Association between consumption of dairy products and incident type 2 diabetes--insights from the European Prospective Investigation into Cancer study.

Nita G Forouhi

doi:10.1093/nutrit/nuv018

Abstract

The public health burden of type 2 diabetes has risen unabated over the past decades, fueled by obesity and lifestyle influences, including diet quality. Epidemiological evidence is accumulating for an inverse association between dairy product intake and type 2 diabetes risk; this is somewhat counterintuitive to the saturated fat and cardiometabolic disease paradigm. The present report reviews the contribution that the findings of the European Prospective Investigation into Cancer (EPIC) study have made to this debate, noting that types of dairy products, particularly fermented dairy products including yogurt, may be more relevant than overall dairy intake for the prevention of type 2 diabetes. The EPIC study has contributed evidence through complementary approaches of a large prospective study across 8 European countries with heterogeneous dietary intakes assessed using food-frequency questionnaires (EPIC-InterAct study) and through a more detailed examination of diet assessed using a 7-day food diary (EPIC-Norfolk study). The implications of these findings are placed in the wider context, including the use of individual fatty acid blood biomarkers in the EPIC-InterAct study and an appraisal of current research gaps and suggestions for future research directions.

Highlights

The global burden of diabetes mellitus is high, and increasing, with the latest estimates from the International Diabetes Federation suggesting that 382 million people had diabetes in 2013; that number is projected to increase to 592 million by 2035.1 The multiple serious consequences of diabetes, including macrovascular and microvascular complications that lead to premature morbidity and mortality, pose a major threat to public health
At the time the InterAct project was conducted,[20] little research evidence was available from Europe on the association between dairy products and incidence of diabetes; only 3 studies had been published that, together, included fewer than 600 incident cases of type 2 diabetes, and 2 of those studies were restricted to men.[21,22,23]
Described in detail previously,[18,20] the EPICInterAct study was a case-cohort study nested within 8 of the 10 countries participating in the European Prospective Investigation into Cancer (EPIC) study

Summary

INTRODUCTION

The global burden of diabetes mellitus is high, and increasing, with the latest estimates from the International Diabetes Federation suggesting that 382 million people had diabetes in 2013; that number is projected to increase to 592 million by 2035.1 The multiple serious consequences of diabetes, including macrovascular and microvascular complications that lead to premature morbidity and mortality, pose a major threat to public health. There is increasing interest in the potential role that dairy products might play in diabetes etiology, though research evidence has been mixed as to whether different types of dairy products have a beneficial, detrimental, or null association with type 2 diabetes.[7,8,9,10] The focus within dietary guidelines to reduce the consumption of saturated fat for the prevention of cardiovascular. Contrary to expectations and based on the strong focus on saturated fat as a risk factor for cardiometabolic disease, recent appraisal of the evidence has not been convincing for the effects of saturated fatty acids on such outcomes.[15,16] Simultaneously, a dialogue has begun on whether the focus of dietary advice should move away from nutrients to a food-based approach.[17] In light of these developments, it has become of great interest to investigate the potential role the intake of dairy products could have on cardiometabolic health. The second objective was to investigate the association between dairy intake and diabetes using more detailed dietary information obtained from a prospective 7-day food diary in the UK–based EPIC Norfolk study.[19]

RATIONALE, METHODS, AND FINDINGS FROM THE EPIC STUDY

Findings in context and future directions

CONCLUSION