Research in context
Evidence before this study
Dietary guidelines recommend restricting the consumption of whole-fat dairy products based on concerns about an adverse effect on blood lipids. We systematically searched PubMed for relevant articles on dairy consumption published between Jan 1, 1970, and April 1, 2018, restricted to the English language using the search terms “total dairy”, “milk”, “yoghurt”, “yogurt”, “cheese”, “cream”, “butter”, “low fat dairy”, “whole fat dairy”, “high fat dairy”, “mortality”, and “cardiovascular disease”. Studies that evaluated association of dairy or dairy products and mortality and cardiovascular disease were considered. Most data are from Europe and North America and have yielded conflicting results, perhaps because of their relatively small sizes and few events.
Added value of this study
We studied 136 384 individuals from 21 countries in whom 10 567 events were recorded. Consistent with the meta-analysis of observational studies and randomised trials, but in contrast to current dietary guidelines, we found that greater dairy consumption was associated with lower risk of mortality and cardiovascular disease.
Implications of all the available evidence
In the context of all other related studies, findings from the Prospective Urban Rural Epidemiology (PURE) study indicate that consumption of dairy products should not be discouraged and perhaps even be encouraged in low-income and middle-income countries where dairy consumption is low.