Milk drinking, ischaemic heart disease and ischaemic stroke I. Evidence from the Caerphilly cohort

Assessing the association between dairy consumption and the 10-year Framingham Risk Score in women

PURPOSE

Cardiovascular diseases are a significant health concern for women in Iran, with previous research suggesting a potential link between dairy consumption and these diseases. This study aims to explore the relationship between the consumption of various dairy products and cardiovascular risk factors, as well as the Framingham Risk Score (FRS) among Iranian women. Various dairy products, including milk, yogurt, cheese, and drinkable yoghurt (dough), were considered, with a focus on dairy fat content (low-fat vs. high fat).

METHODS

In this cross-sectional study, 371 women aged 18 to 50 years were recruited. Dietary intake was assessed using a validated and reliable food frequency questionnaire. FRS was then employed to estimate each participant's 10-year risk of developing cardiovascular diseases.

RESULTS

After adjusting for confounding variables, participants in the highest tertile of low-fat dairy consumption had significantly lower FRS compared to those in the lowest tertile (FRS: -0.26 ± 0.30 vs. 1.06 ± 0.29, P < 0.0001). Higher yogurt consumption was associated with a significantly lower likelihood of having high triglycerides (TAG) (OR: 0.05, 95% CI: 0.003-1.09, P = 0.02) and high LDL-C (OR: 0.19, 95% CI: 0.01-3.2, P = 0.003). Participants in the highest tertile of cheese consumption had significantly lower odds of high fasting blood sugar (FBS) (OR: 0.35, 95% CI: 0.07-1.62, P = 0.001) and high TAG (OR: 0.05, 95% CI: 0.003-1.09, P = 0.04). Additionally, consumption of drinkable yogurt (dough) and high-fat dairy products was inversely associated with LDL-C levels (OR: 0.19, 95% CI: 0.01-3.2, P < 0.0001 and P = 0.02, respectively).

CONCLUSION

Our findings suggest that both high-fat and low-fat dairy consumption are associated with beneficial cardiovascular effects. Higher low-fat dairy, is associated with lower FRS, indicating a reduced 10-year cardiovascular disease risk among women. Additionally, yogurt and cheese consumption were linked to improved lipid profiles, including lower triglycerides and LDL-C levels, which are key contributors to cardiovascular risk. These findings highlight the potential cardioprotective role of dairy consumption, supporting the need for further research to better understand its long-term impact on cardiovascular health.

Cheese consumption on atherosclerosis, atherosclerotic cardiovascular diseases and its complications: A two-sample Mendelian randomization study

BACKGROUND AND AIM

Evidence from prospective cohort studies has revealed an inverse association between cheese consumption and the development of atherosclerosis (AS), atherosclerotic cardiovascular diseases (ASCVD), and their complications. However, it remains unclear whether this observed association is influenced by potential confounding factors that may arise during the long-term development process of AS, ASCVD, and its complications. Therefore, to further clarify the causal relationship between cheese consumption and AS, ASCVD, and its complications, we conducted a two-sample Mendelian randomization (MR) analysis to explore the causal association between cheese intake and the aforementioned health outcomes.

METHODS AND RESULTS

We employed a two-sample MR analysis based on publicly available genome-wide association studies (GWAS) to infer the causal relationship, with no overlap between their participating populations. The effect estimates were calculated using the random-effects inverse-variance-weighted method. Sensitivity analyses were conducted using Cochran's Q statistic, funnel plot, leave-one-out analysis, and MR-Egger intercept tests. The genetically predicted cheese intake was found to be associated with lower risks of coronary AS (odds ratio [OR] = 0.72, 95 % confidence interval [CI] 0.59-0.88, P = 0.001), peripheral vascular AS (OR = 0.56, 95 % CI 0.37-0.84, P = 0.006), other vascular AS (OR = 0.66, 95 % CI 0.44-0.99, P = 0.043), coronary artery disease (OR = 0.64, 95 % CI 0.56-0.74, P = 1.57e-09), angina pectoris (OR = 0.70, 95 % CI 0.58-0.84, P = 4.92e-05), myocardial infarction (OR = 0.63, 95 % CI 0.52-0.77, P = 3.56e-06), heart failure (OR = 0.62, 0.49-0.79, P = 1.20e-04), total ischemic stroke (OR = 0.76, 95 % CI 0.63-0.91, P = 0.003), peripheral artery disease (OR = 0.64, 95 % CI 0.43-0.95, P = 0.028), and cognitive impairment (OR = 0.65, 95 % CI 0.56-0.74, P = 3.40e-10). However, no associations were observed for cerebrovascular AS, arrhythmia, cardiac death, ischemic stroke (large artery AS), ischemic stroke (small vessel), ischemic stroke (cardioembolic), and transient ischemic attack.

CONCLUSION

This two-sample MR analysis reveals a causally inverse association between cheese intake and multi-vascular AS (including coronary AS, peripheral vascular AS, and other vascular AS), as well as multiple types of ASCVD and its complications (such as coronary artery disease, angina pectoris, myocardial infarction, heart failure, total ischemic stroke, and peripheral artery disease). The findings from this study may lay a stronger theoretical foundation and present new opportunities for the dietary management of future atherosclerotic cardiovascular diseases.

Survey on fatty acid profiles of retail pasteurised cow’s milk and cow’s yogurt in Bulgaria

Assessing the consumer’s awareness of the diet-health relationship, this study presents the fatty acid composition of cow’s milk available on Bulgarian market. Over a 5-year period, 100 samples of pasteurised cow’s milk and 135 samples cow’s yogurt were analysed by gas chromatography (ISO 15885:2002). The saturated fatty acids predominated - average amount 70.1% for milk and 71.1% for yogurt. The unsaturated fatty acids proportions were 29.9% and 28.9% respectively. Seasonal variations in the fatty acid composition of milk were detected, due to feeding practices. Non-milk fat was identified in 5 yogurt samples, while all pasteurised milk samples were not adulterated. This study provides the first scientific information for fatty acid composition of cow’s milk on Bulgarian market with respect to dietary intake estimation.

Intake of dairy products and associations with major atherosclerotic cardiovascular diseases: a systematic review and meta-analysis of cohort studies

Specific types of dairy products may be differentially associated with atherosclerotic cardiovascular disease (CVD). We conducted a systematic review and meta-analysis of cohort studies to summarize findings on the associations between total dairy product intake and intake of dairy product subgroups and the risk of major atherosclerotic CVDs in the general adult population. Our protocol was registered in PROSPERO (CRD42019125455). PubMed and Embase were systematically searched through 15 August 2019. For high versus low intake and dose-response meta-analysis, random-effects modelling was used to calculate summary risk ratios (RR). There were 13 cohort studies included for coronary heart disease (CHD), 7 for ischemic stroke and none for peripheral artery disease. High-fat milk was positively associated with CHD (RR 1.08 (95% confidence interval 1.00-1.16) per 200 g higher intake/day) and cheese was inversely associated with CHD (RR 0.96 (95% confidence interval 0.93-0.98) per 20 g higher intake/day). Heterogeneity, however, was observed in high versus low meta-analyses. Milk was inversely associated with ischemic stroke in high versus low meta-analysis only. In conclusion, this systematic review indicates a positive association of high-fat milk and an inverse association of cheese with CHD risk. The findings should be interpreted in the context of the observed heterogeneity.

