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19 Aug 2024
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6 min read
Diabetes prevention Echoes from ASN Nutrition 2024 Expert interviews

Interview with Dr Christopher Cifelli, PhD

Cifelli Diabetes FDA t2d type 2 diabetes
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Type 2 Diabetes is a growing global health crisis, demanding comprehensive strategies to combat its rise. As highlighted during the symposium ‘Yogurt and Reduced Risk of Type 2 Diabetes: Exploring the New FDA Qualified Health Claim and Potential Implications for Improving Public Health’ at the ASN Nutrition 2024, incorporating nutrition expertise and food-based approaches, such as yogurt with its unique nutrient profile, is crucial in addressing diabetes risk. In this interview, Dr Christopher Cifelli, PhD discusses the recent FDA-qualified health claim on yogurt’s role in reducing type 2 diabetes risk and its broader implications for public health and nutrition policies.

Key messages:

  • On March 1st, the FDA announced a qualified health claim outlining that regular yogurt consumption (at least 2 cups or 3 servings per week) may reduce the risk of type 2 diabetes, according to limited scientific evidence.
  • The body of evidence, which analyzed data from over 800,000 individuals, supports that yogurt consumption is associated with better health outcomes, particularly in reducing the risk of type 2 diabetes.
  • Yogurt is a nutrient-dense food that provides essential nutrients and fits well within the three healthy dietary patterns recommended by the Dietary Guidelines for Americans.
  • The unique food matrix of yogurt, including its nutrient content and fermentation products, may contribute to its protective effects on cardiometabolic health, independent of its fat content. Study results align with broader research on yogurt and overall health benefits.

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

I am Senior Vice President of Nutrition Research at the National Dairy Council, which represents the nearly 30,000 dairy farmers across the United States through our checkoff organization.

How would you describe the burden that type 2 diabetes represents?

Type 2 diabetes (T2D) is a significant health concern in the United States, with 38.4 million people affected, representing 11.6% of the population. Additionally, 8.7 million people are undiagnosed, and 97.6 million adults have prediabetes, increasing their risk of developing T2D. Over the past two decades, the number of adults diagnosed with diabetes has more than doubled, making it the eighth leading cause of death. The financial impact is substantial, with medical costs and lost wages for those with diagnosed diabetes totaling $413 billion annually. Medical costs for people with diabetes are more than twice as high as those without the condition.

Healthy lifestyle choices are crucial in reducing the risk of T2D and mitigating public health costs. Maintaining a healthy weight, engaging in regular physical activity, and following a balanced diet are key strategies for T2D prevention, treatment, and management. Weight loss helps lower the risk of T2D and other chronic diseases, regular exercise aids in blood sugar management and reduces the risk of heart disease, and a nutritious diet is essential for overall health. For more detailed information, resources such as the International Diabetes Federation’s data portal and the USDA’s Dietary Guidelines for Americans 2020-2025 can provide valuable insights.

How does yogurt consumption compare with other dairy products in terms of its impact on the risk of type 2 diabetes?

All dairy products contain essential nutrients and are generally healthy. Milk’s unique nutrient package offers a range of essential vitamins and minerals, including calcium, iodine, riboflavin (B2), vitamin B12, protein, potassium, vitamin D, phosphorus, vitamin A, niacin (B3), pantothenic acid (B5), selenium, and zinc. These nutrients make dairy foods a powerful contributor to a healthy diet, providing essential components that support various bodily functions and overall well-being.

However, when it comes to type 2 diabetes, regular yogurt consumption may reduce the risk. This association is observed across numerous prospective cohort studies in various populations both in the US and globally. In contrast, milk and cheese do not exhibit the same level of consistency in reducing type 2 diabetes risk. Yogurt stands out as the most consistently linked dairy food associated with a reduced risk of type 2 diabetes.

What evidence supports the role of yogurt in reducing the risk of type 2 diabetes in different demographic groups such as children, adults, and the elderly?

Most of the research on yogurt’s role in reducing the risk of type 2 diabetes has been conducted in adults, primarily through observational studies. Several meta-analyses have also been performed. The FDA, in their review of the evidence, cited 28 studies, with the majority showing a reduction in type 2 diabetes risk. This body of research spans decades, and demonstrates yogurt’s role in reducing the risk.

Four meta-analyses have consistently associated yogurt intake with a reduced risk of Type 2 Diabetes (T2D). Studies by Tong et al. (2011), Gao et al. (2013), Chen et al. (2014), and Gijsbers et al. (2016) demonstrated relative risk reductions ranging from 0.85 to 0.94 across various cohorts, highlighting yogurt’s beneficial impact. The FDA’s rigorous review process, spanning from 2019 to 2024, culminated in a qualified health claim linking yogurt consumption to a reduced risk of T2D, according to limited scientific evidence. This work, led by Danone, involved a thorough analysis of over 100 studies, and ultimately drew conclusions from 28 studies with over 860,000 subjects from 27 cohorts in 10 countries, consistently showing yogurt’s positive effect. Additionally, research from PREDIMED and other large prospective cohorts in the U.S. and globally supported these findings, demonstrating yogurt’s significant association with reduced T2D risk.

The scientific literature underscores yogurt’s unique role compared to other dairy products in lowering T2D risk. Various studies across different demographic groups, including the general adult population, postmenopausal women, and elderly populations, support the link between regular yogurt consumption and a decreased risk of type 2 diabetes. The Joslin Diabetes Center’s 2018 clinical nutrition guidelines recommend including yogurt as part of a healthy dietary pattern for those with or at risk for T2D, regardless of fat content. Moreover, emerging evidence suggests that yogurt may have anti-inflammatory effects, contributing to the prevention of noncommunicable diseases like diabetes. This extensive body of research highlights the importance of yogurt as a valuable component of a diabetes-prevention diet.

What biological mechanisms have been proposed to explain the inverse relationship between yogurt consumption and the risk of type 2 diabetes?

