Meeting and exceeding dairy recommendations: Effects of dairy consumption on nutrient intakes and risk of chronic disease

Article (PDF Available)inNutrition Reviews 71(4):209-23 · April 2013with87 Reads
DOI: 10.1111/nure.12007 · Source: PubMed
Abstract
The 2010 Dietary Guidelines for Americans indicate the US population is experiencing an epidemic of overweight and obesity while maintaining a nutrient-poor, energy-dense diet associated with an increased risk of osteoarthritis, cardiovascular disease, and type 2 diabetes. To build upon the review of published research in the Report of the Dietary Guidelines Advisory Committee on the Dietary Guidelines for Americans, 2010, this article aims to review the scientific literature pertaining to the consumption of dairy foods and the effects of dairy consumption on nutrient intakes and chronic disease risk published between June 2010, when the report was released, and September 2011. PubMed was searched for articles using the following key words: dairy, milk, nutrient intake, bone health, body composition, cardiovascular disease, type 2 diabetes, and blood pressure. Evidence indicates that increasing dairy consumption to the recommended amount, i.e., three servings daily for individuals ≥9 years of age, helps close gaps between current nutrient intakes and recommendations. Consuming more than three servings of dairy per day leads to better nutrient status and improved bone health and is associated with lower blood pressure and reduced risk of cardiovascular disease and type 2 diabetes.

Figures

Meeting and exceeding dairy recommendations: effects
of dairy consumption on nutrient intakes and risk of
chronic disease
Beth H Rice, Erin E Quann, and Gregory D Miller
The 2010 Dietary Guidelines for Americans indicate the US population is experienc-
ing an epidemic of overweight and obesity while maintaining a nutrient-poor,
energy-dense diet associated with an increased risk of osteoarthritis, cardiovascular
disease, and type 2 diabetes. To build upon the review of published research in the
Report of the Dietary Guidelines Advisory Committee on the Dietary Guidelines
for Americans, 2010, this article aims to review the scientific literature pertaining to
the consumption of dairy foods and the effects of dairy consumption on nutrient
intakes and chronic disease risk published between June 2010, when the report was
released, and September 2011. PubMed was searched for articles using the following
key words: dairy, milk, nutrient intake, bone health, body composition, cardiovascu-
lar disease, type 2 diabetes, and blood pressure. Evidence indicates that increasing
dairy consumption to the recommended amount, i.e., three servings daily for indi-
viduals 9 years of age, helps close gaps between current nutrient intakes and
recommendations. Consuming more than three servings of dairy per day leads to
better nutrient status and improved bone health and is associated with lower blood
pressure and reduced risk of cardiovascular disease and type 2 diabetes.
© 2013 International Life Sciences Institute
INTRODUCTION
Nearly 70% of adults and one-third of children in the
United States are overweight or obese.
1,2
Despite being in
a state of positive energy balance, Americans, on average,
are not meeting recommended intakes for whole grains,
vegetables,fruits, low-fat and fat-free dairy foods, seafood,
and oils; they are also failing to meet recommended
nutrient intakes for potassium, dietary fiber, calcium,
and vitamin D, all of which were identified by the 2010
Dietary Guidelines for Americans (DGA) as nutrients for
which intake is low enough to be of public health
concern.
3–5
In the United States, milk is the primary
dietary source of three of these nutrients: calcium,
vitamin D, and potassium.
6
To help Americans meet nutrient recommendations,
the 2010 DGA recommends 3 cups per day of fat-free or
low-fat milk and milk products for persons 9 years of age
and older, 2.5 cups per day for children 4–8 years of age,
and 2 cups per day for children 2–3 years of age.
3
Data
from the National Health and Nutrition Examination
Surveys (NHANES) indicate that meeting or exceeding
current recommendations for dairy food intake can
increase the dietary intake of several nutrients that are
underconsumed in the United States, such as calcium,
magnesium, and potassium.
7
The 2010 DGA recognizes that, in addition to dairy
foods being a source of essential nutrients, “moderate
evidence shows dairy consumption is associated with
improved bone health, especially in children and adoles-
cents, and a reduced risk of cardiovascular disease and
type 2 diabetes and with lower blood pressure in adults.
3
To build upon the review of published research in the
Report of the Dietary Guidelines Advisory Committee
Affiliations: BH Rice, EE Quann, and GD Miller are with the Dairy Research Institute, Rosemont, Illinois, USA.
Correspondence: BH Rice, Dairy Research Institute, 10255 West Higgins Road, Suite 900, Rosemont,IL, 60018-5616, USA. E-mail:
beth.rice@rosedmi.com. Phone: +1-847-627-3258. Fax: +1-847-627-3294.
Key words: blood pressure, bone, cardiovascular disease, milk, type 2 diabetes
bs_bs_banner
Special Article
doi:10.1111/nure.12007
Nutrition Reviews® Vol. 71(4):209–223 209
(DGAC) that led to this conclusion, this article reviews
the scientific literature pertaining to dairy food consump-
tion and the effects of dairy consumption on nutrient
intakes and risk of chronic disease published between
June 2010, when the DGAC report was released, and
September 2011.
DAIRY CONSUMPTION AND NUTRIENT INTAKE
The dairy food group, which includes milk, cheese, and
yogurt, contributes to the intake of many nutrients in the
American diet, including more than 50% of total vitamin
D and calcium and more than 25% of vitamin A, vitamin
B
12
, and phosphorus, while contributing just 10% of total
calorie intake (Figure 1).
8–10
Dairy intake, however, is
significantly below the levels recommended for most
Americans,
8
with individuals 2 years of age and older
consuming 1.8 servings daily on average
9
and only 15% of
the population meeting recommendations for consump-
tion of dairy foods.
11
The DGA encourages increased
consumption of fruits, vegetables, whole grains, lean
protein sources (e.g., seafood, nuts, legumes), and low-fat
and fat-free dairy foods to help individuals meet nutrient
recommendations. A review of NHANES data from
2003–2004 indicated that three servings of dairy per day
is the minimum amount necessary to ensure adequate
intakes of calcium for Americans 9 years of age and older,
but four servings or more per day may be necessary to
ensure adequate intakes of magnesium and potassium.
7
A recent study that utilized NHANES 2003–2006 data to
examine the impact of adding one serving of dairy to
current intakes supports this conclusion. The addition of
a consumption-weighted composite of dairy foods (milk,
cheese, and yogurt) increased average daily dairy intake
to 2.8 servings and average calcium, magnesium, and
potassium intakes to 1,245 mg, 301 mg, and 2,916 mg,
respectively.
12
Changes in additional dietary intakes are
presented in Table 1. According to another analysis of
NHANES data, from 2003 to 2006, more than one-third
of Americans 2 years of age and older have usual intakes
below the estimated average requirement (EAR) for
vitamin A and calcium, nearly half have intakes below the
EAR for magnesium, more than two-thirds have intakes
below the EAR for vitamin D, and just 3% of the popula-
tion have usual intakes of potassium greater than the
adequate intake.
5
Despite the naturally occurring
amounts of these nutrients in food sources and the addi-
tional contribution from enriched foods and dietary
supplements, shortfalls still exist.
5
Several randomized clinical trials (RCTs) have dem-
onstrated that consuming three or more servings of dairy
foods per day has beneficial effects on nutrient intakes in
adults.
13–16
In middle-aged obese men and women fed a
weight-maintenance diet for 6 months, the consumption
of three or more servings of dairy foods per day resulted
in significantly higher intakes of energy and macronutri-
ents as well as of calcium and vitamin D compared with
intakes of individuals who consumed one or fewer
serving of dairy foods per day. For those who consumed
higher amounts of dairy foods, the average calcium intake
at the end of the study (women, 1,330 39 mg/day; men,
1,448 41 mg/day) was above the EAR (800 mg/day)
for their age group, and vitamin D intakes doubled com-
pared with baseline intake levels (women, 3.6 0.5 to
7.1 0.4 mg/day; men, 4.9 0.8 to 9.7 0.6 mg/day),
which approached the EAR (10 mg/day) for their age
group. For those who consumed lower amounts of dairy
foods, the average calcium intake after 6 months was
below the EAR (women, 587 45; men, 624 36 mg/
day) for their age group, and vitamin D intakes did
not improve from baseline and were well below the
EAR (women, 4.2 0.6 to 2.9 0.4; men, 4.1 0.7 to
3.8 0.5 mg/day) for their age group.