High vs. low-fat dairy and milk differently affects the risk of all-cause, CVD, and cancer death: A systematic review and dose-response meta-analysis of prospective cohort studies

Considerable controversy exists regarding the association between milk and dairy consumption and mortality risk. The present systematic review and meta-analysis of prospective studies was undertaken to examine the association of high vs. low-fat dairy and milk consumption with mortality. We searched PubMed/Medline, ISI Web of Science, and Scopus databases through February 2020 for prospective cohort studies that reported the association between milk and dairy consumption and mortality risk. High-fat milk consumption was significantly associated with a greater risk of all-cause (Pooled ES: 1.15; 95% CI: 1.09-1.20, I²=24.5%, p = 0.22), CVD (Pooled ES: 1.09; 95% CI: 1.02-1.16, I²=4.5%, p = 0.38) and cancer mortality (Pooled ES: 1.17; 95% CI: 1.08-1.28, I²=30.1%, p = 0.19). However, total dairy consumption was associated with a lower risk of CVD mortality (Pooled ES: 0.93; 95% CI: 0.88-0.98, I²=59.7%, p = 0.001). Dose-response analysis revealed a significant non-linear association of total dairy consumption with all-cause and CVD mortality. Moreover, high-fat milk consumption was significantly associated with risk of cancer mortality in linear and non-linear dose-response analysis. In conclusion, we found high-fat milk consumption was associated with a higher risk of all-cause, CVD, and cancer mortality. However, total dairy consumption was associated with a lower risk of CVD mortality.

Milk Intake and Stroke Mortality in the Japan Collaborative Cohort Study-A Bayesian Survival Analysis

The aim of this study was to further examine the relationship between milk intake and stroke mortality among the Japanese population. We used data from the Japan Collaborative Cohort (JACC) Study (total number of participants = 110,585, age range: 40–79) to estimate the posterior acceleration factors (AF) as well as the hazard ratios (HR) comparing individuals with different milk intake frequencies against those who never consumed milk at the study baseline. These estimations were computed through a series of Bayesian survival models that employed a Markov Chain Monte Carlo simulation process. In total, 100,000 posterior samples were generated separately through four independent chains after model convergency was confirmed. Posterior probabilites that daily milk consumers had lower hazard or delayed mortality from strokes compared to non-consumers was 99.0% and 78.0% for men and women, respectively. Accordingly, the estimated posterior means of AF and HR for daily milk consumers were 0.88 (95% Credible Interval, CrI: 0.81, 0.96) and 0.80 (95% CrI: 0.69, 0.93) for men and 0.97 (95% CrI: 0.88, 1.10) and 0.95 (95% CrI: 0.80, 1.17) for women. In conclusion, data from the JACC study provided strong evidence that daily milk intake among Japanese men was associated with delayed and lower risk of mortality from stroke especially cerebral infarction.

Dairy Intake and Risk of Cardiovascular Disease

PURPOSE OF REVIEW

Due to inconsistent findings on dairy consumption and CVD and all-cause mortality, we performed a narrative literature review to the current literature on dairy and its association with CVD.

RECENT FINDINGS

Due to their complex biochemistry, dairy consumption is a rather heterogeneous exposure. Multiple pathways have been proposed from dairy consumption and CVD. Current guidelines advocate for consumption of low-fat dairy products particularly milk, cheese, and yogurt, although the evidence for this is scant. Randomized clinical trials and large prospective studies on lipid-related cardiometabolic disease risk factors are consistent with results from most meta-analyses of prospective cohort studies, which suggest null or inverse relationship between CVD risk and mortality with dairy consumption although there is no clear dose response relationship. Most of current evidence suggests that dairy products are neutral or positive effect on human cardiovascular diseases.

Whole milk consumption and risk of cardiovascular disease and mortality: Isfahan Cohort Study

BACKGROUND

The association between milk intake and cardiovascular disease (CVD) and mortality risk is still controversial but data from Middle-Eastern populations are scarce. We aimed to study these associations in an Iranian population.

METHODS

We used the Isfahan Cohort Study, a population-based prospective study of 6504 adult Iranians. In this analysis, we included 5432 participants free of CVD at baseline with at least one follow-up. Data on whole milk intake and other dietary factors were collected by a food frequency questionnaire at baseline. Cox proportional hazard regression was used to predict risk of CVD events, comprising coronary heart disease (CHD) and stroke, and mortality according to frequency of whole milk intake with adjustment for other potential confounders.

RESULTS

During a median 10.9 years of follow-up, we documented 705 new cases of CVD comprising 564 CHD and 141 stroke cases. Compared with non-consumers, less than daily intake of whole milk was significantly associated with lower risk of CVD (HR 0.80, 95% CI 0.65-0.97), CHD (HR 0.81, 95% CI 0.65-0.99), and a non-significant lower risk of stroke (HR 0.79, 95% CI 0.50-1.27). Daily intake of whole milk was not significantly associated with CVD (HR 1.25, 95% CI 0.89-1.75), CHD, and stroke, but was associated with higher risk of all-cause mortality (HR 1.54, 95% CI 1.04-2.29).

CONCLUSIONS

Less than daily intake of whole milk was associated with a statistically significant, although modest, lower risk of CVD compared with non-consumption, but this potential benefit may not extend to daily intake in this population.

Food groups and risk of coronary heart disease, stroke and heart failure: A systematic review and dose-response meta-analysis of prospective studies

BACKGROUND

Despite growing evidence for food-based dietary patterns' potential to reduce cardiovascular disease risk, knowledge about the amounts of food associated with the greatest change in risk of specific cardiovascular outcomes and about the quality of meta-evidence is limited. Therefore, the aim of this meta-analysis was to synthesize the knowledge about the relation between intake of 12 major food groups (whole grains, refined grains, vegetables, fruits, nuts, legumes, eggs, dairy, fish, red meat, processed meat, and sugar-sweetened beverages [SSB]) and the risk of coronary heart disease (CHD), stroke and heart failure (HF).

METHODS

We conducted a systematic search in PubMed and Embase up to March 2017 for prospective studies. Summary risk ratios (RRs) and 95% confidence intervals (95% CI) were estimated using a random effects model for highest versus lowest intake categories, as well as for linear and non-linear relationships.

RESULTS

Overall, 123 reports were included in the meta-analyses. An inverse association was present for whole grains (RRCHD: 0.95 (95% CI: 0.92-0.98), RRHF: 0.96 (0.95-0.97)), vegetables and fruits (RRCHD: 0.97 (0.96-0.99), and 0.94 (0.90-0.97); RRstroke: 0.92 (0.86-0.98), and 0.90 (0.84-0.97)), nuts (RRCHD: 0.67 (0.43-1.05)), and fish consumption (RRCHD: 0.88 (0.79-0.99), RRstroke: 0.86 (0.75-0.99), and RRHF: 0.80 (0.67-0.95)), while a positive association was present for egg (RRHF: 1.16 (1.03-1.31)), red meat (RRCHD: 1.15 (1.08-1.23), RRstroke: 1.12 (1.06-1.17), RRHF: 1.08 (1.02-1.14)), processed meat (RRCHD: 1.27 (1.09-1.49), RRstroke: 1.17 (1.02-1.34), RRHF: 1.12 (1.05-1.19)), and SSB consumption (RRCHD: 1.17 (1.11-1.23), RRstroke: 1.07 (1.02-1.12), RRHF: 1.08 (1.05-1.12)) in the linear dose-response meta-analysis. There were clear indications for non-linear dose-response relationships between whole grains, fruits, nuts, dairy, and red meat and CHD.

