Recent posts

24 Jun 2024
5 min read
Echoes from ECO 2024 Expert interviews

Michele Sculati: Evolution of the dietary medical approach of obesity

GLP1 liver MASH microbiota NASH obesity sculati yogurt
Related posts
See More
Our Resources
Table of contents
Table of contents

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 Dr Michele Sculati, Medical Doctor, Clinical Nutrition Specialist, PhD Public Health in Italy, speaks about the significance of addressing obesity with a comprehensive approach that includes newly available drugs, lifestyle changes, dietary adjustments, and the beneficial roles of prebiotics, probiotics, and fermented foods on the gut microbiota.

Key messages:

  • Personalized dietary prescriptions and new drugs are crucial for effective obesity treatment, emphasizing the importance of tailoring diets to individual needs and habits.
  • Recent research highlights the significant role of the microbiota in weight regulation and liver health, with diets rich in fiber and probiotics, like yogurt, showing promising benefits.
  • The FDA’s recognition of yogurt’s role in preventing type 2 diabetes underscores its potential health benefits, supported by decades of research linking yogurt consumption to lower diabetes risk and overall healthier dietary habits.

Can you introduce yourself?

I am a medical doctor specializing in Clinical Nutrition, with a strong focus on diet and dietotherapy, areas typically managed by dietitians. My passion lies in understanding how food and dietary habits can influence our health. Additionally, I have a deep interest in endocrinology and metabolism. This Congress, the ECO 2024, covers many of these topics extensively, making it an exciting and relevant event for me.

What do you believe are the key learnings from the ECO 2024 Congress?

There are numerous key messages to consider, given that the scientific program is an extensive 300-page document! Obesity has garnered significant interest, particularly with the advent of new treatment results. One of the most discussed topics is the efficacy of new drugs, including not only GLP-1 inhibitors but also others GP inhibitors and emerging medications. Currently, we have around 20 new molecules in development, making it possible to treat obesity with drugs, in addition to surgery.

However, prescribing drugs alone is not sufficient. When treating a patient with obesity, it’s crucial to remember that better results are achieved if the patient’s habits are changed. Therefore, a nutritionist or medical doctor treating obesity should emphasize the importance of personalized dietary prescriptions. These prescriptions should be tailored to the patient’s needs and habits, ensuring they are practical and achievable in real life. This includes considering the patient’s taste preferences, food preparation time, daily schedule, and activities such as sports or the use of lunch boxes.

Beyond the combination of drug development, clinical approaches and personalized dietary prescriptions, are there new targets in obesity research?

An area of growing interest among scientists is how dietary habits affect the microbiota, which plays a significant role in weight regulation. The microbiota aids in regulating weight through GLP-1. A diet rich in fiber and a healthy microbiota can lead to the production of short-chain fatty acids. These acids stimulate G protein on enterocytes, which in turn promotes the secretion of glucagon-like peptide-1 (GLP-1), the same target as many GLP analog drugs.

In recent years, there has been a shift towards prescribing diets that positively impact the microbiota by enhancing the fermentation of short-chain fatty acids. This can be achieved through diet, prebiotics, and probiotics. Probiotics are not limited to pills or supplements but can also be found in foods like yogurt, which naturally contain probiotics.

Many foods have potential probiotics. However, the way we cook, prepare, and store these foods affects their probiotic content. In contrast, yogurt is a standardized food with known probiotic content and substantial scientific backing.

Based on the sessions you attended here at ECO 2024, can you think of new benefits yogurt may bring to the microbiota?

Definitely! For example, I attended sessions on Metabolically Associated Steatohepatitis (MASH), previously known as Non-Alcoholic Steatohepatitis (NASH). These sessions highlighted the connection between the microbiota and the liver. Poorly differentiated microbiota, lacking healthy taxa, can lead to a thinner mucus layer in the gut, causing a condition known as leaky gut. This allows chemicals like lipopolysaccharides to pass through enterocytes into the bloodstream, reaching the liver directly.

Lipopolysaccharides impact inflammation mediators in the liver, contributing to chronic inflammation associated with non-alcoholic fatty liver disease (NAFLD) and MASH. Once again, as previously stated, modulating the microbiota through dietary habits and probiotics can play a crucial role in managing these conditions.

In March, the FDA accepted a claim that yogurt can help prevent type 2 diabetes. How significant is this claim for clinicians, and will it impact their recommendation of yogurt?

This claim is the result of decades of research, marking a significant milestone. I don’t believe any other food has such a strong claim related to a globally prevalent health issue like type 2 diabetes, making this incredibly important.

It’s not just based on a few years of research; it’s the culmination of extensive studies. While the FDA doesn’t consider the evidence entirely conclusive, the claim they approved is still very strong. We know there’s a negative association between yogurt consumption and the incidence of diabetes: the more yogurt you consume, the lower your risk of developing diabetes.

The exact reasons for this observation are still under investigation. It could be due to bioactive peptides in yogurt or its influence on the microbiota. As mentioned earlier, diet can affect the endogenous secretion of GLP-1, which was initially developed as a drug for diabetes therapy. This might give us some insight into why these observations occur.

Besides diabetes, yogurt offers numerous benefits: it is a nutrient-dense food, which likely explains the negative association between yogurt consumption and BMI. Additionally, yogurt consumption is associated with overall healthy dietary habits.

20 Jun 2024
6 min read
Q&A

Focus on vitamin D

bones calciferol calcium immunity nutrient vitamin D
Related posts
See More
Our Resources
Table of contents
Table of contents

Vitamin D is an essential vitamin for elements such as bones, teeth and the immune system. It is present in fortified dairy but many people do not consume enough. Let’s focus on it.

What is vitamin D?

Vitamin D is a fat-soluble vitamin. It exists on 2 different forms, D2 (ergocalciferol), mainly produced by some plants and D3 (cholecalciferol). The human body synthesizes vitamin D3 in the skin, under the effect of ultraviolet rays.

Vitamin D is known for its significant role in calcium homeostasis and metabolism but it plays a multitude of effects on the body besides bones and calcium metabolism by contributing to:

  • the normal function of the immune system
  • inflammatory response
  • muscle functions

The roles of vitamin D

Vitamin D promotes healthy bones by aiding calcium absorption through modulation of active transport absorption and maintaining a good ratio of calcium and phosphate for bone mineralisation.