While still not fully understood, there are several potential mechanisms by which yogurt consumption may help reduce the risk of type 2 diabetes. Firstly, yogurt itself can help reduce appetite, as dairy proteins have been shown to lower appetite when part of a healthy diet. Secondly, the unique fats produced by the starter cultures in yogurt have been shown to impact liver function, improve metabolism, and reduce insulin resistance. Additionally, studies have indicated that yogurt can help maintain gut barrier function and lower inflammation. These are three key mechanisms through which yogurt may help reduce diabetes risk.

Yogurt’s profile also supports general health. Its essential nutrients such as protein, calcium, and other minerals make it unique when considering nutritional adequacy. Additionally, the bacteria and bacterial enzymes in yogurt can help support digestive health, while fermentation products like short-chain fatty acids, bioactive peptides, and B vitamins contribute to its positive effects. Yogurt also offers other benefits like lower pH and increased nutrient bioavailability, supporting overall health.

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12 Aug 2024
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4 min read
Q&A

Focus on iodine

iodin mineral nutrient thyroid
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Iodine is a trace element, which the body needs in very small amounts to stay healthy. What are its functions and where to find it?

What is iodine?

Iodine is a mineral, a trace element, mostly stored in our thyroid gland, which releases several thyroid hormones like thyroxine (T4) and triiodothyronine (T3). Iodine is essential for these hormones as it makes up 65 and 59% of the weight of the molecules respectively. These hormones are regulated by Thyroid-Stimulating hormone (TSH) whose secretion increases the uptake of iodine in the thyroid. These hormones regulate biochemical reactions including protein synthesis, enzymatic activities and metabolic activities such as body temperature regulation and maintenance of energy levels. In a deficiency state, TSH remains elevated and leads to goitre: an enlargement of the thyroid gland. In pregnancy, even a mild case of iodine deficiency is serious as it can cause problems in the child’s development and cognition, and it is considered one of the easiest preventable deficiencies leading to neurodevelopmental disorders.

Functions of Iodin - YINI

Dietary recommendations

  • For teenagers and adults, it is recommended to consume 150µg per day of iodine.
  • The recommendation climbs to 220µg/day during pregnancy and 290µg during lactation.
  • Recommendations are much higher in the first year of life at 130µg than during childhood (90µg). This is because in early developmental stages, iodine deficiency can lead to stunted growth and neurodevelopmental deficits.
  • During the 9-13-year-old age group, the recommendation goes back up to 120µg.

Although it is difficult to consume too much iodine in a healthy and balanced diet, it is suggested to not consume more than 600µg per day in healthy adults.

Sources of iodine

Iodine can be found mostly in seaweed, fish and seafood, eggs, and dairy.

Source of Iodin

Many countries have fortified table salt with iodine as the salt form of iodine is the main form absorbed in the body. It is estimated that 88% of households have iodine-fortified salt. However, countries also have efforts to decrease salt consumption therefore dairy is becoming a more interesting source of iodine.

When to pay extra attention?

To some people, it might be hard to get enough iodine from their diets, as their needs are increased, or their food sources are limited.

For vegans, vegetarians and those who exclude fish and algae from their diets, it might be difficult to get enough iodine from the diet. They need to pay extra attention to their iodine intake. It is particularly concerning during pregnancy and childhood (up to the age of 3 years old).

Iodine in dairy

Iodine content in milk varies widely depending on the diet of the animal. There can even be seasonal variability in iodine concentrations, for example, cattle grazing on grass in the summer will produce milk with less iodine than cattle fed with cattle feed containing iodine in winter. All of this makes milks’ iodine concentrations vary from 33 to 534 µg/L. This means dairy can represent 13-64% of the recommended daily intake of iodine.

In UK, milk has on average 427µg/L and dairy products contribute to 51% of iodine intake in children and 34% in adults.

Even though the concentration of iodine in dairy milk varies widely it is still on average 10 times higher than in plant-based alternatives. Thus, dairy remains a good source of this nutrient for health, especially in places that don’t have easy access to seafood or iodised salts.

According to the national diet and nutrition survey in the UK, people who consume yogurt regularly were more likely to meet the nutrient recommendations for key vitamins and minerals including iodine compared to those who didn’t eat yogurt regularly.

It is recommended to consume 2-3 portions of dairy per day, yogurt is a nutrient-rich way of getting iodine.

References
  1. (1) EUFIC – Iodine: foods, functions, how much do you need & more.
  2. (2) Office of Dietary Supplements - Iodine.
  3. (3) Van der Reijden OL, Zimmermann MB, Galetti V. Iodine in dairy milk: Sources, concentrations and importance to human health. Best Pract Res Clin Endocrinol Metab. 2017;31: 385–395
  4. (4) Alzahrani A, Ebel R, Norton G, Raab A, Feldmann J. Iodine in plant-based dairy products is not sufficient in the UK: A market survey. Journal of Trace Elements in Medicine and Biology. 2023;79: 127218.
  5. (5) Zhu Y, Jain N, Holschuh N, Smith J. Associations between frequency of yogurt consumption and nutrient intake and diet quality in the United Kingdom. Journal of Nutritional Science. 2021;10: e85.
  6. (6) Niero G, Visentin G, Censi S, Righi F, Manuelian CL, Formigoni A, et al. Invited review: Iodine level in dairy products—A feed-to-fork overview. Journal of Dairy Science. 2023;106: 2213–2229.
  7. (7) Witard OC, Bath SC, Dineva M, Sellem L, Mulet-Cabero A-I, van Dongen LH, et al. Dairy as a Source of Iodine and Protein in the UK: Implications for Human Health Across the Life Course, and Future Policy and Research. Front Nutr. 2022;9: 800559.
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05 Aug 2024
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4 min read
Cardiovascular health Nutri-dense food

Research reveals how whole-fat dairy foods may benefit our cardiometabolic health

lipids Metabolic diseases milk fat
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A growing body of evidence reveals that eating whole-fat dairy foods doesn’t increase the risk of heart disease and may even be good for our cardiometabolic health. These findings fly in the face of previous conventional thinking that has led to dietary guidelines recommending we choose low-fat rather than whole-fat dairy products.