CONCLUSION

An optimal intake of whole grains, vegetables, fruits, nuts, legumes, dairy, fish, red and processed meat, eggs and SSB showed an important lower risk of CHD, stroke, and HF.

Food groups and risk of all-cause mortality: a systematic review and meta-analysis of prospective studies

Background: Suboptimal diet is one of the most important factors in preventing early death and disability worldwide.Objective: The aim of this meta-analysis was to synthesize the knowledge about the relation between intake of 12 major food groups, including whole grains, refined grains, vegetables, fruits, nuts, legumes, eggs, dairy, fish, red meat, processed meat, and sugar-sweetened beverages, with risk of all-cause mortality.Design: We conducted a systematic search in PubMed, Embase, and Google Scholar for prospective studies investigating the association between these 12 food groups and risk of all-cause mortality. Summary RRs and 95% CIs were estimated with the use of a random effects model for high-intake compared with low-intake categories, as well as for linear and nonlinear relations. Moreover, the risk reduction potential of foods was calculated by multiplying the RR by optimal intake values (serving category with the strongest association) for risk-reducing foods or risk-increasing foods, respectively.Results: With increasing intake (for each daily serving) of whole grains (RR: 0.92; 95% CI: 0.89, 0.95), vegetables (RR: 0.96; 95% CI: 0.95, 0.98), fruits (RR: 0.94; 95% CI: 0.92, 0.97), nuts (RR: 0.76; 95% CI: 0.69, 0.84), and fish (RR: 0.93; 95% CI: 0.88, 0.98), the risk of all-cause mortality decreased; higher intake of red meat (RR: 1.10; 95% CI: 1.04, 1.18) and processed meat (RR: 1.23; 95% CI: 1.12, 1.36) was associated with an increased risk of all-cause mortality in a linear dose-response meta-analysis. A clear indication of nonlinearity was seen for the relations between vegetables, fruits, nuts, and dairy and all-cause mortality. Optimal consumption of risk-decreasing foods results in a 56% reduction of all-cause mortality, whereas consumption of risk-increasing foods is associated with a 2-fold increased risk of all-cause mortality.Conclusion: Selecting specific optimal intakes of the investigated food groups can lead to a considerable change in the risk of premature death.

Dairy Food Intake and All-Cause, Cardiovascular Disease, and Cancer Mortality: The Golestan Cohort Study

We investigated the association between dairy product consumption and all-cause, cardiovascular disease (CVD), and cancer mortality in the Golestan Cohort Study, a prospective cohort study launched in January 2004 in Golestan Province, northeastern Iran. A total of 42,403 men and women participated in the study and completed a diet questionnaire at enrollment. Cox proportional hazards models were used to estimate hazard ratios and 95% confidence intervals. We documented 3,291 deaths (1,467 from CVD and 859 from cancer) during 11 years of follow-up (2004-2015). The highest quintile of total dairy product consumption (versus the lowest) was associated with 19% lower all-cause mortality risk (hazard ratio (HR) = 0.81, 95% confidence interval (CI): 0.72, 0.91; Ptrend = 0.006) and 28% lower CVD mortality risk (HR = 0.72, 95% CI: 0.60, 0.86; Ptrend = 0.005). High consumption of low-fat dairy food was associated with lower risk of all-cause (HR = 0.83, 95% CI: 0.73, 0.94; Ptrend = 0.002) and CVD (HR = 0.74, 95% CI: 0.61, 0.89; Ptrend = 0.001) mortality. We noted 11% lower all-cause mortality and 16% lower CVD mortality risk with high yogurt intake. Cheese intake was associated with 16% lower all-cause mortality and 26% lower CVD mortality risk. Higher intake of high-fat dairy food and milk was not associated with all-cause or CVD mortality. Neither intake of individual dairy products nor intake of total dairy products was significantly associated with overall cancer mortality. High consumption of dairy products, especially yogurt and cheese, may reduce the risk of overall and CVD mortality.

Milk and dairy consumption and risk of cardiovascular diseases and all-cause mortality: dose-response meta-analysis of prospective cohort studies

With a growing number of prospective cohort studies, an updated dose-response meta-analysis of milk and dairy products with all-cause mortality, coronary heart disease (CHD) or cardiovascular disease (CVD) have been conducted. PubMed, Embase and Scopus were searched for articles published up to September 2016. Random-effect meta-analyses with summarised dose-response data were performed for total (high-fat/low-fat) dairy, milk, fermented dairy, cheese and yogurt. Non-linear associations were investigated using the spine models and heterogeneity by subgroup analyses. A total of 29 cohort studies were available for meta-analysis, with 938,465 participants and 93,158 mortality, 28,419 CHD and 25,416 CVD cases. No associations were found for total (high-fat/low-fat) dairy, and milk with the health outcomes of mortality, CHD or CVD. Inverse associations were found between total fermented dairy (included sour milk products, cheese or yogurt; per 20 g/day) with mortality (RR 0.98, 95% CI 0.97-0.99; I2 = 94.4%) and CVD risk (RR 0.98, 95% CI 0.97-0.99; I2 = 87.5%). Further analyses of individual fermented dairy of cheese and yogurt showed cheese to have a 2% lower risk of CVD (RR 0.98, 95% CI 0.95-1.00; I2 = 82.6%) per 10 g/day, but not yogurt. All of these marginally inverse associations of totally fermented dairy and cheese were attenuated in sensitivity analyses by removing one large Swedish study. This meta-analysis combining data from 29 prospective cohort studies demonstrated neutral associations between dairy products and cardiovascular and all-cause mortality. For future studies it is important to investigate in more detail how dairy products can be replaced by other foods.

Subgroup dairy products consumption on the risk of stroke and CHD: A systematic review and meta-analysis

Background: There is no global consensus about the relationship between dairy consumption and cardiovascular diseases (CVD). This study aimed at integrating the results of several studies to predict the dairy effects on CVD, e.g. stroke and CHD.

Methods: In the present study, some major databases such as Scopus, Science Direct, and PubMed were searched up to September 2014. All prospective cohort studies dealing with dairy products consumption and CVD were surveyed regardless of their publication date or language. This reference population includes all individuals without any delimitation with regard to age, gender, or race. The quality of the study was evaluated using STROBE Checklist. Study selection and data extraction were done by 2 independent researchers separately. The indices in this study were RR and HR. The random model was used to combine the results.

Results: Out of 6234 articles, 11 were included in the meta-analysis. No relationship was found between stroke and consumption of milk, cream, and butter, and the results are as follow: RR = 0.91 (95%CI: 0.81-1.01) for milk, RR = 0.97 (95%CI: 0.88-1.06) for cream, and RR = 0.95 (95%CI: 0.85-1.07) for butter. However, cheese was found to decrease stroke risk: RR = 0.93 (95%CI: 0.88-0.99). The relationship of CHD with consumption of milk, cheese, cream, and butter are as follows, respectively: RR = 1.05 (95% CI: 0.96- 1.15), RR = 0.90 (95%CI: 0.81-1.01), RR = 0.96 (95% CI: 0.87-1.06), and RR = 0.99 (95%CI: 0.89-1.11). In other words, no relationship existed between dairy products and CHD.

