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The association between dairy product intake and cardiovascular disease mortality in Chinese adults

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Abstract

Purpose

To evaluate the relation of dairy intake with risk of CVD mortality in middle-aged and elderly Chinese in Singapore.

Methods

The Singapore Chinese Health Study is a population-based cohort that recruited 63,257 Chinese adults aged 45–74 years from 1993 to 1998 in Singapore. A validated 165-item semiquantitative food-frequency questionnaire was used to assess usual diet at recruitment. Mortality information was obtained via registry linkage up to December 31, 2011. Cox proportional hazard models were used to calculate hazard ratios (HRs) and corresponding 95 % confidence intervals (95 % CIs) with adjustment for potential confounders, including socio-demographic, lifestyle, and other dietary factors.

Results

Among those without prior history of CVD, the multivariate-adjusted HRs (95 % CIs) comparing the highest (median intake 252 g/d) with lowest (median intake 1.32 g/d) quartiles of total dairy intake were 0.95 (0.87–1.04; P-trend = 0.64) for CVD death, 0.99 (0.89–1.11; P-trend = 0.76) for coronary heart disease (CHD) death, and 0.82 (0.69–0.97; P-trend = 0.03) for stroke death. The significant inverse association with stroke mortality was stronger in men (comparing the highest with the lowest quartiles, HR = 0.71; 95 % CI 0.55–0.92; P-trend = 0.006) than in women (HR = 0.86; 0.65–1.12; P-trend = 0.23), and the interaction test was significant (P = 0.03). No statistically significant associations between total dairy intake and CVD mortality were observed in participants with prior history of CVD (all P-trend >0.40).

Conclusions

In a cohort of Chinese adults with generally low dairy consumption, higher intake of dairy products was associated with a decreased risk of stroke mortality, particularly in men.

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References

  1. GBD 2013 Mortality and Causes of Death Collaborators (2015) Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 385:117–171. doi:10.1016/S0140-6736(14)61682-2

    Article  Google Scholar 

  2. Sarrafzadegan N, Gotay C (2015) CVD prevention in 2014: advances in the prevention of cardiovascular disease. Nat Rev Cardiol 12:71–73. doi:10.1038/nrcardio.2014.209

    Article  Google Scholar 

  3. Rice BH (2014) Dairy and cardiovascular disease: a review of recent observational research. Curr Nutr Rep 3:130–138. doi:10.1007/s13668-014-0076-4

    Article  CAS  Google Scholar 

  4. Ralston RA, Lee JH, Truby H, Palermo CE, Walker KZ (2012) A systematic review and meta-analysis of elevated blood pressure and consumption of dairy foods. J Hum Hypertens 26:3–13. doi:10.1038/jhh.2011.3

    Article  CAS  Google Scholar 

  5. Soedamah-Muthu SS, Verberne LD, Ding EL, Engberink MF, Geleijnse JM (2012) Dairy consumption and incidence of hypertension: a dose-response meta-analysis of prospective cohort studies. Hypertension 60:1131–1137. doi:10.1161/HYPERTENSIONAHA.112.195206

    Article  CAS  Google Scholar 

  6. Tong X, Dong JY, Wu ZW, Li W, Qin LQ (2011) Dairy consumption and risk of type 2 diabetes mellitus: a meta-analysis of cohort studies. Eur J Clin Nutr 65:1027–1031. doi:10.1038/ejcn.2011.62

    Article  CAS  Google Scholar 

  7. Astrup A (2014) Yogurt and dairy product consumption to prevent cardiometabolic diseases: epidemiologic and experimental studies. Am J Clin Nutr 99:1235S–1242S. doi:10.3945/ajcn.113.073015

    Article  CAS  Google Scholar 

  8. Li Y, Hruby A, Bernstein AM, Ley SH, Wang DD, Chiuve SE, Sampson L, Rexrode KM, Rimm EB, Willett WC, Hu FB (2015) Saturated fats compared with unsaturated fats and sources of carbohydrates in relation to risk of coronary heart disease: a prospective cohort Study. J Am Coll Cardiol 66:1538–1548. doi:10.1016/j.jacc.2015.07.055

