Repositorio
Institucional

Dehghan, Mahshid

Mente, Andrew

Rangarajan, Sumathy

Sheridan, Patrick

Mohan, Viswanathan

Iqbal, Romaina

Gupta, Rajeev

Lear, Scott

Wentzel-Viljoen, Edelweiss

Avezum, Alvaro

Lopez-Jaramillo, Patricio

Mony, Prem

Varma, Ravi Prasad

Kumar, Rajesh

Chifamba, Jephat

Alhabib, Khalid F.

Mohammadifard, Noushin

Oguz, Aytekin

Lanas, Fernando

Rozanska, Dorota

Bostrom, Kristina Bengtsson

Yusoff, Khalid

Tsolkile, Lungiswa P.

Dans, Antonio

Yusufali, AfzalHussein

Orlandini, Andres

Poirier, Paul

Khatib, Rasha

Hu, Bo

Wei, Li

Yin, Lu

Deeraili, Ai

Yeates, Karen

Yusuf, Rita

Ismail, Noorhassim

Mozaffarian, Dariush

Teo, Koon

Anand, Sonia S.

Yusuf, Salim

Association of dairy intake with cardiovascular disease and mortality in 21 countries from five continents (PURE): a prospective cohort study

ELSEVIER SCIENCE INC

LANCET

en

Background Dietary guidelines recommend minimising consumption of whole-fat dairy products, as they are a source of saturated fats and presumed to adversely affect blood lipids and increase cardiovascular disease and mortality. Evidence for this contention is sparse and few data for the effects of dairy consumption on health are available from low-income and middle-income countries. Therefore, we aimed to assess the associations between total dairy and specific types of dairy products with mortality and major cardiovascular disease. Methods The Prospective Urban Rural Epidemiology (PURE) study is a large multinational cohort study of individuals aged 35-70 years enrolled from 21 countries in five continents. Dietary intakes of dairy products for 136 384 individuals were recorded using country-specific validated food frequency questionnaires. Dairy products comprised milk, yoghurt, and cheese. We further grouped these foods into whole-fat and low-fat dairy. The primary outcome was the composite of mortality or major cardiovascular events (defined as death from cardiovascular causes, non-fatal myocardial infarction, stroke, or heart failure). Hazard ratios (HRs) were calculated using multivariable Cox frailty models with random intercepts to account for clustering of participants by centre. Findings Between Jan 1, 2003, and July 14, 2018, we recorded 10 567 composite events (deaths [n=6796] or major cardiovascular events [n=5855]) during the 9.1 years of follow-up. Higher intake of total dairy (>2 servings per day compared with no intake) was associated with a lower risk of the composite outcome (HR 0.84, 95% CI 0.75-0.94, p(trend) 0.0004), total mortality (0.83, 0.72-0.96, p(trend) 0.0052), non-cardiovascular mortality (0.86, 0.72-1.02, p(trend)=0.046), cardiovascular mortality (0.77, 0.58-1.01, p(trend)=0.029), major cardiovascular disease (0.78, 0.67-0.90, p(trend)=0.0001), and stroke (0.66, 0.53-0.82, p(trend)=0.0003). No significant association with myocardial infarction was observed (HR 0.89, 95% CI 0.71-1.11,p(trend)=0.163). Higher intake (>1 serving vs no intake) of milk (HR 0.90, 95% CI 0.82-0.99, p(trend)=0.0529) and yogurt (0.86, 0.75-0.99, p(trend)=0.0051) was associated with lower risk of the composite outcome, whereas cheese intake was not significantly associated with the composite outcome (0.88, 0.76-1.02, p(trend)=0.1399). Butter intake was low and was not significantly associated with clinical outcomes (HR 1.09, 95% CI 0.90-1.33, p(trend)=0.4113). Interpretation Dairy consumption was associated with lower risk of mortality and major cardiovascular disease events in a diverse multinational cohort. Copyright (c) 2018 Elsevier Ltd. All rights reserved.

