Tufts University study: Little to no association between butter consumption, chronic disease or total mortality

10 Jul

People are concerned about the effects of fat consumption on overall health. Rochelle Bilow wrote in the Bon Appétit article Is Butter Good for You? Or Bad? What Does Science Say?

It’s time we got to the bottom of things. It’s time to finally, once and for all (sorta), answer the question: What does science say about butter? We combed through a century and a half of scientific studies to find every claim, counter-claim, and counter-counter-claim made about this delicious fat—and its slightly less delicious cousin, margarine.

1855 Americans should use oil instead of butter—because butter may be obsolete. In fact, butter is purely “respiratory,” a food that, like “sugar, starch, and alcohol, goes merely to form fat.” But wait: Maybe butter’s okay if it’s, um, fermented? Storing your butter in a “strong brine” could help it to keep for up to a year.

1884 Margarine can cause your teeth to loosen, your skin to crack, and your hair to fall out. Also, the adulteration of butter (by adding other fat solids) is a damn shame, and because it’s being tampered with, nobody wants to eat it anymore.

1886 Margarine is manufactured under no restrictions; it’s bad for dairymen, and bad for your health.

1901 There’s a lot of bacteria in butter; salted varieties keep better, so you should eat those instead of unsalted varieties.

1913 Butter’s so bad for you that it gets banned from Vassar College (along with cotton mattresses). Also, butter could carry disease. You should eat margarine.

1928 Americans eating margarine instead of butter (and also eating “five times more” potatoes) will reduce the U.S. mortality rate.

1948 Butter and margarine are equally healthy (or equally unhealthy).

1979 Butter is probably better for you than margarine, because butter hasn’t been “chemically tampered with.”

1984 Cholesterol is BAD and butter is the cause.

1990 Butter is worse for men’s cholesterol levels than vegetable oils. Also, margarine is a better choice than butter, so long as its fat levels are under 30 percent trans. Butter is the MOST DANGEROUS fat.

1993 Whether it’s butter or margarine, solid and semi-solid fats are worse for you than are natural oils.

1998 Low-trans-fat margarine is totally better for you than butter. Actually, no. Butter is better, because it’s a fresh, real food. Gah—what to believe!? Margarine apparently improves your “blood lipid profiles” better than butter. Well, that’s something, we guess.

2000 Butter can actually protect you against pretty much every ill, including heart disease, cancer, arthritis, and osteoporosis; butter—or actually the vitamins it contains—is essential for your health.

2002 If you’re overweight (and a rat), eating butter will make you fatter. If you’re thin (and a rat), it’ll make you skinnier.

2004 Eating butter most likely won’t increase your chances for getting breast cancer—but it may increase your ovarian cancer risk.

2006 Butter’s a little bit unhealthy (saturated fats), but so is margarine (trans fats). You should probably just use olive oil instead.

2007 To raise your good cholesterol and lower your bad cholesterol, replace carbohydrates with fat. But this only works with unsaturated fat—so limit that butter.

2008 Artificial butter is harmful to your lungs—if inhaled.

2009 Eating butter may reduce your risk of heart attack.

2010 Margarine is a smarter choice than butter, but butter is a better choice than olive and canola oils, which raise the fats in your blood stream significantly more after eating.

2011 Butter (and cod liver oil) can help halt and reverse tooth decay.

2012 The saturated fat in butter can slow down your cognitive ability.

2013 The removal of saturated fat—that’d be butter—from our diet has made cardiovascular disease more prevalent. Although! People who eat more vegetable fats than animal fats have higher death rates.

2014 Butter—and other full-fat foods—may help us lose weight. In other good news, a new study says there is definitely no link between the saturated fat in butter and heart disease. But wait: Some big flaws with that study prove that there may be a thread of connection between butter and disease after all. No. Wait again. Butter really is okay. Just in moderation, and as a part of a balanced diet….                         http://www.bonappetit.com/entertaining-style/trends-news/article/butter-studies-roundup

Tufts University researched the association between butter consumption and disease.

