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Dairy product consumption reduces cardiovascular mortality: results after 8 year follow-up of ELSA-Brasil

Abstract

Purpose

To investigate whether the consumption of dairy products and their subgroups is associated with the risk of death from cardiovascular disease (CVD) after 8-year follow-up, and verify if dairy products predict changes in high-sensitivity C-reactive protein (hs-CRP) between two follow-up visits of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).

Methods

Prospective study with 6671 participants without CVD at baseline. Consumption in grams/day of total dairy, full-fat and low-fat dairy, fermented dairy, and milk was obtained through a food frequency questionnaire and categorized into sex-specific quartiles. Cox regression and linear mixed-effect models were used to estimate associations of dairy products intake with death from CVD and changes in hs-CRP levels, respectively.

Results

After adjustments, individuals in the 3rd and 4th quartiles of total dairy consumption presented, respectively, 62% (HR 0.38; 95% CI 0.15–0.99) and 64% (HR 0.36; 95% CI 0.14–0.94) lower hazards of death from CVD compared to the 1st quartile. Also, participants in the 4th quartile of milk consumption had 66% (HR 0.34; 95% CI 0.14–0.86) lower hazard to die from CVD, but only the 2nd quartile of full-fat dairy consumption indicated a lower hazard to die from CVD (HR 0.30; 95% CI 0.10–0.92). No association was observed between low-fat or fermented dairy products and cardiovascular mortality. Consumption of total dairy and their subgroups did not predict changes in hs-CRP levels after 4-year follow-up.

Conclusion

Results suggest beneficial effects of total dairy and milk, but only low-to-moderate full-fat dairy consumption, on the risk of death from CVD. Assuming true effects, public policies should encourage the consumption of dairy products, especially milk.

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Data and/or code availability

The data presented in this study are available on request from the corresponding author. The data are not publicly available due to privacy constraints.

References

  1. Guo J, Astrup A, Lovegrove JA, Gijsbers L, Givens DI, Soedamah-Muthu SS (2017) Milk and dairy consumption and risk of cardiovascular diseases and all-cause mortality: dose-response meta-analysis of prospective cohort studies. Eur J Epidemiol 32(4):269–287. https://doi.org/10.1007/s10654-017-0243-1

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  2. Larsson SC, Crippa A, Orsini N, Wolk A, Michaëlsson K (2015) Milk consumption and mortality from all causes, cardiovascular disease, and cancer: a systematic review and meta-analysis. Nutrients 7(9):7749–7763. https://doi.org/10.3390/nu7095363

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  3. Mullie P, Pizot C, Autier P (2016) Daily milk consumption and all-cause mortality, coronay heart disease and stroke: a systematic review and meta-analysis of observational cohort studies. BMC Public Health 16(1):1236. https://doi.org/10.1186/s12889-016-3889-9

    Article  PubMed  PubMed Central  Google Scholar 

  4. Dehghan M, Mente A, Rangarajan S et al (2018) Association of dairy intake with cardiovascular disease and mortality in 21 countries from five continents (PURE): a prospective cohort study. Lancet 392:2288–2297. https://doi.org/10.1016/S0140-6736(18)31812-9

    Article  PubMed  Google Scholar 

  5. 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(5):460–469. https://doi.org/10.1016/j.numecd.2013.12.006

    CAS  Article  PubMed  Google Scholar 

  6. 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(6):569–577. https://doi.org/10.1038/ejcn.2010.45

    CAS  Article  PubMed  Google Scholar 

  7. Farvid MS, Malekshah AF, Pourshams A et al (2017) Dairy food intake and all-cause, carviodascular disease, and cancer mortality: the Golestan Cohort Study. Am J Epidemiol 185(8):697–711. https://doi.org/10.1093/aje/kww139

    Article  PubMed  PubMed Central  Google Scholar 

  8. 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(6):426–436. https://doi.org/10.1080/07315724.2013.875328

