Mortality in German vegetarians: a 21-year follow-up.

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Cancer Epidemiol Biomarkers Prev. 2005 Apr;14(4):963-8.

Lifestyle determinants and mortality in German vegetarians and

health-conscious persons: results of a 21-year follow-up.

Chang-Claude J, Hermann S, Eilber U, Steindorf K.

Division of Clinical Epidemiology, German Cancer Research Center,

Im Neuenheimer Feld 280, D-69120 Heidelberg, Germany. j.chang-

claude@...

BACKGROUND: The long-term observation of vegetarians in affluent

countries can provide insight into the relative effects of a

vegetarian diet and lifestyle factors on mortality. METHODS: A cohort

study of vegetarians and health-conscious persons in Germany was

followed-up prospectively for 21 years, including 1,225 vegetarians

and 679 health-conscious nonvegetarians. Standardized mortality

ratios compared with the German general population were calculated

for all causes and specific causes. Within the cohort, Poisson

regression modeling was used to investigate the joint effects of

several risk factors on overall and cause-specific mortality.

RESULTS: Standardized mortality ratios for all-cause mortality was

significantly below 100: 59 [95% confidence interval (95% CI), 54-

64], predominantly due to a deficit of deaths from circulatory

diseases. Within the cohort, vegetarian compared with nonvegetarian

diet had no effect on overall mortality [rate ratio (RR), 1.10; 95%

CI, 0.89-1.36], whereas moderate and high physical activity

significantly reduced risk of death (RR, 0.62, 0.64), adjusted for

age, sex, smoking, alcohol intake, body mass index, and educational

level. Vegetarian diet was however associated with a reduced RR of

0.70 (95% CI, 0.41-1.18) for ischemic heart disease, which could

partly be related to avoidance of meat. CONCLUSIONS: Both vegetarians

and nonvegetarian health-conscious persons in this study have reduced

mortality compared with the general population. Within the study, low

prevalence of smoking and moderate or high level of physical activity

but not strictly vegetarian diet was associated with reduced overall

mortality. The nonsignificant reduction in mortality from ischemic

heart diseases in vegetarians compared with health-conscious persons

could be explained in part by avoidance of meat intake.