Comparative fracture risk in vegetarians and nonvegetarians

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Eur J Clin Nutr. 2007 Feb 7; [Epub ahead of print]Comparative fracture risk in vegetarians and nonvegetarians inEPIC-Oxford.Appleby P, Roddam A, N, Key T.Cancer Research UK Epidemiology Unit, Nuffield Department of ClinicalMedicine, University of Oxford, Roosevelt Drive, Oxford, UK.Objective: To compare fracture rates in four diet groups (meat eaters,fish eaters, vegetarians and vegans) in the Oxford cohort of theEuropean Prospective Investigation into Cancer and Nutrition (EPIC-Oxford) .Design: Prospective cohort study of self-reported fracture risk atfollow-up. Setting: The United Kingdom. Subjects: A total of 7947 men and 26 749 women aged 20-89 years,including 19 249 meat eaters, 4901 fish eaters, 9420 vegetarians

and1126 vegans, recruited by postal methods and through general practicesurgeries. Methods: regression. Results: Over an average of 5.2 years of follow-up, 343 men and 1555women reported one or more fractures. Compared with meat eaters,fracture incidence rate ratios in men and women combined adjusted forsex, age and non-dietary factors were 1.01 (95% CI 0.88-1.17) for fisheaters, 1.00 (0.89-1.13) for vegetarians and 1.30 (1.02-1.66) forvegans. After further adjustment for dietary energy and calcium intakethe incidence rate ratio among vegans compared with meat eaters was 1.15(0.89-1.49). Among subjects consuming at least 525 mg/day calcium thecorresponding incidence rate ratios were 1.05 (0.90-1.21) for fisheaters, 1.02 (0.90-1.15) for vegetarians and 1.00 (0.69-1.44) for vegans. Conclusions: In this population, fracture risk was similar for meateaters, fish eaters and

vegetarians. The higher fracture risk in thevegans appeared to be a consequence of their considerably lower meancalcium intake. An adequate calcium intake is essential for bone health,irrespective of dietary preferences. Sponsorship: The EPIC-Oxford study is supported by The Medical ResearchCouncil and Cancer Research UK. European Journal of Clinical Nutrition advance online publication, 7February 2007; doi:10.1038/ sj.ejcn.1602659.