Causal link between milk consumption and obesity? A 10-year longitudinal study and a Mendelian randomization study

  • Kuang-Mao Chiang Institution of biomedical sciences, Academia Sinica
  • Wen-Harn Pan Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
Keywords: Milk, Dairy, Body mass index, longitudinal study, CVDFACTS, Mendelian Randomization, Taiwan Biobank.


Background: Obesity control and prevention remains challenging. Randomized controlled trials in western countries have demonstrated efficacy of dairy supplementation on fat mass reduction and lean mass increase, when combined with energy restriction protocols. However, there is scanty information on this issue among the East Asian population.

Objective: The aim of this study is to investigate the association between milk consumption and weight status in Asian.

Design: First, we studied the association between milk intake and body mass index (BMI) changes in a 10-year longitudinal study of Cardiovascular Disease Risk Factor Two-township Study (CVDFACTS) with 1,644 adults. Second, taking advantage of the genetic and phenotype data of 10,000 participants collected by Taiwan Biobank (TWB), we carried out a Mendelian randomization (MR) study to investigate the causal relationship between milk intake and BMI. A lactase persistence genetic marker (rs4954490) was used as the instrumental variable.

Results: We found in the longitudinal study that higher baseline milk consumption level was associated with lower odds of increasing BMI or maintaining overweight/obesity status. In the MR study, we found that G allele of the rs4954490, a surrogate of greater milk intake, was associated with lower odds of being obese (BMI > 27 kg/m2); the odds ratio (OR) for the GG versus AA is 0.85 (P = 0.037), and the OR for the GA versus AA is 0.84 (P = 0.032).

Conclusions: These findings support current food guide in Asian countries to include dairy group as one of the six food groups for nutrition recommendation.


Download data is not yet available.


  1. Castillo JJ, Orlando RA, Garver WS. Gene-nutrient interactions and susceptibility to human obesity. Genes Nutr 2017; 12: 29. doi: 10.1186/s12263-017-0581-3

  2. Chiang KM, Chang HC, Yang HC, Chen CH, Chen HH, Lee WJ, et al. Genome-wide association study of morbid obesity in Han Chinese. BMC Genet 2019; 20(1): 97. doi: 10.1186/s12863-019-0797-x

  3. Annemans L, Spaepen E, Gaskin M, Bonnemaire M, Malier V, Gilbert T, et al. Gout in the UK and Germany: prevalence, comorbidities and management in general practice 2000–2005. Ann Rheum Dis 2008; 67(7): 960–6. doi: 10.1136/ard.2007.076232

  4. Pan WH, Flegal KM, Chang HY, Yeh WT, Yeh CJ, Lee WC. Body mass index and obesity-related metabolic disorders in Taiwanese and US whites and blacks: implications for definitions of overweight and obesity for Asians. Am J Clin Nutr 2004; 79(1): 31–9. doi: 10.1093/ajcn/79.1.31

  5. Wang W, Wu Y, Zhang D. Association of dairy products consumption with risk of obesity in children and adults: a meta-analysis of mainly cross-sectional studies. Ann Epidemiol 2016; 26(12): 870–82.e2.

  6. 2015 Diabetes Atlas. International Diabetes Federation; 2015. Available from:

  7. Chuang SY, Lee SC, Hsieh YT, Pan WH. Trends in hyperuricemia and gout prevalence: nutrition and health survey in Taiwan from 1993–1996 to 2005–2008. Asia Pac J Clin Nutr 2011; 20(2): 301–8.

  8. Abargouei AS, Janghorbani M, Salehi-Marzijarani M, Esmaillzadeh A. Effect of dairy consumption on weight and body composition in adults: a systematic review and meta-analysis of randomized controlled clinical trials. Int J Obes (Lond) 2012; 36(12): 1485–93. doi: 10.1038/ijo.2011.269

  9. te Velde SJ, Snijder MB, van Dijk AE, Brug J, Koppes LL, van Mechelen W, et al. Dairy intake from adolescence into adulthood is not associated with being overweight and metabolic syndrome in adulthood: the Amsterdam Growth and Health Longitudinal Study. J Hum Nutr Diet 2011; 24(3): 233–44. doi: 10.1111/j.1365-277X.2010.01149.x