    Article  CAS  Google Scholar 

  9. Kinjo Y, Beral V, Akiba S, Key T, Mizuno S, Appleby P, Yamaguchi N, Watanabe S, Doll R (1999) Possible protective effect of milk, meat and fish for cerebrovascular disease mortality in Japan. J Epidemiol 9:268–274

    Article  CAS  Google Scholar 

  10. Abbott RD, Curb JD, Rodriguez BL, Sharp DS, Burchfiel CM, Yano K (1996) Effect of dietary calcium and milk consumption on risk of thromboembolic stroke in older middle-aged men the Honolulu heart program. Stroke 27:813–818

    Article  CAS  Google Scholar 

  11. Elwood PC, Strain JJ, Robson PJ, Fehily AM, Hughes J, Pickering J, Ness A (2005) Milk consumption, stroke, and heart attack risk: evidence from the Caerphilly cohort of older men. J Epidemiol Community Health 59:502–505. doi:10.1136/jech.2004.027904

    Article  CAS  Google Scholar 

  12. Ness AR, Smith GD, Hart C (2001) Milk, coronary heart disease and mortality. J Epidemiol Community Health 55:379–382

    Article  CAS  Google Scholar 

  13. Appleby PN, Thorogood M, Mann JI, Key TJ (1999) The Oxford vegetarian study: an overview. Am J Clin Nutr 70:525S–531S

    CAS  Google Scholar 

  14. Larsson SC, Mannisto S, Virtanen MJ, Kontto J, Albanes D, Virtamo J (2009) Dairy foods and risk of stroke. Epidemiology 20:355–360. doi:10.1097/EDE.0b013e3181935dd5

    Article  Google Scholar 

  15. Iso H, Stampfer MJ, Manson JE, Rexrode K, Hennekens CH, Colditz GA, Speizer FE, Willett WC (1999) Prospective study of calcium, potassium, and magnesium intake and risk of stroke in women. Stroke 30:1772–1779

    Article  CAS  Google Scholar 

  16. Sauvaget C, Nagano J, Allen N, Grant EJ, Beral V (2003) Intake of animal products and stroke mortality in the Hiroshima/Nagasaki life span study. Int J Epidemiol 32:536–543

    Article  Google Scholar 

  17. Bostick RM, Kushi LH, Wu Y, Meyer KA, Sellers TA, Folsom AR (1999) Relation of calcium, vitamin D, and dairy food intake to ischemic heart disease mortality among postmenopausal women. Am J Epidemiol 149:151–161

    Article  CAS  Google Scholar 

  18. Elwood PC, Pickering JE, Fehily AM, Hughes J, Ness AR (2004) Milk drinking, ischaemic heart disease and ischaemic stroke I. Evidence from the Caerphilly cohort. Eur J Clin Nutr 58:711–717. doi:10.1038/sj.ejcn.1601868

    Article  CAS  Google Scholar 

  19. Mann JI, Appleby PN, Key TJ, Thorogood M (1997) Dietary determinants of ischaemic heart disease in health conscious individuals. Heart 78:450–455

    Article  CAS  Google Scholar 

  20. Dalmeijer GW, Struijk EA, van der Schouw YT, Soedamah-Muthu SS, Verschuren WM, Boer JM, Geleijnse JM, Beulens JW (2013) Dairy intake and coronary heart disease or stroke–a population-based cohort study. Int J Cardiol 167:925–929. doi:10.1016/j.ijcard.2012.03.094

    Article  Google Scholar 

  21. Soedamah-Muthu SS, Masset G, Verberne L, Geleijnse JM, Brunner EJ (2013) Consumption of dairy products and associations with incident diabetes, CHD and mortality in the Whitehall II study. Br J Nutr 109:718–726. doi:10.1017/s0007114512001845

