Supplementary Table 1.Characteristics of included prospective studies that investigated the association of cheese consumption with risk of cardiovascular disease
Author, year(Country) / Study name, duration / Subjects / Age range (mean/median), yr / No. of events / Reported results / Baseline disease excluded / Adjustment
Mann, 1997[1]
(UK) / Oxford Vegetarian Study,
13.3 yr / 10802 M/F / 16-79 (34.0 in M, 33.0 in F) / 64 fatal IHD / Cheese excluding cottage: ≥5(T3) vs. <1(T1) ser/wk
RR=2.47 (95% CI: 0.97-6.26) / Cancer, angina, hypertension, HD, stroke, and diabetes. / Age, sex, smoking, and social class.
Fraser, 1997[2]
(USA) / Adventists Health Study, 12 yr / 986 M/F / ≥85 / 364 fatal CHD / Cheese: ≥3(T3) vs.<1(T1) ser/wk
RR=0.98 (95% CI: 0.69-1.39)(M/F)
RR=1.19 (95% CI: 0.65-2.18)(M)
RR=0.91 (95% CI: 0.59-1.40)(F) / Cancer and HD. / Aged and sex.
Iso, 1999[3]
(USA) / Nurses’ Health Study, 14 yr / 85764 F / 34-59 (46.0) / 690 fatal/nonfatal stroke / Hard cheese: ≥1 ser/d vs. almost never
RR=0.63 (95% CI: 0.40-0.99)
Cottage cheese: ≥5 ser/wk vs. almost never.
RR=0.94 (95% CI: 0.60-1.47) / Cancer, angina, MI, stroke, and other CVD. / Age and smoking.
Larsson, 2009[4]
(Finland) / ATBC study, 13.6 yr / 26556 M smokers / 50-69 (57.8) / 3281 fatal/ nonfatal stroke / Cheese: 60(Q5) vs. 3(Q1) g/d
RR=0.88 (95% CI: 0.77-1.01) (IS)
RR=1.01 (95% CI: 0.72-1.41) (IHS)
RR=1.07 (95% CI:0.66-1.72) (SHS) / Stroke. / Age, smoking, education, BMI, physical activity, supplementation group, serum total cholesterol, serum HDL cholesterol, histories of diabetes and HD, and intakes of energy, alcohol, caffeine, sugar, red meat, poultry, fish, fruit, fruit juices, vegetables, potatoes, whole grains, and refined grains.
Bonthuis, 2010[5]
(Australia) / NA, 14.4 yr / 1529 M/F / 25-78 (49.8) / 61 fatal CVD / Full-fat cheese: 30(T3) vs. 4(T1) g/d
RR=0.64 (95% CI: 0.27-1.49) / None. / Age, sex, BMI, smoking, physical activity, school leaving age, dietary supplement use, β-carotene treatment during trial, use of medications for hypertension, diabetes mellitus, or cardiac disorder, use of β-adrenergic blocking agents, and intakes of energy, alcohol and calcium.
Sonestedt, 2011[6]
(Sweden) / Malmo Diet and Cancer study, 12 yr / 26445 M/F / 44-74 (56.7 in non-cases) / 2520 fatal/nonfatal CVD,
1344 fatal/ nonfatal CHD, 1176 fatal/nonfatal stroke / Cheese: 75(F)/85(M)(Q5) vs.
12(F)/11(M)(Q1) g/d
RR=0.90 (0.78-1.03)(CVD)
RR=0.88 (95% CI: 0.74-1.04)(CHD)
RR=0.96 (95% CI: 0.80-1.15)(stroke) / MI, stroke, and diabetes / Age, sex, BMI, smoking, physical activity, education season, method, and intakes of energy and alcohol.
Goldbohm, 2011[7]
(the Netherlands) / Netherlands Cohort Study, 10 yr / 8934 M/F
(sub-cohort) / 55-69 (NA) / 3234 fatal IHD,
1054 fatal stroke / Cheese: 56(Q5) vs. 1(Q1) g/d
RR=0.87 (95% CI: 0.62-1.19)(IHD, M)
RR=0.76 (95% CI: 0.49-1.20)(IHD, F)
RR=1.12 (95% CI: 0.70-1.77)(stroke, M)
RR=0.61 (95% CI: 0.34-1.10)(stroke, F) / Angina, MI, and stroke / Age, BMI, smoking, physical activity, education, multivitamin use, and intakes of energy, alcohol, energy-adjusted mono- and polyunsaturated fat, vegetable, and fruit.
