Type of vegetarian diet, obesity and diabetes in adult Indian population

Nutritional Considerations of Plant-Based Diets for People With Food Allergy

Plant-based diets (PBD) have been reported throughout history, but are increasingly common in current times, likely in part due to considerable emphasis on climate change and human health and wellness. Many dietary organisations around the world endorse well-planned, nutritionally adequate PBD, which exclude some or all forms of animal-based foods. However, special attention must be given to patients who follow PBD and also have food allergy (FA), as avoidance may increase the risk of developing nutritional deficiencies, including poor growth in children, weight loss in adults and vitamin and mineral deficiencies. Given the increasing prevalence of both PBD and food allergen avoidance diets, healthcare providers are likely to counsel patients with FA who also follow a PBD. In this review, an overview of PBD in patients with FA is provided, including recent trends, macro- and micronutrient needs, and growth for children and weight gain considerations for adults. With regard to a PBD, special attention should be given to ensure adequate fat and protein intake and improving the bioavailability of several minerals such as iron, zinc, iodine, calcium and magnesium, and vitamins such as A, B2, B12 and D. Although the collective data on growth amongst children following a PBD are varied in outcome and may be influenced in part by the type of PBD, growth must be regularly monitored and in adults weight gain assessed as part of any clinical assessment in those people with FA.

Methods and participant characteristics in the Cancer Risk in Vegetarians Consortium: a cross-sectional analysis across 11 prospective studies

BACKGROUND

The associations of vegetarian diets with risks for site-specific cancers have not been estimated reliably due to the low number of vegetarians in previous studies. Therefore, the Cancer Risk in Vegetarians Consortium was established. The aim is to describe and compare the baseline characteristics between non-vegetarian and vegetarian diet groups and between the collaborating studies.

METHODS

We harmonised individual-level data from 11 prospective cohort studies from Western Europe, North America, South Asia and East Asia. Comparisons of food intakes, sociodemographic and lifestyle factors were made between diet groups and between cohorts using descriptive statistics.

RESULTS

2.3 million participants were included; 66% women and 34% men, with mean ages at recruitment of 57 (SD: 7.8) and 57 (8.6) years, respectively. There were 2.1 million meat eaters, 60,903 poultry eaters, 44,780 pescatarians, 81,165 vegetarians, and 14,167 vegans. Food intake differences between the diet groups varied across the cohorts; for example, fruit and vegetable intakes were generally higher in vegetarians than in meat eaters in all the cohorts except in China. BMI was generally lower in vegetarians, particularly vegans, except for the cohorts in India and China. In general, but with some exceptions, vegetarians were also more likely to be highly educated and physically active and less likely to smoke. In the available resurveys, stability of diet groups was high in all the cohorts except in China.

CONCLUSIONS

Food intakes and lifestyle factors of both non-vegetarians and vegetarians varied markedly across the individual cohorts, which may be due to differences in both culture and socioeconomic status, as well as differences in questionnaire design. Therefore, care is needed in the interpretation of the impacts of vegetarian diets on cancer risk.

Comparison of Biomarkers of Oxidative Stress, Inflammation, and Endothelial Function Among Vegetarians and Non-vegetarians of Vijayapura, India: A Pilot Study

BACKGROUND

The known impact of diet on the pathophysiology of various chronic diseases and the current dietary transition in the country make it essential to assess the influence of dietary patterns specific to this region on inflammation, oxidative stress, and endothelial functions.

OBJECTIVE

This study compared oxidative stress, inflammation, and endothelial functions among vegetarians and non-vegetarians in Vijayapura, Karnataka, India.

METHODS

The present cross-sectional comparative study involved apparently healthy vegetarians (n=35) and non-vegetarians (n=35) aged 20-40. The anthropometric measurements like height (cm) and weight (kg) were recorded, and the BMI was calculated. The physiological parameters like systolic and diastolic blood pressure and pulse rate were recorded. Serum high-sensitivity C-reactive protein (hs-CRP), serum malondialdehyde (MDA), and serum nitric oxide (NO) were estimated as markers of inflammation, oxidative stress, and endothelial function, respectively. Statistical analysis was done using SPSS Statistics version 20.0 (IBM Corp. Released 2011. IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp.).

RESULTS

The average age of vegetarians and non-vegetarians was 25.22 ± 7.63 years and 25.60 ± 5.64 years, respectively. Anthropometric and physiological parameters were comparable between the two groups. However, there was a trend for higher mean body weight among non-vegetarians (53.94± 6.73 vs. 57.22±7.18) with a marginal non-statistically significant p-value (p=0.052). Vegetarians showed significantly higher serum MDA levels than non-vegetarians (2.14 (0.93-2.91) vs. 0.64 (0.35-1.32); p=0.000), while hs-CRP (vegetarians - 0.01 (0.005-0.034) vs. non-vegetarians - 0.03 (0.01-0.04); p=0.18) and serum NO levels (vegetarians - 6.72 (5.46-8.39) vs. non-vegetarians - 5.43 (2.87-9.16); p=0.215) were similar in both groups.

CONCLUSION

The results were intriguing and contrasting, as serum MDA is remarkably higher among vegetarians than non-vegetarians, pointing toward greater oxidative stress among the former and possibly indicating a dietary imbalance among vegetarians, which needs further exploration.

The Association of Total Meat Intake with Cardio-Metabolic Disease Risk Factors and Measures of Sub-Clinical Atherosclerosis in an Urbanising Community of Southern India: A Cross-Sectional Analysis for the APCAPS Cohort

AIM

Meat is commonly consumed in India; however, in comparison to Western settings, it is eaten in relatively lower quantities and with minimal processing. The association between meat intake and cardio-metabolic diseases (CMDs) and their risk factors in India is currently uncertain. We examined whether meat intake is associated with risk factors for CMDs and the measures of subclinical atherosclerosis in urbanising villages in southern India.

METHODS

We conducted a cross-sectional analysis of 6012 adults (52.3% male) participating in the Andhra Pradesh Children and Parents' Study (APCAPS), which is a large prospective, intergenerational cohort study in Southern India that began with the long-term follow-up of the Hyderabad Nutrition Trial (1987-1990). We used cross-sectional data from the third wave of data collection conducted in 2010-2012, where total meat intake was assessed using 100-item, semi-quantitative validated food frequency questionnaires (FFQ). The FFQs were validated using multiple weighed 24 h dietary recalls. The main predictor, 'total meat intake', was calculated as the sum of chicken, red meat, and fish consumption. The risk factors for CMDs [systolic blood pressure (SBP), diastolic blood pressure (DBP), body mass index (BMI), waist circumference (WC), fasting glucose, total cholesterol, homeostasis model assessment insulin resistance (HOMA-IR), total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol, triglycerides, and C-reactive protein] and measures of subclinical atherosclerosis [Carotid Intima-Media Thickness, Pulse Wave Velocity, and Augmentation Index] were assessed using standardised clinical procedures. Stratified by gender, the association of meat intake with the risk factors of CMDs and measures of subclinical atherosclerosis was examined using linear multilevel models with random intercept at the household level.

RESULTS

The mean (SD) age of the male (n = 3128) and female participants (n = 2828) was 34.09 years (15.55) and 34.27 years (12.73), respectively. The median (IQR) intake of meat was 17.79 g/day (8.90, 30.26) in males and 8.90 g/day (4.15, 18.82) in females. In males, a 10 g increase in total meat intake/1000 Kcal/day was positively associated with DBP, BMI, WC, total cholesterol, LDL-C, and triglycerides, whereas in females, a 10 g increase in total meat intake/1000 Kcal/day was positively associated with SBP, DBP, fasting glucose, HOMA-IR, total cholesterol, LDL-C, and triglycerides. There was no relationship between meat consumption and measures of subclinical atherosclerosis.

CONCLUSIONS

Meat intake had a linear positive association with CMD risk factors among the relatively younger Indian population who were consuming meat at lower levels compared to their European counterparts.

Variations in adult BMI among Indian men: a quantile regression analysis

India has not only maintained its top position among countries with the largest number of underweight adults but has also jumped to a higher position among countries with largest increase in the proportion of overweight people in the last three decades. More studies focus on double burden of malnutrition among women than on men. This study uses the quantile regression model to analyse the covariates associated with low and high body mass index (BMI) primarily among men aged 20-54 years during 2015-2016 in India. Occupations that involve more manual work help in maintaining a normal BMI along with better education, dietary diversity, and less sedentary lifestyle. A gendered comparison of men and their spouses highlights the differences in the association of covariates with BMI for men and women. The results from this study will provide insights for behavioural change at an individual level and inputs for public health intervention for addressing ill health concerns arising from underweight, overweight, or obesity.

