Total dairy and cardiovascular disease.
Total dairy and total cardiovascular disease (CVD).
3 articles, providing information about 3 different cohorts were found, including 1,415 cases.
Results: Because few studies examined the relation with total CVD, data about disease risk and mortality were combined. The association with CVD risk
was examined in one cohort (Panagiotakos D), while the association with CVD mortality was examined in both remaining cohorts (Umesawa M; Bonthuis M).
Significant protective effects were found in one cohort (Umesawa M) among both men and women. Among men the effect, but not the trend was significant. While
among women the trend, but not the effect was significant. No other associations were found.
Modifying effect of dairy fat: One cohort provided information about the relation with low-fat dairy vs full-fat dairy (Bonthuis M). A significant
protective effect was found of full-fat dairy, while no association was found with low-fat dairy. In another cohort, data was provided about both total dairy
and low-fat dairy (Panagiotakos D). No difference in effect was found.
Effect modification: No other data was found.
Conclusion: Little data was available about the relation between total dairy and total CVD, and findings were inconsistent.
Also, no consistent difference in effect was found between full-, and low-fat dairy.
No evidence was found for an association between total dairy and total CVD, when risk and mortality were considered as one end point (Excluding incomplete data from
Panagiotakos D [22]: Average RR = 0.75). And no evidence was found for a modifying effect of dairy fat.
| Author | Cohort name | Cases | End point | Relative Risk (RR) |
|---|---|---|---|---|
| 27) Bonthuis M (2010) | No cohort name defined | 61 | CVD mortality | HR = 0.77 (0.32-1.85; P = 0.27). |
| 22) Panagiotakos D (2009) | The ATTICA Study | 170 | CVD risk | No association (P = 0.53). |
| 19) Umesawa M (2006) | The JACC Study | 607 men, and 577 cases | CVD mortality | Men: RR = 0.73 (0.55-0.95; P = 0.06). Women: RR = 0.77 (0.58-1.03; P = 0.01). |
| Total number of cases: 1,415 | Average RR = 0.75 |
Total dairy and coronary heart disease (CHD).
CHD risk.
9 articles, providing information about 5 different cohorts were found, including 3,422 cases.
Results: A significantly increased risk was found in one cohort (Buckland G), including 606 cases. Stratified by sex, the association remained among men
only (480 male cases). No other associations were found.
Inclusion of intermediate levels of consumption:
(Non)significant effects at any level of consumption were restricted to findings among men, in 2 cohorts including 700 male cases. A significantly increased
risk was found in one cohort at the level of consumption of > 237 g/day (Buckland G). And a significantly increased risk was found in another cohort at
the level of consumption of 236-405 g/day (Warensjö E).
Modifying effect of dairy fat: In one cohort examining women, no significant association was found with high consumption of both high-fat-, and low-fat dairy
products (Hu FB; 1999). Examination of the ratio between these dairy products, showed that CHD risk would decrease among subjects with a high dairy consumption if they
would consume less high-fat-, and more low-fat dairy.
In another cohort examining men, the opposite was found: Examination of the ratio between low-fat-, and high-fat dairy products, showed that CHD risk would increase
among subjects if they would consume less high-fat-, and more low-fat dairy (Holmberg S; 2009).
Effect modification: Data about other effect modification was restricted to findings from one study (Holmberg S; 2009). A protective effect against CHD risk
was found from consumption of more high-fat-, and less low-fat dairy, which was restricted to subjects with high (daily) consumption of vegetables and fruit.
Conclusion: A significantly increased CHD risk of high vs low dairy consumption was found among men in one cohort. Stratified by sex, significantly increased
risks among men only were found at an intermediate level of consumption in 2 cohorts. No consistent difference in effect was found between high-fat-, and low-fat dairy.
No evidence for an association was found of high vs low dairy consumption (Average RR = 1.10). Suggestive evidence was found for an increased CHD risk among men at the
level of consumption of 237-405 g/day. No consistent evidence was found for a modifying effect of dairy fat.
CHD mortality.
9 articles, providing information about 7 different cohorts were found, including 2,328 cases.
Results: Significantly increased risks were found in 2 cohorts, including 983 cases (42% of all cases). One cohort examined women only (Kelemen LE),
while the other cohort existed of both men and women (Knekt P). In both cohorts, RRs were not linked to explicit amounts of consumption.
No other associations were found of high vs low consumption.
Modifying effect of dairy fat: Data about dairy fat was provided by one cohort (Bostick RM (1999). No association was found between fat-containing dairy and
IHD mortality.
Effect modification: No other data was found.
