What is the clinical evidence from this study?

Study design: RCT. Population: Moderately high blood pressure (n=153). Intervention: Gamalost cheese and Gouda-type cheese vs. Control (habitual diet avoiding intervention cheeses). Primary outcome: Change in blood pressure at 8 weeks.

January 1, 2016Open Access

Effect of a cheese rich in angiotensin-converting enzyme-inhibiting peptides (Gamalost®) and a Gouda-type cheese on blood pressure: results of a randomised trial

RNRita NilsenNorwegian University of Life Sciences APAre Hugo PrippOslo University Hospital AHArne T. HøstmarkUniversity of Oslo

Key Result

Gamalost and Gouda-type cheeses did not significantly reduce blood pressure compared to a control diet after 8 weeks in a general healthy population.

Study Design

Type

RCT (n=153)

Blinding

Single-blind

Randomization

Randomised to one of three parallel arms

Multicenter

Structured PICO

Does consumption of Gamalost or Gouda-type cheese reduce blood pressure in healthy, unmedicated adults?

Population

153 healthy adults (mean age 43, 52% female) from the general population in Norway, unmedicated for blood pressure. Baseline BP: 22% optimal, 46% moderately high, 31% hypertensive. Excluded: pregnancy and use of BP-lowering medications.

Intervention

Gamalost cheese (50 g/day) or Gouda-type cheese (80 g/day) consumed daily for 8 weeks.

Comparator

Control group maintaining habitual diet but avoiding the intervention cheeses and similar cheeses (allowed other cheeses like blue, mozzarella, or cream cheese).

Outcome

Change in blood pressure (systolic and diastolic) at 8 weeks.surrogate

Consumption of Gamalost or Gouda-type cheese for 8 weeks did not significantly lower blood pressure compared to a control diet in unmedicated adults.

Limitations

Use of in-office sphygmomanometer measurements instead of 24-hour ambulatory blood pressure monitoring
Inclusion of normotensive participants may have left the study underpowered to detect a difference
Control group was allowed to consume other dairy products, which could have confounded the results
Only partial control of the participants' overall diet during the trial

Abstract

BACKGROUND: High blood pressure (BP) is the leading risk factor for global disease burden, contributing to 7% of global disability adjusted life years. Angiotensin converting enzyme (ACE)-inhibiting bioactive peptides have the potential to reduce BP in humans. These peptides have been identified in many dairy products and have been associated with significant reductions in BP. OBJECTIVE: The objective of this trial was to examine whether a cheese rich in ACE-inhibiting peptides (Gamalost(®)), or a standard Gouda-type cheese could lower BP. DESIGN: A total of 153 healthy participants were randomised to one of three parallel arms: Gamalost(®) (n=53, 50 g/day for 8 weeks), Gouda-type cheese (n=50, 80 g/day for 8 weeks), and control (n=50). BP and anthropometric measurements were taken at the baseline and at the end, with an additional BP measurement midway. Based on BP at baseline, participants were categorised as having optimal BP (140/>90 mmHg). Questionnaires about lifestyle, health, and dietary habits were completed at baseline, midway and end. RESULTS: In total, 148 participants (mean age 43, 52% female) completed the intervention. There were no differences among the three groups in relevant baseline characteristics. BP was reduced in the entire study population, but the cheese groups did not differ from control. However, in a subgroup of participants with slightly elevated BP, BP at 4 weeks of intervention seemed to be borderline significantly more reduced in the Gamalost(®) group compared with the control group (Dunnett test: diastolic BP -3.5 mmHg, 95% confidence interval (CI) -7.3, 0.4, systolic BP: -4.3 mmHg, 95% CI -9.8, 1.1). CONCLUSION: An intention-to-treat analysis of the data showed no cheese effect upon BP compared to control, but Gamalost(®) seemed to have a small, non-significant lowering effect on diastolic BP after 4 weeks in people with a normal-high BP.

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