Systematic Review of the Association between Dairy Product Consumption and Risk of Cardiovascular-Related Clinical Outcomes

Total Dairy, Cheese and Milk Intake and Arterial Stiffness: A Systematic Review and Meta-Analysis of Cross-sectional Studies

The aim of this review was to determine the relationship between dairy product consumption and arterial stiffness, measured by pulse wave velocity (PWV). We systematically searched the Medline, Embase and Web of Science databases until 30th January 2019 for cross-sectional data from studies addressing the association between dairy product consumption and PWV. This study was registered with PROSPERO (CRD42018110528). Both the inverse-variance fixed effects method and the DerSimonian and Laird method were used to compute pooled estimates of effect size (ES) and the respective 95% confidence intervals (CIs). Seven studies were included in the meta-analysis, with a total of 16,443 patients. Total dairy product (ES = -0.03; 95% CI [-0.04, -0.01]) and cheese (ES = -0.04; 95% CI [-0.07, -0.01]) consumption were weak, but significantly associated with lower PWV levels. Conversely, milk intake showed no significant association with PWV (ES = 0.02; 95% CI [-0.01, 0.05]). Heterogeneity in the ES was not important for the three groups of dairy products assessed. This systematic review and meta-analysis of seven studies found no detrimental effects of dairy product consumption on arterial stiffness measured by PWV. Due to the scarcity of studies, further investigations are warranted to clarify the role of dairy products on arterial stiffness.

SEA/SEMERGEN consensus document 2019: Dietary recommendations in the prevention of cardiovascular disease

The current paradigm in the nutrition sciences states that the basic nutritional unit is not the nutrients, but the foods that contain them (oils, nuts, dairy products, eggs, red or processed meats, etc.). These act as a food matrix in which the different nutrients synergistically or antagonistically modulate their effects on the various metabolic pathways determining health and disease. Food is not based on nutrients or isolated foods but on complex mixtures of one and the other that are part of a specific food pattern, a concept that has been targeted as the most pertinent to evaluate the associations between nutrition and health or disease. This document presents a summary of the available evidence on the relationship between different foods and cardiovascular health, and offers simple recommendations to be implemented in the dietary advice offered by the health professional.

Meals with Similar Fat Content from Different Dairy Products Induce Different Postprandial Triglyceride Responses in Healthy Adults: A Randomized Controlled Cross-Over Trial

BACKGROUND

Postprandial lipemia is a risk factor for cardiovascular disease. Dairy products differ in nutrient content and food matrix, and little is known about how different dairy products affect postprandial triglyceride (TG) concentrations.

OBJECTIVE

We investigated the effect of meals with similar amounts of fat from different dairy products on postprandial TG concentrations over 6 h in healthy adults.

METHODS

A randomized controlled cross-over study was performed on 47 subjects (30% men), with median (25th-75th percentile) age of 32 (25-46) y and body mass index of 23.6 (21.0-25.8) kg/m2. Meals included 1 of butter, cheese, whipped cream, or sour cream, corresponding to 45 g of fat (approximately 60 energy%). Serum concentrations of TGs (primary outcome), and total cholesterol (TC), low density lipoprotein cholesterol (LDL cholesterol), high density lipoprotein cholesterol (HDL cholesterol), insulin, glucose, non-esterified fatty acids, and plasma glucose-dependent insulinotropic polypeptide (secondary outcomes) were measured before the meal and 2, 4, and 6 h postprandially. Incremental AUC (iAUC) was calculated for the responses, and data were analyzed using a linear mixed model.

RESULTS

Sour cream induced a 61% larger TG-iAUC0-6 h compared to whipped cream (P < 0.001), a 53% larger TG-iAUC0-6 h compared to butter (P < 0.001), and a 23% larger TG-iAUC0-6 h compared to cheese (P = 0.05). No differences in TG-iAUC0-6 h between the other meals were observed. Intake of sour cream induced a larger HDL cholesterol-iAUC0-6 h compared to cheese (P = 0.01). Intake of cheese induced a 124% larger insulin iAUC0-6 h compared to butter (P = 0.006). No other meal effects were observed.

CONCLUSIONS

High-fat meals containing similar amount of fat from different dairy products induce different postprandial effects on serum TGs, HDL cholesterol, and insulin in healthy adults. The potential mechanisms and clinical impact of our findings remain to be further elucidated. The study was registered at www.clinicaltrials.gov as NCT02836106.

Dairy product consumption is associated with pre-diabetes and newly diagnosed type 2 diabetes in the Lifelines Cohort Study

Previous studies show associations between dairy product consumption and type 2 diabetes, but only a few studies conducted detailed analyses for a variety of dairy subgroups. Therefore, we examined cross-sectional associations of a broad variety of dairy subgroups with pre-diabetes and newly diagnosed type 2 diabetes (ND-T2DM) among Dutch adults. In total, 112 086 adults without diabetes completed a semi-quantitative FFQ and donated blood. Pre-diabetes was defined as fasting plasma glucose (FPG) between 5·6 and 6·9 mmol/l or HbA1c% of 5·7-6·4 %. ND-T2DM was defined as FPG ≥7·0 mmol/l or HbA1c ≥6·5 %. Logistic regression analyses were conducted by 100 g or serving increase and dairy tertiles (T1ref), while adjusting for demographic, lifestyle and dietary covariates. Median dairy product intake was 324 (interquartile range 227) g/d; 25 549 (23 %) participants had pre-diabetes; and 1305 (1 %) had ND-T2DM. After full adjustment, inverse associations were observed of skimmed dairy (OR100 g 0·98; 95 % CI 0·97, 1·00), fermented dairy (OR100 g 0·98; 95 % CI 0·97, 0·99) and buttermilk (OR150 g 0·97; 95 % CI 0·94, 1·00) with pre-diabetes. Positive associations were observed for full-fat dairy (OR100 g 1·003; 95 % CI 1·01, 1·06), non-fermented dairy products (OR100 g 1·01; 95 % CI 1·00, 1·02) and custard (ORserving/150 g 1·13; 95 % CI 1·03, 1·24) with pre-diabetes. Moreover, full-fat dairy products (ORT3 1·16; 95 % CI 0·99, 1·35), non-fermented dairy products (OR100 g 1·05; 95 % CI 1·01, 1·09) and milk (ORserving/150 g 1·08; 95 % CI 1·02, 1·15) were positively associated with ND-T2DM. In conclusion, our data showed inverse associations of skimmed and fermented dairy products with pre-diabetes. Positive associations were observed for full-fat and non-fermented dairy products with pre-diabetes and ND-T2DM.

Dairy Product Consumption and Metabolic Diseases in the Di@bet.es Study

To date it is not clear what the role of dairy products is in metabolic diseases like diabetes, obesity, and hypertension. Therefore, the aim of this study is to test the association between dairy product consumption and those pathologies. A cross-sectional study was conducted with 5081 adults included in the di@bet.es study, from 100 health centers around Spain. Food frequency questionnaires were carried out concerning consumption habits, which included dairy product consumption. Logistic regression models were used for the association analyses between the variables controlling confounding variables. Women had a higher consumption of milk, cheese, or yogurt than men (p < 0.0001), but men consumed more sugar dairy products (p < 0.001). People who live in the North of Spain consume more dairy products than those who live in the East. Dairy product consumption was inversely associated with the presence of hypertension regardless of age, sex, geographical region, and body mass index (BMI) (Odds Ratio (OR) 0.743; p = 0.022). The presence of obesity was inversely associated with dairy consumption regardless of age, sex, and geographical region (OR 0.61; p < 0.001). Milk consumption was not associated with diabetes. Our results show that consuming dairy products is associated with a better metabolic profile in the Spanish population.

