New umbrella study of cheese & health outcomes [1].
The authors are Chinese – with the exception of Edward Giovannucci.
A PubMed search for returned 20 papers where Giovannucci was leader (9), primary author (4) or co-author (7). So it’s not surprising to see his name on this Chinese study. His involvement lends credibility imo.
When it seems that there are more meta-analyses than primary sources, someone will have the bright idea of combining the meta-analyses to produce an umbrella review.
Oddly, a PubMed search for returns only the new paper. Cheese itself has never had the spotlight. In some studies, cheese is buried under “dairy products”. In others, we discover nothing about the cheeses consumed – the fat content, age & amounts. In contrast, with milk, the questionnaires often collect the type of milk (skim or full fat) and number of glasses.
A quick review of primary papers finds that milk is often associated with serious PCa, yet cheese is not. I know that many men who avoid milk, avoid all dairy. Whether the milk problem is due to calcium, IGF-I or something else, wouldn’t cheese contain those same components? Perhaps not:
“Each 200 g increment in milk per day was associated with 10.0 µg/L … higher IGF-1. In contrast, we observed no association between cheese or yogurt intake and IGF-1 concentrations.” From: “Association of dietary intake of milk and dairy products with blood concentrations of insulin-like growth factor 1 (IGF-1) in Bavarian adults” [2].
From the umbrella:
“We searched PubMed, Embase, and Cochrane Library to identify meta-analyses/pooled analyses of prospective studies examining the associations between cheese consumption and major health outcomes from inception to August 31, 2022. We reanalyzed and updated previous meta-analyses and performed de novo meta-analyses with recently published prospective studies, where appropriate. We calculated the summary effect size, 95% prediction confidence intervals, between-study heterogeneity, small-study effects, and excess significance bias for each health outcome. We identified 54 eligible articles of meta-analyses/pooled analyses. After adding newly published original articles, we performed 35 updated meta-analyses and 4 de novo meta-analyses. Together with eight previous meta-analyses, we finally included 47 unique health outcomes.”
Phew!“
Cheese consumption was inversely associated with all-cause mortality (highest vs. lowest category: RR=0.95 …), cardiovascular mortality (RR=0.93 …), incident cardiovascular disease (CVD) (RR=0.92 …), coronary heart disease (CHD) (RR=0.92 …), stroke (RR=0.93 …), estrogen receptor-negative (ER-) breast cancer (RR=0.89 …), type 2 diabetes (RR=0.93 …), total fracture (RR=0.90 …), and dementia (RR=0.81 …)”
“Null associations were found for” “cancer mortality, incident hypertension, and prostate cancer”.
“Our findings suggest that cheese consumption has neutral to moderate benefits for human health.”
Something else to consider. We typically know how important vitamin K is for bone health, but … [3]:
“Anticarcinogenic activities of vitamin K have been observed in animal and cell studies.”
“During a median follow-up time of >10 y, 1755 incident cancer cases occurred, of which 458 were fatal. Dietary intake of menaquinones {K2} was nonsignificantly inversely associated with overall cancer incidence (HR for the highest compared with the lowest quartile: 0.86 …), and the association was stronger for cancer mortality (HR: 0.72 …). Cancer risk reduction with increasing intake of menaquinones was more pronounced in men than in women, mainly driven by significant inverse associations with prostate… and lung … cancer. We found no association with phylloquinone {K1} intake.”
“These findings suggest that dietary intake of menaquinones, which is highly determined by the consumption of cheese, is associated with a reduced risk of incident and fatal cancer.”
From a Dutch study [4]:
“Vitamin K2 (menaquinone) concentrations were measured in a wide range of cheeses and the effects of fat content, ripening and origin of the cheeses were investigated. Moreover, the menaquinone content of cheese was compared with that of other foods known to contain vitamin K2. It was found that cheese and curd are the most important sources of long-chain menaquinones in the Western diet and, in general, hard cheeses are richer in menaquinones than soft cheeses. However, the actual menaquinone content varies substantially and is dependent on the type of cheese, the time of ripening, the fat content and the geographic area where the cheeses are produced. Given the fact that poor vitamin K status has been mentioned as a risk factor for cardiovascular disease and mortality, while there is no clear evidence for adverse cardiovascular effects of dairy fats, cheese should be considered as a recommendable component in a heart-healthy diet.”
“A number of Dutch cheeses of different fat content and ripening periods were analyzed for their phylloquinone (vitamin K1) and menaquinones (vitamin K2) content (Table 1). In all cheeses it was found that the very young ones had a slightly lower menaquinone content than the older ones and after 13 weeks of ripening a certain plateau level was reached. This difference is mainly due to the increased levels of long-chain menaquinones in more ripened cheeses, which originate from bacterial growth during fermentation. It was found that in the most popular full fat cheese (Gouda 13 weeks, 50% dry weight fat) the menaquinone content was around 650 ng/g while in the very young cheese (Gouda 4 weeks) it was substantially lower (473 ng/g). No significant difference was found between freshly cut cheese at a stretch and vacuum-packed products. Demi-fat cheese (Milner 4 weeks, 13 weeks or 26 weeks, 30% dry weight fat) had a lower menaquinone content independently of the ripening duration (around 450 ng/g), and low-fat cheese (Slankie 4 weeks, 13 weeks or 26 weeks, 20% dry weight fat) contained not more than approximately 380 ng/g. Edam (40% dry weight fat) and Maasdam (5 weeks, 45% dry weight fat) cheeses were relatively rich in menaquinones with 647 ng/g and 490 ng/g respectively, whereas curd cheese contained between 94 and 140 ng/g, independent of the fat content. Raw milk cheese (not industrially prepared but originating from local farms) was rich in menaquinones (between approximately 600 and 790 ng/g).”
“When comparing cheeses from different countries, remarkable differences were observed (Table 2). Notably, cheeses produced in Mediterranean countries (feta, mozzarella, gorgonzola, pecorino) were low in menaquinone content with Parmesan cheese containing almost negligible amounts (3 ng/g). French cheeses, Brie and Boursin, had low vitamin K2 content (125 ng/g and 111 ng/g, respectively), whereas it was considerably higher Camembert and Roquefort (681 ng/g and 381 ng/g, respectively). The highest content of menaquinones in French cheeses was measured in Münster cheese (originating from the Vosges and made from raw, unpasteurized milk) with 801 ng/g total vitamin K2.“
“Both British cheeses measured (Cheddar and Stilton) contained average to high amounts of menaquinones (235 ng/g and 494 ng/g, respectively) as did Swiss cheeses, Emmenthal (433 ng/g) and Raclette (323 ng/g), while Gruyère contained low amounts (65.3 ng/g). Remarkably, the Swiss Emmental cheese almost exclusively contained MK-10, which is produced by the probiotic Propionibacterium freudenreichii that is also thought to be responsible for the large holes and the typical taste of this cheese. However, it was also reported that these large holes could be due to the presence of hay particles during cheese maturation. Finally, two Norwegian cheeses measured, Gamalost and Norvegia, contained relatively high amounts of menaquinones with 542 ng/g and 415 ng/g, respectively.”
-Patrick
[1] pubmed.ncbi.nlm.nih.gov/373...
[2] pubmed.ncbi.nlm.nih.gov/310...
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