Isfahan University of Medical Sciences

Science Communicator Platform

Stay connected! Follow us on X network (Twitter):
Share this content! On (X network) By
Association of Dairy Intake With Cardiovascular Disease and Mortality in 21 Countries From Five Continents (Pure): A Prospective Cohort Study Publisher Pubmed



Dehghan M1 ; Mente A1, 2 ; Rangarajan S1 ; Sheridan P1 ; Mohan V3 ; Iqbal R4 ; Gupta R5 ; Lear S6 ; Wentzelviljoen E7 ; Avezum A8 ; Lopezjaramillo P9 ; Mony P10 ; Varma RP11 ; Kumar R12 Show All Authors
Authors
  1. Dehghan M1
  2. Mente A1, 2
  3. Rangarajan S1
  4. Sheridan P1
  5. Mohan V3
  6. Iqbal R4
  7. Gupta R5
  8. Lear S6
  9. Wentzelviljoen E7
  10. Avezum A8
  11. Lopezjaramillo P9
  12. Mony P10
  13. Varma RP11
  14. Kumar R12
  15. Chifamba J13
  16. Alhabib KF14
  17. Mohammadifard N15
  18. Oguz A16
  19. Lanas F17
  20. Rozanska D18
  21. Bostrom KB19
  22. Yusoff K20, 21
  23. Tsolkile LP22
  24. Dans A23
  25. Yusufali A24
  26. Orlandini A25
  27. Poirier P26
  28. Khatib R27
  29. Hu B28
  30. Wei L28
  31. Yin L28
  32. Deeraili A29
  33. Yeates K30
  34. Yusuf R1
  35. Ismail N32
  36. Mozaffarian D33
  37. Teo K1
  38. Anand SS1
  39. Yusuf S31
Show Affiliations
Authors Affiliations
  1. 1. Population Health Research Institute, McMaster University, Hamilton, ON, Canada
  2. 2. Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
  3. 3. Madras Diabetes Research Foundation, Chennai, India
  4. 4. Department of Community Health Sciences and Medicine, Aga Khan University, Karachi, Pakistan
  5. 5. Department of Medicine, Eternal Heart Care Centre and Research Institute, Jaipur, India
  6. 6. Faculty of Health Sciences, Simon Fraser University, BC, Canada
  7. 7. Centre of Excellence for Nutrition, North-West University, Potchefstroom Campus, South Africa
  8. 8. Dante Pazzanese Institute of Cardiology, Sao Paulo, Brazil
  9. 9. Research Department, Fundacion Oftalmologica de Santander, Medical School, University of Santander, Floridablanca-Santander, Colombia
  10. 10. Division of Epidemiology and Population Health, St John's Medical College and Research Institute, Bangalore, India
  11. 11. Faculty of Health Sciences, Achutha Menon Centre for Health Science Studies Health Action by People, Thiruvananthapuram, Kerala, India
  12. 12. Post Graduate Institute of Medical Education and Research (PGIMER) School of Public Health, Chandigarh, India
  13. 13. College of Health Sciences, Physiology Department, University of Zimbabwe, Harare, Zimbabwe
  14. 14. Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
  15. 15. Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
  16. 16. Department of Internal Medicine, Istanbul Medeniyet University Faculty of Medicine, Istanbul, Turkey
  17. 17. Department of Medicine, Universidad de La Frontera, Francisco Salazar, Temuco, Chile
  18. 18. Department of Dietetics, Wroclaw Medical University, Wroclaw, Poland
  19. 19. Narhalsan R&D Centre Skaraborg Primary Care Skovde and Department of Public Health and Community Medicine, Primary Health Care, the Sahlgrenska Academy, University of Gothenburg, Sweden
  20. 20. Department of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
  21. 21. Department of Medicine, UCSI University, Cheras, Selangor, Malaysia
  22. 22. School of Public Health, University of the Western Cape, Cape Town, Western Cape Province, South Africa
  23. 23. Department of Medicine, University of the Philippines, Manila, Philippines
  24. 24. Dubai Medical University, Hatta Hospital, Dubai Health Authority, Dubai, United Arab Emirates
  25. 25. Estudios Clinicos Latinoamerica, Rosario, Santa Fe, Argentina
  26. 26. Institut universitaire de cardiologie et pneumologie de Quebec, Universite laval, QC, Canada
  27. 27. Departments of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
  28. 28. State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
  29. 29. Center for Disease Control and Prevention of Xinjiang Hetian, Xinjiang, China
