Glossary. To Be or Not to Be: Vegan vs Omnivore. Dietary Patterns. Glossary. To Be or Not to Be: Vegan vs Omnivore 4/21/2016

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1 To Be or Not to Be: K-L. CATHERINE JEN, PH.D. PROFESSOR, DEPARTMENT OF NUTRITION AND FOOD SCIENCE WAYNE STATE UNIVERSITY M I C H I G A N AC A D E M Y O F N U T R I T I O N A N D D I E T E T I C S A N N UA L C O N F E R E N C E A P R I L 2 1, Glossary Vegetarians: A general term used to describe people who exclude meat, poultry, fish or other animal-derived foods from their diets Vegans: People who exclude all animalderived food (meat, poultry, fish, eggs, and dairy products) from their diets Lacto-vegetarians: People who consume milk and dairy products, but exclude meat, poultry, fish, seafood, and eggs from their diet Glossary Lacto-ovo-vegetarians: People who consume milk, dairy products, and eggs, but exclude meat, poultry, fish, and seafood from their diet Pesco-vegetarians: People who consume milk, dairy products, eggs, fish, and seafood but exclude meat, poultry, from their diet Omnivores: People who have no restriction on eating any foods Dietary Patterns Dietary pattern Red meats Poultry/fish Dairy/eggs Non-vegetarian (Omnivore) Mediterranean Pesco-vegetarian Lacto-ovo-vegetarian Lacto-vegetarian Vegan 1

2 Mediterranean Diet Is a Vegan diet better than Mediterranean, DASH, Ornish, others, pesco-vegetarian, lacto-vegetarian? High intake of fruits, vegetables, legumes, nuts, seeds and unrefined cereals Moderate intake of fish Low intake of saturated fats but high intake of unsaturated fats (olive oil) Low intake of red and processed meats Low to moderate intake of seafood and dairy products (cheese and yogurt), poultry and eggs Modest intake of wine (with meals) Mediterranean Diet Compared to DASH diet Higher fruit and fish intake Lower dairy products Compared to vegetarian diet Meat and seafood are consumed Lower legumes, nuts/seeds and processed soy products The EPIC Study Mediterranean Diet European Prospective Investigation into Cancer and Nutrition The PREDIMED Study PREvención con DIeta MEDiterránea Primary prevention trial Lyon Diet Heart Study Secondary prevention trial in MI survivors 2

3 The EPIC Studies A multicenter, prospective cohort study investigating the role of biological, dietary and environmental factors on cancers and other chronic diseases 23 centers, 10 European countries, ~520,000 participants Mediterranean-diet scale used to evaluate the adherence to Mediterranean diet Scores of 0-9: 0 min adherence diet; 9: max adherence The EPIC Studies Number of death before age 90 years and HR (95% CI) Reg meat eaters Low meat eaters Fish eaters Vegetarians/vegans All cancer * (0.86, 1.07) 0.81 (0.69, 0.95) 0.91 (0.80, 1.03) Ischemic heart (0.78, 1.19) 1.06 (0.80, 1.42) 1.03 (0.82, 1.28) disease CVD (0.68, 1.13) 1.35 (0.98, 1.36) 1.19 (0.91, 1.54) All causes (0.86, 1.00) 0.94 (0.85, 1.04) 0.99 (0.92, 1.07) *After adjusting BMI Appleby et al, Am J Clin Nutr, 103: , 2016 EPIC-Oxford Cohort Study The PREDIMED Study Vitamin B12 intake (ug/day) Omnivores Vegetarians Vegans Vitamin B12 deficiency (%) Omnivores Vegetarians Vegans Multicenter, nutrition intervention RCT in Spain from participants with high risk of CVD Men:55-75 years old Women: years old Mean BMI: 30 kg/m 2 50% with diabetes 70% with dislipidemia 80% with HTN Gilsing et al, Eur J Clin Nutr,

4 The PREDIMED Study Hazard Ratios of 2 MD Diets vs Low Fat Control Diet Three intervention groups Mediterranean diet + extra-virgin olive oil (MD + EVOO) Mediterranean diet + nuts (MD + Nuts) Control diet (low fat) Primary end point Major cardiovascular events (MI, stroke, death) Median follow-up: 4.8 years Hazard Ratio MD Diets vs Low Fat diet Primary CVD Stroke MI CVD death All cause death MD+EVOO MD+Nuts Low Fat 4

5 Conclusion Vegan diet is not the ONLY diet to have health benefits Add a little animal protein, especially fish, may improve health outcome Practical Issues of A Vegan Diet Pattern Health benefits of vegan diet may not be universal Women benefit less than men Seventh-day Adventists studies People in certain countries benefit less Taiwan: Vegans have higher HR for metabolic syndrome than lacto-ovo-vegetarians, pescovegetarinas and nonvegetarians Compliance issues So, What Should Professionals Tell Patients? There are more than five times as many former vegetarians/vegans than there are current vegetarians/vegans. Put differently, 84% of vegetarians/vegans abandon their diet. Interestingly, while 86% of lapsed vegetarians abandon their diet, a smaller proportion (70%) of lapsed vegans do so, suggesting that while people are far less likely to adopt a vegan diet, vegans are also less apt to start opting for meat. Dietary advice should be tailored to each patient s own personal dietary history, beliefs, preferences, motivation and clinical conditions Controlling energy intake still should be the primary goal of nutrition counseling Regardless of dietary patterns Reduce intake of sugar, sugar-sweetened soft drinks, refined grains, saturated fats, trans fats Increase intake of fruits, vegetables, legumes, whole grains, nuts 5

6 THANK YOU 6