Dairy, Metabolic Syndrome and Blood Pressure Evidence from the French MONICA population surveys and other studies Vanina Bongard, MD, PhD Department of Epidemiology and Public Health – UMR 1027 Toulouse University – INSERM, Toulouse, France Lipid Clinic, Rangueil University Hospital, Toulouse, France
Nutrition and cardiovascular (CV) risk: Revisiting the French Paradox The French Paradox is the observation of low coronary heart disease (CHD) death rates despite high intake of dietary cholesterol and saturated fat. Ferrières J. Heart 2004;90:107-111.
Nutrition and cardiovascular (CV) risk: Revisiting the French Paradox Plot of death rate from CHD correlated with daily dietary intake of cholesterol and saturated fat Reproduced from Artaud-Wild SM. Circulation 1993;88:2771-2779. Ferrières J. Heart 2004;90:107-111.
Nutrition and cardiovascular (CV) risk: Revisiting the French Paradox Other fat intakes Fruits, vegetables, dairy products, cereals, meat, Saturated fat intakes fish, alcohol…. Calcium, Magnesium, Sodium… Proteins, carbohydrates Obesity CV risk factors CV risk
Nutrition and cardiovascular (CV) risk: Revisiting the French Paradox Other fat intakes Fruits, vegetables, dairy products, cereals, meat, Saturated fat intakes fish, alcohol…. Calcium, Magnesium, Sodium… Proteins, carbohydrates Obesity Physical activity CV risk factors Smoking and other CV risk environmental exposures
Nutrition and cardiovascular (CV) risk: Revisiting the French Paradox Other fat intakes Fruits, vegetables, dairy products, cereals, meat, Saturated fat intakes fish, alcohol…. Calcium, Magnesium, Sodium… Proteins, carbohydrates Genes – Environment interactions Obesity Physical activity CV risk factors Smoking and other CV risk environmental exposures
Nutrition and cardiovascular (CV) risk: Revisiting the French Paradox As for the French Paradox, studying the link between dairy intake and CV risk cannot be limited to the impact of saturated fats but should take into account : Other components of dairy products Other dietary intakes Intricate relationships with lifestyle habits
Dairy products and cardiovascular risk These issues are of particular importance as: Dairy products are so heterogeneous Varying content of fats Varying content of Ca, Na, Mg Varying proteins with varying properties Wide possibility of recipes with varying content of sugar and fats … .. Consumption of dairy product has been associated with other specific dietary patterns
Food group intakes across quartiles of dairy intakes: The Mona Lisa study Median intake of fruits and vegetables g/1000 kJ across quartiles of dairy intake P -value < 0.001 Huo Yung Kai S. Eur J Prev Cardiol 2013 (in press).
Food group intakes across quartiles of dairy intakes: The Mona Lisa study Median intake of fish g/1000 kJ across quartiles of dairy intake P -value < 0.01 Huo Yung Kai S. Eur J Prev Cardiol 2013 (in press).
Food group intakes across quartiles of dairy intakes: The Mona Lisa study Median intake of alcohol g/1000 kJ across quartiles of dairy intake P -value < 0.001 Huo Yung Kai S. Eur J Prev Cardiol 2013 (in press).
A comprehensive asessment of CV risk: The MONICA registries & population surveys MONICA population surveys French Mona Lisa population survey 1985-1986 1995-1996 1990-1991 2006-2007 MONItoring of trends and determinants in CArdiovascular disease: 37 registries of myocardial infarction Tunstall-Pedoe H. Lancet 1999;353:1547-1557. Tunstall-Pedoe H. Lancet 2000;355;688-700. Kuulasmaa K. Lancet 2000;355;675-687.
A comprehensive asessment of CV risk: The MONICA registries & population surveys Trends in risk factor prevalence MONICA population surveys French Mona Lisa population survey 1985-1986 1995-1996 1990-1991 2006-2007 MONItoring of trends and determinants Trends in MI and in CArdiovascular disease: ACS incidence 37 registries of myocardial infarction Tunstall-Pedoe H. Lancet 1999;353:1547-1557. Tunstall-Pedoe H. Lancet 2000;355;688-700. Kuulasmaa K. Lancet 2000;355;675-687.
The Third French MONICA population survey Recruitment in the population Men - Women 35-65 years survey (1995) from three French areas N=3508 Nutritional record on 3- Sub-sample of men consecutive days 45-65 years N=897 Vital status recorded after a median follow-up of about 14 years
The Third French MONICA population survey Baseline population characteristics N / 897 (%) Education level > baccalaureat 23% Serious chronic condition 2% Framingham risk score Low < 10% 29% Intermediate [10-20%[ 42% High ≥ 20% or secondary prevention 29% Metabolic syndrom (NCEP – ATPIII, 2001) 24% Metabolic syndrom (NCEP – ATPIII, 2005) 34% Metabolic syndrom (AHA-IDF-NHLBI, 2009) 45% Alcohol intake None 12% ≤ 3 glasses per day 47% > 3 glasses per day 42% Current smoking 21% Physical activity No or light (< 1 time per week) 68% Moderate (≥20 min, once or twice a week) 18% Importante (≥20 min on ≥3 times a week) 14%
Dairy intake and Blood Pressure: Baseline relationships Calcium intake Milk intake mm Hg mm Hg 150 p<0.01 150 p<0.0001 141.2 141.2 140.6 139.6 (20.9) (20.8) (21.1) (20.4) 136,9 135.6 135.5 135.1 140 140 (17.4) (17.8) (17.3) (18.6) SBP SBP 130 130 120 120 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 mg/day g/day 142-545 545-743 743-955 > 955 0-3 3-45 45-156 > 156 100 100 p<0.01 p<0.0001 88.5 88.3 86.9 86.3 (12.4) (12.6) 85.3 85.0 90 84.6 90 (11.9) 84.2 (12.0) (11.8) (11.1) (10.2) (11.1) DBP DBP 80 80 70 70 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Ruidavets JB. J Hypertens 2006;24:671-81.