Dairy food intake, diet patterns, and health: Findings from the Maine-Syracuse Longitudinal Study

This study compared the intake of yogurt and other dairy foods in relation to other dietary habits, and associations with cardiovascular health indicators. Comparative analyses of dietary intakes and cardiometabolic health indicators were conducted in participants from the Maine-Syracuse Longitudinal Study, conducted in 2001-2006 (n = 699). Participants (10.2% of sample) who consumed yogurt more frequently (≥ 5 serves per week) also consumed more fruit, vegetables, nuts, and fish, but fewer sweets, sugar-sweetened soft drinks, and alcohol. The yogurt-healthy food score was significantly inversely associated with fasting plasma glucose (p = 0.044), waist circumference (p = 0.004), and smoking (p = 0.004), and significantly positively associated with physical activity (p < 0.001). In addition, the yogurt-healthy food score was associated with protection against MetS abdominal obesity (OR: 0.80, 95% CI: 0.66-0.07, p = 0.02). The yogurt-healthy dietary pattern was significantly associated with a better cardiometabolic profile.

Consumption of dairy product and its association with total and cause specific mortality - A population-based cohort study and meta-analysis

BACKGROUND

The intake of dairy products has been thought to be associated with an increased risk of coronary heart diseases (CHD) and total mortality due to its relatively high content of saturated fat. However, reports on this association particularly among US adults are conflicting and controversial. Therefore, we used data from the 1999-2010 National Health and Nutrition Examination Surveys (NHANES) study to examine whether consumption of total dairy and dairy subgroups was associated with total and cause specific (CHD, cerebrovascular and cancer) mortality. Further we carried out a systematic review and meta-analysis of prospective studies to check for consistency with the NHANES findings.

METHODS

In the NHANES cohort vital status through December 31, 2011 was ascertained. Cox proportional hazard regression models were used to relate baseline dairy intake with all-cause and cause-specific mortality. For the systematic review PubMed, SCOPUS, Web of Science and Google Scholar databases were searched (up to December 2017). The DerSimonian-Laird method and generic inverse variance methods were used for quantitative data synthesis.

RESULTS

In the NHANES data set of 24,474 participants, 3520 deaths occurred during follow-up. In multivariate adjusted Cox models, total mortality risk was lower when comparing the top (Q4) with the lower (Q1) quartiles of total dairy (hazard ratio [HR] 0.98, 95% confidence interval [CI]: 0.95-0.99) and cheese (HR: 0.92, 95% CI: 0.87-0.97) consumption. Using a similar model, we have found a negative association between total dairy and milk consumption with risk of cerebrovascular mortality (HR: 0.96, 95% CI: 0.94-0.98, HR: 0.93, 95% CI: 0.91-0.96, respectively), while milk consumption was associated with increased CHD mortality (HR: 1.04, 95% CI: 1.02-1.06). The meta-analysis with 636,726 participants indicated a significant inverse association between fermented dairy products and total mortality (RR: 0.97, 95% CI: 0.96-0.99), while milk consumption was associated with higher CHD mortality (RR: 1.04, 95% CI: 1.01-1.05). These findings were robust in sensitivity analyses.

CONCLUSIONS

Among American adults, higher total dairy consumption was associated with lower total and cerebrovascular mortality, while higher milk consumption was associated with higher risk of CHD. These findings do not support dogmatic public health advice to reduce total dairy fat consumption, although the association between milk consumption and CHD mortality requires further study.

Lactose Intolerance, Dairy Avoidance, and Treatment Options

Lactose intolerance refers to symptoms related to the consumption of lactose-containing dairy foods, which are the most common source for this disaccharide. While four causes are described, the most common is the genetically-determined adult onset lactose maldigestion due to loss of intestinal lactase governed by control of the gene by a 14,000 kb promoter region on chromosome 2. Gastrointestinal symptoms from lactose have expanded to include systemic effects and have also been confounded by other food intolerances or functional gastrointestinal disorders. Partly because lactose maldigestion is often interpreted as lactose intolerance (symptoms), focus of therapy for these symptoms starts with lactose restriction. However, withholding of dairy foods completely is not appropriate due to a more favorable impact on health. Industrial efforts to substitute with plant-based products is not completely successful at this time. This narrative article reviews the complexities of the perception of lactose intolerance, its epidemiology, and pathogenesis. Treatments are discussed, including the inappropriateness of dairy avoidance. In conjunction, effects of dairy products on 19 common diseases are reviewed. Different methods of treatment, lactose-reduced products, plant-based dairy substitutes, adaptation, prebiotics, exogenous lactase, probiotics, and some other dietary interventions are further discussed.

Dairy Consumption and Cardiometabolic Diseases: Systematic Review and Updated Meta-Analyses of Prospective Cohort Studies

PURPOSE OF REVIEW

Dairy products contain both beneficial and harmful nutrients in relation to cardiometabolic diseases. Here, we provide the latest scientific evidence regarding the relationship between dairy products and cardiometabolic diseases by reviewing the literature and updating meta-analyses of observational studies.

RECENT FINDINGS

We updated our previous meta-analyses of cohort studies on type 2 diabetes, coronary heart disease (CHD), and stroke with nine studies and confirmed previous results. Total dairy and low-fat dairy (per 200 g/d) were inversely associated with a 3-4% lower risk of diabetes. Yogurt was non-linearly inversely associated with diabetes (RR = 0.86, 95% CI: 0.83-0.90 at 80 g/d). Total dairy and milk were not associated with CHD (RR~1.0). An increment of 200 g of daily milk intake was associated with an 8% lower risk of stroke. The latest scientific evidence confirmed neutral or beneficial associations between dairy products and risk of cardiometabolic diseases.

A Mediterranean diet supplemented with dairy foods improves markers of cardiovascular risk: results from the MedDairy randomized controlled trial

Background

The Mediterranean diet (MedDiet) offers benefits to cardiovascular health but may not meet Western recommendations for calcium and dairy intake, which could impede long-term adoption.

Objective

The current study aimed to determine the effect of a MedDiet supplemented with dairy foods on cardiovascular risk factors.

Design

A randomized, controlled, crossover design compared a MedDiet with 3-4 daily servings of dairy (MedDairy) and a low-fat (LF) control diet. Forty-one participants aged ≥45 y and at risk of cardiovascular disease (CVD) were randomly allocated to their first intervention, either the MedDairy or LF diet. Participants followed each intervention for 8 wk, and an 8-wk washout period separated interventions. The primary outcome was home-measured systolic blood pressure (SBP) assessed in the morning, afternoon, and evening. Secondary outcomes included clinic-measured blood pressure (morning), body composition, blood lipids, C-reactive protein (CRP), plasma glucose, serum insulin, and the Framingham Risk Score.

Results

Compared with the LF intervention, the MedDairy intervention resulted in a significantly lower morning SBP (mean difference: -1.6 mm Hg; 95% CI: -2.8, -0.4 mm Hg; P = 0.01), lower morning diastolic blood pressure (mean difference: -1.0; 95% CI: -1.7, -0.2 mm Hg; P = 0.01) and clinic SBP (mean difference: -3.5 mm Hg; 95% CI: -6.4, -0.7 mm Hg; P = 0.02), significantly higher HDL cholesterol (mean difference: 0.04 mmol/L; 95% CI: 0.01, 0.06 mmol/L; P < 0.01), lower triglycerides (mean difference: = -0.05 mmol/L; 95% CI: -0.08, -0.01 mmol/L; P < 0.01), and lower ratio of total to HDL cholesterol (mean difference: -0.4; 95% CI: -0.6, -0.2; P < 0.001). No effects were observed for other outcome measures.

Conclusions

Following a MedDiet with additional dairy foods led to significant changes in markers of cardiovascular risk over 8 wk. The MedDiet supplemented with dairy may be appropriate for an improvement in cardiovascular risk factors in a population at risk of CVD. This trial was registered at anzctr.org.au as ACTRN12616000309482.

Novel perspectives on fermented milks and cardiometabolic health with a focus on type 2 diabetes

This review will explore the observational and mechanistic evidence supporting the hypothesis that fermented milk consumption has beneficial effects on metabolism. Live cultures in fermented dairy are thought to contribute to gut microbial balance, which is likely an instrumental mechanism that protects the host against gut dysbiosis and systemic inflammation associated with cardiometabolic diseases. Lactic acid bacteria (LAB) release bioactive metabolites, such as exopolysaccharides and peptides, that have the potential to exert a wide range of metabolic and regulatory functions. In particular, peptides derived from fermented dairy products are likely to exert greater cardiometabolic and anti-inflammatory effects than nonfermented dairy. It is hypothesized that LAB-derived bioactive peptides have the potential to protect the host against cardiometabolic diseases through antimicrobial actions and to effect changes in gene expression of glucose regulatory and anti-inflammatory signaling pathways. The peptides released through fermentation may explain some of the health effects of fermented dairy products on cardiometabolic disease risk observed in epidemiological studies, particularly type 2 diabetes; however, mechanisms have yet to be explored in detail.

