| | | Hematological, vitamin B,,, and folate studies = on Seventh-day Adventist vegetarians Bruce K, Armstrong? and Carol. Lanwood,? Dip. Diet, ABSTRACT 1 Of the Seventhday Adventist Chur significantly higher mean serum folate than did non-vegetarians. Sex corzlated directly with both meat and egg intake, Subjects with a serum vitamin B | level o <160 pglml had significantly higher mean MCV and MCH and lower mean total ted and white cell counts and red cll folate than the rest of the group. Comparison of the vegstarians with {he Busselton population showed similar difference. The prevalence of low hemoglobin level was not significantly different from that in the Bustelton population, and there was a, evidence of an excess of ign folate dfisiency among the Seventh-day Adventists. Only ong, i volunteer was found to have suffered from symptomatic dietary vitamin By, deficiency, AE jong MCV, MCH, and age in men was found, apparenty du to, in B,, deficiency in older men, Young women also appeared ‘more sensitive to the effects of vitamin B,, deficiency. significant positive correlate ' fan increased sensitivity to $ 1974, | Total abstention fiom foods of animallrigin (fesanism) is known tobe associated witha tow ferum vitamin Bry) lev! (1,2) and Ge Seccasional occurence of meqalobastegpemia or subacute combined. degeneration “BI the spinal cord (3,4), or bath Lact. and lasto-ovo {epetarins have alo been shown to hae low ferum vitamin By levels (5,6) with epgis of Symptomatic vitamin By; defiiency |B, 9) Such deficiency is occurring with infeasing Frequency in Britain doe to Increased nibers of Indian immigrants (10, 11), althogh in many of these eases the dit is also inogeguate sinfolte and other nutrients To asses the. effect of vegetardnifn on hematological variables, serum vita B/, and serum and red cell folate level Ina llfinely affluent (Australian middle els) community, we have stied $62. Seventh-day. Aden Church members, SeventhedayAdventits do not drink alcohol or smoke tobacco, lan they are advised not to eat Mesh foods although ths is not a condition of church’ mehifrship Moderation inthe se of dary product (ram, buter, cheese, and eps) and highly fined foods is also recommended, The group studied The american Joumal of nz MB. BS. MRACP, Richard E, Davis,’ MSc ELMLT, Darryl J. Nicol,’ F-ALMLT., Anthony V. van Merwyk,? Hematological, vitamin B, , and folate levels were measured in $62 mem Clinical Nutrition 27- JOLY 1974, pp. 112-718, Printed in U. | Aa MBBS, FRACS. | arins. Vegetal had um vitamin By» Ive 1» oF whom 431 were vege Am. J. Clin Nutr, 27: 712-18, i have received nutritional education from one of us (BKA) for a number of years. Six hundred and twenty-seven volunteer Soventh-? lday Adventists were accepted for the survey. Vege larians only, aged 30 oF over, were asked to voiuntest lout others who. presented were accepted, All were Ittending 2 1018.8 ne istony of petmicious anemia or therapy 1. of Tver injections: and 5) non-exet Fic femogiobin, Wolonteers with incom Jats were included in thee groups. Fut fifcemation was obtained by a dietitian ( toonal dietary history and 26Ar dietary re Vitamin 1, absorption was tested by axis (16) 08 existing methodology m una level of *7Co vitamin By. Die wa estimated from results af asus ‘i weon Toca! foods and partislly report Results Five hundred and sixty-two comp data were obtained. One woman age aud a macrocytic anemia (hemog }00 ml, MCV 127 42). A *7Co v absorption test showed:vitamin By 2 tion corrected by intrinsic factor a evluded from the study. This lef J 30 to 85 years and 322 women years. They had bgen Seventh-t ‘sts for from 4 months to 80 years ats). Only 29 had been members I The percentages of selected abne n, women, and groups eatin snounts of meat are Shown in Tat person, an 88-year-old wom1562 member. ctarians had 3 sin By Teveh sin B, | level ot {red and white cegetarans with smoglobin tevels shore was 1s ists Only ene deficiency parently due ww a also appeaiad 21: 2-18, 1 from one of untoer Seven fe sume. Ves fd to voluatest shall were RS tion grounds, Of the convention U'the remainder 1 doctor ant atology and Dist ents of Medicine Perth 