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A number of studies have evaluated the health of vegetarians. Others have studied the health effects of foods that are preferred or avoided by vegetarians. The purpose of this review is to look critically at the evidence on the health effects of vegetarian diets and to seek possible explanations where results appear to conflict. There is convincing evidence that vegetarians have lower rates of coronary heart disease, largely explained by low LDL cholesterol, probable lower rates of hypertension and diabetes mellitus, and lower prevalence of obesity. Overall, their cancer rates appear to be moderately lower than others living in the same communities, and life expectancy appears to be greater. However, results for specific cancers are much less convincing and require more study. There is evidence that risk of colorectal cancer is lower in vegetarians and in those who eat less meat; however, results from British vegetarians presently disagree, and this needs explanation. It is probable that using the label 'vegetarian' as a dietary category is too broad and that our understanding will be served well by dividing vegetarians into more descriptive subtypes. Although vegetarian diets are healthful and are associated with lower risk of several chronic diseases, different types of vegetarians may not experience the same effects on health.

Background: A high-fat (HF) diet and sedentary lifestyle are implicated in the development of obesity. Controlled feeding studies and measures of short-term resting energy expenditure (REE) have suggested that the type of dietary fat may alter energy expenditure (EE). Objective: The objective was to examine the effects of an HF diet rich in either monounsaturated or saturated fatty acids (FAs) and of exercise on EE and chronic disease risk factors. Design: Eight healthy men [age: 18-45 y; body mass index (in kg/[m.sup.2]): 22 [+ or -] 3] were randomly assigned in a 2 x 2 crossover design to 1 of 4 treatments: HF diet (50% of energy) with a high amount of saturated fat (22% of energy) plus exercise (SE) or a sedentary (SS) condition or a diet high in monounsaturated fat (30% of energy) plus exercise (UE) or a sedentary (US) condition. The subjects spent 5 d in a metabolic chamber and cycled at 45% of maximal oxygen uptake for 2 h each day during the exercise visits. Respiratory gases and urinary nitrogen were measured to determine 24-h EE. Resting metabolic rate was measured on days 2, 4, and 6. Results: Average 24-h EE was not different with respect to dietary FA composition (3202 [+ or -] 146, 3208 [+ or -] 151, 2240 [+ or -] 82, and 2270 [+ or -] 104 for SE, UE, SS, and US, respectively). Total and LDL cholesterol and blood pressure were significantly greater after the SE and SS treatments than after the UE and US treatments. Conclusion: Resting metabolic rate and 24-b EE were not significantly different after short-term exposure to an HF diet rich in monounsaturated FAs or after exposure to a diet rich in saturated FAs in healthy, nonobese men. Am J Clin Nutr 2009;89:1350-6.

Background: Choline and betaine are linked to phospholipid and one-carbon metabolism. Blood concentrations or dietary intake of these quaternary amines have been related to the risk of chronic diseases, including cardiovascular disease and the metabolic syndrome. Objective: We aimed to determine dietary predictors of plasma choline and betaine among middle-aged and elderly subjects recruited from an area without folic acid fortification. Design: This is a population-based study of 5812 men and women aged 47-49 and 71-74 y, within the Hordaland Health Study cohort. Plasma concentrations per increasing quartile of intake of foods, beverages, and nutrients were assessed by multiple linear regression analysis, and dietary patterns were assessed by factor analysis. Results: Plasma choline was predicted by egg consumption (0.16 [micro]mol/L; P < 0.0001) and cholesterol intake (0.16 [micro]mol/L; P < 0.0001), and betaine was predicted by consumption of high-fiber bread (0.65 [micro]mol/L; P < 0.0001); high-fat dairy products (-0.70 [micro]mol/L; P < 0.0001); complex carbohydrates, fiber, folate, and thiamine (0.66-1.44 [micro]mol/L; P [less than or equal to] 0.0002 for all); and total energy (0.45 [micro] mol/L; P = 0.004). Plasma choline was not significantly associated with any identified dietary patterns, whereas betaine was negatively associated with a Western dietary pattern with a high loading for meat, pizza, sugar, and fat (P < 0.0001). Conclusion: In this population of middle-aged and elderly men and women, recruited from an area with relatively low folate intake, neither plasma choline nor betaine was positively associated with consumption of animal products, fruit, or vegetables, but each was positively associated with the intake of specific food items such as eggs (choline) and bread (betaine).

Approximately 20-30% of Americans consume multivitamin supplements daily, indicating high public interest in the prevention of cancer and other chronic diseases through a nutrition-based approach. Although several bioactive food components, including vitamins and minerals, have been investigated for their ability to affect cancer risk, few large, randomized, placebo-controlled clinical trials of multivitamins with cancer as the primary endpoint have been performed. The results of most large-scale trials of multivitamin supplements (combinations of [greater than or equal to] 2 vitamins and minerals) to prevent cancer have been mixed. The Linxian General Population and Dysplasia trials found a decreased risk of cancer, particularly stomach cancer, for participants taking a multivitamin supplement, but this was in a borderline-deficient population in China. Two trials, the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study and the [beta]-Carotene and Retinol Efficacy Trial, found an increased risk of lung cancer among male cigarette smokers or asbestos-exposed persons taking [beta]-carotene--a surprising result, considering that most epidemiologic studies have suggested that consumption of fruit and vegetables appears to lower cancer risk. To clarify the effects of multivitamin supplements, several large randomized clinical trials are underway, including the Physicians' Health Study II, the Selenium and Vitamin E Cancer Prevention Trial, and a European study, Supplementation en Vitamines et Mineraux Antioxydants (SU.VI. MAX). Because epidemiologic studies generally evaluate foods rather than specific bioactive food components, a systematic approach to determining how combinations of vitamins and minerals may interact to ameliorate cancer risk is necessary to further our understanding of the potential benefits and risks of supplement use. KEY WORDS Multivitamin supplements, randomized clinical trials, cancer prevention, bioactive food components, nutrition

Multivitamin-multimineral (MVM) supplements are widely used in the United States, often in the hope of reducing the risk of cancer, cardiovascular disease, or other chronic disease. This article assesses the potential of randomized controlled trials and epidemiologic cohort studies for yielding reliable information on the effects of MVMs on chronic disease. A brief review of the available literature on MVMs in relation to incidence and mortality rates from prominent cancers and cardiovascular diseases is also provided along with a discussion of needed research. Specifically, the strengths and weaknesses of epidemiologic cohort studies and randomized controlled trials are summarized and discussed in the context of single-vitamin supplements when both types of studies are available. Recent review articles that include an assessment of MVMs in relation to cancer and cardiovascular disease are updated to provide a summary of available data. Few randomized controlled trials and few cohort studies of MVMs that are directly pertinent to cancer or cardiovascular disease are available. The data are not compelling concerning a role for MVMs in preventing cancer or cardiovascular disease morbidity or mortality, although some interesting leads merit further evaluation. Investigators responsible for cohort studies that assessed MVMs should be encouraged to report available data on MVMs and chronic disease. Depending in part on the results of such additional reports, a full-scale randomized controlled trial of well-selected MVMs in women may be warranted on public health grounds. KEY WORDS Cohort study, multivitamin, multimineral, randomized controlled trial, research needs, study design

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