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Taormina VM, Unger AL, Kraft J. Full-fat dairy products and cardiometabolic health outcomes: Does the dairy-fat matrix matter? Front Nutr 2024; 11:1386257. [PMID: 39135556 PMCID: PMC11317386 DOI: 10.3389/fnut.2024.1386257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 06/27/2024] [Indexed: 08/15/2024] Open
Abstract
Reducing dairy fat intake is a common dietary guideline to limit energy and saturated fatty acid intake for the promotion of cardiometabolic health. However, research utilizing a holistic, food-based approach to assess the consumption of the fat found in dairy, a broad and diverse food group, may provide new insight into these guidelines. Dairy fat is comprised of a diverse assembly of fatty acids, triacylglycerols, sterols, and phospholipids, all uniquely packaged in a milk fat globule. The physical structure of this milk fat globule and its membrane is modified through different processing methods, resulting in distinctive dairy-fat matrices across each dairy product. The objectives of this narrative review were to first define and compare the dairy-fat matrix in terms of its unique composition, physical structure, and fat content across common dairy products (cow's milk, yogurt, cheese, and butter). With this information, we examined observational studies and randomized controlled trials published within the last 10 years (2013-2023) to assess the individual effects of the dairy-fat matrix in milk, yogurt, cheese, and butter on cardiometabolic health and evaluate the implications for nutrition guidance. Searches conducted on Ovid MEDLINE and PubMed® utilizing search terms for cardiometabolic health, both broadly and regarding specific disease outcomes and risk factors, yielded 59 studies that were analyzed and included in this review. Importantly, this review stratifies by both dairy product and fat content. Though the results were heterogeneous, most studies reported no association between intake of these individual regular-fat dairy products and cardiometabolic outcome measures, thus, the current body of evidence suggests that regular-fat dairy product consumption may be incorporated within overall healthy eating patterns. Research suggests that there may be a beneficial effect of regular-fat milk and yogurt intake on outcome measures related to body weight and composition, and an effect of regular-fat cheese intake on outcome measures related to blood lipids, but more research is necessary to define the directionality of this relationship. Lastly, we identify methodological research gaps and propose future research directions to bolster the current evidence base available for ascertaining the role of dairy fat in a healthy diet.
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Affiliation(s)
- Victoria M. Taormina
- Department of Animal and Veterinary Sciences, The University of Vermont, Burlington, VT, United States
| | - Allison L. Unger
- Department of Pathology and Laboratory Medicine, The University of Vermont, Burlington, VT, United States
- National Dairy Council, Rosemont, IL, United States
| | - Jana Kraft
- Department of Animal and Veterinary Sciences, The University of Vermont, Burlington, VT, United States
- Department of Medicine, Division of Endocrinology, Metabolism, and Diabetes, The University of Vermont, Colchester, VT, United States
- Department of Nutrition and Food Sciences, The University of Vermont, Burlington, VT, United States
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2
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Wu J, Tao G, Xiao H. Association of different milk fat content with coronary artery disease and myocardial infarction risk: A Mendelian randomization study. PLoS One 2024; 19:e0300513. [PMID: 38598469 PMCID: PMC11006182 DOI: 10.1371/journal.pone.0300513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 02/29/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND Numerous observational studies have investigated on the correlation of whole, semi-skimmed, and skimmed milk with coronary artery disease (CAD) and myocardial infarction (MI) risk; However, no consensus has been reached and evidence on any causal links between these exposures and outcomes remains unclear. This study aimed to conduct univariate and multivariate Mendelian randomization (MR) analyses, using publicly released genome-wide association study summary statistics (GWAS) from the IEU GWAS database, to ascertain the causal association of milk with various fat content with CAD and MI risk. METHODS For the exposure data, 29, 15, and 30 single-nucleotide polymorphisms for whole milk, semi-skimmed milk, and skimmed milk, respectively, obtained from 360,806 Europeans, were used as instrumental variables. CAD and MI comprised 141,217 and 395,795 samples, respectively. We used inverse variance weighted (IVW), weighted median, MR-Egger regression, and MR Pleiotropy Residual Sum and Outlier analyses to determine whether pleiotropy and heterogeneity could skew the MR results. Sensitivity tests were conducted to verify the robustness of the results. RESULTS After adjusting for false discovery rates (FDR), we discovered proof that skimmed milk intake is a genetically predicted risk factor for CAD (odds ratio [OR] = 5.302; 95% confidence interval [CI] 2.261-12.432; P < 0.001; FDR-corrected P < 0.001) and MI (OR = 2.287; 95% CI 1.218-4.300; P = 0.010; FDR-corrected P = 0.009). Most sensitivity assessments yielded valid results. Multivariable MR for CAD and MI produced results consistent with those obtained using the IVW method. There was no causal relationship between whole or semi-skimmed milk, and CAD or MI. CONCLUSION Our findings indicate that the consumption of skimmed milk may increase the risk of CAD and MI. This evidence may help inform dietary recommendations for preventing cardiovascular disease. Further studies are required to elucidate the underlying mechanisms.
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Affiliation(s)
- Jiacan Wu
- Department of Cardiology, The First Hospital of Chongqing Medical University, Chongqing, China
| | - Guanghong Tao
- Department of Cardiology, The First Hospital of Chongqing Medical University, Chongqing, China
| | - Hua Xiao
- Department of Cardiology, The First Hospital of Chongqing Medical University, Chongqing, China
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3
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Zhang M, Dong X, Huang Z, Li X, Zhao Y, Wang Y, Zhu H, Fang A, Giovannucci EL. Cheese consumption and multiple health outcomes: an umbrella review and updated meta-analysis of prospective studies. Adv Nutr 2023; 14:1170-1186. [PMID: 37328108 PMCID: PMC10509445 DOI: 10.1016/j.advnut.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 05/15/2023] [Accepted: 06/13/2023] [Indexed: 06/18/2023] Open
Abstract
This umbrella review aims to provide a systematic and comprehensive overview of current evidence from prospective studies on the diverse health effects of cheese consumption. We searched PubMed, Embase, and Cochrane Library to identify meta-analyses/pooled analyses of prospective studies examining the association between cheese consumption and major health outcomes from inception to August 31, 2022. We reanalyzed and updated previous meta-analyses and performed de novo meta-analyses with recently published prospective studies, where appropriate. We calculated the summary effect size, 95% prediction confidence intervals, between-study heterogeneity, small-study effects, and excess significance bias for each health outcome. We identified 54 eligible articles of meta-analyses/pooled analyses. After adding newly published original articles, we performed 35 updated meta-analyses and 4 de novo meta-analyses. Together with 8 previous meta-analyses, we finally included 47 unique health outcomes. Cheese consumption was inversely associated with all-cause mortality (highest compared with lowest category: RR = 0.95; 95% CI: 0.92, 0.99), cardiovascular mortality (RR = 0.93; 95% CI: 0.88, 0.99), incident cardiovascular disease (CVD) (RR = 0.92; 95% CI: 0.89, 0.96), coronary heart disease (CHD) (RR = 0.92; 95% CI: 0.86, 0.98), stroke (RR = 0.93; 95% CI: 0.89, 0.98), estrogen receptor-negative (ER-) breast cancer (RR = 0.89; 95% CI: 0.82, 0.97), type 2 diabetes (RR = 0.93; 95% CI: 0.88, 0.98), total fracture (RR = 0.90; 95% CI: 0.86, 0.95), and dementia (RR = 0.81; 95% CI: 0.66, 0.99). Null associations were found for other outcomes. According to the NutriGrade scoring system, moderate quality of evidence was observed for inverse associations of cheese consumption with all-cause and cardiovascular mortality, incident CVD, CHD, and stroke, and for null associations with cancer mortality, incident hypertension, and prostate cancer. Our findings suggest that cheese consumption has neutral to moderate benefits for human health.
