Association of Vegetarian and Vegan Diets with Cardiovascular Health: An Umbrella Review of Meta-Analysis of Observational Studies and Randomized Trials
Abstract
:1. Introduction
2. Materials and Methods
2.1. Search Strategy and Information Source
2.2. Eligibility Criteria
2.3. Selection Process
2.4. Data Extraction
2.5. Quality Assessment
2.6. Statistical Analysis
Non-Independence of Effect Sizes
2.7. Credibility Assessment
3. Results
3.1. Study Characteristics
3.1.1. Cardiovascular Events
3.1.2. CVD Mortality
3.1.3. Coronary Heart Disease and CHD Mortality
3.1.4. Ischemic Stroke
3.2. Definition of Vegetarian
3.3. Meta-Analysis Results Grouping by Author and Outcome
3.4. Meta-Analysis Results Grouping by Outcome
3.5. Evaluation of Bias, Heterogeneity, and Quality
3.6. Strength of Evidence
4. Discussion
Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Parameter | Inclusion | Exclusion |
---|---|---|
Population | Adults with age ≥ 16 years | Specific population (e.g., diabetic) |
Intervention | Vegetarian diet, vegan diet, plant-based diet | An omnivorous diet with additional vegetable/fruit |
Comparison | Non-vegetarian diet | |
Outcome | Cardiovascular (CVD) events, CVD mortality, coronary heart disease (CHD), CHD mortality, ischemic stroke | Hemorrhagic stroke |
Study design | Systematic reviews, including meta-analyses (Quantitative analysis) of prospective observational studies (cross-sectional, case-control, cohort) or randomized clinical trials (RCTs) | Systematic review without meta-analysis, narrative review |
Author Year | Country | Outcome | N Studies | N Participants | Cases | Controls | Effect Size | eOR | eOR 95% CI | I2 | Class * | RoB % |
---|---|---|---|---|---|---|---|---|---|---|---|---|
Dinu 2016 [36] | USA, Germany, UK | CVD mortality | 4 | 107,285 | 3778 | 103,507 | OR | 0.85 | 0.61, 1.17 | 93.205 | ns | 44.05 |
IHD mortality | 6 | 225,618 | 5169 | 220,449 | OR | 0.84 | 0.62, 1.14 | 95.475 | ns | 40.69 | ||
Dybvik 2023 [37] | USA, Germany, UK, Taiwan | Cerebrovascular disease | 3 | 121,850 | 1096 | 120,754 | RR | 0.588 | 0.36, 0.97 | 86.36 | IV | 0.00 |
CVD incidence | 1 | 398,448 | 106,690 | 291,758 | RR | 0.71 | 0.68, 0.75 | 1 study | II | 0.00 | ||
CVD mortality | 1 | 36,346 | 987 | 35,359 | HR | 0.87 | 0.75, 1.01 | 1 study | ns | 0.00 | ||
IHD incidence | 3 | 919,768 | 32,800 | 886,968 | RR | 0.605 | 0.44, 0.83 | 88.903 | IV | 0.00 | ||
IHD mortality | 7 | 266,473 | 8523 | 257,950 | OR | 0.733 | 0.59, 0.92 | 96.286 | IV | 0.00 | ||
Stroke incidence | 1 | 422,102 | 5946 | 416,156 | RR | 0.609 | 0.48, 0.78 | 1 study | III | 0.00 | ||
Stroke mortality | 3 | 98,072 | 1417 | 96,655 | RR | 1.136 | 1.02, 1.26 | 0 | IV | 0.00 | ||
Glenn 2019 [39] | USA, Germany, UK | CVD mortality | 4 | 107,285 | 3778 | 103,507 | OR | 0.846 | 0.61, 1.17 | 93.123 | ns | 55.95 |
IHD incidence | 1 | 44,561 | 1235 | 43,326 | RR | 1.474 | 1.32, 1.65 | 1 study | II | 0.00 | ||
IHD mortality | 5 | 181,057 | 3934 | 177,123 | OR | 0.738 | 0.59, 0.92 | 80.08 | IV | 73.90 | ||
Stroke mortality | 4 | 145,326 | 1682 | 143,644 | RR | 0.995 | 0.75, 1.32 | 79.157 | ns | 67.48 | ||
Huang 2012 [41] | USA, Netherlands, UK, Germany, Japan | CVD mortality | 2 | 49,158 | 1205 | 47,953 | RR | 0.792 | 0.37, 1.68 | 96.297 | ns | 100.00 |
IHD mortality | 6 | 92,314 | 2290 | 90,024 | RR | 0.63 | 0.49, 0.80 | 82.323 | III | 100.00 | ||
Stroke mortality | 5 | 80,993 | 1508 | 79,485 | RR | 0.734 | 0.56, 0.97 | 82.995 | IV | 100.00 | ||
Jabri 2021 [43] | USA, Netherlands, UK, Germany, Japan | CVD mortality | 1 | 47,254 | 950 | 46,304 | RR | 0.543 | 0.47, 0.63 | 1 study | IV | 0.00 |