Soedamah-Muthu, 2012[8]
(UK) / Whitehall II study, 10.8 yr / 4255 M/F / NA (56) / 323 fatal/nonfatal CHD / Cheese: 31(T3) vs. 6(T1) g/d
RR=0.82 (95% CI: 0.61-1.09) / CHD / Age, sex, BMI, smoking, physical activity, ethnicity, employment grade, family history of CHD/hypertension, and intakes of energy, alcohol, fruit and vegetables, bread, meat, fish, coffee, and tea.
Avalos, 2012[9]
(USA) / NA, 16.2 yr / 1759 M/F / 50-93 (70.6 in M, 70.1 in F) / 451 fatal/nonfatal CHD / Sometimes/often vs. never/rarely
Cheese:
RR=1.23 (95% CI: 0.70-2.18)(M)
RR=0.71 (95% CI: 0.43-1.20)(F)
Low-fat cheese:
RR=0.98 (95% CI: 0.65-1.46)(M)
RR=2.32 (95% CI: 1.57-3.41)(F) / CHD / Age, BMI, diabetes, hypertension, LDL- cholesterol, and oestrogen use (in F).
Larsson, 2012[10]
(Sweden) / Swedish Mammography Cohort, Cohort of Swedish Men, 10.2 yr / 74961 M/F / 45-83 (60.3) / 4089 fatal/nonfatal stroke / Cheese: 5.0(Q5) vs. 0.4(Q1) ser/d
RR=0.91 (0.81-1.01) (total stroke)
RR=0.95 (95% CI: 0.84-1.08) (IS)
RR=0.87 (95% CI: 0.66-1.14) (HS) / Cancer, CHD, and stroke / Age, sex, BMI, smoking, education, physical activity, aspirin use, history of hypertension, diabetes, family history of MI, and intakes of energy, alcohol, coffee, fresh red meat, processed meat, fish, fruits, and vegetables, and other individual dairy products.
Patterson, 2012[11]
(Sweden) / Swedish Mammography Cohort, 11.6 yr / 33636 F / 48-83 (61.2) / 1392 fatal/nonfatal MI / Cheese: 6.0(Q5) vs. 0.7(Q1) ser/d
RR=0.74 (95% CI: 0.60-0.91)
Low-fat cheese: 2.71(Q5) vs. 0(Q1) ser/d
RR=0.84 (95% CI: 0.66-1.06)
Full-fat cheese: 4.00(Q5) vs. 0(Q1) ser/d
RR=0.83 (95% CI: 0.68-1.01) / Cancer, CVD, and diabetes / Age, WHR, smoking, physical activity, education, alcohol consumption, diagnosis of hypertension or high cholesterol, family history of MI, use of aspirin or hormone therapy, and intakes of energy, alcohol, fruit and vegetables, whole-grain foods, and other individual dairy products.
de Oliveira Otto, 2012[12]
(USA) / Multi-Ethnic Study of Atherosclerosis, 7 yr / 5209 M/F / 45-84 (61.8) / 316 fatal/nonfatal CVD / Per 1 ser/d
Cottage cheese:
RR=1.60 (95% CI: 0.60-2.50)
Regular cheese:
RR=0.50 (95% CI: 0.30-0.95) / CVD and diabetes / Age, sex, BMI, smoking, race-ethnicity, study center, education, physical activity, dietary supplement use, cholesterol lowering medication use, intakes of energy, alcohol, fruits and vegetables, dietary fiber, dietary vitamin E , trans fat, and PUFA.
van Aerde, 2012[13]
(the Netherlands) / Hoorn Study, 12.4 yr / 1956 M/F / 50-75 (61.6) / 116 fatal CVD / Cheese: per 24 g/d
RR=1.09 (95% CI: 0.87-1.35) / CVD / Age, sex, physical activity, and intakes of meat, fish, bread, vegetables, fruit, coffee, and tea.