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Affiliation(s)
- Mingjie Zhang
- Department of Nutrition, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Xiaocong Dong
- Department of Nutrition, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Zihui Huang
- Department of Nutrition, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Xue Li
- Department of Big Data in Health Science School of Public Health, Center of Clinical Big Data and Analytics of The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yue Zhao
- Department of Nutrition, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Yingyao Wang
- Chinese Nutrition Society Academy of Nutrition and Health, Beijing, China.
| | - Huilian Zhu
- Department of Nutrition, School of Public Health, Sun Yat-sen University, Guangzhou, China; Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Aiping Fang
- Department of Nutrition, School of Public Health, Sun Yat-sen University, Guangzhou, China; Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-sen University, Guangzhou, China; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
| | - Edward L Giovannucci
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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4
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Izar MCDO, Giraldez VZR, Bertolami A, Santos Filho RDD, Lottenberg AM, Assad MHV, Saraiva JFK, Chacra APM, Martinez TLR, Bahia LR, Fonseca FAH, Faludi AA, Sposito AC, Chagas ACP, Jannes CE, Amaral CK, Araújo DBD, Cintra DE, Coutinho EDR, Cesena F, Xavier HT, Mota ICP, Giuliano IDCB, Faria Neto JR, Kato JT, Bertolami MC, Miname MH, Castelo MHCG, Lavrador MSF, Machado RM, Souza PGD, Alves RJ, Machado VA, Salgado Filho W. Update of the Brazilian Guideline for Familial Hypercholesterolemia - 2021. Arq Bras Cardiol 2021; 117:782-844. [PMID: 34709306 PMCID: PMC8528358 DOI: 10.36660/abc.20210788] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
| | - Viviane Zorzanelli Rocha Giraldez
- Instituto do Coração (InCor) da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
- Grupo Fleury, São Paulo, SP - Brasil
| | | | | | - Ana Maria Lottenberg
- Hospital Israelita Albert Einstein (HIAE) - Faculdade Israelita de Ciências da Saúde Albert Einstein (FICSAE), São Paulo, SP - Brasil
- Faculdade de Medicina da Universidade de São Paulo, Laboratório de Lípides (LIM10), São Paulo, São Paulo, SP - Brasil
| | | | | | - Ana Paula M Chacra
- Instituto do Coração (InCor) da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | | | | | | | - Andrei C Sposito
- Universidade Estadual de Campinas (UNICAMP), Campinas, SP - Brasil
| | | | - Cinthia Elim Jannes
- Instituto do Coração (InCor) da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | | | | | | | - Fernando Cesena
- Hospital Israelita Albert Einstein (HIAE), São Paulo, SP - Brasil
| | | | | | | | | | | | | | - Marcio Hiroshi Miname
- Instituto do Coração (InCor) da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | - Maria Helane Costa Gurgel Castelo
- Universidade Federal do Ceará (UFC), Fortaleza, CE - Brasil
- Hospital do Coração de Messejana, Fortaleza, CE - Brasil
- Professora da Faculdade Unichristus, Fortaleza, CE - Brasil
| | - Maria Sílvia Ferrari Lavrador
- Hospital Israelita Albert Einstein (HIAE) - Faculdade Israelita de Ciências da Saúde Albert Einstein (FICSAE), São Paulo, SP - Brasil
| | - Roberta Marcondes Machado
- Faculdade de Medicina da Universidade de São Paulo, Laboratório de Lípides (LIM10), São Paulo, São Paulo, SP - Brasil
| | - Patrícia Guedes de Souza
- Hospital Universitário Professor Edgard Santos da Universidade Federal da Bahia (UFBA), Salvador, BA - Brasil
| | | | | | - Wilson Salgado Filho
- Instituto do Coração (InCor) da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
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5
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Chen Z, Ahmed M, Ha V, Jefferson K, Malik V, Ribeiro PAB, Zuchinali P, Drouin-Chartier JP. Dairy Product Consumption and Cardiovascular Health: a Systematic Review and Meta-Analysis of Prospective Cohort Studies. Adv Nutr 2021; 13:S2161-8313(22)00071-0. [PMID: 34550320 PMCID: PMC8970833 DOI: 10.1093/advances/nmab118] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
The association between dairy product consumption and cardiovascular health remains highly debated. We quantitatively synthesized prospective cohort evidence on the associations between dairy consumption and risk of hypertension (HTN), coronary heart disease (CHD) and stroke. We systematically searched PubMed, Embase, and Web of Science through August 1st, 2020 to retrieve prospective cohort studies that reported on dairy consumption and risk of HTN, CHD or stroke. We used random-effects models to calculate the pooled relative risk (RR) and 95% confidence interval (CI) for the highest vs the lowest category of intake and for 1 serving/day increase in consumption. We rated the quality of evidence using NutriGrade. Fifty-five studies were included. Total dairy consumption was associated with a lower risk of HTN (RR for highest vs lowest level of intake: 0.91, 95% CI: 0.86-0.95, I2 = 73.5%; RR for 1 serving/day increase: 0.96, 95% CI: 0.94-0.97, I2 = 66.5%), CHD (highest vs lowest level of intake: 0.96, 95% CI: 0.92-1.00, I2 = 46.6%; 1 serving/day increase: 0.98, 95% CI: 0.95-1.00, I2 = 56.7%), and stroke (highest vs lowest level of intake: 0.90, 95% CI: 0.85-0.96, I2 = 60.8%; 1 serving/day increase: 0.96, 95% CI: 0.93-0.99, I2 = 74.7%). Despite moderate to considerable heterogeneity, these associations remained consistent across multiple subgroups. Evidence on the relationship between total dairy and risk of HTN and CHD were of moderate quality and of low quality for stroke. Low-fat dairy consumption was associated with lower risk of HTN and stroke, and high-fat dairy with a lower risk of stroke. Milk, cheese, or yogurt consumption showed inconsistent associations with the cardiovascular outcomes in high vs. low intake and dose-response meta-analyses. Total dairy consumption was associated with a modestly lower risk of hypertension, CHD and stroke. Moderate to considerable heterogeneity was observed in the estimates and the overall quality of the evidence was low to moderate.
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Affiliation(s)
- Zhangling Chen
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, USA,Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Mavra Ahmed
- Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada,Joannah and Brian Lawson Centre for Child Nutrition, University of Toronto, Toronto, ON, Canada
| | - Vanessa Ha
- School of Medicine, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | | | - Vasanti Malik
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, USA,Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada
| | - Paula A B Ribeiro
- Montreal Behavioural Medicine Centre, CIUSSS du Nord-de-l’Île-de-Montréal, Montréal, QC, Canada,Centre de recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada
| | - Priccila Zuchinali
- Centre de recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada
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6
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Jakobsen MU, Trolle E, Outzen M, Mejborn H, Grønberg MG, Lyndgaard CB, Stockmarr A, Venø SK, Bysted A. Intake of dairy products and associations with major atherosclerotic cardiovascular diseases: a systematic review and meta-analysis of cohort studies. Sci Rep 2021; 11:1303. [PMID: 33446728 PMCID: PMC7809206 DOI: 10.1038/s41598-020-79708-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 12/11/2020] [Indexed: 01/29/2023] Open
Abstract
Specific types of dairy products may be differentially associated with atherosclerotic cardiovascular disease (CVD). We conducted a systematic review and meta-analysis of cohort studies to summarize findings on the associations between total dairy product intake and intake of dairy product subgroups and the risk of major atherosclerotic CVDs in the general adult population. Our protocol was registered in PROSPERO (CRD42019125455). PubMed and Embase were systematically searched through 15 August 2019. For high versus low intake and dose-response meta-analysis, random-effects modelling was used to calculate summary risk ratios (RR). There were 13 cohort studies included for coronary heart disease (CHD), 7 for ischemic stroke and none for peripheral artery disease. High-fat milk was positively associated with CHD (RR 1.08 (95% confidence interval 1.00-1.16) per 200 g higher intake/day) and cheese was inversely associated with CHD (RR 0.96 (95% confidence interval 0.93-0.98) per 20 g higher intake/day). Heterogeneity, however, was observed in high versus low meta-analyses. Milk was inversely associated with ischemic stroke in high versus low meta-analysis only. In conclusion, this systematic review indicates a positive association of high-fat milk and an inverse association of cheese with CHD risk. The findings should be interpreted in the context of the observed heterogeneity.
