Dairy food consumption is associated with a lower risk of the metabolic syndrome and its components: a systematic review and meta-analysis

Umbrella Review of Systematic Reviews and Meta-Analyses on Consumption of Different Food Groups and Risk of Type 2 Diabetes Mellitus and Metabolic Syndrome

Type 2 diabetes is a major contributor to the burden of chronic diseases globally. Most cases of type 2 diabetes are preventable through healthy lifestyle modifications in diet and physical activity. This systematic umbrella review presents a comprehensive overview of the evidence about the associations between risk of type 2 diabetes and metabolic syndrome with 13 food groups, including refined and whole grains, fruits, vegetables, nuts, legumes, fish and fish products, eggs, dairy/milk, sugar-sweetened beverages, processed meat, and unprocessed red and white meat. We present these relationships in per-serving and with high-versus-low comparisons. After doing a systematic search in MEDLINE, Embase, Web of Science, and Epistemonikos (registered with PROSPERO: CRD42024547606), we screened 5074 references published until May 15, 2024, and included 67 articles. This included 46 meta-analyses on risk of type 2 diabetes with half a million participants, 17 meta-analyses on risk of metabolic syndrome, and 4 meta-analyses on risk of diabetes-related mortality. Based on quality assessments using AMSTAR-2, 25 of the 67 studies were classified as high-quality studies, 8 as moderate, 12 as low, and 22 as critically low quality. Our results showed that a high intake of whole grains was associated with a lower risk of type 2 diabetes (metaevidence: moderate) and metabolic syndrome (metaevidence: low), with a similar tendency also for a high intake of fruits and vegetables (metaevidence: moderate). In contrast, the high intakes of processed meat (metaevidence: high), red meat (metaevidence: moderate), and sugar-sweetened beverages (metaevidence: moderate) were associated with a higher risk of type 2 diabetes. For the other food groups, the associations were generally neutral and not statistically significant. The heterogeneity was high for most food groups except fruits, indicating potential differences within each of the food groups in association with type 2 diabetes.

Association of dietary live microbes and nondietary prebiotic/probiotic intake with metabolic syndrome in US adults: evidence from NHANES

BACKGROUND

Metabolic syndrome (MetS) presents substantial health risks, and the supplementation of probiotics and prebiotics is regarded as a promising management approach. This study aims to explore the relationship between dietary intake of live microbes and non-dietary prebiotic/probiotic intake and MetS among US adults.

METHODS

Data from the National Health and Nutrition Examination Survey 1999-2016 was used in this study. MetS is defined according to the criteria set by the National Cholesterol Education Program-Adult Treatment Panel III-2005. Dietary intake information and probiotic/prebiotic intake data were collected through self-reported questionnaires. Multiple logistic models were applied to explore the relationships between dietary live microbes, and probiotic or prebiotic intake with MetS.

RESULTS

A significantly lower prevalence of MetS was observed in individuals with a high intake of dietary live microbes compared to those with a low intake (OR: 0.79, 95% CI: 0.69-0.91). This association was particularly strong among participants with higher economic status and advanced educational attainment (interaction P < 0.05). Similarly, individuals with non-dietary probiotics intake displayed a similar trend (OR: 0.70, 95% CI: 0.54-0.92). Conversely, there was no significant association found between non-dietary prebiotic intake and MetS.

CONCLUSIONS

Dietary live microbes intake and non-dietary probiotic intake were negatively associated with the prevalence of MetS and its components. The study offers novel evidence supporting the effective management of MetS.

Milk and dairy products - a scoping review for Nordic Nutrition Recommendations 2023

Milk and dairy products are major sources of protein, calcium, and other micronutrients. Milk and dairy products contribute with approximately half of the total intake of saturated fat in the Nordic and Baltic diets. Saturated fat is an important determinant of plasma total and low density lipoprotein (LDL)-cholesterol concentrations, and a causal relationship between high LDL-cholesterol and atherosclerotic cardiovascular disease has consistently been documented. The aim of this scoping review is to describe the evidence for the role of milk and dairy products for health-related outcomes as a basis for setting and updating food-based dietary guidelines. Two qualified systematic reviews were included (World Cancer Research Fund and a systematic review for the US Dietary Guidelines Advisory Committee 2020). In addition, systematic reviews published between January 2011 and January 2022 were considered, screened (555 records) and evaluated (159 records) for this review. The systematic reviews suggest that milk or dairy consumption is not associated with increased risk of cardiovascular disease and dyslipidaemia. Current evidence suggests an inverse association with some cardiometabolic risk factors, such as total and LDL-cholesterol, especially regarding fermented dairy products (i.e. yogurt and cheese). There was evidence of an association between intake of dairy products and reduced risk of colorectal cancer. Some studies reported an inverse association between intake of dairy and type 2 diabetes or markers of impaired glucose homeostasis, especially for low-fat dairy, yoghurt, and cheese. Most studies suggest that intake of milk or dairy is not associated with increased risk of cardiovascular risk and some suggestions of inverse association, especially with low-fat products and fermented dairy products, were found with respect to cardiovascular disease, type 2 diabetes, and colorectal cancer. Milk or dairy products are important dietary sources of calcium and iodine, and are fully compatible with a healthy dietary pattern.

Sugar Composition of Thai Desserts and Their Impact on the Gut Microbiome in Healthy Volunteers: A Randomized Controlled Trial

BACKGROUND

The relationship between consuming Thai desserts-predominantly composed of carbohydrates-and gut microbiome profiles remains unclear. This study aimed to evaluate the effects of consuming various Thai desserts with different GI values on the gut microbiomes of healthy volunteers.

METHODS

This open-label, parallel randomized clinical trial involved 30 healthy individuals aged 18 to 45 years. Participants were randomly assigned to one of three groups: Phetchaburi's Custard Cake (192 g, low-GI group, n = 10), Saraburi's Curry Puff (98 g, medium-GI group, n = 10), and Lampang's Crispy Rice Cracker (68 g, high-GI group, n = 10), each consumed alongside their standard breakfast. Fecal samples were collected at baseline and 24 h post-intervention for metagenomic analysis of gut microbiome profiles using 16S rRNA gene sequencing.

RESULTS

After 24 h, distinct trends in the relative abundance of various gut microbiota were observed among the dessert groups. In the high-GI dessert group, the abundance of Collinsella and Bifidobacterium decreased compared to the low- and medium-GI groups, while Roseburia and Ruminococcus showed slight increases. Correlation analysis revealed a significant negative relationship between sugar intake and Lactobacillus abundance in the medium- and high-GI groups, but not in the low-GI group. Additionally, a moderately negative association was observed between Akkermansia abundance and sugar intake in the high-GI group. These bacteria are implicated in energy metabolism and insulin regulation. LEfSe analysis identified Porphyromonadaceae and Porphyromonas as core microbiota in the low-GI group, whereas Klebsiella was enriched in the high-GI group, with no predominant bacteria identified in the medium-GI group.

CONCLUSIONS

The findings suggest that Thai desserts with varying GI levels can influence specific gut bacteria, though these effects may be temporary.

Differential effects of milk, yogurt, and cheese on energy homeostasis and brown adipose tissue phenotype in high-fat diet-induced obese mice

Aim: We hypothesized that milk, yogurt, and cheese have differential impacts on energy expenditure (EE) and obesity in mice fed a high-fat diet (HFD). Methods: C57BL/6 mice (n = 16 per group) were fed a HFD or a HFD supplemented with fat-free milk (MILK), fat-free plain yogurt (YOG), or reduced-fat cheddar cheese (CHE; 19 kcal% fat), each provided at 10% of the daily energy intake, for 8 weeks. EE was quantified using a metabolic chamber. Metabolic pathways related to BAT mitochondrial function and uncoupling protein 1 (UCP1) abundance were assessed. Serum lipidomic profiles were analyzed to identify potential mediators of the observed effects. Results: MILK supplementation lowered weight gain and fat accumulation and enhanced EE and BAT thermogenesis, perhaps via the SIRT1-AMPK-PGC1α axis in BAT. This led to elevated UCP1 abundance and enhanced the abundance of hormone-sensitive lipase (HSL). MILK also altered serum lipid species, indicating enhanced energy use, and promoted BAT thermogenesis and mitochondrial function pathways. YOG exhibited a similar pattern but a lower magnitude of effects than MILK on reducing weight gain and fat mass, increasing EE, and BAT thermogenic proteins, including AMPK-PGC1α-UCP1. Both MILK and YOG showed a relative increase in serum PC 15:0_15:0 and LPC 15:0. In contrast, CHE reduced weight gain and increased EE without impacting BAT thermogenesis proteins or serum lipid species. Conclusion: Our study showed that MILK, YOG, and CHE reduced weight gain in mice on a HFD by increasing EE. MILK and YOG also up-regulated BAT thermogenesis, while both additionally altered lipids involved in fat metabolism and inflammation. CHE did not affect BAT thermogenesis and lipid species compared to HFD.

Low-fat yogurt consumption maintains biomarkers of immune function relative to nondairy control food in women with elevated BMI: A randomized controlled crossover trial

Yogurt consumption may help reduce chronic inflammation associated with obesity. However, the underlying mechanism(s) by which yogurt consumption modulates the immune system have not been validated in human intervention studies. We hypothesized that 4-week yogurt consumption (12 oz/day) attenuates systemic inflammation by modulating the proportion of circulating T helper (Th) 17 and regulatory T (Treg) cells in adult women with elevated body mass index (BMI). To test the hypothesis, we conducted a randomized crossover dietary intervention study consisted of a 4-week dietary intervention in which participants consumed 12 oz of either low-fat dairy yogurt or a soy pudding control snack per day, with a 4-week washout between treatments. Thirty-nine healthy adult women with a BMI between 25 and 40 kg/m2 were enrolled and 20 completed the study. Changes in the biometrics, circulating T cells, and markers of systemic and colonic inflammation were assessed between the 2 treatment groups, as well as 24-hour diet recalls were conducted at baseline and following each treatment. The primary study outcome, the change in the proportion of circulating Th17 cells, was unaffected by the treatments. Secondary outcome measures, circulating Treg, Th17, and markers of chronic inflammation, were maintained by yogurt treatment, whereas circulating Treg was increased and interleukin-10 was reduced by control snack treatment. However, circulating Treg changes were not associated with changes to other biomarkers of inflammation, implying other immune cells and/or tissues may mediate circulating biomarkers of chronic inflammation. This study was approved by the University of Wisconsin-Madison institutional review board and registered at ClinicalTrials.gov NCT04149418.

