A Vegetarian Diet Is Associated with a Lower Risk of Cataract, Particularly Among Individuals with Overweight: A Prospective Study

J Acad Nutr Diet. 2021 Apr;121(4):669-677.e1. doi: 10.1016/j.jand.2020.11.003. Epub 2020 Dec 11.


Background: Cataracts are caused by oxidative stress in the lens of the eyes and plant-based dietary patterns can contain a wide variety of protective antioxidants. However, strict vegetarians with inadequate vitamin B-12 intakes can have elevated homocysteine levels, which could increase the risk of cortical cataracts. Whether the benefits of a vegetarian diet outweigh its risks in the development of cataracts warrants investigation.

Objective: Our aim was to study the prospective association between a Taiwanese vegetarian dietary pattern and cataract risk.

Design: This was a prospective cohort study.

Participants/setting: The Tzu Chi Health Study recruited 6,002 participants from 2007 to 2009 at Dalin Tzu Chi Hospital. Diet was assessed through a validated food frequency questionnaire. Participants 40 years and older and without cataracts at recruitment (3,095 nonvegetarians and 1,341 vegetarians) were followed until the end of 2014, death, or occurrence of cataracts.

Main outcome measures: Cataract incident cases ((International Classification of Diseases, 9th Revision, Clinical Modification code 366) were identified by linkage to the National Health Insurance Research Database in Taiwan.

Statistical analysis: Cox proportional hazard regression with age as the underlying scale was used to estimate the association between dietary patterns and cataract risk while adjusting for potential confounders.

Results: Compared with nonvegetarians, vegetarians had higher intakes of soy, vegetables, nuts, whole grains, dietary fiber, vitamin C, folate, and vitamin A equivalent. In the 25,103 person-years of follow-up, 476 incident cases of cataracts were identified. A vegetarian diet was associated with a 20% reduced risk of cataracts (hazard ratio 0.80, 95% CI 0.65 to 0.99; P = 0.04) after adjusting for sex, education, smoking, alcohol drinking habits, physical activities, Tzu Chi volunteer status, hypertension, diabetes, hyperlipidemia, corticosteroid prescription, and body mass index (calculated as kg/m2). This association was more pronounced among individuals with overweight (defined as body mass index ≥24 in Taiwan [hazard ratio 0.70, 95% CI 0.50 to 0.99; P = 0.04]).

Conclusions: A vegetarian diet was associated with a lower risk of cataracts, particularly in study participants with overweight.

Keywords: Cataract; Smoking; Taiwan; Tzu Chi Health Study; Vegetarian diet.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Cataract / prevention & control*
  • Cohort Studies
  • Confounding Factors, Epidemiologic
  • Diet, Vegetarian*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Overweight / epidemiology
  • Proportional Hazards Models
  • Prospective Studies
  • Taiwan / epidemiology