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Affiliation(s)
- Marianne Uhre Jakobsen
- grid.5170.30000 0001 2181 8870Division for Diet, Disease Prevention and Toxicology, National Food Institute, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Ellen Trolle
- grid.5170.30000 0001 2181 8870Division for Risk Assessment and Nutrition, National Food Institute, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Malene Outzen
- grid.5170.30000 0001 2181 8870Division for Diet, Disease Prevention and Toxicology, National Food Institute, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Heddie Mejborn
- grid.5170.30000 0001 2181 8870Division for Risk Assessment and Nutrition, National Food Institute, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Manja G. Grønberg
- grid.5170.30000 0001 2181 8870Department of Applied Mathematics and Computer Science, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Christian Bøge Lyndgaard
- grid.5170.30000 0001 2181 8870Department of Applied Mathematics and Computer Science, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Anders Stockmarr
- grid.5170.30000 0001 2181 8870Department of Applied Mathematics and Computer Science, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Stine K. Venø
- grid.27530.330000 0004 0646 7349Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Anette Bysted
- grid.5170.30000 0001 2181 8870Division for Food Technology, National Food Institute, Technical University of Denmark, Kgs. Lyngby, Denmark
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7
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Izar MCDO, Lottenberg AM, Giraldez VZR, Santos Filho RDD, Machado RM, Bertolami A, Assad MHV, Saraiva JFK, Faludi AA, Moreira ASB, Geloneze B, Magnoni CD, Scherr C, Amaral CK, Araújo DBD, Cintra DEC, Nakandakare ER, Fonseca FAH, Mota ICP, Santos JED, Kato JT, Beda LMM, Vieira LP, Bertolami MC, Rogero MM, Lavrador MSF, Nakasato M, Damasceno NRT, Alves RJ, Lara RS, Costa RP, Machado VA. Position Statement on Fat Consumption and Cardiovascular Health - 2021. Arq Bras Cardiol 2021; 116:160-212. [PMID: 33566983 PMCID: PMC8159504 DOI: 10.36660/abc.20201340] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
| | - Ana Maria Lottenberg
- Hospital Israelita Albert Einstein (HIAE) - Faculdade Israelita de Ciências da Saúde Albert Einstein (FICSAE), São Paulo, SP - Brasil
- Faculdade de Medicina da Universidade de São Paulo, Laboratório de Lípides (LIM10),São Paulo, São Paulo, SP - Brasil
| | - Viviane Zorzanelli Rocha Giraldez
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP),São Paulo, São Paulo, SP - Brasil
| | - Raul Dias Dos Santos Filho
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP),São Paulo, São Paulo, SP - Brasil
| | - Roberta Marcondes Machado
- Faculdade de Medicina da Universidade de São Paulo, Laboratório de Lípides (LIM10),São Paulo, São Paulo, SP - Brasil
| | - Adriana Bertolami
- Instituto Dante Pazzanese de Cardiologia, São Paulo, São Paulo, SP - Brasil
| | | | | | - André Arpad Faludi
- Instituto Dante Pazzanese de Cardiologia, São Paulo, São Paulo, SP - Brasil
| | | | - Bruno Geloneze
- Universidade Estadual de Campinas (UNICAMP), Campinas, SP - Brasil
| | | | | | | | | | | | | | | | | | | | | | - Lis Mie Misuzawa Beda
- Faculdade de Medicina da Universidade de São Paulo, Laboratório de Lípides (LIM10),São Paulo, São Paulo, SP - Brasil
| | | | | | | | | | - Miyoko Nakasato
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP),São Paulo, São Paulo, SP - Brasil
| | | | - Renato Jorge Alves
- Santa Casa de Misericórdia de São Paulo, São Paulo, São Paulo, SP - Brasil
| | - Roberta Soares Lara
- Núcleo de Alimentação e Nutrição da Sociedade Brasileira de Cardiologia, Rio de Janeiro, RJ - Brasil
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8
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Ghosh S, He W, Gao J, Luo D, Wang J, Chen J, Huang H. Whole milk consumption is associated with lower risk of coronary artery calcification progression: evidences from the Multi-Ethnic Study of Atherosclerosis. Eur J Nutr 2020; 60:1049-1058. [PMID: 32583016 DOI: 10.1007/s00394-020-02301-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 06/05/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE Coronary artery calcification (CAC) progression is a strong predictor of cardiovascular disease (CVD) morbidity and mortality. However, the association between whole milk and CAC progression remains unknown. Recent studies highlighted beneficial effects of short chain fatty acids (SCFA) from whole milk on CVD. In this study, we attempted to investigate the relationship between whole milk consumption and CAC progression, and the potential effect of SCFA in it. METHODS We analyzed a population-based cohort with 5273 participants from the Multi-Ethnic Study of Atherosclerosis (MESA) who completed a dietary questionnaire at baseline. CAC was measured at baseline and subsequent follow-up examinations by multi-detector computed tomography (MDCT) scans with Agatston scores. CAC progression was defined as increased CAC scores in the follow-up from the baseline exam. RESULTS Participants consuming whole milk exhibited lower baseline CAC and CAC progression than those who never/rarely consumed whole milk (P < 0.001 and P = 0.010, respectively). Moreover, multivariable logistic regression analysis demonstrated that whole milk intake was independently associated with lower CAC progression (OR 0.765; 95% CI 0.600-0.977; P = 0.032), especially in males, participants with age ≤ 64 years and with body mass index (BMI) ≤ 25 kg/m2. Mediation analysis further showed that caproic acid, one kind of SCFA, partly mediated protective effects of whole milk on CAC progression. CONCLUSIONS Self-reported whole milk consumption was inversely associated with CAC progression in community-dwelling participants, especially in those at relatively low cardiovascular risks. The beneficial effect was partially mediated by SCFA. Therefore, whole milk can be incorporated into part of a cardio-protective diet. Regarding this, future studies may target SCFA to provide insight into more mechanistic views.
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Affiliation(s)
- Sounak Ghosh
- Department of Cardiology, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.,Cardiovascular Department, The Eighth Affiliated Hospital, Sun Yat-Sen University, Shenzhen, China
| | - Wanbing He
- Department of Cardiology, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.,Cardiovascular Department, The Eighth Affiliated Hospital, Sun Yat-Sen University, Shenzhen, China
| | - Jingwei Gao
- Department of Cardiology, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Dongling Luo
- Cardiovascular Department, The Eighth Affiliated Hospital, Sun Yat-Sen University, Shenzhen, China
| | - Jingfeng Wang
- Department of Cardiology, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Jie Chen
- Department of Radiation Oncology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.
| | - Hui Huang
- Department of Cardiology, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China. .,Cardiovascular Department, The Eighth Affiliated Hospital, Sun Yat-Sen University, Shenzhen, China.
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9
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Verruck S, Balthazar CF, Rocha RS, Silva R, Esmerino EA, Pimentel TC, Freitas MQ, Silva MC, da Cruz AG, Prudencio ES. Dairy foods and positive impact on the consumer's health. ADVANCES IN FOOD AND NUTRITION RESEARCH 2019; 89:95-164. [PMID: 31351531 DOI: 10.1016/bs.afnr.2019.03.002] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The objective of the present chapter was to demonstrate the state of the art in the recent advances in nutritional and functional components of dairy products research. In this chapter, the main mechanisms responsible and essential for a better understanding of nutritional and functional values of the components of milk and dairy products are highlighted. It also includes a discussion about the positive impacts of fermented milk, cheese, butter, ice cream, and dairy desserts components on the consumer's health.
