Nutrients from dairy foods are difficult to replace in diets of Americans: food pattern modeling and an analyses of the National Health and Nutrition Examination Survey 2003-2006

The contribution of milk substitutes to the nutritional status of children with cow's milk allergy

BACKGROUND

The impact of alternative milk substitutes on the nutritional status of children with cow's milk allergy (CMA), the prevailing cause of food allergies, is unresolved.

METHODS

A cross-sectional study was performed in children older than 2 years with IgE-mediated CMA. Patients' clinical characteristics, anthropometric measurements, dietary intake (by 3-day food diary), and biochemical markers of nutritional status were assessed.

RESULTS

One hundred two children with CMA (68.6% boys; median age, 3.7 years; 51% multiple food allergies) were evaluated. 44.1% of the children consumed plant-based beverages (PBB), 19.6% therapeutic formula and 36.3% did not consume any milk substitutes. In all age groups, dietary calcium, riboflavin, and vitamin D intake of those who did not use milk substitutes were lower than those who consumed formula or PBB (p < .01). Also in the 2-3 years old age group, dietary zinc (p = .011) and iron intake (p = .004) of the formula-fed group was higher. Formula-fed patients had higher levels of 25-OH vitamin D (μg/L) and serum vitamin B12 (ng/L) than PBB-fed patients (respectively; p < .001, p = .005) and those who did not consume any milk substitute (p < .001). Patients of all ages who did not utilize a milk substitute failed to obtain an adequate amount of dietary calcium.

CONCLUSION

The use of milk substitutes positively affects dietary calcium, riboflavin, and vitamin D intake in CMA, but their contribution is variable. Those who do not use milk substitutes are at greater risk inadequate of dietary calcium intake. Personalized nutritional advice, given the clinical diversity and the impact of individual differences, is required.

How Can Imbalance in Oral Microbiota and Immune Response Lead to Dental Implant Problems?

Dental implantology is one of the most dynamically developing fields of dentistry, which, despite developing clinical knowledge and new technologies, is still associated with many complications that may lead to the loss of the implant or the development of the disease, including peri-implantitis. One of the reasons for this condition may be the fact that dental implants cannot yield a proper osseointegration process due to the development of oral microbiota dysbiosis and the accompanying inflammation caused by immunological imbalance. This study aims to present current knowledge as to the impact of oral microflora dysbiosis and deregulation of the immune system on the course of failures observed in dental implantology. Evidence points to a strong correlation between these biological disturbances and implant complications, often stemming from improper osseointegration, pathogenic biofilms on implants, as well as an exacerbated inflammatory response. Technological enhancements in implant design may mitigate pathogen colonization and inflammation, underscoring implant success rates.

Dietary intake, nutritional adequacy and food sources of vitamins involved in the methionine-methylation cycle from Spanish children aged one to <10 years: results from the EsNuPI study

Background

Methionine-methylation cycle and the derived critical functions during infancy are key regulated by folates, vitamins B12, and B6. At present in Spain, there is an absence of studies that assess the intakes and dietary sources of total folates and B12 by children consuming all types of milks and those regularly consuming adapted milk formulas. Thus, our aim was to evaluate folates intakes alongside with vitamins B6 and B12 while describing their major dietary contributors in Spanish children aged one to <10 years.

Methods

A total of 1,448 children aged between 1 and 10 years (49.7% girls and 50.3% boys) from the EsNuPI, a prospective cross-sectional study, were allocated into two cohorts: one Spanish Reference Cohort (SRS) of the general population (n = 707), and another including children consuming adapted milks called Adapted Milk Consumers Cohort (AMS) (n = 741) completed two 24 h dietary recalls used to estimate their nutrient intakes and to compare them to the European Food Safety Authority (EFSA) Population Reference Intakes.

Results

The median intake of vitamin B6 was 1.35 (1.06-1.70) mg/day in the SRS and 1.45 (1.17-1.79) mg/day in the AMS, being significantly higher in the AMS for all age-groups. Prevalence of adequacy for vitamin B6 in the SRS and AMS was 97.7 and 98.7%, respectively. Total folates intakes in the AMS were significantly higher (p ≤ 0.001) in all age groups than in the SRS, independently of age. In addition, the prevalence of adequacy for folates intakes in all groups was more than 60%. Vitamin B12 intake increased with age independently of the type of milk consumed. The prevalence of adequacy for vitamin B12 was highly compliant by all population groups. The major contributors to vitamin B6 were milk and dairy products being significantly higher in AMS than SRS (p ≤ 0.001). The highest contributors to folates intakes were milk and dairy products, cereals, vegetables, and fruits in both groups whereas for vitamin B12 in the SRS sample were milk and dairy products followed by meat and meats products and for adapted milks, were milk and dairy products, followed by eggs, then meat and meats products.

Conclusion

A satisfactory prevalence of adequacy for vitamins B6, and B12 amongst the Spanish children population was observed, which was not the case for folates, regardless of the dietary group evaluated. Nevertheless, a possible strategy to increase folate intake among the youngest children is to increase the consumption of milk and dairy products within a healthier dietary pattern, as these may contribute significantly to the vitamin needs of the infant population.

Seeing the forest through the trees: the importance of the food matrix in diet quality and human health

Poor nutrition is linked to morbidity and mortality globally. The nutrition transition towards diets composed of high amounts of ultra-processed foods that are more refined, calorie-dense and nutrient poor, is considered a factor in the rise of diet-related metabolic diseases in low- and middle-income countries. Historically, nutrition strategies aimed at mitigating metabolic diseases linked to sub-optimal diets have targeted isolated nutrients, like fat; however, they overlook the complexity and importance of the whole food and food matrices, which can lead to unintended consequences, such as avoidance of nutrient-dense foods. Dairy foods, such as milk, cheese and yogurt are underconsumed, nutrient-dense foods that are often fall in the cross-hairs of reductionist nutrition strategies because of their contribution of calories, saturated fat, and sodium to the diet. This article highlights dairy foods as an example for exploring the complex matrices of food, nutrients, and other bioactive components that are associated with improved nutrient status and reduced risk of metabolic diseases, while considering a holistic approach to improving diet quality and human health. Statement of Significance Historically, nutrition strategies aimed at mitigating metabolic diseases linked to sub-optimal diets have targeted isolated nutrients, like fat; however, they overlook the complexity and importance of the whole food and food matrices, and can lead to unintended consequences. This article explores the complex matrices of nutrients and other bioactive components that are associated with improved nutrient status and reduced risk of metabolic diseases, and considers a holistic approach to improving diet quality and human health.

Precision cellular agriculture: The future role of recombinantly expressed protein as food

Cellular agriculture is a rapidly emerging field, within which cultured meat has attracted the majority of media attention in recent years. An equally promising area of cellular agriculture, and one that has produced far more actual food ingredients that have been incorporated into commercially available products, is the use of cellular hosts to produce soluble proteins, herein referred to as precision cellular agriculture (PCAg). In PCAg, specific animal- or plant-sourced proteins are expressed recombinantly in unicellular hosts-the majority of which are yeast-and harvested for food use. The numerous advantages of PCAg over traditional agriculture, including a smaller carbon footprint and more consistent products, have led to extensive research on its utility. This review is the first to survey proteins currently being expressed using PCAg for food purposes. A growing number of viable expression hosts and recent advances for increased protein yields and process optimization have led to its application for producing milk, egg, and muscle proteins; plant hemoglobin; sweet-tasting plant proteins; and ice-binding proteins. Current knowledge gaps present research opportunities for optimizing expression hosts, tailoring posttranslational modifications, and expanding the scope of proteins produced. Considerations for the expansion of PCAg and its implications on food regulation, society, ethics, and the environment are also discussed. Considering the current trajectory of PCAg, food proteins from any biological source can likely be expressed recombinantly and used as purified food ingredients to create novel and tailored food products.

Calcium and vitamin D for increasing bone mineral density in premenopausal women

BACKGROUND

Osteoporosis is a condition where bones become fragile due to low bone density and impaired bone quality. This results in fractures that lead to higher morbidity and reduced quality of life. Osteoporosis is considered a major public health concern worldwide. For this reason, preventive measurements need to be addressed throughout the life course. Exercise and a healthy diet are among the lifestyle factors that can help prevent the disease, the latter including intake of key micronutrients for bone, such as calcium and vitamin D. The evidence on whether supplementation with calcium and vitamin D improves bone mineral density (BMD) in premenopausal women is still inconclusive. In this age group, bone accrual is considered to be the goal of supplementation, so BMD is relevant for the future stages of life.

OBJECTIVES

To evaluate the benefits and harms of calcium and vitamin D supplementation, alone or in combination, to increase the BMD, reduce fractures, and report the potential adverse events in healthy premenopausal women compared to placebo.

SEARCH METHODS

We used standard, extensive Cochrane search methods. The latest search was 12 April 2022.