Dairy intake and Blood Pressure: Baseline relationships Reduction in systolic blood pressure (mm Hg) according to tertiles of daily milk intake Tertiles of Ca intake mm Hg 1 st 2 nd 3 rd 2 0 Tertiles of milk intake -2 2 nd vs 1 st -4 ns ns 3 rd vs 1 st -6 < 0.05 -8 < 0.01 Ruidavets JB. J Hypertens 2006;24:671-81.
Accordance with previous data Meta-analyses of cohort studies and RCT Observational studies (Birkett 1998) Randomized controlled trials (Griffith 1998) DASH trial (Appel 1997) -5 -4 -3 -2 -1 0 mm Hg Decrease in systolic blood pressure / 800 mg of dietary Ca Adapted from Miller GD, et al. J Am Coll Nutr 2000;19:147S.
Prevalence of metabolic syndrom accross quartiles of food intakes: baseline relationships Q1 Q2 Q3 Q4 Q5 p Eggs 23.6 29.1 20.7 27.3 17.2 0.12 Fish 29.4 20.6 20.3 - - 0.03 Meat / poultry 20.0 20.2 21.6 25.9 29.7 0.21 Cereals 27.8 32.8 21.9 16.6 18.2 0.009 Vegetables 22.2 24.0 27.2 21.2 22.6 0.71 Fruits 26.9 22.0 25.7 21.7 21.1 0.66 Potatoes 22.4 24.0 16.9 26.3 27.6 0.21 Dairy products 32.6 25.0 21.8 18.8 19.9 0.04 Alcohol 24.6 21.4 18.9 25.0 27.5 0.44 Ruidavets JB. J Epidemiol Community Health 2007;61:810-817.
Reduced incidence of insulin resistance with dairy intake: The CARDIA cohort study Pereira MA. JAMA 2002;287:2081.
Reduced incidence of metabolic syndrome and diabetes with dairy intake: The DESIR cohort study Dairy intakes (except cheese) and risk of metabolic syndrome (METs) and diabetes after 9 years of follow-up Odds ratio (OR) [95% CI] Associated with an increased consumption Mets (IDF) Mets (NCEP) Diabetes ; HG Unadjsuted 0.77 [0.71-0.84] 0.78 [0.70-0.85] 0.74 [0.68-0.81] Model 1 0.86 [0.79-0.94] 0.84 [0.76-0.93] 0.83 [0.75-0.92] Model 2 0.88 [0.79-0.97] 0.89 [0.79-1.00] 0.85 [0.76-0.94] Model1: adjusted for age, gender, alcohol intake, physical activity, fat intake. Model 2: adjusted for the same covariates plus BMI. Fumeron F. Diabetes Care 2011;34:813-17.
Reduced incidence of metabolic syndrome and diabetes with dairy intake: The DESIR cohort study Cheese intake and risk of metabolic syndrome (METs) and diabetes after 9 years of follow-up Odds ratio (OR) [IC 95%] Associated with an increased consumption Mets (IDF) Mets (NCEP) Diabète ; HGJ Non ajusté 0.93 [0.84-1.02] 0.94 [0.84-1.05] 1.07 [0.96-1.19] Modèle 1 0.90 [0.80-1.00] 0.86 [0.76-0.98] 0.94 [0.83-1.07] Modèle 2 0.88 [0.77-1.00] 0.82 [0.71-0.95] 0.93 [0.82-1.06] Model1: adjusted for age, gender, alcohol intake, physical activity, fat intake. Model 2: adjusted for the same covariates plus BMI. Fumeron F. Diabetes Care 2011;34:813-17.
Lower progession in BMI with dairy intake: The DESIR cohort study Dairy products Calcium Cheese Kg/m 2 Kg/m 2 Kg/m 2 p=0.01 p<0.001 p=0.04 Reproduced with permission from Fumeron F et al. Increased consumption
Suggested mechanisms Blood pressure lowering effect of calcium direct impact on smooth vascular muscle impact through PTH and vitamin D secretion increased sodium excretion Blood pressure lowering effect of other components (ACE inhibitor like effect of milk proteins) Intestinal binding of cholesterol and bile acids induced by Ca: formation of intestinal soaps, decreased fat absorption, increased fat excretion leading to decreased blood lipid levels
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