The impact of dairy products on cardiovascular health

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1 The impact of dairy products on cardiovascular health D Vasilopoulou

2 Overview CVD mortality in UK Does dairy consumption increase the risk of CVD? Dairy intake as part of healthy lifestyle RESET project Conclusions 2

3 Age standardized mortality rates CVD in UK A B C A Cardiovascular disease; B Coronary Heart Disease; C Stroke BHF Trends in Cardiovascular Disease,

4 CVD remains leading cause of death 4

5 What is cardiovascular disease? CHD Several decades Stroke 5

6 CVD Risk Factors Obesity Gender Raised cholesterol Genetic determination Raised blood pressure Ethnicity Raised triacylglycerol Age Vascular dysfunction Menopausal status Diabetes Inflammation DIET Smoking Alcohol Physical activity Non-modifiable Stress Modifiable Lifestyle 6

7 Saturated fat intake in the UK Dietary SFA contributes to raised LDL-C levels and CVD risk Fat intake (% FE) Boys 4-10 yearss Men TARGET Scottish children TARGET 7

8 UK dairy consumption Cheese 10% SFA intake Whole milk 2-4% SFA intake Dairy products Contribute 20-25% SFA intake in UK diet Butter 5-10% SFA intake Low-fat milk 4-5% SFA intake Data adapted from NDNS 2008/9 2009/10 8

9 Complexity of dairy products Contains many nutrients which have been linked to an inverse association with CVD risk Micronutrients Carbohydrates Lipids Proteins 9

10 Milk intake and Systolic Blood Pressure 10.4 mmhg lower Livingstone et al., Hypertension 61(1):

11 Milk consumption and vascular disease outcome: meta-analysis of prospective studies OUTCOME RELATIVE RISK (High vs Low) Ischaemic Heart Disease 0.92 (0.86, 0.99) Stroke (all) 0.81 (0.71, 0.92) Haemorrhagic stroke 0.75 (0.6, 0.94) 11 Summary from Givens et al (in press)

12 Strategies to reduce dietary SFA intake Reduction of dairy consumption Consumption of low-fat products Manipulation of bovine feeding: Enrichment with high-oleic rapeseed oil (~75% oleic acid): SFA in milk from 70% to 45-60% of total FAs cis-mufa from 20% to 33% of total FAs (BBSRC/DRINC project: grant BB/ /1) 12

13 Strategy to reduce SFA intake 13

14 Strategies to reduce dietary SFA intake Reduction of dairy consumption Consumption of low-fat products Manipulation of bovine feeding: Enrichment with high-oleic rapeseed oil (~75% oleic acid): SFA in milk from 70% to 45-60% of total FAs cis-mufa from 20% to 33% of total FAs (BBSRC/DRINC project: grant BB/ /1) Can we improve fat composition in milk to further reduce risk? 14

15 Effect of reducing SFA in milk fat on total cholesterol in intervention studies Butter/milk/cheese/ice cream Butter/milk/yog Butter Butter Butter Butter Livingstone et al.,

16 RESET project Aim to investigate whether modified dairy products will significantly reduce specific biomarkers of CVD risk compared to control products 16

17 RESET Strategy Cows fed HOS Production of UHT milk, Intervention study for 3 weeks cheddar cheese & butter 17

18 Work package 1 High oleic sunflower oil fed to cows for 3 weeks Addition of 1kg lipid/d to usual feed Fatty acid profile of milk 18

19 Work package 2 MODIFIED MILK CONTROL MILK UHT MILK 4000 x 300ml bottles UHT MILK 4000 x 300ml bottles Cheddar Cheese 360 x 350g blocks Cheddar Cheese 360 x 350g blocks Butter 210 x 250g blocks Butter 210 x 250g blocks 19

20 Work package 3 Intervention trial (n = 60 subjects at moderate risk of developing CVD) Chronic study: 12-week dietary exchange Acute study: postprandial effects to a two meal challenge 20

21 Work package 3 Human studies Week Wash-out period Control products Control products Modified products Modified products VISIT 1 VISIT 2 VISIT 3 VISIT 4 60 volunteers over two cohorts - Cohort 1: 20 subjects (March December 2014) - Cohort 2: 40 subjects (February November 2015) Randomized, double-blind, cross-over design 21

22 Acute study design Biomarkers of CVD risk response to a two meal challenge Lipids Inflammatory markers Markers of vascular function 22

23 Work package 4 Mechanistic cell studies To examine the influence of plasma following consumption of modified and conventional milk on - gene expression - inflammatory marker secretion - NO production In a co-culture system of smooth muscle cells overlaid with aortic endothelial cells 23

24 Progress so far Successful production of dairy products Screened over 60 potential volunteers Recruited 20 for cohort I 24

25 Conclusions Milk and dairy products are still widely consumed in the UK Low fat products are preferred There is evidence of an inverse association between milk consumption and CVD Modification of milk fat is possible RESET project: investigating the benefit of modified dairy products in traditional and novel CVD risk biomarkers 25

26 Acknowledgements Prof Julie Lovegrove Prof Ian Givens Dr Alistair Grandison Dr Colette Fagan Dr Oonagh Markey Dr Kim Jackson Dr Kirsty Kliem Dr Sue Todd Ms Becky Morgan Mr Dave Humphries Ms Val Bines 26

27 Thank you for your attention! 27