Dairy Intake and Risk Factors for Chronic Disease
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1 Dairy Intake and Risk Factors for Chronic Disease Seminar, Nutri-on Amber Brouille7e Hannah Griswold
2 LETS TAKE A POLL
3 Claims for Dairy Consumption Unnatural Claims Against Cancer development High acid load Bioac-ve hormones High saturated fat Claims For Vitamins and minerals Improves bone density Fa7y acids Reduces chronic disease risk factors Fermented products
4 Outline Objec-ve Composi-on and Forma-on of Bovine Milk & Yogurt Factors that Influence Dairy Nutrient Composi-on Dairy and Metabolic Syndrome Important Fa7y Acids in Dairy Our Findings Clinical Applica-ons Further Research
5 Determine if dairy consump-on is beneficial to health and whether high-fat or low-fat dairy consump-on results in different health outcomes. OBJECTIVE
6 Composition of Bovine Milk Water Lactose Protein Fat Minerals Vitamins 87 Månsson, Food & Ntrn Research, 2008; 52:0.
7 Composition of Milk by % Fat (206g) Whole Milk (3.5% Fat) Semi-Skimmed Milk (1.7% Fat) Skimmed Milk (0.1% Fat) Energy (kcal) Protein (g) Carbohydrate (g) Sugar (g) Fat (g) Saturated fat (g) MUFA (g) PUFA (g) 0.2 Trace Trace Vitamin B12 (μg) Vitamin C (mg) Vitamin D (μg) Trace Trace Trace Calcium (mg) Potassium (mg) Magnesium (mg) Phosphorus (mg) The Dairy Council. The Nutri4onal Composi4on of Dairy Products." Web
8 Milk FA Composition Månsson, Food & Ntrn Research, 2008; 52:0.
9 How Milk Fatty Acids are Formed 2 1 Månsson, Food & Ntrn Research, 2008; 52:0.
10 Palmitoleic Acid trans-palmitoleic acid vs cis-palmitoleic acid Berstein, J Clin Lipidology, 2004;8:612.
11 Palmitoleic Acid Berstein, J Clin Lipidology, 2004;8:612.
12 Conjugated Linoleic Acid (CLA) Isomers of linoleic acid Cis-9, trans-11-cla (9-CLA) Trans-10, cis-12-cla (10-CLA) Found in milk, milk products, meat and meat products of ruminants Dairy fat contains >25 CLA isomers Milk contains <20 isomers (75-90% as 9-CLA) CLA Content from Ruminants Food (serving) mg CLA/ serving Milk, 2% (250 ml) 20.9 Condensed milk (125 ml) Plain yogurt, 2-4% (175 g) Low fat yogurt, 1-2% (175 g) Cheddar cheese (50 g) Bu7er (15 ml) 55.0 Fresh ground beef (90g) 52.9 Chicken 10.9 Benjamin, Nutr & Met, 2009;6:1. Dairy Nutri-on. How Much CLA is Enough? Web.
13 Conjugated Linoleic Acid (CLA) Mechanism of Ac-on Benjamin, Nutr & Met, 2009;6:1.
14 Saturated Fats
15 Saturated Fats Intake of SFA Increase LDL-C Increase risk for CHD Fernandez, J. Nutr. 2005;135:2075. Dawczynski, Nutr, Met & Cardio Disease, 2015;25:1071.
16 BenePicial Components of Dairy Protein content Specific pep-des and amino acids Micronutrients Calcium Magnesium Potassium Phosphorous Vitamin D Bacterial cultures (yogurt, kefir, etc.) Cormier, Eur J Nutr, 2015:1.
17 Composition of Yogurt by % Fat (150g) Whole Milk Yogurt, Plain (3% Fat) Low Fat Yogurt, Plain (1% Fat) Fat Free Yogurt, Plain (0% Fat) Energy (kcal) Protein (g) Carbohydrate (g) Sugar (g) Fat (g) Saturated fat (g) MUFA (g) PUFA (g) 0.3 Trace Trace Vitamin B12 (μg) Vitamin C (mg) Vitamin D (μg) Trace Calcium (mg) Potassium (mg) Magnesium (mg) Phosphorus (mg) The Dairy Council. The Nutri4onal Composi4on of Dairy Products." Web
18 How Yogurt is Made
19 10 High-Input, 10 Organic Low-Input, & 5 Non-Organic Low-Input Dairy Farms Outdoor & Indoor Grazing Periods Butler, J Sci Food Agric, 2008; 88:1431.
20 High-Input Organic Low-Input Non-Organic Low-Input Sample Size 10 farms 10 farms 5 farms Feed - Pure ryegrass swards (outdoor) - Grass silage & higher concentrate: conserved forage ra-o diet (indoor) - Mixed grassclover swards (outdoor) - Conserved forage-based diets (indoor) - Mixed grass-clover swards (outdoor) - Conserved foragebased diets with minimal concentrate/ supplements % Time Fresh Foraging (outdoor) % Time Fresh Foraging (indoor) 37% 84% 95% 0% 24% N/A Regula-ons for minerals or fer-lizers All are allowed - Mineral N - Water-soluble P fer-lizers Allowed: - < 120 kg N ha -1 yearly - Water-soluble P fer-lizer at levels determined by soil analysis Not allowed: - Mineral N - Water-soluble P fer-lizers Allowed: - Finely ground rock phosphate fer-lizer based on soil analysis Butler, J Sci Food Agric, 2008; 88:1431.
