Cheese is nutritious, rich in high quality proteins, vitamins (e.g., A, B12), and minerals (e.g., calcium, phosphorus) but also relatively high in saturated fats och salt. However, despite the high levels of saturated fats och salt, cheese consumption has been linked to reduced cardiovascular disease risk and shown not to increase LDL cholesterol or blood pressure. These unexpected findings are often attributed to the cheese matrix, which includes the combined effect of all nutrients and non-nutrients in cheese, how they are organized in different structures and the physical cheese structure.

With increased knowledge on the role of the cheese matrix on health, there is growing interest in understanding expected health effects when replacing cheese with plant-based alternatives, and the role of their matrix. The aim of this report is to summarize the current knowledge on the role of the cheese matrix in the health effects of cheese, in comparison with plant-based cheese alternatives.

Several matrix factors may contribute to positive cardiometabolic effects of cheese, e.g., unique fatty acids, fat globule organization, casein micelle like structures, bioactive peptides and amino acids, the bioaccessibility of calcium, and vitamin K. Several cheese matrix factors are also suggested to benefit muscle- and bone health, e.g., the content of high-quality protein, favourable calcium-to-phosphorus ratio and content of vitamin K. The favourable ratio of calcium to phosphorus is also positive for dental health. Other positive effects of cheese on dental health are attributed to casein, low carbohydrate content (lactose which is less caries-inducing than other carbohydrates) and the saliva-stimulating effect of chewing cheese.

No study has analyzed the food matrix effect on plant-based cheese alternatives. Therefore, the comparisons to cheese can so far only be inferred from differences in nutrient composition, processing, and raw materials between plant-based and dairy cheese. Specific components in plant-based alternatives, such as anti-nutrients and the fortification of vitamins and minerals may potentially impact their health effect.

In conclusion, current evidence indicates that cheese, due to its unique matrix, may confer health benefits superior to those of plant-based alternatives, particularly with respect to cardiometabolic, dental, and musculoskeletal health outcomes. However, it remains uncertain whether assumptions derived from current knowledge of individual nutrients and ingredients accurately reflect the true health effects of plant-based cheese alternatives. Future research may further develop our understanding of how certain processes, such as fermentation, affect the cheese matrix and reveal unexpected health properties and matrix effects of plant-based cheese alternatives.