Article

Association of dairy intake with cardiovascular disease and mortality in 21 countries from five continents (PURE): a prospective cohort study

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Abstract

Background: Dietary guidelines recommend minimising consumption of whole-fat dairy products, as they are a source of saturated fats and presumed to adversely affect blood lipids and increase cardiovascular disease and mortality. Evidence for this contention is sparse and few data for the effects of dairy consumption on health are available from low-income and middle-income countries. Therefore, we aimed to assess the associations between total dairy and specific types of dairy products with mortality and major cardiovascular disease. Methods: The Prospective Urban Rural Epidemiology (PURE) study is a large multinational cohort study of individuals aged 35-70 years enrolled from 21 countries in five continents. Dietary intakes of dairy products for 136 384 individuals were recorded using country-specific validated food frequency questionnaires. Dairy products comprised milk, yoghurt, and cheese. We further grouped these foods into whole-fat and low-fat dairy. The primary outcome was the composite of mortality or major cardiovascular events (defined as death from cardiovascular causes, non-fatal myocardial infarction, stroke, or heart failure). Hazard ratios (HRs) were calculated using multivariable Cox frailty models with random intercepts to account for clustering of participants by centre. Findings: Between Jan 1, 2003, and July 14, 2018, we recorded 10 567 composite events (deaths [n=6796] or major cardiovascular events [n=5855]) during the 9·1 years of follow-up. Higher intake of total dairy (>2 servings per day compared with no intake) was associated with a lower risk of the composite outcome (HR 0·84, 95% CI 0·75-0·94; ptrend=0·0004), total mortality (0·83, 0·72-0·96; ptrend=0·0052), non-cardiovascular mortality (0·86, 0·72-1·02; ptrend=0·046), cardiovascular mortality (0·77, 0·58-1·01; ptrend=0·029), major cardiovascular disease (0·78, 0·67-0·90; ptrend=0·0001), and stroke (0·66, 0·53-0·82; ptrend=0·0003). No significant association with myocardial infarction was observed (HR 0·89, 95% CI 0·71-1·11; ptrend=0·163). Higher intake (>1 serving vs no intake) of milk (HR 0·90, 95% CI 0·82-0·99; ptrend=0·0529) and yogurt (0·86, 0·75-0·99; ptrend=0·0051) was associated with lower risk of the composite outcome, whereas cheese intake was not significantly associated with the composite outcome (0·88, 0·76-1·02; ptrend=0·1399). Butter intake was low and was not significantly associated with clinical outcomes (HR 1·09, 95% CI 0·90-1·33; ptrend=0·4113). Interpretation: Dairy consumption was associated with lower risk of mortality and major cardiovascular disease events in a diverse multinational cohort. Funding: Full funding sources are listed at the end of the paper (see Acknowledgments).

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... Annually, more than half of the deaths are due to cardiovascular disease (CVD) and cancer worldwide (1,2) . Healthy diet plays a prominent and profound role in these conditions. ...
... Moreover, yogurt provides energy and beneficial compounds such as proteins, minerals, multivitamins, and conjugated linoleic acid that may jointly favor long-term health (4) . However, it is also a source of saturated fats and added sugar, which is presumed to increase risk of CVD and mortality (2,5) . ...
... in Netherlands (14,16,49) , one in Australia (47) , five (seven publications, three of them were reports from one study) in Japan (19-22, 26, 28, 48) , one in Italy (25) , one in Iran (12) , and the study of Dehghan et al (2) cases of CVD mortality were included. One publication included only men (18) , one included only women (22) , and the others included both men and women. ...
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Objectives To quantify the dose-response relation between yogurt consumption and risk of mortality from all causes, cardiovascular disease (CVD), and cancer. Design Systematic review and meta-analysis. Setting We conducted a comprehensive search of PubMed/Medline, ISI Web of Science, and Scopus databases through August 2022 for cohort studies reporting the association of yogurt consumption with mortality from all causes, CVD, and cancer. Summary relative risks and 95% confidence intervals (CIs) were calculated with a random effects model. Participants 17 cohort studies (18 publications) of 896871 participants with 75791 deaths (14623 from CVD and 20926 from cancer). Results High intake of yogurt compared with low intake was significantly associated with a lower risk of deaths from all causes (pooled relative risk 0.93; 95%CI: 0.89-0.98, I ² =47.3%, n= 12 studies) and CVD (0.89; 95% CI: 0.81-0.98, I ² =33.2%, n=11), but not with cancer (0.96; 95% CI: 0.89-1.03, I ² =26.5%, n=12). Each additional serving of yogurt consumption per day was significantly associated with a reduced risk of all-cause (0.93; 95% CI: 0.86-0.99, I ² =63.3%, n=11) and CVD mortality (0.86; 95% CI: 0.77-0.99, I ² =36.6%, n=10). There was evidence of non-linearity between yogurt consumption and risk of all-cause and CVD mortality, and there was no further reduction in risk above 0.5 serving/day. Conclusion Summarizing earlier cohort studies, we found an inverse association between yogurt consumption and risk of all-cause and CVD mortality; however, there was no significant association between yogurt consumption and risk of cancer mortality.
... 1950 publicerade den svenska biokemisten Haqvin Malmros (1895Malmros ( -1995 en studie där han observerat en samvariation mellan konsumtion av kolesterol, mättat fett och hjärtsjukdomar i olika delar av världen (Malmros, 1950 (Astrup et al. 2019;Dehghan et al. 2018;Han et al. 2019;Johnston et al. 2019;Zeeratkar et al. 2019). Jag belyser näringsforskning i kapitel 7. ...
... Dairy consumption was associated with lower risk of mortality and major cardiovascular disease events in a diverse multinational cohort (Dehghan et al. 2018). ...
... Som vi såg i redovisningen av internationellt renommerade studier är mättat fett och kött inte associerat med ohälsa och för tidig död (Astrup et al. 2019;Astrup et al. 2020;Dehghan et al. 2018;Han et al. 2019;Howard et al. 2006;Johnston et al. 2019;Mente et al. 2009;Ramsden et al. 2016;Siri-Tarino, 2010;Teicholz, 2015;Zeeratkar et al. 2019). Att komplettera kosten till 7 -12 månaders barn med kött var associerad betydligt högre zinkupptag jämfört med att komplettera med spannmål (Krebs et al. 2006). ...
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Människan föds med en kombination av social kognition (rytmisk synkronisering av beteende), språk & exekutiva funktioner liksom konstruktivt minne. Dessa möjliggör tillsammans entreprenöriellt tänkande. I bakgrunden lurar mentala fallgropar bekräftelse-bias, tribalism och dysrationalia – oförmågan att tänka logiskt trots tillräcklig intelligens. Från min tidigare forskning vet jag att Entreprenöriellt tänkande påverkas av prospektivt ledarskap. Men vi måste också vara rationella. Från detta projekt föreslår jag tre faktorer: (1) epistemisk vaksamhet (2), numeracy (3) och disjunktivt resonerande. På basis av rationellt entreprenöriellt tänkande kan jordbruket och dess kontext. Klimat är ett komplex där spårgaser rör sig cyklist mellan fem sfärer över lång tid. ’Kolcykeln’ är central. Den moderna biosfären började framträda vid den Kambriska explosionen (-541 miljoner år före nutid; CO2 nivå ~5000 ppm). Sedan dess har Jorden genomgått ~100 klimatförändringar; 90 % av koldioxiden har rört sig från atmosfären till berggrunden, skogar och hav. Efter ett asteroidnedslag i México (66 miljoner år före nutid), öppnades dörren för däggdjuren. Efter två supervulkanutbrott (VEI>8) för ~8 miljoner år sedan delade våra förfäder väg med schimpanser. Efter en följande klimatförändring som tömde och återfyllde Medelhavet lade de kött & benmärg ’på tallriken’. Det ledde till en expansion av deras hjärnor. Större hjärnor möjliggjorde etablering av (1) rytmisk synkronisering och (2) exekutiva funktioner och språk. Efter ytterligare två supervulkanutbrott (~70 000 för nutid; VEI>8) framträdde konstruktivt minne. Det följdes av de första innovationerna, de första bosättningarna, det första kända brödet och det första kända ölet samt nätverkande mellan byar. Efter nästa klimatförändring inträffade den så kallade jordbruksrevolutionen. Det ledde till missväxt och konflikter. Med introduktion av teknologi inledde en effektivisering. Jordbruket (1) upptar en bråkdel Jordens yta och det mesta som växer där passar för idisslare, (2) har sin egen kolcykel - den Biogeniska kolcykeln. Näringsforskning och antropologiska observationer visar att kött, ägg och feta mejerier, ackompanjerat av något grönt, är avgörande för att upprätthålla fysisk och psykisk hälsa. Västvärldens bönder producerar näringsrik mat effektivt och klimatsmart. En trend för matproduktion pekar mot regenerativ produktion med tät djurhållning. Men det vet inte kunderna om. Därför krävs rationellt entreprenöriellt tänkande, nätverkande och marknadskommunikation.