SELECTION CRITERIA

We included randomised controlled trials in healthy premenopausal women (with or without calcium or vitamin D deficiency) comparing supplementation of calcium or vitamin D (or both) at any dose and by any route of administration versus placebo for at least three months. Vitamin D could have been administered as cholecalciferol (vitamin D3) or ergocalciferol (vitamin D2).

DATA COLLECTION AND ANALYSIS

We used standard Cochrane methods. Outcomes included total hip bone mineral density (BMD), lumbar spine BMD, quality of life, new symptomatic vertebral fractures, new symptomatic non-vertebral fractures, withdrawals due to adverse events, serious adverse events, all reported adverse events and additional withdrawals for any reason.

MAIN RESULTS

We included seven RCTs with 941 participants, of whom 138 were randomised to calcium supplementation, 110 to vitamin D supplementation, 271 to vitamin D plus calcium supplementation, and 422 to placebo. Mean age ranged from 18.1 to 42.1 years. Studies reported results for total hip or lumbar spine BMD (or both) and withdrawals for various reasons, but none reported fractures or withdrawals for adverse events or serious adverse events. Results for the reported outcomes are presented for the three comparisons: calcium versus placebo, vitamin D versus placebo, and calcium plus vitamin D versus placebo. In all comparisons, there was no clinical difference in outcomes, and the certainty of the evidence was moderate to low. Most studies were at risk of selection, performance, detection, and reporting biases. Calcium versus placebo Four studies compared calcium versus placebo (138 participants in the calcium group and 123 in the placebo group) with mean ages from 18.0 to 47.3 years. Calcium supplementation may have little to no effect on total hip or lumbar spine BMD after 12 months in three studies and after six months in one study (total hip BMD: mean difference (MD) -0.04 g/cm2, 95% confidence interval (CI) -0.11 to 0.03; I2 = 71%; 3 studies, 174 participants; low-certainty evidence; lumbar spine BMD: MD 0 g/cm2, 95% CI -0.06 to 0.06; I2 = 71%; 4 studies, 202 participants; low-certainty evidence). Calcium alone supplementation does not reduce or increase the withdrawals in the trials (risk ratio (RR) 0.78, 95% CI 0.52 to 1.16; I2 = 0%; 4 studies, 261 participants: moderate-certainty evidence). Vitamin D versus placebo Two studies compared vitamin D versus placebo (110 participants in the vitamin D group and 79 in the placebo group), with mean ages from 18.0 to 32.7 years. These studies reported lumbar spine BMD as a mixture of MDs and percent of change and we were unable to pool the results. In the original studies, there were no differences in lumbar BMD between groups. Vitamin D alone supplementation does not reduce or increase withdrawals for any reason between groups (RR 0.74, 95% CI 0.46 to 1.19; moderate-certainty evidence). Calcium plus vitamin D versus placebo Two studies compared calcium plus vitamin D versus placebo (271 participants in the calcium plus vitamin D group and 270 in the placebo group; 220 participants from Woo 2007 and 50 participants from Islam 2010). The mean age range was 18.0 to 36 years. These studies measured different anatomic areas, one study reported total hip BMD and the other study reported lumbar spine BMD; therefore, data were not pooled for this outcome. The individual studies found no difference between groups in percent of change on total hip BMD (-0.03, 95% CI -0.06 to 0; moderate-certainty evidence), and lumbar spine BMD (MD 0.01, 95% CI -0.01 to 0.03; moderate-certainty evidence). Calcium plus vitamin D supplementation may not reduce or increase withdrawals for any reason (RR 0.82, 95% CI 0.29 to 2.35; I2 = 72%; 2 studies, 541 participants; low-certainty evidence).

AUTHORS' CONCLUSIONS

Our results do not support the isolated or combined use of calcium and vitamin D supplementation in healthy premenopausal women as a public health intervention to improve BMD in the total hip or lumbar spine, and therefore it is unlikely to have a benefit for the prevention of fractures (vertebral and non-vertebral). The evidence found suggests that there is no need for future studies in the general population of premenopausal women; however, studies focused on populations with a predisposition to diseases related to bone metabolism, or with low bone mass or osteoporosis diagnosed BMD would be useful.

Management of Hypoparathyroidism

Hypoparathyroidism (HypoPT) is a rare disorder characterized by hypocalcemia in the presence of a low or inappropriately normal parathyroid hormone level. HypoPT is most commonly seen after neck surgery, which accounts for approximately 75% of cases, whereas approximately 25% have HypoPT due to nonsurgical causes. In both groups of patients, conventional therapy includes calcium and active vitamin D analogue therapy aiming to maintain serum calcium concentration in the low normal or just below the normal reference range and normalize serum phosphorus, magnesium concentrations, and urine calcium levels. The limitations of conventional therapy include wide fluctuations in serum calcium, high pill burden, poor quality of life, and renal complications. Parathyroid hormone (PTH) replacement therapy may improve the biochemical profile in those in whom conventional therapy proves unsatisfactory. Based on a systematic review and meta-analysis of the literature, the panel made a graded recommendation suggesting conventional therapy as first line therapy rather than administration of PTH (weak recommendation, low quality evidence). When conventional therapy is deemed unsatisfactory, the panel considers use of PTH. Because pregnancy and lactation are associated with changes in calcium homeostasis, close monitoring is required during these periods with appropriate adjustment of calcium and active vitamin D analogue therapy to ensure that serum calcium remains in the mid to low normal reference range in order to avoid maternal and fetal complications. Emerging therapies include molecules with prolonged PTH action as well as different mechanisms of action that may significantly enhance drug efficacy and safety. © 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).

Beneficial Effects of Yoghurts and Probiotic Fermented Milks and Their Functional Food Potential

Probiotic fermented milks and yoghurts are acidified and fermented by viable bacteria, usually L. bulgaricus and S. thermophilus, resulting in a thicker product with a longer shelf life. They are a nutrition-dense food, providing a good source of calcium, phosphorus, potassium, vitamin A, vitamin B2, and vitamin B12. Additionally, they deliver high biological value proteins and essential fatty acids. There is accumulating evidence suggesting that yoghurt and fermented milk consumption is related to a number of health advantages, including the prevention of osteoporosis, diabetes, and cardiovascular diseases, as well as the promotion of gut health and immune system modulation. This review aims at presenting and critically reviewing the beneficial effects from the consumption of probiotic fermented milks in human health, whilst revealing potential applications in the food industry.

Physician and Parent Perceptions on Plant-Based Beverages as Substitutes for Cow's Milk: A Single City Survey

This study assessed physician and parent perceptions regarding plant-based beverage consumption in children. We surveyed 128 physicians and 215 parents of patients at University of Miami and Jackson Memorial Hospital. Among physicians, 52% recommended plant-based beverages, typically soy (33%), for cow's milk allergy (32%). Only 40% of physicians knew the typical protein content of plant-based beverages compared to cow's milk. Most physicians (54%) did not discuss potential health risks of plant-based beverages with patients. Among parents, 48% had children <2 years old, and 22% purchased a plant-based beverage, most commonly almond beverage (39%), due to perceived health benefits (54%). In total, 85% of parents believed that plant-based beverages are nutritionally superior or equivalent to cow's milk. Most parents (52%) depended on physicians for information on plant-based beverages. Overall, less than one third of physicians and parents believed that plant-based beverages should be called milk. There is a lack of knowledge among physicians and parents regarding plant-based beverage use as a dairy substitute in children. Despite parents relying on physicians for health information, physicians are not routinely counseling parents. Removing the label "milk" from plant-based beverages may improve consumer awareness of their nutritional differences and circumvent potential associated health risks in children.

Association between Intake of Total Dairy and Individual Dairy Foods and Markers of Folate, Vitamin B6 and Vitamin B12 Status in the U.S. Population

Vitamin B6, B12 and folate are required for energy metabolism and have been identified as nutrients of concern for certain population groups. This study examined the cross-sectional association between the consumption of dairy (total dairy, milk, yogurt and cheese) and biomarkers and adequacy for these nutrients in a nationally representative sample. Twenty-four-hour dietary recall data and concentrations of RBC folate (ng/mL), serum folate (ng/mL), and serum vitamins B6 (nmol/L) and B12 (pg/mL) were obtained from the National Health and Nutrition Examination Survey 2001−2018 (n = 72,831) and were analyzed by linear and logistic regression after adjusting for demographic variables. Significance was set at p < 0.01. Mean intakes of total dairy were 2.21, 2.17, 1.83 and 1.51 cups eq among consumers aged 2−8, 9−18, 19−50 and 51+ years, respectively. Higher intakes of total dairy as well as individual dairy foods (especially milk and yogurt) were positively associated with serum and RBC folate, serum vitamin B6 and serum B12, and generally, with 9−57% lower risk of inadequate or deficient levels of these vitamins. These findings suggest that encouraging dairy consumption may be an effective strategy for improving micronutrient status and provide continued evidence to support the current dietary recommendations for dairy and dairy products.