The unexpected findings have therefore prompted a flurry of research activity to re-examine how whole-fat dairy foods affect health beyond their saturated fat content.

Now a major step towards unlocking this mystery has been made by US researchers who have conducted a literature review into the biological mechanisms underlying the potentially beneficial associations between whole-fat dairy food consumption and risk markers for cardiometabolic health (1).

The secret, the researchers conclude, lies in the complex nutrient matrices of dairy foods and how these interact with the body.

Understanding the dairy food matrix

It is too simplistic just to look at the health effects of dairy foods according to the individual nutrients they contain; rather, we need to consider the whole food matrix – the unique combination and organisation of nutrients such as proteins, fats, vitamins, and minerals. The food matrix differs between milk, cheese, and yogurt, and may dictate how each dairy type affects cardiovascular risk.

In whole-fat dairy foods, part of the matrix comprises dairy fatty acids and polar lipids, contained within the Milk Fat Globular Membrane (MFGM). Researchers found that these components may contribute to cardioprotective benefits through complex pathways involving lipid metabolism, the gut microbiota, and inflammatory regulation.

Milk polar lipids may contribute to cardiometabolic health

Research has shown that milk polar lipids may contribute to improved cardiometabolic health by lowering blood cholesterol levels through reduced absorption of cholesterol in the intestine (2,3).

  • Clinical studies suggest that eating whole-fat dairy foods containing milk polar lipids within the MFGM does not worsen an individual’s cholesterol.
  • Milk polar lipids have been shown to improve markers of cardiometabolic health by interacting with the gut to reduce cholesterol absorption without disrupting the gut microbiota.

Results suggest that milk polar lipids present in the MFGM may also contribute to cardiometabolic health by reducing inflammatory responses to diet (4,5).

  • Results from preclinical studies suggest that high doses of milk polar lipids can benefit cardiometabolic health by modifying inflammatory responses in the gut.
  • Clinical studies show that milk polar lipids within the MFGM can increase levels of anti-inflammatory cytokines.

Some milk fatty acids can have beneficial cardiometabolic effects

The researchers discovered that individual fatty acids present in whole-fat dairy foods may benefit cardiometabolic health by modulating cholesterol levels and inflammatory or metabolic pathways.

  • Study results suggest a potential role for dairy odd-chain fatty acids, C15:0 and C17:0, in promoting cardiometabolic health by modulating cholesterol levels, stimulating cell repair, and reducing inflammation (6).
  • Preclinical studies suggest that dairy branched-chain fatty acids may benefit cardio-metabolic health through anti-inflammatory pathways, although more research is needed.
  • Short- and medium-chain fatty acids have also been implicated in modifying inflammation and beneficial effects on energy homeostasis and metabolic health (7).

The dairy food matrix may play a role in the effects on cardiometabolic health

When the researchers examined the role of the dairy food matrix in the effects of whole-fat dairy foods on cardiometabolic health. They found that whole-fat dairy foods such as milk, cheese, and yogurt have different effects on cardiometabolic health that cannot be predicted by their saturated fat content alone but may be in part due to the differences in their food matrices.

  • Dairy food matrix effects on lipid metabolism, the microbiome, and fat absorption and excretion may contribute to the neutral association between eating whole-fat dairy foods and risk of cardiometabolic disease.
  • The fermented cheese matrix improves blood cholesterol, modulates markers of chronic inflammation, and increases the production of bioactive peptides.
  • The fermented yogurt matrix may beneficially affect the gut microbiota and fermented milk may promote antihypertensive effects through angiotensin-converting enzyme (ACE)-inhibitory activity.

These examples highlight the complexity of various whole-fat dairy foods and how they may differentially impact cardiometabolic health.

“The dairy food matrix, how the macronutrients and micronutrients and other bioactive components of dairy foods are differentially compartmentalized among fluid milk, cheese, and yogurt, may dictate how each affects cardiovascular risk.”

Torres-Gonzalez M, et al., 2023

References
  1. (1) Source: Torres-Gonzalez M, Rice Bradley BH. Whole-Milk Dairy Foods: Biological Mechanisms Underlying Beneficial Effects on Risk Markers for Cardiometabolic Health. Adv Nutr. 2023 Nov;14(6):1523-1537.
  2. (2) C. Vors, L. Joumard-Cubizolles, M. Lecomte, E. Combe, L. Ouchchane, J. Drai, et al., Milk polar lipids reduce lipid cardiovascular risk factors in overweight postmenopausal women: towards a gut sphingomyelincholesterol interplay, Gut 69 (3) (2020) 487–501,
  3. (3) L. Anto, S.W. Warykas, M. Torres-Gonzalez, C.N. Blesso, Milk polar lipids: underappreciated lipids with emerging health benefits, Nutrients 12 (4) (2020) 1001,
  4. (4) Y. Yang, T. Zhang, G. Zhou, X. Jiang, M. Tao, J. Zhang, et al., Prevention of necrotizing enterocolitis through milk polar lipids reducing intestinal epithelial apoptosis, J. Agric. Food Chem. 68 (26) (2020) 7014–7023
  5. (5) E. Demmer, M.D. Van Loan, N. Rivera, T.S. Rogers, E.R. Gertz, J.B. German, et al., Addition of a dairy fraction rich in milk fat globule membrane to a high-saturated fat meal reduces the postprandial insulinaemic and inflammatory response in overweight and obese adults, J. Nutr. Sci. 5 (2016) e14
  6. (6) K. Kurotani, M. Sato, K. Yasuda, K. Kashima, S. Tanaka, T. Hayashi, et al., Even- and odd-chain saturated fatty acids in serum phospholipids are differentially associated with adipokines, PLOS ONE 12 (5) (2017) e0178192
  7. (7) A.L. Unger, M. Torres-Gonzalez, J. Kraft, Dairy fat consumption and the risk of metabolic syndrome: an examination of the saturated fatty acids in dairy, Nutrients 11 (9) (2019) 2200
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23 Jul 2024
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1 min read
Athletes Gut Health Infographics Nutri-dense food

Yogurt in sports nutrition

Athlete casein dairy proteins microbiota probiotic whey
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Discover the new infographic about sports nutrition and yogurt. Engaging in sports activities comes with specific nutritional needs, and yogurt can be a valuable asset in meeting these requirements.