Estimating Lactase Nonpersistence Distributions in the Multi-Ethnic Canadian Demographic: A Population-Based Study

Objectives

The lactase persistence/nonpersistence (LP/LNP) phenotypes follow a geographic pattern that is rooted in the gene-culture coevolution observed throughout the history of human migrations. The immense size and relatively open immigration policy have drawn migrants of diverse ethnicities to Canada. Among the multicultural demographic, two-thirds of the population are derived from the British Isles and northwestern France. A recent assessment of worldwide lactase distributions found Canada to have an LNP rate of 59% (confidence interval [CI] 44%-74%). This estimate is rather high compared with earlier reports that listed Canada as a country with a 10% LNP rate; the authors had also noted that biases were likely because their calculations were based largely on Aboriginal studies. We hereby present an alternate LNP prevalence estimate at the national, provincial and territorial level.

Methods

We applied the referenced LNP frequency distribution data to the 2016 population census to account for the current multi-ethnic distributions in Canada. Prevalence rates for Canada, the provinces and territories were calculated.

Results

The national LNP rate is estimated at 44% (CI 41%-47%) after accounting for the 254 ethnic groups, with the lowest rates found in the eastern provinces and the highest rates in the Northwest Territories (57%) and Nunavut (66%), respectively.

Conclusion

Despite the heterogeneous nature of the referenced data and the inference measures taken, evidently, the validity of our LNP estimate is anchored on the inclusion of multi-ethnic groups representing the current Canadian demographic.

Influence of Mediterranean Diet on Blood Pressure

Hypertension is the main risk factor for cardiovascular disease (CVD) and all-cause mortality. Some studies have reported that food typical of the Mediterranean diet (MedDiet), such as whole grains, vegetables, fruits, nuts, and extra virgin olive oil, have a favorable effect on the risk of hypertension, whereas food not typical of this dietary pattern such as red meat, processed meat, and poultry has an unfavorable effect. In this review, we have summarized observational and intervention studies, meta-analyses, and systematic reviews that have evaluated the effects of the MedDiet as a pattern towards blood pressure (BP). However, the number of such studies is small. In general terms, the MedDiet has a favorable effect in reducing BP in hypertensive or healthy people but we do not have enough data to declare how strong this effect is. Many more studies are required to fully understand the BP changes induced by the MedDiet.

Both low- and regular-fat cheeses mediate improved insulin sensitivity and modulate serum phospholipid profiles in insulin-resistant rats

Dietary recommendations for cheese usually promote low (LOW)- over regular (REG)-fat versions due to the saturated fat. Conversely, epidemiological evidence shows that cheese consumption associates with reduced risk of type 2 diabetes. To investigate how cheese influences diabetes-related outcomes, a feeding trial comparing LOW and REG cheese was conducted in high-fat, lard-based diet (HFD)-fed insulin-resistant rats followed by evaluation of potential mechanisms. After 4 weeks of HFD, LOW or REG was added at 7 and 10 g/100 g diet, respectively, for another 8 weeks. Following either an oral glucose or insulin tolerance test to assess glucoregulation, rats were euthanized and serum was collected for metabolomic and lipid analyses. Hepatic tissue was used to measure glucoregulatory enzymes and lipid content. Both LOW and REG improved insulin sensitivity without effect on oral glucose tolerance, insulin secretion or body weight. Serum metabolomics identified 33 metabolites of interest, with 21 being phosphatidylcholines (PCs) or lysophosphatidylcholines (LPCs). HFD rats had significantly reduced LPC C16:1, C17:0, C18:1, C20:3 and C24:0, and these effects were normalized by LOW or REG cheese. Fourteen PC species were lowest in the HFD group and normalized by cheese feeding. Serum choline was elevated sevenfold in HFD- but not cheese-fed rats compared with rats fed low-fat diet. Liver triglyceride was elevated by LOW feeding. In conclusion, inclusion of both LOW and REG cheeses in the diet of insulin-resistant rats improves in vivo glucoregulation. This is associated with altered phospholipid metabolism, including cheese-mediated normalization of species that are decreased by high-fat feeding.

Trans-repression of NFκB pathway mediated by PPARγ improves vascular endothelium insulin resistance

Previous study has shown that thiazolidinediones (TZDs) improved endothelium insulin resistance (IR) induced by high glucose concentration (HG)/hyperglycaemia through a PPARγ‐dependent‐NFκB trans‐repression mechanism. However, it is unclear, whether changes in PPARγ expression affect the endothelium IR and what the underlying mechanism is. In the present study, we aimed to address this issue. HG‐treated human umbilical vascular endothelial cells (HUVEC) were transfected by either PPARγ‐overexpressing (Ad‐PPARγ) or PPARγ‐shRNA‐containing (Ad‐PPARγ‐shRNA) adenoviral vectors. Likewise, the rats fed by high‐fat diet (HFD) were infected by intravenous administration of Ad‐PPARγ or Ad‐PPARγ‐shRNA. The levels of nitric oxide (NO), endothelin‐1 (ET‐1) and cytokines (TNFα, IL‐6, sICAM‐1 and sVCAM‐1) and the expression levels of PPARγ, eNOS, AKT, p‐AKT, IKKα/β and p‐IKKα/β and IκBα were examined; and the interaction between PPARγ and NFκB‐P65 as well as vascular function were evaluated. Our present results showed that overexpression of PPARγ notably increased the levels of NO, eNOS, p‐AKT and IκBα as well as the interaction of PPARγ and NFκB‐P65, and decreased the levels of ET‐1, p‐IKKα/β, TNFα, IL‐6, sICAM‐1 and sVCAM‐1. In contrast, down‐expression of PPARγ displayed the opposite effects. The results demonstrate that the overexpression of PPARγ improves while the down‐expression worsens the endothelium IR via a PPARγ‐mediated NFκB trans‐repression dependent manner. The findings suggest PPARγ is a potential therapeutic target for diabetic vascular complications.

Lowering Saturated Fat and Increasing Vegetable and Fruit Intake May Increase Insulin Sensitivity 2 Years Later in Children with a Family History of Obesity

Background

Identifying dietary factors that determine insulin sensitivity and secretion in children entering puberty may provide valuable information for the early prevention of type 2 diabetes.

Objectives

We assessed whether macronutrients and food groups are longitudinally associated with insulin sensitivity and secretion over a 2-y period in children with a family history of obesity, and whether associations differ by level of adiposity.

Methods

Data were derived from the Quebec Adipose and Lifestyle Investigation in Youth (QUALITY) Study, an ongoing prospective cohort including 630 children recruited at ages 8-10 y, with ≥1 obese parent, and followed 2 y later (n = 564). The intake of macronutrients and foods was assessed at baseline using three 24-h dietary recalls. At age 10-12 y, insulin sensitivity was assessed by the Matsuda Insulin Sensitivity Index (ISI) and the homeostatic model assessment of insulin resistance. Insulin secretion was assessed by the ratio of the area under the curve of insulin to the area under the curve of glucose at 30 min and at 120 min of an oral-glucose-tolerance test. Multivariable linear regression models were fitted for each dietary factor while adjusting for age, sex, puberty, physical activity, screen time, total energy intake, and percentage of body fat; and interaction terms between dietary factors and percentage of body fat were tested.

Results

Saturated fat intake was associated with a 1.95% lower (95% CI: -3.74%, -0.16%) Matsuda ISI, whereas vegetable and fruit intake was associated with a 2.35% higher (95% CI: 0.18%, 4.52%) Matsuda ISI 2 y later. The association of saturated fat intake with insulin sensitivity was most deleterious among children with a higher percentage of body fat (P-interaction = 0.023). Other than fiber intake, no longitudinal associations between dietary intake and insulin secretion were found.

