Open Access This article is
- freely available
Nutrients 2019, 11(1), 154; https://doi.org/10.3390/nu11010154
Healthy Lifestyle Practices among Argentinian Vegetarians and Non-Vegetarians
Center for Health Sciences Research, School of Medicine and Health Sciences, Universidad Adventista del Plata, Libertador San Martín, 25 de Mayo 99, Entre Ríos 3103, Argentina
Institute for Food Science and Nutrition, Universidad Adventista del Plata, Libertador San Martín, 25 de Mayo 99, Entre Ríos 3103, Argentina
Department of Nutrition, Adventist University of São Paulo-UNASP/SP, Estrada de Itapecerica 5859, Jardim IAE, São Paulo 05858-001, Brazil
Correspondence: [email protected]; Tel.: +54-343-491-8000 (ext. 1236 or 1387); Fax: +54-343-491-0300
These authors contributed equally to this work.
Received: 2 December 2018 / Accepted: 8 January 2019 / Published: 12 January 2019
Although current research has contributed to the promotion of whole-food plant-based diets, few studies have examined healthy vegan dietary and lifestyle factors, especially in South America. Therefore, we aimed at investigating the adherence to healthy vegan lifestyle habits among Argentinian vegetarians and omnivorous, using a recently developed vegetarian lifestyle index adapted to the vegan dietary pattern. Also, accessibility of vegetarian foods, and the proportion of household income spent on food were assessed in a cross-sectional approach with 1454 participants. The population was comprised of females (84.9%), singles (55.0%), young-adults (mean age 32.1, standard deviation (SD) = 13.6), employed (50.8%), with high educational levels (50.4%), and low prevalence of both tobacco smoking (7.0%) and frequent alcohol consumption (7.6%). The mean score of adherence to healthy vegan lifestyle habits was 6.64 (SD = 1.72), with higher scores indicating better adherence. Non-vegetarians (5.75; 95% confidence interval (CI), 5.61–5.89) had a significantly lower adjusted mean score compared to semi-(6.32; 95% CI, 6.17–6.47), pesco-(6.99; 95% CI, 6.59–7.39), lacto-ovo-vegetarians (7.10; 95% CI, 6.96–7.24), as well as vegans (8.59; 95% CI, 8.35–8.83). The mean proportion of household income spent on food was significantly lower among vegans compared with other dietary patterns. The whole population that was studied showed a low consumption of whole grains, legumes, vegetables, nuts, and seeds. Although vegans showed a better diet and lifestyle pattern there is a need to improve eating and lifestyle habits to address risk factors for non-communicable diseases in Argentina.
Keywords:vegan; vegetarian diets; lifestyle habits; dietary patterns; Argentina
There is a growing interest in deepening the understanding of the associations between lifestyle factors and health outcomes. Epidemiologic data have linked healthy dietary patterns and lifestyle habits with lower prevalence of several medical conditions and a quality aging [1,2,3,4,5,6,7,8]. Non-vegetarian dietary patterns, characterized by the frequent intake of animal foods have been associated with increased risk of developing several chronic diseases [9,10,11]. In contrast, vegetarian dietary patterns are generally associated with a more positive health status including lower total mortality , lower prevalence of weight gain or obesity [13,14,15], cardiovascular disease [16,17,18,19], metabolic syndrome [20,21], hypertension , diabetes [15,23,24], and some types of cancer [25,26]. More recent studies have suggested that a vegan dietary pattern may be associated with lower risk factors for some chronic diseases than other vegetarian patterns [27,28]. For instance, a vegan diet may offer additional protection against coronary heart disease [16,18], type 2 diabetes, and cancer [29,30,31].
The identification of specific dietary types of vegetarianisms has not been accurately defined in some epidemiologic studies. Vegetarian diets include a spectrum of dietary patterns which usually do not consume or consume limited amounts of animal meat, especially red meat, poultry and/or fish. Lacto-ovo-vegetarians are known to include dairy and eggs in their diet, and vegans exclude all kinds of animal meats or derived products. Some studies also include other categories of vegetarians such as semi- and pesco-vegetarians which include limited amounts of meat and/or fish in their diets . More recent research suggests that the use of plant-based diets as a means of prevention and treatment of chronic diseases should be promoted through proper dietary recommendations and guidelines . Thus, efforts are needed to evaluate vegan diets and to promote nutritional adequacy for vegetarians. This may be especially relevant in developing countries with high prevalence of non-communicable diseases (NCDs) [14,33,34,35] and few studies about vegetarian dietary patterns and lifestyles.
Along with proper nutrition, other lifestyle factors such as water intake, sunlight exposure, and daily exercise have been included in food guides for the promotion of comprehensive healthy lifestyles [36,37]. Although vegans tend to show healthier lifestyle habits than non-vegetarians [7,21,38,39], the avoidance of animal foods is not always accompanied by the adoption of other healthy dietary or lifestyle habits . In fact, recent research shows that it is possible to have unhealthful plant-based diets with increased risk of coronary heart disease . This may be particularly important when considering that research on vegan lifestyles is relatively recent and conducted mostly among highly-developed countries making it difficult to extrapolate some of the findings to other parts of the world. Usually, in developed contexts, people are exposed to better socioeconomic and educational experiences which may facilitate the adherence to vegan diets than people living in contexts of lower-and middle-income countries. In parallel, most cases of early death and disability on a global scale are associated with chronic diseases, but recent studies indicate that NCDs have a more negative impact on low-income and middle-income countries . Argentina is among one of the South American countries with a high burden of morbidity and mortality associated with NCDs [34,35].
Previous findings from our studies showed a high prevalence of risk factors for NCDs in persons living in central areas of Argentina . This includes unhealthy lifestyle habits associated with low consumption of fruits and vegetables, physical inactivity, high prevalence of overweight and obesity, tobacco smoking, and altered lipid and glucose blood serum profiles . The impact of poor lifestyle habits on cardiovascular diseases and diabetes was shown in a 2018 study conducted in United Kingdom (UK) investigating genetic susceptibility in relation to lifestyle factors. Persons with high genetic risks for certain NCDs and poor lifestyle habits, compared with ideal lifestyles in the low genetic risk group, were several times at an increased risk of developing coronary artery disease (hazard ratio (HR) 4.45, 95% CI, 3.72–5.54), and diabetes (HR 15.46, 95% CI, 10.82–22.08) . Another study with participants of the UK Biobank assessed the genetic risk of incident stroke, and the benefits of adhering to a healthy lifestyle including four factors: non-smoker, healthy diet, body mass index <30 kg/m2, and regular physical exercise. Unfavorable lifestyle, characterized by 1 or less healthy lifestyle habits, was associated with a 66% increased risk of stroke compared with a favorable lifestyle (3 or 4 healthy lifestyle habits) independently of genetic risk levels. Thus, adopting healthy lifestyle habits, may be the most affordable and effective strategy to address the health crisis associated with NCDs worldwide, especially in low-and middle-income countries . Then, there exists an actual need to deepen the comprehension of vegetarian lifestyles in different contexts of the world, to identify risk and protective factors which support health promotion and prevention of NCDs.
The evaluation of individual’s lifestyle habits may be done using several approaches. More recently, researchers have designed new tools to access food intake in a composite mode . This is the case of eating indexes. Considering the diversity of dietary patterns, a specific index was recently developed to assess vegetarian dietary patterns and lifestyle habits. The Vegetarian Lifestyle Index (VLI)  was developed based on the guidelines for healthful vegetarian diets  and was shown to accurately discriminate lifestyle habits between different dietary patterns . This index may be applied in different settings, such as in nutritional research for evaluation of diet and lifestyle adherence in community-based interventions, population surveillance of lifestyle quality, and epidemiological research .
Therefore, this study aimed at investigating the adherence to healthy vegan lifestyle habits among Argentinian vegetarians and non-vegetarians, according to the guidelines for healthful vegetarian diets . We also explored some sociodemographic factors, self-defined proportion of household income spent on food, and the accessibility of vegetarian foods.
2. Materials and Methods
2.1. Study Population
Individuals of 18 years and older were invited to participate in the study mainly through social networks. The invitation was addressed to those interested in knowing the adequacy of their health-related lifestyle habits, and interested in receiving an immediate and personalized feedback based on the major recommendations of the guidelines for healthful vegetarian diets and lifestyle proposed by the Department of Nutrition, School of Public Health at Loma Linda University . Participants from the 23 Argentinian states were enrolled in the study, as well as some who lived abroad. We excluded participants who did not adequately complete the questions of the study.