    CAS  Article  PubMed  Google Scholar 

  9. Kondo I, Ojima T, Nakamura M et al (2013) Consumption of dairy products and death from cardiovascular disease in the Japanese general population: the NIPPON DATA80. J Epidemiol 23(1):47–54. https://doi.org/10.2188/jea.je20120054

    Article  PubMed  Google Scholar 

  10. Mazidi M, Mikhailidis DP, Sattar N et al (2019) Consumption of dairy product and its association with total and cause specific mortality: a population-based cohort study and meta-analysis. Clin Nutr 38(6):2833–2845. https://doi.org/10.1016/j.clnu.2018.12.015

    Article  PubMed  Google Scholar 

  11. Pala V, Sieri S, Chiodini P et al (2019) Associations of dairy product consumption with mortality in the European Prospective Investigation into Cancer and Nutrition (EPIC)—Italy cohort. Am J Clin Nutr 110(5):1220–1230. https://doi.org/10.1093/ajcn/nqz183

    Article  PubMed  Google Scholar 

  12. Praagman J, Franco OH, Ikram MA et al (2015) Dairy products and the risk of stroke and coronary heart disease: the Rotterdam Study. Eur J Nutr 54(6):981–990. https://doi.org/10.1007/s00394-014-0774-0

    CAS  Article  PubMed  Google Scholar 

  13. Talaei M, Koh WP, Yuan JM, Pan A (2017) The association between dairy product intake and cardiovascular disease mortality in Chinese adults. Eur J Nutr 56(7):2343–2352. https://doi.org/10.1007/s00394-016-1274-1

    Article  PubMed  Google Scholar 

  14. Wang C, Yatsuya H, Tamakoshi K et al (2015) Milk drinking and mortality: findings from the Japan Collaborative Cohort Study. J Epidemiol 25(1):66–73. https://doi.org/10.2188/jea.JE20140081

    Article  PubMed  Google Scholar 

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

    CAS  Article  PubMed  Google Scholar 

  16. Bordoni A, Danesi F, Dardevet D et al (2017) Dairy products and inflammation: a review of the clinical evidence. Crit Rev Food Sci Nutr 57(12):2497–2525. https://doi.org/10.1080/10408398.2014.967385

    CAS  Article  PubMed  Google Scholar 

  17. Calder PC, Ahluwalia N, Brouns F et al (2011) Dietary factors and low-grade inflammation in relation to overweight and obesity. Br J Nutr 106:S5-78. https://doi.org/10.1017/S0007114511005460

    CAS  Article  PubMed  Google Scholar 

  18. Drouin-Chartier JP, Brassard D, Tessier-Grenier M et al (2016) Systematic review of the association between dairy product consumption and risk of cardiovascular-related clinical outcomes. Adv Nutr 7(6):1026–1040. https://doi.org/10.3945/an.115.011403

    Article  PubMed  PubMed Central  Google Scholar 

  19. Fontecha J, Calvo MV, Juarez M et al (2019) Milk and dairy product consumption and cardiovascular diseases: an overview of systematic reviews and meta-analyses. Adv Nutr 10:S164–S189. https://doi.org/10.1093/advances/nmy099

    Article  PubMed  PubMed Central  Google Scholar 

  20. Soysal P, Arik F, Smith L, Jackson SE, Isik AT (2020) Inflammation, frailty and cardiovascular disease. Adv Exp Med Biol 1216:55–64. https://doi.org/10.1007/978-3-030-33330-0_7

    Article  PubMed  Google Scholar 

  21. Ulven SM, Holven KB, Gil A, Rangel-Huerta OD (2019) Milk and dairy product consumption and inflammatory biomarkers: an updated systematic review of randomized clinical trials. Adv Nutr 10:S239–S250. https://doi.org/10.1093/advances/nmy072

