Cheese consumption and risk of cardiovascular disease: a meta-analysis of prospective studies



Cheese contains a high content of saturated fatty acids but also lists of potentially beneficial nutrients. How long-term cheese consumption affects the development of cardiovascular disease (CVD) is unclear. A meta-analysis of prospective observational studies was conducted to evaluate the risks of total CVD, coronary heart disease (CHD), and stroke associated with cheese consumption.


Potentially eligible studies were identified by searching PubMed and EMBASE databases and by carefully reviewing the bibliographies of retrieved publications and related reviews. The summary relative risks (RRs) with 95 % confidence intervals (CIs) were calculated using the random-effects model.


The final analyses included 15 prospective studies. Most of the studies excluded prevalent CVD at baseline (14/15) and had a duration >10 years (13/15). The summary RR for high vs. low cheese consumption was 0.90 (95 % CI 0.82–0.99) for total CVD (7 studies, 8076 events), 0.86 (95 % CI 0.77–0.96) for CHD (8 studies, 7631 events), and 0.90 (95 % CI 0.84–0.97) for stroke (7 studies, 10,449 events), respectively. The restricted cubic model indicated evidence of nonlinear relationships between cheese consumption and risks of total CVD (P nonlinearity < 0.001) and stroke (P nonlinearity = 0.015), with the largest risk reductions observed at the consumption of approximately 40 g/d.


This meta-analysis of prospective studies suggests a nonlinear inverse association between cheese consumption and risk of CVD.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Change history

  • 07 January 2019

    In the original publication, the funding and conflict of interest statements were not correct.

  • 07 January 2019

    In the original publication, the funding and conflict of interest statements were not correct.

  • 07 January 2019

    In the original publication, the funding and conflict of interest statements were not correct.


  1. 1.

    Canadian Dairy Information Center. Global Consumption of Dairy Products (2013) Accessed 13 June 2016

  2. 2.

    Rozenberg S, Body JJ, Bruyere O, Bergmann P, Brandi ML, Cooper C, Devogelaer JP, Gielen E, Goemaere S, Kaufman JM, Rizzoli R, Reginster JY (2015) Effects of dairy products consumption on health: benefits and beliefs-a commentary from the Belgian Bone Club and the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases. Calcif Tissue Int 98:1–17

    Article  Google Scholar 

  3. 3.

    Mihaylova B, Emberson J, Blackwell L, Keech A, Simes J, Barnes EH, Voysey M, Gray A, Collins R, Baigent C (2012) The effects of lowering LDL cholesterol with statin therapy in people at low risk of vascular disease: meta-analysis of individual data from 27 randomised trials. Lancet 380:581–590

    CAS  Article  Google Scholar 

  4. 4.

    Perk J, De Backer G, Gohlke H, Graham I, Reiner Z, Verschuren M, Albus C, Benlian P, Boysen G, Cifkova R, Deaton C, Ebrahim S, Fisher M, Germano G, Hobbs R, Hoes A, Karadeniz S, Mezzani A, Prescott E, Ryden L, Scherer M, Syvanne M, Scholte op Reimer WJ, Vrints C, Wood D, Zamorano JL, Zannad F (2012) European Guidelines on cardiovascular disease prevention in clinical practice (version 2012). The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts). Eur Heart J 33:1635–1701

    CAS  Article  Google Scholar 

  5. 5.

    Eckel RH, Jakicic JM, Ard JD, de Jesus JM, Houston Miller N, Hubbard VS, Lee IM, Lichtenstein AH, Loria CM, Millen BE, Nonas CA, Sacks FM, Smith SC Jr, Svetkey LP, Wadden TA, Yanovski SZ (2014) 2013 AHA/ACC guideline on lifestyle management to reduce cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 63:2960–2984

    Article  Google Scholar 

  6. 6.

    de Souza RJ, Mente A, Maroleanu A, Cozma AI, Ha V, Kishibe T, Uleryk E, Budylowski P, Schunemann H, Beyene J, Anand SS (2015) Intake of saturated and trans unsaturated fatty acids and risk of all cause mortality, cardiovascular disease, and type 2 diabetes: systematic review and meta-analysis of observational studies. BMJ 351:h3978

    Article  Google Scholar 

  7. 7.

    Chowdhury R, Warnakula S, Kunutsor S, Crowe F, Ward HA, Johnson L, Franco OH, Butterworth AS, Forouhi NG, Thompson SG, Khaw KT, Mozaffarian D, Danesh J, Di Angelantonio E (2014) Association of dietary, circulating, and supplement fatty acids with coronary risk: a systematic review and meta-analysis. Ann Intern Med 160:398–406

    Article  Google Scholar 

  8. 8.