2.2. Ethical Aspects
A written informed consent was provided at the first electronic page containing the invitation to join in the study. Participants were enrolled after clicking the “accept” icon, meaning that they have agreed with the informed consent terms. All procedures associated with this project were conducted following the international ethical standards proposed by the Helsinki protocol for human research and this study was reviewed and approved by the Research and Ethics Committee of the Adventist University of River Plate School of Medicine (resolution #12/8-2018). This committee is affiliated to the National Register of Health Research (registered under the #000237) of the Ministry of Health, Argentine.
2.3. Sociodemographic Information, Dietary and Lifestyle Factors
Sociodemographic and health information, as well as lifestyle and dietary data were collected using an online survey available to be self-administered through the web link (Supplementary Materials). Briefly, participants provided information on age, city and state of residence, gender, education (elementary, secondary school, tertiary/college and university), employment status, and type of occupation. Data collected also included, cigarette smoking (including numbers of cigarettes), alcohol consumption (frequency of intake), body weight, and height. The history of a medical condition diagnosed by a physician, such as arterial hypertension, cardiovascular diseases, dyslipidemia, diabetes, cancer, chronic respiratory diseases, osteomuscular conditions, thyroid dysfunctions, celiac disease, rheumatoid arthritis, depressive disorders, and other chronic health conditions.
The dietary pattern was self-reported and classified according to Dagnelie & Mariotti . Briefly, non-vegetarians consume red meats, poultry and/or fish regularly; semi-vegetarians consume red meats, poultry or fish no more than once a week; pesco-vegetarians consume fish but not red meat or poultry; lacto-ovo-vegetarians consume eggs and dairy products but not meats; and vegans do not consume meats, dairy products or eggs. The time of adherence to the current dietary habits was classified as less than 6 months, 6 to 12 months, and more than 12 months.
The adherence to healthy lifestyle habits was assessed based on the criteria proposed by the Vegetarian Lifestyle Index , according to the main recommendations of the guidelines for healthful vegetarian diets and lifestyle proposed by the Department of Nutrition, School of Public Health, Loma Linda University . Fourteen items were considered, with eleven related to diet and three related to lifestyle habits. Diet components encompassed a whole-food plant-based nutrition including the consumption of whole grains, legumes and soy, vegetables, fruits, nuts and seeds, dairy products, eggs, sweets, reliable sources of vitamin B-12, and meat foods. The following lifestyle habits were also considered: daily exercise, water intake, and moderate skin exposure to sunlight. Each item presented 3 options of answers and scored 0, 0.5, or 1 point. A score value of 1 was attributed when participants referred to consume ≥6 servings/day of whole grains, ≥3 servings/day of legumes, ≥8 servings/day of vegetables, ≥4 servings/day of fruits, ≥1.5 servings/day of nuts and seeds, 0–2 servings/day of vegetables oils, 0 servings/day of dairy products and eggs, 0–2 servings/week of sweet, ≥2.0 mcg serving equivalent/day of vitamin B-12, 0 servings/day of meat foods, ≥8 glasses water/day, and ≥30 min/day of moderate physical activity or ≥15 min/day of vigorous physical activity, and ≥10 min/day of sunlight skin exposure between 11 a.m. and 1 p.m. The selected cut-off points were defined based on the recommendations of a diet containing approximately 2000 kcal/day for vegans . The cut-offs points of all items are presented in Table 3. Components were equally weighted and the sum of them generates a composite score ranging from 0 to 14 points. Higher total scores indicate greater adherence to healthy vegan lifestyle habits.
2.4. Online Resources and Feedback to Participants
After completing the online survey, participants received an immediate and personalized feedback. For each question, two types of motivational feedback could be offered, depending on the participant’s answer. If the answer was associated with a score 0 or 0.5 points, participants were encouraged to ‘put effort’ to achieve a healthier habit associated with the lifestyle factor which scored low. On the other hand, if the answer scored 1 point, a ‘keep going’ message was delivered (Supplementary Materials). Questions were designed in the Survey Monkey online platform using the Premier plan (SurveyMonkey, San Mateo, CA, USA). Each question included an illustrated image obtained from Shutterstock (New York, NY, USA) used to help participants to choose food portions. To generate the personalized feedback to each one of the 14 answers, images containing an explanatory text and a motivational figure were designed in JPG format. Based on the participant’s answer, a specific image was selected from a set of Cloud Functions of Google Firebase-Blaze plan (Google, San Francisco, CA, USA). The total composite score (gauge type image) was generated using the Application Programming Interface (API) of Google Image Charts (Google, San Francisco, CA, USA), and shows the total percentage obtained by the participant over one hundred percent based on the fourteen points evaluated. Participants could also choose to receive an e-mail copy of their feedback using the SendGrid’s Free Plan API (SendGrid, Denver, CO, USA). All images, graphics, and vectors were used with previous permission or were under a “Creative Commons 0” license.
2.5. Statistical Analysis
Descriptive analyses were carried out for sociodemographic, lifestyle, health and dietary information. Chi-square test was used for assessing differences in categorical variables between groups. The score of adherence to healthy vegan lifestyle habits was compared according to selected demographic variables. To compare the scores among different dietary patterns, we used the Mann–Whitney U-test and the Kruskal–Wallis. Analysis of variance (ANOVA) was conducted to obtain descriptive statistics and unadjusted mean scores according to demographic and lifestyle characteristics of the population. We used a modeling approach to determine mean scores across dietary patterns, with the dietary pattern as the independent variable and the adherence score as the dependent variable in Model 1. Analysis of covariance (ANCOVA) was performed to compare the adjusted means of the adherence scores by categories of the dietary pattern at 95% confidence interval (95% CI). Model 2 was adjusted for gender and age. Model 3 was adjusted as in Model 2 plus body mass index (BMI), tobacco and current alcohol use. Model 4 was adjusted as in Model 3 plus educational level. All statistical analyses were performed using the software SPSS version 22 (SPSS Inc., Chicago, IL, USA). p-values < 0.05 were considered statistically significant.
A total of 1454 participants completed the study. Regarding sociodemographic and other selected characteristics shown in Table 1, most of the participants were females (84.9%), young-adults (mean age 32.1, SD = 13.6, 18–82 years), and single (55.0%). Approximately one half of the population had with high educational level (50.4%) and was employed (50.8%). The population was comprised of individuals from all states of Argentina and from 6 main regions of the country: Northeast, Northwest, Central, Cuyo, Buenos Aires, and South. A small number of participants (2.5%) informed that they were currently living out of Argentina. Between 7 and 8% of participants were tobacco cigarette smokers and referred to consume alcohol regularly (more than once a week). Almost half of the participants were overweight or obese (45.6%), and 33.1% had a medical diagnosis of a chronic condition according to self-reported anthropometric and health information. The dietary patterns were represented by two main groups of non-vegetarians (29.5%), and vegetarians (70.5%). Lacto-ovo-vegetarians were the most prevalent group among vegetarians, and 146 (10%) individuals were vegans. More than 2/3 of the study population referred to adhere to the current dietary pattern for more than 12 months. The mean score of adherence to a healthy vegan lifestyle for the study population was 6.64, SD = 1.72. Table 1 also presents the score of adherence to healthy vegan lifestyle habits in relation to sociodemographic and other characteristic, showing no significant differences for gender, educational level, marital and occupational status, regions of Argentina, time of adherence to dietary pattern and the presence of chronic diseases. The score of adherence to healthy vegan lifestyle habits varied significantly among individuals in different age groups, with distinct smoking status, alcohol use, BMI, and dietary patterns.
