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

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  • Laura Pimpin
  • Jason H Y Wu
  • Hila Haskelberg
  • Liana Del Gobbo
  • Dariush Mozaffarian

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.

Suggested Citation

  • Laura Pimpin & Jason H Y Wu & Hila Haskelberg & Liana Del Gobbo & Dariush Mozaffarian, 2016. "Is Butter Back? A Systematic Review and Meta-Analysis of Butter Consumption and Risk of Cardiovascular Disease, Diabetes, and Total Mortality," PLOS ONE, Public Library of Science, vol. 11(6), pages 1-18, June.
  • Handle: RePEc:plo:pone00:0158118
    DOI: 10.1371/journal.pone.0158118
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    References listed on IDEAS

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    1. Sue Duval & Richard Tweedie, 2000. "Trim and Fill: A Simple Funnel-Plot–Based Method of Testing and Adjusting for Publication Bias in Meta-Analysis," Biometrics, The International Biometric Society, vol. 56(2), pages 455-463, June.
    2. Nicola Orsini & Rino Bellocco & Sander Greenland, 2006. "Generalized least squares for trend estimation of summarized dose–response data," Stata Journal, StataCorp LP, vol. 6(1), pages 40-57, March.
    3. O'Sullivan, T.A. & Hafekost, K. & Mitrou, F. & Lawrence, D., 2013. "Food sources of saturated fat and the association with mortality: A meta-analysis," American Journal of Public Health, American Public Health Association, vol. 103(9), pages 31-42.
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    1. Kathy Trieu & Saiuj Bhat & Zhaoli Dai & Karin Leander & Bruna Gigante & Frank Qian & Andres V Ardisson Korat & Qi Sun & Xiong-Fei Pan & Federica Laguzzi & Tommy Cederholm & Ulf de Faire & Mai-Lis Hell, 2021. "Biomarkers of dairy fat intake, incident cardiovascular disease, and all-cause mortality: A cohort study, systematic review, and meta-analysis," PLOS Medicine, Public Library of Science, vol. 18(9), pages 1-19, September.
    2. Emma Altobelli & Paolo Matteo Angeletti & Leonardo Rapacchietta & Reimondo Petrocelli, 2019. "Overview of Meta-Analyses: The Impact of Dietary Lifestyle on Stroke Risk," IJERPH, MDPI, vol. 16(19), pages 1-22, September.
    3. Hira Javed & Shafia Arshad & Amina Arif & Faiqa Shaheen & Zeemal Seemab & Shafqat Rasool & Hafiza Sobia Ramzan & Hafiz Muhammad Arsalan & Saif Ahmed & Javed Iqbal Watto, 2022. "Comparison of extraction methods and nutritional benefits of proteins of milk and dairy products: A review," Czech Journal of Food Sciences, Czech Academy of Agricultural Sciences, vol. 40(5), pages 331-344.

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