Perspectives from healthcare professionals on the nutritional adequacy of plant-based dairy alternatives: results of a mixed methods inquiry

BACKGROUND

Healthcare professionals are important sources of nutrition and health information for Americans. As plant-based (PB) dairy alternative products increase in popularity, concerns have been raised about their nutritional adequacy, and whether consumers understand nutritional differences to dairy. Healthcare professionals directly advise consumers on dietary choices, therefore we sought to examine their understanding and opinions of PB dairy alternatives.

METHODS

We analyzed comments submitted to the U.S. Food and Drug Administration (FDA) by health professionals (n = 191) in 2018-2019 in response to a request for public comment on the nutrition of PB dairy alternatives and the use of dairy terms like "milk", "cheese", and "yogurt" on their labels. Survey data from healthcare professionals (n = 417) was collected in 2020-2021. Comments and survey responses to open-ended questions were coded using template analysis and thematically analyzed. Logistic regression models examined perceptions across health professional characteristics for close-ended survey responses.

RESULTS

Three-fourths of health professionals believe consumers are confused about the nutritional differences between dairy and PB dairy alternatives. Over half (53%) do not believe either product is nutritionally superior to the other. Many believe dairy products have higher nutrient value, but also believe PB dairy alternatives can be part of a healthful diet. Compared to other types of health professionals, dietetics professionals demonstrated a more accurate understanding of the nutritional value of both products and were more likely to believe nutrients like protein (OR 2.02; 95% CI 1.22-3.34, p = 0.006) and vitamin D (OR 2.46; 95% CI 1.48-4.09, p = 0.001) may be nutrients of concern for PB dairy alternative consumers. They were also more likely to believe consumers are confused about these products (OR 3.44; 95% CI 1.65-7.21; p = 0.001). Health professionals who submitted comments to the FDA showed stronger opinions in favor of PB dairy alternatives.

CONCLUSIONS

Although PB dairy alternatives have nutritional value in certain diets, responses from health professionals suggest that changing their labeling to be different than dairy may reduce confusion. Improved nutrition education among health professionals may also be necessary.

Association between Milk Intake and All-Cause Mortality among Chinese Adults: A Prospective Study

BACKGROUND

Little is known about the effect of milk intake on all-cause mortality among Chinese adults. The present study aimed to explore the association between milk intake and all-cause mortality in the Chinese population.

METHODS

Data from 1997 to 2015 of the China Health and Nutrition Survey (CHNS) were used. A total of 14,738 participants enrolled in the study. Dietary data were obtained by three day 24-h dietary recall. All-cause mortality was assessed according to information reported. The association between milk intake and all-cause mortality were explored using Cox regression and further stratified with different levels of dietary diversity score (DDS) and energy intake.

RESULTS

11,975 (81.25%) did not consume milk, 1341 (9.10%) and 1422 (9.65%) consumed 0.1-2 portions/week and >2 portions/week, respectively. Milk consumption of 0.1-2 portions/week was related to the decreased all-cause mortality (HR: 0.59, 95% CI: 0.41-0.85). In stratified analysis, consuming 0.1-2 portions/week was associated with decreased all-cause mortality among people with high DDS and energy intake.

CONCLUSIONS

Milk intake is low among Chinese adults. Consuming 0.1-2 portions of milk/week might be associated with the reduced risk of death among Chinese adults by advocating health education. Further research is required to investigate the relationships between specific dairy products and cause-specific mortality.

Consumption of Milk and alternatives decreased among Canadians from 2004 to 2015: evidence from the Canadian community health surveys

Background

Milk and milk products make important contributions to the diet of Canadians. The aim of this study was to examine trends in Milk & Alternatives consumption among Canadians (≥2 years) from 2004 to 2015.

Methods

We used nutrition data from 2 nationally representative cross-sectional surveys conducted in 2004 and 2015 [Canadian Community Health Survey (CCHS) 2004 Cycle 2.2 and CCHS-Nutrition 2015] to compare Milk & Alternatives consumption between 2004 and 2015. Data from 24-h dietary recalls were collected using the Automated Multiple-Pass Method (AMPM).

Result

From 2004 to 2015, the proportion of Canadians consuming Milk & Alternatives food group significantly decreased from 89.5 to 87.7% and the number of servings consumed per day dropped from 1.9 to 1.7. Despite their low energy contribution (12.3% of energy), Milk & Alternatives contributed 45.8% of calcium, 39.9% of vitamin D, and 36.0% of vitamin B12 to the diet of the Canadian population in 2015. Milk & Alternatives were among the top sources of vitamin A, phosphorus and riboflavin. Milk & Alternatives food group was a major contributor to saturated fat intake in both 2004 (31.2%) and 2015 (28.6%). In 2015, dietary intakes of calcium and vitamin D among Milk & Alternatives consumers were 137.8, and 59.4% higher, respectively, than those of non-consumers.

Conclusion

Daily intake of Milk & Alternatives has decreased in the Canadian population over time, which may adversely affect the nutritional profile of the diet.

Calcium and vitamin D intake in allergic versus non-allergic children and corresponding parental attitudes towards dairy products

BACKGROUND

It is hypothesized that parents of children with allergic conditions believe dairy products are potentially harmful to their child.

OBJECTIVES

This study compares the calcium and vitamin D intake of allergic versus non-allergic children and parental beliefs about milk and dairy products.

METHODS

A survey and food-frequency-questionnaire were administered to parents of children between 3 and 13 years, 110 with allergic disease (allergic rhinitis, asthma, food allergy, and/or atopic dermatitis) versus 110 without allergic disease. Calcium and vitamin D intake was calculated from the food-frequency-questionnaire and compared to National Institutes of Health recommendations. Associations between atopy, calcium and vitamin D intake, and beliefs were investigated using Chi-square test (α = 0.05). Distribution across subjects was investigated using Mann-Whitney-U test (α = 0.05).

RESULTS

Fewer allergic (51.8%) versus non-allergic children (77.3%) met the recommended calcium intake (p < 0.001). Both had similar rates of insufficient vitamin D intake: 12.7% allergic and 17.3% non-allergic (p = 0.345). 81.7% of parents of allergic versus 94.0% of non-allergic children believe intake of dairy is important (p = 0.009). 23.7% of parents of allergic versus 8.0% of non-allergic children believe dairy negatively impacts their child (p = 0.003). 19.1% of parents of allergic children (excluding 3 with documented milk allergy) versus 2.0% of non-allergic believe their child is allergic or intolerant to dairy (p < 0.001).

CONCLUSIONS

Children are at risk of insufficient calcium and vitamin D intake. Atopic children may be at increased risk for insufficient intake, due in part to parent's negative beliefs regarding dairy products. Physicians should counsel on the importance of micronutrient intake and how allergic conditions do or do not entail dietary restrictions.

Trends in the consumption of conventional dairy milk and plant-based beverages and their contribution to nutrient intake among Canadians

BACKGROUND

Current evidence suggests a shift from conventional dairy milk to plant-based beverages (PBBs) for a number of lifestyles and perceived health-related reasons.

METHODS

Using nationally representative cross-sectional data from the 2004 and 2015 Canadian Community Healthy Surveys, the main objectives of the present study were to (i) examine the trend in the proportion of Canadians (≥ 2 years) consuming plain milk and PBBs and (ii) determine the percentage contribution of plain milk and PBBs to daily energy and nutrient intakes.

RESULTS

From 2004 to 2015, the percentage of Canadians consuming plain milk significantly decreased from 70.2% to 56.1%, whereas the percentage of PBBs consumers significantly increased from 1.8% to 3.0%. In 2015, plain milk provided almost 50% of the daily vitamin D intake, over 30% of calcium and vitamin B12, and over 20% of vitamin A and riboflavin among plain milk consumers. The top five nutrients provided by PBBs among PBBs consumers were vitamin D, calcium, vitamin B12, vitamin A and riboflavin. Although plain milk was a major contributor to saturated fat (14.5%) and protein (12.5%) intake among plain milk consumers, PBBs provided only 0.2% of saturated fat and 1.4% of protein intake in the diet of PBBs consumers.

CONCLUSIONS

The consumption of plain milk by Canadians has declined and the consumption of PBBs has increased, which may differentially affect the nutritional profile of the diet.