  30. 30. Department of Medicine, Queen's University, Kingston, ON, Canada
  31. 31. School of Life Sciences, Independent University, Bashundhara, Dhaka, Bangladesh
  32. 32. Department of Community Health, University Kebangsaan Malaysia Medical Centre, Malaysia
  33. 33. Friedman School of Nutrition Science and Policy, Tufts University, Medford, MA, United States

Source: The Lancet Published:2018


Abstract

Background: Dietary guidelines recommend minimising consumption of whole-fat dairy products, as they are a source of saturated fats and presumed to adversely affect blood lipids and increase cardiovascular disease and mortality. Evidence for this contention is sparse and few data for the effects of dairy consumption on health are available from low-income and middle-income countries. Therefore, we aimed to assess the associations between total dairy and specific types of dairy products with mortality and major cardiovascular disease. Methods: The Prospective Urban Rural Epidemiology (PURE) study is a large multinational cohort study of individuals aged 35–70 years enrolled from 21 countries in five continents. Dietary intakes of dairy products for 136 384 individuals were recorded using country-specific validated food frequency questionnaires. Dairy products comprised milk, yoghurt, and cheese. We further grouped these foods into whole-fat and low-fat dairy. The primary outcome was the composite of mortality or major cardiovascular events (defined as death from cardiovascular causes, non-fatal myocardial infarction, stroke, or heart failure). Hazard ratios (HRs) were calculated using multivariable Cox frailty models with random intercepts to account for clustering of participants by centre. Findings: Between Jan 1, 2003, and July 14, 2018, we recorded 10 567 composite events (deaths [n=6796] or major cardiovascular events [n=5855]) during the 9·1 years of follow-up. Higher intake of total dairy (>2 servings per day compared with no intake) was associated with a lower risk of the composite outcome (HR 0·84, 95% CI 0·75–0·94; ptrend=0·0004), total mortality (0·83, 0·72–0·96; ptrend=0·0052), non-cardiovascular mortality (0·86, 0·72–1·02; ptrend=0·046), cardiovascular mortality (0·77, 0·58–1·01; ptrend=0·029), major cardiovascular disease (0·78, 0·67–0·90; ptrend=0·0001), and stroke (0·66, 0·53–0·82; ptrend=0·0003). No significant association with myocardial infarction was observed (HR 0·89, 95% CI 0·71–1·11; ptrend=0·163). Higher intake (>1 serving vs no intake) of milk (HR 0·90, 95% CI 0·82–0·99; ptrend=0·0529) and yogurt (0·86, 0·75–0·99; ptrend=0·0051) was associated with lower risk of the composite outcome, whereas cheese intake was not significantly associated with the composite outcome (0·88, 0·76–1·02; ptrend=0·1399). Butter intake was low and was not significantly associated with clinical outcomes (HR 1·09, 95% CI 0·90–1·33; ptrend=0·4113). Interpretation: Dairy consumption was associated with lower risk of mortality and major cardiovascular disease events in a diverse multinational cohort. Funding: Full funding sources are listed at the end of the paper (see Acknowledgments). © 2018 Elsevier Ltd
Related Docs
View other Related Docs
1. Whole Milk Consumption and Risk of Cardiovascular Disease and Mortality: Isfahan Cohort Study, European Journal of Nutrition (2019)
2. Diet, Cardiovascular Disease, and Mortality in 80 Countries, European Heart Journal (2023)
3. High Vs. Low-Fat Dairy and Milk Differently Affects the Risk of All-Cause, Cvd, and Cancer Death: A Systematic Review and Dose-Response Meta-Analysis of Prospective Cohort Studies, Critical Reviews in Food Science and Nutrition (2022)
4. Association of Dairy Consumption With Metabolic Syndrome, Hypertension and Diabetes in 147 812 Individuals From 21 Countries, BMJ Open Diabetes Research and Care (2020)
