Dairy Foods and Dairy Fats: New Perspectives on Pathways Implicated in Cardiometabolic Health

ABSTRACT Low-fat and nonfat dairy products have been promoted as part of a healthy dietary pattern by both US dietary guidelines and professional organizations for several decades. The basis for this recommendation stems in part from the putative negative cardiometabolic effects associated with saturated fat consumption. However, as nutrition research has shifted from a single nutrient to a whole-food/dietary pattern approach, the role of dairy foods and dairy fat in the diet–disease relationship is being reexamined. Most observational and experimental evidence does not support a detrimental relationship between full-fat dairy intake and cardiometabolic health, including risks of cardiovascular disease and type 2 diabetes. Indeed, an expanded understanding of the dairy food matrix and the bioactive properties of dairy fats and other constituents suggests a neutral or potentially beneficial role in cardiometabolic health. To consider how consuming dairy foods, including full-fat dairy, is associated with cardiometabolic health, this review provides an innovative perspective on mechanisms that link dairy consumption to 3 main biological systems at the core of metabolic health, the gastrointestinal, hepatic, and vascular systems.

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Dairy Foods, Obesity, and Metabolic Health: The Role of the Food Matrix Compared with Single Nutrients

Advances in Nutrition ◽

10.1093/advances/nmz053 ◽

2019 ◽

Vol 10 (5) ◽

pp. 917S-923S ◽

Cited By ~ 14

Author(s):

Dariush Mozaffarian

Keyword(s):

Weight Gain ◽

Saturated Fat ◽

Dietary Guidelines ◽

Dietary Recommendations ◽

Cvd Risk ◽

Dairy Foods ◽

Dairy Consumption ◽

Reduced Fat ◽

Total Fat ◽

Fermented Dairy

ABSTRACT In the 20th century, scientific and geopolitical events led to the concept of food as a delivery system for calories and specific isolated nutrients. As a result, conventional dietary guidelines have focused on individual nutrients to maintain health and prevent disease. For dairy foods, this has led to general dietary recommendations to consume 2–3 daily servings of reduced-fat dairy foods, without regard to type (e.g., yogurt, cheese, milk), largely based on theorized benefits of isolated nutrients for bone health (e.g., calcium, vitamin D) and theorized harms of isolated nutrients for cardiovascular diseases (CVDs) and obesity (e.g., total fat, saturated fat, total calories). However, advances in nutrition science have demonstrated that foods represent complex matrices of nutrients, minerals, bioactives, food structures, and other factors (e.g., phoshopholipids, prebiotics, probiotics) with correspondingly complex effects on health and disease. The present evidence suggests that whole-fat dairy foods do not cause weight gain, that overall dairy consumption increases lean body mass and reduces body fat, that yogurt consumption and probiotics reduce weight gain, that fermented dairy consumption including cheese is linked to lower CVD risk, and that yogurt, cheese, and even dairy fat may protect against type 2 diabetes. Based on the current science, dairy consumption is part of a healthy diet, without strong evidence to favor reduced-fat products; while intakes of probiotic-containing unsweetened and fermented dairy products such as yogurt and cheese appear especially beneficial.

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Dairy Fat Consumption and the Risk of Metabolic Syndrome: An Examination of the Saturated Fatty Acids in Dairy

Nutrients ◽

10.3390/nu11092200 ◽

2019 ◽

Vol 11 (9) ◽

pp. 2200 ◽

Cited By ~ 8

Author(s):

Unger ◽

Torres-Gonzalez ◽

Kraft

Keyword(s):

