This area of our website is for healthcare professionals only

Please click below to declare your professional status:

YES, I am a healthcare professional  NO, I am not a healthcare professional

Dairy foods

This HEART UK Nutrition Academy webpage has been funded by Novartis Pharmaceuticals UK Ltd who have had no input into the content or development of this material.
 

Full fat dairy foods have been suggested to have a neutral effect on blood lipids. We review the evidence and practical implications.

Take home messages

  • When comparing different dairy foods, studies suggest that not all dairy foods raise blood lipids.
    • Intervention studies demonstrate that full-fat cheese and yogurt have a neutral effect on LDL cholesterol, whereas full-fat dairy milk and butter increase LDL cholesterol.
    • Cohort studies suggest an inverse relationship between some dairy foods and CVD outcomes.
  • However, the devil is in the detail
    • Studies comparing saturated fat from all food sources (including dairy) with unsaturated fats, continually demonstrate that replacing dairy saturated fats with mono- or poly-unsaturated vegetable fats consistently lowers LDL cholesterol and reduces CHD and CVD risk.
    • Many studies demonstrating the unexpected impact on lipids from dairy foods, often fail to account for other significant confounding factors including changes in overall saturated and unsaturated fat intakes between comparisons.
  • Reducing saturated fat intake from all sources - including dairy - and replacing it with unsaturated fats remains the core dietary intervention for managing lipid levels and cardiovascular health.
    • There is a direct association between saturated fat consumption from all sources and elevated blood LDL cholesterol levels, which is atherogenic.
    • Elevated blood LDL cholesterol levels and prolonged exposure are scientifically undisputed as direct causal factors for CVD and CHD.
  • Established dietary patterns proven to lower LDL cholesterol and CVD risk (e.g., Portfolio, DASH, Mediterranean) recommend:
    • Reducing all sources of saturated fat and replacing them with vegetable unsaturated fats.
    • Switching from full-fat dairy to low-fat or fat-free varieties.
  • For the past decade, UK saturated fat intakes have consistently exceeded recommended levels for optimum cardiovascular and overall health outcomes.
    • Full fat dairy foods are one of the key sources of saturated fat in the UK diet
    • This includes butter, creams, full fat milk, cheeses and full fat yogurts as well as products made with dairy foods.
  • Practical implications
    • Shift overall fat intakes from saturated to unsaturated fats which includes:
    • Opting for lower fat dairy products.
    • Replacing butter, ghee and other animal fats with unsaturated vegetable fats such as rapeseed and olive oil.
    • Choosing higher unsaturated fat foods such as nuts and seeds.

In recent years, there has been an increase in scientific publications investigating the impact of full-fat dairy foods on blood lipids and cardiovascular health outcomes. As a result, confusion has arisen regarding patient advice. Here, we unravel the scientific findings and discuss their implications for practical dietary recommendations.

What are dairy foods?

Dairy foods includes: butter, ghee, all dairy creams, dairy milk, dairy yogurt and yogurt drink and all types of cheeses.

Dairy is a broad food group and there’s a wide range of differences among these foods in terms of their physical form and how they are processed, e.g.:

  • Fermented (yogurt) vs unfermented (milk)
  • Full fat dairy vs low fat dairy
  • Solid (cheese) vs liquid (milk)

These differences affect how different dairy foods impact cardiometabolic risk factors such as blood cholesterol, and the associated cardiovascular health outcomes1.

The controversy

The debate surrounds whether dairy's saturated fat content affects blood lipids and cardiovascular health similarly to other food sources of saturated fat.

Reducing saturated fat and replacing it with unsaturated fat is the core dietary recommendation for lipid and cardiovascular health management. The evidence is so compelling that all leading heart health organisations endorse this core message - the American Heart Association (AHA)2, the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS)3 and NICE4.

