Fermented Dairy Product Consumption and Blood Lipid Levels in Healthy Adults: A Systematic Review

Birsen YILMAZ^1*Panagiota Alvanoudi²Aggeliki Kalogeropoulou²Dushica Santa³Tugce Bulmus Tuccar⁴Anastasios Nikolaou⁵Isabel Moreno Indias⁶Patricia Ruiz Limón⁷Carolina Gutiérrez Repiso⁸Elaine Hillesheim⁹Victoria Meslier¹⁰Baltasar Mayo¹¹Jeadran Malagon-Rojas¹²Smilja Praćer¹³Christophe Chassard¹⁴Guy Vergères⁹FANI Th MANTZOURIDOU^2*

• ¹Tata Institute of Fundamental Research Hyderabad, Hyderabad, India
• ²Aristoteleio Panepistemio Thessalonikes, Thessaloniki, Greece
• ³Saints Cyril and Methodius University in Skopje Faculty of Agricultural Sciences and Food, Skopje, North Macedonia
• ⁴Yuksek Ihtisas Universitesi, Ankara, Türkiye
• ⁵Demokriteio Panepistemio Thrakes, Komotini, Greece
• ⁶Instituto de Investigacion Biomedica de Malaga, Málaga, Spain
• ⁷Hospital Universitario Virgen de la Victoria, Málaga, Spain
• ⁸Centro de Investigacion Biomedica en Red Fisiopatologia de la Obesidad y Nutricion, Madrid, Spain
• ⁹Agroscope, Bern, Switzerland
• ¹⁰Universite Paris-Saclay, Gif-sur-Yvette, France
• ¹¹Instituto de Productos Lacteos de Asturias, Villaviciosa, Spain
• ¹²Instituto Nacional de Salud, Bogotá, Colombia
• ¹³Univerzitet u Beogradu Institut za bioloska istrazivanja Sinisa Stankovic, Belgrade, Serbia
• ¹⁴Universite Clermont Auvergne, Clermont-Ferrand, France

Cardiovascular diseases remain the leading cause of global mortality, with diet recognized as a key factor influencing cardiovascular risk biomarkers such as blood lipids. Emerging evidence suggests fermented dairy products may offer cardioprotective benefits via fermentation-derived bioactive metabolites. This systematic review, conducted within COST Action CA20218 Promoting Innovation of ferMENTed fOods (PIMENTO), evaluated the relationship between consumption of conventional fermented dairy products and blood lipid levels and cardiovascular diseases in healthy adults. Data were qualitatively summarized and synthesized narratively, following the European Food Safety Authority's (EFSA) scientific guidance for health claim applications, including food characterization, bioavailability of relevant compounds, mechanisms of action, and safety. Sixty-eight studies were included: 14 controlled interventions (PICO), 37 non-controlled interventions (PIO), and 17 observational studies. Findings from intervention studies were largely inconsistent, with most trials reporting no significant changes in lipid markers following fermented dairy intake. However, a few studies reported modest reductions in total cholesterol and LDL-c or improved LDL/HDL ratios, particularly with yoghurt and kefir.Observational studies also yielded mixed and inconclusive results. Overall, study quality, result consistency, and mechanistic evidence were deemed "neither convincing nor sufficient" per EFSA criteria. Key limitations included high risk of bias, heterogeneous designs, inadequate product characterization, and limited mechanistic data. More rigorous, well-controlled human studies with appropriate comparators are needed to clarify whether conventional fermented dairy products have any lipid-lowering effects.