Substance use and incidence of metabolic syndrome before midlife among military adults: the CHIEF cohort study

BACKGROUNDS

Habitual substance use, i. e., alcohol, tobacco and betel nut, has been found with an increased risk of metabolic syndrome (MetS) in the general population, whereas the association remains unclear in physically fit military personnel. This study aimed to investigate the combination of these substances use and their associations with new-onset MetS in the military.

METHODS

A total of 2,890 military men and women, aged 18-39 years, without MetS were obtained from the cardiorespiratory fitness and health in eastern armed forces study (CHIEF) in Taiwan and followed for incident MetS from baseline (2014) through the end of 2020. Incident MetS event was defined by the International Diabetes Federation guideline and confirmed in the annual health examinations. A self-report was used to assess the alcohol, tobacco and betel nut use status (active vs. former/never). Multivariable Cox regression model was performed to determine the association with adjustments for sex, age, body mass index and physical activity at baseline.

RESULTS

At baseline, there were 279 active betel nut chewers (9.7%), 991 active smokers (34.3%) and 1,159 active alcohol consumers (40.1%). During a mean follow-up of 6.0 years, 673 incident MetS (23.3%) were observed. As compared to no substance users, only one substance, and two and three substances users had a greater risk of incident MetS [hazard ratios (HRs) and 95% confidence intervals: 1.27 (1.06-1.54), 1.38 (1.12-1.69) and 1.78 (1.37-2.32), respectively]. In subgroup analyses, the risk of incident MetS in two and three substances users was significantly greater in those free of baseline low high-density lipoprotein [HRs: 1.54 (1.21-1.95) and 2.57 (1.92-3.46), respectively], as compared to their counterparts (both p for interactions <0.05).

CONCLUSION

A dose-response association of more substances use for new-onset MetS was noted in military personnel. This finding suggests that the combined alcohol, tobacco and betel nut use may play a role in the development of MetS. Further study is required to establish causation and to investigate the potential benefits of substance use cessation in reducing the risk of MetS.

The relationship between fermented and nonfermented dairy products consumption and hypertension among premature coronary artery disease patients: Iran premature coronary artery disease study

Dairy products may affect hypertension (HTN) risk. The aim of this study was to examine the association between fermented and nonfermented dairy foods and HTN in a sample of premature coronary artery disease (PCAD) subjects. This cross-sectional study was performed on 1854 PCAD patients. A 110-item food frequency questionnaire was used to assess dietary intakes. HTN was considered if systolic blood pressure was 140 mmHg and higher and/or diastolic blood pressure was 90 mmHg and higher. The odds ratio of HTN across the quartiles of different types of dairy products was evaluated by binary logistic regression. The mean (SD) of dairy products consumption was 339.8 (223.5) g/day, of which 285.4 g/day was fermented dairy products. In the crude model, participants in the fourth quartile of fermented dairy products had lesser risk of HTN compared to the bottom quartile (OR = 0.70, 95% CI: 0.52, 0.96; p for trend = .058). However, after considering the possible confounders, the significance disappeared. Subjects in the top quartile of high-fat fermented dairy products had 34% lower risk for HTN compared to the bottom quartile (95% CI: 0.49, 0.88; p for trend < .001). Adjustment for potential risk factors weakened the association but remained significant (OR = 0.73, 95% CI: 0.53, 1.01; p for trend = .001). Nonsignificant relation was detected between low-fat fermented, low-fat nonfermented, and high-fat nonfermented dairy products and HTN. Moderate consumption of high-fat fermented dairy products, in a population with low consumption of dairy foods, might relate to reduced likelihood of HTN.

A review of dairy food intake for improving health among black adults in the US

The adult life stage encompasses a range of new experiences, opportunities, and responsibilities that impact health and well-being. During this life stage, health disparities continue to increase for Black Americans, with Black adults having a disproportionate burden of obesity, chronic diseases, comorbidities, and worse treatment outcomes compared to their White peers. While many of the underlying factors for these disparities can be linked to longstanding sociopolitical factors such as systemic racism, food insecurity, and poor access to healthcare, there are also several modifiable risk factors that are known to significantly impact health outcomes, such as improving diet quality, increasing physical activity, and not smoking. Of all the modifiable risk factors known to impact health, improving dietary habits is the factor most consistently associated with better outcomes for body weight and chronic disease. Of the major food groups recommended by the 2020-2025 Dietary Guidelines for Americans (DGA) for achieving healthier dietary patterns, dairy foods have a nutrient profile which matches most closely to what Black Americans are inadequately consuming (e.g., vitamin A, vitamin D, calcium, magnesium). However, Black adults tend to consume less than half the recommended daily servings of dairy foods, in part, due to issues with lactose intolerance, making higher intake of dairy foods an ideal target for improving diet quality and health in this population. This review examines the current body of evidence exploring the links between dairy intake, obesity, cardiometabolic disease risk, chronic kidney disease, and the most common types of cancer, with a special focus on health and disparities among Black adults. Overall, the evidence from most systematic reviews and/or meta-analyses published in the last decade on dairy intake and health outcomes has been conducted on White populations and largely excluded research on Black populations. The findings from this extensive body of research indicate that when teamed with an energy-restricted diet, meeting or exceeding the DGA recommended 3 daily servings of dairy foods is associated with better body weight and composition outcomes and lower rates of most common chronic diseases than lower intake (<2 servings per day). In addition to the number of daily servings consumed, the specific types (e.g., milk, yogurt, cheese) and subtypes (e.g., low-fat, fermented, fortified) consumed have also been shown to play major roles in how these foods impact health. For example, higher intake of fermented dairy foods (e.g., yogurt) and vitamin D fortified dairy products appear to have the most protective effects for reducing chronic disease risk. Along with lactose-free milk and cheese, yogurt is also generally low in lactose, making it an excellent option for individuals with lactose intolerance, who are trying to meet the DGA recommendations for dairy food intake.

Dietary patterns derived by reduced rank regression are associated with lipid disorders among Korean adults: a cross-sectional analysis

BACKGROUND

Lipid disorders are a potent risk factor for cardiovascular diseases. Moreover, the intake of dietary fatty acids has been closely related to blood lipid levels. Therefore, this cross-sectional study examined the associations between dietary patterns related to fatty acid intake and lipid disorders in Korean adults.

METHODS

From the 2013-2019 Korea National Health and Nutrition Examination Surveys data, 8399 men and 11404 women (aged ≥ 19 years) were selected. Reduced rank regression was employed to identify dietary patterns from 26 food groups, aiming to explain the maximum variation in the intake of saturated fatty acids (SFA), polyunsaturated fatty acids (PUFA), omega-3 fatty acids, and the PUFA/SFA ratio. Associations of quintiles (Q) of dietary pattern scores with lipid disorders were examined using multiple logistic regression stratified by sex.

RESULTS

Three dietary patterns were identified: dietary pattern 1 showed positive factor loadings for vegetable oils, seasonings, legumes, nuts, and fish; dietary pattern 2 was high in consumption of red meat, bread and snacks, and milk and dairy products; and dietary pattern 3 was rich in fish and milk and dairy products. In men, dietary pattern 3 was inversely associated with elevated triglycerides (Q5 vs. Q1: odds ratio [OR] = 0.82, 95% confidence interval [CI] = 0.69-0.97, P-trend = 0.008). In women, dietary pattern 2 was positively associated with elevated total cholesterol (OR = 1.31, 95% CI = 1.12-1.52, P-trend < 0.001) but inversely associated with low HDL-cholesterol (OR = 0.70, 95% CI = 0.59-0.83, P-trend < 0.001).

CONCLUSION

In this study, dietary patterns explaining the intake of various types of fatty acids were differentially associated with lipid disorders in Korean adults. Dietary pattern characterized by higher intakes of red meat, bread and snacks and milk and dairy products were positively associated with elevated total cholesterol, whereas dietary pattern rich in fish consumption showed an inverse association with elevated triglycerides. These findings could be instrumental in developing dietary guidelines and strategies for preventing and managing lipid disorders in this population.

The Role of Diet in the Prevention of Hypertension and Management of Blood Pressure: An Umbrella Review of Meta-Analyses of Interventional and Observational Studies

High blood pressure (BP) is a major pathological risk factor for the development of several cardiovascular diseases. Diet is a key modifier of BP, but the underlying relationships are not clearly demonstrated. This is an umbrella review of published meta-analyses to critically evaluate the wide range of dietary evidence from bioactive compounds to dietary patterns on BP and risk of hypertension. PubMed, Embase, Web of Science, and Cochrane Central Register of Controlled Trials were searched from inception until October 31, 2021, for relevant meta-analyses of randomized controlled trials or meta-analyses of observational studies. A total of 175 publications reporting 341 meta-analyses of randomized controlled trials (145 publications) and 70 meta-analyses of observational studies (30 publications) were included in the review. The methodological quality of the included publications was assessed using Assessment of Multiple Systematic Reviews 2 and the evidence quality of each selected meta-analysis was assessed using NutriGrade. This umbrella review supports recommended public health guidelines for prevention and control of hypertension. Dietary patterns including the Dietary Approaches to Stop Hypertension and the Mediterranean-type diets that further restrict sodium, and moderate alcohol intake are advised. To produce high-quality evidence and substantiate strong recommendations, future research should address areas where the low quality of evidence was observed (for example, intake of dietary fiber, fish, egg, meat, dairy products, fruit juice, and nuts) and emphasize focus on dietary factors not yet conclusively investigated.