MILK Symposium review: Sustainability of dairy production and consumption in low-income countries with emphasis on productivity and environmental impact

Sustainable milk production and consumption in low-income countries must address food security and climate change mitigation simultaneously. Socioeconomic sustainability is paramount in low-income countries, where milk production and consumption represent a vehicle to improve human nutrition and health, as well as the potential for economic opportunity and improved livelihood of subsistence farmers. These benefits can only be achieved with judicious use of animal stocks and agricultural practices that do not exhaust available natural resources, which are often shared by regional farming communities. Milk and dairy foods provide variety to the diet and make significant contributions to meeting the needs for high-quality protein, calcium, magnesium, selenium, riboflavin, vitamin B₁₂, and pantothenic acid (vitamin B₅) in at-risk populations, particularly children, pregnant women, and the elderly. Milk production in low-income countries occurs largely in smallholder mixed crop-livestock systems where animals play multiple roles and may suffer from undernutrition, leading to negligible or no milk production during several months of the year. Non-food roles of livestock include draft, fuel (manure), store of capital, and insurance against crop failure. These roles and the social standing associated with animal ownership may incentivize the maintenance of large herds that place stress on feed (land) and water resources. Under these circumstances, sustainable intensification (i.e., increasing milk production from currently available resources) represents the single most important and practical strategy to improve the sustainability of milk production and consumption in low-income countries. Improving the genetic potential of animals and the availability of quality feed, and providing balanced nutrition are the most promising strategies to improve milk production and sustainability in low-income countries. For example, the deficit for milk in Ethiopia is estimated at 4.5 billion liters/year, which can be closed, in part, with balanced animal nutrition. Milk production in low-income countries will be more sustainable if it relies on natural resources available locally and regionally to supply essential nutrients to at-risk human populations.

Protein consumption in Canadian habitual diets: usual intake, inadequacy, and the contribution of animal- and plant-based foods to nutrient intakes

The 2019 Canada's Food Guide (CFG) emphasizes consumption of plant protein with implications for protein adequacy and nutrient intakes, yet a baseline with which to compare future dietary trends that may result from its adoption is not available. The objectives were to assess usual protein intake, inadequacy, and the contribution of animal- and plant-based foods to intake of protein, nutrients, and energy in Canada. Twenty-four-hour dietary recalls from the 2015 Canadian Community Health Survey - Nutrition were used to assess dietary intake among adults (n = 13 616). The National Cancer Institute method was used to estimate usual protein intake and inadequacy. Population ratios were used to determine the contribution of animal- and plant-based foods to intake of protein, nutrients, and energy. Usual protein intake averaged 79.47 ± 0.70 g/d; inadequacy was highest for females ≥71 y (9.76 ± 2.04%). Top protein contributors were red and processed meat (21.6 ± 0.55%), poultry and eggs (20.1 ± 0.81%), cereals, grains, and breads (19.5 ± 0.31%), and dairy (16.7 ± 0.38%). Dairy contributed most to calcium (53.4 ± 0.61%), vitamin D (38.7 ± 1.01%), but also saturated fat (40.6 ± 0.69%), whereas cereals, grains, and breads contributed most to iron (46.5 ± 0.57%) and vegetables and fruit to potassium (32 ± 0.45%). Given that animal sources contributed overwhelmingly to protein intake in 2015, dietary shifts towards plant protein needed to meet the 2019 CFG recommendations may pose a challenge, particularly for populations most at risk of inadequacy. Novelty: Older adults and females are most at risk of not meeting protein recommendations. Animal sources contribute two-thirds of the protein consumed by Canadian adults.

The effects of dairy and dairy derivatives on the gut microbiota: a systematic literature review

The effects of dairy and dairy-derived products on the human gut microbiota remains understudied. A systematic literature search was conducted using Medline, CINAHL, Embase, Scopus, and PubMed databases with the aim of collating evidence on the intakes of all types of dairy and their effects on the gut microbiota in adults. Risk of bias was assessed using the Cochrane risk-of-bias tool.The search resulted in 6,592 studies, of which eight randomized controlled trials (RCTs) met pre-determined eligibility criteria for inclusion, consisting of a total of 468 participants. Seven studies assessed the effect of type of dairy (milk, yogurt, and kefir) and dairy derivatives (whey and casein) on the gut microbiota, and one study assessed the effect of the quantity of dairy (high dairy vs low dairy). Three studies showed that dairy types consumed (milk, yogurt, and kefir) increased the abundance of beneficial genera Lactobacillus and Bifidobacterium. One study showed that yogurt reduced the abundance of Bacteroides fragilis, a pathogenic strain. Whey and casein isolates and the quantity of dairy consumed did not prompt changes to the gut microbiota composition. All but one study reported no changes to bacterial diversity in response to dairy interventions and one study reported reduction in bacterial diversity in response to milk intake.In conclusion, the results of this review suggest that dairy products such as milk, yogurt, and kefir may modulate the gut microbiota composition in favor to the host. However, the broader health implications of these findings remain unclear and warrant further studies.

Use of Exopolysaccharide-Synthesizing Lactic Acid Bacteria and Fat Replacers for Manufacturing Reduced-Fat Burrata Cheese: Microbiological Aspects and Sensory Evaluation

This study aimed to set-up a biotechnological protocol for manufacturing a reduced-fat Burrata cheese using semi-skimmed milk and reduced-fat cream, in different combinations with exopolysaccharides-synthesizing bacterial starters (Streptococcus thermophilus, E1, or Lactococcus lactis subsp. lactis and Lc. lactis subsp. cremoris, E2) and carrageenan or xanthan. Eight variants of reduced-fat cheese (fat concentration 34–51% lower than traditional full-fat Burrata cheese, used as the control) were obtained using: (i) semi-skimmed milk and reduced-fat cream alone (RC) or in combination with (ii) xanthan (RCX), (iii) carrageenan (RCC), (iv) starter E1 (RCE1), (v) starter E2 (RCE2), (vi) both starters (RCE1-2), (vii) E1 and xanthan (RCXE1), or E1 and carrageenan (RCCE1). Post-acidification occurred for the RCC, RCX, and RCE2 Burrata cheeses, due to the higher number of mesophilic cocci found in these cheeses after 16 days of storage. Overall, mesophilic and thermophilic cocci, although showing cheese variant-depending dynamics, were dominant microbial groups, flanked by Pseudomonas sp. during storage. Lactobacilli, increasing during storage, represented another dominant microbial group. The panel test gave highest scores to RCE1-2 and RCXE1 cheeses, even after 16 days of storage. The 16S-targeted metagenomic analysis revealed that a core microbiota (S. thermophilus, Streptococcus lutetiensis, Lc. lactis, Lactococcus sp., Leuconostoc lactis, Lactobacillus delbrueckii, and Pseudomonas sp.), characterized the Burrata cheeses. A consumer test, based on 105 people, showed that more than 50% of consumers did not distinguish the traditional full-fat from the RCXE1 reduced-fat Burrata cheese.

Dairy Consumption and Metabolic Health

Milk and dairy foods are naturally rich sources of a wide range of nutrients, and when consumed according to recommended intakes, contribute essential nutrients across all stages of the life cycle. Seminal studies recommendations with respect to intake of saturated fat have been consistent and clear: limit total fat intake to 30% or less of total dietary energy, with a specific recommendation for intake of saturated fat to less than 10% of total dietary energy. However, recent work has re-opened the debate on intake of saturated fat in particular, with suggestions that recommended intakes be considered not at a total fat intake within the diet, but at a food-specific level. A large body of evidence exists examining the impact of dairy consumption on markers of metabolic health, both at a total-dairy-intake level and also at a food-item level, with mixed findings to date. However the evidence suggests that the impact of saturated fat intake on health differs both across food groups and even between foods within the same food group such as dairy. The range of nutrients and bioactive components in milk and dairy foods are found in different levels and are housed within very different food structures. The interaction of the overall food structure and the nutrients describes the concept of the 'food matrix effect' which has been well-documented for dairy foods. Studies show that nutrients from different dairy food sources can have different effects on health and for this reason, they should be considered individually rather than grouped as a single food category in epidemiological research. This narrative review examines the current evidence, mainly from randomised controlled trials and meta-analyses, with respect to dairy, milk, yoghurt and cheese on aspects of metabolic health, and summarises some of the potential mechanisms for these findings.

Effect of Dairy Protein Intake on Muscle Mass among Korean Adults: A Prospective Cohort Study

This cohort study aimed to identify the associations of dairy protein intake with the risk of developing a low muscle mass during a 12-year follow-up period, using data from 4412 middle-aged Korean Genome and Epidemiology Study participants with a normal baseline muscle mass. Dairy protein intake at baseline was assessed using a semi-quantitative Food Frequency Questionnaire. Skeletal muscle mass index (SMI), defined as the weight-adjusted skeletal muscle mass, was measured biennially using multi-frequency bioelectrical impedance analyses. Cox proportional hazards regression analysis was used to calculate multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs). Overall, 395 subjects developed a low SMI (%) during an average follow-up of 141 (19-152) months. The average consumption of milk and other dairy products was 73.6 and 104.1 g/day, respectively. In men, a higher dairy protein intake was associated with a decreased risk of developing a low SMI (tertile 3 [T3] vs. T1, HR: 0.63; 95% CI: 0.42, 0.94; p for trend = 0.029). In a stratified analysis according to a total protein intake, this association was stronger in the lower-protein intake group (HR: 0.59; 95% CI: 0.35, 0.99; p for trend = 0.036) but not detected in the higher-protein intake group. Men who consumed milk ≥1 time/day had a significantly lower risk of developing a low SMI (HR: 0.62; 95% CI: 0.39, 0.98; p for trend = 0.023). No significant associations were observed in women. In summary, dairy consumption appears to be beneficial for decreasing the risk of developing a low muscle mass in middle-aged Korean men.

