BMJ:乳制品摄入过多,可能增加死亡风险
  • 纳入168 153名女性和49 602名男性,最长随访32年,共记录51 438例死亡事件;
  • 与最低组(0.8 份/天)总乳制品摄入相比,最高组(4.2 份/天)摄入总死亡风险高7%;
  • 按乳制品类型进行分层分析发现,全脂牛奶摄入与较高的总死亡、心血管疾病死亡和癌症死亡风险呈正相关,每天增加0.5份与死亡风险分别增加11%、9%和11%相关;
  • 用坚果、豆类和全谷物代替乳制品与较低的死亡风险相关,而用红肉和加工肉制品代替乳制品与较高的死亡风险相关。
主编推荐语
flying dutchman
乳制品摄入与2型糖尿病、心血管疾病及癌症的研究较多,大部分显示乳制品摄入没有较大的有益作用甚至可能存在有害作用。关于乳制品摄入与死亡风险的前瞻性队列研究目前并不多。近期BMJ发表的一篇文章纳入三项前瞻性队列研究,发现较高的乳制品摄入(4.2份/天,1份=240毫升牛奶,或6克奶油,或120毫升冻酸奶/冰淇淋,或30毫升奶酪),特别是全脂牛奶(≥2份/周)摄入与较高的死亡风险相关;用坚果、豆类和全谷物替代乳制品摄入与较低的死亡风险相关,而用红肉和加工肉制品代替乳制品摄入与较高的死亡风险相关。值得注意的是,该结论与2018年9月Lancet发表的另一项前瞻性队列研究(PURE)结果相反(查看文章)。这两项研究结果不一致的原因可能是进行的比较不同。Lancet研究中,研究人员是对每天>2份(中位数3.2份)与不吃乳制品进行比较;而BMJ研究中,研究人员是对每天约4.2份和和0.8份进行比较。此外,Lancet研究同时纳入了乳制品摄入相对较低的国家,如非洲和亚洲国家;而BMJ研究只纳入乳制品摄入相对较高的美国人群。
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Associations of dairy intake with risk of mortality in women and men: three prospective cohort studies

乳制品摄入和男女死亡风险的关系:三项前瞻性队列研究

10.1136/bmj.l6204

2019-11-27, Article

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Objective: To examine the association of consumption of dairy foods with risk of total and cause specific mortality in women and men.
Design : Three prospective cohort studies with repeated measures of diet and lifestyle factors.
Setting : Nurses’ Health Study, Nurses’ Health Study II, and the Health Professionals Follow-up Study, in the United States.
Participants : 168 153 women and 49 602 men without cardiovascular disease or cancer at baseline.
Main outcome measure: Death confirmed by state vital records, the national death index, or reported by families and the postal system. During up to 32 years of follow-up, 51 438 deaths were documented, including 12 143 cardiovascular deaths and 15 120 cancer deaths. Multivariable analysis further adjusted for family history of cardiovascular disease and cancer, physical activity, overall dietary pattern (alternate healthy eating index 2010), total energy intake, smoking status, alcohol consumption, menopausal status (women only), and postmenopausal hormone use (women only).
Results : Compared to the lowest category of total dairy consumption (average 0.8 servings/day), the multivariate pooled hazard ratio for total mortality was 0.98 (95% confidence interval 0.96 to 1.01) for the second category of dairy consumption (average 1.5 servings/day), 1.00 (0.97 to 1.03) for the third (average 2.0 servings/day), 1.02 (0.99 to 1.05) for the fourth (average 2.8 servings/day), and 1.07 (1.04 to 1.10) for highest category (average 4.2 servings/day; P for trend <0.001). For the highest compared to the lowest category of total dairy consumption, the hazard ratio was 1.02 (0.95 to 1.08) for cardiovascular mortality and 1.05 (0.99 to 1.11) for cancer mortality. For subtypes of dairy products, whole milk intake was significantly associated with higher risks of total mortality (hazard ratio per 0.5 additional serving/day 1.11, 1.09 to 1.14), cardiovascular mortality (1.09, 1.03 to 1.15), and cancer mortality (1.11, 1.06 to 1.17). In food substitution analyses, consumption of nuts, legumes, or whole grains instead of dairy foods was associated with a lower mortality, whereas consumption of red and processed meat instead of dairy foods was associated with higher mortality.
Conclusion : These data from large cohorts do not support an inverse association between high amount of total dairy consumption and risk of mortality. The health effects of dairy could depend on the comparison foods used to replace dairy. Slightly higher cancer mortality was non-significantly associated with dairy consumption, but warrants further investigation.

First Authors:
Ming Ding

Correspondence Authors:
Ming Ding

All Authors:
Ming Ding,Jun Li,Lu Qi,Christina Ellervik,Xuehong Zhang,JoAnn E Manson,Meir Stampfer,Jorge E Chavarro,Kathryn M Rexrode,Peter Kraft,Daniel Chasman,Walter C Willett,Frank B Hu

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