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Author Notes:

Correspondence:Lindsay M Jaacks, PhD, Claudia Nance Rollins Building 7040-I, 1518 Clifton Rd. NE, Atlanta, GA 30307, Phone: 404-727-9976, Fax: 404-727-4590, ljaacks@emory.edu

All authors were involved in the conception and development of the research plan (study question and analysis); LMJ conducted the statistical analysis and wrote the paper; all other authors contributed to editing and revising the paper; LMJ has primary responsibility for final content.

All authors read and approved the final manuscript.

Conflict of Interest: None.


Research Funding:

The CARRS (Centre for cArdiometabolic Risk Reduction in South-Asia) cohort was funded by the National Heart, Lung, and Blood Institute at the National Institutes of Health (HHSN2682009900026C) and the Oxford Health Alliance Vision 2020 of the UnitedHealth Group (Minneapolis, MN, USA).

Additional support was provided by the Fogarty International Center and the Eunice Kennedy Shriver National Institute of Child Health & Human Development at the National Institutes of Health (1 D43 HD065249), and the Emory Global Health Institute


  • Science & Technology
  • Life Sciences & Biomedicine
  • Nutrition & Dietetics
  • Vegetarianism
  • India
  • Obesity
  • Visceral adiposity
  • Food groups

Vegetarianism and cardiometabolic disease risk factors: Differences between South Asian and US adults


Journal Title:

Nutrition in Clinical Practice


Volume 32, Number 9


, Pages 975-984

Type of Work:

Article | Post-print: After Peer Review


Objectives Cardiometabolic diseases are increasing disproportionately in South Asia compared with other regions of the world despite high levels of vegetarianism. This unexpected discordance may be explained by differences in the healthfulness of vegetarian and non-vegetarian diets in South Asia compared with the United States. The aim of this study was to compare the food group intake of vegetarians with non-vegetarians in South Asia and the United States and to evaluate associations between vegetarianism and cardiometabolic disease risk factors (overweight/obesity, central obesity, diabetes, hypertension, high triacylglycerols, high low-density lipoprotein, low high-density lipoprotein, and high Framingham Heart Score). Methods Using cross-sectional data from adults (age 20–69 y) in South Asia (Centre for Cardiometabolic Risk Reduction in South-Asia [CARRS] 2010–2011; N = 15 665) and the United States (National Health and Nutrition Examination Survey 2003–2006; N = 2159), adherence to a vegetarian diet was assessed using food propensity questionnaires. Multivariable logistic regression was used to estimate odds ratios and predicted margins (e.g., adjusted prevalence of the outcomes). Results One-third (33%; n = 4968) of adults in the South Asian sample were vegetarian compared with only 2.4% (n = 59) in the US sample. Among South Asians, vegetarians more frequently ate dairy, legumes, vegetables, fruit, desserts, and fried foods than non-vegitarians (all P  <  0.05). Among Americans, vegetarians more frequently ate legumes, fruit, and whole grains, and less frequently ate refined cereals, desserts, fried foods, fruit juice, and soft drinks than non-vegetarians (all P  <  0.05). After adjustment for confounders (age, sex, education, tobacco, alcohol, and also city in CARRS), South Asian vegetarians were slightly less frequently overweight/obese compared with non-vegetarians: 49% (95% confidence interval [CI], 45%–53%) versus 53% (95% CI, 51%–56%), respectively; whereas US vegetarians were considerably less frequently overweight/obese compared with non-vegetarians: 48% (95% CI, 32%–63%) versus 68% (95% CI, 65%–70%), respectively. Furthermore, US vegetarians were less likely to exhibit central obesity than non-vegetarians: 62% (95% CI, 43%–78%) versus 78% (95% CI, 76%–80%), respectively. Conclusions There is greater divergence between vegetarian and non-vegetarian diets in the United States than in South Asia, and US vegetarians have more consistently healthier food group intakes than South Asian vegetarians. Vegetarians in both populations have a lower probability of overweight/obesity compared with non-vegetarians. The strength of this association may be stronger for US vegetarian diets, which were also protective against central obesity.

Copyright information:

© 2016 Elsevier Inc.

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