    Guasch-Ferre M, Babio N, Martinez-Gonzalez MA, Corella D, Ros E, Martin-Pelaez S, Estruch R, Aros F, Gomez-Gracia E, Fiol M, Santos-Lozano JM, Serra-Majem L, Bullo M, Toledo E, Barragan R, Fito M, Gea A, Salas-Salvado J, Investigators PS (2015) Dietary fat intake and risk of cardiovascular disease and all-cause mortality in a population at high risk of cardiovascular disease. Am J Clin Nutr 102:1563–1573

    CAS  Article  Google Scholar 

  9. 9.

    Wang DD, Li Y, Chiuve SE, Stampfer MJ, Manson JE, Rimm EB, Willett WC, Hu FB (2016) Association of specific dietary fats with total and cause-specific mortality. JAMA Intern Med. 176:1134–1145

    Article  Google Scholar 

  10. 10.

    Blekkenhorst LC, Prince RL, Hodgson JM, Lim WH, Zhu K, Devine A, Thompson PL, Lewis JR (2015) Dietary saturated fat intake and atherosclerotic vascular disease mortality in elderly women: a prospective cohort study. Am J Clin Nutr 101:1263–1268

    CAS  Article  Google Scholar 

  11. 11.

    O’Sullivan TA, Hafekost K, Mitrou F, Lawrence D (2013) Food sources of saturated fat and the association with mortality: a meta-analysis. Am J Public Health 103:e31–e42

    Article  Google Scholar 

  12. 12.

    Ericson U, Hellstrand S, Brunkwall L, Schulz CA, Sonestedt E, Wallstrom P, Gullberg B, Wirfalt E, Orho-Melander M (2015) Food sources of fat may clarify the inconsistent role of dietary fat intake for incidence of type 2 diabetes. Am J Clin Nutr 101:1065–1080

    CAS  Article  Google Scholar 

  13. 13.

    de Oliveira Otto MC, Mozaffarian D, Kromhout D, Bertoni AG, Sibley CT, Jacobs DR Jr, Nettleton JA (2012) Dietary intake of saturated fat by food source and incident cardiovascular disease: the Multi-Ethnic Study of Atherosclerosis. Am J Clin Nutr 96:397–404

    Article  Google Scholar 

  14. 14.

    Hjerpsted J, Leedo E, Tholstrup T (2011) Cheese intake in large amounts lowers LDL-cholesterol concentrations compared with butter intake of equal fat content. Am J Clin Nutr 94:1479–1484

    CAS  Article  Google Scholar 

  15. 15.

    Nilsen R, Hostmark AT, Haug A, Skeie S (2015) Effect of a high intake of cheese on cholesterol and metabolic syndrome: results of a randomized trial. Food Nutr Res. 59:27651

    Article  Google Scholar 

  16. 16.

    Thorning TK, Raziani F, Bendsen NT, Astrup A, Tholstrup T, Raben A (2015) Diets with high-fat cheese, high-fat meat, or carbohydrate on cardiovascular risk markers in overweight postmenopausal women: a randomized crossover trial. Am J Clin Nutr 102:573–581

    CAS  Article  Google Scholar 

  17. 17.

    Hjerpsted J, Tholstrup T (2016) Cheese and cardiovascular disease risk: a review of the evidence and discussion of possible mechanisms. Crit Rev Food Sci Nutr 56:1389–1403

    CAS  Article  Google Scholar 

  18. 18.

    Avalos EE, Barrett-Connor E, Kritz-Silverstein D, Wingard DL, Bergstrom JN, Al-Delaimy WK (2013) Is dairy product consumption associated with the incidence of CHD? Public Health Nutr. 16:2055–2063

    Article  Google Scholar 

  19. 19.

    Bonthuis M, Hughes MC, Ibiebele TI, Green AC, van der Pols JC (2010) Dairy consumption and patterns of mortality of Australian adults. Eur J Clin Nutr 64:569–577

    CAS  Article  Google Scholar 

  20. 20.

    Fraser GE, Shavlik DJ (1997) Risk factors for all-cause and coronary heart disease mortality in the oldest-old. The Adventist Health Study. Arch Intern Med 157:2249–2258

    CAS  Article  Google Scholar 

  21. 21.

    Goldbohm RA, Chorus AM, Galindo Garre F, Schouten LJ, van den Brandt PA (2011) Dairy consumption and 10-y total and cardiovascular mortality: a prospective cohort study in the Netherlands. Am J Clin Nutr 93:615–627

    CAS  Article  Google Scholar 

  22. 22.

    Iso H, Stampfer MJ, Manson JE, Rexrode K, Hennekens CH, Colditz GA, Speizer FE, Willett WC (1999) Prospective study of calcium, potassium, and magnesium intake and risk of stroke in women. Stroke 30:1772–1779

    CAS  Article  Google Scholar 

  23. 23.