Conclusion: Significantly increased risks of total dairy against CHD mortality were found in 2 cohorts, one of which was of small size.
No association was found with dairy fat.
Suggestive evidence was found for an increased risk of CHD mortality from high dairy consumption (Excluding incomplete data from Knekt P [6], and Albert CM [11]:
Average RR = 1.13). The level of consumption for this effect could not be defined. No evidence was found for an association with dairy fat.
Note: When CHD risk and mortality are considered one end point, the evidence for an association was restricted to findings from US and European cohorts.
| Author | Cohort name | Cases | Relative Risk (RR) |
|---|---|---|---|
| 28) Warensjö E (2010) | The NSHDS | 220 men, and 55 women | Men: OR = 1.36 (0.71-2.6; P = 0.68). Women: OR = 0.45 (0.09-2.32; P = 0.71). |
| 24) Buckland G (2009) | The Spanish part of the EPIC Study | 606 | HR = 1.51 (1.21-1.89; P = < 0.001). |
| 21) Umesawa M (2008) | The JPHC Study | 322 | HR = 1.09 (0.74-1.61; P = 0.40). |
| 5) Al-Delaimy WK (2003) | The Health Professional's Follow-up Study | 1,458 | RR = 1.01 (0.83-1.23; P = 0.57). |
| 5) Liu S (2000) | The Nurses' Health Study | 761 | RR = 0.94 (0.74-1.21). |
| Total number of cases: 3,422 | Average RR = 1.10 |
| Author | Cohort name | Cases | Relative Risk (RR) |
|---|---|---|---|
| 25) van der Pols JC (2009) | The Boyd Orr Cohort | 378 | HR = 0.74 (0.45-1.22; P = 0.64). |
| 19) Umesawa M (2006) | The JACC Study | 135 men, and 99 women | Men: RR = 0.80 (0.45-1.44). Women: RR = 1.06 (0.50-2.25). |
| 11) Albert CM (1998) | The Physician's Health Study | 133 | No significant association. |
| 8) Kelemen LE (2005) | The Iowa Women's Health Study | 739 | RR = 1.41 (1.07-1.87; P = 0.02). |
| 6) Knekt P (1994) | The Finnish Mobile Clinic Health Study | 244 | A significantly increased risk (P = < 0.001). |
| 5) Al-Delaimy WK (2003) | The Health Professional's Follow-up Study | 337 | RR = 1.15 (0.80-1.64; P = 0.35). |
| 1) Phillips RL (1978) | The Adventist Health Study | 33 aged 35-64, and 230 aged 65+ | Aged 35-64: RR = 0.6 (0.2-1.6). Aged 65+: RR = 1.1 (0.4-2.8). |
| Total number of cases: 2,328 | Average RR = 1.13 |
Total dairy and stroke.
Total stroke.
Because little data was available, results about the relation with stroke risk & mortality were combined.
5 articles, providing information about 5 different cohorts were found, including, 3,245 cases.
Results: Significant protective effects of high vs low consumption were found in 3 cohorts of moderate size (Sauvaget C; Umesawa M 2006 + 2008), including
2,796 cases (86% of all cases). No associations were found in the remaining cohorts.
All 3 cohorts in which significant protective effects of high vs low consumption were found, included Japanese subjects only. The amount of dairy consumption among
the Japanese cohorts was much lower than among Western cohorts: The highest level of consumption in one cohort was defined as "almost daily" consumption (Sauvaget C),
while the highest levels of consumption in the remaining cohorts were defined as 116, and ≥ 128 mg of dairy calcium consumption/day.
Modifying effect of dairy fat: No data was found.
Effect modification: Data about effect modification was provided by one cohort (Umesawa M 2006). The protective effect of total dairy was found among both current-
and nonsmokers, but was stronger among current- than nondrinkers.
Conclusion: Significant protective effects of high vs low dairy consumption were found in 3 Japanese cohorts of moderate size. The amount of dairy consumed
in these cohorts was relatively low.
"High" vs low consumption of total dairy possibly protects against total stroke (- 31%). This effect was found at relatively low levels of consumption (≥ 128 mg of dairy
calcium/day). The evidence was restricted to findings in Japanese cohorts (- 32%), but data from Western cohorts was limited and all RR's were below 1.