Metabolic syndrome prediction using non-invasive and dietary parameters based on a support vector machine

BACKGROUND AND AIMS

Metabolic syndrome (MetS) is a widely used index for finding people at risk for chronic diseases, including cardiovascular disease and diabetes. Early detection of MetS is especially important in prevention programs. Relying on previous studies that suggest machine learning methods as a valuable approach for diagnosing MetS, this study aimed to develop MetS prediction models based on support vector machine (SVM) algorithms, applying non-invasive and low-cost (NI&LC), and also dietary parameters.

METHODS AND RESULTS

This population-based research was conducted on a large dataset of 4596 participants within the framework of the Shahedieh cohort study. An Extremely Randomized Trees Classifier was used to select the most effective features among NI&LC and dietary data. The prediction models were developed based on SVM algorithms, and their performance was assessed by accuracy, sensitivity, specificity, positive prediction value, negative prediction value, f1-score, and receiver operating characteristic curve. MetS was diagnosed in 14% of men and 22% of women. Among NI&LC features, waist circumference, body mass index, waist-to-height ratio, waist-to-hip ratio, systolic blood pressure, and diastolic blood pressure were the most predictive variables. By using NI&LC features, models with 78.4% and 63.5% accuracy and 81.2% and 75.3% sensitivity were yielded for men and women, respectively. By incorporating NI&LC and dietary features, the accuracy of the model in women improved by 3.7%.

CONCLUSIONS

SVM algorithms had promising potential for early detection of MetS relying on NI&LC parameters. These models can be used in prevention programs, clinical practice, and personal applications.

The cluster of differentiation 36 (CD36) rs1761667 polymorphism interacts with dietary patterns to affect cardiometabolic risk factors and metabolic syndrome risk in apparently healthy individuals

Several studies have examined the association between CD36 rs1761667 polymorphism with cardiometabolic risk factors and metabolic syndrome (MetS). This study aimed to investigate the interactions between rs1761667 polymorphism and dietary patterns on the cardiometabolic risk factors and the risk of MetS in apparently healthy individuals aged 20-70 years. Food consumption data were acquired using a validated semi-quantitative FFQ. Dietary patterns were identified by factor analysis. CD36 rs1761667 was genotyped by PCR-restriction fragment length polymorphism. The gene-diet interaction was detected by the general linear model or logistic regression. Significant or marginally significant interactions were observed between healthy dietary pattern (HDP) and CD36 rs1761667 on weight (P = 0·006), BMI (P = 0·009), waist circumference (P = 0·005), hip circumference (P = 0·06), body muscle percentage (P = 0·02), body fat percentage (P = 0·09), TAG-glucose index (P = 0·057), atherogenic index of plasma (P = 0·07), the risk of MetS (P = 0·02), risk of abdominal obesity (P = 0·02) and elevated blood pressure (P = 0·07). Besides, a gene-diet interaction was detected between the traditional dietary pattern and rs1761667 variants on odds of hypertriglyceridaemia (P = 0·02). The adherence to HDP was associated with a lower weight, BMI and higher odds of HDL-cholesterol only in A-allele carriers. In conclusion, adherence to HDP (a diet with high fibre, fish and dairy products) can be more effective on some cardiometabolic risk factors and risk of MetS components in the A-allele carrier than the GG genotype of rs1761667 polymorphism. However, future studies are required to shed light on this issue.

Dairy products and constituents: a review of their effects on obesity and related metabolic diseases

Obesity has become a global public health problem that seriously affects the quality of life. As an important part of human diet, dairy products contain a large number of nutrients that are essential for maintaining human health, such as proteins, peptides, lipids, vitamins, and minerals. A growing number of epidemiological investigations provide strong evidence on dairy interventions for weight loss in overweight/obese populations. Therefore, this paper outlines the relationship between the consumption of different dairy products and obesity and related metabolic diseases. In addition, we dive into the mechanisms related to the regulation of glucose and lipid metabolism by functional components in dairy products and the interaction with gut microbes. Lastly, the role of dairy products on obesity of children and adolescents is revisited. We conclude that whole dairy products exert more beneficial effect than single milk constituent on alleviating obesity and that dairy matrix has important implications for metabolic health.

Snack consumption patterns and their associations with risk of incident metabolic syndrome: Tehran lipid and glucose study

AIM

Few studies considered the association between snack patterns and metabolic abnormalities. Here we aimed to characterize the major snack patterns among Iranian adults and determine their association with the risk of metabolic syndrome (MetS).

METHODS

This study was conducted on 1713 MetS-free adults who participated in the third phase of the Tehran Lipid and Glucose Study (TLGS). At baseline, dietary intake of snack was assessed using a validated 168-items food frequency questionnaire, and snack patterns were obtained by principal component analysis (PCA). Adjusted Hazard Ratios (HRs) and 95% confidence intervals (CIs) were calculated for the association of incident MetS with the extracted snack patterns.

RESULTS

PCA identified five major snack patterns, defined as "healthy pattern", "low-fructose pattern", "high-trans pattern", "high-caffeine pattern" and "high-fructose pattern". Participants in the highest tertile of the "high-caffeine pattern" had lower risk of MetS (HR = 0.80, 95% CI = 0.65-0.99, P for trend = 0.032). Other snack patterns have not shown any significant association with MetS incidence.

CONCLUSIONS

Our findings suggest that consuming a snack pattern with high loads of caffeine, defined as "High-caffeine pattern" in the present study, could reduce the risk of MetS in healthy adults. Further prospective studies are needed to more fully determine the association between snack patterns and MetS incidence.

The Metabolic Matrix: Re-engineering ultraprocessed foods to feed the gut, protect the liver, and support the brain

Ultraprocessed food is established as a metabolic disruptor acting to increase adiposity, reduce mitochondrial efficiency, drive insulin resistance, alter growth, and contribute to human morbidity and mortality. Consumer packaged goods (CPG) companies are beginning to understand the detrimental impact of the food they market, and have employed substitution strategies to reduce salt, sugar, and fat. However, the harms of ultraprocessed foods are far more complex than any single component, and are not ameliorated by such simple substitutions. Over the past 2 years, the authors have worked with the Kuwaiti Danish Dairy Company (KDD) to conduct a comprehensive scientific evaluation of their entire commercial food and beverage portfolio. Assay of the macronutrients, micronutrients, additives, and toxins contained in each of their products was undertaken to determine the precise nature of each product's ingredients as well as the health impacts of processing. The authors formed a Scientific Advisory Team (SAT) and developed a tiered "Metabolic Matrix" founded in three science-based principles: (1) protect the liver, (2) feed the gut, and (3) support the brain. The Metabolic Matrix categorizes each product and provides the criteria, metrics, and recommendations for improvement or reformulation. Real-time consultation with the KDD Executive and Operations teams was vital to see these procedures through to fruition. This scientific exercise has enabled KDD to lay the groundwork for improving the health, well-being, and sustainability of their entire product line, while maintaining flavor, economic, and fiscal viability. This process is easily transferrable, and we are sharing this effort and its approaches as a proof-of-concept. The key aim of our work is to not only make ultraprocessed food healthier but to urge other food companies to implement similar analysis and reformulation of their product lines to improve the metabolic health and well-being of consumers worldwide.

Yogurt Supplementation Attenuates Insulin Resistance in Obese Mice by Reducing Metabolic Endotoxemia and Inflammation

BACKGROUND

Inflammation is an underlying mechanism for the development of obesity-related health complications. Yogurt consumption inhibits obesity-associated inflammation, but the tissue-specific mechanisms have not been adequately described.

OBJECTIVES

We aimed to determine the tissue-specific responses by which yogurt supplementation inhibits inflammation.

METHODS

C57BL/6 male mice (5 wk old) were fed a Teklad Global 14% Protein Rodent Maintenance diet as a control or a high-fat diet (60% calories from fat) to induce obesity for 11 wk, followed by feeding a Western diet (WD; 43% carbohydrate and 42% fat) or WD supplemented with 5.6% lyophilized yogurt powder for 3 wk to test for the impact of yogurt supplementation. Markers of metabolic endotoxemia and inflammation were assessed in plasma and tissues. Cecal and fecal microbiota were profiled by 16S rRNA sequencing.

RESULTS

In obese mice, relative to the WD control group, yogurt supplementation attenuated HOMA-IR by 57% (P = 0.020), plasma TNF-α by 31% (P < 0.05) and colonic IFN-γ by 46% (P = 0.0034), which were accompanied by a 40% reduction in plasma LPS binding protein (LBP) (P = 0.0019) and 45% less colonic Lbp expression (P = 0.037), as well as alteration in the beta diversity of cecal microbiota (P = 0.0090) and relative abundance of certain cecal microbes (e.g., Lachnospiraceae Dorea longicatena with P = 0.049). There were no differences in the LBP, Lbp, and Cd14 levels in the liver and small intestine between obese mice with and without yogurt supplementation (P > 0.05).

CONCLUSIONS

Yogurt consumption inhibits obesity-induced inflammation in mice by modulating colonic endotoxin detoxification, changing the gut microbiota, and improving glucose metabolism. This work helps to establish the underlying mechanisms by which yogurt consumption affects markers of metabolic and immune health.