See our blog on the right balance of fats

See our e-learning module on Dietary fats: getting the balance right

Evidence underpinning dietary recommendations to reduce total and dairy saturated fats

The evidence is conclusive, that overall intakes of dietary saturated fatty acids (SFA) are linearly associated with blood LDL cholesterol levels whereas an S-shaped curve is seen with increasing saturated fat intakes and coronary heart disease (CHD) and cardiovascular disease (CVD) events3,5–7.  Thus public health policies focus on switching to low saturated fat products including dairy8. Conversely, reducing SFA and replacing with unsaturated fats, especially polyunsaturated fatty acids (PUFA), results in the biggest LDL cholesterol lowering effect

Lipid and cardiovascular disease management policies also recommend lower-fat dairy
After an extensive review of cohort and intervention studies and meta-analysis, the AHA concluded that compared to dietary patterns incorporating full fat dairy products, dietary patterns with low-fat and fat-free dairy demonstrate a significant reduction in all-cause mortality and incidence of CVD9.

The focus on replacing full fat dairy with low and fat-free dairy products is also a core element of the well-established cardioprotective diets such as - DASH, Mediterranean and Portfolio diets10–14.

A nationwide dietary intervention study proving that reducing dairy sources of saturated fat improves cardiovascular outcomes.

In the early 1970s Finland had the highest mortality rates from CHD15–17. This led to the launch of the North Karelia Project in 1972 with the aim of reducing CHD rates and mortality through community driven behaviour change strategies focusing on17:

  • Reducing saturated fat to lower blood cholesterol by reducing butter and switching over to vegetable spreads and moving from full cream to low-fat/skimmed milk
  • Reducing salt intake to control blood pressure
  • Cessation of smoking.

Over 20 years, saturated fat intake decreased from 21% to 16% of energy intake, primarily by switching from full-cream to low-fat dairy and from butter to vegetable spreads. This resulted in an average 1 mmol/L drop in total cholesterol16. Forty years later, CHD mortality fell by 82% in men and 84% in women. Increased consumption of fruits, vegetables, and fish also contributed to the reduction in CHD risk15.

The large US cohort Health Professional's Follow-Up Study and the Nurses' Health Study demonstrated that replacing 5% energy from dairy fat with polyunsaturated fat (PUFA) was associated with a 24% reduced incidence of CVD18. Replacing 5% energy from other animal fats with dairy fat resulted in a 6% increased risk of CVD.

A 12-week crossover study investigated the impact of replacing dairy (cheese, milk and butter) saturated fats with monounsaturated fatty acids (MUFA)19. Compared to the dairy fat group, the MUFA group reduced overall saturated fat intakes from 19% to 16% of total energy and mitigated the LDL cholesterol increase.

Even though evidence suggests that fermented dairy products like yogurt and cheese may have a neutral or even beneficial impact on CHD, the overall findings remain inconclusive2.

Evidence suggesting dairy does not increase blood lipids

Is dairy different? The complex relationship between different dairy foods and cardiovascular outcomes.

Cohort studies

Based on the epidemiological evidence for dairy and cardiovascular outcomes, the data remains inconclusive. Some studies show benefits of specific dairy foods and dairy fatty acids, others show neutral effects, while others show negative effects.

  • A 2021 meta-analysis of prospective cohort studies found that total milk consumption had no association with CHD risk, but did find a 12% lower risk of stroke (RR 0.88, 95% CI 0.79–0.98) in the highest milk intake group vs the lowest20.

However, the total milk intakes included both low fat and whole (full fat) milk. Thus, when the data was re-analysed, separating studies using full-fat from low-fat milk, the results were very different. High intakes of full-fat milk were associated with a 16% higher risk of CHD (RR 1.16, 95% CI 1.01–1.33).

  • The same meta-analysis demonstrated that compared to the lowest intakes, the highest cheese intakes were associated with a 9% lower risk of CHD (RR 0.91, 95% CI 0.84–0.99) and 11% lower risk of stroke (RR 0.89, 95% CI 0.78–1.01)20.

However, upon closer examination of the original studies in the meta-analysis, several issues emerge. None of the studies adjusted for overall dietary fat quality, such as the ratio of saturated to unsaturated fats. Furthermore, cheese intake remained consistently low across most studies; in some cases, even the highest intake groups consumed an average of only around 30g per day. One study compared no cheese consumption with occasional intake ranging from as little as once a year to monthly, while another focused on dairy calcium rather than varying cheese quantities. Additionally, one study found that the highest cheese-consuming group also had the highest intake of unsaturated fats and the lowest intake of saturated fats. These significant confounding factors are likely to have influenced the observed effects on lipid levels.

