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Association of Dairy Consumption with Metabolic Syndrome, Hypertension and Diabetes in 147,812 Individuals from 21 Countries

39 Pages Posted: 19 Feb 2019

See all articles by Bhavadharini Balaji

Bhavadharini Balaji

David Braley Cardiac, Vascular and Stroke Research Institute (DBCVSRI) - Population Health Research Institute; Hamilton Health Sciences; McMaster University

Mahshid Dehghan

David Braley Cardiac, Vascular and Stroke Research Institute (DBCVSRI) - Population Health Research Institute

Andrew Mente

McMaster University

Sumathy Rangarajan

David Braley Cardiac, Vascular and Stroke Research Institute (DBCVSRI) - Population Health Research Institute

Patrick Sheridan

David Braley Cardiac, Vascular and Stroke Research Institute (DBCVSRI) - Population Health Research Institute

Viswanathan Mohan

Madras Diabetes Research Foundation

Romaina Iqbal

Aga Khan University

Rajeev Gupta

Eternal Heart Care Centre and Research Institute

Scott Lear

Simon Fraser University (SFU) - Faculty of Health Sciences

Edelweiss-Wentzel Viljoen

North-West University

Alvaro Avezum

Dante Pazzanese Institute of Cardiology

Patricio Lopez-Jaramillo

University of Santander (UDES)

Prem Mony

St. John's Medical College & Research Institute - Division of Epidemiology & Population Health

Ravi Prasad Varma

Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Achutha Menon Centre for Health Science Studies Health Action by People

Rajesh Kumar

Post Graduate Institute of Medical Education & Research (PGIMER)

Jephat Chifamba

University of Zimbabwe

Khalid F. Alhabib

King Saud University - College of Medicine

Noushin Mohammadifard

Isfahan University of Medical Sciences

Aytekin Oguz

Istanbul Medeniyet University

Fernando Lanas

Universidad de la Frontera

Dorota Rozanska

Wroclaw Medical University

Kristina Bengtsson

University of Gothenburg - Sahlgrenska Academy

Khalid Yusoff

Universiti Teknologi MARA (UiTM)

Lungiswa P. Tsolkile

University of the Western Cape - School of Public Health

Antonio Dans

University of the Philippines, Manila

Afzal Hussein Yusufali

Dubai Medical University

Andres Orlandini

Estudios Clínicos Latinoamérica

Paul Poirier

Université Laval

Rasha Khatib

Northwestern University - Feinberg School of Medicine

Bo Hu

Chinese Academy of Medical Sciences - Peking Union Medical College

Li Wei

Chinese Academy of Medical Sciences - Peking Union Medical College

Lu Yin

Chinese Academy of Medical Sciences - Peking Union Medical College

Ai Deeraili

Center for Disease Control and Prevention of Xinjiang Hetian

Karen Yeates

Queen's University - Department of Medicine

Rita Yusuf

Independent University, Bangladesh (IUB)

Noorhassim Ismail

National University of Malaysia (UKM) - Medical Centre

Dariush Mozaffarian

Tufts University - Friedman School of Nutrition Science and Policy

Koon Teo

McMaster University

Sonia Anand

McMaster University

Salim Yusuf

David Braley Cardiac, Vascular and Stroke Research Institute (DBCVSRI) - Population Health Research Institute; Hamilton Health Sciences; McMaster University

More...

Abstract

Background: Associations of dairy foods, including whole-fat versus low-fat and specific types of dairy, with metabolic syndrome (MetS), hypertension (HTN) and diabetes mellitus (DM) are not well established, especially in diverse global populations.

Methods: The Prospective Urban Rural Epidemiology (PURE) study is a prospective cohort study of individuals aged 35 and 70 years from 21 countries with 9·1 years follow up. Dietary intake of 147,812 individuals was recorded using country specific validated food frequency questionnaires. At baseline, we examined the association of total dairy and types of dairy with the prevalence of MetS and its components. During follow-up, the associations between dairy intake with incident HTN and DM were examined.