    Article  PubMed  PubMed Central  Google Scholar 

  22. Benatar JR, Jones E, White H, Stewart RA (2014) A randomized Trial evaluating the effects of change in dairy food consumption on cardio-metabolic risk factors. Eur J Prev Cardiol 21(11):1376–1386. https://doi.org/10.1177/2047487313493567

    Article  PubMed  Google Scholar 

  23. Benatar JR, Sidhu K, Stewart RA (2013) Effects of high and low fat dairy food on cardio-metabolic risk factors: a meta-analysis of randomized studies. PLoS One 8(10):e76480. https://doi.org/10.1371/journal.pone.0076480

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  24. Moosavian SP, Rahimlou M, Saneei P, Esmaillzadeh A (2020) Effects of dairy products consumption on inflammatory biomarkers among adults: a systematic review and meta-analysis of randomized controlled trials. Nutr Metab Carviovasc Dis 30(6):872–888. https://doi.org/10.1016/j.numecd.2020.01.011

    CAS  Article  Google Scholar 

  25. Ribeiro AG, Mill JG, Matos SMA, Velasquez-Melendez G, Cade NV, Molina MCB (2020) Associações entre consumo de produtos lácteos, proteína C-reativa e perfil lipídico em adultos: resultados do ELSA-Brasil. Cad Saude Publica 36(1):e00028019. https://doi.org/10.1590/0102-311x00028019

    Article  Google Scholar 

  26. Aquino EM, Barreto SM, Bensenor IM et al (2012) Brazilian Longitudinal Study of Adult Health (ELSA-Brasil): objectives and design. Am J Epidemiol 175(4):315–324. https://doi.org/10.1093/aje/kwr294

    Article  PubMed  Google Scholar 

  27. Schmidt MI, Duncan BB, Mill JG et al (2015) Cohort profile: longitudinal study of adult health (ELSA-Brasil). Int J Epidemiol 44(1):68–75. https://doi.org/10.1093/ije/dyu027

    Article  PubMed  Google Scholar 

  28. Barreto SM, Ladeira RM, Bastos MSCBO et al (2013) Estratégias de identificação, investigação e classificação de desfechos incidentes no ELSA-Brasil. Rev Saude Publica 47:79–86. https://doi.org/10.1590/S0034-8910.2013047003836

    Article  PubMed  Google Scholar 

  29. Fedeli LG, Vidigal PG, Leite CM et al (2013) Logística de coleta e transporte de material biológico e organização do laboratório central no ELSA-Brasil. Rev Saude Publica 47:63–71. https://doi.org/10.1590/S0034-8910.2013047003807

    Article  PubMed  Google Scholar 

  30. Molina MCB, Faria CP, Cardoso LO et al (2013) Diet assessment in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil): development of a food frequency questionnaire. Rev Nutr 26(2):167–176. https://doi.org/10.1590/S1415-52732013000200005

    Article  Google Scholar 

  31. Molina MDCB, Benseñor IM, Cardoso LO et al (2013) Reprodutibilidade e validade relativa do Questionário de Frequência Alimentar do ELSA-Brasil. Cad Saude Publica 29(2):379–389. https://doi.org/10.1590/S0102-311X2013000200024

    Article  Google Scholar 

  32. Willett WC (1998) Nutritional epidemiology, 2nd edn. Oxford University Press, New York

    Book  Google Scholar 

  33. International Physical Activity Questionnaire (2005) Guidelines for data processing and analysis—short and long forms. http://www.ipaq.ki.se/. Accessed 28 Mar 2020

  34. Piccinelli M, Tessari E, Bortolomasi M et al (1997) Efficacy of the alcohol use disorders identification test as a screening tool for hazardous alcohol intake and related disorders in primary care: a validity study. BMJ 314(7078):420–424. https://doi.org/10.1136/bmj.314.7078.420

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  35. 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(2):441–454. https://doi.org/10.3390/nu5020441

