European Journal of Epidemiology

, Volume 26, Issue 8, pp 609–618 | Cite as

Dairy products and its association with incidence of cardiovascular disease: the Malmö diet and cancer cohort

  • Emily SonestedtEmail author
  • Elisabet Wirfält
  • Peter Wallström
  • Bo Gullberg
  • Marju Orho-Melander
  • Bo Hedblad


It is unclear whether specific dairy products are associated with risk of cardiovascular disease (CVD). The aim of this project was therefore to examine the association between intake of milk, cheese, cream and butter, and incidence of CVD in the Swedish Malmö Diet and Cancer cohort. Milk was separated into fermented (yoghurt and cultured sour milk) versus non-fermented milk, and low-fat versus high-fat milk. Among 26,445 individuals without a history of myocardial infarction, stroke and diabetes (44–74 years; 62% females), 2,520 CVD cases (coronary and stroke events) were identified during a mean follow-up time of 12 years. Dietary data was collected using a modified diet history method. Overall consumption of dairy products was inversely associated with risk of CVD (P trend = 0.05). Among the specific dairy products, a statistically significant inverse relationship was observed only for fermented milk. The highest versus lowest intake category of fermented milk was associated with 15% (95% CI: 5–24%; P trend = 0.003) decreased incidence of CVD. We observed a statistically significant interaction between sex and cheese intake (P = 0.046). Cheese intake was significantly associated with decreased CVD risk in women (P trend = 0.03), but not in men (P trend = 0.98). The main finding was that a high intake of fermented milk may reduce the risk of CVD. This study suggests that it is important to examine dairy products separately when investigating their health effects.


Cardiovascular disease Cohort Dairy Malmö Milk 



Body mass index


Cardiovascular disease


Hemoglobin A1c


High-density lipoprotein cholesterol


Homeostasis model assessment


Hazard ratio


International classification of diseases, 9th revision


Low-density lipoprotein cholesterol


Malmö diet and cancer



This work was supported by the Lund University Diabetes Center (LUDC); the Swedish Medical Research Council (K2009-65X-15358-11-3); the Swedish Heart and Lung Foundation (2009-014); the Region Skåne; the Skåne University Hospital Foundation; the Albert Påhlsson Research Foundation; and the Crafoord foundation.

Supplementary material

10654_2011_9589_MOESM1_ESM.doc (154 kb)
Supplementary material 1 (DOC 155 kb)


