Milk and Dairy for Cardiometabolic Health

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1 Milk and Dairy for Cardiometabolic Health Anne Mullen, BSc, PhD, FHEA, RD Director of Nutrition at The Dairy Council November Tel: Web: Twitter: TheDairyCouncil 210 High Holborn, London WC1V 7EP

2 Who we are Non-profit making organisation with a remit to address human health and disease issues relating to dairy Staffed by registered dietitians and registered nutritionists Provide information on the health benefits of dairy to consumers, healthcare professionals, media and industry Engage with opinion formers in clinical and public health Liaise with international health and nutrition bodies Facilitate dairy and human nutrition research in partnership with organisations such as AHDB Dairy [cardiovascular disease, obesity, hormones, healthy ageing, environmental sustainability]

3 Composition High in Vitamin A, Vitamin B12 and Zinc per 100g Whole Semiskimmed Milk Yogurt Cheese Skimmed Plain Plain lowfat Fromage frais Cheddar Cottage cheese Energy (kcal) Protein (g) Carbohydrate (g) Fat (g) Sat Fat (g) Sodium (mg) Potassium (mg) Calcium (mg) Phosphorus (mg) Iodine (µg) Thiamin (mg) Riboflavin (mg) Cheese spread McCance and Widdowson s The Composition of Foods 7 th Edition (2015)

4 Contribution to UK diet Milk and Milk Products yrs 4-10 yrs yrs yrs 65+ yrs Energy 25% 15% 9% 9% 12% Protein 34% 21% 14% 13% 17% Fat 34% 20% 13% 13% 16% NMES 18% 12% 7% 6% 8% Calcium 61% 45% 35% 36% 42% Iodine 64% 51% 40% 33% 37% Riboflavin 55% 41% 29% 28% 34% Vitamin B12 63% 49% 36% 33% 35% Sodium 18% 11% 8% 9% 11% Milk and milk products are nutritious foods integral to the nation s diet NDNS Years 1 to 4 rolling programme 2008/ /2012(2014)

5 Kromhaut (1999) Seven Countries Study

6 Kromhaut (1999) Seven Countries Study Classic diet-heart hypothesis

7 Siri-Tarino et al (2010) SFA & Coronary Outcomes CHD & SFA RR 1.07 no association Stroke & SFA RR 0.81 no association

8 SFA & Coronary Outcomes De Souza et al (2015)

9 FA & Coronary Outcomes Chowdhury et al (2014)

10 not all saturated fatty acids are created equal Chowdhury et al (2014)

11 Soedamah-Muthu et al (2011) Milk and CVD RR 0.94 association

12 Soedamah-Muthu et al (2011) Milk and CHD RR 1.00 no association

13 Soedamah-Muthu et al (2011) Milk and Stroke RR 0.87 no significant association

14 Soedamah-Muthu et al (2012) Dairy and Hypertension RR 0.97 association

15 Chen et al (2012) Dairy and Body Weight no energy restriction change 0.39kg no association energy restriction change -0.79kg association

16 Chen et al (2012) Dairy and Body Fat change -0.45kg association

17 Chen et al (2014) A YOGHURT A DAY KEEPS DIABETES AWAY, SAY SCIENTISTS NHS: 121,700 females; 7841 incident cases of T2DM (30yrs f/up) NHS II: 116,671 females; 3951 incident cases of T2DM (16yrs f/up) HPFS: 51,529 males; 3634 incident cases of T2DM (24ys f/up) Pooled

18 Chen et al (2014)

19 always consider heterogeneity Chen et al (2014)

20 always consider heterogeneity Chen et al (2014)

21 HRs (and 95% CIs) for the association of energy-adjusted total dairy products (A), milk (B), yogurt and thick fermented milk (C), cheese (D), and combined fermented dairy products (E) with diabetes risk (highest compared with lowest quintile) by American Society for Nutrition Sluijs et al (2012)

22 Mechanisms Probiotics Calcium Bioactive peptides Milk fat globules membranes Polyunsaturated fatty acids Odd-chain saturated fatty acids

