Effet du régime végétarien sur la solidité osseuse et santé?

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Differences in Bone Mineral Density between Adult Vegetarians and Nonvegetarians Become Marginal when Accounting for Differences in Anthropometric Factors
Nena Karavasiloglou, The Journal of Nutrition, Volume 150, Issue 5, May 2020, Pages 1266–1271,

Background
Persons following plant-based diets have lower bone mineral density (BMD) and higher fracture risk, possibly due to suboptimal nutrient supply. However, anthropometric measures were not considered as potential confounders in many previous studies, and body mass index (BMI) is positively associated with BMD but also generally lower among vegans and vegetarians.

Objectives
Our objective was to investigate if BMD measurements differ between vegetarians and nonvegetarians from the adult general population when accounting for important determinants of BMD, especially BMI and waist circumference.

Methods
Using data from the NHANES (cycles 2007–2008 and 2009–2010), we evaluated the differences in BMD (femoral neck, total femoral, and total lumbar spine) between adult vegetarians and nonvegetarians. Linear regression models were used to determine the associations between BMD and diet. Statistical models were adjusted for important factors, i.e., age, sex, race/ethnicity, smoking status, alcohol consumption, serum vitamin D and calcium concentrations, waist circumference, and BMI.

Results
In statistical models adjusted for age, sex, race/ethnicity, menopausal status, and education level, BMD values were significantly lower among vegetarians than among nonvegetarians (P < 0.001). These differences were attenuated upon adjustment for lifestyle factors, and became statistically nonsignificant upon adjustment for anthropometric variables (BMI and waist circumference) for femoral neck (0.77 compared with 0.79 g/cm2 among vegetarians versus nonvegetarians, P = 0.10) and total femoral BMD (0.88 compared with 0.90 g/cm2, P = 0.12). A small but statistically significant difference remained for total lumbar spine BMD (1.01 compared with 1.04 g/cm2, P = 0.005).

Conclusions
These findings suggest that lower BMD among adult vegetarians is in larger parts explained by lower BMI and waist circumference.

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Effects of phosphorus and calcium to phosphorus consumption ratio on mineral metabolism and cardiometabolic health
Orlando M.Gutiérrez The Journal of Nutritional Biochemistry Volume 80, June 2020, 108374

Phosphorus is a common additive used in food processing that is typically consumed in excess of the recommended daily allowance; however, our knowledge of its effects on health, in the context of normal renal function, is limited. Unlike phosphorus, calcium intake is generally less than recommended, and it has been hypothesized that the calcium to phosphorus ratio may be partly responsible for the proposed negative health consequences.

Therefore, this study sought to determine the effects of increased phosphorus additive intake, in the context of high calcium consumption, on endocrine markers of mineral metabolism and cardiometabolic health. An outpatient feeding study was performed in which healthy adults were fed a run-in control diet for 2 weeks followed by a phosphorus additive enhanced diet with supplemental calcium to an approximate ratio of 1 (experimental diet) for 2 weeks. Blood and urine samples were collected, and participants had brachial flow-mediated dilatation measured, with analyses comparing follow-up measures to baseline.

Two weeks of experimental diet increased serum fibroblast growth factor 23 concentrations but lowered body weight and serum leptin; however, other phosphorus responsive factors such as osteopontin and osteocalcin did not increase. A complementary study in male mice also demonstrated that the regulation of known dietary phosphorus responsive factors was mostly abrogated when dietary calcium was raised in parallel with phosphorus.

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Gender-specific effect of vegetarian diet on adiponectin levels and insulin sensitivity in healthy non-obese individuals
Marijana Vučić Nutrition 14 May 2020,

Highlights
• Adiponectin and insulin resistance were tested in vegetarians and non-vegetarians
• Vegetarian women had higher adiponectin levels than non-vegetarian controls
• Vegetarian women had lower insulin resistance than non-vegetarian controls
• No diet-dependent difference in adiponectin and insulin resistance in men was found
• Women may benefit more than men from vegetarian diet in terms of metabolic health

Objectives
The beneficial influence of a vegetarian diet in reducing the risk of metabolic syndrome has been evidenced. However, adiponectin production and secretion are scarcely studied in vegetarians, despite the important role in recovering metabolic homeostasis by reducing visceral obesity, inflammation, and insulin resistance. This study aimed to evaluate the effect of a vegetarian diet on serum adiponectin levels and its association with the established biomarkers of insulin sensitivity and inflammation in healthy, non-obese subjects.

