René Rizzoli, MD, PhD, Professor of Medicine and Head of the Service of Bone Diseases at the University Hospitals of Geneva, is the International Osteoporosis Foundation (IOF) representative in the Yogurt in Nutrition Initiative (YINI).

In post-menopausal women, yogurt contributes to support intakes of protein and calcium and vitamin D, particularly when enriched in those nutrients.  Dr. Rizzoli has examined extensively the importance of dairy protein for musculoskeletal health.

Dr. Rizzoli participated in a working group within the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) to provide clinical recommendations on protein and vitamin D intakes for prevention of the age-related musculoskeletal disorders in postmenopausal or elderly women.

While external supplementation is available, the working group recommended optimal dietary protein and vitamin D intakes, regular physical exercise and advised consuming preferentially high quality protein, such as those from dairy sources.

“One of the most important modifications of yogurt in modern times is the global access of ready to eat products, whether in packages suitable for children, with probiotics or with claims regarding intestinal functioning,” said Mauro Fisberg, MD, PhD, Federal University of Sao Paulo, Brazil.

“There is a growing body of evidence linking yogurt consumption to good health, and additional research to identify the scientific link between yogurt and potential health benefits is underway.”

Milk protein in yogurt are beneficial to elderly heath status especially muscle strength and mass, as was discussed at the 2nd Global Summit on the Health Effects of Yogurt by Robert R. Wolfe, PhD, the Director of the Center for Translational Research in Aging and Longevity at the University of Arkansas for Medical Sciences.

Dr. Wolfe’s recent study focused on the importance of plentiful protein for the elderly not just in maintaining muscle mass, but to benefit in cardiovascular and bone health. For the elderly, the optimal intake of protein is approximately 1.5 grams/kilogram body weight/day, which yogurt can help meet. Therefore yogurt and other milk proteins can help people through lifespan consume enough high quality protein without overloading on calories.

Nutrient profile models calculate the content of key nutrients per 100 g, 100 kcal, or per serving size of food. Nutrient profile models need to be based on nutrient composition data that are public and also to be validated against independent measures of healthy diet.

The Nutrient-Rich Foods (NRF) family of nutrient profile models included beneficial nutrients as well as nutrients to limit. The NRF model performance was repeatedly tested against the Healthy Eating Index (HEI), an independent measure of a healthy diet. The final NRF9.3 index was based on 9 nutrients to encourage (protein; fiber; vitamins A, C, and E; calcium; iron; potassium; and magnesium) and on 3 nutrients to limit (saturated fat, added sugar, and sodium). Higher NRF9.3 scores were associated with lower energy density and more nutrient-rich diets.

The nutrient density of foods, together with an efficient program of consumer education, can become the foundation of dietary recommendations and guidelines.

Source : Drewnowski A, Fulgoni VL. Am J Clin Nutr. 2014 May;99(5 Suppl):1223S-8S. doi: 10.3945/ajcn.113.073395. Epub 2014 Mar 19.

Low lactase activity allows undigested lactose to reach the colon where the anaerobic activity of bacteria yields different products. These are principally short chain fatty acids, hydrogen, carbon dioxide and methane, responsible for symptoms mainly consisting of abdominal pain, bloating, flatulence and diarrhoea.

Lactase deficiency may be genetically mediated or acquired after weaning, or secondary to diseases damaging the small bowel mucosa, such as celiac disease, enteritis or Crohn’s disease. Lactose malabsorption is due to lactase deficiency and its clinical expression is lactose intolerance: in clinical practice, lactose malabsorption is diagnosed using the hydrogen breath test (HBT) that should be accompanied by the collection of intolerance symptoms potentially provoked by HBT.

The treatment is lactose avoidance/reduction in the diet: this approach should be reserved for symptomatic patients (“intolerants”). Dietetic advice should aim to ensure nutritional adequacy of the diet and to avoid nutritional deficiencies, in particular due to a lower calcium intake. Yogurt is well tolerated by symptomatic subjects, as a result of the residual activity of lactase in the bacteria that it contains, breaking down the lactose.

Source: Dainese-Plichon R et al. Nutr Clin Métabol 2014 ; 28(1) : 46-51.

This review provides a current perspective on proposed mechanisms that may underlie these effects.

Results from epidemiological studies generally support that consumption of milk and dairy products is associated with a lower incidence of type 2 diabetes (T2D) or improvements in glucose homeostasis indices. In addition, studies of animal and cell models support a positive effect of dairy-rich diets or components on metabolic and inflammation factors relevant to T2D and insulin resistance.

Emerging evidence indicates that dairy components that alter mitochondrial function (e.g. leucine actions on silent information regulator transcript 1 (SIRT1)-associated pathways), promote gut microbial population shifts, or influence inflammation and cardiovascular function (e.g. Ca-regulated peptides calcitonin gene-related peptide [CGRP] or calcitonin) should be considered as possible mechanistic factors linking dairy intake with lower risk for T2D. The possibility that dairy-derived trans-palmitoleic acid (tC16:1) has metabolic bioactivities has also been suggested.

Source: Hirahatake KM et al Metabolism – Clinical and Experimental Volume 63, Issue 5, Pages 618–627, May 2014

This review examined the evidence behind dietary guidelines for dairy.

Most countries recommend the consumption of dairy products. When amounts are specified, recommendations are typically for 2 or 3 servings per day. Specific recommendations for dairy products are based partly on culture and availability but primarily on meeting nutrient requirements.