Metabolic Syndrome ◽

Fatty Acids ◽

Disease Risk ◽

Saturated Fatty Acids ◽

Saturated Fat ◽

Dietary Guidelines ◽

The Body ◽

Specific Chemical ◽

Dairy Consumption ◽

The Impact

Lifestyle is a key modifiable risk factor involved in the manifestation of metabolic syndrome and, in particular, diet plays a pivotal role in its prevention and development. Current dietary guidelines discourage the consumption of saturated fat and dietary sources rich in saturated fat, such as dairy products, despite data suggesting that full-fat dairy consumption is protective against metabolic syndrome. This narrative review assessed the recent epidemiological and clinical research that examined the consumption of dairy-derived saturated fatty acids (SFA) on metabolic syndrome risk. In addition, this review evaluated studies of individual SFA to gain insight into the potential mechanisms at play with intake of a diet enriched with these dairy-derived fatty acids. This work underscores that SFA are a heterogenous class of fatty acids that can differ considerably in their biological activity within the body depending on their length and specific chemical structure. In summary, previous work on the impact of dairy-derived SFA consumption on disease risk suggests that there is currently insufficient evidence to support current dietary guidelines which consolidate all dietary SFA into a single group of nutrients whose consumption should be reduced, regardless of dietary source, food matrix, and composition.

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Faith in Fat: A Multisite Examination of University Students’ Perceptions of Fat in the Diet

Nutrients ◽

10.3390/nu12092560 ◽

2020 ◽

Vol 12 (9) ◽

pp. 2560

Author(s):

Matthew J. Landry ◽

Jasmine M. Olvany ◽

Megan P. Mueller ◽

Tiffany Chen ◽

Dana Ikeda ◽

...

Keyword(s):

College Students ◽

Nutrition Education ◽

Food System ◽

Saturated Fat ◽

The United States ◽

Vital Role ◽

Dietary Guidelines ◽

First Year Students ◽

Unsaturated Fat ◽

Fat Consumption

Despite recent relaxation of restrictions on dietary fat consumption in dietary guidelines, there remains a collective “fear of fat”. This study examined college students’ perceptions of health among foods with no fat relative to foods with different types of fats (unsaturated and saturated). Utilizing a multisite approach, this study collected data from college students at six university dining halls throughout the United States. Data were available on 533 students. Participants were 52% male and consisted largely of first-year students (43%). Across three meal types, the no-fat preparation option was chosen 73% of the time, the unsaturated fat option was selected 23% of the time, and the saturated fat option was chosen 4% of the time. Students chose the no-fat option for all meal types 44% of the time. Findings suggest that college students lack knowledge regarding the vital role played by the type and amount of fats within a healthy diet. Nutrition education and food system reforms are needed to help consumers understand that type of fat is more important than total amount of fat. Efforts across various sectors can encourage incorporating, rather than avoiding, fats within healthy dietary patterns.

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Daily Inclusion of Potatoes Into a Dietary Guidelines for Americans-Based Dietary Pattern Does Not Adversely Impact Cardiometabolic Risk in Adults With Metabolic Syndrome

Current Developments in Nutrition ◽

10.1093/cdn/nzab037_010 ◽

2021 ◽

Vol 5 (Supplement_2) ◽

pp. 300-300

Author(s):

Sisi Cao ◽

William Quarles ◽

Emily Shaw ◽

Geoffrey Sasaki ◽

Priyankar Dey ◽

...

Keyword(s):

