Background
Methods
Study design and participants
Diet group
Outcome ascertainment
Statistical analyses
Main analyses
Subgroup analyses
Mediation analyses
Sensitivity analyses
Results
Participants
Descriptive data
Characteristics, mean (SD), or n (%) | Total | Diet group | |||
---|---|---|---|---|---|
Regular meat-eater | Occasional meat-eater | Pescatarian | Vegetarian | ||
Participants (%) | 413,914 | 258,765 (62.5) | 137,954 (33.3) | 9557 (2.3) | 7638 (1.8) |
Cases (%) | 3503 (0.8) | 2045 (0.8) | 1310 (0.9) | 78 (0.8) | 70 (0.9) |
Socio-demographics | |||||
Age, years (SD) | 56.3 (8.1) | 56.1 (8.1) | 56.9 (8.0) | 53.9 (8.0) | 52.9 (7.9) |
Sex (%) | |||||
Male | 199,688 (48.2) | 139,354 (53.9) | 54,842 (39.8) | 2811 (29.4) | 2681 (35.1) |
Female | 214,226 (51.8) | 119,411 (46.1) | 83,112 (60.2) | 6746 (70.6) | 4957 (64.9) |
Region (%) | |||||
England | 366,964 (88.7) | 228,925 (88.5) | 122,492 (88.8) | 8581 (89.8) | 6966 (91.2) |
Scotland | 29,709 (7.2) | 19,130 (7.4) | 9616 (7.0) | 575 (6.0) | 388 (5.1) |
Wales | 17,241 (4.2) | 10,710 (4.1) | 5846 (4.2) | 401 (4.2) | 284 (3.7) |
Ethnicity (%) | |||||
White | 393,251 (95.0) | 247,212 (95.5) | 130,780 (94.8) | 8977 (93.9) | 6282 (82.2) |
Black | 6113 (1.5) | 4109 (1.6) | 1824 (1.3) | 138 (1.4) | 42 (0.5) |
Asian | 8692 (2.1) | 3970 (1.5) | 3253 (2.4) | 285 (3.0) | 1184 (15.5) |
Mixed | 2402 (0.6) | 1445 (0.6) | 814 (0.6) | 84 (0.9) | 59 (0.8) |
Other | 3456 (0.8) | 2029 (0.8) | 1283 (0.9) | 73 (0.8) | 71 (0.9) |
Degree-level education (%) | 141,274 (47.4) | 82,529 (44.6) | 49,546 (49.9) | 5274 (68.6) | 3925 (65.4) |
Townsend deprivation index (SD) | − 1.4 (3.0) | − 1.4 (3.0) | − 1.4 (3.0) | − 1.0 (3.1) | − 0.7 (3.1) |
Live alone (%) | 75,245 (18.2) | 41,406 (16.0) | 29,930 (21.7) | 2287 (23.9) | 1622 (21.2) |
Lifestyle | |||||
Physical activity, MET.mins/week (SD) | 2951 (3879) | 2984 (3993) | 2885 (3689) | 3038 (3572) | 2895 (3690) |
Smoking status (%) | |||||
Current | 42,697 (10.3) | 28,316 (10.9) | 13,188 (9.6) | 676 (7.1) | 517 (6.8) |
Former | 143,863 (34.8) | 90,750 (35.1) | 47,390 (34.4) | 3437 (36.0) | 2286 (29.9) |
Never | 227,354 (54.9) | 139,699 (54.0) | 77,376 (56.1) | 5444 (57.0) | 4835 (63.3) |
Alcohol consumption (drinks/day) | 1.2 (1.4) | 1.3 (1.5) | 1.0 (1.3) | 1.0 (1.2) | 0.7 (1.2) |
Nutritional supplementation (%) | 206,442 (49.9) | 124,388 (48.1) | 72,604 (52.6) | 5372 (56.2) | 4078 (53.4) |
Anthropometrics | |||||
BMI, kg/m2 (SD) | 27.3 (4.7) | 27.8 (4.8) | 26.7 (4.5) | 25.2 (4.2) | 25.6 (4.6) |
< 18.5 (%) | 2070 (0.5) | 955 (0.4) | 846 (0.6) | 149 (1.6) | 120 (1.6) |
18.5–24.9 (%) | 136,230 (32.9) | 74,806 (28.9) | 52,611 (38.1) | 5038 (52.7) | 3775 (49.4) |
≥ 25 (%) | 275,614 (66.6) | 183,004 (70.7) | 84,497 (61.3) | 4370 (45.7) | 3743 (49.0) |
Height, m (SD) | 169.0 (9.3) | 169.7 (9.3) | 167.8 (9.1) | 167.4 (8.7) | 167.1 (9.3) |
Comorbidities | |||||
History of diabetes (%) | 36,970 (8.9) | 25,162 (9.7) | 10,859 (7.9) | 395 (4.1) | 554 (7.3) |
History of cancer (%) | 42,641 (10.3) | 25,788 (10.0) | 15,221 (11.0) | 1001 (10.5) | 631 (8.3) |
