and Blood Pressure Evidence from the French MONICA population - - PowerPoint PPT Presentation
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
Department of Epidemiology and Public Health – UMR 1027 Toulouse University – INSERM, Toulouse, France Lipid Clinic, Rangueil University Hospital, Toulouse, France
Ferrières J. Heart 2004;90:107-111.
Ferrières J. Heart 2004;90:107-111.
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.
Saturated fat intakes
Other fat intakes Calcium, Magnesium, Sodium… Proteins, carbohydrates Fruits, vegetables, dairy products, cereals, meat, fish, alcohol….
Saturated fat intakes
Other fat intakes Calcium, Magnesium, Sodium… Proteins, carbohydrates Fruits, vegetables, dairy products, cereals, meat, fish, alcohol…. Physical activity Smoking and other environmental exposures
Saturated fat intakes
Other fat intakes Calcium, Magnesium, Sodium… Proteins, carbohydrates Fruits, vegetables, dairy products, cereals, meat, fish, alcohol…. Physical activity Smoking and other environmental exposures Genes – Environment interactions
g/1000 kJ P-value < 0.001 Median intake of fruits and vegetables across quartiles of dairy intake
Huo Yung Kai S. Eur J Prev Cardiol 2013 (in press).
g/1000 kJ P-value < 0.01 Median intake of fish across quartiles of dairy intake
Huo Yung Kai S. Eur J Prev Cardiol 2013 (in press).
g/1000 kJ P-value < 0.001 Median intake of alcohol across quartiles of dairy intake
Huo Yung Kai S. Eur J Prev Cardiol 2013 (in press).
Tunstall-Pedoe H. Lancet 1999;353:1547-1557. Tunstall-Pedoe H. Lancet 2000;355;688-700. Kuulasmaa K. Lancet 2000;355;675-687.
1985-1986 1990-1991 1995-1996 MONICA population surveys MONItoring of trends and determinants in CArdiovascular disease: 37 registries of myocardial infarction French Mona Lisa population survey 2006-2007
Tunstall-Pedoe H. Lancet 1999;353:1547-1557. Tunstall-Pedoe H. Lancet 2000;355;688-700. Kuulasmaa K. Lancet 2000;355;675-687.
1985-1986 1990-1991 1995-1996 MONICA population surveys MONItoring of trends and determinants in CArdiovascular disease: 37 registries of myocardial infarction French Mona Lisa population survey 2006-2007 Trends in MI and ACS incidence Trends in risk factor prevalence
Recruitment in the population survey (1995) N=3508 Nutritional record on 3- consecutive days N=897 Sub-sample of men 45-65 years Men - Women 35-65 years from three French areas Vital status recorded after a median follow-up of about 14 years
Baseline population characteristics N / 897 (%)
Education level > baccalaureat 23% Serious chronic condition 2% Framingham risk score Low < 10% Intermediate [10-20%[ High ≥ 20% or secondary prevention 29% 42% 29% Metabolic syndrom (NCEP – ATPIII, 2001) 24% Metabolic syndrom (NCEP – ATPIII, 2005) 34% Metabolic syndrom (AHA-IDF-NHLBI, 2009) 45% Alcohol intake None ≤ 3 glasses per day > 3 glasses per day 12% 47% 42% Current smoking 21% Physical activity No or light (< 1 time per week) Moderate (≥20 min, once or twice a week) Importante (≥20 min on ≥3 times a week) 68% 18% 14%
141.2 (20.8) 140.6 (21.1) 135.6 (17.8) 135.5 (17.3)
120 130 140 150 Q1 Q2 Q3 Q4 SBP
p<0.0001
g/day
0-3 3-45 45-156 > 156 mm Hg
88.5 (12.4) 86.9 (11.9) 84.2 (11.1) 85.0 (11.1)
70 80 90 100 Q1 Q2 Q3 Q4 DBP
p<0.0001
Milk intake
141.2 (20.9) 139.6 (20.4) 136,9 (17.4) 135.1 (18.6)
120 130 140 150 Q1 Q2 Q3 Q4 SBP
p<0.01
mg/day
142-545 545-743 743-955 > 955 mm Hg
88.3 (12.6) 86.3 (12.0) 84.6 (10.2) 85.3 (11.8)
70 80 90 100 Q1 Q2 Q3 Q4 DBP
p<0.01
Calcium intake
Ruidavets JB. J Hypertens 2006;24:671-81.
