lacto-ovo-vegetarian also accepts egg prod- ... of vegetarian diets, ... food analysis method now has been applied to the lactovegetarian diet from a health center.
Original
Research
Communications-methods
Nutrient intake and health status of lactovegetarians: chemical analyses of diets using the duplicate portion sampling technique13 MD, MD,
ABSTRACT Six middle-aged lactovegetarians (three men and three women) collected copies of four 24-h diets using the duplicate portion sampling technique. By chemical analyses, the nutrient composition of the lactovegetarian diet was determined in detail and compared with that ofa mixed Swedish diet (normal) and a vegan diet (vegan) studied previously. The nutrient composition of the lactovegetarian diet expressed per 1000 kcal represented an average between normal and vegan diets. It was in closer agreement with Swedish recommended dietary allowances than the normal Swedish diet. Thus, the lactovegetarian diet contained 35% ofthe energy as fat and was rich in polyunsaturated fatty acids, especially linoleic acid, which resulted in a polyunsaturated/saturated fat ratio of0.6. The lactovegetarian diet had a cholesterol concentration only half of that of a normal diet. Protein content and amino acid composition were well above recommendations. The lactovegetarian diets contained less sucrose than normal and vegan diets, but the sum of the intake of low molecular weight carbohydrates was comparable to normal and vegan diets. Dietary fiber was three times higher than in a normal diet. Essential minerals and trace elements, ie, Ca, Mg, Na, K, Fe, Zn, Cu, Se, satisfied current requirements. The intake of vitamin B,2 by the lactovegetarians was around 1.4 zg daily, which is below the recommendations. The intake of folates was high, 300 to 400 g daily. The clinical and biochemical investigation of the subjects revealed no signs of nutritional deficiency. Their plasma lipoproteins and the blood pressures were low for their age, in agreement with observations made earlier in a group ofvegans. Am J C/in Nutr 1984;40:325-338. KEY
WORDS
Lactovegetarian
diet,
duplicate
portion,
chemical
ergy, fat, fatty acid, sterols, protein, amino acids, carbohydrates, elements, vitamin B,2, folic acid, nitrate, nitrite, nutritional status,
Introduction .
.
Dunng the last few decades, vegetarian diets have attracted considerable attention in discussions concerning human health and disease, and vegetarian diets have been proposed to cure or relieve symptoms ofseveral chronic and disabling diseases (1-5). Vegetariandiets are subdivided in the vegan diet, le, stnctly vegetanan, accepting only foods of vegetable origin. The lactovegetarian diet The American Journal ofClinical Nutrition 40: © 1984 American Society for Clinical Nutrition
AUGUST
analyses
of nutrients,
dietary fiber, minerals, blood parameters
entrace
in addition includes milk products and lacto-ovo-vegetarian also accepts egg products &cause of the suggested beneficial effects ‘From (MA, Health
the Centre
IA, ID, Mi, Center
Cariol tistry, 1984,
(DB),
for Health AN,
of Tallmorden University
Malm#{246};Department pp
325-338.
Care
55), University
Printed
Sciences
(K-OA), of Lund, ofNutrition in USA
at Dalby
of Lund,
School (MJ),
Lund;
SunnansjO, of DenChemical 325
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MohammedAbdulla, MD, Karl-Otto Aly, MD, Ingrid Andersson,4 Nils-Georg Asp, Dowen Birkhed, DDS, Ingrid Denker, Claes-GOran Johansson, MSc, 4’fargaretha Jagerstad. PhD, Kurt Kolar, MSc, Baboo M Nair,5Peter Nilsson-Ehle, Ake Nord#{233}n,MD, Solvig Rassner, BSc, Sven Svensson,4 BjOrn Akesson, MD, and Per-Arne Ockerman, MD
ABDULLA
326
Materials
and
methods
Participants Six healthy volunteers, three men and three women (aged 46 to 58 yr), who had followed a lactovegetarian dietary regimen for 29 yr (median range 3 to 42 yr), were selected among the staffat a lactovegetarian health Center, University of Lund, Lund; Swedish Meat Research Institute (KK), Kavling#{231}Department of Clinical Chemistry (MA, PN-E, SR. BA, PO), University Hospital, Lund, Sweden. 2Supported by a special grant within the Centre for Health Care Sciences at Dalby from the Swedish National Board ofHealth and Social Welfare and by grants from the Swedish Medical Research Council (Project 3968), Foundations of Ekhaga, A P#{226}hlson,Kiholms H#{228}lsohem,and H#{228}lsokostr#{227}det. 3Address reprint requests to: Margaretha Jagerstad, PhD, Department of Nutrition, University of Lund, Chemical Center, PG Box 740, 5-220 07 Lund, Sweden. 4 Technician. Doctor of Technology. Received April 19, 1983. Accepted for publication February 7. 1984.
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center (Tallmog#{227}rden, located in central Sweden). The protocol for this study was approved by the human subjects commiUee ofthe University of Lund. Food
sampling
The subjects collected foods during the same 4 consecutive days (September 1979). At each meal, everything consumed had to be duplicated as exactly as possible by visual measurements, and the duplicate was used for chemical analyses(6). The importance of maintaming the usual eating habits was stressed. In addition, a protocol was made up every day in which the participants recorded the type offood consumed and a rough estimation ofquantities consumed expressed as spoonful, cupful, etc. A total of24 duplicate portions, including drinking fluids consumed between the meals, were collected and frozen as described earlier (6, 7). Urinary
samples
Urine samples were obtained on the same day as the food collection. The urine was collected in bottles contaming 5 ml conc HCI. The volume was measured, and a representative sample of each 24-h urine collection was stored at -17#{176}Cuntil assayed. Medical
and laboratory
examinations
At the time of the nutritional investigation, the six participants underwent a medical examination and completed a standardized questionnaire regarding present and past illnesses and diseases. All examinations were performed by one ofthe authors (K-OA), and the main findings are summarized in Table 1. Blood samples were taken after 10 h of fasting for laboratory determinations. The analyses were performed at the Department ofClinical Chemistry, University Hospital, Lund, Sweden. Analyses
offood
and urine
solids
The analyses ofnutrients and other food components were performed as described earlier (6, 7). Most components analyzed are shown in Table 2. Energy intake expressed as kcal was calculated from fat as 9.3 x g fat, from protein as 4. 1 x 6.25 x g nitrogen, and from carbohydrate as 4. 1 x g fat-free powder minus protein and 7% ash (carbohydrate by difference). The data were rounded off to the nearest 50 kcal.