Metabolic Syndrome ◽

Endothelial Function ◽

Resistant Starch ◽

Dietary Pattern ◽

Dietary Guidelines ◽

Cardiometabolic Health ◽

Oral Glucose ◽

Vascular Endothelial ◽

Vascular Endothelial Function ◽

Dietary Guidelines For Americans

Abstract Objectives Observational studies suggest that the regular ingestion of potatoes adversely affects cardiometabolic health, but controlled studies in humans are needed to establish causality. Our objective was to assess whether daily inclusion of non-fried potato foods as part of a Dietary Guidelines for Americans (DGA)-based dietary pattern would impair cardiometabolic health in adults with metabolic syndrome (MetS). Methods In a 2-arm, randomized controlled, crossover trial separated by a 2-wk washout period, MetS adults were provided a eucaloric DGA-based dietary pattern containing potato (350 g with 17.5 g/d resistant starch; POTATO) or an energy-matched bagel (0 g/d resistant starch; CON) for 14 d. Fasting blood was collected on d 0 and 14. On d 14, after a 75 g oral glucose tolerance test, brachial artery flow-mediated dilation (FMD) was measured and blood was collected at 30 min intervals for 2 h to assess vascular endothelial function and metabolic excursions, respectively. Circulating endotoxin, glucose, insulin, and nitric oxide metabolites (NOx) were assessed by spectrophotometry, and malondialdehyde (MDA) and arginine and its metabolites by HPLC. Data were analyzed using two-way repeated measures ANOVA. Results MetS adults (n = 27; 32.5 ± 1.3 y; 35.0 ± 1.0 kg/m2) completed the study with no adverse effects or significant changes in body weight. The 14-d DGA-based dietary pattern had a small but significant effect to decrease glucose (107 ± 1.9 vs. 102 ± 1.7 mg/dL; P = 0.04) and insulin (19 ± 2.9 vs. 14 ± 1.5 μIU/mL; P = 0.03), but these were unaffected by POTATO. Fasting endotoxin, NOx, and MDA and FMD were also unaffected by POTATO compared to CON, as were postprandial AUC0–2h of FMD, insulin, glucose, arginine, MDA, endotoxin, and NOx. Conclusions Findings of this acute controlled trial, which require long-term validation, support that a DGA-based dietary pattern may help to improve insulin resistance and that potatoes can be effectively incorporated into the diet without compromising vascular endothelial function or cardiometabolic health in persons with MetS. Funding Sources Alliance for Potato Research and Education.

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Energy and Nutrient Intake of Americans according to Meeting Current Dairy Recommendations

Nutrients ◽

10.3390/nu12103006 ◽

2020 ◽

Vol 12 (10) ◽

pp. 3006 ◽

Cited By ~ 1

Author(s):

Julie M. Hess ◽

Christopher J. Cifelli ◽

Victor L. Fulgoni III

Keyword(s):

Nutrient Intake ◽

Saturated Fat ◽

Dietary Guidelines ◽

Adequate Intake ◽

Dairy Food ◽

Added Sugars ◽

Dairy Foods ◽

Dietary Guidelines For Americans ◽

Calcium Magnesium ◽

Using Data

Most Americans do not meet dairy food recommendations from the 2015 Dietary Guidelines for Americans (DGA). This study assesses differences in nutrient intake between Americans who meet recommendations for dairy intake and those who do not, using data from the National Health and Nutrition Examination Survey from 2013–2014 and 2015–2016 (n = 5670 children ages 2–18 years and n = 10,112 adults ages 19+). Among children and adults, those meeting dairy food recommendations were significantly more likely to have adequate intake (% above Estimated Average Requirement (EAR)) of calcium, magnesium, phosphorus, riboflavin, vitamin A, vitamin B12, and zinc and consume above the Adequate Intake (AI) for potassium and choline than Americans not meeting dairy recommendations, regardless of age, sex, or race/ethnicity. Americans meeting dairy recommendations were also more likely to exceed recommendations for sodium and saturated fat but consume less added sugars. Nearly 60% of Americans 2 years and older not meeting dairy recommendations consumed calcium and magnesium below the EAR. Only about 20% of Americans who did not meet dairy recommendations consumed above the AI for potassium. Dairy foods make important and unique contributions to dietary patterns, and it can be difficult to meet nutrient needs without consuming recommended amounts of dairy foods.

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Abstract MP004: Dietary Intakes of Saturated Fat and Cardiovascular Disease: Results from the Multi-Ethnic Study of Atherosclerosis

Circulation ◽

10.1161/circ.125.suppl_10.amp004 ◽

2012 ◽

Vol 125 (suppl_10) ◽

Author(s):

Marcia Otto ◽

David R Jacobs ◽

Dariush Mozaffarian ◽

Daan Kromhout ◽

Alain G Bertoni ◽

...

