title: Associations of dairy intake with glycemia and insulinemia, independent of obesity, in Brazilian adults: the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).
abstract: BACKGROUND
  Inverse associations between dairy intake and the risk of type 2 diabetes have been shown, but more studies are needed, especially from low- and middle-income countries.
  
  
  OBJECTIVE
  The objective was to describe the association between dairy products and direct measures of glycemic status in adults without known diabetes.
  
  
  METHODS
  The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) includes 15,105 adults, aged 35-74 y, enrolled from universities and research institutions in 6 Brazilian capital cities. We excluded participants with a known diabetes diagnosis, cardiovascular diseases, and cancer. Dairy consumption was assessed by a food-frequency questionnaire, and we computed servings per day for total and subgroups of dairy. Associations with fasting blood glucose (FG) and fasting insulin, 2-h postload glucose (PG), 2-h postload insulin (PI), glycated hemoglobin (Hb A1c), and homeostasis model assessment of insulin resistance (HOMA-IR) were assessed through multivariable linear regression analysis with adjustment for demographic characteristics, behavioral risk factors, other dietary factors, and anthropometric measurements.
  
  
  RESULTS
  The sample size after exclusions was 10,010. The intake of total dairy was inversely associated with FG (linear β for dairy servings/d = -0.46 ± 0.2 mg/dL), PG (-1.25 ± 0.5 mg/dL), PI (-1.52 ± 0.6 mg/dL), Hb A1c (-0.02 ± 0.0%), and HOMA-IR (-0.04 ± 0.0) after adjustment for all covariates (P < 0.05 for all). The findings were consistent across categories of sex, race, obesity status, and dairy fat amount (reduced-fat vs. full-fat dairy). Fermented dairy products showed particularly strong inverse associations with the outcomes, with adjusted differences for a 1-serving/d increment of -0.24 (95% CI: -0.46, -0.02) mg/dL for FG, -0.86 (-1.42, -0.30) mg/dL for PG, and -0.01% (-0.02%, 0.00%) for Hb A1c. Myristic acid was the only nutrient that appeared to mediate the association between dairy intake and glycemia.
  
  
  CONCLUSIONS
  Dairy intake, especially fermented dairy, was inversely associated with measures of glycemia and insulinemia in Brazilian adults without diagnosed diabetes. This trial was registered at clinicaltrials.com as NCT02320461.
authors.affiliation: From the Department of Social Medicine, School of Medicine, Postgraduate Studies Program in Epidemiology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil (MD, MIS, and BBD); the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN (MAP); the Health Sciences Center, Federal University of Espirito Santo, Vitoria, Brazil (MDCBM); the Institute of Collective Health, Federal University of Bahia, Salvador, Brazil (SA); and the Center for Clinical and Epidemiologic Research, University of Sao Paulo, Sao Paulo, Brazil (PAL).
authors.forename: Michele
authors.initials: M
authors.lastname: Drehmer
authors.affiliation: From the Department of Social Medicine, School of Medicine, Postgraduate Studies Program in Epidemiology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil (MD, MIS, and BBD); the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN (MAP); the Health Sciences Center, Federal University of Espirito Santo, Vitoria, Brazil (MDCBM); the Institute of Collective Health, Federal University of Bahia, Salvador, Brazil (SA); and the Center for Clinical and Epidemiologic Research, University of Sao Paulo, Sao Paulo, Brazil (PAL).
authors.forename: Mark A
authors.initials: MA
authors.lastname: Pereira
authors.affiliation: From the Department of Social Medicine, School of Medicine, Postgraduate Studies Program in Epidemiology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil (MD, MIS, and BBD); the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN (MAP); the Health Sciences Center, Federal University of Espirito Santo, Vitoria, Brazil (MDCBM); the Institute of Collective Health, Federal University of Bahia, Salvador, Brazil (SA); and the Center for Clinical and Epidemiologic Research, University of Sao Paulo, Sao Paulo, Brazil (PAL).
authors.forename: Maria Inês
authors.initials: MI
authors.lastname: Schmidt
authors.affiliation: From the Department of Social Medicine, School of Medicine, Postgraduate Studies Program in Epidemiology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil (MD, MIS, and BBD); the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN (MAP); the Health Sciences Center, Federal University of Espirito Santo, Vitoria, Brazil (MDCBM); the Institute of Collective Health, Federal University of Bahia, Salvador, Brazil (SA); and the Center for Clinical and Epidemiologic Research, University of Sao Paulo, Sao Paulo, Brazil (PAL).
authors.forename: Maria
authors.initials: M
authors.lastname: Del Carmen B Molina
authors.affiliation: From the Department of Social Medicine, School of Medicine, Postgraduate Studies Program in Epidemiology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil (MD, MIS, and BBD); the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN (MAP); the Health Sciences Center, Federal University of Espirito Santo, Vitoria, Brazil (MDCBM); the Institute of Collective Health, Federal University of Bahia, Salvador, Brazil (SA); and the Center for Clinical and Epidemiologic Research, University of Sao Paulo, Sao Paulo, Brazil (PAL).
authors.forename: Sheila
authors.initials: S
authors.lastname: Alvim
authors.affiliation: From the Department of Social Medicine, School of Medicine, Postgraduate Studies Program in Epidemiology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil (MD, MIS, and BBD); the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN (MAP); the Health Sciences Center, Federal University of Espirito Santo, Vitoria, Brazil (MDCBM); the Institute of Collective Health, Federal University of Bahia, Salvador, Brazil (SA); and the Center for Clinical and Epidemiologic Research, University of Sao Paulo, Sao Paulo, Brazil (PAL).
authors.forename: Paulo A
authors.initials: PA
authors.lastname: Lotufo
authors.affiliation: From the Department of Social Medicine, School of Medicine, Postgraduate Studies Program in Epidemiology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil (MD, MIS, and BBD); the Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN (MAP); the Health Sciences Center, Federal University of Espirito Santo, Vitoria, Brazil (MDCBM); the Institute of Collective Health, Federal University of Bahia, Salvador, Brazil (SA); and the Center for Clinical and Epidemiologic Research, University of Sao Paulo, Sao Paulo, Brazil (PAL).
authors.forename: Bruce B
authors.initials: BB
authors.lastname: Duncan
mesh_terms: D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism*; D001938:Brazil; D003430:Cross-Sectional Studies; D003611:Dairy Products; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000517:prevention & control; D005215:Fasting; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007328:Insulin / Q000097:blood; D016014:Linear Models; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D019814:Myristic Acid / Q000097:blood; D015596:Nutrition Assessment; D009765:Obesity / Q000097:blood*; D011446:Prospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007328:Insulin; D019814:Myristic Acid
keywords: cohort studies; dairy products; glycemia; insulinemia; obesity