    Larsson SC, Mannisto S, Virtanen MJ, Kontto J, Albanes D, Virtamo J (2009) Dairy foods and risk of stroke. Epidemiology 20:355–360

    Article  Google Scholar 

  24. 24.

    Larsson SC, Virtamo J, Wolk A (2012) Dairy consumption and risk of stroke in Swedish women and men. Stroke 43:1775–1780

    CAS  Article  Google Scholar 

  25. 25.

    Mann JI, Appleby PN, Key TJ, Thorogood M (1997) Dietary determinants of ischaemic heart disease in health conscious individuals. Heart 78:450–455

    CAS  Article  Google Scholar 

  26. 26.

    Patterson E, Larsson SC, Wolk A, Akesson A (2013) Association between dairy food consumption and risk of myocardial infarction in women differs by type of dairy food. J Nutr 143:74–79

    CAS  Article  Google Scholar 

  27. 27.

    Praagman J, Dalmeijer GW, van der Schouw YT, Soedamah-Muthu SS, Monique Verschuren WM, Bas Bueno-de-Mesquita H, Geleijnse JM, Beulens JW (2015) The relationship between fermented food intake and mortality risk in the European Prospective Investigation into Cancer and Nutrition-Netherlands cohort. Br J Nutr 113:498–506

    CAS  Article  Google Scholar 

  28. 28.

    Soedamah-Muthu SS, Masset G, Verberne L, Geleijnse JM, Brunner EJ (2013) Consumption of dairy products and associations with incident diabetes, CHD and mortality in the Whitehall II study. Br J Nutr 109:718–726

    CAS  Article  Google Scholar 

  29. 29.

    Sonestedt E, Wirfalt E, Wallstrom P, Gullberg B, Orho-Melander M, Hedblad B (2011) Dairy products and its association with incidence of cardiovascular disease: the Malmo diet and cancer cohort. Eur J Epidemiol 26:609–618

    CAS  Article  Google Scholar 

  30. 30.

    van Aerde MA, Soedamah-Muthu SS, Geleijnse JM, Snijder MB, Nijpels G, Stehouwer CD, Dekker JM (2013) Dairy intake in relation to cardiovascular disease mortality and all-cause mortality: the Hoorn Study. Eur J Nutr 52:609–616

    Article  Google Scholar 

  31. 31.

    von Ruesten A, Feller S, Bergmann MM, Boeing H (2013) Diet and risk of chronic diseases: results from the first 8 years of follow-up in the EPIC-Potsdam study. Eur J Clin Nutr 67:412–419

    Article  Google Scholar 

  32. 32.

    Hu D, Huang J, Wang Y, Zhang D, Qu Y (2014) Dairy foods and risk of stroke: a meta-analysis of prospective cohort studies. Nutr Metab Cardiovasc Dis 24:460–469

    CAS  Article  Google Scholar 

  33. 33.

    Qin LQ, Xu JY, Han SF, Zhang ZL, Zhao YY, Szeto IM (2015) Dairy consumption and risk of cardiovascular disease: an updated meta-analysis of prospective cohort studies. Asia Pac J Clin Nutr 24:90–100

    PubMed  Google Scholar 

  34. 34.

    Aune D, Navarro Rosenblatt DA, Chan DS, Vieira AR, Vieira R, Greenwood DC, Vatten LJ, Norat T (2015) Dairy products, calcium, and prostate cancer risk: a systematic review and meta-analysis of cohort studies. Am J Clin Nutr 101:87–117

    CAS  Article  Google Scholar 

  35. 35.

    Jiang W, Ju C, Jiang H, Zhang D (2014) Dairy foods intake and risk of Parkinson’s disease: a dose-response meta-analysis of prospective cohort studies. Eur J Epidemiol 29:613–619

    CAS  Article  Google Scholar 

  36. 36.

    Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, Moher D, Becker BJ, Sipe TA, Thacker SB (2000) Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA 283:2008–2012

    CAS  Article  Google Scholar 

  37. 37.

    Soedamah-Muthu SS, Ding EL, Al-Delaimy WK, Hu FB, Engberink MF, Willett WC, Geleijnse JM (2011) 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 93:158–171

    CAS  Article  Google Scholar 

  38. 38.

    Wells GA, Shea B, O’Connell D, Peterson J, Welch V, Losos M, Tugwell P (2013) The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses.

  39. 39.

    DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7:177–188

    CAS  Article  Google Scholar 

  40. 40.

    Greenland S, Longnecker MP (1992) Methods for trend estimation from summarized dose-response data, with applications to meta-analysis. Am J Epidemiol 135:1301–1309

    CAS  Article  Google Scholar 

  41. 41.

    Orsini N, Bellocco R, Greenland S (2006) Generalized least squares for trend estimation of summarized dose-respose data. Stata J 6:40–57

    Article  Google Scholar 

  42. 42.