Diet and odor hedonic ratings: comparative study between vegetarians, flexitarians, and omnivores

OBJECTIVES

Odor hedonic perception is well known to exhibit great variability and to depend on several parameters, i.e. stimulus, context, and subject characteristics. As hedonic perception (pleasant/unpleasant character) of food odors is considered one of the most prominent dimensions in eating behavior, the question of hedonic variability in this context arises. Thus, the aim of the present study was to compare odor hedonic ratings in three populations with regard to diet (i.e. omnivore, vegetarian, and flexitarian diets).

METHODS

Four categories of odors were compared: meat, vegetable, other food, and non-food odors.

RESULTS

The results showed that vegetarian and flexitarian individuals rated meat odors as more unpleasant than omnivores, while no significant difference was found for other categories of odors.

DISCUSSION

The question of whether the diet influences the hedonic perception or/and inversely is discussed, regarding several aspects of food consumption such as eating disorders, food education, … and could further serve to manage eating behaviors.

PRACTICAL APPLICATIONS

This study evidenced that vegetarians and flexitarians specifically rated meat odors as being more unpleasant than those of omnivores. Because of the growing number of vegetarians and flexitarians in the general population, it could be suggested to take into account the odor hedonic perception (especially regarding food odors) in studies related to diets. Besides, the present results could further serve research in several aspects of food consumption such as eating disorders (anorexia, bulimia … etc.) or food education as well as the management of eating behaviors, especially in an elderly population.

Influence of Plant-Based Diet on the Cardiovascular System: A Narrative Review

A plant-based diet (PBD) includes multiple dietary patterns such as vegetarianism, veganism, lacto-ovo-vegetarianism, etc. A well-balanced PBD has positive effects on body mass index, hyperlipidemia, and type 2 diabetes, and it is associated with decreased risk of cardiovascular diseases. Due to its high fiber content, which lowers levels of low-density lipoprotein cholesterol, high antioxidant content, which prevents capillary wall damage; the presence of polyunsaturated fatty acids, which have an anti-inflammatory effect, improvement in glucose homeostasis through improved insulin sensitivity, and impact on the gut microbiota, it has been proven to be beneficial for the heart. Despite their possible benefits, PBDs can be low in essential nutrients such as vitamin B12, zinc, vitamin D, iodine, and amino acids. This review aims to analyze the influence of PBDs on the cardiovascular system and associated disease progression.

Vegetarianism and Its Implications for Body Mass Index, Health, and Dietary Awareness in a Metropolitan City in India: A Cross-Sectional Study

Background This cross-sectional study aimed to assess and analyze the awareness of vegetarianism and its prevalence as a lifestyle practice in an urban population of Hyderabad, India. Methodology A predesigned, semi-structured questionnaire was used to collect data from consenting study participants. The questionnaire was administered, and the response data were extracted and analyzed using Microsoft Excel and Open Epi. The chi-square test was employed, and an appropriate p-value was set for each parametrical calculation and analysis. Results The study revealed that 43.7% of the study group followed a vegetarian diet, while the remaining population consumed a mixed diet. Most vegetarians were born into vegetarian families and adhered to it due to religious beliefs. Additionally, some individuals converted to vegetarianism for perceived health benefits, such as efficient weight management and decreased cholesterol levels. However, many vegetarians reported deficiencies in certain micro and macronutrients, necessitating additional supplementation. Lacto-ovo vegetarians were found to experience the most health benefits from this practice, exhibiting desirable body mass index rates and higher rates of satisfaction. Conclusions Vegetarianism is prevalent in the urban population of Hyderabad, India. The decision to follow a vegetarian lifestyle is influenced by various factors, including religious beliefs and perceived health benefits. However, it is important to address the potential nutrient deficiencies associated with vegetarian diets. Lacto-ovo vegetarians, in particular, seem to derive significant health benefits from their dietary choices.

Vegetarian diets in Spain: Temporal evolution through national health surveys and their association with healthy lifestyles

OBJECTIVE

To assess the prevalent consumption trend between 2001 and 2017 and the healthy lifestyles associated with consuming a plant-based diet in the Spanish population.

METHODOLOGY

A representative Spanish sample was analysed (>15 years old) from the Spanish National Health Survey for years 2001 (n=8568), 2006 (n=25,649), 2011 (n=19,027) and 2017 (n=21,986). The population was classified as omnivore, vegetarian, or vegan. The lifestyle variables were physical activity, tobacco and alcohol consumption, and body mass index (BMI). The χ2 test was used to evaluate diet change between 2001 and 2017. T-Student and χ2 were used to compare lifestyles of omnivores and vegetarians/vegans. Logistic regression was used to analyse lifestyles associated with plant-based diets.

RESULTS

0.2% of the Spanish population followed a plant-based diet. Between plant-based diet consumers there was an increase in vegans vs. vegetarians between 2001 (9.5% vs. 90.5%) and 2017 (65.3% vs. 34.7%) (p=0.007). Compared to 2001, following a plant-based diet was more likely in 2006 (OR=2.08, p=0.004), 2011 (OR=1.89, p=0.02) and 2017 (OR=1.75, p=0.04). Those who consume alcohol (OR=0.65, p=0.008), who were overweight (OR=0.48, p<0.001) or who were obese (OR=0.40, p=0.001) were less likely to consume a plant-based diet.

CONCLUSIONS

Despite an increase in the consumption of plant-based diets between 2001 and 2017, there was a low prevalence of consumption in all years studied. There was a greater probability of consuming plant-based diets among the Spanish population with healthy behaviours. These findings could help design strategies focused on healthy nutritional behaviours.

The effects of vegetarian diets on glycemia and lipid parameters in adult patients with overweight and obesity: a systematic review and meta-analysis

Several randomized controlled trials have reported the effects of vegetarian diets on blood lipids and glucose homeostasis in adults, but not in overweight or obese individuals. Thus, the purpose of this study was to evaluate the effects of vegetarian diets on blood lipids and glucose homeostasis in overweight or obese adults by systematic review and meta-analysis. We searched Medline, Embase, and the Cochrane Library through October 2021. We chose to include overweight or obese patients in the studies of the vegetarian diet for metabolic control. Seven trials with a total of 783 overweight or obese adult were included in the meta-analysis. The analysis of the data revealed that the vegetarian diets significantly reduced low-density lipoprotein cholesterol (LDL-C) (WMD, -0.31; 95% CI, -0.46 to -0.16), total cholesterol (TC) (WMD, -0.37; 95% CI, -0.52 to -0.22), and HbA1c (WMD (%), -0.33; 95% CI, -0.55 to -0.11). The vegetarian diets had an elevated effect on blood triglycerides (WMD, 0.29; 95% CI, 0.11-0.47). However, there were no significant effects of vegetarian diets on high-density lipoprotein cholesterol (HDLC), Fasting plasma glucose(FPG), and HOMA-IR in these individuals. The results of this study suggest that vegetarian diets effectively reduce LDL-C, TC, and HbA1c levels, thus functioning as a promising therapeutic strategy for improving the metabolic dysfunction in overweight or obese individuals. However, further large-scale clinical trials are required to confirm the validity of these findings.

Healthy plant-based diets improve dyslipidemias, insulin resistance, and inflammation in metabolic syndrome. A narrative review

Plant-based diets (PBDs) have become very popular in recent years and have been identified as a dietary strategy associated with protection against chronic disease. However, the classifications of PBDs vary depending on the type of diet. Some PBDs have been recognized as healthful for their high content of vitamins, minerals, antioxidants, and fiber, or unhealthful if they are high in simple sugars and saturated fat. Depending on this classification, the type of PBD impacts its protective effects against disease dramatically. Metabolic syndrome (MetS), characterized by the presence of high plasma triglycerides and low HDL cholesterol, impaired glucose metabolism, elevated blood pressure, and increased concentrations of inflammatory biomarkers, also increases the risk for heart disease and diabetes. Thus, healthful plant-based diets could be considered favorable for individuals having MetS. The different types of plant-based diets (vegan, lacto-vegetarian, lacto-ovo-vegetarian, or pescatarian) are discussed with a focus on specific effects of dietary components in maintaining a healthy weight, protecting against dyslipidemias, insulin resistance, hypertension, and low-grade inflammation.