  1. 1.
    Sacks FM, Katan M. Randomized clinical trials on the effects of dietary fat and carbohydrate on plasma lipoproteins and cardiovascular disease. Am J Med. 2002;113(Suppl 9B):13S–24S.PubMedCrossRefGoogle Scholar
  2. 2.
    Riserus U, Willett WC, Hu FB. Dietary fats and prevention of type 2 diabetes. Prog Lipid Res. 2009;48:44–51.PubMedCrossRefGoogle Scholar
  3. 3.
    Nordiska ministerr*det. Nordic Nutrition Recommendations 2004: integrating nutrition and physical activity. Copenhagen: Nordic Council of Ministers; 2004.Google Scholar
  4. 4.
    Gibson RA, Makrides M, Smithers LG, et al. The effect of dairy foods on CHD: a systematic review of prospective cohort studies. Br J Nutr. 2009;102:1267–75.PubMedCrossRefGoogle Scholar
  5. 5.
    Elwood PC, Pickering JE, Givens DI, Gallacher JE. The consumption of milk and dairy foods and the incidence of vascular disease and diabetes: an overview of the evidence. Lipids 2010.Google Scholar
  6. 6.
    Soedamah-Muthu SS, Ding EL, Al-Delaimy WK, et al. Milk and dairy consumption and incidence of cardiovascular diseases and all-cause mortality: dose-response meta-analysis of prospective cohort studies. Am J Clin Nutr. 2011;93:158–71.PubMedCrossRefGoogle Scholar
  7. 7.
    Cani PD, Delzenne NM. The role of the gut microbiota in energy metabolism and metabolic disease. Curr Pharm Des. 2009;15:1546–58.PubMedCrossRefGoogle Scholar
  8. 8.
    Berglund G, Elmstahl S, Janzon L, Larsson SA. The Malmo Diet and Cancer Study. Design and feasibility. J Intern Med. 1993;233:45–51.PubMedCrossRefGoogle Scholar
  9. 9.
    Manjer J, Elmstahl S, Janzon L, Berglund G. Invitation to a population-based cohort study: differences between subjects recruited using various strategies. Scand J Public Health. 2002;30:103–12.PubMedGoogle Scholar
  10. 10.
    Callmer E, Riboli E, Saracci R, et al. Dietary assessment methods evaluated in the Malmo food study. J Intern Med. 1993;233:53–7.PubMedCrossRefGoogle Scholar
  11. 11.
    Taylor HL, Jacobs DR Jr, Schucker B, et al. A questionnaire for the assessment of leisure time physical activities. J Chronic Dis. 1978;31:741–55.PubMedCrossRefGoogle Scholar
  12. 12.
    Manjer J, Carlsson S, Elmstahl S, et al. The Malmo Diet and Cancer Study: representativity, cancer incidence and mortality in participants and non-participants. Eur J Cancer Prev. 2001;10:489–99.PubMedCrossRefGoogle Scholar
  13. 13.
    Hedblad B, Nilsson P, Engstrom G, et al. Insulin resistance in non-diabetic subjects is associated with increased incidence of myocardial infarction and death. Diabet Med. 2002;19:470–5.PubMedCrossRefGoogle Scholar
  14. 14.
    Kathiresan S, Melander O, Anevski D, et al. Polymorphisms associated with cholesterol and risk of cardiovascular events. N Engl J Med. 2008;358:1240–9.PubMedCrossRefGoogle Scholar
  15. 15.
    Calling S, Hedblad B, Engstrom G, et al. Effects of body fatness and physical activity on cardiovascular risk: risk prediction using the bioelectrical impedance method. Scand J Public Health. 2006;34:568–75.PubMedCrossRefGoogle Scholar
  16. 16.
    Socialstyrelsen. Värdering av diagnoskvaliteten för akut hjärtinfarkt i patientregistret 1987 och 1995. Stockholm 2000.Google Scholar
  17. 17.
    Zia E, Pessah-Rasmussen H, Khan FA, et al. Risk factors for primary intracerebral hemorrhage: a population-based nested case-control study. Cerebrovasc Dis. 2006;21:18–25.PubMedCrossRefGoogle Scholar
  18. 18.
    Wirfalt E, Mattisson I, Johansson U, et al. A methodological report from the Malmo Diet, Cancer study: development, evaluation of altered routines in dietary data processing. Nutr J. 2002;1:3.PubMedCrossRefGoogle Scholar
  19. 19.
    Riboli E, Elmstahl S, Saracci R, et al. The Malmo Food Study: validity of two dietary assessment methods for measuring nutrient intake. Int J Epidemiol. 1997;26(Suppl 1):S161–73.PubMedCrossRefGoogle Scholar
  20. 20.
    Elmstahl S, Riboli E, Lindgarde F, et al. The Malmo Food Study: the relative validity of a modified diet history method and an extensive food frequency questionnaire for measuring food intake. Eur J Clin Nutr. 1996;50:143–51.PubMedGoogle Scholar
  21. 21.
    Mente A, de Koning L, Shannon HS, Anand SS. A systematic review of the evidence supporting a causal link between dietary factors and coronary heart disease. Arch Intern Med. 2009;169:659–69.PubMedCrossRefGoogle Scholar
