Dairy versus other saturated fats source and cardiometabolic risk markers: Systematic review of randomized controlled trials

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.

The role of dairy food intake for improving health among black Americans across the life continuum: A summary of the evidence

Decades of health data show major health disparities occurring at every life stage between Black and White Americans. These disparities include greater mortality rates among Black mothers and their offspring, higher levels of malnutrition and obesity among Black children and adolescents, and a higher burden of chronic disease and lower life expectancy for Black adults. Although nutrition is only one of many factors that influence human health and well-being across the life continuum, a growing body of research continues to demonstrate that consuming a healthy dietary pattern is one of the most dominant factors associated with increased longevity, improved mental health, improved immunity, and decreased risk for obesity and chronic disease. Unfortunately, large percentages of Black Americans tend to consume inadequate amounts of several essential nutrients such as vitamin A, vitamin D, calcium, and magnesium; and simultaneously consume excessive amounts of fast foods and sugar-sweetened beverages to a greater degree than other racial/ethnic groups. Therefore, strategies that can help improve dietary patterns for Black Americans could make up a major public health opportunity for reducing nutrition-related diseases and health disparities across the life course. A key intervention strategy to improve diet quality among Black Americans is to focus on increasing the intake of nutrient-rich dairy foods, which are significantly underconsumed by most Black Americans. Compared to other food group, dairy foods are some of the most accessible and affordable sources of essential nutrients like vitamin A, D, and B12, calcium, magnesium, potassium, selenium, and zinc in the food supply, as well as being some of the primary sources of several health-promoting bioactive compounds, including polar lipids, bioactive proteins and peptides, oligosaccharides, and live and active cultures in fermented products. Given the complex relationships that many Black Americans have with dairy foods, due to issues with lactose intolerance, and/or negative perceptions about the health effects of dairy foods, there is still a need to examine the role that dairy foods play in the health and well-being of Black Americans of all ages and life stages. Therefore, the National Medical Association and its partners have produced multiple reports on the value of including adequate dairy in the diet of Black Americans. This present summary paper and its associated series of evidence reviews provide an examination of an immense amount of research focused on dairy intake and health outcomes, with an emphasis on evidence-based strategies for improving the health of Black Americans. Overall, the findings and conclusions from this body of research continue to indicate that higher dairy intake is associated with reduced risk for many of the most commonly occurring deficiencies and diseases impacting each life stage, and that Black Americans would receive significantly greater health benefits by increasing their daily dairy intake levels to meet the national recommendations than they would from continuing to fall short of these recommendations. However, these recommendations must be considered with appropriate context and nuance as the intake of different dairy products can have different impacts on health outcomes. For instance, vitamin D fortified dairy products and fermented dairy products like yogurt - which are low in lactose and rich in live and active cultures - tend to show the greatest benefits for improved health. Importantly, there are significant limitations to these research findings for Black Americans, especially as they relate to reproductive and child health, since most of the research on dairy intake and health has failed to include adequate representation of Black populations or to sufficiently address the role of dairy intake during the most vulnerable life stages, such as pregancy, lactation, fetal development, early childhood, and older age. This population and these life stages require considerably more research and policy attention if health equity is ever to be achieved for Black Americans. Sharing and applying the learnings from this summary paper and its associated series of evidence reviews will help inform and empower nutrition and health practitioners to provide more evidence-based dietary recommendations for improving the health and well-being of Black Americans across the life course.

Fats and oils - a scoping review for Nordic Nutrition Recommendations 2023

This scoping review for the Nordic Nutrition Recommendations 2023 summarizes the available evidence on fats and oils from a food level perspective. A literature search for systematic reviews (SRs) and meta-analyses was conducted in PubMed. There are few SRs and meta-analyses available that investigate the association between fats and oils (food level) and health outcomes; the majority report associations at the nutrient level (fatty acid classes). All identified SRs and meta-analyses were of low methodological quality, thus the findings and conclusions presented within this scoping review should be interpreted cautiously. Based on this limited evidence, the following results were indicated: the intake of olive oil may be associated with reduced risk of cardiovascular disease (CVD), type 2 diabetes (T2D), and total mortality in prospective cohort studies. The intake of butter was not associated with the risk of CVD but may be related to slightly lower risk of T2D and higher risk of total mortality in prospective cohort studies. For cancer, the evidence is sparse and primarily based on case-control studies. The intake of olive oil may be associated with reduced risk of cancer, whereas the intake of butter may be associated with increased risk of certain cancer types. Butter increases LDL-cholesterol when compared to virtually all other fats and oils. Palm oil may increase LDL-cholesterol when compared to oils rich in MUFA or PUFA but may not have any effect on glucose or insulin. Coconut oil may increase LDL-cholesterol when compared to other plant oils but may decrease LDL-cholesterol when compared to animal fats rich in SFA. Canola/rapeseed oil may decrease LDL-cholesterol compared to olive oil, sunflower oil and sources of SFA and may also reduce body weight compared to other oils. Olive oil may decrease some inflammation markers but may not have a differential effect on LDL-cholesterol compared to other fats and oils. The effect on risk markers likely differs depending on the type/version of oil, for example, due to the presence of polyphenols, phytosterols and other minor components. Taken together, based on the available evidence, oils rich in unsaturated fat (e.g. olive oil, canola oil) are to be preferred over oils and fats rich in saturated fat (e.g. butter, tropical oils).