Conclusions

Lowering saturated fat and increasing vegetable and fruit intakes during childhood may improve insulin sensitivity as children enter puberty. This study was registered at www.clinicaltrials.gov as NCT03356262.

Intake of fermented and non-fermented dairy products and risk of incident CHD: the Kuopio Ischaemic Heart Disease Risk Factor Study

Recent dairy product studies have suggested that fermented rather than non-fermented dairy products might provide benefits on cardiovascular health, but the evidence is inconclusive. Therefore, we investigated whether fermented and non-fermented dairy products have distinct associations with the risk of incident CHD in a population with high dairy product intake. The present study included a total of 1981 men, aged 42-60 years, from the Kuopio Ischaemic Heart Disease Risk Factor Study, with no CHD at baseline. Dietary intakes were assessed with instructed 4-d food records. We used Cox's proportional hazards regression model to estimate the associations with the risk of CHD. Fatal and non-fatal CHD events were ascertained from national registries. During a mean follow-up of 20·1 years, 472 CHD events were recorded. Median intakes were 105 g/d for fermented (87 % low-fat products) and 466 g/d for non-fermented dairy products (60 % low-fat products). After adjusting for potential confounders, those in the highest (v. lowest) intake quartile of fermented dairy products had 27 % (95 % CI 5, 44; P-trend=0·02) lower risk of CHD. In contrast, those in the highest intake quartile of non-fermented dairy products had 52 % (95 % CI 13, 104; P-trend=0·003) higher risk of CHD. When analysed based on fat content, low-fat (<3·5 % fat) fermented dairy product intake was associated with lower risk (hazard ratio in the highest quartile=0·74; 95 % CI 0·57, 0·97; P-trend=0·03), but high-fat fermented dairy and low-fat or high-fat non-fermented dairy products had no association. These results suggest that fermented and non-fermented dairy products can have opposite associations with the risk of CHD.

Dairy milk, regardless of fat content, protects against postprandial hyperglycemia-mediated impairments in vascular endothelial function in adults with prediabetes by limiting oxidative stress responses that reduce nitric oxide bioavailability

Postprandial hyperglycemia (PPH) transiently impairs vascular endothelial function (VEF) in an oxidative-stress-dependent manner by decreasing nitric oxide (NO^•) bioavailability. Dairy milk, regardless of fat content, attenuates PPH, but whether this improves VEF by limiting oxidative stress responses that otherwise decrease NO^• bioavailability is not known. We hypothesized that nonfat and full-fat dairy milk would similarly improve VEF by attenuating PPH-induced oxidative stress that otherwise decreases NO^• biosynthesis and bioavailability. A randomized, crossover trial was conducted in adults with prediabetes (n=22) who ingested glucose (75 g) dissolved in 473 ml of water (GLU), or glucose with an equal volume of nonfat dairy milk (NFM) or full-fat dairy milk (FFM). Prior to and at 30-min intervals for 180 min postprandially, we assessed brachial artery flow-mediated dilation (FMD) and measured circulating biomarkers of glycemic control, oxidative stress and NO^• homeostasis. AUC_{0-180 min} for FMD and NO^• metabolites was lowest in GLU but relatively greater in NFM and FFM. Compared with GLU, AUCs for glucose, malondialdehyde, F₂-isoprostanes and endothelin-1 were similarly lower in dairy trials. Milk-mediated vasoprotection was accompanied by greater levels of plasma arginine and lower levels of asymmetric dimethylarginine and symmetric dimethylarginine. Postprandial insulin, lipids and tetrahydrobiopterin redox status did not differ among trials. Thus, dairy milk, regardless of its fat content, attenuates PPH-mediated impairments in VEF by limiting oxidative stress. This improves NO^• bioavailability to the vascular endothelium by increasing arginine availability and limiting competitive inhibition on NO^• biosynthesis by asymmetric dimethylarginine.

Metabolic effects in mice of cream formulation: Addition of both thickener and emulsifier does not alter lipid metabolism but modulates mucus cells and intestinal endoplasmic reticulum stress

Additives stabilize or improve the organoleptic or functional properties (or both) of many dairy products including whipping cream. Their influence on the metabolic effect of dairy cream is scarcely known. We tested the hypothesis that added emulsifier (lactic acid esters of mono- and diglycerides; MAG/DAG), thickener (carrageenan, CGN), or both, could modify the metabolic effect, notably in the intestine and liver. Nine-week-old male C57Bl/6J mice were fed UHT cream (indirect treatment) mixed with nonlipidic powder (final: 13% milkfat) for 1 or 4 wk. We compared creams (1) without additive (Ctl), (2) with thickener (Th), 0.02% of κ-CGN, and (3) with both thickener and emulsifier, 0.1% of MAG/DAG esters (Th/Em). We analyzed plasma parameters, intestine, and liver. Fasting glycemia, insulinemia, triglyceridemia, nonesterified fatty acids, body weight gain, and liver weight did not differ among groups. After 1 wk, Th/Em had higher expression in the duodenum of some of the genes involved in (1) intestinal lipid absorption and (2) tight junction proteins versus Ctl and Th. After 4 wk, mucus cell number in the small intestine was higher in Th/Em versus Ctl and Th. Genes involved in endoplasmic reticulum (ER) stress in the duodenum were more expressed in Th/Em after 1 wk. After 4 wk, in the colon, a higher expression of ER stress genes was observed for Th versus Th/Em and Ctl. Liver damage score was not altered by additives. Adding both CGN (0.02%) and MAG/DAG esters (0.1%) in dairy cream did not result in deleterious outcomes in mice after 4 wk regarding lipid metabolism, intestinal permeability, and liver disorders. The longer term effect of intestinal ER stress modulation deserves further investigation.

Fermented dairy products, diet quality, and cardio-metabolic profile of a Mediterranean cohort at high cardiovascular risk

BACKGROUND AND AIMS

Fermented dairy products have been associated with a better diet quality and cardio-metabolic profile. However, in Mediterranean populations, these associations have not been well characterized. The aim of this study was to assess the diet quality and the associations between the consumption of total fermented dairy products and their subtypes and the prevalence of Metabolic Syndrome (MetS) components in a Mediterranean population at high cardiovascular risk.

METHODS AND RESULTS

Baseline cross-sectional analyses were conducted on 6,572 men and women (mean age: 65 years) with overweight or obesity and MetS recruited into the PREDIMED-Plus cohort. A 143-item Food Frequency Questionnaire (FFQ) was used, and anthropometrical, biochemical, and blood pressure measurements were recorded. Multivariate-adjusted Cox regressions were fitted to analyze the association between quartiles of consumption of fermented dairy products and their subtypes and MetS components to estimate the relative risk (RR) and 95% confidence intervals (95% CIs). Participants who were high consumers of fermented dairy products reported a higher consumption of fruit, vegetables, fish, nuts, and whole bread and a lower consumption of white bread, alcohol, and cookies. Participants in the higher quartile showed a lower prevalence of the low HDL-cholesterol component of the MetS (RR=0.88; 95% CI: 0.78-0.98) than those in the lowest quartile of cheese consumption. Cheese consumption was inversely associated with the prevalence of hypertriglyceridemia. Total fermented dairy products, yogurt, and its types were not associated with any of the MetS components.

CONCLUSIONS

Compared to nonconsumers, participants consuming fermented dairy products reported a better diet quality and, particularly, cheese consumers presented a lower prevalence of hypertriglyceridemia and low HDL-cholesterol plasma levels, which are MetS components.