It reduces inflammation, modulates cell growth, glucose metabolism, neuromuscular and immune function through the modulation of genes encoding proteins that regulate these processes.

functions of vitamin D - YINI

A chronic deficiency in vitamin D leads to improper bone mineralisation, as less calcium and phosphorous are absorbed in the small intestine and can induce hypocalcaemia (low levels of calcium in the blood) and phosphaturia (phosphate in urine) causing accelerated bone demineralization. This can result in bone mineralisation diseases such as osteomalacia, osteoporosis, and rickets in children. Adequate levels of vitamin D combined with calcium can help prevent these diseases.

Vitamin D consumed in the diet is absorbed through passive diffusion in the gut and this absorption is enhanced by fat.

Diet recommendations

Vitamin D is synthesised by the skin when exposed to UV light. However, the amount synthesised depends on a multitude of factors such as where you live, weather, skin melanin levels, and wearing sunscreen.

Diet recommendations usually assume skin endogenous production of vitamin D is equal to 0 to ensure guidelines provide enough vitamin D through diet alone. The recommended daily intake is 15µg per day for adults. The ability of the body to produce and absorb vitamin D decreases with age which is why this recommendation increases to 20µg per day for people over the age of 70.

It is important not to consume too much vitamin D because excess vitamin D in the body is toxic and can lead to symptoms such as headache, nausea and vomiting, weight loss or fatigue. It is recommended to not consume more than 100µg per day. However, this happens almost only in cases of supplement overuse and it is not something the majority of the population has to worry about. In fact, most people fall short of meeting recommended intakes. In the USA, over 90% of adults do not consume enough vitamin D and this is similar in most northern hemisphere countries.

Dietary sources of vitamin D

Dietary sources of vitamin D are quite rare. Some vitamin D can be found in fatty fish, fish liver oils, beef liver, egg yolk, cheese and fortified dairy. For example, in the USA, almost all milk is fortified with vitamin D and it is compulsory in Canada.

Some mushrooms can have vitamin D if they are treated with UV light which makes the mushroom produce vitamin D.

Dietary sources of vitamin D - YINI

Vitamin D in dairy

As dairy products are often fortified in vitamin D, it is a major source of this nutrient for populations. For example, in France, 25% of vitamin D intake comes from dairy products.

Dairy products were chosen to be fortified as it doesn’t change the taste and it also helps in absorbing the high content of calcium and ensure healthy bones.

Fortified dairy products are an interesting source of vitamin D as they provide a large portion of the dietary recommendation.

Data from the USA National Health Nutrition and Examination Survey (NHANES), the Canadian Community Health Survey, and the UK National Diet and Nutrition Survey show that yogurt consumers have higher daily intakes of several key nutrients including vitamin D.

Research shows that people that consume yogurt have stronger bones and lower bone resorption markers. In older adults, yogurt consumption is linked to increased bone mineral density and physical function. Therefore, 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.

See also

Sources
13 Jun 2024
6 min read
Echoes from ECO 2024 Expert interviews Weight management

Niamh Arthurs: Food habits among children and adolescent with obesity

Arthurs children dairy ECO2024 obesity
Related posts
See More
Our Resources
Table of contents
Table of contents

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 Niam Arthurs, pediatric dietitian and researcher in the area of child and adolescent obesity based in Dublin, Ireland, speaks about her research on child obesity.

Key messages:

  • Understanding children’s and parents’ eating habits is crucial for creating effective, personalized dietary treatments for childhood obesity.
  • The study aims at allowing dietitians to identify key target points such as the fact that many children and teenagers are not meeting the recommended daily intakes for calcium.
  • Addressing misinformation and providing evidence-based recommendations, such as the FDA claim about the role of yogurt in the prevention of type 2 diabetes, can help dietitians’ design personalized dietary treatments, especially in the context of childhood obesity.

 

Can you introduce yourself and tell us what you work on?

I’m a senior pediatric dietitian and researcher in the area of child and adolescent obesity based in Dublin, Ireland. My team works on food habits among children with obesity. Our main objective is to gather intelligence about our young patients’ habits before implementing any obesity treatment in order to maximize the effectiveness of personalized dietary approaches.

Firstly, we examine the nutritional quality of children’s reported food and fluid intakes. For this specific aspect, we use a 28-item food frequency questionnaire, conducted with the parents.

Secondly we evaluate the level of parental knowledge about nutrition, their self-reported cooking confidence and their relationship to food consumption. Ultimately, these elements guide us in determining the relationship between parental nutritional knowledge and children’s dietary habits. That is the basis for tailoring personalized treatment.

What have you learned about personalized dietary treatment for children with obesity using this method?

Getting a baseline idea about what children and teenagers are actually eating, combined with parents’ nutrition knowledge and their ease with cooking preparations allowed us to avoid making assumptions about children’s environments. This truly helped us make the connection between gathered information and its relationship with food consumption.

Our study found that parents who reported lower levels of cooking confidence tended to have households with higher consumption of convenience meals and takeaway foods. For dietitians aiming at framing their patients’ specific needs, such elements represent key targets for designing their interventions.

Assessing levels of knowledge in nutrition also enables understanding of general food and nutrient recommendations knowledge. We observed that the consumption of dairy products was a lot lower than the recommended amounts, in all age groups. From 5- to 88-year-olds, only about over 50% of the studied population met the recommended daily intakes for dairy products.

In Ireland, dairy products are the main source of calcium in children’s and teenagers’ diets. This nutrient is of pivotal importance during this age of growth. However, none of the 9- to 16-year-olds included in the survey met the recommended daily intakes for calcium, from either dairy products or other calcium-rich foods.

Again, the study aims at identifying such key target points to let dietitians design relevant interventions.

How do these results translate in your day-to-day consultation?

Expanding on the earlier example of calcium deficiency, the study highlighted that our interventions need to focus more on dairy products. This implies addressing the myths around dairy products and exploring with the families the reasons why they do not consume enough dairy products, particularly children and teenagers.

In this instance, it appears that a lot of the parents simply do not know what the recommendations for dairy foods are – i.e. 3 portions of dairy foods per day from up to 8 years, and 5/day after 8 years old, in Ireland – nor what a serving size corresponds to.

That information is crucial for health and nutrition literacy, and we need to incorporate it more into our one-on-one consultations and group education programs to ensure that individuals are receiving adequate levels of necessary knowledge.

Do you provide them with simple ways to incorporate more dairy into their meals?

This is where tailoring comes in. It’s important to understand what children and teenagers are currently eating to make small, specific suggestions for incorporating more dairy. For example, many children begin skipping breakfast when they transition from primary to secondary school, often due to time constraints or lack of appetite. However, breakfast is an important opportunity to consume calcium-rich foods.