Table 2 shows that males tend prefer meat-containing diet patterns, such as the non- and semi-vegetarian patterns. Pesco-vegetarian and vegan dietary patterns showed higher proportions of females. Adults between 21 and 64 years old were mostly non-vegetarians. Vegetarian dietary patterns (semi-vegetarians, pesco-vegetarians, lacto-ovo-vegetarians, and vegans) were more prevalent at younger ages and among older individuals. There was a higher prevalence of vegetarian dietary patterns among individuals who were currently married, married in the past, retired, living in Buenos Aires and central areas of Argentina, non-tobacco smokers, non-alcohol users, and with lower BMI (underweight and normal weight). Females, never married, employed, living in Buenos Aires, non-smoker, non-alcohol user, normal and underweight BMI, without any chronic conditions were the most prevalent characteristics among vegans. There were no significant associations between the dietary patterns, educational levels and smoking status. The presence of one or more chronic condition was more prevalent in non-vegetarians and semi-vegetarians compared with pesco-vegetarians, lacto-ovo-vegetarians, and vegans. Significant differences were found considering the proportion of the total household income spent on food among all dietary patterns. The mean proportion of household income spent on food was significantly lower among vegans when compared with other dietary patterns.
According to the data shown in Table 3, the study population presented a low consumption of whole grains, legumes, vegetables, nuts, and seeds. A high intake of vegetable oils and an intermediate consumption of fruits, dairy products, eggs, reliable sources of vitamin B-12, and water were detected. Sunlight exposure was low or moderate in most individuals. Moreover, participants presented low levels of regular physical activity practice.
Considering the recommended intake of different food groups, we found that a vegan dietary pattern was significantly associated with the consumption of ≥6 servings/day of whole grains, ≥3 servings/day of legumes, ≥4 servings/day of fruits, ≥1.5 servings/day nuts and seeds. The consumption of ≥8 servings/day of vegetables, 0–2 servings/day of vegetable oils, and 0–2 servings/week of sweets was associated with a pesco-vegetarian pattern. The intake of >2 servings/day of dairy, and >1 servings/day of eggs was associated with the non-vegetarian dietary pattern. The intake of sweets <2 servings/week were similarly associated with the pesco-vegetarian and vegan diets. The vegan dietary pattern was associated with the lowest intake of vitamin B-12 (<1.0 mcg/serving equivalent day). There was no association of dietary patterns with daily exercise, water intake, and sunlight exposure in this population.
Table 4 reports the adjusted and unadjusted mean scores of adherence to healthy vegan lifestyle habits by categories of vegetarian dietary patterns. Non-vegetarians had a significantly lower mean score (5.72; 95% CI, 5.58–5.85) than the vegetarian groups, including semi- (6.33; 95% CI 6.18–6.48), pesco- (6.97; 95% CI, 6.57–7.36), and lacto-ovo-vegetarians (7.11; 95% CI, 6.96–7.27), as well as vegans (8.62; 95% CI, 8.37–8.87). Some minor changes occurred after adjusting for sociodemographic and lifestyle factors in Model 4, meaning that non-vegetarians (5.75; 95% CI, 5.61–5.89) had significantly lower mean compared to semi- (6.32; 95% CI, 6.17–6.47), pesco- (6.99; 95% CI, 6.59–7.39), lacto-ovo-vegetarians (7.10; 95% CI, 6.96–7.24), and vegans (8.59; 95% CI, 8.35–8.83).
Table 5 shows the vegetarian food availability for purchase nearby the participant’s neighborhood. Most of the participants reported buying vegetarian foods in grocery stores with a distance of less than 1 km from their residence. Natural fruit juices, fortified dairy milk, nuts, seeds, and olive oils are the most available foods. Tofu and other vegan cheeses are the least bought foods by this population.
This study provides new data about healthy vegan lifestyle habits, sociodemographic and other selected characteristics among non-vegetarians and vegetarians in Argentina. Research about vegetarian nutrition and its influence on health are scarce in South America, and especially in Argentina where meat food intakes are high [49,50]. In our study, vegetarians showed healthier lifestyle habits and lower risk factors for NCDs than non-vegetarians. However, levels of adherence to whole-food plant-based diets are insufficient including for vegans. Another finding is that the mean score composite of adherence to a healthy vegan lifestyle was significantly different among the dietary patterns evaluated. The higher mean score of adherence to a healthy vegan lifestyle was found in the vegan dietary pattern, followed by the lacto-ovo-vegetarian, pesco-vegetarian, semi-vegetarian, and non-vegetarian dietary pattern, even after adjusting for sociodemographic characteristics and lifestyle factors. The approaches used in our study could discriminate the eating habits of different dietary patterns as similar to other research done with vegetarians [7,51].
The predominant group of participants of this study was comprised of highly educate young adult females, as observed in other investigations of vegetarian populations [13,51,52,53,54]. There were no significant differences in the mean score of adherence to a healthy vegan lifestyle among categories of sociodemographic variables such as gender, educational level, marital and occupational status, and region of residencies in Argentina, suggesting certain homogeneity in the studied population concerning to diet choices. In contrast, the mean score of adherence to a healthy vegan lifestyle was significantly higher in non-smokers, non-alcohol consumers, and individuals with normal BMI, showing the association of higher lifestyle scores with important protective factors for NCDs. Most of the participants reported having had the current dietary pattern for more than 12 months suggesting that the information provided reflects a certain adherence to their current dietary pattern.
The participation of individuals from different areas of Argentina reveals the wide distribution of the online survey of this study throughout the country. Some regions had higher participation such as the capital zone, Buenos Aires. The study was also announced during the VegFest-Argentina, a meeting held in this city, reaching out individuals from different parts of the country interested in vegetarian diets. This explains the expressive number of vegan participants. We also advertised this research through the social networks of our University in the state of Entre Ríos, a central area of Argentina, influenced by the immigration of Russo-German Adventists  involved with the promotion of healthy lifestyles, including vegetarian diets. Some of the findings of this study such as the low prevalence of tobacco cigarette smoking, and alcohol intake, besides the high prevalence of vegetarian dietary patterns, with relation to the general population of Argentina, suggest that participants of this study show characteristics of being a health/vegetarian-oriented population.
Several studies associate healthy vegetarian lifestyles with adequate body weight and better health status [13,56]. The BMI information from this study showed a lower prevalence of overweight and obesity when compared to similar self-reported statistics of the general Argentinian population [57,58]. This may be attributed to the high prevalence of individuals with vegetarian dietary patterns in this population, similarly found in other research [38,59,60]. In line with this, our study also reported a lower prevalence of chronic conditions throughout all dietary patterns but particularly in vegetarians as found in similar studies [13,20,61].
In our study, participants have self-defined their dietary patterns. This classification was mostly corroborated with the indicated consumption of different food groups. For instance, vegans did not consume meat or flesh products. However, around 5% of this population reported some occasional intake of dairy/eggs. The same proportion of lacto-ovo-vegetarians also reported occasional meat intake (Table 3). This may depend on limit of self-reported classification of participants.
Individuals following the vegan dietary pattern had highest intakes of whole grains, legumes, fruits, and nuts and seeds compared with other dietary groups. Pesco-vegetarians and lacto-ovo-vegetarians showed to some extent similar prevalence of consumption of legumes, vegetables, fruits, nuts and seeds. The lowest intakes of sweets were found similarly in vegans and pesco-vegetarians. However, it should be highlighted that a global analysis of the results obtained from all participants, including vegans, show the need of improvements in dietary and lifestyle habits. Some of food groups, including whole grains, legumes, vegetables, nuts, and seeds are not properly consumed by the general population of this study. Only around 5% of the total population showed adequate intakes of legumes and vegetables according to the standards proposed for a healthy vegan diet. Also, a very low intake of whole grains was observed, suggesting that this population may be consuming predominantly refined-processed grains. Unhealthy dietary and lifestyle habits may be associated with the high prevalence of NCDs observed in Argentina [49,58]. Several studies show that adequate intakes of fruits and vegetables are associated with lower morbidity and mortality for NCDs [35,50,62,63]. Corroborating with this, we have previously described a very low intake of fruits and vegetables in the general population of some areas of Argentina associated with high prevalence of risk factors for NCDs, and multimorbidity, disproportionately affecting young adults . We also found low consumption of fruits, vegetables, and legumes in men with prostate cancer and other cancers in Argentina .
When following a vegan dietary pattern, it is important to get appropriate amounts of a variety of whole-foods to obtain macro- and micronutrients to achieve nutritional adequacy. In our study, the vegan dietary pattern reported the lowest prevalence of intake of reliable sources of vitamin B-12. Studies show that persons adopting a vegan dietary pattern should regularly consume vitamin B-12 fortified foods or take vitamin B-12 supplements [65,66].
