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Summary

Numerous publications have reported conflicting results on the association between cow’s milk intake and coronary heart disease (CHD). However, studies involving postmenopausal women are very limited. Recently, Ha et al. [1] reported the results of a study that aimed to identify the relationship between cow’s milk intake and the risk of CHD in postmenopausal women. For this purpose, the authors used data from the 6th Korean National Health and Nutrition Assessment Survey, including in the analysis 1,825 postmenopausal women aged 50 to 64 years. The frequency of cow’s milk consumption for each participant was determined using the semi-quantitative food frequency questionnaire, classifying women into four groups: Q1, those who did not drink milk (n= 666); Q2, frequency of milk intake per week ≤ 1 (n=453); Q3, milk consumption per week ≤ 3 (n=319); and Q4, milk intake >3 times per week (n=387). General characteristics such as education, region (large city, medium or small city, rural), family income, and level of obesity were compared among the 4 groups. Percentages of daily nutrient intake were estimated in comparison with the Korean Dietary Reference Intake recommendations, determining as indicators of CHD risk: the Framingham risk score (FRS), the atherogenic index (AI) and atherogenic index of plasma (AIP). Except for family income, there were no differences among the four groups in terms of age, education, area of ​​residence, or obesity. Comparing the Dietary Reference Intake, the proportion of intake of calcium, phosphorus and riboflavin was higher in the Q4 group than in the Q1-Q3 groups. HDL cholesterol (HDL-C) was higher in Q4 than in Q1. CHD risk factors, represented by FRS, AI, and AIP, were lower in the Q4 group compared to the other groups (FRS [%]: Q1 9.4, Q4 8.5; AI: Q1 3.06, Q4 2.83, and AIP: Q1 0.37, Q2 0.31, Q4 0.32). It was observed that the FRS had a significant positive correlation with the AI ​​or the AIP, and a negative correlation with the frequency of consumption of cow’s milk and calcium intake. The authors conclude that compared to women who have not consumed cow’s milk, those who have -and frequently- had a better nutritional status of calcium, phosphorus and vitamin B12, higher levels of HDL-C and lower values of CHD risk indicators, such as FRS, AI, and AIP, which would contribute to a decrease in CHD risk over a 10-year period. Therefore, to prevent the risk of CHD in postmenopausal women, it is recommended that there should be a greater emphasis on the consumption of cow’s milk, four or more times per week.

Commentary

In this study, the FRS revealed a negative correlation with the frequency of cow’s milk consumption, that is, lower risk with higher milk consumption. CHD risk indicators were generally more favorable in cow’s milk consumers, as much as to suggest the authors that postmenopausal women should systematically ingest dairy products in order to prevent CHD. Menopause is associated with the appearance or exacerbation of cardiovascular risk factors and, consequently, with CHD. Besides the classical preventive factors that must be worked upon, diet is a transcendental factor that modifies the risk of chronic diseases. Cow’s milk and its derivatives are nutrient-dense foods that provide energy and high-quality proteins, and a variety of essential micronutrients such as calcium, magnesium, potassium, zinc and phosphorus, in an easily absorbed form. In addition, they also provide biologically active compounds like probiotic bacteria, antioxidants, vitamins, peptides and many others; all these conform milk´s food matrix. In general, the Dietary Guidelines suggest the intake of low-fat or fat-free dairy products, since whole milk is rich in saturated fat. In fact, an association of whole milk intake with increased cardiovascular risk has been described when its consumption is excessive. However, the evidence is contradictory, with studies showing favorable or neutral effects [2].

In women from the WHI study, who had baseline normal weight, dairy intake and its association with the development of overweight/obesity were prospectively evaluated. Higher intake of high-fat dairy products, but not the intake of low-fat dairy products, was associated with less weight gain [3]. There is increasing evidence that it is necessary to follow nutritional recommendations based on food rather than isolated nutrients, because saturated fats are a heterogeneous group of fatty acids, and their effect on health depends on the food matrix in which they are found, as occurs with the milk matrix.

The Korean research, which is being commented, was not able to study cardiovascular risk calculation according to the type of milk. Other dietary factors, such as the consumption of fruits, vegetables, grains or foods rich in fat, or exercise, were also not considered. It is noteworthy to mention that there were no differences in morbidity risk (hypertension, diabetes, dyslipidemia) among the different milk consumption analyzed groups. Their findings, and the existing evidence [4], point to the need for further studies evaluating cow’s milk as an intervention to reduce cardiovascular risk in postmenopausal women and, as an important added value, its contribution to preventing bone loss.

Paulina Villaseca-Delano, MD
Gineco-Endocrinología
Centro de Excelencia en Biomedicina de Magallanes (CEBIMA-UMAG)
Experta Latinoamericana en Climaterio (FLASCYM)
Ex-integrante del Board de la International Menopause Society
Miembro del Comité Editorial de Climacteric

 

References

  1. Ha AW, Kim WK, Kim SH. Cow’s Milk Intake and Risk of Coronary Heart Disease in Korean Postmenopausal Women. Nutrients. 2022;14(5):1092.
    https://pubmed.ncbi.nlm.nih.gov/35268066/
  2. Jakobsen MU, Trolle E, Outzen M, et al. Intake of dairy products and associations with major atherosclerotic cardiovascular diseases: a systematic review and meta-analysis of cohort studies. Sci Rep. 2021;11(1):1303.
    https://pubmed.ncbi.nlm.nih.gov/33446728/
  3. Rautiainen S, Wang L, Lee IM, Manson JE, Buring JE, Sesso HD. Dairy consumption in association with weight change and risk of becoming overweight or obese in middle-aged and older women: a prospective cohort study. Am J Clin Nutr. 2016;103(4):979-88.
    https://pubmed.ncbi.nlm.nih.gov/26912496/
  4. Givens DI. Milk and dairy foods: implications for cardiometabolic health. Cardiovasc Endocrinol Metab. 2018;7(3):56-57.
    https://pubmed.ncbi.nlm.nih.gov/31646282/

 


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