Association of dairy intake with cardiovascular disease and mortality in 21 countries from five continents (PURE): a prospective cohort study

Prospective Urban Rural Epidemiology (PURE) study investigators

Research output: Contribution to journalArticle

41 Citations (Scopus)

Abstract

Background: Dietary guidelines recommend minimising consumption of whole-fat dairy products, as they are a source of saturated fats and presumed to adversely affect blood lipids and increase cardiovascular disease and mortality. Evidence for this contention is sparse and few data for the effects of dairy consumption on health are available from low-income and middle-income countries. Therefore, we aimed to assess the associations between total dairy and specific types of dairy products with mortality and major cardiovascular disease. Methods: The Prospective Urban Rural Epidemiology (PURE) study is a large multinational cohort study of individuals aged 35–70 years enrolled from 21 countries in five continents. Dietary intakes of dairy products for 136 384 individuals were recorded using country-specific validated food frequency questionnaires. Dairy products comprised milk, yoghurt, and cheese. We further grouped these foods into whole-fat and low-fat dairy. The primary outcome was the composite of mortality or major cardiovascular events (defined as death from cardiovascular causes, non-fatal myocardial infarction, stroke, or heart failure). Hazard ratios (HRs) were calculated using multivariable Cox frailty models with random intercepts to account for clustering of participants by centre. Findings: Between Jan 1, 2003, and July 14, 2018, we recorded 10 567 composite events (deaths [n=6796] or major cardiovascular events [n=5855]) during the 9·1 years of follow-up. Higher intake of total dairy (>2 servings per day compared with no intake) was associated with a lower risk of the composite outcome (HR 0·84, 95% CI 0·75–0·94; ptrend=0·0004), total mortality (0·83, 0·72–0·96; ptrend=0·0052), non-cardiovascular mortality (0·86, 0·72–1·02; ptrend=0·046), cardiovascular mortality (0·77, 0·58–1·01; ptrend=0·029), major cardiovascular disease (0·78, 0·67–0·90; ptrend=0·0001), and stroke (0·66, 0·53–0·82; ptrend=0·0003). No significant association with myocardial infarction was observed (HR 0·89, 95% CI 0·71–1·11; ptrend=0·163). Higher intake (>1 serving vs no intake) of milk (HR 0·90, 95% CI 0·82–0·99; ptrend=0·0529) and yogurt (0·86, 0·75–0·99; ptrend=0·0051) was associated with lower risk of the composite outcome, whereas cheese intake was not significantly associated with the composite outcome (0·88, 0·76–1·02; ptrend=0·1399). Butter intake was low and was not significantly associated with clinical outcomes (HR 1·09, 95% CI 0·90–1·33; ptrend=0·4113). Interpretation: Dairy consumption was associated with lower risk of mortality and major cardiovascular disease events in a diverse multinational cohort. Funding: Full funding sources are listed at the end of the paper (see Acknowledgments).

Original languageEnglish
Pages (from-to)2288-2297
Number of pages10
JournalThe Lancet
Volume392
Issue number10161
DOIs
Publication statusPublished - 24 Nov 2018
Externally publishedYes

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Epidemiology
Cohort Studies
Cardiovascular Diseases
Prospective Studies
Dairy Products
Mortality
Fats
Yogurt
Cheese
Milk
Stroke
Myocardial Infarction
Food
Nutrition Policy
Butter
Proportional Hazards Models
Cluster Analysis
Cause of Death
Heart Failure
Lipids

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Association of dairy intake with cardiovascular disease and mortality in 21 countries from five continents (PURE) : a prospective cohort study. / Prospective Urban Rural Epidemiology (PURE) study investigators.

In: The Lancet, Vol. 392, No. 10161, 24.11.2018, p. 2288-2297.

