Cheese and Healthy Diet: Associations With Incident Cardio-Metabolic Diseases and All-Cause Mortality in the General Population

Louise H. Dekker; Petra C. Vinke; Ineke J. Riphagen; Isidor Minovic; Manfred L. Eggersdorfer; Ellen G. H. M. van den Heuvel; Leon J. Schurgers; Ido P. Kema; Stephan J. L. Bakker; Gerjan Navis

doi:10.3389/fnut.2019.00185

Cheese and Healthy Diet: Associations With Incident Cardio-Metabolic Diseases and All-Cause Mortality in the General Population

Louise H. Dekker, Petra C. Vinke, Ineke J. Riphagen, Isidor Minovic, Manfred L. Eggersdorfer, Ellen G. H. M. van den Heuvel, Leon J. Schurgers, Ido P. Kema, Stephan J. L. Bakker, Gerjan Navis^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

Background: Many countries have established Food-Based Dietary Guidelines (FBDG). For some foods, such as cheese, there is no consensus on whether or not to include them in these guidelines. Cheese may, however, be an excellent source of vitamin K2, which is a macronutrient with demonstrated positive results on cardiovascular-related outcomes. Aim: First, we assessed the role of cheese within the recently developed Lifelines Diet Score (LLDS), a score based on the Dutch FBDG 2015 in relation to incident cardio-metabolic diseases and all-cause mortality. Secondly, we assessed the association of cheese intake with desphospho-uncarboxylated matrix Gla protein (dp-ucMGP), a marker for functional vitamin K2 status, in a subset of the population. Methods: From the Lifelines cohort study, 122,653 adult participants were included to test the association between de LLDS and health outcomes. In a subset of 1,059 participants aged 60-75 years, dp-ucMGP levels were measured. Dietary intake was assessed using a 110-item Food Frequency Questionnaire. Logistic regression were applied, adjusted for relevant confounders. Results: Median cheese intake was 23.5 [12.6-40.6] g/day. We found a positive correlation between cheese intake and the LLDS (Spearman's rho = 0.024, p <0.001). The LLDS in quintiles was associated with T2DM [OR (95% CI) Q5 (healthy diet) vs. Q1 (poor diet) = 0.54 (0.43-0.67)] and all-cause mortality [Q5 vs. Q1 = 0.62 (0.50-0.76)]. Inclusion of cheese did not alter these associations. Additionally, we found no significant association of total cheese intake with plasma dp-ucMGP levels. Conclusion: In this population-based cohort study, the inclusion of cheese in the LLDS did not change the inverse associations with incident cardio-metabolic diseases and all-cause mortality. Furthermore, we found no significant association of total cheese intake with plasma dp-ucMGP. The results suggest that cheese is a neutral food group that fits a healthy diet.

Original language	English
Article number	185
Number of pages	9
Journal	Frontiers in nutrition
Volume	6
DOIs	https://doi.org/10.3389/fnut.2019.00185
Publication status	Published - 17 Dec 2019

Keywords

nutrition
diet
vitamin K2
cardio-metabolic diseases
all-cause mortality
DAIRY PRODUCT
METAANALYSIS
CONSUMPTION
CALCIUM
SUPPLEMENTATION
MENAQUINONES
MATRIX
LIPIDS
FOOD

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10.3389/fnut.2019.00185Licence: CC BY

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Dekker, L. H., Vinke, P. C., Riphagen, I. J., Minovic, I., Eggersdorfer, M. L., van den Heuvel, E. G. H. M., Schurgers, L. J., Kema, I. P., Bakker, S. J. L., & Navis, G. (2019). Cheese and Healthy Diet: Associations With Incident Cardio-Metabolic Diseases and All-Cause Mortality in the General Population. Frontiers in nutrition, 6, Article 185. https://doi.org/10.3389/fnut.2019.00185

@article{54762fe9fd2041438cde8193f3d3c676,

title = "Cheese and Healthy Diet: Associations With Incident Cardio-Metabolic Diseases and All-Cause Mortality in the General Population",

