Public Health Nutrition

Nutrition and health

Legumes and meat analogues consumption are associated with hip fracture risk independently of meat intake among Caucasian men and women: the Adventist Health Study-2

Vichuda Lousuebsakul-Matthewsa1a2 c1, Donna L Thorpea3, Raymond Knutsena2, W Larry Beesona2, Gary E Frasera2 and Synnove F Knutsena2

a1 Department of Health Services, Los Angeles County, CA, USA

a2 Department of Epidemiology & Biostatistics, School of Public Health, Loma Linda University, Loma Linda, CA 92350, USA

a3 Department of Physical Therapy, School of Allied Health Professions, Loma Linda University, Loma Linda, CA, USA


Objective In contrast to non-vegetarians, vegetarians consume more legumes and meat analogues as sources of protein to substitute for meat intake. The present study aimed to assess the association between foods with high protein content (legumes, meat, meat analogues) by dietary pattern (vegetarians, non-vegetarians) and hip fracture incidence, adjusted for selected lifestyle factors.

Design A prospective cohort of Adventist Health Study-2 (AHS-2) enrollees who completed a comprehensive lifestyle and dietary questionnaire between 2002 and 2007.

Setting Every two years after enrolment, a short questionnaire on hospitalizations and selected disease outcomes including hip fractures was sent to these members.

Subjects Respondents (n 33 208) to a baseline and a follow-up questionnaire.

Results In a multivariable model, legumes intake of once daily or more reduced the risk of hip fracture by 64 % (hazard ratio = 0·36, 95 % CI 0·21, 0·61) compared with those with legumes intake of less than once weekly. Similarly, meat intake of four or more times weekly was associated with a 40 % reduced risk of hip fracture (hazard ratio = 0·60, 95 % CI 0·41, 0·87) compared with those whose meat intake was less than once weekly. Furthermore, consumption of meat analogues once daily or more was associated with a 49 % reduced risk of hip fracture (hazard ratio = 0·51, 95 % CI 0·27, 0·98) compared with an intake of less than once weekly.

Conclusions Hip fracture incidence was inversely associated with legumes intake and, to a lesser extent, meat intake, after accounting for other food groups and important covariates. Similarly, a high intake of meat analogues was associated with a significantly reduced risk of hip fracture.

(Received February 04 2013)

(Revised July 21 2013)

(Accepted August 28 2013)

(Online publication October 08 2013)


  • Legumes;
  • Meat analogues;
  • Vegetable protein;
  • Hip fracture;
  • Dietary protein


c1 Corresponding author: Email