Different saturated fatty acids in dairy will produce different cardiovascular outcomes

There are two saturated fatty acids found in dairy that cannot be synthesised in the body and so make good biomarkers for assessing dairy intakes.  These fatty acids are C15:0 (pentadecanoic acid) and C17:0 (heptadecanoic acid). An analysis of a large UK cohort study found that higher blood levels of these two fatty acids (and therefore higher intakes of dairy) were associated with a reduced risk of CHD [-27% (OR 0.73, 95% CI 0.59-0.91)]21. Conversely, higher blood levels of the longer and even-chained saturated fatty acids found in cheese (C16:0 palmitic and C18:0 stearic acid) were associated with a higher risk of CHD [+75% (OR 1.75, 95% CI 1.27-2.41)].

However, it's important to note that the content of C15:0 and C17:0 in cheese is exceptionally low, collectively accounting for no more than 2% of the total fat content. In contrast, palmitic acid (C16:0), the well established LDL cholesterol-raising fatty acid, constitutes over a third of the fat in cheese.

Which food sources of saturated fat are manipulated and compared is a critical factor in cardiovascular disease outcomes

The Multi-Ethnic Study of Atherosclerosis cohort demonstrated an inverse association between saturated fat intakes from dairy and CVD risk, which remained significant after accounting for other dietary factors22. Further, when 2% of saturated fat energy from meat sources was replaced with dairy sources, they found a 25% lower risk of CVD (HR 0.75, 95% CI 0.63-0.91).

However, this benefit was observed without considering other dietary confounding factors. It's important to note that consumption of red and processed meat is independently associated with increased CVD risk23,24. Upon closer examination, this cohort showed a disproportionate contribution of saturated fat from dairy compared to other food sources. The authors emphasise this point, highlighting the relatively low reported intakes of key saturated fat food sources such as processed meats, butter, and plant sources, which could potentially limit statistical power to detect association. 

 

Intervention studies comparing different dairy food

Cheese

Intervention trials provide further insights into the differential effects of dairy fats and the whole-food matrix on blood cholesterol levels.
Feeney et al. investigated the effects of consuming dairy fat from various dairy foods in older adults (~60yrs) over a six-week period. Participants were randomised to one of four groups each providing 40g of dairy fat daily25:

  • Group A: 120g full-fat cheddar cheese (FFCC)
  • Group B: 120g reduced-fat cheddar cheese + 21g butter
  • Group C: 49g butter + 30g calcium-casein powder + calcium supplement
  • Group D: 120g full-fat white cheddar cheese (following 6-weeks on a cheese-free diet)

Important to note: All groups' baseline total saturated fat intake exceeded recommendations (providing 12-14% of energy), each intervention food/s were matched for energy, total fat, casein protein, and calcium.

Results

After six weeks, a reduction in LDL cholesterol across all groups was demonstrated, with the greatest reductions in the cheese groups: Groups A (-0.45 mmol/L) and B (-0.27 mmol/L). Group C saw a smaller reduction (-0.14 mmol/L). Group D had an increase during the cheese-free period (+0.13 mmol/L) and a slight decrease during the cheese consumption phase (-0.07 mmol/L).

Overall this intervention study demonstrates that when comparing differences between dairy foods, cheese and the presence of casein (dairy protein) and calcium may attenuate the cholesterol raising effect of saturated fat found in some dairy foods.

Was it dairy per se or the overall quality of the diet post intervention?

It is important to note, that the total dietary saturated fat intakes decreased across all four groups post-intervention, shifting from exceeding to meeting recommended intakes (12%-14% of energy as saturated fat at baseline to 9.4%-10.4% of energy at the end of the intervention).
This reduction in overall saturated fat alone could explain why all four groups showed a reductions in LDL cholesterol levels, as saturated fat intakes are linearly linked to LDL cholesterol levels6. Additionally, the study does not provide the full nutritional profile of the diets – except that they were similar for macronutrient intakes. Thus, intakes of other foods such as oil rich fish, fibre, fruit and vegetables, which could impact on lipid profiles were not disclosed.