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Affiliation(s)
- Silvani Verruck
- Universidade Federal de Santa Catarina (UFSC), Departamento de Ciência e Tecnologia de Alimentos, Florianópolis, Brazil
| | | | - Ramon Silva Rocha
- Universidade Federal Fluminense (UFF), Faculdade de Veterinária, Niterói, Brazil; Instituto Federal de Educação, Ciência e Tecnologia do Rio de Janeiro (IFRJ), Departamento de Alimentos, Rio de Janeiro, Brazil
| | - Ramon Silva
- Universidade Federal Fluminense (UFF), Faculdade de Veterinária, Niterói, Brazil; Instituto Federal de Educação, Ciência e Tecnologia do Rio de Janeiro (IFRJ), Departamento de Alimentos, Rio de Janeiro, Brazil
| | | | | | | | - Marcia Cristina Silva
- Instituto Federal de Educação, Ciência e Tecnologia do Rio de Janeiro (IFRJ), Departamento de Alimentos, Rio de Janeiro, Brazil
| | - Adriano Gomes da Cruz
- Instituto Federal de Educação, Ciência e Tecnologia do Rio de Janeiro (IFRJ), Departamento de Alimentos, Rio de Janeiro, Brazil.
| | - Elane Schwinden Prudencio
- Universidade Federal de Santa Catarina (UFSC), Departamento de Ciência e Tecnologia de Alimentos, Florianópolis, Brazil
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Zhang K, Chen X, Zhang L, Deng Z. Fermented dairy foods intake and risk of cardiovascular diseases: A meta-analysis of cohort studies. Crit Rev Food Sci Nutr 2019; 60:1189-1194. [PMID: 30652490 DOI: 10.1080/10408398.2018.1564019] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Kui Zhang
- Department of Forensic Pathology, West China School of BasicMedical Sciences & Forensic Medicine, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Xiaogang Chen
- Department of Forensic Pathology, West China School of BasicMedical Sciences & Forensic Medicine, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Lin Zhang
- Department of Forensic Pathology, West China School of BasicMedical Sciences & Forensic Medicine, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Zhenhua Deng
- Department of Forensic Pathology, West China School of BasicMedical Sciences & Forensic Medicine, Sichuan University, Chengdu, Sichuan, People’s Republic of China
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11
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Whole milk consumption and risk of cardiovascular disease and mortality: Isfahan Cohort Study. Eur J Nutr 2017; 58:163-171. [PMID: 29151136 DOI: 10.1007/s00394-017-1581-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 11/10/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND The association between milk intake and cardiovascular disease (CVD) and mortality risk is still controversial but data from Middle-Eastern populations are scarce. We aimed to study these associations in an Iranian population. METHODS We used the Isfahan Cohort Study, a population-based prospective study of 6504 adult Iranians. In this analysis, we included 5432 participants free of CVD at baseline with at least one follow-up. Data on whole milk intake and other dietary factors were collected by a food frequency questionnaire at baseline. Cox proportional hazard regression was used to predict risk of CVD events, comprising coronary heart disease (CHD) and stroke, and mortality according to frequency of whole milk intake with adjustment for other potential confounders. RESULTS During a median 10.9 years of follow-up, we documented 705 new cases of CVD comprising 564 CHD and 141 stroke cases. Compared with non-consumers, less than daily intake of whole milk was significantly associated with lower risk of CVD (HR 0.80, 95% CI 0.65-0.97), CHD (HR 0.81, 95% CI 0.65-0.99), and a non-significant lower risk of stroke (HR 0.79, 95% CI 0.50-1.27). Daily intake of whole milk was not significantly associated with CVD (HR 1.25, 95% CI 0.89-1.75), CHD, and stroke, but was associated with higher risk of all-cause mortality (HR 1.54, 95% CI 1.04-2.29). CONCLUSIONS Less than daily intake of whole milk was associated with a statistically significant, although modest, lower risk of CVD compared with non-consumption, but this potential benefit may not extend to daily intake in this population.
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Bechthold A, Boeing H, Schwedhelm C, Hoffmann G, Knüppel S, Iqbal K, De Henauw S, Michels N, Devleesschauwer B, Schlesinger S, Schwingshackl L. Food groups and risk of coronary heart disease, stroke and heart failure: A systematic review and dose-response meta-analysis of prospective studies. Crit Rev Food Sci Nutr 2017; 59:1071-1090. [PMID: 29039970 DOI: 10.1080/10408398.2017.1392288] [Citation(s) in RCA: 362] [Impact Index Per Article: 51.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Despite growing evidence for food-based dietary patterns' potential to reduce cardiovascular disease risk, knowledge about the amounts of food associated with the greatest change in risk of specific cardiovascular outcomes and about the quality of meta-evidence is limited. Therefore, the aim of this meta-analysis was to synthesize the knowledge about the relation between intake of 12 major food groups (whole grains, refined grains, vegetables, fruits, nuts, legumes, eggs, dairy, fish, red meat, processed meat, and sugar-sweetened beverages [SSB]) and the risk of coronary heart disease (CHD), stroke and heart failure (HF). METHODS We conducted a systematic search in PubMed and Embase up to March 2017 for prospective studies. Summary risk ratios (RRs) and 95% confidence intervals (95% CI) were estimated using a random effects model for highest versus lowest intake categories, as well as for linear and non-linear relationships. RESULTS Overall, 123 reports were included in the meta-analyses. An inverse association was present for whole grains (RRCHD: 0.95 (95% CI: 0.92-0.98), RRHF: 0.96 (0.95-0.97)), vegetables and fruits (RRCHD: 0.97 (0.96-0.99), and 0.94 (0.90-0.97); RRstroke: 0.92 (0.86-0.98), and 0.90 (0.84-0.97)), nuts (RRCHD: 0.67 (0.43-1.05)), and fish consumption (RRCHD: 0.88 (0.79-0.99), RRstroke: 0.86 (0.75-0.99), and RRHF: 0.80 (0.67-0.95)), while a positive association was present for egg (RRHF: 1.16 (1.03-1.31)), red meat (RRCHD: 1.15 (1.08-1.23), RRstroke: 1.12 (1.06-1.17), RRHF: 1.08 (1.02-1.14)), processed meat (RRCHD: 1.27 (1.09-1.49), RRstroke: 1.17 (1.02-1.34), RRHF: 1.12 (1.05-1.19)), and SSB consumption (RRCHD: 1.17 (1.11-1.23), RRstroke: 1.07 (1.02-1.12), RRHF: 1.08 (1.05-1.12)) in the linear dose-response meta-analysis. There were clear indications for non-linear dose-response relationships between whole grains, fruits, nuts, dairy, and red meat and CHD. CONCLUSION An optimal intake of whole grains, vegetables, fruits, nuts, legumes, dairy, fish, red and processed meat, eggs and SSB showed an important lower risk of CHD, stroke, and HF.
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Affiliation(s)
| | - Heiner Boeing
- b Department of Epidemiology , German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE) , Nuthetal , Germany
| | - Carolina Schwedhelm
- b Department of Epidemiology , German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE) , Nuthetal , Germany
| | - Georg Hoffmann
- c Department of Nutritional Sciences , University of Vienna , Vienna , Austria
| | - Sven Knüppel
- b Department of Epidemiology , German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE) , Nuthetal , Germany
| | - Khalid Iqbal
- b Department of Epidemiology , German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE) , Nuthetal , Germany
| | | | - Nathalie Michels
- d Department of Public Health , Ghent University , Gent , Belgium
| | - Brecht Devleesschauwer
- e Department of Public Health and Surveillance , Scientific Institute of Public Health (WIV-ISP) , Brussels , Belgium
| | - Sabrina Schlesinger
- f Institute for Biometry and Epidemiology, Deutsches Diabetes-Zentrum (DDZ) at Heinrich Heine University Düsseldorf , Düsseldorf , Germany
| | - Lukas Schwingshackl
- b Department of Epidemiology , German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE) , Nuthetal , Germany
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Fernandez MA, Panahi S, Daniel N, Tremblay A, Marette A. Yogurt and Cardiometabolic Diseases: A Critical Review of Potential Mechanisms. Adv Nutr 2017; 8:812-829. [PMID: 29141967 PMCID: PMC5682997 DOI: 10.3945/an.116.013946] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Associations between yogurt intake and risk of diet-related cardiometabolic diseases (CMDs) have been the subject of recent research in epidemiologic nutrition. A healthy dietary pattern has been identified as a pillar for the prevention of weight gain and CMDs. Epidemiologic studies suggest that yogurt consumption is linked to healthy dietary patterns, lifestyles, and reduced risk of CMDs, particularly type 2 diabetes. However, to our knowledge, few to no randomized controlled trials have investigated yogurt intake in relation to cardiometabolic clinical outcomes. Furthermore, there has been little attempt to clarify the mechanisms that underlie the potential beneficial effects of yogurt consumption on CMDs. Yogurt is a nutrient-dense dairy food and has been suggested to reduce weight gain and prevent CMDs by contributing to intakes of protein, calcium, bioactive lipids, and several other micronutrients. In addition, fermentation with bacterial strains generates bioactive peptides, resulting in a potentially greater beneficial effect of yogurt on metabolic health than nonfermented dairy products such as milk. To date, there is little concrete evidence that the mechanisms proposed in observational studies to explain positive results of yogurt on CMDs or parameters are valid. Many proposed mechanisms are based on assumptions that commercial yogurts contain strain-specific probiotics, that viable yogurt cultures are present in adequate quantities, and that yogurt provides a minimum threshold dose of nutrients or bioactive components capable of exerting a physiologic effect. Therefore, the primary objective of this review is to investigate the plausibility of potential mechanisms commonly cited in the literature in order to shed light on the inverse associations reported between yogurt intake and various cardiometabolic health parameters that are related to its nutrient profile, bacterial constituents, and food matrix. This article reviews current gaps and challenges in identifying such mechanisms and provides a perspective on the research agenda to validate the proposed role of yogurt in protecting against CMDs.