Keyword(s):

Fatty Acids ◽

Saturated Fatty Acids ◽

Saturated Fat ◽

Food Sources ◽

Dietary Intakes ◽

Cvd Risk ◽

Ethnic Study ◽

Fat Consumption ◽

Underlying Mechanisms ◽

Dairy Fats

Background: Prospective studies have shown generally null associations between overall saturated fat consumption and CVD events. Understanding whether food sources of saturated fatty acids (SF) influence these relationships may help explain inconsistencies and provide insights as to underlying mechanisms. Objective and Hypothesis: We investigated associations between SF consumption from different major dietary sources (SF from each of meat, dairy, fats/oils, and plants) and CVD incidence in the Multi-Ethnic Study of Atherosclerosis (MESA). We hypothesized that associations between SF and CVD incidence would be influenced by the food sources delivering SF. Methods: Participants 45–84 years of age at baseline (n = 5,209) were followed between 2000 and 2007. Dietary intake was assessed using a 120-item food frequency questionnaire. Cox proportional hazard models were used to estimate hazard ratios (HR) and 95% CIs for incident CVD (275 cases) across categories of energy-adjusted intakes of SF by food source. Energy density substitution models were used to estimate the effect of substituting a percentage of energy intake from a specific SF source for the same amount of SF from another source. All models were adjusted for demographics, behavioral and dietary confounders such as intakes of fruit and vegetables, fiber, trans-fat and PUFA. Results: After multivariable adjustment, each 1-g greater intake of meat SF corresponded to 5% higher risk of CVD (HR [CI] per 1-g: 1.05 [1.01– 1.10]). In contrast, each 1-g greater intake of dairy SF intake corresponded to 4% lower risk of CVD (HR [CI] per 1-g: 0.96 [0.93– 0.99]). Substituting 1% of energy from meat SF with energy from dairy SF was associated with a 14% reduction in CVD risk (HR [CI]: 0.86 [0.78–0.95]). The replacements of energy from meat SF with fats/oils SF or with plant SF did not show statistically significant impacts on relative estimates of CVD risk (HR [CI]: 0.93 [0.83–1.05] and 0.93 [0.59 to 1.46], respectively), and neither intake of fats/oils SF nor intake of plant SF was independently associated with CVD risk. Conclusion: These findings suggest that associations between SF and CVD may depend on known differences in type of saturated fatty acids contained in specific food sources or other non-SF constituents in these sources.

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Usual Intake of Food Components in Adults Age 71+ from WWEIA, NHANES 2013–2016

Current Developments in Nutrition ◽

10.1093/cdn/nzaa046_069 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 569-569

Author(s):

Lois Steinfeldt ◽

Carrie Martin ◽

Joseph Goldman ◽

Alanna Moshfegh

Keyword(s):

Physical Activity ◽

Saturated Fat ◽

Dietary Guidelines ◽

Activity Level ◽

Specific Recommendation ◽

Dairy Foods ◽

Food Components ◽

Food Patterns ◽

Usual Intake ◽

Males And Females

Abstract Objectives Compare the usual intake of food components and the percent meeting the Dietary Guidelines for Americans 2015–2020 (DGA) energy-specific recommendations for males and females age 71+. Methods This analysis is based on 24-hr recalls from 1422 individuals age 71 and older from What We Eat in America, National Health and Nutrition Examination Survey 2013–2016 (WWEIA, NHANES). It uses the Food Patterns Equivalents Databases for 2013–2014 and 2015–2016. These databases contain the amounts of Food Patterns components for each food and beverage reported by each WWEIA, NHANES respondent. Usual intake distributions of selected food patterns components are estimated using the National Cancer Institute method. These distributions are then compared to the energy-specific recommendations in the DGA as appropriate for each respondent, based on age, sex, and physical activity level. The NHANES Physical Activity Questionnaire is used to classify respondents as sedentary, moderately active, or active. Results Significantly more males than females meet the energy-specific recommendation for protein foods (52% vs 30%, P < .001) and dairy foods (6% vs 1%, P < .001) while significantly more females than males meet the recommendation for limiting sodium (34% vs 9%, P < .001). There are no significant differences between males and females meeting the recommendations for vegetables, fruits, grains, added sugars, and saturated fat. Within the protein foods subgroups, significantly more males than females meet the recommendations for the meat, poultry, and egg subgroup (59% vs 40%, P < .001), but there are no differences for the total fish and seafood or the nuts, seeds, and soy products subgroups. Within the vegetable subgroups, there are no significant differences between males and females meeting the recommendations for dark green, red/orange, total starchy, legumes or other vegetables. Conclusions Less than half of adults age 71+ meet any of the DGA energy-specific recommendations with the exception of males where 52% meet the recommendation for protein foods and 59% meet the recommendation for the meat, poultry, egg subgroup within protein foods. Only 1% of women meet the recommendation for dairy foods. Funding Sources USDA, ARS.