... The evidence, therefore, from prospective studies on the association of SFA with mortality and CVD events is mixed although most studies/meta-analyses (Chowdhury et al., 2014;de Souza et al., 2015;Dehghan et al., 2018;Heileson, 2019;Mazidi et al., 2020;Schwingshackl et al., 2021;Siri-Tarino et al., 2010) reported a neutral association. The PURE study (Dehghan et al., 2018;Mente et al., 2017) is of particular interest as it also provided details on blood lipids. ...
... The evidence, therefore, from prospective studies on the association of SFA with mortality and CVD events is mixed although most studies/meta-analyses (Chowdhury et al., 2014;de Souza et al., 2015;Dehghan et al., 2018;Heileson, 2019;Mazidi et al., 2020;Schwingshackl et al., 2021;Siri-Tarino et al., 2010) reported a neutral association. The PURE study (Dehghan et al., 2018;Mente et al., 2017) is of particular interest as it also provided details on blood lipids. Increased SFA intake increased serum TC and LDL-C but also increased HDL-C leading to a reduction in the TC:HDL-C ratio, in agreement with the observed reduction in all-cause mortality and stroke. ...
... There is good evidence that most SFA increase LDL-C and HDL-C (Mensink et al., 2003), and there is now no doubt that LDL particles have a direct causative role in the development of atherosclerotic CVDs (Ference et al., 2017), and the consensus paper of Borén et al. (2020) explores the complexity of the mechanisms involved. There is, however, increasing uncertainty that lowering LDL-C concentration by reducing/replacing dietary SFA intake will inevitably lead to CVD risk reduction (Dehghan et al., 2018;Mente et al., 2017). As noted earlier, some of the studies that have contributed to the evidence are flawed for various reasons including being underpowered and poorly designed but there are a number of other possible reasons that contribute to the uncertainty. ...
Article
Cardiovascular diseases (CVDs) are a major cause of death and morbidity in many parts of the world, and many dietary guidelines limit the intake of saturated fatty acids (SFA) as they are regarded as an important risk factor for CVDs due to their association with increased blood cholesterol. Dairy foods are often a major contributor to dietary intake of SFA, and since many dietary guidelines contain restrictions on SFA intake, this can lead to a moderation of dairy food intake despite meta‐analyses generally showing dairy to have a neutral or negative association with CVDs. Many prospective studies and randomised controlled trials do not support a simple positive association between SFA intake and the risk of atherosclerotic CVD and its components although some early studies had a number of methodological weakness. Studies that included blood cholesterol data do broadly support the positive relationship between SFA and blood low‐density lipoprotein cholesterol (LDL‐C) but without increased CVD risk resulting, despite LDL being a causal factor in atherosclerotic CVD. These data suggest that LDL‐C alone is not a consistently good predictor or cause of CVD risk, perhaps particularly in relation to dairy food consumption although some non‐dairy food studies have also shown LDL‐C reduction was not reflected in reduced CVD risk. This narrative review examines some reasons for these findings. Overall, restrictions on dairy food intake do not seem warranted, although there remains a need to further understand the association of different dairy food types with chronic diseases, perhaps particularly for type 2 diabetes.
... However, in recent years, observational studies and meta-analyses found contradictory results with respect to the different types of dairy or milk (e.g., whole milk and reduced fat milk) in relation to health, particularly in terms of total mortality and cardiovascular mortality [4,7,8]. Some studies concluded that full-fat dairy is not clearly associated with risk of CVD [9], with some indicating that full-fat dairy plays a protective role in the prevention of CVD [10][11][12]. This protection is explained by the high bioavailability of highvalue nutrients and anti-inflammatory properties of full-fat dairy [13], including specific amino acids, medium-chain and odd-chain saturated fats, phospholipids, unsaturated and branched-chain fats, natural trans fats, vitamin K1 and K2 and calcium [8,14,15]. ...
... Secondly, the role of dairy products in the secondary prevention and management of CVD is largely overlooked; hence, attention needs to be directed to the critical part that diet can play to prevent cardiovascular events. Most studies focus on dairy consumption and the risk of incident CVD as part of primary prevention (10)(11)(12), with very few tracking dairy consumptions among people diagnosed with CVD. We therefore focused on people diagnosed with CVD. ...
... Recently there is more consistent evidence pointing towards total dairy intake associated with lower cardiovascular mortality. For example, the Prospective Urban Rural Epidemiology (PURE) study including data from 21 countries found that a higher intake of total dairy and milk associated with lower cardiovascular mortality than a lower dairy and milk intake, whereas a higher intake of cheese had a neutral effect on CVD [11]. A meta-analysis of nine cohort studies reported that a high total milk consumption has no effect on CVD, but was associated with a lower risk of hypertension [29]. ...
Article
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Most studies disregard long-term dairy consumption behaviour and how it relates to mortality. We examined four different types of long-term milk consumption, namely whole milk, reduced fat milk, skim milk and soy milk, in relation to mortality among adults diagnosed with cardiovascular disease (CVD). A retrospective population-based study was conducted in Australia (the 45 and Up Study) linking baseline (2006-2009) and follow-up data (2012-2015) to hospitalisation and mortality data up to 30 September 2018. A total of 1,101 deaths occurred among 7236 participants with CVD over a mean follow-up of 8.4 years. Males (Hazard Ratio, HR = 0.69, 95% CI (0.54; 0.89)) and females (HR = 0.59 (0.38; 0.91)) with long-term reduced fat milk consumption had the lowest risk of mortality compared to counterparts with long-term whole milk consumption. Among participants with ischemic heart disease, males with a long-term reduced fat milk consumption had the lowest risk of mortality (HR = 0.63, 95% CI: 0.43; 0.92). We conclude that among males and females with CVD, those who often consume reduced fat milk over the long-term present with a 31-41% lower risk of mortality than those who often consume whole milk, supporting dairy advice from the Heart Foundation of replacing whole milk with reduced fat milk to achieve better health.
... However, it is generally agreed that the risk factors of central obesity, high blood pressure (BP), elevated levels of triglycerides (TG), low concentration of high-density lipoprotein cholesterol (HDL) and elevated fasting plasma glucose (FPG) tend to co-exist and are important indicators of an individual's risk of CVDs and T2D [9][10][11][12][13]. The increasing prevalence of these risk factors has been linked to genetic and environmental factors [1,[14][15][16][17], and there is growing interest in the role of different types of food in the development of MS [1,5,16,17]. Several studies have reported a protective effect of dairy consumption on the risk of MS [5,[18][19][20][21]. ...