Science Daily reported in Little to no association between butter consumption, chronic disease or total mortality:

Butter consumption was only weakly associated with total mortality, not associated with cardiovascular disease, and slightly inversely associated (protective) with diabetes, according to a new epidemiological study which analyzed the association of butter consumption with chronic disease and all-cause mortality. This systematic review and meta-analysis, published in PLOS ONE, was led by Tufts scientists including Laura Pimpin, Ph.D., former postdoctoral fellow at the Friedman School of Nutrition Science and Policy at Tufts in Boston, and senior author Dariush Mozaffarian, M.D., Dr.P.H., dean of the School.

Based on a systematic review and search of multiple online academic and medical databases, the researchers identified nine eligible research studies including 15 country-specific cohorts representing 636,151 unique individuals with a total of 6.5 million person-years of follow-up. Over the total follow-up period, the combined group of studies included 28,271 deaths, 9,783 cases of cardiovascular disease, and 23,954 cases of new-onset type 2 diabetes. The researchers combined the nine studies into a meta-analysis of relative risk.

Butter consumption was standardized across all nine studies to 14 grams/day, which corresponds to one U.S. Department of Agriculture estimated serving of butter (or roughly one tablespoon). Overall, the average butter consumption across the nine studies ranged from roughly one-third of a serving per day to 3.2 servings per day. The study found mostly small or insignificant associations of each daily serving of butter with total mortality, cardiovascular disease, and diabetes.

“Even though people who eat more butter generally have worse diets and lifestyles, it seemed to be pretty neutral overall,” said Pimpin, now a data analyst in public health modelling for the UK Health Forum. “This suggests that butter may be a “middle-of-the-road” food: a more healthful choice than sugar or starch, such as the white bread or potato on which butter is commonly spread and which have been linked to higher risk of diabetes and cardiovascular disease; and a worse choice than many margarines and cooking oils — those rich in healthy fats such as soybean, canola, flaxseed, and extra virgin olive oils — which would likely lower risk compared with either butter or refined grains, starches, and sugars….”                                                                     https://www.sciencedaily.com/releases/2016/06/160629145200.htm

Citation:

Little to no association between butter consumption, chronic disease or total mortality

Date:               June 29, 2016

Source:           Tufts University, Health Sciences Campus

Summary:

An epidemiological study analyzing the association of butter consumption with chronic disease and mortality finds that butter was only weakly associated with total mortality, not associated with heart disease, and slightly inversely associated (protective) with diabetes.

Journal Reference:

  1. Pimpin L, Wu JHY, Haskelberg H, Del Gobbo L, Mozaffarian D. Is Butter Back? A Systematic Review and Meta-Analysis of Butter Consumption and Risk of Cardiovascular Disease, Diabetes, and Total Mortality. PLOS ONE, June 2016 DOI: 10.1371/journal.pone.0158118

PLoS One. 2016 Jun 29;11(6):e0158118. doi: 10.1371/journal.pone.0158118. eCollection 2016.

Is Butter Back? A Systematic Review and Meta-Analysis of Butter Consumption and Risk of Cardiovascular Disease, Diabetes, and Total Mortality.

Pimpin L1, Wu JH2, Haskelberg H2, Del Gobbo L1,3, Mozaffarian D1.

Author information

Abstract

BACKGROUND:

Dietary guidelines recommend avoiding foods high in saturated fat. Yet, emerging evidence suggests cardiometabolic benefits of dairy products and dairy fat. Evidence on the role of butter, with high saturated dairy fat content, for total mortality, cardiovascular disease, and type 2 diabetes remains unclear. We aimed to systematically review and meta-analyze the association of butter consumption with all-cause mortality, cardiovascular disease, and diabetes in general populations.