Findings: In multivariable-adjusted analyses, lower prevalence of MetS was seen with higher intake of total dairy (>=2 servings/d vs zero serving/day; OR 0·76; 95%CI 0·71-0·80, p-trend <0·0001) and whole-fat dairy (OR 0·72; 95%CI 0·66-0·78, p-trend<0·0001). Total dairy and whole-fat dairy intake, but not low-fat dairy, were also associated with more favourable levels of each individual component of MetS except HDL-C (no significant association). Milk, yoghurt, cheese, and butter were individually associated with a lower prevalence of MetS. During follow-up, 13,640 cases of incident HTN and 5,351 cases of incident DM were recorded. Higher intake of total and whole fat (but not low fat) dairy were associated with a lower incidence of HTN (HR 0·89; 95%CI 0·82-0·97, ptrend=0·02) and DM (HR 0·88; 95%CI 0·76-1·02, p-trend=0·01), with consistent results across geographic regions.

Interpretation: Higher intake of total dairy and whole-fat (but not low fat) dairy were associated with a lower prevalence of MetS and most of its component factors, and with a lower incidence of HTN and DM. Our findings should be evaluated in large randomized trials evaluating the effects of whole fat dairy on the risks of MetS, hypertension, and diabetes.

Funding Statement: Dr S Yusuf is supported by the Mary W Burke endowed chair of the Heart and Stroke Foundation of Ontario. The PURE study is an investigator-initiated study that is funded by the Population Health Research Institute, the Canadian Institutes of Health Research, Heart and Stroke Foundation of Ontario, Support from Canadian Institutes of Health Research’s Strategy for Patient Oriented Research, through the Ontario SPOR Support Unit, as well as the Ontario Ministry of Health and Long-Term Care and through unrestricted grants from several pharmaceutical companies [with major contributions from AstraZeneca (Canada), Sanofi-Aventis (France and Canada), Boehringer Ingelheim (Germany and Canada), Servier, and GlaxoSmithKline], and additional contributions from Novartis and King Pharma and from various national or local organisations in participating countries. These include: Argentina: Fundacion ECLA (Estudios Clínicos Latino America) ; Bangladesh: Independent University, Bangladesh and Mitra and Associates; Brazil: Unilever Health Institute, Brazil; Canada: Public Health Agency of Canada and Champlain Cardiovascular Disease Prevention Network; This study was supported by an unrestricted grant from Dairy Farmers of Canada and the National Dairy Council (U.S.). Chile: Universidad de la Frontera; China: National Center for Cardiovascular Diseases and ThinkTank Research Center for Health Development; Colombia: Colciencias (grant number: 6566-04-18062); India: Indian Council of Medical Research; Malaysia: Ministry of Science, Technology and Innovation of Malaysia (grant number: 100-IRDC/BIOTEK 16/6/21 [13/2007], and 07-05-IFN-BPH 010), Ministry of Higher Education of Malaysia (grant number: 600- RMI/LRGS/5/3 [2/2011]), Universiti Teknologi MARA, Universiti Kebangsaan Malaysia (UKMHejim-Komuniti-15-2010); Occupied Palestinian territory: the United Nations Relief and Works Agency for Palestine Refugees in the Near East, occupied Palestinian territory; International Development Research Centre, Canada; Philippines: Philippine Council for Health Research and Development; Poland: Polish Ministry of Science and Higher Education (grant number: 290/W-PURE/2008/0), Wroclaw Medical University; Saudi Arabia: Saudi Heart Association, Dr. Mohammad Alfagih Hospital, The Deanship of Scientific Research at King Saud University, Riyadh, Saudi Arabia (Research group number: RG-1436-013); South Africa: The North-West University, SA and Netherlands Programme for Alternative Development, National Research Foundation, Medical Research Council of South Africa, The South Africa Sugar Association, Faculty of Community and Health Sciences; Sweden: Grants from the Swedish state under the Agreement concerning research and education of doctors; the Swedish Heart and Lung Foundation; the Swedish Research Council; the Swedish Council for Health, Working Life and Welfare, King Gustaf V:s and Queen Victoria Freemason’s Foundation, AFA Insurance; Turkey: Metabolic Syndrome Society, AstraZeneca, Sanofi Aventis; United Arab Emirates: Sheikh Hamdan Bin Rashid Al Maktoum Award For Medical Sciences and Dubai Health Authority, Dubai. Role of Sponsor: The funders and sponsors had no role in the design and conduct of the study; in the collection, analysis, and interpretation of the data; in the preparation, review, or approval of the manuscript; or in the decision to submit the manuscript for publication.