Butter - consistently raises LDL cholesterol

Unlike cheese and yogurt, the evidence for butter is undisputed. Butter saturated fat will elevate LDL cholesterol level.

Rosqvist et al. compared two diets each consumed for 8-weeks, with different dairy products including fat-free milk with butter oil26The fat-free milk group showed no change in LDL cholesterol whilst the butter oil group showed an increase of 13% in LDL cholesterol. 

Brassard et al. in a cross-sectional study design compared two diets containing ~12% saturated fat, but with saturated fats enriched from either cheese or butter27. Compared to butter, the cheese diet resulted in a 0.11mmol/L decrease in LDL cholesterol. The adverse effect of butter on LDL cholesterol was also greatest in participants with higher baseline LDL cholesterol levels.

The composition of dairy food matrices might explain why butter raises cholesterol compared to cheese or yogurt, which seem to have a neutral or cholesterol-lowering effect27–29.

How different dairy foods may impact blood lipids differently?

Proposed mechanisms

Casein (dairy protein) and calcium present in dairy foods is hypothesised to contribute to the unexpected impact on LDL cholesterol observed in certain dairy products30.

 

  • The casein protein matrix found in dairy foods, can trap dairy fat globules within a protective encapsulation known as the ‘milk-fat globule membrane’ (MFGM) which can reduce the absorption of dairy fat from the gut and increase faecal excretion.
  • Additionally, high calcium intakes of 1,800mg compared to 500mg (700mg is the UK recommended intake for adults) in conjunction with moderate protein intakes have been shown to result in a 2.5-fold higher faecal fat excretion30. Potentially, calcium forms 'soaps' with saturated fat in the gut lumen, reducing its absorption by the body31.
  • Further, cheese is also a fermented dairy product, which may influence the whole-food matrix, while butter is churned and refined which removes the MFGM in addition to depleting the calcium content27,28.

Thus when comparing different dairy foods, butter which lacks both casein and calcium, will elevate LDL cholesterol, cheese with the highest concentration of both casein and calcium will show a neutral effect and potentially lowering LDL cholesterol whilst yogurt's effect falls somewhere in between.

Unsaturated fats versus dairy saturated fat

Unsaturated vegetable fats will always be superior to dairy and other animal fats for lipid management. The recent INNOVALAIT Study, a randomized double-blind trial, investigated the effects of vegetable fats versus dairy fats on blood cholesterol over eight weeks in participants with mildly elevated levels32. Four diet groups were compared: vegetable Fat Diet (control diet), spring milk fat diet, winter milk fat diet and winter milk with calcium diet. Each diet aimed for ~38% of energy from total fat, with 12-14% from saturated fats, exceeding current recommendations of no more than 35% total fat and 10% saturated fat.

  • After eight weeks, LDL cholesterol decreased the most (-36%) in the vegetable fat diet.

Similar results were observed in the Brassard et al. trial, comparing cheese and butter-enriched diets to those enriched in polyunsaturated (PUFA) or monounsaturated fats (MUFA)27. Compared to cheese and butter:

  • PUFA-enriched diet resulted in ~12% and 16% lower LDL cholesterol, respectively
  • MUFA-enriched diet resulted in ~5% and ~9% lower LDL cholesterol, respectively

These findings are consistent with the overwhelming evidence from metabolic ward studies that unsaturated fats, and specifically PUFA, exert the greatest cholesterol-lowering effect of all dietary fat subtypes5,33.

