The Consumption of Milk and Dairy Foods and the Incidence of Vascular Disease and Diabetes: An Overview of the Evidence
Corresponding Author
Peter C. Elwood
- [email protected]
- +44-29-20687233
Department of Primary Care and Public Health, Cardiff University, University Hospital of Wales, Cardiff, CF14 4YS UK
[email protected]Search for more papers by this authorD. Ian Givens
Nutritional Sciences Research Unit, School of Agriculture, Policy and Development, University of Reading, Reading, Berkshire, UK
Search for more papers by this authorJohn E. Gallacher
Department of Primary Care and Public Health, Cardiff University, University Hospital of Wales, Cardiff, CF14 4YS UK
Search for more papers by this authorCorresponding Author
Peter C. Elwood
- [email protected]
- +44-29-20687233
Department of Primary Care and Public Health, Cardiff University, University Hospital of Wales, Cardiff, CF14 4YS UK
[email protected]Search for more papers by this authorD. Ian Givens
Nutritional Sciences Research Unit, School of Agriculture, Policy and Development, University of Reading, Reading, Berkshire, UK
Search for more papers by this authorJohn E. Gallacher
Department of Primary Care and Public Health, Cardiff University, University Hospital of Wales, Cardiff, CF14 4YS UK
Search for more papers by this authorAbstract
The health effects of milk and dairy food consumption would best be determined in randomised controlled trials. No adequately powered trial has been reported and none is likely because of the numbers required. The best evidence comes, therefore, from prospective cohort studies with disease events and death as outcomes. Medline was searched for prospective studies of dairy food consumption and incident vascular disease and Type 2 diabetes, based on representative population samples. Reports in which evaluation was in incident disease or death were selected. Meta-analyses of the adjusted estimates of relative risk for disease outcomes in these reports were conducted. Relevant case–control retrospective studies were also identified and the results are summarised in this article. Meta-analyses suggest a reduction in risk in the subjects with the highest dairy consumption relative to those with the lowest intake: 0.87 (0.77, 0.98) for all-cause deaths, 0.92 (0.80, 0.99) for ischaemic heart disease, 0.79 (0.68, 0.91) for stroke and 0.85 (0.75, 0.96) for incident diabetes. The number of cohort studies which give evidence on individual dairy food items is very small, but, again, there is no convincing evidence of harm from consumption of the separate food items. In conclusion, there appears to be an enormous mis-match between the evidence from long-term prospective studies and perceptions of harm from the consumption of dairy food items.
References
- 1Elwood PC (2001) Milk, coronary disease and mortality. J Epidemiol Community Health 55: 375
10.1136/jech.55.6.375 Google Scholar
- 2Cochrane AL (1972) Effectiveness and efficiency. Random reflections on health services. Nuffield Provincial Hospitals Trust, London
- 3Alvarez-León E-E, Román-Viñas B, Serra-Majem LS (2006) Dairy products and health: a review of the epidemiological evidence. Br J Nutr 96: S94–S99
- 4Egger M, Davey Smith G, Altman DG (2001) Systematic reviews in health care: meta-analysis in context. BMJ Books, London
10.1002/9780470693926 Google Scholar
- 5Moher D, Liberati A, Tetzlaff J, Altman DG; PRISMA Group (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 339: b2535
- 6Gao X, LaValley MP, Tucker KL (2005) Prospective studies of dairy product and calcium intakes and prostate cancer risk: a meta-analysis. J Natl Cancer Inst 97: 1769–1777
10.1093/jnci/dji402 Google Scholar