... However, it is generally agreed that the risk factors of central obesity, high blood pressure (BP), elevated levels of triglycerides (TG), low concentration of high-density lipoprotein cholesterol (HDL) and elevated fasting plasma glucose (FPG) tend to co-exist and are important indicators of an individual's risk of CVDs and T2D [9][10][11][12][13]. The increasing prevalence of these risk factors has been linked to genetic and environmental factors [1,[14][15][16][17], and there is growing interest in the role of different types of food in the development of MS [1,5,16,17]. Several studies have reported a protective effect of dairy consumption on the risk of MS [5,[18][19][20][21]. ...
... The average intake of SFA (% of energy) for this study population, Chennai urban area was 9% of total energy intake (TEI), which is within the recommended daily allowance of <10% of TEI [46]. Dairy is known to contain high amounts of SFA which is linked to elevated LDL concentration and high risk of CVDs leading to concerns about the health benefits of dairy, with some people resorting to low-fat dairy alternatives [17,47]. However, it has been noted that, SFAs are a large group of fatty acids, and their effects may vary depending on the type of food [17]. ...
Article
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There is conflicting evidence about the association between dairy products and cardiometabolic risk (CMR). We aimed to assess the association of total dairy intake with CMR factors and to investigate the association of unfermented and fermented dairy intake with CMR in Asian Indians who are known to have greater susceptibility to type 2 diabetes and cardiovascular diseases compared to white Europeans. The study comprised 1033 Asian Indian adults with normal glucose tolerance chosen from the Chennai Urban Rural Epidemiological Study (CURES). Dietary intake was assessed using a validated open-ended semi-quantitative food frequency questionnaire. Metabolic syndrome (MS) was diagnosed based on the new harmonising criteria using central obesity, dyslipidaemia [low high-density lipoprotein cholesterol (HDL) and increased serum triglycerides (TG)], hypertension and glucose intolerance. Increased consumption of dairy (≥5 cups per day of total, ≥4 cups per day of unfermented or ≥2 cups per day of fermented dairy) was associated with a lower risk of high fasting plasma glucose (FPG) [hazards ratio (HR), 95% confidence interval (CI): 0.68, 0.48–0.96 for total dairy; 0.57, 0.34–0.94 for unfermented dairy; and 0.64, 0.46–0.90 for fermented dairy; p < 0.05 for all] compared to a low dairy intake (≤1.4 cups per day of total dairy; ≤1 cup per day of unfermented dairy; and ≤0.1 cup per day of fermented dairy). A total dairy intake of ≥5 cups per day was also protective against high blood pressure (BP) (HR: 0.65, 95% CI: 0.43–0.99, p < 0.05), low HDL (HR: 0.63, 95% CI: 0.43–0.92, p < 0.05) and MS (HR: 0.71, 95% CI: 0.51–0.98, p < 0.05) compared to an intake of ≤1.4 cups per day. A high unfermented dairy intake (≥4 cups per day) was also associated with a lower risk of high body mass index (BMI) (HR: 0.52, 95% CI: 0.31–0.88, p < 0.05) compared to a low intake (≤1 cup per day), while a reduced risk of MS was observed with a fermented dairy intake of ≥2 cups per day (HR: 0.71, 95% CI: 0.51–0.98, p < 0.05) compared to an intake of ≤0.1 cup per day. In summary, increased consumption of dairy was associated with a lower risk of MS and components of CMR.
... In contrast, the Northern Sweden Health and Disease Study (n = 108,065) showed that higher intakes of milk were associated with an increased risk of myocardial infarction (HR 1.17, 95% CI 1.03-1.34) and type II diabetes (HR 1.23, 95% CI 1.10-1.37) in men, but not women (60). Intakes of fermented milk, butter and cheese were not significantly associated with these CVD-related outcomes. ...
... No adverse associations were observed. intake on individual CMD risk factors have been examined as well, including blood lipids (61)(62)(63)(64)(65), hypertension (66)(67)(68)(69)(70), body mass index and obesity (71-76), type II diabetes, glycemia and insulin homeostasis (60,74,77,78), also with conflicting findings. A review of 16 meta-analyses by Gille et al. (79) showed weakly beneficial albeit inconsistent links between fermented dairy products and several CMD risk factors ( Table 3). ...
Article
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Unhealthy diets contribute to the increasing burden of non-communicable diseases. Annually, over 11 million deaths worldwide are attributed to dietary risk factors, with the vast majority of deaths resulting from cardiometabolic diseases (CMDs) including cardiovascular disease (∼10 million) and type II diabetes (∼339,000). As such, defining diets and dietary patterns that mitigate CMD risk is of great public health importance. Recently, the consumption of fermented foods has emerged as an important dietary strategy for improving cardiometabolic health. Fermented foods have been present in the human diet for over 10,000 years, but knowledge on whether their consumption benefits human health, and the molecular and microbiological mechanisms underpinning their purported health benefits, is relatively nascent. This review provides an overview of the definitions of fermented foods, types and qualities of fermented foods consumed in Europe and globally, possible mechanisms between the consumption of fermented foods and cardiometabolic health, as well as the current state of the epidemiological evidence on fermented food intake and cardiometabolic health. Finally, we outline future perspectives and opportunities for improving the role of fermented foods in human diets.
... Depuis, de très nombreux travaux ont montré un effet favorable des produits laitiers sur le risque cardiovasculaire et métabolique. L'étude « Prospective Urban Rural Epidemiology » (PURE), en 2018 [2], menée dans 21 pays auprès de 136 384 sujets de 39-70 ans suivis pendant 9,1 ans, montrait une diminution de 23 % de la mortalité cardiovasculaire, de 22 % de la survenue d'évènements cardiovasculaires majeurs, et de 34 % de la survenue d'accidents vasculaires cérébraux pour une consommation de plus de 2 produits laitiers par jour. De nombreux points méritent d'être détaillés et discutés : qu'en est-il de l'effet des graisses saturées ? ...
... L'étude PURE [2] a montré une réduction majeure de ce risque. Dans deux méta-analyses, Elwood et al. avaient montré une réduction de 17 % et de 23 % du risque d'accident vasculaire cérébral (AVC) [67,68]. ...
... Over past decades, the effects of dairy product consumption on chronic non-communicable diseases and other conditions, including cardiovascular disease, metabolic disorders, diabetes and cancers have been studied [11][12][13][14][15]. While some studies identified dairy product consumption as having favorable effects on health [11,16], other studies indicated adverse effects [14,15]. ...
... Over past decades, the effects of dairy product consumption on chronic non-communicable diseases and other conditions, including cardiovascular disease, metabolic disorders, diabetes and cancers have been studied [11][12][13][14][15]. While some studies identified dairy product consumption as having favorable effects on health [11,16], other studies indicated adverse effects [14,15]. ...
Article
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Background Hypertension, a well-known risk factor, contributes to millions of deaths from cardiovascular and renal diseases worldwide. However, evidence on the association between frequency of dairy product consumption and hypertension is inconsistent. Methods The data for the present study are from the Tongxiang baseline dataset of the China Kadoorie Biobank prospective study. A total of 53,916 participants aged 30–79 years were included in the final analysis. Multivariable logistic regression was utilized to evaluate the association of dairy product consumption with hypertension, and multiple linear regression was conducted to assess the association of dairy product consumption with systolic and diastolic blood pressure. Results Of the 53,916 participants, 2.6% reported consuming dairy products weekly, and 44.4% had prevalent hypertension. After adjusting for socio-demographic status, lifestyle factors, BMI, waist circumference, sleep duration and snoring, when compared with participants who never consumed dairy products, the odds ratios (95% CI) for hypertension among those consuming dairy products less than once per week, and ≥ 1 time per week were 0.85 (0.77–0.95) and 0.74 (0.65–0.84), respectively. The corresponding odds ratios (95% CI) for men were 0.85 (0.71–1.02) and 0.75 (0.61–0.92), respectively (Ptrend = 0.001), and for women were 0.88 (0.76–1.01) and 0.77 (0.65–0.91), respectively. (Ptrend < 0.001). Conclusions In this large epidemiological study, higher frequency of dairy product consumption is associated with significantly lower odds of hypertension among Chinese adults.