The devil is in the detail

Care should always be taken when interpreting the scientific data, as the context in which dairy foods are investigated will influence outcomes. Thus, when reviewing the evidence consideration should be given to:

  • The comparative food. What is dairy being compared to? Other dairy foods, other food sources of saturated fat or other food sources of unsaturated fat?
  • Is dairy compared in isolation or within a mixed healthy diet.
  • Has the total saturated and unsaturated fat intake between the comparative diets been considered; pre and post intervention?
  • Is the study adequately powered and how do baseline lipids levels compare.
  • Have all other dietary factors which can influence blood lipids and CVD outcomes been accounted for e.g., oil rich fish, saturated fat to unsaturated fat ratio, fruit and vegetables, viscous fibres, nuts, use of plant sterols or stanol esters.
  • Have all other confounding factors been accounted for e.g., baseline blood lipids, use of lipid lowering medications, other risk factors etc.
  • If its a meta-analysis, spot check the original studies for the quality of the dietary methodology.

Key sources of saturated fat in the UK diet

UK adult (19-64 years) saturated fat intakes, continue to exceed recommended intakes of no more than 10% of energy (for those at risk, no more than 7% of energy)34.

Currently, adults are consuming 25.3g saturated fat daily, equivalent to 12.3% energy from saturated fat, with little change over the past decade34.

Thus for both public health and for general lipid and cardiovascular mangement, the focus should be on reducing intakes of foods which most contributed to dietary saturated fat intakes.

In the UK, there are three key dietary sources for adults, each contributing to 21% of total saturated fat intakes (i.e., a total of 63% of all saturated fat comes from):

  • Cereal products with added fats (e.g., pizzas, pasta sauces, ready meals, pastries)
  • Dairy – highest contributor is cheese, but closely followed by dairy milk
  • Meat and meat products.

In addition to being one of the top three sources of saturated fat in the UK diet, dairy foods significantly contribute to the high saturated fat content in cereal-based products. This includes cheese used on pizza or in pasta sauces, as well as butter or cream in buns, cakes, and biscuits.

What does this mean in practice?

One to one consultations

During one to one consultations an individual's diet can be scrutinised to a greater degree and personalised nutrition advice can be provided. The nuance of the dairy saturated fat science could be applied.

 

The overarching advice should focus on reducing their personal key food sources of saturated fat, whether they are cereal products, fatty meats or dairy. And ensuring the majority of fat consumed is unsaturated.

 

The health professional should consider:

 

  • the quality of the overall diet – other dietary factors may need to be prioritised
  • the quantity and type of dairy foods consumed – and which are in excess
  • whether salt and energy needs to be moderated

Depending on the above and if dairy foods are consumed daily, the following advice should be considered:

 

  1. Prioritise replacement of dairy butter and other animal fats it with PUFA vegetable fats e.g., sunflower, rapeseed, corn oil. This will bring about the biggest improvement in LDL cholesterol levels.
  2. Avoid all foods that are rich in animal butter and cream.
  3. Switch to lower fat dairy milk and/or fortified plant-based drinks (excluding rice and coconut).
  4. Saturated fat from yogurts and cheese could potentially have a neutral effect on cardiovascular outcomes when consumed as part of a balaced diet and when overall saturated fat intakes are within recommendations20,22,35–37.  Thus it would be prudent to prioritise other saturated fat foods sources in the diet especially animal fats, fatty and processed meats, processed cerealse.g., pastries, ready meals, take-away and fast foods.

Yogurt: if energy needs to be moderated and if yogurt is a primary saturated fat contributor – then advice should be to switch to low fat and fat free varieties without added sugars.

 

Cheese: if it is the main saturated fat contributor and/or energy and salt needs to be reduced in the diet then the advice should be to moderate intakes to no more than 30g (two thumb-widths) daily.

Summary

"Dairy" as a food group may be too broad to capture the nuanced biological responses to saturated fats within different food matrices. Intervention and cohort studies consistently show that butter and full-cream milk increase blood lipids and CVD risk. In contrast, the evidence for cheese and yogurt is more complex; some studies show a neutral effect on serum cholesterol, while others suggest a reduced CVD risk. However, many of these studies have methodological flaws and often fail to account for other factors influencing blood lipids.

For managing blood cholesterol levels and reducing CVD and CHD risk, advice should consider the weight of evidence and place dairy within the context of overall dietary patterns. Despite the nuances between different dairy foods, the evidence for replacing saturated fats with PUFA remains undisputed, and dairy is no exception.

