Associations of dairy intake with glycemia and insulinemia, independent of obesity, in Brazilian adults: the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

Am J Clin Nutr. 2015 Apr;101(4):775-82. doi: 10.3945/ajcn.114.102152. Epub 2015 Jan 21.


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.

Design: 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.

Conclusion: 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 as NCT02320461.

Keywords: cohort studies; dairy products; glycemia; insulinemia; obesity.

Publication types

  • Multicenter Study
  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Blood Glucose / metabolism*
  • Brazil
  • Cross-Sectional Studies
  • Dairy Products*
  • Diabetes Mellitus, Type 2 / blood*
  • Diabetes Mellitus, Type 2 / prevention & control
  • Fasting
  • Female
  • Glycated Hemoglobin / metabolism
  • Humans
  • Insulin / blood
  • Linear Models
  • Logistic Models
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Myristic Acid / blood
  • Nutrition Assessment
  • Obesity / blood*
  • Prospective Studies
  • Risk Factors
  • Surveys and Questionnaires


  • Blood Glucose
  • Glycated Hemoglobin A
  • Insulin
  • Myristic Acid

Associated data