Intra-cluster correlations in socio-demographic variables and their implications: An analysis based on large-scale surveys in India

Individuals who share similar socio-economic and cultural characteristics also share similar health outcomes. Consequently, they have a propensity to cluster together, which results in positive intra-class correlation coefficients (ICCs) in their socio-demographic and behavioural characteristics. In this study, using data from four rounds of the National Family Health Survey (NFHS), we estimated the ICC for selected socio-demographic and behavioural characteristics in rural and urban areas of six states namely Assam, Gujarat, Kerala, Punjab, Uttar Pradesh, and West Bengal. The socio-demographic and behavioural characteristics included religion & caste of the household head, use of contraception & prevalence of anaemia among currently married women and coverage of full immunization services among children aged 12-23 months. ICC was computed at the level ofPrimary Sampling Units (PSUs), that is, villages in rural areas and census enumeration blocks in urban areas. Our research highlights high clustering in terms of religion and caste within PSUs in India. In NFHS-4, the ICCs for religion ranged from the lowest of 0.19 in rural areas of Kerala to the highest of 0.67 in urban areas of West Bengal. For the caste of the household head, the ICCs ranged from the lowest of 0.12 in the urban areas of Punjab to the highest of 0.46 in the rural areas of Assam. In most of the states selected for the study, the values of ICC were higher for the use of family planning methods than for full immunization. The value of ICC for use of contraception was highest for rural areas of Assam (0.15) followed by rural areas of Gujarat (0.13). A higher value of ICC has considerable implications for determining an effective sample size for large-scale surveys. Our findings agree with the fact that for a given cluster size, the higher the value of ICC, the higher is the loss in precision of the estimate. Knowing and taking into account ICCs can be extremely helpful in determining an effective sample size when designing a large-scale demographic and health survey to arrive at estimates of parameters with the desired precision.

Fracture Risk in Vegetarians and Vegans: the Role of Diet and Metabolic Factors

PURPOSE OF REVIEW

There is strong evidence that poor dietary intake of certain micro- and macro-nutrients can negatively affect bone health. It is unclear if diet is the primary culprit for poor bone health in the vegan population.

RECENT FINDINGS

Plant-based diets are gaining public interest since they may improve metabolic health. Studies that examine vegetarians and vegans together show a lower bone mineral density (BMD), but not always increased fracture risk compared to omnivores. However, vegans consistently have higher risk of fracture at multiple bone sites, especially at the hip. There is higher fracture risk in vegans which may be due to calcium and vitamin D intake, as well as amount of dietary protein and quality. Other nutrients (B vitamins, Se, Zn, Fe, iodine) or physiological factors (lower body mass index, microbiome, or endocrine profile) may also play a role but have not been examined and require further study.

Differences in the risk of cardiovascular disease across ethnic groups: UK Biobank observational study

BACKGROUND AND AIMS

To describe sociodemographic, lifestyle, environmental and traditional clinical risk factor differences between ethnic groups and to investigate the extent to which such differences confound the association between ethnic groups and the risk of cardiovascular disease (CVD) METHODS AND RESULTS: A total of 440,693 white European (55.9% women), 7305 South Asian (48.6%) and 7628 black African or Caribbean (57.7%) people were included from UK Biobank. Associations between ethnicity and cardiovascular outcomes (composite of non-fatal stroke, non-fatal myocardial infarction and CVD death) were explored using Cox-proportional hazard models. Models were adjusted for sociodemographic, lifestyle, environmental and clinical risk factors. Over a median (IQR) of 12.6 (11.8, 13.3) follow-up years, there were 22,711 (5.15%) cardiovascular events in white European, 463 (6.34%) in South Asian and 302 (3.96%) in black African or Caribbean individuals. For South Asian people, the cardiovascular hazard ratio (HR) compared to white European people was 1.28 (99% CI [1.16, 1.43]). For black African or Caribbean people, the HR was 0.80 (0.66, 0.97). The elevated risk of CVD in South Asians remained after adjusting for differences in sociodemographic, lifestyle, environmental and clinical factors, whereas the lower risk in black African or Caribbean was largely attenuated.

CONCLUSIONS

South Asian, but not black African or Caribbean individuals, have a higher risk of CVD compared to white European individuals. This higher risk in South Asians was independent of sociodemographic, lifestyle, environmental and clinical factors.

Prevalence of vegan/vegetarian diet and eating behavior among Saudi adults and its correlation with body mass index: A cross-sectional study

Background

Globalization has steered the spread of vegetarianism around the world. Vegetarianism has achieved increased acceptance by different populations.

Objective

The present study aims to assess vegetarian diet, and eating behavior prevalence among Saudi adults and their association with demographics and body mass index.

Method

A cross-sectional study conducted on 1,143 Saudi adults [418 (36.6%) males and 725 (63.4%) females]. An online survey questionnaire containing questions on demographics, type of diet, eating behavior and physical activity was provided to participants for self-administration. Statistical analysis was performed to associate demographic and eating behavior variables with the type of diet using Pearson's Chi-square test and Spearman's partial correlation test was used to correlate BMI and eating behavior.

Results

Prevalence of veganism was 4.7% (n = 54/1,143) and vegetarianism was 7.8% (89/1,143). A significantly higher prevalence of vegan diet was observed in females than males (79.6% vs. 20.4%, p < 0.0001). A significantly higher proportion of participants on vegetarian diet selected "Always" as response for eating breakfast, vegetables and fruits as well as for eating or drinking dairy foods, and for eating canned food than participants on non-vegetarian diet (p < 0.0001). A significantly higher proportion of participants on vegan diet selected 'Never' for eating fast-food and fried food as well as for drinking fizzy or soft drinks (p < 0.0001). A positive moderate correlation was found between BMI and eating fast-food and fried food [r(1, 140) = 0.529, p < 0.0001], drinking fizzy or soft drinks with meals [r(1, 140) = 0.495, p = 0.001], and eating canned food [r(1, 140) = 0.510, p < 0.0001].

Conclusion

Our study shows that vegan and vegetarian diet have gained access into the lifestyle of Saudi adults with a prevalence of 4.7 and 7.8%, respectively. Participants on vegetarian diet showed better lifestyle like higher physical activity level, higher consumption of fruits, vegetables, dairy products and low intake of fast-foods and fizzy beverages.

Hypertension among women in reproductive age in India: Can we predict the risk? An analysis from National Family Health Survey (2015-2016)

Background

Hypertension in women of reproductive age group is of special concern because of the vulnerability of women to pregnancy-induced hypertension apart from socio-cultural vulnerability.

Aim

The objective of the study was to identify the predictors for hypertension among Indian women and to develop a risk score which would provide an opportunity for early detection and appropriate action.

Material and Methods

This study was based on the data collected in National Family Health Survey in 2015-2016. Women in India of 15-49 years were the study population. Data were analysed using SPSS v17. Logistic regression analysis was carried and expressed as odds ratio with 95% confidence intervals to identify predictors of hypertension. The risk score for hypertension was developed after shrinkage of variables and by using regression coefficients obtained by standard Logistic Regression Model.

Results

Among 6,87,230 women between 15 and 49 years, 77,788 (11.3%) were hypertensive. The study results revealed that there was an increasing trend in the prevalence of hypertension (26.5%) with increasing age, and with increasing weight (23.4%). Urban areas (12.3% vs 10.9%), alcoholics (19.2%) and various forms of tobacco users (14.8%) had more prevalence of hypertension.

Conclusion

Age, residing in urban area, consuming tobacco products, consumption of alcohol, non-vegetarian diet and overweight, were found to be the significant predictor variables, and were used to develop the Risk Prediction score using logistic regression model.

A vegan diet improves insulin resistance in individuals with obesity: a systematic review and meta-analysis

BACKGROUND

A vegan diet has benefits on weight reduction and on the parameters of glucose and lipid metabolism. This meta-analysis aimed to investigate the efficacy of plant-based diets on insulin resistance and blood lipids in patients with obesity.

METHODS

PubMed, Embase, and the Cochrane Library were searched for available papers published up to March 2021. The primary outcome was insulin resistance which was assessed by Homeostasis Model Assessment Insulin Resistance (HOMA-IR), other metabolic parameters measures including the pre/post-diet changes in triglycerides, HDL-cholesterol, total cholesterol, LDL-cholesterol. All analyses were performed using the random-effects model.

RESULTS

Six studies (seven datasets) were included. Compared with baseline, the plant-based diet improved the HOMA-IR (SMD = 1.64, 95%CI 0.95, 2.33; I2 = 91.8%, Pheterogeneity < 0.001), total cholesterol (SMD = 2.51, 95% CI 0.88, 4.13; I2 = 98.0%, Pheterogeneity < 0.001), HDL-cholesterol (SMD = 1.55, 95% CI 0.66, 2.44; I2 = 92.0%, Pheterogeneity < 0.001), and LDL-cholesterol (SMD = 2.50, 95% CI 1.30, 3.70; I2 = 94.4%, Pheterogeneity < 0.001), but not the triglycerides (SMD = - 0.62, 95% CI - 1.92, 0.68; I2 = 97.8%, Pheterogeneity < 0.001). The sensitivity analyses showed that the results were robust.