  22. 22.
    Sonestedt E, Wirfalt E, Gullberg B, Berglund G. Past food habit change is related to obesity, lifestyle and socio-economic factors in the Malmo Diet and Cancer Cohort. Public Health Nutr. 2005;8:876–85.PubMedCrossRefGoogle Scholar
  23. 23.
    Sonestedt E, Gullberg B, Wirfalt E. Both food habit change in the past and obesity status may influence the association between dietary factors and postmenopausal breast cancer. Public Health Nutr. 2007;10:769–79.PubMedCrossRefGoogle Scholar
  24. 24.
    Becker W, Pearson M. Riksmaten 1997-98: kostvanor och näringsintag i Sverige: metod- och resultatanalys. Uppsala: Livsmedelsverket 2002.Google Scholar
  25. 25.
    Siri-Tarino PW, Sun Q, Hu FB, Krauss RM. Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease. Am J Clin Nutr. 2010.Google Scholar
  26. 26.
    Pfeuffer M, Schrezenmeir J. Milk and the metabolic syndrome. Obes Rev. 2007;8:109–18.PubMedCrossRefGoogle Scholar
  27. 27.
    Jacobs DR Jr, Tapsell LC. Food, not nutrients, is the fundamental unit in nutrition. Nutr Rev. 2007;65:439–50.PubMedCrossRefGoogle Scholar
  28. 28.
    Warensjo E, Jansson JH, Cederholm T, et al. Biomarkers of milk fat and the risk of myocardial infarction in men and women: a prospective, matched case-control study. Am J Clin Nutr. 2010;92:194–202.PubMedCrossRefGoogle Scholar
  29. 29.
    Agerholm-Larsen L, Bell ML, Grunwald GK, Astrup A. The effect of a probiotic milk product on plasma cholesterol: a meta-analysis of short-term intervention studies. Eur J Clin Nutr. 2000;54:856–60.PubMedCrossRefGoogle Scholar
  30. 30.
    Larsen N, Vogensen FK, van den Berg FW, et al. Gut microbiota in human adults with type 2 diabetes differs from non-diabetic adults. PLoS One. 2010;5:e9085.PubMedCrossRefGoogle Scholar
  31. 31.
    Jauhiainen T, Korpela R. Milk peptides and blood pressure. J Nutr. 2007;137:825S–9S.PubMedGoogle Scholar
  32. 32.
    Severin S, Wenshui X. Milk biologically active components as nutraceuticals: review. Crit Rev Food Sci Nutr. 2005;45:645–56.PubMedCrossRefGoogle Scholar
  33. 33.
    Nilsson M, Stenberg M, Frid AH, et al. Glycemia and insulinemia in healthy subjects after lactose-equivalent meals of milk and other food proteins: the role of plasma amino acids and incretins. Am J Clin Nutr. 2004;80:1246–53.PubMedGoogle Scholar
  34. 34.
    Holst JJ, Orskov C. Incretin hormones—an update. Scand J Clin Lab Invest Suppl. 2001;234:75–85.PubMedGoogle Scholar
  35. 35.
    Ostman EM, Liljeberg Elmstahl HG, Bjorck IM. Inconsistency between glycemic and insulinemic responses to regular and fermented milk products. Am J Clin Nutr. 2001;74:96–100.PubMedGoogle Scholar
  36. 36.
    Nestel PJ, Chronopulos A, Cehun M. Dairy fat in cheese raises LDL cholesterol less than that in butter in mildly hypercholesterolaemic subjects. Eur J Clin Nutr. 2005;59:1059–63.PubMedCrossRefGoogle Scholar
  37. 37.
    Biong AS, Muller H, Seljeflot I, et al. A comparison of the effects of cheese and butter on serum lipids, haemostatic variables and homocysteine. Br J Nutr. 2004;92:791–7.PubMedCrossRefGoogle Scholar
  38. 38.
    Tholstrup T, Hoy CE, Andersen LN, et al. Does fat in milk, butter and cheese affect blood lipids and cholesterol differently? J Am Coll Nutr. 2004;23:169–76.PubMedGoogle Scholar
  39. 39.
    Mann JI, Appleby PN, Key TJ, Thorogood M. Dietary determinants of ischaemic heart disease in health conscious individuals. Heart. 1997;78:450–5.PubMedGoogle Scholar
  40. 40.
    Gartside PS, Wang P, Glueck CJ. Prospective assessment of coronary heart disease risk factors: the NHANES I epidemiologic follow-up study (NHEFS) 16-year follow-up. J Am Coll Nutr. 1998;17:263–9.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2011

Authors and Affiliations

  • Emily Sonestedt
    • 1
    Email author
  • Elisabet Wirfält
    • 1
  • Peter Wallström
    • 1
  • Bo Gullberg
    • 1
  • Marju Orho-Melander
    • 2
  • Bo Hedblad
    • 1
  1. 1.Department of Clinical Sciences in Malmö, Clincial Research CentreLund UniversityMalmöSweden
  2. 2.Department of Clinical Sciences in Malmö, Clincial Research CentreLund UniversityMalmöSweden

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