There is strong evidence indicating that elevated plasma total homocysteine (tHcy) levels are a major independent biomarker and/or a contributor to chronic conditions, such as CVD. A deficiency of vitamin B12 can elevate homocysteine. Vegetarians are a group of the population who are potentially at greater risk of vitamin B12 deficiency than omnivores. This is the first systematic review and meta-analysis to appraise a range of studies that compared the homocysteine and vitamin B12 levels of vegetarians and omnivores. The search methods employed identified 443 entries, from which, by screening using set inclusion and exclusion criteria, six eligible cohort case studies and eleven cross-sectional studies from 1999 to 2010 were revealed, which compared concentrations of plasma tHcy and serum vitamin B12 of omnivores, lactovegetarians or lacto-ovovegetarians and vegans. Of the identified seventeen studies (3230 participants), only two studies reported that vegan concentrations of plasma tHcy and serum vitamin B12 did not differ from omnivores. The present study confirmed that an inverse relationship exists between plasma tHcy and serum vitamin B12, from which it can be concluded that the usual dietary source of vitamin B12 is animal products and those who choose to omit or restrict these products are destined to become vitamin B12 deficient. At present, the available supplement, which is usually used for fortification of food, is the unreliable cyanocobalamin. A well-designed study is needed to investigate a reliable and suitable supplement to normalise the elevated plasma tHcy of a high majority of vegetarians. This would fill the gaps in the present nutritional scientific knowledge.

The association of plasma phospholipid (PL) fatty acid composition with plasma homocysteine (Hcy) in Chinese vegetarians is not understood. The main aim of the present study was to investigate the plasma PL fatty acid status, and its association with plasma Hcy in Chinese vegetarians and omnivores. A total of 103 male vegetarians and 128 male omnivores were recruited in Linyin Temple, Hangzhou. Plasma Hcy and PL fatty acid concentrations were determined by standard methods. Compared with omnivores, plasma PL n-3 PUFA (P< 0·001), 22 : 6n-3 (P< 0·001), 22 : 5n-6 (P= 0·021), 22 : 2n-6 (P< 0·001) and SFA (P= 0·017) were significantly lower, while plasma PL n-6 PUFA (P= 0·007) and total PUFA (P< 0·001) were significantly higher in vegetarians. The prevalence of hyperhomocysteinaemia (HHcy) in vegetarians (26·47 %) was significantly higher than that in omnivores (13·28 %). In vegetarians, plasma PL 22 : 6n-3 (r − 0·257, P= 0·046) was significantly negatively associated with plasma Hcy. In omnivores, plasma PL 18 : 1n-7 (r 0·237, P= 0·030) was significantly positively associated with plasma Hcy. Plasma PL 22 : 6n-3 (r − 0·217, P= 0·048) was negatively associated with plasma Hcy in omnivores. Plasma PL SFA were positively associated with the prevalence of HHcy. It would seem appropriate for vegetarians to increase their dietary n-3 PUFA and decrease dietary SFA, and thus reduce the risk of HHcy.

The effect of long-term differences in diet composition on whole-body acid–base status was examined in thirty-three young healthy females. The volunteers were recruited from two separate groups matched approximately for age, height and weight; one group regularly ate meat (omnivores; n 20) and one group did not (vegetarians; n 13). All subjects completed a 7 d weighed intake of food, and from their dietary records, total energy, carbohydrate (CHO), fat and protein content were estimated using computer-based food composition tables. During this week they reported to the laboratory on two occasions, following an overnight fast and separated by at least 48h. Arterialized venous blood samples were obtained on each visit and these were analysed for blood acid–base status. Haemoglobin and packed cell volume, serum total cholesterol and HDL-cholesterol, serum albumin and total protein were also determined. Two 24 h urine collections were completed; the volume was recorded and samples were analysed for pH, titratable acid and Mg and Ca concentration. Total energy intake of the omnivores was greater (P = 0.0003) than that of the vegetarian group. Dietary intake of CHO (P = 0.024), fat (P = 0.0054) and protein (P = 0.0002) were higher in the omnivorous group than in the vegetarians. There were no differences between the two groups with respect to blood CO2 partial pressure, plasma HCO3- and blood base excess, but blood pH was slightly higher in the omnivores (P = 0.064). Measures of urine acid–base status suggested a lower pH in the omnivore group, but this difference was not statistically significant; a greater titratable acid output was observed with the omnivorous group compared with the vegetarians (48.9 (se 20.3) ν. 35.3 (se 23.3) mEq/24h; P = 0.018). Although the dietary intake of Ca was not different between the two groups, urinary Ca excretion of the omnivores was significantly higher (3.87 (sd 1.34) ν. 3.22 (sd 1.20) mmol/24h) than that of the vegetarians (P = 0.014). It is suggested that the higher protein intake of the omnivores resulted in an increase in urinary total acid excretion, which may explain the higher rate of Ca excretion.