Sports, nutrition and yogurt

The regular practice of a sport leads the body to certain physiological adaptations and it may result in an increase in total daily energy expenditure.

Yogurt provides vitamins, minerals, ferments and high-quality proteins, which are invaluable for muscle repair and maintenance and fermented dairy products offer a range of options for naturally supplying the required amount of protein.

Besides, ferment can have positive impacts on the gut health of sports people.

Gut health, sports practices and ferments

Studies show a link between sports practices and gut health.

Fermented dairy products may contain probiotics. Some of these can affect performance parameters, in particular : promote gut health and immune function; facilitate digestion and nutrient absorption, potentially reduce the risk of gastrointestinal upset during exercise.

Yogurt in sports nutrition: the infographic

Download the infographic (pdf)

Download the infographic (pdf)
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22 Jul 2024
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3 min read
Q&A

Focus on Phosphorus

micronutrient phosphorus
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Phosphorus is an essential nutrient for many functions and body parts such as bone and teeth. It is present in dairy, let’s focus on it.

What is phosphorus?

Phosphorus is a mineral found in many components of the body. 85% is found in bones and teeth, 15% in blood and soft tissues and it makes up to 1-1,4% of the fat free mass of the body.

Phosphorus plays a role in a multitude of processes:

  • Bones and teeth structure. Along with calcium it forms hydroxyapatite which is the main structural components of bones and enamel. They are regulated by vitamin D which means these 3 nutrients are interrelated for bone health.
  • Cell membranes: it is present in phospholipids which make up the majority of the cell membranes and it contributes to the to the normal functioning of cell membranes
  • Part of the body’s key energy source: it is part of adenosine triphosphate (ATP) which is the source of energy of the body in metabolic processes and it supports normal energy metabolism.
  • DNA and RNA: it is present in the backbone of the molecule and has a role in gene transcription and activation of enzymes
  • Nervous system: it protects the cells and provides energy.
  • pH balance: it acts as a buffer in extracellular fluids.
  • Oxygen delivery to cells: it binds to haemoglobin to regulate oxygen delivery.
  • Phosphorylation of sugars and proteins: it is the first step to convert them to usable energy by the body.
About phosphorus - functions - YINI

Deficiency in phosphorus can lead to symptoms of anaemia, loss of appetite, muscle weakness, confusion, increased infection risk and of course bone diseases (bone pain, rickets, osteomalacia, osteoporosis).

According to the National Health and Nutrition Examination Survey (NHANES) in the USA, most Americans consume more than the recommended amounts therefore deficiency is rare and most likely not a result of low dietary intakes.

Dietary recommendations

The recommended daily intake of phosphorus for adults is 700mg. For teenagers, a higher intake (1250mg) is recommended  to accommodate rapid growth and to ensure healthy bones.

In a healthy and balanced diet, it is unlikely to consume too much phosphorus to the point of having negative health effects as the safe upper limit is 3000 mg per day.

Phosphorus can be found in many different types of food especially those high in protein such as dairy, meat, fish, grains and legumes.

In some food products, the bioavailability of phosphorus remains poor. For example, in unleavened bread and seeds it is found in its storage form of phytic acid. The body lacks the phytase enzyme to break it down and absorb the phosphorus.

Phosphorus in dairy

Dairy represents about 20% of total phosphorus consumption in the USA. Dairy also contains calcium and vitamin D which are the other micronutrients essential for bone health.

Phosphorus in dairy - YINI

Keeping a good calcium/phosphorus ratio is important. If phosphorus is consumed in high amounts and calcium in low amounts, the high amount of phosphorus will prevent some of the calcium to be absorbed causing low levels of calcium and issues for bone health. The same is true the other way around.

Dairy products are a good way to get some bioavailable phosphorus as well as other micronutrients involved in bone and overall health.

Studies show that people who consume yogurt have stronger bones and better mobility in older age. Yogurt consumption of is also associated with higher bone mineral density in children

It is recommended to consume 2-3 portions of dairy per day.

References
  1. (1) EUFIC - Phosphorus: foods, functions, how much do you need & more.
  2. (2) Office of Dietary Supplements - Phosphorus.
  3. (3) CIQUAL – La table de composition nutritionnelle des aliments. ANSES, France.
  4. (4) US department of agriculture – What we eat in America (2022).
  5. (5) 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
  6. (6) 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
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15 Jul 2024
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6 min read
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by YINI Editorial team
Other studies

Eating yogurt may help protect against tooth decay and gum disease

YINI Editorial team
The YINI team includes nutritionists, food engineers, registered dietitians and scientific writers.
gum probiotics tooth tooth decay
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Research suggests that eating yogurt can modify the mouth’s microbiome and is associated with improved oral health, helping to protect against tooth decay and gum disease – the main causes of tooth loss.

Regular yogurt consumption may reduce the risk of tooth decay and inflammatory gum disease

Adults who eat yogurt every day have a lower risk of tooth loss resulting from gum disease, compared with those who don’t eat any yogurt.

Eating yogurt daily has also been associated with a reduced risk of tooth decay among children and teenagers, compared with not eating yogurt. Several studies have shown that daily consumption of dairy products, including yogurt, is associated with improved oral health compared with less frequent consumption:

  • One study showed that adults who ate or drank more than six servings of dairy food (including milk and yogurt) per week had a 24% lower prevalence of gum disease than those who didn’t consume any dairy food. This difference was reduced to just 9% for infrequent consumption of dairy food (one serving per week or less).
  • Authors of one study recommended daily consumption of yogurt to improve oral health after they found that adults who ate yogurt daily were 76% less likely to have gum disease than those who ate yogurt less than once a week.
  • Another study reported greater oral health improvements in children who drank Lactobacillus probiotic milk every day, compared with three times a week – these benefits remained for at least 6 months after discontinuation.