We can suggest alternatives such as eating something once they get to school or choosing quicker options for the morning to overcome time barriers. Additionally, they can incorporate more calcium-rich foods into their lunch. For instance, they could add cheese to their sandwiches or bring pouch yogurts, which are convenient and less likely to burst in their bags. Drinkable yogurts are also a good option. These types of recommendations are often more acceptable and practical for their routines.

In March 2024, the FDA published a qualified health claim about the role of yogurt in the prevention of type 2 diabetes. Can this have an impact on the recommendations? Do you think it can be an opportunity for patients?

It’s incredibly valuable to have strong, evidence-based claims because there’s so much misinformation surrounding dairy foods. For instance, myths about dairy contributing to acne, containing hormones, or causing inflammation are not supported by scientific evidence. Unfortunately, the science community isn’t reaching these target groups effectively. Families are increasingly getting their information from social media, so we need to be much louder in our communication. Having well-supported claims can help us do that.

Moreover, these claims are particularly significant in our world today, where we face rising rates and high prevalence of conditions like type 2 diabetes. These conditions can severely impact an individual’s quality of life and health if not properly managed. Strong, scientifically-backed claims not only help us communicate more effectively but also attract media attention. This can encourage individuals, families, and teenagers who might be avoiding calcium-rich foods, such as dairy products, to reconsider their choices.

10 Jun 2024
6 min read
Benefits for planet health

Should all ultra-processed foods be categorised under one umbrella?

diet health NOVA Ultraprocessed food
Related posts
See More
Our Resources
Table of contents
Table of contents

Eating ultra-processed foods is linked to the risk of developing long-term health problems, according to the latest evidence from an umbrella study conducted by an international team of researchers (1).

But questions remain on just how much do these ready-to-eat products affect our well-being and should they all be assessed under the same umbrella.

An umbrella approach to assessing ultra-processed food effects

A growing body of evidence suggests that eating certain ultra-processed foods may affect our risk of developing chronic diseases (2). However, while multiple meta-analyses have examined observational studies on the associations between ultra-processed foods and health outcomes, no one has carried out a comprehensive data review. Until now…

To bridge the gap, researchers from Australia, France, Ireland, and the USA set out to test the strength of evidence relating to the link between ultra-processed foods and health. They performed an umbrella review of data from 14 meta-analyses in nearly 10 million participants, evaluating a range of health outcomes including mortality, cancer, and mental health, respiratory, cardiovascular, gastrointestinal, and metabolic disorders. Here’s what they found…

Overall, ultra-processed foods are associated with poor health outcomes

Eating more ultra-processed foods (UPFs) was consistently associated with a higher risk of adverse health outcomes. However, the strength of evidence varied, and the quality of evidence was generally low, pointing to a need for further robust research.

Among the most convincing evidence, the study found that greater consumption of ultra-processed foods was linked to higher risks of cardiovascular disease-related mortality, common mental disorder outcomes, and type 2 diabetes.

UPFs were also associated with all-cause mortality, heart disease-related mortality, depressive outcomes, adverse sleep-related outcomes, wheezing, and obesity. The researchers found weak or no evidence for connections with other conditions including cancer-related deaths, asthma, and ulcerative colitis.

Ultra-processing can alter the nutrient composition and matrix effects of foods

So, what are the mechanisms behind the link between ultra-processed foods and poor health outcomes? Evidence indicates that ultra-processed foods differ from unprocessed foods in several ways:

  • UPFs differ from unprocessed or minimally-processed foods and often have poorer nutrient profiles.
  • They may displace more nutritious foods in diets, resulting in a reduce intake of beneficial bioactive compounds (3).
  • As a result, diets rich in UPFs are associated with markers of poor diet quality, such as high levels of added sugars, saturated fat, and sodium, high energy density and low levels of fiber, protein, and micronutrients (3).
  • Finally, processing, ingredients or by-products can cause alterations to the food matrix – the physical and chemical structure of foods – which may affect digestion, nutrient absorption, and feelings of satiety (4).

Different types of ultra-processed foods may have different health effects

One limitation of umbrella reviews is that they tend to provide only a high-level overview – for example, this study did not consider possible differences in the effects of various types of ultra-processed food on chronic disease outcomes.

For example, a meta-analysis included in this umbrella review found that while eating certain types of UPF was associated with a higher risk of type 2 diabetes, other types – such as cereals, dark/wholegrain bread, packaged savoury snacks, fruit-based products, yogurt and dairy-based desserts – were associated with a lower risk (5).

These findings demonstrate the complexity of relationships between ultra-processed foods consumption and health outcomes and highlight the need for further research to understand the mechanisms behind potential associations:

  • For some experts, understanding the differences between types of UPFs and within subcategories of UPFs may help consumers to adopt healthier dietary patterns, compared to maximally reducing their consumption on the whole.
  • Others propose to focus on the overall quality of the diet, based on the hypothesis that a high-calorie diet, consisting of foods that are not nutrient-dense, may be harmful for health, which is confirmed by this approach that considers UPFs.

As we still do not have enough knowledge on this subject, it is necessary to look at the overall quality of the diet and the health effects across the subgroups within the NOVA category,

“Although our umbrella review provides a systematic synthesis of the role of ultra-processed dietary patterns in chronic disease outcomes, a related consideration is the possible heterogeneity of associations between subgroups and subcategories of ultra-processed foods and chronic disease outcomes”– Lane MM, et al., 2024

How do we define ultra-processed foods?

Ultra-processed foods, encompass a broad range of ready-to-eat products including packaged snacks, carbonated soft drinks, instant noodles, or ready-made meals (6). They are defined by the following characteristics (7):

  • Primarily composed of chemically modified substances extracted from foods
  • Contain additives to enhance taste, texture, appearance, and durability

While various systems have been developed to classify foods on the basis of processing, the most commonly used is the Nova food classification system (8). Nova has received recognition from global health and nutrition bodies including the United Nations and the World Health Organization. However, the Nova classification system has also received criticism, with concerns raised about possible imprecision and inconsistencies.

For more information on food processing, see Food processing explained.