Dairy products are a rich source of many minerals and vitamins as well as high-quality protein. Thus, dairy consumption is a marker for diet quality. The recommendation for low-fat dairy is more an argument to reduce energy intake from fat and added sugar than from evidence of health concerns.

Milk and cheese represent 9.2% of the intake of energy, 10.9% of fat, and 8.3% of carbohydrates in the diet of Americans, but these products also contribute 46.3% of calcium, 11.6% of potassium, and 7.9% of magnesium to the American diet, which may provide overriding benefits to health.

A recent report found that yogurt specifically is a good marker of diet quality. The food patterns recommended by the 2010 Dietary Guidelines for Americans Advisory Committee (DGAC) include 3 cups of low-fat milk and milk products. Few people achieve their recommended intakes of several shortfall nutrients without meeting their recommendations for dairy.

Newer data since the recommendations of the 2010 DGAC are presented. However, the strength of the evidence for links between dairy consumption and health is limited by the lack of appropriately powered randomized controlled trials.

Source: Weaver CM. Am J Clin Nutr 2014;99(suppl):1217S.

This brief review focuses on children and adolescents, introducing new concepts underlying the effect of yogurt consumption on body weight maintenance and the prevention of cardiovascular diseases. Yogurt is an easy-to-digest, nutrient-dense, satiating food that contains high-quality protein and specific amino acids such as BCAAs.

Moreover, yogurt may act as a modulator of the gut microbiota in infancy and the specific matrix of yogurt has bioavailability and metabolic properties that can be exploited to increase the functionality of this dairy product.

Epidemiological studies and clinical trials that consider the interactions of yogurt nutrients and bacteria within the food matrix are warranted, in order to evaluate the effect of yogurt on the modulation of gut microbiota and the prevention of obesity and cardiometabolic diseases.

Source: Marette A| Picard-Deland E. Am J Clin Nutr 2014;99(suppl):1243S

Evolutionary evidence shows clearly that the consumption of milk and dairy products into later childhood and adulthood has conferred significant advantages in terms of survival and/or reproductive success among our ancestors.

This ability to consume high amounts of lactose without unpleasant side effects has been achieved through evolution of the lactase persistence (LP) trait and through domestication of lactic acid bacteria to create fermented milk products.

Indeed, for people lacking the LP trait, the fermentation of milk into yogurt and related products (a process known for >/=8500 y) aids milk digestion through the breakdown of some lactose and the provision of beta-galactosidase, which remains active in the gastrointestinal tract. In global ecological comparisons, milk and dairy intakes are strongly associated with adult height, and many international advisory bodies recommend the consumption of 400-500 ml milk equivalents/d. There are very few countries where such high intakes are met.

Populations with a low intake of dairy products have adaptive mechanisms that allow them to grow and maintain good bone health even at calcium intakes that are greatly below the RNI in high-income countries. The disturbance of these adaptations has been reported to cause some adverse sequelae, so it should not always be assumed that increasing calcium intake would be beneficial.

For this reason, a global RNI value may not be appropriate. Despite concerns that the high-saturated-fat content of full-fat dairy products may promote heart disease, recent meta-analyses show that dairy consumption is neutral or beneficial for weight control, coronary disease, diabetes, hypertension, and most cancers.

Source: Prentice AM. Am J Clin Nutr 2014;99(suppl):1212S

Studies analysing the relationship between consumption of yogurt and prevention of obesity or becoming overweight have been carried out in recent years.

The recent publication of the SUN cohort has provided new evidence concluding that high consumption of yogurt (at least 7 units a week) is associated with lower risk of becoming obese or overweight.

The scientific journal “Nutrition, Metabolism, and Cardiovascular Diseases” has published the results of the study “Yogurt consumption, weight change, and risk of overweight/obesity: The SUN cohort study” in which the consumption of yogurt by 8,513 individuals was monitored for six years and eight months. None of these subjects were overweight at the start of the study but 1,860 became overweight or obese during the follow-up period.

Yogurt and healthy lifestyle

The study was led by Prof. Miguel Ángel Martínez, Head of Preventive Medicine and Public Health at the University of Navarra and member of the nutrition and obesity CIBER . The participants were classified according to total consumption of yogurt (full-fat and skimmed) in five categories: less than two, two to five, five to seven, seven, and more than seven yogurts a week. All other variables related to obesity being equal, it was observed that participants in the category of largest yogurt consumption (7 or more units a week) presented significantly less risk of becoming obese or overweight.

Furthermore, the study found that the risk of obesity associated with consumption of yogurt is reduced even more among participants with high fruit consumption, concluding that consumption of yogurt can play a role in the prevention of obesity and becoming overweight and specifically when combined with a healthy overall dietary pattern.

Calcium is key

A possible biological mechanism suggested by other studies that may explain the relationship between consumption of yogurt and lower risk of gaining weight is the calcium content. The study presented in this paper proposed that calcium affects the metabolism of fats; therefore, increased ingestion of calcium, contained in dairy products, may increase the oxidation of fats.

Source : Martinez-Gonzalez MA et al. Nutr Metab Cardiovasc Dis. 2014 Jun 15. pii: S0939-4753(14)00197-5. doi: 10.1016/j.numecd.2014.05.015. [Epub ahead of print]