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04 Nov 2024
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2 min read
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by YINI Editorial team
Q&A

Focus on vitamin B2

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The YINI team includes nutritionists, food engineers, registered dietitians and scientific writers.
nutrient riboflavin vitamin B2
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Riboflavin known as vitamin B2 is essential to health. Let’s focus on its effects and its presence in the diet.

What is vitamin B2?

Vitamin B2 or Riboflavin is a water-soluble vitamin involved in the maintenance of energy levels. It forms an essential part of co-enzymes Flavin mononucleotide (FMN) and flavin adenine dinucleotide (FAD) which play major role in energy production, cellular function, growth and development, as well as in the metabolism of fats, drugs and steroids.

FAD is involved in the conversion of the amino acid tryptophan into niacin (vit B3). and FMN in the conversion of vit B6 into a co-enzyme.

Riboflavin helps maintain normal levels of homocysteine in blood.

Dietary recommendations

The daily dietary recommendations are:

  • 1.3mg for men,
  • 1.1mg for women,
  • 1.4mg during pregnancy,
  • 1.6mg during lactation.

When excess vitamin B2 is consumed, it is either not absorbed or is excreted in urine therefore consuming high quantities is relatively harmless and no safe upper limit has been defined.

Deficiency is very rare in developed countries. Symptoms are non-specific and include skin disorders, oedema of mouth and throat, cheilosis (swollen cracked lips), hair loss, reproductive problems, sore throat, itchy and red eyes. Typically, people who have a vitamin B2 deficiency also have deficiencies in other nutrients such as other B vitamins.

Sources of vitamin B2

90% of vitamin B2 found in the diet is in the form of FAD or FMN, only 10% is found in its free form, glycosides or esters. However, the main form found in eggs and milk is free riboflavin.

Vitamin B2 is found in a multitude of foods especially in animal sources such as eggs, organ meats, lean meats, milk and dairy products. It is present in some plant sources such as mushrooms, nuts (ex: almonds) and dark leafy green vegetables. Grains and cereals can be fortified in B2, this is the case in around 56 countries in the world including the USA.

Vitamin B2 in dairy

In the USA, the largest contributor to riboflavin in the diet is milk and milk-based drinks. Milk and dairy products contribute to around 25-27% of riboflavin daily intake in the UK population.

As such, dairy is a great source of vitamin B2. Yogurt is nutrient dense and provides a multitude of vitamins and minerals essential to health. 100g of yogurt contributes to around 15% of vitamin B2 daily intake.

It is recommended to consume about 2-3 portions of dairy per day. Such recommendation varies across countries.

References
  1. (1) Office of Dietary Supplements – Riboflavin
  2. (2) EUFIC – Riboflavin (vitamin B2): foods, functions, how much you need & more
  3. (3) Gliszczyńska-Świgło A, Rybicka I. Minerals and vitamin B2 in flavoured dairy products. Journal of Food Composition and Analysis. 2023;124: 105695.
  4. (4) Yeates AJ, Pourshahidi LK, O’Kane SM, Ward M, Mulhern MS, Lamers Y, et al. Effect of increasing cow’s milk consumption on riboflavin intake and plasma riboflavin measures in women of child-bearing age. Proceedings of the Nutrition Society. 2021;80: E138.
  5. (5) CIQUAL – La table de composition nutritionnelle des aliments. ANSES, France.
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21 Oct 2024
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4 min read
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by YINI Editorial team
Cardiovascular health Healthy Diets & Lifestyle

Could swapping meat with dairy products help protect heart health?

YINI Editorial team
The YINI team includes nutritionists, food engineers, registered dietitians and scientific writers.
cardiovascular CVD dairy meat saturated fats SFA
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Latest research suggests the type of food saturated fats come from might alter how they affect our heart health. Swapping saturated fats from meat with those from dairy products may help lower cardiovascular risk, the evidence suggests.

Eating too much food high in saturated fats has long been associated with increased risk to the heart and blood vessels. But a recent study highlights that not all saturated fats behave the same way – the type of food they come from can make a big difference in how they affect heart health.

Researchers from the UK investigated whether replacing saturated fatty acids (SFAs) from different meat products with those from individual dairy foods could reduce the risk of cardiovascular events, with intriguing results (1).

Understanding saturated fatty acids and cardiovascular health

Dietary recommendations to reduce risk of cardiovascular disease (CVD) include limiting SFAs to 10% of total energy intake and replacing meat consumption with other plant- and animal-based foods (2,3).

Previous modelling studies have shown a lower incidence of CVD when replacing SFAs from meat products with those from dairy foods (4,5). But scientists haven’t yet unravelled the associations between individual meat products or dairy foods and CVD risk.

With this in mind, researchers from the University of Reading in England looked into how replacing SFAs from meat products (including processed, red, and poultry) with those from individual dairy foods (milk, cheese, and yogurt) was associated with CVD in the UK population.

The researchers analysed data from over 21,000 participants, aged 40–79 years, who were part of the European Prospective Investigation into Cancer and Nutrition-Norfolk (EPIC-Norfolk) study (6). Using food frequency questionnaires, they recorded dietary habits and followed participants for over two decades to track incidence of CVD, coronary artery disease (CAD), and stroke. Here’s what they found…

Swapping from meat to dairy foods may help reduce CVD risk

Results showed that overall, replacing 2.5% of daily energy intake from SFAs in meat with SFAs from dairy foods was associated with a significantly reduced risk of developing CVD. Specifically, replacing total meat SFAs with total dairy SFAs was associated with an 11% lower incidence of CVD and a 12% lower incidence of CAD. These results took other socio-demographic, lifestyle, cardio-metabolic, and dietary factors into account.

Replacing SFAs from red and processed meat may have the greatest CVD benefit

Analyses of individual meat products and dairy foods revealed significantly reduced CVD risks when replacing SFAs from red or processed meat with those from dairy foods.

So, replacing SFAs from processed meat with those from cheese was associated with a 23% lower incidence of CVD and coronary artery disease (CAD) and a 19% lower incidence of stroke, while replacement of SFAs from red meat with those from cheese was associated with a 14% lower incidence of CVD. Similarly, replacing SFAs from processed meat with those from milk was associated with a 16% lower incidence of CVD and a 17% lower incidence of CAD.

Replacing SFAs from poultry with those from dairy products was associated with an increased risk of CVD and stroke. However, the researchers urge caution in interpreting this result. The narrow range of poultry fat intake led to imprecise risk estimates, as indicated by the large confidence intervals, suggesting these findings cannot be generalized. Consequently, the study’s results do not align with previous research, which indicates that the intake of poultry meat and dairy products has a neutral effect on CVD risk.

Why does CVD risk change when replacing SFAs from meat with dairy?

The cause and underlying mechanisms of the changes seen in CVD risk when replacing SFAs from meat products with those from dairy foods remain unclear, but researchers propose several potentially contributing factors:

  • Different proportions of individual SFAs contained within meat and dairy foods may have a differential impact on CVD risk. For example, high concentrations of odd-chain fatty acids found in dairy foods have been linked with lower CVD risk.
  • Other constituents within meat (e.g., sodium, preservatives, and nitrates) and dairy matrices (e.g., protein, calcium, bacteria and the milk fat globule membrane) may also modulate the impact of SFAs on CVD risk.

The authors of this study suggest that future research should focus on the replacement of different types of red meat (unprocessed and processed) with different types of poultry and dairy foods to help specify food-based dietary recommendations for CVD prevention.

“Replacement of SFA from meat products, and especially processed meat, by dairy products may lower incidence of CVD and CAD. Our findings also add to the evidence that different types of meat (…) should be considered separately.”

