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Associations of dairy intake with glycemia and insulinemia, independent of obesity, in Brazilian adults: the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).
Am J Clin Nutr. 2015 Apr; 101(4):775-82.AJ

Abstract

BACKGROUND

Inverse associations between dairy intake and the risk of type 2 diabetes have been shown, but more studies are needed, especially from low- and middle-income countries.

OBJECTIVE

The objective was to describe the association between dairy products and direct measures of glycemic status in adults without known diabetes.

DESIGN

The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) includes 15,105 adults, aged 35-74 y, enrolled from universities and research institutions in 6 Brazilian capital cities. We excluded participants with a known diabetes diagnosis, cardiovascular diseases, and cancer. Dairy consumption was assessed by a food-frequency questionnaire, and we computed servings per day for total and subgroups of dairy. Associations with fasting blood glucose (FG) and fasting insulin, 2-h postload glucose (PG), 2-h postload insulin (PI), glycated hemoglobin (Hb A1c), and homeostasis model assessment of insulin resistance (HOMA-IR) were assessed through multivariable linear regression analysis with adjustment for demographic characteristics, behavioral risk factors, other dietary factors, and anthropometric measurements.

RESULTS

The sample size after exclusions was 10,010. The intake of total dairy was inversely associated with FG (linear β for dairy servings/d = -0.46 ± 0.2 mg/dL), PG (-1.25 ± 0.5 mg/dL), PI (-1.52 ± 0.6 mg/dL), Hb A1c (-0.02 ± 0.0%), and HOMA-IR (-0.04 ± 0.0) after adjustment for all covariates (P < 0.05 for all). The findings were consistent across categories of sex, race, obesity status, and dairy fat amount (reduced-fat vs. full-fat dairy). Fermented dairy products showed particularly strong inverse associations with the outcomes, with adjusted differences for a 1-serving/d increment of -0.24 (95% CI: -0.46, -0.02) mg/dL for FG, -0.86 (-1.42, -0.30) mg/dL for PG, and -0.01% (-0.02%, 0.00%) for Hb A1c. Myristic acid was the only nutrient that appeared to mediate the association between dairy intake and glycemia.

CONCLUSION

Dairy intake, especially fermented dairy, was inversely associated with measures of glycemia and insulinemia in Brazilian adults without diagnosed diabetes. This trial was registered at clinicaltrials.com as NCT02320461.

Authors+Show Affiliations

From the Department of Social Medicine, School of Medicine, Postgraduate Studies Program in Epidemiology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil (MD, MIS, and BBD); the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN (MAP); the Health Sciences Center, Federal University of Espirito Santo, Vitoria, Brazil (MDCBM); the Institute of Collective Health, Federal University of Bahia, Salvador, Brazil (SA); and the Center for Clinical and Epidemiologic Research, University of Sao Paulo, Sao Paulo, Brazil (PAL).From the Department of Social Medicine, School of Medicine, Postgraduate Studies Program in Epidemiology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil (MD, MIS, and BBD); the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN (MAP); the Health Sciences Center, Federal University of Espirito Santo, Vitoria, Brazil (MDCBM); the Institute of Collective Health, Federal University of Bahia, Salvador, Brazil (SA); and the Center for Clinical and Epidemiologic Research, University of Sao Paulo, Sao Paulo, Brazil (PAL).From the Department of Social Medicine, School of Medicine, Postgraduate Studies Program in Epidemiology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil (MD, MIS, and BBD); the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN (MAP); the Health Sciences Center, Federal University of Espirito Santo, Vitoria, Brazil (MDCBM); the Institute of Collective Health, Federal University of Bahia, Salvador, Brazil (SA); and the Center for Clinical and Epidemiologic Research, University of Sao Paulo, Sao Paulo, Brazil (PAL).From the Department of Social Medicine, School of Medicine, Postgraduate Studies Program in Epidemiology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil (MD, MIS, and BBD); the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN (MAP); the Health Sciences Center, Federal University of Espirito Santo, Vitoria, Brazil (MDCBM); the Institute of Collective Health, Federal University of Bahia, Salvador, Brazil (SA); and the Center for Clinical and Epidemiologic Research, University of Sao Paulo, Sao Paulo, Brazil (PAL).From the Department of Social Medicine, School of Medicine, Postgraduate Studies Program in Epidemiology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil (MD, MIS, and BBD); the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN (MAP); the Health Sciences Center, Federal University of Espirito Santo, Vitoria, Brazil (MDCBM); the Institute of Collective Health, Federal University of Bahia, Salvador, Brazil (SA); and the Center for Clinical and Epidemiologic Research, University of Sao Paulo, Sao Paulo, Brazil (PAL).From the Department of Social Medicine, School of Medicine, Postgraduate Studies Program in Epidemiology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil (MD, MIS, and BBD); the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN (MAP); the Health Sciences Center, Federal University of Espirito Santo, Vitoria, Brazil (MDCBM); the Institute of Collective Health, Federal University of Bahia, Salvador, Brazil (SA); and the Center for Clinical and Epidemiologic Research, University of Sao Paulo, Sao Paulo, Brazil (PAL).From the Department of Social Medicine, School of Medicine, Postgraduate Studies Program in Epidemiology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil (MD, MIS, and BBD); the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN (MAP); the Health Sciences Center, Federal University of Espirito Santo, Vitoria, Brazil (MDCBM); the Institute of Collective Health, Federal University of Bahia, Salvador, Brazil (SA); and the Center for Clinical and Epidemiologic Research, University of Sao Paulo, Sao Paulo, Brazil (PAL).