Perspective: It is possible that the protective effect among Japanese populations is due to their relatively low consumption. A significant protective
effect in a European cohort was found at the intermediate level of consumption of 255 g/day (van der Pols JC), and the US cohort shows that the lowest risk was
observed in the middle quintile of intake, but no data shown is shown (Ascherio A).
| Author | Cohort name | Cases | End point | Relative Risk (RR) |
|---|---|---|---|---|
| 25) van der Pols JC (2009) | The Boyd Orr cohort | 121 | Mortality | HR = 0.61 (0.27-1.38; P = 0.16). |
| 21) Umesawa M (2008) | The JPHC Study | 1,321 | Risk | HR = 0.70 (0.57-0.86; P = 0.01). |
| 19) Umesawa M (2006) | The JACC Study | 284 male cases, and 282 female cases | Mortality | Men: RR = 0.53 (0.34-0.81; P = < 0.01). RR = 0.57 (0.38-0.86; P = 0.04). |
| 17) Sauvaget C (2003) | The Hiroshima/Nagasaki Life Span Study | 909 | Mortality | HR = 0.73 (0.57-0.94; P = 0.024). |
| 5) Ascherio A (1998) | The Health Professional's Follow-up Study | 328 | Risk | RR = 0.83 (0.59-1.17). |
| Total number of cases: 3,245 | Average RR = 0.69 |
Ischemic stroke.
7 articles, providing information about 6 different cohorts were found, including 4,425 cases.
Results: Significant protective effects were found in 4 cohorts, including 1,513 cases (Iso H; Abbott RD; Umesawa M 2006 & 2008).
The effect was significant in all cohorts, but the trend was not.
The protective effects were found at levels of dairy calcium varying from 116 to ≥ 296 mg/day. 3 out of 4 cohorts existed of Japanese subjects only,
and the fourth consisted of US women (Iso H).
Modifying effect of dairy fat: The association with high fat diary products was examined in one cohort (Extended table: He K 2003). No association was found.
Effect modification: Data about effect modification was provided by one cohort (Larsson SC). The association was not modified by BMI, hypertension, serum
total HDL, physical activity, and some other variables.
Conclusion: Significant protective effects were found in 4 out of 6 cohorts, but these included only a minority of the total amount of cases (34%).
Suggestive evidence was found for a protective effect of total dairy against ischemic stroke. This effect was found at relatively low levels of consumption (116-≥ 296
mg dairy calcium/day).
Stratified analysis showed total dairy possibly protects against ischemic stroke among Asian populations (Average RR = 0.65).
| Author | Cohort name | Cases | End point | Relative Risk (RR) |
|---|---|---|---|---|
| 23) Larsson SC (2009) | The ATBC Study | 2,702 | Risk | RR = 1.14 (0.99-1.32; P = 0.12). |
| 21) Umesawa M (2008) | The JPHC Study | 664 | Risk | HR = 0.70 (0.52-0.94; P = 0.06). |
| 19) Umesawa M (2006) | The JACC Study | 146 men, and 127 women | Mortality | Men: RR = 0.53 (0.29-0.99; P = < 0.01). Women: RR = 0.50 (0.27-0.95; P = 0.31). |
| 7) Abbott RD (1996) | The Honolulu Heart Program | 229 | Risk | RR = 1.5 (1.0-2.2; P = < 0.01) for low vs high consumption. |
| 5) Iso H (1999) | The Nurses' Health Study | 347 | Risk | RR = 0.70 (0.41-0.97; P = 0.08). |
| 5) Ascherio A (1998) | The Health Professionals Follow-up Study | 210 | Risk | RR = 0.90 (0.59-1.37). |
| Total number of cases: 4,425 | Average RR = 0.97 |
Intracerebral hemorrhage.
3 articles, providing information about 3 different cohorts were found, including 948 cases.
Results: In one cohort, a significant protective effect was found, though the trend was not significant (Umesawa M 2008). No other associations were found,
but all RRs were well below the 1 in both Japanese cohorts (Umesawa M 2006 & 2008).
Modifying effect of dairy fat: No data was found.
Effect modification: Data about effect modification was provided by one cohort (Larsson SC). The association was not modified by age, alcohol intake, smoking,
BMI, hypertension, serum total HDL, physical activity, or randomization to vitamin E and/or beta carotene.
Conclusion: Few associations were found. No evidence was found for an association between total dairy consumption and intracerebral hemorrhage. But stratified
analysis showed the RR among Asian populations was similar to the ones for total-, and ischemic stroke (Average RR = 0.65).
| Author | Cohort name | Cases | End point | Relative Risk (RR) |
|---|---|---|---|---|
| 23) Larsson SC (2009) | The ATBC Study | 383 | Risk | RR = 1.32 (0.89-1.94; P = 0.19). |
| 21) Umesawa M (2008) | The JPHC Study | 425 | Risk | HR = 0.65 (0.43-0.97; P = 0.18). |
| 19) Umesawa M (2006) | The JACC Study | 76 men, and 64 women | Mortality | Men: RR = 0.63 (0.28-1.38; P = 0.51). Women: RR = 0.65 (0.28-1.52; P = 0.11). |
| Total number of cases: 948 | Average RR = 0.92 |
subarachnoid hemorrhage.