Document of recommendations of the SEA 2018. Lifestyle in cardiovascular prevention

Lifestyle is a complex concept that includes aspects external to ourselves that can modulate and influence our health. The knowledge of the relationship between lifestyle and cardiovascular risk does not attain the level of evidence achieved with clinical trials with drugs, because clinical studies are scarce and mainly of observational nature, albeit based on large cohorts. Nutritional epidemiology has the added difficulty of being based mostly on subjective dietary recall methods to ascertain nutrient and food intake over time, with the additional problems of incomplete data collection, variable measurements of adherence due to seasonal and geographical differences in food composition, and the changing eating behavior that human beings have over time. The purpose of this document is to carry out an updated and hierarchical review of the relationship between lifestyle and cardiovascular disease based on current evidence, paying attention to three aspects that are of great pathogenic importance and are directly modifiable: physical activity, tobacco consumption, and diet. With this, we intend to update the knowledge on this relationship, construct evidence-based recommendations, and provide a simple tool for clinical practice especially directed to health professionals involved in the care of people at cardiovascular risk, defining simple and easy strategies for individuals who receive advice for the primary and secondary prevention of cardiovascular diseases.

Cardiovascular Disease Prevention by Diet Modification: JACC Health Promotion Series

Reduction in excess calories and improvement in dietary composition may prevent many primary and secondary cardiovascular events. Current guidelines recommend diets high in fruits, vegetables, whole grains, nuts, and legumes; moderate in low-fat dairy and seafood; and low in processed meats, sugar-sweetened beverages, refined grains, and sodium. Supplementation can be useful for some people but cannot replace a good diet. Factors that influence individuals to consume a low-quality diet are myriad and include lack of knowledge, lack of availability, high cost, time scarcity, social and cultural norms, marketing of poor-quality foods, and palatability. Governments should focus on cardiovascular disease as a global threat and enact policies that will reach all levels of society and create a food environment wherein healthy foods are accessible, affordable, and desirable. Health professionals should be proficient in basic nutritional knowledge to promote a sustainable pattern of healthful eating for cardiovascular disease prevention for both healthy individuals and those at higher risk.

Modeling the Impact of Adding a Serving of Dairy Foods to the Healthy Mediterranean-Style Eating Pattern Recommended by the 2015-2020 Dietary Guidelines for Americans

OBJECTIVE

The Healthy Mediterranean-Style Eating Pattern (HMEP) in the 2015 Dietary Guidelines for Americans (DGA) recommends that adults eating less than 2400 kcal a day consume only two daily servings (or cup-equivalents) of low-fat or fat-free dairy foods like milk, cheese, and yogurt, which does not provide enough calcium, potassium, and vitamin D to meet dietary reference intakes (DRIs). Our objective was to assess the impact of additional servings of dairy foods on the nutrient adequacy of the 1600, 2000, and 2400 kcal HMEP in the 2015 DGA.

METHODS

Using the same food pattern modeling procedures as the 2015 DGA, we assessed the nutrient composition of three alternative models of the 1600, 2000, and 2400 kcal HMEP. For Model 1, we increased servings of dairy foods (77 kcal/serving). For Model 2, we added one serving of dairy foods and removed one serving of refined grains (85 kcal/serving), and for Model 3 (2400 kcal HMEP only), we added one-half serving of dairy foods and removed one-half serving of refined grains. We then assessed these models for nutrient adequacy and compared them to the Healthy U.S.-Style Eating Pattern and the HMEP.

RESULTS

The changes to the HMEP with these models increased the amounts of several nutrients to encourage, including calcium, vitamin D, potassium, vitamin A, phosphorus, riboflavin, vitamin B12, zinc, and magnesium. For instance, Model 1 increased the calcium (by 295 mg), vitamin D (by 59.3 IU), potassium (by 235 mg), vitamin A (by 98 mcg), and phosphorus (by 232 mg) content of the original HMEP, and Model 3 increased the amounts of these nutrients by half of those amounts. Model 2 increased the calcium content by 266 mg, vitamin D by 58 IU, potassium by 202 mg, vitamin A by 88 mcg, and phosphorus by 193 mg. Notably, Models 1 and 2 increased the vitamin D content of the HMEP to about 62% of the DRI (average across all calorie levels) and the potassium content to 78% of the DRI (average across all calorie levels), from 52% and 73%, respectively, in the original HMEP. Most of our models increased the saturated fat (0.5 g in Model 1 and 0.2 g in Model 2) and sodium (202 mg in Model 1 and 101 mg in Model 2) content as well. The amounts of these nutrients to limit remained within the ranges recommended in the 2015 DGA.

CONCLUSIONS

The addition of a dairy food serving to the 1600, 2000, and 2400 kcal HMEP brings their nutrient profiles closer to the DRIs for several nutrients to encourage, including calcium, vitamin D, and potassium.

A priori dietary patterns and blood pressure in the EPIC Florence cohort: a cross-sectional study

PURPOSE

Several foods and nutrients have been independently associated with systolic (SBP) and diastolic (DBP) blood pressure values. This study aimed to evaluate the effects of combined dietary habits on SBP and DBP values in a large cohort of healthy adults, with a cross-sectional design. Adherence of participants to four a priori dietary patterns was considered: the Healthy Eating Index 2010 (HEI-2010); the Dietary Approaches to Stop Hypertension (DASH); the Greek Mediterranean Diet Score (MDS); and the Italian Mediterranean Index (IMI).

METHODS

Overall, 13,597 volunteers (35-64 years) were enrolled in 1993-1998 in the EPIC-Florence cohort. Information on dietary habits, anthropometry, smoking status, education, physical activity habits, previous diagnosis of hypertension and SBP and DBP measurements were collected at baseline. Multivariate regression models were performed on 10,163 individuals (7551 women) after excluding subjects with prevalent hypertension.

RESULTS

IMI, DASH and HEI-2010 were significantly and inversely associated with SBP and DBP values in the total population. The strongest association emerged between IMI and SBP (β - 1.80 excellent adherence vs low adherence, 95% CI - 2.99; - 0.61, p trend 0.001) and DBP (β - 1.12, 95% CI - 1.869; - 0.39, p trend 0.001) values. In sub-group analyses, an inverse association also emerged between IMI and SBP and DBP values among females and between DASH and DBP among males. MDS was not associated with SBP or DBP.

CONCLUSION

Overall, this study, carried out in a large cohort of healthy adults from Tuscany (Central Italy), showed inverse significant associations between specific a priori dietary patterns, identifying general models of health-conscious diet, and blood pressure values.

Adherence to the traditional Mediterranean diet in a population of South of Italy: factors involved and proposal of an educational field-based survey tool

We developed and validated a tool assessing the adherence to the Mediterranean diet based on current nutritional recommendations for health promotion (MEDI-Quest). Four-hundred-and-eleven clinically healthy subjects completed both the MEDI-Quest-score and the validated MedDietScore (MDS). A good accordance between MEDI-Quest and MDS was observed (R = 0.638), as well as for the percentage of individuals having similar scores with both methods for each food group. Regarding socio-cultural-factors, higher adherence was observed in people with older-age (OR = 1.030, p < .0001), more qualifier-employment (OR = 1.136, p < .005), higher-income (OR = 1.925, p < .0001), interest in reading-food-labels (OR = 2.057, p < .0001), and having frequent physical activity (OR = 1.608, p < .05). In conclusion, our findings show that (1) the MEDI-Quest score well correlate with MDS, and (2) the adherence to the Mediterranean diet is not particularly high due to less cultural roots. It could be necessary to improve people's knowledge about food and nutrition, taking into consideration believes embedded in their family, tradition and religion.

The combination of single nucleotide polymorphisms rs6720173 (ABCG5), rs3808607 (CYP7A1), and rs760241 (DHCR7) is associated with differing serum cholesterol responses to dairy consumption

Existing evidence on the influence of genetic architecture on serum cholesterol responsiveness to dietary interventions focuses on individual single nucleotide polymorphisms and single nutrients. We associated the combination of ABCG5 rs6720173-C, CYP7A1 rs3808607-TT, and DHCR7 rs760241-GG genotypes with lower low-density lipoprotein cholesterol concentrations relative to the combination of rs6720173-GG, rs3808607-G, and rs760241-A genotypes (-0.37 ± 0.12 (n = 9) vs. +0.38 ± 0.14 mmol/L (n = 7), p = 0.0016) following a blended dairy (3 servings/day for 4 weeks) intervention.