Vogtschmidt YD, et al., 2024

References
  1. (1) Source: (1) Vogtschmidt YD, Soedamah-Muthu SS, Imamura F, Givens DI, Lovegrove JA. Replacement of Saturated Fatty Acids from Meat by Dairy Sources in Relation to Incident Cardiovascular Disease: The European Prospective Investigation into Cancer and Nutrition (EPIC)-Norfolk Study. Am J Clin Nutr. 2024 Jun;119(6):1495-1503. doi: 10.1016/j.ajcnut.2024.04.007. PMID: 38608753.
  2. (2) A.H. Lichtenstein, L.J. Appel, M. Vadiveloo, F.B. Hu, P.M. Kris-Etherton, C.M. Rebholz, et al., 2021 Dietary Guidance to improve cardiovascular health: a scientific statement from the American Heart Association, Circulation 144 (23) (2021) e472–e487
  3. (3) Food Standards Agency, The Eatwell Guide: helping you eat a healthy and balanced diet, Food Standards Agency, United Kingdom, 2020
  4. (4) M.C. de Oliveira Otto, D. Mozaffarian, D. Kromhout, A.G. Bertoni, C.T. Sibley, D.R. Jacobs Jr., et al., Dietary intake of saturated fat by food source and incident cardiovascular disease: the Multi-Ethnic Study of Atherosclerosis, Am. J. Clin. Nutr. 96 (2) (2012) 397–404,
  5. (5) L.E.T. Vissers, J. Rijksen, J.M.A. Boer, W.M.M. Verschuren, Y.T. van der Schouw, I. Sluijs, Fatty acids from dairy and meat and their association with risk of coronary heart disease, Eur. J. Nutr. 58 (7) (2019) 2639–2647
  6. (6) N.E. Day, S. Oakes, R.N. Luben, K.T. Khaw, S.A. Bingham, A.A. Welch, et al., EPIC-Norfolk: study design and characteristics of the cohort. European Prospective Investigation of Cancer, Br. J. Cancer. 80 (Suppl) (1999) 95–103
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14 Oct 2024
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3 min read
Q&A

Focus on vitamin B12

nutrient vitamin vitamin B12
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Cobalamin known as vitamin B12 is essential to health. Let’s focus on its effects and its presence in the diet.

What is vitamin B12?

Vitamin B12 is a water-soluble vitamin part of the vitamin B complex. It is essential for the:

  • function of the nervous system,
  • red blood cell formation
  • DNA synthesis

It is a cofactor of two specific enzymes:

  • Methionine synthase which involved in the conversion of methionine, involved in DNA, RNA, proteins and lipids formation.
  • L-methyl malonyl-CoA mutase, involved in the metabolism of macronutrients.

Dietary recommendations

The dietary recommendation for adults is 4µg per day, it increases to 4.5µg during pregnancy and to 5µg during lactation. No safe upper limit has been determined as B12 has a low potential to become toxic since the body does not absorb or store excessive amounts.

When eating a balanced diet, the body is able to store 1000 to 2000 times more B12 than needed in a day which explains why it might take a while before the deficiency becomes symptomatic.

Symptoms of a deficiency can include megaloblastic anaemia (large abnormally nucleated red blood cells), palpitations, pale skin, dementia, weight loss, infertility, and neurological changes such as numbness and tingling in hands and feet. A deficiency during pregnancy and breastfeeding can lead to neural tube defects, developmental delays, failure to thrive and anaemia in the infant.

Deficiency remains rare in developed countries; it is most commonly caused by diet deficiency. People at risk of B12 inadequacy are mainly:

  • older adults,
  • vegetarians who consume little animal products (eggs, dairy)
  • vegans.
  • people with pernicious anaemia,
  • people with GI disorders, GI surgery which removes part of the stomach,

Sources of vitamin B12

Vitamin B12 is only found in animal sources such as fish, meat, poultry, eggs, and dairy.

Plant foods do not contain B12 naturally, but they can be fortified. For example: breakfast cereal, nutritional yeast, plant-based milk or yogurt alternatives such as fortified soy milk.

People who follow a vegan diet or a vegetarian diet with little to no dairy products should be mindful of their B12 intake and supplement if they do not consume enough fortified plant foods.

Vitamin B12 in dairy

Dairy is a great source of B12. People who consume dairy products are more likely to have adequate B12 levels. Furthermore, people who consume yogurt have a 7.1% higher B12 consumption than those who do not.

Dairy intake recommendations vary across countries. In most cases, it is recommended to consume 2-3 portions of dairy per day. This can help achieve about half of the daily recommended intake of B12.

References
  1. (1) Office of Dietary Supplements – Vitamin B12.
  2. (2) EUFIC – Vitamin B12: foods, functions, how much do you need & more
  3. (3) CIQUAL – La table de composition nutritionnelle des aliments. ANSES, France.
  4. (4) Cifelli CJ, Agarwal S, Fulgoni VL. Association of Yogurt Consumption with Nutrient Intakes, Nutrient Adequacy, and Diet Quality in American Children and Adults. Nutrients. 2020;12: 3435.
  5. (5) Cifelli CJ, Agarwal S, Fulgoni III VL. 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. Nutrients. 2022;14: 2441. doi:10.3390/nu14122441
  6. (6) Niklewicz A, Smith AD, Smith A, Holzer A, Klein A, McCaddon A, et al. The importance of vitamin B12 for individuals choosing plant-based diets. Eur J Nutr. 2023;62: 1551–1559. doi:10.1007/s00394-022-03025-4
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30 Sep 2024
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6 min read
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by YINI Editorial team
Bone health

Yogurt consumption is associated with stronger bones and reduced fracture risk

YINI Editorial team
The YINI team includes nutritionists, food engineers, registered dietitians and scientific writers.
bones osteoporisis
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Yogurt (as part of the dairy product group) is recommended in many dietary guidelines because of its nutrient content essential for bone health.

Yogurt is rich in elements essential for bone health

Dairy products including yogurt are rich in protein and several micronutrients important for bone health – phosphorus, potassium, vitamin D (when fortified) and most notably calcium.

In addition, yogurts containing live bacteria and those with added prebiotics – food ingredients that promote the growth or activity of beneficial microorganisms – may benefit bone health by modifying the gut microbiota and increasing calcium absorption.

Yogurt consumption increases children’s intake of vital micronutrients for bone health

Yogurt is linked to healthy growth of bones during childhood and adolescence

  • In a study in China, adding one serving of yogurt to the usual diet of preschool children for 5 days each week over 9 months promoted growth (height and weight gain) and significantly increased bone mineral density compared with children not receiving yogurt supplementation.
  • Consumption of fermented dairy products, such as yogurt, is associated with improved bone health,
    particularly bone mineral density, in children and teenagers.

“For most age groups, it is difficult to meet the nutrient requirements for healthy bones without three servings of dairy products each day.”

Connie Weaver

Professor

Yogurt is associated with stronger bones and better physical function in older people

Increasing yogurt consumption could be a convenient way of improving the nutritional status and health of older adults, including their bone health.
The association between yogurt consumption and bone health was investigated in a study of people aged over 60 years. Results showed:

  • Women who frequently ate yogurt (more than one serving per day) had stronger bones than those who rarely or never ate yogurt (less than one serving per week). Total hip and femoral neck bone mineral density was 3.1–3.9% higher among frequent yogurt consumers.
  • In men, vertebral bone mineral density was 4.1% higher in low-yogurt consumers compared with non-consumers. High-yogurt consumers were found to have 12.9% higher mean vitamin D concentrations than low-/non-consumers. A potential protective effect on bone was supported by changes in levels of the bone biomarker TRAP 5b (tartrate-resistant acid phosphatase 5b), a direct marker of osteoclasts – bone cells involved in the maintenance and repair of bone.
  • Compared with low-/non-consumers, women who often ate yogurt had better scores for daily living activities and physical self-maintenance.

