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Dairy Consumption: Effects on Nutrient

Status and Risk of Chronic Disease

Beth H. Rice, PhD, Director, Scientific Affairs

June, 2013

Established under the leadership of America's dairy farmers with a

commitment to nutrition, product and sustainability research.

A 501(c)(3) non-profit organization that works with and through

industry, academic, government and commercial partners to drive pre-

competitive research on behalf of the Innovation Center for U.S.

Dairy®, the National Dairy Council® and other partners.

Beth H. Rice, PhD, Director, Scientific Affairs

[email protected]

+1-(631)-804-4274

www.usdairy.com/dairyresearchinstitute

1

Dairy Research Institute

mailto:[email protected]

http://www.usdairy.com/dairyresearchinstitute

2

Nutrition is defined as food necessary for survival

Giuseppe Arcimboldo, 1590, Holy Roman Emperor Rudolf II

3

Americans are overweight and undernourished

Centers for Disease Control and Prevention

Dietary Guidelines for Americans 2010

4

Dairy’s place in the diet of the overweight and

undernourished

Choosemyplate.gov

5

Dairy and nutrient status

Many Americans fall short on nutrient intakes

6

0 10 20 30 40 50 60 70 80

seleniumcopper

zinciron

magnesiumphosphorus

folatevitamin B-12

vitamin B-6niacin

riboflavinthiamin

vitamin Evitamin Cvitamin A

calciumvitamin D

% below the Estimated Average Requirement

% of Americans with nutrient intakes from food and supplements below the Estimated Average Requirement

Adapted from Fulgoni et al., J Nutr. (2011) 1847 - 1854

Just 2.5% of Americans have intakes from food and supplements

above the Adequate Intake for potassium

Dairy contributes nutrients to the American diet

10

58

51

28

16 13

26 25 28

18 16

11 14

26

NHANES (2003-2006), Ages 2+ yr

7

Percent of calories & nutrients from dairy

Dairy contributes nutrients to the global diet

8

Nutrients Aus Bel Can Den Fra Ire Neth UK

Calories 11 13 11 7

Fat 14 16 14 25 15

Vitamin A 10 20 12 22 17 7-8 10

Vitamin D 50 12 7 9 7-9

Vitamin B12 30 35 19 30-37 35

Riboflavin 20 20 42 33 46-50 30

Calcium 50 54 50 57 52 39 69-75 40

Magnesium 10 15 15 11 17-18 10

Phosphorus 20 20 35 25 20 20

Potassium 10 15 17 12 10

% contributed from dairy to total diet

Global Dairy Platform, International Dairy Federation

Recommended dairy servings

9

Country Recommendation

United States 3 cups low-fat and fat-free milk, cheese and yogurt for

people 9+ years

Denmark Select low-fat and fat-free milk and milk products

Belgium 3 - 4 glasses of milk or milk products (~ 450 – 600 ml total)

and 1 to 2 slices of cheese (~20 - 40 g total) depending on

age, preferably low-fat

The Netherlands 400 – 650 mL of milk and milk products and 20 – 30 g of

cheese depending on age

10

Gaps between current and recommended intakes: US

Usual intakes as % of recommendations

2010 Dietary Guidelines

for Americans

“Choose foods that provide more

potassium, dietary fiber,

calcium, and vitamin D.

“These foods include

vegetables, fruits, whole grains,

and milk and milk products.”

GOAL

US Department of Agriculture and US Department of Health and Human

Services. Dietary Guidelines for Americans, 2010. 7th Edition, Washington,

DC: US Government Printing Office, December 2010

11

Removing dairy from the diet would widen nutrient gaps

1.7 SERVINGS

Modeled intakes - no dairy

GOAL

Modeled intakes – no dairy

33%

10%

45%


for Americans







Adapted from Fulgoni et al., Nutr Res (2011) 759 - 765

Adding a serving of dairy would help close nutrient gaps

12

GOAL

Modeled intakes – add one dairy serving

GOAL

Modeled intakes – add one dairy serving


for Americans







Adapted from Fulgoni et al., Nutr Res (2011) 759 - 765

13

Gaps between current and recommended intakes:

worldwide

Global Dairy Platform, International Dairy Federation

14

Dairy offers a high nutrient value for its monetary cost

Adapted from Drewnowski , Am J Clin Nutr (2010) 1181 - 1188

15

Dairy and cardiovascular disease

CVD

31%

NCD

33%

Injuries

9% Communicable,

maternal, perinatal,

and nutritional

conditions 31%

16

CVD mortality around the world

WHO, 2011, Global Atlas on CVD Prevention and Control

“Moderate evidence also indicates that intake of

milk and milk products is associated with a reduced

risk of cardiovascular disease and type 2 diabetes

and with lower blood pressure in adults”

