Editorial
Transformational Insights on Dairy Foods beyond Saturated Fatty Acids might be Needed for Cardiovascular Health
2025 Volume 32 Issue 5 Pages 565-566
Details
2025 Volume 32 Issue 5 Pages 565-566
See article vol. 32: 596-607
Cardiovascular disease (CVD) is a leading cause of death worldwide. According to the World Health Organization (WHO), 17.9 million people die every year from CVD, representing 31% of worldwide deaths1). Dietary patterns, including dairy intake, have been implicated in the management and modification of CVD risk2). Because milk and dairy products containing milk fat are major sources of saturated fatty acids (SFAs), which have been linked to an increased risk of cardiovascular-related outcomes such as CVD, including coronary heart disease and stroke, the French paradox was highlighted. This paradox refers to the observation of lower CVD rates in France despite high SFA intake3).
Studies have reported conflicting results regarding the consumption of dairy products and their impact on health outcomes due to their complex composition and fat content. Billions of people worldwide consume dairy products, including milk, cheese, and yogurt4). Unlike in Japan, dairy products are also major food sources of SFAs in the USA4-6). The annual mean per capita milk supply in Japan is 46.8 kg, while that in the US is 218.3 kg4). The intake of SFAs increases LDL cholesterol levels7) and may induce chronic inflammation, thereby increasing the risk of CVD5-8). However, other specific fatty acids in dairy products, including n-6 polyunsaturated fatty acids (PUFAs), have been associated with a lower cardiometabolic risk5, 8). For example, whole milk is primarily water (approximately 88%) and contains approximately 4% fat, 3% protein, 5% carbohydrate (as lactose), and ＜1% vitamins and minerals. Milk contributes significantly to the global intake of calcium, magnesium, riboflavin, and vitamin B12 4).
Miyagawa et al. reported that higher total dairy and milk intake in women and yogurt intake in both men and women were associated with a reduced risk of all-cause mortality in the general population across Japan. The results also showed inverse associations between yogurt intake and CVD risk in women, as well as all-cause mortality risk in both men and women9). One of the intriguing results of this study was that, in women, differences were found in the association between the risk of CVD mortality and milk and yogurt intake. An inverse association was found between yogurt intake and the risk of CVD mortality in women, but not between milk intake and CVD mortality risk. Although the lack of a significant inverse association between milk intake and CVD mortality risk might be due to the low number of mortalities in this study, the other reasons for this discrepancy should also be discussed.
Yogurt is a dairy product produced by the fermentation of milk. A diet high in fermented dairy products, particularly yogurt, may be beneficial for glycemic control and CVD risk10, 11). Beneficial compounds produced in the fermentation process have been shown to improve levels of plasma glucose, serum lipids, and blood pressure, which are CVD risk factors12-14). As recently reported, the Australian Longitudinal Study on Women’s Health found an association between a high intake of total fermented dairy products and a lower CVD risk. However, no associations were found with other dairy groups14). Fermented dairy products may also contribute to the cardiovascular and other health benefits associated with a Mediterranean diet15). It is currently unclear whether the benefits for cardiometabolic risk come from fermentation products or from yogurt itself.
Although dairy consumption was associated with a lower risk of mortality and major CVD events in a diverse multinational cohort, dairy foods, including yogurt, are rich in SFAs, which are related to increased levels of LDL cholesterol and CVD risk5, 6, 16, 17). According to a large body of literature, dietary SFA intake should be reduced and dietary SFAs should be replaced with PUFAs to reduce LDL cholesterol levels and CVD risk. However, as previously reported, the consumption of full-fat dairy foods has a neutral or inverse association with adverse cardiometabolic health outcomes, and the superiority of low-fat dairy compared with full-fat dairy in cardiometabolic health is not necessarily supported by results from recent prospective studies18). Therefore, even though the food matrix alters the biological response to SFAs in dairy foods, further studies and transformational insights are needed to clarify how the dairy food matrix affects LDL-cholesterol and CVD risk in response to SFAs.
H. Yoshida received honoraria for speaking activities and paper-writing fees from Kowa and for advisory fees from Denka.