Yogurt may reduce the risk of hip fracture

Available evidence suggests that yogurt is associated with a lower risk of hip fracture in older adults.

  • Improving calcium and protein intakes with dairy foods (milk, yogurt and cheese) reduces the risk of all bone fractures occurring in older care residents by one-third.
  • A meta-analysis reported that a higher intake of yogurt was associated with a 25% reduction in hip fracture risk when compared with low intake.
  • A study in middle-aged and elderly Swedish women showed that low intake of fermented milk products (yogurt and soured milk) was associated with high rates of hip fracture.
  • Hip fracture rates were lowest among women with a high intake of fermented milk products in combination with a high intake of fruit and vegetables.

Yogurt could reduce the risk of osteoporosis

In people over the age of 60 years, statistical modelling of yogurt intake and bone health predicted that each increase of one serving per week of yogurt intake was associated with a 39% lower risk of osteoporosis in women and a 52% lower risk in men.
Encouraging older people to eat yogurt more often, particularly vitamin D- and calcium-fortified yogurt, may be a valuable public health strategy to stave off osteoporosis.

Yogurt is recommended as part of a healthy diet

Many international advisory boards recommend the consumption of dairy products in amounts equivalent to 400–500 mL (~14–17 fluid ounces) milk per day. By consuming three servings of dairy products per day, the recommended daily intakes of nutrients essential for good bone health may be readily achieved.
Several countries include yogurt (as part of dairy products) in their dietary guidelines. These include, among others, the USA, Canada, Japan, the UK, Australia, Switzerland, Sweden, and Portugal.

“Yogurt is rich in protein, calcium, and several micronutrients important for bone health at all ages but particularly during childhood growth phases, and in later life to maintain stronger bones and physical function, and to reduce risk of falls and fractures.”

René Rizzoli

Professor

References:

  • Rozenberg S, Body JJ, Bruyère O, et al. 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. Calcif Tissue Int. 2016;98:1–17.
  • Drewnowski A. Measures and metrics of sustainable diets with a focus on milk, yogurt, and dairy products. Nutr Rev. 2018;76:21–8.
  • Caroli A, Poli A, Ricotta D, et al. Invited review: Dairy intake and bone health: A viewpoint from the state of the art. J Dairy Sci. 2011;94:5249–62.
  • Rizzoli R. Dairy products, yogurts, and bone health. Am J Clin Nutr. 2014;99(5 Suppl):1256S–62S.
  • Rizzoli R, Biver E. Effects of fermented milk products on bone. Calcif Tissue Int. 2018;102:489–500.
  • He M, Yang YX, Han H, et al. Effects of yogurt supplementation on the growth of preschool children in Beijing suburbs. Biomed Environ Sci. 2005;18:192–7.
  • De Lamas C, de Castro MJ, Gil-Campos M, et al. Effects of dairy product consumption on height and bone mineral content in children: a systematic review of controlled trials. Adv Nutr. 2019;10:S88–96.
  • Saviano DA, Hutkins RW. Yogurt, cultured fermented milk, and health: a systematic review. Nutr Rev. 2021;79:599–614.
  • El-Abbadi NH, Dao MC, Meydani SN. Yogurt: role in healthy and active aging. Am J Clin Nutr. 2014;99(5Suppl):1263S–70S.
  • Laird E, Molloy AM, McNulty H, et al. Greater yogurt consumption is associated with increased bone mineral density and physical function in older adults. Osteoporos Int. 2017;28:2409–19.
  • van den Heuvel EGHM, Steijns JMJM. Dairy products and bone health: how strong is the scientific evidence? Nutr Res Rev. 2018;31:164–78.
  • Iuliano S, Poon S, Robbins J, et al. Effect of dietary sources of calcium and protein on hip fractures and falls in older adults in residential care: cluster randomised controlled trial. BMJ. 2021;375:n2364.
  • Bian S, Hu J, Zhang K, et al. Dairy product consumption and risk of hip fracture: a systematic review and metaanalysis. BMC Public Health. 2018;18:165.
  • Michaëlsson K, Wolk A, Lemming EW, et al. Intake of milk or fermented milk combined with fruit and vegetable consumption in relation to hip fracture rates: a cohort study of Swedish women. J Bone Miner Res. 2018;33:449–57.
  • Bonjour JP, Benoit V, Payen F, et al. Consumption of yogurts fortified in vitamin D and calcium reduces serum parathyroid hormone and markers of bone resorption: a double-blind randomized controlled trial in institutionalized elderly women. J Clin Endocrinol Metab. 2013;98:2915–21.
  • Bonjour JP, Benoit V, Atkin S, et al. Fortification of yogurts with vitamin D and calcium enhances the inhibition of serum parathyroid hormone and bone resorption markers: a double blind randomized controlled trial in women over 60 living in a community dwelling home. J Nutr Health Aging. 2015;19:563–9.
  • Sahni S, Mangano KM, Kiel DP, et al. Dairy intake is protective against bone loss in older vitamin D supplement users: the Framingham study. J Nutr. 2017;147:645–52.
  • Prentice AM. Dairy products in global public health. Am J Clin Nutr. 2014;99(5 Suppl):1212S–6S.
  • Bell V, Ferrão J, Fernandes T. Nutritional guidelines and fermented food frameworks. Foods. 2017;6:65.
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23 Sep 2024
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3 min read
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by YINI Editorial team
Q&A

Focus on vitamin A

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The YINI team includes nutritionists, food engineers, registered dietitians and scientific writers.
nutrient vitamin vitamin A
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Vitamin A is an essential compound to health at every life stage. What are its functions and where to find it?

What is vitamin A?

Vitamin A is essential at every stage of life. It contributes to the mechanism of vision. Vitamin A is present in the light sensitive protein rhodopsin in the retina and helps the differentiation of the membrane and cornea in the eye.

It is also involved in the regulation (activation, repression) of gene expression, and is thus implicated in numerous bodily functions: embryonic development, cell growth, tissue renewal (skin, intestinal mucosa), immune system…

Deficiency can lead to night blindness and in most serious cases permanent blindness. During pregnancy and early childhood, it can cause abnormal lung development and risk of anaemia. However, vitamin A deficiency is quite rare in developed countries, as most people get enough vitamin A in their diet.

Dietary recommendations

In the diet, Vitamin A can be found in two main forms; retinol and carotenoids:

  • Retinol is the form of vitamin A that is best absorbed and metabolised directly by the human body as it is pre-formed vitamin A.
  • Carotenoids (such as beta-caroten) are precursors (pro-vitamin A), absorbed and converted into vitamin A.

Thus, diet recommendations are given in Retinol Equivalent (RE) and 1µg RE is 6µg of beta-carotene and 12µg of other carotenoids.

The recommendation is of 650-750 µg RE for healthy adults, 700µg RE during pregnancy and 1300µg RE during lactation.

It is recommended to consume no more than 3000 µg RE per day for adults including during pregnancy and lactation, as an excess in vitamin A can increase the risk of birth defects, and not more than 1500µg RE per day, in postmenopausal women, as it could increase bone fracture risk.

Dietary sources of Vitamin A

Vitamin A can be found in plant and animal sources.

In vegetables, vitamin A is found in the form of carotenoids. They are responsible for the orange and red pigments of plants and we find it in vegetable or fruits such as carrots, sweet potatoes, pumpkin, mango or melon. They are also present in dark leafy green vegetables (kale, spinach for example).

Animal sourced-food contain vitamin A in the form of retinol. It can be found for example in dairy, eggs, liver meats.