Nutrient-rich, high-quality, protein-containing dairy foods in combination with exercise in aging persons to mitigate sarcopenia

Sarcopenic declines in muscle mass and function contribute to the risk of falls, reduced mobility, and progression to frailty in older persons. Mitigation of sarcopenia can be achieved by consumption of higher quality protein in sufficient quantities, which current research suggests are greater than the recommended intakes of approximately 0.8 g/kg bodyweight/d. In addition, higher levels of physical activity and participation in exercise to support cardiovascular fitness and musculoskeletal function work additively with protein in attenuating sarcopenia. This narrative review provides evidence to support a recommendation for per-meal protein targets in older persons that are underpinned by knowledge of muscle protein turnover. Based on work examining acute dose-responses of muscle protein synthesis (MPS) to protein, a proposed per-meal target for protein intakes is set at approximately 0.4-0.6 g protein/kg bodyweight/meal for older persons. Habitual patterns of dietary protein intake tend to emphasize a skewed protein distribution, which would not maximize muscle anabolism. Observational studies show that more even patterns of protein intake are associated with increased muscle mass and improved muscle function. A food-based approach to achieving these protein targets would be advantageous, and the nutrient density of the protein-containing foods would be particularly important for older persons. Dairy foods provide high-quality protein and contain several nutrients of concern for older persons. This brief review provides an overview of the science underpinning why dairy foods should be a point of nutritional emphasis for older persons. Practical suggestions are provided for implementation of dairy foods into dietary patterns to meet the protein and other nutrient targets for older persons.

Risk factors for the formation of striae gravidarum in women in Jiangsu Province of China

OBJECTIVE

We study the risk factors that affect the formation of striae gravidarum in women in Jiangsu Province of China under current living habits.

MATERIALS AND METHODS

This sample is based on 400 primiparas from obstetric of the Affiliated Hospital of Jiangnan University in Wuxi from February 2017 to October 2017. Among them, there are 200 pregnant women with striae gravidarum and 200 without striae gravidarum. Striae gravidarum predictors were selected such as age, height, pre-pregnancy BMI, postpartum BMI, daily sitting time, weight gain during pregnancy, fetal weight, and diet on maternal.

RESULTS

(1) The pregnant women who had striae gravidarum were generally lower in height than those who did not have striae gravidarum and had a higher BMI index than those who did not have striae gravidarum before and after childbirth. (2) In the pregnant women who have had striae gravidarum, the incidence of abdominal striae gravidarum in sedentary women is significantly lower than those in non-sedentary women, the incidence of striae gravidarum in legs is higher than those in non-sedentary women, and no significant difference in hip striae gravidarum. (3) In all pregnant women who have striae gravidarum, abdomen striae gravidarum tend to be lighter and leg striae gravidarum tends to be heavier in sedentary women, but no significant effect on the hip. (4) Regular consumption of honey, milk, trotters, freshwater fish, eggs, and tremella can reduce the incidence of striae gravidarum.

CONCLUSION

The lifestyle and eating habits have a certain influence on the formation and severity of stretch marks.

Dairy Intake Would Reduce Nutrient Gaps in Chinese Young Children Aged 3-8 Years: A Modelling Study

Dairy foods are under-consumed among Chinese children. We modeled the impact of increased dairy consumption on nutrient inadequacy and assessed whether the consumption of formulated milk powder for children ≥3 years (FMP3+) is useful for reducing nutrient gaps. Data from 3–8-year-old children, with completed socio-demographic and dietary measurements from the China Health and Nutrition Survey 2015, were used (n = 1122). Dietary intakes were modeled in two scenarios: Scenario 1 added FMP3+ or cow’s milk to reported diet to reach recommended dairy intakes; Scenario 2 replaced the currently consumed milk with an equal volume of FMP3+. Reported nutrient intakes were compared with each model. Only 32.5% of children consumed dairy products; the average intake amount in total was 48.6 g/day. Most children (97.6%) did not meet dairy intake recommendation. Inadequate nutrient intakes were observed for calcium, potassium, thiamin, riboflavin, vitamin C and selenium. In Scenario 1, both FMP3+ and cow’s milk improved the intake of all analyzed nutrients. In Scenario 2, FMP3+ substitution increased the intake of most nutrients, and reduced the proportion of children with an inadequate intake of vitamin C, thiamin, vitamin A, iron, zinc and potassium. Thus, increasing dairy consumption would reduce nutrient gaps, and FMP3+ is a good food source to help children meet nutrient requirements.

Do Dietary Supplements and Nutraceuticals Have Effects on Dental Implant Osseointegration? A Scoping Review

Several factors affect dental implant osseointegration, including surgical issues, bone quality and quantity, and host-related factors, such as patients' nutritional status. Many micronutrients might play a key role in dental implant osseointegration by influencing some alveolar bone parameters, such as healing of the alveolus after tooth extraction. This scoping review aims to summarize the role of dietary supplements in optimizing osseointegration after implant insertion surgery. A technical expert panel (TEP) of 11 medical specialists with expertise in oral surgery, bone metabolism, nutrition, and orthopedic surgery performed the review following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) model. The TEP identified micronutrients from the "European Union (EU) Register of nutrition and health claims made on foods" that have a relationship with bone and tooth health, and planned a PubMed search, selecting micronutrients previously identified as MeSH (Medical Subject Headings) terms and adding to each of them the words "dental implants" and "osseointegration". The TEP identified 19 studies concerning vitamin D, magnesium, resveratrol, vitamin C, a mixture of calcium, magnesium, zinc, and vitamin D, and synthetic bone mineral. However, several micronutrients are non-authorized by the "EU Register on nutrition and health claims" for improving bone and/or tooth health. Our scoping review suggests a limited role of nutraceuticals in promoting osseointegration of dental implants, although, in some cases, such as for vitamin D deficiency, there is a clear link among their deficit, reduced osseointegration, and early implant failure, thus requiring an adequate supplementation.

An Exploration of Milk Product Health Beliefs and Dietary Calcium Intake in Young Adults

Purpose: Milk products (fluid milk, cheese, yogurt) typically provide a rich source of calcium and other nutrients, yet consumption is declining in Canada. This study examined milk product health beliefs among young adults and the association between these beliefs and dietary calcium intake. Methods: Seventy-nine participants (25 ± 4 y; 40 males) completed a milk product health belief questionnaire to determine a milk product health belief score (MPHBS) and a 3-day food record to assess dietary intake. Results: Despite generally positive views, young adults were uncertain about milk products in relation to health, weight management, and ethical concerns. Females would be more likely than males to increase milk product intake if they were confident that milk products are ethically produced. There was no significant association between MPHBS and dietary calcium intake. Energy-adjusted dietary calcium intake was positively associated with intakes of vitamin A (r = 0.3, P < 0.05), riboflavin (r = 0.5, P < 0.01), vitamin B₁₂ (r = 0.5, P = < 0.01), vitamin D (r = 0.4, P < 0.01), phosphorus (r = 0.4, P < 0.01), zinc (r = 0.3, P < 0.01), and with milk and alternatives servings (r = 0.8, P < 0.01). Conclusion: Nutrition education efforts focused on increasing calcium-rich food consumption will help consumers to be better informed when making dietary choices.

Comparing the cost of essential nutrients from different food sources in the American diet using NHANES 2011-2014

Background

One reason that some Americans do not meet nutrient needs from healthy eating patterns is cost. Food cost affects how people eat, and healthy diets tend to be more expensive. Cost is also important for diet sustainability. Sustainable eating patterns must be both nutritionally adequate and affordable. The objective of this study was to compare the cost of obtaining shortfall nutrients from different food groups to help identify cost-effective ways Americans can move towards healthy and sustainable eating patterns.

Methods

This analysis used dietary intake data from the National Health and Nutrition Examination Survey from 2011 to 2012 and 2013–2014 (n = 5876 children 2–18 years and n = 9953 adults 19–99 years). Americans’ nutrient intake from food categories in “What We Eat in America” and the 2015–2020 Dietary Guidelines for Americans was determined using the Food and Nutrient Database for Dietary Studies. Food cost and the cost of nutrients were obtained from Center for Nutrition Promotion and Policy food cost database 2001–2002 and 2003–2004 (adjusted for inflation).