Source: (1) Lane MM, Gamage E, Du S, et al. Ultra-processed food exposure and adverse health outcomes: umbrella review of epidemiological meta-analyses. BMJ. 2024 Feb 28:384:e077310.
Additional references
  1. (2) Chassaing B. Ultra-processed foods and human health: from epidemiological evidence to mechanistic insights. Lancet Gastroenterol Hepatol 2022;7:1128-40.
  2. (3) Martini D, Godos J, Bonaccio M, Vitaglione P, Grosso G. Ultra-Processed Foods and Nutritional Dietary Profile: A Meta-Analysis of Nationally Representative Samples. Nutrients 2021;13:3390
  3. (4) Fardet A. Minimally processed foods are more satiating and less hyperglycemic than ultra-processed foods: a preliminary study with 98 ready-to-eat foods. Food Funct 2016;7:2338-46.
  4. (5) Chen Z, Khandpur N, Desjardins C, et al. Ultra-Processed Food Consumption and Risk of Type 2 Diabetes: Three Large Prospective U.S. Cohort Studies. Diabetes Care 2023;46:1335-44.
  5. (6) Monteiro CA, Cannon G, Lawrence M, et al. Ultra-processed foods, diet quality, and health using the NOVA classification system. Food and Agriculture Organization of the United Nations. Food and Agriculture Organization, 2019.
  6. (7) Monteiro CA, Cannon G, Levy RB, et al. Ultra-processed foods: what they are and how to identify them. Public Health Nutr 2019;22:936-41.
  7. (8) Monteiro CA, Cannon G, Moubarac J-C, Levy RB, Louzada MLC, Jaime PC. The UN Decade of Nutrition, the NOVA food classification and the trouble with ultra-processing. Public Health Nutr 2018;21:5-17.
03 Jun 2024
6 min read
by YINI Editorial team
Non classé Nutri-dense food Publications

Yogurt is a nutrient-rich food

NRF Nutrient density nutrient richness yogurt
Related posts
See More
Our Resources
Table of contents
Table of contents

Yogurt contains both micronutrients – vitamins and minerals – and macronutrients, including proteins and fatty acids.

Yogurt contains high-quality protein, including all nine essential amino acids in the proportions needed for protein synthesis.

Yogurt is a rich source of calcium, providing up to 20% of daily calcium intake per 116 g or ~4-ounce portion (one average pot).

Yogurt also provides smaller amounts of many other micronutrients, including potassium, zinc, phosphorus, magnesium, iodine, vitamin A, riboflavin (vitamin B2), vitamin B5, vitamin B12 and in some countries, vitamin D.

Yogurt consumption helps meet nutrient intake requirements

Yogurt and other dairy products contribute to key nutrient intakes for adults and children. That is why most regional and national food-based dietary guidelines recommend the consumption of dairy products – and, when amounts are specified, two or three servings per day are typically recommended.

Adults

Many people fall short of meeting recommended intakes of certain nutrients in their diet. Close to 30% of men and 60% of women in the USA do not consume enough calcium and >90% do not consume enough vitamin D. Deficiencies of several nutrients persist in the Middle East, North Africa and Central Asia including calcium, vitamins A, D, B12 and zinc.
Yogurt contributes many of these nutrients. For example, 125 g (~4 ounces) of plain yogurt provides, among other nutrients, 20% of an adult’s recommended daily intake of calcium, 21% of riboflavin, 11% of vitamin B12, and 16% of phosphorus.

Data from the USA National Health Nutrition and Examination Survey (NHANES), the Canadian Community Health Survey, and the UK National Diet and Nutrition Survey show that yogurt consumers have higher daily intakes of several key nutrients including riboflavin, vitamin C, folate, vitamin D, potassium, iron, magnesium and calcium.

Contribution of yogurt to daily energy and nutrient intake - YINI
Nutrient inadequacy in yogurt consumers versus non-consumers - YINI


Furthermore, regular yogurt eaters are more likely to meet or exceed nutrient recommendations for vitamins and minerals including vitamin A, riboflavin, folate, potassium, calcium, magnesium, zinc and iodine

“Yogurt is a nutrient-dense food containing a wide range of macro and micro-nutrients. Eating yogurt every day can help us meet our recommended levels of several key nutrients.”

Professor Frans Kok

Children

Good diet quality is important for children and adolescents to support growth and development.
Teenagers are especially at risk of nutrient shortfall, and vitamin D, calcium, potassium, fibre and iron are of particular concern. Yogurt is a valuable part of a balanced nutrient-rich diet during childhood, contributing a substantial percentage of a child’s needs for micronutrients and macronutrients.

Data from the USA NHANES show that increasing dairy food consumption (milk, cheese and yogurt) to meet the recommended level in the USA for adolescents of three servings per day can make up for the shortfall of three nutrients of public health concern – calcium, vitamin D and potassium.

The UK survey data suggest that adding a 125 g (~4 ounces) pot of low-fat fruit yogurt per day to adolescents’ diets would increase mean calcium intake from below to above the Recommended Nutrient Intake.

Yogurt’s contribution to total and added sugar intake is relatively low

The World Health Organization recommends limiting the consumption of non-milk extrinsic sugars – which include those added to food by manufacturers or by consumers – to a maximum of 10% energy intake. However, many people in Western societies are exceeding this threshold.

Concerns that sweetened yogurt contributes to these excess sugar intakes are not supported by the scientific data. In the USA, a NHANES analysis found that flavoured yogurt contributes about 1% of added sugars to the diets of adults. This compared with 28.1% from soft drinks.

Added sugar intake increases throughout childhood and amounts to 15% of total daily energy intake among adolescents. While more than 50% of total sugars and 66% of added sugars in children’s diets come from sweet products such as cakes, sweets and sugary drinks, yogurt accounts for only 1–8% of total sugars and 4–9% of added sugar in children’s diets in Europe.

References:

27 May 2024
6 min read
Benefits for planet health

Evaluating milk and plant-based drinks

dairy milk plant-based drinks sustainable diet
Related posts
See More
Our Resources
Table of contents
Table of contents

Sustainable dietary choices depend not only on carbon footprints per unit mass, but should consider an overall perspective including lowest “societal cost”, nutrient content and retail price, study reveals. Taking this broader perspective may change the optimal sustainable dietary choices.

Many people think of sustainable foods as those that simply have a small carbon footprint. But when it comes to advising them about their planet-friendly food choices, a much more complex picture is emerging, say researchers from The Netherlands. They’ve taken a deep dive into the sustainability profiles of foods, using semi skimmed milk and plant-based beverages as case studies – with unexpected results.

Their findings provide fresh insights that will empower consumers and healthcare professionals to make informed decisions in the pursuit of a healthier and more sustainable future.

The research also underscores the importance of adopting a holistic approach when evaluating the sustainability of dietary choices, incorporating nutritional content, environmental impact and economic costs associated with foods and drinks.

