Cheese consumption and multiple health outcomes: an umbrella review and updated meta-analysis of prospective studies

Abstract

ABSTRACT This umbrella review aims to provide a systematic and comprehensive overview of current evidence from prospective studies on the diverse health effects of cheese consumption. We searched PubMed, Embase, and Cochrane Library to identify meta-analyses/pooled analyses of prospective studies examining the association between cheese consumption and major health outcomes from inception to August 31, 2022. We reanalyzed and updated previous meta-analyses and performed de novo meta-analyses with recently published prospective studies, where appropriate. We calculated the summary effect size, 95% prediction confidence intervals, between-study heterogeneity, small-study effects, and excess significance bias for each health outcome. We identified 54 eligible articles of meta-analyses/pooled analyses. After adding newly published original articles, we performed 35 updated meta-analyses and 4 de novo meta-analyses. Together with 8 previous meta-analyses, we finally included 47 unique health outcomes. Cheese consumption was inversely associated with all-cause mortality (highest compared with lowest category: RR ¼ 0.95; 95% CI: 0.92, 0.99), cardiovascular mortality (RR ¼ 0.93; 95% CI: 0.88, 0.99), incident cardiovascular disease (CVD) (RR ¼ 0.92; 95% CI: 0.89, 0.96), coronary heart disease (CHD) (RR ¼ 0.92; 95% CI: 0.86, 0.98), stroke (RR ¼ 0.93; 95% CI: 0.89, 0.98), estrogen receptor-negative (ER) breast cancer (RR ¼ 0.89; 95% CI: 0.82, 0.97), type 2 diabetes (RR ¼ 0.93; 95% CI: 0.88, 0.98), total fracture (RR ¼ 0.90; 95% CI: 0.86, 0.95), and dementia (RR ¼ 0.81; 95% CI: 0.66, 0.99). Null associations were found for other outcomes. According to the NutriGrade scoring system, moderate quality of evidence was observed for inverse associations of cheese consumption with all-cause and cardiovascular mortality, incident CVD, CHD, and stroke, and for null associations with cancer mortality, incident hypertension, and prostate cancer. Our findings suggest that cheese consumption has neutral to moderate benefits for human health. Keywords: cheese consumption, umbrella review, updated meta-analyses, all-cause mortality, cardiovascular disease, cancer, fracture, metabolic disease