Nutritional Composition of Breakfast in Children and Adolescents with and without Celiac Disease in Spain-Role of Gluten-Free Commercial Products

Eating a nutritionally balanced breakfast can be a challenge when following a gluten-free diet (GFD). We assessed the ingredients and nutrient composition of 364 gluten-free breakfast products (GFPs) and 348 gluten-containing counterparts (GCCs), and we analysed the nutritional quality of breakfast in a group of Spanish children and adolescents with celiac disease (CD) (n = 70), as compared to controls (n = 67). Food intakes were estimated using three 24 h dietary records. The composition of GFPs and GCCs was retrieved from the package labels of commercially available products. Most participants (98.5%) ate breakfast daily, and only one person in each group skipped breakfast once. The breakfast contribution of the total daily energy was 19% in participants with CD and 20% in controls. CD patients managed a balanced breakfast in terms of energy (54% from carbohydrates; 12% from proteins; 34% from lipids) and key food groups (cereals, dairy, fruits), but their intake of fruits needs improvement. Compared to controls, breakfast in the CD group provided less protein and saturated fat, a similar amount of carbohydrates and fibre, and more salt. Fibre is frequently added to GFPs, but these contain less protein because of the flours used in formulation. Gluten-free bread contains more fat and is more saturated than is GCC. Sugars, sweets, and confectionery contribute more to energy and nutrient intakes in participants with CD, while grain products do so in controls. Overall, breakfast on a GFD can be adequate, but can be improved by GFPs reformulation and a lower consumption of processed foods.

Associations between dairy fat intake, milk-derived free fatty acids, and cardiometabolic risk in Dutch adults

PURPOSE

Milk-derived free fatty acids (FFAs) may act as both biomarkers of intake and metabolic effect. In this study we explored associations between different types of dairy consumption, a selection of milk-derived free fatty acids, and cardiometabolic disease (CMD) risk factors.

METHODS

Sixty-seven FFAs were quantified in the plasma of 131 free-living Dutch adults (median 60 years) using gas chromatography-flame ionization detector. Intakes of different dairy foods and groups were assessed using a food frequency questionnaire. Twelve different CMD risk factors were analyzed. Multiple linear regressions were used to evaluate the associations under study.

RESULTS

Based on the fully adjusted models, 5 long-chain unsaturated FFAs (C18:1 t13 + c6 + c7 + u, C18:2 c9t11 + u, C20:1 c11, C20:3 c8c11c14, and C20:4 c5c8c11c14), 2 medium-chain saturated FFAs (C15, C15 iso), and a trans FFA (C16:1 t9) were positively associated with at least one variable of dairy intake, as well as plasma total and LDL cholesterol, blood pressure, and SCORE (p ≤ 0.05). A long-chain PUFA associated with high-fat fermented dairy intake (C18:2 t9t12), was negatively associated with serum triglyceride levels, and a long-chain saturated FFA associated with cheese intake (C18:1 u1) was negatively associated with plasma LDL cholesterol and serum triglyceride levels. No clear associations were observed between dairy intake and CMD risk factors.

CONCLUSION

Milk-derived FFAs could act as sensitive biomarkers for dairy intake and metabolism, allowing the association between dairy and CMD risk to be more precisely evaluated.

Evaluating the effects of high-oil rapeseed cake or natural additives on methane emissions and performance of dairy cows