Declaration of Interests: The authors declare no competing interests.

Ethics Approval Statement: The protocol was approved by the ethics committee at each participating centre and all participants provided written informed consent. Data were transferred to the Population Health Research Institute (PHRI) Hamilton, ON, Canada, where additional checks were undertaken.

Keywords: dairy, metabolic syndrome, diabetes, hypertension, global

Suggested Citation

Balaji, Bhavadharini and Dehghan, Mahshid and Mente, Andrew and Rangarajan, Sumathy and Sheridan, Patrick and Mohan, Viswanathan and Iqbal, Romaina and Gupta, Rajeev and Lear, Scott and Viljoen, Edelweiss-Wentzel and Avezum, Alvaro and Lopez-Jaramillo, Patricio and Mony, Prem and Varma, Ravi Prasad and Kumar, Rajesh and Chifamba, Jephat and Alhabib, Khalid F. and Mohammadifard, Noushin and Oguz, Aytekin and Lanas, Fernando and Rozanska, Dorota and Bengtsson, Kristina and Yusoff, Khalid and Tsolkile, Lungiswa P. and Dans, Antonio and Yusufali, Afzal Hussein and Orlandini, Andres and Poirier, Paul and Khatib, Rasha and Hu, Bo and Wei, Li and Yin, Lu and Deeraili, Ai and Yeates, Karen and Yusuf, Rita and Ismail, Noorhassim and Mozaffarian, Dariush and Teo, Koon and Anand, Sonia and Yusuf, Salim, Association of Dairy Consumption with Metabolic Syndrome, Hypertension and Diabetes in 147,812 Individuals from 21 Countries (February 15, 2019). Available at SSRN: https://ssrn.com/abstract=3335038 or http://dx.doi.org/10.2139/ssrn.3335038

Bhavadharini Balaji (Contact Author)

David Braley Cardiac, Vascular and Stroke Research Institute (DBCVSRI) - Population Health Research Institute ( email )

Canada

Hamilton Health Sciences ( email )

McMaster University Medical Centre
1200 Main Street West
Hamilton, Ontario L8S 4J9
Canada

McMaster University ( email )

1280 Main Street West
Hamilton, Ontario L8S 4M4
Canada

Mahshid Dehghan

David Braley Cardiac, Vascular and Stroke Research Institute (DBCVSRI) - Population Health Research Institute

Andrew Mente

McMaster University

1280 Main Street West
Hamilton, Ontario L8S 4M4
Canada

Sumathy Rangarajan

David Braley Cardiac, Vascular and Stroke Research Institute (DBCVSRI) - Population Health Research Institute

Canada

Patrick Sheridan

David Braley Cardiac, Vascular and Stroke Research Institute (DBCVSRI) - Population Health Research Institute

Canada

Viswanathan Mohan

Madras Diabetes Research Foundation

Chennai
India

Romaina Iqbal

Aga Khan University

Stadium Road, P.O. Box 3500
Karachi, 74800
Pakistan

Rajeev Gupta

Eternal Heart Care Centre and Research Institute

Jaipur
India

Scott Lear

Simon Fraser University (SFU) - Faculty of Health Sciences

8888 University Drive
Burnaby, British Columbia V5A 1S6
Canada

Edelweiss-Wentzel Viljoen

North-West University

Private Bag X6001
Faculty of Economic and Management Sciences
Potchefstroom, Northwest 2520
South Africa

Alvaro Avezum

Dante Pazzanese Institute of Cardiology

Sao Paulo
Brazil

Patricio Lopez-Jaramillo

University of Santander (UDES)