... In general, dairy consumption varied between geographical regions. It has been reported that the total intake of these products is higher in Europe and North America, the Middle East, and South America than in other regions (Dehghan et al., 2018;Bhupathi et al., 2020). This partly agrees with our findings, however, among European countries, we had very few respondents from Spain. ...
... It has been reported that consumption of dairy products is generally low in low-income and middle-income countries (Dehghan et al., 2018). This general assumption about consumer distribution was not particularly supported by our findings. ...
Article
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This study aimed to assess consumer knowledge, attitudes, and perceptions toward dairy products from sheep and goats. A web-based survey was conducted in Latin America (Mexico and Chile), Europe (Italy, Spain, Greece, and Denmark), and Asia (Bangladesh). From March to June 2021, adult participants answered an online survey available in 5 languages. In total, 1,879 surveys were completed. Categorical and ordinal data were analyzed as frequencies and percentages. To determine the relationship between the variables for purchasing and consumption behaviors of respondents who declared that they consume dairy products, a multiple correspondence analysis was carried out. Most completed surveys were from Mexico and Italy (30% and 33.7%, respectively). Most respondents were between 18 and 29 yr old, female, highly educated, and employed. The majority of respondents (70.8%) declared that they consume dairy products from small ruminants. Consumers preferred products from both sheep and goats (49.4%); however, it was observed that in Mexico, Denmark, and Bangladesh, more than 50% preferred goat dairy products. The most-consumed products were mature and fresh cheeses. Mature cheese was the most-preferred product in Chile; in Mexico, Italy, Greece, and Denmark, it was fresh cheese. Unlike the rest of the countries, in Bangladesh, dairy product consumption from small ruminants was observed by more than 30% of respondents. In Mexico, a higher percentage of people do not consume sheep or goat dairy products because they are unfamiliar with them. In Mexico, Chile, and Bangladesh, limited market availability was also a variable responsible for nonconsumption. In European and Asian countries, sheep and goat dairy products are not consumed because consumers dislike them, in addition to a greater awareness of sustainability and climate change issues. The multiple correspondence analysis defined 5 dimensions. Dimension 1 was associated with the geographic location of the respondent (country and continent), the type of milk (sheep or goat), and the consideration of well-being and health as characteristics associated with the consumption of dairy products from small ruminants. Dimension 2 was associated with the respondent's country of origin and the frequency of consumption. Dimension 3 was associated with gender, education, and employment status. Dimension 4 was associated with the respondent's age, the association of the “healthy” concept of sheep and goat dairy products, and the consideration of the nutritional benefits of dairy as responsible for considering them healthy. Dimension 5 was associated with a “strong smell and taste” of sheep and goat dairy products. This study showed that consumer attitudes toward dairy products from sheep and goats vary between continents. In conclusion, results showed consumer interest in animal welfare and environmental impact issues related to small ruminant farming as well as a general attraction to local products. It seems that these factors contribute to consumers' perception of the quality of dairy products, so the industry and select farmers should carefully consider incorporating them into their supply chain.
... The long-term influence of lactose intolerance behaviors may contribute to a later risk of osteoporosis. Conversely, some studies reported that older adults enjoyed many benefits from dairy product intake, such as decreased mortality and chronic disease risk (such as stroke, hypertension, hip fracture, Alzheimer's disease, sarcopenia, and cardiovascular disease mortality risk) [4][5][6][7][8][9][10][11][12][13]. Other studies have reported that enough dairy product intake might reduce colorectal cancer by 10%, metabolic syndrome by 13%, obesity by 16%, and osteoporosis risk by 39% [10,11,[14][15][16]. ...
... In the preparation stage, IC had a positive correlation with dietary intake behaviors. Older adults might be scared that their health will become worse, so that the increase of the IC score led to more frequency of dairy intake behaviors [2][3][4][5][6][7][8][9][10][11][12][13]. Furthermore, IP made an impact on dairy product intake merely in the preparation stage (Table 5). ...
Article
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Adequate dairy product intake can reduce the risk of chronic disease, mortality, low quality of life, and healthcare expenditure. However, the insufficient consumption of dairy products is a serious issue in Eastern societies. To the authors’ knowledge, few studies have explored dairy intake among Taiwanese older adults, especially using the transtheoretical model. The study aims were to address the following unknowns: (i) the distribution of dairy product intake behavior on stages of change (SOC); (ii) differences in variables (intake knowledge (IK), intake cons (IC), intake pros (IP), and intake self-efficacy (ISE)) among SOCs; (iii) discriminative abilities of variables on SOCs; and (iv) predictive ability of variables (IK, IC, IP, and ISE) for dairy product intake behavior on SOC for older adults. An explorative cross-sectional study was conducted to collect data from northern Taiwan using a questionnaire. A total of 342 older adults were recruited. Data were analyzed using multivariate analysis of variance, discriminant analysis, and multiple linear regression. There was a significant difference between the variables and SOCs. There was a better discriminant among the five SOCs. Dairy product intake behaviors were significantly associated with knowledge and self-efficacy in the pre-action stage, and with cons, pros, and self-efficacy in the post-action stage. In conclusion, appropriate nutritional empowerment could benefit older adults by improving dairy intake among the different SOCs.
... Health-related lifestyle data (health lifelog data) provide essential information on one's daily behaviors that directly influence health; thus, such data needs to be used for the management of one's health [1][2][3]. Health-related lifestyle data are usually captured outside the clinical environment by patients and form a considerable part of the patient-generated health data (PGHD) [4]. Analyzing health-related lifestyle data with clinical, biological, and environmental data may offer additional insights into one's health status [5]. ...
Article
Background: Dietary habits offer crucial information on one's health and form a considerable part of the patient-generated health data. Dietary data are collected through various channels and formats; thus, interoperability is a significant challenge to reusing this type of data. The vast scope of dietary concepts and the colloquial expression style add difficulty to standardizing the data. The interoperability issues of dietary data can be addressed through Common Data Elements with metadata annotation to some extent. However, making culture-specific dietary habits and questionnaire-based dietary assessment data interoperable still requires substantial efforts. Objective: The main goal of this study was to address the interoperability challenge of questionnaire-based dietary data from different cultural backgrounds by combining ontological curation and metadata annotation of dietary concepts. Specifically, this study aimed to develop a Dietary Lifestyle Ontology (DILON) and demonstrate the improved interoperability of questionnaire-based dietary data by annotating its main semantics with DILON. Methods: By analyzing 1158 dietary assessment data elements (367 in Korean and 791 in English), 515 dietary concepts were extracted and used to construct DILON. To demonstrate the utility of DILON in addressing the interoperability challenges of questionnaire-based multicultural dietary data, we developed 10 competency questions that asked to identify data elements sharing the same dietary topics and assessment properties. We instantiated 68 data elements on dietary habits selected from Korean and English questionnaires and annotated them with DILON to answer the competency questions. We translated the competency questions into Semantic Query-Enhanced Web Rule Language and reviewed the query results for accuracy. Results: DILON was built with 262 concept classes and validated with ontology validation tools. A small overlap (72 concepts) in the concepts extracted from the questionnaires in 2 languages indicates that we need to pay closer attention to representing culture-specific dietary concepts. The Semantic Query-Enhanced Web Rule Language queries reflecting the 10 competency questions yielded correct results. Conclusions: Ensuring the interoperability of dietary lifestyle data is a demanding task due to its vast scope and variations in expression. This study demonstrated that we could improve the interoperability of dietary data generated in different cultural contexts and expressed in various styles by annotating their core semantics with DILON.