Methods
Adiponectin, C-reactive protein (CRP), uric acid, glucose, insulin, lymphocyte- and polymorphonuclear cell counts were determined in the blood of gender- and age-matched healthy vegetarian (N=40) and omnivore (N=36) subjects. The homeostatic model assessment (HOMA-2) calculator was used for the beta-cell function (HOMA2-%B) and insulin resistance index (HOMA2-IRI) estimation.

Results
Adiponectin levels were significantly higher in female vegetarians than the respective omnivore controls (P=0.03), whereas no dietary-associated difference was observed in male subjects. HOMA2-%B was significantly higher in vegetarians than omnivore controls (P=0.04), while no diet-dependent differences were found in insulin, HOMA2-IRI, inflammatory and metabolic biomarkers. Multiple regression analysis showed that adiponectin levels were significantly predicted by the type of diet only in females (P=0.042), while no associations were found in male subjects.

Conclusions
A vegetarian diet resulted in improved beta-cell function. Favourable adiponectin and insulin sensitivity response in women reveals a distinct effect of diet to metabolic homeostasis, indicating an interesting pattern of gender dimorphism regarding the beneficial metabolic effect of a vegetarian diet.

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Genetic susceptibility, plant-based dietary patterns, and risk of cardiovascular disease
Yoriko Heianza, The American Journal of Clinical Nutrition, 13 May 2020

Background
Plant-based dietary patterns may be related to better cardiovascular profiles. Whether a healthy plant-based dietary index is predictive of future cardiovascular disease (CVD) across people with different genetic susceptibility remains uncertain.

Objective
We investigated associations of adherence to healthy plant-based diets with the incidence of CVD considering the genetic susceptibility.

Methods
This prospective cohort study included a total of 156,148 adults initially free of CVD and cancer. We calculated a healthful plant-based diet index (healthful-PDI) in which healthy plant foods received positive scores, and less healthy plant foods and animal foods received reverse scores. Genetic risk scores (GRSs) for myocardial infarction (MI) and stroke were calculated to assess interactions between healthful-PDI and GRSs.

Results
During 5 y of follow-up, we observed 1812 incident cases of CVD. Higher healthful-PDI was associated with a lower CVD risk [HR per 10-unit increment: 0.87 (95% CI: 0.81, 0.93) after adjusting for demographic, lifestyle, and other dietary factors (model 1); HR 0.90 (0.84, 0.97) after further adjusting for obesity and metabolic factors (model 2)]. The risk of CVD was gradually decreased in association with higher adherence to healthful-PDI, regardless of genetic susceptibility. The inverse associations of healthful-PDI with CVD were consistently observed in people with low GRS-MI [HR 0.85 (95% CI: 0.76, 0.94) in model 1; HR 0.88 (0.79, 0.97) in model 2] and those with high GRS-MI [HR 0.91 (0.82, 0.99) in model 1; HR 0.94 (0.86, 1.04) in model 2], without significant interactions (Pinteraction = 0.59 in model 1; Pinteraction = 0.66 in model 2). Similarly, higher healthful-PDI was related to a lower risk of CVD, regardless of low/high GRS-stroke.

Conclusion
Adherence to healthy plant-based diets may be associated with a decreased incidence of CVD in the entire population, suggesting that plant-based dietary patterns may modify the risk of CVD, regardless of genetic susceptibility.

[Nutrimuscle-Diététique]

Traduction de l'étude

Sensibilité génétique, régimes alimentaires à base de plantes et risque de maladie cardiovasculaire
Yoriko Heianza, The American Journal of Clinical Nutrition, 13 mai 2020

Contexte
Les régimes alimentaires à base de plantes peuvent être liés à de meilleurs profils cardiovasculaires. On ne sait pas encore si un indice alimentaire sain à base de plantes est prédictif de futures maladies cardiovasculaires (MCV) chez des personnes ayant une sensibilité génétique différente.