21 Butler, J Sci Food Agric, 2008; 88:1431.
22 Conclusion Milk composipon is affected by: 1. ProducPon system 2. Stage and length of grazing period 3. Diet composipon Butler, J Sci Food Agric, 2008; 88:1431.
23 Factors Affecting Composition Other than Nutrition Season Age Infec-on Stage of Lacta-on Milk Composi-on Gene-cs Heinrichs, Penn State College of Agricultural Sciences, 1997: 1.
24 Factors Affecting Composition Related to Nutrition Body Condi-on Energy Effects Protein Effects Feeding Management Concentrate Intakes Rumen func-on Forage Level and physical form Source of milk components Milk Composi-on Added fat or oil in feed Heinrichs, Penn State College of Agricultural Sciences, 1997: 1.
25 Dairy Consumption and Risk Factors for Chronic Disease
26 Metabolic Syndrome Presence of >3 of the following risk determinants: abdominal obesity waist circumference of 102 cm for men waist circumference 88 cm for women high triglycerides (150 mg/dl) low HDL cholesterol <40 mg/dl for males <50 mg/dl for females elevated blood pressure (130/85 mm Hg) high fas-ng glucose (100 mg/dl)
27 40 overweight and obese adults with metabolic syndrome Random assignment to AD or LD AD -- adequate-dairy (3.5 daily servings) LD -- low-dairy or LD (<0.5 daily servings) Weight-maintenance diets for 12 wks Effects on oxida-ve and inflammatory biomarkers and MetS risk determinants Stancliffe, Am J Clin Nutr, 2011; 422.
28 Stancliffe, R. A., T. Thorpe, and M. B. Zemel. "Dairy A7entuates Oxida-ve and Inflammatory Stress in Metabolic Syndrome." American Journal of Clinical Nutri4on 94.2 (2011): Web.
29 Stancliffe, Am J Clin Nutr, 2011; 422.
30 Stancliffe, Am J Clin Nutr, 2011; 422.
31 Limitations & Conclusion Don t specify if the milk is high or low-fat Short study Self-reported diet recalls All par-cipants were likely low dairy consumers prior to star-ng the study An increase in dairy intake axenuates oxidapve and inflammatory stress in metabolic syndrome Stancliffe, Am J Clin Nutr, 2011; 422.
32 1868 men and women (55 80 y old) without Metabolic Syndrome at baseline 137-item validated FFQ yearly Median follow-up = 3.2 years
33 1 cup milk = 228 g 1 oz cheese = 28 g 6 oz yogurt = 170 g
34 Babio, J of Nutr, 2015; 2308.
35 Babio, J of Nutr, 2015; 2308.
36 Babio, J of Nutr, 2015; 2308.
37 Limitations Incident MetS was a secondary endpoint of PREDIMED Popula-on Measurement errors Babio, J of Nutr, 2015; 2308.
38 Conclusion Lower incidence of metabolic syndrome Lower incidence of all metabolic syndrome components Increased risk of metabolic syndrome Babio, J of Nutr, 2015; 2308.
39 664 par-cipants 91-item validated FFQ Yogurt consump-on was divided into three categories on the basis of their fat content: 1. fat-free yogurt (0% M.F.) 2. low-fat yogurt (<2% M.F.) 3. high-fat yogurt ( 2 M.F.) Western and Prudent dietary pa7erns Cormier, Eur J Nutr, 2015:1.
40 Cormier, Eur J Nutr, 2015:1.
41 Results Consumer Lower BMI, waistto-hip ra-o, waist circumference Non- Consumer Higher total cholesterol and fas-ng insulin Normal Weight Consumer More high-fat yogurt daily Overweight/ Obese Consumer More reducedfat or fat-free yogurt daily Prudent diet Western diet Cormier, Eur J Nutr, 2015:1.
42 Limitations & Conclusion Limita-ons: Cross-sec-onal study using an FFQ at one -me point Conclusions: Yogurt consump-on was associated with lower weight, waist-tohip ra-o, and waist circumference. Normal weight individuals consumed more high-fat yogurts, whereas overweight/obese individuals consumed more fat-free yogurt. Cormier, Eur J Nutr, 2015:1.
43 Important Fatty Acids in Dairy Effect on Risk Factors for Chronic Disease
44 PALMITOLEIC ACID
45 30-day parallel, double-blinded, randomized, placebo-control trial Interven-on: mg per capsule (52% palmitoleic acid) Placebo: 1000 mg MCT oil Berstein, J Clin Lipidology, 2004;8:612.