History of CVD (%) | 46,095 (11.1) | 30,129 (11.6) | 14,853 (10.8) | 609 (6.4) | 504 (6.6) |
History of other fractures (%) | 41,196 (10.0) | 25,800 (10.0) | 13,560 (9.8) | 1026 (10.7) | 810 (10.6) |
Female-specific covariates | |||||
Menopausal status (%) | |||||
Premenopausal | 62,162 (29.0) | 36,214 (30.3) | 21,389 (25.7) | 2516 (37.3) | 2043 (41.2) |
Postmenopausal | 152,064 (71.0) | 83,197 (69.7) | 61,723 (74.3) | 4230 (62.7) | 2914 (58.8) |
HRT use (%) | |||||
Current | 13,102 (6.1) | 7385 (6.2) | 5111 (6.1) | 394 (5.8) | 212 (4.3) |
Former | 59,758 (27.9) | 33,525 (28.1) | 24,129 (29.0) | 1331 (19.7) | 773 (15.6) |
Never | 141,366 (66.0) | 78,501 (65.7) | 53,872 (64.8) | 5021 (74.4) | 3972 (80.1) |
≥ 1 child (%) | 172,827 (80.7) | 99,652 (83.5) | 65,071 (78.3) | 4673 (69.3) | 3431 (69.2) |
Diet groups
Diet group | Predicted incidence per 1000 people over 10 yearsa | Absolute rate difference per 1000 people over 10 yearsb |
---|---|---|
Regular meat-eater | 6.5 (6.2, 6.8) | Reference |
Occasional meat-eater | 6.5 (6.1, 6.8) | 0 (− 0.4, 0.3) |
Pescatarian | 7.0 (5.6, 8.7) | 0.5 (− 0.9, 2.2) |
Vegetarian | 9.7 (7.7, 12.3) | 3.2 (1.2, 5.8) |
Subgroup analyses
Stratifying variable | n cases, adjusted HR (95% CI) | p interaction | |||
---|---|---|---|---|---|
Age | < 60 years | ≥ 60 years | |||
Regular meat-eaters (reference) | 514/152,486 | 1.00 | 1531/106,279 | 1.00 | |
Occasional meat-eaters | 317/75,670 | 1.03 (0.89, 1.18) | 993/62,284 | 0.98 (0.91, 1.07) | |
Pescatarians | 31/6747 | 1.15 (0.80, 1.65) | 47/2810 | 1.04 (0.77, 1.39) | |
Vegetarians | 32/5770 | 1.58 (1.10, 2.26) | 38/1868 | 1.45 (1.04, 2.00) | 0.9 |
Sex | Male | Female | |||
Regular meat-eaters (reference) | 883/139,354 | 1.00 | 1162/199,411 | 1.00 | |
Occasional meat-eaters | 381/54,842 | 0.98 (0.87, 1.10) | 929/83,112 | 1.00 (0.92, 1.09) | |
Pescatarians | 19/2811 | 1.29 (0.82, 2.03) | 59/6746 | 1.02 (0.79, 1.33) | |
Vegetarians | 24/2681 | 2.04 (1.36, 3.08) | 46/4957 | 1.32 (0.98, 1.78) | 0.3 |
BMI | BMI ≤ 22.5 | BMI > 22.5 | |||
Regular meat-eaters (reference) | 343/25,794 | 1.00 | 1702/232,971 | 1.00 | |
Occasional meat-eaters | 279/21,297 | 0.86 (0.74, 1.01) | 1031/116,657 | 1.06 (0.98, 1.15) | |
Pescatarians | 27/2564 | 0.90 (0.61, 1.33) | 51/6993 | 1.22 (0.92, 1.61) | |
Vegetarians | 31/1925 | 1.61 (1.12, 2.34) | 39/5713 | 1.42 (1.03, 1.96) | 0.08 |
Mediation analyses
Vegetarians vs regular meat-eaters | Conditional effect, HR or % (95% CI) | ||||
---|---|---|---|---|---|
Potential mediator | n/N | Total effect | Direct effect | Indirect effect | % mediation |
BMI | 2115/266,403 | 1.77 (1.34, 2.25) | 1.51 (1.11, 2.03) | 1.17 (1.00, 1.35) | 27.8 (1.1, 69.8) |
FFM | 2056/262,679 | 1.68 (1.27, 2.13) | 1.78 (1.19, 2.44) | 0.95 (0.73, 1.21) | − 10.5 (− 77.4, 44.8) |
Vitamin D | 1874/238,837 | 1.67 (1.26, 2.10) | 1.61 (1.18, 2.13) | 1.03 (0.86, 1.23) | 6.5 (− 35.4, 45.6) |
IGF-1 | 1949/248,163 | 1.63 (1.25, 2.06) | 1.64 (1.25, 2.08) | 1.00 (0.94, 1.06) | − 0.8 (− 16.7, 14.4) |