This experimental pilot study compared the composition of a snack in a multidimensional approach to satiety in 18 healthy young men of normal weight.

Volunteers were asked to eat four meals a day in the laboratory, including a snack consisting of either liquid yogurt or a chocolate bar, identical in weight (366 g) and calories (285 kcal). The perception of hunger, appetite, desire to eat and stomach fullness were measured at regular intervals of 20 minutes. The time until the next meal and its caloric intake were also assessed.

The results show a higher perception of satiety after 60 minutes with yogurt, but no significant difference between the two foodstuffs in the time before taking the next meal or the calories it contained.

Source: Chapelot D, Payen F. Br J Nutr. 2010 Mar; 103(5):760-7. doi: 10.1017/S000711450999225X. Epub 2009 Oct 29.

Consumption of dairy products (full-fat, low-fat, yogurts) was assessed at the beginning and after 3 years of monitoring. At the end of the study, the results after adjustment suggest that consumption of low-fat dairy products is inversely associated with the risk of type 2 diabetes.

In the highest quintile of consumption (2.8 servings per day), the relative risk amounted to 0.5 compared with the lowest quintile (0.05 servings per day). The analysis also indicates a lower risk in women with a high BMI and high consumption of yogurt. No relationship was observed with full-fat dairy products.

Source: Margolis KL et al. J Nutr. 2011 November; 141(11): 1969–1974.Published online 2011 September 21. doi: 10.3945/jn.111.143339

What makes this review original is that it makes comparisons between low-fat dairy products, full-fat dairy products, cheese and liquid dairy products (milk and yogurt). The results show a 13% reduction in the risk of hypertension with consumption of dairy products.

Segmentation by category of dairy products, however, showed a significant association with low-fat dairy products (- 16%) and liquid dairy products (- 8%). This effect was not observed for cheese and full-fat dairy products.

Source: Ralston RA et al. J Hum Hypertens. 2012 Jan; 26(1):3-13. doi: 10.1038/jhh.2011.3. Epub 2011 Feb 10.

The Yogurt in Nutrition Initiative’s presentations on September 16 at the International Union of Nutritional Science’s 20th International Congress of Nutrition (Granada, Spain) featured information from experts who spoke about the main science related to yogurt and identified gaps that need to be addressed within the scientific community, including the influence on “nutrition economy”.

Not only does yogurt consumption hold promise for individual health, it may also carry positive impacts for the cost of healthcare,” said Dr. David McCarron, MD, Department of Nutrition, University of California-Davis. A 2004 analysis from our program calculated the potential healthcare savings in the U.S for common medical conditions known to be responsive to increased dairy product consumption. Using conservative estimates, we projected first year savings of approximately $26 billion and 5-year cumulative savings in excess of $200 billion.

This presentation updates that 2004 analysis of healthcare savings and defines the central role of yogurt and related products consumption in achieving an optimal dietary pattern known to impact common chronic diseases. Using a standard PubMed search process recent reports that assessed dairy and yogurt consumption as an essential component of diet quality were identified. Estimated one-year and five-year healthcare savings were calculated employing conservative assumptions as to the percentage of individuals actually achieving adequate yogurt consumption as an essential component of a high quality diet.

Based on current estimates of U.S. healthcare costs and conservative estimates of the impact on specific conditions, this current analysis projects that in the U.S., $83 billion would be saved in the first year and up to $910 billion over five years. Worldwide first year healthcare savings are estimated at $95 billion. The potential healthcare savings from consuming an optimal diet that is adequate in yogurt and dairy are profound for the U.S. as well as worldwide and have increased substantially in the past decade.

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Sources:

McCarron DA, Heaney RP. Estimated healthcare savings associated with adequate dairy food intake. Am J Hypertens 2004;17:88-97.

Mozaffarian D, Hao T, Rimm EB, Willett WC, Hu FB. Changes in diet and lifestyle and long-term weight gain in women and men. N Engl J Med 2011;364:2392-2404.