5. Estimation and Prediction of Avoidable Health Care Costs of Cardiovascular Diseases and Type 2 Diabetes Through Adequate Dairy Food Consumption: A Systematic Review and Micro Simulation Modeling Study, Archives of Iranian Medicine (2018)
6. Associations of Fats and Carbohydrate Intake With Cardiovascular Disease and Mortality in 18 Countries From Five Continents (Pure): A Prospective Cohort Study, The Lancet (2017)
7. Associations of Cereal Grains Intake With Cardiovascular Disease and Mortality Across 21 Countries in Prospective Urban and Rural Epidemiology Study: Prospective Cohort Study, The BMJ (2021)
8. Dairy As a Functional Food in Cardiovascular Disease, Nutrients in Dairy and Their Implications for Health and Disease (2017)
Experts (# of related papers)
View all Related Experts
Noushin Mohammadifard (66)
Nizal Sarrafzadegan (55)
Other Related Docs
9. Glycemic Index, Glycemic Load, and Cardiovascular Disease and Mortality, New England Journal of Medicine (2021)
10. Associations of Fish Consumption With Risk of Cardiovascular Disease and Mortality Among Individuals With or Without Vascular Disease From 58 Countries, JAMA Internal Medicine (2021)
11. Fruit, Vegetable, and Legume Intake, and Cardiovascular Disease and Deaths in 18 Countries (Pure): A Prospective Cohort Study, The Lancet (2017)
12. Associations of Unprocessed and Processed Meat Intake With Mortality and Cardiovascular Disease in 21 Countries [Prospective Urban Rural Epidemiology (Pure) Study]: A Prospective Cohort Study, American Journal of Clinical Nutrition (2021)
13. Longitudinal Association of Dietary Carbohydrate and the Risk Cardiovascular Disease: A Dose-Response Meta-Analysis, Critical Reviews in Food Science and Nutrition (2022)
14. Association of Nut Intake With Risk Factors, Cardiovascular Disease, and Mortality in 16 Countries From 5 Continents: Analysis From the Prospective Urban and Rural Epidemiology (Pure) Study, American Journal of Clinical Nutrition (2020)
15. Variations in the Association of Height With Mortality, Cardiovascular Disease and Cancer in Low-, Middle-And High-Income Countries, International Journal of Epidemiology (2022)
16. The Longitudinal Association Between Soybean and Non-Soybean Legumes Intakes and Risk of Cardiovascular Disease: Isfahan Cohort Study, British Food Journal (2021)
17. Dairy Consumption and Premature Coronary Artery Disease Onset: Iran Premature Coronary Artery Disease (Ipad) Study Insights, Scientific Reports (2025)
18. Dairy Consumption, Cardiovascular Risk Factors and Inflammation in Elderly Subjects, ARYA Atherosclerosis (2015)
19. Ultra-Processed Food Consumption and Cardiovascular Events Rate: An Analysis From Isfahan Cohort Study (Ics), Nutrition, Metabolism and Cardiovascular Diseases (2024)
20. The Association Between Dairy Products and the Risk of Covid-19, European Journal of Clinical Nutrition (2022)
21. Consumption of Dairy Products and Odds of Breast Cancer: An Iranian Case–Control Study, Breast Cancer (2022)
22. Dairy Products and Metabolic Syndrome Among Iranian Adult Population: Isfahan Healthy Heart Program, International Dairy Journal (2020)
23. Metabolic, Behavioural, and Psychosocial Risk Factors and Cardiovascular Disease in Women Compared With Men in 21 High-Income, Middle-Income, and Low-Income Countries: An Analysis of the Pure Study, The Lancet (2022)
24. Ultra-Processed Foods and Mortality: Analysis From the Prospective Urban and Rural Epidemiology Study, American Journal of Clinical Nutrition (2023)
25. Associations of the Glycaemic Index and the Glycaemic Load With Risk of Type 2 Diabetes in 127 594 People From 20 Countries (Pure): A Prospective Cohort Study, The Lancet Diabetes and Endocrinology (2024)
26. Dairy Consumption and Risk of Stroke: A Case‑Control Study, International Journal of Preventive Medicine (2016)
27. Association of Dietary Nutrients With Blood Lipids and Blood Pressure in 18 Countries: A Cross-Sectional Analysis From the Pure Study, The Lancet Diabetes and Endocrinology (2017)