13
In another study
in which total energy intake did not differ between
groups, the consumption of four servings of dairy foods
daily for 21 weeks by middle-aged obese adults resulted
in significantly higher calcium intakes (1,200 370 mg/
day) compared with intakes in the group who consumed
two servings of dairy foods per day (668 273 mg/
day).
15
The group who consumed four servings of dairy
10
51
13
28
16
18
25
28
26
58
16
14
26
11
0
20
40
60
80
100
Average %
Ener
gy
and Nutrients
Figure 1 Percent energy and select nutrient
contributions of dairy foods to the US diet from 1.8
average servings consumed per day. Data obtained from
day 1 of the 2003–2004 and 2005–2006 National Health
and Nutrition Examination Surveys 24-hour dietary recall
for individuals 2 years and older, excluding pregnant
and lactating females (n = 16,822). Mixed dishes were
disaggregated using the USDA Nutrient Database for
Standard Reference food codes and linked to the
appropriate food composition databases using the SR-Link
file of the Food and Nutrient Database for Dietary Studies
(FNDDS 2.0 and 3.0, based on SR 18 and SR 20, respectively),
allowing for determination of the contribution of dairy
foods used in mixed dishes to total nutrient intake.
9
Nutrition Reviews® Vol. 71(4):209–223210
foods per day had calcium intakes above the EAR for
their age group, whereas the group who consumed two
servings of dairy foods per day did not reach the EAR
for calcium intake.
15
Another RCT showed that, in
groups of postmenopausal women between the ages of
55 and 65 years, matched for total energy and macronu-
trient consumption, consumption of three servings of
low-fat calcium- and vitamin-D-fortified dairy products
(2 servings of milk and 1 serving of yogurt) per day for
30 months resulted in no significant difference in intakes
of total calories or macronutrients and significantly
greater intakes of calcium, magnesium, vitamin D,
and phosphorus (1,337 500 mg/day, 329 124 mg/
day, 18.5 1.4 mg/day, and 1,561 675 mg/day, respec-
tively) compared with intakes in a control group who
did not consume three servings of fortified dairy
products daily (564 310 mg/day, 247 104 mg/day,
0.8 1.4 mg/day, and 1,133 mg/day, respectively).
16
Similarly, in another study in which three servings of
low-fat calcium- and vitamin-D-fortified dairy products
were provided to postmenopausal women daily for 30
months, calcium, phosphorus, and vitamin D intakes
were higher (1,183 283 mg/day, 1,409 627 mg/day,
and 18.8 1.3 mg/day, respectively) compared with
intakes in the control group (671 334 mg/day, 1,091
484 mg/day, and 1.2 0.6 mg/day, respectively).
14
There
were no significant differences in calorie, carbohydrate,
or fat intakes, and protein intake was significantly higher
in the dairy intervention group. Both of these studies
reported intakes that increased from sub-EAR levels to
levels that exceeded the EARs for calcium, vitamin D,
and magnesium (1,000 mg/day, 10 mg/day, and 265 mg/
day, respectively).
14,16
These higher nutrient intakes were
a significant improvement for this age group, which may
be at risk for underconsuming calcium and vitamin D.
17
The results of these studies indicate that exceeding daily
dairy recommendations has beneficial effects on nutrient
intakes.
DAIRY CONSUMPTION AND BONE HEALTH
Based on the review of the scientific literature by the
DGAC, the 2010 DGA stated there was moderate evi-
dence linking dairy consumption with improved bone
health, especially in children and adolescents.
3
Since the
release of the DGAC report, several RCTs reinforced that
dairy consumption also has benefits on bone health
in adults, particularly in women (Table 2).
14,16,18–20
In a
4-month trial in overweight premenopausal women who
consumed a calorie-restricted diet, three or more daily
servings of low-fat dairy foods (average daily calcium
intakes above 1,300 mg) combined with resistance exer-
cise increased lumbar spine bone mineral density com-
pared with one or fewer servings of low-fat dairy foods
per day combined with resistance exercise.
20
In another
study in healthy, young premenopausal women who
followed a 12-week diet and resistance-exercise plan,
four daily servings of fat-free milk added to participants’
normal diets resulted in improved markers of bone turn-
over compared with an isoenergetic carbohydrate con-
Table 1 Current dairy and nutrient intakes, based on NHANES 2003–2006 data (day 1, consumers aged 2 years
and older, n = 16,882)
9
and the dietary impact if one serving of dairy (consumption-weighted composite of milk,
cheese, and yogurt) was added.
Nutrient Current intake
(mean SE)
a
One serving of dairy
added (mean SE)
a
Dairy (cup equivalent) 1.8 0.0 2.8 0.0**
Energy (kcal) 2,176 16 2,319 16**
Protein (g) 81.1 0.8 90.3 0.8**
Total fatty acids (g) 82.3 0.8 89.1 0.8**
Saturated fatty acids (g) 27.7 0.3 31.9 0.3**
Vitamin A, RAE (mg) 605 10 721 10**
Riboflavin (mg) 2.26 0.03 2.64 0.03**
Niacin (mg) 24.3 0.3 24.6 0.3
Vitamin B
12
(mg) 5.34 0.09 6.32 0.09**
Vitamin D (mg) 4.96 0.11 7.11 0.1**
Calcium (mg) 944 12 1,245 12**
Phosphorus (mg) 1,329 13 1,573 13**
Magnesium (mg) 277 3 301 3**
Zinc (mg) 12.1 0.1 13.4 0.1**
Sodium (mg) 3,422 28 3,634 28**
Potassium (mg) 2,619 25 2,916 25**
** P < 0.01, significant difference between means before and after modeling diet change.
a
Sample-weighted means and standard errors were estimated using SUDAAN® statistical software.
Abbreviations: RAE, retinol activity equivalents.
Adapted from Fulgoni et al. (2011).
12
Nutrition Reviews® Vol. 71(4):209–223 211
Table 2 Effects of dairy intake on markers of bone health: summary of randomized clinical trials conducted between June 2010 and September 2011, using
the search terms dairy,milk,“bone health, and “body composition.
Reference Characteristics of
participants
Study objective Dairy servings
per day in
experimental
group
Results
Josse et al.
(2010)
19
Young healthy women
(n = 10) and matched
controls (n = 10),
23.2 2.8 years of age
Determine the effects of 500 mL fat-free
milk versus isoenergetic CHO control
immediately and 1 h post exercise daily
on body composition after 12 weeks
4 Milk group showed increased osteocalcin (P < 0.05), decreased
carboxy-terminal collagen crosslinks C-telopeptides (P < 0.005), and no
effect on bone-specific alkaline phosphatase compared with control
group; serum 25-(OH)-D increased in milk group and control group
(P < 0.05); serum 25-(OH)-D increased more in milk group than in control
group (6.5 1.1 versus 2.8 1.3 nM, P < 0.05); PTH decreased in milk
group only (-1.2 0.2 pM, P < 0.01); control group and milk group
gained lean mass (P < 0.01); milk group gained more lean mass than
control group (1.9 0.2 versus 1.1 0.2 kg, P < 0.01); fat mass
decreased in milk group only (-1.6 0.4 kg, P < 0.01); isotonic strength
increased in milk group only (P < 0.05); control group gained weight
after training (0.86 0.04 kg, P < 0.05)
Habibzadeh
(2010)
18
Obese (n = 9) and thin
(n = 10) women and
obese (n = 9) and thin
(BMI < 20; n = 10)
matched controls, 20–24
years of age
Assess the effect of 2 servings of milk/day, 3
times per week, on BMD for 2 months
2 BMD increased in hip and spine of obese and thin experimental groups by
4–7% (P < 0.05); body fat decreased in the thin experimental group
(-8%, P < 0.05); lean body mass increased in the thin experimental group
(3%, P < 0.001); serum calcium decreased in all groups except obese
controls (3–5%, P < 0.05).
Thomas et al.