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Dairy Fats and Cardiovascular Disease: Do We Really Need to Be Concerned?

Foods ◽

10.3390/foods7030029 ◽

2018 ◽

Vol 7 (3) ◽

pp. 29 ◽

Cited By ~ 79

Author(s):

Ronan Lordan ◽

Alexandros Tsoupras ◽

Bhaskar Mitra ◽

Ioannis Zabetakis

Keyword(s):

Cardiovascular Diseases ◽

Dairy Products ◽

Cardiovascular Health ◽

Dairy Product ◽

Scientific Data ◽

Dietary Guidelines ◽

Dairy Consumption ◽

Increased Risk ◽

Dairy Fats ◽

Neutral Effect

Cardiovascular diseases (CVD) remain a major cause of death and morbidity globally and diet plays a crucial role in the disease prevention and pathology. The negative perception of dairy fats stems from the effort to reduce dietary saturated fatty acid (SFA) intake due to their association with increased cholesterol levels upon consumption and the increased risk of CVD development. Institutions that set dietary guidelines have approached dairy products with negative bias and used poor scientific data in the past. As a result, the consumption of dairy products was considered detrimental to our cardiovascular health. In western societies, dietary trends indicate that generally there is a reduction of full-fat dairy product consumption and increased low-fat dairy consumption. However, recent research and meta-analyses have demonstrated the benefits of full-fat dairy consumption, based on higher bioavailability of high-value nutrients and anti-inflammatory properties. In this review, the relationship between dairy consumption, cardiometabolic risk factors and the incidence of cardiovascular diseases are discussed. Functional dairy foods and the health implications of dairy alternatives are also considered. In general, evidence suggests that milk has a neutral effect on cardiovascular outcomes but fermented dairy products, such as yoghurt, kefir and cheese may have a positive or neutral effect. Particular focus is placed on the effects of the lipid content on cardiovascular health.

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Differences in Dairy Intake Among Americans by Ethnicity and Age: NHANES 2015–2018

Current Developments in Nutrition ◽

10.1093/cdn/nzab053_035 ◽

2021 ◽

Vol 5 (Supplement_2) ◽

pp. 1042-1042

Author(s):

Julie Hess ◽

Christopher Cifelli ◽

Victor III Fulgoni

Keyword(s):

Daily Intake ◽

Ethnic Disparities ◽

Dietary Guidelines ◽

Cottage Cheese ◽

Dairy Foods ◽

Dairy Intake ◽

Funding Sources ◽

Dairy Consumption ◽

Using Data ◽

Hispanic White

Abstract Objectives Consuming dairy foods helps Americans meet recommendations for calcium, vitamin A, vitamin D, and protein. The Healthy U.S.-Style Dietary Pattern in the 2020 Dietary Guidelines for Americans (DGA) recommends 3 daily servings of low-fat or fat-free milk, cheese, and yogurt for those 9 years and older, 2.5 servings for children 4–8 years and 2 servings for children 2–3 years. The objective of this study was to assess dairy consumption by Americans 2 years of age and older to identify population groups at higher risk for underconsumption. Methods Using data from the National Health and Nutrition Examination Survey (NHANES) 2015–2016 and 2017–2018, we evaluated the daily intake of total dairy foods, milk (total, white, flavored), cheese (total and cottage cheese separately), yogurt (regular and Greek), and milk substitutes (soy, rice, almond and others) by Americans, separating into groups by age (2 + years, 2–4 years, 4–8 years, 9–13 years, 14–18 years, 19 + years) and ethnicity (Asian, Hispanic, non-Hispanic Black, non-Hispanic White). Dairy serving amounts were defined as MyPlate serving size cup-equivalents. Results Regardless of age or ethnicity, Americans did not meet the DGA's dairy intake recommendations. Average total daily dairy intake for Americans ages 2 + was 1.57 ± 0.03 cup-equivalents, with 0.73 servings coming from milk and 0.73 from cheese. Children ages 2–4 and 4–8 years came the closest to meeting recommendations, consuming an average of 1.93 ± 0.06 and 1.93 ± 0.05 servings, respectively, of dairy foods daily. Intake fell to 1.83 ± 0.06 daily servings among children ages 9–13, more than 30% below the recommendation that children begin consuming 3 daily servings at age 9. Daily dairy intake continued to decrease among those 14–18 years (1.75 ± 0.07 servings) and among adults 19+ (1.48 ± 0.03 servings). Among those ages 2 and older, non-Hispanic Black Americans had the lowest average intake (1.18 ± 0.04 servings daily) and non-Hispanic White Americans (1.67 ± 0.03) had the highest. Across all ethnic groups, plain milk was consumed in greater quantities than any other dairy food. Conclusions Both age and ethnic disparities exist in dairy intake for Americans. Improving adherence to dairy recommendations from the DGA could help Americans move closer to nutrient recommendations and overall healthy dietary patterns. Funding Sources National Dairy Council.