Antecedentes Las guías dietéticas recomiendan minimizar el consumo de productos lácteos enteros, ya que son una fuente de grasas saturadas y se presume que afectan negativamente a los lípidos en sangre y aumentan las enfermedades cardiovasculares y la mortalidad. La evidencia para esta afirmación es escasa y hay pocos datos disponibles sobre los efectos del consumo de lácteos en la salud en países de ingresos bajos y medios. Por lo tanto, nuestro objetivo fue evaluar las asociaciones entre los lácteos totales y tipos específicos de productos lácteos con la mortalidad y las enfermedades cardiovasculares mayores. Métodos El estudio Prospective Urban Rural Epidemiology (PURE) es un gran estudio de cohorte multinacional de individuos de 35 a 70 años de edad inscritos en 21 países en cinco continentes. Se registraron las ingestas dietéticas de productos lácteos de 136 384 individuos utilizando cuestionarios de frecuencia de alimentos validados específicos del país. Los productos lácteos comprendían leche, yogur y queso. Además, agrupamos estos alimentos en lácteos enteros y bajos en grasa. El resultado primario fue la combinación de mortalidad o eventos cardiovasculares mayores (definidos como muerte por causas cardiovasculares, infarto de miocardio no mortal, accidente cerebrovascular o insuficiencia cardíaca). Los cocientes de riesgo (HR) se calcularon mediante modelos multivariables de fragilidad de Cox con intersecciones aleatorias para tener en cuenta la agrupación de los participantes por centro. Resultados: Entre el 1 de enero de 2003 y el 14 de julio de 2018, se registraron 10 567 eventos compuestos (muertes [n = 6796] o eventos cardiovasculares mayores [n = 5855]) durante los 9,1 años de seguimiento. Una mayor ingesta total de productos lácteos (>2 porciones por día en comparación con ninguna ingesta) se asoció con un menor riesgo del resultado compuesto (HR 0,84, IC del 95 % 0,75-0,94, p(tendencia) 0,0004), mortalidad total (0,83, 0,72-0,96, p(tendencia) 0,0052), mortalidad no cardiovascular (0,86, 0,72-1,02, p(tendencia)=0,046), mortalidad cardiovascular (0,77, 0,58-1,01, p(tendencia)=0,029), enfermedad cardiovascular grave (0,78, 0,67-0,90, p(tendencia)=0,0001) y accidente cerebrovascular (0,66, 0,53-0,82, p(tendencia)=0,0003). No se observó asociación significativa con infarto de miocardio (HR 0,89, IC del 95% 0,71-1,11, p(tendencia)=0,163). Una mayor ingesta (>1 ración vs. ninguna ingesta) de leche (HR 0,90, IC del 95% 0,82-0,99, p(tendencia)=0,0529) y yogur (0,86, 0,75-0,99, p(tendencia)=0,0051) se asoció con un menor riesgo del resultado compuesto, mientras que la ingesta de queso no se asoció significativamente con el resultado compuesto (0,88, 0,76-1,02, p(tendencia)=0,1399). La ingesta de mantequilla fue baja y no se asoció significativamente con los resultados clínicos (HR 1,09, IC del 95% 0,90-1,33, p(tendencia)=0,4113). Interpretación: El consumo de lácteos se asoció con un menor riesgo de mortalidad y eventos cardiovasculares graves en una cohorte multinacional diversa. Copyright (c) 2018 Elsevier Ltd. Todos los derechos reservados.