For example, it’s not just the food’s composition that matters: the availability and uptake of nutrients in the body and the potential synergistic effects of components in the food matrix may also play a crucial role.

Mounting concerns over climate change drive the pursuit of sustainable diets

As concerns mount over climate change, the search for more sustainable food systems is becoming more intense. One manifestation of this is the drive to switch away from animal-based proteins towards more plant-based proteins.

The improvement in sustainability tends to be measured by the greenhouse gas emissions (GHGs), and generally plant-based alternatives have smaller footprints than cow’s milk [2]. But it’s not as simple as measuring emissions in relation to weight of a food product, say the researchers. Because of the lower nutrient density of many dairy alternatives, the gap narrows when considering emission per amount of nutrients [3].

Environmental impacts of food products have many variables. For dairy milk, GHGs can vary according to the production chain, the geographical region, and milk production per cow [4]. Similarly, the carbon footprint of plant-based alternatives varies between regions, depending on their source, yield per hectare, energy used, and soil treatment.

Multiple components are needed to build a sustainability profile

With this in mind, the researchers used multiple criteria to build full sustainability profiles of semi-skimmed cow’s milk and several plant-based beverages in both fortified and non-fortified formulations – including oat, soy, rice, coconut, and almond drinks. For one serving of each product, they assessed the Nutrient Rich Food (NRF) score, protein digestibility, and essential amino acid content.

Next, they calculated the true price of each product, converting carbon footprints to euros using the European Union Emissions Trading System, and adding them to supermarket prices. The environmental costs were based on GHGs associated with production, land use, and water consumption. These environmental impacts were assessed throughout the entire life cycle of each beverage, from raw material extraction and production, to distribution and consumption.

“The comprehensive method used, which considers retail price, environmental costs, and nutrient content, demonstrates that, in terms of sustainability, choosing a serving of semi-skimmed milk remains the optimal choice. Following this, soy-based beverages represent the next best alternative.‘’ – de Jong P, et al., 2024

Cow’s milk and plant-based drinks each have advantages

The carbon footprint of plant-based beverages is lower per unit mass than that of semi-skimmed milk. However, the analysis showed that to achieve the same NRF score the consumer would need to drink more servings of unfortified plant-based beverages than semi-skimmed milk, resulting in larger carbon footprints. The exception was soy drink – but when emerging farm practices were taken into account, semi-skimmed milk and soy drinks showed similar carbon footprints for a given NRF score.

Among fortified plant-based beverages, the nutrient-based footprint of soy, oat, and almond beverages was smaller than that of semi-skimmed milk, while coconut and rice had larger footprints. These findings underscore the need for plant-based beverages to be fortified to achieve a reasonable sustainability footprint, the researchers say.

When combining the economic costs of environmental impact with the price consumers have to pay for these products, semi-skimmed milk emerged as the best choice.

A mix of plant- and animal-sourced foods for the future diets

The findings suggest that, although popular as an alternative to milk, plant-based beverages should not necessarily be seen as a replacement for cow’s milk. If people consume plant-based drinks without compensating with other food sources, they risk having insufficient nutrient intake [5-8].

Soy seems to have the highest potential to become a basis for sustainable plant-based drinks, in addition to cow’s milk.

Semi-skimmed milk belongs to the group of food products with the best value for money.

In reality, the growing world population implies that we need to find best use of available land and future diets are likely to contain a mix of plant-based and animal-based foods. It’s also important to remember that the bioactivity of nutrients is influenced by other components in the food matrix. For example, lactose in cow’s milk boosts the bioactivity of calcium and other minerals, whereas sugars in plants do not, the researchers say.

Sustainable dietary guidelines should not only recommend foods with lower carbon emissions per unit mass, but take time to consider the broader perspective including national values. The researchers call for more research to learn how the food matrix modulates nutrient bioavailability and effectiveness.

“The research underscores that understanding a food product’s nutritional value requires more than knowledge of its composition; uptake into the body maintenance and potential synergistic effects of other components in the food matrix play crucial roles.” – de Jong P, et al., 2024

Source: (1) de Jong P, Woudstra F, van Wilk AN. Sustainability Evaluation of Plant-Based Beverages and Semi-Skimmed Milk Incorporating Nutrients, Market Prices, and Environmental Costs. Sustainability 2024, 16(5), 1919
Additional references
  1. (2) Clune, S.; Crossin, E.; Verghese, K. Systematic review of greenhouse gas emissions for different fresh food categories.  Clean. Prod.2017, 140, 766–783.
  2. (3) Drewnowski, A.; Rehm, C.D.; Martin, A.; Verger, E.O.; Voinnesson, M.; Imbert, P. Energy and nutrient density of foods in relation to their carbon footprint.  J. Clin. Nutr.2015, 101, 184–191.
  3. (4) Adewale, C.; Reganold, J.P.; Higgins, S.; Evans, R.D.; Carpenter-Boggs, L. Agricultural carbon footprint is farm specific: Case study of two organic farms.  Clean. Prod.2019, 229, 795–805.
  4. (5) Kalyn, M.; Collard, M.D.; David, P.; McCormick, M.D. A nutritional comparison of cow’s milk and alternative milk products.  Pediatr.2020, 21, 1067–1069.
  5. (6) Walther, B.; Guggisberg, D.; Badertscher, R.; Egger, L.; Portmann, R.; Dubois, S.; Haldimann, M.; Kopf-Bolanz, K.; Rhyn, P.; Zoller, O.; et al. Comparison of nutritional composition between plant-based drinks and cow’s milk.  Nutr.2022, 9, 988707.
  6. (7) Chalupa-Krebzdak, S.; Long, C.J.; Bohrer, B.M. Nutrient density and nutritional value of milk and plant-based milk alternatives.  Dairy J.2018, 87, 84–92.
  7. (8) Fulgoni, V.L.; Keast, D.R.; Auestad, N.; Quann, E.E. Nutrients from dairy foods are difficult to replace in diets of Americans: Food pattern modeling and an analyses of the national health and nutrition examination survey 2003-2006.  Res.2011, 31, 759–765.
20 May 2024
6 min read
Athletes Gut Health

Exploring the microbial secrets behind athletic excellence

Athlete microbiota SCFA sport
Related posts
See More
Our Resources
Table of contents
Table of contents

A new study has shed light on the link between the gut microbiome and athletic performance. The research has revealed that athletes have their own microbiome “signature”, and indicates that certain microbiome features are associated with improved physical prowess [1] .

By unlocking the secrets of the microbial world within the gut, such research may pave the way towards innovative approaches that harness the relationship between microbiome and physiological function. It could lead to changes in sport nutrition and performance enhancement.