Dietary sources of vitamin A - YINI

Vitamin A in dairy

In dairy, vitamin A is found mostly as retinol and a little bit of beta carotene.

Most dairy products are also a source of lipids which help with the absorption of fat-soluble vitamins, such as vitamin A

Fat free dairy contains much less vitamin A.

That is why when choosing a yogurt, it is best to choose one with some fat (whole milk or semi skimmed milk dairy) to optimize vitamin A intakes.

Vitamin A in dairy - YINI
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16 Sep 2024
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6 min read
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by YINI Editorial team
Diabetes prevention Echoes from ASN Nutrition 2024 Expert interviews

Interview with Wendy Reinhardt Kapsak, MS, RDN

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ASN Cifelli Diabetes FDA Kapsak
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Diabetes is a growing global health crisis, demanding comprehensive and evidence-based 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 ASN Nutrition 2024, incorporating nutrition expertise and food-based approaches, such as yogurt with its unique nutrient profile, is crucial in addressing Type 2 diabetes and related health challenges.

In this interview, Wendy Reinhardt Kapsak, MS, RDN discusses the recent FDA-approved 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:

  • FDA-qualified health claims, such as the potential link between yogurt consumption and reduced risk of type 2 diabetes, are crucial for providing consumers with science-backed information. These claims help consumers make informed dietary choices that support health and well-being.
  • Regular consumption of yogurt, at least three servings per week, may reduce the risk of developing type 2 diabetes according to limited scientific evidence, contributing to public health efforts in managing and preventing chronic diseases.
  • Yogurt is a nutrient-dense, versatile, and enjoyable food that can provide essential nutrients often under-consumed in the United States, such, calcium, and vitamin D. It can be easily incorporated into various meals and snacks, making it a convenient option for improving dietary habits and supporting health goals like muscle and bone health.
  • Yogurt addresses current consumer trends by being a fresh,  high-quality protein food. Its adaptability to different dietary patterns caters to the diverse needs of younger and older generations thereby encouraging healthier eating habits and lifestyle changes.

Can you introduce yourself and let us know about your work?

I am President, CEO of the International Food Information Council (IFCI). IFIC is a nonprofit organization focused on consumer research and education. Its mission is to effectively communicate science-based information on food safety, nutrition, and sustainable food systems for public benefit.

Could you start by explaining what FDA-regulated claims are and how they differ from health claims or marketing statements?

In the United States, there are several types of claims related to food products. A “Nutrient Content Claim” specifies the nutrient content of a product, such as “This product contains calcium.” A “Structure/Function Claim” suggests the role of a nutrient in supporting normal body functions, like “This product supports bone health.” These two types of claims can be made without submitting extensive scientific evidence to the FDA.

However, two additional claims require FDA engagement. An “Authorized Health Claim” necessitates significant scientific agreement and involves a detailed and lengthy process to establish, indicating a strong link between a nutrient and reduced risk of a disease. A “Qualified Health Claim” allows for claims based on less conclusive scientific evidence reviewed by the FDA. While it doesn’t require significant scientific agreement, it provides a way to discuss the current level of scientific knowledge about the relationship between a nutrient and a disease.

Could you provide examples of FDA-regulated qualified health claims that have been effectively used to communicate health benefits to consumers? What about the FDA qualified health claim on yogurt consumption and the reduction of the risk of type 2 diabetes?

One example of an FDA-regulated qualified health claim involves nuts and the risk reduction of  heart disease, particularly due to the dietary fats contained in nuts. Another claim discussed today is the potential link between regularly consuming yogurt and reducing the risk of type 2 diabetes, specifically at least three servings over the course of a week. These claims contribute to public health goals by promoting dietary patterns that can help reduce the risk of chronic diseases and improve overall health.

In the case of yogurt, consuming at least three servings per week may reduce the risk of developing type 2 diabetes. Type 2 diabetes remains a critical public health issue in the U.S., with an annual increase of 1.2 million new cases since 2004, making it the 8th leading cause of death. Despite efforts, the portion of the population with type 2 diabetes reached 12% in 2023, highlighting the urgent need for preventive measures and better management strategies. Projections indicate that by 2030, 20% of Black females and 12% of White females will have type 2 diabetes, underscoring the ongoing and escalating challenge of this disease.

Incorporating yogurt into a healthy diet not only may lower the risk of type 2 diabetes but can also positively impact other diet-related health outcomes. This demonstrates how specific dietary choices can play a crucial role in improving public health outcomes.

In your presentation you provided a lot of elements regarding consumer trends. What are their main characteristics?

Today’s consumers are more knowledgeable and health-conscious. More than half of Americans are familiar with My Plate*, and nearly half report that it has led them to eat a more balanced diet. This awareness is particularly high among millennials, college graduates, married individuals, those with higher incomes, and families with children under 18.

Consumers are increasingly following specific eating patterns or diets to feel better and have more energy, with younger generations prioritizing energy and weight loss, and older generations focusing on healthy aging. There is also a notable trend towards higher protein consumption, with younger generations seeking protein from supplements and older generations preferring food sources. Additionally, “fresh,” “good source of protein,” and “low in sugar” are the top criteria for defining healthy food, and more Americans are favoring lifestyle changes over medication for health conditions.

Taking these consumer trends into account, could you elaborate on the benefits of yogurt, particularly the part of your presentation where you mentioned its ease of consumption and accessibility?

Yogurt effectively addresses consumer characteristics through its nutrient density and versatility, providing essential nutrients that are often under-consumed in the United States due to the general under-consumption of dairy. It aligns with the health criteria consumers often prioritize, offering a good source of complete protein, calcium, and often vitamin D. Yogurt can be easily incorporated into various meals and snacks, making it a convenient and enjoyable option for those aiming to improve their diet. The FDA-qualified health claim linking yogurt consumption to a reduced risk of type 2 diabetes positions it as a beneficial food for managing and preventing chronic diseases.

Yogurt can also provide many essential nutrients that are typically under-consumed in the United States, primarily because dairy is an under-consumed food group. Nutrients like calcium, and vitamin D are often abundant in dairy, making yogurt a particularly beneficial choice for many consumers. These nutrients are crucial for maintaining overall health, and yogurt serves as an accessible source for those looking to improve their intake.

Additionally, many consumers find yogurt delicious on its own or when paired with other nutrient-rich foods like fruits or vegetables. This versatility makes it not only easy to incorporate into a diet but also enjoyable and fun to consume. The variety of flavor profiles that yogurt offers excites consumers, encouraging them to include it more frequently in their meals.

Finally, yogurt’s adaptability to various dietary patterns makes it suitable for different generational needs, whether for energy, weight loss, or healthy aging. By offering a tasty and easy-to-consume option, yogurt encourages healthier eating habits, supporting the consumer preference for lifestyle changes. With healthcare professionals and dietitians being the most trusted sources of dietary information, yogurt’s health benefits can be effectively communicated to consumers, reinforcing its role in a balanced diet and contributing to overall public health.

*My plate is the current nutrition guide published by the United States Department of Agriculture’s Center for Nutrition Policy and Promotion, and serves as a recommendation based on the Dietary Guidelines for Americans.

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09 Sep 2024
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5 min read
Diabetes prevention

Can regular consumption of whole-fat dairy foods help reverse pre-diabetes?

dairy Diabetes pre-diabetes t2d yogurt
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A recent study sheds light on an intriguing possibility: a daily dairy intake might play a significant role in reversing pre-diabetes, potentially steering those at risk away from developing Type 2 diabetes (T2D).

Researchers tracked the dietary habits and health outcomes of people with pre-diabetes over nearly a decade, providing new insights into how specific types of dairy products could influence their journey toward or away from diabetes. Eating more whole-fat dairy foods such as yogurt may prove to help reverse the progression of pre-diabetes and lower our risk of developing T2D, the research suggests (1).