Results

The daily mean cost of food was $4.74 ± 0.06 for children and $6.43 ± 0.06 for adults. “Protein foods” and “mixed dishes” were the two most expensive food categories (43–45% of daily food costs), while “grains,” “fruits,” and “vegetables” combined accounted for ~ 18% of the daily cost, and “milk and dairy” accounted for 6–12% of total daily food costs in both adults and children. “Milk and dairy” were the least expensive dietary sources of calcium and vitamin D in the American diet, while “grains” were the least expensive sources of iron and magnesium, and “protein foods” were the least expensive sources of choline. “Fruits” and “vegetables” were the least expensive sources of potassium and vitamin C, respectively, and “snacks and sweets” were the least expensive sources of vitamin E.

Conclusion

“Milk and dairy” were inexpensive sources of three of the four nutrients of public health concern (calcium, vitamin D, and potassium), while “grains” were the least expensive source of fiber. The results of this work reinforce the importance of consuming a variety of nutrient-rich foods for cost-effective, sustainable eating patterns.

Elevating dairy research and extension through partnership: Outcomes from the United States Department of Agriculture and National Dairy Council collaborative meeting to develop a coordination roadmap

Dairy foods provide a significant portion of the recommended daily nutrition for much of the US population. Improving the availability of safe and nutritious dairy products and decreasing the environmental impact of the dairy community continue to be high priorities for both industry and the public sector. In recognition of these shared priorities, scientists and other specialists from the USDA, National Dairy Council, industry, academia, and nongovernmental organizations participated in the "Elevating Dairy Research and Extension Through Partnership" meeting on June 19, 2018. The purpose of the meeting was to strengthen partnerships and identify dairy-related research and extension needs in human nutrition, environmental sustainability, food safety, and product innovation that would benefit from enhanced coordination and collaboration across the dairy community, academia, and government. To catalyze further progress on these topics, the meeting organizers agreed to leverage the content and expertise that emerged from the meeting to develop a dairy research and extension coordination roadmap. The roadmap will establish and articulate a vision for coordinated collaboration between USDA researchers, the National Dairy Council, university researchers, extension specialists, and other dairy community stakeholders in the private and public sectors. This article represents the proceedings of the meeting and is intended to broadly communicate the dairy research and extension discussion and next steps to the dairy research and extension communities and other stakeholders in industry, academic, and government sectors.

Dairy Product Intake in Older Adults across Europe Based On the SHARE Database

Objective: To evaluate dairy intake patterns in older adults across Europe. Methods: We conducted cross-sectional analysis using data from the fourth wave (2011/2012) of the Survey of Health, Aging and Retirement in Europe (SHARE) database. Prevalence rates regarding the number of weekly servings of dairy in individuals ≥50 years old were calculated for 16 European countries. Results: The overall prevalence rate of daily dairy product intake in Europe was 66.95% (CI95%: 66.28-67.63%). Global prevalence in men was 63.35% (CI95%:62.37-64.35%) and in women 69.80% (CI95%:68.86-70.71%). Among men, this type of intake was highest in Denmark (84.89% [CI95%: 79.11-90.66%]) and lowest in Poland (26.15% [CI95%: 22.71-29.58%]). Among women, the highest prevalence was found in Spain (89.51% [CI95%: 85.16-93.86%]) and the lowest in Poland (31.33% [CI95%: 27.05-35.61%]). The overall prevalence rate of dairy product intake less than once a week was 3.99% (CI95%: 3.83-4.16%). In terms of gender, men in Hungary (11.02% [CI95%: 9.16-12.89%]) and women in Slovenia (8.76% [CI95%: 7.26-10.25%]) had the lowest such intake. Conclusions: Dairy intake is very heterogeneous across Europe, with overall intake levels lower than recommended. Differences were also observed between genders, with a lower intake in men, and with age, with the intake lower in older individuals.

Australian children and adolescents who were drinkers of plain and flavored milk had the highest intakes of milk, total dairy, and calcium

Dairy is important for children and adolescents' bone development and nutritional needs, and it is not known how the type of milk consumed relates to overall dietary intakes. This study assessed the hypothesis that Australian children and adolescents who drink milk have greater milk, dairy, and micronutrient intakes compared to those who consume milk in other ways or avoid milk. A secondary analysis using day 1 data from the 2011-2012 National Nutrition and Physical Activity Survey was performed (n = 2812, 2-18 years). Children were classified as plain or flavored milk drinkers, other milk drinkers (eg, smoothies, milkshakes), nondrinkers of milk (eg. on cereal), or milk avoiders. Intakes of total dairy, milk, calcium, free sugars, and sugar-sweetened beverages were determined and adjusted for confounders. Milk consumption was popular (81%), and the majority (63%) of milk consumers were drinkers, and of those, 46% were plain, 32% were flavored, and 21% were other milk drinkers. Flavored and plain milk drinkers had higher total daily milk (480, 95% confidence interval [CI] 459-501 and 445, 95% CI 427-462 g, respectively), dairy (2.8, 95% CI 2.7-2.9 and 2.6, 95% CI 2.5-2.7 servings, respectively), and calcium (1049 ± 18 and 980 ± 15 mg, respectively) intakes than all other groups. Plain milk drinkers (10.7%, SD 6.2%) had a lower proportion of daily energy from free sugars than all other groups, but there was no difference in free sugars intake between plain and flavored milk drinkers, and there were no differences in anthropometric measures across groups. Plain and flavored milk drinkers and nondrinkers of milk had the lowest prevalence of sugar-sweetened beverages intake (P < .001). Plain milk drinkers followed by flavored milk drinkers had the most favorable milk, dairy, and nutrient intakes.

Nutrient intake disparities in the US: modeling the effect of food substitutions

Background

Diet quality among federal food assistance program participants remains low, and little research has assessed the diet quality of food insecure non-participants. Further research is needed to assess the extent to which food substitutions can improve the nutritional status of these vulnerable populations. Substituting egg dishes for other commonly consumed dishes at certain eating occasions may be an effective strategy for improving the daily nutrient intake among these groups. Eggs are rich in many important nutrients, and are low-cost and part of a wide range of cultural food menus, which are important considerations for low-income and ethnically diverse populations. To help guide the focus of targeted nutrition interventions and education campaigns for vulnerable populations, the present work begins by 1) estimating the prevalence of nutrient inadequacy among these groups, and then models the effect of consuming egg dishes instead of commonly consumed dishes at each eating occasion on 2) the prevalence of nutrient inadequacy, and 3) the mean intake of nutrients.

Methods

Dietary data from 34,741 adults ≥ 20 y were acquired from the National Health and Nutrition Examination Survey, 2001–2014. Diet pattern modeling was used to substitute commonly consumed egg dishes for commonly consumed main dishes at breakfast, lunch, and dinner. National Cancer Institute usual intake methods were used to estimate the prevalence of inadequate intake of 31 nutrients pre- and post-substitution, and a novel index was used to estimate change in intake of all nutrients collectively.

Results

Substituting eggs for commonly consumed main dishes at lunch or dinner did not change total daily nutrient intake for each group (P > 0.05), but decreased the prevalence of vitamin D inadequacy by 1–4 percentage points (P < 0.01). Substituting eggs for commonly consumed foods at breakfast increased the prevalence of folate inadequacy by 8–12 percentage points among each group (P < 0.01).

Conclusions

When making food substitutions to increase nutrient intake, eating occasion should be an important consideration. Further research is needed to better understand how food substitutions affect diet costs, which may be an important driver of food purchasing decisions among low income individuals with limited food budgets.

Electronic supplementary material

The online version of this article (10.1186/s12937-018-0360-z) contains supplementary material, which is available to authorized users.

Low calcium intakes among Australian adolescents and young adults are associated with higher consumption of discretionary foods and beverages

OBJECTIVES

Calcium is an essential nutrient required for peak bone mass growth during adolescence and into young adulthood. The aim of this study was to examine the calcium intake of Australian adolescents and young adults from both food sources and supplements; and the relationship between calcium intake and intake of food groups.

METHODS

Dietary data from 770 adolescents (14-18 y of age) and 774 young adults (19-25 y of age) from the 2011 to 12 National Nutrition and Physical Activity Survey were used. Analysis of covariances were conducted to identify associations between calcium intake and consumption of food groups.

RESULTS

For adolescents, 83% of males and 95% of females did not meet the Estimated Average Requirement (EAR); whereas for young adults, 69% of males and 83% of females failed to meet the EAR. Food sources contributing to calcium intake were similar across age groups and sex. The largest contributors included regular milk (15-24%), cheese (10-12%), refined low-fiber bread (10%), and low-fat milk (7-9%). For both age groups, the lowest consumers of calcium were the poorest consumers of dairy products and the highest consumers of discretionary food choices and alcoholic beverages. A higher consumption of calcium was associated with a higher intake of dairy products and lower intakes of meat and alternatives and all discretionary choices.