The gut microbiota – a community of little helpers

How well people perform as athletes profoundly depends on what’s happening on a microscopic scale in the gut. That’s because each one of us is a walking ecosystem of human cells and gut microbial cells working symbiotically to determine our health and wellbeing. Among the metabolites produced by the community of 10-100 trillion gut microbes are short-chain fatty acids (SCFAs) [2] that contribute to gut homeostasis, modulate the immune system, and even influence brain function [3].

But the microbiome is a sensitive community, influenced by diet, age, stress, illness, and certain drug treatments [3,4,5]. And recent studies have shown that physical exercise is another influencer, enhancing the diversity and composition of the gut microbiome [6]. The evidence suggests that microbiome activity is linked to sports performance [7].

The characteristics of an athlete’s microbiome depend on their type of sport, previous research has suggested. Endurance training, such as marathon-running, increases the production of SCFAs – an advantage during prolonged activity as they contribute to energy maintenance – and to an abundance of microbiota species with anti-inflammatory properties. On the other hand, the microbial profile in strength-based sports enhances protein use to support muscle development and performance [8].

These findings have raised the question of whether each athlete’s abilities could be optimised by changing microbiome composition for targeted improvements in performance.

Identifying exercise-induced microbiome changes

Delving deeper into this possibility, the researchers compared changes in the microbiomes before and after exercise in three groups of healthy people: two athletic populations – strength athletes and endurance athletes – and a non-athletic but physically active control group [1]. The athletes were not competing at a professional level.

Each of the three groups performed two exercise bouts, separated by a 2-week period, to assess:

  • explosive and high intensity fitness using a repeated 30-second all-out activity on a cycle ergometer
  • cardiorespiratory fitness using a treadmill

Physical fitness is linked to improved microbiome diversity

Results showed that at the start of the study, the endurance, strength and control groups shared some common features in the microbiome, including similar levels of diversity and proportions of phyla – as could be expected for people who are fit and healthy. But one-third of the species identified were unique to each group.

Following exercise, all three groups showed changes in the microbiome profiles, with physical fitness improving microbial diversity. In this study, no marked differences emerged between the control, strength and endurance groups – probably because they were all similarly active, but not training on a professional level, the researchers say.

Longitudinal samples – taken pre- and post-exercise – revealed an abundance of Alistipes communis in the strength athletes during the high intensity fitness test. During the cardiorespiratory fitness test, 88 species showed differences between the three groups.

Among the bacterial species consistently found throughout the study, there were enhancements in two species that are short chain fatty acid producers, Bifidobacterium longum and Bifidobacterium adolescentis. These two probiotic species, which are commonly found in commercial products, both correlated with improvements in all the fitness parameters measured, especially cardiorespiratory fitness (measured as VO2max during the treadmill test).

Other bacterial types that were linked with higher VO2max included species associated with improved glucose metabolism.

“We were particularly excited to see an enrichment of indigestible carbohydrate degrading bacteria in the endurance group, thereby suggesting performance-specific adaptations.” – Humińska-Lisowska K et al., 2024

Further research

The study confirmed that taking exercise can be a hallmark of microbiome diversity, which in turn is an indicator of general good health, the researchers concluded.

However, they saw various individual responses, suggesting there may be many confounding factors. Hence their results highlight the intricate relationship between different forms of physical activity and expression of gut microbiota. To investigate this relationship further, the researchers recommended further studies to identify sport-specific microbiomes could include elite athletes who would be adapted to different aerobic or anaerobic activities, the researchers said.

“… Physical activity may be a hallmark of microbiome diversity, which correlates with general health and homeostasis maintenance.” – – Humińska-Lisowska K et al., 2024

Source: (1) Humińska-Lisowska K, Zielińska K, Mieszkowski J, Michałowska-Sawczyn M, Cięszczyk P, Łabaj PP, Wasąg B, Frączek B, Grzywacz A, Kochanowicz A, Kosciolek T. Microbiome features associated with performance measures in athletic and non-athletic individuals: A case-control study. PLoS One. 2024 Feb 21;19(2):e0297858.

Additional references

(2) Rios-Covian D, Ruas-Madiedo P, Margolles A, et al. Intestinal Short Chain Fatty Acids and their Link with Diet and Human Health. Frontiers in Microbiology, 2016, 7, 185.

(3). Sharon G, Sampson TR, Geschwind DH, Mazmanian SK. The Central Nervous System and the Gut Microbiome. Cell, 2016, 167(4), 915–932.

(4). Asnicar F, Berry SE, Valdes AM, et al. Microbiome connections with host metabolism and habitual diet from 1,098 deeply phenotyped individuals. Nat Med, 2021, 27, 321–332.

(5). Rinninella E, Raoul P, Cintoni M, et al. What is the Healthy Gut Microbiota Composition? A Changing Ecosystem across Age, Environment, Diet, and Diseases. Microorganisms.2019. 10;7(1):14.

(6). Allen JM, Mailing LJ, Niemiro GM, et al. Exercise Alters Gut Microbiota Composition and Function in Lean and Obese Humans. Med Sci Sports Exerc. 2018,50(4):747–757.

(7). Mohr AE, Jäger R, Carpenter KC, et al. The athletic gut microbiota, Journal of the International Society of Sports Nutrition, 12;17(1):24.

(8). Jang LG, Choi G, Kim SW, et al. The combination of sport and sport-specific diet is associated with characteristics of gut microbiota: an observational study. J Int Soc Sports Nutr. 2019. 3;16(1):21.

13 May 2024
5 min read
Q&A

Focus on calcium

calcium dairy micronutrients nutrient
Related posts
See More
Our Resources
Table of contents
Table of contents

Calcium is an essential micro-nutrient for bone and teeth health. It is present in high quantities in dairy. Let’s focus on calcium.

What is calcium?

Calcium is the most abundant mineral in the body. The adult human body contains around 1kg of calcium. 99% of the calcium can be found in bones and teeth where it plays a structural role. The rest of the calcium is needed for the proper functioning of the nervous system, heart, muscles, and for the release of hormones.

Bone is a living tissue, constantly getting remodelled to ensure adequate calcium levels in our body. High calcium levels will lead to bone formation, while a calcium deficiency leads to the breakdown of bones and calcium release. Calcium deficiency can lead to several diseases:

  • Osteoporosis occurs when the bone becomes less dense hence porous which leads to fragile bones and increases the risk of fractures.
  • Rickets happens in children when lack of calcium induces improper mineralisation of the bone matrix. As a result, bones lack proper structure and become soft and weak.
  • Osteomalacia causes improper mineralisation of the bone matrix resulting in soft bones in adults.

