Association between dairy products and dyslipidemia among the PERSIAN Guilan cohort study population

Nazanin  Motamed; Farahnaz Joukar; Heydar Ali Balou; Saman  Maroufizadeh; Marjan  Mahdavi Roshan; Mohammadreza  Naghipour; Fariborz Mansour-Ghanaei

doi:10.61882/jcbior.5.4.296

Authors

Nazanin Motamed Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
Farahnaz Joukar Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran https://orcid.org/0000-0001-8432-8879
Heydar Ali Balou Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
Saman Maroufizadeh Department of Biostatistics and Epidemiology, School of Health, Guilan University of Medical Sciences, Rasht, Iran
Marjan Mahdavi Roshan Cardiovascular Diseases Research Center, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
Mohammadreza Naghipour Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
Fariborz Mansour-Ghanaei Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran https://orcid.org/0000-0002-6264-0025

DOI:

https://doi.org/10.61882/jcbior.5.4.296

Keywords:

Dyslipidemia, Diary products, Hypertriglisirid, Hypercholesteremia

Abstract

Dyslipidemia is a major risk factor for cardiovascular diseases, and the role of dairy intake in modulating lipid profiles remains debated. This study aimed to investigate the association between dairy product consumption and dyslipidemia prevalence among adults in the Prospective Epidemiological Research Studies (PERSIAN) Guilan Cohort study (PGCS) population. In this cross-sectional analysis, 10,520 adults aged 35–70 years were included. Demographic and lifestyle factors were recorded, and fasting blood samples were analyzed for total cholesterol, triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C). Dyslipidemia was defined as cholesterol ≥200 mg/dL, TG ≥150 mg/dL, LDL-C ≥100 mg/dL, or HDL-C ≤40 mg/dL. Dairy intake was categorized into tertiles. Dietary data were assessed using a validated and reliable Persian Food Frequency Questionnaire (FFQ). Overall, 76.4% of participants had dyslipidemia, with 40.3% having hypercholesterolemia, 43.1% hypertriglyceridemia, 29.0% high LDL-C, and 41.5% low HDL-C. Dyslipidemia prevalence showed a non-significant increasing trend with higher dairy intake (P=0.056). No significant trends were found for hypercholesterolemia, hypertriglyceridemia, or high LDL-C. A significant inverse trend was observed between dairy intake and low HDL-C in men (P=0.026); however, this association lost significance after multivariable adjustment (aOR=0.87; 95%CI: 0.73–1.02; P=0.093). This study revealed prevalent dyslipidemia across lipid profiles. Dairy intake showed a non-significant association with overall dyslipidemia and no associations with specific lipid abnormalities. A transient protective trend against low HDL-C in men disappeared post-adjustment, supporting no conclusive link between dairy consumption and dyslipidemia risk.

References

1. Thongtang N, Sukmawan R, Llanes EJB, Lee ZV. Dyslipidemia management for primary prevention of cardiovascular events: Best in-clinic practices. Prev Med Rep. 2022;27:101819.

DOI: 10.1016/j.pmedr.2022.101819 PMID: 35656215

2. Abera A, Worede A, Hirigo AT, Alemayehu R, Ambachew S. Dyslipidemia and associated factors among adult cardiac patients: a hospital-based comparative cross-sectional study. Eur J Med Res. 2024;29(1):237. DOI: 10.1186/s40001-024-01802-x

PMID: 38622622

3. Zheng J, Wang J, Zhang Y, Xia J, Guo H, Hu H, et al. The Global Burden of Diseases attributed to high low-density lipoprotein cholesterol from 1990 to 2019. Front Public Health. 2022;10:891929. DOI: 10.3389/fpubh.2022.891929

PMID: 36051998

4. Sanjulian L, Fernandez-Rico S, Gonzalez-Rodriguez N, Cepeda A, Miranda JM, Fente C, et al. The Role of Dairy in Human Nutrition: Myths and Realities. Nutrients. 2025;17(4):646.

DOI: 10.3390/nu17040646 PMID: 40004974

5. Auestad N, Layman DK. Dairy bioactive proteins and peptides: a narrative review. Nutr Rev. 2021;79(Suppl 2):36-47.

DOI: 10.1093/nutrit/nuab097 PMID: 34879145

6. Pokala A, Kraft J, Taormina VM, Michalski MC, Vors C, Torres-Gonzalez M, et al. Whole milk dairy foods and cardiometabolic health: dairy fat and beyond. Nutr Res. 2024;126:99-122.