Conclusion: No relationship was found between consumption of various dairy products and CHD or stroke, except for cheese that decreased stroke risk by 7%. Considering the small number of studies, the result of the present study is not generalizable and more studies need to be conducted

Invited review: The anti-inflammatory properties of dairy lipids

Dairy product consumption is often associated with negative effects because of its naturally high levels of saturated fatty acids. However, recent research has shown that dairy lipids possess putative bioactivity against chronic inflammation. Inflammation triggers the onset of several chronic diseases, including cardiovascular disease, type 2 diabetes mellitus, obesity, and cancer. This review discusses the anti-inflammatory properties of dairy lipids found in milk, yogurt, and cheese, and it examines them in relation to their implications for human health: their protective effects and their role in pathology. We also consider the effect of lipid profile alteration in dairy products-by using ruminant dietary strategies to enrich the milk, or by lipid fortification in the products. We critically review the in vivo, in vitro, ex vivo, and epidemiological studies associated with these dairy lipids and their role in various inflammatory conditions. Finally, we discuss some suggestions for future research in the study of bioactive lipids and dairy products, with reference to the novel field of metabolomics and epidemiological studies.

The effect of dairy consumption on the prevention of cardiovascular diseases: A meta-analysis of prospective studies

Introduction: There is no global consensus on the relationship of dairy products with cardiovascular diseases. This study was conducted to evaluate the effect of the consumption of dairy products on cardiovascular diseases, including stroke and coronary heart disease (CHD). Methods: Important electronic databases such as the Scopus, Science Direct, and PubMed were evaluated up to September 2014. All prospective cohort studies that evaluated the relationship between dairy products consumption and cardiovascular diseases were included regardless of their publication date and language. The study participants were evaluated regardless of age, sex, and ethnicity. The STROBE checklist was used to assess quality of the study. Two investigators separately selected the studies and extracted the data. The designated effects were risk ratio (RR) and hazard ratio (HR). The random effect model was used to combine the results. Results: Meta-analysis was performed on 27 studies. There were 8648 cases of cardiovascular diseases (CVD), 11806 cases of CHD, and 29300 cases of stroke. An inverse association was found between total dairy intake and CVD (RR=0.90, 95% CI: 0.81-0.99) and stroke (RR=0.88, 95% CI: 0.82-0.95) while no association was observed between total dairy intake and CHD. The total diary intake was associated with decreased mortality of stroke (RR=0.80, 95% CI: 0.76-0.83) although it had no association with its incidence (RR=0.96, 95% CI: 0.88-1.04). Conclusion: This is the first meta-analysis of the relationship of total dairy intake with CVD. This study showed an inverse relationship between total dairy intake and CVD while no relationship was found for CHD. Considering the limited number of studies in this regard, more studies are required to investigate the effect of different factors on the association of dairy intake and CVD.

Dietary Patterns in Relation to Cardiovascular Disease Incidence and Risk Markers in a Middle-Aged British Male Population: Data from the Caerphilly Prospective Study

Dietary behaviour is an important modifiable factor in cardiovascular disease (CVD) prevention. The study aimed to identify dietary patterns (DPs) and explore their association with CVD incidence and risk markers. A follow-up of 1838 middle-aged men, aged 47–67 years recruited into the Caerphilly Prospective Cohort Study at phase 2 (1984–1988) was undertaken. Principal component analysis identified three DPs at baseline, which explained 24.8% of the total variance of food intake. DP1, characterised by higher intakes of white bread, butter, lard, chips and sugar-sweetened beverages and lower intake of wholegrain bread, was associated with higher CVD (HR 1.35: 95% CI: 1.10, 1.67) and stroke (HR 1.77; 95% CI: 1.18, 2.63) incidence. DP3, characterised by higher intakes of sweet puddings and biscuits, wholegrain breakfast cereals and dairy (excluding cheese and butter) and lower alcohol intake, was associated with lower CVD (HR 0.76; 95% CI: 0.62, 0.93), coronary heart disease (HR: 0.68; 95% CI: 0.52, 0.90) and stroke (HR: 0.68; 95% CI: 0.47, 0.99) incidence and a beneficial CVD profile at baseline, while DP1 with an unfavourable profile, showed no clear associations after 12 years follow-up. Dietary pattern 2 (DP2), characterised by higher intake of pulses, fish, poultry, processed/red meat, rice, pasta and vegetables, was not associated with the aforementioned outcomes. These data may provide insight for development of public health initiatives focussing on feasible changes in dietary habits.

Daily milk consumption and all-cause mortality, coronary heart disease and stroke: a systematic review and meta-analysis of observational cohort studies

BACKGROUND

Observational studies and meta-analyses relating milk consumption by adults to all-cause mortality, coronary heart disease and stroke have obtained contradictory results. Some studies found a protective effect of milk consumption, whilst other found an increased risk.

METHODS

We performed a systematic literature search until June 2015 on prospective studies that looked at milk consumption, all-cause mortality, coronary heart disease and stroke. Random-effect meta-analyses were performed with dose-response.

RESULTS

Twenty-one studies involving 19 cohorts were included in this meta-analysis, 11 on all-cause mortality, 9 on coronary heart disease, and 10 on stroke. Milk intake ranged from 0 to 850 mL/d. The summary relative risk (SRR) for 200 mL/d milk consumption was 1.01 (95% CI: 0.96-1.06) for all-cause mortality, 1.01 (95% CI: 0.98-1.05) for fatal and non fatal coronary heart disease, and 0.91 (95% CI: 0.82-1.02) for fatal and non fatal stroke. Stratified analyses by age, Body Mass Index, total energy intake and physical acitivity did not alter the SRR estimates. The possibility of publication bias was found for all cause mortality and for stroke, indicating a gap in data that could have suggested a higher risk of these conditions with increased milk consumption.

CONCLUSIONS

We found no evidence for a decreased or increased risk of all-cause mortality, coronary heart disease, and stroke associated with adult milk consumption. However, the possibility cannot be dismissed that risks associated with milk consumption could be underestimated because of publication bias.

Dairy Consumption and Risk of Stroke: A Systematic Review and Updated Dose-Response Meta-Analysis of Prospective Cohort Studies

BACKGROUND

A higher milk consumption may be associated with a lower stroke risk. We conducted a comprehensive systematic review and dose-response meta-analysis of milk and other dairy products in relation to stroke risk.

METHODS AND RESULTS

Through a systematic literature search, prospective cohort studies of dairy foods and incident stroke in stroke-free adults were identified. Random-effects meta-analyses with summarized dose-response data were performed, taking into account sources of heterogeneity, and spline models were used to systematically investigate nonlinearity of the associations. We included 18 studies with 8 to 26 years of follow-up that included 762 414 individuals and 29 943 stroke events. An increment of 200 g of daily milk intake was associated with a 7% lower risk of stroke (relative risk 0.93; 95% CI 0.88-0.98; P=0.004; I(2)=86%). Relative risks were 0.82 (95% CI 0.75-0.90) in East Asian and 0.98 (95% CI 0.95-1.01) in Western countries (median intakes 38 and 266 g/day, respectively) with less but still considerable heterogeneity within the continents. Cheese intake was marginally inversely associated with stroke risk (relative risk 0.97; 95% CI 0.94-1.01 per 40 g/day). Risk reductions were maximal around 125 g/day for milk and from 25 g/day onwards for cheese. Based on a limited number of studies, high-fat milk was directly associated with stroke risk. No associations were found for yogurt, butter, or total dairy.