    Article  CAS  Google Scholar 

  22. Larsson SC, Virtamo J, Wolk A (2012) Dairy consumption and risk of stroke in Swedish women and men. Stroke 43:1775–1780. doi:10.1161/strokeaha.111.641944

    Article  CAS  Google Scholar 

  23. Bonthuis M, Hughes MC, Ibiebele TI, Green AC, van der Pols JC (2010) Dairy consumption and patterns of mortality of Australian adults. Eur J Clin Nutr 64:569–577. doi:10.1038/ejcn.2010.45

    Article  CAS  Google Scholar 

  24. Louie JC, Flood VM, Burlutsky G, Rangan AM, Gill TP, Mitchell P (2013) Dairy consumption and the risk of 15-year cardiovascular disease mortality in a cohort of older Australians. Nutrients 5:441–454. doi:10.3390/nu5020441

    Article  Google Scholar 

  25. van Aerde MA, Soedamah-Muthu SS, Geleijnse JM, Snijder MB, Nijpels G, Stehouwer CD, Dekker JM (2013) Dairy intake in relation to cardiovascular disease mortality and all-cause mortality: the Hoorn study. Eur J Nutr 52:609–616. doi:10.1007/s00394-012-0363-z

    Article  Google Scholar 

  26. Patterson E, Larsson SC, Wolk A, Akesson A (2013) Association between dairy food consumption and risk of myocardial infarction in women differs by type of dairy food. J Nutr 143:74–79. doi:10.3945/jn.112.166330

    Article  CAS  Google Scholar 

  27. Kondo I, Ojima T, Nakamura M, Hayasaka S, Hozawa A, Saitoh S, Ohnishi H, Akasaka H, Hayakawa T, Murakami Y, Okuda N, Miura K, Okayama A, Ueshima H (2013) Consumption of dairy products and death from cardiovascular disease in the Japanese general population: the NIPPON DATA80. J Epidemiol 23:47–54

    Article  Google Scholar 

  28. Soedamah-Muthu SS, Ding EL, Al-Delaimy WK, Hu FB, Engberink MF, Willett WC, Geleijnse JM (2011) Milk and dairy consumption and incidence of cardiovascular diseases and all-cause mortality: dose-response meta-analysis of prospective cohort studies. Am J Clin Nutr 93:158–171. doi:10.3945/ajcn.2010.29866

    Article  CAS  Google Scholar 

  29. Maruyama K, Iso H, Date C, Kikuchi S, Watanabe Y, Wada Y, Inaba Y, Tamakoshi A, Group JS (2013) Dietary patterns and risk of cardiovascular deaths among middle-aged Japanese: JACC study. Nutr Metab Cardiovasc Dis 23:519–527. doi:10.1016/j.numecd.2011.10.007

    Article  CAS  Google Scholar 

  30. Hu D, Huang J, Wang Y, Zhang D, Qu Y (2014) Dairy foods and risk of stroke: a meta-analysis of prospective cohort studies. Nutr Metab Cardiovasc Dis 24:460–469. doi:10.1016/j.numecd.2013.12.006

    Article  CAS  Google Scholar 

  31. Qin LQ, Xu JY, Han SF, Zhang ZL, Zhao YY, Szeto IM (2015) Dairy consumption and risk of cardiovascular disease: an updated meta-analysis of prospective cohort studies. Asia Pac J Clin Nutr 24:90–100. doi:10.6133/apjcn.2015.24.1.09

    Google Scholar 

  32. Sun Y, Jiang C, Cheng KK, Zhang W, Leung GM, Lam TH, Schooling CM (2014) Milk consumption and cardiovascular risk factors in older Chinese: the Guangzhou Biobank Cohort study. PLoS ONE 9:e84813. doi:10.1371/journal.pone.0084813

    Article  Google Scholar 

  33. Hankin JH, Stram DO, Arakawa K, Park S, Low SH, Lee HP, Yu MC (2001) Singapore Chinese health study: development, validation, and calibration of the quantitative food frequency questionnaire. Nutr Cancer 39:187–195. doi:10.1207/S15327914nc392_5

