Table 2.
Synthesis of characteristics of eligible RCTs on the impact of isoenergetic replacement of cheese with other dairy products on blood lipid markers in the fasted state1
| First author, year (country) | Health status | Study completers, n (%, M/F) | Age (mean or range) | BMI (mean or range) | Study design, type of dietary intervention, duration of intervention and washout (d) | Study arms, n | Intervention | Comparator | Relevant outcomes | Industrial funding (yes/no) | Overall RoB |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Cheese vs. butter | |||||||||||
| Tholstrup, 2004 (Denmark) [45] | Healthy | 14 (100/0) | 23 y | 22 kg/m2 | Crossover, fully controlled, 21-d intervention, ≥28-d washout (habitual diet) | 3 | 205 g/10 MJ Samsø (hard) cheese (45% fat/dry weight): 26% fat and 1989 mg Ca/10 MJ Milk fat contributed to 20%TE (SFA: 16%TE) |
64 g/10 MJ butter: 54 g fat + 10 mg Ca/10 MJ Milk fat contributed to 20%TE (SFA: 16%TE) |
ApoA-I, apoB, HDL-C, HDL2-C, HDL3-C, LDL-C, LDL-C:HDL-C ratio, TC, TG, and VLDL-C PO: NR |
Yes | Some concerns |
| Biong, 2004 (Norway) [46] | Healthy | 22 (41/59) | 23–54 y | 19–37 kg/m2 | Crossover, fully controlled, 21-d intervention, 7-d washout (habitual diet) | 3 | 150 g/d Jarlsberg (hard) cheese (equivalent to 20%TE from total fat; SFA: 12.1%TE); Ca: 2108 mg/8 MJ | 52 g/d butter with Ca-caseinate (equivalent to 20%TE from total fat; SFA: 12.1%TE) Ca: 1143 mg/8 MJ | ApoA-I, apoB HDL-C, Lp(a), LDL-C, LDL-C:HDL-C ratio, TC, TG PO: NR |
Yes | Some concerns |
| Nestel, 2005 (Australia) [47] | Elevated plasma LDL-C: >3.6–<6.0 mmol/L | 19 (74/26) | 56.3 y | 27.7 kg/m2 | Crossover, semicontrolled, 28-d, 14-d washout/run-in (low-fat dairy, moderately increased carbohydrate diet) | 2 | 120 g/d mature Cheddar (hard) cheese (33% fat of wet weight); 40 g/d dairy fat (SFA: NR); Ca: NR; Diet: Total fat: 36.2%TE; SFA: 16.7%TE | ∼50 g/d butter; 40 g/d dairy fat (SFA: NR); Ca: NR; Diet: Total fat: 37.4%TE; SFA: 17.2%TE | HDL-C, LDL-C (PO), TC, TG | Yes | Some concerns |
| Hjerpsted, 2011 (Denmark) [31] | Healthy | 49 (57/43) | 55.5 y | 25.3 kg/m2 | Crossover, semicontrolled, 42-d, 14-d washout/run-in (habitual diet) | 2 | 143 g/d Samsø (hard) cheese (27 g fat/100 g) at medium energy level. Fat content of cheese replaced 13%TE from dietary fat (SFA: 63.9% by weight) and 34 mg Ca/100g | 47 g/d salted butter at medium energy level. Fat content of cheese replaced 13%TE from dietary fat (SFA: 64.9% by weight) and 19 mg Ca/100g | HDL-C, LDL-C, TC, TG PO: NR |
Yes | Some concerns |
| Soerensen, 2014 (Denmark) [48] | Healthy | 15 (100/0) | 27.2 y | 23.1 kg/m2 | Crossover, fully controlled, 14-d-, ≥ 14-d washout (habitual diet) | 3 | 120 g/d Klovborg (semi-hard) cheese (per 10 MJ); 45% fat/dry weight (SFA: 47.1 g); Dairy Ca: 810 mg/10 MJ; Non-dairy Ca: 362 mg/10 MJ | Butter (quantity NR2) (per 10 MJ); (SFA: 45.1 g); Dairy Ca: 0 mg/10 MJ; Non-dairy Ca: 362 mg/10 MJ | HDL-C, LDL-C, TC, TG PO: total excretion of fecal fat |