23 Soerensen et al (2014) Calcium 15 healthy young men randomised crossover study of 3 x 2 week isocaloric interventions Faecal fat excretion increased more with consumption of both milk and cheese diets than control (5.2 ± 0.4 g/d, 5.7 ± 0.4 g/d, 3.9 ± 0.3 g/d respectively; p<0.001)

24 Odd-chain SFA Represent <0.5% total plasma fatty acids Low-cost internal standards Biomarkers for dairy intake C15:0 and C17:0 positive health associations EPIC-Norfolk and Insulin Resistance Atherosclerosis Study (IRAS), C15:0 +/- C17:0 significantly associated with decreased incident CHD and diabetes risk, respectively Khaw et al (2012), Santaran et al (2014), Jenkins et al (2015)

25 Rosqvist et al (2015) MFGM Milk fat globules Butter fat globules

26 Overview Milk and dairy foods have complex matrices, are nutrient-rich and make significant contributions to the nutritional intake of the UK population Associations between saturated fat intake and disease outcomes has been questioned Evidence suggests neutral or protective effects of milk and dairy foods consumption for coronary outcomes and risk of type 2 diabetes There are quite a number of mechanisms proposed, reflecting the array of nutrients in the complex dairy matrix Recent review (Lovegrove & Givens, 2016) cautions against reducing dairy food for CVD risk

27 References Chen et al (2012) Effects of dairy intake on body weight and fat: a meta-analysis of randomized controlled trials. Am J Clin Nutr Chen et al (2014) Dairy consumption and risk of type 2 diabetes: 3 cohorts of US adults and an updated meta-analysis. BMC Medicine 12, 215 Chowdhury et al (2014) Association of Dietary, Circulating and Supplement Fatty Acids With Coronary Risk: A Systematic Review and Metaanalysis. Ann Intern Med 160, De Souza et al (2015) Intake of saturated and trans unsaturated fatty acids and risk of all cause mortality, cardiovascular disease, and type 2 diabetes: systematic review and meta-analysis of observational studies. BMJ 11, 351:h3978 Finglas et al (2015) McCance and Widowson s The Composition of Foods, 7 th summary edition. Royal Society of Chemistry, Cambridge, UK Jenkins et al (2015) A review of Odd-Chain Fatty Acid Metabolism and the Role of Pentadecanoic Acid (C15:0) and Heptadecanoic Acid (C17:0) in Health and Disease. Molecules 20, Khaw et al (2012) Plasma phospholipid fatty acid concentration and incident coronary heart disease in men and women: the EPIC-Norfolk prospective study. PLoS Med 9, e Kromhaut (1999) On the waves of the Seven Countries Study: A public health perspective on cholesterol. Eur Heart Jour 20, Lovegrove & Givens (2016) Dairy food products: good or bad for cardiometabolic disease? Nutr Res Rev 26, 1-19 National Diet and Nutrition Survey (2012) National Diet and Nutrition Survey: results from Years 1 to 4 (combined) of the rolling programme for 2008 and 2009 to 2011 and Public Health England, London, United Kingdom Rosqvist et al (2015) Potential role of milk fat globule membrane in modulating plasma lipoproteins, gene expression, and cholesterol metabolism in humans: a randomised study. Am J Clin Nutr 102, Santaren et al (2014) Serum pentadecanoic acid (15:0), a short-term marker of dairy food intake, is inversely associated with incident type 2 diabetes and its underlying disorders. Am J Clin Nutr 100, Siri-Tarino et al (2010) Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease. Am J Clin Nutr 91, Sluijs et al (2012) The amount and type of dairy product intake and incident type 2 diabetes: results from the EPIC-InterAct Study. Am J Clin Nutr 96, Soedamah-Muthu et al (2011) Milk and dairy consumption and incidence of cardiovascular diseases and all-cause mortality: dose-response meta-analysis of prospective cohort studies. Am J Clin Nutr 93, Soedamah-Muthu et al (2012) Dairy Consumption and Incidence of Hypertension: A Dose-Response Meta-Analysis of Prospective Cohort Studies. Hypertension 60, Soerensen et al (2014) Effect of dairy calcium from cheese and milk on fecal fat excretion, blood lipids, and appetite in young men. Am J Clin Nutr 99,