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Contribution of Dairy Foods to Energy and Nutrient Intakes in Children and Adults: Analysis of Nhanes 2015–2018

Current Developments in Nutrition ◽

10.1093/cdn/nzab053_014 ◽

2021 ◽

Vol 5 (Supplement_2) ◽

pp. 1021-1021

Author(s):

Christopher Cifelli ◽

Julie Hess ◽

Victor III Fulgoni

Keyword(s):

Vitamin D ◽

Vitamin A ◽

Vitamin B12 ◽

Saturated Fat ◽

Dietary Guidelines ◽

Health Concern ◽

Food Groups ◽

Food Category ◽

Dairy Foods ◽

Total Fat

Abstract Objectives Dairy foods are foundational foods in healthy eating patterns. Consumption of dairy foods helps both children and adults meet the recommendations of a variety of essential nutrients. Accordingly, the objective of this study was to determine the contribution of total dairy, milk, cheese, and yogurt to energy and nutrient intake in children and adults. Methods Twenty-four-hour dietary recall data from children age 2–18 (n = 5038) and adults age 19–99 (n = 9813) participating in the National Health and Nutrition Examination Survey (NHANES) 2015–2016 and 2017–2018 were analyzed. Intakes (both absolute amounts and as a percentage of total intake) of energy and nutrients were determined for all food groups using the USDA food category system. Data were generated on an as consumed basis and on a disaggregated basis; the latter approach reallocated energy and nutrients from milk and cheese found in other foods (e.g., pizza) back to the respective dairy food group. Total dairy was defined as milk, cheese, and yogurt in this analysis. Results On a disaggregated basis, total dairy provided 14.2% and 9.7% of total kcal/d in children and adults, respectively. At current consumption levels, milk, cheese, and yogurt contributed 61.6% of calcium, 65.8% of vitamin D, 22.8% of potassium, 23.7% of protein, 38.5% of vitamin A, 38.3% of vitamin B12, 31.1% of riboflavin, 36.3% of phosphorus, 22.7% of zinc, and 18.1% of magnesium in children, on average. Dairy foods also contributed 19% of total fat, 31.1% of saturated fat, 13.9% of sodium, and 4.7% of added sugar to the diets of children. Similarly, in adults, milk, cheese, and yogurt contributed 49.5% of calcium, 45.9% of vitamin D, 11.6% of potassium, 15.7% of protein, 26.6% of vitamin A, 24.9% of vitamin B12, 18.6% of riboflavin, 25% of phosphorus, 15.5% of zinc, and 9.4% of magnesium to the diet, on average. Total dairy also provided 14.2% of total fat, 24.8% of saturated fat, and 10.1% of sodium in adults. Milk was the top source of calcium and vitamin D in both children and adults. Conclusions Milk, cheese, and yogurt remain significant sources of key nutrients for children and adults, including three out of the four underconsumed nutrients of public health concern (vitamin D, calcium, and potassium) as defined by the 2020 Dietary Guidelines for Americans. Funding Sources National Dairy Council.

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