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© 1999 American Society for Clinical Nutrition
II Nutritional status and life cycle issues
Plasma amino acids discriminate between total vegetarians and
nonvegetarians
Alfredo Mejia, Merritt C Horning, and Albert Sanchez. Nutrition Department, Loma Linda University, CA; the Lassen
Foundation, Chico, CA; and the Pacific Health Education Center, Bakersfield, CA.
Subjects consuming total vegetarian diets have very low risk of coronary heart disease (CHD) compared with the general
population. They also have a unique plasma amino acid profile, including higher concentrations of arginine (Arg) and glycine
(Gly); and lower concentrations of lysine (Lys) and valine (Val) when compared with subjects who eat regular omnivorous
diets. We performed discriminant analysis to determine whether the plasma concentrations of Arg, Gly, Lys, and Val are
predictive of the type of diet ingested. The sample population consisted of 38 healthy total vegetarians (20 men and 18
women) and 53 omnivores (20 men and 33 women). Plasma concentrations of Arg, Gly, Lys, and Val are predictive of the
type of diet 94% of the time in all subjects, and when the data were analyzed by sex, were 95% predictive for men and 98%
for women. Plasma concentrations of Arg, Gly, Lys, and Val can be used as metabolic markers to discriminate between
subjects eating omnivorous and total plant food diets with >93% certainty. Those amino acids should be included
simultaneously in the discriminant analysis equation because if they are used individually, their predictive value is weaker
(Val, 65%; Lys, 71%; Gly, 72%; and Arg, 81%). Discriminant analysis based on Arg, Gly, Lys, and Val is highly predictive
to discriminate among subjects eating total vegetarian or omnivorous diets. Thus, these plasma amino acids could be used
to assess the compliance of subjects participating in clinical trials based on total vegetarian and omnivorous diets. In addition,
we hypothesize that the unique plasma amino acid profile of total vegetarians may be a protective factor against CHD.
Previous SectionNext Section
Next Section
Bone mineral status in vegan, lactoovovegetarian, and omnivorous
premenopausal women
Patricia K Johnston, School of PublicHealth, Loma Linda University, CA.
The relation of bone mineral density he (BMD)diet continues to be investigated. Evidence suggests a positive relation with
calcium protein, particularly from animal sources, appears to be negatively related. Vegetarian populations are of interest
because they have lower animal protein intake however depending on food choices their calcium intake may vary
considerably. Previous studies of vegetarians primarily investigated postmenopausal lactoovovegetarians. We report BMD
results from a study of 50 premenopausal women divided among vegan (n = 17)lactoovovegetarian (n =18) omnivorous (n
= 15) subjects. Vegetarians had followed their respective diets for ≥4 y. All subjects were within 20% of their ideal body
weight had regular menstrual cycles engaged in <5 h/wk of aerobic or strength building exercise did not consume calcium
supplements or take any medications known to affect bone metabolism including oral contraceptives. The 3 groups did not
differ with respect to age height weight or BMI. Percent of expected BMD of t the spine as determined by quantitative
computed tomography (QCT) was significantly less in vegans (x̄ ± SE: 88 ± 2.7%) compared with lactoovovegetarians (107
±3.7% P < 0.001) or omnivores (101 ± 4.9% P <0.05)but not different between lactoovovegetarians omnivores.
Previous SectionNext Section
Influence of carotenoid depletion and repletion on serum carotenoid and
vitamin A concentrations
Betty Jane Burri, Anne L Sowell, and Monica Wong. Western Human Nutrition Research Center, USDA/ARS/PWA, San
Francisco 94129 and Centers for Disease Control and Prevention, Atlanta.
β-Carotene and other provitamin carotenoids are the major sources of vitamin A for most vegetarians. Cartenoids are also
believed to be fat-soluble antioxidants. Therefore, β-carotene metabolism and its conversion to vitamin A are of importance
to vegetarians. Carotenoid metabolism appears to be highly variable in healthy, well-fed individuals. We hypothesized that
vitamin A status, body fat stores, and oxygen consumption might influence serum carotenoid metabolism and concentrations.