Determination of the level of evidence for the association between different food groups/items and dietary fiber intake and the risk of cardiovascular diseases and hypertension: An umbrella review

Evidence has suggested that nutrition is a preventive factor against cardiovascular disease (CVD) risk. Because of a sharp growth in published meta-analyses and pooled analyses in recent years, a reassessment of old evidence is needed. We aimed to determine the level of evidence for the association between the consumption of different food groups/items and dietary fiber and the incidence risk of CVDs, hypertension, and atrial fibrillation from meta-analyses and pooled analyses of observational studies. Databases Scopus, PubMed/Medline, and Web of Science were searched for related studies. Fifty-eight articles met the inclusion criteria for evidence grading. In summary, grading the level of evidence showed a suggestive inverse association between the higher consumption of fruits, whole grains, fish, legumes, nuts, and dietary fibers with the incidence risk of hypertension and different types of CVD. Also, there was a probable inverse association between the higher consumption of total and low-fat dairy products and the risk of hypertension. Higher red meat consumption had a probable association with the increased risk of ischemic stroke. Higher consumption of processed meat and poultry also had a suggestive direct association with the incidence risk of stroke and hypertension. We have tried to present a comprehensive and useful overview of the level of evidence based on the most updated findings. The summary of results in the current umbrella review can be a helpful tool for nutritionists, dietitians, and researchers to establish new studies and identify research gaps in related issues.

'Superfoods': Reliability of the Information for Consumers Available on the Web

The term 'superfoods', used frequently with marketing purposes, is usually associated with foodstuffs with beneficial health properties. 'Superfoods' appears in many information sources, including digital media. The information they provide is easily accessible for consumers through Internet search engines. The objective of this work is to investigate the data that web pages offer to consumers and their accuracy according to current scientific knowledge. The two main search engines were utilized for English language websites search, introducing the term 'superfoods'. In total, 124 search results were found. After applying the selection criteria, 45 web pages were studied. A total of 136 foods were considered as 'superfoods' by sites; 10 of them (kale, spinach, salmon, blueberries, avocado, chia, walnuts, beans, fermented milks and garlic) were mentioned on at least 15 sites. Nutritional and healthy properties displayed on sites were compared to scientific information. In conclusion, websites present the information in a very simplified manner and it is generally not wrong. However, they should offer to consumers comprehensible information without raising false expectations regarding health benefits. In any case, 'superfoods' consumption can have salutary effects as part of a balanced diet.

Animal- and Plant-Based Protein Sources: A Scoping Review of Human Health Outcomes and Environmental Impact

Dietary proteins are indispensable to human nutrition. In addition to their tissue-building function, they affect body composition and regulate various metabolic pathways, as well as satiety and immune system activity. Protein use can be examined from a quantitative or qualitative viewpoint. In this scoping review, we compare animal- and plant-based protein sources in terms of their effects on human health and the environment. We conclude that the consumption of vegetable protein sources is associated with better health outcomes overall (namely, on the cardiovascular system) than animal-based product use. The healthier outcomes of vegetable protein sources dovetail with their lower environmental impact, which must be considered when designing an optimal diet. Indeed, the health of the planet cannot be disjointed from the health of the human being. Future research will clarify the mechanisms of action underlying the health effects of plant-based protein sources when compared with animal sources, fostering better agronomic practices and influencing public health in a direction that will benefit both the planet and its inhabitants.

Association of milk consumption with management and incidence of hypertension among South Korean adults: A prospective analysis of the health examinees study cohort

BACKGROUND AND AIMS

Studies have revealed a positive relationship between milk consumption and hypertension. However, few researchers have investigated the association between milk consumption and changes in blood pressure (BP) in South Korean adults. Therefore, we examined the association between milk intake and the management and risk of hypertension in South Korean adults.

METHODS AND RESULTS

Participants were selected from the Health Examinees study. The definition of hypertension was based on the guidelines of the Korean Society of Hypertension. The participants were divided into three groups according to changes between baseline and follow-up BP data. Milk consumption was assessed using food frequency questionnaires. In both men and women, the higher milk consumption group had increased odds of trends of BP improvement (OR: 1.249, 95% CI: 1.043-1.496, p for trend: 0.2271 in men; OR: 1.147, 95% CI: 1.014-1.297, p for trend: 0.0293 in women) and decreased odds of trends of worsening (OR: 0.861, 95% CI: 0.756-0.980, p for trend: <0.0001 in men, OR: 0.866, 95% CI: 0.794-0.943, p for trend: 0.0010 in women) compared to those of the non-consumption group. In the prospective study, milk intake was inversely associated with hypertension risk (HR: 0.900, 95% CI: 0.811-0.999, p for trend: 0.0076 in men; HR: 0.879, 95% CI: 0.814-0.949, p for trend: 0.0002 in women).

CONCLUSION

Increased intake of milk was inversely related to the risk of increased BP, with a decreased risk of hypertension events.

Screening of lactic acid bacteria strains with urate-lowering effect from fermented dairy products

Hyperuricemia is a well-known cause of gout and also a risk factor for various comorbidities. Current agents like xanthine oxidase inhibitors prevent hyperuricemia, but usually induce severe side effects. Alternative strategies, such as novel dietary supplementations, are necessary for the management of hyperuricemia. Lactic acid bacteria (LAB) have been used in human diet for a long time with a good safety record. In this study, 345 LAB strains isolated from traditional fermented dairy products were tested for assimilating abilities of guanosine. Two LAB strains, Lacticaseibacillus rhamnosus 1155 (LR1155) and Limosilactobacillus fermentum 2644 (LF2644), showing great capacities of guanosine transformation and degradation were selected. Compared to LR1155, LF2644 showed a better effect with 100.00% transforming rate and 55.10% degrading rate. In an in vivo test, a hyperuricemic rat model was established and the results showed that administration of LR1155 (p < 0.01) or LF2644 (p < 0.01) prevented the rise of serum uric acid with more than 20% decrease when compared with the hyperuricemia rats. In addition, an increased fecal uric acid level was observed in LF2644 or LR1155 treated rats (LR1155-M p < 0.05, others p < 0.01). This study proved that LR1155 and LF2644 can be promising candidates of dietary supplements for prevention or improvement of hyperuricemia. PRACTICAL APPLICATION: The LAB strains tested in this study could be considered as good potential probiotic candidates for dietary supplements because of their urate-lowering effects, which provide a novel antihyperuricemic strategy with advantages of safety and sustainability.

Associations of Calcium Intake and Calcium from Various Sources with Blood Lipids in a Population of Older Women and Men with High Calcium Intake

Promoting calcium intake is a cornerstone for osteoporosis management. Some individuals limit dairy product consumption, a major calcium source, due to their high content in saturated fats and their perceived negative impact on lipid profiles. This study explored the associations of calcium from various sources with blood lipids in community-dwelling elderly (n = 717) from the GERICO cohort. Dietary calcium intake was assessed at several timepoints using a validated food frequency questionnaire (FFQ) and calcium supplement use was recorded. Blood lipids were treated as categorical variables to distinguish those with normal and abnormal levels. Increasing total calcium intake was associated with lower risks for high total cholesterol (p = 0.038) and triglycerides (p = 0.007), and low HDL-cholesterol (p = 0.010). Dairy calcium (p = 0.031), especially calcium from milk (p = 0.044) and milk-based desserts (p = 0.039), i.e., low-fat (p = 0.022) and non-fermented (p = 0.005) dairy products, were associated with a lower risk of high total cholesterol. Greater calcium intakes from total dairies (p = 0.020), milk (p = 0.020) and non-fermented dairies (p = 0.027) were associated with a lower risk of hypertriglyceridemia. No association was observed between calcium from non-dairy sources, cheese or high-fat dairies and blood lipids. Increasing calcium through supplements was associated with lower risks for hypertriglyceridemia (p = 0.022) and low HDL-cholesterol (p = 0.001), but not after adjustments. Our results suggest that higher calcium intakes from dietary sources or supplements are not adversely associated with blood lipids in the elderly, whilst total, and particularly low-fat, dairy products are valuable calcium sources potentially related to favorable lipid profiles.

Stages of Change in Dairy Intake among Older Adults: Application of the Transtheoretical Model

Adequate dairy product intake can reduce the risk of chronic disease, mortality, low quality of life, and healthcare expenditure. However, the insufficient consumption of dairy products is a serious issue in Eastern societies. To the authors’ knowledge, few studies have explored dairy intake among Taiwanese older adults, especially using the transtheoretical model. The study aims were to address the following unknowns: (i) the distribution of dairy product intake behavior on stages of change (SOC); (ii) differences in variables (intake knowledge (IK), intake cons (IC), intake pros (IP), and intake self-efficacy (ISE)) among SOCs; (iii) discriminative abilities of variables on SOCs; and (iv) predictive ability of variables (IK, IC, IP, and ISE) for dairy product intake behavior on SOC for older adults. An explorative cross-sectional study was conducted to collect data from northern Taiwan using a questionnaire. A total of 342 older adults were recruited. Data were analyzed using multivariate analysis of variance, discriminant analysis, and multiple linear regression. There was a significant difference between the variables and SOCs. There was a better discriminant among the five SOCs. Dairy product intake behaviors were significantly associated with knowledge and self-efficacy in the pre-action stage, and with cons, pros, and self-efficacy in the post-action stage. In conclusion, appropriate nutritional empowerment could benefit older adults by improving dairy intake among the different SOCs.

Total, low-fat, and full-fat dairy consumption and risk of metabolic syndrome among workers

BACKGROUND & AIM

Dairy products may play a beneficial role against metabolic syndrome; however, epidemiological evidence is scarce in Asian populations, who consume less dairy than Western populations. We prospectively investigated the association between dairy product intake, both overall and by fat content, and metabolic syndrome in a Japanese working population.

METHODS

Participants were 1014 workers (aged 19-68 years) without metabolic syndrome at baseline who completed a 3-year follow-up survey. Dietary intake was assessed using a validated self-administered diet history questionnaire. Metabolic syndrome was defined according to the Joint Interim Statement (JIS) criteria. Multiple logistic regression was used to estimate the odds ratio of metabolic syndrome according to tertile of total, low-fat, and full-fat dairy product intake with adjustment for covariates.