METHODS AND FINDINGS:

We searched 9 databases from inception to May 2015 without restriction on setting, or language, using keywords related to butter consumption and cardiometabolic outcomes. Prospective cohorts or randomized clinical trials providing estimates of effects of butter intake on mortality, cardiovascular disease including coronary heart disease and stroke, or diabetes in adult populations were included. One investigator screened titles and abstracts; and two reviewed full-text articles independently in duplicate, and extracted study and participant characteristics, exposure and outcome definitions and assessment methods, analysis methods, and adjusted effects and associated uncertainty, all independently in duplicate. Study quality was evaluated by a modified Newcastle-Ottawa score. Random and fixed effects meta-analysis pooled findings, with heterogeneity assessed using the I2 statistic and publication bias by Egger’s test and visual inspection of funnel plots. We identified 9 publications including 15 country-specific cohorts, together reporting on 636,151 unique participants with 6.5 million person-years of follow-up and including 28,271 total deaths, 9,783 cases of incident cardiovascular disease, and 23,954 cases of incident diabetes. No RCTs were identified. Butter consumption was weakly associated with all-cause mortality (N = 9 country-specific cohorts; per 14g(1 tablespoon)/day: RR = 1.01, 95%CI = 1.00, 1.03, P = 0.045); was not significantly associated with any cardiovascular disease (N = 4; RR = 1.00, 95%CI = 0.98, 1.02; P = 0.704), coronary heart disease (N = 3; RR = 0.99, 95%CI = 0.96, 1.03; P = 0.537), or stroke (N = 3; RR = 1.01, 95%CI = 0.98, 1.03; P = 0.737), and was inversely associated with incidence of diabetes (N = 11; RR = 0.96, 95%CI = 0.93, 0.99; P = 0.021). We did not identify evidence for heterogeneity nor publication bias.

CONCLUSIONS:

This systematic review and meta-analysis suggests relatively small or neutral overall associations of butter with mortality, CVD, and diabetes. These findings do not support a need for major emphasis in dietary guidelines on either increasing or decreasing butter consumption, in comparison to other better established dietary priorities; while also highlighting the need for additional investigation of health and metabolic effects of butter and dairy fat.

PMID:

27355649

DOI:

10.1371/journal.pone.0158118

Here is the press release from Tufts University:

Little to no association between butter consumption and chronic disease or total mortality

For More Information or to Request a Photo from this News Release, Contact:

Siobhan Gallagher

siobhan.gallagher@tufts.edu

617.636.6586

BOSTON—Butter consumption was only weakly associated with total mortality, not associated with cardiovascular disease, and slightly inversely associated (protective) with diabetes, according to a new epidemiological study which analyzed the association of butter consumption with chronic disease and all-cause mortality. This systematic review and meta-analysis, published in PLOS ONE, was led by Tufts scientists including Laura Pimpin, Ph.D., former postdoctoral fellow at the Friedman School of Nutrition Science and Policy at Tufts in Boston, and senior author Dariush Mozaffarian, M.D., Dr.P.H., dean of the School.

Based on a systematic review and search of multiple online academic and medical databases, the researchers identified 9 eligible research studies including 15 country-specific cohorts representing 636,151 unique individuals with a total of 6.5 million person-years of follow-up. Over the total follow-up period, the combined group of studies included 28,271 deaths, 9,783 cases of cardiovascular disease, and 23,954 cases of new-onset type 2 diabetes. The researchers combined the nine studies into a meta-analysis of relative risk.

Butter consumption was standardized across all nine studies to 14grams/day, which corresponds to one U.S. Department of Agriculture estimated serving of butter (or roughly one tablespoon). Overall, the average butter consumption across the nine studies ranged from roughly one-third of a serving per day to 3.2 servings per day. The study found mostly small or insignificant associations of each daily serving of butter with total mortality, cardiovascular disease, and diabetes.

“Even though people who eat more butter generally have worse diets and lifestyles, it seemed to be pretty neutral overall,” said Pimpin, now a data analyst in public health modelling for the UK Health Forum. “This suggests that butter may be a “middle-of-the-road” food: a more healthful choice than sugar or starch, such as the white bread or potato on which butter is commonly spread and which have been linked to higher risk of diabetes and cardiovascular disease; and a worse choice than many margarines and cooking oils – those rich in healthy fats such as soybean, canola, flaxseed, and extra virgin olive oils – which would likely lower risk compared with either butter or refined grains, starches, and sugars.”

