The controversial role of dairy products in cardiovascular health: Time to pass from epidemiology to basic research

Dairy products remain an essential part of a balanced diet. However, in an era where food items or entire food groups are deemed as healthy or unhealthy, the hitherto literature regarding milk-derived products remains inconclusive. The vast majority of heart-friendly food patterns persist on promoting the consumption of low-fat over whole-fat milk-derived products. This unanimously propagated claim was raised by the anticipated reduction in the consumed saturated fatty acids. Nevertheless, the relationship between dairy fat and health remains unsettled with current evidence not conclusively pointing to a disease-related benefit one way or another. Focusing on cardiovascular diseases (CVD), a very recent meta-analysis of observational studies revealed from a null to even a
reverse association of dairy products and their particular types with CVD
incidence or mortality, irrespective of their fat content.1,2 On the other side, there are indications that within this diverse food group some products may have different health effects compared with others; for instance, in an updated meta-analyses of Guo et al., 3 marginally inverse associations of total fermented dairy products with all-cause mortality and CVD were observed yet in case of milk a neutral relation was revealed. Such findings spur the need to pose several questions: ‘Does the consumption of dairy products decrease CVD risk?’, ‘Is their nutrient profile linked with cardioprotective mechanisms?’, ‘Do we have to choose specific types of dairy products, i.e. low-fat or full-fat, fermented or non-fermented?’. In this large body of inconclusive evidence regarding dairy products and cardiac health, the contributors of the Prospective Urban Rural Epidemiology study came to provide additional information towards this issue, from an epidemiological standpoint.