28. Dietary Intake of Total, Animal and Plant Proteins and the Risk of Coronary Heart Disease and Hypertension: A Systematic Review and Dose-Response Meta-Analysis of Prospective Cohort Studies, Critical Reviews in Food Science and Nutrition (2022)
29. Cheese Consumption in Relation to Cardiovascular Risk Factors Among Iranian Adults-Ihhp Study, Nutrition Research and Practice (2014)
30. Dairy Products Consumption and the Risk of Hypertension in Adults: An Updated Systematic Review and Dose–Response Meta-Analysis of Prospective Cohort Studies, Nutrition, Metabolism and Cardiovascular Diseases (2021)
31. Association Between Dairy Consumption and Circulating Levels of Inflammatory Markers Among Women, Journal of Isfahan Medical School (2007)
32. White Rice Intake and Incident Diabetes: A Study of 132,373 Participants in 21 Countries, Diabetes Care (2020)
33. Nutrient Intake and Unhealthy Dietary Pattern of Iranian Women: A Cross Sectional Study, Progress in Nutrition (2018)
34. Medications for Blood Pressure, Blood Glucose, Lipids, and Anti-Thrombotic Medications: Relationship With Cardiovascular Disease and Death in Adults From 21 High-, Middle-, and Low-Income Countries With an Elevated Body Mass Index, European Journal of Preventive Cardiology (2022)
35. Longitudinal Association of Dietary Habits and the Risk of Cardiovascular Disease Among Iranian Population Between 2001 and 2013: The Isfahan Cohort Study, Scientific Reports (2023)
36. Effects of Dairy Products Consumption on Inflammatory Biomarkers Among Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials, Nutrition, Metabolism and Cardiovascular Diseases (2020)
37. Association of Ultra-Processed Food Intake With Risk of Inflammatory Bowel Disease: Prospective Cohort Study, The BMJ (2021)
38. Variations Between Women and Men in Risk Factors, Treatments, Cardiovascular Disease Incidence, and Death in 27 High-Income, Middle-Income, and Low-Income Countries (Pure): A Prospective Cohort Study, The Lancet (2020)
39. The Long-Term Association of Different Dietary Protein Sources With Metabolic Syndrome, Scientific Reports (2021)
40. Validity and Reproducibility of a Semi-Quantitative Food Frequency Questionnaire for Iranian Adults, Nutrition and Dietetics (2021)
41. The Relationship Between Carbohydrate, Fiber, and Sugar Intake With Premature Heart Disease, Journal of Health System Research (2024)
42. How Prices and Income Influence Global Patterns in Saturated Fat Intake by Age, Sex and World Region: A Cross-Sectional Analysis of 160 Countries, BMJ Open (2024)
43. Dietary Patterns and Frailty: A Systematic Review and Meta-Analysis, Nutrition Reviews (2019)
44. Dietary Calcium Intake in Relation to Blood Lipids and Lipoproteins Profiles: A Systematic Review and Meta-Analysis of Epidemiologic Studies, Nutrition, Metabolism and Cardiovascular Diseases (2022)
45. Availability and Affordability of Blood Pressure-Lowering Medicines and the Effect on Blood Pressure Control in High-Income, Middle-Income, and Low-Income Countries: An Analysis of the Pure Study Data, The Lancet Public Health (2017)
46. Associations Between Empirically Derived Dietary Patterns and Cardiovascular Risk Factors Among Older Adult Men: A Cross-Sectional Study, International Journal for Vitamin and Nutrition Research (2023)
47. Dietary Patterns and Mortality From Cardiovascular Disease: Isfahan Cohort Study, European Journal of Clinical Nutrition (2017)
48. Association of Sitting Time With Mortality and Cardiovascular Events in High-Income, Middle-Income, and Low-Income Countries, JAMA Cardiology (2022)
49. Intake of Legumes and the Risk of Cardiovascular Disease: Frailty Modeling of a Prospective Cohort Study in the Iranian Middle-Aged and Older Population, European Journal of Clinical Nutrition (2016)
50. The Relationship Between Fermented and Nonfermented Dairy Products Consumption and Hypertension Among Premature Coronary Artery Disease Patients: Iran Premature Coronary Artery Disease Study, Food Science and Nutrition (2024)