Objectif
Nous avons étudié les associations de l'adhésion à des régimes alimentaires sains à base de plantes avec l'incidence des maladies cardiovasculaires en tenant compte de la sensibilité génétique.

Les méthodes
Cette étude de cohorte prospective a inclus un total de 156 148 adultes initialement indemnes de MCV et de cancer. Nous avons calculé un indice de régime alimentaire sain à base de plantes (sain-PDI) dans lequel les aliments végétaux sains ont obtenu des scores positifs, et les aliments végétaux et aliments pour animaux moins sains ont reçu des scores inverses. Les scores de risque génétique (GRS) pour l'infarctus du myocarde (MI) et l'AVC ont été calculés pour évaluer les interactions entre le PDI sain et les GRS.

Résultats
Pendant 5 ans de suivi, nous avons observé 1812 cas incidents de MCV. Un PDI sain plus élevé était associé à un risque de MCV plus faible [HR par tranche de 10 unités: 0,87 (IC à 95%: 0,81, 0,93) après ajustement pour tenir compte des facteurs démographiques, du mode de vie et d'autres facteurs alimentaires (modèle 1); HR 0,90 (0,84, 0,97) après ajustement supplémentaire pour l'obésité et les facteurs métaboliques (modèle 2)]. Le risque de MCV a été progressivement diminué en association avec une adhérence plus élevée à un PDI sain, quelle que soit la sensibilité génétique. Les associations inverses du PDI sain avec les MCV ont été systématiquement observées chez les personnes ayant un GRS-MI faible [HR 0,85 (IC à 95%: 0,76, 0,94) dans le modèle 1; HR 0,88 (0,79, 0,97) dans le modèle 2] et ceux avec un GRS-MI élevé [HR 0,91 (0,82, 0,99) dans le modèle 1; HR 0,94 (0,86, 1,04) dans le modèle 2], sans interactions significatives (Pinteraction = 0,59 dans le modèle 1; Pinteraction = 0,66 dans le modèle 2). De même, un PDI sain plus élevé était lié à un risque plus faible de MCV, indépendamment d'un AVC GRS faible / élevé.

Conclusion
L'adhésion à des régimes alimentaires sains à base de plantes peut être associée à une diminution de l'incidence des maladies cardiovasculaires dans l'ensemble de la population, ce qui suggère que les modèles alimentaires à base de plantes peuvent modifier le risque de maladies cardiovasculaires, quelle que soit la sensibilité génétique.

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Health Benefits of a Vegan Diet: Current Insights
Radnitz C, Nutrition and Dietary Supplements 12 May 2020 Volume 2020:12 Pages 57—85

To assess the health benefits of a vegan diet, observational studies of diabetes (non-insulin dependent; NIDDM), cancer, mortality, gut microbiota, hypertension, lipids, and overweight were examined. Utilizing PRISMA items to identify articles and assess their quality for inclusion, 44 studies were screened into the review. In two separate studies, vegans did not have a reduced risk of diagnosis of “any” cancer, nor of specific cancers when the effects of BMI were adjusted. When data were aggregated, there was a reduced risk of any cancer.

Vegans had lower total cholesterol and LDL-C levels compared to omnivores, and in some cases other dietary groups. In the US, there was a reduced risk of a diagnosis of NIDDM and in Western countries, vegans had lower BMI.

Research support for reduced risk of diagnosis of female cancers, improved mortality rates, lower blood pressure, lower triglycerides, and a healthier microbiome for vegans compared to omnivores was inconsistent.

There was no evidence that reduced specific cancer incidence rates were lower in vegans although inadequate sample sizes had hampered these analyses. In vegans, HDL-C levels were either lower or not significantly different from omnivores. Geographic location was a strong moderator with the most compelling evidence for the health advantages of a vegan diet coming from the US, whereas in Taiwan, India and Vietnam, there was much less evidence of its benefit.

