Vegetarian diets and risk of hospitalisation or death with diabetes in British adults: results from the EPIC-Oxford study

Keren Papier,Georgina K. Fensom,Julie A. Schmidt,Aurora Perez-Cornago,Tammy Y. N. Tong,Paul N. Appleby,Timothy J. Key,Anika Knuppel

doi:10.1038/s41387-019-0074-0

Abstract

BackgroundThe global prevalence of diabetes is high and rapidly increasing. Some previous studies have found that vegetarians might have a lower risk of diabetes than non-vegetarians.ObjectiveWe examined the association between vegetarianism and risk of hospitalisation or death with diabetes in a large, prospective cohort study of British adults.MethodsThe analysed cohort included participants from the European Prospective Investigation into Cancer and Nutrition (EPIC)-Oxford study who were diabetes free at recruitment (1993–2001), with available dietary intake data at baseline, and linked hospital admissions and death data for diabetes over follow-up (n = 45,314). Participants were categorised as regular meat eaters (≥50 g per day: n = 15,181); low meat eaters (<50 g of meat per day: n = 7615); fish eaters (ate no meat but consumed fish: n = 7092); and vegetarians (ate no meat or fish, including vegans: n = 15,426). We used multivariable Cox proportional hazards models to assess associations between diet group and risk of diabetes.ResultsOver a mean of 17.6 years of follow-up, 1224 incident cases of diabetes were recorded. Compared with regular meat eaters, the low meat eaters, fish eaters, and vegetarians were less likely to develop diabetes (hazard ratio (HR) = 0.63, 95% confidence interval (CI) 0.54–0.75; HR = 0.47, 95% CI 0.38–0.59; and HR = 0.63, 95% CI 0.54–0.74, respectively). These associations were substantially attenuated after adjusting for body mass index (BMI) (low meat eaters: HR = 0.78, 95% CI 0.66–0.92; fish eaters: HR = 0.64, 95% CI 0.51–0.80; and vegetarians: HR = 0.89, 95% CI 0.76–1.05).ConclusionsLow meat and non-meat eaters had a lower risk of diabetes, in part because of a lower BMI.

Highlights

The number of people affected by diabetes globally is rapidly increasing, with estimates already surpassing 425 million in 2017 and projected to reach 629 million in 20451
A more recent cohort study of Taiwanese Buddhists reported that consuming a vegetarian diet was associated with a lower risk in diabetes occurrence[11]. To explore this further in a population-based, European cohort, we investigated the association between vegetarianism and diabetes in a large, population-based study of British adults participating in the European Prospective Investigation into Cancer and Nutrition (EPIC)-Oxford study, which includes a large number of vegetarians
We assessed whether selected food and nutrient intakes were associated with diabetes risk to identify potential nutritional confounders or mediators of the association of diet group with diabetes; we found that inclusion of these factors in our models did not change the association between diet groups and diabetes risk and we did not include these in our final analyses

Summary

Introduction

The number of people affected by diabetes globally is rapidly increasing, with estimates already surpassing 425 million in 2017 and projected to reach 629 million in 20451. This imposes substantial economic burdens on healthcare systems[2]. The identification of modifiable risk factors is vital for the reduction of the growing diabetes epidemic. Diet is one such lifestyle factor that might play a key role in the prevention of diabetes. Evidence suggests that a diet abundant in whole grains, vegetables, fruits, dairy, legumes, and nuts may help lower the risk of diabetes, Nutrition and Diabetes. Some previous studies have found that vegetarians might have a lower risk of diabetes than non-vegetarians

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