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Affiliation(s)
- Melissa Anne Fernandez
- Heart and Lung Institute of Quebec, Laval University, Quebec, Canada
- Institute of Nutrition and Functional Foods, Laval University, Quebec, Canada
- School of Nutrition, Faculty of Agriculture and Food Sciences, Laval University, Quebec, Canada
| | - Shirin Panahi
- Department of Kinesiology, Laval University, Quebec, Canada
| | - Noémie Daniel
- Heart and Lung Institute of Quebec, Laval University, Quebec, Canada
- Institute of Nutrition and Functional Foods, Laval University, Quebec, Canada
- School of Nutrition, Faculty of Agriculture and Food Sciences, Laval University, Quebec, Canada
| | - Angelo Tremblay
- Heart and Lung Institute of Quebec, Laval University, Quebec, Canada
- School of Nutrition, Faculty of Agriculture and Food Sciences, Laval University, Quebec, Canada
- Department of Kinesiology, Laval University, Quebec, Canada
| | - André Marette
- Heart and Lung Institute of Quebec, Laval University, Quebec, Canada
- Institute of Nutrition and Functional Foods, Laval University, Quebec, Canada
- Department of Medicine, Faculty of Medicine, Laval University, Quebec, Canada
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Tognon G, Nilsson LM, Shungin D, Lissner L, Jansson JH, Renström F, Wennberg M, Winkvist A, Johansson I. Nonfermented milk and other dairy products: associations with all-cause mortality. Am J Clin Nutr 2017; 105:1502-1511. [PMID: 28490510 PMCID: PMC6546226 DOI: 10.3945/ajcn.116.140798] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 04/05/2017] [Indexed: 11/14/2022] Open
Abstract
Background: A positive association between nonfermented milk intake and increased all-cause mortality was recently reported, but overall, the association between dairy intake and mortality is inconclusive.Objective: We studied associations between intake of dairy products and all-cause mortality with an emphasis on nonfermented milk and fat content.Design: A total of 103,256 adult participants (women: 51.0%) from Northern Sweden were included (7121 deaths; mean follow-up: 13.7 y). Associations between all-cause mortality and reported intakes of nonfermented milk (total or by fat content), fermented milk, cheese, and butter were tested with the use of Cox proportional hazards models that were adjusted for age, sex, body mass index, smoking status, education, energy intake, examination year, and physical activity. To circumvent confounding, Mendelian randomization was applied in a subsample via the lactase LCT-13910 C/T single nucleotide polymorphism that is associated with lactose tolerance and milk intake.Results: High consumers of nonfermented milk (≥2.5 times/d) had a 32% increased hazard (HR: 1.32; 95% CI: 1.18, 1.48) for all-cause mortality compared with that of subjects who consumed milk ≤1 time/wk. The corresponding value for butter was 11% (HR: 1.11; 95% CI: 1.07, 1.21). All nonfermented milk-fat types were independently associated with increased HRs, but compared with full-fat milk, HRs were lower in consumers of medium- and low-fat milk. Fermented milk intake (HR: 0.90; 95% CI: 0.86, 0.94) and cheese intake (HR: 0.93; 95% CI: 0.91, 0.96) were negatively associated with mortality. Results were slightly attenuated by lifestyle adjustments but were robust in sensitivity analyses. Mortality was not significantly associated with the LCT-13910 C/T genotype in the smaller subsample. The amount and type of milk intake was associated with lifestyle variables.Conclusions: In the present Swedish cohort study, intakes of nonfermented milk and butter are associated with higher all-cause mortality, and fermented milk and cheese intakes are associated with lower all-cause mortality. Residual confounding by lifestyle cannot be excluded, and Mendelian randomization needs to be examined in a larger sample.
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Affiliation(s)
- Gianluca Tognon
- Section for Epidemiology and Social Medicine, Department of Public Health and Community Medicine, and
| | - Lena M Nilsson
- Arcum, Arctic Research Center at Umeå University, Umeå, Sweden
| | - Dmitry Shungin
- Odontology,Public Health and Clinical Medicine, Nutritional Research, Umeå University,
Umeå, Sweden
| | - Lauren Lissner
- Section for Epidemiology and Social Medicine, Department of Public Health
and Community Medicine
| | | | - Frida Renström
- Departments of Biobank Research,Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Maria Wennberg
- Public Health and Clinical Medicine, Nutritional Research, Umeå University,
Umeå, Sweden
| | - Anna Winkvist
- Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy,
University of Gothenburg, Gothenburg, Sweden,Public Health and Clinical Medicine, Nutritional Research, Umeå University,
Umeå, Sweden
| | - Ingegerd Johansson
- Odontology,Public Health and Clinical Medicine, Nutritional Research, Umeå University,
Umeå, Sweden
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Wu L, Sun D. Consumption of Yogurt and the Incident Risk of Cardiovascular Disease: A Meta-Analysis of Nine Cohort Studies. Nutrients 2017; 9:E315. [PMID: 28327514 PMCID: PMC5372978 DOI: 10.3390/nu9030315] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 03/13/2017] [Accepted: 03/21/2017] [Indexed: 01/20/2023] Open
Abstract
Previous systematic reviews and meta-analyses have evaluated the association of dairy consumption and the risk of cardiovascular disease (CVD). However, the findings were inconsistent. No quantitative analysis has specifically assessed the effect of yogurt intake on the incident risk of CVD. We searched the PubMed and the Embase databases from inception to 10 January 2017. A generic inverse-variance method was used to pool the fully-adjusted relative risks (RRs) and the corresponding 95% confidence intervals (CIs) with a random-effects model. A generalized least squares trend estimation model was used to calculate the specific slopes in the dose-response analysis. The present systematic review and meta-analysis identified nine prospective cohort articles involving a total of 291,236 participants. Compared with the lowest category, highest category of yogurt consumption was not significantly related with the incident risk of CVD, and the RR (95% CI) was 1.01 (0.95, 1.08) with an evidence of significant heterogeneity (I² = 52%). However, intake of ≥200 g/day yogurt was significantly associated with a lower risk of CVD in the subgroup analysis. There was a trend that a higher level of yogurt consumption was associated with a lower incident risk of CVD in the dose-response analysis. A daily dose of ≥200 g yogurt intake might be associated with a lower incident risk of CVD. Further cohort studies and randomized controlled trials are still demanded to establish and confirm the observed association in populations with different characteristics.