... Previous reports are not up-to-date, 21,22 reported on only a few ASF subtypes, 23 used crude national estimates of food availability or expenditure 23 that may not reflect dietary intakes, 24 or are focused on select countries, regions, or age groups. [25][26][27][28][29] Furthermore, global consumption levels among children or by education attainment and urban versus rural residence have not been previously reported. ...
Article
Background: Diet is a major modifiable risk factor for human health and overall consumption patterns affect planetary health. We aimed to quantify global, regional, and national consumption levels of animal-source foods (ASF) to inform intervention, surveillance, and policy priorities. Methods: Individual-level dietary surveys across 185 countries conducted between 1990 and 2018 were identified, obtained, standardised, and assessed among children and adults, jointly stratified by age, sex, education level, and rural versus urban residence. We included 499 discrete surveys (91·2% nationally or subnationally representative) with data for ASF (unprocessed red meat, processed meat, eggs, seafood, milk, cheese, and yoghurt), comprising 3·8 million individuals from 134 countries representing 95·2% of the world population in 2018. We used Bayesian hierarchical models to account for differences in survey methods and representativeness, time trends, and input data and modelling uncertainty, with five-fold cross-validation. Findings: In 2018, mean global intake per person of unprocessed red meat was 51 g/day (95% uncertainty interval [UI] 48-54; region-specific range 7-114 g/day); 17 countries (23·9% of the world's population) had mean intakes of at least one serving (100 g) per day. Global mean intake of processed meat was 17 g/day (95% UI 15-21 g/day; region-specific range 3-54 g/day); seafood, 28 g/day (27-30 g/day; 12-44 g/day); eggs, 21 g/day (18-24 g/day; 6-35 g/day); milk 88 g/day (84-93 g/day; 45-185 g/day); cheese, 8 g/day (8-10 g/day; 1-34 g/day); and yoghurt, 20 g/day (17-23 g/day; 7-84 g/day). Mean national intakes were at least one serving per day for processed meat (≥50 g/day) in countries representing 6·9% of the global population; for cheese (≥42 g/day) in 2·3%; for eggs (≥55 g/day) in 0·7%; for milk (≥245 g/day) in 0·3%; for seafood (≥100 g/day) in 0·8%; and for yoghurt (≥245 g/day) in less than 0·1%. Among the 25 most populous countries in 2018, total ASF intake was highest in Russia (5·8 servings per day), Germany (3·8 servings per day), and the UK (3·7 servings per day), and lowest in Tanzania (0·9 servings per day) and India (0·7 servings per day). Global and regional intakes of ASF were generally similar by sex. Compared with children, adults generally consumed more unprocessed red meat, seafood and cheese, and less milk; energy-adjusted intakes of other ASF were more similar. Globally, ASF intakes (servings per week) were higher among more-educated versus less-educated adults, with greatest global differences for milk (0·79), eggs (0·47), unprocessed red meat (0·42), cheese (0·28), seafood (0·28), yoghurt (0·22), and processed meat (0·21). This was also true for urban compared to rural areas, with largest global differences (servings per week) for unprocessed red meat (0·47), milk (0·38), and eggs (0·20). Between 1990 and 2018, global intakes (servings per week) increased for unprocessed red meat (1·20), eggs (1·18), milk (0·63), processed meat (0·50), seafood (0·44), and cheese (0·14).
... Previous reports are not up-to-date, 21,22 reported on only a few ASF subtypes, 23 used crude national estimates of food availability or expenditure 23 that may not reflect dietary intakes, 24 or are focused on select countries, regions, or age groups. [25][26][27][28][29] Furthermore, global consumption levels among children or by education attainment and urban versus rural residence have not been previously reported. ...
Article
Background: Diet is a major modifiable risk factor for human health and overall consumption patterns affect planetary health. We aimed to quantify global, regional, and national consumption levels of animal-source foods (ASF) to inform intervention, surveillance, and policy priorities. Methods: Individual-level dietary surveys across 185 countries conducted between 1990 and 2018 were identified, obtained, standardised, and assessed among children and adults, jointly stratified by age, sex, education level, and rural versus urban residence. We included 499 discrete surveys (91·2% nationally or subnationally representative) with data for ASF (unprocessed red meat, processed meat, eggs, seafood, milk, cheese, and yoghurt), comprising 3·8 million individuals from 134 countries representing 95·2% of the world population in 2018. We used Bayesian hierarchical models to account for differences in survey methods and representativeness, time trends, and input data and modelling uncertainty, with five-fold cross-validation. Findings: In 2018, mean global intake per person of unprocessed red meat was 51 g/day (95% uncertainty interval [UI] 48-54; region-specific range 7-114 g/day); 17 countries (23·9% of the world's population) had mean intakes of at least one serving (100 g) per day. Global mean intake of processed meat was 17 g/day (95% UI 15-21 g/day; region-specific range 3-54 g/day); seafood, 28 g/day (27-30 g/day; 12-44 g/day); eggs, 21 g/day (18-24 g/day; 6-35 g/day); milk 88 g/day (84-93 g/day; 45-185 g/day); cheese, 8 g/day (8-10 g/day; 1-34 g/day); and yoghurt, 20 g/day (17-23 g/day; 7-84 g/day). Mean national intakes were at least one serving per day for processed meat (≥50 g/day) in countries representing 6·9% of the global population; for cheese (≥42 g/day) in 2·3%; for eggs (≥55 g/day) in 0·7%; for milk (≥245 g/day) in 0·3%; for seafood (≥100 g/day) in 0·8%; and for yoghurt (≥245 g/day) in less than 0·1%. Among the 25 most populous countries in 2018, total ASF intake was highest in Russia (5·8 servings per day), Germany (3·8 servings per day), and the UK (3·7 servings per day), and lowest in Tanzania (0·9 servings per day) and India (0·7 servings per day). Global and regional intakes of ASF were generally similar by sex. Compared with children, adults generally consumed more unprocessed red meat, seafood and cheese, and less milk; energy-adjusted intakes of other ASF were more similar. Globally, ASF intakes (servings per week) were higher among more-educated versus less-educated adults, with greatest global differences for milk (0·79), eggs (0·47), unprocessed red meat (0·42), cheese (0·28), seafood (0·28), yoghurt (0·22), and processed meat (0·21). This was also true for urban compared to rural areas, with largest global differences (servings per week) for unprocessed red meat (0·47), milk (0·38), and eggs (0·20). Between 1990 and 2018, global intakes (servings per week) increased for unprocessed red meat (1·20), eggs (1·18), milk (0·63), processed meat (0·50), seafood (0·44), and cheese (0·14). Interpretation: Our estimates of ASF consumption identify populations with both lower and higher than optimal intakes. These estimates can inform the targeting of intervention, surveillance, and policy priorities relevant to both human and planetary health. Funding: Bill & Melinda Gates Foundation and American Heart Association.
... An increment of 200 g of milk per day was associated with 8% lower risk of total stroke in recent meta-analysis [1], while other studies showed no association between milk consumption and stroke [2,3]. These differences could be due to the population studied, e.g., whether the population have in general a low or a high consumption of milk [1,4,5], which may entail different reference categories [6]. Furthermore, milk may represent all sorts of milk, including fermented milk (yogurt and sour milk) which may have different properties and associations with stroke risk compared to unfermented milk. ...