    Article  CAS  Google Scholar 

  34. Willett W, Stampfer MJ (2013) Implications of total energy intake for epidemiologic analysis. In: Willett W (ed) Nutritional epidemiology. Oxford University Press, Oxford, p 260

    Google Scholar 

  35. Elwood PC, Pickering JE, Givens DI, Gallacher JE (2010) The consumption of milk and dairy foods and the incidence of vascular disease and diabetes: an overview of the evidence. Lipids 45:925–939. doi:10.1007/s11745-010-3412-5

    Article  CAS  Google Scholar 

  36. Eguchi E, Iso H, Tanabe N, Wada Y, Yatsuya H, Kikuchi S, Inaba Y, Tamakoshi A, Japan Collaborative Cohort Study G (2012) Healthy lifestyle behaviours and cardiovascular mortality among Japanese men and women: the Japan collaborative cohort study. Eur Heart J 33:467–477. doi:10.1093/eurheartj/ehr429

    Article  Google Scholar 

  37. Huang LY, Wahlqvist ML, Huang YC, Lee MS (2014) Optimal dairy intake is predicated on total, cardiovascular, and stroke mortalities in a Taiwanese cohort. J Am Coll Nutr 33:426–436. doi:10.1080/07315724.2013.875328

    Article  CAS  Google Scholar 

  38. Lin PH, Yeh WT, Svetkey LP, Chuang SY, Chang YC, Wang C, Pan WH (2013) Dietary intakes consistent with the DASH dietary pattern reduce blood pressure increase with age and risk for stroke in a Chinese population. Asia Pac J Clin Nutr 22:482–491. doi:10.6133/apjcn.2013.22.3.05

    CAS  Google Scholar 

  39. Health Promotion Board (2016) Build a healthy food foundation. http://www.hpb.gov.sg/HOPPortal/health-article/2638. Accessed 17 Feb 2016

  40. Rice BH, Cifelli CJ, Pikosky MA, Miller GD (2011) Dairy components and risk factors for cardiometabolic syndrome: recent evidence and opportunities for future research. Adv Nutr 2:396–407. doi:10.3945/an.111.000646

    Article  CAS  Google Scholar 

  41. Astrup A (2014) A changing view on saturated fatty acids and dairy: from enemy to friend. Am J Clin Nutr 100:1407–1408. doi:10.3945/ajcn.114.099986

    Article  CAS  Google Scholar 

  42. de Oliveira Otto MC, Nettleton JA, Lemaitre RN, Steffen LM, Kromhout D, Rich SS, Tsai MY, Jacobs DR, Mozaffarian D (2013) Biomarkers of dairy fatty acids and risk of cardiovascular disease in the Multi-ethnic study of Atherosclerosis. J Am Heart Assoc 2:e000092. doi:10.1161/jaha.113.000092

    Google Scholar 

  43. Mozaffarian D, de Oliveira Otto MC, Lemaitre RN, Fretts AM, Hotamisligil G, Tsai MY, Siscovick DS, Nettleton JA (2013) Trans-Palmitoleic acid, other dairy fat biomarkers, and incident diabetes: the Multi-Ethnic Study of Atherosclerosis (MESA). Am J Clin Nutr 97:854–861. doi:10.3945/ajcn.112.045468

    Article  CAS  Google Scholar 

  44. Forouhi NG, Koulman A, Sharp SJ, Imamura F, Kroger J, Schulze MB, Crowe FL, Huerta JM, Guevara M, Beulens JW, van Woudenbergh GJ, Wang L, Summerhill K, Griffin JL, Feskens EJ, Amiano P, Boeing H, Clavel-Chapelon F, Dartois L, Fagherazzi G, Franks PW, Gonzalez C, Jakobsen MU, Kaaks R, Key TJ, Khaw KT, Kuhn T, Mattiello A, Nilsson PM, Overvad K, Pala V, Palli D, Quiros JR, Rolandsson O, Roswall N, Sacerdote C, Sanchez MJ, Slimani N, Spijkerman AM, Tjonneland A, Tormo MJ, Tumino R, van der A DL, van der Schouw YT, Langenberg C, Riboli E, Wareham NJ (2014) Differences in the prospective association between individual plasma phospholipid saturated fatty acids and incident type 2 diabetes: the EPIC-InterAct case-cohort study. Lancet Diabetes Endocrinol 2:810–818. doi:10.1016/S2213-8587(14)70146-9

