Type 2 Diabetes is a growing global health crisis, demanding comprehensive strategies to combat its rise. As highlighted during the symposium ‘Yogurt and Reduced Risk of Type 2 Diabetes: Exploring the New FDA Qualified Health Claim and Potential Implications for Improving Public Health’ at the ASN Nutrition 2024, incorporating nutrition expertise and food-based approaches, such as yogurt with its unique nutrient profile, is crucial in addressing diabetes risk. In this interview, Dr Christopher Cifelli, PhD discusses the recent FDA-qualified health claim on yogurt’s role in reducing type 2 diabetes risk and its broader implications for public health and nutrition policies.
Key messages:
- On March 1st, the FDA announced a qualified health claim outlining that regular yogurt consumption (at least 2 cups or 3 servings per week) may reduce the risk of type 2 diabetes, according to limited scientific evidence.
- The body of evidence, which analyzed data from over 800,000 individuals, supports that yogurt consumption is associated with better health outcomes, particularly in reducing the risk of type 2 diabetes.
- Yogurt is a nutrient-dense food that provides essential nutrients and fits well within the three healthy dietary patterns recommended by the Dietary Guidelines for Americans.
- The unique food matrix of yogurt, including its nutrient content and fermentation products, may contribute to its protective effects on cardiometabolic health, independent of its fat content. Study results align with broader research on yogurt and overall health benefits.
Can you introduce yourself and let us know about your work?
I am Senior Vice President of Nutrition Research at the National Dairy Council, which represents the nearly 30,000 dairy farmers across the United States through our checkoff organization.
How would you describe the burden that type 2 diabetes represents?
Type 2 diabetes (T2D) is a significant health concern in the United States, with 38.4 million people affected, representing 11.6% of the population. Additionally, 8.7 million people are undiagnosed, and 97.6 million adults have prediabetes, increasing their risk of developing T2D. Over the past two decades, the number of adults diagnosed with diabetes has more than doubled, making it the eighth leading cause of death. The financial impact is substantial, with medical costs and lost wages for those with diagnosed diabetes totaling $413 billion annually. Medical costs for people with diabetes are more than twice as high as those without the condition.
Healthy lifestyle choices are crucial in reducing the risk of T2D and mitigating public health costs. Maintaining a healthy weight, engaging in regular physical activity, and following a balanced diet are key strategies for T2D prevention, treatment, and management. Weight loss helps lower the risk of T2D and other chronic diseases, regular exercise aids in blood sugar management and reduces the risk of heart disease, and a nutritious diet is essential for overall health. For more detailed information, resources such as the International Diabetes Federation’s data portal and the USDA’s Dietary Guidelines for Americans 2020-2025 can provide valuable insights.
How does yogurt consumption compare with other dairy products in terms of its impact on the risk of type 2 diabetes?
All dairy products contain essential nutrients and are generally healthy. Milk’s unique nutrient package offers a range of essential vitamins and minerals, including calcium, iodine, riboflavin (B2), vitamin B12, protein, potassium, vitamin D, phosphorus, vitamin A, niacin (B3), pantothenic acid (B5), selenium, and zinc. These nutrients make dairy foods a powerful contributor to a healthy diet, providing essential components that support various bodily functions and overall well-being.
However, when it comes to type 2 diabetes, regular yogurt consumption may reduce the risk. This association is observed across numerous prospective cohort studies in various populations both in the US and globally. In contrast, milk and cheese do not exhibit the same level of consistency in reducing type 2 diabetes risk. Yogurt stands out as the most consistently linked dairy food associated with a reduced risk of type 2 diabetes.
What evidence supports the role of yogurt in reducing the risk of type 2 diabetes in different demographic groups such as children, adults, and the elderly?
Most of the research on yogurt’s role in reducing the risk of type 2 diabetes has been conducted in adults, primarily through observational studies. Several meta-analyses have also been performed. The FDA, in their review of the evidence, cited 28 studies, with the majority showing a reduction in type 2 diabetes risk. This body of research spans decades, and demonstrates yogurt’s role in reducing the risk.
Four meta-analyses have consistently associated yogurt intake with a reduced risk of Type 2 Diabetes (T2D). Studies by Tong et al. (2011), Gao et al. (2013), Chen et al. (2014), and Gijsbers et al. (2016) demonstrated relative risk reductions ranging from 0.85 to 0.94 across various cohorts, highlighting yogurt’s beneficial impact. The FDA’s rigorous review process, spanning from 2019 to 2024, culminated in a qualified health claim linking yogurt consumption to a reduced risk of T2D, according to limited scientific evidence. This work, led by Danone, involved a thorough analysis of over 100 studies, and ultimately drew conclusions from 28 studies with over 860,000 subjects from 27 cohorts in 10 countries, consistently showing yogurt’s positive effect. Additionally, research from PREDIMED and other large prospective cohorts in the U.S. and globally supported these findings, demonstrating yogurt’s significant association with reduced T2D risk.
The scientific literature underscores yogurt’s unique role compared to other dairy products in lowering T2D risk. Various studies across different demographic groups, including the general adult population, postmenopausal women, and elderly populations, support the link between regular yogurt consumption and a decreased risk of type 2 diabetes. The Joslin Diabetes Center’s 2018 clinical nutrition guidelines recommend including yogurt as part of a healthy dietary pattern for those with or at risk for T2D, regardless of fat content. Moreover, emerging evidence suggests that yogurt may have anti-inflammatory effects, contributing to the prevention of noncommunicable diseases like diabetes. This extensive body of research highlights the importance of yogurt as a valuable component of a diabetes-prevention diet.
What biological mechanisms have been proposed to explain the inverse relationship between yogurt consumption and the risk of type 2 diabetes?
While still not fully understood, there are several potential mechanisms by which yogurt consumption may help reduce the risk of type 2 diabetes. Firstly, yogurt itself can help reduce appetite, as dairy proteins have been shown to lower appetite when part of a healthy diet. Secondly, the unique fats produced by the starter cultures in yogurt have been shown to impact liver function, improve metabolism, and reduce insulin resistance. Additionally, studies have indicated that yogurt can help maintain gut barrier function and lower inflammation. These are three key mechanisms through which yogurt may help reduce diabetes risk.
Yogurt’s profile also supports general health. Its essential nutrients such as protein, calcium, and other minerals make it unique when considering nutritional adequacy. Additionally, the bacteria and bacterial enzymes in yogurt can help support digestive health, while fermentation products like short-chain fatty acids, bioactive peptides, and B vitamins contribute to its positive effects. Yogurt also offers other benefits like lower pH and increased nutrient bioavailability, supporting overall health.