  10. Snijder MB, van Dam RM, Stehouwer CD, Hiddink GJ, Heine RJ, Dekker JM. A prospective study of dairy consumption in relation to changes in metabolic risk factors: the Hoorn Study. Obesity (Silver Spring) 2008; 16(3): 706–9. doi: 10.1038/oby.2007.93

  11. Rajpathak SN, Rimm EB, Rosner B, Willett WC, Hu FB. Calcium and dairy intakes in relation to long-term weight gain in US men. Am J Clin Nutr 2006; 83(3): 559–66. doi: 10.1093/ajcn.83.3.559

  12. Liu M, Liu H, Feng F, Xie A, Kang GJ, Zhao Y, et al. Magnesium deficiency causes a reversible, metabolic, diastolic cardiomyopathy. J Am Heart Assoc 2021; 10(12): e020205.

  13. Aburto NJ, Hanson S, Gutierrez H, Hooper L, Elliott P, Cappuccio FP. Effect of increased potassium intake on cardiovascular risk factors and disease: systematic review and meta-analyses. BMJ 2013; 346: f1378.

  14. Catalano A, Basile G, Lasco A. Hypocalcemia: a sometimes overlooked cause of heart failure in the elderly. Aging Clin Exp Res 2012; 24(4): 400–3. doi: 10.1007/BF03325272

  15. Lee MS, Wahlqvist ML, Peng CJ. Dairy foods and health in Asians: Taiwanese considerations. Asia Pac J Clin Nutr 2015; 24 Suppl 1: S14–20.

  16. Storhaug CL, Fosse SK, Fadnes LT. Country, regional, and global estimates for lactose malabsorption in adults: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol 2017; 2(10): 738–46. doi: 10.1016/S2468-1253(17)30154-1

  17. Holmes MV, Ala-Korpela M, Smith GD. Mendelian randomization in cardiometabolic disease: challenges in evaluating causality. Nat Rev Cardiol 2017; 14(10): 577–90. doi: 10.1038/nrcardio.2017.78

  18. Chuang SY, Hsu PF, Chang HY, Bai CH, Yeh WT, Pan HW. C-reactive protein predicts systolic blood pressure and pulse pressure but not diastolic blood pressure: the Cardiovascular Disease Risk Factors Two-Township Study. Am J Hypertens 2013; 26(5): 657–64. doi: 10.1093/ajh/hps095

  19. Weng LC, Yeh WT, Bai CH, Chen HJ, Chuang SY, Chang HY, et al. Is ischemic stroke risk related to folate status or other nutrients correlated with folate intake? Stroke 2008; 39(12): 3152–8.

  20. Taiwan Food Composition Database [Internet]. Available from:

  21. Lee MS, Pan WH, Liu KL, Yu MS. Reproducibility and validity of a Chinese food frequency questionnaire used in Taiwan. Asia Pac J Clin Nutr 2006; 15(2): 161–9.

  22. Brown CC, Kipnis V, Freedman LS, Hartman AM, Schatzkin A, Wacholder S. Energy adjustment methods for nutritional epidemiology: the effect of categorization. Am J Epidemiol 1994; 139(3): 323–38. doi: 10.1093/oxfordjournals.aje.a117000

  23. Chu NF. Prevalence of obesity in Taiwan. Obes Rev 2005; 6(4): 271–4. doi: 10.1111/j.1467-789X.2005.00175.x

  24. Chen CH, Yang JH, Chiang CWK, Hsiung CN, Wu PE, Chang LC, et al. Population structure of Han Chinese in the modern Taiwanese population based on 10,000 participants in the Taiwan Biobank project. Hum Mol Genet 2016; 25(24): 5321–31.

  25. Taiwan Biobank. Available from:

  26. Sun HM, Qiao YD, Chen F, Xu LD, Bai J, Fu SB. The lactase gene -13910T allele can not predict the lactase-persistence phenotype in north China. Asia Pac J Clin Nutr 2007; 16(4): 598–601.

