The objective of this systematic review was to determine if dairy product consumption is detrimental, neutral, or beneficial to cardiovascular health and if the recommendation to consume reduced-fat as opposed to regular-fat dairy is evidence-based. A systematic review of meta-analyses of prospective population studies associating dairy consumption with cardiovascular disease (CVD), coronary artery disease (CAD), stroke, hypertension, metabolic syndrome (MetS), and type 2 diabetes (T2D) was conducted on the basis of the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. Quality of evidence was rated by using the Grading of Recommendations Assessment, Development, and Evaluation scale. High-quality evidence supports favorable associations between total dairy intake and hypertension risk and between low-fat dairy and yogurt intake and the risk of T2D. Moderate-quality evidence suggests favorable associations between intakes of total dairy, low-fat dairy, cheese, and fermented dairy and the risk of stroke; intakes of low-fat dairy and milk and the risk of hypertension; total dairy and milk consumption and the risk of MetS; and total dairy and cheese and the risk of T2D. High- to moderate-quality evidence supports neutral associations between the consumption of total dairy, cheese, and yogurt and CVD risk; the consumption of any form of dairy, except for fermented, and CAD risk; the consumption of regular- and high-fat dairy, milk, and yogurt and stroke risk; the consumption of regular- and high-fat dairy, cheese, yogurt, and fermented dairy and hypertension risk; and the consumption of regular- and high-fat dairy, milk, and fermented dairy and T2D risk. Data from this systematic review indicate that the consumption of various forms of dairy products shows either favorable or neutral associations with cardiovascular-related clinical outcomes. The review also emphasizes that further research is urgently needed to compare the impact of low-fat with regular- and high-fat dairy on cardiovascular-related clinical outcomes in light of current recommendations to consume low-fat dairy.

Because regular-fat dairy products are a major source of cholesterol-raising saturated fatty acids (SFAs), current US and Canadian dietary guidelines for cardiovascular health recommend the consumption of low-fat dairy products. Yet, numerous randomized controlled trials (RCTs) have reported rather mixed effects of reduced- and regular-fat dairy consumption on blood lipid concentrations and on many other cardiometabolic disease risk factors, such as blood pressure and inflammation markers. Thus, the focus on low-fat dairy in current dietary guidelines is being challenged, creating confusion within health professional circles and the public. This narrative review provides perspective on the research pertaining to the impact of dairy consumption and dairy fat on traditional and emerging cardiometabolic disease risk factors. This comprehensive assessment of evidence from RCTs suggests that there is no apparent risk of potential harmful effects of dairy consumption, irrespective of the content of dairy fat, on a large array of cardiometabolic variables, including lipid-related risk factors, blood pressure, inflammation, insulin resistance, and vascular function. This suggests that the purported detrimental effects of SFAs on cardiometabolic health may in fact be nullified when they are consumed as part of complex food matrices such as those in cheese and other dairy foods. Thus, the focus on low-fat dairy products in current guidelines apparently is not entirely supported by the existing literature and may need to be revisited on the basis of this evidence. Future studies addressing key research gaps in this area will be extremely informative to better appreciate the impact of dairy food matrices, as well as dairy fat specifically, on cardiometabolic health.