CONCLUSIONS

In obese individuals with insulin resistance, a vegan diet improves insulin resistance and dyslipidemia, except for triglycerides.

Profiles of Physical Activity and Physical Performance in Matched Religious Vegetarian and Nonvegetarian Women: A Preliminary Observational Study in Taiwan

Religious vegetarianism has become more popular with women and increases with age. However, concerns have been raised that vegetarians are less productive than nonvegetarians. Thus, we aimed to compare the characteristics of physical activity and physical performance in properly matched religious vegetarian and nonvegetarian women aged ≥ 45 years. Participants (n = 160) were recruited via convenience sampling in the community of Hualien, Taiwan, and matched by demographic and cognitive characteristics. Physical activity was assessed using the International Physical Activity Questionnaire-Short Form (IPAQ-SF). Physical performance was assessed with handgrip strength, five-times-sit-to-stand, gait speed, timed up-and-go, and functional reach tests (FRT). Overall, 90% of religious vegetarians practiced lacto-ovo-vegetarianism. The proportions of those with low physical activity levels and poor physical performance did not significantly differ between religious vegetarians and nonvegetarians. Additionally, there were no significant between-group differences in IPAQ-SF scores and physical performance, except for FRT performance (mean 24.5 cm vs. 19.7 cm, p < 0.001). Exhaustion after work, busyness, and a lack of interest were three main reasons for low physical activity levels, and none of these had significant between-group differences (p = 0.936). Our results show a similar profile of physical activity and physical performance in religious vegetarian and nonvegetarian women.

It's not just about the food: Motivators of food patterns and their link with sustainable food neophobia

Food sustainability has been a growing focus in an attempt to limit climate change; as a result, the sustainable food market and an onset of social behaviors, such as shopping local and eating plant-based, is increasing. Limited however, is the understanding of how these sustainable food options are perceived among individuals who have different motivations for eating the way that they do. The situated identity enactment model and food neophobia literature are used to conceptualize the development of a model outlining how physical health, culture, and sustainability driven motivations of food patterns influence one's fear of sustainable food-moving beyond attitude as a suitable measurement in this context due to the complexity in the way select situational ques are cognitively processed. Data were collected among a representative U.S sample (n = 414) and analyzed through structural equation modeling using plant-based meat as the product of focus. Individuals whose food choices are culturally driven showed greater sustainable food neophobia and as motivations were more sustainability driven, the less fear they had of such foods. Contrary to what existing literature suggests, those driven by physical health showed no significance in the effects of their food patterns on neophobia even when considering a food option often positioned as healthier. Results also provided evidence of high local identity being a positive predictor of neophobia among those whose choices were culturally and sustainably driven. This study highlights the sensitivity of sustainable food and the importance of considering context, norms, and identity on food behaviors, regardless of one's underlying motives for food choices. Findings are influential in advancing social psychology literature on food behaviors and encourages the use of the model on other sustainable food products.

Awareness, Treatment, and Control of Diabetes in Bangladesh: Evidence from the Bangladesh Demographic and Health Survey 2017/18

BACKGROUND

The prevalence of diabetes is increasing in Bangladesh from ∼5% in 2001 to ∼13% in 2017/18 (∼8.4 million cases). The prevalence of undiagnosed diabetes was also found to be higher at 6% in 2017/18. However, very little is known about the management of diabetes assessed by diabetes awareness, treatment, and control. We aimed to estimate the age-standardised prevalence of awareness, treatment, and control of diabetes and its associated factors.

METHODS

Cross-sectional data from 1,174 Bangladeshi adults aged 18 years and older available from the most recent nationally representative Bangladesh Demographic and Health Survey (BDHS) 2017-18 were analysed. Outcomes were age-standardised prevalence of awareness, treatment, and control of diabetes, estimated using the direct standardisation. Multilevel mixed-effects Poisson regression models were used to identify factors associated with awareness, treatment, and control of diabetes.

RESULTS

Of the respondents we analysed, 30.9% (95% CI, 28.2-33.6) were aware that they had the condition, and 28.2% (95% CI, 25.6-30.7) were receiving treatment. Among those treated for diabetes, 26.5% (95% CI, 19.5-33.5) had controlled diabetes. The prevalence of diabetes awareness, treatment, and control was lower in men than women. Factors positively associated with awareness and treatment were increasing age and hypertension, while factors negatively associated with awareness and treatment were being men and lower education. Factors associated with poor control were secondary education and residing in Rajshahi and Rangpur divisions.

CONCLUSIONS

This study provides evidence of poor management of diabetes in Bangladesh, especially in men. Less than one-third of the people with diabetes were aware of their condition. Just over one-fourth of the people with diabetes were on treatment, and among those who were treated only one-fourth had controlled diabetes. Interventions targeting younger people, in particular men and those with lower education, are urgently needed. Government policies that address structural factors including the cost of diabetes care and that strengthen diabetes management programmes within primary healthcare in Bangladesh are urgently needed.

Lean Mass Improvement from Nutrition Education and Protein Supplementation among Rural Indian Women Living with HIV/AIDS: Results from Cluster Randomized Factorial Trial at 18-Month Follow-Up

Loss of lean muscle mass impairs immunity and increases mortality risk among individuals with HIV/AIDS. We evaluated the relative contributions of protein supplementation and nutrition education on body composition among 600 women living with HIV/AIDS in rural Andhra Pradesh, India. We conducted a cluster randomized controlled 2 × 2 factorial trial lasting six months with follow up at twelve and eighteen months. Interventions occurred in the Nellore and Prakasam regions of Andhra Pradesh by trained village women, ASHA (Accredited Social Health Activists), and included: (1) the usual supportive care from ASHA (UC); (2) UC plus nutrition education (NE); (3) UC plus nutritional protein supplementation (NS); (4) combined UC plus NE plus NS. A Bioimpedance Analyzer Model 310e measured body composition. SAS 9.4 analyzed all data. Mixed models using repeated measures evaluated lean mass change from baseline as primary and fat weight and total weight as secondary outcomes. Lean mass change was significantly associated with NS (p = 0.0001), NE (p = 0.0001), and combined NS plus NE (p = 0.0001), with similar associations for secondary outcomes. Stronger associations for total weight were observed with greater ART adherence. Nutritional interventions may improve physiologic response to HIV. Significant increases in lean mass resulted from independent and combined protein supplementation and nutrition education.

The potential role of plantains, moringa, plantain-moringa combined diets, and other plant-based dietary patterns in controlling glycaemia among T2DM persons, a hospital based cross sectional survey in Ghana

BACKGROUND

Diabetes mellitus (DM) is an independent risk-factor for cardiovascular diseases. Plant-based dietary-patterns have been shown to reverse the effects of these cardiovascular risk-factors. Our study therefore aimed to investigate the potential roles moringa, moringa-plantain combined, and other plant based dietary-patterns could play in controlling glycaemia among persons with type-2-diabetes Mellitus (T2DM).

METHODS

Facility-based cross-sectional-study was conducted among 530 T2DM patients from August 2018 to September 2019 in Ghana. Structured-questionnaires were used to collect demographic, anthropometric, and clinical variables. Adherence to plant-based dietary-patterns were assessed using 3-day food record. SPSS version-20 was used to analyse the data.

RESULTS

BMI, HbA1c%, HDL-cholesterol and LDL-cholesterol were significantly correlated with adherence to plant-based dietary-patterns (p-value < 0.05). After adjusting for physical activity, adherence to plantain diets Standardized regression coefficient β (95%CI): -0.098 (-0.321, -0.022), yam β (95%CI): 0.148 (0.066, 0.496), moringa diets β (95%CI): -0.095 (-0.325,-0.011) and bean-diets β (95%CI): -0.112 (-0.577, -0.007) were significantly associated with glycemic control. Adherence to plantain-moriga combined diets β (95%CI): -0.406 (-0.413, -0.049) and plantain-beans combined diets β (95%CI): -0.128 (-0.188, -0.038) were also significantly associated with glycemic control.

CONCLUSION

Adherence to plantain, yam, beans, plantain-moriga combined diets, and plantain-beans combined diets could be associated with glycemic-control. Health care workers should prioritize these plant-based dietary-patterns for disease prevention and health promotion.

Perspective: Striking a Balance between Planetary and Human Health: Is There a Path Forward?