Other health-related lifestyle habits, such as sunlight exposure and physical activity, were examined and found to be similarly adopted among different dietary pattern groups. The sunlight exposure was either low or intermediate in all groups including in vegans, therefore the organic supply of vitamin D may be impaired, unless proper replacement of vitamin D is provided with fortified foods or supplements [67,68,69]. Studies show that vitamin D produced through sunlight exposure has a longer half-life than of those obtained from other sources, and helps to maintain serum vitamin D concentrations within the normal range [70,71].
A meat-free diet is not enough to guarantee a healthy lifestyle. Despite the known health benefits of vegetarian diets [65,72], other aspects of the lifestyle such as physical activity are also important for health promotion and prevention of NCDs [73,74,75]. In the present study the use of tobacco and alcohol intake was lower in the vegetarian dietary patterns compared with non-vegetarians showing the consistency regarding the adoption of healthy lifestyle habits by vegetarians as similarly shown in some studies with vegetarians, including vegans [21,76,77]. In a recent investigation, vegans do not differ much from non-vegetarians in regard to non-eating health related behaviors such as tobacco smoking, alcohol intake and physical activity . Thus, it is important to discriminate between vegetarian diets from healthy dietary and lifestyle habits.
The score of adherence to a healthy vegan lifestyle of our study was based on the dietary and the lifestyle components of the Vegetarian Lifestyle Index , using an online survey, and attributing higher scores for increasing adherence to healthful vegan diet and lifestyle factors [7,47]. The score of adherence to a healthy vegan lifestyle calculated in our study was based on the recommendations for an approximately 2000 kcal vegan diet according to the recommendations from the food pyramid guide from the Loma Linda University . For practical reasons, the components to measure the adherence to a healthy vegan lifestyle were presented in an online survey as a simple tool to an initial assessment of main health-related lifestyle habits. Several studies mention that it is opportune to use online methods for carrying out health surveys, as they are reliable, fast, effective, and interactive, avoiding some of the barriers presented in traditional approaches [78,79].
Moreover, this e-health survey may be a helpful tool for primary health care contexts for health promotion and prevention of NCDs. The healthy vegan lifestyle survey also has some educational purposes since the feedbacks may help to trigger the interest of participants to implement lifestyle changes. This form of personalized feedback derived from the individual evaluation has been shown to be valuable in other studies . We speculate that several persons were attracted to participate in the study in order to receive an immediate feedback about their dietary/lifestyle current status. It is interesting to observe that an important number of non-vegetarians also participated in the study, which may suggest a concern about issues associated with diet and lifestyle.
Regarding the score of adherence to a healthy vegan lifestyle, the findings of our study point to a steady increase in the mean score from (5.72, SD = 1.41) in non-vegetarians to (8.62, SD = 1.52) in vegans. This variability is consistent with supplanting of animal products and adopting whole food plant-based nutrition. It would be important that future prospective studies to be developed in South America correlate vegetarian lifestyle scores with different health outcomes since vegans in other studies were shown to present higher scores for dietary components such as in ours [51,80]. The mean score of the adherence to a healthy vegan lifestyle in this Argentinian population (6.64, SD = 1.72) is lower than the score (7.42, SD = 1.75) found in the Adventist Health Study-2 cohort investigation considering the recommendations for a 2000 kcal for lacto-ovo-vegetarian diet with moderate intakes of dairy and eggs . Although both populations presented health-oriented profiles, several factors may have accounted for the observed differences as of diets considered, socioeconomic factors, religious and cultural idiosyncrasies.
In this study, we also evaluated the accessibility of vegetarian foods and we find that it is possible for participants to find healthy vegan foods within a relatively nearby area of the neighborhood. It should be noted that the vegan foods’ availability reported by consumers is higher for natural foods than for processed food products. This is especially important since the healthy plant-based diet incorporate more whole grains, vegetables, fruits, seeds and nuts in a natural form or in some simple-homemade preparations [50,81]. Processed foods tend to incorporate more salt, sugar, and chemical additives which may compromise their nutritional value and health effects [39,82,83]. In Argentina, vegetarian dietary patterns are not very common and according to the participants of this study, the processed food options for vegans are scarce but this may be an advantage to develop a healthier vegan lifestyle.
The major findings of our study indicate that vegetarians in Argentina have healthier lifestyle habits, with lower risk factors for NCDs than non-vegetarians independent of their sociodemographic characteristics. In addition, individuals adopting the vegan dietary pattern presented the highest mean score of adherence to a healthy vegan lifestyle, lower prevalence of unhealthy habits (i.e., tobacco smoking, alcohol intake), and lower BMI compared to the individuals with other dietary patterns. However, it should be noted that the promotion of nutritional health education merits further attention and needs to be encouraged in all dietary groups to increase the compliance with recommendations for healthy diets and improved lifestyle habits in order to address risk factors associated with NCDs in Argentina.
The following are available online at https://www.mdpi.com/2072-6643/11/1/154/s1: The online survey with a schematic representation of the electronic feedback provided to participants with the total composite score.
S.O.S.P. and F.J.P. participated in the study design, data analyses and manuscript preparation. R.V.G., S.L., E.M.M.-C., and M.C.T.M. contributed to the study design, and manuscript preparation. D.X. and I.A.C.-G. contributed with the online resources and electronic feedback to participants and manuscript preparation. R.V.G., S.L. and E.M.M.-C. supervised data collection. G.N.G.-F. contributed to the interpretation of the data and participated in the manuscript preparation. All the authors review the content of the manuscript and approved the final version of the manuscript.
The study was funded by a research grant (registered under the #18/36-2018) from the Adventist University of River Plate School of Medicine.
The authors would like to express their gratitude to all the subjects who participated in this study.
Conflicts of Interest
The authors declare no conflict of interest.
- Craig, W.J. Health effeets of vegan diets. Am. J. Clin. Nutr. 2009, 89, 1627S–1633S. [Google Scholar] [CrossRef] [PubMed]
- Jenkins, D.J.A.; Kendall, C.W.C.; Faulkner, D.A.; Kemp, T.; Marchie, A.; Nguyen, T.H.; Wong, J.M.W.; de Souza, R.; Emam, A.; Vidgen, E.; et al. Long-term effects of a plant-based dietary portfolio of cholesterol-lowering foods on blood pressure. Eur. J. Clin. Nutr. 2008, 62, 781–788. [Google Scholar] [CrossRef] [PubMed]
- Fraser, G.E. Vegetarian diets: What do we know of their effects on common chronic diseases? Am. J. Clin. Nutr. 2009, 89, 1607S–1612S. [Google Scholar] [CrossRef] [PubMed]