Pre-diabetes is a pre-cursor to Type 2 diabetes and cardiovascular disease

Pre-diabetes – characterised by higher-than-normal blood sugar levels that aren’t yet high enough to be classified as diabetes – affects over a quarter of middle-aged adults worldwide. Numbers are expected to soar to 470 million people by 2030 (2). Every year, between 5 and 10% of people with pre-diabetes progress to T2D; these people are also at high risk of developing cardiovascular disease and of premature death (3).

While the risk factors for developing T2D are well established, less is known about potential moderators of pre-diabetes progression. Regular consumption of dairy products, especially yogurt, has been associated with a reduced risk of developing T2D.

With this in mind, researchers from the Shahid Beheshti University of Medical Sciences in Iran looked into whether regularly eating dairy products may affect pre-diabetes regression to normal glycaemia or progression to T2D. They followed 334 adults with pre-diabetes for up to nine years, recording the dairy foods they ate using validated Food frequency questionnaires and regularly monitoring their blood sugar levels.

To assess the association between regression to normal glycaemia or progression to T2D, the researchers used several models, taking into account various well-know T2D risk factors:

  • Model 1, adjusted for age, sex, post-prandial glycemia, and T2D risk score
  • Model 2, additionally adjusted for smoking and physical activity
  • Model 3, taking into account all the above risk factors and, additionally adjusted for dietary intakes of fruits, vegetables, legumes, nuts, grains, and meats.

Eating whole-fat dairy foods is associated with reduced risk of pre-diabetes progression

Results showed that eating higher amounts of whole-fat dairy products is significantly associated with pre-diabetes regression. Specifically, each additional 200g of whole-fat dairy per day was associated with a 69% higher likelihood of returning to normal glycaemia, in the model 3 adjusted for the well-established risk factors for T2D development. A higher intake of whole-fat dairy was also linked to lower average blood sugar levels after eating.

Interestingly, the researchers did not find a significant association between the consumption of total (whole-fat and low-fat dairy, or low-fat dairy alone and the chance of pre-diabetes regression or progression, regardless of the model.

These results support previous studies demonstrating a greater protective effect of whole fat dairy consumption against the risk of developing T2D (4,5).

Dairy food choices may vary in their association with pre-diabetes

When looking at the different dairy categories (yogurt, milk, cheese, cream or butter), only yogurt showed a particular beneficial effect and was associated with pre diabetes regression. There was no significant link between the consumption of milk, cheese, cream or butter and changes in pre-diabetes status, regardless of the model:

  • Eating a higher daily amount of yogurt was associated with an 82% greater chance of returning to normal blood sugar levels. Once again, this association was only found in model 3 adjusted for most of the well-established risk factors for T2D development. People who returned to normal glycaemia during the follow-up period also ate more yogurt on average than those whose pre-diabetes remained (1.7 vs. 1.1 servings/day).
  • Drinking milk was associated with some effect on blood glucose level but did not lead to a significant regression of pre-diabetes. A higher daily intake of milk (0.5 or 1.9 vs. <0.2 servings/day) was related to lower average blood sugar levels after eating, ,this did not lead to a significant regression of pre-diabetes.
  • Finally, cheese consumption appeared to negatively affect blood glucose levels, as a higher daily intake of cheese (≥ 1.0 vs. < 0.4 servings/day) was associated with higher average blood sugar levels after eating. People who developed T2D during the follow-up period appeared to eat more cheese than those who did not.

These results support previous findings on the unique role of yogurt in potentially decreasing the risk of developing T2D (6).

What biological mechanisms could be associated with pre-diabetes regression?

The cause and underlying mechanisms of the observed relationships between dairy intake and the risk of developing T2D remain unclear (5). Scientists attribute the protective effects of dairy products against T2D to their fatty acids profiles along with other bioactive components including probiotics, menaquinones, and the milk fat globule membrane (6,7).

The researchers of this study suggest that potential effects of regular dairy intake on the regression or progression of pre-diabetes are mediated through improved glucose tolerance and insulin sensitivity, as dairy intake was associated with changes to blood sugar levels after eating but not fasting levels.

“These findings further support that regular consumption of dairy may attenuate the risk of developing Type 2 diabetes or the chance of returning to normal glycemia, and various dairy products may affect these pathways differently.”

Bahadoran Z, et al., 2024

References
  1. (1) Source: Bahadoran Z, Mirmiran P, Azizi F. Usual intake of dairy products and the chance of pre-diabetes regression to normal glycemia or progression to type 2 diabetes: a 9-year follow-up. Nutr Diabetes. 2024 Apr 9;14(1):15. doi: 10.1038/s41387-024-00257-7. PMID: 38594262.
  2. (2) Makaroff LE. The need for international consensus on prediabetes. Lancet Diabetes Endocrinology 2017;5:5–7
  3. (3) Cai X, Zhang Y, Li M, Wu JH, Mai L, Li J, et al. Association between prediabetes and risk of all cause mortality and cardiovascular disease: updated meta-analysis. BMJ; 2020;370:m2297.
  4. (4) Hruby A, Ma J, Rogers G, Meigs JB, Jacques PF. Associations of dairy intake with incident prediabetes or diabetes in middle-aged adults vary by both dairy type and glycemic status. J Nutr. 2017;147:1764–7
  5. (5) Bhavadharini B, Dehghan M, Mente A, Rangarajan S, Sheridan P, Mohan V, et al. Association of dairy consumption with metabolic syndrome, hypertension and diabetes in 147 812 individuals from 21 countries. BMJ Open Diabetes Res Care. 2020;8:e000826
  6. (6) Zhang K, Bai P, Deng Z. Dose-dependent effect of intake of fermented dairy foods on the risk of diabetes: results from a meta-analysis. Can J Diabetes. 2022;46:307–12.
  7. (7) Mozaffarian D. Dairy foods and type 2 diabetes: profiling our metabolites and health. Am J Clin Nutr. 2021;114:5–6.
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Cardiovascular health Publications

Eating yogurt is associated with reduced risk of cardiovascular disease

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cardiometabolic cardiovascular disease cardiovascular risk hypertension
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Dairy products such as yogurt have consistently been linked with either neutral or beneficial effects on risk of cardiovascular disease (CVD), a finding highlighted by multiple literature reviews and a metaanalysis.

Yogurt may reduce the risk of high blood pressure

Among adults included in the USA NHANES (1999–2014) survey, the prevalence of hypertension was 20% lower for those that consumed yogurt, compared with non-consumers, and blood pressure levels were significantly lower.
Another study of adults in the USA found that greater intakes of dairy, low-fat/fat-free dairy, low-fat/skimmed milk and yogurt were associated with a lower risk of developing high blood pressure per year.
Eating one extra serving of yogurt per week was related to a 6% lower risk of developing high blood pressure.

Yogurt may reduce risk of CVD

Yogurt consumption is associated with lower CVD risk.

A meta-analysis of 10 cohort studies from the USA, Sweden, The Netherlands, Finland, Australia and the UK, including 385,122 participants found a 17% decreased risk of CVD with fermented dairy food intake. Sub-group analysis found that yogurt consumption was associated with a 22% fall in CVD risk.

A study of 7,679 Australian women found that high yogurt intake (>70 g or ~2 ounces/day) was associated with 16% lower CVD risk over 15 years compared with no intake.

Among a Greek population (N=3042), a 20–30% lower CVD risk over 10 years was found per 200 g or ~7 ounces/day yogurt consumption, with the greater effect seen in women.