17

Dietary Guidelines point to an association between dairy

consumption and lower risk for chronic disease




18

Recent evidence shows that dairy intake is associated

with lower CVD risk

The intake of total dairy was

associated with lower risks for

several CVD outcomes

Some, but not all, of these

trials were completed before

low-fat dairy products were

commonly consumed

More observational evidence

on full-fat dairy is needed

Elwood et al. Lipids (2010) 925 939

19

More evidence since the 2010 DGAC

Study Endpoint Outcomes

Bonthuis et al

(2010) CVD

• Overall intake of dairy products was not associated with mortality, while full-fat dairy intake

was associated with reduced CVD mortality

Warensjö et al

(2010) CVD

• Circulating fatty acids from dairy were associated with a lower risk of developing a first

myocardial infarction, especially in women.

Soedamah-Muthu et

al (2011) CVD

• Meta-analysis concludes milk intake is not associated with total mortality but may be

inversely associated with overall CVD risk

Sonestedt et al

(2011) CVD

• Intake of fermented milk reduced risk of CVD

• Cheese intake was significantly associated with decreased CVD risk in women

Dalmeijer et al

(2012) CVD

• High intakes of total and low-fat dairy were associated with a lower risk of CHD among

participants without hypertension

• Fermented dairy was associated with a reduced risk of stroke.

Larsson et al

(2012) CVD • Low-fat dairy consumption was inversely associated with the risk of stroke.

de Oliveira Otto et al

(2012) CVD • A higher intake of dairy saturated fat was associated with lower CVD risk.

Avalos et al

(2012) CVD

• Higher risk in women consuming low-fat cheese and non-fat milk

• Trend for reduced risk in women with full-fat cheese

Patterson et al

(2013) CVD

• Total cheese was inversely associated with risk of MI in women.

• Butter used on bread but was positively associated with MI, but butter used in cooking was

not associated with MI.

• No association with other dairy foods and no difference between low-fat and full-fat.

Louie et al

(2013) CVD

• For total dairy intake, there was a reduction in risk of CVD seen in tertile 2, and for CHD

both tertile 2 and tertile 3 were associated with a reduced risk; however there were no

linear trends between total dairy consumption and these outcomes.

20

Milk inversely associated with CVD in dose-response

meta-analysis of prospective cohort studies

per 200 mL/d

Adapted from Soedamah-Muthu et al., Am J Clin Nutr (2011) 158 - 171

21

Cheese consumption does not detrimentally impact

blood lipids in randomized dietary intervention

Run-In Cheese Butter Run-In Cheese Butter

Run-In Cheese Butter

Adapted from Hjerpsted et al., Am J Clin Nutr (2011) 1479 - 1484

22

Dairy and blood pressure

23



van Meijl and

Mensink (2011)

Blood

Pressure • Dairy reduced systolic blood pressure; trend for a reduction in diastolic blood pressure

Ralston et al. (2012) Blood

Pressure

• Meta-analysis supports the inverse association between low-fat dairy foods and fluid dairy

foods and risk of elevated blood pressure

Soedamah-Muthu et

al. (2012)

Blood

Pressure

• Dose-response meta-analysis showing that total dairy, low-fat dairy, and milk were

associated with reduced risk of hypertension.

• Yogurt, cheese, full-fat dairy, and fermented dairy were neutral

Livingstone et al.