Artículo original

SY cuenta con el apoyo de la cátedra Mary W. Burke de la Fundación del Corazón y el Accidente Cerebrovascular de Ontario. El estudio PURE es un estudio iniciado por investigadores y financiado por el Instituto de Investigación en Salud Poblacional, los Institutos Canadienses de Investigación en Salud (CIHR), la Fundación del Corazón y el Accidente Cerebrovascular de Ontario, la Estrategia para la Investigación Orientada al Paciente (SPOR) de los CIHR a través de la Unidad de Apoyo SPOR de Ontario, así como el Ministerio de Salud y Cuidados a Largo Plazo de Ontario, y subvenciones sin restricciones de varias compañías farmacéuticas, con importantes contribuciones de AstraZeneca (Canadá), Sanofi-Aventis (Francia y Canadá), Boehringer Ingelheim (Alemania y Canadá), Servier y GlaxoSmithKline, y contribuciones adicionales de Novartis y King Pharma, así como de diversas organizaciones nacionales o locales de los países participantes. Estos incluyen Argentina: Fundación ECLA, Bangladesh: Independent University, Bangladesh y Mitra and Associates, Brasil: Unilever Health Institute, Brasil, Canadá: Public Health Agency of Canada y Champlain Cardiovascular Disease Prevention Network, Canadian Institutes of Health Research (Catalyst Grant: eHealth Innovations número de subvención: 126524), Chile: Universidad de La Frontera (Registro interno DI13-PE11), China: National Center for Cardiovascular Diseases, Colombia: Colciencias, número de subvención: 6566-04-18062, India: Indian Council of Medical Research, Malasia: Ministry of Science, Technology and Innovation of Malaysia número de subvención 100-IRDC/BIOTEK 16/6/21 (13/2007), número de subvención 07-05-IFN-BPH 010, Ministry of Higher Education of Malaysia número de subvención 600-RMI/LRGS/5/3 (2/2011), Universiti Teknologi MARA, Facultad de Medicina, Universiti Kebangsaan Malaysia, Kuala Lumpur Malaysia, CRIM, Universidad Kebangsaan Malaysia, Territorio Palestino Ocupado: Organismo de Obras Públicas y Socorro de las Naciones Unidas para los Refugiados de Palestina en el Cercano Oriente (OOPS), territorio palestino ocupado, Centro Internacional de Investigaciones para el Desarrollo (IDRC), Canadá, Perú: Instituto Nacional del Corazón, los Pulmones y la Sangre (HHSN268200900033C), Instituto Nacional del Cáncer (1P20CA217231), Wellcome (103994/Z/14/Z), Filipinas: Consejo Filipino para la Investigación y el Desarrollo en Salud (PCHRD), Polonia: Subvención número 290/W-PURE/2008/0 del Ministerio de Ciencia y Educación Superior de Polonia, Universidad Médica de Wroclaw, Universidad Médica de Wroclaw, Arabia Saudita: Asociación Cardiovascular Saudita, Decanato de Investigación Científica de la Universidad Rey Saud, Riad, Arabia Saudita (Número de grupo de investigación: RG-1436-013), Sudáfrica: Universidad del Noroeste, SANPAD (Programa de Sudáfrica y los Países Bajos para Desarrollo Alternativo), Fundación Nacional de Investigación, Consejo de Investigación Médica de Sudáfrica, Asociación Sudafricana del Azúcar (SASA), Facultad de Ciencias de la Comunidad y la Salud (UWC), Suecia: Subvenciones del estado sueco en virtud del Acuerdo sobre investigación y educación de médicos, Fundación Sueca del Corazón y los Pulmones, Consejo Sueco de Investigación, Consejo Sueco para la Salud, la Vida Laboral y el Bienestar, Fundación de los Francmasones Rey Gustavo V y Reina Victoria, AFA Insurance, Tanzania: Centro de Investigación en Salud Pamoja Tunaweza (Tanzania), Queen's University, Departamento de Medicina, Turquía: Sociedad del Síndrome Metabólico, Astra Zeneca, Turquía, EAU: Premio Sheikh Hamdan Bin Rashid Al Maktoum para Ciencias Médicas y Autoridad de Salud de Dubái, Dubái, EAU.

SY 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 (CIHR), Heart and Stroke Foundation of Ontario, support from CIHR's Strategy for Patient Oriented Research (SPOR) 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, 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, Canadian Institutes of Health Research (Catalyst Grant: eHealth Innovations grant number: 126524), Chile: Universidad de La Frontera (Internal Registry DI13-PE11), China: National Center for Cardiovascular Diseases, 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), grant number 07-05-IFN-BPH 010, Ministry of Higher Education of Malaysia grant number 600-RMI/LRGS/5/3 (2/2011), Universiti Teknologi MARA, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur Malaysia, CRIM, University Kebangsaan Malaysia, Occupied Palestinian territory: The United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA), occupied Palestinian territory, International Development Research Centre (IDRC), Canada, Peru: National Heart, Lung and Blood Institute (HHSN268200900033C), National Cancer Institute (1P20CA217231), Wellcome (103994/Z/14/Z), Philippines: Philippine Council for Health Research & Development (PCHRD), Poland: Polish Ministry of Science and Higher Education grant number 290/W-PURE/2008/0, Wroclaw Medical University, Wroclaw Medical University, Saudi Arabia: Saudi Heart Association, The Deanship of Scientific Research at King Saud University, Riyadh, Saudi Arabia (Research group number: RG-1436-013), South Africa: The North-West University, SANPAD (SA and Netherlands Programme for Alternative Development), National Research Foundation, Medical Research Council of SA, The SA Sugar Association (SASA), Faculty of Community and Health Sciences (UWC), 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, Tanzania: Pamoja Tunaweza Health Research Centre (Tanzania), Queen's University, Department of Medicine, Turkey: Metabolic Syndrome Society, Astra Zeneca, Turkey, UAE: Sheikh Hamdan Bin Rashid Al Maktoum Award for Medical Sciences and Dubai Health Authority, Dubai UAE.