A French study of 104,805 adults from the NutriNet-Santé cohort (2009–2019) found no association between overall dairy intake and CVD risk over 5 years but did find that eating at least 160 g or ~6 ounces/day of fermented dairy (yogurt and cheese) was associated with 19% lower risk of cerebrovascular disease compared with intakes of less than 57 g/day (~2 ounces/day).

In people with high blood pressure:

  • Consuming two or more servings of yogurt per week, especially when part of a healthy diet, was associated with a reduced risk of heart attack or stroke compared with eating less than one serving per month.
  • Among those eating two or more servings of yogurt per week, women had a 17% lower CVD risk and men had a 21% lower risk compared with those who ate less than one serving per month.

Children and teenagers could benefit too

In European adolescents, consumption of milk and yogurt was inversely associated with being overweight and positively associated with cardiorespiratory fitness.

Dairy consumption was inversely associated with CVD risk score in European girls aged 12.5–17.5
years.

Yogurt may reduce mortality risk

Yogurt consumption is associated with reduced risk of all-cause and CVD mortality across population-based studies.

A meta-analysis of 17 cohort studies of 896,871 participants, with 75,791 deaths, found the highest intake of yogurt was associated with a 7% lower risk of death from all causes and 11% lower risk of death from CVD than the lowest intake. Each additional serving of yogurt per day (244 g or ~8 ounces) was associated with a 7% reduced risk of all-cause mortality and 14% reduced risk of CVD mortality.

While the association between yogurt consumption and all-cause mortality has met with mixed results from large cohort studies in the past,152,162 more recent studies show an association with reduced risk of mortality.

A meta-analysis of 235,676 participants in eight cohort studies found that yogurt intake of at least 200 g/day (~7 ounces/day) was associated with12% lower all-cause mortality and 13% lower risk of CVD mortality compared with lower yogurt intake.

In the Prospective Urban Rural Epidemiology (PURE) study (2003–2018) of 136,384 people aged 35–70 years from 21 countries in five continents, higher intake of yogurt (>1 serving/ day) was associated with a 14% lower risk of death or major cardiovascular event, 17% lower risk of total mortality and 10% lower risk of major CVD compared with no intake.

A large population survey of adults (N=32,625) in the USA NHANES (1999–2014) study found a
17% reduced risk for all-cause mortality with yogurt intake over 8 years. The health benefits of yogurt were more pronounced among women, people aged ≥60 years, and non-Hispanic Black people.

A Japanese population study (N=14,264) showed a 28–30% reduction in mortality over 9 years with
increasing yogurt intake among people aged 40–74 years.

How might yogurt reduce CVD risk?

Blood pressure modulation following the consumption of yogurt may be linked to an association with
improved lipid profiles, reduced BMI, or the ability to produce anti-hypertensive peptides that inhibit angiotensin-converting enzyme, which plays a crucial role in blood pressure regulation.
The association between yogurt consumption and reduced risk of CVD may be due to the protective properties of some components.

Yogurt and other dairy products are rich in micronutrients and proteins, some of which have
been shown to lower blood pressure.

Low-grade inflammation underlies the pathology of CVD, and some saturated fatty acids found in dairy products (e.g., lauric acid) may have antiinflammatory effects.

Calcium, potassium and magnesium found in yogurt have been linked to a reduced risk of stroke.

The dairy matrix may contribute to the beneficial effects of yogurt and other dairy products and determine the fat bioavailability.

Fermented milk products such as probioticcontaining yogurts have a high antioxidant potential and could play a part in healthy and active ageing.

“Yogurt consumption is associated with reduced risk of cardiovascular disease – and large population-based studies reveal a link between yogurt consumption and reduced risk of death from cardiovascular and all causes”

Professor Luis Moreno

References :

  • Melini F, Melini V, Luziatelli F, et al. Health-promoting components in fermented foods: an up-to-date systematic review. Nutrients. 2019;11:1189.
  • He M, Yang YX, Han H, et al. Effects of yogurt supplementation on the growth of preschool children in Beijing suburbs. Biomed Environ Sci. 2005;18:192–7.
  • Lau E, Sergio Neves J, Ferreira-Magalhaes M, et al. Probiotic ingestion, obesity, and metabolic-related disorders: results from NHANES, 1999–2014. Nutrients. 2019;11:1482.
  • Moreno LA, Bel-Serrat S, Santaliestra-Pasías A, et al. Dairy products, yogurt consumption, and cardiometabolic risk in children and adolescents. Nutr Rev. 2015;73(Suppl 1):8–14.
  • Drouin-Chartier JP, Brassard D, Tessier-Grenier M, et al. Systematic review of the association between dairy product consumption and risk of cardiovascular-related clinical outcomes. Adv Nutr. 2016;7:1026–40.
  • Givens DI. Saturated fats, dairy foods and health: a curious paradox? Nutr Bull. 2017;42:274–82.
  • Guo J, Astrup A, Lovegrove JA, et al. Milk and dairy consumption and risk of cardiovascular diseases and all-cause mortality: dose-response meta-analysis of prospective cohort studies. Eur J Epidemiol. 2017;32:269–87.
  • Lordan R, Tsoupras A, Mitra B, et al. Dairy fats and cardiovascular disease: do we really need to be concerned? Foods. 2018;7:29.
  • Wang H, Fox CS, Troy LM, et al. Longitudinal association of dairy consumption with the changes in blood pressure and the risk of incident hypertension: the Framingham Heart Study. Br J Nutr. 2015:114:1887–99.
  • Zhang K, Chen X, Zhang L, et al. Fermented dairy foods intake and risk of cardiovascular diseases: a meta-analysis of cohort studies. Crit Rev Food Sci Nutr. 2020;60:1189–94.
  • Buziau AM, Soedamah-Muthu SS, Geleijnse JM, et al. Total fermented dairy food intake is inversely associated with cardiovascular disease risk in women. J Nutr. 2019;149:1797–1804.
  • Kouvari M, Panagiotakos DB, Chrysohoou C, et al. Dairy products, surrogate markers, and cardiovascular disease; a sex-specific analysis from the ATTICA prospective study. Nutr Metab Cardiovasc Dis. 2020;30:2194e2206.
  • Sellem L, Srour B, Jackson KG, et al. Consumption of dairy products and CVD risk: results from the French prospective cohort NutriNet-Santé. Br J Nutr. 2022;127:752–62.
  • Buendia JR, Li Y, Hu FB, et al. Regular yogurt intake and risk of cardiovascular disease among hypertensive adults. Am J Hypertens. 2018;31:557–65.
  • Bel-Serrat S, Mouratidou T, Jiménez-Pavón D, et al. Is dairy consumption associated with low cardiovascular disease risk in European adolescents? Results from the HELENA Study. Pediatr Obes. 2014;9:401–10.
  • Tutunchi H, Naghshi S, Naemi M, et al. Yogurt consumption and risk of mortality from all causes, CVD and cancer: a comprehensive systematic review and dose-response meta-analysis of cohort studies. Public Health Nutr. 2023;26: 1196–209.
  • Soedamah-Muthu SS, de Goede J. Dairy consumption and cardiometabolic diseases: systematic review and updated meta-analyses of prospective cohort studies. Curr Nutr Rep. 2018;7:171–82.
  • Gao X, Jia H-Y, Chen G-C, et al. Yogurt Intake Reduces All-Cause and Cardiovascular Disease Mortality: A Meta-Analysis of Eight Prospective Cohort Studies. Chin J Integr Med. 2020;26:462–8.
  • Dehghan M, Mente A, Rangarajan S, et al. Association of dairy intake with cardiovascular disease and mortality in 21 countries from five continents (PURE): a prospective cohort study. Lancet. 2018;392:2288–97.
  • Lin P, Gui X, Liang Z, Wang T. Association of yogurt and dietary supplements containing probiotic consumption with all-cause and cause-specific mortality in US adults: a population-based cohort study. Front Nutr. 2022;9:803076.
  • Nakanishi A, Homma E, Osaki T, et al. Association between milk and yogurt intake and mortality: a community-based cohort study (Yamagata study). BMC Nutrition. 2021;7:33.
  • Kim H-K, Kim S-H, Jang C-S, et al. The combined effects of yogurt and exercise in healthy adults: Implications for biomarkers of depression and cardiovascular diseases. Food Sci Nutr. 2018;6:1968–74.
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26 Aug 2024
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5 min read
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by YINI Editorial team
Healthy Diets & Lifestyle Publications Weight management

Yogurt can enhance satiety and may help to manage energy intake

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The YINI team includes nutritionists, food engineers, registered dietitians and scientific writers.
energy intake hunger satiation satiety Weight management
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Consuming yogurt can increase satiety – the feeling of being full – which in turn may help reduce energy/food intake.