We measured serum carotenoid and vitamin A concentrations in 23 women participating in 3 metabolic research unit studies.
Most of these women were fed low-carotenoid diets supplemented with β-carotene and mixed carotenoid capsules for >100
d. Activities, exercise, diet and medications were controlled. We compared serum carotenoid concentrations to dietary
intakes of carotenoids, vitamin A status (estimated by stable isotope dilution), body composition, and oxygen consumption.
Carotenoid concentrations appeared todecrease asymptotically in all women during carotenoid depletion, then increased in
all women during carotenoid supplementation. However, carotenoid concentrations were highly variable. Serum vitamin A
concentrations were unchanged. Carotenoid concentration changes were negatively correlated to vitamin A status (r ≈ −0.7)
in one study, but this influence appeared to be relatively small. Body composition and oxygen consumption had little or no
influence on serum carotenoid concentrations. The major influence on carotenoid concentrations and metabolism remains
unknown but is probably genetic.
Previous SectionNext Section
Influence of plasma β-carotene concentration on bioavailability and
conversion of β-carotene-d8 stable isotope in young healthy women
Jin-Young K Park, Betty Jane Burri, Tatyana Lukoyanova, and Stephen Dueker. Western Human Nutrition Research Center,
USDA/ARS/PWA, San Francisco, and the Department of Nutrition, University of California, Davis. Supported in part by
the U S Department of Agriculture.
Bioavailability and conversion of a stable isotope of β-carotene (BC-d8) was determined in 4 young healthy women. They
selected their own diets from a limited menu offered them during 21 d of metabolic-research-unit study. Their plasma βcarotene (BC) concentrations were between 0.5 and 3 mg/L. After a 40-mg oral dose of BC-d8 in olive oil was given before
breakfast, BC-d8 and retinol-d4 (VA-d4) concentrations in serial plasmas were measured by using high-performance liquid
chromatography and gas chromatography–mass spectrometry, respectively. Area under the plasma concentration curve of
BC-d8 or VA-d4 over 21 d was used as an index of percentage bioavailability or percentage conversion of BC-d8 to VAd4, respectively. Plasma percentage bioavailability of BC-d8 in individuals was highly variable. Individual's percentage
conversion of BC-d8 to VA-d4 was also variable. There was a positive association between percentage bioavailability of
BC-d8 and its percentage conversion to VA-d4 (r2 = 0.6). Plasma BC concentrations show a positive association with
percentage conversion of BC-d8 to VA-d4 (r2 = 0.7). Body weight (between 47 and 60 kg) had a negative association with
percentage conversion of BC-d8 to Va-d4 (r2 = 0.9). The results of our study suggest a significant individual genetic variation
of absorption and metabolism for β-carotene with a trend toward positive associations between absorption and metabolism.
The people who absorb more β-carotene may more efficiently metabolize the compound.
Previous SectionNext Section
Cobalamin studies on 2 total vegetarian (vegan) families
Milton G Crane, UD Register, and Richard Lukens. Weimar Institute, Weimar, CA, and the Department of Medicine and
School of Public Health, Loma Linda University, CA. Funded by Donald and Barbara Cox and the Callicott-Register fund.
