Milk-and-Dairy-Products-in-Human-Nutrition-FAO

Chapter 4 – Milk and dairy products as part of the diet 145
adherence to the diets among people selecting their own food or the long-term
effects of the diets on blood pressure and clinical cardiovascular events. Although
European guidelines on CVD prevention recommend healthy nutrition based on
the DASH trial, whether this effect on CVD is due to low-fat dairy product intake
is not yet proven (Soedamah-Muthu et al., 2011). According to other authors, the
DASH study was an efficacy-feeding study, not an effectiveness study; therefore, it
may not have any effect on CHD events despite its known metabolic effects (Yancy
et al., 2003).
The current recommendations by health authorities and governments to eat lowfat
dairy foods in preference to high-fat dairy foods are also supported by the data
published in 1999 from the Nurses Health Study (Hu et al., 1999), which examined
high- versus low-fat dairy foods. This was a large prospective cohort study of
female nurses aged 34–59 years residing in the United States (baseline population
greater than 80 000), and included a 14-year follow-up. This found that total fat
intake was not significantly related to the risk of coronary disease. The study also
showed that the ratio of high-fat dairy (whole milk, hard or cream cheese, ice cream
and butter) to low-fat dairy (skim or low-fat milk, yoghurt and cottage cheese)
consumed was positively associated with risk of CHD, even though separate analyses
of intakes of high-fat and low-fat dairy food showed no significant association
with CHD. Among the dairy products, consumption of whole milk was associated
with a significantly increased risk of CHD. In contrast, a greater consumption of
skim milk was associated with a non-significantly lower risk of CHD. Dairy foods
were among the top five contributors to total saturated fat intake, with hard cheese
contributing 11 percent of the intake and low-fat milk 4 percent.
Bernstein et al. (2010) found that higher intakes of red meat, red meat excluding
processed meat, and high-fat dairy (whole milk, ice cream, hard cheese, full-fat
cheese, cream, sour cream, cream cheese and butter) were significantly associated
with elevated risk of CHD. Higher intakes of poultry, fish and especially nuts were
significantly associated with lower risk. The authors concluded that the risk of
CHD may be reduced by changing the sources of protein in the diet.
In the Cornell China Study, dietary, lifestyle and disease mortality data were
collected in 1983 from 6 500 adults in 65 counties in rural China. People in rural
China consumed one third less fat daily than people in the United States, 10 times
less animal protein and three times more fibre and had profoundly less CVD (5.6-
and 16.7-fold lower, for men and women, respectively) (Campbell and Chen, 1999).
Energy intake per kg of body weight was about 30 percent higher in China than in
the United States, but the prevalence of obesity was much lower in China. Higher
animal protein intake in the United States was linked to higher blood cholesterol
levels. Combined CHD mortality rates for men and women in rural China were
found to be inversely associated with the intake of green vegetables. However,
lifestyle factors other than diet (e.g. spirituality, levels of stress) (Mullin, 2010) and
factors such as smoking, physical activity, adiposity etc. may have confounded
these results.
The Mediterranean-style diet (MD), which refers to a dietary profile commonly
available in the 1960s in the various countries bordering the Mediterranean Sea, has
long been reported to have cardioprotective properties (Sofi et al., 2010; Kastorini
et al., 2011). It is characterized by high consumption of MUFAs, primarily from