“Overall, our results suggest that butter should neither be demonized nor considered “back” as a route to good health,” said Mozaffarian. “More research is needed to better understand the observed potential lower risk of diabetes, which has also been suggested in some other studies of dairy fat. This could be real, or due to other factors linked to eating butter – our study does not prove cause-and-effect.”

Additional authors of this study are Jason HY Wu, M.Sc., Ph.D., and Hila Haskelberg, Ph.D., both of The George Institute for Global Health, University of Sydney, Australia; and Liana Del Gobbo, Ph.D., formerly a postdoctoral fellow at the Friedman School and currently a research fellow in cardiovascular medicine at Stanford School of Medicine.

This work was supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health, under award number 5R01HL085710. For conflicts of interest disclosure, please see the study.

Pimpin L, Wu JHY, Haskelberg H, Del Gobbo L, Mozaffarian D (2016) Is Butter Back? A Systematic Review and Meta-Analysis of Butter Consumption and Risk of Cardiovascular Disease, Diabetes, and Total Mortality. PLoS ONE 11(6): e0158118. doi:10.1371/journal.pone.0158118

About the Friedman School of Nutrition Science and Policy at Tufts University

The Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy at Tufts University is the only independent school of nutrition in the United States. The school’s eight degree programs – which focus on questions relating to nutrition and chronic diseases, molecular nutrition, agriculture and sustainability, food security, humanitarian assistance, public health nutrition, and food policy and economics – are renowned for the application of scientific research to national and international policy.

# # #

Related Links

https://now.tufts.edu/news-releases/little-no-association-between-butter-consumption-and-chronic-disease-or-total

Reactions to study:

Prof Tom Sanders, Professor emeritus of Nutrition and Dietetics, King’s College London, said:

“A significant limitation of this review is that some of the prospective studies adjusted for difference in serum cholesterol at baseline as well as other aspects of diet, including a healthy eating index and the intake of monounsaturated and polyunsaturated fatty acids.

“However, the finding is not surprising as 14g butter per day would only be expected to change blood cholesterol level by 1% and this alone would have an imperceptible effect on risk of CVD.

“The studies were also unable to make any allowance for butter in processed foods such as cake and biscuits.

“There is some speculation in the discussion that butter may provide extra vitamin D. However, this is mistaken as butter is a poor source of vitamin D and it is margarine that is fortified with vitamin D.

“Generally, I agree with the review that it is the overall dietary pattern that matters rather than the intake of specific food items.”

 

Prof Pete Wilde, Research Leader, Food and Health Programme, Institute of Food Research, said:

“This study appears to add to the evidence that whilst many dairy products can be beneficial to health when consumed in moderation, higher fat products can mitigate this beneficial effect, so this certainly isn’t carte blanche to consume large amounts of butter. This study was normalised to a 14g per day intake (which is roughly an average intake) but other studies show a dose response indicating an increased risk with increased intake of high fat dairy products.

“As mentioned in the article, the consumption of many dairy products has been linked with a range of positive health benefits. The biggest effects are seen with lower fat dairy products, but some positive effects are also seen with cheese consumption. These products have a much lower fat content than butter, and it is thought that the positive health effects are linked to the water soluble compounds such as the vitamin, mineral and protein content. Butter on the other hand consists of about 80% milk fat, with only 20% water, so a lot of the protein, minerals etc. are lost. The fat is also high in saturated fat but does contain a fair amount of the fat soluble vitamins, especially vitamin A.

“Other studies have also shown that high fat dairy products give a small increase in risk of CVD, and are neutral in terms of total mortality, but lower fat content dairy products are linked to reduced risk overall. Other analyses also show some U shaped curves, with moderate consumption reducing risk, but higher levels of consumption could lead to an increased risk.

“Also, it is not clear how associated lifestyle affects this relationship. It could be that consumers of butter also consume a range of other dairy products.”

