Dairy Intake and Risk Factors for Chronic Disease

Transcription

1 Dairy Intake and Risk Factors for Chronic Disease Seminar, Nutrition Amber Brouillette Hannah Griswold

2 LETS TAKE A POLL

3 Claims for Dairy Consumption Unnatural Claims Against Cancer development High acid load Bioactive hormones High saturated fat Claims For Vitamins and minerals Improves bone density Fatty acids Reduces chronic disease risk factors Fermented products

4 Outline Objective Composition and Formation of Bovine Milk & Yogurt Factors that Influence Dairy Nutrient Composition Dairy and Risk Factors for Chronic Disease Important Fatty Acids in Dairy Discussion

5 Determine if dairy consumption is beneficial to health and whether high-fat or low-fat dairy consumption 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 Nutritional Composition 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) Butter (15 ml) 55.0 Fresh ground beef (90g) 52.9 Chicken 10.9 Benjamin, Nutr & Met, 2009;6:1. Dairy Nutrition. How Much CLA is Enough? Web.

13 Conjugated Linoleic Acid (CLA) Mechanism of Action 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 Beneficial Components of Dairy Protein content Specific peptides 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 Nutritional Composition of Dairy Products." Web

18 How Yogurt is Made Raw Milk PASTUERIZATION Pasteurized Milk Add starter HOMOGENIZATION FERMENTATION Raw Yogurt Add fruit HEAT TREATMENT & PACKAGING Processed Yogurt

19 Factors Affecting Milk Composition

20 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.

21 High-Input Feed - Pure ryegrass swards (outdoor) - Grass silage & higher concentrate: conserved forage ratio diet (indoor) % Time Fresh Foraging (outdoor) Organic Low- Input - Mixed grassclover swards (outdoor) - Conserved forage-based diets (indoor) Non-Organic Low-Input - Mixed grass-clover swards (outdoor) - Conserved foragebased diets with minimal concentrates supplements 37% 84% 95% % Time Fresh Foraging (indoor) 0% 24% N/A Regulations for minerals or fertilizers Butler, J Sci Food Agric, 2008; 88:1431. All are allowed - Mineral N - Water-soluble P fertilizers Not allowed: - Mineral N - Water-soluble P fertilizers Allowed: - Finely ground rock phosphate fertilizer based on soil analysis Allowed: - < 120 kg N ha -1 yearly - Water-soluble P fertilizer at levels determined by soil analysis

22 Butler, J Sci Food Agric, 2008; 88:1431.

23 Conclusion Milk composition is affected by: 1. Production system 2. Stage and length of grazing period 3. Diet composition Butler, J Sci Food Agric, 2008; 88:1431.

24 Factors Affecting Composition Other than Nutrition Season Age Infection Stage of Lactation Milk Composition Genetics Heinrichs, Penn State College of Agricultural Sciences, 1997: 1.

25 Factors Affecting Composition Related to Nutrition Body Condition Energy Effects Protein Effects Feeding Management Concentrate Intakes Rumen function Forage Level and physical form Source of milk components Milk Composition Added fat or oil in feed Heinrichs, Penn State College of Agricultural Sciences, 1997: 1.

26 Dairy Consumption and Risk Factors for Chronic Disease

27 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 fasting glucose (100 mg/dl)

28 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 Stancliffe, Am J Clin Nutr, 2011; 422.

29 Stancliffe, R. A., T. Thorpe, and M. B. Zemel. "Dairy Attentuates Oxidative and Inflammatory Stress in Metabolic Syndrome." American Journal of Clinical Nutrition 94.2 (2011): Web.

30 Stancliffe, Am J Clin Nutr, 2011; 422.

31 Stancliffe, Am J Clin Nutr, 2011; 422.

32 Limitations & Conclusion Don t specify if the milk is high or low-fat Short study Self-reported diet recalls All participants were likely low dairy consumers prior to starting the study An increase in dairy intake attenuates oxidative and inflammatory stress in metabolic syndrome Stancliffe, Am J Clin Nutr, 2011; 422.

33 1868 men and women (55 80 y old) without Metabolic Syndrome at baseline 137-item validated FFQ yearly Median follow-up = 3.2 years

34 1 cup milk = 228 g! 1 oz cheese = 28 g! 6 oz yogurt = 170 g!

35 Babio, J of Nutr, 2015; 2308.

36 Babio, J of Nutr, 2015; 2308.

37 Babio, J of Nutr, 2015; 2308.

38 Limitations Incident MetS was a secondary endpoint of PREDIMED Population Measurement errors Babio, J of Nutr, 2015; 2308.

39 Conclusion Lower incidence of metabolic syndrome Lower incidence of all metabolic syndrome components Increased risk of metabolic syndrome Babio, J of Nutr, 2015; 2308.

40 664 participants 91-item validated FFQ Yogurt consumption 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 patterns Cormier, Eur J Nutr, 2015:1.