(2010)
20
Overweight women, 29-45
years of age (n = 29)
Examine lower-dairy calcium versus
higher-dairy calcium diet, combined with
resistance exercise, on body composition
after 16 weeks
3 Lumbar spine BMD increased in the higher-dairy calcium group versus the
lower-dairy calcium group (0.8% versus -1.5%, P < 0.05), higher-dairy
calcium group consumed 1,312 183 mg/day calcium, lower-dairy
calcium group consumed 454 143 mg/day calcium
Hinton et al.
(2010)
13
Obese subjects, 40.8 0.6
years of age (n = 49
men, n = 64 women)
Determine if recommended dairy and
calcium intake affect BMD and BMC after
24 weeks
3 Total body BMD and weight maintenance did not differ between
recommended and low dairy groups; recommended dairy group had
higher intake than low dairy group for protein (92 2.0 versus
75 3.0 g/day, P < 0.05), calcium (1,330 39.0 versus 587 45.0 mg/
day, P < 0.05), and vitamin D (7.1 0.4 versus 2.9 0.4 mg/day,
P < 0.05); serum 25-(OH)-D decreased in both groups during weight
maintenance (P < 0.05)
Palacios et al.
(2011)
15
Puerto Rican obese adults,
21–50 years of age
(n = 20 women, n = 5
men)
Determine if high-dairy diet to provide
~1,300 mg/day of calcium or
high-calcium diet to provide ~1,300 mg/
day calcium (~700 mg/day from diet,
~600 mg/day from supplements) alters
body composition and serum lipids after
21 weeks
4 No differences in total BMC, total BMD, total body lean mass, weight, BMI,
total body fat mass, total body fat, or trunk fat mass between groups.
TAG levels were lower in high-dairy group for women only (18%,
P < 0.05). FFQ data: high-dairy group consumed 1,337 380 mg/day
calcium, high-calcium group consumed 988 250 mg/day calcium,
control group consumed 463 325 mg/day calcium, which was lower
than the high-dairy and high-calcium groups (P < 0.05). Food record
data: high-dairy group consumed 1,200 370 mg/day calcium,
high-calcium group consumed 1,171 265 mg/day calcium, control
group consumed 668 273 mg/day calcium, which was lower than the
high-dairy and high-calcium groups (P < 0.001)
Nutrition Reviews® Vol. 71(4):209–223212
Moschonis
et al.
(2010)
14
Postmenopausal women in
dietary group (n = 35)
and matched controls
(n = 31), 59–60 years of
age
Examine effects of 1,200 mg calcium and
7.5 mg vitamin D through fortified dairy
products for 12 months followed by
1,200 mg calcium and 22.5 mg vitamin D
for an additional 18 months on BMD
3 Dietary intervention resulted in more favorable changes in dietary group
versus control group for arm (0.033 versus -0.047 g/cm
2
, P < 0.01), total
spine (0.118 versus 0.049 g/cm
2
, P < 0.001), and total body BMD (0.003
versus -0.03 g/cm
2
, P < 0.01), total fat intake from baseline (31.7 7.4
versus 35.2 6.6 KJ, P < 0.05), calcium intake from baseline
(1,182.8 283.4 versus 678.6 275.1 mg/day, P < 0.001), phosphorus
intake from baseline (1,409.2 626.9 versus 993.5 280.9 mg/day,
P = 0.046), magnesium intake from baseline (314.9 107.9 versus
195.4 46.6 mg/day, P < 0.001), and vitamin D intake from baseline
(18.8 1.3 versus 0.76 1.09 mg/day, P < 0.001)
Tenta et al.
(2011)
16
Postmenopausal women in
dietary group (n = 20)
and matched controls
(n = 20), 55–65 years of
age
Examine effects of 1,200 mg calcium and
7.5 mg vitamin D through fortified dairy
products for 12 months followed by
1,200 mg calcium and 22.5 mg vitamin D
for an additional18 months on bone
metabolism and bone mass indices
3 Serum PTH was lower in the dietary group versus the control group
(38.5 19.8 versus 48.8 20.9 pg/mL, P = 0.049), serum 25-(OH)-D was
higher in the dietary group versus control group (27.2 8.4 versus
15.3 6.0, P < 0.001), and serum RANKL was lower in the dietary group
versus control group (0.35 0.22 versus 0.47 0.30, P = 0.005). Protein
intake was higher in the dietary group versus control group (14.6 3.9
versus 12.2 4.4% kcal, P = 0.02), calcium intake was higher in the
dietary group versus control group (1,336.6 500 versus
563.6 309.5 mg/day, P < 0.001), phosphorus intake was higher in the
dietary group versus control group (1,561.0 674.6 versus
1,132.7 539.1 mg/day, P = 0.01), magnesium intake was higher in the
dietary group versus control group (329 120.4 versus
247.3 104.2 mg/day, P < 0.001), and vitamin D intake was higher in the
dietary group versus control group (18.47 1.42 versus 0.77 1.38 mg/
day, P < 0.001)
Campbell &
Tang
(2010)
51
Study 1: 28
postmenopausal
women, 51–60 years of
age.
Study 2: 54
postmenopausal
women, 51–60 years of
age
Examine effects of higher-protein diets on
bone.
Study 1: subjects consumed
energy-restricted diet: lacto-ovo diet with
18% energy from protein (n = 15 subjects)
versus omnivorous diet with 30% energy
from protein (n = 13 subjects) for 12
weeks.
Study 2: subjects consumed habitual diet
(control, n = 11 subjects) versus
energy-restricted diet with 16% energy
from nonmeat protein sources (n = 14
subjects) or 26% energy from chicken
(n = 15) or beef (n = 14) protein sources
for 9 weeks
<2 Study 1: BMD decreased with weight loss in higher-protein diet only
(-0.0167 0.004 g/cm
2
, P < 0.05).
Study 2: BMD values decreased in chicken (-1.1%, P < 0.05) and beef
(-1.4%, P < 0.05) groups compared with baseline values
Abbreviations: BMD, bone mineral density; BMC, bone mineral content; BMI, body mass index; CHO, carbohydrate; FFQ, food frequency questionnaire; PTH, parathyroid hormone; RANKL, receptor activator of
nuclear factor-kappaB ligand; TAG, triglyceride; 25-(OH)-D, 25 hydroxy-vitamin D.
Nutrition Reviews® Vol. 71(4):209–223 213
trol.
19
In the group that consumed four additional
servings of fat-free milk per day, serum vitamin D (25-
[OH]-D) increased and parathyroid hormone decreased
more than in the group that did not consume any addi-
tional fat-free milk per day.
19
Serum 25-(OH)-D levels above 80 nM/L have been
related to improved bone health.
17
Participants who
consumed the four additional servings of fat-free milk
each day had serum 25-(OH)-D levels that increased to
between 48.2 nM/L and 79.2 nM/L; thus some were
still vitamin D insufficient (50–80 nM/L) or deficient
(<50 nM/L).
17,19
The beneficial effects on markers of bone
health that resulted from consuming four additional
servings of fat-free milk per day may have been due to the
approximately 1,200 mg of added calcium contributed
by milk to the diet, which allowed serum calcium to be
maintained within the recommended circulating range.
19
Greater gains in lean muscle mass and a decrease in
fat mass compared with the control group were also
observed, showing a beneficial effect of four daily servings
of milk on total body composition during weight loss.
19
In
a trial that examined the effect of milk consumption on
body composition in lean and obese premenopausal
females, an average of just two added servings of reduced-
fat milk three days a week to the normal diet of both lean
and obese participants for 8 weeks resulted in increased
bone mineral density of the hip and spine compared with
that in controls who did not consume any additional
dairy foods.
18
Additionally, lean body mass increased and
percent body fat decreased in the lean milk-consuming
group.
18
The results of these studies indicate that exceed-
ing daily dairy recommendations may have beneficial
effects on markers of bone health and body composition
in female adults.
In a study of obese men and premenopausal women
who participated in a 12-week weight-loss intervention
followed by a 24-week weight-maintenance period, total
body bone mineral content was increased from baseline
in women who consumed 3 servings of dairy per day
(recommended) as well as in those who consumed 1
serving of dairy per day (low consumption).
13
Despite
increases in total body bone mineral content, no changes
in total body bone mineral density were detected.
