Dairy consumption and incident prediabetes: Prospective associations and network models in the large population-based Lifelines study

Background Evidence on associations between dairy consumption and incident prediabetes is inconsistent. One potential explanation for heterogeneity is that health behavior and food intake covary with the consumption of various high-fat and low-fat dairy types. Objective The objective was to investigate the associations of total dairy and dairy types with incident prediabetes and to assess how dairy intake is linked with metabolic risk factors, lifestyle behaviors, and foods, as potential explanations for these associations. Methods Overall, 74,132 participants from the prospective population-based Lifelines study were included (mean age, 45.5 ± 12.3 y; 59.7% female). Baseline dairy intake was measured using a validated food frequency questionnaire. Prediabetes at follow-up was defined based on the World Health Organization/International Expert Committee criteria as fasting plasma glucose of 110–125 mg/dL or glycated hemoglobin concentrations of 6.0%–6.5%. Associations were analyzed using Poisson regression models adjusted for social demographics, lifestyle behaviors, family history of diabetes, and food group intake. Interconnections were assessed with mixed graphical model networks. Results At a mean follow-up of 4.1 ± 1.1 y, 2746 participants developed prediabetes (3.7%). In regression analyses, neutral associations were found for most dairy types. Intake of plain milk and low-fat milk were associated with a higher risk of prediabetes in the top compared with bottom quartiles (relative risk [RR]: 1.17; 95% confidence interval [CI]: 1.05, 1.30; P-trend = 0.04 and RR: 1.18; 95% CI: 1.06, 1.31; P-trend =0.01). Strong but nonsignificant effect estimates for high-fat yogurt in relation to prediabetes were found (RR servings/day: 0.80; 95% CI: 0.64, 1.01). The network analysis showed that low-fat milk clustered with energy-dense foods, including bread, meat, and high-fat cheese, whereas high-fat yogurt had no clear link