Controversies persist concerning the association between intake of dietary saturated fatty acids (SFAs) and cardiovascular disease risk. We compared the impact of consuming equal amounts of SFAs from cheese and butter on cardiometabolic risk factors. In a multicenter, crossover, randomized controlled trial, 92 men and women with abdominal obesity and relatively low HDL-cholesterol concentrations were assigned to sequences of 5 predetermined isoenergetic diets of 4 wk each separated by 4-wk washouts: 2 diets rich in SFAs (12.4-12.6% of calories) from either cheese or butter; a monounsaturated fatty acid (MUFA)-rich diet (SFAs: 5.8%, MUFAs: 19.6%); a polyunsaturated fatty acid (PUFA)-rich diet (SFAs: 5.8%, PUFAs: 11.5%); and a low-fat, high-carbohydrate diet (fat: 25%, SFAs: 5.8%). Serum HDL-cholesterol concentrations were similar after the cheese and butter diets but were significantly higher than after the carbohydrate diet (+3.8% and +4.7%, respectively; < 0.05 for both). LDL-cholesterol concentrations after the cheese diet were lower than after the butter diet (-3.3%, < 0.05) but were higher than after the carbohydrate (+2.6%), MUFA (+5.3%), and PUFA (+12.3%) diets ( < 0.05 for all). LDL-cholesterol concentrations after the butter diet also increased significantly (from +6.1% to +16.2%, < 0.05) compared with the carbohydrate, MUFA, and PUFA diets. The LDL-cholesterol response to treatment was significantly modified by baseline values (-interaction = 0.02), with the increase in LDL cholesterol being significantly greater with butter than with cheese only among individuals with high baseline LDL-cholesterol concentrations. There was no significant difference between all diets on inflammation markers, blood pressure, and insulin-glucose homeostasis. The results of our study suggest that the consumption of SFAs from cheese and butter has similar effects on HDL cholesterol but differentially modifies LDL-cholesterol concentrations compared with the effects of carbohydrates, MUFAs, and PUFAs, particularly in individuals with high LDL cholesterol. In contrast, SFAs from either cheese or butter have no significant effects on several other nonlipid cardiometabolic risk factors. This trial was registered at clinicaltrials.gov as NCT02106208.

Twenty-four-hour dietary recalls can provide high-quality dietary intake data, but are considered expensive, as they rely on trained professionals for both their administration and coding. The objective of this study was to develop an automated, self-administered web-based 24-h recall (R24W) for a French-Canadian population. The development of R24W was inspired by the United States Department of Agriculture (USDA) Automated Multiple-Pass Method. Questions about the context of meals/snacks were included. Toppings, sauces and spices frequently added to each food/dish were suggested systematically. A list of frequently forgotten food was also suggested. An interactive summary allows the respondent to track the progress of the questionnaire and to modify or remove food as needed. The R24W prototype was pre-tested for usability and functionality in a convenience sample of 29 subjects between the ages of 23 and 65 years, who had to complete one recall, as well as a satisfaction questionnaire. R24W includes a list of 2865 food items, distributed into 16 categories and 98 subcategories. A total of 687 recipes were created for mixed dishes, including 336 ethnic recipes. Pictures of food items illustrate up to eight servings per food item. The pre-test demonstrated that R24W is easy to complete and to understand. This new dietary assessment tool is a simple and inexpensive tool that will facilitate diet assessment of individuals in large-scale studies, but validation studies are needed prior to the utilization of the R24W.

Abstract Background Recent evidence suggests that the association between dietary saturated fatty acids (SFAs) and coronary artery disease risk varies according to food sources. How SFAs from butter and cheese influence HDL-mediated cholesterol efflux capacity (CEC), a key process in reverse cholesterol transport, is currently unknown. Objective In a predefined secondary analysis of a previously published trial, we have examined how diets rich in SFAs from either cheese or butter influence HDL-mediated CEC, compared with diets rich in either monounsaturated fatty acids (MUFAs) or polyunsaturated fatty acids (PUFAs). Methods In a randomized crossover controlled consumption trial, 46 men and women with abdominal obesity consumed 5 isocaloric diets, each for 4 wk. Two diets were rich in SFAs either from cheese (CHEESE) or butter (BUTTER) [12.4–12.6% of energy (%E) as SFAs, 32%E as fat, 52%E as carbohydrates]. In 2 other diets, SFAs (5.8%E) were replaced with either MUFAs from refined olive oil (MUFA) or PUFAs from corn oil (PUFA). Finally, a lower fat and carbohydrate diet was used as a control (5.8%E as SFAs, 25.0%E as fat, 59%E as carbohydrates; CHO). Post-diet HDL-mediated CEC was determined ex vivo using radiolabelled J774 macrophages incubated with apolipoprotein B–depleted serum from the participants. Results Mean (±SD) age was 41.4 ± 14.2 y, and waist circumference was 107.6 ± 11.5 cm in men and 94.3 ± 12.4 cm in women. BUTTER and MUFA increased HDL-mediated CEC compared with CHEESE (+4.3%, P = 0.026 and +4.7%, P = 0.031, respectively). Exploring the significant diet × sex interaction (P = 0.044) revealed that the increase in HDL-mediated CEC after BUTTER compared with CHEESE was significant among men (+6.0%, P = 0.047) but not women (+2.9%, P = 0.19), whereas the increase after MUFA compared with CHEESE was significant among women (+9.1%, P = 0.008) but not men (–0.6%, P = 0.99). Conclusion These results provide evidence of a food matrix effect modulating the impact of dairy SFAs on HDL-mediated CEC with potential sex-related differences that deserve further investigation. This trial was registered at clinicaltrials.gov as NCT02106208.