Two families (4 adults and 5 children) ranging in age from 10 to 53 y volunteered for evaluation of cobalamin (Cbl; vitamin
B-12) status. All were total vegetarians for 2–6 y, except for a little milk (<1 serving/mo). All were healthy and free of
recognizable symptoms of cobalamin deficiency. After evaluation, urine and fasting blood samples were drawn before and
after 60 d consuming 500 μg Cbl/d (chewed). Results were as follows: initial red blood cell count ranged from 3.94 to 4.92,
and hematocrit ranged from 36.8 to 43.2. Six of 9 were slightly below normal. Their mean corpuscular volume, mean
corpuscular hemoglobin, and serum iron were all in the midnormal range. Serum folate ranged from 7.3 to 17 (n>2.7). Serum
Cbl was <200 pg/mL in 8 of 9 (1 was 331 pg/mL) and all increased to 356–728 pg/mL while taking Cbl (P < 0.005). Serum
methymalonic acid concentrations were elevated in 5 of 8 subjects, and the values of all but one decreased to within normal
limits while taking Cbl (average, −67.9%; P < 0.005). Urine methylmalonic acid (fmol/nmol creatinine) (UMMA) values
were elevated in 7 of 8; all decreased to within normal limits while taking Cbl (P < 0.005). Serum total homocysteine
(STHcys; in fmol/L) and serum total 2-methylcitric acid (ST2-Mca; in fmol/L) were within normal limits in all 8 subjects
initially; both decreased significantly (P < 0.005) while taking Cbl by 31% and 28.2%, respectively. Serum cystathionine
concentrations (in nmol/L) were below normal and remained low in 3 of 8 subjects, indicating adequate B-6 intake. These
studies indicate that all total vegetarians should assure themselves of a reliable source of vitamin B-12, and verify their
ability to absorb it. If we combine the data of the Cbl and UMMA, all 9 of the subjects showed evidence of Cbl deficiency.
Of interest was that the initial values for STHcys and ST2-Mca were within normal limits, yet decreased consistently by an
average of 31% and 28.2% (P < 0.005), respectively, on Cbl therapy.
Previous SectionNext Section
Effect of the type of lactation on the psychomotor development in Mexican
infants
O Angulo-G, N Cruz-Cansino, MD Callejas-Flores, C Rivas-Valerio, ML Suarez-Quiroz, and I Rivas. Instituto Tecnologico
de Veracruz, Dpto. Ing. Quimicay Bioquimica Veracruz, 91880, Ver. Mexico.
The n−6 and n−3 long chain polyunsaturated fatty acids LCPUFAs (Arachidonic; AA and docosahexaenoic acids, DHA)
are important components of the central nervous system. AA and DHA are normally derived by desaturation and elongation
of linoleic and linolenic acids. However, newborn babies seem to present reduced desaturation and elongation enzyme
activities, making it necessary to supply LCPUFAs by dietary means. The purpose of this study was first of all, to determine
the fatty acid composition of human milk and infant formulas commercially available in Veracruz, Mexico. Secondly, to
determine the effect of breast-feeding compared with formula-feeding on psychomotor development during the first 4 mo
of life. Thirty samples of milk were obtained from lactating women in Veracruz and 20 infant formulas were analyzed for
their fatty acid profile. The psychomotor development was evaluated according to a modified method derived from the
Gessel Scale in 30 breast-fed and 30 formula-fed babies over 4 mo. Body weight, length, and head circumference were
registered monthly. Results showed that human milk indeed contains LCPUFAs whereas infant formulas contain linoleic
acid and linolenic acid as the longest fatty acids. Small differences were registered for monounsaturated and short-chain
fatty acids. There were no significant anthropometric differences between the 2 groups evaluated. Breast-fed infants, on the
contrary, manifested higher psychomotor scores than did formula fed infants. In summary, human milk provides necessary
LCPUFAs for better psychomotor development in full-term infants. Careful consideration should be given to inform
pregnant mothers as to these benefits that lactation offers to the infant she carries.
Previous Section Next Section
Dietary and supplement intake of vegetarians during pregnancy
Rana Drake, Sheela Reddy, and G Jill Davies. South Bank University, London, and Leatherhead Food RA, Surrey, United
Kingdom. Supported in part by Cow and Gate Nutricia.
Little is known about the nutrient intake of vegetarians during pregnancy. Studies of nonpregnant vegetarians have
highlighted potential problems, but dietary intakes are known to change during pregnancy owing to a variety of factors.