The global adoption of predominantly plant-based sustainable healthy diets will help reduce the risk of obesity- and malnutrition-related non-communicable diseases while protecting the future health of our planet. This review examines the benefits and limitations of different types of plant-based diets in terms of health and nutrition, affordability and accessibility, cultural (ethical and religious) acceptability, and the environment (i.e., the four pillars underlying sustainable healthy diets). Results suggest that, without professional supervision, traditional plant-based diets (vegan, vegetarian and pescatarian diets) can increase the risk of nutritional deficiencies among infants, children/adolescents, adult females, pregnant/lactating women and the elderly. In contrast, flexitarian diets and territorial diversified diets (TDDs, e.g., Mediterranean and New Nordic diets) that include large quantities of plant-sourced foods, low levels of red meat and moderate amounts of poultry, fish, eggs and dairy can meet the energy and nutrition needs of different populations without the need for dietary education or supplementation. Compared to vegan, vegetarian and pescatarian diets, more diverse flexitarian diets and TDDs are associated with reduced volumes of food waste and may be more acceptable and easier to maintain for people who previously followed western diets. Although flexitarian diets and TDDs have a greater impact on the environment than vegan, vegetarian and pescatarian diets, the negative effects are considerably reduced compared to western diets, especially if diets include locally-sourced seasonal foods. Further studies are required to define more precisely optimal sustainable healthy diets for different populations and to ensure that diets are affordable and accessible to people in all countries.

Unequal burden of equal risk factors of diabetes between different gender in India: a cross-sectional analysis

Many studies have supported that the burden of diabetes is shared differently by different genders due to various factors associated with it. This study aims at capturing whether women and men with a similar background, dietary and smoking habits, and biological conditions (blood pressure and body mass index (BMI)) are being affected equally or differently by diabetes. We have used cross-sectional data of NFHS-4 by covering the age group 15-49 years. Association between socio-economic background, dietary habits, biological conditions, and diabetes has been estimated using two separate multivariate logistic regression models. Results show that the overall prevalence of diabetes is higher among men (2.63%) than women (2.35%). Whereas, women belonging to urban areas (3.53%), Christian category (3.92%), richer section (3.22%), women with no schooling (2.51%), those reported never to consume pulses (2.66%) and green vegetables (2.40%) and daily consuming eggs (3.66%) and chicken or meat (3.54%) are more affected by diabetes than their men counterparts. Whereas men residing in rural areas (2.30%), belonging to the general category (3.12%), SCs (2.37%) and STs (1.72%) are more affected than their women counterparts. Results have also shown a higher prevalence of diabetes among obese men (11.46%), non-vegetarian (2.71%) and those who watch television almost every day (3.03%) as compared to their women counterparts. Regression analyses show that the richest, hypertensive, and obese women and men are significantly more likely to suffer from diabetes. This study concludes that women and men with similar socio-economic status, biological conditions, dietary and smoking habits are being affected differently by diabetes. Thus, there is a need for gender dimension in research to understand and validate the differences in the needed interventions for diabetes control in India.

Plant-Based Dietary Practices and Socioeconomic Factors That Influence Anemia in India

While rates of malnutrition have declined over the last decade in India due to successful government interventions, the prevalence of anemia remains high. Staple foods provide almost 70% of the daily iron intake. As staple foods are a rich source of phytate, this ingested iron is poorly absorbed. Currently, 59% of children below 3 years of age, 50% of expectant mothers and 53% of women aged 15-19 years are anemic. The most common intervention strategy has been through the use of iron supplements. While the compliance has been low and supplies irregular, such high rates of anemia cannot be explained by iron deficiency alone. This review attempts to fit dietary and cooking practices, field-level diagnostics, cultural beliefs and constraints in implementation of management strategies into a larger picture scenario to offer insights as to why anemia continues to plague India. Since the rural Indian diet is predominantly vegetarian, we also review dietary factors that influence non-heme iron absorption. As a reference point, we also contrast anemia-related trends in India to the U.S.A. Thus, this review is an effort to convey a holistic evaluation while providing approaches to address this public health crisis.

Vegetarian diet duration's influence on women's gut environment

BACKGROUND

Nutrient composition of vegetarian diets is greatly different from that of omnivore diets, which may fundamentally influence the gut microbiota and fecal metabolites. The interactions between diet pattern and gut environment need further illustration. This study aims to compare the difference in the gut microbiota and fecal metabolites between vegetarian and omnivore female adults and explore associations between dietary choices/duration and gut environment changes.

METHODS

In this study, investigations on the fecal metabolome together with the gut microbiome were performed to describe potential interactions with quantitative functional annotation. In order to eliminate the differences brought by factors of gender and living environment, 80 female adults aged 20 to 48 were recruited in the universities in Beijing, China. Quantitative Insights Into Microbial Ecology (QIIME) analysis and Ingenuity Pathway Analysis (IPA) were applied to screen differential data between groups from gut microbiota and fecal metabolites. Furthermore, weighted gene correlation network analysis (WGCNA) was employed as the bioinformatics analysis tool for describing the correlations between gut microbiota and fecal metabolites. Moreover, participants were further subdivided by the vegetarian diet duration for analysis.

RESULTS

GPCR-mediated integration of enteroendocrine signaling was predicted to be one of the regulatory mechanisms of the vegetarian diet. Intriguingly, changes in the gut environment which occurred along with the vegetarian diet showed attenuated trend as the duration increased. A similar trend of returning to "baseline" after a 10-year vegetarian diet was detected in both gut microbiota and fecal metabolome.

CONCLUSIONS

The vegetarian diet is beneficial more than harmful to women. Gut microbiota play roles in the ability of the human body to adapt to external changes.

The Impact of Vegan Diet in the Prevention and Treatment of Type 2 Diabetes: A Systematic Review

A protective effect of vegan diets on health outcomes has been observed in previous studies, but its impact on diabetes is still debated. The aim of this review is to assess the relationship between vegan diets and the risk for type 2 diabetes (T2D) along with its effect on glycemic control and diabetes-related complications. In accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta–Analyses) guidelines, Pubmed and Cochrane library databases were systematically searched for all relevant studies. Seven observational and eight randomized controlled (RCTs) studies were included. The methodological quality of studies was assessed using the National Institutes of Health quality assessment tool for observational cohort and cross-sectional studies and the Cochrane Risk of Bias Tool for RCTs. We found that a vegan diet is associated with lower T2D prevalence or incidence and in T2D patients decreases high glucose values and improves glucose homeostasis, as reported from the majority of included studies. This approach seems to be comparable to other recommended healthful eating models, but as it may have potential adverse effects associated with the long-term exclusion of some nutrients, appropriate nutritional planning and surveillance are recommended, particularly in specific groups of diabetic patients such as frail elderly, adolescents, and pregnant or breastfeeding women.

The link between plant-based diet indices with biochemical markers of bone turn over, inflammation, and insulin in Iranian older adults

BACKGROUND

The association of plant-based diets and biomarkers of bone, insulin, and inflammation is still unclear.

OBJECTIVES

We investigated the associations between biomarkers of bone, insulin, and inflammation and three plant-based diet indices: an overall plant-based diet index (PDI); a healthy plant-based diet index (hPDI); and an unhealthy plant-based diet index (uPDI).

METHODS

We included 178 elderly subjects who referred to health centers in Tehran. Blood and urine samples were collected to measure osteocalcin. The Human C-telopeptide of type Ⅰ collagen (u-CTX-I), highly sensitive C-reactive protein (hs-CRP), parathyroid hormone (PTH), 25(OH) D, and insulin resistance and sensitivity. We created an overall PDI, hPDI, and uPDI from semi-quantitative food frequency questionnaire (FFQ) data.

RESULTS

Dietary groups of Vegetables (r = .15, p = .03), nuts (r = .16, p = .03), dairy (r = .25, p = .001), eggs (r = .27, p < .001), red meat, and animal products (r = .25, p = .001) were directly correlated with osteocalcin. Refined grains were also had a positive association with serum insulin concentration (r = .14, p = .04). PTH levels are inversely associated with PDI score (β = -0.18, p = .01). Also, serum insulin concentration was negatively associated with PDI score (β = -0.10, p = .04). Urine CTX-1 levels were significantly associated with hPDI score (β = -0.06, p = .04). u-CTX-1 levels are inversely associated with uPDI score. This significance did not change with the adjustment of the confounders (β = -0.28, p < .001).

CONCLUSIONS

More adherence to PDI and hPDI and less in uPDI may have a beneficial effect on biomarkers of bone, inflammation, and insulin thus preserving chronic diseases.