RESULTS

At the 3-year follow-up, 66 (6.5%) workers were newly identified as having metabolic syndrome. A trend towards decreased odds of developing metabolic syndrome was observed among those in the highest tertile of total and full-fat dairy product intake: multivariable-adjusted odds ratio for the highest versus lowest tertile was 0.54 (95% CI 0.26-1.12; P for trend = 0.094) for total dairy products and 0.50 (95% CI 0.24-1.05; P for trend = 0.038) for full-fat dairy products. Low-fat dairy intake was not associated with metabolic syndrome.

CONCLUSIONS

Our results suggest that higher intake of full-fat, but not low-fat, dairy products may be associated with a lower risk of metabolic syndrome among Japanese.

Dietary Mediators of the Genetic Susceptibility to Obesity-Results from the Quebec Family Study

BACKGROUND

Recent studies showed that eating behaviors such as disinhibition, emotional and external eating, and snacking mediate genetic susceptibility to obesity. It remains unknown if diet quality and intake of specific food groups also mediate the genetic susceptibility to obesity.

OBJECTIVE

This study aimed to assess if diet quality and intakes of specific food groups mediate the association between a polygenic risk score (PRS) for BMI and BMI and waist circumference (WC). We hypothesized that poor diet quality, high intakes of energy-dense food groups, and low intakes of nutrient-dense food groups mediate the genetic susceptibility to obesity.

METHODS

This cross-sectional study included 750 participants (56.3% women, aged 41.5 ± 14.9 y, BMI 27.8 ± 7.5 kg/m2) from the Quebec Family Study. A PRSBMI based on >500,000 genetic variants was calculated using LDpred2. Dietary intakes were assessed with a 3-d food record from which a diet quality score (i.e. Nutrient Rich Food Index 6.3) and food groups were derived. Mediation analyses were conducted using a regression-based and bootstrapping approach.

RESULTS

The PRSBMI explained 25.7% and 19.8% of the variance in BMI and WC, respectively. The association between PRSBMI and BMI was partly mediated by poor diet quality (β = 0.33 ± 0.12; 95% CI: 0.13, 0.60), high intakes of fat and high-fat foods (β = 0.46 ± 0.16; 95% CI: 0.19, 0.79) and sugar-sweetened beverages (β = 0.25 ± 0.14; 95% CI: 0.05, 0.60), and low intakes of vegetables (β = 0.15 ± 0.08; 95% CI: 0.03, 0.32), fruits (β = 0.37 ± 0.12; 95% CI: 0.17, 0.64), and dairy products (β = 0.17 ± 0.09; 95% CI: 0.02, 0.37). The same trends were observed for WC.

CONCLUSIONS

The genetic susceptibility to obesity was partly mediated by poor diet quality and intakes of specific food groups. These results suggest that improvement in diet quality may reduce obesity risk among individuals with high genetic susceptibility and emphasize the need to intervene on diet quality among these individuals.

Plant-based diet quality and the risk of total and disease-specific mortality: A population-based prospective study

BACKGROUND AND AIMS

Plant-based diets have been suggested to have health benefits, and risk differs by quality of plant foods. However, evidence on the association between the quality of plant-based diets and mortality are limited. This study examined the associations between 3 different types of plant-based diet indices and risk of total and disease-specific mortality.

METHODS

Analyses were based on a population-based cohort of 118,577 South Korean adults (40-69 years of age) who participated in the Korean Genome and Epidemiology Study_Health Examinees (2004-2019). Dietary intakes were assessed using a validated food frequency questionnaire. Based on the questionnaire, we calculated 3 plant-based diet indices: overall plant-based diet index (PDI), healthful plant-based diet index (hPDI), and unhealthful plant-based diet index (uPDI). The PDI assigned higher scores for higher consumption of all plant foods. The hPDI assigned higher scores for higher consumption of only healthy plant foods. The uPDI assigned higher scores for higher consumption of only unhealthy plant foods.

RESULTS

During a total of 1,191,426 person-years of follow-up, we ascertained 3074 deaths, including 447 deaths from cardiovascular disease and 1515 deaths from cancer. Comparing the highest versus lowest quintiles of PDI, the multivariable-adjusted hazard ratios of total mortality were 0.76 (95% CI, 0.68-0.85, P-trend<0.0001). Comparing the highest versus lowest quintile of uPDI, the hazard ratios were 1.30 for total mortality (95% CI, 1.15-1.48, P-trend<0.0001), 1.55 for cardiovascular disease mortality (95% CI, 1.08-2.25, P-trend = 0.06), and 1.23 for cancer mortality (95% CI, 1.02-1.47, P-trend = 0.06) after adjustment for demographic characteristics and lifestyle factors. For 10-point higher in PDI score was associated with 13% (95% CI, 0.82-0.92, P < 0.0001) lower risk of total mortality. In contrast, 10-point higher in uPDI score was associated with 16% (95% CI, 1.06-1.17, P < 0.0001) higher risk of total mortality with modest association with cancer mortality. No association was observed between hPDI and any cause of mortality. The correlation coefficients were 0.39 between PDI and hPDI, -0.22 between hPDI and uPDI, and 0.07 between PDI and uPDI.

CONCLUSIONS

Overall, greater adherence to a plant-based dietary pattern was associated with lower total mortality, but among those with predominantly unhealthful plant-based diets, total and disease-specific mortality rates were higher. The quality of plant foods may be crucial for reducing mortality in a population that mainly consume diets rich in plant foods.

Whole-fat dairy products do not adversely affect adiposity or cardiometabolic risk factors in children in the Milky Way Study: a double-blind randomized controlled pilot study

BACKGROUND

Limited evidence supports the common public health guideline that children >2 y of age should consume dairy with reduced fat content.

OBJECTIVES

We aimed to investigate the effects of whole-fat compared with reduced-fat dairy intake on measures of adiposity and biomarkers of cardiometabolic risk in healthy 4- to 6-y-old children.

METHODS

The Milky Way Study enrolled 49 children (mean ± SD age: 5.2 ± 0.9 y; 47% girls) who were habitual consumers of whole-fat dairy, then randomly assigned them in a double-blind fashion to remain on whole-fat dairy or switch their dairy consumption to reduced-fat products for 3 mo. Primary endpoints included measures of adiposity, body composition, blood pressure, fasting serum lipids, blood glucose, glycated hemoglobin (HbA1c), and C-reactive protein (CRP) and were assessed at baseline and study end. Pre- and postintervention results were compared using linear mixed models, adjusted for growth, age, and sex.

RESULTS

Dairy fat intake was reduced by an adjusted (mean ± SEM) 12.9 ± 4.1 g/d in the reduced-fat compared with the whole-fat dairy group (95% CI: -21.2, -4.6 g/d; P = 0.003), whereas dietary energy intakes remained similar (P = 0.936). We found no significant differential changes between dairy groups in any measure of adiposity, body composition, blood pressure, or fasting serum lipids, glucose, HbA1c, and CRP.

CONCLUSIONS

Our results suggest that although changing from whole-fat to reduced-fat dairy products does reduce dairy fat intake, it does not result in changes to markers of adiposity or cardiometabolic disease risk in healthy children.This trial was registered at www.anzctr.org.au as ACTRN12616001642471.

Dietary Approaches to Stop Hypertension (DASH) diet, Mediterranean diet and blood lipid profiles in less-developed ethnic minority regions

Different from developed countries, there is a paucity of research examining how the Dietary Approaches to Stop Hypertension (DASH) and Mediterranean diets relate to lipids in less-developed ethnic minority regions (LEMR). A total of 83 081 participants from seven ethnic groups were retrieved from the baseline data of the China Multi-Ethnic Cohort study, which was conducted in less-developed Southwest China between May 2018 and September 2019. Multivariable linear regression models were then used to examine the associations of the DASH and alternative Mediterranean diet (AMED) scores, assessed by modified DASH score and AMED, as well as their components with total cholesterol (TC), LDL-cholesterol, HDL-cholesterol, TAG and TC/HDL-cholesterol. The DASH scores were negatively associated with TC, HDL-cholesterol and TAG. Comparing the highest quintiles with the lowest DASH scores, TC decreased 0·0708 (95 % CI -0·0923, -0·0493) mmol/l, HDL-cholesterol decreased 0·0380 (95 % CI -0·0462, -0·0299) mmol/l and TAG decreased 0·0668 (95 % CI -0·0994, -0·0341) mmol/l. The AMED scores were negatively associated with TC, LDL-cholesterol and HDL-cholesterol. Comparing the highest quintiles with the lowest AMED scores, TC decreased 0·0816 (95 % CI -0·1035, -0·0597) mmol/l, LDL-cholesterol decreased 0·0297 (95 % CI -0·0477, -0·0118) mmol/l and HDL-cholesterol decreased 0·0275 (95 % CI -0·0358, -0·0192) mmol/l. Although both the DASH diet and the Mediterranean diet were negatively associated with blood lipids, those associations showed different patterns in LEMR, particularly for TAG and HDL-cholesterol.