 

Tracy Parker, Heart Health Dietitian at the British Heart Foundation, said:

“Understanding the true relationship between diet and our health is difficult, but we know that replacing saturated fat with unsaturated fats seems to have a positive impact on our heart health and this is recognised by the authors of this study.

“Whilst the findings of this review indicate a small or neutral association between butter consumption and increased cardiovascular risk, it does not give us the green light to start eating more butter. More investigations are needed into the effects of saturated fat.

“What we do know is fat is just one element of our diet. There are many factors which cause cardiovascular disease and no single food or nutrient is solely responsible for this. To protect your heart health we would recommend a balanced Mediterranean style diet rich in fruit, vegetables and pulses.”

* ‘Is butter back? A systematic review and meta-analysis of butter consumption and risk of cardiovascular disease, diabetes, and total mortality’ by Laura Pimpin et al. will be published in PLOS ONE  on Wednesday 29 June 2016.

 

Declared interests

Prof Tom Sanders: “Prof Tom Sanders is a Scientific Governor of the charity British Nutrition Foundation, member of the scientific advisory committee of the Natural Hydration Council (which promotes the drinking of water), and honorary Nutritional Director of the charity HEART UK. Prof. Tom Sanders is now emeritus but when he was doing research at King’s College London, the following applied: Tom does not hold any grants or have any consultancies with companies involved in the production or marketing of sugar-sweetened drinks. In reference to previous funding to Tom’s institution: £4.5 million was donated to King’s College London by Tate & Lyle in 2006; this funding finished in 2011. This money was given to the College and was in recognition of the discovery of the artificial sweetener sucralose by Prof. Hough at the Queen Elizabeth College (QEC), which merged with King’s College London. The Tate & Lyle grant paid for the Clinical Research Centre at St Thomas’ that is run by the Guy’s & St Thomas’ Trust, it was not used to fund research on sugar. Tate & Lyle sold their sugar interests to American Sugar so the brand Tate & Lyle still exists but it is no longer linked to the company Tate & Lyle PLC, which gave the money to King’s College London in 2006. Tom also used to work for Ajinomoto on aspartame about 8 years ago.  Tom was a member of the FAO/WHO Joint Expert Committee that recommended that trans fatty acids be removed from the human food chain. Tom has previously acted as a member of the Global Dairy Platform Scientific Advisory Panel and Tom is a member of the Programme Advisory Committee of the Malaysian Palm Oil Board. In the past Tom has acted as a consultant to Archer Daniel Midland Company and received honoraria for meetings sponsored by Unilever PLC. Tom’s research on fats was funded by Public Health England/Food Standards Agency.”

Prof Pete Wilde: “I don’t think I have any relevant interests to declare.  I am employed by the Institute of Food Research, member of the Royal Society of Chemistry, and treasurer of its Food Group committee.  My funding comes mainly from the BBSRC, and other governmental sources. I do have a small amount of industry funding, but nothing to do with dairy products, and concerns sensory aspects of food structures and not with nutrition and health. I have no position outside of the IFR with any decision making or policy changing powers. I am an honorary Professor at the University of East Anglia (School of Pharmacy).”

Tracy Parker: “No interests to declare.”

http://www.sciencemediacentre.org/expert-reaction-to-paper-looking-at-butter-consumption-and-cardiovascular-disease-diabetes-and-mortality/

Obviously, the Tufts University study is a piece in answering the questions about the health effects of butter consumption.

Kris Gunnars, BSc wrote in 7 Reasons Why Butter is Healthy in Moderation:

Despite having been demonized in the past, butter (especially from grass-fed cows) is actually pretty healthy.

That being said, there is no reason to go out of your way to eat more of it.

Butter in small amounts is fine, but it may cause problems if you eat way too much (for example, by adding a few tablespoons to your morning coffee).

Plus, it is not as healthy as extra virgin olive oil, which is the world’s healthiest fat.                 https://authoritynutrition.com/7-reasons-why-butter-is-good-for-you/

The key concept is moderation.

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