Research output: Contribution to journalArticle

Prospective Urban Rural Epidemiology (PURE) study investigators. / Association of dairy intake with cardiovascular disease and mortality in 21 countries from five continents (PURE) : a prospective cohort study. In: The Lancet. 2018 ; Vol. 392, No. 10161. pp. 2288-2297.
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title = "Association of dairy intake with cardiovascular disease and mortality in 21 countries from five continents (PURE): a prospective cohort study",
abstract = "Background: Dietary guidelines recommend minimising consumption of whole-fat dairy products, as they are a source of saturated fats and presumed to adversely affect blood lipids and increase cardiovascular disease and mortality. Evidence for this contention is sparse and few data for the effects of dairy consumption on health are available from low-income and middle-income countries. Therefore, we aimed to assess the associations between total dairy and specific types of dairy products with mortality and major cardiovascular disease. Methods: The Prospective Urban Rural Epidemiology (PURE) study is a large multinational cohort study of individuals aged 35–70 years enrolled from 21 countries in five continents. Dietary intakes of dairy products for 136 384 individuals were recorded using country-specific validated food frequency questionnaires. Dairy products comprised milk, yoghurt, and cheese. We further grouped these foods into whole-fat and low-fat dairy. The primary outcome was the composite of mortality or major cardiovascular events (defined as death from cardiovascular causes, non-fatal myocardial infarction, stroke, or heart failure). Hazard ratios (HRs) were calculated using multivariable Cox frailty models with random intercepts to account for clustering of participants by centre. Findings: Between Jan 1, 2003, and July 14, 2018, we recorded 10 567 composite events (deaths [n=6796] or major cardiovascular events [n=5855]) during the 9·1 years of follow-up. Higher intake of total dairy (>2 servings per day compared with no intake) was associated with a lower risk of the composite outcome (HR 0·84, 95{\%} CI 0·75–0·94; ptrend=0·0004), total mortality (0·83, 0·72–0·96; ptrend=0·0052), non-cardiovascular mortality (0·86, 0·72–1·02; ptrend=0·046), cardiovascular mortality (0·77, 0·58–1·01; ptrend=0·029), major cardiovascular disease (0·78, 0·67–0·90; ptrend=0·0001), and stroke (0·66, 0·53–0·82; ptrend=0·0003). No significant association with myocardial infarction was observed (HR 0·89, 95{\%} CI 0·71–1·11; ptrend=0·163). Higher intake (>1 serving vs no intake) of milk (HR 0·90, 95{\%} CI 0·82–0·99; ptrend=0·0529) and yogurt (0·86, 0·75–0·99; ptrend=0·0051) was associated with lower risk of the composite outcome, whereas cheese intake was not significantly associated with the composite outcome (0·88, 0·76–1·02; ptrend=0·1399). Butter intake was low and was not significantly associated with clinical outcomes (HR 1·09, 95{\%} CI 0·90–1·33; ptrend=0·4113). Interpretation: Dairy consumption was associated with lower risk of mortality and major cardiovascular disease events in a diverse multinational cohort. Funding: Full funding sources are listed at the end of the paper (see Acknowledgments).",
author = "{Prospective Urban Rural Epidemiology (PURE) study investigators} and Mahshid Dehghan and Andrew Mente and Sumathy Rangarajan and Patrick Sheridan and Viswanathan Mohan and Romaina Iqbal and Rajeev Gupta and Scott Lear and Edelweiss Wentzel-Viljoen and Alvaro Avezum and Patricio Lopez-Jaramillo and Prem Mony and Varma, {Ravi Prasad} and Rajesh Kumar and Jephat Chifamba and Alhabib, {Khalid F.} and Noushin Mohammadifard and Aytekin Oguz and Fernando Lanas and Dorota Rozanska and Bostrom, {Kristina Bengtsson} and Khalid Yusoff and Tsolkile, {Lungiswa P.} and Antonio Dans and Yusufali, {Afzal Hussein} and Andres Orlandini and Paul Poirier and Rasha Khatib and Bo Hu and Li Wei and Lu Yin and Ai Deeraili and Karen Yeates and Rita Yusuf and Ismail, {Noor Hassim} and Dariush Mozaffarian and Koon Teo and Anand, {Sonia S.} and Salim Yusuf",
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TY - JOUR

T1 - Association of dairy intake with cardiovascular disease and mortality in 21 countries from five continents (PURE)

T2 - a prospective cohort study

AU - Prospective Urban Rural Epidemiology (PURE) study investigators

AU - Dehghan, Mahshid

AU - Mente, Andrew

AU - Rangarajan, Sumathy

AU - Sheridan, Patrick

AU - Mohan, Viswanathan

AU - Iqbal, Romaina

AU - Gupta, Rajeev

AU - Lear, Scott

AU - Wentzel-Viljoen, Edelweiss

AU - Avezum, Alvaro

AU - Lopez-Jaramillo, Patricio

AU - Mony, Prem

AU - Varma, Ravi Prasad

AU - Kumar, Rajesh

AU - Chifamba, Jephat

AU - Alhabib, Khalid F.

AU - Mohammadifard, Noushin

AU - Oguz, Aytekin

AU - Lanas, Fernando

AU - Rozanska, Dorota

AU - Bostrom, Kristina Bengtsson

AU - Yusoff, Khalid

AU - Tsolkile, Lungiswa P.

AU - Dans, Antonio

AU - Yusufali, Afzal Hussein

AU - Orlandini, Andres

AU - Poirier, Paul

AU - Khatib, Rasha

AU - Hu, Bo

AU - Wei, Li

AU - Yin, Lu

AU - Deeraili, Ai

AU - Yeates, Karen

AU - Yusuf, Rita

AU - Ismail, Noor Hassim

AU - Mozaffarian, Dariush

AU - Teo, Koon

AU - Anand, Sonia S.