DOI: 10.1016/j.nutres.2024.03.010 PMID: 38669850

7. Lordan R, Tsoupras A, Mitra B, Zabetakis I. Dairy Fats and Cardiovascular Disease: Do We Really Need to be Concerned? Foods. 2018;7(3):29. DOI: 10.3390/foods7030029

PMID: 29494487

8. Hirahatake KM, Astrup A, Hill JO, Slavin JL, Allison DB, Maki KC. Potential Cardiometabolic Health Benefits of Full-Fat Dairy: The Evidence Base. Adv Nutr. 2020;11(3):533-547.

DOI: 10.1093/advances/nmz132 PMID: 31904812

9. Giosue A, Calabrese I, Vitale M, Riccardi G, Vaccaro O. Consumption of Dairy Foods and Cardiovascular Disease: A Systematic Review. Nutrients. 2022;14(4):831.

DOI: 10.3390/nu14040831 PMID: 35215479

10. Visioli F, Strata A. Milk, dairy products, and their functional effects in humans: a narrative review of recent evidence. Adv Nutr. 2014;5(2):131-43. DOI: 10.3945/an.113.005025

PMID: 24618755

11. Hansson P, Holven KB, Oyri LKL, Brekke HK, Biong AS, Gjevestad GO, et al. Meals with Similar Fat Content from Different Dairy Products Induce Different Postprandial Triglyceride Responses in Healthy Adults: A Randomized Controlled Cross-Over Trial. J Nutr. 2019;149(3):422-431.

DOI: 10.1093/jn/nxy291 PMID: 30759235

12. Givens DI. Saturated fats, dairy foods and cardiovascular health: No longer a curious paradox? Nutr Bull. 2022;47(4):407-422. DOI: 10.1111/nbu.12585 PMID: 36285545

13. Soedamah-Muthu SS, de Goede J. Dairy Consumption and Cardiometabolic Diseases: Systematic Review and Updated Meta-Analyses of Prospective Cohort Studies. Curr Nutr Rep. 2018;7(4):171-182. DOI: 10.1007/s13668-018-0253-y

PMID: 30406514

14. Lamarche B, Astrup A, Eckel RH, Feeney E, Givens I, Krauss RM, et al. Regular-fat and low-fat dairy foods and cardiovascular diseases: perspectives for future dietary recommendations. Am J Clin Nutr. 2025;121(5):956-964.

DOI: 10.1016/j.ajcnut.2025.03.009 PMID: 40088974

15. Wang M, Liu M, Li F, Guo C, Liu Z, Pan Y, et al. Gender heterogeneity in dyslipidemia prevalence, trends with age and associated factors in middle age rural Chinese. Lipids Health Dis. 2020;19(1):135. DOI: 10.1186/s12944-020-01313-8

PMID: 32532299

16. Nguyen BT, Nguyen TV, Le TAD, Le NT. Gender Differences in Risk Factors for Dyslipidemia in the Khmer Ethnic People, Vietnam. Iran J Public Health. 2022;51(11):2484-2493.

DOI: 10.18502/ijph.v51i11.11165 PMID: 36561254

17. Feng L, Nian S, Tong Z, Zhu Y, Li Y, Zhang C, et al. Age-related trends in lipid levels: a large-scale cross-sectional study of the general Chinese population. BMJ Open. 2020;10(3):e034226. DOI: 10.1136/bmjopen-2019-034226 PMID: 32193266

18. Downer B, Estus S, Katsumata Y, Fardo DW. Longitudinal trajectories of cholesterol from midlife through late life according to apolipoprotein E allele status. Int J Environ Res Public Health. 2014;11(10):10663-93. DOI: 10.3390/ijerph111010663

PMID: 25325355

19. Fernandez ML, Murillo AG. Postmenopausal Women Have Higher HDL and Decreased Incidence of Low HDL than Premenopausal Women with Metabolic Syndrome. Healthcare (Basel). 2016;4(1):20. DOI: 10.3390/healthcare4010020

PMID: 27417608

20. Cho KH. The Current Status of Research on High-Density Lipoproteins (HDL): A Paradigm Shift from HDL Quantity to HDL Quality and HDL Functionality. Int J Mol Sci. 2022;23(7):3967. DOI: 10.3390/ijms23073967 PMID: 35409326

21. Cho KH, Park HJ, Kim SJ, Kim JR. Decrease in HDL-C is Associated with Age and Household Income in Adults from the Korean National Health and Nutrition Examination Survey 2017: Correlation Analysis of Low HDL-C and Poverty. Int J Environ Res Public Health. 2019;16(18):3329.