    Article  PubMed  PubMed Central  Google Scholar 

  36. Goldbohm RA, Chorus AM, Galindo Garre F, Schouten LJ, van den Brandt PA (2011) Dairy consumption and 10-y total and cardiovascular mortality: a prospective cohort study in the Netherlands. Am J Clin Nutr 93(3):615–627. https://doi.org/10.3945/ajcn.110.000430

    CAS  Article  PubMed  Google Scholar 

  37. Ding M, Li J, Qi L et al (2019) Associations of dairy intake with risk of mortality in women and men: three prospective cohort studies. BMJ 367:l6204. https://doi.org/10.1136/bmj.l6204

    Article  PubMed  PubMed Central  Google Scholar 

  38. Van Aerde MA, Soedamah-Muthu SS, Geleijnse JM et al (2013) Dairy intake in relation to cardiovascular disease mortality and all-cause mortality: the Hoorn Study. Eur J Nutr 52(2):609–916. https://doi.org/10.1007/s00394-012-0363-z

    Article  PubMed  Google Scholar 

  39. Murphy MM, Barraj LM, Toth LD, Harkness LS, Bolster DR (2016) Daily intake of dairy products in Brazil and contributions to nutrient intakes: a cross-sectional study. Public Health Nutr 19(3):393–400. https://doi.org/10.1017/S1368980015001780

    Article  PubMed  Google Scholar 

  40. Hjartåker A, Lagiou A, Slimani N et al (2002) Consumption of dairy products in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort: data from 35955 24-hour dietary recalls in 10 European countries. Public Health Nutr 5(6B):1259–1271. https://doi.org/10.1079/PHN2002403

    Article  PubMed  Google Scholar 

  41. Michaëlsson K, Wolk A, Langenskiöld S et al (2014) Milk intake and risk of mortality and fractures in women and men: cohort studies. BMJ 349:g6015. https://doi.org/10.1136/bmj.g6015

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  42. Sah K, Karki P, Adesogan A et al (2019) MILK Symposium: improving milk production, quality, and safety in developing countries. J Dairy Sci 102:416–419

    Google Scholar 

  43. Siqueira KB (2019) O mercado consumidor de leite e derivados. Ministério da Agricultura, Pecuária e Abastecimento. Embrapa. https://ainfo.cnptia.embrapa.br/digital/bitstream/item/199791/1/CT-120-MercadoConsumidorKennya.pdf. Accessed 01 May 2020

  44. Instituto Brasileiro de Geografia e Estatística (2020) Pesquisa de Orçamentos Familiares 2017–2018: avaliação nutricional da disponibilidade domiciliar de alimentos no Brasil. https://biblioteca.ibge.gov.br/visualizacao/livros/liv101704.pdf. Accessed 15 Nov 2020

  45. Ministério da Saúde (2017) Vigitel Brasil 2016: vigilância de fatores de risco e proteção para doenças crônicas por inquérito telefônico: estimativas sobre frequência e distribuição sociodemográfica de fatores de risco e proteção para doenças crônicas nas capitais dos 26 estados brasileiros e no Distrito Federal em 2016. http://bvsms.saude.gov.br/bvs/publicacoes/vigitel_brasil_2016_saude_suplementar.pdf. Accessed 05 Dec 2020

  46. Hodges JK, Cao S, Cladis DP, Weaver CM (2019) Lactose intolerance and bone health: the challenge of ensuring adequate calcium intake. Nutrients 11(4):718. https://doi.org/10.3390/nu11040718

    CAS  Article  PubMed Central  Google Scholar 

  47. Fekete ÁA, Givens DI, Lovegrove JA (2013) The impact of milk proteins and peptides on blood pressure and vascular function: a review of evidence from human intervention studies. Nutr Res Rev 26(2):177–190. https://doi.org/10.1017/S0954422413000139

    CAS  Article  PubMed  Google Scholar 

  48. Fardet A, Rock E (2018) In vitro and in vivo antioxidant potential of milks, yoghurts, fermented milks and cheeses: a narrative review of evidence. Nutr Res Rev 31(1):52–70. https://doi.org/10.1017/S0954422417000191