In some instances, sex moderated the association between adopting the diet and health outcomes. Adherence, specific content of the diet, and dietary comparison groups utilized in studies may also affect results. Although a vegan diet is associated with some health benefits, the level of support for the benefit varied according to the health outcome being measured, with evidence emerging that BMI is an important mediator and geography and to a lesser extent sex are important moderators.

[Nutrimuscle-Diététique]

Traduction de l'étude

Avantages pour la santé d'un régime végétalien: perspectives actuelles
Radnitz C, Suppléments nutritionnels et diététiques 12 mai 2020 Volume 2020: 12 pages 57—85

Pour évaluer les avantages pour la santé d'un régime végétalien, des études observationnelles sur le diabète (non insulino-dépendant; NIDDM), le cancer, la mortalité, le microbiote intestinal, l'hypertension, les lipides et le surpoids ont été examinées. En utilisant des articles PRISMA pour identifier les articles et évaluer leur qualité pour inclusion, 44 études ont été sélectionnées dans la revue. Dans deux études distinctes, les végétaliens n'avaient pas un risque réduit de diagnostic de «tout» cancer, ni de cancers spécifiques lorsque les effets de l'IMC étaient ajustés. Lorsque les données ont été agrégées, le risque de cancer était réduit.

Les végétaliens avaient des taux de cholestérol total et de LDL-C inférieurs à ceux des omnivores et, dans certains cas, d'autres groupes alimentaires. Aux États-Unis, le risque de diagnostic de NIDDM était réduit et dans les pays occidentaux, les végétaliens avaient un IMC plus faible.

Le soutien à la recherche pour réduire le risque de diagnostic de cancers féminins, améliorer les taux de mortalité, abaisser la pression artérielle, réduire les triglycérides et un microbiome plus sain pour les végétaliens par rapport aux omnivores n'était pas cohérent.

Il n'y avait aucune preuve que les taux d'incidence spécifiques de cancer réduits étaient plus faibles chez les végétaliens, bien que des tailles d'échantillons inadéquates aient entravé ces analyses. Chez les végétaliens, les niveaux de HDL-C étaient inférieurs ou pas significativement différents des omnivores. La situation géographique a été un modérateur solide avec les preuves les plus convaincantes des avantages pour la santé d'un régime végétalien en provenance des États-Unis, tandis qu'à Taiwan, en Inde et au Vietnam, il y avait beaucoup moins de preuves de son avantage.

Dans certains cas, le sexe a modéré l'association entre l'adoption du régime alimentaire et les résultats pour la santé. L'adhésion, le contenu spécifique du régime alimentaire et les groupes de comparaison diététique utilisés dans les études peuvent également affecter les résultats. Bien qu'un régime végétalien soit associé à certains avantages pour la santé, le niveau de soutien à cet avantage variait selon le résultat de santé mesuré, avec des preuves émergeant que l'IMC est un médiateur important et la géographie et dans une moindre mesure le sexe sont des modérateurs importants.

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The effects of vegetarian diets on bone health: A literature review
Alberto Falchetti Front. Endocrinol., 05 August 2022

In these recent years many people are adopting a vegetarian type diet due to the numerous positive health effects of this regimen such as the reduction of the incidence of many chronic disorders like diabetes, hypertension, obesity and cancer.

However this diet is quite restrictive and so it could be possible to have a deficiency in some specific nutrients, increasing the risk of osteoporosis and fractures. Although there are conflicting results on the effects of the vegetarian diet on bone health and fracture incidence, it is always recommendable in vegetarian people to have an adequate intake of calcium and vitamin D, through an increased intake of supplements, natural and fortified foods, an adequate intake of protein, fruit, vegetables, as well as vitamin B12.

The aim of this literature review is to revise the actual knowledge of the effect of some nutrients and vegetarian diets on bone health.

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Risk of hip fracture in meat-eaters, pescatarians, and vegetarians: results from the UK Women’s Cohort Study
James Webster, BMC Medicine volume 20, Article number: 275 (2022)

Background
The risk of hip fracture in women on plant-based diets is unclear. We aimed to investigate the risk of hip fracture in occasional meat-eaters, pescatarians, and vegetarians compared to regular meat-eaters in the UK Women’s Cohort Study and to determine if potential associations between each diet group and hip fracture risk are modified by body mass index (BMI).

