Article Text

Association of dairy consumption with metabolic syndrome, hypertension and diabetes in 147 812 individuals from 21 countries
  1. Balaji Bhavadharini1,
  2. Mahshid Dehghan1,
  3. Andrew Mente1,2,
  4. Sumathy Rangarajan1,
  5. Patrick Sheridan1,
  6. Viswanathan Mohan3,4,
  7. Romaina Iqbal5,
  8. Rajeev Gupta6,
  9. Scott Lear7,
  10. Edelweiss Wentzel-Viljoen8,
  11. Alvaro Avezum9,
  12. Patricio Lopez-Jaramillo10,
  13. Prem Mony11,
  14. Ravi Prasad Varma12,
  15. Rajesh Kumar13,
  16. Jephat Chifamba14,
  17. Khalid F Alhabib15,
  18. Noushin Mohammadifard16,
  19. Aytekin Oguz17,
  20. Fernando Lanas18,
  21. Dorota Rozanska19,
  22. Kristina Bengtsson Bostrom20,
  23. Khalid Yusoff21,
  24. Lungiswa P Tsolkile22,
  25. Antonio Dans23,
  26. Afzalhussein Yusufali24,
  27. Andres Orlandini25,
  28. Paul Poirier26,
  29. Rasha Khatib27,
  30. Bo Hu28,
  31. Li Wei29,
  32. Lu Yin28,
  33. Ai Deeraili30,
  34. Karen Yeates31,
  35. Rita Yusuf32,
  36. Noorhassim Ismail33,
  37. Dariush Mozaffarian34,
  38. Koon Teo1,2,35,
  39. Sonia S Anand1,2,35,
  40. Salim Yusuf1,2,35
  1. 1Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
  2. 2Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
  3. 3Epidemiology, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
  4. 4Diabetology, Dr Mohan’s Diabetes Specialities Centre Gopalapuram, Chennai, Tamil Nadu, India
  5. 5Aga Khan University, Karachi, Pakistan
  6. 6Preventive Cardiology, Eternal Heart Care Centre & Research Institute, Jaipur, Rajasthan, India
  7. 7Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada
  8. 8North-West University, Potchefstroom, South Africa
  9. 9Research Division, Dante Pazzanese Institute of Cardiology, São Paulo, Brazil
  10. 10University of Santander, Bucaramanga, Colombia
  11. 11St John’s Medical College & Research Institute, Bengaluru, Karnataka, India
  12. 12Achutha Menon Centre for Health Science Studies, Thiruvananthapuram, Kerala, India
  13. 13Post Graduate Institute of Medical Education and Research, Chandigarh, India
  14. 14University of Zimbabwe, Harare, Zimbabwe
  15. 15King Saud University, Riyadh, Riyadh Province, Saudi Arabia
  16. 16Isfahan University of Medical Sciences, Isfahan, Iran (the Islamic Republic of)
  17. 17Internal Medicine, Goztepe Training and Research Hospital, Istanbul, Marmara, Turkey
  18. 18Universidad de La Frontera, Temuco, Chile
  19. 19Wroclaw Medical University, Wroclaw, Dolnoslaskie, Poland
  20. 20University of Gothenburg, Goteborg, Sweden
  21. 21Universiti Teknologi MARA, Shah Alam, Selangor, Malaysia
  22. 22University of the Western Cape, Bellville, South Africa
  23. 23University of the Philippines System, Quezon City, Metro Manila, Philippines
  24. 24Dubai Health Authority, Dubai, UAE
  25. 25Estudios Clinicos Latino America, Rosario, Argentina
  26. 26Cardiology, Institut universitaire de cardiologie et de pneumologie de Quebec, Quebec City, Quebec, Canada
  27. 27Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
  28. 28Peking Union Medical College School of Basic Medicine, Beijing, China
  29. 29Medical Research & Biometrics Center, Chinese Academy of Medical Sciences and Peking Union Medical College Fuwai Hospital, Xicheng District, Beijing, China
  30. 30Xinjiang Uighur Autonomous Region Center for Disease Control and Prevention, Wulumuqi, Xinjiang, China
  31. 31Queen's University, Kingston, Ontario, Canada
  32. 32Independent University, Dhaka, Bangladesh
  33. 33Universiti Kebangsaan Malaysia, Bangi, Selangor, Malaysia
  34. 34Tufts Friedman School of Nutrition Science & Policy, Boston, Massachusetts, USA
  35. 35Department of Medicine, McMaster University, Hamilton, Ontario, Canada
  1. Correspondence to Dr Andrew Mente; andrew.mente{at}


Objective Our aims were to assess the association of dairy intake with prevalence of metabolic syndrome (MetS) (cross-sectionally) and with incident hypertension and incident diabetes (prospectively) in a large multinational cohort study.

Methods The Prospective Urban Rural Epidemiology (PURE) study is a prospective epidemiological study of individuals aged 35 and 70 years from 21 countries on five continents, with a median follow-up of 9.1 years. In the cross-sectional analyses, we assessed the association of dairy intake with prevalent MetS and its components among individuals with information on the five MetS components (n=112 922). For the prospective analyses, we examined the association of dairy with incident hypertension (in 57 547 individuals free of hypertension) and diabetes (in 131 481 individuals free of diabetes).

