Does dairy fat matters?

A review of the effects of cheese

and dairy matrix on health

Benoît Lamarche, PhD

Chair of Nutrition

School of Nutrition,

INAF, Université Laval

Québec, Canada

IDF World Dairy

Summit

Rotterdam

October 2016

DisclosuresFunding (last 5 years)

• CIHR, NSERC, FRQ-NT, FRQ-S

• Dairy Farmers of Canada/Agriculture Agri-Food Canada

• Dairy Research Institute

• Canola Council of Canada/Agriculture Agri-Food Canada

• Atrium Innovations

• Merck Frosst

Other (advisory, honoraria, last 5 years)• Health Canada

• Canadian Nutrition Society

• Centre Européen pour la Nutrition & la Santé (CENS)

• Dairy Farmers of Canada

• Danone Canada

Recommendations

regarding dairy:

Low fat dairy.

« Take a few portions of dairy producedaily, including milk or yogurt »

EJCN 2016 70, 869–878

« A disctinction between the effects of low fat and high fat dairy produce was not possible, because of insufficient evidence »

Dairy fat: harmful or beneficial?

Can J Cardiol 2016 Aug;32(8):1026-32

+

• High quality protein

• Calcium

• Vit D

• Other Vit, minerals

• Displacement effect

-

• SFA intake

• Allergies, intolerance

• Environmental issues

Sources of SFA, US Population age > 2 yrs

NHANES 2005–2006

SFA 12%9%

2010: SFA vs CHD risk…?

7

Hjerpsted, Am J Clin Nutr 2011;94:1479–84.

Cheese vs. butter lowers LDL-C

Run-in Cheese Butter

13% of energy from cheese or butter

Tessier-Grenier, unpublished

HDL Trial

Study design

Diet 2

Visits

Medical Evaluation

Randomization

Feeding

Anthropometry

OUTCOMES

HDL related

Lipids, apos, particle size

Inflammation

2 3 4Weeks 1Re

cru

tme

nt

Diet 1 Diet 3 Diet 4

1 2 3 4

Diet 5

2 3 41 1 2 3 4 1 2 3 4

Washout Washout Washout Washout

CHEESE BUTTER MUFA PUFA CHO

Energy1 (kcal) 2654 ± 567 2615 ± 537 2649 ± 576 2649 ± 576 2618 ± 561

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

CHO (%) 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 (mg/2500 kcal) 31 31 31 31 31

Methods

Experimental diets

Values are means ± SD Tessier-Grenier et al unpublished

Methods

• 92 men and women• 18 - 65 years• Waist ≥ 94 cm ♂ et ≥ 80 cm ♀

• HDL-C ≤ 1,43 mmol/L ♂ et ≤ 1,64 mmol/L ♀• Stable weight ≥ 3 mo• Ø diabetes, smokers, CVD, endocrine

disorders, food allergies, vegetarians• Medication stable ≥ 6 mo

Tessier-Grenier et al unpublished

HDL TrialResults LDL-C

P tx*baseline LDL-C =0.01

Tessier-Grenier et al unpublished

vs. CHO vs. MUFA vs. PUFAvs. Cheese

Low High Low High Low High

0

0,1

0,2

0,3

0,4

0,5

0,6

0,7

Low High

Baseline LDL-C

ΔL

DL

-C (

mm

ol/

l)

P<0.05

P<0.05

P<0.05

P<0.05

Cheese

Butter

Tessier-Grenier, unpublished

HDL TrialResults HDL-C

CHEESE BUTTER MUFA PUFA

0,6

0,7

0,8

0,9

1,0

1,1

1,2

1,3

CHO

HD

L-C

(m

mo

l/L

)

P<0.05

HDL function/proteomic

Richard et al, JNN 2014

Acutephase

Antioxidant

Binding

Coagulation

Cholesterolhomeostasis

Complement activationComplement inhibition

Immune response

Oxygen transport

Proteolysis

HDL mediated Chol efflux

Rader JCI 2006

Impact of the food matrix

Brassard et al unpublished

dE

fflu

xv

s.