We evaluated the potential of feeding high-oil rapeseed cake or natural additives as rumen modifiers on enteric methane (CH₄) emissions, nutrient utilization, performance, and milk fatty acid (FA) profile of dairy cows. Eight Nordic Red dairy cows averaging (mean ± SD) 81 ± 21 d in milk and 41.0 ± 1.9 kg of milk yield at the beginning of the study were randomly assigned to a replicated 4 × 4 Latin square design with 21-d periods. Treatments comprised grass silage-based diets (45:55 forage to concentrate ratio on dry matter basis) including (1) control containing 19.3% rapeseed meal (CON), (2) CON with full replacement of rapeseed meal with rapeseed cake (RSC), (3) supplementation of CON with 50 g/d of yeast hydrolysate product plus coniferous resin acid-based compound (YHR), and (4) supplementation of CON with 20 g/d of combination of garlic-citrus extract and essential oils in a pellet (GCE). Apparent total-tract digestibility was measured using total collection of feces, and CH₄ emissions were measured in respiratory chambers on 4 consecutive days. Data collected during d 17 and 21 in each period were used for ANOVA analysis using a mixed model. Treatments did not affect dry matter intake (DMI), whereas feeding RSC increased crude protein and ether extract digestibility compared with the other diets. Emissions of CH₄ per day, per kilogram of DMI, and per kilogram of energy-corrected milk, and gross energy intake were lower for RSC compared with other diets. We found no effect of YHR on daily CH₄ emissions, whereas CH₄ yield (g of CH₄/kg of DMI or as percentage of gross energy intake) decreased with GCE compared with CON. Treatments did not influence energy balance. Further, RSC reduced the proportion of N intake excreted in feces, and YHR improved N balance compared with CON diet. Feeding RSC resulted in greatest yields of milk and energy-corrected milk, and feed efficiency. Relative to the CON diet, RSC decreased saturated FA by 10% in milk fat by increasing cis-monounsaturated FA but also increased the proportion of trans FA. Proportion of odd- and branched-chain FA increased with GCE and YHR compared with CON. We conclude that replacing rapeseed meal by rapeseed cake decreased CH₄ emissions, whereas YHR or GCE had no effect on CH₄ emissions in this study.

The role of fats in the transition to sustainable diets

In comparison with protein, dietary fat receives little attention in the food system sustainability literature, although we calculate that the average consumption of fats in many populous regions of the world is below nutritional recommendations. Animal products are the major source of dietary fat, particularly in regions with excess fat consumption. We estimate that an additional 45 Mt of dietary fat per year need to be produced and consumed for the global population to reach recommended levels of fat consumption, and we review different strategies to fill this gap sustainably. These strategies include diverting oils currently used for energy production to human consumption, increasing palm oil and peanut oil yields while avoiding further deforestation, developing sustainable cropping systems for the production of rapeseed and soybean oils, increasing the consumption of whole soybeans and derived products, and expanding the use of animal fats already produced.

Seaweeds as Valuable Sources of Essential Fatty Acids for Human Nutrition

The overexploitation of terrestrial habitats, combined with the ever-growing demand for food, has led to the search for alternative food sources. The importance of seaweeds as food sources has been growing, and their potential as sources of fatty acids (FA) make seaweeds an interesting feedstock for the food and nutraceutical industries. The aim of this study is to assess the potential of five red seaweeds (Asparagospis armata, Calliblepharis jubata, Chondracanthus teedei var. lusitanicus, Gracilaria gracilis, and Grateloupia turuturu) and three brown seaweeds (Colpomenia peregrina, Sargassum muticum and Undaria pinnatifida), harvested in central Portugal, as effective sources of essential FA for food or as dietary supplements. FA were extracted from the biomass, transmethylated to methyl esters, and analyzed through gas chromatography-mass spectrometry. G. gracilis presented the highest content of saturated fatty acids (SFA) (41.49 mg·g-1), whereas C. jubata exhibited the highest content of highly unsaturated fatty acids (HUFA) (28.56 mg·g-1); the three G. turuturu life cycle stages presented prominent SFA and HUFA contents. Omega-6/omega-3 ratios were assessed and, in combination with PUFA+HUFA/SFA ratios, it is suggested that C. jubata and U. pinnatifida may be the algae with highest nutraceutical potential, promoting health benefits and contributing to a balanced dietary intake of fatty acids.

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.

Trends in the consumption of conventional dairy milk and plant-based beverages and their contribution to nutrient intake among Canadians

BACKGROUND

Current evidence suggests a shift from conventional dairy milk to plant-based beverages (PBBs) for a number of lifestyles and perceived health-related reasons.

METHODS

Using nationally representative cross-sectional data from the 2004 and 2015 Canadian Community Healthy Surveys, the main objectives of the present study were to (i) examine the trend in the proportion of Canadians (≥ 2 years) consuming plain milk and PBBs and (ii) determine the percentage contribution of plain milk and PBBs to daily energy and nutrient intakes.

RESULTS

From 2004 to 2015, the percentage of Canadians consuming plain milk significantly decreased from 70.2% to 56.1%, whereas the percentage of PBBs consumers significantly increased from 1.8% to 3.0%. In 2015, plain milk provided almost 50% of the daily vitamin D intake, over 30% of calcium and vitamin B12, and over 20% of vitamin A and riboflavin among plain milk consumers. The top five nutrients provided by PBBs among PBBs consumers were vitamin D, calcium, vitamin B12, vitamin A and riboflavin. Although plain milk was a major contributor to saturated fat (14.5%) and protein (12.5%) intake among plain milk consumers, PBBs provided only 0.2% of saturated fat and 1.4% of protein intake in the diet of PBBs consumers.