White, primiparous women from different dietary groups were recruited by magazine advertisements, posters in cafes and
shops, and with the assistance of midwives. Volunteers answered questions about dietary changes they had made during
pregnancy and completed a 3-d estimated record of their diet. Dietary records were analyzed from 31 lactoovovegetarians,
14 pesco-vegetarians, and 69 nonvegetarians. Energy and fat intakes were similar in each group, whereas the 2 vegetarian
groups were found to derive significantly more energy from carbohydrates and less from protein. In addition, the
lactoovovegetarians had significantly lower vitamin B-12 intakes than the other 2 groups. Many women reported making
dietary changes during pregnancy due to cravings, aversions, and other influences. Many also started to take nutrient
supplements. The dietary changes made by women in all 3 groups were similar and were in line with general antenatal
advice. Sources of dietary advice were investigated and significantly more vegetarians than nonvegetarians reported finding
the dietary advice available to them to be inadequate. It is concluded that some vegetarian women would benefit from
specifically targeted dietary advice for pregnancy.
Previous SectionNext Section
Health of vegetarians during pregnancy and pregnancy outcome
Rana Drake, Sheela Reddy, and G Jill Davies. South Bank University, London, and Leatherhead Food RA, Surrey, United
Kingdom. Supported in part by Cow and Gate Nutricia.
The quality of a woman's diet influences her health during pregnancy and the well-being of her infant. The implications of
an increasing number of young women eating a vegetarian type diet is therefore of interest. Whereas slightly lower birth
weights have been reported among Indian vegetarian groups, white vegetarians in the United Kingdom have received little
attention. White, primiparous women from different dietary groups were recruited by placing ads in magazines, posters in
cafes and shops and with the assistance of midwives. Questionnaires concerning diet, lifestyle and health were completed
by 132 women during pregnancy including 34 lactoovovegetarians, 17 pesco-vegetarians and 81 nonvegetarians. Volunteers
were sent a second questionnaire soon after their expected date of delivery to collect information about pregnancy outcome;
these were returned by 126 women. The incidence of nausea and constipation was similar in all 3 groups. More
lactoovovegetarians (26%) reported suffering from anemia than nonvegetarians (11%) or pesco-vegetarians (6%). When
pregnancy outcomes were compared between the groups, no significant differences were found in length of gestation, infant
birth weights, or the incidence of complications or health problems. In conclusion, lactoovovegetarians more frequently
reported anemia during pregnancy, but this was not associated with any adverse pregnancy outcomes.
Previous SectionNext Section
Nutrient intake and nutritional status of vegetarians and low-meat eaters
consuming a diet meeting preventive recommendations
Ingrid Hoffmann, Maike J Groeneveld, and Claus Leitzmann, Institute of Nutritional Science, Justus Liebig-University
Giessen, Germany.
The dietary recommendations for the prevention of nutrition-related diseases are based on a high consumption of vegetables
(including potatoes), fruit, whole-grain products, dairy products, and on reduced consumption of meat and meat products.
In a cross sectional study, a group of 243 healthy women (25–65 y of age) who practiced such a wholesome diet for ≥5 y
were studied on the consequences of their intake and nutritional status of nutrients: essential, protective, and unfavorable
ones. One subgroup (111 vegetarians, VEG) completely omitted meat and fish from their diet, the other subgroup (132
nonvegetarians, NVEG) included small amounts of meat (≈30 g/d on average). They were compared with a corresponding
group of 175 women eating a normal mixed diet containing ≈130 g meat/d (control group). The VEG group clearly showed
the highest intake of protective nutrients (eg, complex carbohydrates, antioxidants, and dietary fiber) and the best nutrient
ratio. The VEG group had the lowest intake of substances known to be unfavorable (eg, total fat, saturated fatty acids,
cholesterol, and alcohol). For essential nutrients, a high intake could be observed for those vitamins that are dominant in
plant foods such as vitamin B1, B-6, folic acid, and vitamins C and E. The intake of vitamins mainly provided by animal
foods (especially vitamins B-2, B-12, and D) was lower than for the NVEG and control groups. Only for vitamin B-12 were
critical plasma values detected, specifically in those in the VEG group who consumed <380 g dairy products/d. The high
iron intake of the VEG group was mainly based on plant foods, causing lower ferritin concentrations than in the NVEG and
the control groups without differences in the serum iron concentrations. This study shows that strict adherence to the
preventive recommendations (vegetarian version) in a daily diet needs careful planning and that a diet meeting the preventive
recommendations containing small amounts of meat retains the advantages of a vegetarian diet while avoiding its possible
disadvantages.