Ruminant meat and milk contain δ-valerobetaine, another precursor of trimethylamine N-oxide (TMAO) like γ-butyrobetaine

Quaternary ammonium compounds containing N-trimethylamino moiety, such as choline derivatives and carnitine, abundant in meat and dairy products, are metabolic precursors of trimethylamine (TMA). A similar fate is reported for N^ε-trimethyllysine and γ-butyrobetaine. With the aim at investigating the metabolic profile of such metabolites in most employed animal dietary sources, HPLC-ESI-MS/MS analyses on ruminant and non-ruminant milk and meat were performed. Results demonstrate, for the first time, the presence of δ-valerobetaine, occurring at levels higher than γ-butyrobetaine in all ruminant samples compared to non-ruminants. Demonstration of δ-valerobetaine metabolic origin, surprisingly, showed that it originates from rumen through the transformation of dietary N^ε-trimethyllysine. These results highlight our previous findings showing the ubiquity of free N^ε-trimethyllysine in vegetable kingdom. Furthermore, δ-valerobetaine, similarly to γ-butyrobetaine, can be degraded by host gut microbiota producing TMA, precursor of the proatherogenic trimethylamine N-oxide (TMAO), unveiling its possible role in the biosynthetic route of TMAO.

Fermented Food and Non-Communicable Chronic Diseases: A Review

Fermented foods represent a significant fraction of human diets. Although their impact on health is positively perceived, an objective evaluation is still missing. We have, therefore, reviewed meta-analyses of randomized controlled trials (RCT) investigating the relationship between fermented foods and non-transmissible chronic diseases. Overall, after summarizing 25 prospective studies on dairy products, the association of fermented dairy with cancer was found to be neutral, whereas it was weakly beneficial, though inconsistent, for specific aspects of cardio-metabolic health, in particular stroke and cheese intake. The strongest evidence for a beneficial effect was for yoghurt on risk factors of type 2 diabetes. Although mechanisms explaining this association have not been validated, an increased bioavailability of insulinotropic amino acids and peptides as well as the bacterial biosynthesis of vitamins, in particular vitamin K2, might contribute to this beneficial effect. However, the heterogeneity in the design of the studies and the investigated foods impedes a definitive assessment of these associations. The literature on fermented plants is characterized by a wealth of in vitro data, whose positive results are not corroborated in humans due to the absence of RCTs. Finally, none of the RCTs were specifically designed to address the impact of food fermentation on health. This question should be addressed in future human studies.

Saturated Fats from Butter but Not from Cheese Increase HDL-Mediated Cholesterol Efflux Capacity from J774 Macrophages in Men and Women with Abdominal Obesity

Background

Recent evidence suggests that the association between dietary saturated fatty acids (SFAs) and coronary artery disease risk varies according to food sources. How SFAs from butter and cheese influence HDL-mediated cholesterol efflux capacity (CEC), a key process in reverse cholesterol transport, is currently unknown.

Objective

In a predefined secondary analysis of a previously published trial, we have examined how diets rich in SFAs from either cheese or butter influence HDL-mediated CEC, compared with diets rich in either monounsaturated fatty acids (MUFAs) or polyunsaturated fatty acids (PUFAs).

Methods

In a randomized crossover controlled consumption trial, 46 men and women with abdominal obesity consumed 5 isocaloric diets, each for 4 wk. Two diets were rich in SFAs either from cheese (CHEESE) or butter (BUTTER) [12.4-12.6% of energy (%E) as SFAs, 32%E as fat, 52%E as carbohydrates]. In 2 other diets, SFAs (5.8%E) were replaced with either MUFAs from refined olive oil (MUFA) or PUFAs from corn oil (PUFA). Finally, a lower fat and carbohydrate diet was used as a control (5.8%E as SFAs, 25.0%E as fat, 59%E as carbohydrates; CHO). Post-diet HDL-mediated CEC was determined ex vivo using radiolabelled J774 macrophages incubated with apolipoprotein B-depleted serum from the participants.

Results

Mean (±SD) age was 41.4 ± 14.2 y, and waist circumference was 107.6 ± 11.5 cm in men and 94.3 ± 12.4 cm in women. BUTTER and MUFA increased HDL-mediated CEC compared with CHEESE (+4.3%, P = 0.026 and +4.7%, P = 0.031, respectively). Exploring the significant diet × sex interaction (P = 0.044) revealed that the increase in HDL-mediated CEC after BUTTER compared with CHEESE was significant among men (+6.0%, P = 0.047) but not women (+2.9%, P = 0.19), whereas the increase after MUFA compared with CHEESE was significant among women (+9.1%, P = 0.008) but not men (-0.6%, P = 0.99).

Conclusion

These results provide evidence of a food matrix effect modulating the impact of dairy SFAs on HDL-mediated CEC with potential sex-related differences that deserve further investigation. This trial was registered at clinicaltrials.gov as NCT02106208.

Dairy Fats and Cardiovascular Disease: Do We Really Need to be Concerned?

Cardiovascular diseases (CVD) remain a major cause of death and morbidity globally and diet plays a crucial role in the disease prevention and pathology. The negative perception of dairy fats stems from the effort to reduce dietary saturated fatty acid (SFA) intake due to their association with increased cholesterol levels upon consumption and the increased risk of CVD development. Institutions that set dietary guidelines have approached dairy products with negative bias and used poor scientific data in the past. As a result, the consumption of dairy products was considered detrimental to our cardiovascular health. In western societies, dietary trends indicate that generally there is a reduction of full-fat dairy product consumption and increased low-fat dairy consumption. However, recent research and meta-analyses have demonstrated the benefits of full-fat dairy consumption, based on higher bioavailability of high-value nutrients and anti-inflammatory properties. In this review, the relationship between dairy consumption, cardiometabolic risk factors and the incidence of cardiovascular diseases are discussed. Functional dairy foods and the health implications of dairy alternatives are also considered. In general, evidence suggests that milk has a neutral effect on cardiovascular outcomes but fermented dairy products, such as yoghurt, kefir and cheese may have a positive or neutral effect. Particular focus is placed on the effects of the lipid content on cardiovascular health.

Optimise the microbial flora with milk and yoghurt to prevent disease

Pathogenic bacteria, which are temporary or permanent members of our microbial flora, cause or contribute to a wide range of human disease at all ages. Conditions include Alzheimer's disease, atherosclerosis, diabetes mellitus, obesity, cancer, autoimmunity and psychosis, amongst others. The mechanism of damage is inflammation which can be chronic or acute. An optimal microbial flora includes a wide range of pathogenic bacteria in low dose. This allows specific immunity to be developed and maintained with minimal inflammatory damage. Human milk has evolved to deliver an optimal microbial flora to the infant. Cow's milk has the potential, following appropriate fortification, to maintain an optimal human microbial flora throughout life. Yoghurt is a fermented milk product in which bacteria normally present in milk convert sugars to lactic acid. The acid suppresses the growth of pathogens in the oral cavity, oropharynx and oesophagus. Thus yoghurt can restore an optimal flora in these regions in the short term. Since bacteria are transported between epithelial surfaces, yoghurt will also optimise the flora elsewhere. The judicious use of milk and yogurt could prevent a high proportion of human disease.

Dairy-Related Dietary Patterns, Dietary Calcium, Body Weight and Composition: A Study of Obesity in Polish Mothers and Daughters, the MODAF Project

The role of the family environment in regards to dairy products and dietary calcium in the context of obesity is not fully understood. The aim of the study was to investigate the association among dairy-related dietary patterns (DDPs), dietary calcium, body weight and composition in mothers and daughters. Data were collected through a cross-sectional survey within the MODAF Project. A total sample of 712 pairs of mothers (<60 years) and daughters (12-21 years) was studied. This study included 691 pairs. A semi-quantitative food frequency questionnaire (ADOS-Ca) was used to collect dietary data. Waist circumference (WC), body fat, waist-to-height ratio (WHtR) and body mass index (BMI) were determined. Previously derived DDPs were used-three in mothers and three in daughters. In mothers, two of the DDPs were characterized by higher consumption of various dairy products with suboptimal calcium content (means: 703 or 796 mg/day) which decreased the chance of: z-WC > 1 standard deviation (SD), WC > 80 cm, body fat > 32%, WHtR > 0.5, BMI = 25-29.9 kg/m² or BMI ≥ 30 kg/m² by 44-67% when compared to low-dairy low-calcium DDP (288 mg/day). In mothers per 100 mg/day of dietary calcium, the chance of z-WC > 1SD, WC > 80 cm, z-WHtR > 1SD, WHtR > 0.5 cm, BMI = 25 to 29.9 kg/m² or BMI ≥ 30 kg/m² decreased by 5-9%. In correspondence analysis, a clear association was found between mothers' and daughters' low-dairy low-calcium DDPs and upper categories of z-WC (>1 SDs). This study reinforces evidence of the similarity between mothers and daughters in dairy-related dietary patterns and provides a new insight on the adverse relation between low-dairy low-calcium dietary patterns and obesity. It was found that diets containing various dairy products with suboptimal dietary calcium content may be recommended in obesity prevention.