CONCLUSIONS

Calcium intake among Australian adolescents and young adults remains below recommendations, particularly in females. A higher intake of calcium was associated with a better dietary pattern. Further investment in interventions is indicated.

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.

Characterizing trends in fruit and vegetable intake in the USA by self-report and by supply-and-disappearance data: 2001-2014

OBJECTIVE

To examine the comparability of fruit and vegetable (F&V) intake data in the USA from 2001 to 2014 between data acquired from two national data collection programmes.

DESIGN

Cross-sectional analysis. Linear regression models estimated trends in daily per capita intake of total F&V. Pooled differences in intake of individual F&V (n 109) were examined by processing form (fresh, frozen, canned, dried and juice).

SETTING

What We Eat in America (WWEIA, 2001-2014) and Loss-Adjusted Food Availability data series (LAFA, 2001-2014).

RESULTS

No temporal trends were observed in daily per capita intake of total F&V from 2001 to 2014 using WWEIA and LAFA. Modest differences between WWEIA and LAFA were observed in mean pooled intake of most individual F&V.

CONCLUSIONS

WWEIA and LAFA produced similar estimates of F&V intake. However, WWEIA may be best suited for monitoring intake at the national level because it allows for the identification of individual F&V in foods with multiple ingredients, and it is structured for sub-population analysis and covariate control. LAFA does retain advantages for other research protocols, specifically by providing the only nationally representative estimates of food losses at various points in the food system, which makes it useful for examining the adequacy of the food supply at the agricultural, retail and consumer levels.

Evaluation of Physicochemical and Glycaemic Properties of Commercial Plant-Based Milk Substitutes

The market for plant-based dairy-type products is growing as consumers replace bovine milk in their diet, for medical reasons or as a lifestyle choice. A screening of 17 different commercial plant-based milk substitutes based on different cereals, nuts and legumes was performed, including the evaluation of physicochemical and glycaemic properties. Half of the analysed samples had low or no protein contents (<0.5 %). Only samples based on soya showed considerable high protein contents, matching the value of cow's milk (3.7 %). An in-vitro method was used to predict the glycaemic index. In general, the glycaemic index values ranged from 47 for bovine milk to 64 (almond-based) and up to 100 for rice-based samples. Most of the plant-based milk substitutes were highly unstable with separation rates up to 54.39 %/h. This study demonstrated that nutritional and physicochemical properties of plant-based milk substitutes are strongly dependent on the plant source, processing and fortification. Most products showed low nutritional qualities. Therefore, consumer awareness is important when plant-based milk substitutes are used as an alternative to cow's milk in the diet.

Are Dietary Supplements and Nutraceuticals Effective for Musculoskeletal Health and Cognitive Function? A Scoping Review

OBJECTIVE

The aim of our scoping review was to summarize the state of the art regarding micronutrients in order to identify which of them might effectively improve health status in the areas typically impaired in older people: bone, skeletal muscle, and cognitive function.

DESIGN

Scoping review.

METHODS

The Italian Study Group on Healthy Aging by Nutraceuticals and Dietary Supplements (HANDS) performed this scoping review, based on the following steps: doing a list of micronutrients related with musculoskeletal or cognitive functions, included in dietary supplements and nutraceuticals commercialized in Italy; planning a research on PubMed, according to an evidence-based approach, in order to the most relevant positive study for each micronutrient into each of the three areas involved (bone, skeletal muscle and cognitive function); identifying the micronutrients effective in maintaining or achieving an adequate health status in older people, specifying the effective and safe daily doses, according to the selected studies.

RESULTS

In literature we found 12 relevant positive studies (1 international society guidelines/recommendations, 1 systematic review, 7 randomized controlled trials, and 3 prospective cohort studies). We showed that only 16 micronutrients resulted to have appropriate scientific evidences in terms of improving musculoskeletal health and/or cognitive function in older people: beta-alanine, calcium, creatine, fluorides, leucine, magnesium, omega-3 fatty acids, potassium, vitamin B6, vitamin B9, vitamin B12, vitamin C, vitamin D, vitamin E, vitamin K2, and zinc.

CONCLUSION

This scoping review showed that selected micronutrients in adequate doses might have an ancillary role in musculoskeletal health and cognitive functions in older people.

Dairy Intakes in Older Irish Adults and Effects on Vitamin Micronutrient Status: Data from the TUDA Study

BACKGROUND

Consumption of dairy products has been associated with positive health outcomes including a lower risk of hypertension, improved bone health and a reduction in the risk of type 2 diabetes. The suggested dairy intake for health in older adults is three servings per day but recent analysis of the NHANES data for older adults reported 98% were not meeting these recommendations. No studies have investigated the consequences of such declines in the dairy intakes of Irish older adults and the subsequent effects on vitamin micronutrient status.

OBJECTIVES

To study the daily dairy intakes of older Irish adults and to examine how the frequency of dairy food consumption affects vitamin micronutrient status.

METHODS

Participants (n 4,317) were from the Trinity Ulster Department of Agriculture (TUDA) Study, a large study of older Irish adults (aged >60 yrs) designed to investigate gene-nutrient interactions in the development of chronic diseases of aging. The daily intake portion for milk, cheese and yoghurt was calculated from food frequency questionnaire (FFQ) responses. Blood samples were analysed for vitamin biomarkers as follows: vitamin B12 (total serum cobalamin and holotranscobalamin (holoTC)), folate (red cell folate (RCF) and serum folate), vitamin B2 (erythrocyte glutathione reductase activation coefficient (EGRac)), vitamin B6 (serum pyridoxal phosphate) and vitamin D (serum 25(OH)D).

RESULTS

The mean total reported dairy intake was 1.16 (SD 0.79) portions per day with males consuming significantly fewer total dairy portions compared to females (1.07 vs 1.21 respectively) (P<0.05). There was no significant difference in total daily dairy serving intakes by age decade (60-69, 70-79, >80 yrs). Overall, only 3.5% of the total population (n 151) achieved the recommended daily dairy intake of three or more servings per day. A significantly higher proportion of females (4%) compared to males (2.4%) met these dairy requirements (P=0.011). Blood concentrations of vitamin B12 biomarkers, RCF, vitamin B2 and vitamin B6 were significantly worse in those with the lowest tertile of dairy intake (0-0.71 servings) compared to those in the highest tertile (1.50-4.50 servings) (P<0.05).

CONCLUSION

This study found that more than 96% of the older adults sampled did not meet current daily dairy intake recommendations. The study is the largest to-date examining dairy intakes in older Irish adults, and provides evidence that daily dairy intakes (in particular yogurt) contribute significantly to the B-vitamin and vitamin D biomarker status of older adults. These results suggest that older adults who are already vulnerable to micronutrient inadequacies, are forgoing the nutritional advantages of vitamin-rich dairy products.

Complexity of vitamin E metabolism

Bioavailability of vitamin E is influenced by several factors, most are highlighted in this review. While gender, age and genetic constitution influence vitamin E bioavailability but cannot be modified, life-style and intake of vitamin E can be. Numerous factors must be taken into account however, i.e., when vitamin E is orally administrated, the food matrix may contain competing nutrients. The complex metabolic processes comprise intestinal absorption, vascular transport, hepatic sorting by intracellular binding proteins, such as the significant α-tocopherol-transfer protein, and hepatic metabolism. The coordinated changes involved in the hepatic metabolism of vitamin E provide an effective physiological pathway to protect tissues against the excessive accumulation of, in particular, non-α-tocopherol forms. Metabolism of vitamin E begins with one cycle of CYP4F2/CYP3A4-dependent ω-hydroxylation followed by five cycles of subsequent β-oxidation, and forms the water-soluble end-product carboxyethylhydroxychroman. All known hepatic metabolites can be conjugated and are excreted, depending on the length of their side-chain, either via urine or feces. The physiological handling of vitamin E underlies kinetics which vary between the different vitamin E forms. Here, saturation of the side-chain and also substitution of the chromanol ring system are important. Most of the metabolic reactions and processes that are involved with vitamin E are also shared by other fat soluble vitamins. Influencing interactions with other nutrients such as vitamin K or pharmaceuticals are also covered by this review. All these processes modulate the formation of vitamin E metabolites and their concentrations in tissues and body fluids. Differences in metabolism might be responsible for the discrepancies that have been observed in studies performed in vivo and in vitro using vitamin E as a supplement or nutrient. To evaluate individual vitamin E status, the analytical procedures used for detecting and quantifying vitamin E and its metabolites are crucial. The latest methods in analytics are presented.