Deficiency in calcium is not the only reason for bone mass loss. After the age of 30, the bone mass naturally starts to slowly decrease. In women, the peak bone density is lower than men and the rate of bone density loss is higher, which results in women being more likely to develop osteoporosis than men.

Dietary recommendations

Recommendations vary across countries but generally advise for adults a daily calcium intake of 1000 mg. During the teenage years, the recommendation is 1300mg/day to ensure proper bone density during peak bone growth.

After the age of 50 in women and 70 in men it is recommended to consume 1200mg to limit the rate of bone loss.

It is best to consume calcium through the diet rather than supplementation whenever possible so as to avoid excessive calcium consumption. While an adequate calcium intake is important, an excess of this nutrient in the body can lead to higher risks of heart disease and low levels of other minerals such as phosphate or iron. The safe upper limit of calcium consumption in adults is 2500mg per day.

Calcium- dietary recommandations - YINI

Food sources of calcium

Calcium can be found in a variety of foods from both plant and animal sources such as nuts, seeds, beans, leafy greens, canned fish (sardines), mineral water and of course dairy. Dairy sources of calcium are the most bioavailable sources. This is due to the presence in dairy of other nutrients essential to bone health like phosphorus and vitamin D.

Dairy is the most important source of dietary calcium and accounts for 75% of the calcium intake in Europe and north America.

After eating, calcium is absorbed in the small intestine through passive and active absorption. The active absorption pathway is modulated by vitamin D. Vitamin D and calcium go hand in hand for bone health.

Calcium - dietary sources - YINI

Calcium in dairy

Dairy naturally contain quite high levels of calcium that is highly bioavailable.

Dairy products - calcium - YINI

Yogurt as a dairy product is a good source of calcium. On top of that, the presence of probiotic bacteria in yogurt may be beneficial for bone health by modifying the gut microbiota and increasing the absorption of calcium. They also help the immune system and protect against inflammation which might help in reducing the rate of bone loss. This makes yogurt and other fermented dairy an interesting source of calcium for bone health.

Research found that yogurt promotes healthy growth and higher bone mineral density in children consuming yogurt compared to non-yogurt consumers.

Yogurt consumption is also associated with lowers risks of osteoporosis in older age. It was found that yogurt consumers had stronger bones than non-yogurt consumers and increasing one serving of yogurt per week was associated with a 39% decrease in osteoporosis in women and 54% in men.

Yogurt and dairy products are a rich in protein and micronutrients important for bone health and can be consumed as part of a healthy diet.


See also:

Sources:

06 May 2024
6 min read
by YINI Editorial team
Fermentation benefits Gut Health Publications

Yogurt with live cultures may contribute to gut health

bacteria gut health live cultures probiotics
Related posts
See More
Our Resources
Table of contents
Table of contents

Habitual yogurt consumption modifies the composition and function of the gut microbiota in a way that may lead to health benefits.

Diet can influence the diversity of the gut microbiota, which is important for health.

The gut microbiota plays an important role in digestion. It may also be essential for the normal development and functioning of the immune and nervous systems.

Maintaining the healthy diversity of the gut microbiota is important in preventing disease.

Researchers have proposed that there is a gut microbiota “signature” that could promote intestinal inflammation and subsequent systemic low-grade inflammation, a condition that predisposes to Type 2 diabetes (T2D) and obesity.

“As a fermented food containing millions of live bacteria, yogurt may have a beneficial effect on gut health, increasing gut microbiota richness and robustness, protecting the intestinal barrier, and preventing a range of gastrointestinal disorders.”

Dr Joël Doré

The composition of the gut microbiota is influenced by our diet, among other factors. Moreover, in fermented foods such as yogurt, the products of fermentation and particularly the bacteria involved in the fermentation process, can provide additional properties to the food beyond basic nutrition.

Hence, fermented foods such as yogurt are arousing research interest as potentially having benefits beyond an extended shelf life and improved texture and flavour.

Yogurt can deliver millions of live bacteria to the gut and may beneficially alter the gut microbiota

Yogurt with live cultures contains millions of bacteria and eating yogurt daily could potentially increase the number of bacteria in the diet by up to 10,000-fold.

Yogurt and live bacteria - YINI

While probiotic bacteria are unlikely to have longlasting effects on the gut microbiota, consuming yogurt with live cultures on a regular basis will at least temporarily bolster the live bacteria in the gut, most commonly the yogurt starters Streptococcus thermophilus and Bifidobacterium animalis subsp. lactis.

In addition, prebiotics may be added to yogurt (often in the form of fruit) and these may stimulate the proliferation of beneficial bacteria in the gut.

Daily yogurt consumption appears to boost the numbers of Lactobacilli in the gut and is associated with a slight increase in microbial diversity over a 42-day period.

As well as beneficially altering the composition of the gut microbiota, probiotic bacteria – live microorganisms intended to have health benefits when consumed – in yogurt may alter the function of the existing resident bacteria by affecting the production of SCFAs;  these have beneficial effects on energy metabolism.

Yogurt may help to protect the intestinal barrier

Animal studies have suggested that a peptide derived from the milk protein found in yogurt, β-casein, increases the production of mucin, an essential component of the mucus layer that lines and protects the intestine.

“Modulation of the gut microbiota through yogurt consumption may prove to help in treating and preventing irritable bowel syndrome, infectious diarrhoea, and allergy gastroenteritis. Studies are needed to explore these potential benefits.”

Professor Olivier Goulet

Yogurt may protect against gastrointestinal disease

Research suggests that yogurt might play a role in the prevention and treatment of gastrointestinal disorders.

For children with mild to moderate persistent diarrhoea, a yogurt-based diet may be recommended as it has been shown to reduce stool
output and the duration of diarrhoea.

Modulation of the gut microbiota by yogurt, particularly yogurt containing Lactobacillus and Bifidobacterium, might be of value in the prevention or treatment of gastrointestinal diseases such as irritable bowel syndrome, infectious diarrhoea and allergy gastroenteritis.

Yogurt is frequently used in many countries for the nutritional management of acute gastroenteritis, although data on this approach are limited and large randomised controlled trials are needed to provide evidence to support it.