  27. Smith CE, Coltell O, Sorli JV, Estruch R, Martinez-Gonzalez MA, Salas-Salvado J, et al. Associations of the MCM6-rs3754686 proxy for milk intake in Mediterranean and American populations with cardiovascular biomarkers, disease and mortality: Mendelian randomization. Sci Rep 2016; 6: 33188. doi: 10.1038/srep33188

  28. Machiela MJ, Chanock SJ. LDlink: a web-based application for exploring population-specific haplotype structure and linking correlated alleles of possible functional variants. Bioinformatics 2015; 31(21): 3555–7. doi: 10.1093/bioinformatics/btv402

  29. Holmberg S, Thelin A. High dairy fat intake related to less central obesity: a male cohort study with 12 years’ follow-up. Scand J Prim Health Care 2013; 31(2): 89–94. doi: 10.3109/02813432.2012.757070

  30. Bergholdt HK, Nordestgaard BG, Ellervik C. Milk intake is not associated with low risk of diabetes or overweight-obesity: a Mendelian randomization study in 97,811 Danish individuals. Am J Clin Nutr 2015; 102(2): 487–96. doi: 10.3945/ajcn.114.105049

  31. Hartwig FP, Horta BL, Smith GD, de Mola CL, Victora CG. Association of lactase persistence genotype with milk consumption, obesity and blood pressure: a Mendelian randomization study in the 1982 Pelotas (Brazil) Birth Cohort, with a systematic review and meta-analysis. Int J Epidemiol 2016; 45(5): 1573–87. doi: 10.1093/ije/dyw074

  32. Mendelian Randomization of Dairy Consumption Working G. Dairy consumption and body mass index among adults: Mendelian randomization analysis of 184802 individuals from 25 studies. Clin Chem 2018; 64(1): 183–91.

  33. Dougkas A, Reynolds CK, Givens ID, Elwood PC, Minihane AM. Associations between dairy consumption and body weight: a review of the evidence and underlying mechanisms. Nutr Res Rev 2011; 24(1): 72–95. doi: 10.1017/S095442241000034X

  34. Tremblay A, Gilbert JA. Human obesity: is insufficient calcium/dairy intake part of the problem? J Am Coll Nutr 2011; 30(5 Suppl 1): 449S–53S.

  35. Teegarden D, White KM, Lyle RM, Zemel MB, Van Loan MD, Matkovic V, et al. Calcium and dairy product modulation of lipid utilization and energy expenditure. Obesity (Silver Spring) 2008; 16(7): 1566–72. doi: 10.1038/oby.2008.232

  36. Bendtsen LQ, Lorenzen JK, Bendsen NT, Rasmussen C, Astrup A. Effect of dairy proteins on appetite, energy expenditure, body weight, and composition: a review of the evidence from controlled clinical trials. Adv Nutr 2013; 4(4): 418–38. doi: 10.3945/an.113.003723

  37. Kratz M, Baars T, Guyenet S. The relationship between high-fat dairy consumption and obesity, cardiovascular, and metabolic disease. Eur J Nutr 2013; 52(1): 1–24. doi: 10.1007/s00394-012-0418-1

  38. Bowen J, Noakes M, Trenerry C, Clifton PM. Energy intake, ghrelin, and cholecystokinin after different carbohydrate and protein preloads in overweight men. J Clin Endocrinol Metab 2006; 91(4): 1477–83. doi: 10.1210/jc.2005-1856

  39. Zemel MB. Role of calcium and dairy products in energy partitioning and weight management. Am J Clin Nutr 2004; 79(5): 907S–12S.

  40. Zemel MB, Teegarden D, Loan MV, Schoeller DA, Matkovic V, Lyle RM, et al. Dairy-rich diets augment fat loss on an energy-restricted diet: a multicenter trial. Nutrients 2009; 1(1): 83–100. doi: 10.3390/nu1010083

  41. Brion MJ, Shakhbazov K, Visscher PM. Calculating statistical power in Mendelian randomization studies. Int J Epidemiol 2013; 42(5): 1497–501. doi: 10.1093/ije/dyt179

How to Cite
Chiang, K.-M., & Pan, W.-H. (2021). Causal link between milk consumption and obesity? A 10-year longitudinal study and a Mendelian randomization study. Food & Nutrition Research, 65.
Original Articles