Dairy products have several protective effects against tooth decay

According to evidence from both interventional and observational studies, consuming dairy products may be associated with a reduced risk of tooth decay due to several different protective effects:

  • Lactose in milk has lower potential for causing tooth decay than other dietary sugars as it is not fermented to acidic products in the mouth.
  • Calcium and phosphate in milk help prevent the decay of tooth enamel and may even support remineralisation of tooth enamel.
  • The proteins and fats in milk may also reduce the ability of plaque to stick to tooth enamel and produce acids. It is likely that the protective potential of plain unsweetened yogurt is similar to that of milk.

“Eating yogurt every day may contribute to improved oral health by modifying the mouth’s microbiome, reducing the risk of developing tooth decay and gum disease in both adults and children.”- Professor Sharon Donovan

The probiotic content of some yogurts may add to their oral health benefits

Several randomised controlled trials have demonstrated that yogurts containing added Bifidobacterium or Lactobacillus probiotic cultures are effective antibacterial agents against plaque-causing Streptococcus mutans bacteria.

Such probiotic yogurts were shown to reduce levels of Streptococcus mutans bacteria in the saliva and dental plaque of both adults and children.

In one study, probiotic yogurt also increased salivary pH, reducing the acidity of saliva by diminishing the acid production ability of Streptococcus mutans.

Laboratory cultures have also shown that Lactobacillus probiotic yogurt can inhibit the growth and adhesion of Streptococcus mutans bacteria.

Randomised controlled trials have shown that eating yogurt containing added Bifidobacterium or Lactobacillus probiotic cultures is associated withreductions in several markers of gum inflammation

People who ate probiotic-containing yogurts experienced greater reductions in plaque formation, gum inflammation, probing depth, bleeding on probing, and inflammatory fluids or markers, compared with those who ate non-probiotic containing yogurt.

These oral health benefits may be achieved through modifying the oral microbiome

Studies in adults and children suggest that consumption of dairy products containing added probiotics, including yogurt containing added Bifidobacterium or Lactobacillus probiotic strains, may help prevent tooth decay through modification of the oral microbiome.

Evidence suggests that these benefits are achieved due to the ability of the live bacteria in probiotic containing dairy products to modify the composition of the mouth’s microbiome, and so reduce the decay-causing bacteria that can lead to oral disease.

The characteristics of individual dairy products may also have an important role – the lactic acid bacteria starter cultures used to make fermented dairy products, such as yogurt, may also help to reduce tooth decay-causing bacteria.

Benefits to oral health of consuming dairy products containing added probiotics - YINI

For more information, check the complete publication “Yogurt from science to health”

References:

YINI Editorial team
The YINI team includes nutritionists, food engineers, registered dietitians and scientific writers.
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04 Jul 2024
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7 min read
Diabetes prevention Echoes from ASN Nutrition 2024 Expert interviews

Yogurt and reduced risk of T2D: exploring the new FDA qualified health claim

Diabetes FDA t2d type 2 diabetes
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In March 2024, the U.S. Food and Drug Administration (FDA) approved a qualified health claim regarding the consumption of yogurt and its association with a reduced risk of type 2 diabetes (T2D). On June 29, 2024, a conference organized as part of the Nutrition 2024 Congress in Chicago revisited this announcement. It provided an opportunity for Christopher J. Cifelli (NDC) and Wendy Reinhardt Kapsak (IFIC) to elaborate on the scientific basis of this claim and discuss its potential implications.

The health burden of Type 2 diabetes

In the United States, 38.4 million people have diabetes, which represents 11.6% of the population. Additionally, it is estimated that 97.6 million adults have pre-diabetes, putting them at greater risk of developing type 2 diabetes (T2D). Over the past 20 years, the number of adults diagnosed with diabetes has more than doubled.

However, adopting healthy lifestyle choices can help reduce the risk of T2D and lower public health costs:

  • Excess body weight is a significant risk factor for T2D. Maintaining a healthy weight can reduce the risk of T2D and many other chronic diseases.
  • Regular exercise helps manage blood sugar levels and lowers the risk of heart disease and other complications.
  • A healthy diet forms a crucial part of the foundation for T2D prevention, treatment, and management.

Yogurt as part of a balanced diet: specific benefits for T2D

Yogurt offers specific benefits for type 2 diabetes (T2D) when included as part of a balanced diet. Four meta-analyses have consistently reported an association between yogurt consumption and a reduced risk of T2D (2-5).

Yogurt associated with reduction risk of T2D - YINI

The inverse association between yogurt consumption and T2D risk has been observed in populations across North America, Europe, the UK, Australia, and Japan. A meta-analysis of 14 studies, encompassing 483,090 individuals (with 32,896 T2D cases), found a 7% reduction in the risk of T2D for every 50 g (approximately 2 ounces) increase in daily yogurt consumption.

Evaluating the association between yogurt intake and diabetes-related parameters

In addition to the four meta-analyses, extensive data supports the role of yogurt in reducing the risk of type 2 diabetes (T2D). The FDA’s qualified health claim is based on robust methodology, and the association between yogurt intake and diabetes-related parameters was evaluated through a comprehensive literature search of 140 publications. Many articles were excluded for the following reasons:

  • Background materials (reviews, meta-analyses, reports),
  • Lack of assessment of yogurt’s effect on T2D-related parameters,
  • Absence of scientific conclusions.

Ultimately, 28 observational studies, encompassing 860,000 subjects from 27 cohorts across 10 different countries, were included in the final analysis. These studies allowed for scientific conclusions to be drawn. Among these:

  • 6 high-quality methodological studies on prospective cohorts in the U.S. or Spain found an inverse relationship between yogurt consumption and the risk of T2D (3,6-10).
  • 3 high-quality studies examined changes in yogurt intake and reported a reduced risk of T2D (11-13).
  • 12 studies of lower methodological quality showed positive but inconsistent findings or varying results.

