Association of Dairy Consumption with Metabolic Syndrome, Hypertension and Diabetes in 147,812 Individuals from 21 Countries

Background: Associations of dairy foods, including whole-fat versus low-fat and specific types of dairy, with metabolic syndrome (MetS), hypertension (HTN) and diabetes mellitus (DM) are not well established, especially in diverse global populations. Methods: The Prospective Urban Rural Epidemiology (PURE) study is a prospective cohort study of individuals aged 35 and 70 years from 21 countries with 9·1 years follow up. Dietary intake of 147,812 individuals was recorded using country specific validated food frequency questionnaires. At baseline, we examined the association of total dairy and types of dairy with the prevalence of MetS and its components. During follow-up, the associations between dairy intake with incident HTN and DM were examined. Findings: In multivariable-adjusted analyses, lower prevalence of MetS was seen with higher intake of total dairy (>=2 servings/d vs zero serving/day; OR 0·76; 95%CI 0·71-0·80, p-trend <0·0001) and whole-fat dairy (OR 0·72; 95%CI 0·66-0·78, p-trend<0·0001). Total dairy and whole-fat dairy intake, but not low-fat dairy, were also associated with more favourable levels of each individual component of MetS except HDL-C (no significant association). Milk, yoghurt, cheese, and butter were individually associated with a lower prevalence of MetS. During follow-up, 13,640 cases of incident HTN and 5,351 cases of incident DM were recorded. Higher intake of total and whole fat (but not low fat) dairy were associated with a lower incidence of HTN (HR 0·89; 95%CI 0·82-0·97, ptrend=0·02) and DM (HR 0·88; 95%CI 0·76-1·02, p-trend=0·01), with consistent results across geographic regions. Interpretation: Higher intake of total dairy and whole-fat (but not low fat) dairy were associated with a lower prevalence of MetS and most of its component factors, and with a lower incidence of HTN and DM. Our findings should be evaluated in large randomized trials evaluating the effects of whole fat dairy on the risks of MetS, hypertension, and diabetes. Funding Statement: Dr S Yusuf 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, 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 organisations in participating countries. These include: Argentina: Fundacion ECLA (Estudios Clinicos Latino America) ; Bangladesh: Independent University, Bangladesh and Mitra and Associates; Brazil: Unilever Health Institute, Brazil; Canada: Public Health Agency of Canada and Champlain Cardiovascular Disease Prevention Network; This study was supported by an unrestricted grant from Dairy Farmers of Canada and the National Dairy Council (U.S.). Chile: Universidad de la Frontera; China: National Center for Cardiovascular Diseases and ThinkTank Research Center for Health Development; Colombia: Colciencias (grant number: 6566-04-18062); 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 (UKMHejim-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, 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. Role of Sponsor: The 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. Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: The protocol was approved by the ethics committee at each participating centre and all participants provided written informed consent. Data were transferred to the Population Health Research Institute (PHRI) Hamilton, ON, Canada, where additional checks were undertaken.