Floridablanca-Santander
Colombia

Prem Mony

St. John's Medical College & Research Institute - Division of Epidemiology & Population Health

Bangalore
India

Ravi Prasad Varma

Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Achutha Menon Centre for Health Science Studies Health Action by People

Medical College P.O.
Trivandrum, Kerala 695011
India

Rajesh Kumar

Post Graduate Institute of Medical Education & Research (PGIMER)

Department of Community Medicine and Schoo
PGIMER, Sec. 12
Chandigarh, 160012
India

Jephat Chifamba

University of Zimbabwe

c/o Hall Farm, Wenhaston
Suffolk Ip19 9HE, Mashonaland
Zimbabwe

Khalid F. Alhabib

King Saud University - College of Medicine

Saudi Arabia

Noushin Mohammadifard

Isfahan University of Medical Sciences

Hezar Jerib Avenue
Isfahan, 81745
Iran

Aytekin Oguz

Istanbul Medeniyet University

D-100 Karayolu
Merdivenkoy Mevkii No:6/1 Goztepe/Kadıkoy
Istanbul
Turkey

Fernando Lanas

Universidad de la Frontera

Temuco
Chile

Dorota Rozanska

Wroclaw Medical University

Rektorat, wybrzeże Ludwika Pasteura 1
Wroclaw, 50-367
Poland

Kristina Bengtsson

University of Gothenburg - Sahlgrenska Academy

PO Box 400
Göteborg, SE405 30
Sweden

Khalid Yusoff

Universiti Teknologi MARA (UiTM)

40450 Shah Alam
Johor
Dungun, Selangor 23000
Malaysia

Lungiswa P. Tsolkile

University of the Western Cape - School of Public Health

Cape Town
South Africa

Antonio Dans

University of the Philippines, Manila

Padre Faura Street
Ermita
Manila, Metro Manila 1000
Philippines

Afzal Hussein Yusufali

Dubai Medical University

Dubai
United Arab Emirates

Andres Orlandini

Estudios Clínicos Latinoamérica

Sante Fe
Argentina

Paul Poirier

Université Laval

2214 Pavillon J-A. DeSeve
Quebec, Quebec G1K 7P4
Canada

Rasha Khatib

Northwestern University - Feinberg School of Medicine

Chicago, IL 60611
United States

Bo Hu

Chinese Academy of Medical Sciences - Peking Union Medical College

NO. 9, Dongdan Santiao
Beijing, Dongcheng District
China

Li Wei

Chinese Academy of Medical Sciences - Peking Union Medical College

NO. 9, Dongdan Santiao
Beijing, Dongcheng District
China

Lu Yin

Chinese Academy of Medical Sciences - Peking Union Medical College

NO. 9, Dongdan Santiao
Beijing, Dongcheng District
China

Ai Deeraili

Center for Disease Control and Prevention of Xinjiang Hetian

Xinjiang
China

Karen Yeates

Queen's University - Department of Medicine

Kingston, Ontario
Canada

Rita Yusuf

Independent University, Bangladesh (IUB)

Plot 16 Block B, Aftabuddin Ahmed Road Bashundhara
Bashundhara R/A
Dhaka, 1229
Bangladesh

Noorhassim Ismail

National University of Malaysia (UKM) - Medical Centre

Kuala Lumpur
Malaysia

Dariush Mozaffarian

Tufts University - Friedman School of Nutrition Science and Policy

150 Harrison Avenue
Boston, MA 02111
United States

Koon Teo

McMaster University

1280 Main Street West
Hamilton, Ontario L8S 4M4
Canada

Sonia Anand

McMaster University

1280 Main Street West
Hamilton, Ontario L8S 4M4
Canada

Salim Yusuf

David Braley Cardiac, Vascular and Stroke Research Institute (DBCVSRI) - Population Health Research Institute ( email )

Canada

Hamilton Health Sciences ( email )

McMaster University Medical Centre
1200 Main Street West
Hamilton, Ontario L8S 4J9
Canada

McMaster University ( email )

1280 Main Street West
Hamilton, Ontario L8S 4M4
Canada

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