No statistically significant association was found between yogurt intake or changes in yogurt intake and a reduced risk of type 2 diabetes among the six studies with high methodological quality.

Based on this detailed analysis, credible scientific evidence indicates a statistically significant association between yogurt consumption and a reduced risk of type 2 diabetes. This association pertains to yogurt as a whole food rather than any single nutrient or compound within yogurt, regardless of its fat or sugar content.

How might yogurt reduce T2D risk?

Several mechanisms may explain the association between yogurt consumption and a reduced risk of type 2 diabetes (T2D).

People who consume yogurt are less likely to have unhealthy lifestyles that are linked to an increased risk of T2D (15).

Yogurt is a low glycemic index food, meaning it does not cause a significant spike in blood glucose levels after a meal.

Chronic systemic inflammation may contribute to many noncommunicable diseases, including diabetes, and recent evidence suggests that regular yogurt consumption may have an anti-inflammatory effect (16,17).

Live bacteria in yogurt can improve gut microbiota composition, which may help reduce inflammation, a factor linked to T2D.

Conclusion: Substantial evidence links yogurt consumption to better health outcomes

Numerous high and moderate-quality studies have found an inverse relationship between yogurt intake and type 2 diabetes.

Yogurt is a nutrient-dense food, providing essential nutrients, and is included in all three healthy dietary patterns recommended by the Dietary Guidelines for Americans.

Yogurt has a unique food matrix that may contribute to its protective effects on cardiometabolic health, regardless of its fat content.

These study results are consistent with other research examining the broader health benefits of yogurt consumption.

Thank you for Christopher J. Cifelli, PhD, Senior Vice President of Nutrition Research National Dairy Council, for this intervention on “Exploring the Scientific Evidence: Yogurt and Reduced Risk of Type 2 Diabetes” during the ASN Nutrition 2024 conference “Yogurt and reduced risk of T2D: exploring the new FDA qualified health claim and potential implication for improving public health”.

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01 Jul 2024
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5 min read
Children Healthy Diets & Lifestyle Nutri-dense food

Can dairy foods contribute to teens’ nutrient intakes?

calcium children dairy micronutrients nutrient
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Dietary strategies must be devised to target teenagers who are commonly falling short of their nutrient intake requirements, according to research from the Republic of Ireland.

Nutritionists have discovered a concerning trend that many teenagers in Western countries have shortfalls in their diet of micronutrients needed for this critical period of physical and cognitive growth and development (1). Eating dairy foods as part of a balanced and environmentally sustainable diet may help to provide a key source of micronutrients vital for teenage health and wellbeing, the research suggests.

Assessing the nutritional needs of teenagers

As they go through their teenage years, young folk have increasing independence over their food choices and eating behaviour. However, nutrient intakes are not always uppermost in teens’ minds when making their food choices, with potential consequences for health into adulthood (2).

To find out whether teens are getting enough nutrients from their diet, nutrition researchers from Cork, Ireland delved into the micronutrient intakes of teenagers and their implications for public health.

The researchers examined data from recent surveys on micronutrient intakes among teenagers in Europe, Canada, the United States, Australia and New Zealand. They found that Western teenagers are consistently failing to meet recommended intake levels for vitamins A, C, D and E, along with folate, calcium, iron, magnesium, zinc and potassium. This could have far-reaching consequences for bone health, cognitive function, and immunity.

What are the nutritional needs of teenagers?

Micronutrients play vital roles in the health and development of teenagers by contributing to a wide range of critical functions in the body (3):

  • Vitamin D, calcium, magnesium, and phosphorus – essential for building bone mass and bone health
  • Vitamins A and C – necessary for the development of cells, cell integrity and tissue repair
  • Vitamin B and folate – important for growth, DNA synthesis and cell division
  • Iron – essential for the transport of oxygen, with increased requirements during teenage years
  • Zinc – a key contributor to gene expression and regulating intracellular signalling
  • Iodine – vital for the development of neurological and cognitive skills.

Dairy foods are a key component of bone health in teenagers

Study results showed that intakes of vitamin D, calcium and magnesium are low amongst Western teenagers, with inadequate levels of vitamin D among 70–95%, calcium among 45–73%, and magnesium among 33–88% of teens.

This is important because over half of a person’s bone mass is laid down during the teenage years, requiring sufficient intakes of vitamin D, calcium and magnesium (4). Teenage bone health may be affected by low intakes of these nutrients, resulting in an increased risk of fracture and osteoporosis in later life.

According to the researchers, key sources of calcium, magnesium and vitamin D in teenagers include dairy foods, meat products and fortified cereals. Such nutrient sources should be incorporated into a healthy teenage diet.

A healthy balanced diet can help boost teenage cognitive function

Results also showed that iron and folate intake tend to be low in Western teenagers compared with recommended levels, with inadequate levels of iron and folate in 7–44% and 14–57% of teens, respectively. Iron deficiency is generally more common amongst girls than boys.

This is important because the teenage years are a period of rapid cognitive growth and development, which may be negatively impacted by low intake of folate and iron (3). Iron requirements in particular escalate throughout adolescence due to increased total blood volume and lean body composition, as well as the onset of menstruation in girls.

The researchers highlighted that a combination of dairy, meat, and cereal products provide key sources of iron and folate in teenagers, while vegetables are also an important source of folate.

Teenage diet choices influence general health and immunity

The study found that intakes of nutrients important for general health – including vitamins A, C, E, zinc and potassium – are also generally below recommended levels among Western teenagers.

Low intakes of these vitamins and minerals may result in an increased risk of impaired immunity and susceptibility to infections (5,6).

The researchers pointed out that dairy and meat products are important sources of vitamin A and zinc in teenagers, while fruit and vegetables are key sources of vitamin C. Vegetables, cereals, meat and dairy are all key sources of potassium, while fats and oils are an important source of vitamin E.

So, what can be done to address this issue?

While this study highlights teenage deficiencies in nutrient intake, it also offers some reassurance. Based on current dietary patterns, there seems to be little risk of excessive micronutrient intake, said the researchers.