CH

O

CHEESE BUTTER MUFA PUFA

Impact of the food matrix

Tessier-Grenier et al unpublished

CHEESE BUTTER MUFA PUFA CHO P

hs-CRP 2.82 ± 2.82 2.48 ± 2.40 2.15 ± 2.03 2.56 ± 2.53 2.53 ± 2.38 0.88

Adiponectin 7.01 ± 3.14 7.07 ± 2.91 7.05 ± 3.00 6.95 ± 2.89 6.86 ± 2.83 0.77

Systolic BP 109.9 ± 13.4 109.0 ± 12.4 111.4 ± 12.9 109.9 ± 13.0 109.8 ± 12.6 0.19

Diastolic BP 70.0 ± 10.4 68.9 ± 9.8 68.7 ± 9.8 68.8 ± 11.3 69.9 ± 10.0 0.36

Fasting Glucose 4.99 ± 0.57 4.96 ± 0.54 4.97 ± 0.51 4.99 ± 0.55 4.94 ± 0.55 0.88

Insulin 118 ± 70 118 ± 60 120 ± 81 118 ± 64 115 ± 55 0.65

HOMA-IR 3.85 ± 2.57 3.78 ± 2.03 3.89 ± 2.88 3.82 ± 2.82 3.65 ± 1.88 0.48

SFA and Cardiometabolic risk

ApoB

LDL-C

HDL-C

Coagulation

Vascular

Insulin

Inflammation

SBP

Sources of SFA vs risk?

?

Reduced Increased

5% increase in ES

ou

rce

of

SF

A

0 0,5 1 1,5 2 2,5

Total

Dairy

Meat

Butter

Plant

Mixed

-29%

-38%

+48%

-17%

-38%

-17%

Hazard Ratio for CVD

FOOD-SPECIFIC SFA AND CVD De Oliviera Otto et al Am J Clin Nutr 2012;96:397–404

N=5209Follow-up 10 yrs

Dairy fat: good or bad ?

Systematic-review of the association

between dairy product consumption

and risk of cardiovascular-related

clinical outcomes

Drouin-Chartier, Côté, Brassard, Tessier-

Grenier, Labonté, Desroches, Couture,

Lamarche

Adv Nutr 2016 (in press)

Adv Nutr in press 2016

Dairy: good or bad ?

Adv Nutr in press 2016

1.Is dairy consumption detrimentally,

neutrally or beneficially associated with

cardiovascular-related clinical

outcomes?

2.Is the recommendation to consume low-

fat, as opposed to regular/high-fat dairy,

evidence-based?

Dairy: good or bad ?

Elwood et al. 2004

Elwood et al. 2008

Elwood et al. 2010

Soedamah-Muthu et al. 2011

Tong et al. 2011

Bendsen et al. 2011

Ralston et al. 2012

Soedamah-Muthu et al. 2012

Aune et al. 2013

Gao et al. 2013

O'Sullivan et al. 2013

Chen et al. 2014

Chowdhury et al. 2014

Hu et al. 2014

Qin et al. 2015

De Souza et al. 2015

Larsson et al. 2015

Chen et al. 2015

Kim and Je 2015

Alexander et al. 2016

Gijsberg et al. 2016

Adv Nutr in press 2016

Dairy and risk of CHDSystematic review - meta-analyses

0,60 0,70 0,80 0,90 1,00 1,10 1,20 1,30 1,40

Total dairy

High-fat

Low-fat

Dairy fat

Milk

Cheese

Yogurt

Fermented

Relative risk

17:0 Chowdhury et al., 2014 (47)

15:0 Chowdhury et al., 2014 (47) 15:0 De Souza et al., 2015 (46)

R-TFA De Souza et al., 2015 (46)

Soedamah-Muthu et al., 2011 (30)Qin et al., 2015 (9)

Qin et al., 2015 (9)

Elwood et al., 2010 (49)Qin et al., 2015 (9)

Elwood et al., 2004 (22)Elwood et al., 2008 (48)Elwood et al., 2010 (49)Soedamah-Muthu et al., 2011 (30)

R-TFA Bendsen et al., 2011 (45)

17:0 De Souza et al., 2015 (46)Cis16:1 ω-7 Chowdhury et al., 2014 (47)

Alexander et al., 2016 (10)

Alexander et al., 2016 (10)

Alexander et al., 2016 (10)

Alexander et al., 2016 (10)

Soedamah-Muthu et al., 2011 (30)Qin et al., 2015 (9)Alexander et al., 2016 (10)

Soedamah-Muthu et al., 2011 (30)Qin et al., 2015 (9)Alexander et al., 2016 (10)

Dairy and risk of strokeSystematic review - meta-analyses

0,60 0,70 0,80 0,90 1,00 1,10 1,20 1,30 1,40

Total dairy

High-fat

Low-fat

Dairy fat

Milk

Cheese

Yogurt

Fermented

Relative risk

Hu et al., 2014 (81)Qin et al., 2015 (9)

