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Nonfermented milk and other dairy products : Associations with all-cause mortality

Tognon, Gianluca; Nilsson, Lena M.; Shungin, Dmitry; Lissner, Lauren; Jansson, Jan-Håkan; Renström, Frida LU ; Wennberg, Maria; Winkvist, Anna and Johansson, Ingegerd (2017) In American Journal of Clinical Nutrition 105(6). p.1502-1511
Abstract

Background: A positive association between nonfermented milk intake and increased all-cause mortality was recently reported, but overall, the association between dairy intake and mortality is inconclusive. Objective: We studied associations between intake of dairy products and all-cause mortality with an emphasis on nonfermented milk and fat content. Design: A total of 103,256 adult participants (women: 51.0%) from Northern Sweden were included (7121 deaths; mean follow-up: 13.7 y). Associations between all-cause mortality and reported intakes of nonfermented milk (total or by fat content), fermented milk, cheese, and butter were tested with the use of Cox proportional hazards models that were adjusted for age, sex, body mass index,... (More)

Background: A positive association between nonfermented milk intake and increased all-cause mortality was recently reported, but overall, the association between dairy intake and mortality is inconclusive. Objective: We studied associations between intake of dairy products and all-cause mortality with an emphasis on nonfermented milk and fat content. Design: A total of 103,256 adult participants (women: 51.0%) from Northern Sweden were included (7121 deaths; mean follow-up: 13.7 y). Associations between all-cause mortality and reported intakes of nonfermented milk (total or by fat content), fermented milk, cheese, and butter were tested with the use of Cox proportional hazards models that were adjusted for age, sex, body mass index, smoking status, education, energy intake, examination year, and physical activity. To circumvent confounding, Mendelian randomization was applied in a subsample via the lactase LCT-13910 C/T single nucleotide polymorphism that is associated with lactose tolerance and milk intake. Results: High consumers of nonfermented milk (≥2.5 times/d) had a 32% increased hazard (HR: 1.32; 95% CI: 1.18, 1.48) for all-cause mortality compared with that of subjects who consumed milk ≤1 time/wk. The corresponding value for butter was 11% (HR: 1.11; 95% CI: 1.07, 1.21). All nonfermented milk-fat types were independently associated with increased HRs, but compared with full-fat milk, HRs were lower in consumers of medium-and low-fat milk. Fermented milk intake (HR: 0.90; 95% CI: 0.86, 0.94) and cheese intake (HR: 0.93; 95% CI: 0.91, 0.96) were negatively associated with mortality. Results were slightly attenuated by lifestyle adjustments but were robust in sensitivity analyses. Mortality was not significantly associated with the LCT-13910 C/T genotype in the smaller subsample. The amount and type of milk intake was associated with lifestyle variables. Conclusions: In the present Swedish cohort study, intakes of nonfermented milk and butter are associated with higher all-cause mortality, and fermented milk and cheese intakes are associated with lower all-cause mortality. Residual confounding by lifestyle cannot be excluded, and Mendelian randomization needs to be examined in a larger sample. Am J Clin Nutr 2017;105:1502-11.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
All-cause mortality, Butter, Cheese, Dairy products, Fermented dairy products, Fermented milk, Milk, Nonfermented milk
in
American Journal of Clinical Nutrition
volume
105
issue
6
pages
10 pages
publisher
American Society for Clinical Nutrition
external identifiers
  • scopus:85020520256
  • wos:000402612200030
ISSN
0002-9165
DOI
10.3945/ajcn.116.140798
language
English
LU publication?
yes
id
c2faecce-a289-4a36-973f-3d2594e19bdd
date added to LUP
2017-08-17 11:38:08
date last changed
2018-04-15 04:46:30
@article{c2faecce-a289-4a36-973f-3d2594e19bdd,
  abstract     = {<p>Background: A positive association between nonfermented milk intake and increased all-cause mortality was recently reported, but overall, the association between dairy intake and mortality is inconclusive. Objective: We studied associations between intake of dairy products and all-cause mortality with an emphasis on nonfermented milk and fat content. Design: A total of 103,256 adult participants (women: 51.0%) from Northern Sweden were included (7121 deaths; mean follow-up: 13.7 y). Associations between all-cause mortality and reported intakes of nonfermented milk (total or by fat content), fermented milk, cheese, and butter were tested with the use of Cox proportional hazards models that were adjusted for age, sex, body mass index, smoking status, education, energy intake, examination year, and physical activity. To circumvent confounding, Mendelian randomization was applied in a subsample via the lactase LCT-13910 C/T single nucleotide polymorphism that is associated with lactose tolerance and milk intake. Results: High consumers of nonfermented milk (≥2.5 times/d) had a 32% increased hazard (HR: 1.32; 95% CI: 1.18, 1.48) for all-cause mortality compared with that of subjects who consumed milk ≤1 time/wk. The corresponding value for butter was 11% (HR: 1.11; 95% CI: 1.07, 1.21). All nonfermented milk-fat types were independently associated with increased HRs, but compared with full-fat milk, HRs were lower in consumers of medium-and low-fat milk. Fermented milk intake (HR: 0.90; 95% CI: 0.86, 0.94) and cheese intake (HR: 0.93; 95% CI: 0.91, 0.96) were negatively associated with mortality. Results were slightly attenuated by lifestyle adjustments but were robust in sensitivity analyses. Mortality was not significantly associated with the LCT-13910 C/T genotype in the smaller subsample. The amount and type of milk intake was associated with lifestyle variables. Conclusions: In the present Swedish cohort study, intakes of nonfermented milk and butter are associated with higher all-cause mortality, and fermented milk and cheese intakes are associated with lower all-cause mortality. Residual confounding by lifestyle cannot be excluded, and Mendelian randomization needs to be examined in a larger sample. Am J Clin Nutr 2017;105:1502-11.</p>},
  author       = {Tognon, Gianluca and Nilsson, Lena M. and Shungin, Dmitry and Lissner, Lauren and Jansson, Jan-Håkan and Renström, Frida and Wennberg, Maria and Winkvist, Anna and Johansson, Ingegerd},
  issn         = {0002-9165},
  keyword      = {All-cause mortality,Butter,Cheese,Dairy products,Fermented dairy products,Fermented milk,Milk,Nonfermented milk},
  language     = {eng},
  month        = {06},
  number       = {6},
  pages        = {1502--1511},
  publisher    = {American Society for Clinical Nutrition},
  series       = {American Journal of Clinical Nutrition},
  title        = {Nonfermented milk and other dairy products : Associations with all-cause mortality},
  url          = {http://dx.doi.org/10.3945/ajcn.116.140798},
  volume       = {105},
  year         = {2017},
}