(2013)

Blood

Pressure

• Augmentation index was 1.8% lower in subjects in the highest quartiles of dairy product

intake compared with the lowest

• In the highest group of milk consumption, systolic blood pressure was 10.4 mm Hg lower

than in non-milk consumers after a 22.8-year follow-up

• Across increasing groups of milk intake glucose was lower and across increasing total

dairy product intake triglycerides were lower

24

Total and low-fat dairy inversely associated with risk of elevated

blood pressure in meta-analysis of prospective cohort studies

Adapted from Ralston et al., J Hum Hypertens (2012) 3 - 13

Full-fat dairy had no association with risk of EBP

Cheese had no association with risk of EBP

Fluid dairy inversely association with risk of EBP

25

Dairy’s effect on risk of elevated blood pressure may be

driven by fluid milk

Adapted from Ralston et al., J Hum Hypertens (2012) 3 - 13

Total dairy, low-fat dairy, and

milk were inversely and linearly

associated with a lower risk of

hypertension

Full-fat dairy, total fermented

dairy, yogurt, and cheese were

not significantly associated with

incidence of hypertension

Clinical studies to test an

independent effect of dairy on

blood pressure are warranted

26

Dairy inversely associated with risk of hypertension in

meta-analysis of prospective cohort studies

Adapted from Sodamah-Muthu et al., J Hum Hypertens (2012) 1131 - 1137

27

Dairy and type 2 diabetes

28

Diabetes prevalence and public health burden

Percent 0 - 6.5

6.6 - 8.0

8.1 - 9.4

9.5 - 11.1

> 11.2

2004

2009

Diagnosed diabetes among adults aged ≥ 20 yrs

25 M = number of people in the

United States affected by diabetes,

2010

11.3% of all people ≥ 20yrs

26.9% of all people ≥ 65yrs

79 M = number of people in the

United States estimated to have pre-

diabetes

$174 B = estimated total diabetes

medical costs in the United States,

2007

Centers for Disease Control and Prevention

29

Aggressive lifestyle intervention can slow progression

to type 2 diabetes

Reduction in the Incidence of Type 2 Diabetes With Lifestyle Intervention or Metformin

DPP Research Group, N Engl J Med (2002) 393 - 403


30


Mozaffarian et al.

(2010) T2D

• Circulating trans-palmitoleate, a biomarker of dairy fat intake, is associated with lower

insulin resistance, presence of atherogenic dyslipidemia, and incident diabetes.

Tong et al.

(2011) T2D

• Meta-analysis reports low-fat dairy and yogurt consumption were associated with

significant reductions in type 2 diabetes risk

• An additional serving per day of low-fat dairy foods was associated with a 10% decrease in

type 2 diabetes risk

Malik et al.

(2011) T2D

• Dairy product intake of women during high school was significantly inversely associated

with type 2 diabetes risk in adulthood

Margolis et al.

(2011) T2D

• Low-fat dairy product consumption was inversely associated with the risk of type 2 diabetes

• High yogurt consumption was associated with a significant decrease in diabetes risk

Granthem et al.

(2012) T2D

• Dairy product consumption was inversely associated with the risk of type 2 diabetes in

men, with a similar non-significant trend in women

Sluijs et al.

(2012) T2D

• A higher combined intake of fermented dairy products (cheese, yogurt, and fermented milk)

was inversely associated with type 2 diabetes

• No association between total dairy product intake and diabetes risk

Struijk et al.

(2012) T2D

• Cheese intake was associated with improved glucose tolerance

• Fermented dairy intake was associated with improved fasting glucose and HbA(1c)

• No association with incident type 2 diabetes

Mozaffarian et al.

(2013) T2D

• Circulating trans-palmitoleate, a biomarker of dairy fat intake, is associated with higher LDL

cholesterol but also with lower triglycerides, fasting insulin, blood pressure, and incident

diabetes in a multiethnic US cohort

31

Dairy inversely related to type 2 diabetes in meta-

analysis of prospective cohort studies

Tong et al., Eur J Clin Nutr (2011) 1027 - 1031

An additional serving per day

of low-fat dairy foods was

associated with a 10%

decrease in type 2 diabetes

risk

Low-fat dairy (-18%) and

yogurt consumption (-17%)

were associated with

significant reductions in type

2 diabetes risk

Those with high dairy intake in

high school had a 38% lower

risk for developing type 2

diabetes as adults

Need to sustain dairy intake in

adulthood to maximize risk

reduction

32

Higher dairy intake is associated with lower incidence

of type 2 diabetes

High (3.8)

Med (2.5)Low (1.5)

0

0,2

0,4

0,6

0,8

1

1,2

Low(1.3)

Med(2.3)

High(3.6)

Current

Re

lati

ve

Ris

k ref

Adapted from Malik et al. Am J Clin Nutr (2011) 854 - 861

33

Adequate dairy lowers biomarkers for pre-diabetes

-6

-4

-2

0

2

4

6

Low Dairy Adequate Dairy

Fa

sti

ng

In

su

lin

(µ

U/m

L)