AU - Yusuf, Salim

PY - 2018/11/24

Y1 - 2018/11/24

N2 - Background: Dietary guidelines recommend minimising consumption of whole-fat dairy products, as they are a source of saturated fats and presumed to adversely affect blood lipids and increase cardiovascular disease and mortality. Evidence for this contention is sparse and few data for the effects of dairy consumption on health are available from low-income and middle-income countries. Therefore, we aimed to assess the associations between total dairy and specific types of dairy products with mortality and major cardiovascular disease. Methods: The Prospective Urban Rural Epidemiology (PURE) study is a large multinational cohort study of individuals aged 35–70 years enrolled from 21 countries in five continents. Dietary intakes of dairy products for 136 384 individuals were recorded using country-specific validated food frequency questionnaires. Dairy products comprised milk, yoghurt, and cheese. We further grouped these foods into whole-fat and low-fat dairy. The primary outcome was the composite of mortality or major cardiovascular events (defined as death from cardiovascular causes, non-fatal myocardial infarction, stroke, or heart failure). Hazard ratios (HRs) were calculated using multivariable Cox frailty models with random intercepts to account for clustering of participants by centre. Findings: Between Jan 1, 2003, and July 14, 2018, we recorded 10 567 composite events (deaths [n=6796] or major cardiovascular events [n=5855]) during the 9·1 years of follow-up. Higher intake of total dairy (>2 servings per day compared with no intake) was associated with a lower risk of the composite outcome (HR 0·84, 95% CI 0·75–0·94; ptrend=0·0004), total mortality (0·83, 0·72–0·96; ptrend=0·0052), non-cardiovascular mortality (0·86, 0·72–1·02; ptrend=0·046), cardiovascular mortality (0·77, 0·58–1·01; ptrend=0·029), major cardiovascular disease (0·78, 0·67–0·90; ptrend=0·0001), and stroke (0·66, 0·53–0·82; ptrend=0·0003). No significant association with myocardial infarction was observed (HR 0·89, 95% CI 0·71–1·11; ptrend=0·163). Higher intake (>1 serving vs no intake) of milk (HR 0·90, 95% CI 0·82–0·99; ptrend=0·0529) and yogurt (0·86, 0·75–0·99; ptrend=0·0051) was associated with lower risk of the composite outcome, whereas cheese intake was not significantly associated with the composite outcome (0·88, 0·76–1·02; ptrend=0·1399). Butter intake was low and was not significantly associated with clinical outcomes (HR 1·09, 95% CI 0·90–1·33; ptrend=0·4113). Interpretation: Dairy consumption was associated with lower risk of mortality and major cardiovascular disease events in a diverse multinational cohort. Funding: Full funding sources are listed at the end of the paper (see Acknowledgments).

AB - Background: Dietary guidelines recommend minimising consumption of whole-fat dairy products, as they are a source of saturated fats and presumed to adversely affect blood lipids and increase cardiovascular disease and mortality. Evidence for this contention is sparse and few data for the effects of dairy consumption on health are available from low-income and middle-income countries. Therefore, we aimed to assess the associations between total dairy and specific types of dairy products with mortality and major cardiovascular disease. Methods: The Prospective Urban Rural Epidemiology (PURE) study is a large multinational cohort study of individuals aged 35–70 years enrolled from 21 countries in five continents. Dietary intakes of dairy products for 136 384 individuals were recorded using country-specific validated food frequency questionnaires. Dairy products comprised milk, yoghurt, and cheese. We further grouped these foods into whole-fat and low-fat dairy. The primary outcome was the composite of mortality or major cardiovascular events (defined as death from cardiovascular causes, non-fatal myocardial infarction, stroke, or heart failure). Hazard ratios (HRs) were calculated using multivariable Cox frailty models with random intercepts to account for clustering of participants by centre. Findings: Between Jan 1, 2003, and July 14, 2018, we recorded 10 567 composite events (deaths [n=6796] or major cardiovascular events [n=5855]) during the 9·1 years of follow-up. Higher intake of total dairy (>2 servings per day compared with no intake) was associated with a lower risk of the composite outcome (HR 0·84, 95% CI 0·75–0·94; ptrend=0·0004), total mortality (0·83, 0·72–0·96; ptrend=0·0052), non-cardiovascular mortality (0·86, 0·72–1·02; ptrend=0·046), cardiovascular mortality (0·77, 0·58–1·01; ptrend=0·029), major cardiovascular disease (0·78, 0·67–0·90; ptrend=0·0001), and stroke (0·66, 0·53–0·82; ptrend=0·0003). No significant association with myocardial infarction was observed (HR 0·89, 95% CI 0·71–1·11; ptrend=0·163). Higher intake (>1 serving vs no intake) of milk (HR 0·90, 95% CI 0·82–0·99; ptrend=0·0529) and yogurt (0·86, 0·75–0·99; ptrend=0·0051) was associated with lower risk of the composite outcome, whereas cheese intake was not significantly associated with the composite outcome (0·88, 0·76–1·02; ptrend=0·1399). Butter intake was low and was not significantly associated with clinical outcomes (HR 1·09, 95% CI 0·90–1·33; ptrend=0·4113). Interpretation: Dairy consumption was associated with lower risk of mortality and major cardiovascular disease events in a diverse multinational cohort. Funding: Full funding sources are listed at the end of the paper (see Acknowledgments).

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