Mitrou PN, Kipnis V, Thiébaut AC, Reedy J, Subar AF, Wirfält E, Flood A, Mouw T, Hollenbeck AR, Leitzmann MF, Schatzkin A. Mediterranean dietary pattern and prediction of all-cause mortality in a US population: results from the NIH-AARP Diet and Health Study. Arch Intern Med 2007;167:2461-2468.

McNaughton SA, Bates CJ, Mishra GD. Diet quality is associated with all-cause mortality in adults aged 65 years and older. J Nutr 2012;142:320-325. doi: 10.3945/jn.111.148692.

Kant AK, Leitzmann MF, Park Y, Hollenbeck A, Schatzkin A. Patterns of recommended dietary behaviors predict subsequent risk of mortality in a large cohort of men and women in the United States. J Nutr 2009;139:1374-1380.

Nicklas TA, Qu H, Hughes SO, He M, Wagner SE, Foushee HR, Shewchuk RM. Self-perceived lactose intolerance results in lower intakes of calcium and dairy foods is associated with hypertension and diabetes in adults. Am J Clin Nutr 2011;94:191-198.

Wang H, Livingston KA, Fox CS, Meigs JB, Jacques PF. Yogurt consumption is associated with better diet quality and metabolic profile in American men and women. Nutr Res 2013;33:18-26.

Murray CJL, Lopez AD. Measuring the global burden of disease. N Engl J Med 2013; 369: 448-457.

According to Andrew M Prentice, PhD, from MRC International Nutrition Group, London School of Hygiene & Tropical Medicine, the intake of dairy produce shows enormous diversity between regions, cultures and individuals around the world. At the geographical level intake maps closely onto the distribution of lactase persistence (LP); a genetic trait that allows milk to be consumed beyond the weaning period without gastrointestinal side effects.

The LP trait has been independently selected at least 4 times and is under rapid positive selection showing that dairy consumption has very positive dietary benefits. For people lacking the LP trait and those with irritable bowel syndrome (IBD) the fermentation of milk into yogurt and related products (a process known for at least 8500y) aids milk digestion through the breakdown of lactose and the provision of bacterially-derived beta-galactosidase which remains active in the gastrointestinal tract.

Dietary recommendations

Despite concerns that the high saturated fat content of full-fat dairy produce would promote heart disease the latest meta-analyses show dairy consumption to be neutral or beneficial for weight control, coronary disease, diabetes, hypertension and most cancers.

In global ecological comparisons milk and dairy intake is strongly associated with adult height and many international advisory bodies recommend the consumption of 400-500ml milk equivalents per day, but few population groups meet these levels. Of 50 national food-based dietary guidelines (FBDG) surveyed two-thirds make reference to yogurt and either give guideline quantities or encourage an increase in consumption within the wider guideline to increase intakes of low-fat dairy produce.

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Further reading:

Brussow H. Nutrition, population growth and disease: A short history of lactose. Environmental Microbiology (2013) doi:10.1111/1462-2920.12117

Tishkoff SA, Reed FA, Ranciaro A, Voight BF, Babbitt CC, Silverman JS, Powell K, Mortensen HM, Hirbo JB, Osman M, Ibrahim M, Omar SA, Lema G, Nyambo TB, Ghori J, Bumpstead S, Pritchard JK, Wray GA, Deloukas P. Convergent adaptation of human lactase persistence in Africa and Europe. Nat Genet. 2007;39:31-40.

The Yogurt in Nutrition Initiative’s presentations on September 16 at the International Union of Nutritional Science’s 20th International Congress of Nutrition featured information from experts who spoke about the main science related to yogurt.

On her side, Nicole Darmon, PhD, Research Director at the National Research Institute of Agronomy (INRA), has examined how yogurt can fit into a nutritionally adequate diet.

Individual diet modeling with linear programming (2) was used to analyse and quantify the food changes needed to achieve a whole set of nutrient-based recommendations in a French adult population, with a focus on dairy products. From each individual weekly food intake (observed diets) of adults (n=1171) participating in the French national INCA (Enquête Individuelle et Nationale sur les Consommations Alimentaires) dietary survey, an isocaloric modelled diet was designed to simultaneously meet a whole set of nutrient recommendations (proteins, lipids, carbohydrates, fiber, essential fatty acids, 10 vitamins, 9 minerals, sodium, saturated fatty acids, cholesterol, and free sugars) while deviating the least from the observed food intakes.

