Vegetarian diet and incidence of total, ischemic, and hemorrhagic stroke in 2 cohorts in Taiwan

Abstract

ObjectiveTo determine how a vegetarian diet affects stroke incidence in 2 prospective cohorts and to explore whether the association is modified by dietary vitamin B12 intake.MethodsParticipants without stroke in the Tzu Chi Health Study (cohort 1, n = 5,050, recruited in 2007–2009) and the Tzu Chi Vegetarian Study (cohort 2, n = 8,302, recruited in 2005) were followed until the end of 2014. Diet was assessed through food frequency questionnaires in both cohorts at baseline. Stroke events and baseline comorbidities were identified through the National Health Insurance Research Database. A subgroup of 1,528 participants in cohort 1 were assessed for serum homocysteine, vitamin B12, and folate. Associations between vegetarian diet and stroke incidences were estimated by Cox regression with age as time scale, adjusted for sex, education, smoking, alcohol, physical activities, body mass index (only in cohort 1), hypertension, diabetes, dyslipidemia, and ischemic heart diseases.ResultsVegetarians had lower serum vitamin B12 and higher folate and homocysteine than nonvegetarians. In cohort 1, 54 events occurred in 30,797 person-years follow-up. Vegetarians (vs nonvegetarians) experienced lower risk of ischemic stroke (hazard ratio [HR], 0.26; 95% confidence interval [CI], 0.08–0.88). In cohort 2, 121 events occurred in 76,797 person-years follow-up. Vegetarians (vs nonvegetarians) experienced lower risk of overall stroke (HR, 0.52; 95% CI, 0.33–0.82), ischemic stroke (HR, 0.41; 95% CI, 0.19–0.88), and hemorrhagic stroke (HR, 034; 95% CI, 0.12–1.00). Our explorative analysis showed that vitamin B12 intake may modify the association between vegetarian diet and overall stroke (p interaction = 0.046).ConclusionTaiwanese vegetarian diet is associated with a lower risk of ischemic and hemorrhagic strokes.

Cerebral small vessel disease and vascular cognitive impairment: from diagnosis to management

“…Interestingly, the preventive effect of exercise and cultural activities on cognition is enhanced when conducted in company, reinforcing the importance of social networks [ 147 ]. Furthermore, Mediterranean diet is generally recommended to reduce the risk of cognitive decline [ 148 , 149 ], and both Mediterranean and vegetarian diets were shown to be associated with stroke risk reduction [ 150 , 151 ▪ ].…”

A Vegetarian Diet Is Associated with a Lower Risk of Cataract, Particularly Among Individuals with Overweight: A Prospective Study

“…The results in this study are more in line with the EPIC-Oxford Cohort, which found a 26% reduced risk of cataracts in vegetarians compared with nonvegetarians, 20 than with the positive cross-sectional association found for Asians in Leicester. 21 Despite lower vitamin B-12 status and its corresponding elevation of homocysteine in vegetarians in both this cohort 26 and the EPIC Oxford cohort, 27 vegetarian and vegan diets were associated with protective rather than harmful association. These findings contrast that of the Blue Mountains Eye Study, in which both serum homocysteine elevation and methylenetetrahydrofolate reductase C677T polymorphism (CT/TT vs CC-polymorphisms that influence homocysteine level) were associated with a higher risk of cortical cataracts.…”

“…19 The findings from this current study suggest that the potential benefits of vegetarian diets might outweigh the risk related to homocysteine. Unfortunately, in both the EPIC-Oxford and this current study, only a limited number of participants had plasma homocysteine available, 26,27 precluding further analysis on how homocysteine might influence cataract risk in vegetarians. Vegetarian diets are defined by meat avoidance.…”

“…33 In a subsample (406 vegetarians and 877 nonvegetarians) of this cohort study, vegetarians were reported to have higher median plasma folate than their nonvegetarian counterparts (13.4 vs 10.6 ng/mL [to convert to nmol/L, multiply by 2.266]; P < 0.01). 26 Folate insufficiency was associated with cataracts in the Elderly Nutrition and Health Survey in Taiwan conducted in 1999 to 2000. 34 However, serum folate levels can be a surrogate marker for dietary intakes of vegetables, and it is unclear whether it is folate per se or other components of vegetables that protect against cataracts.…”

Homocysteine Level and Risk of Hemorrhage in Brain Arteriovenous Malformations

“…However, after McEvoy et al first presented the relationship between Hcy and hemorrhagic stroke [ 16 ], its role in hemorrhagic stroke subsequently reported remains controversial [ 17 – 19 ], let alone in bAVMs. Currently, most studies, including meta-analyses, failed to confirm this association [ 20 – 22 ].…”