IJCS | Volume 32, Nº6, November / December 2019

624 Pimentel et al. Nutritional status and vegetarians Int J Cardiovasc Sci. 2019;32(6):623-634 Original Article meat, poultry and fish from their diet, and may include or not dairy products and eggs. 4 In the last 30 years, several researches have reported important and measurable benefits of vegetarian diets, especially of well-planned diets followed by individuals living in places where vegetable foods are highly available. Under these conditions, vegetarians can enjoy good health, with body mass index (BMI) 5 and plasma cholesterol levels 6 within healthy ranges, 6 in addition to increased serum levels of antioxidants, 7 lowprevalence of obesity, cardiovascular diseases, 8 type 2 diabetesmellitus, 9 systemic arterial hypertension, 10 metabolic syndrome, 11 colon polyps, 12 many types of cancer, 8 and increased life expectancy. 13 There ismuch evidence that a vegetariandiet can be recommended for the prevention and treatment of cardiovascular diseases 14 and even as a therapeutic alternative for diabetes, 15 hypertension 16 and obesity. 17 Vegetarian diets offer nutritional benefits, including lower levels of saturated fat, cholesterol and animal protein, as well as higher levels of carbohydrates, dietary fiber, magnesium, potassium, folate, antioxidant vitamins and other bioactive compounds. However, vegans may have a deficient intake of vitamin B-12, calcium, vitamin D and omega-3 fatty acid. 18 The marginal intake of some nutrients does not prevent these diets from being recommended, based on strong scientific evidence showing that the health benefits of these diets exceed potential risks. 19 Studies comparing body weight of vegetarians and non-vegetarians have shown that those who follow a vegetarian diet tend to have lower weight. 5 Therefore, it seems that the main characteristic of vegetarian diets, i.e., the exclusion of meat or reduction of its consumption, when combined with a high nutrient density, plays an important role in maintenance of a healthy nutritional status. Thus, the expansion of the study of vegetarian diets may lead to more efficient strategies for weight control, development of healthy habits and consequent reduction of NCDs. The aimof this study was to assess and compare the nutritional status, bymeans of anthropometric and biochemical parameters, of a sample of adult vegetarians and omnivores from the same population in São Paulo, Brazil. Methods This was a cross-sectional study. Calculation of the sample size (non-probabilistic, convenience sampling) was based on the test of the difference of means of BMI, described in a previous study involving a similar population. 20 BMI was chosen because the variable encompasses a large number of individuals, thereby increasing the power of the sample. Fifty-eight individuals in each group would be necessary for statistically significant results (Student’s t-test), with 80% power and level of significance of α = 0.05. We studied adults (≥ 18 years and < 60 years) of both sexes. A total of 198 individuals were first selected, and thenwe excluded women using oral contraceptives (in attempt to establish a hormonal profile), and individuals using antidepressants, anti-hypertensive drugs, beta-blockers or vasodilators. Ninety-six individuals (56 vegetarians and 40 omnivores) were included in the study. In general, studies comparing the effects of vegetarian diet on health in relation to omnivore diet have not considered different types of vegetarian diets. Rather, the authors have reported differences between exposed and non-exposed to vegetarian diets, or between vegetarians and omnivores. 14 The exceptions in this regard are population-based, longitudinal, cohort studies that involve large sample populations and hence allow a stratified analysis by the type of vegetarian diet. In the present study, we opted to dichotomize the study group as vegetarians and omnivores and to compare the nutritional status and life style between these groups. For recruitment of vegetarian volunteers (Figure 1), we contacted the SVB, which supported and publicized the study. An e-mail was sent to the addresses registered in the SVB database of more than 2,000 individuals (omnivores and vegetarians), who were invited to participate in the study. The message contained an electronic address to which the volunteers willing to participate in the study could make contact. Those interested in participating got their first visit scheduled by e-mail; they also published the call for participation on online social medias. After the first interview, vegetarians who met the inclusion criteria were invited via e-mail to the second phase of the study (collection of blood samples). Omnivores were recruited through advertisement of the study in social medias and in universities, based on the same flowchart of vegetarians (Figure 2). The first stage of data collection comprised: explanation of the study; explanation of the informed consent form; administration of the questionnaire containing sociodemographic data, lifestyle information and assessment of the nutritional status, with measurement