Current recommendations, therefore, are consistent with the overall weight of evidence: the aim should be to reduce all sources of saturated fat to less than 10% of total energy for public health and less than 7% for those at high risk of CVD.

Whether cheese and yogurt need moderation depends on individual dietary patterns and other sources of saturated fat in the diet. Additionally, it should be remembered that cheese is a source of salt and concentrated calories, which should be considered when advising patients.

References

  1. Lovegrove JA, Givens DI. Dairy food products: good or bad for cardiometabolic disease? Nutr Res Rev. 2016;29(2):249-267. doi:10.1017/S0954422416000160
  2. Arnett DK, Blumenthal RS, Albert MA, et al. 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019;140(11):e596-e646. doi:10.1161/CIR.0000000000000678
  3. Visseren FLJ, Mach F, Smulders YM, et al. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice: Developed by the Task Force for cardiovascular disease prevention in clinical practice with representatives of the European Society of Cardiology and 12 medical societies With the special contribution of the European Association of Preventive Cardiology (EAPC). European Heart Journal. 2021;42(34):3227-3337. doi:10.1093/eurheartj/ehab484
  4. NICE. Cardiovascular disease: risk assessment and reduction, including lipid modification. Clinical guideline CG181. Published May 2023. Accessed September 29, 2023. https://www.nice.org.uk/guidance/cg181/chapter/Recommendations#lifestyle-changes-for-the-primary-and-secondary-prevention-of-cardiovascular-disease
  5. Keys A, Anderson JT, Grande F. Prediction of serum-cholesterol responses of man to changes in fats in the diet. Lancet. 1957;273(7003):959-966. doi:10.1016/s0140-6736(57)91998-0
  6. Mensink RP, World Health Organization. Effects of Saturated Fatty Acids on Serum Lipids and Lipoproteins: A Systematic Review and Regression Analysis. World Health Organization; 2016. Accessed October 16, 2023. https://iris.who.int/handle/10665/246104
  7. SACN. Saturated fats and health. GOV.UK. Published August 2019. Accessed October 16, 2023. https://www.gov.uk/government/publications/saturated-fats-and-health-sacn-report
  8. Public Health England. The Eatwell Guide. GOV.UK. Published September 25, 2018. Accessed June 9, 2023. https://www.gov.uk/government/publications/the-eatwell-guide
  9. Lichtenstein AH, Appel LJ, Vadiveloo M, et al. 2021 Dietary Guidance to Improve Cardiovascular Health: A Scientific Statement From the American Heart Association. Circulation. 2021;144(23). doi:10.1161/CIR.0000000000001031
  10. Soltani S, Arablou T, Jayedi A, Salehi-Abargouei A. Adherence to the dietary approaches to stop hypertension (DASH) diet in relation to all-cause and cause-specific mortality: a systematic review and dose-response meta-analysis of prospective cohort studies. Nutrition Journal. 2020;19(1):37. doi:10.1186/s12937-020-00554-8
  11. Shoaibinobarian N, Danehchin L, Mozafarinia M, et al. The Association between DASH Diet Adherence and Cardiovascular Risk Factors. Int J Prev Med. 2023;14:24. doi:10.4103/ijpvm.ijpvm_336_21
  12. Razquin C, Ruiz-Canela M, Wernitz A, et al. Effects of Supplemented Mediterranean Diets on Plasma-Phospholipid Fatty Acid Profiles and Risk of Cardiovascular Disease after 1 Year of Intervention in the PREDIMED Trial. Clin Chem. 2023;69(3):283-294. doi:10.1093/clinchem/hvac221
  13. Laffond A, Rivera-Picón C, Rodríguez-Muñoz PM, et al. Mediterranean Diet for Primary and Secondary Prevention of Cardiovascular Disease and Mortality: An Updated Systematic Review. Nutrients. 2023;15(15):3356. doi:10.3390/nu15153356