13
In the
men, both low dairy consumption and recommended
dairy consumption resulted in increased total body bone
mineral density over the course of the intervention. Total
body bone mineral content, however, decreased in the
men over time.
13
Estrogen is known to inhibit bone
resorption,
21
perhaps explaining why differences in treat-
ment effects on bone health were observed between the
women and the men. Why differences in total body bone
mineral content were not reflected in total body bone
mineral density cannot be explained. In another trial,
Palacios et al.
15
reported that Puerto Rican obese men
and women who consumed four servings of low-fat milk,
cheese, and yogurt daily for 21 weeks had no differences
in total body bone mineral content or density from base-
line or compared with those who consumed 1,200–
1,300 mg of calcium per day from a dietary supplement
or those who consumed less-than-recommended
amounts of dairy foods and no calcium supplement
(<700 mg calcium/day). Mixed results from these two
trials that studied dairy intake and bone health in obese
subjects indicate that obesity, in addition to gender, may
have a considerable effect on bone health regardless of
dairy and micronutrient intakes. This may be because,
in obese individuals, compounds vital to bone health
such as vitamin D are incorporated into adipose tissue
and do not contribute to serum 25-(OH)-D concentra-
tions.
22
Whereas trials in obese individuals have pro-
duced inconsistent results, RCTs in normal-weight
individuals show a beneficial effect of dairy consumption
on bone health.
DAIRY CONSUMPTION AND CARDIOVASCULAR
DISEASE
Dairy foods provide bioavailable calcium and have been
associated with beneficial effects on risk of cardiovascular
disease.
8
Two meta-analyses that aimed to investigate the
effects of calcium supplementation on cardiovascular
events indicated that nondietary calcium supplementa-
tion may increase the risk of cardiovascular events in
women over 40 years of age.
23,24
The DGAC report indi-
cated calcium naturally occurring in foods is the recom-
mended source.
8
Based on the DGAC’s review of the scientific litera-
ture, which presented evidence from two systematic
reviews and meta-analyses and one case-controlled
study,
8
the 2010 DGA stated, “Moderate evidence also
indicates that intake of milk and milk products is associ-
ated with a reduced risk of cardiovascular disease and
type 2 diabetes and with lower blood pressure in adults.
3
The 2010 DGA recommends the consumption of low-fat
and fat-free milk and milk products (milk, yogurt, and
cheese) as a means to obtaining the same nutrients that
are available in full-fat varieties but with a reduced
amount of calories and saturated fat.
3
While dairy foods
can contribute to saturated fat intake, the research sum-
marized in the 2010 DGAC report indicates consumption
of milk products may not have a predictable effect on
serum lipids; it may not raise total cholesterol and may
favorably impact high-density lipoprotein cholesterol.
Since the release of the 2010 DGAC report, several
epidemiological studies have examined the associations
between dairy consumption and cardiovascular disease
endpoints, such as coronary heart disease and stroke
(Table 3).
25–31
A meta-analysis of prospective cohort
Nutrition Reviews® Vol. 71(4):209–223214
Table 3 Effects of dairy intake on risk factors for cardiovascular disease: summary of epidemiological studies conducted between June 2010 and September
2011, using the search terms dairy,“milk, and cardiovascular disease.
Reference Characteristics of
participants
Study design and
objective
Mean
servings
of dairy
per day
Results
Soedamah-
Muthu
et al.
(2011)
30
Adults from the USA,
Japan, and Europe,
56 13 years of
age (n = 611,430)
Meta-analysis of 17 prospective
cohort studies to examine the
associations of milk, total dairy,
and high- and low-fat dairy
intakes with the risk of CVD and
total mortality over a mean
follow-up of 14 6 years
<2 Modest inverse association between milk intake and risk of overall CVD (4
studies: RR, 0.94 per 200 mL/day; 95%CI, 0.89–0.99); milk intake was
not associated with risk of CHD (6 studies: RR, 1.00; 95%CI, 0.96–1.04),
stroke (6 studies: RR, 0.87; 95%CI, 0.72–1.05), or total mortality (8
studies: RR per 200 mL/day, 0.99; 95%CI, 0.95–1.03); no association
between total, total high-fat, or total low-fat dairy products (200 g/day)
and CHD
Bernstein
et al.
(2010)
26
American adult
women, 30–55
years of age
(n = 84,136)
Prospective study to examine the
relationship between foods that
are major dietary protein sources
and incident CHD
<1–3 Low-fat and high-fat dairy foods substituted for red meat were associated
with a decreased risk of CHD (P < 0.05) and, when substituted for fish,
were associated with an increased risk of CHD (P < 0.05); a serving of
high-fat dairy was associated with an increased hazard ratio for CHD
(1.03; 95%CI, 1.00–1.06, P < 0.05)
Panagiotakos
et al.
(2010)
52
Greek adults, 18–89
years of age
(n = 1,514 men
and 1,528 women)
Cross-sectional study to investigate
the association between
consumption of dairy products
and levels of various inflammatory
markers among adults with no
evidence of CVD or other chronic
diseases
1–2 1.5–2 servings of dairy/day associated with lower plasma total cholesterol,
TAG, and hypercholesterolemia versus <1 serving/day (P < 0.05),
regardless of full-fat or low-fat dairy (P > 0.76); 2 servings/day versus <1
serving/day associated with lower CRP (1.61 1.8 versus
2.26 1.6 mg/L, P = 0.32), IL-6 (1.34 0.32 versus 1.48 0.37 ng/mL,
P = 0.001), and TNF-a (5.58 2.8 versus 1.48 0.37 mg/dL, P < 0.001);
1 additional serving of full-fat dairy/week associated with decreased
IL-6 (b=-0.071 0.05 mg/L, P = 0.02) and TNF-a
(b=-0.047 0.02 mg/dL, P = 0.02); 1 additional serving of low-fat
dairy/week associated with decreased CRP (b=-0.071 0.02 mg/L,
P = 0.02), IL-6 (b=-0.066 0.01 ng/mL, P = 0.03). and TNF-a
(b=-0.040 0.01 mg/dL, P = 0.01)
Goldbohm
et al.
(2011)
28
Dutch adults, 55–69
years of age
(n = 120,852)
Prospective study to investigate the
association between dairy product
consumption and the risk of death
from all causes, IHD, and stroke
2 Butter and dairy fat intake increased risk of all-cause and IHD mortality in
women only (Rate Ratio
mortality,
1.04 per 10 g/day; 95%CI, 1.01–1.06 per
10 g/day, P < 0.05); fermented full-fat milk was inversely associated with
all-cause mortality
Aslibekyan
et al.
(2012)
25
Costa Rican adults,
58–59 years of age
(n = 3,360)
Case-control study to evaluate the
association between dairy intake
as measured by FFQ and adipose
tissue content of C 15:0 and C 17:0
fatty acids with risk of nonfatal MI
1 No association between dairy consumption and risk of nonfatal MI
Nutrition Reviews® Vol. 71(4):209–223 215
Table 3 Continued
Reference Characteristics of
participants
Study design and
objective
Mean
servings
of dairy
per day
Results
Bonthuis
et al.
(2010)
27
Australian adults,
25–78 years of age
(n = 1,529)
Prospective study to investigate the
relationship between intake of
dairy products or related nutrients
and mortality due to CVD, cancer,
and all causes over a follow-up
period of 16 years
<1–2.5 Higher intake of full-fat dairy foods associated with decreased hazard
ratios of CVD mortality (1.5 servings/day = 0.31; 95%CI, 0.12–0.79
versus <1 serving/day = 0.73; 95%CI, 0.35–1.54; P = 0.04)
Warensjö
et al.