Yogurt consumption reduces the feeling of hunger more than other dairy products

Greater appetite suppression is seen with yogurt than other dairy products.

Hunger was 8% lower when participants consumed yogurt as a mid-morning snack than when they ate a portion of cheese matched for energy content and volume.

In one study, hunger was 10% lower after a yogurt snack than after a matched serving of milk and 8% lower compared with a matched portion of cheese.

In another study, appetite and subsequent energy intake were reduced most after yogurt and cheese, but only yogurt reduced appetite more than milk in young adults (aged 20–30 years).

In a study of children (aged 9–14 years), Greek yogurt and cheese snacks reduced average appetite compared with a low-fat milk snack.

However, similar appetite suppression and subsequent food intake were obtained after consumption of Greek yogurt or a cultured coconut-based product for breakfast.

Low-fat yogurts increase feelings of fullness more than fruit-based drinks

Higher satiety ratings were seen following consumption of low-fat yogurts in a study comparing them with fruit drinks containing the same amounts of calories.

Yogurt containing peach – whether eaten with a spoon or in drinkable form – was more satiating than a peach-flavoured dairy drink and a peach juice drink: both the yogurts were associated with less hunger and higher fullness ratings.

“Yogurt is a high protein, low energy density food associated with greater appetite suppression than other dairy foods. This may help to regulate energy intake when it is eaten as a snack.”

Dr Anestis Dougkas

High-protein yogurt could be a healthy replacement for high energy-dense snacks

Consuming yogurt as a high-protein, less energy dense snack instead of high-fat snack foods may improve appetite control and satiety and reduce subsequent energy intake.

Women participating in a study were less hungry after consuming a mid-afternoon snack of high protein yogurt than after consuming high-fat crackers or chocolate matched for energy content. Despite having the same energy content as the high-fat snacks, yogurt delayed the participants’ desire to eat the next meal by around 30 minutes. Moreover, the women consumed around 100 fewer calories in a subsequent meal after consuming yogurt than after eating crackers or chocolate.

Among healthy young men, a yogurt drink taken as a mid-afternoon snack induced a greater feeling of fullness in the hour before a meal than a chocolate bar of the same energy content.

How might yogurt exert its satiating effect?

Several factors may account for the satiating properties of yogurt, including nutrient content and effects on appetite-regulating hormones.

  • The high protein content of yogurt could partly account for the higher satiety effect of yogurt seen in these findings.
  • Protein ‘preloading’ – in which small amounts of protein are eaten at a set time before a meal – enhances satiety and reduces appetite by slowing stomach emptying and direct communication with the brain’s appetite-regulation centre.
  • Other factors that may influence the satiating effects of yogurt include its energy density, the way it is consumed (with a spoon or drunk), and its rate of passage through the digestive tract. The potential effects of fermentation may also play a role.
  • Yogurt may influence appetite-regulating hormone release in the gut.
  • Yogurt consumed before a meal stimulates metabolic responses leading to reduced premeal appetite, later food intake, and post-meal glycaemia.

“Yogurt, thanks to the presence of high-quality amino acid pattern, promotes satiety and reduces energy intake. Increased acidity during fermentation positively affects calcium absorption; increased calcium bioavailability plays an important role, especially in low-calcium consumers, in the control of blood glucose and energy metabolism.”

Professor Michele Sculati

Download the booklet “Yogurt from science to health”

References:

  • Dougkas A, Minihane AM, Givens, DI, et al. Differential effects of dairy snacks on appetite, but not overall energy intake. Br J Nutr. 2012;108:2274–85.
  • Tsuchiya A, Almiron-Roig E, Lluch A, et al. Higher satiety ratings following yogurt consumption relative to fruit drink or dairy fruit drink. J Am Diet Assoc. 2006;106:550–7. 96.
  • Chapelot D, Payen F. Comparison of the effects of a liquid yogurt and chocolate bars on satiety: a multidimensional approach. Br J Nutr. 2010;103:760–7. 97.
  • Ortinau LC, Hoertel HA, Douglas SM, et al. Effects of high-protein vs. high-fat snacks on appetite control, satiety, and eating initiation in healthy women. Nutr J. 2014;13:97. 98.
  • Vien S, Fard S, El Khoury D, et al. Age and sex interact to determine the effects of commonly consumed dairy products on post-meal glycemia, satiety, and later meal food intake in adults. J Nutr. 2021;151:2161–74. 99.
  • Gheller BJF, Li AC, Gheller ME, et al. The effect of dairy products and non-dairy snacks on food intake, subjective appetite and cortisol levels in children: a randomized control study. Appl Physiol Nutr Metab. 2021;46:1097–104. 100.
  • Mather K, Boachie R, Anini Y, et al. Effects of cultured dairy and nondairy products added to breakfast cereals on blood glucose control, satiation, satiety, and short-term food intake in young women. Appl Physiol Nutr Metab. 2020;45:1118–26.101.
  • Baspinar B, Güldaş M. Traditional plain yogurt: a therapeutic food for metabolic syndrome? Crit Rev Food Sci Nutr. 2021;61:3129–43. 103.
  • Eales J, Lenoir-Wijnkoop I, King S, et al. Is consuming yoghurt associated with weight management outcomes? Results from a systematic review. Int J Obes (Lond). 2016;40:731–46. 104.
  • Sayón-Orea C, Martínez-González MA, Ruiz-Canela M, et al. Associations between yogurt consumption and weight gain and risk of obesity and metabolic syndrome: a systematic review. Adv Nutr. 2017;8:146S–54S.

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22 Aug 2024
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8 min read
Echoes from ASN Nutrition 2024 Expert interviews

Yogurt consumption and decreased risk of T2D: Understanding the FDA Qualified Health Claim process and its evaluation of the science, by Tanya Halliday

FDA Qualified Health Claim t2d Tanya Halliday
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Tanya M Halliday was in Chicago covering the Nutrition 2024 Congress in July 2024. She attended the conference on yogurt consumption and reduced risk of type 2 diabetes and shared her analysis with us. She deciphered for us the science and process behind a qualified health claim.

As Registered Dietitians (RDs), staying up to date with both nutrition science and food label claims allows us to provide both evidence-based and actional nutrition-related advice to clients. In March the U.S. Food and Drug Administration (FDA) approved a Qualified Health Claim regarding yogurt consumption and reduced risk of Type 2 Diabetes. To better understand how FDA came to authorize this first claim related to yogurt, this post will: 1. Explain what a Qualified Health Claim is; and 2. Summarize the FDAs process for evaluating the science behind the health claim.

What is a “Qualified Health Claim”?

In the United States, “health claims” that can be used on food and dietary supplemental labels are defined by statute and/or FDA regulations and have two levels. [1].