    Aune D, Norat T, Romundstad P, Vatten LJ (2013) Dairy products and the risk of type 2 diabetes: a systematic review and dose-response meta-analysis of cohort studies. Am J Clin Nutr 98:1066–1083

    CAS  Article  Google Scholar 

  43. 43.

    Orsini N, Li R, Wolk A, Khudyakov P, Spiegelman D (2012) Meta-analysis for linear and nonlinear dose-response relations: examples, an evaluation of approximations, and software. Am J Epidemiol 175:66–73

    Article  Google Scholar 

  44. 44.

    Wang X, Ouyang Y, Liu J, Zhu M, Zhao G, Bao W, Hu FB (2014) Fruit and vegetable consumption and mortality from all causes, cardiovascular disease, and cancer: systematic review and dose-response meta-analysis of prospective cohort studies. BMJ 349:g4490

    Article  Google Scholar 

  45. 45.

    Higgins JP, Thompson SG (2002) Quantifying heterogeneity in a meta-analysis. Stat Med 21:1539–1558

    Article  Google Scholar 

  46. 46.

    Egger M, Davey Smith G, Schneider M, Minder C (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ 315:629–634

    CAS  Article  Google Scholar 

  47. 47.

    Begg CB, Mazumdar M (1994) Operating characteristics of a rank correlation test for publication bias. Biometrics 50:1088–1101

    CAS  Article  Google Scholar 

  48. 48.

    Duval S, Tweedie R (2000) Trim and fill: a simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics 56:455–463

    CAS  Article  Google Scholar 

  49. 49.

    Dalmeijer GW, Struijk EA, van der Schouw YT, Soedamah-Muthu SS, Verschuren WM, Boer JM, Geleijnse JM, Beulens JW (2013) Dairy intake and coronary heart disease or stroke–a population-based cohort study. Int J Cardiol 167:925–929

    Article  Google Scholar 

  50. 50.

    Gartside PS, Wang P, Glueck CJ (1998) Prospective assessment of coronary heart disease risk factors: the NHANES I epidemiologic follow-up study (NHEFS) 16-year follow-up. J Am Coll Nutr 17:263–269

    CAS  Article  Google Scholar 

  51. 51.

    Wang X, Chen H, Ouyang Y, Liu J, Zhao G, Bao W, Yan M (2014) Dietary calcium intake and mortality risk from cardiovascular disease and all causes: a meta-analysis of prospective cohort studies. BMC Med 12:158

    Article  Google Scholar 

  52. 52.

    Larsson SC, Orsini N, Wolk A (2013) Dietary calcium intake and risk of stroke: a dose-response meta-analysis. Am J Clin Nutr 97:951–957

    CAS  Article  Google Scholar 

  53. 53.

    Mitchell PL, McLeod RS (2008) Conjugated linoleic acid and atherosclerosis: studies in animal models. Biochem Cell Biol 86:293–301

    CAS  Article  Google Scholar 

  54. 54.

    Mullen A, Moloney F, Nugent AP, Doyle L, Cashman KD, Roche HM (2007) Conjugated linoleic acid supplementation reduces peripheral blood mononuclear cell interleukin-2 production in healthy middle-aged males. J Nutr Biochem 18:658–666

    CAS  Article  Google Scholar 

  55. 55.

    Cho YA, Kim J (2015) Effect of probiotics on blood lipid concentrations: a meta-analysis of randomized controlled trials. Med (Baltim) 94:e1714

    Article  Google Scholar 

  56. 56.

    Sofi F, Buccioni A, Cesari F, Gori AM, Minieri S, Mannini L, Casini A, Gensini GF, Abbate R, Antongiovanni M (2010) Effects of a dairy product (pecorino cheese) naturally rich in cis-9, trans-11 conjugated linoleic acid on lipid, inflammatory and haemorheological variables: a dietary intervention study. Nutr Metab Cardiovasc Dis 20:117–124

    CAS  Article  Google Scholar 

  57. 57.

    Chen GC, Szeto IM, Chen LH, Han SF, Li YJ, van Hekezen R, Qin LQ (2015) Dairy products consumption and metabolic syndrome in adults: systematic review and meta-analysis of observational studies. Sci Rep 5:14606

    CAS  Article  Google Scholar 

  58. 58.

    Houston DK, Driver KE, Bush AJ, Kritchevsky SB (2008) The association between cheese consumption and cardiovascular risk factors among adults. J Hum Nutr Diet 21:129–140

    CAS  Article  Google Scholar 

Download references

Author information



Corresponding author

Correspondence to Li-Qiang Qin.

Ethics declarations

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 66 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Chen, G., Wang, Y., Tong, X. et al. Cheese consumption and risk of cardiovascular disease: a meta-analysis of prospective studies. Eur J Nutr 56, 2565–2575 (2017).

Download citation


  • Dairy
  • Cheese
  • Cardiovascular disease
  • Meta-analysis