6,00". Ir. R. E, Davis i Perth Hospi natologist, Rov! x, Heemstoloe’ | Surgery. Univ ian, Royal Per Printed in USA. ompleted a standard questionnatein which dietary {Soe present and past medical hifery, and current mual eatment were recorded. The Hegh, weg, Pe blood presure wore measured ad 2 I-ml venous Mad ample was drown, For the hemoglobin and ‘ier hematlogieal variables, § ml Blood was ante etSiuted with EDTA. The blood samples were Sed between 2 and SC and within 24 Ne of ‘ction the hemoglobin, packed cil volume (PCV), Stout red-and white cell counts were messored Mine Coulter counter modelS. | ‘rom vitamin D, was measured by the method of icols and Piney (12) using Euslna pecs. a the (eanim, ‘Serum and. ted (eel folate were » usted by the method of Davie (3). “Asessment of abnormal result jas made sing famoal ranges compiled for Westen Australia Table Tall complete ets of data were analjzed on Delish PDP 12 computer, Significance of differences feiveen means war dussed wang 2 Wit oF test Senincance of correlation coefisiehis and differences bermesn percentages was asessed by calculating the Standard exror of the coefficient of the difference. A tocfceat or dference of greater than twice the Stnduid eror was considered senificant 0S) ‘Approuimstely J year afce the survey, further shes were done on all those fo the survey inthe fsioing groups: ) serum tami By» <100 rel; ‘Jy scrum folate <2.8 nglml; 3) peru vitamin By, Y8.S ng: 4) pat Aistory of pernicious anemia or therapy with vitamin fy, ov Iver Injections, and 8) ndpvegetarian with a ow hemoglobin. Volunteers with| incomplete survey fap were included in these groupe Further dietary inlormation was obtained by aden (CJL), using 8 foal dietary history and ke etary recall ‘Vamin B,abuorption Was tested by our moi cation (16) of exiting methodsogy measuring the flame level of ?7Co vitamin Bl, Dietary vitamin Boe ented rm ret fs pesomed pS us on local foods and partially| reported elsewhere In. ic nl Results Five hundred and sixty-tw complete sets of data were obtained, One woman aped 63 years tad 2 mecrocytic’ anemia {hemoglobin 108 £100 ml, MCV 127 y?). Aji?Co vitamin By2 Absorption test shosted vitamin By malabsorp- tion coreected by intrinsic factor and she was excluded from the study, This left 239 men aged 30 to 8S years and 322}women aged 26 t0 91 years, They had been Seventhdlay Advent- ‘sts for from 4 months to 80, years (median 33 yes). Only 29 had been members for less than 2years, The percentages of selected abnormalities in men, women, and groups eating different amounts of meat are shows} in Table 2. Only one person, an 88- year-old woman with a Abed FOLATE STUDIES ON VEGETARIANS 713, TABLE 1 [Normal hematological and vitamin assay ranges (14) Men jomen Hemoglobin, 2/100 ml 123-163 113-149 Pv, 386-506 356-472 Red cell, x 10%/ul 43-87. 3.7533 MCHC, 297-347 29.0-342 249-325 249-329 T9-101.0 775-104. 37-3 38-141 Serum vitamin By p/m 160-875 Serum folic acid, mg/l 25-185 Red cell oli acid, net 160-640 normal hemoglobin level, serum vitamin By» of 150 pg/ml, and previously proven vitamin By malabsorption, had a high MCV (107 4"). Results from 122 volunteers with a serum * vitamin By level <160 pg/ml are shown in Table 3, Ten men, and eleven women had a serum vitamin B), <100 pg/ml and four’ were <0 pe/ml. When results from men and women were combined, those with a serum vitamin B, » <160 pglmi had a significantly lower mean red cell folate (mean 370.09, SD 124.78 ng/ml) than those with a normal serum vitamin By 2 (mean 398.75, SD 146.17 ng/ml; P < 0.05). Results from the thtee groups eating differ ent amounts of meat are shown in Table 4 and results from the three subgroups eating dif- ferent amounts of eggs are shown in Table 5 ‘Hematological results from men and women eating meat less than once per month are shown in Table 6 and compared with results from the 1969 Busselton population survey (Busselton Population Studies Group, unpublished data). ‘The Busselton survey covered 91% of the population aged 21 years and over of the Shire fof Busselton in Western Australia, These mea- surements are part of a follow-up to a similar survey mage in 1966 (18). ‘The following significant correlation coeffi- cients between vitamin levels were calculated from the whole group: serum vitamin B, , and folate, r= -0.11 (P< 0.01); serum vitamin By2 and red cell folate, r= 0.18 (P < 0.001), Correlation coefficients between age and all variables were calculated using results from all volunteers, The following were statistically significant: men, MCV, r = 0.40 (P < 0.001); MCH, r = 0.29 (P-<0.001); white cell count, r = =0.15 (P< 0.05); women, hemoglobin level, = 0.14 (P < 005); PCV, r= 0.12 (P<0.05).TABLE 2 Percent © of selected abnotmait No. with "Allvot- abnor ( unteers Men Women Group 1 Group’? Abnormality malty 61) 23) G22) 6 Low hemoglobin 8 32001342 22 Low MCH 16 230134 32 00 History ofrgn deficiency 124" [221 gas’ 28 yor thenapy® Low serum vitamin By 12 ae nt 262 87 | | Low serum foie acid 13) 2522 23 22 Low red cell folie acid B 17 8 26 00 History of pernicious 8 os 378 09 ‘anemia, vitamin B, oF liver therapy [Numbers in parentheses refer to numbes of volunteers in the grou. 2 Group I, dietary ment < once/monih; sroup 2, di | aictary meat’ > once/week,, » Pregnancy excluded, versus group 3,P-< 0.08.4 Significant difference, men | level on hematotogi TABLE 3 Influence ofa low serum vitamin 8 ARMSTRONG ET AL, itary meat > once/month but < oncejweck! group 3 Significant difference, men vetsus women or ov. versus women or group I versus group 3,P < OL ical variables and foie acid levels HEMATOLOGICAL, VITA smuin By2_upon MCH, MCHC aie (but not MCV) was also 24 30 to 49 years (serum vitam srl, mean MCH 28.19, SD 1 WHC 31.80, SD 0.95%; mean 4 41. SD 91.48 ng/ml; serum 160 pel, mean MCH 27.26, sean MCHC 31.23, SD 1.08%: ‘ate 408.78, SD 150.04 n/m). Further study after 1 year of sith a serum vitamin By 2 <100 jut the serum vitamin Bra W cli in six and 160 pe/ml in i for had they dev siosis or showed clinical eviden 8): deficiency. One 68-year-l corum vitamin By» persistently 18 592 Serum folic acid, ug/mt = 6B3* $137.71 Red cell folic acid, ugiml 400.25: 142161 369.41 "Numbers in parentheses refer to numbers of volunteers Mean = SD: sex, POL "0.001. Signiicant ference, men versus oo ‘Those eating meatless than oned! per month were subdivided by sex, age, and seni vitamin By. The increase in MCV and MCH, with age in men. was almost entirely due to both being Signticanly greater (P < 0.01) in men aged 50 to 90 years than in men aged 30 t0 49 yeas, with serum vitamin By <160 pg/ml (50 to 90 years, mean MCV 92.09, SD 4.00 x? , mean MCH 38,94, SD 1.43 pg, 30 to 49 years, mean MCV 87.91, SD 3.03 yw’, mean MCH 27,96, SD 1.00 Significant difference, serum vitamin B,, < 160 pe/ml versus B,, > 160 pp/m! in same © Significant diference, serum vitamin B, » < 160 pg/ml versus B,, > 160 pglml in same sex. Significant difference, men veus Women in same serum vitamin B, group, P < 0.001 Sera vita nl (54) 160 pel (68) 160 pelt (254) +1298 S055 1436 5347+ 1547 fo 0ss 13092 11S 12962 116 | 286 4197s 957 altos _ 4s 2 asx “4782 O41” a608 415 87921 $46 © 97s: 3336 87902. 4d 89.64 2 134 27S1s 157 R26 : o91¢ 31392 098 ini S 12ie “6922 167 627s 677354 543 E637 3976s! 148.71 inthe groups frien in same serum’ vitamin By, soup. P pg)-In men aged 50 t0 90 years, the mean MCV was also significantly greater (P < 0.001) and the red cell folate significantly less (P < 0405) in those with serum vitamin By < 160 pe/m than in those with serum vitamin B, » >160 palm (serum vitamin By, <160 pg/ml, mean red cell folate 352.91, SD 131.8 nel Vitamin B, ; 160 pg/ml, mean MCV 89.03, SD 4.111, mean red cell folate 424.91, SD 148.0 ngiml)."A significant effect of a low serum Age, years Hemozlobin, 5/100 mt PCV Red ce MeV, n? MICH pe McHC White cells, 10° wt Serum vitamin B, 5, pafnt Serum folie acs fe Red ell ole acid, nm X10 ‘Numbers in parentheses refer co num 2° "Group I, dietary meat <, once! seary meat > once/week, Mean §ierence trom group 1, P< 0.001 IBLE Inruence of eag intake on hematolosc ‘se than once per mont Hemoglobin, 2/100 mt MeV Serum vitamin B, ,.pAlnt Age-orrectedseturn vita By Sevum folic acid. nell 4 ‘Values in parentheses refer to num © Suberoup A. ees < once/month mncefwesk, Meant SD. © Si