Consensus on Medical Nutrition Therapy for Diabesity (CoMeND) in Adults: A South Asian Perspective

Diabetes and obesity are both increasing at a fast pace and giving rise to a new epidemic called diabesity. Lifestyle interventions including diet play a major role in the treatment of diabetes, obesity and diabesity. There are many guidelines on dietary management of diabetes or obesity globally and also from South Asia. However, there are no global or South Asian guidelines on the non-pharmacological management of diabesity. South Asia differs from the rest of the world as South Asians have different phenotype, cooking practices, food resources and exposure, medical nutrition therapy (MNT) practices, and availability of trained specialists. Therefore, South Asia needs its own guidelines for non-pharmacological management of diabesity in adults. The aim of the Consensus on Medical Nutrition Therapy for Diabesity (CoMeND) in Adults: A South Asian Perspective is to recommend therapeutic and preventive MNT in the South-Asians with diabesity.

Plant-based dietary practices in Canada: examining definitions, prevalence and correlates of animal source food exclusions using nationally representative data from the 2015 Canadian Community Health Survey-Nutrition

OBJECTIVE

While plant-based dietary practices (PBDPs) have been recommended to improve both population health and environmental sustainability outcomes, no nationally representative Canadian studies have described the prevalence or correlates of excluding animal source foods. The current study therefore: (1) created operationalised definitions of PBDPs based on animal source food exclusions to estimate the prevalence of Canadians who adhere to PBDPs and (2) examined key correlates of PBDPs.

DESIGN

Population representative, cross-sectional data were from the 2015 Canadian Community Health Survey-Nutrition. Respondents' PBDPs were categorised as: (1) vegan (excluded red meat, poultry, fish, eggs and dairy); (2) vegetarian (excluded red meat, poultry and fish); (3) pescatarian (excluded red meat and poultry) and (4) red meat excluder (excluded red meat). Descriptive statistics and multivariable regression analyses were used to examine the prevalence and correlates of these PBDP categories.

SETTING

All ten provinces in Canada.

PARTICIPANTS

Canadians aged 2 years and above (n 20 477).

RESULTS

In 2015, approximately 5 % of Canadians reported adhering to any PBDP (all categories combined) with the majority (2·8 %) categorised as a red meat excluder, 1·3 % as vegetarian, 0·7 % as pescatarian and 0·3 % as vegan. South Asian cultural identity (OR 19·70 (95 % CI 9·53, 40·69)) and higher educational attainment (OR 1·97 (95 % CI 1·02, 3·80)) were significantly associated with reporting a vegetarian/vegan PBDP.

CONCLUSIONS

Despite growing public discourse around PBDPs, only 5 % of Canadians reported PBDPs in 2015. Understanding the social and cultural factors that influence PBDPs is valuable for informing future strategies to promote environmentally sustainable dietary practices.

Vegan Diet Health Benefits in Metabolic Syndrome

Plant-based diets (PBDs) are increasingly consumed by the Italian population and around the world. In particular, among PBDs, the vegan diet is a food pattern characterized by the exclusion of all animal-origin foods. What drives people to adopt this model are mainly ethical, health and environmental reasons. A vegan diet, if well-balanced and varied, can help in achieving and maintaining an optimal state of health. However, this nutritional approach, if not well-balanced, can cause deficiencies in proteins, ω-3 fatty acids, iron, vitamin D and calcium, zinc, iodine and, above all, vitamin B12. Oral food supplements especially fortified foods are recommended in these cases to restore the nutritional deficiencies. A vegan diet generally reduces the risk of developing chronic non-communicable degenerative diseases, such as metabolic syndrome (MetS) and, in addition, requires fewer natural resources for food production than an omnivorous diet. The aim of this review is to analyze the possible impact of the vegan diet on MetS onset and its treatment.

Intake of Dietary Salicylates from Herbs and Spices among Adult Polish Omnivores and Vegans

There is a growing body of evidence that a diet rich in bioactive compounds from herbs and spices has the ability to reduce the risk of chronic diseases. The consumption of herbs and spices is often overlooked in the studies on food intake. However, measurement of dietary intake of these products, as a source of bioactive compounds, including salicylates, has recently gained much significance. The aims of the study were (i) to assess the intake of herbs and spices at the individual level and (ii) to calculate the dietary salicylates intake from herbs and spices among adult omnivores and vegans. The study group consisted of 270 adults aged 19 to 67 years, including 205 women and 65 men. Among all, 208 individuals were following an omnivorous diet while 62 were vegans. A semi-quantitative food frequency questionnaire (FFQ) was designed to assess the habitual intake of 61 fresh and dried herbs and spices during the preceding three months. The five most frequently eaten herbs among omnivores were parsley, garlic, dill, marjoram and basil, while among vegans they were garlic, parsley, ginger, basil and dill. An average intake of all condiments included in the study was 22.4 ± 18.4 g/day and 25.8 ± 25.9 g/day for both omnivores and vegans, respectively (p = 0.007). Estimated medial salicylates intake was significantly higher among vegans (p = 0.000) and reached 5.82 mg/week vs. 3.13 mg/week for omnivores. Our study confirmed that herbs and spices are important sources of salicylates; however, the type of diet influenced their level in the diet. Vegans consume significantly more total salicylates than omnivores.

A Pilot Study on the Whole Exome Sequencing of Prostate Cancer in the Indian Phenotype Reveals Distinct Polymorphisms

Prostate cancer (PCa) is the third most common cancer among men in India, and no next-generation sequencing (NGS) studies have been attempted earlier. Recent advances in NGS have heralded the discovery of biomarkers from Caucasian/European and Chinese ancestry, but not much is known about the Indian phenotype/variant of PCa. In a pilot study using the whole exome sequencing of benign/PCa patients, we identified characteristic mutations specific to the Indian sub-population. We observed a large number of mutations in DNA repair genes, viz. helicases, TP53, and BRCA besides the variants of unknown significance with a possibly damaging rare variant (rs730881069/chr19:55154172C/TR136Q) in the TNNI3 gene that has been previously reported as a semi-conservative amino acid substitution. Our pilot study attempts to bring an understanding of PCa prognosis and recurrence for the Indian phenotype.

Changes in biochemical parameters by gender and time: Effect of short-term vegan diet adherence

Background

Vegetarian diets adapted for various reasons that may include religious, ethical, and health considerations have reasonable health benefits including weight loss, and favorable metabolic changes. However, studies that assessed health benefits associated with vegan diet practices during the Ethiopian Orthodox Christian (EOC) Lenten fasting remains limited. This study has, therefore, assessed how short-term vegan diet associated with metabolic traits, including weight, body mass index (BMI), circumference, blood pressure, total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C), through longitudinal cross-sectional study design.

Methods

Seventy-five subjects (34 females and 41 males) with a mean age of [+SD] 27.3 + 5.8 years (range, 18 and 35) took part in the study. The study followed three assessment sessions: at baseline, during the Lenten (week 7), and 7 weeks after the end of the Lenten (week 14). An automatic chemistry analyzer (Mindray, BE-2000, China) used for lipid profile analysis. We used paired sample t-test in pre and post-performance and repeated measures ANOVA with Bonferroni post hoc adjustment between time points. The statistical significance was set at p < 0.05.

Results

The EOC fasting with vegan diet induced significantly lower blood pressure, weight, BMI, TC, HDL-C, LDL-C, and TC: HDL-C ratios, during Lenten (that is vegan diet consumption), but a regain noted in these parameters 7-weeks after Lenten (that is omnivore diet). On gender differences, vegan diet associated with significantly lower blood pressure, TC, and LDL-C in females compared with age-matched male counterparts. Some methodological limitations of this study are discussed with particular reference to lack of a randomized control group and self-reported data that limit this study in establishing a causal relationship through observed associations.

Conclusions

Vegan diet consumption even for short period corroborate ideal metabolic traits, with more favorable changes noted in women than age-matched men counterparts. These findings might help to define vegetarian diets as part of religious fasting (beyond its spiritual goals) as a non-pharmacological prescription in different populations, and our findings add to growing evidence in these subjects.

Gender differences in the risk factors for high and very high blood glucose levels: A study of Kerala

BACKGROUND AND AIMS

Worldwide, lifestyle is a significant risk factor for diabetes. Lifestyle changes can lead to differences in the extent of risk of diabetes among women and men. Kerala, a state with one of the best health indicators in India, has a high prevalence of diabetes. This study aimed at comparing the variations in the risk factors for HBG and VHBG among adult women and men in Kerala.

METHODS

Data from the fourth round of the National Family Health Survey (2015-16) used to examine the differences in the risk factors for HBG and VHBG in men and women aged 15-49 years. We used bivariate, multivariate and Population Attributable Risk (PAR) techniques for analysing the data.