CONCLUSIONS

Milk and cheese consumption were inversely associated with stroke risk. Results should be placed in the context of the observed heterogeneity. Future epidemiological studies should provide more details about dairy types, including fat content. In addition, the role of dairy in Asian populations deserves further attention.

Formation and Degradation of Beta-casomorphins in Dairy Processing

Milk proteins including casein are sources of peptides with bioactivity. One of these peptides is beta-casomorphin (BCM) which belongs to a group of opioid peptides formed from β-casein variants. Beta-casomorphin 7 (BCM7) has been demonstrated to be enzymatically released from the A1 or B β-casein variant. Epidemiological evidence suggests the peptide BCM 7 is a risk factor for development of human diseases, including increased risk of type 1 diabetes and cardiovascular diseases but this has not been thoroughly substantiated by research studies. High performance liquid chromatography coupled to UV-Vis and mass spectrometry detection as well as enzyme-linked immunosorbent assay (ELISA) has been used to analyze BCMs in dairy products. BCMs have been detected in raw cow's milk and human milk and a variety of commercial cheeses, but their presence has yet to be confirmed in commercial yoghurts. The finding that BCMs are present in cheese suggests they could also form in yoghurt, but be degraded during yoghurt processing. Whether BCMs do form in yoghurt and the amount of BCM forming or degrading at different processing steps needs further investigation and possibly will depend on the heat treatment and fermentation process used, but it remains an intriguing unknown.

Dairy consumption and CVD: a systematic review and meta-analysis

Inverse associations between dairy consumption and CVD have been reported in several epidemiological studies. Our objective was to conduct a meta-analysis of prospective cohort studies of dairy intake and CVD. A comprehensive literature search was conducted to identify studies that reported risk estimates for total dairy intake, individual dairy products, low/full-fat dairy intake, Ca from dairy sources and CVD, CHD and stroke. Random-effects meta-analyses were used to generate summary relative risk estimates (SRRE) for high v. low intake and stratified intake dose-response analyses. Additional dose-response analyses were performed. Heterogeneity was examined in sub-group and sensitivity analyses. In total, thirty-one unique cohort studies were identified and included in the meta-analysis. Several statistically significant SRRE below 1.0 were observed, namely for total dairy intake and stroke (SRRE=0·91; 95% CI 0·83, 0·99), cheese intake and CHD (SRRE=0·82; 95% CI 0·72, 0·93) and stroke (SRRE=0·87; 95% CI 0·77, 0·99), and Ca from dairy sources and stroke (SRRE=0·69; 95% CI 0·60, 0·81). However, there was little evidence for inverse dose-response relationships between the dairy variables and CHD and stroke after adjusting for within-study covariance. The results of this meta-analysis of prospective cohort studies have shown that dairy consumption may be associated with reduced risks of CVD, although additional data are needed to more comprehensively examine potential dose-response patterns.

Effects of supplementation with a calcium-rich marine-derived multi-mineral supplement and short-chain fructo-oligosaccharides on serum lipids in postmenopausal women

Recent literature suggests that Ca supplements have adverse effects on cardiovascular health. The effects of a Ca-rich supplement administered alone or in combination with short-chain fructo-oligosaccharides (scFOS) on serum lipids in postmenopausal women were examined using secondary data from a 24-month double-blind randomised controlled study. A total of 300 postmenopausal women were randomly assigned to daily supplements of 800 mg of Ca (2·4 g Aquamin) (Ca), 800 mg of Ca with 3 g of scFOS (CaFOS) or control (maltodextrin) (MD). A full lipid profile, body composition, blood pressure and a range of cytokines were measured at baseline and after 24 months. Intention-to-treat ANCOVA assessed treatment effects between the groups. A significant time-by-treatment effect was observed for LDL and total cholesterol for the Ca and CaFOS groups, with both groups having lower LDL and total cholesterol concentrations compared with MD after 24 months. The control group had mean (5·2 mmol/l) total cholesterol concentrations above the normal range (≤5 mmol/l) at 24 months, whereas values remained within the normal range in the treatment groups. There was no significant treatment effect on HDL-cholesterol, TAG, body composition, blood pressure or cytokine concentrations at 24 months, with the exception of IL-4, where there was a significant increase in the CaFOS group compared with the placebo. This study demonstrates a lipid-lowering effect of both the Ca-rich supplement alone and the supplement with scFOS. At the 4-year follow-up, there was no significant difference between the groups for reported diagnosed cardiovascular conditions.

Milk Consumption and Mortality from All Causes, Cardiovascular Disease, and Cancer: A Systematic Review and Meta-Analysis

Results from epidemiological studies of milk consumption and mortality are inconsistent. We conducted a systematic review and meta-analysis of prospective studies assessing the association of non-fermented and fermented milk consumption with mortality from all causes, cardiovascular disease, and cancer. PubMed was searched until August 2015. A two-stage, random-effects, dose-response meta-analysis was used to combine study-specific results. Heterogeneity among studies was assessed with the I² statistic. During follow-up periods ranging from 4.1 to 25 years, 70,743 deaths occurred among 367,505 participants. The range of non-fermented and fermented milk consumption and the shape of the associations between milk consumption and mortality differed considerably between studies. There was substantial heterogeneity among studies of non-fermented milk consumption in relation to mortality from all causes (12 studies; I² = 94%), cardiovascular disease (five studies; I² = 93%), and cancer (four studies; I² = 75%) as well as among studies of fermented milk consumption and all-cause mortality (seven studies; I² = 88%). Thus, estimating pooled hazard ratios was not appropriate. Heterogeneity among studies was observed in most subgroups defined by sex, country, and study quality. In conclusion, we observed no consistent association between milk consumption and all-cause or cause-specific mortality.

Yogurt and dairy product consumption to prevent cardiometabolic diseases: epidemiologic and experimental studies

Dairy products contribute important nutrients to our diet, including energy, calcium, protein, and other micro- and macronutrients. However, dairy products can be high in saturated fats, and dietary guidelines generally recommend reducing the intake of saturated fatty acids (SFAs) to reduce coronary artery disease (CAD). Recent studies question the role of SFAs in cardiovascular disease (CVD) and have found that substitution of SFAs in the diet with omega-6 (n-6) polyunsaturated fatty acids abundant in vegetable oils can, in fact, lead to an increased risk of death from CAD and CVD, unless they are balanced with n-3 polyunsaturated fat. Replacing SFAs with carbohydrates with a high glycemic index is also associated with a higher risk of CAD. Paradoxically, observational studies indicate that the consumption of milk or dairy products is inversely related to incidence of CVD. The consumption of dairy products has been suggested to ameliorate characteristics of the metabolic syndrome, which encompasses a cluster of risk factors including dyslipidemia, insulin resistance, increased blood pressure, and abdominal obesity, which together markedly increase the risk of diabetes and CVD. Dairy products, such as cheese, do not exert the negative effects on blood lipids as predicted solely by the content of saturated fat. Calcium and other bioactive components may modify the effects on LDL cholesterol and triglycerides. Apart from supplying valuable dairy nutrients, yogurt may also exert beneficial probiotic effects. The consumption of yogurt, and other dairy products, in observational studies is associated with a reduced risk of weight gain and obesity as well as of CVD, and these findings are, in part, supported by randomized trials.

Dairy foods and risk of stroke: a meta-analysis of prospective cohort studies

BACKGROUND AND AIMS

Epidemiological studies evaluating the association of dairy foods with risk of stroke have produced inconsistent results. We conducted a meta-analysis to summarize the evidence from prospective cohort studies regarding the association between dairy foods and risk of stroke.