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Affiliation(s)
- Lei Wu
- Department of Epidemiology, Institute of Geriatrics, Chinese People's Liberation Army General Hospital, Beijing 100853, China.
| | - Dali Sun
- Department of Nanomedicine, Houston Methodist Research Institute, Houston, TX 77030, USA.
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Gholami F, Khoramdad M, Esmailnasab N, Moradi G, Nouri B, Safiri S, Alimohamadi Y. The effect of dairy consumption on the prevention of cardiovascular diseases: A meta-analysis of prospective studies. J Cardiovasc Thorac Res 2017; 9:1-11. [PMID: 28451082 PMCID: PMC5402021 DOI: 10.15171/jcvtr.2017.01] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Accepted: 03/10/2017] [Indexed: 01/20/2023] Open
Abstract
Introduction: There is no global consensus on the relationship of dairy products with cardiovascular diseases. This study was conducted to evaluate the effect of the consumption of dairy products on cardiovascular diseases, including stroke and coronary heart disease (CHD). Methods: Important electronic databases such as the Scopus, Science Direct, and PubMed were evaluated up to September 2014. All prospective cohort studies that evaluated the relationship between dairy products consumption and cardiovascular diseases were included regardless of their publication date and language. The study participants were evaluated regardless of age, sex, and ethnicity. The STROBE checklist was used to assess quality of the study. Two investigators separately selected the studies and extracted the data. The designated effects were risk ratio (RR) and hazard ratio (HR). The random effect model was used to combine the results. Results: Meta-analysis was performed on 27 studies. There were 8648 cases of cardiovascular diseases (CVD), 11806 cases of CHD, and 29300 cases of stroke. An inverse association was found between total dairy intake and CVD (RR=0.90, 95% CI: 0.81-0.99) and stroke (RR=0.88, 95% CI: 0.82-0.95) while no association was observed between total dairy intake and CHD. The total diary intake was associated with decreased mortality of stroke (RR=0.80, 95% CI: 0.76-0.83) although it had no association with its incidence (RR=0.96, 95% CI: 0.88-1.04). Conclusion: This is the first meta-analysis of the relationship of total dairy intake with CVD. This study showed an inverse relationship between total dairy intake and CVD while no relationship was found for CHD. Considering the limited number of studies in this regard, more studies are required to investigate the effect of different factors on the association of dairy intake and CVD.
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Affiliation(s)
- Fatemeh Gholami
- Department of Epidemiology, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Malihe Khoramdad
- Faculty of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Nader Esmailnasab
- Social Determinants of Health Research Center, Department of Epidemiology and Biostatistics, School of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Ghobad Moradi
- Social Determinants of Health Research Center, Department of Epidemiology and Biostatistics, School of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Bijan Nouri
- Social Determinants of Health Research Center, Department of Epidemiology and Biostatistics, School of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Saeid Safiri
- Department of Public Health, School of Public Health, Maragheh University of Medical Sciences, Maragheh, Iran
| | - Yousef Alimohamadi
- Noor Research Center for Ophthalmic Epidemiology, Noor Eye Hospital, Tehran, Iran
- Department of Epidemiology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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17
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Cheese Consumption and Risk of All-Cause Mortality: A Meta-Analysis of Prospective Studies. Nutrients 2017; 9:nu9010063. [PMID: 28098767 PMCID: PMC5295107 DOI: 10.3390/nu9010063] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 11/14/2016] [Accepted: 01/09/2017] [Indexed: 12/18/2022] Open
Abstract
The association between cheese consumption and risk for major health endpoints has been investigated in many epidemiologic studies, but findings are inconsistent. As all-cause mortality can be viewed as the final net health effect of dietary intakes, we conducted a meta-analysis to examine the long-term association of cheese consumption with all-cause mortality. Relevant studies were identified by a search of the PubMed database through May 2016. Reference lists from retrieved articles were also reviewed. Summary relative risks (RR) and 95% confidence intervals (CI) were calculated using a random-effects model. Pre-specified stratified and dose-response analyses were also performed. The final analysis included nine prospective cohort studies involving 21,365 deaths. The summary RR of all-cause mortality for the highest compared with the lowest cheese consumption was 1.02 (95% CI: 0.97, 1.06), and little evidence of heterogeneity was observed. The association between cheese consumption and risk of all-cause mortality did not significantly differ by study location, sex, age, number of events, study quality score or baseline diseases excluded. There was no dose-response relationship between cheese consumption and risk of all-cause mortality (RR per 43 g/day = 1.03, 95% CI: 0.99-1.07). No significant publication bias was observed. Our findings suggest that long-term cheese consumption was not associated with an increased risk of all-cause mortality.
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Mullie P, Pizot C, Autier P. Daily milk consumption and all-cause mortality, coronary heart disease and stroke: a systematic review and meta-analysis of observational cohort studies. BMC Public Health 2016; 16:1236. [PMID: 27927192 PMCID: PMC5143456 DOI: 10.1186/s12889-016-3889-9] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 11/29/2016] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Observational studies and meta-analyses relating milk consumption by adults to all-cause mortality, coronary heart disease and stroke have obtained contradictory results. Some studies found a protective effect of milk consumption, whilst other found an increased risk. METHODS We performed a systematic literature search until June 2015 on prospective studies that looked at milk consumption, all-cause mortality, coronary heart disease and stroke. Random-effect meta-analyses were performed with dose-response. RESULTS Twenty-one studies involving 19 cohorts were included in this meta-analysis, 11 on all-cause mortality, 9 on coronary heart disease, and 10 on stroke. Milk intake ranged from 0 to 850 mL/d. The summary relative risk (SRR) for 200 mL/d milk consumption was 1.01 (95% CI: 0.96-1.06) for all-cause mortality, 1.01 (95% CI: 0.98-1.05) for fatal and non fatal coronary heart disease, and 0.91 (95% CI: 0.82-1.02) for fatal and non fatal stroke. Stratified analyses by age, Body Mass Index, total energy intake and physical acitivity did not alter the SRR estimates. The possibility of publication bias was found for all cause mortality and for stroke, indicating a gap in data that could have suggested a higher risk of these conditions with increased milk consumption. CONCLUSIONS We found no evidence for a decreased or increased risk of all-cause mortality, coronary heart disease, and stroke associated with adult milk consumption. However, the possibility cannot be dismissed that risks associated with milk consumption could be underestimated because of publication bias.
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Affiliation(s)
- Patrick Mullie
- International Prevention Research Institute, Espace Européen, Building G, Allée Claude Debussy, Lyon Ouest, Ecully, 69130, France
- Vrije Universiteit Brussel, Elsene, Belgium
| | - Cécile Pizot
- International Prevention Research Institute, Espace Européen, Building G, Allée Claude Debussy, Lyon Ouest, Ecully, 69130, France
| | - Philippe Autier
- International Prevention Research Institute, Espace Européen, Building G, Allée Claude Debussy, Lyon Ouest, Ecully, 69130, France.
- University of Strathclyde Institute of Global Public Health at iPRI, International Prevention Research Institute, Ecully, France.
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Thorning TK, Raben A, Bendsen NT, Jørgensen HH, Kiilerich P, Ardö Y, Lorenzen JK, Kristiansen K, Astrup A. Importance of the fat content within the cheese-matrix for blood lipid profile, faecal fat excretion, and gut microbiome in growing pigs. Int Dairy J 2016. [DOI: 10.1016/j.idairyj.2016.04.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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20
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Cheese consumption and risk of cardiovascular disease: a meta-analysis of prospective studies. Eur J Nutr 2016; 56:2565-2575. [PMID: 27517544 DOI: 10.1007/s00394-016-1292-z] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 08/06/2016] [Indexed: 01/05/2023]
Abstract
PURPOSE Cheese contains a high content of saturated fatty acids but also lists of potentially beneficial nutrients. How long-term cheese consumption affects the development of cardiovascular disease (CVD) is unclear. A meta-analysis of prospective observational studies was conducted to evaluate the risks of total CVD, coronary heart disease (CHD), and stroke associated with cheese consumption. METHODS Potentially eligible studies were identified by searching PubMed and EMBASE databases and by carefully reviewing the bibliographies of retrieved publications and related reviews. The summary relative risks (RRs) with 95 % confidence intervals (CIs) were calculated using the random-effects model. RESULTS The final analyses included 15 prospective studies. Most of the studies excluded prevalent CVD at baseline (14/15) and had a duration >10 years (13/15). The summary RR for high vs. low cheese consumption was 0.90 (95 % CI 0.82-0.99) for total CVD (7 studies, 8076 events), 0.86 (95 % CI 0.77-0.96) for CHD (8 studies, 7631 events), and 0.90 (95 % CI 0.84-0.97) for stroke (7 studies, 10,449 events), respectively. The restricted cubic model indicated evidence of nonlinear relationships between cheese consumption and risks of total CVD (P nonlinearity < 0.001) and stroke (P nonlinearity = 0.015), with the largest risk reductions observed at the consumption of approximately 40 g/d. CONCLUSIONS This meta-analysis of prospective studies suggests a nonlinear inverse association between cheese consumption and risk of CVD.