The results indicated that, among seven main food groups, the quantities of three food groups had to be increased to reach nutritional adequacy, and the dairy group was one of them, together with fruit and vegetables (including nuts), and starches and grains. For all the food groups except the dairy one, their variation in energy contribution between the optimal diets and the observed ones followed their variation in weight.

Nutrient density

For instance, the contributions of fruits and vegetables to both total diet weight and total energy intake had to be increased by one third, and that of added fats had to be reduced by one third. The dairy group behave differently, as its weight increased by about 19% while its energy contribution decreased by 14%. This was explained by a heterogeneity within the dairy group, with an increase (in weight) of fresh dairy products (+ 60%) and milk (+17%), a decrease of cheese (-48%), without significant change of dairy desserts.

Lastly, Darmon and her team quantified the changes needed, within the dairy group, that were compatible with the fulfillment of all nutrient recommendations. Cheeses represented one out of two consumed portions of milk-based products in observed diets, whereas in modeled diets cheeses, milk, and yogurts each represented about one portion per day. Milk desserts were similar before and after optimization, at approximately one portion per week.

These results confirm that a large increase in intake of plant-based products is needed. They show that rebalancing the intake of milk-based products in favor of the least energy-dense ones (i.e., yogurts and milk) will help individuals in this population reach nutritional adequacy.

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Sources:

Clerfeuille E, Maillot M, Verger EO, Lluch A, Darmon N, Rolf-Pedersen N. Dairy products: how they fit in nutritionally adequate diets. J Acad Nutr Diet 2013;113:950-6.

Maillot M, Vieux F, Amiot J, Darmon N. Individual diet modeling translates nutrient recommendations into realistic and individual-specific food choices. Am J Clin Nutr 2010;91:421-30.

According to Arne Astrup (Department of Nutrition, Exercise and Sports, University of Copenhagen, Denmark), dairy products contribute important nutrients to our diet, including calcium, protein and other micro- and macro-nutrients.

Dairy products can be high in saturated fats, and dietary guidelines generally recommend reducing the intake of saturated fatty acids (SFAs) to reduce cardiovascular disease (CVD).

However, recent evidence question the role of SFAs in CVD, finding that substitution of SFAs in the diet with omega-6 (n-6) polyunsaturated fatty acids abundant in vegetable oils can, in fact, lead to an increased risk of death from coronary heart disease (CHD) and CVD, unless it is balanced with n-3 polyunsaturated fat. Replacing SFAs with carbohydrates of high glycemic index is also associated with a higher risk of CHD. Paradoxically, observational studies indicate that consumption of milk or dairy products is inversely related to incidence of CVD and diabetes.

Consumption of dairy products has been suggested to ameliorate characteristics of the metabolic syndrome, a cluster of risk factors including dyslipidemia, insulin resistance, increased blood pressure and abdominal obesity that together markedly increase the risk of diabetes and CVD.

Dairy products, like cheese, do not exert the negative effects on blood lipids as predicted solely by the content of saturated fat. Calcium, protein and other bioactive components may modify the effects on low-density lipoprotein cholesterol, triglycerides, blood pressure and energy balance. Apart from supplying valuable dairy nutrients, yogurt may also exert beneficial probiotic effects.

The consumption of yogurt, and other dairy products, in observational studies is associated with a reduced risk of weight gain and obesity, as well as CVD, and these findings are, in part, supported by randomized trials.

Yogurt is a nutrient-dense, tasty, handy and easily digested product to help people reach their daily dairy intake without excess calories. Replacing less healthy snacks and foods with yogurt is a simple way to re-establish healthier daily dietary habits.

Guidelines: the ‘Ideal’ healthy snacks

• Consuming products with a low energy density should be more satiating as, for the same number of calories, one would have to eat more of those foods (in volume).
• An ‘ideal’ healthy snack should have a high nutrient density and promote the feeling of satiation/satisfaction.
• Where weight control and obesity are a concern, an ideal snack should also have a low energy density.
• Yogurt is a nutrient-dense, tasty, handy and easily digested product to help people reach their daily dairy intake without excess calories.
• Replacing less healthy snacks and foods with yogurt is a simple way to re-establish healthier daily dietary habits.