Effects of Dairy Products Consumption on Health: Benefits and Beliefs--A Commentary from the Belgian Bone Club and the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases

Dairy products provide a package of essential nutrients that is difficult to obtain in low-dairy or dairy-free diets, and for many people it is not possible to achieve recommended daily calcium intakes with a dairy-free diet. Despite the established benefits for bone health, some people avoid dairy in their diet due to beliefs that dairy may be detrimental to health, especially in those with weight management issues, lactose intolerance, osteoarthritis, rheumatoid arthritis, or trying to avoid cardiovascular disease. This review provides information for health professionals to enable them to help their patients make informed decisions about consuming dairy products as part of a balanced diet. There may be a weak association between dairy consumption and a possible small weight reduction, with decreases in fat mass and waist circumference and increases in lean body mass. Lactose intolerant individuals may not need to completely eliminate dairy products from their diet, as both yogurt and hard cheese are well tolerated. Among people with arthritis, there is no evidence for a benefit to avoid dairy consumption. Dairy products do not increase the risk of cardiovascular disease, particularly if low fat. Intake of up to three servings of dairy products per day appears to be safe and may confer a favourable benefit with regard to bone health.

An overview of the contribution of dairy and cheese intakes to nutrient intakes in the Irish diet: results from the National Adult Nutrition Survey

Dairy products are important contributors to nutrient intakes. However, dairy intakes are reportedly declining in developed populations, potentially due to concerns regarding Na and SFA in dairy foods, particularly cheese. This could impact other nutrient intakes. The present study used data from the National Adult Nutrition Survey (NANS) to (1) examine dairy intakes, with a specific focus on cheese, and (2) to examine the contribution of cheese to population nutrient intakes. The NANS captured detailed dietary intake data from a nationally representative sample (n 1500) between 2008 and 2010 using 4-d semi-weighed food diaries; 99·9 % of the population reported dairy intake. Mean daily population dairy intake was 290·0 (sd 202·1) g. Dairy products provided 8·7 % of the population intake of reported dietary Na, 19·8 % SFA, 39 % Ca, 34·5 % vitamin B12 and 10·5 % Mg. Cheese alone provided 3·9 % Na intake, 9·1 % Ca, 12·6 % retinol, 8·3 % SFA, 3·7 % protein, 3·4 % vitamin B12 and 3·2 % riboflavin. High dairy consumers had greater Ca and Mg intakes per 10 MJ, greater total energy intake, greater percentage of energy from carbohydrate and SFA and lower Na intakes compared with low dairy consumers. Similar trends were observed for high consumers of cheese for most nutrients except Na. These results demonstrate that dairy and cheese are important contributors to nutrient intakes of public health interest, such as Ca and B12. Our analysis also demonstrated that food-based dietary guidelines recommending lower-fat versions of dairy products are warranted.

Dairy Products and Health: Recent Insights

Milk, cheese, yogurt, and other dairy products have long been known to provide good nutrition. Major healthful contributors to the diets of many people include the protein, minerals, vitamins, and fatty acids present in milk. Recent studies have shown that consumption of dairy products appears to be beneficial in muscle building, lowering blood pressure and low-density lipoprotein cholesterol, and preventing tooth decay, diabetes, cancer, and obesity. Additional benefits might be provided by organic milk and by probiotic microorganisms using milk products as a vehicle. New research on dairy products and nutrition will improve our understanding of the connections between these products, the bioactive compounds in them, and their effects on the human body.

Calcium requirements from dairy foods in France can be met at low energy and monetary cost

Inadequate Ca intakes are a concern for global public health. In France, most dietary Ca is provided by dairy products: milks, fermented milks (mostly yogurts), dairy desserts and cheeses. The present dairy database (n 837) included milks (n 101), fermented milks, yogurts and other fresh dairy products (n 326), desserts (n 162) and a wide variety of cheeses (n 248). Energy and nutrient values were obtained from industry sources and the French national nutrient composition database. Retail prices were from Paris supermarkets. Products in each group were aggregated into twenty-one categories using clustering analyses. The costs in energy (kJ (kcal)), euros (€), and in SFA, added sugar and Na (defined here as nutrients to LIMit) associated with providing 120 mg of Ca (equivalent to 15 % daily value (15 % DV)) were calculated for each product group and category. The milk group supplied Ca at the lowest energy, monetary and LIM cost. Fresh plain and ‘light’ yogurts and fermented milks were next, followed by sweetened yogurts and flavoured milks. Light dairy desserts provided Ca with relatively few energy but were more expensive. Cheeses were a heterogeneous group. Hard cheeses (Comté) provided the most Ca per serving. Semi-hard cheeses (Camembert) and cream and blue cheeses (Roquefort) provided Ca at a cost comparable with sweetened yogurts and flavoured milks. Double cream, soft and goat cheeses were not optimal Ca sources. New value metrics can help identify affordable dairy foods that provide Ca without excessive energy or nutrients to limit. These conditions were satisfied by a wide variety of dairy products in France.

Sources and Amounts of Animal, Dairy, and Plant Protein Intake of US Adults in 2007-2010

Dietary guidelines suggest consuming a mixed-protein diet, consisting of high-quality animal, dairy, and plant-based foods. However, current data on the distribution and the food sources of protein intake in a free-living, representative sample of US adults are not available. Data from the National Health and Nutrition Examination Survey (NHANES), 2007–2010, were used in these analyses (n = 10,977, age ≥ 19 years). Several US Department of Agriculture (USDA) databases were used to partition the composition of foods consumed into animal, dairy, or plant components. Mean ± SE animal, dairy, and plant protein intakes were determined and deciles of usual intakes were estimated. The percentages of total protein intake derived from animal, dairy, and plant protein were 46%, 16%, and 30%, respectively; 8% of intake could not be classified. Chicken and beef were the primary food sources of animal protein intake. Cheese, reduced-fat milk, and ice cream/dairy desserts were primary sources of dairy protein intake. Yeast breads, rolls/buns, and nuts/seeds were primary sources of plant protein intake. This study provides baseline data for assessing the effectiveness of public health interventions designed to alter the composition of protein foods consumed by the American public.

Daily intake of dairy products in Brazil and contributions to nutrient intakes: a cross-sectional study

Objective

Dairy products are sources of protein and micronutrients important in a healthy diet. The purpose of the present analysis was to estimate consumption of dairy products by Brazilians and identify contributions of dairy products to nutrient intakes.

Design

Dairy consumption data were obtained from 24 h dietary records. Dairy products were defined as milk (including flavoured), cheese and yoghurt. Estimates of dairy product intakes were generated for all individuals, individuals in urban and rural households and for age groups 10–18 years, 19–59 years and ≥60 years. Contributions to nutrient intakes were estimated for the total sample and sub-populations.

Setting

Nationwide cross-sectional survey, 2008–2009.

Subjects

Nationally representative sample of individuals aged ≥10 years in the Individual Food Intake survey, a component of the Brazilian Household Budget Survey (n 34 003).

Results

Among individuals aged ≥10 years, per capita intake of dairy products was 142 (se 2·1) g/d. Dairy product intake was higher among individuals in urban compared with rural areas and among groups 10–18 years and ≥60 years compared with adults aged 19–59 years. Dairy products accounted for 6·1 % of daily energy intake, 7·3 % of protein, 16·9 % of saturated fat, 11·1 % and 4·3 % of total and added sugars, respectively, and 10·2–37·9 % of daily Ca, vitamin D, P, vitamin A and K.

Conclusions

Dairy products were substantial contributors to daily intakes of selected nutrients of concern in Brazil, although mean daily dairy product consumption was less than a typical portion. Education efforts in Brazil to raise awareness about the nutritional role of dairy foods may serve to improve overall diet quality.

Commonly consumed protein foods contribute to nutrient intake, diet quality, and nutrient adequacy

The amount of dietary protein needed to prevent deficiency in most individuals is defined in the United States and Canada by the Recommended Dietary Allowance and is currently set at 0.8 g protein · kg^-1 · d^-1 for adults. To meet this protein recommendation, the intake of a variety of protein food sources is advised. The goal of this article is to show that commonly consumed food sources of protein are more than just protein but also significant sources of essential nutrients. Commonly consumed sources of dietary protein frequently contribute substantially to intakes of nutrients such as calcium, vitamin D, potassium, dietary fiber, iron, and folate, which have been identified as nutrients of "concern" (i.e., intakes are often lower than recommended). Despite this, dietary recommendations to reduce intakes of saturated fat and solid fats may result in dietary guidance to reduce intakes of commonly consumed food sources of protein, in particular animal-based protein. We propose that following such dietary guidance would make it difficult to meet recommended intakes for a number of nutrients, at least without marked changes in dietary consumption patterns. These apparently conflicting pieces of dietary guidance are hard to reconcile; however, we view it as prudent to advise the intake of high-quality dietary protein to ensure adequate intakes of a number of nutrients, particularly nutrients of concern.