41 Cormier, Eur J Nutr, 2015:1.

42 Results Consumer Lower BMI, waist-to-hip ratio, waist circumference Non- Consumer Higher total cholesterol and fasting 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.

43 Limitations & Conclusion Limitations: Cross-sectional study using an FFQ at one time point Overweight/Obese adults who were consumers of yogurt have more favorable cardio-metabolic profiles than overweight/obese non-consumers. Cormier, Eur J Nutr, 2015:1.

44 Important Fatty Acids in Dairy Effect on Risk Factors for Chronic Disease

45 PALMITOLEIC ACID

46 30-day parallel, double-blinded, randomized, placebo-control trial Intervention: mg per capsule (52% palmitoleic acid) Placebo: 1000 mg MCT oil Berstein, J Clin Lipidology, 2004;8:612.

47 Limitations & Conclusions Limitations: Small sample size Short duration Did not assess plasma concentration 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 anti-inflammatory and lipid-modulating properties when compared to a placebo Berstein, J Clin Lipidology, 2004;8:612.

48 Large, multiethnic prospective cohort study Examined association of phospholipid trans-palmitoleic acid with metabolic risk and incident diabetes Evaluated biomarkers for dairy consumption Validated 120-item FFQ Mozaffarin, Am J Clin Nutr, 2013;97:854

49 Mozaffarin, Am J Clin Nutr, 2013;97:854

50 Mozaffarin, Am J Clin Nutr, 2013;97:854

51 Limitations & Conclusions Limitations: Cross-sectional 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 consumption of hydrogenated oils Higher trans-palmitoleic acid levels were associated with lower triglycerides, fasting insulin and blood pressure, but higher LDL levels. Mozaffarin, Am J Clin Nutr, 2013;97:854

52 CONJUGATED LINOLEIC ACID (CLA)

53 Conjugated Linoleic Acid (CLA) Proposed benefits: Anti-obesity Anti-carcinogenesis Anti-atherosclerosis Anti-diabetes effects Proposed negative effects: Fatty liver and spleen Induction of colon carcinogenesis Hyperproinsulinaemia Benjamin, Nutr & Met, 2009;6:1.

54 Benjamin, Nutr & Met, 2009;6:1.

55 Examined effect of naturally incorporated CLA on disease risk factors n = 18 females Intervention 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.

56 Results No differences were found in insulin sensitivity, body composition, circulating blood lipids, or other measured disease risk factors Brown, Nutr Res, 2011;31:33.

57 Limitations & Conclusions Limitations Small sample size on only females CLA diet does not affect insulin sensitivity, body composition, lipids, or other risk factors for disease. Mushtaq et al. (2010): CLA content in whole milk = 2.0 mg/g fat, semi-skimmed milk = 2.1 mg/g fat and was undetected in skimmed milk Mean daily intake of CLA was 97.5 mg/d Not close to recommended 2-3 g/day to observe health benefits Mushtaq, British J of Nutr, 2010;103:1366. Brown, Nutr Res, 2011;31:33.

58 SATURATED FATTY ACIDS

59 Inverse association suggests that odd-chain SFA, which reflect milk or dairy consumption, 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 association 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) association with CVD Found negative associations between circulating C15:0 and C17:0 and coronary outcomes However, Results of 1 study used twice Odd-chain SFA do not positively correlate with total SFA amount Dawczynski, Nutr, Met & Cardio Disease, 2015;25:1071.

61 When excluding articles focusing on C15:0 and C17:0 fats, a positive association 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 consumption? When recommending dairy to a patient, would you recommend high or low fat dairy? Does your recommendation change if it s for yourself? Organic vs. Non Low vs. High

64 Our Findings Outcome Population Source /- + - Reduces oxidative and inflammatory biomarkers High -fat yogurt, low-fat dairy and low-fat milk decreases incidence of metabolic symptoms Overweight/Obese adults who were consumers of yogurt have more favorable cardio-metabolic profiles than overweight/obese non-consumers. Palmitoleic acid supplementation is anti-inflammatory and lipid-modulating Higher circulating trans-palmitoleic acid is associated with lower TG, fasting insulin, BP, and incident diabetes CLA does not affect insulin sensitivity, body composition, lipids, or other risk factors for disease Odd-chain SFA may have less harmful effect in risk for coronary heart disease With exclusion of dairy specific SFA, positive association between total SFA levels and coronary outcomes was found Overweight and obese adults with metabolic syndrome Elderly patients at high risk for CVD Stancliffe Babio 664 Participants from INFOGENE Cromier Participants with mild systemic inflammation Older adults (45-84 y) free of clinical cardiovascular disease Non-obese, women aged y N/A N/A Bernstein Mozzafarin Brown Chowdhury Dawczynski

65 Clinical Application Dairy Adequate servings daily (~3) Plain, whole fat, in proper portion Milk Organic Fortified with Vitamin D Yogurt Plain Added live cultures Cheese Limit: no more than 1 serving per day