Cheese consumption in relation to cardiovascular risk factors among Iranian adults- IHHP Study

  • Sadeghi, Masoumeh (Cardiac Rehabilitation Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences) ;
  • Khosravi-Boroujeni, Hossein (Griffith Health Institute, Griffith University) ;
  • Sarrafzadegan, Nizal (Isfahan Cardiovascular Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences) ;
  • Asgary, Sedigheh (Physiology research center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences) ;
  • Roohafza, HamidReza (Mental health department, Isfahan Cardiovascular Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences) ;
  • Gharipour, Mojgan (Isfahan Cardiovascular Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences) ;
  • Sajjadi, Firouzeh (Isfahan Cardiovascular Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences) ;
  • Khalesi, Saman (Griffith Health Institute, Griffith University) ;
  • Rafieian-kopae, Mahmoud (Medical Plants Research Centre, Shahrekord University of Medical Sciences)
  • Received : 2013.06.04
  • Accepted : 2014.04.03
  • Published : 2014.06.01


BACKGROUND/OBJECTIVE: It is expected that dairy products such as cheeses, which are the main source of cholesterol and saturated fat, may lead to the development or increase the risk of cardiovascular and metabolic diseases; however, the results of different studies are inconsistent. This study was conducted to assess the association between cheese consumption and cardiovascular risk factors in an Iranian adult population. SUBJECTS/METHODS: Information from the Isfahan Healthy Heart Program (IHHP) was used for this cross-sectional study with a total of 1,752 participants (782 men and 970 women). Weight, height, waist and hip circumference measurement, as well as fasting blood samples were gathered and biochemical assessments were done. To evaluate the dietary intakes of participants a validated food frequency questionnaire, consists of 49 items, was completed by expert technicians. Consumption of cheese was classified as less than 7 times per week and 7-14 times per week. RESULTS: Higher consumption of cheese was associated with higher C-Reactive Protein (CRP), apolipoprotein A and high density lipoprotein cholesterol (HDL-C) level but not with fasting blood sugar (FBS), total cholesterol, low density lipoprotein cholesterol (LDL-C), triglyceride (TG) and apolipoprotein B. Higher consumption of cheese was positively associated with consumption of liquid and solid oil, grain, pulses, fruit, vegetable, meat and dairy, and negatively associated with Global Dietary Index. After control for other potential confounders the association between cheese intake and metabolic syndrome (OR: 0.81; 96%CI: 0.71-0.94), low HDL-C level (OR: 0.87; 96%CI: 0.79-0.96) and dyslipidemia (OR: 0.88; 96%CI: 0.79-0.98) became negatively significant. CONCLUSION: This study found an inverse association between the frequency of cheese intake and cardiovascular risk factors; however, further prospective studies are required to confirm the present results and to illustrate its mechanisms.


  1. Writing Group Members, Lloyd-Jones D, Adams RJ, Brown TM, Carnethon M, Dai S, De Simone G, Ferguson TB, Ford E, Furie K, Gillespie C, Go A, Greenlund K, Haase N, Hailpern S, Ho PM, Howard V, Kissela B, Kittner S, Lackland D, Lisabeth L, Marelli A, McDermott MM, Meigs J, Mozaffarian D, Mussolino M, Nichol G, Roger VL, Rosamond W, Sacco R, Sorlie P, Roger VL, Thom T, Wasserthiel- Smoller S, Wong ND, Wylie-Rosett J; American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics--2010 update: a report from the American Heart Association. Circulation 2010;121:e46-215.
  2. Sarraf-Zadegan N, Boshtam M, Malekafzali H, Bashardoost N, Sayed-Tabatabaei FA, Rafiei M, Khalili A, Mostafavi S, Khami M, Hassanvand R. Secular trends in cardiovascular mortality in Iran, with special reference to Isfahan. Acta Cardiol 1999;54:327-33.
  3. Sarraf-Zadegan N, Sadri G, Malek Afzali H, Baghaei M, Mohammadi Fard N, Shahrokhi S, Tolooie H, Poormoghaddas M, Sadeghi M, Tavassoli A, Rafiei M, Kelishadi R, Rabiei K, Bashardoost N, Boshtam M, Asgary S, Naderi G, Changiz T, Yousefie A. Isfahan Healthy Heart Programme: a comprehensive integrated community-based programme for cardiovascular disease prevention and control. Design, methods and initial experience. Acta Cardiol 2003;58:309-20.