Methods
UK women, ages 35–69 years, were classified as regular meat-eaters (≥ 5 servings/week), occasional meat-eaters (< 5 servings/week), pescatarian (ate fish but not meat), or vegetarian (ate neither meat nor fish) based on a validated 217-item food frequency questionnaire completed in 1995–1998. Incident hip fractures were identified via linkage to Hospital Episode Statistics up to March 2019. Cox regression models were used to estimate the associations between each diet group and hip fracture risk over a median follow-up time of 22.3 years.

Results
Amongst 26,318 women, 822 hip fracture cases were observed (556,331 person-years). After adjustment for confounders, vegetarians (HR (95% CI) 1.33 (1.03, 1.71)) but not occasional meat-eaters (1.00 (0.85, 1.18)) or pescatarians (0.97 (0.75, 1.26)) had a greater risk of hip fracture than regular meat-eaters. There was no clear evidence of effect modification by BMI in any diet group (p-interaction = 0.3).

Conclusions
Vegetarian women were at a higher risk of hip fracture compared to regular meat-eaters. Further research is needed to confirm this in men and non-European populations and to identify factors responsible for the observed risk difference. Further research exploring the role of BMI and nutrients abundant in animal-sourced foods is recommended.

[Nutrimuscle-Diététique]

Traduction de l'étude

Risque de fracture de la hanche chez les mangeurs de viande, les pescatariens et les végétariens : résultats de la UK Women's Cohort Study
James Webster, BMC Medicine volume 20, numéro d'article : 275 (2022)

Arrière plan
Le risque de fracture de la hanche chez les femmes suivant un régime à base de plantes n'est pas clair. Nous avons cherché à étudier le risque de fracture de la hanche chez les consommateurs occasionnels de viande, les pescatariens et les végétariens par rapport aux consommateurs réguliers de viande dans l'étude de cohorte féminine britannique et à déterminer si les associations potentielles entre chaque groupe de régime et le risque de fracture de la hanche sont modifiées par la masse corporelle. indice (IMC).

Méthodes
Les femmes britanniques, âgées de 35 à 69 ans, ont été classées comme consommatrices régulières de viande (≥ 5 portions/semaine), consommatrices occasionnelles de viande (< 5 portions/semaine), pescatariennes (mangaient du poisson mais pas de viande) ou végétariennes (ne mangeaient ni viande ni poisson) sur la base d'un questionnaire validé de fréquence alimentaire de 217 articles rempli en 1995-1998. Les fractures de la hanche incidentes ont été identifiées via un lien avec les statistiques sur les épisodes hospitaliers jusqu'en mars 2019. Des modèles de régression de Cox ont été utilisés pour estimer les associations entre chaque groupe de régime alimentaire et le risque de fracture de la hanche sur une durée de suivi médiane de 22,3 ans.

Résultats
Parmi 26 318 femmes, 822 cas de fracture de la hanche ont été observés (556 331 personnes-années). Après ajustement pour les facteurs de confusion, les végétariens (HR (IC à 95 %) 1,33 (1,03 ; 1,71)) mais pas les consommateurs occasionnels de viande (1,00 (0,85 ; 1,18)) ou les pescatariens (0,97 (0,75 ; 1,26)) avaient un risque plus élevé de fracture que les mangeurs de viande réguliers. Il n'y avait aucune preuve claire de modification de l'effet par l'IMC dans aucun groupe de régime (p-interaction = 0,3).

conclusion
Les femmes végétariennes présentaient un risque plus élevé de fracture de la hanche que les consommatrices régulières de viande. Des recherches supplémentaires sont nécessaires pour confirmer cela chez les hommes et les populations non européennes et pour identifier les facteurs responsables de la différence de risque observée. Des recherches supplémentaires explorant le rôle de l'IMC et des nutriments abondants dans les aliments d'origine animale sont recommandées.