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Milk, yogurt, cheese and butter: do they help?

comment by Oksana Sivakova, EAPC Young Ambassador Russian Federation

Nutrition, Malnutrition and Heart Disease
Risk Factors and Prevention

Naturally milk is the very first human food. Studies show benefits of breastfeeding for babies [1, 2]. Mother’s milk gives all needed nutrients for a newborn during first months of life.

Afterwards, throughout life, dairy products remain an important diet component of the majority of the population in the world. However, the benefit of dairy products in adults is not so obvious, since they contain saturated fats, which may contribute to the progression of atherosclerosis.

The research group of The Prospective Urban Rural Epidemiology (PURE) study examined the association between dairy consumption and cardiovascular morbidity and mortality (composite outcome - defined as death from cardiovascular causes, non-fatal myocardial infarction, stroke or heart failure) [3]. Other outcomes were total mortality and major cardiovascular disease.

The authors analyzed the level of consumption of dairy products (normal and low fat), such as milk, yogurt, cheese and butter, and the level of cardiovascular diseases and mortality in 136 384 adults from 21 countries in 5 continents, 35-70 years old. The median follow-up was 9.1 years.

According to PURE authors’ data, total dairy intake was higher in Europe and North America, the Middle East, and South America than in Africa, South Asia, Southeast Asia and China.  

The categories of comparison for total dairy were: zero, less than one serving per day, one to two servings per day, and more than two servings per day of intake; the categories of comparison for concrete product (milk, yogurt, cheese or butter) were: zero, less than half a serving per day, half to one serving per day, and more than one serving per day of intake.

In general more than two servings of total dairy per day versus zero intake was associated with lower risk of the composite outcome (HR 0,84, 95% CI 0,75 – 0,94; ptrend=0,0004), total mortality (0,83, 0,72 – 0,96; ptrend=0,0052), non-cardiovascular mortality (0,86, 0,72 – 1,02; ptrend=0,046), cardiovascular mortality (0,77, 0,58 – 1,01; ptrend=0,029), major cardiovascular disease (0,78, 0,67 – 0,90; ptrend=0,0001), and stroke (0,66, 0,53 – 0,82; ptrend=0,0003). Whole-fat and low-fat dairy had similar associations. There were no significant association for myocardial infarction (0,89, 0,71 – 1,11; ptrend=0,163).

Higher consumption (more than one serving per day versus no serving) of milk (0,9, 0,82 – 0,99; ptrend=0,0529) and yogurt (0,86, 0,75 – 0,99; ptrend=0,0051) was associated with a lower risk of the composite outcome; cheese intake was not significantly associated with composite outcome (0,88, 0,76 – 1,02; ptrend=0,1399). The level of butter consumption was low and was not associated with clinical outcomes (1,09, 0,90 – 1,33; 0,4113).

Similar data about positive effect of dairy products on cardiovascular health were obtained in previous studies [4]. One of the exceptions is the prospective cohort study in Sweden [5]. In this study intake of two or more servings of milk per day was associated with higher risk of cardiovascular mortality. One of possible explanations of such difference is that in Sweden intake of dairy is one of the highest in the world.
Favorable effects of dairy products may be due to calcium, bioactive proteins, milk fatty acids, and the whole dairy food matrix, but more studies are needed to reveal exact mechanisms [6].

Note: The content of this article reflects the personal opinion of the author and is not necessarily the official position of the European Society of Cardiology. 


Oksana Sivakova commented on this article:
3) Dehghan M, et al. Association of dairy intake with cardiovascular disease and mortality in 21 countries from five continents (PURE): a prospective cohort study. Lancet 2018 Sep 11 pii: S0140-6736(18)31812-9.

Additional References:
1) Zalewski BM, et al. Nutrition of infants and young children (one to three years) and its effect on later health: A systematic review of current recommendations (EarlyNutrition project). Crit Rev Food Sci Nutr. 2017; 57(3):489-500.
2) Wong PD, et al. The Association of Breastfeeding Duration and Early Childhood Cardiometabolic Risk. J Pediatr. January 2018;192:80-85.
4) Alexander DD, et al. Dairy consumption and CVD: a systematic review and meta-analysis. Br J Nutr. 2016 Feb 28;115(4):737-50.
5) Tognon G, et al. Nonfermented milk and other dairy products: associations with all-cause mortality. Am J Clin Nutr. 2017; 105: 1502-1511.
6) Louie JCY, Rangan AM. No need to change dairy food dietary guidelines yet. Lancet, September 11, 2018.