Yes | Some concerns |
| Brassard, 2017 (Canada) [32] | Abdominally obese: WC: ≥94 and ≥80 cm for M and F, respectively, and low serum HDL-C: ≤1.34 and ≤1.53 mmol/L for M and F, respectively | 92 (47/53) - completed ≥1 diet (n = 77 post-intervention) | 18–65 y | 30.6 kg/m2 (mean BMI for cheese and butter groups) | Crossover, fully controlled, 28-d, ≥24-d washout (median: 33 d; habitual diet) | 5 | 90 g/2500 kcal full-fat Cheddar (hard) cheese; Diet: Total fat: 32.0%TE; SFA: ∼12.6%TE (mainly from cheese); Ca: 1261.0 mg/2500 kcal | 49 g/2500 kcal butter; Diet: Total fat: 32.0%TE; SFA: ∼12.4%TE (mainly from butter); Ca: 811.1 mg/2500 kcal | apoB, HDL-C (PO), LDL-C, TC, TC:HDL-C ratio, TG | Yes | Some concerns |
| Feeney, 2018 (Ireland) [44] | Overweight | Per-protocol analysis: 127 (NR): n = 40 and n = 28 for cheese and butter treatments, respectively | 50–70 y | ≥25 kg/m2 | Parallel, semicontrolled, 42-d, NA | 4 | 120 g/d full-fat Cheddar (hard) cheese (489 ± 19 kcal/d); Total fat: 40.8 g (SFA: 25.2 g); Ca: 828 mg | 49 g/d butter + Ca-caseinate powder (30 g) + 500 mg Ca supplement (CaCO3) (489 ± 19 kcal/d); Total fat: 39.2 g (SFA: 25.9 g); Ca: 817 mg | HDL-C, LDL-C (PO), NEFA, TC, TG | No | Some concerns |
| Cheese vs. milk | |||||||||||
| Tholstrup, 2004 (Denmark) [45] | Healthy | 14 (100/0) | 23 y | 22 kg/m2 | Crossover, fully controlled, 21-d intervention, ≥28-d washout (habitual diet) | 3 | 205 g/10 MJ Samsø (hard) cheese (45% fat/dry weight): 26% fat and 1989 mg Ca/10 MJ Milk fat contributed to 20%TE (SFA: 16%TE) |
1500 mL/10 MJ whole fat milk: 54 g of fat + 1779 mg Ca/10 MJ Milk fat contributed to 20%TE (SFA: 16%TE) |
apoA-I, apoB, HDL-C, LDL-C, LDL-C:HDL-C ratio, TC, TG, VLDL-C PO: NR |
Yes | Some concerns |
| Soerensen, 2014 (Denmark) [48] | Healthy | 15 (100/0) | 27.2 y | 23.1 kg/m2 | Crossover, fully controlled, 14-d, ≥14-d washout (habitual diet) | 3 | 120 g/d Klovborg (semi-hard) cheese (per 10 MJ); 45% fat/dry weight (SFA: 47.1 g) Dairy Ca: 810 mg/10 MJ; Non-dairy Ca: 362 mg/10 MJ |
∼670 mL semi-skimmed milk (per 10 MJ; 1.5% fat) (SFA: 46.5 g); Dairy Ca: 781 mg/10 MJ; Non-dairy Ca: 362 mg/10 MJ | HDL-C, LDL-C, TC, TG PO: total excretion of fecal fat |
Yes | Some concerns |
Abbreviations: apo, apolipoprotein; Ca, calcium; F, females; HDL2-C, high-density lipoprotein 2 cholesterol; HDL3-C, high-density lipoprotein 3 cholesterol; LDL-C, LDL cholesterol; Lp(a), lipoprotein (a); M, males; NEFA, nonesterified fatty acid; PO, primary outcome; NA, not applicable; NR, not reported; TC, total cholesterol; TG, triacylglycerol; WC, waist circumference; %TE, percent total energy.
1
Fully controlled intervention: all foods consumed were provided to participants, for either home or on-site consumption (on campus, metabolic ward, etc.). Semicontrolled intervention: experimental foods were provided to participants together with dietary advice for nonexperimental foods.
2
Mean daily intake estimated as 52 g/d.