They concluded that strategies aimed at increasing micronutrient intake among teenagers should focus on boosting intake rather than worrying about overconsumption. Such strategies must be carefully designed and monitored to ensure that they effectively consider the importance of meat and dairy foods to the nutrient intake of teenagers, but are also environmentally sustainable.

“Sufficient micronutrient intakes are crucial during the teenage years to promote optimal health and growth during this life stage and into adulthood, with key dietary habits also forming which have been shown to track into later life.”– Walsh NM, et al., 2024

Source: (1) Walsh NM, Flynn A, Walton J, Kehoe L. Optimal growth and development: are teenagers getting enough micronutrients from their diet? Proc Nutr Soc. 2024 Mar 4:1-9. doi: 10.1017/S002966512400017X.

Additional references
  1. (2) Daly AN, O’Sullivan EJ & Kearney JM (2022) Considerations for health and food choice in adolescents. Proc Nutr Soc 81, 75–86.
  2. (3) EFSA Panel on Dietetic Products Nutrition and Allergies (2017) Dietary reference values for nutrients summary report. EFSA Support Publ 14, e15121E.
  3. (4) Levine MA (2012) Assessing bone health in children and adolescents. na J Endocrinol Metab 16, S205–S212.
  4. (5) Carr AC & Maggini S (2017) Vitamin C and immune function. Nutr 9, 1211.
  5. (6) Zhao T, Liu S, Zhang R et al. (2022) Global burden of vitamin A deficiency in 204 countries and territories from 1990–2019. Nutrients 14, 950.
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27 Jun 2024
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6 min read
Echoes from ECO 2024 Expert interviews Weight management

Odysseas Androutsos – Dietary guidelines for childhood obesity

Androustos children children obesity dietary guidelines ECO obesity
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YINI attended the 2024 ECO congress to gather scientific updates and expert’s advice on the role of diet and dairy in the management and prevention of obesity. The congress offered a great opportunity to meet with experts from various fields of expertise. Here Odysseas Androutsos, Associate Professor at the Department of Nutrition and Dietetics at the University of Thessaly, speaks about his work on the dietary guidelines for children.

Key messages:

  • Childhood obesity has significantly increased over the past decade, necessitating urgent attention and the development of comprehensive guidelines by experts at ESDN Obesity, EFAD, and EASO for treating obesity in children and adolescents.
  • Effective obesity treatment plans for children and adolescents must prioritize a holistic, patient-centered approach, incorporating long-term strategies, medical nutrition therapy, and the inclusion of nutrient-dense foods like yogurt, fruits, and vegetables to support overall health and growth.
  • Dietitians can access the latest obesity treatment guidelines on the EASO and EFAD websites, and are encouraged to collaborate in multidisciplinary teams, gather feedback through qualitative research, and implement these evidence-based recommendations into daily practice to optimize patient outcomes.

Can you introduce yourself?

I’m an Associate Professor at the Department of Nutrition and Dietetics at the University of Thessaly and Director of the Lab of Clinical Nutrition and Dietetics.

You just gave your presentation at the ECO 2024. What should our readers know about your work?

Based on recent findings, it is evident that childhood obesity has significantly increased over the past decade. The prevalence of obesity in adolescence has quadrupled since the 1990s. According to the latest figures provided by the World Health Organization (WHO), 37 million children under the age of 5 and 390 million children and adolescents worldwide are overweight, with 160 million of them living with obesity.

The severity of this issue requires urgent attention. To address these rising trends, my colleagues and I at the European Specialist Dietetic Network (ESDN) Obesity, under the European Federation of the Associations of Dietitians (EFAD), in collaboration with the European Association for the Study of Obesity (EASO), have developed the latest guidelines for treating obesity in childhood and adolescence.

Could you outline the key principles recommended in these guidelines?

First and foremost, it is essential to recognize obesity as a disease. Therefore, healthcare professionals need to focus on intensive and long-term strategies to optimize treatment for young individuals. Instead of solely concentrating on weight loss or the maintenance of weight loss, we must consider patient-centered health outcomes. This holistic approach aims to achieve results that impact overall health and disease management.

Furthermore, through the implementation of these long-term and regular interventions, we emphasize medical nutrition therapy to maintain an energy deficit and sustain the weight loss achieved. Concurrently, our optimized approach ensures the provision of essential nutrients to develop healthy diet plans. These plans will not only lead to initial weight loss but also help in maintaining a healthy weight over time.

What are the key considerations and strategies for developing effective obesity treatment plans for children and adolescents?

While focusing on weight management, it is equally important to ensure that children and adolescents receive optimal nutritional intake to meet their requirements. This is crucial from our perspective. We must promote and incorporate low-energy, nutrient-dense foods, such as yogurt, fruits and vegetables, into their diet plans. Replacing energy-dense foods like salty snacks and sweets with healthier options is essential, not only during main meals but also in intermediate meals and breakfast.

Evidence from literature and our recommendations shows, for example, that increasing fruit intake by 0.5 servings and vegetable intake by 1.5 servings per day can be sustained over a long period. Our treatment approach must be personalized, as a one-size-fits-all strategy is ineffective. Specific, measurable, and time-related goals should be set for each patient to meet their unique needs and expectations.

Working in multidisciplinary teams is vital. Collaboration among pediatricians, dietitians, nutritionists, physical education experts, psychologists, and other professionals ensures optimal results. This team approach addresses psychological, social, and physical health aspects of obesity.

Role modeling is another crucial aspect. It extends beyond healthcare professionals to include families, parents, caregivers, teachers, and others in the child’s social environment. Promoting healthy role models is essential. Additionally, using non-stigmatizing, person-first language is important. We must respect and work individually with each person to optimize our efforts.

The care environment must be safe and welcoming, making children and adolescents feel comfortable and happy. These are the main pillars of creating a healthy environment for providing care. Overall, these are the core goals of the medical nutrition therapy described in our recommendations.

What is the place of dairy products in the guidelines, and more specifically yogurt?