    Article  CAS  Google Scholar 

  45. Santaren ID, Watkins SM, Liese AD, Wagenknecht LE, Rewers MJ, Haffner SM, Lorenzo C, Hanley AJ (2014) Serum pentadecanoic acid (15:0), a short-term marker of dairy food intake, is inversely associated with incident type 2 diabetes and its underlying disorders. Am J Clin Nutr 100:1532–1540. doi:10.3945/ajcn.114.092544

    Article  CAS  Google Scholar 

  46. Mozaffarian D, Cao H, King IB, Lemaitre RN, Song X, Siscovick DS, Hotamisligil GS (2010) Trans-palmitoleic acid, metabolic risk factors, and new-onset diabetes in U.S. adults: a cohort study. Ann Intern Med 153:790–799. doi:10.7326/0003-4819-153-12-201012210-00005

    Article  Google Scholar 

  47. Xu JY, Qin LQ, Wang PY, Li W, Chang C (2008) Effect of milk tripeptides on blood pressure: a meta-analysis of randomized controlled trials. Nutrition 24:933–940. doi:10.1016/j.nut.2008.04.004

    Article  CAS  Google Scholar 

  48. Norman PE, Powell JT (2014) Vitamin D and cardiovascular disease. Circ Res 114:379–393. doi:10.1161/CIRCRESAHA.113.301241

    Article  CAS  Google Scholar 

  49. Yang Z, Laillou A, Smith G, Schofield D, Moench-Pfanner R (2013) A review of vitamin D fortification: implications for nutrition programming in Southeast Asia. Food Nutr Bull 34:S81–S89

    Article  Google Scholar 

  50. Health Promotion Board (1999) National Health Survey 1998, Singapore. Ministry of Health, Epidemiology and Disease Control Department, Singapore. http://www.hpb.gov.sg/HOPPortal/content/conn/HOPUCM/path/Contribution%20Folders/uploadedFiles/HPB_Online/Publications/nationalnutritionsurvey1998.pdf. Accessed 16 May 2016

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Acknowledgments

We thank Siew-Hong Low of the National University of Singapore for supervising the field work of the Singapore Chinese Health Study and Dr. Naeime Hosseini for assisting us with literature review. Finally, we acknowledge the founding principal investigator of the Singapore Chinese Health Study, Dr. Mimi C. Yu.

Author contributions

W.P.K., A.P.: designed and conducted research, and supervised data analysis; M.T.: analyzed data and wrote the first draft; W.P.K., J.M.Y.: assisted in interpreting the data and edited the paper; A.P. had primary responsibility for final content. All authors read and approved the final manuscript.

Funding sources

The Singapore Chinese Health Study was supported by the United States National Institutes of Health (NCI R01 CA144034 and UM1 CA182876). MT is supported by SINGA Scholarship. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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Authors and Affiliations

  1. Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore

    Mohammad Talaei & Woon-Puay Koh

  2. Duke-NUS Graduate Medical School, Singapore, Singapore

    Woon-Puay Koh

  3. Division of Cancer Control and Population Sciences, University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA

    Jian-Min Yuan

  4. Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA

    Jian-Min Yuan

  5. MOE Key Laboratory of Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China

    An Pan

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  1. Mohammad Talaei
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Correspondence to An Pan.

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M. Talaei, W.P. Koh, J.M. Yuan, and A. Pan have no conflicts of interest.

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Talaei, M., Koh, WP., Yuan, JM. et al. The association between dairy product intake and cardiovascular disease mortality in Chinese adults. Eur J Nutr 56, 2343–2352 (2017). https://doi.org/10.1007/s00394-016-1274-1

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