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Is Butter Back? A Systematic Review and Meta-Analysis of Butter Consumption and Risk of Cardiovascular Disease, Diabetes, and Total Mortality. PLoS One 2016; 11:e0158118. [PMID: 27355649 PMCID: PMC4927102 DOI: 10.1371/journal.pone.0158118] [Citation(s) in RCA: 120] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 06/12/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Dietary guidelines recommend avoiding foods high in saturated fat. Yet, emerging evidence suggests cardiometabolic benefits of dairy products and dairy fat. Evidence on the role of butter, with high saturated dairy fat content, for total mortality, cardiovascular disease, and type 2 diabetes remains unclear. We aimed to systematically review and meta-analyze the association of butter consumption with all-cause mortality, cardiovascular disease, and diabetes in general populations. METHODS AND FINDINGS We searched 9 databases from inception to May 2015 without restriction on setting, or language, using keywords related to butter consumption and cardiometabolic outcomes. Prospective cohorts or randomized clinical trials providing estimates of effects of butter intake on mortality, cardiovascular disease including coronary heart disease and stroke, or diabetes in adult populations were included. One investigator screened titles and abstracts; and two reviewed full-text articles independently in duplicate, and extracted study and participant characteristics, exposure and outcome definitions and assessment methods, analysis methods, and adjusted effects and associated uncertainty, all independently in duplicate. Study quality was evaluated by a modified Newcastle-Ottawa score. Random and fixed effects meta-analysis pooled findings, with heterogeneity assessed using the I2 statistic and publication bias by Egger's test and visual inspection of funnel plots. We identified 9 publications including 15 country-specific cohorts, together reporting on 636,151 unique participants with 6.5 million person-years of follow-up and including 28,271 total deaths, 9,783 cases of incident cardiovascular disease, and 23,954 cases of incident diabetes. No RCTs were identified. Butter consumption was weakly associated with all-cause mortality (N = 9 country-specific cohorts; per 14g(1 tablespoon)/day: RR = 1.01, 95%CI = 1.00, 1.03, P = 0.045); was not significantly associated with any cardiovascular disease (N = 4; RR = 1.00, 95%CI = 0.98, 1.02; P = 0.704), coronary heart disease (N = 3; RR = 0.99, 95%CI = 0.96, 1.03; P = 0.537), or stroke (N = 3; RR = 1.01, 95%CI = 0.98, 1.03; P = 0.737), and was inversely associated with incidence of diabetes (N = 11; RR = 0.96, 95%CI = 0.93, 0.99; P = 0.021). We did not identify evidence for heterogeneity nor publication bias. CONCLUSIONS This systematic review and meta-analysis suggests relatively small or neutral overall associations of butter with mortality, CVD, and diabetes. These findings do not support a need for major emphasis in dietary guidelines on either increasing or decreasing butter consumption, in comparison to other better established dietary priorities; while also highlighting the need for additional investigation of health and metabolic effects of butter and dairy fat.
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Abstract
Inverse associations between dairy consumption and CVD have been reported in several epidemiological studies. Our objective was to conduct a meta-analysis of prospective cohort studies of dairy intake and CVD. A comprehensive literature search was conducted to identify studies that reported risk estimates for total dairy intake, individual dairy products, low/full-fat dairy intake, Ca from dairy sources and CVD, CHD and stroke. Random-effects meta-analyses were used to generate summary relative risk estimates (SRRE) for high v. low intake and stratified intake dose-response analyses. Additional dose-response analyses were performed. Heterogeneity was examined in sub-group and sensitivity analyses. In total, thirty-one unique cohort studies were identified and included in the meta-analysis. Several statistically significant SRRE below 1.0 were observed, namely for total dairy intake and stroke (SRRE=0·91; 95% CI 0·83, 0·99), cheese intake and CHD (SRRE=0·82; 95% CI 0·72, 0·93) and stroke (SRRE=0·87; 95% CI 0·77, 0·99), and Ca from dairy sources and stroke (SRRE=0·69; 95% CI 0·60, 0·81). However, there was little evidence for inverse dose-response relationships between the dairy variables and CHD and stroke after adjusting for within-study covariance. The results of this meta-analysis of prospective cohort studies have shown that dairy consumption may be associated with reduced risks of CVD, although additional data are needed to more comprehensively examine potential dose-response patterns.
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23
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Engel S, Tholstrup T. Butter increased total and LDL cholesterol compared with olive oil but resulted in higher HDL cholesterol compared with a habitual diet. Am J Clin Nutr 2015; 102:309-15. [PMID: 26135349 DOI: 10.3945/ajcn.115.112227] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 05/26/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Butter is known to have a cholesterol-raising effect and, therefore, has often been included as a negative control in dietary studies, whereas the effect of moderate butter intake has not been elucidated to our knowledge. OBJECTIVE We compared the effects of moderate butter intake, moderate olive oil intake, and a habitual diet on blood lipids, high-sensitivity C-reactive protein (hsCRP), glucose, and insulin. DESIGN The study was a controlled, double-blinded, randomized 2 × 5-wk crossover dietary intervention study with a 14-d run-in period during which subjects consumed their habitual diets. The study included 47 healthy men and women (mean ± SD total cholesterol: 5.22 ± 0.90 mmol/L) who substituted a part of their habitual diets with 4.5% of energy from butter or refined olive oil. RESULTS Study subjects were 70% women with a mean age and body mass index (in kg/m²) of 40.4 y and 23.5, respectively. Butter intake increased total cholesterol and LDL cholesterol more than did olive oil intake (P < 0.05) and the run-in period (P < 0.005 and P < 0.05, respectively) and increased HDL cholesterol compared with the run-in period (P < 0.05). No difference in effects was observed for triacylglycerol, hsCRP, insulin, and glucose concentrations. The intake of saturated fatty acids was significantly higher in the butter period than in the olive oil and run-in periods (P < 0.0001). CONCLUSIONS Moderate intake of butter resulted in increases in total cholesterol and LDL cholesterol compared with the effects of olive oil intake and a habitual diet (run-in period). Furthermore, moderate butter intake was also followed by an increase in HDL cholesterol compared with the habitual diet. We conclude that hypercholesterolemic people should keep their consumption of butter to a minimum, whereas moderate butter intake may be considered part of the diet in the normocholesterolemic population.
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Affiliation(s)
- Sara Engel
- Department of Nutrition, Exercise, and Sports, Faculty of Science, University of Copenhagen, Frederiksberg, Denmark
| | - Tine Tholstrup
- Department of Nutrition, Exercise, and Sports, Faculty of Science, University of Copenhagen, Frederiksberg, Denmark
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24
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Abstract
Cardiovascular disease (CVD) prevalence at a global level is predicted to increase substantially over the next decade due to the increasing ageing population and incidence of obesity. Hence, there is an urgent requirement to focus on modifiable contributors to CVD risk, including a high dietary intake of saturated fatty acids (SFA). As an important source of SFA in the UK diet, milk and dairy products are often targeted for SFA reduction. The current paper acknowledges that milk is a complex food and that simply focusing on the link between SFA and CVD risk overlooks the other beneficial nutrients of dairy foods. The body of existing prospective evidence exploring the impact of milk and dairy consumption on risk factors for CVD is reviewed. The current paper highlights that high milk consumption may be beneficial to cardiovascular health, while illustrating that the evidence is less clear for cheese and butter intake. The option of manipulating the fatty acid profile of ruminant milk is discussed as a potential dietary strategy for lowering SFA intake at a population level. The review highlights that there is a necessity to perform more well-controlled human intervention-based research that provides a more holistic evaluation of fat-reduced and fat-modified dairy consumption on CVD risk factors including vascular function, arterial stiffness, postprandial lipaemia and markers of inflammation. Additionally, further research is required to investigate the impact of different dairy products and the effect of the specific food matrix on CVD development.