Pub Type(s)

Journal Article
Multicenter Study
Observational Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

25833975

Citation

Drehmer, Michele, et al. "Associations of Dairy Intake With Glycemia and Insulinemia, Independent of Obesity, in Brazilian Adults: the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)." The American Journal of Clinical Nutrition, vol. 101, no. 4, 2015, pp. 775-82.
Drehmer M, Pereira MA, Schmidt MI, et al. Associations of dairy intake with glycemia and insulinemia, independent of obesity, in Brazilian adults: the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Am J Clin Nutr. 2015;101(4):775-82.
Drehmer, M., Pereira, M. A., Schmidt, M. I., Del Carmen B Molina, M., Alvim, S., Lotufo, P. A., & Duncan, B. B. (2015). Associations of dairy intake with glycemia and insulinemia, independent of obesity, in Brazilian adults: the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). The American Journal of Clinical Nutrition, 101(4), 775-82. https://doi.org/10.3945/ajcn.114.102152
Drehmer M, et al. Associations of Dairy Intake With Glycemia and Insulinemia, Independent of Obesity, in Brazilian Adults: the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Am J Clin Nutr. 2015;101(4):775-82. PubMed PMID: 25833975.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Associations of dairy intake with glycemia and insulinemia, independent of obesity, in Brazilian adults: the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). AU - Drehmer,Michele, AU - Pereira,Mark A, AU - Schmidt,Maria Inês, AU - Del Carmen B Molina,Maria, AU - Alvim,Sheila, AU - Lotufo,Paulo A, AU - Duncan,Bruce B, Y1 - 2015/01/21/ PY - 2014/10/29/received PY - 2014/12/29/accepted PY - 2015/4/3/entrez PY - 2015/4/4/pubmed PY - 2015/6/4/medline KW - cohort studies KW - dairy products KW - glycemia KW - insulinemia KW - obesity SP - 775 EP - 82 JF - The American journal of clinical nutrition JO - Am. J. Clin. Nutr. VL - 101 IS - 4 N2 - BACKGROUND: Inverse associations between dairy intake and the risk of type 2 diabetes have been shown, but more studies are needed, especially from low- and middle-income countries. OBJECTIVE: The objective was to describe the association between dairy products and direct measures of glycemic status in adults without known diabetes. DESIGN: The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) includes 15,105 adults, aged 35-74 y, enrolled from universities and research institutions in 6 Brazilian capital cities. We excluded participants with a known diabetes diagnosis, cardiovascular diseases, and cancer. Dairy consumption was assessed by a food-frequency questionnaire, and we computed servings per day for total and subgroups of dairy. Associations with fasting blood glucose (FG) and fasting insulin, 2-h postload glucose (PG), 2-h postload insulin (PI), glycated hemoglobin (Hb A1c), and homeostasis model assessment of insulin resistance (HOMA-IR) were assessed through multivariable linear regression analysis with adjustment for demographic characteristics, behavioral risk factors, other dietary factors, and anthropometric measurements. RESULTS: The sample size after exclusions was 10,010. The intake of total dairy was inversely associated with FG (linear β for dairy servings/d = -0.46 ± 0.2 mg/dL), PG (-1.25 ± 0.5 mg/dL), PI (-1.52 ± 0.6 mg/dL), Hb A1c (-0.02 ± 0.0%), and HOMA-IR (-0.04 ± 0.0) after adjustment for all covariates (P < 0.05 for all). The findings were consistent across categories of sex, race, obesity status, and dairy fat amount (reduced-fat vs. full-fat dairy). Fermented dairy products showed particularly strong inverse associations with the outcomes, with adjusted differences for a 1-serving/d increment of -0.24 (95% CI: -0.46, -0.02) mg/dL for FG, -0.86 (-1.42, -0.30) mg/dL for PG, and -0.01% (-0.02%, 0.00%) for Hb A1c. Myristic acid was the only nutrient that appeared to mediate the association between dairy intake and glycemia. CONCLUSION: Dairy intake, especially fermented dairy, was inversely associated with measures of glycemia and insulinemia in Brazilian adults without diagnosed diabetes. This trial was registered at clinicaltrials.com as NCT02320461. SN - 1938-3207 UR - https://www.unboundmedicine.com/medline/citation/25833975/Associations_of_dairy_intake_with_glycemia_and_insulinemia_independent_of_obesity_in_Brazilian_adults:_the_Brazilian_Longitudinal_Study_of_Adult_Health__ELSA_Brasil__ L2 - https://academic.oup.com/ajcn/article-lookup/doi/10.3945/ajcn.114.102152 DB - PRIME DP - Unbound Medicine ER -