Dairy products are an integral part of a healthy dietary pattern and should certainly be included when prescribing healthy diets for children. Their inclusion is not solely for the treatment of overweight or obesity; rather, dairy should be a regular component of the diet plan for all children and adolescents.

In the context of obesity treatment, dairy products provide essential nutrients crucial for growth in children and adolescents, such as proteins and calcium. Additionally, yogurt offers beneficial ferments that positively affect gut microbiota, which play a significant role in maintaining a healthy diet. Incorporating these microbial benefits is an important aspect of effective obesity treatment.

Do you have a message for dietitians on how they can effectively utilize these guidelines?

Dietitians looking to utilize these guidelines can easily access them. The guidelines are uploaded and freely available on the websites of EASO and EFAD. Anyone interested can simply click on the links to access the information. Our committee is also open to any questions and future networking opportunities to optimize the implementation of these recommendations.

Additionally, it is important to note that we are actively working with healthcare professionals to gather their feedback. Through qualitative research methods, such as interviews and focus groups, we are collecting their views and suggestions on how to enhance the implementation of these guidelines. While we have compiled the best available evidence, another crucial step is optimizing the guidelines’ uptake and integration into health systems across Europe, ensuring they are effectively implemented in daily practice.

References:

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24 Jun 2024
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Echoes from ECO 2024 Expert interviews Weight management

Maria Hassapidou – Dietary Guidelines for Obesity in Europe

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YINI attended the 2024 ECO congress to gather scientific updates and expert’s advice on the role of diet and dairy in the management and prevention of obesity. The congress offered a great opportunity to meet with experts from various fields of expertise. Here Maria Hassapidou, Professor of Nutrition and Dietetics at the Alexander Technological Educational Institution of Thessaloniki (Greece) tells us about her work on the dietary guidelines for Obesity in Europe.

Key messages:

  • The newly developed dietary guidelines emphasize treating comorbidities and improving overall health, rather than solely focusing on weight loss or reducing BMI, to provide a holistic approach to obesity management for both adults and children.
  • The guidelines are based on extensive research and collaboration with international experts, incorporating evidence-based recommendations for various diets and food groups, including evidence-based support for the health benefits of vegetables and dairy products, including yogurt.
  • These guidelines are freely accessible online through the EASO and EFAD websites, and we are actively working to disseminate them through workshops and webinars to ensure widespread awareness and implementation among health professionals.

Can you introduce yourself?

I am a Professor of Nutrition and Dietetics at the International Hellenic University in Thessaloniki, Greece, and I chair the ESDN Obesity of EFAD, the specialized dietetic group on obesity of the European Federation of the Association of Dietitians. Additionally, I co-chair the Nutrition Working Group of the European Association for the Study of Obesity (EASO).

For the past decade, our collaboration between dietitians and obesity experts has been immensely beneficial. This synergy between the two groups was instrumental in the joint publication of the guidelines.

During the Congress, we observed that a multidisciplinary approach is crucial for managing obesity. Can you share the method used to develop the dietary guidelines?

As I mentioned during my presentation, our journey began with an EU umbrella project, providing an opportunity to develop dietary guidelines for obesity, particularly focusing on medical nutrition therapy. We conducted surveys across Europe to assess the existing guidelines and published comparative studies to identify similarities and differences. This process highlighted the need for unified European guidelines, which was strongly supported by scientists and healthcare professionals across various countries.

To address this, we collaborated between EFAD and EASO, forming working and writing groups. We conducted a systematic literature review, drawing heavily on the comprehensive Canadian guidelines for obesity treatment. By extending their methodology up to 2023 and sharing our findings with our Canadian colleagues, we benefited greatly from this collaboration. Simultaneously, we developed guidelines for children with obesity, incorporating significant contributions from Australian researchers and maintaining the same rigorous methodology.

Our guidelines categorize the strength of evidence into various grades and levels based on the methods used. I hope, as I mentioned, that we have produced a well-received consensus document. Initial feedback from dietitians and the European Federation Association has been positive, but it will take time to evaluate the practical implementation and effectiveness of these guidelines.

What are according to you the main highlights from these dietary guidelines?

As I mentioned during my presentation, the key point of these guidelines for both adults and children is the emphasis on treating comorbidities. These guidelines are not solely focused on weight loss or reducing BMI: their primary goal is to improve overall health. Medical nutrition therapy aims to reduce comorbidities, making health improvement the main objective. Different diets are graded based on evidence, demonstrating their effectiveness in reducing factors like cholesterol or blood pressure. While losing weight is important, maintaining overall health is paramount.

Another important aspect is the grading of different diets. We have gathered extensive information, including evidence on specific food groups. Common questions often revolve around the effects of particular foods, such as nuts or vegetables. For example, there is strong evidence that increasing vegetable intake can help reduce body weight. A significant focus of the guidelines is dedicated to food groups, with particular interest in dairy products.

Regarding dairy, we have a specific recommendation based on evidence. There was a substantial number of studies showing positive results for certain health parameters related to dairy consumption. Overall, the inclusion of dairy, and specifically yogurt, is supported by evidence in our guidelines.

In March 2024, the FDA accepted a qualified health claim on the preventive role of yogurt in type 2 diabetes. Is it something that could lead to an update of dietary guidelines?

There are European guidelines for diabetes that are updated every few years, managed by specialists in that field. Our focus is on obesity, so I can’t provide specific data on diabetes. However, as a nutritionist, I can say that yogurt plays a significant role in the microbiota, which is related to both obesity and diabetes. The type of yogurt matters, and there is substantial evidence supporting its benefits through physiological mechanisms.

Where or how can dietitians find the guidelines?

Dietitians can access our guidelines by downloading the free papers available online. They are also accessible on the EASO and EFAD websites. To encourage their use, we are planning workshops and webinars for health professionals to ensure they are aware of these guidelines. These efforts are being made through EASO, EFAD, and national associations. While it will take some time for the guidelines to be fully integrated, initial feedback from health professionals, especially dietitians, has been very positive, and they have expressed their intention to use them.

References:

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