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Affiliation(s)
- O Markey
- Hugh Sinclair Unit of Human Nutrition and Institute for Cardiovascular and Metabolic Research (ICMR), Department of Food and Nutritional Sciences, University of Reading UK
| | - D Vasilopoulou
- Hugh Sinclair Unit of Human Nutrition and Institute for Cardiovascular and Metabolic Research (ICMR), Department of Food and Nutritional Sciences, University of Reading UK ; Food Production and Quality Research Division, School of Agriculture, Policy and Development, Faculty of Life Sciences, University of Reading UK
| | - D I Givens
- Food Production and Quality Research Division, School of Agriculture, Policy and Development, Faculty of Life Sciences, University of Reading UK
| | - J A Lovegrove
- Hugh Sinclair Unit of Human Nutrition and Institute for Cardiovascular and Metabolic Research (ICMR), Department of Food and Nutritional Sciences, University of Reading UK
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25
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Givens DI, Livingstone KM, Pickering JE, Fekete ÁA, Dougkas A, Elwood PC. Milk: White elixir or white poison? An examination of the associations between dairy consumption and disease in human subjects. Anim Front 2014. [DOI: 10.2527/af.2014-0009] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- D. I. Givens
- Food Production and Quality Division, Faculty of Life Sciences, University of Reading, Reading, UK
| | - K. M. Livingstone
- Food Production and Quality Division, Faculty of Life Sciences, University of Reading, Reading, UK
- Department of Food and Nutritional Sciences, Faculty of Life Sciences, University of Reading, Reading, UK
| | - J. E. Pickering
- Institute of Primary Care & Public Health, Cardiff University School of Medicine, Cardiff, UK
| | - Á. A. Fekete
- Food Production and Quality Division, Faculty of Life Sciences, University of Reading, Reading, UK
- Department of Food and Nutritional Sciences, Faculty of Life Sciences, University of Reading, Reading, UK
| | - A. Dougkas
- Applied Nutrition and Food Chemistry, Department of Food Technology, Engineering and Nutrition, Lund University, Lund, Sweden
| | - P. C. Elwood
- Institute of Primary Care & Public Health, Cardiff University School of Medicine, Cardiff, UK
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26
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Abstract
The consumption of dairy, including milk, cheese and yogurt, has been associated with better quality of diet and reduced risk of cardiovascular disease, the leading cause of death globally. The purpose of this review is to examine recent literature on the relationship between dairy consumption and risk of cardiovascular disease incidence and mortality. Eighteen observational studies were reviewed, the results of which indicate that total dairy intake does not contribute to cardiovascular disease incidence or death. Based on available data, it appears that milk, cheese, and yogurt are inversely associated with cardiovascular disease risk. Data pertaining to dairy fat were inconclusive, but point to a potential protective effect of full-fat milk, cheese, and yogurt on risk of cardiovascular disease. Currently, there is a need to study specific well-defined foods, as opposed to calculating nutrients, in order to better understand these relationships. Future research need not replicate the body of literature on total dairy consumption and associated risk of disease, but rather should focus on the effects of individual dairy foods on cardiovascular events in male and female populations.
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Affiliation(s)
- Beth H. Rice
- Dairy Research Institute, 10255 West Higgins Road, Suite 900, Rosemont, IL 60018-5616 USA
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27
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Visioli F, Strata A. Milk, dairy products, and their functional effects in humans: a narrative review of recent evidence. Adv Nutr 2014; 5:131-43. [PMID: 24618755 PMCID: PMC3951796 DOI: 10.3945/an.113.005025] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Milk is a widely consumed beverage that is essential to the diet of several millions of people worldwide because it provides important macro- and micronutrients. Milk is recognized as being useful during childhood and adolescence because of its composition; however, its relatively high saturated fat proportion raises issues of potential detrimental effects, namely on the cardiovascular system. This review evaluates the most recent literature on dairy and human health, framed within epidemiologic, experimental, and biochemical evidence. As an example, the effects of milk (notably skimmed milk) on body weight appear to be well documented, and the conclusions of the vast majority of published studies indicate that dairy consumption does not increase cardiovascular risk or the incidence of some cancers. Even though the available evidence is not conclusive, some studies suggest that milk and its derivatives might actually be beneficial to some population segments. Although future studies will help elucidate the role of milk and dairy products in human health, their use within a balanced diet should be considered in the absence of clear contraindications.
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Affiliation(s)
- Francesco Visioli
- Laboratory of Functional Foods, Madrid Institute for Advanced Studies (IMDEA)-Food, CEI UAM+CSIC, Madrid, Spain
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28
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Sun Y, Jiang C, Cheng KK, Zhang W, Leung GM, Lam TH, Schooling CM. Milk consumption and cardiovascular risk factors in older Chinese: the Guangzhou Biobank Cohort Study. PLoS One 2014; 9:e84813. [PMID: 24416290 PMCID: PMC3885601 DOI: 10.1371/journal.pone.0084813] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Accepted: 11/27/2013] [Indexed: 12/15/2022] Open
Abstract
Background Dairy products consumption is increasingly common globally. Most of the evidence concerning dairy products comes from observational studies in western populations which are inevitably open to confounding. To triangulate the evidence concerning dairy products, we examined the associations of whole cow's milk consumption with cardiovascular risk factors in a non-Western setting with a different pattern of milk consumption and cardiovascular diseases from Western populations. Methods We used multivariable censored linear or logistic regression to examine cross-sectionally the adjusted associations of whole cow's milk consumption (none (n = 14892), 1–3/week (n = 2689) and 3+/week (n = 2754)) with cardiovascular risk factors in Chinese (≥50 years) in the Guangzhou Biobank Cohort Study. Results Whole cow's milk consumption was negatively associated with systolic blood pressure (3+/week compared to none −2.56 mmHg, 95% confidence interval (CI) −3.63 to −1.49), diastolic blood pressure (−1.32 mmHg, 95% CI −1.87 to −0.77) and triglycerides (−0.06 mmol/L, 95% CI −0.11 to −0.002), but was positively associated with HDL-cholesterol (0.02 mmol/L,95% CI 0.01 to 0.04) and fasting glucose (0.08 mmol/L, 95% CI 0.01 to 0.16) adjusted for age, sex, phase of study, socio-economic position, lifestyle (smoking, alcohol use and physical activity) and adiposity, but had no obvious association with LDL-cholesterol or the presence of diabetes. Conclusions Whole cow's milk consumption had heterogeneous associations with cardiovascular risk factors. Higher whole cow's milk consumption was associated with lower levels of specific cardiovascular risk factors which might suggest risk factor specific biological pathways with different relations to blood pressure and lipids than glucose.
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Affiliation(s)
- Yangbo Sun
- Lifestyle and Lifecourse Epidemiology Group, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, SAR, China
| | | | - Kar Keung Cheng
- Department of Public Health and Epidemiology, University of Birmingham, Birmingham, United Kingdom
| | | | - Gabriel M. Leung
- Lifestyle and Lifecourse Epidemiology Group, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, SAR, China
| | - Tai Hing Lam
- Lifestyle and Lifecourse Epidemiology Group, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, SAR, China
- * E-mail:
| | - C. Mary Schooling
- Lifestyle and Lifecourse Epidemiology Group, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, SAR, China
- School of Public Health, CUNY, New York, New York, United States of America
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