Hu et al., 2014 (81)Qin et al., 2015 (9)

Hu et al., 2014 (81)Qin et al., 2015 (9)

Elwood et al., 2004 (22)Elwood et al., 2008 (48)Elwood et al., 2010 (49)Soedamah-Muthu et al., 2011 (30)Hu et al., 2014 (81)

Elwood et al., 2010 (49)Hu et al., 2014 (81)Qin et al., 2015 (9)

Qin et al., 2015 (9)

Hu et al., 2014 (81)

Alexander et al., 2016 (10)

Alexander et al., 2016 (10)

Alexander et al., 2016 (10)

Alexander et al., 2016 (10)

Alexander et al., 2016 (10)

Dairy and risk of type 2 diabetesSystematic review - meta-analyses

0,40 0,60 0,80 1,00 1,20 1,40

Total dairy

High-fat

Low-fat

Dairy fat

Milk

Cheese

Yogurt

Fermented

Relative risk

Elwood et al., 2010 (49)Tong et al., 2011 (120)Gao et al., 2013 (121)Aune et al., 2013 (122)Chen et al., 2014 (123)

Tong et al., 2011 (120)Gao et al., 2013 (121)Aune et al., 2013 (122)

Tong et al., 2011 (120)Gao et al., 2013 (121)Aune et al., 2013 (122)

R-TFA De Souza et al., 2015 (46)15:0 De Souza et al., 2015 (46)17:0 De Souza et al., 2015 (46)

Elwood et al., 2008 (48)Gao et al., 2013 (121)Aune et al., 2013 (122)

HF milk - Tong et al., 2011 (120)HF milk - Gao et al., 2013 (121)

LF milk - Gao et al., 2013 (121)

Gao et al., 2013 (121)Aune et al., 2013 (122)

Tong et al., 2011 (120)Gao et al., 2013 (121)Aune et al., 2013 (122)Chen et al., 2014 (123)

Gao et al., 2013 (121)Aune et al., 2013 (122)

Gijsbers et al., 2016 (124)

HF Gijsbers et al., 2016 (124)

LF milk Gijsbers et al., 2016 (124)

Gijsbers et al., 2016 (124)

Gijsbers et al., 2016 (124)

Gijsbers et al., 2016 (124)

Gijsbers et al., 2016 (124)

Gijsbers et al., 2016 (124)

Gijsbers et al., 2016 (124)

Dairy and healthSystematic review - meta-analyses

GRADE:Grading of Recommendations Assessment, Development and Evaluation

Quality assessment:

HIGH: further research very unlikely to change

confidence in the risk estimate

MODERATE: further research likely to have an

important impact on confidence in the effect

and may change the risk estimate

LOW, VERY LOW…

CVD CHD Stroke BP MetS T2D

Total dairyNeutralModerate

NeutralHigh

FavorableModerate

FavorableHigh

FavorableModerate

FavorableModerate

Milk UncertainNeutralModerate

NeutralModerate

FavorableModerate

FavorableModerate

NeutralModerate

CheeseNeutral

High

NeutralModerate

FavorableModerate

NeutralHigh

UncertainFavorable

Moderate

YogurtNeutralModerate

NeutralModerate

NeutralModerate

NeutralModerate

UncertainFavorable

High

GRADE assessment of evidence

Unresolved issues• Do regular/full fat and reduced/non-fat dairy

products have similar or different effects on

health outcomes?

• To what extent are potential health effects of

dairy consumption modulated by the foods it is

replacing in the diet?

• What is the impact of dairy consumption on

other vascular-related disease outcomes such

as peripheral arterial disease, chronic kidney

disease and cognitive decline?

Can J Cardiol 2016 Aug;32(8):1026-32

Take home messages

• Consumption of dairy poses no health

riskCould dairy simply be neutral foods?

• Consumption of specific dairy products

may have favorable health effectsOn their ownBy replacing other foodsBy contributing to specific nutrients

• Current recommendations on low fat

dairy needs to be substantiated

Remerciements

Amélie Charest

Iris Gigleux

Johanne

Marin

Marie-Ève

Paradis

Georges

Cousineau

Steve

Larouche

Louise

Corneau

Valérie

Guay

Danielle

Aubin

Sandra

Gagnon

Julie

Maltais-G.

Marie-Claude

Lépine

36

Thank you!