(2010)
31
Swedish adults,
50–60 years of age
(n = 444 cases and
556 controls)
Case-control study to investigate the
association between dairy intake
as measured by adipose tissue
content of C 15:0 and C 17:0 fatty
acids and their sum with risk of
first MI
1–2 Higher intake of dairy as indicated by biomarkers of milk fat was inversely
associated with first MI (OR, 0.74; 95%CI, 0.58–0.94 in women);
quartiles of reported intake of cheese were inversely related to first MI
in men and women (P < 0.05); quartiles of reported intake of fermented
milk products were inversely related to first MI in men (P < 0.05)
Esmaillzadeh
&
Azadbakht
(2010)
53
Tehrani women,
40–60 years of age
(n = 486)
Cross-sectional study to assess the
association between dairy
consumption and circulating
levels of inflammatory markers
<0.5 Low-fat dairy consumption was inversely associated with sVCAM-1
(b=-0.03, P < 0.05); high-fat dairy consumption was positively
associated with serum amyloid A (b=0.08, P < 0.05) and sVCAM-1
(b=0.05, P < 0.05); and there was no association between overall dairy
consumption and circulating markers of inflammation
Ivey et al.
(2011)
29
Australian women,
>70 years of age
(n = 1,080)
Prospective study to assess the
association between dairy
consumption and CCA-IMT after a
period of 3 years
<0.5–1.2 Total dairy product, milk, and cheese consumption was not associated
with CCA-IMT (P < 0.05); yogurt consumption was inversely associated
with CCA-IMT (b=-0.075, P = 0.015); participants who consumed >0.5
servings of yogurt per day had lower CCA-IMT versus those who
consumed <0.5 serving of yogurt per day (-0.023 mm, P = 0.003)
Abbreviations: C, carbon; CCA-IMT, common carotid artery intima-media thickness; CRP, C-reactive protein; CVD, cardiovascular disease; CI, confidence interval; CHD, coronary heart disease;
FFQ, food frequency questionnaire; IHD, ischemic heart disease; IL-6, interleukin-6; MI, myocardial infarction; RR, relative risk; sVCAM-1, soluble vascular cell adhesion molecule; TAG,
triglyceride; TNF-a, tumor necrosis factor-a.
Nutrition Reviews® Vol. 71(4):209–223216
studies examining the associations of milk and total dairy
intakes with the risk of cardiovascular diseases in over
600,000 participants in the United States, Europe, and
Japan found that milk intake was associated with a
reduced risk of overall cardiovascular diseases (dose
response of 6% reduced risk for each 200 mL/day).
30
Mean intake among participants was one serving of dairy
foods per day.
30
Notably, when analyzed according to fat
content, no association between high-fat, low-fat, or com-
bined total fat content of dairy foods and coronary heart
disease was detected, indicating a neutral effect of milk fat
on risk of coronary heart disease.
30
In a prospective study among adult women in the
United States, substituting dairy foods for fish was asso-
ciated with increased risk of coronary heart disease, and
consumption of high-fat dairy foods was associated with
an increased risk of coronary heart disease.
23
Consump-
tion of low-fat and high-fat dairy foods, however, when
compared with consumption of red meat, was associated
with a substantially lower risk of coronary heart disease.
26
The highest median dairy food intake was two servings
daily.
26
In another prospective investigation among
Dutch adults who consumed on average three servings of
dairy foods per day, fermented full-fat milk was inversely
associated with all-cause mortality, but dairy fat was asso-
ciated with an increased risk of all-cause and ischemic
heart disease mortality among women only.
28
Inacase-
control study of over 3,000 Costa Rican adults, however,
no association between dairy fat and risk of myocardial
infarction was detected.
25
In another investigation of over
1,500 Australian adults followed for 16 years, higher
intake of higher-fat dairy foods was associated with
decreased risk of cardiovascular mortality; 69% less risk
was associated with consuming about 1.5 servings of
higher-fat dairy foods per day versus 27% less risk asso-
ciated with consuming less than 0.5 serving of higher-fat
dairy foods per day.
27
In over 400 Swedish adults who
consumed one to two servings of dairy foods daily, higher
intake of dairy foods, as measured by biomarkers of milk
fat in adipose tissue, was associated with 26% less likeli-
hood of first myocardial infarction.
31
The men and
women studied consumed both low- and high-fat dairy
products such as milk, fermented milk, cheese, and
cream.
31
In postmenopausal women in Australia, con-
sumption of milk, cheese, and total dairy product (mean
intake of 2.3 servings per day) was not associated with
coronary heart disease as measured by common carotid
artery intima-media thickness.
29
Yogurt consumption was
inversely associated with coronary heart disease, and in
those women who consumed more than one-half serving
of yogurt daily, arterial thickness was less than in those
who consumed less than one-half serving daily.
29
The
results of these epidemiological studies indicate that low-
fat dairy foods are associated with decreased risk of coro-
nary heart disease. Whereas some studies pointed to
detrimental effects, the majority indicated that full-fat
dairy foods may have beneficial effects on risk of coronary
heart disease. Research on the effects of milk fat on risk of
coronary heart disease is ongoing.
Since the release of the DGAC report, four RCTs
have examined the effects of dairy consumption on biom-
arkers associated with risk of cardiovascular disease
(Table 4).
32–35
In addition to traditional lipid screenings,
biomarkers of inflammation have emerged as equally if
not more valuable indicators of coronary heart disease
risk.
36
In overweight and obese subjects, a weight-
maintenance diet including three daily servings of low-fat
dairy smoothies that provided a total of 1,050 mg of
calcium per day was shown to reduce biomarkers of oxi-
dative stress and chronic inflammation within 28 days
compared with a soy-based placebo smoothie that pro-
vided 500–600 mg of calcium per day.
35
The dairy inter-
vention also lowered serum low-density lipoprotein
cholesterol and had no adverse effects on blood pressure
or serum total cholesterol, high-density lipoprotein cho-
lesterol, or triglycerides.
35
Notably, in another study in
postmenopausal women, when three servings of reduced-
fat (2% fat) cow’s milk was compared with a vanilla soy
beverage containing comparable amounts of macronutri-
ents and calcium for 1 month, no differences in serum
lipids between groups, or from baseline, were detected.
32
In middle-aged overweight and obese adults, it was dem-
onstrated that daily consumption of three servings of
low-fat milk and yogurt had beneficial effects on several
biomarkers of inflammation.
34
Another intervention
designed to test the differences between effects of high-fat
and low-fat dairy foods on biomarkers of inflammation
following a single dairy meal showed that high-fat dairy
foods such as butter, cheese, cream, and yogurt (45 g of fat
per single-meal intervention) reduced several biomarkers
of inflammation as well as levels of both low-density and
high-density lipoprotein cholesterol.
33
Collectively, these studies indicate an inverse asso-
ciation between consumption of dairy foods and coro-
nary heart disease, adding to the evidence that led the
DGAC to conclude that “bioactive components that alter
serum lipid levels may be contained in milk fat.
8
Addi-
tionally, controlled trials that examined differences in
coronary heart disease risk based on the fat level of dairy
foods showed that the consumption of milk fat does not
detrimentally and may beneficially affect biomarkers
of coronary heart disease.
DAIRY CONSUMPTION AND TYPE 2 DIABETES
The review of the scientific literature by the DGAC pre-
sented findings from a meta-analysis of four prospective
studies and found the relative risk of type 2 diabetes was
Nutrition Reviews® Vol. 71(4):209–223 217
Table 4 Effects of dairy intake on biomarkers for cardiovascular disease risk: summary of randomized clinical trials conducted between June 2010 and
September 2011, using search terms dairy,milk, and cardiovascular disease.
Reference Characteristics of
participants
Study objective Dairy servings/
day in experimental
group
Results
Zemel et al.
(2010)
35
Obese and overweight
subjects (n = 20; 14
men, 6 women),
31 10.3 years of
age
Examine the effects of a soy-based
placebo weight-maintenance diet
(500–600 mg calcium/day) versus a
dairy diet (1,200–1,400 mg calcium/
day) for 28 days on body
composition, markers of oxidative
and inflammatory stress, blood
pressure, and other biochemical
variables
3 Dairy diet reduced markers of oxidative stress
(malondialdehyde, 22%, P < 0.05; 8-isoprostane F2a, 12%,
P < 0.02) compared with soy (no effect); dairy decreased
circulating TNF-a, IL-6, and CRP compared with soy
(P < 0.05); dairy increased adiponectin compared with soy
(P < 0.05); dairy decreased LDL cholesterol compared with
soy (P < 0.05); treatments had no effect on blood pressure,
total cholesterol, HDL cholesterol, or TAG
Nestel et al.