  4. Helfand M, Buckley DI, Freeman M, Fu R, Rogers K, Fleming C, Humphrey LL. Emerging risk factors for coronary heart disease: a summary of systematic reviews conducted for the U.S. Preventive Services Task Force. Ann Intern Med 2009;151:496-507.
  5. Khosravi-Boroujeni H, Mohammadifard N, Sarrafzadegan N, Sajjadi F, Maghroun M, Khosravi A, Alikhasi H, Rafieian M, Azadbakht L. Potato consumption and cardiovascular disease risk factors among Iranian population. Int J Food Sci Nutr 2012;63:913-20.
  6. Khosravi-Boroujeni H, Sarrafzadegan N, Mohammadifard N, Alikhasi H, Sajjadi F, Asgari S, Esmaillzadeh A. Consumption of sugarsweetened beverages in relation to the metabolic syndrome among Iranian adults. Obes Facts 2012;5:527-37.
  7. Esmaillzadeh A, Boroujeni HK, Azadbakht L. Consumption of energy-dense diets in relation to cardiometabolic abnormalities among Iranian women. Public Health Nutr 2012;15:868-75.
  8. Renaud S, Lanzmann-Petithory D. Coronary heart disease: dietary links and pathogenesis. Public Health Nutr 2001;4:459-74.
  9. Chi D, Nakano M, Yamamoto K. Milk and milk products consumption in relationship to serum lipid levels: a community-based study of middle-aged and older population in Japan. Cent Eur J Public Health 2004;12:84-7.
  10. Moss M. Does milk cause coronary heart disease? J Nutr Environ Med 2002;12:207-16.
  11. Elwood PC, Pickering JE, Hughes J, Fehily AM, Ness AR. Milk drinking, ischaemic heart disease and ischaemic stroke II. Evidence from cohort studies. Eur J Clin Nutr 2004;58:718-24.
  12. Mennen LI, Lafay L, Feskens EJ, Novak M, Lepinay P, Balkau B. Possible protective effect of bread and dairy products on the risk of the metabolic syndrome. Nutr Res 2000;20:335-47.
  13. Pereira MA, Jacobs DR Jr, Van Horn L, Slattery ML, Kartashov AI, Ludwig DS. Dairy consumption, obesity, and the insulin resistance syndrome in young adults: the CARDIA Study. JAMA 2002;287: 2081-9.
  14. Hu FB, Stampfer MJ, Manson JE, Ascherio A, Colditz GA, Speizer FE, Hennekens CH, Willett WC. Dietary saturated fats and their food sources in relation to the risk of coronary heart disease in women. Am J Clin Nutr 1999;70:1001-8.
  15. McNamara DJ, Lowell AE, Sabb JE. Effect of yogurt intake on plasma lipid and lipoprotein levels in normolipidemic males. Atherosclerosis 1989;79:167-71.
  16. Jacqmain M, Doucet E, Despres JP, Bouchard C, Tremblay A. Calcium intake, body composition, and lipoprotein-lipid concentrations in adults. Am J Clin Nutr 2003;77:1448-52.
  17. Hajjar IM, Grim CE, Kotchen TA. Dietary calcium lowers the age-related rise in blood pressure in the United States: the NHANES III survey. J Clin Hypertens (Greenwich) 2003;5:122-6.
  18. Jorde R, Bonaa KH. Calcium from dairy products, vitamin D intake, and blood pressure: the Tromso Study. Am J Clin Nutr 2000;71: 1530-5.
  19. Loos RJ, Rankinen T, Leon AS, Skinner JS, Wilmore JH, Rao DC, Bouchard C. Calcium intake is associated with adiposity in Black and White men and White women of the HERITAGE Family Study. J Nutr 2004;134:1772-8.
  20. Zemel MB, Miller SL. Dietary calcium and dairy modulation of adiposity and obesity risk. Nutr Rev 2004;62:125-31.
  21. St-Onge MP, Farnworth ER, Jones PJ. Consumption of fermented and nonfermented dairy products: effects on cholesterol concentrations and metabolism. Am J Clin Nutr 2000;71:674-81.
  22. Colquhoun DM, Somerset S, Irish K, Leontjew LM. Cheese added to a low fat diet does not affect serum lipids. Asia Pac J Clin Nutr 2003;12 Suppl:S65.
  23. Tholstrup T, Hoy CE, Andersen LN, Christensen RD, Sandstrom B. Does fat in milk, butter and cheese affect blood lipids and cholesterol differently? J Am Coll Nutr 2004;23:169-76.
