Longitudinal associations between vegetarian dietary habits and site-specific cancers in the Adventist Health Study-2 North American cohort

Fraser, Gary et al. Longitudinal associations between vegetarian dietary habits and site-specific cancers in the Adventist Health Study-2 North American cohort, The American Journal of Clinical Nutrition, 2025 Aug, Volume 122, Issue 2, Pages 535-543, ISSN 0002-9165, https://doi.org/10.1016/j.ajcnut.2025.06.006.

Background: Associations between vegetarian diets and risk of common cancers are somewhat understood, but such data on medium-frequency cancers are scarce and often imprecise.

Objectives: The objectives of this study was to describe multivariable-adjusted associations between different types of vegetarian diets (compared with nonvegetarians) and risk of cancers at different bodily sites.

Methods: The Adventist Health Study is a cohort of 95,863 North American Seventh-day Adventists established between 2002 and 2007. These analyses used 79,468 participants initially free of cancer. Baseline dietary data were obtained using a food frequency questionnaire and incident cancers by matching with state and Canadian provincial cancer registries. Hazard ratios (HRs) were estimated using proportional hazard regression. Small amounts of missing data were filled using multiple imputations.

Results: Overall cancers, all vegetarians combined compared with nonvegetarians, had HR: 0.88; 95% confidence interval (CI): 0.83,0.93; P < 0.001, and for medium frequency cancers, HR: 0.82; 95% CI: 0.76, 0.89; P < 0.001. Of specific cancers, colorectal (HR: 0.79; 95% CI: 0.66, 0.95; P ¼ 0.011), stomach (HR: 0.55; 95% CI: 0.32, 0.93; P ¼ 0.025), and lymphoproliferative (HR: 0.75; 95% CI: 0.60,0.93; P ¼ 0.010) cancers, were significantly less frequent among vegetarians. A joint test that HR ¼ 1.0 for all vegetarian subtypes compared with nonvegetarians was rejected for cancers of the breast (P ¼ 0.012), lymphoma (P ¼ 0.031), all lymphoproliferative cancers (P ¼ 0.004), prostate cancer (P ¼ 0.030), colorectal cancers (P ¼ 0.023), medium frequency cancers (P < 0.001), and for all cancers combined (P < 0.001).

Conclusions: These data indicate a lower risk in vegetarians for all cancers combined, as well as for medium-frequency cancers as a group. Specific cancers with evidence of lower risk are breast, colorectal, prostate, stomach, and lymphoproliferative subtypes. Risk at some other sites may also differ in vegetarians, but statistical power was limited. Keywords: vegetarian subtypes, site-specific cancers, Seventh-day Adventists, North American subjects, Adventist Health Study-2