abstract = "Background: Many countries have established Food-Based Dietary Guidelines (FBDG). For some foods, such as cheese, there is no consensus on whether or not to include them in these guidelines. Cheese may, however, be an excellent source of vitamin K2, which is a macronutrient with demonstrated positive results on cardiovascular-related outcomes. Aim: First, we assessed the role of cheese within the recently developed Lifelines Diet Score (LLDS), a score based on the Dutch FBDG 2015 in relation to incident cardio-metabolic diseases and all-cause mortality. Secondly, we assessed the association of cheese intake with desphospho-uncarboxylated matrix Gla protein (dp-ucMGP), a marker for functional vitamin K2 status, in a subset of the population. Methods: From the Lifelines cohort study, 122,653 adult participants were included to test the association between de LLDS and health outcomes. In a subset of 1,059 participants aged 60-75 years, dp-ucMGP levels were measured. Dietary intake was assessed using a 110-item Food Frequency Questionnaire. Logistic regression were applied, adjusted for relevant confounders. Results: Median cheese intake was 23.5 [12.6-40.6] g/day. We found a positive correlation between cheese intake and the LLDS (Spearman's rho = 0.024, p <0.001). The LLDS in quintiles was associated with T2DM [OR (95% CI) Q5 (healthy diet) vs. Q1 (poor diet) = 0.54 (0.43-0.67)] and all-cause mortality [Q5 vs. Q1 = 0.62 (0.50-0.76)]. Inclusion of cheese did not alter these associations. Additionally, we found no significant association of total cheese intake with plasma dp-ucMGP levels. Conclusion: In this population-based cohort study, the inclusion of cheese in the LLDS did not change the inverse associations with incident cardio-metabolic diseases and all-cause mortality. Furthermore, we found no significant association of total cheese intake with plasma dp-ucMGP. The results suggest that cheese is a neutral food group that fits a healthy diet.",

keywords = "nutrition, diet, vitamin K2, cardio-metabolic diseases, all-cause mortality, DAIRY PRODUCT, METAANALYSIS, CONSUMPTION, CALCIUM, SUPPLEMENTATION, MENAQUINONES, MATRIX, LIPIDS, FOOD",

author = "Dekker, {Louise H.} and Vinke, {Petra C.} and Riphagen, {Ineke J.} and Isidor Minovic and Eggersdorfer, {Manfred L.} and {van den Heuvel}, {Ellen G. H. M.} and Schurgers, {Leon J.} and Kema, {Ido P.} and Bakker, {Stephan J. L.} and Gerjan Navis",

note = "Funding Information: The LifeLines Biobank initiative has been made possible by funds from FES (Fonds Economische Structuurversterking), SNN (Samenwerkingsverband Noord Nederland), and REP (Ruimtelijk Economisch Programma). The authors wish to acknowledge the services of the LifeLines Cohort Study, the contributing research centers delivering data to LifeLines, and all study participants. This study was partly funded by the Nutrition and Health initiative of the University of Groningen. Funding Information: Conflict of Interest: EH was employed by company Friesland Campina. The authors declare that this study received funding from the Dutch Dairy Association. Funding Information: The LifeLines Biobank initiative has been made possible by funds from FES (Fonds Economische Structuurversterking), SNN (Samenwerkingsverband Noord Nederland), and REP (Ruimtelijk Economisch Programma). The authors wish to acknowledge the services of the LifeLines Cohort Study, the contributing research centers delivering data to LifeLines, and all study participants. This study was partly funded by the Nutrition and Health initiative of the University of Groningen. Funding. The funder, the Dutch Dairy Association, had no involvement with the study design, data collection and analysis, decision to publish, or preparation of the manuscript. Publisher Copyright: {\textcopyright} Copyright {\textcopyright} 2019 Dekker, Vinke, Riphagen, Minovi{\'c}, Eggersdorfer, van den Heuvel, Schurgers, Kema, Bakker and Navis.",

year = "2019",

month = dec,

day = "17",

doi = "10.3389/fnut.2019.00185",

language = "English",

volume = "6",

journal = "Frontiers in nutrition",

issn = "2296-861X",

publisher = "Frontiers Media S.A.",

}

TY - JOUR

T1 - Cheese and Healthy Diet

T2 - Associations With Incident Cardio-Metabolic Diseases and All-Cause Mortality in the General Population

AU - Dekker, Louise H.

AU - Vinke, Petra C.

AU - Riphagen, Ineke J.

AU - Minovic, Isidor

AU - Eggersdorfer, Manfred L.

AU - van den Heuvel, Ellen G. H. M.

AU - Schurgers, Leon J.

AU - Kema, Ido P.

AU - Bakker, Stephan J. L.

AU - Navis, Gerjan

N1 - Funding Information: The LifeLines Biobank initiative has been made possible by funds from FES (Fonds Economische Structuurversterking), SNN (Samenwerkingsverband Noord Nederland), and REP (Ruimtelijk Economisch Programma). The authors wish to acknowledge the services of the LifeLines Cohort Study, the contributing research centers delivering data to LifeLines, and all study participants. This study was partly funded by the Nutrition and Health initiative of the University of Groningen. Funding Information: Conflict of Interest: EH was employed by company Friesland Campina. The authors declare that this study received funding from the Dutch Dairy Association. Funding Information: The LifeLines Biobank initiative has been made possible by funds from FES (Fonds Economische Structuurversterking), SNN (Samenwerkingsverband Noord Nederland), and REP (Ruimtelijk Economisch Programma). The authors wish to acknowledge the services of the LifeLines Cohort Study, the contributing research centers delivering data to LifeLines, and all study participants. This study was partly funded by the Nutrition and Health initiative of the University of Groningen. Funding. The funder, the Dutch Dairy Association, had no involvement with the study design, data collection and analysis, decision to publish, or preparation of the manuscript. Publisher Copyright: © Copyright © 2019 Dekker, Vinke, Riphagen, Minović, Eggersdorfer, van den Heuvel, Schurgers, Kema, Bakker and Navis.