  24. Hostmark AT, Haug A, Tomten SE, Thelle DS, Mosdol A. Serum hdl cholesterol was positively associated with cheese intake in the Oslo Health Study. J Food Lipids 2009;16:89-102.
  25. Moss M, Freed D. The cow and the coronary: epidemiology, biochemistry and immunology. Int J Cardiol 2003;87:203-16.
  26. Goldbohm RA, Chorus AM, Galindo Garre F, Schouten LJ, van den Brandt PA. Dairy consumption and 10-y total and cardiovascular mortality: a prospective cohort study in the Netherlands. Am J Clin Nutr 2011;93:615-27.
  27. Kabagambe EK, Baylin A, Siles X, Campos H. Individual saturated fatty acids and nonfatal acute myocardial infarction in Costa Rica. Eur J Clin Nutr 2003;57:1447-57.
  28. Tavani A, Gallus S, Negri E, La Vecchia C. Milk, dairy products, and coronary heart disease. J Epidemiol Community Health 2002; 56:471-2.
  29. Alizadeh M, Hamedi M, Khosroshahi A. Optimizing sensorial quality of iranian white brine cheese using response surface methodology. J Food Sci 2005;70:S299-303.
  30. Sarrafzadegan N, Baghaei A, Sadri G, Kelishadi R, Malekafzali H, Boshtam M, Amani A, Rabie K, Moatarian A, Rezaeiashtiani A, Paradis G, O'Loughlin J. Isfahan healthy heart program: evaluation of comprehensive, community-based interventions for non-communicable disease prevention. Prev Control 2006;2:73-84.
  31. Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem 1972;18: 499-502.
  32. Elwood PC, Pickering JE, Fehily AM. Milk and dairy consumption, diabetes and the metabolic syndrome: the Caerphilly prospective study. J Epidemiol Community Health 2007;61:695-8.
  33. Biong AS, Muller H, Seljeflot I, Veierod MB, Pedersen JI. A comparison of the effects of cheese and butter on serum lipids, haemostatic variables and homocysteine. Br J Nutr 2004;92:791-7.
  34. Renaud S, De Lorgeril M. Dietary lipids and their relation to ischaemic heart disease: from epidemiology to prevention. J Intern Med Suppl 1989;731:39-46.
  35. Nestel PJ, Chronopulos A, Cehun M. Dairy fat in cheese raises LDL cholesterol less than that in butter in mildly hypercholesterolaemic subjects. Eur J Clin Nutr 2005;59:1059-63.
  36. Hjerpsted J, Leedo E, Tholstrup T. Cheese intake in large amounts lowers LDL-cholesterol concentrations compared with butter intake of equal fat content. Am J Clin Nutr 2011;94:1479-84.
  37. Samuelson G, Bratteby LE, Mohsen R, Vessby B. Dietary fat intake in healthy adolescents: inverse relationships between the estimated intake of saturated fatty acids and serum cholesterol. Br J Nutr 2001;85:333-41.
  38. Azadbakht L, Mirmiran P, Esmaillzadeh A, Azizi F. Dairy consumption is inversely associated with the prevalence of the metabolic syndrome in Tehranian adults. Am J Clin Nutr 2005;82:523-30.
  39. Hostmark AT, Tomten SE. The Oslo Health Study: cheese intake was negatively associated with the metabolic syndrome. J Am Coll Nutr 2011;30:182-90.
  40. Appleby PN, Thorogood M, Mann JI, Key TJ. The Oxford Vegetarian Study: an overview. Am J Clin Nutr 1999;70:525S-531S.
  41. Beydoun MA, Gary TL, Caballero BH, Lawrence RS, Cheskin LJ, Wang Y. Ethnic differences in dairy and related nutrient consumption among US adults and their association with obesity, central obesity, and the metabolic syndrome. Am J Clin Nutr 2008;87:1914-25.
  42. Jacobsen R, Lorenzen JK, Toubro S, Krog-Mikkelsen I, Astrup A. Effect of short-term high dietary calcium intake on 24-h energy expenditure, fat oxidation, and fecal fat excretion. Int J Obes (Lond) 2005;29:292-301.
  43. Yacowitz H, Fleischman AI, Bierenbaum ML. Effects of oral calcium upon serum lipids in man. Br Med J 1965;1:1352-4.
  44. Andersen LF, Johansson L, Solvoll K. Usefulness of a short food frequency questionnaire for screening of low intake of fruit and vegetable and for intake of fat. Eur J Public Health 2002;12:208-13.

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