- McEvoy, C.T.; Temple, N.; Woodside, J.V. Vegetarian diets, low-meat diets and health: A review. Public Health Nutr. 2012, 15, 2287–2294. [Google Scholar] [CrossRef]
- King, K.; Meader, N.; Wright, K.; Graham, H.; Power, C.; Petticrew, M.; White, M.; Sowden, A.J. Characteristics of Interventions Targeting Multiple Lifestyle Risk Behaviours in Adult Populations: A Systematic Scoping Review. PLoS ONE 2015, 10, e0117015. [Google Scholar] [CrossRef] [PubMed]
- Bodai, B.; Nakata, T.; Wong, W.; Clark, D.; Lawenda, S.; Tsou, C.; Liu, R.; Shiue, L.; Cooper, N.; Rehbein, M.; et al. Lifestyle Medicine: A Brief Review of Its Dramatic Impact on Health and Survival. Perm. J. 2018, 22, 17–25. [Google Scholar] [CrossRef]
- Le, L.T.; Sabaté, J.; Singh, P.N.; Jaceldo-Siegl, K. The Design, Development and Evaluation of the Vegetarian Lifestyle Index on Dietary Patterns among Vegetarians and Non-Vegetarians. Nutrients 2018, 10, 542. [Google Scholar] [CrossRef]
- Visser, M.; Wijnhoven, H.A.H.; Comijs, H.C.; Thomése, F.G.C.F.; Twisk, J.W.R.; Deeg, D.J.H. A Healthy Lifestyle in Old Age and Prospective Change in Four Domains of Functioning. J. Aging Health 2018. [Google Scholar] [CrossRef]
- Bouvard, V.; Loomis, D.; Guyton, K.Z.; Grosse, Y.; El Ghissassi, F.; Benbrahim-Tallaa, L.; Guha, N.; Mattock, H.; Straif, K.; Stewart, B.W.; et al. Carcinogenicity of consumption of red and processed meat. Lancet Oncol. 2015, 16, 1599–1600. [Google Scholar] [CrossRef][Green Version]
- Wolk, A. Potential health hazards of eating red meat. J. Intern. Med. 2017, 281, 106–122. [Google Scholar] [CrossRef]
- Schulze, M.B.; Martínez-González, M.A.; Fung, T.T.; Lichtenstein, A.H.; Forouhi, N.G. Food based dietary patterns and chronic disease prevention. BMJ 2018, 361, k2396. [Google Scholar] [CrossRef] [PubMed][Green Version]
- Martínez-González, M.A.; Sánchez-Tainta, A.; Corella, D.; Salas-Salvadó, J.; Ros, E.; Arós, F.; Gómez-Gracia, E.; Fiol, M.; Lamuela-Raventós, R.M.; Schröder, H.; et al. A provegetarian food pattern and reduction in total mortality in the Prevención con Dieta Mediterránea (PREDIMED) study. Am. J. Clin. Nutr. 2014, 100, 320S–328S. [Google Scholar] [CrossRef] [PubMed][Green Version]
- Jaacks, L.M.; Kapoor, D.; Singh, K.; Narayan, K.V.; Ali, M.K.; Kadir, M.M.; Mohan, V.; Tandon, N.; Prabhakaran, D. Vegetarianism and cardiometabolic disease risk factors: Differences between South Asian and American adults. Nutrition 2016, 32, 975–984. [Google Scholar] [CrossRef] [PubMed]
- Singh, P.N.; Arthur, K.N.; Orlich, M.J.; James, W.; Purty, A.; Job, J.S.; Rajaram, S.; Sabaté, J. Global epidemiology of obesity, vegetarian dietary patterns, and noncommunicable disease in Asian Indians. Am. J. Clin. Nutr. 2014, 100, 359S–364S. [Google Scholar] [CrossRef] [PubMed][Green Version]
- Agrawal, S.; Millett, C.J.; Dhillon, P.K.; Subramanian, S.; Ebrahim, S. Type of vegetarian diet, obesity and diabetes in adult Indian population. Nutr. J. 2014, 13, 89. [Google Scholar] [CrossRef][Green Version]
- Kahleova, H.; Levin, S.; Barnard, N.D. Vegetarian Dietary Patterns and Cardiovascular Disease. Prog. Cardiovasc. Dis. 2018, 61, 54–61. [Google Scholar] [CrossRef] [PubMed]
- Dominique Ashen, M. Vegetarian Diets in Cardiovascular Prevention. Curr. Treat. Options Cardiovasc. Med. 2013, 15, 735–745. [Google Scholar] [CrossRef]
- Kwok, C.S.; Umar, S.; Myint, P.K.; Mamas, M.A.; Loke, Y.K. Vegetarian diet, Seventh Day Adventists and risk of cardiovascular mortality: A systematic review and meta-analysis. Int. J. Cardiol. 2014, 176, 680–686. [Google Scholar] [CrossRef]
- Navarro, J.A.; Caramelli, B. Vegetarians from Latin America. Am. J. Cardiol. 2010, 105, 902. [Google Scholar] [CrossRef]
- Martins, M.C.T.; Jaceldo-Siegl, K.; Orlich, M.; Fan, J.; Mashchak, A.; Fraser, G.E. A New Approach to Assess Lifetime Dietary Patterns Finds Lower Consumption of Animal Foods with Aging in a Longitudinal Analysis of a Health-Oriented Adventist Population. Nutrients 2017, 9, 1118. [Google Scholar] [CrossRef]
- Orlich, M.J.; Singh, P.N.; Sabaté, J.; Jaceldo-Siegl, K.; Fan, J.; Knutsen, S.; Beeson, W.L.; Fraser, G.E. Vegetarian Dietary Patterns and Mortality in Adventist Health Study 2. JAMA Intern. Med. 2013, 173, 1230–1238. [Google Scholar] [CrossRef] [PubMed]
- Eleutério da Silva, L.B.; Eleutério da Silva, S.S.; Garcia Marcílio, A.; Geraldo Pierin, A.M. Prevalence of Arterial Hypertension Among Seventh-Day Adventists of the Sao Paulo State Capital and Inner Area. Arq. Bras. Cardiol. 2012, 98, 329–337. [Google Scholar] [CrossRef]
- Tonstada, S.; Stewarta, K.; Odab, K.; Batechb, M.; Herringa, R.P.; Frase, G.E.; Tonstad, S.; Stewart, K.; Oda, K.; Batech, M.; et al. Vegetarian diets and incidence of diabetes in the Adventist Health Study-2. Nutr. Metab. Cardiovasc. Dis. 2013, 23, 292–299. [Google Scholar] [CrossRef] [PubMed][Green Version]
- Pawlak, R. Vegetarian Diets in the Prevention and Management of Diabetes and Its Complications. Diabetes Spectr. 2017, 30, 82–88. [Google Scholar] [CrossRef]
- Key, T.J.; Appleby, P.; Crowe, F.; Bradbury, K.; Schmidt, J.A.; Travis, R.C. Cancer in British vegetarians: Updated analyses of 4998 incident cancers in a cohort of 32,491 meat eaters, 8612 fish eaters, 18,298 vegetarians, and 2246 vegans 1–4. Am. J. Clin. Nutr. 2014, 100, 378S–385S. [Google Scholar] [CrossRef]
- Orlich, M.J.; Singh, P.N.; Sabaté, J.; Fan, J.; Sveen, L.; Bennett, H.; Knutsen, S.F.; Beeson, W.L.; Jaceldo-Siegl, K.; Butler, T.L.; et al. Vegetarian Dietary Patterns and the Risk of Colorectal Cancers. JAMA Intern. Med. 2015, 175, 767–776. [Google Scholar] [CrossRef]
- Yokoyama, Y.; Levin, S.M.; Barnard, N.D. Association between plant-based diets and plasma lipids: A systematic review and meta-analysis. Nutr. Rev. 2017, 75, 683–698. [Google Scholar] [CrossRef]
- Yokoyama, Y.; Nishimura, K.; Barnard, N.D.; Miyamoto, Y. Blood Pressure and Vegetarian Diets; Elsevier: New York, NY, USA, 2017; ISBN 9780128039694. [Google Scholar]
- Segovia-Siapco, G.; Sabaté, J. Health and sustainability outcomes of vegetarian dietary patterns: A revisit of the EPIC-Oxford and the Adventist Health Study-2 cohorts. Eur. J. Clin. Nutr. 2018, 1. [Google Scholar] [CrossRef]
- Dinu, M.; Abbate, R.; Gensini, G.F.; Casini, A.; Sofi, F. Vegetarian, vegan diets and multiple health outcomes: A systematic review with meta-analysis of observational studies. Crit. Rev. Food Sci. Nutr. 2017, 57, 3640–3649. [Google Scholar] [CrossRef]
- Tantamango-Bartley, Y.; Jaceldo-Siegl, K.; Fan, J.; Fraser, G. Vegetarian Diets and the Incidence of Cancer in a Low-risk Population. Cancer Epidemiol. Prev. Biomarkers 2013, 22, 286–294. [Google Scholar] [CrossRef]
- Orlich, M.J.; Jaceldo-Siegl, K.; Sabaté, J.; Fan, J.; Singh, P.N.; Fraser, G.E. Patterns of food consumption among vegetarians and non-vegetarians. Br. J. Nutr. 2014, 112, 1644–1653. [Google Scholar] [CrossRef] [PubMed][Green Version]
- Li, D. Effect of the vegetarian diet on non-communicable diseases. J. Sci. Food Agric. 2014, 94, 169–173. [Google Scholar] [CrossRef] [PubMed]
- Organización Panamericana de la Salud. Organización Mundial de la Salud Enfermedades Transmisibles y Análisis de Salud/Información y Análisis de Salud: Situación de Salud en las Américas: Indicadores Básicos 2017; Pan American Health Organization: Washington, DC, USA, 2017. [Google Scholar]
- World Health Organization. Noncumminicable Diseases Progress Monitor 2017; World Health Organization: Geneva, Switzerland, 2017; ISBN 9789241513029. [Google Scholar]
- International Congress on Vegetarian Nutrition (ICVN) Loma Linda University Vegetarian Food Guide Pyramid. 2012. Available online: http://www.vegetariannutrition.org/6icvn/food-pyramid.pdf (accessed on 1 December 2018).