    CAS  Article  PubMed  Google Scholar 

  49. Rautiainen S, Wang L, Manson JE, Sesso HD (2013) The role of calcium in the prevention of cardiovascular disease: a review of Observational Studies and Randomized Clinical Trials. Curr Atheroscler Rep 15(11):362. https://doi.org/10.1007/s11883-013-0362-4

    CAS  Article  PubMed  Google Scholar 

  50. Jahreis G, Dawczynski C (2020) Trans and conjugated fatty acids in dairy products: cause for concern?, Chapter 4. In: Milk and dairy foods: their functionality in human health and disease, 1st edn. Academic Press, Massachusetts, pp 87–120. https://doi.org/10.1016/B978-0-12-815603-2.00004-8

  51. Lordan R, Zabetakis I (2017) Invited review: the anti-inflammatory properties of dairy lipids. J Dairy Sci 100(6):4197–4212. https://doi.org/10.3168/jds.2016-12224

    CAS  Article  PubMed  Google Scholar 

  52. Maluf CB, Barreto SM, Giatti L et al (2020) Association between C reactive protein and all-cause mortality in the ELSA-Brasil cohort. J Epidemiol Community Health 74(5):421–427. https://doi.org/10.1136/jech-2019-213289

    Article  PubMed  Google Scholar 

  53. Schmidt MI, Griep RH, Passos VM et al (2013) Estratégias e desenvolvimento de garantia e controle de qualidade no ELSA-Brasil. Rev Saude Publica 47:105–112. https://doi.org/10.1590/S0034-8910.2013047003889

    Article  PubMed  Google Scholar 

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Acknowledgements

The authors thank the staff and participants of the ELSA-Brasil for their important contributions.

Funding

This work was supported by the Brazilian Ministry of Health (Department of Science and Technology) and the Brazilian Ministry of Science, Technology and Innovation (Financiadora de Estudos e Projetos—FINEP; and Conselho Nacional de Desenvolvimento Científico e Tecnológico—CNPq), through Grant nos. 01 06 0010.00 RS, 01 06 0212.00 BA, 01 06 0300.00 ES, 01 06 0278.00 MG, 01 06 0115.00 SP and 01 06 0071·00 RJ. Grants follow-up 01 10 0643-03 RS; 01 10 0742-00 BA; 01 11 0093-01 RJ; 01 12 0284-00 ES; 01 10 0746-00 MG; 01 10 0773-00 SP. F.M.S received part of doctoral scholarship from Fundação de Amparo à Pesquisa do Estado de Minas Gerais (FAPEMIG) and another part from Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)—Finance Code 001. S.M.B. and L.G. are research fellows of CNPq, Brazil.

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Contributions

FMS, SMB and LG contributed to the conception and design, analysis and interpretation of data, drafting the manuscript and critical review of the manuscript. LCCB and MFHSD contributed to the design and critical review of the manuscript for important intellectual content. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Sandhi Maria Barreto.

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The authors declare that they have no conflict of interest.

Ethics approval

This study was performed in line with the principles of the Declaration of Helsinki. ELSA-Brasil was approved by the Research Ethics Committees of the participating educational and research institutions. Ethics approval numbers: 669/06 (SP); 343/06 (RJ); 186/06 (MG); 041/06 (ES); 06-194 (RS); 027-06 (BA).

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All participants signed the informed consent forms before study visits.

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Silva, F.M., Giatti, L., Diniz, M.d.F.H.S. et al. Dairy product consumption reduces cardiovascular mortality: results after 8 year follow-up of ELSA-Brasil. Eur J Nutr 61, 859–869 (2022). https://doi.org/10.1007/s00394-021-02686-x

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Keywords

  • Dairy products
  • Cardiovascular mortality
  • Inflammation
  • Cohort study
  • Diet composition
  • Prevention