Using data on dietary habits and mortality from the Prospective Urban Rural Epidemiology (PURE) cohort and covering 80 countries, Canadian scientists developed a diet score based on the intake of six foods – fruit, vegetables, nuts, pulses, fish, and mostly whole dairy – and calculated associations with mortality, myocardial infarction, stroke, and total cardiovascular disease (CVD), including fatal CVD and non-fatal myocardial infarction, stroke, and heart failure.
Publishing their findings in the peer-reviewed European Heart Journal, the scientists, led by Andrew Mente from the Population Health Research Institute at McMaster University in Canada, found that diets high in fruit, vegetables, mainly whole-fat dairy, nuts, pulses, and fish were linked with a lower risk of CVD.
Up to two daily servings of mainly full-fat dairy can therefore be included in a healthy diet, they concluded. (The dairy products in the study included milk, yoghurt, cheese, or mixed dishes with these foods, but not butter and whipped cream.)
‘Unrelenting’ government advice is not backed by science
These findings on the healthiness of full-fat dairy are at odds with national dietary guidelines in many countries. The 2020-2025 edition of the US dietary guidelines advise people to switch to low-fat or fat-free dairy milk and yoghurt, for instance, while the UK’s Eatwell guide tells consumers to choose lower-fat dairy products where possible, recommending semi-skimmed, skimmed or 1% fat milk, reduced-fat cheese, and low-fat yoghurt.
In regions where front-of-pack nutrition labels are used, these may also discourage the public from buying full-fat dairy products by featuring a red traffic light colour or an octagonal “high in” label to warn consumers about a high saturated fat content.
Although the team of researchers led by Mente say theirs is “by far the most diverse study of nutrition and health outcomes in the world” and is the only one with sufficient representation from high-, middle- and low-income countries, this is not the first time the protective nature of full-fat dairy has been demonstrated.
Previous scientific research has highlighted the benefits of whole fat dairy consumption on lean body mass and shown protective associations for diabetes, hypertension, and metabolic syndrome.
The PURE study therefore adds to this growing body of research, and highlights the need for a re-evaluation of the “unrelenting” guidelines that tell consumers to avoid whole-fat dairy products, wrote Dr Dariush Mozaffarian of the Friedman School of Nutrition Science and Policy at Tufts University in Boston in an editorial accompanying the publication of the study.
‘The low-fat message hasn’t worked for wider health’
National dietary guidelines aim to shape public opinion on what constitutes a healthy diet and, for decades, consumers have looked for low-fat dairy products. Food manufacturers have responded by creating such products and positioning them as better-for-you options. Additives such as texturisers, modified starches, gums, gelatine, thickeners, and even sugar are often used to restore the creaminess and mouthfeel that is lost when fat is removed from products.
Dr Carrie Ruxton, nutritionist and director at Nutrition Communications, said the PURE study supported what many nutritionists have been saying for some time: that the public policy focus on saturated fat and sugar has distracted society from the role of positive nutrients and foods in health, which include nuts, seeds, and regular dairy products, particularly yoghurt.
“Populations in high income countries have successfully reduced their fat intakes over the last few decades yet obesity and type 2 diabetes levels have gone up. This suggests the low-fat message hasn’t worked for wider health,” she told this publication.
Mozaffarian called for those working on national nutrition guidelines, private sector innovations, government tax policy and agricultural incentives, food procurement policies, labelling and other regulatory priorities to “catch up with the science”.
“Millions of lives depend on it,” he added.
Implications for the food industry
But should manufacturers begin to renovate their product portfolios to remove reduced-fat options, even if public health advice remains unchanged?
According to Ruxton, the take-home message of the PURE study is that industry needs to “get back to naturally nutritious ingredients” – but she said she doubted this would sit well with manufacturers for two reasons.
“First, the trend towards ultra processing is because the food industry is caught between policy demands to cut sugar, fat, calories and salt and consumer demands for tasty, cheap, long-lasting foods.
“Secondly, there is less profit in selling natural foods as the cost of ingredients is higher. However, I hope a way forward can be found. This will require more meaningful engagement between policy makers and industry which recognises the demands and needs of consumers.”
Consumer attitudes to fat are changing
Market research suggests that consumer attitudes towards fat content are indeed changing – but that a generational gap exists.
New Nutrition Business (NNB) conducted a survey across five countries and found that over one-third (34%) of 25- to 44-year-olds wanted to eat more healthy fats. However, less than one-quarter (23%) of people aged 55 to 64 – the generation of consumers who grew up in the era in which “low fat is best” was the nutritional dogma, noted NNB analysts – were trying to eat more healthy fats.
Julian Mellentin, director of New Nutrition Business, wrote: “In all categories, as time passes there will be less reason to produce products that have low levels of fat. The challenge for companies is to ensure they use good quality fats where they can point to a good, natural source.”