- Reedy, J.; Krebs-Smith, S.M. A Comparison of Food-Based Recommendations and Nutrient Values of Three Food Guides: USDA’s MyPyramid, NHLBI’s Dietary Approaches to Stop Hypertension Eating Plan, and Harvard’s Healthy Eating Pyramid. J. Am. Diet. Assoc. 2008, 108, 522–528. [Google Scholar] [CrossRef] [PubMed]
- Sherf-Dagan, S.; Hod, K.; Buch, A.; Mardy-Tilbor, L.; Regev, Z.; Ben-Porat, T.; Sakran, N.; Goitein, D.; Raziel, A. Health and Nutritional Status of Vegetarian Candidates for Bariatric Surgery and Practical Recommendations. Obes. Surg. 2018, 28, 152–160. [Google Scholar] [CrossRef] [PubMed]
- Monteiro, C.A.; Cannon, G.; Moubarac, J.C.; Levy, R.B.; Louzada, M.L.C.; Jaime, P.C. The UN Decade of Nutrition, the NOVA food classification and the trouble with ultra-processing. Public Health Nutr. 2018, 21, 5–17. [Google Scholar] [CrossRef] [PubMed]
- Heiss, S.; Coffino, J.A.; Hormes, J.M. Eating and health behaviors in vegans compared to omnivores: Dispelling common myths. Appetite 2017, 118, 129–135. [Google Scholar] [CrossRef] [PubMed]
- Satija, A.; Bhupathiraju, S.N.; Spiegelman, D.; Chiuve, S.E.; Manson, J.A.E.; Willett, W.; Rexrode, K.M.; Rimm, E.B.; Hu, F.B. Healthful and Unhealthful Plant-Based Diets and the Risk of Coronary Heart Disease in U.S. Adults. J. Am. Coll. Cardiol. 2017, 70, 411–422. [Google Scholar] [CrossRef]
- Niessen, L.W.; Mohan, D.; Akuoku, J.K.; Mirelman, A.J.; Ahmed, S.; Koehlmoos, T.P.; Trujillo, A.; Khan, J.; Peters, D.H. Tackling socioeconomic inequalities and non-communicable diseases in low-income and middle-income countries under the Sustainable Development agenda. Lancet 2018, 391, 2036–2046. [Google Scholar] [CrossRef]
- Olivares, D.E.V.; Chambi, F.R.V.; Chañi, E.M.M.; Craig, W.J.; Pacheco, S.O.S.; Pacheco, F.J. Risk Factors for Chronic Diseases and Multimorbidity in a Primary Care Context of Central Argentina: AWeb-Based Interactive and Cross-Sectional Study. Int. J. Environ. Res. Public Health 2017, 14, 251. [Google Scholar] [CrossRef]
- Abdullah Said, M.; Verweij, N.; Van Der Harst, P. Associations of Combined Genetic and Lifestyle Risks With Incident Cardiovascular Disease and Diabetes in the UK Biobank Study. JAMA Cardiol. 2018, 3, 693–702. [Google Scholar] [CrossRef]
- Rutten-Jacobs, L.C.A.; Larsson, S.C.; Malik, R.; Rannikmäe, K.; Sudlow, C.L.; Dichgans, M.; Markus, H.S.; Traylor, M. Genetic risk, incident stroke, and the benefits of adhering to a healthy lifestyle: Cohort study of 306 473 UK Biobank participants. BMJ 2018, 363, k4168. [Google Scholar] [CrossRef] [PubMed]
- Roy, R.; Hebden, L.; Rangan, A.; Allman-Farinelli, M. The development, application, and validation of a Healthy eating index for Australian Adults (HEIFA-2013). Nutrition 2016, 32, 432–440. [Google Scholar] [CrossRef] [PubMed]
- Haddad, E.H.; Sabaté, J.; Whitten, C.G. Vegetarian food guide pyramid: A conceptual framework. Am. J. Clin. Nutr. 1999, 70, 615S–619S. [Google Scholar] [CrossRef] [PubMed]
- Dagnelie, P.C.; Mariotti, F. Vegetarian Diets: Definitions and Pitfalls in Interpreting Literature on Health Effects of Vegetarianism. In Vegetarian and Plant-Based Diets in Health and Disease Prevention; Mariotti, F., Ed.; Elsevier: New York, NY, USA, 2017; pp. 3–10. ISBN 9780128039687. [Google Scholar]
- Ministerio de Salud PRESIDENCIA DE LA NACIÓN de Argentina ENNyS Encuesta Nacional de Nutrición y Salud. Available online: http://www.msal.gob.ar/images/stories/bes/graficos/0000000257cnt-a08-ennys-documento-de-resultados-2007.pdf (accessed on 1 December 2018).
- Ministerio de Salud PRESIDENCIA DE LA NACIÓN de Argentina Guías Alimentarias para la Población Argentina. Available online: http://www.msal.gob.ar/images/stories/bes/graficos/0000001007cnt-2017-06_guia-alimentaria-poblacion-argentina.pdf (accessed on 1 December 2018).
- Clarys, P.; Deliens, T.; Huybrechts, I.; Deriemaeker, P.; Vanaelst, B.; De Keyzer, W.; Hebbelinck, M.; Mullie, P. Comparison of Nutritional Quality of the Vegan, Vegetarian, Semi-Vegetarian, Pesco-Vegetarian and Omnivorous Diet. Nutrients 2014, 6, 1318–1332. [Google Scholar] [CrossRef] [PubMed][Green Version]
- Bradbury, K.E.; Crowe, F.L.; Appleby, P.N.; Schmidt, J.A.; Travis, R.C.; Key, T.J. Serum concentrations of cholesterol, apolipoprotein A-I, and apolipoprotein B in a total of 1 694 meat-eaters, fish-eaters, vegetarians, and vegans. Eur. J. Clin. Nutr. 2014, 68, 178. [Google Scholar] [CrossRef] [PubMed]
- Allès, B.; Baudry, J.; Méjean, C.; Touvier, M.; Péneau, S.; Hercberg, S.; Kesse-Guyot, E. Comparison of Sociodemographic and Nutritional Characteristics between Self-Reported Vegetarians, Vegans, and Meat-Eaters from the NutriNet-Santé Study. Nutrients 2017, 9, 1023. [Google Scholar] [CrossRef] [PubMed]
- Appleby, P.N.; Crowe, F.L.; Bradbury, K.E.; Travis, R.C.; Key, T.J. Mortality in vegetarians and comparable nonvegetarians in the United Kingdom. Am. J. Clin. Nutr. 2015, 103, 218–230. [Google Scholar] [CrossRef][Green Version]
- Flores, F. Social networks and religious space: From a colony of Germans from Russia to an Adventist village. Puiggari, Argentina, 1870–1920. Estud. Migr. Latinoam. 2001, 16, 623–640. [Google Scholar]
- Wright, N.; Wilson, L.; Smith, M.; Duncan, B.; McHugh, P. The BROAD study: A randomised controlled trial using a whole food plant-based diet in the community for obesity, ischaemic heart disease or diabetes. Nutr. Diabetes 2017, 7, e256. [Google Scholar] [CrossRef]
- Ruby, M.B.; Alvarenga, M.S.; Rozin, P.; Kirby, T.A.; Richer, E.; Rutsztein, G. Attitudes toward beef and vegetarians in Argentina, Brazil, France, and the USA. Appetite 2016, 96, 546–554. [Google Scholar] [CrossRef]
- Ministerio de Salud de la Nación de Argentina ENCUESTA NACIONAL DE FACTORES DE RIESGO. 2005. Available online: http://www.msal.gob.ar/images/stories/bes/graficos/0000000553cnt-2014-10_encuesta-nacional-factores-riesgo-2005_informe-breve-final.pdf (accessed on 1 December 2018).