(2012)
33
Overweight subjects in
single-meal
intervention (n = 12)
and overweight
subjects in 4-week
intervention (n = 12),
44–69 years of age
Examine the effect of full-fat dairy
meals on inflammatory biomarkers of
CVD risk after a single meal and after
a 4-week intervention, measured
against a fat-free milk control
Approximately 2 Single-meal effects: following each full-fat meal, plasma TAG
increased (22%, butter; 20%, cheese; 40%, cream; 48%,
yogurt; P < 0.05), LDL cholesterol decreased (-6to-9%;
P < 0.05), HDL cholesterol decreased after butter (-3%),
cream (-6%), and yogurt (-7%), P < 0.05, plasma glucose
decreased after butter (-10%) and cheese (-23%), P < 0.05;
changes in inflammatory biomarkers were not different
between groups; within groups, MCP-1a, MIP-1a, and
sVCAM-1 were decreased in the cream group (P < 0.05),
IL-6 was decreased in the butter, cream, and control groups
(P < 0.05), IL-1b was decreased in the butter, cream, and
control groups (P < 0.05), TNF-a was decreased in the
butter, cream, and control groups (P < 0.05), and
high-sensitivity CRP was decreased in the butter and cream
groups (P < 0.05). There was no difference between the
different fat groups after the 4-week intervention
Van Meijl &
Mensink
(2010)
34
Overweight and obese
adults, 50 years of
age (n = 35)
Investigate the effects of low-fat dairy
consumption (milk and yogurt) on
inflammatory markers and adhesion
molecules after an 8-week period
>2.5 Low-fat dairy consumption decreased the plasma TNF-a to
TNF-a receptor-1 ratio (P = 0.015) but had no effect on
other markers of chronic inflammation and endothelial
function
Beavers
et al.
(2010)
32
Postmenopausal
women, 40–60 years
of age (n = 32)
Examine the effect of reduced-fat cow’s
milk (4.5 g per serving) versus vanilla
soy beverage (4 g of fat per serving)
on plasma cholesterol concentrations
after a period of 4 weeks
3 There were no differences in TAG, LDL cholesterol, or HDL
cholesterol between cow’s milk and soy beverage groups
or from baseline in either group after the intervention
Abbreviations: CRP, C-reactive protein; CVD, cardiovascular disease; HDL, high-density lipoprotein; IL-6, interleukin-6; IL-1b, interleukin-1b; LDL, low-density lipoprotein; MIP-1a, macrophage
inflammatory protein; MCP-1a, monocyte chemoattractant protein-1 a; sVCAM-1, soluble vascular cell adhesion molecule; TAG, triglyceride; TNF-a, tumor necrosis factor-a.
Nutrition Reviews® Vol. 71(4):209–223218
estimated to be 10% lower in people with higher milk
intake than in those with lower consumption.
8
Based on
this finding, the 2010 DGA stated that moderate evidence
indicates the intake of dairy foods is associated with a
reduced risk of type 2 diabetes.
3
Several epidemiological
studies designed to assess the relationship between dairy
consumption and type 2 diabetes have been published
since the release of the 2010 DGAC report and all have
reported an inverse association between the intake of
milk and milk products and the risk of type 2 diabetes
(Table 5).
37–40
A prospective study that assessed how dairy
consumption by adolescents was associated with the inci-
dence of type 2 diabetes in adulthood found that adults
who reported consistently consuming two servings of
dairy per day during adolescence had a 43% less risk of
developing type 2 diabetes in adulthood when compared
with adults who reported consuming one-half serving or
less of dairy per day during adolescence.
38
Consumption
of both low-fat and full-fat dairy foods in adolescence was
inversely associated with type 2 diabetes in adulthood.
38
A
prospective study of older adults found that circulating
trans-9 C16:1, a biomarker indicative of dairy fat con-
sumption, was associated with a 62% lower incidence of
type 2 diabetes in adults who consumed at least one
serving compared to those who consumed less than one
serving of reduced-fat (2% milk fat) and/or full-fat dairy
foods daily.
39
Another study conducted in French adults
found that those who consumed more than three servings
of milk or yogurt daily had a 15% lower risk of incident
metabolic syndrome and/or type 2 diabetes compared
with those who consumed less than one serving of milk or
yogurt daily.
37
Cheese consumption had no effect on the
incidence of metabolic syndrome and/or type 2 diabe-
tes.
37
In a meta-analysis of over 300,000 American, Japa-
nese, and Chinese middle-aged participants, higher dairy
consumption (>3 servings/day versus <1 serving/day)
was associated with a 15% reduced risk of type 2 diabe-
tes.
40
A dose-response analysis showed that the risk of
type 2 diabetes could be reduced by 5% for each addi-
tional serving of total dairy products and by 10% for each
additional serving of low-fat dairy products consumed.
40
Findings from these epidemiological investigations indi-
cate milk and milk products, regardless of fat level, are
associated with a reduced risk of type 2 diabetes. Further-
more, exceeding current recommendations of three serv-
ings daily may further reduce risk.
Since the release of the 2010 DGAC report, two RCTs
have investigated the effects of dairy consumption on risk
factors associated with type 2 diabetes.
41,42
It was demon-
strated in middle-aged overweight and obese individuals
that consumption of three and one-half servings of dairy
per day, with two of the three being milk and/or yogurt
(fat level not reported), resulted in increased insulin sen-
sitivity and decreased plasma insulin within 1 week of
consuming dairy foods, changes that were sustained
throughout the 12-week duration of the study.
42
Addi-
tionally, beneficial effects on several lipid and inflamma-
tory markers of metabolic health were observed when
comparing these individuals with those who consumed
less than one-half serving of dairy daily.
42
In middle-aged
subjects with type 2 diabetes, vitamin-D- and calcium-
fortified yogurt drinks consumed twice daily for 3
months led to decreases in fasting serum glucose, glycated
hemoglobin, and insulin resistance measured by the
Homeostasis Model of Assessment–Insulin Resistance,
which are indicators of glycemic status.
41
DAIRY CONSUMPTION AND BLOOD PRESSURE
The 2010 DGA stated there was moderate evidence that
dairy consumption is associated with lower blood pres-
sure in adults.
3
Dietary patterns that incorporate at least
three servings of dairy daily, such as the Dietary
Approaches to Stop Hypertension eating plan, which
includes low-fat milk, cheese, and yogurt and one serving
of full-fat cheese each day, have been successful in reduc-
ing blood pressure.
8
The DGAC, however, noted that an
independent relationship between dairy intake and blood
pressure is complicated to evaluate due to varying types
of dairy products consumed in research trials, confound-
ing effects of calcium intake from other food sources, and
the beneficial effect of weight loss on blood pressure.
8
A
systematic review and meta-analysis of studies evaluating
the association between dairy intake and blood pressure
in approximately 45,000 adults found that consumption
of dairy foods was associated with a 13% reduced risk of
elevated blood pressure.
43
Separation of high-fat and low-
fat dairy foods revealed an inverse association between
only low-fat dairy foods and elevated blood pressure, with
no effect from high-fat dairy foods or cheese.
43
Since the release of the 2010 DGAC report, four
RCTs have investigated the effects of dairy foods on
blood pressure and components of blood pressure
control (Table 6).
42,44–46
While other RCTs have tested
the effects of specific dairy ingredients on blood pressure
control,
47–50
those trials were beyond the scope of this
review. In middle-aged overweight and obese adults, daily
consumption of greater than two and one-half servings of
low-fat milk and yogurt for 8 weeks was demonstrated to
reduce systolic blood pressure by 2.9 mmHg.
45
In another
study of overweight and obese middle-aged adults,
consumption of greater than three and one-half com-
pared with less than three servings of dairy foods, two
of which were milk and/or yogurt (fat content not
reported), daily for 12 weeks decreased systolic blood
pressure by 7.1 3.1 mmHg and diastolic blood pressure
by 4.1 1.9 mmHg.
42
In two studies of borderline hyper-
tensive adults fed just over one serving daily of fermented
Nutrition Reviews® Vol. 71(4):209–223 219
Table 5 Effects of dairy intake on risk of type 2 diabetes: summary of studies conducted between June 2010 and September 2011, using search terms dairy,
“milk, and “type 2 diabetes.