- 7Kahn HA, Phillips RL, Snowdon DA, Choi W (1984) Association between reported diet and all-cause mortality. Twenty-one-year follow-up on 27,530 adult Seventh-Day Adventists. Am J Epidemiol 119: 775–787
- 8van der Vijver LPL, van der Waal MAE, Weterings KGC, Dekker JM, Schouten EG, Kok F (1992) Calcium intake and 28-year cardiovascular and coronary heart disease mortality in Dutch civil servants. Int J Epidemiol 21: 36–39
- 9Hu FB, Stampfer MJ, Manson JE, Ascherio A, Colditz GA, Speizer FE, Hennekens CH, Willett WC (1999) Dietary saturated fats and their food sources in relation to the risk of coronary heart disease in women. Am J Clin Nutr 70: 1001–1008
- 10Sun Q, Ma J, Campos H, Hu FB (2007) Plasma and erythrocyte biomarkers of dairy fat intake and risk of ischemic heart disease. Am J Clin Nutr 86: 929–937
- 11Elwood P, Fehily A, Pickering J, Givens I (2008) Pentadecanoic acid (15:0), milk, and ischemic heart disease. Am J Clin Nutr 87: 1540–1541
10.1093/ajcn/87.5.1540 Google Scholar
- 12Snowdon DA (1998) Animal product consumption and mortality because of all causes combined, coronary heart disease, stroke, diabetes, and cancer in Seventh-day Adventists. Am J Clin Nutr 48: 739–748
10.1093/ajcn/48.3.739 Google Scholar
- 13Jacobsen BK, Stensvold I (1992) Milk—a better drink? Relationships with total serum cholesterol in a cross-sectional survey. The Nordland Health Study. Scand J Soc Med 20: 204–208
10.1177/140349489202000403 Google Scholar
- 14Elwood PC, Givens DI, Beswick AD, Fehily AM, Pickering JE, Gallacher JE (2008) The survival advantage of milk and dairy consumption: an overview of evidence from cohort studies of vascular diseases, diabetes and cancer. J Am Coll Nutr 27: 723S–734S
- 15Ciccarone E, Di Castelnuovo A, Salcuni M, Siani A, Giacco A, Donati MB, de Gaetano G, Capani F, Iacoviello L (2003) A highscore Mediterranean dietary pattern is associated with a reduced risk of peripheral arterial disease in Italian patients with Type 2 diabetes. J Thromb Haemost 1: 1744–1752
- 16Gillman MW, Cupples LA, Gagnon D, Millen BE, Ellison RC, Castelli WP (1997) Margarine intake and subsequent coronary heart disease in men. Epidemiology 8: 144–149
- 17Lockheart MSK, Steffen LM, Rebnord HM, Fimreite RL, Ringstad J, Thelle DS, Pedersen JI, Jacobs DR (2007) Dietary patterns, food groups and myocardial infarction: a case–control study. Br J Nutr 98: 380–387
- 18Gramenzi A, Gentile A, Fasoli M, Negri E, Parazzini F, La Vecchia C (1990) Association between certain foods and risk of acute myocardial infarction in women. BMJ 300: 771–773
- 19Iso H, Stampfer MJ, Manson JE, Rexrode K, Hennekens CH, Colditz GA, Speizer FE, Willett WC (1999) Prospective study of calcium, potassium, and magnesium intake and risk of stroke in women. Stroke 30: 1772–1779
- 20Tholstrup T (2006) Dairy products and cardiovascular disease. Curr Opin Lipidol 17: 1–10
- 21Biong AS, Rebnord HM, Fimreite RL, Trygg KU, Ringstad J, Thelle DS, Pedersen JI (2008) Intake of dairy fat and dairy products, and risk of myocardial infarction: a case–control study. Int J Food Sci Nutr 59: 155–165
- 22Tavani A, Gallus S, Negri E, La Vecchia C (2002) Milk, dairy products, and coronary heart disease. J Epidemiol Com Health 56: 471–472
- 23Larsson SC, Männistö S, Virtanen MJ, Kontto J, Albanes D, Virtamo J (2009) Dairy foods and risk of stroke. Epidemiology 20: 355–360
- 24Elwood PC, Pickering JE, Fehily AM (2007) Milk and dairy consumption, diabetes and the metabolic syndrome: the Caerphilly prospective study. J Epidemiol Community Health 61(8): 695–698
- 25Temme EHM, Mensink RP, Hornstra G (1996) Comparison of the effects of diets enriched in lauric, palmitic, or oleic acids on serum lipids and lipoproteins in healthy women and men. Am J Clin Nutr 63: 897–903