METHODS AND RESULTS

Pertinent studies were identified by searching Embase (1950-November, 2013), Web of Knowledge (1950-November, 2013) and Pubmed (1945-November, 2013). Random-effect model was used to combine the results. Dose-response relationship was assessed by restricted cubic spline. Eighteen separate results from fifteen prospective cohort studies, with 28,138 stroke events among 764,635 participants, were included. Total dairy [relative risk (95% CI): 0.88 (0.82-0.94)], low-fat dairy [0.91 (0.85-0.97)], fermented milk [0.80 (0.71-0.89)] and cheese [0.94 (0.89-0.995)] were significantly associated with reduced risk of stroke, but whole/high-fat dairy, nonfermented milk, butter and cream were not significantly associated with risk of stroke. Stronger association was found for stroke mortality than incidence, and for studies conducted in Asia than Europe, while the association did not differ significantly by sex. Limited data did not find any significant association with either ischemic or hemorrhagic stroke. A non-linear dose-response relationship (P = 2.80*10(-13)) between milk and risk of stroke was found, and the relative risk of stroke was 0.88 (0.86-0.91), 0.82 (0.79-0.86), 0.83 (0.79-0.86), 0.85 (0.81-0.89), 0.86 (0.82-0.91), 0.91 (0.84-0.98) and 0.94 (0.86-1.02) for 100, 200, 300, 400, 500, 600 and 700 ml/day of milk, respectively.

CONCLUSIONS

Dairy foods might be inversely associated with the risk of stroke.

Health effects associated with foods characteristic of the Nordic diet: a systematic literature review

Background

In preparing the fifth edition of the Nordic Nutrition Recommendations (NNR), the scientific basis of specific food-based dietary guidelines (FBDG) was evaluated.

Objective

A systematic review (SR) was conducted to update the NNR evidence based on the association between the consumption of potatoes, berries, whole grains, milk and milk products, and red and processed meat, and the risk of major diet-related chronic diseases.

Design

The SR was based on predefined research questions and eligibility criteria for independent duplicate study selection, data extraction, and assessment of methodological quality and applicability. We considered scientific data from prospective observational studies and intervention studies, published since year 2000, targeting the general adult population. Studies of meat and iron status included children, adolescents, and women of childbearing age.

Results

Based on 7,282 abstracts, 57 studies met the quality criteria and were evidence graded. The data were too limited to draw any conclusions regarding: red and processed meat intake in relation to cardiovascular disease (CVD) and iron status; potatoes and berries regarding any study outcomes; and dairy consumption in relation to risk of breast cancer and CVD. However, dairy consumption seemed unlikely to increase CVD risk (moderate-grade evidence). There was probable evidence (moderate-grade) for whole grains protecting against type 2 diabetes and CVD, and suggestive evidence (low-grade) for colorectal cancer and for dairy consumption being associated with decreased risk of type 2 diabetes and increased risk of prostate cancer. The WCRF/AICR concludes that red and processed meat is a convincing cause of colorectal cancer.

Conclusions

Probable (moderate) evidence was only observed for whole grains protecting against type 2 diabetes and CVD. We identified a clear need for high-quality nutritional epidemiological and intervention studies and for studies of foods of the Nordic diet.

An update on the cardiovascular pleiotropic effects of milk and milk products

Hypertension is a major risk factor in addition to atherosclerosis and type 2 diabetes mellitus for the development of coronary heart disease and strokes. Several prospective clinical studies have demonstrated a possible protective effect of milk and dairy product consumption on these conditions. The putative effects of milk and dairy products are possibly mediated through their mineral content of calcium, magnesium, potassium, and vitamin D. These dairy substances exercise their blood pressure-lowering effect either directly on the arterial wall by these minerals or indirectly through blockade of the angiotensin-converting enzyme (ACE) by the amino acids contained in the casein and whey of milk. The blockade of ACE results in the inhibition of production of angiotensin II, a potent vasoconstrictive peptide, and the prevention of degradation of bradykinin, a potent vasodilating peptide. For this concise review, a Medline search of the English language literature was conducted from 2006 to September 2012 and 16 pertinent papers were selected. The potential beneficial pleiotropic effects from these studies together with collateral literature will be discussed in this review.

Dairy and blood pressure: a fresh look at the evidence

The Dietary Guidelines for Americans, 2010 indicated there is moderate evidence for an association between the consumption of dairy foods and lower blood pressure in adults; however, it also stated that more evidence was needed, especially in clinical trials, to fully delineate a causal relationship. The purpose of this review is to provide background by examining the historical literature and the evidence reviewed by the 2010 Dietary Guidelines Advisory Committee, to examine the gaps in knowledge indicated by that committee, and to determine if recently published evidence is sufficient to elucidate or dismiss an association between dairy foods and blood pressure maintenance. Examination of the newly published literature, together with evaluation of the evidence as a whole, shows that the preponderance of evidence indicates dairy foods are beneficially associated with blood pressure; however, additional research is necessary to identify the mechanism of action of dairy foods. New evidence should come from carefully designed clinical trials that examine not only blood pressure outcomes but also the ability of dairy foods to affect the vasculature.

Dairy intake in relation to cardiovascular disease mortality and all-cause mortality: the Hoorn Study

PURPOSE

Existing data from prospective cohort studies on dairy consumption and cardiovascular diseases are inconsistent. Even though the association between total dairy and cardiovascular diseases has been studied before, little is known about the effect of different types of dairy products on cardiovascular diseases (CVD). The objective of this study was to examine the relationship between (type of) dairy intake and CVD mortality and all-cause mortality in a Dutch population.

METHODS

We examined the relationship between dairy intake and CVD mortality and all-cause mortality in 1956 participants of the Hoorn Study (aged 50-75 years), free of CVD at baseline. Hazard ratios with 95 % CIs were obtained for CVD mortality and all-cause mortality per standard deviation (SD) of the mean increase in dairy intake, with adjustment for age, sex, BMI, smoking, education, total energy intake, alcohol consumption, physical activity, and dietary intakes.

RESULTS

During 12.4 years of follow-up, 403 participants died, of whom 116 had a fatal CVD event. Overall dairy intake was not associated with CVD mortality or all-cause mortality. Each SD increase in high-fat dairy intake was associated with a 32 % higher risk of CVD mortality (95 % CI; 7-61 %).

CONCLUSION

In this prospective cohort study, the intake of high-fat dairy products was associated with an increased risk of CVD mortality.

Consumption of dairy products and associations with incident diabetes, CHD and mortality in the Whitehall II study

Few prospective studies have examined the effects of different types of dairy food on the risks of type 2 diabetes, CHD and mortality. We examined whether intakes of total dairy, high-fat dairy, low-fat dairy, milk and fermented dairy products were related to these outcomes in the Whitehall II prospective cohort study. At baseline, dairy consumption was assessed by FFQ among 4526 subjects (72% men) with a mean age 56 (sd 6) years. Death certificates and medical records were used to ascertain CHD mortality and non-fatal myocardial infarction. Incident diabetes was detected by the oral glucose tolerance test or self-report. Incidence data were analysed using Cox proportional hazards models, adjusted for lifestyle and dietary factors. During approximately 10 years of follow-up, 273 diabetes, 323 CHD and 237 all-cause mortality cases occurred. In multivariable models, intakes of total dairy and types of dairy products were not significantly associated with incident diabetes or CHD (all P values for trend >0·1). Fermented dairy products was inversely associated with overall mortality (hazard ratios approximately 0·7 in the middle and highest tertiles; P for trend < 0·01) but not with incident CHD or diabetes (P>0·3). In conclusion, intakes of total dairy and types of dairy products showed no consistent relationship with incident diabetes, CHD or all-cause mortality.