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The role of milk and fermented milk consumption in stroke risk is unclear. We investigated associations of time-updated information on milk and fermented milk consumption (1997 and 2009) with total stroke, cerebral infarction, and hemorrhagic stroke risk among 79,618 Swedish women and men (mean age 61.3 years). During a mean follow-up of 17.7 years, we identified 9735 incident cases of total stroke, of which 7573 were cerebral infarctions, 1470 hemorrhagic strokes, and 692 unspecified strokes. Compared with an intake of 100 g/day of milk, the multivariable-adjusted hazard ratios (95% confidence interval) of cerebral infarction were 1.05 (1.02–1.08) for 0 g/day, 0.97 (0.95–0.99) for 200 g/day, 0.96 (0.92–1.00) for 400 g/day, 0.98 (0.94–1.03) for 600 g/day, and 1.01 (0.94–1.07) for 800 g/day. Corresponding estimates for hemorrhagic stroke were 0.98 (0.91–1.05) for 0 g/day, 1.02 (0.97–1.07) for 200 g/day, 1.07 (0.98–1.17) for 400 g/day, 1.13 (1.02–1.25) for 600 g/day, and 1.19 (1.03–1.36) for 800 g/day. No associations were observed between milk consumption and total stroke or for fermented milk consumption and any of the stroke outcomes. Higher long-term milk consumption based on repeated measures of intake was weakly and non-linearly associated with cerebral infarction, and was directly associated with hemorrhagic stroke.
... Dehghan et al. reported that dairy product consumption was negatively associated with death risk due to CVDs or CVD risk. In that study, those who consumed two or more servings/day of total dairy products had a 22% lower risk of major CVD and a 23% lower cardiovascular mortality rate than those who did not consume any dairy products [26]. A multi-ethnic study regarding atherosclerosis reported that a higher intake of saturated fatty acids from dairy products was associated with a lower risk of overall mortality from atherosclerosis and cardiovascular events. ...
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Coronary artery disease (CAD) has been linked to one of the highest death rates globally. The atherogenic index of plasma (AIP) may be an important predictor of atherosclerosis and cardiovascular disease, superior to the standard atherosclerotic lipid profile. This study investigated the relationship between AIP and obesity indices, blood glucose, lipid profile, and nutrient intake status in Korean adult men. The study included 1292 males aged ≥19 years old who participated in the Korea National Health and Nutrition Examination Survey, 2013–2014. Participants were divided into four groups according to AIP quartiles, calculated as log (triglyceride (TG)/high-density lipoprotein cholesterol (HDL-C)). Body mass index, waist circumference, fasting blood glucose, hemoglobin A1c, total cholesterol, TG, and low-density lipoprotein cholesterol levels increased as AIP levels increased, whereas HDL-C level declined. As the level of AIP increased, intake of saturated fatty acid, calcium, phosphorus, riboflavin, milk, and dairy product decreased significantly, and the contribution rate of milk and dairy products to fat intake decreased. AIP was linked to obesity indices, blood glucose, and blood lipid profile in Korean men, suggesting that it could predict CAD.
... The PURE study (n 5 135,335) showed greater than 2 daily servings of dairy is inversely correlated with mortality, major CVD, and stroke when compared with no dairy consumption. 33 Compared with unsaturated fat, however, dairy fat significantly increases LDL and total cholesterol levels (P > .05). 34 Current literature and guidelines therefore suggest limiting SF intake and replacing it with polyunsaturated fats and complex carbohydrates. ...
Article
This review highlights the key components of a heart-healthy diet and presents an evidence-based overview of recent research. Diets that increase plant-based food sources and healthy unsaturated fats consumption and limit foods that are processed and/or high in sodium, refined sugar, and saturated fat are recommended. Dietary modification can be supplemented with lifestyle-based therapies (eg, exercise, time-restricted eating) to maximize clinical benefit and achieve the "cardiometabolic jackpot." Physicians should take into account cultural preferences, affordability and accessibility of foods, and their patients' cultural values or expectations when recommending dietary interventions.
... The relationship between cardiovascular disease and the consumption of living microbes in the diet has not been explored explicitly. Fermented dairy and other products were confirmed have an association with the incidence of cardiovascular disease [7][8][9][10][11]. However, not only fermented foods include living microbes, but also a wide variety of other foods, including raw, unpeeled fruits and vegetables [12,13]. ...
Article
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Objective: To detect the potential association between dietary live microbe and cardiovascular diseases (CVD). Methods: Data of 10,875 participants aged 18 years or older in this study were collected from the National Health and Nutrition Examination Survey (NHANES). Participants in this study were divided into three groups according to the Sanders dietary live microbe classification system: low, medium, and high dietary live microbe groups. CVD was defined by a combination of self-reported physician diagnoses and standardized medical status questionnaires. The analyses utilized weighted logistic regression models. Results: After the full adjustment for confounders, patients in the medium dietary live microbe group had a low prevalence of CVD in contrast to those in the low dietary live microbe group (OR: 0.78, 95% CI: 0.52-0.99, and p < 0.05), but no significant association with CVD was detected between the high and low dietary live microbe groups. Higher dietary live microbe groups were negatively associated with the prevalence of stroke (p for trend = 0.01) and heart attack (p for trend = 0.01). People who were male were more likely to suffer stroke due to low dietary live microbe (p for interaction = 0.03). Conclusion: A high dietary live microbe intake was associated with a low prevalence of CVD, and the significant association was detected when the analysis was limited to stroke and heart attack.
... Some studies have suggested that dairy consumption has a positive or a neutral association with cardiovascular disease and all-cause mortality [7][8][9]. Observational studies from western countries suggested that the intake of full-fat dairy was in a neutral or inverse association with the onset of IHD [10,11]. With higher consumption of butter and cheese, most Western countries' dietary guidelines recommended the intake of low-fat milk (i.e., milk fat < 0.5%) in place of full-fat dairy (i.e., milk fat > 3%) [12], while the WHO recommended an intake of whole milk or dairy products (e.g., cheese) of 250 g/day [13]. ...
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Background Previous studies linking dairy consumption with ischemic heart disease (IHD) are almost from western countries, with little from China. The present study was to explore the relationship between dairy consumption and IHD among Chinese adults. Methods The data for the present study was from the prospective cohort study of China Kadoorie Biobank in Qingdao, a total of 33,355 participants in the present study. An interviewer-administered laptop-based questionnaire was used to collect information on the consumption frequency of dairy, incident IHD cases were identified through Disease Surveillance Point System and the new national health insurance databases. Cox regression analyses were performed to estimate adjusted hazard ratios (HRs) and confidence interval for the relationship between the incidence of IHD and dairy consumption. Results The baseline survey reported that 32.4% of males and 34.6% of females consumed dairy regularly (i.e. ≥ 4 days/week). Over an average of 9.2 years follow-up, 2712 new-onset IHD were documented. Compared with participants who never or rarely consume dairy, the HR of consumed dairy regularly was 0.85(0.73–0.98) for males ( P < 0.05), while no significant benefits were identified for females. Conclusions Regular dairy consumption had an inverse association to the onset of IHD among males, with no similar findings for females.
... Weight loss and regular moderate intensity physical activity/exercise are significant factors for IR prevention and/or treatment [12]. From a dietary perspective, dietary fiber, cereal fiber, fruit fiber, whole grains, full-fat dairy products [13][14][15][16], magnesium, and calcium lower IR, whereas high glycemic index (GI) and glycemic load (GL) foods, saturated fat, salt (deficiency or excess), and alcohol (>30 g/day) increase IR [17]. T2DM development stems from various genetic and/or environmental factors and is characterized by deficient pancreatic β-cell insulin secretion and decreased sensitivity/responsiveness of insulin-sensitive tissues to insulin [18]. ...
Article
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As years progress, we are found more often in a postprandial than a postabsorptive state. Chrononutrition is an integral part of metabolism, pancreatic function, and hormone secretion. Eating most calories and carbohydrates at lunch time and early afternoon, avoiding late evening dinner, and keeping consistent number of daily meals and relative times of eating occasions seem to play a pivotal role for postprandial glycemia and insulin sensitivity. Sequence of meals and nutrients also play a significant role, as foods of low density such as vegetables, salads, or soups consumed first, followed by protein and then by starchy foods lead to ameliorated glycemic and insulin responses. There are several dietary schemes available, such as intermittent fasting regimes, which may improve glycemic and insulin responses. Weight loss is important for the treatment of insulin resistance, and it can be achieved by many approaches, such as low-fat, low-carbohydrate, Mediterranean-style diets, etc. Lifestyle interventions with small weight loss (7–10%), 150 min of weekly moderate intensity exercise and behavioral therapy approach can be highly effective in preventing and treating type 2 diabetes. Similarly, decreasing carbohydrates in meals also improves significantly glycemic and insulin responses, but the extent of this reduction should be individualized, patient-centered, and monitored. Alternative foods or ingredients, such as vinegar, yogurt, whey protein, peanuts and tree nuts should also be considered in ameliorating postprandial hyperglycemia and insulin resistance. This review aims to describe the available evidence about the effects of diet, chrononutrition, alternative dietary interventions and exercise on postprandial glycemia and insulin resistance.
