Month: Oct 2023

Mortality in vegetarians and comparable nonvegetarians in the
United Kingdom 2016

Paul N Appleby, Francesca L Crowe, Kathryn E Bradbury, Ruth C Travis, and Timothy J Key*
Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom

ABSTRACT
Background: Vegetarians and others who do not eat meat have been
observed to have lower incidence rates than meat eaters of some chronic
diseases, but it is unclear whether this translates into lower mortality.

Objective: The purpose of this study was to describe mortality in
vegetarians and comparable nonvegetarians in a large United Kingdom cohort.

Design: The study involved a pooled analysis of data from 2 prospective studies that included 60,310 persons living in the United Kingdom, comprising 18,431 regular meat eaters (who ate meat
$5 times/wk on average), 13,039 low (less-frequent) meat eaters,
8516 fish eaters (who ate fish but not meat), and 20,324 vegetarians
(including 2228 vegans who did not eat any animal foods).

Mortality by diet group for each of 18 common causes of death was estimated
with the use of Cox proportional hazards models.

Results: There were 5294 deaths before age 90 in .1 million y of
follow-up. There was no significant difference in overall (all-cause)
mortality between the diet groups: HRs in low meat eaters, fish
eaters, and vegetarians compared with regular meat eaters were
0.93 (95% CI: 0.86, 1.00), 0.96 (95% CI: 0.86, 1.06), and 1.02
(95% CI: 0.94, 1.10), respectively; P-heterogeneity of risks =
0.082.

There were significant differences in risk compared with
regular meat eaters for deaths from circulatory disease [higher in
fish eaters (HR: 1.22; 95% CI: 1.02, 1.46)]; malignant cancer [lower
in fish eaters (HR: 0.82; 95% CI: 0.70, 0.97)], including pancreatic
cancer [lower in low meat eaters and vegetarians (HR: 0.55; 95%
CI: 0.36, 0.86 and HR: 0.48; 95% CI: 0.28, 0.82, respectively)] and
cancers of the lymphatic/hematopoietic tissue [lower in vegetarians
(HR: 0.50; 95% CI: 0.32, 0.79)]; respiratory disease [lower in low
meat eaters (HR: 0.70; 95% CI: 0.53, 0.92)]; and all other causes
[lower in low meat eaters (HR: 0.74; 95% CI: 0.56, 0.99)]. Further
adjustment for body mass index left these associations largely
unchanged.

Conclusions: United Kingdom–based vegetarians and comparable
nonvegetarians have similar all-cause mortality. Differences found
for specific causes of death merit further investigation. Am J
Clin Nutr 2016;103:218–30

BMJ 20 May 2023 Adapted from Letter of the Week by Ellen Fallows, British Society of Lifestyle Medicine

Changing the mindset in medicine

Clinicians are often overwhelmed when they see patients with many complex conditions who have brought both physical and social problems to a long awaited but short consultation.

When medical guidelines are viewed in totality, it is clear that we can’t see the wood for the trees, have forgotten the person behind the disease, and are failing to tackle the root cause of their symptoms.

Basic science now describes a common underlying pathology to long term conditions: immune dysregulation resulting in chronic systemic inflammation. Key drivers include environmental and lifestyle factors influencing gene expression and our microbiome.

Our current medical model is however based on a reductionist and deterministic view of health that stems from the era of gene discoveries. This has led to a belief that diseases exist in isolation and we are powerless without medicine and drugs. This is not the case. If we step back from the relentless assessment, quantification, and labelling of disease and spend more time tackling its root causes, we can support people to reverse- or at least improve or delay-these conditions.

Fewer guidelines and assessments are needed, as well as more public health measures and more lifestyle medicine. Lifestyle medicine is a discipline that considers the socioeconomic drivers of behaviour, acknowledges the difficulties people face, and uses person centred techniques to support lifestyle changes to tackle nutrition, physical activity, social isolation, sleep, mental wellbeing, and consumption of harmful substances such as tobacco and alcohol.

This approach isn’t new or controversial- it is the first step in all major long term condition guidelines. But it is neglected, with funds for creating good quality education and an evidence base sorely lacking and requiring a policy shift.

The hardest behaviour to change however, is not that of patients but that within medicine itself.

My comment: I am so much in agreement with this letter. It was impressive that the BMJ published it so prominently.