Rethinking Dairy Fat and Cardiovascular Disease: Evidence from an Expert Review

The long-standing recommendation to limit saturated fat intake, typically to less than 10% of total energy intake, is increasingly questioned, as emerging evidence challenges its scientific basis—particularly in the context of dairy fat and its relationship with cardiovascular disease (CVD) risk.

To address the complexities in the relationship between dairy fat and CVD risk, a high-level workshop was held with a panel of international nutrition experts in 2024. Drawing from the summary produced after the workshop, this overview outlines the current evidence from epidemiological, mechanistic, and clinical studies; explores expert insights on the role of regular- and low-fat dairy in dietary guidelines; and identifies gaps in the research on dairy fat’s impact on health.¹

Given the variability in how regular- and low-fat dairy products are classified across different studies and countries, the expert summary adopts the following definitions to ensure clarity and consistency:

• Low-fat dairy: Products generally recognized as reduced in fat according to most dietary guidelines (e.g., milk with 2% fat or less; yogurt with ~3% fat or less; and cheese with 6% fat or less, or at least 25% less fat than its standard version).
• Regular-fat dairy:  Full-fat or whole-fat products.

Dairy fat and CVD risk: What is the evidence?

Findings from Epidemiological Studies

A 2016 systematic review of meta-analyses published found that dairy consumption, both regular- and low-fat, was neutrally or favourably associated with CVD outcomes, supported by moderate to high-quality evidence. Importantly, no individual dairy products were linked to higher CVD risk.²

Since then, several more recent meta-analyses and high-quality prospective studies, such as the large multinational Prospective Urban Rural Epidemiology (PURE) observational cohort study, have reinforced these favourable or neutral associations.^3-8 For example, the PURE study found that total dairy intake has either a beneficial or no association to CVD risk (including stroke and coronary artery disease). These findings are consistent with other studies indicating no association between dairy intake and overall mortality, or the incidence of type 2 diabetes, a known risk factor for CVD.^3-5,9

The authors note that while certain studies have reported a slight increase in coronary artery disease risk with higher intakes of regular-fat milk, these results are based on a small number of studies with notable limitations, such as small sample sizes and study heterogeneity. Moreover, these findings are at odds with the favourable effects found for hypertension, atherosclerosis, stroke, and other major CVD events. Overall, the experts state that the evidence remains too limited and inconsistent to support separate dietary recommendations for regular fat versus low-fat dairy products in CVD prevention.

Key Considerations

Most evidence on dairy and cardiovascular health comes from European and North American populations, where dairy intake tends to be moderate or high. However, the PURE study found consistent cardiovascular benefits of higher dairy intake across high- and low-intake regions. In lower-intake populations, like East Asia, stronger associations between milk and reduced stroke risk have been observed—highlighting the need for more global research on dose-response relationships.³

The authors state that epidemiological studies should avoid grouping dairy products by fat content or as a single category, as this overlooks that they are fundamentally different foods and creates inconsistencies that complicate comparisons. For example, “low-fat” often signifies different fat percentages in different products, ranging from 0-1% in milk to 5-25% in cheese. Additionally, substitution models, which often replace saturated fat with polyunsaturated fat, may overlook the distinct health effects of whole dairy foods and their overall nutritional profile.

Findings from randomized controlled trials

While long-term randomized controlled trials (RCTs) on dairy and CVD outcomes are lacking due to logistical challenges, short-term studies provide meaningful insights on the effects of dairy intake on important risk factors. Several meta-analyses of RCTs have found that consuming regular-fat dairy does not increase the levels of total or LDL cholesterol, with key findings including the following:

• Regular- and low-fat dairy intake had no effect on HDL cholesterol or triglyceride levels, compared to minimal or no dairy consumption.^10-12
• Despite similar fat profiles, hard and semihard cheeses lowered total and LDL cholesterol compared to butter.^13-15
• Higher intake of dairy foods, irrespective of fat content, has no effect on most non-lipid cardiometabolic markers including body weight and composition, blood pressure, glycemic control, and inflammation—though some studies suggest minor anti-inflammatory effects.^10,12,16-18
• In the DASH diet, both regular- and low-fat dairy led to similar reductions in blood pressure.¹⁹

While some RCTs suggest minor effects of dairy intake on glucose regulation, these changes do not appear to increase type 2 diabetes risk in long-term studies.^5,9 Probiotic yogurt, however, has been linked to improved glycemic markers, and the Food and Drug Administration (FDA) recently acknowledged evidence linking higher yogurt intake, regardless of fat content, to reduced diabetes risk. More research is needed to determine if regular- and low-fat dairy differ in their effects on blood lipids.²⁰

Key considerations

Both RCTs and observational studies show no significant difference in cardiovascular risk markers between regular- and low-fat dairy. The expert panellists point out limitations in current RCTs on dairy and CVD risk, including limited population samples and short durations, that should be addressed in future research.

Evidence of the effects of the dairy matrix on biological mechanisms

Accurately assessing the relationship between dairy intake and CVD risk requires consideration of the unique and complex nature of dairy foods. The dairy matrix, which includes nutrient composition, fat structure, the supramolecular food matrix, and bioactive peptides, works synergistically and influences processes such as digestion, lipid metabolism, gut signalling, and postprandial lipid responses in a manner that transcends their isolated effects. These interactions may help explain the generally neutral impact of dairy on cardiometabolic health. As a result, the expert panel reaffirmed that categorizing dairy solely by saturated fat content overlooks the diversity and functional complexity of these foods.

While much of the current evidence comes from animal and in vitro studies, human RCT data are emerging but still limited, highlighting the need for further research to confirm these mechanisms in humans.

Key takeaways and recommendations

The authors note that shifting the focus from saturated fatty acids (SFA) alone to overall dietary patterns offers a more effective approach to promoting heart health. Without intentional substitution, broad recommendations to limit SFA intake may lead to unintentional decreases in key nutrient intakes, including calcium, vitamin D, iodine, and vitamin B12. Having a more food-based approach to these guidelines may help mitigate these nutrient shortfalls while promoting cardiovascular health.

A 2015 study of the Canadian population found that replacing high-SFA non-dairy foods with low-SFA, high-unsaturated fat options led to the largest predicted decrease in SFA intake, with 82% of the population meeting the <10% total energy intake limit for SFA.²¹ According to the authors, reducing intake of SFA from foods such as pastries, salty snacks, and processed or unprocessed meats rather than from dairy, is a more effective strategy to lower overall SFA intake while reducing intake of energy-dense, nutrient-poor foods.

Overall, the current available evidence in adults does not support the differentiation of low-fat dairy products from regular-fat ones in dietary recommendations. They alternatively propose the following:

1. Dietary guidelines for adults should prioritize food-based approaches that more effectively reduce SFA intake at the population level. This includes the replacement of energy-dense, nutrient-poor foods, which are the main contributors of SFA.
2. Dairy products, regardless of fat content, can fit well in a healthy diet that prioritizes whole grains and minimally processed plant-based foods, while limiting SFAs from processed foods and meats. This will inevitably result in important decreases in SFA intake at the population level.
3. More research is needed to better understand how dietary patterns that include different types of dairy products with varying fat contents relate to CVD risk across diverse populations with different risk profiles.