Results of the Copenhagen Cheese Studies: Importance of the matrix

Tanja Kongerslev Thorning, Post doc Arne Astrup, Professor MD

University of Copenhagen

World Dairy Summit 2016

Saturated fat

• SF has for decades been considered being the bad guy

• Known to increases LDL-cholesterol

• Also SF increases HDL-cholesterol and reduces TG

• Humans does not eat groups of fatty acids but complex foods with mixtures of fatty acids

Micha & Mozaffarian, Lipids (2010)

Saturated fat

Is saturated fat independent on the food matrix?

Favors a high cheese intake

Prospective studies of cheese intake and risk of CVD, CHD and stroke

Chen et al. (2016) Eur J Nutr., Aug 12

Intervention studies on cheese intake and LDL-cholesterol

= correct?

De Goede et al.

Nutrition Reviews (2015)

High content of active components in cheese

Calcium *

(per 100 g)

Phosphate *

(per 100 g)

Fermented

(+/-)

MFGM **

(per 100 g)

Whey/casein

Cheese (25%) 659 mg 510 mg + 0.15 g casein

Milk (skimmed) 124 mg 96.8 mg - 0.015 g whey/casein

Milk (whole) 116 mg 93 mg - 0.035 g whey/casein

Yoghurt (low fat) 136 mg 99 mg + ~ 0.015 g whey/casein

Cream (38%) 67 mg 57 mg - 0.20 g -

Butter 15 mg 24 mg - - -

http://frida.fooddata.dk/ DTU ** Dewettinck et al. (2008), International Dairy Journal vol 18, 436–457 + Conway et al (2014), Animal Frontiers , Vol. 4, No. 2

The cheese-matrix may modulate the effect of saturated fat on LDL-cholesterol

Possible mechanisms of cheese

Milk fat globule membrane - polar lipids

Fermentation and ripening - bacteria

Minerals - calcium and phosphate

Reduce hepatic de novo FA synthesisModulate expression of genes in lipid metabolism

Inhibit intestinal cholesterolabsorption

Change gut microbiotacomposition

We need to study foods rather than nutrients!

Generate bioactivecomponents

Amorphous calcium-phosphate

• Favors long chain saturated fattyacids

Christensen et al., obesity reviews (2009)

Lorenzen and Astrup, Am. J. Clin. Nutr. (2007)

Ch

ylo

mic

ron

TG (

mm

ol/

L)Calcium fatty acid soaps

Dairy calcium from milk and cheese

Am J Clin Nutr 2014;99:984–91.

The Copenhagen Cheese Project (4 studies)

The aim was to examine the effects of• Cheese fat content• Cheese ripening duration• Cheese saturated fatty acid composition

…on • Fecal fat excretion• Markers of cardiovascular disease • Markers of type 2 diabetes

Study I:Fat within cheese-matrix vs. outside cheese-matrix (porcine)

14-day parallel intervention in 36 pigs

Study dietsThree iso-caloric macronutrient-matched intervention diets

REG: diet with regular-fat cheese RED: diet with reduced-fat cheese + butter BUT: control diet with butter

Strongcorrelation!

r=0.86 (P< 0.0001)

Importance of the location of dairy-fat?

Results of the Copenhagen Cheese Studies: Importance of the matrix

Lack of difference in LDL-cholesterol may be due to balancing diets with potato protein

Study II:Regular-fat vs. reduced-fat cheese vs. CHO (Humans)

• Parallel study in 139 free-living subjects with metabolic syndrome

• 3-months equal intake of regular-fat cheese to reduced-fat cheese or an isocaloric amount of carbohydrate-rich foods

(AJCN, 2016, in press)

Blood lipids• No difference in LDL-cholesterol concentrations between regular- or reduced-fat

cheese• Despite significant differences in dietary fat E% and saturated fat intake• Tendency to an increase in HDL-cholesterol concentration by regular-fat cheese

Currently awaiting particle size data…

Body weight• No difference in body weight• ~200 kJ/d lower energy supply with the reduced-fat cheese• May support an importance of the fat excretion (stronger with regular-fat cheese)• Fat excretion not measured

Study II:Regular-fat vs. reduced-fat cheese vs. CHO (Humans)

McSweeney (2004)

Study III:Cheese ripening time (porcine)

21-day parallel intervention in 36 pigs

Isocaloric diets with equal amounts of cheese (35g cheese/100g diet)

4-MRC: 4-month ripened cheddar14-MRC: 14-month ripened cheddar24-MRC: 24-month ripened cheddar

4-MRC 14-MRC 24-MRC

Casein % 13.0 7.6 7.2 Peptides % 7.4 10.1 9.3 Free amino acids % 2.7 4.8 7.4

Study III:Cheese ripening time (porcine)

• No differences in TC, LDL, HDL, or TG after intake of the cheeses

• No difference in plasma glucose after intake of the cheeses

Long-term ripened cheddar may improve insulin sensitivity

Study III:Cheese ripening time (porcine)

Study IV:Saturated fat in cheese vs. meat vs. CHO (humans)

• 14-day 3-period cross-over study• 14 overweight, postmenopausal women with slightly increased cholesterol

Fecal fat excretion depends on:

• the dietary fat content

• the calcium content

Study IV:Saturated fat in cheese vs. meat vs. CHO (humans)

0

0,2

0,4

0,6

0,8

1

1,2

1,4

1,6

1,8

CHEESE diet CARB diet MEAT diet

HD

L-C

(m

mo

l/L)

0

0.2

0.4

0.6

0.8

1

1.2

1.4

1.6

CHEESE diet CARB diet MEAT dietA

po

A-1

(g

/L)

ab a

P diet= 0.002

P diet= 0.002

Surprisingly, no difference in LDL-cholesterol

ab

a HDL responsedepends on the

dietary fat content

Study IV:Saturated fat in cheese vs. meat vs. CHO (humans)

Carbohydrates expected to reduce LDL-cholesterol compared to saturated fat

Explained by the higher fecal bile acid excretion with cheese and meat?

Study IV:Saturated fat in cheese vs. meat vs. CHO (humans)

ConclusionsFecal fat excretion• Cheese increases fecal fat excretion compared to carbohydrates, butter, and

meat• The effect may be strongest for fat imbedded in the cheese-matrix (porcine)• Fecal fat excretion is not affected by the ripening duration (porcine)

Blood lipids• Cheese causes less increase in LDL-cholesterol compared to butter, but similar

LDL-cholesterol as a diet with a high meat or carbohydrate content • Regular-fat cheese seems to have a distinct effect on HDL-cholesterol but equal

effect on LDL-cholesterol compared to reduced-fat cheese• A long-term ripened cheese (cheddar) causes lower NEFA concentration than

short-term ripened cheese (in porcine)

Insulin sensitivity• Long-term ripened cheese (cheddar) improves HOMA-IR (in porcine)

• More research in whole foods

• Moving towards food based dietary guidelines

• Studies including a broader range of cardiovascular risk markers

• One diet does not fit all – moving towards personalized nutrition

True?

Future perspectives

Acknowledgements

Study participants

Funding

Danish Dairy Research Foundation

Dairy Research Institute (USA)

Dairy farmers of Canada

National Interprofessional Center

for Dairy Economy (France)

Dairy Australia

Dutch Dairy Association

Colleagues

Arne Astrup, UCPH

Anne Raben, UCPH

Farinaz Raziani, UCPH

Tine Tholstrup, UCPH

Nathalie Bendsen, UCPH

Janne Lorenzen, UCPH

Pia Kiilerich, UCPH

Ylva Ardö, UCPH

Henry Jörgensen, AU

Søren Krogh Jensen, AU