3 articles, providing information about 3 different cohorts were found, including 514 cases.
Results: Protective effects were found in both Japanese cohorts. The effect but not the trend was significant in one cohort (Umesawa M 2006), while a
nonsignificant trend of a protective effect was found in the remaining cohort (Umesawa M 2008).
Modifying effect of dairy fat: No data was found.
Effect modification: Data about effect modification was provided by one cohort (Larsson SC). The association was not modified by age, alcohol intake, smoking,
BMI, hypertension, serum total HDL, physical activity, or randomization to vitamin E and/or beta carotene.
Conclusion: Protective effects were found in both Japanese cohorts, but the effect was nonsignificant once. Inconclusive evidence was found for an
association between total dairy and subarachnoid hemorrhage. Stratified analysis showed the RR among Asian populations was similar to the ones for other stroke types
(Average RR = 0.61).
| Author | Cohort name | Cases | End point | Relative Risk (RR) |
|---|---|---|---|---|
| 23) Larsson SC (2009) | The ATBC Study | 196 | Risk | RR = 1.35 (0.80-2.29; P = 0.30). |
| 21) Umesawa M (2008) | The JPHC Study | 217 | Risk | HR = 0.74 (0.46-1.21; P = 0.10). |
| 19) Umesawa M (2006) | The JACC Study | 37 men, and 64 women | Mortality | Men: RR = 0.19 (0.04-0.87; P = 0.25). Women: RR = 0.41 (0.17-0.97; P = 0.22). |
| Total number of cases: 514 | Average RR = 0.89 |
Total dairy and venous thromboembolism.
2 articles, providing information about 2 different cohorts were found, including 2,147 cases.
Results: No significant associations were found of high vs low consumption.
Modifying effect of dairy fat: No data was found.
Effect modification: No modifying effects were found by age and BMI.
Conclusion: No associations were found. No evidence was found for an association between total dairy consumption and venous thromboembolism.
| Author | Cohort name | Cases | Relative Risk (RR) |
|---|---|---|---|
| 20) Steffen LM (2007) | The LITE | 197 | No association was found. |
| 8) Lutsey PL (2009) | The Iowa Women's Health Study | 1,950 | HR = 1.07 (0.91-1.25). |
| Total number of cases: |
| Author | Cohort name | Subjects | Years of follow-up | Cases | End point | Consumption of | Relative Risk (RR) | Adjustments | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 27) Bonthuis M (2010) | No cohort name defined | 1,529 participants in a skin cancer prevention trial aged 25-78 from Nambour. (Australia) | 14.4 (1992-96 to 2007) | 61 | Cardiovascular disease mortality (any CHD or stroke) | Total dairy (low-fat dairy [skim milk, low-fat milk, low-fat yoghurt, cottage or ricotta cheese], and high-fat dairy [whole milk, cream, ice cream, yoghurt, full-fat cheese and custard) |
HR = 0.77 (0.32-1.85; P = 0.27) for the highest vs lowest tertile of consumption. Amount specific data (grams): 8-270: HR = 1. 271-429: HR = 0.50 (0.21-1.16). 430-1580: HR = 0.77 (0.32-1.85).
Age, sex, total energy, BMI, alcohol, school leaving age, physical activity, pack years of smoking, dietary supplement use, beta-carotene treatment during trial, and using medications for hyptertension, diabetes mellitus, or cardiac disorder and use of beta-adrenergic blocking agents. |
22) Panagiotakos D (2009) | The ATTICA Study | 2,101 men and women aged 18-89 without CVD. | (Greece) 5 | (2001-2002 to 2006) 170 | (108 men and 62 women) Cardiovascular disease incidence (fatal or non-fatal acute myocardial infarction, ustable angina, or any other type of CVD) | Dairy products (like cheese, yoghurt, milk) |
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Age. |
19) Umesawa M (2006) | The JACC Study | 21,068 men and 32,319 women aged 40-79. | (Japan) 9.6 | (1989-90 to 1999) See variables | Total cardiovascular disease mortality | Dairy calcium (from milk, yoghurt, and cheese) |
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One serving of milk was calculated to 121 mg calcium, 1 serving of yoghurt to 118 mg, and 1 serving of cheese to 107 mg. BMI, history of hypertension, history of diabetes, smoking status, ethanol intake, potassium intake, and total energy. |
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