- 26Mensink RP, Zock PL, Kester AD, Katan MB (2003) Effects of dietary fatty acids and carbohydrates on the ratio of serum total to HDL cholesterol and on serum lipids and apolipoproteins: a meta-analysis of 60 controlled trials. Am J Clin Nutr 77: 1146–1155
- 27Griffith LE, Guyatt GH, Cook RJ, Bucher HC, Cook DJ (1999) The influence of dietary and nondietary calcium supplementation on blood pressure: an updated meta-analysis of randomized controlled trials. Am J Hypertens 12: 84–92
- 28Garcia-Palmieri MR, Costas R Jr, Cruz-Vidal M, Sorlie PD, Tillotson J, Havlik RJ (1984) Milk consumption, calcium intake, and decreased hypertension in Puerto Rico. Puerto Rico Heart Health Program study. Hypertension 6: 322–328
- 29 World Cancer Research Fund/American Institute for Cancer Research (2007) Food, nutrition, physical activity, and the prevention of cancer: a global perspective. American Institute of Cancer Research (AICR), Washington, pp 129–132
- 30Ness AR, Davey Smith G, Hart C (2001) Milk, coronary heart disease and mortality. J Epidemiol Community Health 55: 379–382
- 31Elwood PC, Pickering JE, Fehily AM, Hughes J, Ness AR (2004) Milk drinking, ischaemic heart disease and ischaemic stroke I. Evidence from the Caerphilly cohort. Eur J Clin Nutr 58: 711–717
- 32Umesawa M, Iso H, Ishihara J, Saito I, Kokubo Y, Inoue M, Tsugane S, JPHC Study Group (2008) Dietary calcium intake and risks of stroke, its subtypes, and coronary heart disease in Japanese: the JPHC Study Cohort I. Stroke 39: 2449–2456
- 33Snowdon DA, Phillips RL, Fraser GE (1984) Meat consumption and fatal ischemic heart disease. Prev Med 13: 490–500
- 34Elwood PC, Strain JJ, Robson PJ, Fehily AM, Hughes J, Pickering J, Ness A (2005) Milk consumption, stroke, and heart attack risk: evidence from the Caerphilly cohort of older men. J Epidemiol Com Health 59: 502–505
- 35Gibson RA, Makrides M, Smithers LG, Voevodin M, Sinclair AJ (2009) The effect of dairy foods on CHD: a systematic review of prospective cohort studies. Br J Nutr 102: 1267–1275
- 36Mente A, de Koning L, Shannon HS, Anand SS (2009) A systematic review of the evidence supporting a causal link between dietary factors and coronary heart disease. Arch Intern Med 169: 659–669
- 37Shaper AG, Wannamethee G, Walker M (1991) Milk, butter, and heart disease. Br Med J 302: 785–786
- 38German JB, Dillard CJ (2004) Saturated fats: what dietary intake? Am J Clin Nutr 80: 550–559
- 39Ditscheid B, Keller S, Jahreis G (2005) Cholesterol metabolism is affected by calcium phosphate supplementation in humans. J Nutr 135: 1678–1682
- 40Engberink MF, Hendriksen MA, Schouten EG, van Rooij FJA, Hofman A, Witteman JC, Geleijnse JM (2009) Inverse association between dairy intake and hypertension: the Rotterdam Study. Am J Clin Nutr 89: 1877–1883
- 41Massey LK (2001) Dairy food consumption, blood pressure and stroke. J Nutr 131: 1875–1878
- 42Clare DA, Swaisgood HE (2000) Bioactive milk peptides: a prospectus. J Dairy Sci 83: 1187–1195
- 43Renaud S, Ciavatti M, Thevenon C, Ripoll JP (1983) Protective effects of dietary calcium and magnesium on platelet function and atherosclerosis in rabbits fed saturated fat. Atherosclerosis 47: 187–198
- 44Elwood PC, Beswick A, Pickering J, McCarron P, O'Brien JR, Renaud SR, Flower RJ (2001) Platelet tests in the prediction of myocardial infarction and ischaemic stroke: evidence from the Caerphilly Prospective study. Br J Haematol 113: 514–520
- 45Kelemen LE, Kushi LH, Jacobs DR Jr, Cerhan JR (2005) Associations of dietary protein with disease and mortality in a prospective study of postmenopausal women. Am J Epidemiol 161: 239–249