RESULTS

Bivariate results have shown the pattern of HBG and VHBG prevalence in women and men was same among all the age groups; however, men show a higher HBG and VHBG than women in all the age groups. Prevalence of HBG and VHBG was higher in women with a primary education, who were poor and not working as compared to their male counterparts. PARs results show that the prevalence of VHBG was higher among obese men and women as compared to normal men and underweight women. Prevalence of HBG was higher among men as compared to women due to alcohol use and weekly consumption of non-vegetarian food.

CONCLUSIONS

The study suggests that there is an urgent need for targeted intervention programs to address the problem of HBG and VHBG in both men and women in Kerala to control blood glucose levels.

Modelling and prediction of global non-communicable diseases

Background

Non-communicable diseases (NCDs) are the main health and development challenge facing humankind all over the world. They are inextricably linked to socio-economic development. Deaths caused by NCDs should be different in different socio-economic development stages. The stratified heterogeneity of NCD deaths is currently not fully explored.

Methods

Countries were classified according to their socio-economic types and development stages, which were illustrated as a tree-like structure called Geotree. NCD deaths were linked to the countries and so were attached to the Geotree, which was modelled by a multilevel model (MLM) approach. Accordingly, the levels of NCD death indexes were predicted for 2030.

Results

Through the Geotree structure constructed in the study, it can be seen that the NCD death index has obvious stratified heterogeneity; that is, the NCD death index shows different trends in different country types and socio-economic development stages. In the first-level branches (country type), as national income increases, NCD mortality rate decreases and the proportion of NCD deaths to total deaths increases. In the secondary-level trunks (socio-economic development stage), as a country’s development stage rises, the NCD mortality rate decreases and the proportion of NCD deaths to total deaths increases. In addition, combined with the hierarchical nature of the evolution tree model, the MLM was used to predict the global NCD death index for 2030. The result was that by 2030, the global average age-standardized NCD mortality rate would be 510.54 (per 100,000 population) and the global average mortality for NCD deaths of the total number of deaths would be 75.26%.

Conclusions

This study found that there is a significant association between socio-economic factors and NCD death indicators in the tree-like structure. In the Geotree, countries on the same branch or trunk can learn from countries with higher development stages to formulate more effective NCD response policies and find the right prevention and treatment path.

Is India Ready for Alt-Meat? Preferences and Willingness to Pay for Meat Alternatives

Little is known about the consumer preferences of next-generation plant-based and cell-based meat alternatives, two food technologies that offer a demand-side solution to the environmental, nutritional, and other societal concerns associated with animal-intensive agriculture. To address this gap, this paper estimates consumers’ willingness to pay for four sources of protein (conventional meat, plant-based meat, cell-based meat, and chickpeas) in a developing country with rising demand for meat—India. A latent class model of a discrete choice experiment conducted in Mumbai identifies four heterogeneous segments in the Indian market. Aggregating across all four segments, respondents are willing to pay a premium for plant-based meat and a smaller premium for cell-based meat over the price of conventional meat. However, our main findings show that these premiums strongly differ across the four consumer-class segments. The results offer important insights into future price points and policy options that might make these meat alternatives commercially successful, and therefore, a viable option in addressing societal concerns.

Prevalence and psychopathology of vegetarians and vegans - Results from a representative survey in Germany

The aim of the study was to investigate the prevalence of, and attitudes toward, vegetarianism and veganism. We also assessed the association between vegetarianism/veganism and eating disorder, depressive, and somatic symptoms. A cross-sectional questionnaire survey in adults in Germany that was representative in terms of age, gender, and educational level was carried out. Data from 2449 adults (53.5% females) were included. Mean age was 49.6 (SD 17.1) years. A total of 5.4% of participants reported following a vegetarian or vegan diet. While the majority of participants agreed that vegetarian diets are healthy and harmless (56.1%), only 34.8% believed this to be true of vegan diets. The majority of participants also believed that a vegetarian (58.7%) or vegan (74.7%) diet can lead to nutritional deficiency. Female gender, younger age, higher education, lower body mass index (BMI), and higher depressive and eating disorder symptoms were found to be associated with vegetarianism/veganism. We did not find increased physical complaints in the group of vegetarians/vegans. Our results point toward a moderate prevalence of vegetarianism/veganism among the general population. Our findings suggest that health care professionals should keep eating disorder pathology, affective status in mind when dealing with individuals who choose a vegetarian/vegan dietary pattern.

Which Is a Good Diet-Veg or Non-veg? Faith-Based Vegetarianism for Protection From Obesity-a Myth or Actuality?

INTRODUCTION

India ranks first among nations with the largest population of vegetarians, and 40% of Asian Indians are vegetarian. There seems to occur a "nutrition transition" among vegetarians in India with a decline in the consumption of whole plant food content and replacement with processed foods, fried foods, and refined carbohydrates. This study evaluates the association between the consumption of a vegetarian diet and the prevalence of morbid obesity necessitating bariatric surgery in Asian Indians.

MATERIAL AND METHODS

This is a retrospective cohort study analyzing records of 235 Indian patients suffering from morbid obesity and who underwent bariatric surgery at our center through the years 2015 to 2017. Pearson's chi-square test for independence of attributes was applied to analyze the difference between a number of vegetarians versus non-vegetarians undergoing bariatric surgery.

RESULTS

The difference in the number of vegetarians versus non-vegetarians undergoing bariatric surgery was not significant for years 2015 and 2017, but the number was numerically higher for vegetarians. The difference was significantly higher for vegetarians in the year 2016. The difference in female vegetarians versus female non-vegetarians undergoing bariatric surgery was not significant for the year 2017 but was significantly higher for vegetarians during the years 2015 and 2016. The difference in male vegetarians versus non-vegetarians undergoing bariatric surgery was not significant for all the years.

CONCLUSION

In an Asian Indian cohort, we found that vegetarian dietary patterns were associated with a higher incidence of morbid obesity culminating in bariatric surgery. Our study is a myth breaker that all vegetarian diets are healthy diets. Our findings can be utilized to discourage refined and processed food consumption and promote healthy vegetarian food choices.

Vegetarian Epidemiology: Review and Discussion of Findings from Geographically Diverse Cohorts

Epidemiologic cohort studies enrolling a large percentage of vegetarians have been highly informative regarding the nutritional adequacy and possible health effects of vegetarian diets. The 2 largest such cohorts are the European Prospective Investigation into Cancer and Nutrition-Oxford (EPIC-Oxford) and the Adventist Health Study-2 (AHS-2). These cohorts are described and their findings discussed, including a discussion of where findings appear to diverge. Although such studies from North America and the United Kingdom have been important, the large majority of the world's vegetarians live in other regions, particularly in Asia. Findings from recent cohort studies of vegetarians in East and South Asia are reviewed, particularly the Tzu Chi Health Study and Indian Migration Study. Important considerations for the study of the health of vegetarians in Asia are discussed. Vegetarian diets vary substantially, as may associated health outcomes. Cohort studies remain an important tool to better characterize the health of vegetarian populations around the globe.

The relationships between macronutrient and micronutrient intakes and type 2 diabetes mellitus in South Asians: A review

BACKGROUND

South Asians (SA) have increased prevalence of type 2 diabetes mellitus (T2DM). The role of nutrient intakes in T2DM in SA is not well understood, however.

OBJECTIVE

The paper reviewed the relationship between macronutrient and micronutrients intakes and T2DM in SA.

METHODS

The MEDLINE database was searched for relevant papers on this topic in SA.

RESULTS

There was some evidence that dietary fiber and linoleic acid intake may reduce but carbohydrates may increase the risk of T2DM. Some studies found higher energy from protein and fat in subjects with T2DM versus controls. Other studies, however, found lower carbohydrate intake among those with T2DM or no relationship between diet composition and T2DM. Several vitamins and minerals were also inversely related to T2DM.

CONCLUSIONS

The data were limited to a few epidemiological studies. Most studies did not distinguish between undiagnosed and known T2DM. Subjects with known T2DM are more likely to have changed their diet. Prospective cohort or randomized controlled studies examining the role of diet composition, using precise image-assisted dietary assessment method and blood biomarkers, in the development of T2DM among migrant and native SA are needed. Lastly, a more complete nutrient database for foods consumed by SA is needed.