  1. Authorized Health Claims, in which there must be “significant scientific agreement (SSA)…that provides a high level of confidence in the validity of the substance/disease relationship”. [2] To date only 12 qualified health claims have been approved [3].
  2. Qualified Health Claims, which are “supported by scientific evidence, but do not meet the more rigorous ‘significant scientific agreement’ standard required for an authorized health claim. [4] Essentially, while there is scientific support for these claims, the wording required ensures the potential health benefit is not overstated. A full list of qualified health claims can be found online.

Specifically, the FDA does not “approve” qualified health claims. Instead, it will issue a “letter of enforcement” which provides the agency’s evaluation of the scientific evidence relevant to the proposed qualified health claim and (if moving forward) will provide specific language for which the FDA will provide enforcement discretion.

Specifics for the yogurt and Type 2 Diabetes Qualified Health Claim

The qualified health claim for yogurt was initiated via a petition submitted by Danone North America, which the FDA responded to on March 1, 2024. All 51 pages of it can be read here. Ultimately the outcome was that the FDA “intends to consider exercising its enforcement discretion for the following qualified health claims:

  1. “Eating yogurt regularly, at least 2 cups (3 servings) per week, may reduce the risk of type 2 diabetes. FDA has concluded that there is limited information supporting this claim”
  2. “Eating yogurt regularly, at least 2 cups (3 servings) per week, may reduce the risk of type 2 diabetes according to limited scientific evidence”

Fat and Added Sugar Content Specifics: Given that there are a variety of yogurts available for purchase with varying fat and added sugar content there have been concerns voiced about yogurts high in these components. However, as most of studies did not differentiate between specific types of yogurts and the credible scientific evidence still found a statistically significant reduction in type 2 diabetes risk irrespective of fat or sugar content, this claim does not require use only on products with specific fat or added sugar levels.

Disqualifying Nutrient Levels: Under the FDAs general requirement for health claims, claims are not allowed on any product that exceeds “disqualifying nutrient levels” for total fat, saturated fat, cholesterol, or sodium. [5] Specific disqualifying health levels, such as 13g of fat per RACC (reference amount customarily consumed) and per label serving size, are generally not reached for the majority of yogurt products, and thus unlikely to be a concern for consumers. There is not currently a disqualifying nutrient level for added sugar content of food. However, the FDA did note in their response to petition that “we are concerned that the use of a qualified health claim on yogurts that contain a significant amount of added sugars could contribute empty calories to the diet” and ultimately that because “…some yogurts on the market are high in added sugars, FDA encourages careful consideration of whether to use the claim on products that could contribute significant amounts of added sugars to the diet”.

The evidence for yogurt consumption and Type 2 Diabetes Qualified Health Claim

In the petition submitted by Danone North America, 117 publications were cited. The FDA identified additional literature (mostly published after submission of the petition) to consider.

Of these, the FDA included only 28 observational studies from which scientific conclusions could be drawn! So why did they “toss out” so many studies? Multiple reasons!

First, literature considered “background materials”, including review articles, meta-analyses, reports from federal agencies, etc. were not included as they “do not contain sufficient information on the individual studies reviewed, and therefore, FDA could not draw any scientific conclusions regarding the substance-disease relationship from these sources”.

Second, the 20 controlled intervention studies which examined the effect of yogurt on type 2 diabetes surrogate endpoints were not considered because they were determined to not be sufficiently controlled. For instance, conventional yogurt was compared to a modified yogurt (such as supplemented with brewer’s yeast), but not to a non-yogurt placebo.

Third, for the observational studies, several were excluded due to a variety of reasons. While not listing all of the reasons (you can read those all in the 51 page response from the FDA though!) for example, these include: studies not exclude participants with type 2 diabetes at baseline; studies not adjust the analysis for relevant cofounders (such as physical activity); and failed to evaluate the independent effect of yogurt.

Of the 28 observational studies, over 860,000 participants were included across 27 cohorts and 10 countries. All but one study estimated yogurt intake using food frequency questionnaires (FFQ). The one remaining study by O’Connor et al, 2014 [6] used a 7-day food recall. Studies included could look at the association between yogurt intake and incidence of type 2 diabetes or surrogate end points (such as prediabetes), as well as the change in yogurt intake and incidence of diabetes or surrogate end points. Importantly, the FDA classifies the literature based on methodological quality. 9 were considered to be of high methodological quality and a significant association was observed for both incidence of type 2 diabetes and the surrogate end point of fasting glucose. 19 were considered to be of moderate methodological quality and findings were mixed and inconsistent. For instance, Liang et al 2017 [7] found that yogurt intake was statistically associated with a reduced risk of type 2 diabetes among women, but not men.

Summary and implications for dietary advice

Overall, the FDA concluded that while there is credible evidence supporting a relationship between regular yogurt consumption and reduced risk of type 2 diabetes, the evidence is limited. Specifically, no randomized controlled trials were included and there were inconsistent findings. That being said, it is unlikely that there will ever be randomized controlled trials conducted to determine the influence of yogurt consumption on diabetes risk. This is because diabetes takes years to develop and it would not be feasible to randomize people to different yogurt intake levels for most of their life.

When working with clients, this new qualified health claim can be utilized to support the recommendations you are already likely to give to your clients. Yogurt can be a versatile and nutritious addition or substitution to meals and snacks that provide protein, probiotics, and essential nutrients. Furthermore, the addition of yogurt to the diet can aid in clients meeting the Healthy Eating Index’s dairy component targets as part of an overall healthful diet!

Bon appetit!

Tanya Halliday, PhD, RD is an Assistant Professor in the Department of Health & Kinesiology at the University of Utah. Her research focuses on how exercise of differing modalities influences appetite regulation and energy intake; development of novel interventions for weight loss maintenance, and examination of lifestyle interventions and glycemic-related outcomes. Dr. Halliday completed her Bachelor’s degree in Dietetics from the University of Wyoming (2010), and her Dietetic Internship at the University of Houston (2011). After receiving her RD credential, she went to Virginia Tech for her PhD in Clinical Physiology, and Metabolism. She graduated in 2016, receiving the College of Agriculture and Life Sciences Outstanding Doctoral Student Award, before moving to Denver for postdoctoral training at the University of Colorado’s Anschutz Medical Campus from 2016-2018. Dr. Halliday has been at the University of Utah since 2018 where her research has been funded by the NIH and multiple internal pilot grants. In addition to her research program, Tanya serves as a member of the Academy of Nutrition and Dietetics’ Weight Management Expert Panel. She is passionate about the career development of her lab member’s and in 2022 received the College of Health’s Distinguished Mentor Award.

References
  1. (1) https://www.fda.gov/food/food-labeling-nutrition/label-claims-food-dietary-supplements
  2. (2) https://www.fda.gov/food/food-labeling-nutrition/authorized-health-claims-meet-significant-scientific-agreement-ssa-standard
  3. (3) https://www.fda.gov/food/food-labeling-nutrition/authorized-health-claims-meet-significant-scientific-agreement-ssa-standard
  4. (4) https://www.fda.gov/food/food-labeling-nutrition/qualified-health-claims
  5. (5) https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfcfr/cfrsearch.cfm?fr=101.14
  6. (6) O'Connor LM, Lentjes MA, Luben RN, Khaw KT, Wareham NJ, Forouhi NG. Dietary dairy product intake and incident type 2 diabetes: a prospective study using dietary data from a 7-day food diary. Diabetologia. 2014 May;57(5):909-17.
  7. (7) Liang J, et al. Association between fruit, vegetable, seafood, and dairy intake and a reduction in the prevalence of type 2 diabetes in Qingdao, China. Asia Pac J Clin Nutr. 2017 Mar;26(2):255-261.
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