... This is because higher saturated fatty acid is associated with ruminants' products and the consumption of which is implicated for increased occurrence of cardiovascular disease in human [9]. This has given a negative health perception concerning the consumption of ruminants' products against the promising benefits that could be derived from the consumption of such products [10]. Certain rumen microbes are responsible for hydrogen production and the saturation of fatty acids in the rumen via biohydrogenation which is the type made available to the host animal [11]. ...
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The effect and conversion of diets containing water-washed neem (Azadirachta indica A. Juss) fruit (WN) biomass as substantiable feed resource was determined on rumen microbial population, fermentation, and meat fatty acid profile of fattened West African dwarf rams. One-year old, individually housed rams (N = 25; 12.3 ± 2.0 kg), five per treatment, were allocated in a completely randomized design to one of the five dietary treatments. Each treatment received 0 (WN0), 2.5 (WN2.5), 5 (WN5), 7.5 (WN7.5), and 10 (WN10) % of WN (% dry matter) of complete diet offered for 90 days. Rumen liquor was collected 4 h post feeding for microbial and fermentation assay while Longissimus dorsi muscle was taken after slaughtering the animal for fatty acids (FAs) determination, post feeding trial. Inclusion of WN initially increased but subsequently reduced (P < 0.05) the population of bacteria and fungi but consistently reduced the population of protozoa. The WN decreased NH3-N in WN7.5 and WN10 compared to other treatments. Propionate was higher in WN5 compared to the control. There was increased concentration of meat linolenic, vaccenic, rumenic, oleic, and lauric FAs in WN10 than WN0. Dietary inclusion of WN increased (P < 0.05) the constituent of unsaturated fatty acids, and total desaturase index in WN5 compared to other treatments. Incorporation of water-washed neem fruit beyond 5% reduced rumen microbial population, ammonia nitrogen, and propionate with increased unsaturated fatty acids including rumenic acid, a conjugated linoleic acid known for its health promoting benefits. This imply that at 5% inclusion of water-washed neem fruit biomass there was better substantiable feed resource for stimulation of microbial growth for increased microbial protein production for host’s growth, efficiency in energy use, and the consumption of functional food. Graphical abstract
... Limited precision when assessing dairy foods consumed within composite dishes (e.g. pizza, bakery items or coffee drinks), which might independently impact CMD risk, is a further shortcoming of these dietary assessment methods that may be overcome by deconstructing dairy-derived ingredients from composite dishes and re-allocating them to dairy food categories, as illustrated in the Prospective Urban Rural Epidemiology (PURE) study (16) . Whilst these methodological limitations are not restricted to dairy fat intakes and are commonplace in nutritional science, the integration of data from traditional methods of dietary assessment with more objective biomarkers of intake may improve the accuracy of dietary intake assessments and prediction of disease risk. ...
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In epidemiological studies, dairy food consumption has been associated with minimal effect or decreased risk of some cardiometabolic diseases (CMD). However, current methods of dietary assessment do not provide objective and accurate measures of food intakes. Thus, the identification of valid and reliable biomarkers of dairy intake is an important challenge to best determine the relationship between dairy consumption and health status. This review investigated potential biomarkers of dairy fat consumption, such as odd-chain, trans - and branched-chain fatty acids, which may improve the assessment of full-fat dairy product consumption. Overall, the current use of serum/plasma fatty acids as biomarkers of dairy fat consumption is mostly based on observational evidence, with a lack of well-controlled, dose response intervention studies to accurately assess the strength of the relationship. Circulating odd-chain saturated fatty acids and trans -palmitoleic acid are increasingly studied in relation to CMD risk and seem to be consistently associated with a reduced risk of type 2 diabetes in prospective cohort studies. However, associations with cardiovascular diseases are less clear. Overall, adding less studied fatty acids such as vaccenic and phytanic acids to the current available evidence may provide a more complete assessment of dairy fat intake and minimise potential confounding from endogenous synthesis. Finally, the current evidence base on the direct effect of dairy fatty acids on established biomarkers of CMD risk (e.g. fasting lipid profiles and markers of glycaemic control) mostly derives from cross-sectional, animal, and in vitro studies, and should be strengthened by well-controlled human intervention studies.
... The impact of dairy intake on mortality has been extensively studied, but results are not conclusive [35,36]. The divergence of results could be due to variation between the different types of dairy products being investigated (i.e., total dairy, specific categories of dairy such as milk, yoghurt, cheese, low-fat/high-fat dairy), different cut-off points between studies, but also the quality of the underlying diet in different populations. ...
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Background The shape of the associations between intake of foods basic in a healthy Nordic diet and long-term health is not well known. Therefore, we have examined all-cause mortality in a large, prospective cohort of women in Norway in relation to intake of: Nordic fruits and vegetables, fatty fish, lean fish, wholegrain products, and low-fat dairy products. Methods A total of 83 669 women who completed a food frequency questionnaire between 1996 and 2004 were followed up for mortality until the end of 2018. Cox proportional hazards regression models were used to examine the associations between consumption of the Nordic food groups and all-cause mortality. The Nordic food groups were examined as categorical exposures, and all but wholegrain products also as continuous exposures in restricted cubic spline models. Results A total of 8 507 women died during the 20-year follow-up period. Nordic fruits and vegetables, fatty fish and low-fat dairy products were observed to be non-linearly associated with all-cause mortality, while higher intake of lean fish and wholegrain products reduced all-cause mortality. Intake levels and hazard ratios (HR) and 95% confidence intervals (CI) associated with lowest mortality were approximately 200 g/day of Nordic fruits and vegetables (HR 0.83 (95% CI: 0.77–0.91)), 10–20 g/day of fatty fish (10 g/day: HR 0.98 (95% CI: 0.94–1.02)) and 200 g/day of low-fat dairy products (HR 0.96 (95% CI: 0.81–1.01)) compared to no consumption. Consumption of fatty fish ≥ 60 g/day compared to no intake statistically significantly increased the mortality (60 g/day: HR 1.08 (95% CI: 1.01–1.16)), as did consumption of low-fat dairy products ≥ 800 g/day compared to no intake (800 g/day: HR 1.10 (95% CI: 1.02–1.20)). After stratification by smoking status, the observed association between Nordic fruits and vegetables and all-cause mortality was stronger in ever smokers. Conclusion The associations between intake of foods basic in healthy Nordic diets and all-cause mortality may be non-linear. Therefore, assumptions of linear associations between traditional Nordic food groups and health outcomes could lead to wrong conclusions in analyses of healthy Nordic diets.
... Although studies linking dairy products and sodium to NAFLD are scarce, there is strong evidence regarding associations between the two components and metabolic disorders, which supports our findings. For dairy products, findings from the Prospective Urban Rural Epidemiology (PURE) study [46] and another Chinese cohort study [47] demonstrated that dairy consumption was associated with a significantly lower risk of diabetes and favorable changes in cardiometabolic traits, indicating that consumption of dairy products should be encouraged in less-developed countries where dairy consumption is low. Some nutrients, such as milkfat, vitamin D, calcium, magnesium, potassium, and whey proteins, in dairy products may play protective roles [48]. ...