- Schüpbach, R.; Wegmüller, R.; Berguerand, C.; Bui, M.; Herter-Aeberli, I. Micronutrient status and intake in omnivores, vegetarians and vegans in Switzerland. Eur. J. Nutr. 2017, 56, 283–293. [Google Scholar] [CrossRef] [PubMed]
- Ruby, M.B. Vegetarianism. A blossoming field of study. Appetite 2012, 58, 141–150. [Google Scholar] [CrossRef] [PubMed]
- Rajaram, S.; Sabaté, J. Health Benefits of a Vegetarian Diet. Proc. Nutr. Soc. 1999, 58, 271–275. [Google Scholar] [CrossRef]
- Appleby, P.N.; Key, T.J. The long-term health of vegetarians and vegans. Proc. Nutr. Soc. 2016, 75, 287–293. [Google Scholar] [CrossRef] [PubMed]
- Ryden, L.; Grant, P.J.; Anker, S.D.; Berne, C.; Cosentino, F.; Danchin, N.; Deaton, C.; Escaned, J.; Hammes, H.P.; Huikuri, H.; et al. ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD—Summary The Task Force on diabetes, pre-diabetes, and cardiovascular diseases of the European Society of Cardiology (ESC) and developed in col. Diabetes Vasc. Dis. Res. 2014, 11, 133–173. [Google Scholar] [CrossRef]
- Pacheco, S.O.S.; Pacheco, F.J.; Zapata, G.M.J.; Garcia, J.M.E.; Previale, C.A.; Cura, H.E.; Craig, W.J. Food Habits, Lifestyle Factors, and Risk of Prostate Cancer in Central Argentina: A Case Control Study Involving Self-Motivated Health Behavior Modifications after Diagnosis. Nutrients 2016, 8, 419. [Google Scholar] [CrossRef] [PubMed]
- Melina, V.; Craig, W.; Levin, S. Position of the Academy of Nutrition and Dietetics: Vegetarian Diets. J. Acad. Nutr. Diet. 2016, 116, 1970–1980. [Google Scholar] [CrossRef]
- Agnoli, C.; Baroni, L.; Bertini, I.; Ciappellano, S.; Fabbri, A.; Papa, M.; Pellegrini, N.; Sbarbati, R.; Scarino, M.L.; Siani, V.; et al. Position paper on vegetarian diets from the working group of the Italian Society of Human Nutrition. Nutr. Metab. Cardiovasc. Dis. 2017, 27, 1037–1052. [Google Scholar] [CrossRef]
- Elorinne, A.L.; Alfthan, G.; Erlund, I.; Kivimäki, H.; Paju, A.; Salminen, I.; Turpeinen, U.; Voutilainen, S.; Laakso, J. Food and Nutrient Intake and Nutritional Status of Finnish Vegans and Non-Vegetarians. PLoS ONE 2016, 11, e0148235. [Google Scholar] [CrossRef]
- Schwarz, J.; Dschietzi, T.; Schwarz, J.; Dura, A.; Nelle, E.; Watanabe, F.; Wintgens, K.F.; Reich, M.; Armbruster, F.P. The Influence of a Whole Food Vegan Diet with Nori Algae and Wild Mushrooms on Selected Blood Parameters. Clin. Lab. 2014, 60, 2039–2050. [Google Scholar] [CrossRef]
- Dyett, P.; Rajaram, S.; Haddad, E.H.; Sabate, J. Evaluation of a Validated Food Frequency Questionnaire for Self-Defined Vegans in the United States. Nutrients 2014, 6, 2523–2539. [Google Scholar] [CrossRef] [PubMed][Green Version]
- Holick, M.F.; Binkley, N.C.; Bischoff-Ferrari, H.A.; Gordon, C.M.; Hanley, D.A.; Heaney, R.P.; Murad, M.H.; Weaver, C.M. Evaluation, Treatment, and Prevention of Vitamin D Deficiency: An Endocrine Society Clinical Practice Guideline. J. Clin. Endocrinol. Metab. 2011, 96, 1911–1930. [Google Scholar] [CrossRef] [PubMed]
- Webb, T.L.; Joseph, J.; Yardley, L.; Michie, S. Using the Internet to Promote Health Behavior Change: A Systematic Review and Meta-analysis of the Impact of Theoretical Basis, Use of Behavior Change Techniques, and Mode of Delivery on Efficacy. J. Med. Internet Res. 2010, 12. [Google Scholar] [CrossRef] [PubMed]
- Pilis, W.; Stec, K.; Zych, M.; Pilis, A. Health benefits and risk associated with adopting a vegetarian diet. Rocz. Panstw. Zakl. Hig. 2014, 65, 9–14. [Google Scholar] [CrossRef]
- Kahn, E.B.; Ramsey, L.T.; Brownson, R.C.; Heath, G.W.; Howze, E.H.; Powell, K.E.; Stone, E.J.; Rajab, M.W.; Corso, P.; Task Force on Community Preventive Services. The Effectiveness of Interventions to Increase Physical Activity A Systematic Review. Am. J. Prev. Med. 2002, 22, 73–107. [Google Scholar] [CrossRef]
- Hills, A.P.; Street, S.J.; Byrne, N.M. Physical Activity and Health: “What is Old is New Again”. Adv. Food Nutr. Res. 2015, 75, 77–95. [Google Scholar] [CrossRef] [PubMed]
- Boniol, M.; Dragomir, M.; Autier, P.; Boyle, P. Physical activity and change in fasting glucose and HbA1c: A quantitative meta-analysis of randomized trials. Acta Diabetol. 2017, 54, 983–991. [Google Scholar] [CrossRef]
- Gacek, M. Selected lifestyle and health condition indices of adults with varied models of eating. Rocz. Panstw. Zakl. Hig. 2010, 61, 65–69. [Google Scholar]
- Waldmann, A.; Koschizke, J.W.; Leitzmann, C.; Hahn, A. Dietary intakes and lifestyle factors of a vegan population in Germany: Results from the German vegan study. Eur. J. Clin. Nutr. 2003, 57, 947–955. [Google Scholar] [CrossRef]
- Lunde, P.; Nilsson, B.B.; Bergland, A.; Kværner, K.J.; Bye, A. The Effectiveness of Smartphone Apps for Lifestyle Improvement in Noncommunicable Diseases: Systematic Review and Meta-Analyses. J. Med. Internet Res. 2018, 20. [Google Scholar] [CrossRef]
- Deady, M.; Johnston, D.; Milne, D.; Glozier, N.; Peters, D.; Calvo, R.; Harvey, S. Preliminary Effectiveness of a Smartphone App to Reduce Depressive Symptoms in the Workplace: Feasibility and Acceptability Study. JMIR mHealth uHealth 2018, 6, e11661. [Google Scholar] [CrossRef] [PubMed]
- Clarys, P.; Deriemaeker, P.; Huybrechts, I.; Hebbelinck, M.; Mullie, P. Dietary pattern analysis: A comparison between matched vegetarian and omnivorous subjects. Nutr. J. 2013, 12, 82. [Google Scholar] [CrossRef] [PubMed]
- Pan American Health Organization. Ultra-processed Food and Drink Products in Latin America: Trends, Impact on Obesity, Policy Implications; Pan American Health Organization: Washington, DC, USA, 2015. [Google Scholar]
- Albuquerque, T. Evaluation of the potential impact of processed foods on public health. In Proceedings of the 4o Simpósio Nacional Promoção de uma Alimentação Saudável e Segura (SPASS 2017), Lisboa, Portugal, 21 September 2017. [Google Scholar]
- Fardet, A. Characterization of the Degree of Food Processing in Relation with Its Health Potential and Effects, 1st ed.; Elsevier Inc.: New York, NY, USA, 2018; Volume 85. [Google Scholar]
Table 1. Distribution of the score of adherence to healthy vegan lifestyle habits among individuals from an Argentinian population according to sociodemographic and other selected characteristics.
|Characteristics||Distribution||Score of Adherence to HVLH|
|n||(%)||Mean||SD||p-Value for Kruskal–Wallis|
|Secondary school or less||420||(28.9)||6.55||1.69|
|Married in the past||80||(5.5)||6.44||1.54|
|No health professional||671||(46.1)||6.62||1.74|
|Unpaid domestic work||88||(6.1)||6.25||1.65|
|Region of Argentina||NS|
|Buenos Aires region||405||(27.9)||6.56||1.78|
|Out of Argentina **||36||(2.5)||7.02||2.10|
|Up to 10 cigarettes/day||94||(6.5)||6.25||1.89|
|More than 10 cigarettes/day||17||(1.2)||6.02||1.84|
|Up to once a week||552||(38.0)||6.51||1.69|
|More than once a week||110||(7.6)||6.09||1.44|
|Vegetarian dietary pattern||<0.001|
|Time of adherence to current dietary pattern||NS|
|Less than 6 months||168||(11.6)||6.76||1.60|
|More than 12 months||1090||(75.0)||6.59||1.75|
HVLH = Healthy Vegan Lifestyle Habits; NS = Non-significant; BMI = body mass index; NCD = non-communicable diseases; SD = standard deviation; * p-value for Mann–Whitney U-test; ** Argentinian living out of Argentina.