Healthy Vegan Lifestyle Habits among Argentinian Vegetarians and Non-Vegetarians

Although current research has contributed to the promotion of whole-food plant-based diets, few studies have examined healthy vegan dietary and lifestyle factors, especially in South America. Therefore, we aimed at investigating the adherence to healthy vegan lifestyle habits among Argentinian vegetarians and omnivorous, using a recently developed vegetarian lifestyle index adapted to the vegan dietary pattern. Also, accessibility of vegetarian foods, and the proportion of household income spent on food were assessed in a cross-sectional approach with 1454 participants. The population was comprised of females (84.9%), singles (55.0%), young-adults (mean age 32.1, standard deviation (SD) = 13.6), employed (50.8%), with high educational levels (50.4%), and low prevalence of both tobacco smoking (7.0%) and frequent alcohol consumption (7.6%). The mean score of adherence to healthy vegan lifestyle habits was 6.64 (SD = 1.72), with higher scores indicating better adherence. Non-vegetarians (5.75; 95% confidence interval (CI), 5.61–5.89) had a significantly lower adjusted mean score compared to semi-(6.32; 95% CI, 6.17–6.47), pesco-(6.99; 95% CI, 6.59–7.39), lacto-ovo-vegetarians (7.10; 95% CI, 6.96–7.24), as well as vegans (8.59; 95% CI, 8.35–8.83). The mean proportion of household income spent on food was significantly lower among vegans compared with other dietary patterns. The whole population that was studied showed a low consumption of whole grains, legumes, vegetables, nuts, and seeds. Although vegans showed a better diet and lifestyle pattern there is a need to improve eating and lifestyle habits to address risk factors for non-communicable diseases in Argentina.

Association between a vegetarian diet and emotional symptoms: a cross-sectional study among adolescents in four developing countries

BACKGROUND

Studies assessing the association between vegetarianism and mental health have found divergent results. Evidence from adolescents in developing countries is scarce.

OBJECTIVE

To evaluate the association between a vegetarian diet and emotional symptoms in 15-year-old adolescents from Ethiopia, India, Peru and Vietnam.

METHODS

A cross-sectional, secondary analysis of the Young Lives cohort study was used. The exposure variable was the self-report of being a vegetarian (yes or no). The outcome was the level of emotional symptoms, numerically evaluated using the score obtained in the subscale "Emotional Symptoms" of the Strengths and Difficulties Questionnaire (SDQ). We calculated crude and adjusted coefficients (β) with 95% confidence intervals (95% CIs), using generalized linear models of the Gaussian family, considering each sentinel site as a cluster. The analysis was stratified by country. Additionally, we made a global analysis including the four countries.

RESULTS

A total of 3484 adolescents were analyzed. The overall prevalence of vegetarianism was 4.4%, but it varied between countries (from 0.4% in Vietnam to 11.5% in India). The average emotional symptoms score was 3.5 [standard deviation (SD) 2.3] points. The scores were not statistically different between vegetarians and non-vegetarians (p > 0.05). In the adjusted analysis, in Vietnam, vegetarians had lower emotional symptoms scores on average than non-vegetarians [β: -1.79; 95% CI: -3.05 to -0.55]. No differences were found neither in the other countries nor in the overall sample.

CONCLUSION

There was no association between a vegetarian diet and emotional symptoms in the analyzed adolescents of four developing countries.

Dietary Patterns and Breast Cancer Risk: A Multi-Centre Case Control Study among North Indian Women

Evidence from India, a country with unique and distinct food intake patterns often characterized by lifelong adherence, may offer important insight into the role of diet in breast cancer etiology. We evaluated the association between Indian dietary patterns and breast cancer risk in a multi-centre case-control study conducted in the North Indian states of Punjab and Haryana. Eligible cases were women 30⁻69 years of age, with newly diagnosed, biopsy-confirmed breast cancer recruited from hospitals or population-based cancer registries. Controls (hospital- or population-based) were frequency matched to the cases on age and region (Punjab or Haryana). Information about diet, lifestyle, reproductive and socio-demographic factors was collected using a structured interviewer-administered questionnaire. All participants were characterized as non-vegetarians, lacto-vegetarians (those who consumed no animal products except dairy) or lacto-ovo-vegetarians (persons whose diet also included eggs). The study population included 400 breast cancer cases and 354 controls. Most (62%) were lacto-ovo-vegetarians. Breast cancer risk was lower in lacto-ovo-vegetarians compared to both non-vegetarians and lacto-vegetarians with odds ratios (95% confidence intervals) of 0.6 (0.3⁻0.9) and 0.4 (0.3⁻0.7), respectively. The unexpected difference between lacto-ovo-vegetarian and lacto-vegetarian dietary patterns could be due to egg-consumption patterns which requires confirmation and further investigation.

Dietary and physical activity recommendations to prevent type 2 diabetes in South Asian adults: A systematic review

Intervention trials and guidelines for the prevention of type 2 diabetes (T2D) in populations of South Asian origin often include strategies to improve diet and physical activity that are based on those developed for other populations. These may be suboptimal for the South Asian target populations. We aimed to provide an overview of included recommended dietary and physical activity components, and to identify whether these were supported by evidence of their effectiveness. Databases were searched until September 2017 for intervention studies and guidelines with an adult South Asian population without T2D. The protocol was registered in PROSPERO, registration number: CRD42015207067. The quality of included studies and guidelines was assessed. Dietary and physical activity components, and effects on T2D incidence, glycemic status and adiposity measures, were summarized in tabular format and evaluated narratively. Eighteen intervention studies and four guidelines were identified. Dietary and physical activity components were similar to recommendations for the general population. Intervention studies and guidelines did not reference evidence to support the effectiveness of components included in the intervention for South Asian populations in particular. Moreover, we were unable to assess patterns of components to determine the effects of specific components. Evaluation of current and emerging components among South Asian populations and subgroups seems necessary to formulate more specific recommendations in future intervention studies and guidelines.

Anthropometric and physiologic characteristics in white and British Indian vegetarians and nonvegetarians in the UK Biobank

Background

A detailed description of anthropometric and physiologic characteristics of persons in different diet groups is lacking.

Objective

We aimed to perform cross-sectional analyses of diet group with anthropometric and physiologic characteristics in a large cohort in the United Kingdom.

Design

The UK Biobank recruited ∼500,000 middle-aged participants throughout the United Kingdom in 2006-2010. Anthropometric indexes (height, weight, waist and hip circumference, body composition) and other physiologic characteristics (heel bone mineral density, grip strength, blood pressure, pulse rate) were measured following standardized protocols. We estimated the age-adjusted means of each characteristic in 6 diet groups (198,166 regular meat eaters, 199,784 low meat eaters, 4381 poultry eaters, 9674 fish eaters, 6366 vegetarians, and 378 vegans) in white women and men, and in 2 diet groups (3322 meat eaters and 1186 vegetarians) in British Indian women and men.

Results

In white women, after adjustment for age and compared with regular meat eaters, non-red meat eaters had lower adiposity (e.g., 4.5% lower body fat in vegan women) and lower systolic and diastolic blood pressure (-4.2 and -3.3 mm Hg, respectively), and generally lower heel bone mineral density t-score (-0.26). Patterns of differences by diet group were similar in white men. In the Indian population, compared with meat eaters, vegetarian women were shorter (-1.1 cm) and had lower lean mass (-0.5 kg), and both vegetarian women and men had lower grip strength (-1.3 and -1.4 kg, respectively). No significant differences in the other characteristics were observed.

Conclusions

Differences in anthropometric and physiologic characteristics were observed across diet groups in white participants, but fewer differences were observed in British Indian participants. The observed differences may be important as intermediate markers of long-term health in different diet groups. This observational study was registered at http://www.isrctn.com/ as ISRCTN10125697.

S, Shaikh S, P. S, Dubey AK, Mande SS. A snapshot of gut microbiota of an adult urban population from Western region of India

The human gut microbiome contributes to a broad range of biochemical and metabolic functions that directly or indirectly affect human physiology. Several recent studies have indicated that factors like age, geographical location, genetic makeup, and individual health status significantly influence the diversity, stability, and resilience of the gut microbiome. Of the mentioned factors, geographical location (and related dietary/socio-economic context) appears to explain a significant portion of microbiome variation observed in various previously conducted base-line studies on human gut microbiome. Given this context, we have undertaken a microbiome study with the objective of cataloguing the taxonomic diversity of gut microbiomes sampled from an urban cohort from Ahmedabad city in Western India. Computational analysis of microbiome sequence data corresponding to 160 stool samples (collected from 80 healthy individuals at two time-points, 60 days apart) has indicated a Prevotella-dominated microbial community. Given that the typical diet of participants included carbohydrate and fibre-rich components (predominantly whole grains and legume-based preparations), results appear to validate the proposed correlation between diet/geography and microbiome composition. Comparative analysis of obtained gut microbiome profiles with previously published microbiome profiles from US, China, Finland, and Japan additionally reveals a distinct taxonomic and (inferred) functional niche for the sampled microbiomes.