Dairy Product Consumption and Cardiovascular Health: a Systematic Review and Meta-Analysis of Prospective Cohort Studies

The association between dairy product consumption and cardiovascular health remains highly debated. We quantitatively synthesized prospective cohort evidence on the associations between dairy consumption and risk of hypertension (HTN), coronary heart disease (CHD) and stroke. We systematically searched PubMed, Embase, and Web of Science through August 1st, 2020 to retrieve prospective cohort studies that reported on dairy consumption and risk of HTN, CHD or stroke. We used random-effects models to calculate the pooled relative risk (RR) and 95% confidence interval (CI) for the highest vs the lowest category of intake and for 1 serving/day increase in consumption. We rated the quality of evidence using NutriGrade. Fifty-five studies were included. Total dairy consumption was associated with a lower risk of HTN (RR for highest vs lowest level of intake: 0.91, 95% CI: 0.86-0.95, I2 = 73.5%; RR for 1 serving/day increase: 0.96, 95% CI: 0.94-0.97, I2 = 66.5%), CHD (highest vs lowest level of intake: 0.96, 95% CI: 0.92-1.00, I2 = 46.6%; 1 serving/day increase: 0.98, 95% CI: 0.95-1.00, I2 = 56.7%), and stroke (highest vs lowest level of intake: 0.90, 95% CI: 0.85-0.96, I2 = 60.8%; 1 serving/day increase: 0.96, 95% CI: 0.93-0.99, I2 = 74.7%). Despite moderate to considerable heterogeneity, these associations remained consistent across multiple subgroups. Evidence on the relationship between total dairy and risk of HTN and CHD were of moderate quality and of low quality for stroke. Low-fat dairy consumption was associated with lower risk of HTN and stroke, and high-fat dairy with a lower risk of stroke. Milk, cheese, or yogurt consumption showed inconsistent associations with the cardiovascular outcomes in high vs. low intake and dose-response meta-analyses. Total dairy consumption was associated with a modestly lower risk of hypertension, CHD and stroke. Moderate to considerable heterogeneity was observed in the estimates and the overall quality of the evidence was low to moderate.

Higher yogurt intake is associated with lower blood pressure in hypertensive individuals: Cross-sectional findings from the Maine-Syracuse Longitudinal study

Associations between fermented dairy products and blood pressure are unclear. The current study therefore examined the association between yogurt and blood pressure in hypertensive and non-hypertensive individuals. Cross-sectional analyses were undertaken on 915 community-dwelling adults from the Maine-Syracuse Longitudinal Study. Habitual yogurt consumption was measured using a food frequency questionnaire. The primary outcomes were systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and pulse pressure. Secondary outcomes included BMI (kg m^-2), total cholesterol (mg dL^-1), glucose (mg dL^-1), HDL (mg dL^-1), LDL (mg dL^-1), triglycerides (mg dL^-1), and plasma homocysteine (μmol L^-1). Multivariable regression analyses revealed significant inverse associations between yogurt and both SBP (p < 0.05) and MAP (p < 0.05) in hypertensive (n = 564) but not non-hypertensive participants (n = 351). Future observational and intervention studies should continue to focus on at-risk individuals to examine the potential benefits of yogurt.

Association between dairy product intake and high blood pressure in Chilean adults

BACKGROUND

Hypertension is a major risk for cardiovascular disease. Several studies have connected dairy consumption with lower blood pressure (BP). However, these have not considered the Latin American population. The aim of this study was to examine the relationship between consumption of full-fat or low fat/fat free dairy products and high blood pressure in Chilean adults.

METHODS

Cross-sectional study containing data from 3,807 adults between 20 and 98 years old from the National Health Survey (NHS) of Chile 2016-2017. Information on lifestyle, food frequency, and socio-demographics was collected using standardized questionnaires. Trained fieldworkers took anthropometric and blood pressure measurements. The frequency of consumption data included seven ad-hoc questions on habitual eating and frequency options, based on the Mediterranean diet (fish products, fruit and vegetable, and dairy products) and its protective effect on cardiovascular diseases. The selection of foods was supported by expert opinion.

RESULTS

Of the 3,807 adults, 37% were male and 63% were female. Sex, education level, frequency of dairy products and fish, smoking, and sport or physical activity had a direct relationship with consumption of dairy products (P < 0.05). Consumption of low fat/fat free dairy products was protectively associated with high blood pressure in the unadjusted model (OR: 0.76, CI 95% 0.64-0.91). However, after adjustment for confounding variables (education level modifies the effect 10.2%), this association was attenuated (OR: 0.88; CI 95% 0.71-1.08).

CONCLUSION

We found limited evidence that the type of dairy products consumed is associated with high blood pressure in the Chilean population.

Age and Sex Interact to Determine the Effects of Commonly Consumed Dairy Products on Postmeal Glycemia, Satiety, and Later Meal Food Intake in Adults

BACKGROUND

Dairy consumption reduces postprandial glycemia and appetite when consumed with carbohydrates.

OBJECTIVES

The objective was to test the effects of frequently consumed dairy products, age, and sex on glycemia, appetite, and food intake.

METHODS

In a randomized, unblinded, crossover design, 30 older [60-70 y; BMI (kg/m2): 18.5-29.9] and 28 young (20-30 y; BMI: 18.5-24.9) adults consumed 500 mL of a calorie-free control (water), skim milk and whole milk, 350 g Greek yogurt, and 60 g cheddar cheese. Food intake at an ad libitum meal was measured 120 min later. Glycemia, appetite, and gastric hormone responses were measured premeal (15-120 min), within-meal (120-140 min), and postmeal (140-170 min). Effects of treatment, age, and sex and their interactions were analyzed using ANOVA followed by Tukey's post hoc test.

RESULTS

All forms of dairy, compared with water, decreased postmeal glycemia, premeal appetite, and meal intake (P < 0.0001). Premeal glucose, insulin, and glucagon-like peptide 1 increased, and ghrelin decreased, but effects of dairy differed with age and sex. Older adults had 10% higher pre- and postmeal glucose (P < 0.01). Premeal appetite suppression per 100 kcal of treatments was more after yogurt than other dairy, but overall appetite suppression was less in older adults than in young adults and in males than in females (P < 0.05). Pizza intake was reduced by 175 kcal after yogurt and cheese and by 82 kcal after milks compared to water (P < 0.001). Mealtime reduction for treatment calories averaged 62% after yogurt and cheese but was less at 33% after milks (P < 0.05). Compensation was less in older (33%) than in young (63%) adults (P < 0.03).

CONCLUSIONS

Dairy products consumed in usual forms before a meal stimulate metabolic responses leading to reduced premeal appetite, later food intake, and postmeal glycemia, but their effects differ in magnitude and with the sex and age of adults.

Dairy Consumption and Risk of Metabolic Syndrome: Results from Korean Population and Meta-Analysis

Dairy consumption has been associated with decreased risk of metabolic syndrome (MetS) in previous studies, but the association may be different according to each type of dairy products and its subgroups. Thus, we conducted an updated meta-analysis of observational studies to examine the association between various dairy products and risk of MetS. The PubMed and Web of Science databases were searched for eligible studies published up to February 2021. In addition, we included unpublished results from Korea National Health and Nutrition Examination Survey, 2013-2018, including 23,319 Korean adults and the elderly. A total of 35 studies (12 cohort studies and 25 cross-sectional studies) with 398,877 subjects were included in the meta-analysis. The pooled relative risks (RR) of MetS for the highest versus lowest categories of dairy consumption was 0.80 [95% confidence interval (CI): 0.72-0.88]. For the type of dairy products, there were also significant inverse associations with milk (RR: 0.83; 95% CI: 0.78-0.89) and yogurt consumption (RR: 0.89; 95% CI: 0.83-0.95). For cheese consumption, however, no significant association was found (RR: 0.98; 95% CI: 0.86-1.11). Our findings suggest that milk and yogurt consumption is inversely associated with the risk of MetS, but not cheese consumption.

Indicators and Recommendations for Assessing Sustainable Healthy Diets

Research coupling human nutrition and sustainability concerns is a rapidly developing field, which is essential to guide governments' policies. This critical and comprehensive review analyzes indicators and approaches to "sustainable healthy diets" published in the literature since this discipline's emergence a few years ago, identifying robust gauges and highlighting the flaws of the most commonly used models. The reviewed studies largely focus on one or two domains such as greenhouse gas emissions or water use, while overlooking potential impact shifts to other sectors or resources. The present study covers a comprehensive set of indicators from the health, environmental and socio-economic viewpoints. This assessment concludes that in order to identify the best food option in sustainability assessments and nutrition analysis of diets, some aspects such as the classification and disaggregation of food groups, the impacts of the rates of local food consumption and seasonality, preservation methods, agrobiodiversity and organic food and different production systems, together with consequences for low-income countries, require further analysis and consideration.

A Novel Machine Learning Strategy for the Prediction of Antihypertensive Peptides Derived from Food with High Efficiency

Strategies to screen antihypertensive peptides with high throughput and rapid speed will doubtlessly contribute to the treatment of hypertension. Food-derived antihypertensive peptides can reduce blood pressure without side effects. In the present study, a novel model based on the eXtreme Gradient Boosting (XGBoost) algorithm was developed and compared with the dominating machine learning models. To further reflect on the reliability of the method in a real situation, the optimized XGBoost model was utilized to predict the antihypertensive degree of the k-mer peptides cutting from six key proteins in bovine milk, and the peptide-protein docking technology was introduced to verify the findings. The results showed that the XGBoost model achieved outstanding performance, with an accuracy of 86.50% and area under the receiver operating characteristic curve of 94.11%, which were better than the other models. Using the XGBoost model, the prediction of antihypertensive peptides derived from milk protein was consistent with the peptide-protein docking results, and was more efficient. Our results indicate that using the XGBoost algorithm as a novel auxiliary tool is feasible to screen for antihypertensive peptides derived from food, with high throughput and high efficiency.

Effect of Yogurt Consumption on Metabolic Syndrome Risk Factors: a Narrative Review

PURPOSE OF REVIEW

Metabolic syndrome (MetS) comprises risk factors such as obesity, hypertriglyceridemia, hypertension, and hyperglycemia. Here we described the outcome of various yogurt consumption, either conventional, low-fat, high-fat, Greek, or enriched with nutrients or probiotics: (1) on the parameters of MetS risk factors and (2) on the mechanisms of action of the MetS risk factors.

RECENT FINDING

The majority (25 studies) of clinical trials and meta-analyses of clinical trials reported a beneficial effect of yogurt consumption in the prevention of MetS risk. Yogurt components, such as calcium, vitamin D, proteins, and probiotics, were associated with the multiple beneficial effects on the prevention of MetS. In general, yogurt consumption may be promoted within healthy dietary patterns to prevent MetS. More studies are needed to determine what type of yogurt has the greatest benefits for specific MetS risk factor prevention.