10.1016/S0140-6736(18)31812-9

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Medicine, General & Internal

Nutrición y Dietética

Sistema Cardiovascular y Cardiaco

Epidemiología

version publicada

hibrida

verde

metadata

metadata

WOS:000451067600027

Association of dairy intake with cardiovascular disease and mortality in 21 countries from five continents (PURE): a prospective cohort study

Artículo original

ELSEVIER SCIENCE INC

LANCET

Medicina general e interna

0140-6736

en

Heart and Stroke

CIHR

AstraZeneca (Canada)

Sanofi-Aventis (France)

Sanofi-Aventis (Canada)

Boehringer Ingelheim (Germany)

Boehringer Ingelheim (Canada)

Servier

GlaxoSmithKline

Novartis

King Pharma

Ministry of Science, Technology and Innovation of Malaysia 07-05-IFN-BPH 010

Ministry of Science, Technology and Innovation of Malaysia 100-IRDC/BIOTEK 16/6/21 13/2007

Ministry of Higher Education of Malaysia 600-RMI/LRGS/5/3 2/2011

UFRO DI13-PE11

Colciencias 6566-04-18062

HHSN 268200900033C

NCI 1P20CA217231

Wellcome 103994/Z/14/Z

Polish Ministry of Science and Higher Education 290/W-PURE/2008/0

Saudi Heart Association

King Saud University, Riyadh, Saudi Arabia RG-1436-013

Wellcome Trust 103994/Z/14/Z

SY 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 (CIHR), Heart and Stroke Foundation of Ontario, support from CIHR's Strategy for Patient Oriented Research (SPOR) 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, 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, Canadian Institutes of Health Research (Catalyst Grant: eHealth Innovations grant number: 126524), Chile: Universidad de La Frontera (Internal Registry DI13-PE11), China: National Center for Cardiovascular Diseases, 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), grant number 07-05-IFN-BPH 010, Ministry of Higher Education of Malaysia grant number 600-RMI/LRGS/5/3 (2/2011), Universiti Teknologi MARA, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur Malaysia, CRIM, University Kebangsaan Malaysia, Occupied Palestinian territory: The United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA), occupied Palestinian territory, International Development Research Centre (IDRC), Canada, Peru: National Heart, Lung and Blood Institute (HHSN268200900033C), National Cancer Institute (1P20CA217231), Wellcome (103994/Z/14/Z), Philippines: Philippine Council for Health Research & Development (PCHRD), Poland: Polish Ministry of Science and Higher Education grant number 290/W-PURE/2008/0, Wroclaw Medical University, Wroclaw Medical University, Saudi Arabia: Saudi Heart Association, The Deanship of Scientific Research at King Saud University, Riyadh, Saudi Arabia (Research group number: RG-1436-013), South Africa: The North-West University, SANPAD (SA and Netherlands Programme for Alternative Development), National Research Foundation, Medical Research Council of SA, The SA Sugar Association (SASA), Faculty of Community and Health Sciences (UWC), 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, Tanzania: Pamoja Tunaweza Health Research Centre (Tanzania), Queen's University, Department of Medicine, Turkey: Metabolic Syndrome Society, Astra Zeneca, Turkey, UAE: Sheikh Hamdan Bin Rashid Al Maktoum Award for Medical Sciences and Dubai Health Authority, Dubai UAE.

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Heart and Stroke#CIHR#AstraZeneca (Canada)#Sanofi-Aventis (France)#Sanofi-Aventis (Canada)#Boehringer Ingelheim (Germany)#Boehringer Ingelheim (Canada)#Servier# GlaxoSmithKline# Novartis#King Pharma#Ministry of Science, Technology and Innovation of Malaysia 07-05-IFN-BPH 010#Ministry of Science, Technology and Innovation of Malaysia 100-IRDC/BIOTEK 16/6/21 13/2007#Ministry of Higher Education of Malaysia 600-RMI/LRGS/5/3 2/2011#UFRO DI13-PE11#Colciencias 6566-04-18062#HHSN 268200900033C#NCI 1P20CA217231#Wellcome 103994/Z/14/Z#Polish Ministry of Science and Higher Education 290/W-PURE/2008/0#Saudi Heart Association# King Saud University, Riyadh, Saudi Arabia RG-1436-013#Wellcome Trust 103994/Z/14/Z

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