DOI: 10.3390/ijerph16183329 PMID: 31509977

22. Poustchi H, Eghtesad S, Kamangar F, Etemadi A, Keshtkar AA, Hekmatdoost A, et al. Prospective Epidemiological Research Studies in Iran (the PERSIAN Cohort Study): Rationale, Objectives, and Design. Am J Epidemiol. 2018;187(4):647-655. DOI: 10.1093/aje/kwx314 PMID: 29145581

23. Mansour-Ghanaei F, Joukar F, Naghipour MR, Sepanlou SG, Poustchi H, Mojtahedi K, et al. The PERSIAN Guilan Cohort Study (PGCS). Arch Iran Med. 2019;22(1):39-45.

PMID: 30821159

24. Melmed S, Polonsky KS, Larsen PR, Kronenberg HM. Williams textbook of endocrinology E-Book. Elsevier Health Sciences; 2015. DOI: 10.4183/aeb.2016.113

25. Rezazadeh A, Omidvar N, Tucker KL. Food frequency questionnaires developed and validated in Iran: a systematic review. Epidemiol Health. 2020;42:e2020015.

DOI: 10.4178/epih.e2020015 PMID: 32229793

26. Pan L, Yang Z, Wu Y, Yin RX, Liao Y, Wang J, et al. The prevalence, awareness, treatment and control of dyslipidemia among adults in China. Atherosclerosis. 2016;248:2-9.

DOI: 10.1016/j.atherosclerosis.2016.02.006 PMID: 26978581

27. Peltzer K. Prevalence and correlates of dyslipidemia, awareness, and management among adults in Bangladesh in 2018. Popul Med. 2023;5(June):1-9. DOI: 10.18332/popmed/167806

28. Sarrafzadegan N, Kelishadi R, Baghaei A, Hussein Sadri G, Malekafzali H, Mohammadifar N, et al. Metabolic syndrome: an emerging public health problem in Iranian women: Isfahan Healthy Heart Program. Int J Cardiol. 2008;131(1):90-6.

DOI: 10.1016/j.ijcard.2007.10.049 PMID: 18190978

29. Pengpid S, Peltzer K. National high prevalence, and low awareness, treatment and control of dyslipidaemia among people aged 15-69 years in Mongolia in 2019. Sci Rep. 2022;12(1):10478. DOI: 10.1038/s41598-022-14729-2

PMID: 35729323

30. Xi Y, Niu L, Cao N, Bao H, Xu X, Zhu H, et al. Prevalence of dyslipidemia and associated risk factors among adults aged ≥35 years in northern China: a cross-sectional study. BMC Public Health. 2020;20(1):1068. DOI: 10.1186/s12889-020-09172-9 PMID: 32631296

31. Qi L, Ding X, Tang W, Li Q, Mao D, Wang Y. Prevalence and Risk Factors Associated with Dyslipidemia in Chongqing, China. Int J Environ Res Public Health. 2015;12(10):13455-65.

32. DOI: 10.3390/ijerph121013455 PMID: 26516874

33. Soriano-Maldonado C, Lopez-Pineda A, Orozco-Beltran D, Quesada JA, Alfonso-Sanchez JL, Pallares-Carratala V, et al. Gender Differences in the Diagnosis of Dyslipidemia: ESCARVAL-GENERO. Int J Environ Res Public Health. 2021;18(23):12419. DOI: 10.3390/ijerph182312419

PMID: 34886144

34. Huang C, Zhang WQ, Tang WW, Liu Y, Liu JX, Xu RH, et al. Prevalence and related factors of dyslipidemia among urban adults aged 35 to 79 years in Southwestern China. Sci Rep. 2021;11(1):17579. DOI: 10.1038/s41598-021-96864-w

PMID: 34475467

35. Najafipour H, Shokoohi M, Yousefzadeh G, Sarvar Azimzadeh B, Moshtaghi Kashanian G, Bagheri MM, et al. Prevalence of dyslipidemia and its association with other coronary artery disease risk factors among urban population in Southeast of Iran: results of the Kerman coronary artery disease risk factors study (KERCADRS). J Diabetes Metab Disord. 2016;15:49.

DOI: 10.1186/s40200-016-0268-0 PMID: 27777902

36. Cheng KC, Chen YL, Lai SW. Prevalence of dyslipidemia in patients receiving health checkups: a hospital-based study. Cholesterol. 2011;2011:314234. DOI: 10.1155/2011/314234 PMID: 22110906

37. Ali N, Kathak RR, Fariha KA, Taher A, Islam F. Prevalence of dyslipidemia and its associated factors among university academic staff and students in Bangladesh. BMC Cardiovasc Disord. 2023;23(1):366. DOI: 10.1186/s12872-023-03399-1 PMID: 37479968

38. Ambikairajah A, Walsh E, Cherbuin N. Lipid profile differences during menopause: a review with meta-analysis. Menopause. 2019;26(11):1327-1333.