Does dairy food intake predict arterial stiffness and blood pressure in men?: Evidence from the Caerphilly Prospective Study

Arterial stiffness is an independent predictor of cardiovascular disease events and mortality, and like blood pressure, may be influenced by dairy food intake. Few studies have investigated the effects of consumption of these foods on prospective measures of arterial stiffness. The present analysis aimed to investigate the prospective relationship between milk, cheese, cream, and butter consumption and aortic pulse wave velocity, augmentation index, systolic and diastolic blood pressure, as well as cross-sectional relationships between these foods and systolic and diastolic blood pressure and metabolic markers using data from the Caerphilly Prospective Study. Included in this cohort were 2512 men, aged 45 to 59 years, who were followed up at 5-year intervals for a mean of 22.8 years (number follow-up 787). Augmentation index was 1.8% lower in subjects in the highest quartiles of dairy product intake compared with the lowest (P trend=0.021), whereas in the highest group of milk consumption systolic blood pressure was 10.4 mm Hg lower (P trend=0.033) than in nonmilk consumers after a 22.8-year follow-up. Cross-sectional analyses indicated that across increasing quartiles of butter intake, insulin (P trend=0.011), triacylglycerol (P trend=0.023), total cholesterol (P trend=0.002), and diastolic blood pressure (P trend=0.027) were higher. Across increasing groups of milk intake and quartiles of dairy product intake, glucose (P trend=0.032) and triglyceride concentrations (P trend=0.031) were lower, respectively. The present results confirm that consumption of milk predicts prospective blood pressure, whereas dairy product consumption, excluding butter, is not detrimental to arterial stiffness and metabolic markers. Further research is needed to better understand the mechanisms that underpin these relationships.

Is dairy product consumption associated with the incidence of CHD?

OBJECTIVE

Studies examining the association of dairy consumption with incident CHD have yielded inconsistent results. The current prospective study examined the association between dairy consumption and CHD in a population-based sample of older community-dwelling adults.

DESIGN

Baseline CHD risk factors were assessed and an FFQ was self-administered. Participants were followed for morbidity and mortality with periodic clinic visits and annual mailed questionnaires for an average of 16?2 years, with a 96% follow-up rate for fatal and non-fatal CHD.

SETTING

Community.

SUBJECTS

Participants were 751 men and 1008 women aged 50–93 years who attended a clinic visit in 1984–1987.

RESULTS

At baseline the mean age was 70.6 (SD 9.8) years for men and 70.1 (SD 9.3) years for women. Participants who developed CHD during follow-up were significantly older (P < 0.001), had higher BMI (P = 0.035) and higher total cholesterol (P = 0.050), and were more likely to be male (P < 0.001), diabetic (P = 0.011) and hypertensive (P < 0.001), than those who did not develop CHD. Multivariate regression analyses adjusting for age, BMI, diabetes, hypertension, LDL-cholesterol and oestrogen use (in women) indicated that women who consumed low-fat cheese ‘sometimes/often’ and women who consumed non-fat milk ‘sometimes/often’ had an increased risk of incident CHD (hazard ratio 52.32; 95% CI 1.57, 3.41) and CHD (hazard ratio 51.48; 95% CI 1.02, 2.16) compared with women who ‘never/rarely’ ate these dairy products.

CONCLUSIONS

Woman with higher intake of low-fat cheese and non-fat milk seem to have a higher risk of incident CHD. This needs further investigation considering recent evidence of cardiovascular benefits from certain dairy fat.

Influence of dairy product and milk fat consumption on cardiovascular disease risk: a review of the evidence

Although evidence has linked the consumption of saturated fat (SF) to increased LDL levels and an increased risk of the development of cardiovascular disease (CVD), recent findings have indicated that the link between CVD and SF may be less straightforward than originally thought. This may be due to the fact that some food sources high in SF contain an array of saturated and unsaturated fatty acids, each of which may differentially affect lipoprotein metabolism, as well as contribute significant amounts of other nutrients, which may alter CVD risk. The purpose of this review is to examine the published research on the relationship between milk fat containing dairy foods and cardiovascular health. The findings indicate that the majority of observational studies have failed to find an association between the intake of dairy products and increased risk of CVD, coronary heart disease, and stroke, regardless of milk fat levels. Results from short-term intervention studies on CVD biomarkers have indicated that a diet higher in SF from whole milk and butter increases LDL cholesterol when substituted for carbohydrates or unsaturated fatty acids; however, they may also increase HDL and therefore might not affect or even lower the total cholesterol:HDL cholesterol ratio. The results from the review also indicate that cheese intake lowers LDL cholesterol compared with butter of equal milk fat content. In addition, the review highlights some significant gaps in the research surrounding the effects of full-fat dairy on CVD outcomes, pointing to the need for long-term intervention studies.

The effect of dairy consumption on blood pressure in mid-childhood: CAPS cohort study

BACKGROUND/OBJECTIVES

It has been postulated that a higher dairy consumption may affect blood pressure regulation. The aim of this study was to examine the association between dairy consumption and blood pressure in mid-childhood.

SUBJECTS/METHODS

Subjects (n = 335) were participants of a birth cohort at high risk of asthma with information on diet at 18 months and blood pressure at 8 years. Multivariate analyses were used to assess the association of dairy consumption (serves) and micronutrient intakes (mg). In a subgroup of children (n = 201), dietary intake was also measured at approximately 9 years.

RESULTS

Children in the highest quintile of dairy consumption at 18 months had lower systolic blood pressure (SBP) and diastolic blood pressure (DBP) at 8 years (2.5 mm Hg, P=0.046 and 1.9 mm Hg, P = 0.047, respectively) than those in the lowest quintiles. SBP was lowest among children in the highest quintiles of calcium, magnesium and potassium intakes. Significant negative linear trends were observed between SBP and intakes of dairy serves, calcium, magnesium and potassium. Furthermore, SBP and DBP were lowest in the group of children that consumed at least two dairy serves at both 18 months and the follow-up dietary data collection at 9 years, compared with all other children (SBP 98.7 vs 101.0 mm Hg, P = 0.07; and DBP 56.5 vs 59.3 mm Hg, P = 0.006, respectively).

CONCLUSION

These results are consistent with a protective effect of dairy consumption in childhood on blood pressure at age 8 years.

Dairy consumption and 10-y total and cardiovascular mortality: a prospective cohort study in the Netherlands

BACKGROUND

The consumption of dairy products (milk, cheese, and butter) has been positively associated with the risk of ischemic heart disease (IHD), stroke, and total mortality because of the saturated fat content of these products; and protective effects against these outcomes have been attributed to the calcium content and low-fat choices of dairy products. However, robust evidence on the net effect of dairy product consumption on mortality is limited.

OBJECTIVE

The objective was to investigate the association between dairy product consumption and the risk of death (from all causes, IHD, and stroke) in the Netherlands Cohort Study (NLCS).

