Low SF fermented dairy may be better than non-fermented for CVD

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circular
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Low SF fermented dairy may be better than non-fermented for CVD

Post by circular »

Here's an interesting new comparison of fermented dairy vs non-fermented in 1981 men. I don't have access. I'm suspicious about the part in the abstract suggesting they based results on a measly four-day diet questionnaire? I'm hoping the full text is more illuminating and encouraging. I'm also clueless when it comes to interpreting the statistics:

Intake of fermented and non-fermented dairy products and risk of incident CHD: the Kuopio Ischaemic Heart Disease Risk Factor Study
During a mean follow-up of 20·1 years, 472 CHD events were recorded. Median intakes were 105 g/d for fermented (87 % low-fat products) and 466 g/d for non-fermented dairy products (60 % low-fat products). After adjusting for potential confounders, those in the highest (v. lowest) intake quartile of fermented dairy products had 27 % (95 % CI 5, 44; P-trend=0·02) lower risk of CHD. In contrast, those in the highest intake quartile of non-fermented dairy products had 52 % (95 % CI 13, 104; P-trend=0·003) higher risk of CHD. When analysed based on fat content, low-fat (<3·5 % fat) fermented dairy product intake was associated with lower risk (hazard ratio in the highest quartile=0·74; 95 % CI 0·57, 0·97; P-trend=0·03), but high-fat fermented dairy and low-fat or high-fat non-fermented dairy products had no association. These results suggest that fermented and non-fermented dairy products can have opposite associations with the risk of CHD. [Emphasis added]
ApoE 3/4 > Thanks in advance for any responses made to my posts.
BrianR
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Re: Low SF fermented dairy may be better than non-fermented for CVD

Post by BrianR »

circular wrote:Here's an interesting new comparison of fermented dairy vs non-fermented in 1981 men....
Science Daily has marginally more detail,
When the study participants were divided into four groups on the basis of their consumption of fermented dairy products with less than 3.5% fat, the risk of incident coronary heart disease was 26% lower in the highest consumption group compared to the lowest consumption group. Sour milk was the most commonly used low-fat fermented dairy product. The consumption of high-fat fermented dairy products, such as cheese, was not associated with the risk of incident coronary heart disease.

However, the researchers found that a very high consumption on non-fermented dairy products was associated with an increased risk of incident coronary heart disease. Milk was the most commonly used product in this category, and a very high consumption was defined as an average daily milk intake of 0.9 litres. Lower consumption levels were not associated with the risk.
I wonder if the "beneficial effect" is really just crowding out a detrimental effect. That is, if the higher SFA dairy products are appreciably more harmful, at least for some of the population, but you're a fermented low-fat dairy kind of person, you don't get the effect of the additional harm.

This seems like another one of those studies where you'd like to see genetic sampling and stratification of all the participants.
circular
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Re: Low SF fermented dairy may be better than non-fermented for CVD

Post by circular »

BrianR wrote:I wonder if the "beneficial effect" is really just crowding out a detrimental effect.
Good question, but I'm guessing that the probiotics have some beneficial effects the non-fermented group may not be getting regularly any othe way, in addition to benefits of the lower saturated fat intake, at least in some. Weren't they saying that the lower fat fermented group did better than the lower fat non-fermented group?
ApoE 3/4 > Thanks in advance for any responses made to my posts.
BrianR
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Re: Low SF fermented dairy may be better than non-fermented for CVD

Post by BrianR »

circular wrote:Good question, but I'm guessing that the probiotics have some beneficial effects the non-fermented group may not be getting regularly any othe way, in addition to benefits of the lower saturated fat intake, at least in some. Weren't they saying that the lower fat fermented group did better than the lower fat non-fermented group?
Good point, iirc, consumption of fermented dairy tends to cause increased production of SCFA in the gut, which has various health benefits. However, looking at the full paper at https://sci-hub.tw/10.1017/S0007114518002830 I see lots of potential confounders:
Compared with men in the lowest quartile of fermented dairy product intake, men in the highest quartile were more likely to live in a rural area and less likely to be current smokers. They also had higher intakes of energy, fibre, and fruits, berries and vegetables, and lower intakes of MUFA and PUFA, and consumed less alcohol. Compared with men in the lowest quartile of non-fermented dairy product intake, men in the highest quartile were more likely to live in a rural area and to be current smokers, and less likely to be physically active or married, and they had fewer years of education. In addition, they had higher intakes of energy, fibre and SFA, and lower intakes of MUFA and PUFA, and fruits, berries and vegetables.
Their models seems to attempt to take these factors (and many others) into account, but I wonder about synergistic interaction. (They acknowledge this in the discussion.)

Some points from the Discussion (emphasis mine):
Total dairy product intake had no association with the CHD risk, but in the subgroup analyses, fermented dairy products had an inverse association whereas non-fermented dairy products had a direct association with the risk. Further analyses of low-fat and high-fat categories showed that only lowfat fermented dairy product intake was inversely associated with the CHD risk. Butter or cheese were not associated with the risk, but total milk intake was associated with a higher risk. Neither lowfat nor high-fat milk consumption was associated with the CHD risk, however.
...
For example, in the KIHD, low-fat fermented dairy products comprised mostly of sour milk and, in much lower amounts, of low-fat yogurt and cultured buttermilk known as viili(30), and high-fat fermented dairy products were mainly cheese, whereas yogurt comprised a significant amount of the fermented dairy product intake in the Dutch cohorts(27,31). As two previous meta-analyses found no significant association between yogurt consumption and CHD risk(21,32), the type of fermented dairy food might also matter. Even though yogurt, viili and sour milk are somewhat similar products regarding fermentation, fat content and viscosity, the different ways these products are consumed might affect the outcomes. In Finland, for example, sour milk has been a common lunch or dinner beverage, whereas yogurt and viili are snack-like products and can be often combined with berries, muesli or added sugar, for example. These combinations are difficult to account for in statistical analyses but could have divergent effects on health.
...
High SFA intake could also explain the observed association with total non-fermented dairy product intake but adjusting multivariate models further for SFA intake had no effect on the association. [So much for my initial hypothesis - Brian. Also, they had additional interesting things to say about high SFA dairy in the discussion.]
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