Effect of whole milk compared with skimmed milk on fasting blood lipids in healthy adults: a 3-week randomized crossover study

BACKGROUND/OBJECTIVES

Dietary guidelines have for decades recommended choosing low-fat dairy products due to the high content of saturated fat in dairy known to increase blood concentration of LDL cholesterol. However, meta-analyses including observational studies show no association between overall dairy intake and risk of cardiovascular disease and even point to an inverse association with type 2 diabetes. The objective was to compare the effects of whole milk (3.5% fat) with skimmed milk (0.1% fat) on fasting serum blood lipids, insulin, and plasma glucose in healthy subjects.

SUBJECT/METHODS

A randomized, controlled 2 × 3-week crossover dietary intervention in 18 healthy adults randomly assigned to a sequence of treatments consisting of 0.5 L/d of whole milk and skimmed milk as part of their habitual diet. A total of 17 subjects completed the intervention.

RESULTS

Whole milk increased HDL cholesterol concentrations significantly compared to skimmed milk (P < 0.05). There were no significant differences between whole milk and skimmed milk in effects on total and LDL cholesterol, triacylglycerol, insulin, and glucose concentrations.

CONCLUSIONS

Intake of 0.5 L/d of whole milk did not adversely affect fasting blood lipids, glucose, or insulin compared to skimmed milk. Moreover, intake of whole milk increased HDL cholesterol concentration compared to skimmed milk. These findings suggest that if the higher energy content is taken into account, whole milk might be considered a part of a healthy diet among the normocholesterolemic population.

Differential impact of the cheese matrix on the postprandial lipid response: a randomized, crossover, controlled trial

Background: In a simulated gastrointestinal environment, the cheese matrix modulates dairy fat digestion. However, to our knowledge, the impact of the cheese matrix on postprandial lipemia in humans has not yet been evaluated.Objective: In healthy subjects, we compared the impact of dairy fat provided from firm cheese, soft cream cheese, and butter on the postprandial response at 4 h and on the incremental area under the curve (iAUC) of plasma triglycerides.Design: Forty-three healthy subjects were recruited to this randomized, crossover, controlled trial. In random order at intervals of 14 d and after a 12-h fast, subjects ingested 33 g fat from a firm cheese (young cheddar), a soft cream cheese (cream cheese), or butter (control) incorporated into standardized meals that were matched for macronutrient content. Plasma concentrations of triglycerides were measured immediately before the meal and 2, 4, 6, and 8 h after the meal.Results: Cheddar cheese, cream cheese, and butter induced similar increases in triglyceride concentrations at 4 h (change from baseline: +59%, +59%, and +62%, respectively; P = 0.9). No difference in the triglyceride iAUC_{0-8 h} (P-meal = 0.9) was observed between the 3 meals. However, at 2 h, the triglyceride response caused by the cream cheese (change from baseline: +44%) was significantly greater than that induced by butter (change from baseline: +24%; P = 0.002) and cheddar cheese (change from baseline: +16%; P = 0.0004). At 6 h, the triglyceride response induced by cream cheese was significantly attenuated compared with that induced by cheddar cheese (change from baseline: +14% compared with +42%; P = 0.0004).Conclusion: This study demonstrates that the cheese matrix modulates the impact of dairy fat on postprandial lipemia in healthy subjects. This trial was registered at clinicaltrials.gov as NCT02623790.

Yogurt and Cardiometabolic Diseases: A Critical Review of Potential Mechanisms

Associations between yogurt intake and risk of diet-related cardiometabolic diseases (CMDs) have been the subject of recent research in epidemiologic nutrition. A healthy dietary pattern has been identified as a pillar for the prevention of weight gain and CMDs. Epidemiologic studies suggest that yogurt consumption is linked to healthy dietary patterns, lifestyles, and reduced risk of CMDs, particularly type 2 diabetes. However, to our knowledge, few to no randomized controlled trials have investigated yogurt intake in relation to cardiometabolic clinical outcomes. Furthermore, there has been little attempt to clarify the mechanisms that underlie the potential beneficial effects of yogurt consumption on CMDs. Yogurt is a nutrient-dense dairy food and has been suggested to reduce weight gain and prevent CMDs by contributing to intakes of protein, calcium, bioactive lipids, and several other micronutrients. In addition, fermentation with bacterial strains generates bioactive peptides, resulting in a potentially greater beneficial effect of yogurt on metabolic health than nonfermented dairy products such as milk. To date, there is little concrete evidence that the mechanisms proposed in observational studies to explain positive results of yogurt on CMDs or parameters are valid. Many proposed mechanisms are based on assumptions that commercial yogurts contain strain-specific probiotics, that viable yogurt cultures are present in adequate quantities, and that yogurt provides a minimum threshold dose of nutrients or bioactive components capable of exerting a physiologic effect. Therefore, the primary objective of this review is to investigate the plausibility of potential mechanisms commonly cited in the literature in order to shed light on the inverse associations reported between yogurt intake and various cardiometabolic health parameters that are related to its nutrient profile, bacterial constituents, and food matrix. This article reviews current gaps and challenges in identifying such mechanisms and provides a perspective on the research agenda to validate the proposed role of yogurt in protecting against CMDs.

Dairy consumption and inflammatory profile: A cross-sectional population-based study, São Paulo, Brazil

OBJECTIVES

The aim of this study was to investigate the association between dairy product consumption and plasma inflammatory biomarkers levels among a representative sample of Brazilian adults from São Paulo City.

METHODS

Data were acquired from the Health Survey for São Paulo, a cross-sectional population-based study. All individuals 20 to 59 y of age with complete food consumption information (24-h dietary recall and food frequency questionnaire) and blood sample analysis were included (N = 259). The sample was separated into two groups according to systemic inflammatory pattern considering plasma levels of C-reactive protein; tumor necrosis factor-α; soluble intracellular adhesion molecule; soluble vascular cell adhesion molecule, monocyte chemoattractant protein; interleukin-1β, -6, -8, -10, and -12; adiponectin; leptin; and homocysteine. Multiple logistic regression tests were conducted to estimate the odds ratio for the inflammatory cluster across tertiles of dairy consumption.

RESULTS

When adjusted by age, smoking status, and energy intake the odds ratio for the inflammatory cluster group in the highest tertile of yogurt consumption was 0.34 (95% confidence interval [CI], 0.14-0.81) relative to the reference tertile, demonstrating also a linear effect (P_trend = 0.015). Cheese consumption exhibited an odds ratio of 2.49 (95% CI, 1.09-5.75) relative to the reference.

CONCLUSIONS

Increasing yogurt consumption might have a protective effect on inflammation, whereas cheese consumption appears to be associated with a proinflammatory status. The results of the present study aggregate a new perspective on existing evidence demonstrating the importance of assessing the contribution of dairy products on diet and their effect on the development of non-communicable diseases and associated risk factors.