DESIGN

The NLCS was initiated in 120,852 men and women aged 55-69 y at baseline in 1986. After 10 y of follow-up, 16,136 subjects with complete dietary information had died. Twenty-nine percent (men) and 22% (women) of these deaths were due to IHD or stroke. The validated 150-item food-frequency questionnaire provided detailed information on dairy products.

RESULTS

Multivariate survival analyses following a case-cohort approach showed only a few statistically significant, but mostly weak, associations. A slightly increased risk of all-cause and IHD mortality was found for both butter and dairy fat intake (per 10 g/d; rate ratio(mortality): 1.04; 95% CI: 1.01, 1.06) only in women. Fermented full-fat milk was inversely associated with all-cause and nonsignificantly with stroke mortality in both sexes.

CONCLUSIONS

The role of dairy product consumption in mortality generally appeared to be neutral in men. In women, dairy fat intake was associated with slightly increased all-cause and IHD mortality. More research is warranted on a possible protective effect of fermented milk on stroke mortality.

Associations between dairy consumption and body weight: a review of the evidence and underlying mechanisms

As the incidence of obesity is reaching 'epidemic' proportions, there is currently widespread interest in the impact of dietary components on body-weight and food intake regulation. The majority of data available from both epidemiological and intervention studies provide evidence of a negative but modest association between milk and dairy product consumption and BMI and other measures of adiposity, with indications that higher intakes result in increased weight loss and lean tissue maintenance during energy restriction. The purported physiological and molecular mechanisms underlying the impact of dairy constituents on adiposity are incompletely understood but may include effects on lipolysis, lipogeneis and fatty acid absorption. Furthermore, accumulating evidence indicates an impact of dairy constituents, in particular whey protein derivatives, on appetite regulation and food intake. The present review summarises available data and provides an insight into the likely contribution of dairy foods to strategies aimed at appetite regulation, weight loss or the prevention of weight gain.

Milk and dairy consumption and incidence of cardiovascular diseases and all-cause mortality: dose-response meta-analysis of prospective cohort studies

BACKGROUND

The consumption of dairy products may influence the risk of cardiovascular disease (CVD) and total mortality, but conflicting findings have been reported.

OBJECTIVE

The objective was to examine the associations of milk, total dairy products, and high- and low-fat dairy intakes with the risk of CVD [including coronary heart disease (CHD) and stroke] and total mortality.

DESIGN

PubMed, EMBASE, and SCOPUS were searched for articles published up to February 2010. Of > 5000 titles evaluated, 17 met the inclusion criteria, all of which were original prospective cohort studies. Random-effects meta-analyses were performed with summarized dose-response data. Milk as the main dairy product was pooled in these analyses.

RESULTS

In 17 prospective studies, there were 2283 CVD, 4391 CHD, 15,554 stroke, and 23,949 mortality cases. A modest inverse association was found between milk intake and risk of overall CVD [4 studies; relative risk (RR): 0.94 per 200 mL/d; 95% CI: 0.89, 0.99]. Milk intake was not associated with risk of CHD (6 studies; RR: 1.00; 95% CI: 0.96, 1.04), stroke (6 studies; RR: 0.87; 95% CI: 0.72, 1.05), or total mortality (8 studies; RR per 200 mL/d: 0.99; 95% CI: 0.95, 1.03). Limited studies of the association of total dairy products and of total high-fat and total low-fat dairy products (per 200 g/d) with CHD showed no significant associations.

CONCLUSION

This dose-response meta-analysis of prospective studies indicates that milk intake is not associated with total mortality but may be inversely associated with overall CVD risk; however, these findings are based on limited numbers.

The consumption of milk and dairy foods and the incidence of vascular disease and diabetes: an overview of the evidence

The health effects of milk and dairy food consumption would best be determined in randomised controlled trials. No adequately powered trial has been reported and none is likely because of the numbers required. The best evidence comes, therefore, from prospective cohort studies with disease events and death as outcomes. Medline was searched for prospective studies of dairy food consumption and incident vascular disease and Type 2 diabetes, based on representative population samples. Reports in which evaluation was in incident disease or death were selected. Meta-analyses of the adjusted estimates of relative risk for disease outcomes in these reports were conducted. Relevant case-control retrospective studies were also identified and the results are summarised in this article. Meta-analyses suggest a reduction in risk in the subjects with the highest dairy consumption relative to those with the lowest intake: 0.87 (0.77, 0.98) for all-cause deaths, 0.92 (0.80, 0.99) for ischaemic heart disease, 0.79 (0.68, 0.91) for stroke and 0.85 (0.75, 0.96) for incident diabetes. The number of cohort studies which give evidence on individual dairy food items is very small, but, again, there is no convincing evidence of harm from consumption of the separate food items. In conclusion, there appears to be an enormous mis-match between the evidence from long-term prospective studies and perceptions of harm from the consumption of dairy food items.

Milk intake and its association with metabolic syndrome in Korean: analysis of the third Korea National Health and Nutrition Examination Survey (KNHANES III)

Although previous studies have shown that milk intake has some protective effects on metabolic syndrome (MS), there are few data on the relation between MS and milk consumption in Korean. To evaluate the association between milk intake frequency and MS, 4,890 subjects (2,052 men and 2,838 women) were included in the analysis, based on the national data from representative random sample of the third Korea National Health and Nutrition Examination Survey (KNHANES III) in 2005. We conducted both univariate and multivariate logistic regression analysis with adjustment for confounding factors associated with MS. Mean (±SD) age of subjects was 47.1±15.5 yr. In univariate analysis, the risk of MS was inversely associated with the frequency of milk intake, but this relation was attenuated in multivariate regression. In the individuals with BMI ≥23 kg/m(2), those with highest quartile of milk consumption (once daily or more) had significantly lower risk of MS (OR [95% CI] 0.72 [0.57-0.92] compared with lowest quartile [those rarely consumed]) after adjustment, but not among leaner individuals (BMI <23 kg/m(2)). Korean overweight adults who drink milk more frequently may be protected against MS. But it seems that this relation is somewhat different among MS components.

Dairy food consumption and obesity-related chronic disease

Dairy food comprises a range of different products with varying nutritional components. In the context of a healthy diet, dairy food may provide protection against and amelioration of chronic diseases related to obesity. These include overweight, insulin resistance/metabolic syndrome/type 2 diabetes, hypertension/stroke, and cardiovascular disease. Eliciting how dairy food may have this impact represents a challenge for modern nutritional science and requires an integration of knowledge from observational studies of population dietary patterns and disease prevalence, and experimental studies testing the effect of dairy food consumption. It also benefits from the recent identification of biomarkers of dairy fat intake and from mechanistic studies that support the plausibility of the observed effects. Future research might discriminate between types of dairy foods and focus on the synergy provided by the food matrix, rather than simply the component parts of the food.

Role of dairy beverages in the diet

The U.S. Dietary Guidelines for Americans recommends 3 cups of low fat milk or equivalent daily for most calorie levels [1]. Milk provides over 10% of the requirement for calcium, vitamin D, magnesium, phosphorus, potassium, riboflavin, protein, and carbohydrates for most people. Obtaining adequate intakes of calcium, potassium, and magnesium without milk in the diet requires effort. Milk has bioactive ingredients that may play unique roles in health. Benefits of dairy consumption are associated with reduced risk of low bone mass, stroke, metabolic syndrome, and some cancers. Concerns over milk consumption have focused on saturated fats historically. More research is needed to resolve potential concerns of milk consumption and risk of several disorders including ovarian cancer and soft tissue calcification.