“Yogurt is an important part of nutrition and dietary guidelines as it offers both a great nutrient density and also live bacteria to contribute to gut health. “

Professor Seppo Salminen

References:

29 Apr 2024
6 min read
Elderly Healthy Diets & Lifestyle

Which proteins to choose to prevent malnutrition in the elderly?

dairy denutrition Malnutrition meat plant based proteins
Related posts
See More
Our Resources
Table of contents
Table of contents

Choosing plant-based over meat-based protein sources may be better for nutritional health in old age, latest research from Spain suggests.

While both animal- and plant-based proteins are important in maintaining nutritional status, substituting certain meat proteins with plant alternatives may offer additional benefits to older people.

However, maintaining the intake of proteins from dairy foods is a key component to combating malnutrition in older adults, the research suggests.

Malnutrition among older people: a major cause for concern

Malnutrition is a global concern, having an impact not only on health, but also on physical function and quality of life. In high-income countries, malnutrition is most common in older adults, where prevalence can be as high as 28%, 18%, and 9% in hospital, residential care, and community settings respectively [2].

Eating protein-rich foods can help prevent and treat malnutrition. But the best food sources of protein remain a topic for debate among scientists.

While animal-based foods are generally considered to be an effective source of proteins, experts worry about their potential to increase the risk of chronic diseases. On the other hand, eating plant-based food proteins has a lower risk of developing chronic diseases but may be less effective at improving nutrition.

Assessing the nutritional benefits of plant- and animal-based proteins

With this in mind, researchers looked at the impact of consuming protein from plant and animal sources on changes in nutritional status among older adults.

Their study examined dietary and nutritional information from nearly 3,000 Spanish people aged at least 60 years old. Protein intake was assessed at the start, while measures of malnutrition including weight loss, low body mass index and reduced muscle mass were evaluated at baseline and after 2.6 years.

Overall, more than 65% of all protein consumed was from animal sources. The main sources of animal protein were (from largest to smallest) meat, dairy, fish, and eggs, while the main sources of plant protein were cereals, legumes, and nuts. The researchers compared the associations of different plant and animal protein sources with improvements in nutritional status, with surprising results.

The source of protein influences improvements in nutritional status

Results showed that while higher animal-based and plant-based protein intake were both associated with improvements in nutritional status, this improvement was markedly larger with plant-based protein than with animal-based protein. Every 0.25-gram increase in protein consumption per kilogram of bodyweight per day (0.25 g/kg/day) was associated with a 15% improvement in nutritional status for animal protein and a 77% improvement for plant protein.

Cereals were the plant protein source that were most strongly associated with improvements in nutritional status. Nutritional status improvement more than doubled per 0.25g/kg/day of cereal protein intake, compared with no significant improvements with either legume or nut protein intake.

Among animal sources, eating protein from eggs was associated with a nearly 3-fold improvement in nutritional status per 0.25g/kg/day, while dairy protein intake showed a positive trend in nutritional status, with a 28% improvement per 0.25g/kg/day. No significant improvements in nutritional status were seen with increased meat and fish protein intake.

Replacing meat-based with plant-based protein was associated with improved nutrition

Further analysis showed that replacing a portion of meat or fish protein – but not dairy or egg protein – with vegetable protein was linked to additional enhancements in nutritional status. Specifically, replacing 0.25 g/kg/day of total animal protein, meat, or fish protein with plant protein was associated with 54%, 70% and 77% improvements in nutritional status, respectively.

These findings came as no surprise to the researchers; previous studies have shown that dietary proteins vary in quality, depending on several factors including the presence and amount of specific amino acids, protein digestibility, the food matrix, and food processing [3].

Among animal proteins, Dairy proteins are key to improvements in nutritional status

In this study, dairy protein showed a stronger association with improvements in nutritional status than protein from meat and fish. This is consistent with previous evidence on dairy protein and malnutrition-related outcomes.

For example, a systematic review and meta-analysis found that supplemental protein from dairy products increases body weight and lean body mass, especially in frail or older adults [4]. Trials using cheese and milk protein supplementation have also shown improvements in fat-free mass and muscle quality, especially in people with geriatric syndromes [5,6].

This could be due to several macro- and micro-nutrients that are found in dairy products more than in any other food group – including lactose, calcium, phosphorus, and vitamin D. Such nutrients have demonstrated potential growth-stimulating effects or a positive impact on muscle mass and strength [7,8].

“Dairy protein showed in our study a somewhat stronger association with improvements in nutritional status than protein coming from meat and fish. This is consistent with extensive evidence on dairy protein and malnutrition-related outcomes.” – Carballo-Casla A, et al., 2024

Source: (1) Carballo-Casla A, Sotos-Prieto M, García-Esquinas E, et al. Animal and vegetable protein intake and malnutrition in older adults: a multicohort study. J Nutr Health Aging. 2024 Jan;28(1):100002.

Additional references
  1. 2. Leij-Halfwerk S, Verwijs MH, van Houdt S, Borkent JW, Guaitoli PR, Pelgrim T, et al. Prevalence of protein-energy malnutrition risk in European older adults in community, residential and hospital settings, according to 22 malnutrition screening tools validated for use in adults 65 years: a systematic review and meta-analysis. Maturitas 2019;126:80–9.
  2. 3. Dardevet D, Mosoni L, Savary-Auzeloux I, PeyronMA, Polakof S, Remond D. Important determinants to take into account to optimize protein nutrition in the elderly: solutions to a complex equation. Proc Nutr Soc. 2021;80:207–20.
  3. 4. Dewansingh P, Melse-Boonstra A, Krijnen WP, van der Schans CP, Jager-Wittenaar H, van den Heuvel EGHM. Supplemental protein from dairy products increases body weight and vitamin D improves physical performance in older adults: a systematic review and meta-analysis. Nutr Res. 2018;49:1–22.
  4. 5. Zanini B, Simonetto A, Zubani M, Castellano M, Gilioli G. The effects of cow-milk protein supplementation in elderly population: systematic review and narrative synthesis. Nutrients. 2020;12:1–26.
  5. 6. Cuesta-Triana F, Verdejo-Bravo C, Fernández-Pérez C, Martín-Sánchez FJ. Effect of milk and other dairy products on the risk of frailty, sarcopenia, and cognitive performance decline in the elderly: a systematic review. Adv Nutr. 2019;10(suppl_2):S105–19.
  6. 7. Du Y, Oh C, No J. Advantage of dairy for improving aging muscle. J Obes Metab Syndr. 2019;28:167–74.
  7. 8. Grenov B, Michaelsen KF. Growth components of cow’s milk: emphasis on effects in undernourished children. Food Nutr Bull. 2018;39(2_suppl):S45–53.