Previous SectionNext Section
Investigation of the effects of a vegetarian diet on the growth, body
composition, metabolism, and energynutritional intakes of young children
Riccardo Trespidi, Public Health Service, Verona, Italy; Leonardo Pinelli, Pediatria Preventiva e Sociale, Universita di
Verona, Verona, Italy; Claudio Maffeis, Diabetologia Pediatrica, Universita di Verona, Verona, Italy.
Growth, body composition, metabolism, energy, and nutritional intakes were compared in lactoovovegetarian,
lactovegetarian, and nonvegetarian Italian children who were 8–9 y old at the start of the 2-y study. The omnivorous control
group followed a standard Mediterranean diet. Nutritional intakes were broken down into animal and vegetable protein,
saturated and nonsaturated lipids, cholesterol, simple and complex carbohydrates, fiber, and iron. Results showed no
significant difference between meatless and meat-based diets with respect to growth, body composition, or metabolism,
although the vegetarian children were, on the whole, slimmer. In the lactoovovegetarians and lactovegetarians, energy intake
was significantly higher; intake of protein, saturated fatty acids, and cholesterol was lower; and intakes of mono- and
polyunsaturated lipids and vitamin B-12 were comparable. In addition, the fiber intake was more than double that of the
nonvegetarians and the iron intake was also significantly higher. Lastly, comparison of the vegetarians' blood chemical
parameters revealed no significant differences with respect to standard values.
Previous SectionNext Section
Changes in body composition after 6 mo on a self-selected vegetarian diet
Frances Robinson, Allan Hackett, David Billington, and Gareth Stratton, School of Education and Community Studies,
Liverpool John Moores University, United Kingdom.
It is known that white vegetarians tend to be leaner and closer to desirable body weights than their nonvegetarian
counterparts. Evidence from several previous studies that investigated some of the changes apparent after switching to a
vegetarian diet has shown that body weight was reduced, but these studies provided guidelines on what the diet should
include. This paper examines some of the anthropometric changes that occurred as a result of changing to a self-selected
UK vegetarian diet. Thirty-six volunteers, recruited as they changed to a vegetarian diet, completed the study. Measurements
of weight, height, mid-arm circumference, triceps and biceps skinfold thicknesses (from which percentage body fat was
calculated), and waist and hip circumference were taken. After 6 mo on their self-selected vegetarian diets, volunteers were
invited back and measurements were repeated. Paired t tests showed that significant changes (P < 0.05) were found in hip
and waist circumferences, waist-to-height ratio, biceps and triceps skinfold thickness, and percentage body fat, all of which
had decreased compared with baseline. These results would suggest that these volunteers changing to a self-selected
vegetarian diet experienced considerable changes in body composition.
Previous SectionNext Section
Does a vegetarian diet reduce the variety of foods consumed?
Frances Robinson and Allan Hackett, School of Education and Community Studies, Liverpool John Moores University,
Liverpool, United Kingdom.
Omitting meat from the diet could lead to the assumption that one has a less varied diet. Work in Japan (Okuda, 1991) found
that consuming more foods was associated with more people achieving recommended nutrient intakes. In this study,
volunteers kept dietary records from the time that they switched to a self-selected vegetarian diet. This paper describes the
change in the number of different foods eaten over 3 d, as recorded in dietary diaries while eating meat (baseline) and then
after 3 and 6 mo on the vegetarian diet had elapsed. Two control groups of meat eaters and long-standing vegetarians were
also included in the study and the number of different foods eaten over the 3 d by each group was compared with baseline
and after 3 and 6 mo. The number of foods eaten on each occasion was compared using a Wilcoxon matched-pairs test.