OBJECTIVEThe association between dietary saturated fat (SFA) intake and cardiovascular disease risk remains controversial. Emerging data suggest that SFA from different sources may show different association with cardiovascular and cardiometabolic risk. The objective of this study was to examine how SFA from cheese (CHEESE) influences HDL‐mediated cholesterol efflux capacity (CEC), a key anti‐atherogenic property of HDL, compared with a low fat/high carbohydrate diet (CHO), a diet rich in SFA from butter (BUTTER) and diets either high in monounsaturated (MUFA) or polyunsaturated fatty acids (PUFA).METHODSA total of 46 men and women with abdominal obesity and with relatively low HDL cholesterol (HDL‐C) completed this randomized crossover controlled trial consisting of 5 predetermined isoenergetic diets of 4 weeks each (Table 1): 1) CHEESE, 2) BUTTER, 3) MUFA, 4) PUFA, 5) CHO. All foods were provided to participants during each experimental diet. CEC was assessed with radiolabelled J774 macrophages using apolipoprotein B depleted serum samples taken from participants at the end of each dietary phase. HDL lipid composition (gas chromatography) and HDL particle size distribution (polyacrylamide gradient gel electrophoresis) were also assessed.RESULTSAll higher fat diets increased HDL‐C concentrations compared to CHO (all p<0.001). BUTTER and CHEESE increased low‐density lipoprotein cholesterol (LDL‐C) concentrations more than CHO, MUFA and PUFA diets, particularly among individuals with high baseline LDL‐C (all p<0.001). LDL‐C concentrations tended to be greater after BUTTER than after CHEESE (p=0.07). BUTTER, PUFA and CHEESE significantly increased large HDL2b levels compared to CHO (all p≤0.01). BUTTER also increased HDL2b levels more than MUFA (p=0.04). There was no difference in HDL‐mediated CEC between CHEESE and CHO (p=NS). BUTTER significantly increased HDL‐mediated CEC compared to CHEESE and CHO (both p<0.05). MUFA also increased CEC compared to CHEESE and CHO (both p<0.05). PUFA had no significant effect on HDL CEC compared to the others diets (p=NS). The increase in LDL‐C after BUTTER (vs. CHO) was significantly correlated with concurrent increase in CEC in men (r=0.44, p=0.04), but not in women (r=0.27, p=0.20).CONCLUSIONSThese results provide evidence of a matrix effect modulating the effects of dairy SFA on HDL characteristics and function, with greater changes seen with SFA from butter than with SFA from cheese in men and women with abdominal obesity and with relatively low HDL‐C levels. The increase in HDL‐mediated CEC seen with SFA from butter parallels the increase in LDL‐C among men, but not among women. Additional studies assessing other HDL functions will provide further insights on how the food source may modify the effects of SFA on cardiometabolic risk.Support or Funding InformationDairy Research Cluster Initiative (Dairy Farmers of Canada, Agriculture and Agri‐Food Canada, the Canadian Dairy Network and the Canadian Dairy Commission) and the National Dairy Council. Macronutrients (% energy), calcium, sodium and fibers content of experimental diets CHEESE BUTTER MUFA PUFA CHO Lipids (%) 32.0 32.0 32.0 32.0 25.0 SFA (%) 12.6 12.4 5.8 5.8 5.8 MUFA (%) 12.5 12.3 19.6 12.6 12.6 PUFA (%) 4.8 4.8 4.8 11.5 4.8 Carbohydrates (%) 51.9 52.0 51.9 51.9 58.9 Proteins (%) 16.0 16.0 16.0 16.0 16.0 Calcium (mg/2500 kcal) 1261 811 812 812 842 Sodium (mg/2500 kcal) 2482 2480 2479 2479 2485 Fibers (g/2500 kcal) 31 31 31 31 31

