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Dairy consumption of around three servings per day is associated with lower rates of cardiovascular disease and mortality, those who consumed three servings of whole fat dairy dilay had lower rates of mortality and cardiovascular disease compared to those who consumed less than 0.5 serving of whole fat dairy per day.
The findings are consistent with previous meta-analyses of observational studies and randomised trials, but stand in contrast to current dietary guidelines which recommend consuming 2-4 servings of fat-free or low-fat dairy per day, and minimising consumption of whole-fat dairy products for cardiovascular disease prevention.
Consumption of dairy products might be beneficial for mortality and cardiovascular disease, especially in low-income and middle-income countries where dairy consumption is much lower than in North America or Europe. The Prospective Urban Rural Epidemiological (PURE) study included data from 136,384 individuals aged 35-70 years in 21 countries.
Dietary intakes were recorded at the start of the study using country-specific validated food questionnaires. Participants were followed up for an average of 9.1 years. During this time, there were 6,796 deaths and 5,855 major cardiovascular events.
One standard serving of dairy was equivalent to a glass of milk at 244g, a cup of yoghurt at 244g, one slice of cheese at 15g, or a teaspoon of butter at 5g. Dairy consumption was highest in North America and Europe (368g/day or above 4 servings of total dairy per day) and lowest in south Asia, China, Africa and southeast Asia (147, 102, 91 and 37g/day respectively—less than 1 serving of total dairy per day).
Participants were grouped into four categories: no dairy (28,674 people), less than 1 serving per day (55,651), 1-2 servings per day (24,423), and over 2 servings per day (27,636). Compared to the no intake group, the high intake group (mean intake of 3.2 servings per day) had lower rates of total mortality (3.4% vs 5.6%), non-cardiovascular mortality (2.5% vs 4%), cardiovascular mortality (0.9% vs 1.6%), major cardiovascular disease (3.5% vs 4.9%), and stroke (1.2% vs 2.9%). There was no difference in the rates of myocardial infarction between the two groups (1.9% vs 1.6%).
Among those who consumed only whole-fat dairy, higher intake (mean intake of 2.9 servings of whole fat dairy per day) was associated with lower rates of total mortality (3.3% vs 4.4%) and major cardiovascular disease (3.7% vs 5.0%), compared to those who consumed less than 0.5 servings whole-fat dairy per day.
Higher intake of milk and yoghurt (above 1 serving per day) was associated with lower rates of the composite outcome, which combines total mortality and cardiovascular disease (milk: 6.2% vs 8.7%; yoghurt: 6.5% vs 8.4%), compared to no consumption. The differences in the composite outcome for butter and cheese were not significant as intake was lower than for milk and yoghurt.