Milk consumption and multiple health outcomes: umbrella review of systematic reviews and meta-analyses in humans

In order to recapitulate the best available evidence of milk consumption and multiple health-related outcomes, we performed an umbrella review of meta-analyses and systematic reviews in humans. Totally, 41 meta-analyses with 45 unique health outcomes were included. Milk consumption was more often related to benefits than harm to a sequence of health-related outcomes. Dose–response analyses indicated that an increment of 200 ml (approximately 1 cup) milk intake per day was associated with a lower risk of cardiovascular disease, stroke, hypertension, colorectal cancer, metabolic syndrome, obesity and osteoporosis. Beneficial associations were also found for type 2 diabetes mellitus and Alzheimer's disease. Conversely, milk intake might be associated with higher risk of prostate cancer, Parkinson’s disease, acne and Fe-deficiency anaemia in infancy. Potential allergy or lactose intolerance need for caution. Milk consumption does more good than harm for human health in this umbrella review. Our results support milk consumption as part of a healthy diet. More well-designed randomized controlled trials are warranted.

Role of Amino Acids in Blood Glucose Changes in Young Adults Consuming Cereal with Milks Varying in Casein and Whey Concentrations and Their Ratio

BACKGROUND

Increasing the total protein content and reducing the casein to whey ratio in milks consumed with breakfast cereal reduce postprandial blood glucose (BG).

OBJECTIVES

We aimed to explore associations between plasma amino acids (AAs), BG, and glucoregulatory hormones.

METHODS

In this repeated-measures design, 12 healthy adults consumed cereal (58 g) and milks (250 mL) with 3.1 wt% or high 9.3 wt% protein concentrations and with casein to whey ratios of either 80:20 or 40:60. Blood was collected at 0, 30, 60, 120, 140, 170, and 200 min for measurement of the primary outcome, BG, and for the exploratory outcomes such as plasma AA, gastric emptying, insulin (INS), and glucoregulatory hormones. Measures were made prior to and after an ad libitum lunch at 120 min. Exploratory correlations were conducted to determine associations between outcomes.

RESULTS

Pre-lunch plasma AA groups [total (TAA), essential (EAA), BCAA, and nonessential (NEAA)] were higher after 9.3 wt% than 3.1 wt% milks by 12.7%, 21.4%, 20.9%, and 7.6%, respectively (P ≤ 0.05), while post-lunch AA groups were higher by 10.9%, 19.8%, 18.8%, and 6.0%, respectively (P ≤ 0.05). Except for NEAA, pre-lunch AAs were higher after 40:60 than 80:20 ratio milks by 4.5%, 8.3%, and 9.3% (P ≤ 0.05). When pooled by all treatments, pre-lunch AA groups associated negatively with BG (r/ρ ≥ -0.45, P ≤ 0.05), but post-lunch only TAA and NEAA correlated (r ≥ -0.37, P < 0.05). Pre-lunch BG was inversely associated with Leu, Ile, Lys, Met, Thr, Cys-Cys, Asn, and Gln (r/ρ ≥ -0.46, P ≤ 0.05), but post-lunch, only with Thr, Ala, and Gly (r ≥ -0.50, P ≤ 0.05). Pre-lunch associations between AA groups and INS were not found.

CONCLUSIONS

Protein concentration and the ratio of casein to whey in milks consumed at breakfast with cereal affect plasma AA concentrations and their associations with decreased BG. The decrease in BG could be explained by INS-independent mechanisms. This trial was registered at www.clinicaltrials.gov as NCT02471092.

Association of food industry ties with findings of studies examining the effect of dairy food intake on cardiovascular disease and mortality: systematic review and meta-analysis

OBJECTIVE

To determine if the association of dairy foods with cardiovascular disease (CVD) outcomes differs between studies with food industry ties versus those without industry ties. To determine whether studies with or without industry ties differ in their risk of bias.

ELIGIBILITY CRITERIA

We included cohort and case-control studies that estimated the association of dairy foods with CVD outcomes in healthy adults.

INFORMATION SOURCES

We searched eight databases on 1 February 2019 from 2000 to 2019 and hand searched reference lists.

RISK OF BIAS

We used the Risk of Bias in Non-Randomised Studies-of Exposure tool.

INCLUDED STUDIES

43 studies (3 case-controls, 40 cohorts).

SYNTHESIS OF RESULTS

There was no clear evidence of an association between studies with industry ties (1/14) versus no industry ties (8/29) and the reporting of favourable results, risk ratio (RR)=0.26 (95% CI 0.04 to 1.87; n=43 studies) and studies with industry ties (4/14) versus no industry ties (11/29) and favourable conclusions, RR=0.75 (95% CI 0.29 to 1.95; n=43). Studies with industry sponsorship, (HR=0.78; n=3 studies) showed a decreased magnitude of risk of CVD outcomes compared with studies with no industry sponsorship (HR=0.97; n=18) (ratio of HRs 0.80 (95% CI 0.66 to 0.97); p=0.03).

STRENGTHS AND LIMITATIONS OF EVIDENCE

Every study had an overall high risk of bias rating; this was primarily due to confounding.

INTERPRETATION

There was no clear evidence of an association between studies with food industry ties and the reporting of favourable results and conclusions compared with studies without industry ties. The statistically significant difference in the magnitude of effects identified in industry-sponsored studies compared with non-industry-sponsored studies, however, is important in quantifying industry influence on studies included in dietary guidelines.

PROSPERO REGISTRATION NUMBER

CRD42019129659.

Dairy products, surrogate markers, and cardiovascular disease; a sex-specific analysis from the ATTICA prospective study

BACKGROUND AND AIMS

Dairy products are a very diverse food group with multiple effects on the cardiac health of men and women. The aim of this work was to evaluate the sex-specific association between dairy products (total and subtypes) and 10-year first fatal/nonfatal cardiovascular disease (CVD) incidence.

METHODS AND RESULTS

In 2001-2002, n = 1514 men and n = 1528 women (>18 years old) from greater Athens area, Greece, were enrolled. Dietary assessment was based on a validated semi-quantitative food frequency questionnaire. Dairy product consumption was examined in relation to 10-year CVD incidence. Follow-up (2011-2012) was achieved in n = 2020 participants (n = 317 CVD cases). Ranking from lowest (<1 serving/day) to highest (>2 servings/day) total dairy intake, CVD incidence in men was 17.8%, 15.0%, and 10.9% (p = 0.41), while in women it was 14%, 6.0%, and 5.7% (p = 0.02). Multiadjusted analysis revealed that total dairy intake protected against CVD only in women [Hazard Ratio (HR) = 0.48 and 95% Confidence Interval (95% CI) (0.23, 0.90)], irrespective of the fat content. Further analysis revealed that only fermented products (yogurt and cheese), protected against CVD. For per 200 g/day yogurt consumption, CVD risk was 20%-30% lower with this claim being more evident in women, while for per 30 g/day cheese intake, about 5% lower risk was observed particularly in men. As for butter, nonsignificant associations were highlighted. These associations were mainly retained in the case of hepatic steatosis, insulin resistance, and systemic inflammation.

CONCLUSIONS

This work provides incentives for researchers to elucidate the diversity of ingredients and mechanisms through which dairy products exert their effect on cardiac health separately for men and women.

The role of yoghurt consumption in the management of type II diabetes

Enrichment of yoghurt with specific ingrdients beneficially affects the management of Type II Diabetes Mellitus (DMII). As far as the role of yoghurt in the management of DMII is concerned, the limited number of randomized clinical trials (RCTs) which have been conducted suggest that daily intake of yoghurt enriched with vitamin D and/or calcium as well as probiotics positively influences glycemic regulation and may contribute to more effective control of the disease. It is argued that the various ingredients which are already contained in the complex matrix of food, such as bioactive peptides, calcium, B-complex vitamins and beneficial microbes, as well as the fact that it can be used as a vehicle for the inclusion of other effective ingredients can have an impact on the metabolic control of diabetic patients. The aim of this review is to present the RCTs which have been conducted in the last decade in patients with DMII in an attempt to highlight the positive effects of yoghurt in the management of the disease.

Nutritional breakfast quality and cardiometabolic risk factors: Health Survey of São Paulo, a population-based study

OBJECTIVE

To evaluate the association between nutritional quality of breakfast and cardiometabolic risk factors.

DESIGN

Cross-sectional study, 2015 Health Survey of São Paulo (2015 ISA-Capital) with Focus on Nutrition Study (2015 ISA-Nutrition).

SETTINGS

Population-based study, with a representative sample of adults and elderlies living in São Paulo, Brazil.

PARTICIPANTS

The sample included 606 adults (aged 20-59 years) and 537 elderlies (aged ≥60 years) from the 2015 Health Survey of São Paulo. Dietary intake was assessed by at least one 24-h recall. Breakfast quality was evaluated using the proposed Brazilian Breakfast Quality Index (BQI), ranging scores from 0 to 10. BQI associations with sociodemographic, lifestyle, dietetic and cardiometabolic variables were estimated using survey-weighted multiple logistic regression models.

RESULTS

Being ≥60 years of age, self-identifying as White or Asian, having a per capita family income with ≥1 minimum wage, being sufficiently active at leisure time and non-smoker were associated with better scores of BQI. A higher BQI score was inversely associated with elevated blood pressure (OR 0·81, 95 % CI 0·70, 0·94), fasting glucose (OR 0·85, 95 % CI 0·73, 0·98), HOMA-IR (OR 0·86, 95 % CI 0·74, 0·98), total cholesterol (OR 0·87, 95 % CI 0·76, 0·99), LDL-C (OR 0·85, 95 % CI 0·74, 0·97), metabolic syndrome (OR 0·82, 95 % CI 0·72, 0·93) and being overweight (OR 0·87, 95 % CI 0·76, 0·99).