Ruidavets JB. J Hypertens 2006;24:671-81.
2 mm Hg
Tertiles of milk intake 2nd vs 1st 3rd vs 1st
< 0.05 < 0.01
Tertiles of Ca intake 1st 2nd 3rd
ns ns
Decrease in systolic blood pressure / 800 mg of dietary Ca
mm Hg Observational studies (Birkett 1998) Randomized controlled trials (Griffith 1998) DASH trial (Appel 1997)
Adapted from Miller GD, et al. J Am Coll Nutr 2000;19:147S.
Ruidavets JB. J Epidemiol Community Health 2007;61:810-817.
Q1 23.6 29.4 20.0 27.8 22.2 26.9 22.4 32.6 24.6 Q2 29.1 20.6 20.2 32.8 24.0 22.0 24.0 25.0 21.4 Q3 20.7 20.3 21.6 21.9 27.2 25.7 16.9 21.8 18.9 Q4 27.3
16.6 21.2 21.7 26.3 18.8 25.0 Q5 17.2
18.2 22.6 21.1 27.6 19.9 27.5 p 0.12 0.03 0.21 0.009 0.71 0.66 0.21 0.04 0.44 Eggs Fish Meat / poultry Cereals Vegetables Fruits Potatoes Dairy products Alcohol
Pereira MA. JAMA 2002;287:2081.
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.
Cheese intake and risk of metabolic syndrome (METs) and diabetes after 9 years of follow-up
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.
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]
Kg/m2 Kg/m2 Kg/m2
Dairy products Calcium Cheese
Increased consumption
p=0.01 p<0.001 p=0.04
Reproduced with permission from Fumeron F et al.
Huo Yung Kai S. Eur J Prev Cardiol 2013 (in press).
Adjusted OR 95% CI P-value for trend Q2 vs Q1 Q3 vs Q1 Q4 vs Q1 Total dairy intake 1.05 0.79 0.71 0.001 0.84-1.31 0.63-0.99 0.56-0.90 Low-fat dairy intake 0.92 0.84 0.66 0.001 0.74-1.15 0.67-1.05 0.52-0.84 High-fat dairy intake 1.20 1.18 0.90 0.350 0.46-1.50 0.94-1.47 0.72-1.13
%
0 t1 t2 t3 0 t1 t2 t3 0 t2 t3 q1 q2 q3 q4 q1 q2 q3 q4 0 (non consumpion) ; t (tertile) ; q (quartile) p=0,006 p=0,009 p=0,012 p=0,001 p<0,001
Adjsutment for centre, age, education and socio-economic levels, baseline serious chronic disease, Framigham risk score, alcohol intake, smoking, physical activity, a diet quality score, and total daily energy intake.
Adjusted hazard ratio for all-cause death
Milk Tertile 1 0,75 Milk Tertile 2 0,60 Milk Tertile 3 Fish intake 0,45 Fruits & vegatables Quartiles 2-4 vs Q1
Cereals Quartiles 2-4 vs Q1 0,77 0,60 0,59 0,231 0,056 0,007 0,193 0,018 0,008
Bongard V. 2012 meeting of the European Society of Cardiology.
Bongard V. 2012 meeting of the European Society of Cardiology.
Strenghs Quantitative assessment of food intakes Long follow-up period (up to 16 years) Multiple adjustments for main confounders, taken into account, at least partially, intricate relationships between feeding behaviour and lifestyle Limits Causality is still not proven due to the lack of randomisation Intricate relationships between feeding behaviour and lifestyle Lack of re-assessment of food intakes during follow-up Sample restricted to middle-aged men
Limits Causality is still not proven due to the lack of randomisation Intricate relationships between feeding behaviour and lifestyle Lack of re-assessment of food intakes during follow-up Sample restricted to middle-aged men Strenghs Quantitative assessment of food intakes Long follow-up period (up to 16 years) Multiple adjustments for main confounders, taken into account, at least partially, intricate relationships between feeding behaviour and lifestyle