- 46Mann JI, Appleby PN, Key TJ, Thorogood M (1997) Dietary determinants of ischaemic heart disease in health conscious individuals. Heart 78: 450–455
- 47Trichopoulou A, Psaltopoulou T, Orfanos P, Trichopoulos D (2006) Diet and physical activity in relation to overall mortality amongst adult diabetics in a general population cohort. J Intern Med 259: 583–591
- 48van der Pols JC, Gunnell D, Williams GM, Holly JM, Bain C, Martin RM (2009) Childhood dairy and calcium intake and cardiovascular mortality in adulthood: 65-year follow-up of the Boyd Orr cohort. Heart 19: 1600–1606
10.1136/hrt.2009.168716 Google Scholar
- 49Fraser GE (1994) Diet and coronary heart disease: beyond dietary fats and low-density-lipoprotein cholesterol. Am J Clin Nutr 59: 1117S–1123S
- 50Nettleton JA, Steffen LM, Loehr LR, Rosamond WD, Folsom AR (2008) Incident heart failure is associated with lower whole-grain intake and greater high-fat dairy and egg intake in the Atherosclerosis Risk in Communities (ARIC) study. J Am Diet Assoc 108: 1881–1887
- 51Bostick RM, Kushi LH, Wu Y, Meyer KA, Sellers TA, Folsom AR (1999) Relation of calcium, vitamin D, and dairy food intake to ischemic heart disease mortality among postmenopausal women. Am J Epidemiol 149: 151–161
- 52Al-Delaimy WK, Rimm E, Willett WC, Stampfer MJ, Hu FB (2003) A prospective study of calcium intake from diet and supplements and risk of ischemic heart disease among men. Am J Clin Nutr 77: 814–818
- 53Larmarche B (2004) Dairy products—the metabolic syndrome and cardiovascular disease: lessons from Canada. Paper given at the World Dairy Summit, Melbourne, Australia, November 2004
- 54Umesawa M, Iso H, Date C, Yamamoto A, Toyoshima H, Watanabe Y, Kikuchi S, Koizumi A, Kondo T, Inaba Y, Tanabe N, Tamakoshi A (2006) Dietary intake of calcium in relation to mortality from cardiovascular disease: the JACC study. Stroke 37: 20–26
- 55Kinjo Y, Beral V, Akiba S, Key T, Mizuno S, Appleby P, Yamaguchi N, Watanabe S, Doll R (1999) Possible protective effect of milk, meat and fish for cerebrovascular disease mortality in Japan. J Epidemiol 9: 268–274
- 56Sauvaget C, Nagano J, Allen N, Grant EJ, Beral V (2003) Intake of animal products and stroke mortality in the Hiroshima/Nagasaki Life Span Study. Int J Epidemiol 32: 536–543
- 57He K, Merchant A, Rimm EB, Rosner BA, Stampfer MJ, Willett WC, Ascherio A (2003) Dietary fat intake and risk of stroke in male US healthcare professionals: 14 year prospective cohort study. BMJ 327: 777–782
- 58Abbott RD, Curb JD, Rodriguez BL, Sharp DS, Burchfiel CM, Yano K (1996) Effect of dietary calcium and milk consumption on risk of thromboembolic stroke in older middle-aged men. The Honolulu Heart Program. Stroke 27: 813–818
- 59Gartside PS, Wang P, Glueck CJ (1998) Prospective assessment of coronary heart disease risk factors: the NHANES I epidemiologic follow-up study (NHEFS) 16-year follow-up. J Am Coll Nutr 17: 263–269
- 60Choi HK, Willett WC, Stampfer MJ, Rimm E, Hu FB (2005) Dairy consumption and risk of type 2 diabetes mellitus in men: a prospective study. Arch Intern Med 165: 997–1003
- 61Liu S, Song Y, Ford ES, Manson JE, Buring JE, Ridker PM (2005) Dietary calcium, vitamin D, and the prevalence of metabolic syndrome in middle-aged and older U.S. women. Diabetes Care 28: 2926–2932
- 62van Dam RM, Hu FB, Rosenberg L, Krishnan S, Palmer JR (2006) Dietary calcium and magnesium, major food sources, and risk of type 2 diabetes in U.S. black women. Diabetes Care 29: 2238–2243
- 63Villegas R, Gao Y-T, Dai Q, Yang G, Cai H, Li H, Zheng W, Shu XO (2009) Dietary calcium and magnesium intakes and the risk of type 2 diabetes: the Shanghai Women's Health Study. Am J Clin Nutr 89: 1059–1067