DOI: 10.1097/GME.0000000000001403 PMID: 31567869

39. Phan BA, Toth PP. Dyslipidemia in women: etiology and management. Int J Womens Health. 2014;6:185-94.

DOI: 10.2147/IJWH.S38133 PMID: 24532973

40. Nie G, Yang X, Wang Y, Liang W, Li X, Luo Q, et al. The Effects of Menopause Hormone Therapy on Lipid Profile in Postmenopausal Women: A Systematic Review and Meta-Analysis. Front Pharmacol. 2022;13:850815.

DOI: 10.3389/fphar.2022.850815 PMID: 35496275

41. Zitnanova I, Siarnik P, Fullop M, Oravec S, Penesova A, Durackova Z, et al. Gender differences in LDL- and HDL-cholesterol subfractions in patients after the acute ischemic stroke and their association with oxidative stress markers. J Clin Biochem Nutr. 2018;63(2):144-148. DOI: 10.3164/jcbn.17-105 PMID: 30279626

42. Guo J, Astrup A, Lovegrove JA, Gijsbers L, Givens DI, Soedamah-Muthu SS. Milk and dairy consumption and risk of cardiovascular diseases and all-cause mortality: dose-response meta-analysis of prospective cohort studies. Eur J Epidemiol. 2017;32(4):269-287. DOI: 10.1007/s10654-017-0243-1

PMID: 28374228

43. Gholami F, Khoramdad M, Esmailnasab N, Moradi G, Nouri B, Safiri S, et al. The effect of dairy consumption on the prevention of cardiovascular diseases: A meta-analysis of prospective studies. J Cardiovasc Thorac Res. 2017;9(1):1-11.

DOI: 10.15171/jcvtr.2017.01 PMID: 28451082

44. de Goede J, Soedamah-Muthu SS, Pan A, Gijsbers L, Geleijnse JM. Dairy Consumption and Risk of Stroke: A Systematic Review and Updated Dose-Response Meta-Analysis of Prospective Cohort Studies. J Am Heart Assoc. 2016;5(5):e002787. DOI: 10.1161/JAHA.115.002787

PMID: 27207960

45. Soedamah-Muthu SS, Ding EL, Al-Delaimy WK, Hu FB, Engberink MF, Willett WC, et al. Milk and dairy consumption and incidence of cardiovascular diseases and all-cause mortality: dose-response meta-analysis of prospective cohort studies. Am J Clin Nutr. 2011;93(1):158-71. DOI: 10.3945/ajcn.2010.29866 PMID: 21068345

46. Thorning TK, Raben A, Tholstrup T, Soedamah-Muthu SS, Givens I, Astrup A. Milk and dairy products: good or bad for human health? An assessment of the totality of scientific evidence. Food Nutr Res. 2016;60:32527.

DOI: 10.3402/fnr.v60.32527 PMID: 27882862

47. Pei R, Martin DA, DiMarco DM, Bolling BW. Evidence for the effects of yogurt on gut health and obesity. Crit Rev Food Sci Nutr. 2017;57(8):1569-1583.

DOI: 10.1080/10408398.2014.883356 PMID: 25875150

48. Derakhshandeh-Rishehri SM, Ghobadi S, Akhlaghi M, Faghih S. No adverse effects of dairy products on lipid profile: A systematic review and meta-analysis of randomized controlled clinical trials. Diabetes Metab Syndr. 2021;15(6):102279.

DOI: 10.1016/j.dsx.2021.102279 PMID: 34562868

49. Charlton KE, Kolbe-Alexander TL, Nel JH. Micronutrient dilution associated with added sugar intake in elderly black South African women. Eur J Clin Nutr. 2005;59(9):1030-42.

DOI: 10.1038/sj.ejcn.1602208 PMID: 16015273

50. Alexander DD, Bylsma LC, Vargas AJ, Cohen SS, Doucette A, Mohamed M, et al. Dairy consumption and CVD: a systematic review and meta-analysis. Br J Nutr. 2016;115(4):737-50.

DOI: 10.1017/S0007114515005000 PMID: 26786887

51. Bays HE, Kirkpatrick C, Maki KC, Toth PP, Morgan RT, Tondt J, etal. Obesity, dyslipidemia, and cardiovascular disease: A joint expert review from the Obesity Medicine Association and the National Lipid Association 2024. Obes Pillars. 2024;10:100108. DOI: 10.1016/j.obpill.2024.100108 PMID: 38706496