BackgroundLow‐density lipoproteins (LDL) constitute a heterogeneous class of lipoproteins among which small and dense LDL may be more atherogenic than large LDL particles, independent of cholesterol concentrations. The aim of this study was to examine how consumption of saturated fat (SFA) from different dairy sources modifies the LDL particle size phenotype compared with other dietary fats (monounsaturated ‐ MUFA and polyunsaturated fat‐ PUFA) and a low‐fat diet/high carbohydrate diet.MethodsA randomized crossover controlled trial was conducted in 92 men and women with abdominal obesity and relatively low HDL‐C. Subjects were assigned to sequences of 5 isoenergetic diets of 4 weeks each (Table): 1) a diet rich in SFA from cheese (CHEESE); a diet rich in SFA from butter (BUTTER); a diet rich in MUFA; a diet rich in PUFA and a low‐fat, high carbohydrate diet (CHO). All foods were provided to the participants during the experimental phases. Features of the LDL particle size phenotype (mean LDL particle size, proportion of small and large) were assessed by one dimension nondenaturing polyacrylamide gel electrophoresis.ResultsLDL particle size at baseline (mean±SD) in women was larger than in men (252.24±2.85 vs. 251.67±3.49, p=0.04), although differences were no longer significant after adjustment for waist circumference. The CHEESE diet had no significant impact on all phenotypic measures of LDL particle size compared with BUTTER, CHO, MUFA and PUFA. Consumption of the BUTTER diet significantly increased LDL mean size compared with CHO (p=0.021) and MUFA (p=0.005). The increase in mean LDL size with BUTTER was more apparent among individuals with small LDL particles at baseline than among those with large LDL (P treatment × baseline LDL size=0.047). There was no difference in the distribution of small and large LDL particles among diets.ConclusionsResults from this full‐feeding study suggest 1‐ that SFA from butter and cheese have similar effects on features of the LDL particle size phenotype, and 2‐ that consumption of SFA from butter may be associated with less atherogenic LDL particles. These data are partly consistent with the fact that consumption of cheese and butter are not associated with an increased risk of cardiovascular disease.Support or Funding InformationSource of Research Support : Dairy Research Cluster Initiative (Dairy Farmers of Canada, Agriculture and Agri‐Food Canada, the Canadian Dairy Network and the Canadian Dairy Commission). Macronutrient (% energy), calcium and sodium content of experimental diets CHEESE BUTTER MUFA PUFA CHO Lipids (%) 32.0 32.0 32.0 32.0 25.0 SFA (%) 12.6 12.4 5.8 5.8 5.8 MUFA (%) 12.5 12.3 19.6 12.6 12.6 PUFA (%) 4.8 4.8 4.8 11.5 4.8 Carbohydrates (%) 51.9 52.0 51.9 51.9 58.9 Proteins (%) 16.0 16.0 16.0 16.0 16.0 Calcium (mg/2500 kcal) 1261 811 812 812 842 Sodium (mg/2500 kcal) 2482 2480 2479 2479 2485 Fibers (g/2500kcal) 31 31 31 31 31