Table 2. Sociodemographic and other selected characteristics according to the vegetarian dietary pattern in an Argentinian population.
|High school or less||120||28.6||105||25.0||17||4.0||132||31.4||46||11.0|
|Married in the past||22||27.5||30||37.5||4||5.0||18||22.5||6||7.5|
|No health professional||195||29.1||192||28.6||19||2.8||197||29.4||68||10.1|
|Unpaid domestic work||33||37.5||29||33.0||4||4.5||16||18.2||6||6.8|
|Region of Argentina||<0.001|
|Out of Argentina †||5||13.9||15||41.7||2||5.6||8||22.2||6||16.7|
|Up to 10 cigarettes/day||39||41.5||18||19.1||3||3.2||27||28.7||7||7.4|
|Up to once a week||195||35.3||122||22.1||21||3.8||158||28.6||56||10.1|
|More than once a week||53||48.2||23||20.9||4||3.6||24||21.8||6||5.5|
|Household income spent on food (mean; SD)||45.3||20.4||41.6||19.2||42.4||16.1||40.2||18.7||38.6||19.2||0.001 ¥|
NS = Non-significant; BMI = body mass index; NCD = non-communicable disease; SD = standard deviation, * p-value for chi-square test; † Argentinian living out of Argentina; ¥ p-value for Kruskal-Wallis test.
Table 3. Habits related to healthy vegan diet and lifestyle according to vegetarian dietary pattern in an Argentinian population.
|Vegan Lifestyle Habits||Score||Total||Non-||Semi-||Pesco-||Lacto-Ovo||Vegan||p-Value *|
|Whole grains||<3 servings/day||0||920||63.3||315||73.4||261||66.4||35||67.3||246||56.7||63||43.2||<0.001|
|≥3 and <6 servings/day||0.5||485||33.4||104||24.2||123||31.3||15||28.8||170||39.2||73||50.0|
|Legumes, soy and meat substitutes||<1 serving/day||0||693||47.7||309||72.0||211||53.7||21||40.4||135||31.1||17||11.6||<0.001|
|≥1 and <3 servings/day||0.5||677||46.6||114||26.6||173||44.0||27||51.9||261||60.1||102||69.9|
|≥4 and <8 servings/day||0.5||537||36.9||137||31.9||133||33.8||21||40.4||179||41.2||67||45.9|
|≥2 and <4 servings/day||0.5||703||48.3||185||43.1||208||52.9||30||57.7||209||48.2||71||48.6|
|Nuts and seeds||<4 servings/week||0||767||52.8||271||63.2||216||55.0||18||34.6||218||50.2||44||30.1||<0.001|
|≥4 servings/week and <1.5 servings/day||0.5||440||30.3||117||27.3||113||28.8||20||38.5||131||30.2||59||40.4|
|Vegetable oils||>4 servings/day||0||35||2.4||10||2.3||10||2.5||1||1.9||8||1.8||6||4.1||NS|
|>2 and ≤4 servings/day||0.5||292||20.1||90||21.0||75||19.1||6||11.5||85||19.6||36||24.7|
|Dairy products||>2 servings/day||0||291||20||126||29.4||76||19.3||12||23.1||77||17.7||0||0.0||<0.001|
|>0 and ≤2 servings/day||0.5||789||54.3||249||58.0||250||63.6||29||55.8||253||58.3||8||5.5|
|>0 and ≤1 serving/day||0.5||927||63.8||288||67.1||295||75.1||41||78.8||296||68.2||7||4.8|
|>2 and ≤5 servings/week||0.5||605||41.6||190||44.3||179||45.5||14||26.9||174||40.1||48||32.9|
|Reliable sources of vitamin B-12||<1.0 mcg serving equivalent/day||0||394||27.1||26||6.1||102||26.0||19||36.5||159||36.6||88||60.3||<0.001|
|≥1.0 and <2.0 mcg serving equivalent/day||0.5||604||41.5||162||37.8||190||48.3||22||42.3||185||42.6||45||30.8|
|≥2.0 mcg serving equivalent/day||1||456||31.4||241||56.2||101||25.7||11||21.2||90||20.7||13||8.9|
|Flesh-food intake||>1 time/week||0||545||37.5||400||93.2||130||33.1||8||15.4||7||1.6||0||0.0||<0.001|
|>1 time/month and ≤1 time/week||0.5||291||20.0||27||6.3||230||58.5||16||30.8||18||4.1||0||0.0|
|Other lifestyle components|
|Daily exercise||0 min/day of any moderate or vigorous exercise||0||261||18.0||92||21.4||66||16.8||7||13.5||77||17.7||19||13.0||NS|
|>0 and <30 min/day of moderate or >0 and <15 min/day of vigorous exercise||0.5||536||36.9||137||31.9||150||38.2||18||34.6||166||38.2||65||44.5|
|≥30 min/day of moderate or ≥15 min/day of vigorous exercise||1||657||45.2||200||46.6||177||45.0||27||51.9||191||44.0||62||42.5|
|Water intake||<4 glasses of water/day||0||309||21.3||98||22.8||88||22.4||11||21.2||96||22.1||16||11.0||NS|
|≥4 and <8 glasses of water/day||0.5||702||48.3||200||46.6||185||47.1||27||51.9||214||49.3||76||52.1|
|≥8 glasses of water/day||1||443||30.5||131||30.5||120||30.5||14||26.9||124||28.6||54||37.0|
|Sunlight exposure||<5 min/day||0||533||36.7||163||38.0||140||35.6||20||38.5||168||38.7||42||28.8||NS|
|≥5 and <10 min/day||0.5||555||38.2||152||35.4||154||39.2||23||44.2||161||37.1||65||44.5|
NS = Non-significant; * p-value for chi-square test.
Table 4. Mean score of adherence to heathy vegan lifestyle habits according to vegetarian dietary patterns in an Argentinian population.
|Vegetarian Dietary Pattern||Model 1||Model 2||Model 3||Model 4|
|Mean||±SD||95% CI||Mean||95% CI||Mean||95% CI||Mean||95% CI|
Model 1: Unadjusted model. Model 2: Adjusted for gender and age. Model 3: Adjusted as in Model 2 + BMI, tobacco and alcohol use. Model 4: Adjusted as in Model 3 + educational level. Marginal (adjusted) means were reported for analysis of covariance (ANCOVA) models 2, 3, and 4. A global p-trend test with p < 0.05 indicates statistical significance. Model 1, 2, 3, and 4 (p-trend < 0.0001); CI = confidence interval.
Table 5. Vegetarian food availability referred by consumers from an Argentinian population.
|Food Groups and Products||Less Than 1 km||More Than 1 km||Internet||Total Availability †|
|Fortified dairy milk and yogurt *||761||70.5||296||27.4||13||1.2||969||89.7|
|Vegetable (milk) drink||488||33.5||311||21.4||11||0.8||779||53.6|
|Tofu and other vegan cheeses||276||19.0||197||13.5||16||1.1||453||31.8|
|Vegetable cold cuts||325||22.4||218||15.0||27||1.9||543||37.3|
|Vegan bread and desserts||531||36.5||313||21.5||38||2.6||814||56.0|
|100% natural fruit juices||576||39.5||235||16.2||15||1.0||1454||100.0|
* Frequencies considered only for the dairy milk consumers. † These values for the total availability show the frequencies of participants who refer to buy foods or food products in at least one place of purchase. Others may be either non-consumers of the products or have indicated its unavailability.
© 2019 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).