Meta-analysisindependent cross-checkabstract checked I-FAT-111 standard review
Butter raises LDL cholesterol more than cheese with the same fat
Effect of Isoenergetic Substitution of Cheese with Other Dairy Products on Blood Lipid Markers in the Fasted and Postprandial State: An Updated and Extended Systematic Review and Meta-Analysis of Randomized Controlled Trials in Adults.
Overview
Pradeilles R et al.. Adv Nutr 2023 · PMID 37717700 · DOI 10.1016/j.advnut.2023.09.003
LDL 0.19 mmol/L higher on butter than on cheese.
Does the study support the specific claim? No · Methodological quality: moderate
Plain-language summary
Study explained simply
- What did the researchers want to find out?
Compare cheese fat with butter fat.
- How was the study done?
Meta-analysis of RCTs.
- How many people, animals or samples were studied?
7 RCTs.
- What was actually found?
Butter gave higher LDL.
- How large was the observed effect?
LDL -0.19 mmol/L with cheese.
- What do the results mean in everyday life?
Butter/ghee fat is not neutral for cholesterol.
- What are the study's limitations?
Few, short trials.
- What does it say about Elawady's specific claim?
Contradicts the claim.
- Do the results apply to Germany and Europe?
Applicable.
- What can explicitly not be concluded from this study?
Cannot show heart events.
Scientific in-depth review
1. Full reference
- Authors
- Pradeilles R et al.
- Journal
- Adv Nutr
- Year
- 2023
- Identifier
- PMID 37717700 DOI 10.1016/j.advnut.2023.09.003
- Verification
- verified – PubMed efetch 2026-10-26
- Retracted
- no
- Corrections
- none
- Extent checked
- abstract only
- Conflicts of interest and funding
not stated in abstract
2. Research question
Does fat from cheese affect blood lipids differently from equal fat in other dairy foods?
3. Study design and population
- Study design
- Meta-analysis – Systematic review and meta-analysis of RCTs (RoB 2; PROSPERO CRD42022299748)
- Population
Adults in RCTs
- Country
Multinational
- Period
to June 2022
- Sample size
10 articles; 7 RCTs in main pooled analysis
- Inclusion and exclusion criteria
Isoenergetic substitution of hard/semi-hard cheese with other dairy
4. Methods and endpoints
- Exposure / intervention
~135 g/d cheese
- Comparator
~52 g/d butter (same fat)
- Endpoints
Fasting and postprandial lipids
- Statistical methods
Random-effects WMD
5. Actual results
- Results
Cheese v butter (>=14 days): total cholesterol -0.24 mmol/L (-0.34 to -0.15; I2 59.8%), LDL-C -0.19 mmol/L (-0.27 to -0.12; I2 42.8%), HDL-C -0.04 mmol/L (-0.08 to -0.00). No evidence of benefit replacing cheese with milk (2 RCTs). RoB: all some concerns.
- Absolute risks
not reported
- Authors' conclusion
Dairy fat consumed as cheese has a differential effect on blood lipids relative to some other dairy food structures; further RCTs needed.
6. Strengths
- RCTs
- Isoenergetic design
7. Weaknesses
- Few trials
- Heterogeneity
- Short duration
8. Risk of bias
- Orienting tool
- AMSTAR 2
- Type of assessment
- simplified assessment (abstract only)
- Full formal assessment
- no
- Overall risk of bias
- some concerns
- Rationale
Small evidence base.
9. Assessment of the statistical interpretation
LDL difference ~0.19 mmol/L; CTT scaling suggests ~5% vascular event difference if sustained (assumption).
10. Relevance to the specific claim
Butter fat raised LDL cholesterol more than the same amount of fat eaten as cheese: butter is not neutral for blood lipids, although the food matrix matters.
11. Independent contrary findings
I-FAT-07 (matrix argument; partly consistent).
12. Transferability to Germany and Europe
Applicable; ghee likely behaves like butter fat (assumption).
13. Overall methodological judgement
Direct RCT evidence that butter raises LDL relative to cheese.
| Multidimensional assessment | |
|---|---|
| Authenticity of the source | verified |
| Methodological quality | moderate |
| Risk of bias | some concerns |
| Precision of results | moderate |
| Directness | direct |
| Reproducibility | unknown |
| Consistency with the overall evidence | mixed |
| Regional transferability | moderate |
| Adequacy of the interpretation (by the archive) | not applicable |
14. Open questions
Ghee specifically.
15. Linked fact checks
- Natural fats such as baladi ghee and butter are not a cause of clogged arteries (contrary to the previously dominant view); 'good fats do not stick'. – Studies contradicting or limiting the claim