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Vissers LET, Sluijs I, Burgess S, Forouhi NG, Freisling H, Imamura F, Nilsson TK, Renström F, Weiderpass E, Aleksandrova K, Dahm CC, Perez-Cornago A, Schulze MB, Tong TYN, Aune D, Bonet C, Boer JMA, Boeing H, Chirlaque MD, Conchi MI, Imaz L, Jäger S, Krogh V, Kyrø C, Masala G, Melander O, Overvad K, Panico S, Sánches MJ, Sonestedt E, Tjønneland A, Tzoulaki I, Verschuren WMM, Riboli E, Wareham NJ, Danesh J, Butterworth AS, van der Schouw YT. Milk intake and incident stroke and CHD in populations of European descent: a Mendelian randomisation study. Br J Nutr 2022; 128:1789-1797. [PMID: 34670632 PMCID: PMC9592953 DOI: 10.1017/s0007114521004244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 07/01/2021] [Accepted: 09/22/2021] [Indexed: 12/29/2022]
Abstract
Higher milk intake has been associated with a lower stroke risk, but not with risk of CHD. Residual confounding or reverse causation cannot be excluded. Therefore, we estimated the causal association of milk consumption with stroke and CHD risk through instrumental variable (IV) and gene-outcome analyses. IV analysis included 29 328 participants (4611 stroke; 9828 CHD) of the European Prospective Investigation into Cancer and Nutrition (EPIC)-CVD (eight European countries) and European Prospective Investigation into Cancer and Nutrition-Netherlands (EPIC-NL) case-cohort studies. rs4988235, a lactase persistence (LP) SNP which enables digestion of lactose in adulthood was used as genetic instrument. Intake of milk was first regressed on rs4988235 in a linear regression model. Next, associations of genetically predicted milk consumption with stroke and CHD were estimated using Prentice-weighted Cox regression. Gene-outcome analysis included 777 024 participants (50 804 cases) from MEGASTROKE (including EPIC-CVD), UK Biobank and EPIC-NL for stroke, and 483 966 participants (61 612 cases) from CARDIoGRAM, UK Biobank, EPIC-CVD and EPIC-NL for CHD. In IV analyses, each additional LP allele was associated with a higher intake of milk in EPIC-CVD (β = 13·7 g/d; 95 % CI 8·4, 19·1) and EPIC-NL (36·8 g/d; 95 % CI 20·0, 53·5). Genetically predicted milk intake was not associated with stroke (HR per 25 g/d 1·05; 95 % CI 0·94, 1·16) or CHD (1·02; 95 % CI 0·96, 1·08). In gene-outcome analyses, there was no association of rs4988235 with risk of stroke (OR 1·02; 95 % CI 0·99, 1·05) or CHD (OR 0·99; 95 % CI 0·95, 1·03). Current Mendelian randomisation analysis does not provide evidence for a causal inverse relationship between milk consumption and stroke or CHD risk.
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Affiliation(s)
- L. E. T. Vissers
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | - I. Sluijs
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | - S. Burgess
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- MRC Biostatistics Unit, University of Cambridge, Cambridge, UK
| | - N. G. Forouhi
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - H. Freisling
- International Agency for Research on Cancer, Lyon, France
| | - F. Imamura
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - T. K. Nilsson
- Department of Medical Biosciences/Clinical Chemistry, Umeå University, Umeå, Sweden
| | - F. Renström
- Department of Biobank Research, Umeå University, Umeå, Sweden
- Division of Endocrinology and Diabetes, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - E. Weiderpass
- International Agency for Research on Cancer, Lyon, France
| | - K. Aleksandrova
- Germany Institute of Nutritional Sciences, University of Potsdam, Nuthetal, Germany
| | - C. C. Dahm
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - A. Perez-Cornago
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - M. B. Schulze
- German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
- Germany Institute of Nutritional Sciences, University of Potsdam, Nuthetal, Germany
| | - T. Y. N. Tong
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - D. Aune
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- Department of Nutrition, Bjørknes University College, Oslo, Norway
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
| | - C. Bonet
- Unit of Nutrition and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology-IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain
| | - J. M. A. Boer
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - H. Boeing
- German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
| | - M. D. Chirlaque
- Department of Epidemiology, Regional Health Council, IMIB-Arrixaca, Murcia University, Murcia, Spain
- CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - M. I. Conchi
- Navarra Public Health Institute – IdiSNA, Pamplona, Spain
- Research Network on Health Services in Chronic Diseases (REDISSEC), Pamplona, Spain
| | - L. Imaz
- Ministry of Health of the Basque Government, Public Health Division of Gipuzkoa, Donostia-San Sebastian, Spain
- Biodonostia Health Research Institute, Donostia-San Sebastian, Spain
| | - S. Jäger
- German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - V. Krogh
- Epidemiology and prevention Unit, Fondazione IRCCS Instituto Nazionale dei Tumori, Milano, Italy
| | - C. Kyrø
- Danish Cancer Society Research Center, Copenhagen, Denmark
| | - G. Masala
- Cancer Risk Factors and Life-Style Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network – ISPRO, Florence, Italy
| | - O. Melander
- Lund University, Department of Clinical Sciences, Malmö, Sweden
| | - K. Overvad
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - S. Panico
- Dipartemento di medicina clinica e chirurgia, Federico II University, Naples, Italy
| | - M. J. Sánches
- CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Andalusian School of Public Health (EASP), Granada, Spain
- Instituto de Investigación Biosanitaria de Granada, Granada, Spain
- Universidad de Granada, Granada, Spain
| | - E. Sonestedt
- Lund University, Department of Clinical Sciences, Malmö, Sweden
| | - A. Tjønneland
- Danish Cancer Society Research Center, Copenhagen, Denmark
| | - I. Tzoulaki
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - W. M. M. Verschuren
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - E. Riboli
- School of Public Health, Imperial College London, UK
| | - N. J. Wareham
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - J. Danesh
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - A. S. Butterworth
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Y. T. van der Schouw
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
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