A step further

Nutrient versus energy density: glossary (1,2)

• Nutrient density* describes the ratio of nutrients (in grams) to energy content (in joules or calories) of any particular food.
• Energy density* describes the amount of calories per gram of food. Its use helps consumers evaluate the energy provided by snacks through a given mass/volume ratio.

*calculation varies according to country

Snacking: what is a healthier alternative?

• An unhealthy snack can be described as having a low nutrient content and a high energy density, and failing to satiate, thus potentially promoting the craving for further consumption.
• An ‘ideal’ healthy snack would therefore have a high nutrient density and promote a feeling of satiation and satisfaction, which may limit its excessive consumption.

 Relevance of yogurt today

• According to the Nutrient Rich Foods (NRF) Index and the SAIN/LIM Index, 2 systems to rank foods according to their nutritional content validated in the USA and FRANCE, milk and yogurt are the second most nutrient-dense group of foods, behind vegetables and fruits (2, 7).

• Yogurt is a good source of protein, calcium and phosphorus, and also contains zinc and vitamin B2, B12, B5, B9 and A. The bioavailability of these nutrients in yogurt is also generally good (3).
• The proteins in yogurt contain all 9 essential amino acids and are of a higher quality than proteins from plant sources (4).
• Yogurt has a much lower energy density than most cheeses (5).
• The consumption of dairy, including yogurt but not cheese, is associated with a reduced incidence of type 2 diabetes and lower fasting blood glucose levels (6).

 Sources:

1. Dietary Guidelines for Americans, 2010. Available at www.dietaryguidelines.gov
2. Drewnowski A. Concept of a nutritious food: toward a nutrient density score. Am J Clin Nutr. Oct 2005; 82 (4) : 721-32
3. Gaucheron F. Milk and dairy products: a unique micronutrient combination. J Am Coll Nutr. 2011; 30 (5 Suppl1) : 400S-9S
4. Bos C et al. Nutritional and physiological criteria in the assessment of milk protein quality for humans. J Am Coll Nutr. 2000 ; 19 (2 Suppl) : 191S-205S
5. French food composition table, Table Ciqual 2008. Available at http://www.ansespro.fr/TableCIQUAL/
6. Fumeron F et al. Dairy consumption and the incidence of hyperglycemia and the metabolic syndrome: results from a French prospective study. Data from the Epidemiological Study on the Insulin Resistance Syndrome (DESIR). Diabetes Care 2011 ; 34 (4) : 813-7
7. Darmon N et al. Am J Clin Nutr April 2009 vol. 89 no. 4 1227-1236

Are the symptoms attributed to lactose intolerance really caused by lactose?

Researchers from Barcelona set out to ascertain this in 353 patients, who underwent a hydrogen test. The results show that the symptoms that the patients said they experienced following the consumption of dairy products at home were significantly more severe than those reported during the test, in which the participants were required to ingest 50 g of lactose.

Moreover, the test reveals an ‘over-perception’ of lactose intolerance at home, among both women and men. This study therefore shows that many symptoms are mistakenly attributed to lactose maldigestion.

Source: Casellas F et al. Clin Gastroenterol Hepatol. 2010 Jul;8(7):581-6. doi: 10.1016/j.cgh.2010.03.027. Epub 2010 Apr 10.

A team of researchers at the University of São Paulo in Brazil analysed the diagnosis, and genetic and clinical factors of lactose intolerance.

Their conclusion is that the symptoms of lactose intolerance may have been exaggerated and that persons with lactase non-persistence can tolerate up to 12 g of lactose. Consequently, they need not limit their consumption of dairy products to lactose-free milk and/or fermented milk, which could be beneficial to their bone mass density.

Source: Mattar R et al. Clin Exp Gastroenterol. 2012; 5: 113–121. Published online 2012 July 5. doi: 10.2147/CEG.S32368