The relationship between fermented food intake and mortality risk in the European Prospective Investigation into Cancer and Nutrition-Netherlands cohort

Abstract

The objective of the present study was to investigate the relationship between total and subtypes of bacterial fermented food intake (dairy products, cheese, vegetables and meat) and mortality due to all causes, total cancer and CVD. From the European Prospective Investigation into Cancer and Nutrition-Netherlands cohort, 34 409 Dutch men and women, aged 20-70 years who were free from CVD or cancer at baseline, were included. Baseline intakes of total and subtypes of fermented foods were measured with a validated FFQ. Data on the incidence and causes of death were obtained from the national mortality register. Cox proportional hazards models were used to analyse mortality in relation to the quartiles of fermented food intake. After a mean follow-up of 15 (SD 2·5) years, 2436 deaths occurred (1216 from cancer and 727 from CVD). After adjustment for age, sex, total energy intake, physical activity, education level, hypertension, smoking habit, BMI, and intakes of fruit, vegetables and alcohol, total fermented food intake was not found to be associated with mortality due to all causes (hazard ratio upper v. lowest quartile (HR Q4 v. Q1 ) 1·00, 95 % CI 0·88, 1·13), cancer (HR Q4 v. Q1 1·02, 95 % CI 0·86, 1·21) or CVD (HR Q4 v. Q1 1·04, 95 % CI 0·83, 1·30). Bacterial fermented foods mainly consisted of fermented dairy foods (78 %) and cheese (16 %). None of the subtypes of fermented foods was consistently related to mortality, except for cheese which was moderately inversely associated with CVD mortality, and particularly stroke mortality (HR Q4 v. Q1 0·59, 95 % CI 0·38, 0·92, P trend ¼ 0·046). In conclusion, the present study provides no strong evidence that intake of fermented foods, particularly fermented dairy foods, is associated with mortality.

Dairy Food Intake and All-Cause, Cardiovascular Disease, and Cancer Mortality

“…There is mixed evidence from prospective studies concerning a role of dairy food consumption in mortality risk (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29). Consistent with our results, in the Whitehall II Study (21), higher consumption of dairy products was associated with reduced all-cause mortality risk in comparison with the lowest intake.…”

“…Similar findings for total dairy products and mortality risk have been reported among men and women in Switzerland (22). Previous findings in the Whitehall II Study (21), the Rotterdam Study (23), the Hoorn Study (24), and the European Prospective Investigation into Cancer and Nutrition-Netherlands (EPIC-NL) cohort study (25) did not support a significant inverse association between yogurt consumption and CVD mortality risk. We observed that yogurt consumption was associated with lower risk of all-cause and CVD mortality.…”

“…We also found a suggestion that high cheese intake was inversely associated with all-cause and CVD mortality risk. Previous findings on cheese intake have been few and inconsistent (20,21,(23)(24)(25). Among Swedish men and women, cheese intake decreased CVD, cancer, and all-cause mortality risk (20).…”

“…Among Swedish men and women, cheese intake decreased CVD, cancer, and all-cause mortality risk (20). However, cheese intake was not associated with mortality risk in the Whitehall II Study (21), the Rotterdam Study (23), the Hoorn Study (24), or EPIC-NL (25). This heterogeneity of results between studies and populations might be due to the different composition of dairy products and interactions with other dietary and nondietary factors.…”

“…The roles of other dairy foods, such as yogurt or cheese, in mortality risk are less clear (20,21,(23)(24)(25). Notably, most prior evidence on the association between dairy food consumption and mortality risk has been from studies carried out in Western countries with high dairy food consumption, especially high milk intake; the relationships of dairy foods to mortality risk in countries with lower dairy food consumption have been minimally studied.…”