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Is Low-Fat Dairy Superior to Full-Fat?

Low-fat dairy is recommended in dietary guidelines over natural, full-fat dairy, but is this recommendation actually justified by evidence? Or is it simply outdated?

Key points

  • In the context of a healthy diet, (replete in nutrients) full-fat dairy is associated with better heart disease and some cancer outcomes that low-fat
  • Full-fat dairy may be preferable for body-composition than low-fat
  • Overall, there is little difference in major health outcomes whether using low-fat or full-fat dairy and improved nutrient provision from full-fat suggests that it is likely to be a better addition to the diet than low-fat varieties of dairy foods

Full-fat dairy products are contributors to increased saturated fat in the diet. Because of the purported (but now mostly discredited) relationship between saturated fat and mortality, full-fat dairy has typically been advised against, while low-fat has been recommended in dietary guidelines for health. However, this guideline stands in contrast to the evidence.

Previously, the evidence had suggested that full-fat dairy promotes better outcomes for both death and disease than low-fat dairy and this is especially true when we look at the context of diet quality overall. For example, full-fat dairy in combination with a diet high in fruit and vegetables exerts a protective effect against coronary artery disease (an effect not seen with low-fat dairy),1 and colorectal cancer.2 In another study and in contrast to the author’s hypothesis, it was discovered that lower-fat varieties of milk products (and not dairy fat) were associated with weight gain in an investigation of dairy consumption in close to 13,000 children.3 A review of the literature by Kratz and colleagues concluded that the recommendation to consume low-fat dairy foods is in contrast to the observational evidence of a reduced cardiometabolic risk.4

In more recent reviews, both low and high fat yoghurt are associated with reduced risk of metabolic syndrome with little meaningful difference between them (low-fat yogurt: 2 study comparisons; RR: 0.72; 95% CI: 0.62, 0.84; whole-fat yogurt: 2 study comparisons; RR: 0.81; 95% CI: 0.70, 0.94).5 Either total or low-fat dairy are not associated with metabolic syndrome risk,5 and the risk of diabetes is reduced by both low- and high-fat dairy with little meaningful difference between them.6

Either total or low-fat dairy are not associated with metabolic syndrome risk

In a review of 15 prospective cohort studies, no significant relationships between dairy fat intake and cardiovascular disease or type 2 diabetes were found.7 Similarly, in a review of randomised controlled trials and meta-analyses, 17 studies meeting the criteria for inclusion showed either positive or no benefit from dairy at different doses for heart disease and stroke and no significant changes to risk measures for cardiovascular disease such as blood pressure, cholesterol and LDL cholesterol. Either low-fat or full-fat dairy had no meaningful effect on the risk of cardiovascular disease.8

In reviews of 22 cohort and randomised, controlled trials no meaningful difference had been found between low-fat and full-fat dairy for diabetes and heart disease

The evidence suggests that low-fat dairy is not superior to full-fat dairy for health.

References

1.       Holmberg S, Thelin A, Stiernström E-L. Food Choices and Coronary Heart Disease: A Population Based Cohort Study of Rural Swedish Men with 12 Years of Follow-up. Int J Environ Res Public Health. 2009;6(10):2626-38.

2.       Larsson SC, Bergkvist L, Rutegård J, Giovannucci E, Wolk A. Calcium and dairy food intakes are inversely associated with colorectal cancer risk in the Cohort of Swedish Men. The American Journal of Clinical Nutrition. 2006;83(3):667-73.

3.       Berkey CS, Rockett HH, Willett WC, Colditz GA. Milk, dairy fat, dietary calcium, and weight gain: A longitudinal study of adolescents. Archives of Pediatrics & Adolescent Medicine. 2005;159(6):543-50.

4.       Kratz M, Baars T, Guyenet S. The relationship between high-fat dairy consumption and obesity, cardiovascular, and metabolic disease. Eur J Nutr. 2013;52(1):1-24.

5.       Mena-Sánchez G, Becerra-Tomás N, Babio N, Salas-Salvadó J. Dairy Product Consumption in the Prevention of Metabolic Syndrome: A Systematic Review and Meta-Analysis of Prospective Cohort Studies. Advances in Nutrition. 2019;10(suppl_2):S144-S53.

6.       Khoramdad M, Alimohamadi Y, Safiri S, Pakzad R, Shakiba E, Shafiei J, et al. Dairy Products Consumption and Risk of Type 2 Diabetes: A Systematic Review and Meta-Analysis of Prospective Cohort Studies. Iran Red Crescent Med J. 2017;19(7):e14140.

7.       Key J, Cantarero A, Cohen D, Conn C, Cerami J. The Dairy Fat Paradox: A Systematic Review of the Evidence. Topics in Clinical Nutrition. 2016;31(4):280-95.

8.       Fontecha J, Calvo MV, Juarez M, Gil A, Martínez-Vizcaino V. Milk and Dairy Product Consumption and Cardiovascular Diseases: An Overview of Systematic Reviews and Meta-Analyses. Advances in Nutrition. 2019;10(suppl_2):S164-S89.

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