IHD mortality | 4 | 70,942 | 1342 | 69,600 | RR | 0.54 | 0.41, 0.70 | 60.845 | III | 0.00 | ||
Stroke mortality | 3 | 60,103 | 1042 | 59,061 | RR | 0.722 | 0.46, 1.15 | 84.096 | ns | 0.00 | ||
Jafari 2022 [40] | USA, UK, Germany, Europe, Spain, Australia | CVD mortality | 5 | 101,665 | 14,091 | 87,574 | OR | 0.827 | 0.63, 1.09 | 95.208 | ns | 35.75 |
IHD mortality | 8 | 313,305 | 2912 | 310,393 | OR | 0.629 | 0.48, 0.82 | 89.477 | III | 31.08 | ||
Stroke mortality | 3 | 68,144 | 731 | 67,413 | RR | 0.727 | 0.57, 0.93 | 50.186 | IV | 0.00 | ||
Kwok 2014 [42] | USA, Netherlands, UK, Germany, Japan | CVD mortality | 6 | 156,443 | 4983 | 151,460 | OR | 0.827 | 0.62, 1.10 | 93.59 | ns | 62.84 |
IHD mortality | 11 | 270,678 | 6985 | 263,693 | OR | 0.753 | 0.61, 0.94 | 93.969 | IV | 35.33 | ||
Stroke mortality | 6 | 207,912 | 2721 | 205,191 | RR | 0.804 | 0.62, 1.05 | 96.291 | ns | 45.46 | ||
Lu 2021 [44] | USA, UK, Taiwan | Ischemic Stroke | 6 | 679,034 | 12,791 | 666,243 | RR | 0.688 | 0.50, 0.95 | 73.083 | IV | 7.1 866 |
Quek 2021 [38] | Europe, North America, Asia, Europe | CVD mortality | 1 | 4282 | 1565 | 2717 | HR | 0.681 | 0.58, 0.80 | 1 study | III | 0.00 |
Ischemic Stroke | 2 | 61,540 | 604 | 60,936 | RR | 0.473 | 0.28, 0.79 | 61.765 | IV | 0.00 |
Outcome | N Studies | Total N | Cases | Controls | Measure | eOR | eOR 95% CI | I2 | Class | RoB % |
---|---|---|---|---|---|---|---|---|---|---|
Cerebrovascular disease | 3 | 121,850 | 1096 | 120,754 | RR | 0.588 | 0.36, 0.97 | 86.36 | IV | 0 |
CVD incidence | 1 | 398,448 | 106,690 | 291,758 | RR | 0.71 | 0.68, 0.75 | 1 study | II | 0 |
CVD mortality | 7 | 145,227 | 17,263 | 127,964 | OR | 0.862 | 0.71, 1.05 | 92.83 | ns | 16.31 |
IHD incidence | 4 | 964,329 | 34,035 | 930,294 | RR | 0.759 | 0.46, 1.24 | 98.24 | ns | 0 |
IHD mortality | 15 | 619,430 | 13,740 | 605,690 | OR | 0.679 | 0.55, 0.84 | 96.68 | III | 18.49 |
Ischemic stroke | 6 | 692,386 | 12,876 | 679,510 | RR | 0.671 | 0.47, 0.96 | 78.19 | IV | 0 |
Stroke incidence | 1 | 422,102 | 5946 | 416,156 | RR | 0.609 | 0.48, 0.78 | 1 study | III | 0 |
Stroke mortality | 6 | 196,925 | 3280 | 193,645 | RR | 0.884 | 0.67, 1.17 | 97.13 | ns | 40.97 |
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Ocagli, H.; Berti, G.; Rango, D.; Norbiato, F.; Chiaruttini, M.V.; Lorenzoni, G.; Gregori, D. Association of Vegetarian and Vegan Diets with Cardiovascular Health: An Umbrella Review of Meta-Analysis of Observational Studies and Randomized Trials. Nutrients 2023, 15, 4103. https://doi.org/10.3390/nu15194103
Ocagli H, Berti G, Rango D, Norbiato F, Chiaruttini MV, Lorenzoni G, Gregori D. Association of Vegetarian and Vegan Diets with Cardiovascular Health: An Umbrella Review of Meta-Analysis of Observational Studies and Randomized Trials. Nutrients. 2023; 15(19):4103. https://doi.org/10.3390/nu15194103
Chicago/Turabian StyleOcagli, Honoria, Giacomo Berti, Davide Rango, Federica Norbiato, Maria Vittoria Chiaruttini, Giulia Lorenzoni, and Dario Gregori. 2023. "Association of Vegetarian and Vegan Diets with Cardiovascular Health: An Umbrella Review of Meta-Analysis of Observational Studies and Randomized Trials" Nutrients 15, no. 19: 4103. https://doi.org/10.3390/nu15194103
APA StyleOcagli, H., Berti, G., Rango, D., Norbiato, F., Chiaruttini, M. V., Lorenzoni, G., & Gregori, D. (2023). Association of Vegetarian and Vegan Diets with Cardiovascular Health: An Umbrella Review of Meta-Analysis of Observational Studies and Randomized Trials. Nutrients, 15(19), 4103. https://doi.org/10.3390/nu15194103