Results In cross-sectional analysis, higher intake of total dairy (at least two servings/day compared with zero intake; OR 0.76, 95% CI 0.71 to 0.80, p-trend<0.0001) was associated with a lower prevalence of MetS after multivariable adjustment. Higher intakes of whole fat dairy consumed alone (OR 0.72, 95% CI 0.66 to 0.78, p-trend<0.0001), or consumed jointly with low fat dairy (OR 0.89, 95% CI 0.80 to 0.98, p-trend=0.0005), were associated with a lower MetS prevalence. Low fat dairy consumed alone was not associated with MetS (OR 1.03, 95% CI 0.77 to 1.38, p-trend=0.13). In prospective analysis, 13 640 people with incident hypertension and 5351 people with incident diabetes were recorded. Higher intake of total dairy (at least two servings/day vs zero serving/day) was associated with a lower incidence of hypertension (HR 0.89, 95% CI 0.82 to 0.97, p-trend=0.02) and diabetes (HR 0.88, 95% CI 0.76 to 1.02, p-trend=0.01). Directionally similar associations were found for whole fat dairy versus each outcome.

Conclusions Higher intake of whole fat (but not low fat) dairy was associated with a lower prevalence of MetS and most of its component factors, and with a lower incidence of hypertension and diabetes. Our findings should be evaluated in large randomized trials of the effects of whole fat dairy on the risks of MetS, hypertension, and diabetes.

  • nutrition
  • hypertension
  • endocrinology
  • adult diabetes

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  • Contributors BB and MD designed the present study. BB performed its statistical analysis, and wrote the first draft of the manuscript. SY designed the present study, conceived and initiated the overall Prospective Urban Rural Epidemiology (PURE) study, supervised its conduct and data analysis, and provided critical comments on all drafts of the manuscript. MD and AM reviewed and provided critical comments on drafts. SR coordinated the worldwide PURE study and reviewed and commented on drafts. All other authors coordinated the study and collected the data in their respective countries and provided comments on drafts of the manuscript.

  • Funding The study was mainly funded by the Population Health Research Institute (PHRI). SY is supported by the Mary W Burke endowed chair of the Heart and Stroke Foundation of Ontario. The PURE study is an investigator-initiated study that is funded by the Population Health Research Institute, Hamilton Health Sciences Research Institute (HHSRI), the Canadian Institutes of Health Research, Heart and Stroke Foundation of Ontario, Support from Canadian Institutes of Health Research’s Strategy for Patient Oriented Research, through the Ontario SPOR Support Unit, as well as the Ontario Ministry of Health and Long-Term Care and through unrestricted grants from several pharmaceutical companies (with major contributions from AstraZeneca (Canada), Sanofi-Aventis (France and Canada), Boehringer Ingelheim (Germany and Canada), Servier, and GlaxoSmithKline), and additional contributions from Novartis and King Pharma and from various national or local organizations in participating countries.These include: Argentina: Fundacion ECLA (Estudios Clínicos Latino America); Bangladesh: Independent University, Bangladesh and Mitra and Associates; Brazil: Unilever Health Institute, Brazil; Canada: this study was supported by an unrestricted grant from Dairy Farmers of Canada and the National Dairy Council (US), Public Health Agency of Canada and Champlain Cardiovascular Disease Prevention Network; Chile: Universidad de la Frontera; China: National Center for Cardiovascular Diseases and ThinkTank Research Center for Health Development; Colombia: Colciencias (grant 6566-04-18062 and grant 6517-777-58228); India: Indian Council of Medical Research; Malaysia: Ministry of Science, Technology and Innovation of Malaysia (grant number: 100-IRDC/BIOTEK 16/6/21 (13/2007), and 07–05-IFN-BPH 010), Ministry of Higher Education of Malaysia (grant number: 600-RMI/LRGS/5/3 (2/2011)), Universiti Teknologi MARA, Universiti Kebangsaan Malaysia (UKM-Hejim-Komuniti-15–2010); occupied Palestinian territory: the United Nations Relief and Works Agency for Palestine Refugees in the Near East, occupied Palestinian territory; International Development Research Centre, Canada; Philippines: Philippine Council for Health Research and Development; Poland: Polish Ministry of Science and Higher Education (grant number: 290/W-PURE/2008/0), Wroclaw Medical University; Saudi Arabia: Saudi Heart Association, Saudi Gastroenterology Association, Dr. Mohammad Alfagih Hospital, The Deanship of Scientific Research at King Saud University, Riyadh, Saudi Arabia (Research group number: RG −1436–013); South Africa: The North-West University, SA and Netherlands Programme for Alternative Development, National Research Foundation, Medical Research Council of South Africa, The South Africa Sugar Association, Faculty of Community and Health Sciences; Sweden: grants from the Swedish state under the Agreement concerning research and education of doctors; the Swedish Heart and Lung Foundation; the Swedish Research Council; the Swedish Council for Health, Working Life and Welfare, King Gustaf V:s and Queen Victoria Freemason’s Foundation, AFA Insurance; Turkey: Metabolic Syndrome Society, AstraZeneca, Sanofi Aventis; United Arab Emirates: Sheikh Hamdan Bin Rashid Al Maktoum Award For Medical Sciences and Dubai Health Authority, Dubai.

  • Disclaimer The external funders and sponsors had no role in the design and conduct of the study; in the collection, analysis, and interpretation of the data; in the preparation, review, or approval of the manuscript; or in the decision to submit the manuscript for publication.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No data are available. The PURE study is a large international prospective cohort study that is still ongoing. Data are not publicly available at this time.