  14. Chiavaroli L, Nishi SK, Khan TA, et al. Portfolio Dietary Pattern and Cardiovascular Disease: A Systematic Review and Meta-analysis of Controlled Trials. Progress in Cardiovascular Diseases. 2018;61(1):43-53. doi:10.1016/j.pcad.2018.05.004
  15. Jousilahti P, Laatikainen T, Peltonen M, et al. Primary prevention and risk factor reduction in coronary heart disease mortality among working aged men and women in eastern Finland over 40 years: population based observational study. BMJ. 2016;352:i721. doi:10.1136/bmj.i721
  16. Pietinen P, Vartiainen E, Seppänen R, Aro A, Puska P. Changes in Diet in Finland from 1972 to 1992: Impact on Coronary Heart Disease Risk. Preventive Medicine. 1996;25(3):243-250. doi:10.1006/pmed.1996.0053
  17. Puska P, Jaini P. The North Karelia Project: Prevention of Cardiovascular Disease in Finland Through Population-Based Lifestyle Interventions. Am J Lifestyle Med. 2020;14(5):495-499. doi:10.1177/1559827620910981
  18. Chen M, Li Y, Sun Q, et al. Dairy fat and risk of cardiovascular disease in 3 cohorts of US adults123. The American Journal of Clinical Nutrition. 2016;104(5):1209-1217. doi:10.3945/ajcn.116.134460
  19. Vasilopoulou D, Markey O, Kliem KE, et al. Reformulation initiative for partial replacement of saturated with unsaturated fats in dairy foods attenuates the increase in LDL cholesterol and improves flow-mediated dilatation compared with conventional dairy: the randomized, controlled REplacement of SaturatEd fat in dairy on Total cholesterol (RESET) study. The American Journal of Clinical Nutrition. 2020;111(4):739-748. doi:10.1093/ajcn/nqz344
  20. Jakobsen MU, Trolle E, Outzen M, et al. Intake of dairy products and associations with major atherosclerotic cardiovascular diseases: a systematic review and meta-analysis of cohort studies. Sci Rep. 2021;11(1):1303. doi:10.1038/s41598-020-79708-x
  21. Khaw KT, Friesen MD, Riboli E, Luben R, Wareham N. Plasma phospholipid fatty acid concentration and incident coronary heart disease in men and women: the EPIC-Norfolk prospective study. PLoS Med. 2012;9(7):e1001255. doi:10.1371/journal.pmed.1001255
  22. de Oliveira Otto MC, Mozaffarian D, Kromhout D, et al. Dietary intake of saturated fat by food source and incident cardiovascular disease: the Multi-Ethnic Study of Atherosclerosis. Am J Clin Nutr. 2012;96(2):397-404. doi:10.3945/ajcn.112.037770
  23. Papier K, Knuppel A, Syam N, Jebb SA, Key TJ. Meat consumption and risk of ischemic heart disease: A systematic review and meta-analysis. Critical Reviews in Food Science and Nutrition. 2021;63(3):426-437. doi:10.1080/10408398.2021.1949575
  24. Shi W, Huang X, Schooling CM, Zhao JV. Red meat consumption, cardiovascular diseases, and diabetes: a systematic review and meta-analysis. European Heart Journal. 2023;44(28):2626-2635. doi:10.1093/eurheartj/ehad336
  25. Feeney EL, Barron R, Dible V, et al. Dairy matrix effects: response to consumption of dairy fat differs when eaten within the cheese matrix-a randomized controlled trial. Am J Clin Nutr. 2018;108(4):667-674. doi:10.1093/ajcn/nqy146
  26. Rosqvist F, Smedman A, Lindmark-Månsson H, et al. Potential role of milk fat globule membrane in modulating plasma lipoproteins, gene expression, and cholesterol metabolism in humans: a randomized study. Am J Clin Nutr. 2015;102(1):20-30. doi:10.3945/ajcn.115.107045
  27. Brassard D, Tessier-Grenier M, Allaire J, et al. Comparison of the impact of SFAs from cheese and butter on cardiometabolic risk factors: a randomized controlled trial. Am J Clin Nutr. 2017;105(4):800-809. doi:10.3945/ajcn.116.150300
  28. Biong AS, Müller H, Seljeflot I, Veierød MB, Pedersen JI. A comparison of the effects of cheese and butter on serum lipids, haemostatic variables and homocysteine. Br J Nutr. 2004;92(5):791-797. doi:10.1079/bjn20041257
