Nutritional, Cardiovascular Health and Lifestyle Status of ‘Health Conscious’ Adult Vegans and Non-Vegans from Slovenia: A Cross-Sectional Self-Reported Survey

Abstract

The study aim was to investigate differences in nutritional, cardiovascular and lifestyle status of ‘health conscious’ subjects. In a partial ‘lock-down’ during the COVID-19 pandemic period, we performed a web-based, cross-sectional study. We compared 80 self-selected subjects (51 vegans, 67% females, and 29 non-vegans, 55% females, p = 0.344). Nutritional status was assessed by bio-electrical impedance and standardized food frequency questionnaires (i.e., contribution of nutrients from foods and supplementation, combined and separate). Serum lipid concentrations and blood pressure (BP) were assessed from annual or initial examination reports, while sociodemographic, economic, and lifestyle statuses were obtained by standardized questionnaires. Finally, a multivariate linear regression model was used to estimate the relationship between total fiber and saturated fatty acid (SFA) intake and low-density lipoprotein cholesterol (LDL cholesterol) values. The vegans had a significantly lower body mass index (22.8 ± 2.4 vs. 26.6 ± 3.6 kg/m2, p < 0.001) and body fat % (19.3 ± 7.3 vs. 25.8 ± 8.2%, p < 0.001) than the non-vegans. There were significant differences between vegans and non-vegans in energy intake, and most macronutrient (10/12) and micronutrient (15/23) intakes in units/day. Both diets were well designed, with high fiber and low SFA and free sugar intake but remained insufficient in n-3 long chain polyunsaturated fatty acids (for vegans), vitamin D, calcium, sodium (for vegans) and iodine. Vegans also had a significantly lower lipid profile and BP than non-vegans, except for high-density lipoprotein cholesterol. However, both groups met targeted recommendations. Furthermore, fiber and SFA intake and age explained 47% of the variance in LDL cholesterol. In conclusion, ‘health conscious’ vegans and non-vegans with comparable lifestyle statuses had significant differences in dietary intake, body composition and cardiovascular health status.

Placing a Well-Designed Vegan Diet for Slovenes

“…Vegan diets have been explored with various study designs (i.e., randomized/nonrandomized (un)controlled, crossover, cross-sectional, a meta-analysis of intervention/observational studies and narrative review) and have shown reduced body mass [56][57][58][59][60][61][62][63][64][65][66][67] and improved body composition status [59,60,[67][68][69][70][71][72][73]. For example, a 12-week randomized controlled trial ("the Broad study") showed substantial body mass loss results in overweight or obese patients with type 2 diabetes or some form of cardiovascular disease within 3 months (−8.6 kg), 6 months (−12.1 kg), and 12 months (−11.5 kg) of follow-up without mandating regular PA or restricting total energy intake [56].…”

“…Many study designs have shown that a vegan diet successfully reduces common CVD risk factors or is associated with beneficial short-and long-term health effects (i.e., lowdensity lipoprotein cholesterol, triglycerides, blood pressure) [56,60,61,65,67,68,71,[96][97][98][99][100][101][102][103][104][105][106][107]. A meta-analysis of 31 observational studies comparing the effect of a vegan diet with an omnivorous diet on CVD risk factors showed that vegans' average LDL cholesterol values were 2.36 mmol/L, their triglycerides were 1.1 mmol/L and their blood pressure was 118/77 mmHg [63].…”

“…For adults (of both sexes) in Slovenia, an adequate intake of calcium is set to 1000 mg/day [184,186]. According to the results of recent European cross-sectional studies, this quantity can be easily met with a well-designed vegan diet or is comparable to intake on an omnivorous diet [71,98,190,191,199]; however, other studies disagree [188,189,192,193,195,231,247]. Notably, omnivore groups in these studies also did not reach the calcium intake recommendation [192,194,231,248].…”

“…For adults (of both sexes) in Slovenia, adequate intake of selenium for females and males is set to 60 µg/day and 70 µg/day [196]. According to the results of recent European cross-sectional studies, this quantity can be easily met with a well-designed vegan diet or is comparable to selenium intake on an omnivore diet [71,190,231,247]; however, other studies disagree [195,248]. Importantly, several cross-sectional studies evaluating the dietary intake of vegans did not report selenium intake [188,189,191,192,199], which suggests that there is an urgent need to improve the database on the nutrient content of selenium in various foods and products.…”

“…Based on official Slovenian and different European recommendations for generally healthy adults [184][185][186]279,280] and the (review) studies on a vegan diet [23,24,56,58,60,67,71,73,100,104,114,124,137,140,148,199,281], we suggest the main points of a well-designed vegan diet for healthy adults. It should be characterized by a high intake of fiber (≥45-60 g/day), a moderate intake of protein (<15% of energy), and a low intake of total fat (10-20% of energy), saturated fat (≤5% of energy), free sugars (<5% of energy) and sodium (1500 mg/day).…”