Vegetarian and Vegan Diets and Risks of Total and Site-Specific Fractures: Results from the Prospective EPIC-Oxford Study Tammy Y
Tong et al. BMC Medicine (2020) 18:353 https://doi.org/10.1186/s12916-020-01815-3 RESEARCH ARTICLE Open Access Vegetarian and vegan diets and risks of total and site-specific fractures: results from the prospective EPIC-Oxford study Tammy Y. N. Tong1* , Paul N. Appleby1, Miranda E. G. Armstrong2, Georgina K. Fensom1, Anika Knuppel1, Keren Papier1, Aurora Perez-Cornago1, Ruth C. Travis1 and Timothy J. Key1 Abstract Background: There is limited prospective evidence on possible differences in fracture risks between vegetarians, vegans, and non-vegetarians. We aimed to study this in a prospective cohort with a large proportion of non-meat eaters. Methods: In EPIC-Oxford, dietary information was collected at baseline (1993–2001) and at follow-up (≈ 2010). Participants were categorised into four diet groups at both time points (with 29,380 meat eaters, 8037 fish eaters, 15,499 vegetarians, and 1982 vegans at baseline in analyses of total fractures). Outcomes were identified through linkage to hospital records or death certificates until mid-2016. Using multivariable Cox regression, we estimated the risks of total (n = 3941) and site-specific fractures (arm, n = 566; wrist, n = 889; hip, n = 945; leg, n = 366; ankle, n = 520; other main sites, i.e. clavicle, rib, and vertebra, n = 467) by diet group over an average of 17.6 years of follow-up. Results: Compared with meat eaters and after adjustment for socio-economic factors, lifestyle confounders, and body mass index (BMI), the risks of hip fracture were higher in fish eaters (hazard ratio 1.26; 95% CI 1.02–1.54), vegetarians (1.25; 1.04–1.50), and vegans (2.31; 1.66–3.22), equivalent to rate differences of 2.9 (0.6–5.7), 2.9 (0.9–5.2), and 14.9 (7.9–24.5) more cases for every 1000 people over 10 years, respectively.
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