  29. Nestel PJ, Chronopulos A, Cehun M. Dairy fat in cheese raises LDL cholesterol less than that in butter in mildly hypercholesterolaemic subjects. Eur J Clin Nutr. 2005;59(9):1059-1063. doi:10.1038/sj.ejcn.1602211
  30. Jacobsen R, Lorenzen JK, Toubro S, Krog-Mikkelsen I, Astrup A. Effect of short-term high dietary calcium intake on 24-h energy expenditure, fat oxidation, and fecal fat excretion. Int J Obes (Lond). 2005;29(3):292-301. doi:10.1038/sj.ijo.0802785
  31. Stroebinger N, Rutherfurd SM, Henare SJ, Hernandez JFP, Moughan PJ. Fatty Acids from Different Fat Sources and Dietary Calcium Concentration Differentially Affect Fecal Soap Formation in Growing Pigs. J Nutr. 2021;151(5):1102-1110. doi:10.1093/jn/nxaa438
  32. Bard JM, Drouet L, Lairon D, et al. Effect of milk fat on LDL cholesterol and other cardiovascular risk markers in healthy humans: the INNOVALAIT project. Eur J Clin Nutr. 2020;74(2):285-296. doi:10.1038/s41430-019-0528-4
  33. Clarke R, Frost C, Collins R, Appleby P, Peto R. Dietary lipids and blood cholesterol: quantitative meta-analysis of metabolic ward studies. BMJ. 1997;314(7074):112-117. doi:10.1136/bmj.314.7074.112
  34. PHE. National Diet and Nutrition Survey Rolling Programme Years 9 to 11 (2016/2017 to 2018/2019). Public Health England & FSA UK; 2020:29. https://www.gov.uk/government/statistics/ndns-results-from-years-9-to-11-2016-to-2017-and-2018-to-2019
  35. Ivey KL, Lewis JR, Hodgson JM, et al. Association between yogurt, milk, and cheese consumption and common carotid artery intima-media thickness and cardiovascular disease risk factors in elderly women. Am J Clin Nutr. 2011;94(1):234-239. doi:10.3945/ajcn.111.014159
  36. Qin LQ, Xu JY, Han SF, Zhang ZL, Zhao YY, Szeto IM. Dairy consumption and risk of cardiovascular disease: an updated meta-analysis of prospective cohort studies. Asia Pac J Clin Nutr. 2015;24(1):90-100. doi:10.6133/apjcn.2015.24.1.09
  37. Thorning TK, Raben A, Thorning T, Soedamah-Muthu SS, Givens I, Astrup A. Milk and dairy products: good or bad for human health? An assessment of the totality of scientific evidence. Food & Nutrition Research. 2016;60. doi:10.3402/fnr.v60.32527

Published: 26th June 2024

Our cookies

We use cookies, which are small text files, to improve your experience on our website.
You can allow or reject non essential cookies or manage them individually.

Manage cookiesAllow all

Cookie policy

Our cookies

Allow all

We use cookies, which are small text files, to improve your experience on our website. You can allow all or manage them individually.

You can find out more on our cookie page at any time.

EssentialThese cookies are needed for essential functions such as logging in and making payments. Standard cookies can't be switched off and they don't store any of your information.
AnalyticsThese cookies help us collect information such as how many people are using our site or which pages are popular to help us improve customer experience. Switching off these cookies will reduce our ability to gather information to improve the experience.
FunctionalThese cookies are related to features that make your experience better. They enable basic functions such as social media sharing. Switching off these cookies will mean that areas of our website can't work properly.
AdvertisingThese cookies help us to learn what you're interested in so we can show you relevant adverts on other websites and track the effectiveness of our advertising.
PersonalisationThese cookies help us to learn what you're interested in so we can show you relevant content.

Save preferences