PY - 2019/12/17

Y1 - 2019/12/17

N2 - Background: Many countries have established Food-Based Dietary Guidelines (FBDG). For some foods, such as cheese, there is no consensus on whether or not to include them in these guidelines. Cheese may, however, be an excellent source of vitamin K2, which is a macronutrient with demonstrated positive results on cardiovascular-related outcomes. Aim: First, we assessed the role of cheese within the recently developed Lifelines Diet Score (LLDS), a score based on the Dutch FBDG 2015 in relation to incident cardio-metabolic diseases and all-cause mortality. Secondly, we assessed the association of cheese intake with desphospho-uncarboxylated matrix Gla protein (dp-ucMGP), a marker for functional vitamin K2 status, in a subset of the population. Methods: From the Lifelines cohort study, 122,653 adult participants were included to test the association between de LLDS and health outcomes. In a subset of 1,059 participants aged 60-75 years, dp-ucMGP levels were measured. Dietary intake was assessed using a 110-item Food Frequency Questionnaire. Logistic regression were applied, adjusted for relevant confounders. Results: Median cheese intake was 23.5 [12.6-40.6] g/day. We found a positive correlation between cheese intake and the LLDS (Spearman's rho = 0.024, p <0.001). The LLDS in quintiles was associated with T2DM [OR (95% CI) Q5 (healthy diet) vs. Q1 (poor diet) = 0.54 (0.43-0.67)] and all-cause mortality [Q5 vs. Q1 = 0.62 (0.50-0.76)]. Inclusion of cheese did not alter these associations. Additionally, we found no significant association of total cheese intake with plasma dp-ucMGP levels. Conclusion: In this population-based cohort study, the inclusion of cheese in the LLDS did not change the inverse associations with incident cardio-metabolic diseases and all-cause mortality. Furthermore, we found no significant association of total cheese intake with plasma dp-ucMGP. The results suggest that cheese is a neutral food group that fits a healthy diet.

AB - Background: Many countries have established Food-Based Dietary Guidelines (FBDG). For some foods, such as cheese, there is no consensus on whether or not to include them in these guidelines. Cheese may, however, be an excellent source of vitamin K2, which is a macronutrient with demonstrated positive results on cardiovascular-related outcomes. Aim: First, we assessed the role of cheese within the recently developed Lifelines Diet Score (LLDS), a score based on the Dutch FBDG 2015 in relation to incident cardio-metabolic diseases and all-cause mortality. Secondly, we assessed the association of cheese intake with desphospho-uncarboxylated matrix Gla protein (dp-ucMGP), a marker for functional vitamin K2 status, in a subset of the population. Methods: From the Lifelines cohort study, 122,653 adult participants were included to test the association between de LLDS and health outcomes. In a subset of 1,059 participants aged 60-75 years, dp-ucMGP levels were measured. Dietary intake was assessed using a 110-item Food Frequency Questionnaire. Logistic regression were applied, adjusted for relevant confounders. Results: Median cheese intake was 23.5 [12.6-40.6] g/day. We found a positive correlation between cheese intake and the LLDS (Spearman's rho = 0.024, p <0.001). The LLDS in quintiles was associated with T2DM [OR (95% CI) Q5 (healthy diet) vs. Q1 (poor diet) = 0.54 (0.43-0.67)] and all-cause mortality [Q5 vs. Q1 = 0.62 (0.50-0.76)]. Inclusion of cheese did not alter these associations. Additionally, we found no significant association of total cheese intake with plasma dp-ucMGP levels. Conclusion: In this population-based cohort study, the inclusion of cheese in the LLDS did not change the inverse associations with incident cardio-metabolic diseases and all-cause mortality. Furthermore, we found no significant association of total cheese intake with plasma dp-ucMGP. The results suggest that cheese is a neutral food group that fits a healthy diet.

KW - nutrition

KW - diet

KW - vitamin K2

KW - cardio-metabolic diseases

KW - all-cause mortality

KW - DAIRY PRODUCT

KW - METAANALYSIS

KW - CONSUMPTION

KW - CALCIUM

KW - SUPPLEMENTATION

KW - MENAQUINONES

KW - MATRIX

KW - LIPIDS

KW - FOOD

U2 - 10.3389/fnut.2019.00185

DO - 10.3389/fnut.2019.00185

M3 - Article

C2 - 31921878

SN - 2296-861X

VL - 6

JO - Frontiers in nutrition

JF - Frontiers in nutrition

M1 - 185

ER -