46 Limitations & Conclusions Limita-ons: Small sample size Short dura-on Did not assess plasma concentra-on of palmitoleic acid to assess compliance Lifestyle and dietary factors weren t evaluated in detail Amount of dairy need to consume to reach mg palmitoleic acid = about 2.5 cups full fat milk Palmitoleic acid was found to exert anp-inflammatory and lipid-modulapng properpes when compared to a placebo Berstein, J Clin Lipidology, 2004;8:612.
47 Large, mul-ethnic prospec-ve cohort study Examined associa-on of phospholipid transpalmitoleic acid with metabolic risk and incident diabetes Evaluated biomarkers for dairy consump-on Validated 120-item FFQ Mozaffarin, Am J Clin Nutr, 2013;97:854
48 Mozaffarin, Am J Clin Nutr, 2013;97:854
49 Mozaffarin, Am J Clin Nutr, 2013;97:854
50 Limitations & Conclusions Limita-ons: Cross-sec-onal Possible that other components of dairy fat may have contributed to lower metabolic risk Uncertain if health benefits are only from dairy intake due to consump-on of hydrogenated oils Higher trans-palmitoleic acid levels were associated with lower triglycerides, faspng insulin and blood pressure, but higher LDL levels. Mozaffarin, Am J Clin Nutr, 2013;97:854
51 CONJUGATED LINOLEIC ACID (CLA)
52 Conjugated Linoleic Acid (CLA) Proposed benefits: An--obesity An--carcinogenesis An--atherosclerosis An--diabetes effects Proposed nega-ve effects: Fa7y liver and spleen Induc-on of colon carcinogenesis Hyperproinsulinaemia Benjamin, Nutr & Met, 2009;6:1.
53 Benjamin, Nutr & Met, 2009;6:1.
54 Examined effect of naturally incorporated CLA on disease risk factors n = 18 females Interven-on group consumed 1.17g/day of CLA, whereas the control group consumed 0.35 g/day Strict diet consumed on site Brown, Nutr Res, 2011;31:33.
55 Results No differences were found in insulin sensi-vity, body composi-on, circula-ng blood lipids, or other measured disease risk factors Brown, Nutr Res, 2011;31:33.
56 Limitations & Conclusions Limita-ons Small sample size Only females CLA diet does not affect insulin sensipvity, body composipon, lipids, or other risk factors for disease. Brown, Nutr Res, 2011;31:33.
57 Determined CLA intake in food products and in 18 par-cipants using 7 day weighed intake record Results: CLA content in whole milk = 2.0 mg/g fat, semi-skimmed milk = 2.1 mg/g fat and was undetected in skimmed milk (because contains less than 0.3% fat) Mean daily intake of cis-9, trans-11 CLA was 97.5 (SD 73.3) mg/d Not close to recommended 2-3 g/day to observe health benefits Mushtaq, Bri4sh J of Nutr, 2010;103:1366.
58 SATURATED FATTY ACIDS
59 Inverse associapon suggests that odd-chain SFA, which reflect milk or dairy consumppon, may have a less harmful effect in risk for coronary heart disease. Chowdhury, Ann Intern Med, 2014;160:398.
60 Review of the meta-analysis by Chowdhury et al. (2014) that found no associa-on between CAD and blood levels of total SFA Used 2 of 8 studies that looked at pentadecanoic acid (C15:0) and heptadecanoic acid (C17:0) associa-on with CVD Found nega-ve associa-ons between circula-ng C15:0 and C17:0 and coronary outcomes However, Results of 1 study used twice Odd-chain SFA do not posi-vely correlate with total SFA amount Dawczynski, Nutr, Met & Cardio Disease, 2015;25:1071.
61 When excluding arpcles focusing on C15:0 and C17:0 fats, a posipve associapon between total SFA levels and coronary outcomes was found Dawczynski, Nutr, Met & Cardio Disease, 2015;25:1071.
62 GROUP DISCUSSION
63 Discussion Questions Do you support dairy consump-on? When recommending dairy to a pa-ent, would you recommend high or low fat dairy? Does your recommenda-on change if it s for yourself? Organic vs. Non Low vs. High
64 Our Findings Outcome PopulaPon Source + Reduces oxida-ve and inflammatory biomarkers Overweight and obese adults with metabolic syndrome Stancliffe + High -fat yogurt, low-fat dairy and low-fat milk decreases incidence of metabolic symptoms Elderly pa-ents at high risk for CVD Babio + Cromier + Palmitoleic acid supplementa-on is an-- inflammatory and lipid-modula-ng Par-cipants with mild systemic inflamma-on Bernstein + Higher circula-ng trans-palmitoleic acid is associated with lower TG, fas-ng insulin, BP, and incident diabetes Older adults (45-84 y) free of clinical cardiovascular disease Non-obese, women aged y Mozzafarin Brown
65 Clinical Application Dairy: Adequate servings daily (~3) Plain, whole fat, in proper por-on For Milk: Organic For-fied with Vitamin D Yogurt Plain Added live cultures Cheese Limit no more than 1 serving per day
66 Further Research Well
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