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CME / CE

High-Fat Dairy Intake Reduces Risk for Anovulatory Infertility

  • Authors: News Author: Laurie Barclay, MD
    CME Author: Laurie Barclay, MD
  • CME / CE Released: 3/5/2007; Reviewed and Renewed: 3/4/2008
  • THIS ACTIVITY HAS EXPIRED FOR CREDIT
  • Valid for credit through: 3/4/2009, 11:59 PM EST
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Target Audience and Goal Statement

This article is intended for primary care clinicians, fertility specialists, obstetricians, gynecologists, endocrinologists, nutritionists, and other specialists caring for women attempting to conceive.

The goal of this activity is to provide medical news to primary care clinicians and other healthcare professionals in order to enhance patient care.

Upon completion of this activity, participants will be able to:

  • Identify the increased risk for anovulatory infertility associated with intake of low-fat dairy foods.
  • Identify the decreased risk for anovulatory infertility associated with intake of high-fat dairy foods.


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Medscape, LLC encourages Authors to identify investigational products or off-label uses of products regulated by the US Food and Drug Administration, at first mention and where appropriate in the content.


Author(s)

  • Laurie Barclay, MD

    Laurie Barclay, MD is a freelance reviewer and writer for Medscape.

    Disclosures

    Disclosure: Laurie Barclay, MD has disclosed no relevant financial relationships.

CME Author(s)

  • Laurie Barclay, MD

    Laurie Barclay is a freelance reviewer and writer for Medscape.

    Disclosures

    Disclosure: Laurie Barclay, MD, has disclosed no relevant financial relationships.


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CME / CE

High-Fat Dairy Intake Reduces Risk for Anovulatory Infertility

Authors: News Author: Laurie Barclay, MD CME Author: Laurie Barclay, MDFaculty and Disclosures
THIS ACTIVITY HAS EXPIRED FOR CREDIT

CME / CE Released: 3/5/2007; Reviewed and Renewed: 3/4/2008

Valid for credit through: 3/4/2009, 11:59 PM EST

processing....

March 5, 2007 -- Intake of high-fat dairy products is linked with a lower risk for anovulatory infertility, whereas low-fat dairy foods increased the risk for this condition, according to the results of a prospective study of healthy women reported in the February 28 Advance Access issue of Human Reproduction.

"Dairy foods and lactose may impair fertility by affecting ovulatory function," write J. E. Chavarro, MD, of the Harvard School of Public Health in Boston, Massachusetts, and colleagues. "Yet, few studies have been conducted in humans and their results are inconsistent. We evaluated whether intake of dairy foods was associated with anovulatory infertility and whether this association differed according to fat content."

During an 8-year period, the investigators prospectively followed up 18,555 married, premenopausal women without a history of infertility who attempted a pregnancy or became pregnant, and they evaluated their diet twice using food frequency questionnaires (FFQ).

Infertility caused by an ovulatory disorder was reported by 438 women during follow-up. After multivariate adjustment, the relative risk (RR) for anovulatory infertility for women consuming 2 or more servings of low-fat dairy foods per day vs women consuming 1 or fewer servings per week was 1.85 (95% confidence interval [CI], 1.24 - 2.77; P for trend = .002), and for high-fat dairy foods, the RR was 0.73 (95% CI, 0.52 - 1.01; P = .01).

Although dairy fat intake was inversely associated with anovulatory infertility ( P for trend = .05), intakes of lactose, calcium, phosphorus, and vitamin D were unrelated to anovulatory infertility.

"High intake of low-fat dairy foods may increase the risk of anovulatory infertility whereas intake of high fat dairy foods may decrease this risk," the authors conclude. "Further, lactose (the main carbohydrate in milk and dairy products) may not affect fertility within the usual range of intake levels in humans."

Study limitations include failure to study a cohort of women known to be planning a pregnancy, lack of information on exposures of the participants' partners that might influence female fertility, and possibly spurious association of eating low-fat dairy foods with an increased risk for anovulatory infertility.

"We observed a positive association between intake of low-fat dairy foods (especially yogurt and sherbet/frozen yogurt) and anovulatory infertility and an inverse association between intake of high-fat dairy foods (especially whole milk and ice cream) and this disease," the authors conclude. "The intake of dairy fat, or a fat-soluble substance present in dairy foods, may partly explain the association between high-fat dairy and anovulatory infertility.... Clarifying the role of dairy foods intake on fertility is particularly important since the current Dietary Guidelines for Americans recommend that adults consume three or more daily servings low-fat milk or equivalent dairy products (United States Department of Health and Human Services and United States Department of Agriculture, 2005); a strategy that may be deleterious for women planning to become pregnant."