von Ruesten, 2013[14]
(Germany) / EPIC-Postsdam, 8yr / 23531 M/F / 35-65 (NA) / 363 fatal/ nonfatal CVD / Per 30 g/d
Low-fat cheese:
RR=1.00 (95% CI: 0.78-1.30)
High-fat cheese:
RR=1.02 (95% CI: 0.85-1.22) / Cancer, CVD, and T2DM / Age, sex, BMI, WHR, smoking, physical activity, education, hypertension, high blood lipids, vitamin supplementation, and intakes of energy intake, alcohol and other food groups
Praagman, 2015[15]
(the Netherlands) / EPIC-Netherlands, 15 yr / 34409 M/F / 20-70 (43.0 in M, 51.0 in F) / 253 fatal CHD,
159 fatal stroke / Cheese: 30.2(Q4) vs. 15.8 (Q1) g/d / Cancer and CVD. / Age, sex, smoking, BMI, physical activity, education, hypertension at baseline, and intakes of total energy, alcohol and energy-adjusted fruit and vegetables.
ATBC, Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study;CHD, coronary heart disease; CI, confidence interval; CVD, cardiovascular disease; d, day; EPIC, European Prospective Investigation into Cancer and Nutrition; F, female; FFQ, Food frequency questionnaire; g, grams; HD, heart disease; HDL, high-density lipoprotein; HS, hemorrhagic stroke; IHD, ischemic heart disease; IHS, Intracranial hemorrhage stroke; IS, ischemic stroke; LDL, low-density lipoprotein; M, male; MI, myocardial infarction; NA, not available; PUFA, Polyunsaturated fatty acids; RR, relative risk; SHS, Subarachnoid hemorrhage stroke; T2DM, Diabetes mellitus; wk, week; WHR, Waist-to-hip ratio; yr, years.
Supplementary Table 2.The quality of included studies assessed by the Newcastle Ottawa Scale a
Selection / Comparability / Outcome / Total starsStudy / Representativeness
of exposed cohort / Selection of the non- exposed
cohort / Ascertainment of exposure / Demonstration that outcome of interest was not present at start of study / Comparability
of cohorts on the basis of the design or analysis / Assessment of outcome / Was follow-up long enough for
outcomes to
occur / Adequacy of follow up of cohorts
Mann, 1997[1] / 0 / 1 / 0 / 1 / 2 / 1 / 1 / 0 / 6
Fraser, 1997[2] / 0 / 1 / 0 / 1 / 0 / 1 / 1 / 1 / 5
Iso, 1999[3] / 0 / 1 / 1 / 1 / 1 / 1 / 1 / 0 / 6
Larsson, 2009[4] / 0 / 1 / 1 / 1 / 2 / 1 / 1 / 0 / 7
Bonthuis, 2010[5] / 0 / 1 / 1 / 0 / 2 / 1 / 1 / 1 / 7
Sonestedt, 2011[6] / 1 / 1 / 1 / 1 / 2 / 1 / 1 / 0 / 8
Goldbohm, 2011[7] / 1 / 1 / 1 / 1 / 2 / 1 / 1 / 1 / 9
Soedamah-Muthu, 2012[8] / 0 / 1 / 1 / 1 / 2 / 1 / 1 / 1 / 8
Avalos, 2012[9] / 0 / 1 / 0 / 1 / 1 / 1 / 1 / 1 / 7
Larsson, 2012[10] / 1 / 1 / 1 / 1 / 2 / 1 / 1 / 0 / 8
Patterson, 2012[11] / 1 / 1 / 1 / 1 / 2 / 1 / 1 / 0 / 8
de Oliveira Otto, 2012[12] / 1 / 1 / 1 / 1 / 2 / 1 / 1 / 0 / 8
van Aerde, 2012[13] / 1 / 1 / 1 / 1 / 1 / 1 / 1 / 0 / 7
von Ruesten, 2013[14] / 1 / 1 / 1 / 1 / 2 / 1 / 1 / 1 / 9
Praagman, 2015[15] / 1 / 1 / 1 / 1 / 2 / 1 / 1 / 1 / 9
aA study can be awarded a maximum of one star for each numbered item within the Selection and Outcome categories and a maximum of two stars for Comparability.
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