Reference Characteristics of
participants
Study design and objective Mean
servings
of dairy
per day
Results
Epidemiological studies
Malik et al.
(2011)
38
Women, 34–53 years of
age (n = 37,038)
Prospective study to assess the relationship between dairy
product consumption as reported through a diet recall FFQ
and incidence of T2D in adulthood
0.5–2 Two servings of dairy per day associated with 27% lower risk of T2D (RR,
0.73; 95%CI, 0.54–0.97; P = 0.02) and was attenuated with adjustment
for adult dairy product consumption. Multivariate analysis of
adolescent and adult consumption showed consistently higher intakes
of dairy were associated with the lowest risk of T2D (RR, 0.57; 95%CI,
0.39–0.82; P < 0.05)
Tong et al.
(2011)
40
American, Japanese, and
Chinese adults
(>23,000 cases), 39–57
years of age
(n > 330,000)
Meta-analysis to elucidate the association between
consumption of dairy products and T2D
0–3 Dairy consumption inversely associated with T2D (combined RR, 0.86;
95%CI, 0.79–0.92). Individual dairy foods were inversely or not
associated with T2D: low-fat dairy (combined RR, 0.82; 95%CI,
0.74–0.90), high-fat dairy (combined RR, 1.00; 95%CI, 0.89–1.10),
whole milk (combined RR, 0.95; 95%CI, 0.86–1.05), yogurt (combined
RR, 0.83; 95%CI 0,74–0.93). Dose-response analysis showed T2D risk
could be reduced 5% for total dairy products and 10% for low-fat
dairy products
Fumeron et al.
(2011)
37
French adults, 30–65
years of age
(n = 3,435)
Prospective study to assess the influence of milk and dairy
products (not including cheese) versus cheese on incident
MetS and impaired fasting glycemia and/or T2D after 9
years of follow-up
0.5–>1 Milk and dairy products (not including cheese) inversely associated with
incident MetS and impaired fasting glycemia and/or T2D (OR, 0.85;
95%CI, 0.76–0.94; P = 0.001). Cheese not associated with incident
MetS and impaired fasting glycemia and/or T2D (P > 0.05)
Mozaffarian
et al.
(2010)
39
Adults, 75 years of age
(n = 3,736)
Prospective cohort study to investigate whether circulating
trans-9 C16:1 (a biomarker of ruminant milk and meat
intake) is independently related to lower metabolic risk
and incident T2D
1–2 Whole-fat dairy consumption (whole milk, 2% milk, cheese, butter, and
ice cream) most strongly associated with higher trans-9 C16:1. trans-9
C16:1 associated with higher HDL cholesterol (1.9%, P = 0.04), lower
TAG (-19%, P < 0.001), lower total cholesterol to HDL cholesterol ratio
(-4.7%, P < 0.001), lower CRP (-13.8%, P = 0.05), lower insulin
resistance (-16.7%, P < 0.001), and lower incidence of T2D (HR, 0.38;
95%CI, 0.24–0.62; P < 0.001)
Clinical trials
Nikooyeh
et al.
(2011)
41
Diabetic Iranian adults,
30–60 years of age
(n = 90)
Examine the effects of 200 mL plain yogurt drink (150 mg Ca),
vitamin-D-fortified yogurt drink (500 IU vitamin D and
150 mg Ca), and vitamin D + Ca-fortified yogurt drink
(500 IU vitamin D and 250 mg Ca) twice daily for 12 weeks
on fasting serum glucose, glycated hemoglobin, HOMA–IR,
serum lipid profile, and percent fat mass
2 Vitamin-D-fortified and vitamin D + Ca-fortified yogurt drink decreased
fasting serum glucose (P = 0.015), glycated hemoglobin (P < 0.001),
HOMA–IR (P 0.001), waist circumference (P < 0.001), and BMI
(P 0.005) compared with the plain yogurt drink
Stancliffe et al.
(2011)
42
Overweight and obese
adults, 37 9.9 years
of age (n = 40)
Determine the early (7-day) and sustained (4- and 12-week)
effects of higher-dairy (3.5 dairy servings/day) and
lower-dairy (<0.5 serving/day) diets on oxidative and
inflammatory biomarkers in subjects with MetS
<0.5–3.5 Higher-dairy diet decreased malondialdehyde and oxidized LDL
cholesterol at 7 days (P < 0.01), suppressed TNF-a (P < 0.05), IL-6
(P < 0.02), and MCP-1 (P < 0.05), and increased adiponectin (P < 0.01)
from baseline, whereas lower-dairy diet had no effect on oxidative or
inflammatory markers
Abbreviations: BMI, body mass index; C, carbon; Ca, calcium; CRP, C-reactive protein; CI, confidence interval; FFQ, food frequency questionnaire; HDL, high-density lipoprotein; HOMA–IR, homeostasis
model of assessment–insulin resistance; HR, hazard ratio; IL-6, interleukin-6; IU, international units; LDL, low-density lipoprotein; MCP-1, monocyte chemoattractant protein 1; MetS, metabolic
syndrome; OR, odds ratio; RR, relative risk; TAG, triglyceride; T2D, type 2 diabetes; TNF-a, tumor necrosis factor-a.
Nutrition Reviews® Vol. 71(4):209–223220
Table 6 Effects of dairy and dairy ingredients on blood pressure control: Summary of randomized clinical trials conducted between June 2010 and September
2011, using search terms dairy,milk,“blood pressure, and “hypertension.
Reference Characteristics of
participants
Study objective Dairy servings per day in
experimental group
Results
van Meijl &
Mensink
(2011)
45
Overweight and
obese adults, 50
years of age
(n = 35)
Investigate the effects of daily
consumption of low-fat
dairy products on metabolic
risk parameters after a
period of 8 weeks
>2.5 servings of
low-fat milk and
yogurt
SBP decreased by 2.9 mmHg (95%CI , -5.5–-0.3; P = 0.027),
HDL cholesterol decreased by 0.04 mmol/L (95%CI,
-0.07–-0.01; P = 0.021), apo/A-1 decreased by 0.04 g/L
(95%CI , -0.07–-0.01; P = 0.016). There was no difference
in DBP, total cholesterol, LDL cholesterol, apo B, TAG, NEFA,
glucose, insulin, CRP, or plasminogen activator inhibitor-1
Stancliffe et al.
(2011)
42
Overweight and
obese adults,
37–40 years of age
(n = 48)
Determine early and sustained
effects of higher dairy
consumption versus lower
dairy consumption after
periods of 7 days, 4 weeks,
and 12 weeks
3.5 servings of dairy
foods
Consumption of 3.5 servings/day decreased SBP (P < 0.01)
and DBP (P < 0.05), insulin sensitivity (P < 0.05), plasma
insulin (P < 0.05), malondialdehyde (P < 0.01), oxidized LDL
(P < 0.02), TNF-a (P < 0.01), MCP-1 (P < 0.02), IL-6 (P < 0.02),
CRP (P < 0.02), DBP in only the obese (P < 0.05), plasma
cholesterol in only the obese (P < 0.02), and plasma TAG in
only the obese (P < 0.05)
Usinger et al.
(2010)
46
Borderline-hypertensive
adults, 54–56
years of age
(n = 94)
Study the effect of
Lactobacillus helveticus
fermented milk on blood
pressure control after a
period of 8 weeks
>1 serving of
fermented milk
No ACE inhibition by fermented milk was detected
Usinger et al.
(2010)
44
Borderline-hypertensive
adults, 54–56
years of age
(n = 94)
Study the effect of
Lactobacillus helveticus
fermented milk on blood
pressure control after a
period of 8 weeks
>1 serving of
fermented milk
No difference in SBP or DBP was detected between lower and
higher consumption
Abbreviations: apo, apolipoprotein; ACE, angiotensin-converting enzyme; CI, confidence interval; CRP, C-reactive protein; DBP, diastolic blood pressure; HDL, high-density lipoprotein; IL-6,
interleukin-6; LDL, low-density lipoprotein; MAP, mean arterial pressure; MCP-1, monocyte chemoattractant protein 1; NEFA, nonesterified fatty acid; sVCAM-1, soluble vascular cell adhesion
molecule; SBP, systolic blood pressure; TAG, triglyceride; TNF-a, tumor necrosis factor-a.
