/wk: RR = 1.17 (1.09-1.25).
1-3 times/mo: RR = 1.38 (1.27-1.48).
None: RR = 1.78 (1.58-2.01).
Subarachnoid haemorrhage mortality: RR = 0.55 (90% CI = 0.21-1.42; No P-value) for the lowest vs highest quartile of consumption.
Amount specific data (Frequency of consumption):
≥ 4 times/wk: RR = 1.
1-3 times/wk: RR = 0.66 (0.46-0.93).
1-3 times/mo: RR = 0.90 (0.60-1.34).
None: RR = 0.55 (0.21-1.42).
|
Cerebrovascular disease mortality: RR = 1.39 (90% CI = 1.23-1.56; No P-value) for the lowest vs highest quartile of consumption.
Amount specific data (Frequency of consumption):
≥ 4 times/wk: RR = 1.
1-3 times/wk: RR = 1.13 (1.04-1.24).
1-3 times/mo: RR = 1.25 (1.14-1.38).
None: RR = 1.39 (1.23-1.56).
Subarachnoid haemorrhage mortality: RR = 0.40 (90% CI = 0.21-0.78; No P-value) for the lowest vs highest quartile of consumption.
Amount specific data (Frequency of consumption):
≥ 4 times/wk: RR = 1.
1-3 times/wk: RR = 0.72 (0.50-1.04).
1-3 times/mo: RR = 0.94 (0.53-1.39).
None: RR = 0.40 (0.21-0.78).
|
Confounding and interaction (using multivariate logistic regression analysis).
RRs of cerebrovascular disease among men of 4 variables for individual and joint consumption (No 90% CI):
| Individual consumption | Joint consumption |
Cigarette smoking: RR = 1.02.
Meat: RR = 0.92.
Green yellow-vegetables: RR = 0.98.
Alcohol: RR = 1.05. |
Meat & Smoking: RR = 0.84.
Meat & Green yellow-vegetables: RR = 0.78.
Meat & Alcohol: RR = 1.11. |
Confounding and interaction (using multivariate logistic regression analysis).
RRs of subarachnoid haemorrhage among men of 4 variables for individual and joint consumption (No 90% CI):
| Individual consumption | Joint consumption |
Cigarette smoking: RR = 1.87.
Meat: RR = 1.64.
Green yellow-vegetables: RR = 1.22.
Alcohol: RR = 0.48. |
Meat & Smoking: RR = 2.36.
Meat & Green yellow-vegetables: RR = 1.14.
Meat & Alcohol: RR = 1.49. |
Confounding and interaction (using multivariate logistic regression analysis).
RRs of cerebral haemorrhage among men of 4 variables for individual and joint consumption (No 90% CI):
| Individual consumption | Joint consumption |
Cigarette smoking: RR = 1.84 (P = < 0.05).
Meat: RR = 0.87.
Green yellow-vegetables: RR = 0.80 (P = < 0.05).
Alcohol: RR = 1.11. |
Meat & Smoking: RR = 0.48 (P for main effect only = < 0.05).
Meat & Green yellow-vegetables: RR = 0.74.
Meat & Alcohol: RR = 0.96. |
Confounding and interaction (using multivariate logistic regression analysis).
RRs of cerebral embolism among men of 4 variables for individual and joint consumption (No 90% CI):
| Individual consumption | Joint consumption |
Cigarette smoking: RR = 1.13.
Meat: RR = 0.93.
Green yellow-vegetables: RR = 1.16.
Alcohol: RR = 1.00. |
Meat & Smoking: RR = 1.27.
Meat & Green yellow-vegetables: RR = 0.71 (P for main effect only = < 0.01).
Meat & Alcohol: RR = 1.15 (P for main effect only = < 0.05). |
RRs of meat, green-yellow vegetables, and alcohol are for consumption ≥ 4 times/wk. RR of smoking is for daily smoking. No reference groups are defined.
Definitions: Green-yellow vegetables (containing ≥ 600 mcg carotene/100 g edible parts. Including carrots, spinach, green peppers, Italian broccoli, pumpkin, turnip leaves, green lettuce, chives leeks [green], asparagus, [green], chicory and parsley.), Alcohol (sake, shochu, beer, whiskey, and others).
Not defined (possibly only age).
Age and sex-adjusted for the RRs of associations with men & women combined. |
| 8) Appleby PN (2002) | The Health Food Shoppers Study | 10,736 subjects aged 16-89.
(UK) | 1973-79 to 1997 | 330 | Cerebrovascular disease death | Vegetarianism (not defined) | DRR = 0.99 (0.79-1.24) for vegetarians vs nonvegetarians. | Age at entry, sex and smoking. |
| 2) Key TJ (1996) | The Health Food Shoppers Study | 10.771 (4.336 men and 6.435 women) aged ≥ 16, recruited through health food shops, vegeterian societies, and magazines.
(UK) | 16.8
(1973-79 to 1995) | 147? (68 men, 79 women) | Cerebrovascular disease mortality | vegetarianism | RR = 0.96 (0.69-1.34; No P-value). | age, sex, and smoking |
| 2) Burr ML (1982) | The Health Food Shoppers Study | 10,923 subjects with a special interest in health foods.
(Britain) | 7
(1973-1980) | ? | Cerebrovascular disease mortality | Vegetarianism | No significant association (No data shown). | Unadjusted. |
| | | |