Results
and
discussion
Lactovegetarian
diet
A typical lactovegetarian menu at the health center was as follows: breakfast usually included milk and porridge or different kinds of fermented milk, eg, yoghurt and buttermilk. In addition, several kinds of raw cereal, nuts, and fresh or dried fruits were consumed. Lunch was started with mixed salads of minced vegetables, roots, and pulses followed by a warm dish. Dinner also started with raw salads and was followed by
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of vegetarian diets, it is of interest to know their nutrient composition as compared with an ordinary mixed diet. Such data are still scarce and most often incomplete. In a recent study, we investigated the nutrient composition of a diet collected in a vegan center in central Sweden, where a dietary regimen usually followed by Swedish vegans has been established. Using chemical analyses of duplicate portions of 24-h food collections, detailed information regarding the composition of fats, sterols, protein, carbohydrates, essential trace elements, and two vitamins (folic acid and vitamin B12) were obtained (6). The nutrient composition of the vegan diet was compared with that of the ordinary mixed Swedish diet studied previously using the same food collection method (7). The same food analysis method now has been applied to the lactovegetarian diet from a health center in central Sweden, where a dietary regimen usually followed by Swedish lactovegetarians has been established. The purpose ofthe present study was to compare the nutrient composition of the lactovegetarian diet with current dietary recommendations and also with the composition of the vegan diet (6) and ordinary mixed diet (7), both examined previously. In addition, the health status of the lactovegetarians as reflected by clinical and biochemical findings was studied.
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ABDULLA
328 TABLE 2 Mean (± SD) daily collecting duplicate 1000 kcal)
intake ofenergy portions during
and nutrients 4 consecutive
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by three male and three female lactovegetarians days; the nutrient quality expressed as nutrient Daily
Nutrients
intake
Nutrients
Men
Women
()
Energy(kcal) (MJ) Total fat (g) (%) Linoleic acid (g) Totalsterols(mg) Cholesterol(mg) Protein(g) (%) Total carbohydrate
(g) (%)
density
Men + women
()
‘4.
l2diets
l2diets
2600±530 10.8±2.2 98 ± 26 35±6 25 ± 9.2 436± 170 151±58 64±16 10±2 346 ± 89 55±6 22±14 53±17 104±31 125±32 703 ± 236 505 ± 156 16.0 ± 3.0 11.5±3.3 2.4 ± 0.8 68±31 1.3 ± 0.5 442 ± 108
1900±380 8.0± 1.6 72 ± 26 35±7 13 ± 6.6 343± 115 155±60 57±12 12±1 245 ± 44 53±7 14±7 33±8 88±45 87±27 1024 ± 265 350 ± 64 12.7 ± 4.0 10.1 ± 1.4 1.8 ± 0.4 61±17 1.5 ± 0.2 359 ± 122
37 ± 6.8 35±6.5 8.2 ± 3.4 174±29 69±25 28±4.9 11±2 132 ± 16 54±6.6 8±5 19±5 43± 16 47±9 429 ± 169 191 ± 37 6.6 ± 2.0 5.0± 1.2 1.0 ± 0.2 30±10 0.7 ± 0.2 182 ± 59
14.8 ± 6.6 I 1.6 ± 6. 1
1 1.2 ± 5.7 7.3 ± 2.2
5.8 ± 2.9 4.2 ± I .8
a hot soup. Bread was served with all meals. Most ofthe beverages, such as water, several kinds of herb teas, fruit and vegetable juices, were served between meals. All animal foods, except milk and dairy products were excluded. Salt, sugar, pepper, coffee, and Indian tea were not used. In addition, four of the six subjects consumed a few nutrient supplements such as yeast (DLV- 1 ), calcium (DLV- 1 , DLV-2, DLV-3), h-pantoten (DLV-2), wheat-germ (DLV-2), and an extract of fruits and vegetables containing minerals and vitamins (DLV-5). Some of these preparations, yeast, wheat germ, and calcium, were included in the collected food duplicates and may have contributed to some extent to their nutrient values. Since six staff members cannot be regarded as representative for lactovegetarians in general, it should be stressed that a main interest of the present study was to investigate the nutrient composition of a
lactovegetarian health center. Validity technique
diet
ofthe
(per
collected
duplicate
on
portion
a leading
sampling
To check the food sampling method, the intake and urinary excretion of protein (nitrogen), sodium, and potassium was compared. As seen in Table 3, the mean daily intake of nitrogen was 9.6 g, whereas the mean urinary excretion of nitrogen was 7.3 g, which was significantly lower (p < 0.00 1). Ifestimated nitrogen losses through the skin TABLE 3 Daily nutrient excretion
intake
compared
Daily
intake
with daily
urinary
Daily urinary excretion
Nitrogen (g) Sodium (mmol) Potassium (mmol) a
Mean
9.6±2.3 96±39 106±35
± SD of 24 observations.
7.3± 1.3 p