Nutrition Reviews® Vol. 71(4):209–223 221
milk for 8 weeks, no changes in systolic or diastolic blood
pressure or components of blood pressure control were
observed.
44,46
These studies indicate that at least two and
one-half servings of dairy per day is the level at which the
effects of dairy on blood pressure are seen. Further studies
in normal-weight and obese individuals with and without
underlying hypertension will aid in better understanding
the relationship between dairy consumption and blood
pressure control.
CONCLUSION
Since the release of the 2010 DGAC report on the 2010
DGA, many studies have been published that make
important contributions to the literature on the relation-
ship between dairy consumption, nutrient intakes, and
reduced risk of chronic diseases. As the US population
continues to underconsume nutrients such as vitamin D,
calcium, magnesium, and potassium,
3,5
they also under-
consume the recommended daily servings of dairy
foods. Since milk and milk products are major contribu-
tors of these nutrients to the typical diet in the United
States,
8–10
consuming, at minimum, three servings of
dairy foods each day would help close the gap on several
nutrients that are typically underconsumed.
7
The totality
of the evidence indicates that consumption of three or
more servings of dairy per day has beneficial effects on
bone in adults, but four servings per day may be neces-
sary to achieve the nutrient status associated with
optimal bone health in adulthood. Recent studies con-
tinue to build on the evidence that dairy consumption is
inversely associated with the development of cardiovas-
cular disease, even at intakes below recommended levels.
Milk fat may contribute to the beneficial effects of dairy
foods on cardiovascular disease risk, but more research
is needed. Recent findings further support the evidence
reviewed by the DGAC indicating that meeting recom-
mendations for dairy consumption reduces the risk of
type 2 diabetes and has beneficial effects on blood pres-
sure, and that exceeding recommendations may provide
further benefits.
In conclusion, meeting and exceeding recommenda-
tions for consumption of dairy products each day, in
combination with a healthy dietary pattern, leads to better
nutrient status, can lead to improved bone health, and is
associated with lower blood pressure and a reduced risk
of cardiovascular disease and type 2 diabetes.
Acknowledgments
Declaration of interest. The authors are employees of the
Dairy Research Institute/Dairy Management Inc., Rose-
mont, Illinois, USA.
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    • "For example, a recent systematic review and meta-analysis reported that the available evidence does not support recommendations to consume more polyunsaturated fatty acids and less saturated fatty acids [38]. Specific to dairy foods, several recent meta-analyses [39,40] and systematic reviews [41][42][43][44]have either found no association or an inverse association between the consumption of dairy foods and cardiovascular risk. Finally, higher sodium intakes are associated with elevated blood pressure and increased risk for hypertension, especially in at-risk individuals. "
    [Show abstract] [Hide abstract] ABSTRACT: Diets rich in plant foods and lower in animal-based products have garnered increased attention among researchers, dietitians and health professionals in recent years for their potential to, not only improve health, but also to lessen the environmental impact. However, the potential effects of increasing plant-based foods at the expense of animal-based foods on macro- and micronutrient nutrient adequacy in the U.S. diet is unknown. In addition, dairy foods are consistently under consumed, thus the impact of increased dairy on nutrient adequacy is important to measure. Accordingly, the objective of this study was to use national survey data to model three different dietary scenarios to assess the effects of increasing plant-based foods or dairy foods on macronutrient intake and nutrient adequacy. Data from the National Health and Nutrition Examination Survey (NHANES) 2007-2010 for persons two years and older (n = 17,387) were used in all the analyses. Comparisons were made of usual intake of macronutrients and shortfall nutrients of three dietary scenarios that increased intakes by 100%: (i) plant-based foods; (ii) protein-rich plant-based foods (i.e., legumes, nuts, seeds, soy); and (iii) milk, cheese and yogurt. Scenarios (i) and (ii) had commensurate reductions in animal product intake. In both children (2-18 years) and adults (≥19 years), the percent not meeting the Estimated Average Requirement (EAR) decreased for vitamin C, magnesium, vitamin E, folate and iron when plant-based foods were increased. However the percent not meeting the EAR increased for calcium, protein, vitamin A, and vitamin D in this scenario. Doubling protein-rich plant-based foods had no effect on nutrient intake because they were consumed in very low quantities in the baseline diet. The dairy model reduced the percent not meeting the EAR for calcium, vitamin A, vitamin D, magnesium, and protein, while sodium and saturated fat levels increased. Our modeling shows that increasing plant-based foods could lead to unintended dietary outcomes without simultaneous changes in the types and amounts of plant foods currently consumed. Increasing dairy foods, which are currently under-consumed, could assist in improving the intakes of many nutrients of concern.
    Full-text · Article · Jul 2016
    • "Yet, milk is a significant source of nutrients also for adults. Consuming more than three servings of dairy per day leads to better nutrient status, improved bone health and is associated with lower blood pressure, reduced risk of cardiovascular disease and type 2 diabetes (Rice et al. 2013 ). Thus technologies, which allow modification of milk proteins to increase tolerability of milk provide potential to develop new dairy products also for adults with milk sensitivity. "
    [Show abstract] [Hide abstract] ABSTRACT: Gastrointestinal symptoms associated with milk are common. Besides lactose, milk proteins may cause symptoms in sensitive individuals. We have developed a method for mild enzymatic hydrolysation of milk proteins and studied the effects of hydrolysed milk on gastrointestinal symptoms in adults with a self-diagnosed sensitive stomach. In a double blind, randomised placebo-controlled study, 97 subjects consumed protein-hydrolysed lactose-free milk or commercially available lactose-free milk for 10 d. Frequency of gastrointestinal symptoms during the study period was reported and a symptom score was calculated. Rumbling and flatulence decreased significantly in the hydrolysed milk group ( P < 0·05). Also, the total symptom score was lower in subjects who consumed hydrolysed milk ( P < 0·05). No difference between groups was seen in abdominal pain ( P = 0·47) or bloating ( P = 0·076). The results suggest that mild enzymatic protein hydrolysation may decrease gastrointestinal symptoms in adults with a sensitive stomach.
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    • "Conclusion U.S. American nutrition guidelines state that most dairy product choices should be fat-free or reduced-fat, based on the potentially detrimental health effects of SFA [64]. Nonetheless, there is no conclusive evidence that whole milk consumption is harmful to human health [7]. The reduced intake of milk fat in response to these guidelines may result in consumers lacking in various bioactive FA provided by whole-fat dairy products. "
    [Show abstract] [Hide abstract] ABSTRACT: Dairy products contain bioactive fatty acids (FA) and are a unique dietary source of an emerging class of bioactive FA, branched-chain fatty acids (BCFA). The objective of this study was to compare the content and profile of bioactive FA in milk, with emphasis on BCFA, among Holstein (HO), Jersey (JE), and first generation HO x JE crossbreeds (CB) across a lactation to better understand the impact of these factors on FA of interest to human health. Twenty-two primiparous cows (n = 7 HO, n = 7 CB, n = 8 JE) were followed across a lactation. All cows were fed a consistent total mixed ration (TMR) at a 70:30 forage to concentrate ratio. Time points were defined as 5 days in milk (DIM), 95 DIM, 185 DIM, and 275 DIM. HO and CB had a higher content of n-3 FA at 5 DIM than JE and a lower n-6:n-3 ratio. Time point had an effect on the n-6:n-3 ratio, with the lowest value observed at 5 DIM and the highest at 185 DIM. The content of vaccenic acid was highest at 5 DIM, yet rumenic acid was unaffected by time point or breed. Total odd and BCFA (OBCFA) were higher in JE than HO and CB at 185 and 275 DIM. Breed affected the content of individual BCFA. The content of iso-14:0 and iso-16:0 in milk was higher in JE than HO and CB from 95 to 275 DIM. Total OBCFA were affected by time point, with the highest content in milk at 275 DIM. In conclusion, HO and CB exhibited a higher content of several bioactive FA in milk than JE. Across a lactation the greatest content of bioactive FA in milk occurred at 5 DIM and OBCFA were highest at 275 DIM.
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