The main Nurses' Health Study II (NHS II) grant (National Institutes of Health) and the training grant T32 DK-007703 supported this study.

Hum Reprod. Published online February 28, 2007.

Clinical Context

Clinical and laboratory evidence suggest that high intake of milk and dairy products may increase the risk for infertility because of ovulatory dysfunction in otherwise healthy women, but few studies have been conducted in humans, and their results are inconsistent. Yet, there are theoretical reasons supporting the benefits of dairy foods to ovarian function, with not all dairy foods sharing the same effect on fertility.

Dairy food intake has been associated with a lower risk for insulin resistance syndrome and type 2 diabetes, which have both been linked to ovulatory dysfunction. Intake of low-fat dairy foods, but not high-fat dairy foods, has been linked to symptoms of androgen excess, a component of the polycystic ovary syndrome.

The present study prospectively evaluated whether the intakes of low-fat dairy foods, high-fat dairy foods, lactose, and other nutrients concentrated in dairy foods were associated with anovulatory infertility in a large cohort of healthy women enrolled in the NHS II.

Study Highlights

  • NHS II is a prospective cohort started in 1989 with more than 116,000 female registered nurses aged 24 to 42 years who completed and returned a mailed questionnaire at baseline and every 2 years since then.
  • This prospective analysis of incident anovulatory infertility includes 18,555 married, premenopausal women without a history of infertility or diabetes who attempted a pregnancy or became pregnant during the 8-year follow-up period and who completed the FFQ twice during the study.
  • The FFQ included more than 130 food items, 11 individual dairy foods, and 9 options for average frequency of intake during the previous year, ranging from less than 1 time per month to 6 times or more per day.
  • Women were divided into groups based on frequency of their total, low-fat, high-fat, and specific dairy food intake and were also divided into quintiles of intake of components of dairy foods intake (dairy fat, lactose, calcium, phosphorus, and vitamin D). Models were adjusted for total energy intake, age, and time at the beginning of each questionnaire cycle. Multivariate models were also adjusted for body mass index (BMI), parity, smoking history, physical activity, history of contraceptive use, and dietary factors found to be related to infertility in preliminary analyses.
  • At baseline, women who consumed more low-fat dairy foods were less likely to smoke or to drink more than 2 cups of coffee/day and had a higher average level of physical activity. Women who consumed more high-fat dairy foods were more likely to consume alcohol and less likely to be nulliparous and to exercise. Women consuming more dairy foods, regardless of fat content, were also more likely to use multivitamins and less likely to use oral contraceptives.
  • Between 1991 and 1999, the 18,555 women had a total of 26,971 eligible pregnancies and pregnancy attempts. Of 3430 incident reports of infertility from any cause during follow-up, 438 were caused by an ovulatory disorder.
  • Intake of total dairy foods was not associated with the risk for anovulatory infertility. After multivariate adjustment, RR for anovulatory infertility for women consuming more than 2 servings per day of low-fat dairy foods vs women consuming 1 or fewer servings per week was 1.85 (95% CI, 1.24 - 2.77; P for trend = .002) and for high-fat dairy, the RR was 0.73 (95% CI, 0.52 - 1.01; P = .01).
  • After adjustment, an increase in low-fat dairy foods of 1 serving per day, while holding calories constant, was associated with an 11% greater risk for anovulatory infertility. The corresponding RR associated with an increase in intake of high-fat dairy foods by 1 serving per day was 0.78.
  • After adjustment, dairy fat intake was inversely associated with anovulatory infertility ( P for trend = .05), but intakes of lactose, calcium, phosphorus, and vitamin D were unrelated to anovulatory infertility.

Pearls for Practice

  • After multivariate adjustment, risk for anovulatory infertility for women consuming 2 or more servings per day of low-fat dairy vs women consuming 1 or fewer servings per week of low-fat dairy foods was increased by 85%. An increase in low-fat dairy foods of 1 serving per day, while holding calories constant, was associated with an 11% greater risk for anovulatory infertility.
  • After multivariate adjustment, risk for anovulatory infertility for women consuming 2 or more servings per day of high-fat dairy foods vs women consuming 1 or fewer servings per week of high-fat dairy foods was decreased by 27%. An increase in intake of high-fat dairy foods by 1 serving per day, while holding calories constant, was associated with a 22% lower risk for anovulatory infertility.

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