CONCLUSIONS

Breakfast quality of Brazilian adults needs improvement with disparities across some sociodemographic factors. BQI was associated with lower odds of cardiometabolic risk factors, suggesting a beneficial effect in this population and emphasising the role of breakfast in reducing the risk of CVD.

Traditional plain yogurt: a therapeutic food for metabolic syndrome?

Dairy products have an important role in a healthy diet due to their high-quality protein and rich micronutrients. Yogurt, a fermented milk product, has a similar composition to milk but is a more concentrated product in terms of group B vitamins, minerals, and proteins. It is known that bioactive metabolites and live enzymes that occur by fermentation and digestion, affect the health positively by improving gut microbiota. In recent years, the prevalence of metabolic syndrome, which threatens public health, is increasing rapidly. As with other noninfectious diseases, the diet has an important effect on the prevention and treatment of metabolic syndrome. It has been demonstrated that yogurt has a high-quality amino acid pattern, reduces energy intake by stimulating satiety, and regulates blood glucose level. In addition to the rich protein variety, yogurt also contains peptides that positively affect blood pressure. Unlike milk, increased acidity during the fermentation of yogurt positively affects calcium absorption. Calcium plays an important role in the control of blood glucose and energy metabolism through insulin-dependent and non-insulin-dependent routes. In addition to reducing inflammation, calcium has a positive effect on the regulation of the blood lipid profile by increasing fecal fat excretion. There are many lipid and lipoid nutrients such as saturated fatty acids, phospholipids, sphingolipids, and conjugated linoleic acid that may affect the blood lipid profile in yogurt positively or negatively. There are seen very few randomized controlled studies that are focused on the relationship between yogurt and metabolic syndrome, and these are based on contradictory results. In this review, based on the clinical studies conducted to date, and the nutrient content of yogurt, possible mechanisms of these contradictory results are investigated.

The association between nutrient patterns and metabolic syndrome among Iranian adults: cross-sectional analysis of Shahedieh cohort study

OBJECTIVE

To assess the association between patterns of nutrient intake and metabolic syndrome (MetS) in a large sample of Iranian adults.

DESIGN

Baseline data from the Shahedieh cohort study were used in the current cross-sectional study. Dietary intakes were assessed through the use of a validated semi-quantitative FFQ. Nutrient patterns (NP) were derived using factor analysis. The MetS was defined according to criteria introduced from the National Cholesterol Education Program Adult Treatment Panel III, modified for Iranian adults.

SETTING

Yazd, Iran.

PARTICIPANTS

A total of 7325 Iranian adults aged between 30 and 75 years.

RESULTS

Three NP were identified. A significant positive association was found between adherence to semi-plant NP (characterised by the high intakes of P; vitamins B1, B3, B6 and B5; Se; Mg; Fe; protein; Cr; Cu; fibre; biotin; Mn; Zn and Na) and odds of MetS (OR 1·68, 95 % CI 1·43, 1·98). However, after adjusting for potential confounders, this association became non-significant. In addition, after taking potential confounders into account, individuals in the highest quintile of the semi-animal NP, rich in Ca; K; vitamins B2, B12, A, D, K and C; SFA; dietary cholesterol and trans-fatty acid, were 26 % more likely to have MetS compared with those in the lowest quintile (OR 1·26, 95 % CI 1·05, 1·51). No significant association was seen between adherence to the high-carbohydrate/low-fat NP and odds of MetS.

CONCLUSIONS

We found that adherence to a semi-animal NP was associated with increased odds of MetS.

Dietary habits, lipoprotein metabolism and cardiovascular disease: From individual foods to dietary patterns

Cardiovascular disease (CVD) remains the first cause of mortality in Western countries. Among cardiometabolic risk factors, dyslipidemia, and especially high low-density lipoprotein cholesterol (LDL-C) concentrations, have been extensively linked to the development and progression of atherosclerosis and to CVD events. Recent evidence has shown that the prevention of unhealthy dietary habits and sedentarism is crucial in the management of dyslipidemia. In this sense, a number of scientific societies recommend the adherence to certain healthy dietary patterns (DPs), such as the Mediterranean diet (MedDiet), the Dietary Approaches to Stop Hypertension (DASH), the Portfolio diet, the Vegetarian diet, the Nordic diet and low-carbohydrate diets, as well as increased physical activity between others. This nutritional and lifestyle advice could be adopted by government bodies and implemented in different health programs as a reliable way of providing health-care professionals with efficient tools to manage cardiometabolic risk factors and thus, prevent CVD. In this narrative review, we will discuss recent data about the effects of nutrition on dyslipidemia, mainly focusing on high LDL-C concentrations and other lipid particles related to atherogenic dyslipidemia such as triglycerides (TG) and non-high density lipoprotein cholesterol (non-HDL-C), that are related to CVD. On the other hand, we also comment on other cardiometabolic risk factors such as type 2 diabetes mellitus (T2DM), high blood pressure (HBP), inflammation and endothelial dysfunction. This review includes food groups as well as different healthy DPs.

Potential Cardiometabolic Health Benefits of Full-Fat Dairy: The Evidence Base

Since their inception in 1980, the Dietary Guidelines for Americans have promoted low- or fat-free dairy foods. Removing fat from dairy does not reduce putatively beneficial nutrients per serving, including calcium, vitamin D, and potassium. Additionally, links between saturated fat and dietary cholesterol intakes with cardiovascular disease risk have helped to sustain the view that low-fat dairy foods should be recommended. Emerging evidence shows that the consumption of full-fat dairy foods has a neutral or inverse association with adverse cardiometabolic health outcomes, including atherosclerotic cardiovascular disease, type 2 diabetes, and associated risk factors. Thus, although low-fat dairy is a practical, practice-based recommendation, its superiority compared with full-fat dairy is not obviously supported by results from recent prospective cohort studies or intervention trials. To evaluate the emerging science on full-fat dairy, a group of nutrition experts convened to summarize and discuss the scientific evidence regarding the health effects of consuming full-fat dairy foods. Future studies should focus on full-fat dairy foods (milk, yogurt, and cheese) in the context of recommended dietary patterns and consider meal composition and metabolic phenotype in assessing the relation between full-fat dairy consumption and cardiometabolic health.

Association of dairy consumption with metabolic syndrome, hypertension and diabetes in 147 812 individuals from 21 countries

OBJECTIVE

Our aims were to assess the association of dairy intake with prevalence of metabolic syndrome (MetS) (cross-sectionally) and with incident hypertension and incident diabetes (prospectively) in a large multinational cohort study.

METHODS

The Prospective Urban Rural Epidemiology (PURE) study is a prospective epidemiological study of individuals aged 35 and 70 years from 21 countries on five continents, with a median follow-up of 9.1 years. In the cross-sectional analyses, we assessed the association of dairy intake with prevalent MetS and its components among individuals with information on the five MetS components (n=112 922). For the prospective analyses, we examined the association of dairy with incident hypertension (in 57 547 individuals free of hypertension) and diabetes (in 131 481 individuals free of diabetes).

RESULTS

In cross-sectional analysis, higher intake of total dairy (at least two servings/day compared with zero intake; OR 0.76, 95% CI 0.71 to 0.80, p-trend<0.0001) was associated with a lower prevalence of MetS after multivariable adjustment. Higher intakes of whole fat dairy consumed alone (OR 0.72, 95% CI 0.66 to 0.78, p-trend<0.0001), or consumed jointly with low fat dairy (OR 0.89, 95% CI 0.80 to 0.98, p-trend=0.0005), were associated with a lower MetS prevalence. Low fat dairy consumed alone was not associated with MetS (OR 1.03, 95% CI 0.77 to 1.38, p-trend=0.13). In prospective analysis, 13 640 people with incident hypertension and 5351 people with incident diabetes were recorded. Higher intake of total dairy (at least two servings/day vs zero serving/day) was associated with a lower incidence of hypertension (HR 0.89, 95% CI 0.82 to 0.97, p-trend=0.02) and diabetes (HR 0.88, 95% CI 0.76 to 1.02, p-trend=0.01). Directionally similar associations were found for whole fat dairy versus each outcome.

CONCLUSIONS

Higher intake of whole fat (but not low fat) dairy was associated with a lower prevalence of MetS and most of its component factors, and with a lower incidence of hypertension and diabetes. Our findings should be evaluated in large randomized trials of the effects of whole fat dairy on the risks of MetS, hypertension, and diabetes.

Dietary Calcium Intake and the Risk of Metabolic Syndrome: A Systematic Review and Meta-Analysis

Growing evidence has suggested a possible relationship between dietary calcium intake and metabolic syndrome (MetS) risk. However, the findings of these observational studies are inconclusive, and the dose-response association between calcium intake and risk of MetS remains to be determined. Here, we identified relevant studies by searching PubMed and Web of Science databases up to December 2018, and selected observational studies reporting relative risk (RR) with 95% confidence interval (CI) for MetS based on calcium intake and estimated the summary RRs using random-effects models. Eight cross-sectional and two prospective cohort studies totaling 63,017 participants with 14,906 MetS cases were identified. A significantly reduced risk of MetS was associated with the highest levels of dietary calcium intake (RR: 0.89; 95% CI: 0.80–0.99; I² = 75.3%), with stronger association and less heterogeneity among women (RR: 0.74, 95% CI: 0.66–0.83; I² = 0.0%) than among men (RR: 1.06, 95% CI: 0.82–1.37; I² = 72.6%). Our dose-response analysis revealed that for each 300 mg/day increase in calcium intake, the risk of MetS decreased by 7% (RR: 0.93; 95% CI: 0.87–0.99; I² = 77.7%). In conclusion, our findings suggest that dietary calcium intake may be inversely associated with the risk of MetS. These findings may have important public health implications with respect to preventing the disease. Further studies, in particular longitudinal cohort studies and randomized clinical trials, will be necessary to determine whether calcium supplementation is effective to prevent MetS.