Number of foods consumed at baseline, 3 mo, and 6 mo by study volunteers was 32, 31, and 31; by vegetarians, 31, 30, and
30; and by omnivores, 32, 29, and 31 respectively. No significant differences were found. These results show that all groups
were eating similar numbers of foods. It does not seem, therefore, that changing to a vegetarian diet causes any significant
reduction in the number of foods eaten.
Previous SectionNext Section
Does switching to a self-selected vegetarian diet alter macronutrient
intake?
Frances Robinson, Allan Hackett, David Billington, and Gareth Stratton, School of Education and Community Studies,
Liverpool John Moores University, Liverpool, United Kingdom.
Despite many studies of the diets of vegetarians compared with omnivores, the effects of changing from an omnivorous diet
to a nonprescribed vegetarian diet has received little attention. In the present study, 43 adults (32 women and 11 men, mean
age 31 y) who were embarking on a vegetarian diet of their choice kept a record of food intake for 3 d while still consuming
a mixed diet. Subsequent 3-d food intake records were kept at 3, 6, 9, and 12 mo after subjects had changed to their vegetarian
diet. Differences in intakes of macronutrient composition of the diet from each record were examined by paired t test. The
results showed that after 3 mo on a vegetarian diet, marked differences were observed in the macronutrient intakes of the
female subjects. Percentage of energy from carbohydrate increased significantly (P < 0.05) and percentages of energy from
protein and total fat decreased. Both male and female subjects experienced reductions in energy intake (P < 0.05) from 6
mo onward. It may be concluded that although energy intake of both male and female subjects dropped after changing to a
vegetarian diet, more marked effects on macronutrient intake were experienced by female subjects.
Previous Section
A study of the use of nutritional supplements by a group of vegetarians in
South Wales
Marv Barasi and Frances Robinson, Faculty of Community Health Sciences, University of Wales Institute Cardiff, Cardiff,
Wales.
Commercially manufactured nutritional supplements are widely available over the counter. As a result, many people may
be taking unnecessary supplements leading to potentially more harm than good. This study aimed to investigate supplement
usage by vegetarians in an urban area of South Wales. Seventy-eight volunteers completed a questionnaire that asked about
supplement use and included a dietary assessment. A diet score was derived, and a higher score meant a potentially greater
need for supplements. Thirty-eight of the respondents claimed to be regular supplement users and a startling number took
more than 2 supplements daily. When asked their reason for taking supplements, more than half of those who claimed to
take supplements regularly said they did not know. From the dietary assessment, it appeared that nonusers of supplements
had higher diet scores than users indicating, a greater potential need for supplements. In conclusion, it appears that a large
proportion of this group of vegetarians were taking nutritional supplements whether or not they were needed. People should
be made more aware of their nutritional needs before prescribing supplements to themselves, and advice should be made
easily available on the use and misuse of nutritional supplements, especially to new vegetarians who may believe that
supplements are needed.
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Bone mineral status in vegan, lactoovovegetarian, and omnivorous premenopausal women
Influence of carotenoid depletion and repletion on serum carotenoid and vitamin A concentrations
Influence of plasma β-carotene concentration on bioavailability and conversion of β-carotene-d8 stable isotope in young healthy women
Cobalamin studies on 2 total vegetarian (vegan) families
Plasma amino acids discriminate between total vegetarians and nonvegetarians
Effect of the type of lactation on the psychomotor development in Mexican infants
Dietary and supplement intake of vegetarians during pregnancy
Health of vegetarians during pregnancy and pregnancy outcome
Nutrient intake and nutritional status of vegetarians and low-meat eaters consuming a diet meeting preventive recommendations
Investigation of the effects of a vegetarian diet on the growth, body composition, metabolism, and energynutritional intakes of young children
Changes in body composition after 6 mo on a self-selected vegetarian diet
Does a vegetarian diet reduce the variety of foods consumed?
Does switching to a self-selected vegetarian diet alter macronutrient intake?
A study of the use of nutritional supplements by a group of vegetarians in South Wales
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