(< 0.5 daily serv) (3.5 daily serv)

Adapted from Stancliffe et al., Am J Clin Nutr (2011) 422 - 430

34

Higher levels of a dairy specific fatty acid are associated

with a lower incidence of type 2 diabetes

0

0,2

0,4

0,6

0,8

1

1,2

1 2 3 4 5

Quintiles of trans-Palmitoleic Acid in Blood

Rela

tive R

isk o

f In

cid

ent

Dia

bete

s

Adapted from Mozaffarian et al. Ann Intern Med (2010) 790 - 800

French Data from the Epidemiological Study on the Insulin Resistance

Syndrome (DESIR) cohort (n = 3,435) was analyzed to assess the

influence of dairy products on 9-year incident metabolic syndrome,

impaired fasting glucose and/or type 2 diabetes

Dairy product consumption (w/o cheese) and calcium intake were

inversely associated with incident metabolic syndrome and type 2

diabetes

Cheese intake was inversely associated with metabolic syndrome

All three parameters (dairy consumption, calcium intake, and cheese intake) were

associated lower diastolic blood pressure, and with a lower BMI gain

Higher cheese intake and calcium intake were associated with a lower increase in

waist circumference and lower triglyceride levels

35

Cheese intake inversely associated with metabolic

syndrome in DESIR cohort

Fumeron et al. Diabetes Care (2011) 813 - 817

Data from 7,815 men and 9,685 women enrolled in the Oslo Health

Study were analyzed to determine a relationship between frequency

of cheese intake and metabolic syndrome

Cheese intake was associated with reduced risk for metabolic

syndrome, fewer metabolic syndrome risk factors, and improvement in

individual metabolic syndrome components

Relationship prevailed after controlling for sex, age, time since last meal, intake of

fruit/berries, fruit juice, fatty fish, coffee, alcohol, smoking, physical activity,

education, and birthplace

Cheese intake was associated with a lower risk for CVD and type 2 diabetes

Higher frequency of cheese intake was also associated with a significantly lower

body mass index in all but the oldest women (75-76 years)

36

Cheese intake inversely associated with metabolic

syndrome in Oslo Health Study

Høstmark and Tomten. J Am Coll Nutr (2011) 182 - 190

37

Dairy and bone

38

Bone mass declines after age 30

nlm.nih.gov

39

7 clinical trials published since the Dietary Guidelines for Americans

2010 indicate the dairy consumption improves bone health in women

“Moderate evidence shows that intake of milk and milk products is

linked to improved bone health, especially in children and

adolescents.”

Dairy contributes to bone health throughout the

lifespan




40

Dairy and weight

41

Certain foods are associated with weight change in

adults

Dairy

Weight change associated with each increased

daily serving, per 4-year period (lbs)

Three large cohorts • Nurses Health Study

• Nurses Health Study II

• Health Professionals Follow-up Study

Mozaffarian et al., New Eng J Med (2011) 2392 - 2404

42

Dairy may help contribute to lower weight in adults in

meta-analysis of randomized controlled clinical trials

Abargouei et al., Int J Obesity (2012) 1485 - 1493

43

Dairy may help contribute to lower weight in adults in

meta-analysis of randomized controlled clinical trials

Chen et al., Am J Clin Nutr (2012) 735 - 747

Dairy foods, including milk, cheese and yogurt, contribute essential

nutrients to the diet

Consuming low-fat and fat-free dairy foods is associated with:

better nutrient status

reduced risk of cardiovascular disease and type 2 diabetes in adults

lower blood pressure in adults

bone health throughout the lifespan

healthy weight

44

Dairy is a key contributor to a healthy diet

45

End of deck

Three of the top 10 sources of calories and SFA (beef, milk and cheese)

contribute 46.3% of the calcium, 49.5% of the vitamin D, 42.3% of the

vitamin B12 as well as other essential nutrients to the American diet

Conversely, foods categorized as desserts, snacks, or beverages, contribute

25.5% of total calories, 83% of added sugar intake, and provide little or no

nutritional value.

46

Don’t throw baby out with the bath water

Documents

Dairy Consumption: Effects on Nutrient Status and Risk of ...milk.kadanza.com/fileadmin/events/downloads/june_2013_symposiu… · risk of cardiovascular disease and type 2 diabetes