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Results of the Copenhagen Cheese Studies: Importance of the matrix
Tanja Kongerslev Thorning, Post doc Arne Astrup, Professor MD
University of Copenhagen
World Dairy Summit 2016
Saturated fat
• SF has for decades been considered being the bad guy
• Known to increases LDL-cholesterol
• Also SF increases HDL-cholesterol and reduces TG
• Humans does not eat groups of fatty acids but complex foods with mixtures of fatty acids
Micha & Mozaffarian, Lipids (2010)
Saturated fat
Is saturated fat independent on the food matrix?
Favors a high cheese intake
Prospective studies of cheese intake and risk of CVD, CHD and stroke
Chen et al. (2016) Eur J Nutr., Aug 12
Intervention studies on cheese intake and LDL-cholesterol
= correct?
De Goede et al.
Nutrition Reviews (2015)
High content of active components in cheese
Calcium *
(per 100 g)
Phosphate *
(per 100 g)
Fermented
(+/-)
MFGM **
(per 100 g)
Whey/casein
Cheese (25%) 659 mg 510 mg + 0.15 g casein
Milk (skimmed) 124 mg 96.8 mg - 0.015 g whey/casein
Milk (whole) 116 mg 93 mg - 0.035 g whey/casein
Yoghurt (low fat) 136 mg 99 mg + ~ 0.015 g whey/casein
Cream (38%) 67 mg 57 mg - 0.20 g -
Butter 15 mg 24 mg - - -
http://frida.fooddata.dk/ DTU ** Dewettinck et al. (2008), International Dairy Journal vol 18, 436–457 + Conway et al (2014), Animal Frontiers , Vol. 4, No. 2
The cheese-matrix may modulate the effect of saturated fat on LDL-cholesterol
Possible mechanisms of cheese
Milk fat globule membrane - polar lipids
Fermentation and ripening - bacteria
Minerals - calcium and phosphate
Reduce hepatic de novo FA synthesisModulate expression of genes in lipid metabolism
Inhibit intestinal cholesterolabsorption
Change gut microbiotacomposition
We need to study foods rather than nutrients!
Generate bioactivecomponents
Amorphous calcium-phosphate
• Favors long chain saturated fattyacids
Christensen et al., obesity reviews (2009)
Lorenzen and Astrup, Am. J. Clin. Nutr. (2007)
Ch
ylo
mic
ron
TG (
mm
ol/
L)Calcium fatty acid soaps
Dairy calcium from milk and cheese
Am J Clin Nutr 2014;99:984–91.
The Copenhagen Cheese Project (4 studies)
The aim was to examine the effects of• Cheese fat content• Cheese ripening duration• Cheese saturated fatty acid composition
…on • Fecal fat excretion• Markers of cardiovascular disease • Markers of type 2 diabetes
Study I:Fat within cheese-matrix vs. outside cheese-matrix (porcine)
14-day parallel intervention in 36 pigs
Study dietsThree iso-caloric macronutrient-matched intervention diets
REG: diet with regular-fat cheese RED: diet with reduced-fat cheese + butter BUT: control diet with butter
Strongcorrelation!
r=0.86 (P< 0.0001)
Importance of the location of dairy-fat?
Results of the Copenhagen Cheese Studies: Importance of the matrix
Lack of difference in LDL-cholesterol may be due to balancing diets with potato protein
Study II:Regular-fat vs. reduced-fat cheese vs. CHO (Humans)
• Parallel study in 139 free-living subjects with metabolic syndrome
• 3-months equal intake of regular-fat cheese to reduced-fat cheese or an isocaloric amount of carbohydrate-rich foods
(AJCN, 2016, in press)
Blood lipids• No difference in LDL-cholesterol concentrations between regular- or reduced-fat
cheese• Despite significant differences in dietary fat E% and saturated fat intake• Tendency to an increase in HDL-cholesterol concentration by regular-fat cheese
Currently awaiting particle size data…
Body weight• No difference in body weight• ~200 kJ/d lower energy supply with the reduced-fat cheese• May support an importance of the fat excretion (stronger with regular-fat cheese)• Fat excretion not measured
Study II:Regular-fat vs. reduced-fat cheese vs. CHO (Humans)
McSweeney (2004)
Study III:Cheese ripening time (porcine)
21-day parallel intervention in 36 pigs
Isocaloric diets with equal amounts of cheese (35g cheese/100g diet)
4-MRC: 4-month ripened cheddar14-MRC: 14-month ripened cheddar24-MRC: 24-month ripened cheddar
4-MRC 14-MRC 24-MRC
Casein % 13.0 7.6 7.2 Peptides % 7.4 10.1 9.3 Free amino acids % 2.7 4.8 7.4
Study III:Cheese ripening time (porcine)
• No differences in TC, LDL, HDL, or TG after intake of the cheeses
• No difference in plasma glucose after intake of the cheeses
Long-term ripened cheddar may improve insulin sensitivity
Study III:Cheese ripening time (porcine)
Study IV:Saturated fat in cheese vs. meat vs. CHO (humans)
• 14-day 3-period cross-over study• 14 overweight, postmenopausal women with slightly increased cholesterol
Fecal fat excretion depends on:
• the dietary fat content
• the calcium content
Study IV:Saturated fat in cheese vs. meat vs. CHO (humans)
0
0,2
0,4
0,6
0,8
1
1,2
1,4
1,6
1,8
CHEESE diet CARB diet MEAT diet
HD
L-C
(m
mo
l/L)
0
0.2
0.4
0.6
0.8
1
1.2
1.4
1.6
CHEESE diet CARB diet MEAT dietA
po
A-1
(g
/L)
ab a
P diet= 0.002
P diet= 0.002
Surprisingly, no difference in LDL-cholesterol
ab
a HDL responsedepends on the
dietary fat content
Study IV:Saturated fat in cheese vs. meat vs. CHO (humans)
Carbohydrates expected to reduce LDL-cholesterol compared to saturated fat
Explained by the higher fecal bile acid excretion with cheese and meat?
Study IV:Saturated fat in cheese vs. meat vs. CHO (humans)
ConclusionsFecal fat excretion• Cheese increases fecal fat excretion compared to carbohydrates, butter, and
meat• The effect may be strongest for fat imbedded in the cheese-matrix (porcine)• Fecal fat excretion is not affected by the ripening duration (porcine)
Blood lipids• Cheese causes less increase in LDL-cholesterol compared to butter, but similar
LDL-cholesterol as a diet with a high meat or carbohydrate content • Regular-fat cheese seems to have a distinct effect on HDL-cholesterol but equal
effect on LDL-cholesterol compared to reduced-fat cheese• A long-term ripened cheese (cheddar) causes lower NEFA concentration than
short-term ripened cheese (in porcine)
Insulin sensitivity• Long-term ripened cheese (cheddar) improves HOMA-IR (in porcine)
• More research in whole foods
• Moving towards food based dietary guidelines
• Studies including a broader range of cardiovascular risk markers
• One diet does not fit all – moving towards personalized nutrition
True?
Future perspectives
Acknowledgements
Study participants
Funding
Danish Dairy Research Foundation
Dairy Research Institute (USA)
Dairy farmers of Canada
National Interprofessional Center
for Dairy Economy (France)
Dairy Australia
Dutch Dairy Association
Colleagues
Arne Astrup, UCPH
Anne Raben, UCPH
Farinaz Raziani, UCPH
Tine Tholstrup, UCPH
Nathalie Bendsen, UCPH
Janne Lorenzen, UCPH
Pia Kiilerich, UCPH
Ylva Ardö, UCPH
Henry Jörgensen, AU
Søren Krogh Jensen, AU