CONCLUSIONS

The consumption of plain milk by Canadians has declined and the consumption of PBBs has increased, which may differentially affect the nutritional profile of the diet.

Nutritional Viewpoints on Eggs and Cholesterol

Although most current epidemiologic studies indicate no significant association between consuming one egg daily and blood cholesterol levels and cardiovascular risk, arguments still persist with a positive association. Since the diet is one of the most influential factors for this association, we illustrate characteristic features in Japanese people whose dietary pattern is distinct from that, for example, the US (United States) population. Available epidemiologic studies in healthy Japanese people show no association between consumption of one egg daily and blood cholesterol level, consistent with those observed in the US population. However, when consumption of major nutrients and food sources of cholesterol are compared to the US population, Japanese people may have an extra-reserve against the influence of eggs on cardiovascular risk markers, despite consuming relatively more eggs. Further discussion on the influence of nutrients contained in the egg and dietary pattern, including interaction with gut microbes, is necessary. In addition, special consideration at the personalized level is needed for judgment regarding dietary cholesterol not only for hypercholesterolemic patients but for hyper-responsive healthy persons. Although randomized controlled trials with long-term follow-up are required to evaluate the association between consumption of eggs and human health, available information, at least from the nutritional viewpoint, suggests that egg is a healthy and cost-efficient food worldwide.

Breakfast Habits of a Representative Sample of the Spanish Child and Adolescent Population (The ENALIA Study): Association with Diet Quality

The association between breakfast quality and total diet quality of children and adolescents ((1-17.9 years (n = 1570)) from the National Dietary Survey on the Child and Adolescent Population in Spain (ENALIA) was analyzed. Dietary information was collected using two non-consecutive one-day food diaries (1-10 years old) or two 24 h dietary recalls (>10 years). Breakfast quality index (BQI) and a variant of Nutrient Rich Foods index (NRF9.3) were calculated to assess the total diet quality. Children and adolescents who had breakfast on at least one day (n = 1561) were divided into two groups according to BQI: Worse Quality Breakfast (WQB) (BQI < 4 points (P66), n = 781) and Good Quality Breakfast (GQB) (BQI ≥ 4, n = 780). Younger children and those whose parents have university education presented higher BQI. GQB group had significantly higher intakes of micronutrients (vitamins A, D, C, B1, B2, B6, niacin, folate, calcium, potassium, magnesium). Fewer GQB children exceeded the Acceptable Macronutrient Distribution Range for fat and had folate and calcium intakes below their estimated average requirement. Daily NRF9.3 was 496.2 ± 54.0, being higher in GQB (503.8 ± 50.6 vs. 488.6 ± 56.2, p < 0.001). Increasing the quality of breakfast increased the possibility of having a NRF9.3 higher than P50 (OR: 1.893, CI: 1.549-2.315, p < 0.0001). Breakfasts have room for quality improvement in a high percentage of children. A higher quality breakfast is associated with a benefit in the quality of the total diet.

Metabolomics Study Revealing the Potential Risk and Predictive Value of Fragmented QRS for Acute Myocardial Infarction

Patients with nonobstructive coronary artery disease (NOCAD) have high risk associated with acute myocardial infarction (AMI), and fragmented QRS (fQRS) has a predictive value of AMI after percutaneous coronary intervention (PCI). A cohort of 254 participants were recruited including 136 NOCAD and 118 AMI patients from Xi'an No. 1 Hospital. Comprehensive metabolomics was performed by UPLC-Q/TOF-MS with multivariate statistical analyses. Hazard ratios were measured to discriminate the prognostic in AMI after PCI between differential metabolites and fQRS. OPLS-DA separated metabolites from NOCAD and AMI in serum. A total of 23 differential metabolites were identified between NOCAD and AMI. In addition, four differential metabolites, namely, acetylglycine, threoninyl-glycine, glutarylglycine, and nonanoylcarnitine, were identified between fQRS and non-fQRS in AMI. The hazard ratios demonstrate that the metabolites were associated with the risk of cardiac death, recurrent angina, readmissions, and major adverse cardiovascular events, which may clarify the mechanism of fQRS as a predictor in the prognostic of AMI after PCI. This study identified novel differential metabolites to distinguish the difference from NOCAD to AMI and clarify the mechanism of fQRS in prognostic of AMI after PCI, which may provide novel insights into potential risks and prognostic of AMI.