Gene-Dairy Food Interactions and Health Outcomes: A Review of Nutrigenetic Studies

Each person differs from the next by an average of over 3 million genetic variations in their DNA. This genetic diversity is responsible for many of the interindividual differences in food preferences, nutritional needs, and dietary responses between humans. The field of nutrigenetics aims to utilize this type of genetic information in order to personalize diets for optimal health. One of the most well-studied genetic variants affecting human dietary patterns and health is the lactase persistence mutation, which enables an individual to digest milk sugar into adulthood. Lactase persistence is one of the most influential Mendelian factors affecting human dietary patterns to occur since the beginning of the Neolithic Revolution. However, the lactase persistence mutation is only one of many mutations that can influence the relationship between dairy intake and disease risk. The purpose of this review is to summarize the available nutrigenetic literature investigating the relationships between genetics, dairy intake, and health outcomes. Nonetheless, the understanding of an individual’s nutrigenetic responses is just one component of personalized nutrition. In addition to nutrigenetic responses, future studies should also take into account nutrigenomic responses (epigenomic, transcriptomic, proteomic, metabolomic), and phenotypic/characteristic traits (age, gender, activity level, disease status, etc.), as these factors all interact with diet to influence health.

Resveratrol prevents the combined maternal plus postweaning high-fat-diets-induced hypertension in male offspring

Maternal high-fat (HF) diet is believed to induce oxidative stress and activate nutrient-sensing signals, which increase the risk of adult offspring to develop hypertension. We investigated whether resveratrol prevents the combined maternal plus postweaning HF-diets-induced hypertension in adult male offspring, with a focus on the kidney. Female Sprague-Dawley rats received either a normal diet (ND) or HF diet (D12331, Research Diets) for 5 weeks before mating and during gestation and lactation. The male offspring were placed on either the ND or HF diet from weaning to 4 months of age, resulting in four experimental groups (maternal diet/postweaning diet; n=8-10/group): ND/ND, ND/HF, HF/ND and HF/HF. Another group of HF/HF rats (n=10) was treated with 0.5% resveratrol in drinking water between 2 and 4 months of age (HF/HF+R). Rats were killed at 4 months of age. We found that HF/HF-induced hypertension in adult offspring was prevented by resveratrol. Resveratrol mediated its protective effect on HF/HF-induced hypertension in the kidneys of male offspring by diminishing oxidative stress; reducing renal asymmetric dimethylarginine levels; mediating the renin-angiotensin system (RAS) in favor of vasodilatation; restoring nutrient-sensing pathways via increased levels of silent information regulator transcript 1 (SIRT1), AMP-activated protein kinase 2α and peroxisome proliferator-activated receptor gamma coactivator 1-α; and inducing autophagy. Our data implicated an association between oxidative stress, RAS, nitric oxide, and nutrient-sensing signals in HF/HF-induced hypertension. Resveratrol, acting as an antioxidant as well as a SIRT1 activator, might be a therapeutic approach for hypertension.

Development of an Evidence-Informed Blog to Promote Healthy Eating Among Mothers: Use of the Intervention Mapping Protocol

BACKGROUND

Low adherence to dietary guidelines and a concurrent rise of obesity-related chronic diseases emphasize the need for effective interventions to promote healthy eating. There is growing recognition that behavior change interventions should draw on theories of behavior change. Online interventions grounded in theory lead to increased effectiveness for health behavior change; however, few theory-driven social media-based health promotion interventions have been described in the literature.

OBJECTIVE

The objective of this study was to describe the application of the Intervention Mapping (IM) protocol to develop an evidence-informed blog to promote healthy eating among French-Canadian mothers of preschool and school-aged children.

METHODS

The following six steps of the IM protocol were performed. In Step 1, a preliminary needs assessment included a literature search on theoretical domains predicting Vegetables and Fruits intakes and Milk and Alternatives intakes in adults (ie, knowledge, beliefs about capabilities, beliefs about consequences, intention/goals) and a qualitative study including focus groups to identify female Internet users' perceptions of their use of healthy eating blogs. In Step 2, two behavioral outcomes were selected (ie, increase daily intakes of Vegetables and Fruits and Milk and Alternatives of mothers to reach Canadian dietary recommendations) and subsequently divided into six performance objectives inspired by national and international dietary recommendations such as planning for healthy meals. A matrix of change objectives was then created by crossing performance objectives with theoretical domains predicting Vegetables and Fruits intakes and Milk and Alternatives intakes in adults. Step 3 consisted of selecting theory-based intervention methods (eg, modeling and goal setting) and translating them into practical applications for the context of a dietary intervention delivered through a blog. A 6-month intervention was developed in Step 4 in which we aimed to address one performance objective per month in weekly blog publications written by a registered dietitian. For Step 5, we sought to include engagement-promoting methods (eg, peer and counselor support) to promote mothers' use of the blog and adherence to the intervention. Finally in Step 6, a randomized controlled trial has been launched to evaluate the effects of the blog on dietary behaviors of French-Canadian mothers.

RESULTS

The intervention study is expected to be completed in March 2018.

CONCLUSIONS

An intervention mapping protocol allowed for effective decision making in the development of a novel knowledge translation tool to increase adherence to dietary recommendations among mothers of preschool and school-aged children.

Effects of high-fat diet and fructose-rich diet on obesity, dyslipidemia and hyperglycemia in the WBN/Kob-Leprfa rat, a new model of type 2 diabetes mellitus

Obesity and type 2 diabetes mellitus (T2DM) are occurring at epidemic-like rates, and these epidemics appear to have emerged largely from changes in daily diet. In the present study, we compared effects of high-fat diet (HFD) and fructose-rich diet (FRD) in WBN/Kob-Lepr^fa (WBKDF) rats that spontaneously develop obesity, dyslipidemia and T2DM. After a 4-week feeding of each diet, WBKDF-HFD and WBKDF-FRD rats exhibited aggravated obesity and dyslipidemia compared with WBKDF rats fed standard diet (STD). In contrast, hyperglycemia developed in WBKDF-STD rats was significantly inhibited in WBKDF-FRD rats, but not in WBKDF-HFD rats. The present study demonstrated that the 4-week feeding of HFD and FRD caused diet-induced obesity with a distinct phenotype in the glucose metabolism in WBKDF rats.

Comparison of the impact of SFAs from cheese and butter on cardiometabolic risk factors: a randomized controlled trial

Background: Controversies persist concerning the association between intake of dietary saturated fatty acids (SFAs) and cardiovascular disease risk.Objective: We compared the impact of consuming equal amounts of SFAs from cheese and butter on cardiometabolic risk factors.Design: In a multicenter, crossover, randomized controlled trial, 92 men and women with abdominal obesity and relatively low HDL-cholesterol concentrations were assigned to sequences of 5 predetermined isoenergetic diets of 4 wk each separated by 4-wk washouts: 2 diets rich in SFAs (12.4-12.6% of calories) from either cheese or butter; a monounsaturated fatty acid (MUFA)-rich diet (SFAs: 5.8%, MUFAs: 19.6%); a polyunsaturated fatty acid (PUFA)-rich diet (SFAs: 5.8%, PUFAs: 11.5%); and a low-fat, high-carbohydrate diet (fat: 25%, SFAs: 5.8%).Results: Serum HDL-cholesterol concentrations were similar after the cheese and butter diets but were significantly higher than after the carbohydrate diet (+3.8% and +4.7%, respectively; P < 0.05 for both). LDL-cholesterol concentrations after the cheese diet were lower than after the butter diet (-3.3%, P < 0.05) but were higher than after the carbohydrate (+2.6%), MUFA (+5.3%), and PUFA (+12.3%) diets (P < 0.05 for all). LDL-cholesterol concentrations after the butter diet also increased significantly (from +6.1% to +16.2%, P < 0.05) compared with the carbohydrate, MUFA, and PUFA diets. The LDL-cholesterol response to treatment was significantly modified by baseline values (P-interaction = 0.02), with the increase in LDL cholesterol being significantly greater with butter than with cheese only among individuals with high baseline LDL-cholesterol concentrations. There was no significant difference between all diets on inflammation markers, blood pressure, and insulin-glucose homeostasis.Conclusions: The results of our study suggest that the consumption of SFAs from cheese and butter has similar effects on HDL cholesterol but differentially modifies LDL-cholesterol concentrations compared with the effects of carbohydrates, MUFAs, and PUFAs, particularly in individuals with high LDL cholesterol. In contrast, SFAs from either cheese or butter have no significant effects on several other nonlipid cardiometabolic risk factors. This trial was registered at clinicaltrials.gov as NCT02106208.