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Background: Little is known about the associations between healthy dietary patterns and metabolic dysfunction-associated fatty liver disease (MAFLD) in less-developed ethnic minority regions (LEMRs), where the prevalence of MAFLD is increasing rapidly and dietary habits are quite different from those in developed countries. Moreover, a significant subset of MAFLD individuals in LEMRs are nonobese, but the efficacy of dietary patterns on MAFLD individuals with different obese statuses is also unclear. We aimed to test the associations of two wildly recommended a priori dietary patterns-Alternate Mediterranean diet (AMED) and Dietary Approaches to Stop Hypertension (DASH)-with the risk of MAFLD in the total population, and further in nonobese and obese individuals. Methods: We recruited 99,556 participants in the China Multi-Ethnic Cohort Study, an ongoing cohort study in less-developed southwest China. Using validated food frequency questionnaire, each participant was assigned an AMED score and a DASH score. MAFLD was ascertained as hepatic steatosis on ultrasound together with diabetes, overweight/obesity, or two other metabolic risk factors. We performed logistic regression with inverse probability of exposure weighting (IPEW) to examine associations between two dietary patterns and MAFLD, adjusting for potential confounders under the guidance of directed acyclic graphs. Further, analyses were stratified by body mass index. Results: We included 66,526 participants (age 49.5±11.0; 62.6% women), and the prevalence of MAFLD was 16.1%. Participants in the highest quintile of DASH score showed strong inverse associations with risks of MAFLD (OR = 0.85; 95% CI, 0.80-0.91; Ptrend < 0.001) compared with participants in the lowest quintile. The association between DASH and nonobese MAFLD (OR = 0.69; 95% CI, 0.61-0.78; Ptrend < 0.001) was stronger (I2 = 78.5 % ; Pheterogeneity = 0.001) than that with obese MAFLD (OR = 0.90; 95% CI, 0.83-0.98; Ptrend = 0.002). There was a null association between AMED and MAFLD risk. Conclusions: In LEMRs, a DASH diet but not AMED was associated with MAFLD. The relationship appeared to be more pronounced in nonobese MAFLD individuals than in obese MAFLD individuals.
... Although findings from the original DASH diet have revealed the benefits of low-fat dairy foods combined with a diet high in fruits and vegetables on BP [36], a meta-analysis showed that total dairy products were inversely associated with the risk of hypertension or elevated blood pressure [37]. Considering that low-fat dairy accounts for a relatively small proportion of the total consumption of dairy products in most LMICs such as China compared with HICs [38], our results imply that the modified DASH diet, which includes total dairy products rather than low-fat dairy products only, may also produce strong protective effects on blood pressure in less-developed regions in China. Furthermore, as one of the typical characteristics of the aMED, a high MUFA:SFA ratio failed to show significant beneficial effects on blood pressure in the food group analysis. ...
Article
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Objective We aimed to investigate the association of Dietary Approaches to Stop Hypertension (DASH)-style diet and Mediterranean-style diet with blood pressure in less-developed ethnic minority regions (LMERs). Design Cross-sectional study. Setting Dietary intakes were assessed by a validated food frequency questionnaire. Dietary quality was assessed by the DASH-style diet score and the alternative Mediterranean-style diet (aMED) score. The association between dietary quality and blood pressure was evaluated using multivariate linear regression model. We further examined those associations in subgroups of blood pressure level. Participants A total of 81433 adults from the China Multi-Ethnic Cohort (CMEC) study were included in this study. Results In the overall population, compared with the lowest quintile, the highest quintile of DASH-style diet score was negatively associated with systolic BP (coefficient: −2.78, 95% CI: −3.15 to −2.41; P-trend<0.001), while the highest quintile of aMED score had a weaker negative association with systolic BP (coefficient: −1.43, 95% CI: −1.81 to −1.05; P-trend<0.001). Both dietary indices also showed a weaker effect on diastolic BP (coefficient for DASH-style diet: −1.06, 95% CI: −1.30 to −0.82; coefficient for aMED: −0.43, 95% CI: −0.68 to −0.19). In the subgroup analysis, both dietary indices showed a stronger beneficial effect on systolic BP in the hypertension group than in either of the other subgroups. Conclusion Our results indicated that the healthy diet originating from Western developed countries can also have beneficial effects on blood pressure in LEMRs. DASH-style diet may be a more appropriate recommendation than aMED as part of a dietary strategy to control blood pressure, especially in hypertensive patients.
... However, our results showed that milk consumption among Chinese adults was obviously inadequate; most participants did not consume milk during the follow-up. Similar results have been shown by other studies [17,19]. A national review revealed that only 23.7% of participants consumed dairy every day, and the average Chinese milk intakes in large-, small-, and medium-sized cities and rural areas in 2016 were 64.3, 24.2, 9.1, and 4.9 g/day, respectively [19], which were far lower than the recommendation of CDG-2016 (300 g/day) and consumption in other countries. ...
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Background: Little is known about the effect of milk intake on all-cause mortality among Chinese adults. The present study aimed to explore the association between milk intake and all-cause mortality in the Chinese population. Methods: Data from 1997 to 2015 of the China Health and Nutrition Survey (CHNS) were used. A total of 14,738 participants enrolled in the study. Dietary data were obtained by three day 24-h dietary recall. All-cause mortality was assessed according to information reported. The association between milk intake and all-cause mortality were explored using Cox regression and further stratified with different levels of dietary diversity score (DDS) and energy intake. Results: 11,975 (81.25%) did not consume milk, 1341 (9.10%) and 1422 (9.65%) consumed 0.1-2 portions/week and >2 portions/week, respectively. Milk consumption of 0.1-2 portions/week was related to the decreased all-cause mortality (HR: 0.59, 95% CI: 0.41-0.85). In stratified analysis, consuming 0.1-2 portions/week was associated with decreased all-cause mortality among people with high DDS and energy intake. Conclusions: Milk intake is low among Chinese adults. Consuming 0.1-2 portions of milk/week might be associated with the reduced risk of death among Chinese adults by advocating health education. Further research is required to investigate the relationships between specific dairy products and cause-specific mortality.
... Findings regarding the effect of yoghurt consumption on cardiovascular risk remain controversial. Meta-analyses of both observational studies and randomised clinical trials report inconsistent results, showing protective effects (48) or no effect (49) of yoghurt on cardiovascular risk or mortality. Recently, a meta-analysis showed that probiotic intake was associated with a decrease in blood pressure (50). ...
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Background and AimsLittle is known about the effects of probiotics on inflammation in the context of chronic kidney disease (CKD). We investigated the association between probiotic intake and inflammation in patients with moderate-to-advanced CKD.Methods We performed a cross-sectional study of 888 patients with stage 3–5 CKD and data on serum C-reactive protein (CRP) levels and a concomitant food frequency questionnaire. We estimated the odds ratios (ORs) [95% confidence interval (CI)] for various CRP thresholds (>3, >4, >5, >6, and >7 mg/L) associated with three intake categories (no yoghurt, ordinary yoghurt, and probiotics from yoghurts or dietary supplements) and two frequency categories (daily or less than daily).ResultsThe 888 study participants (median age: 70; men: 65%) had a median estimated glomerular filtration rate of 28.6 mL/min/1.73 m2 and a median [interquartile range] CRP level of 3.0 [1.6, 7.0] mg/L. Fifty-seven percent consumed ordinary yoghurt and 30% consumed probiotic yoghurt. The median intake frequency for yoghurt and probiotics was 7 per week. Relative to participants not consuming yoghurt, the ORs [95% CI] for CRP > 6 or >7 mg/L were significantly lower for participants consuming ordinary yoghurt (0.58 [0.37, 0.93] and 0.57 [0.35, 0.91], respectively) and for participants consuming probiotics (0.54 [0.33, 0.9] and 0.48 [0.28, 0.81], respectively), independently of age, sex, body mass index, CKD stage, cardiovascular disease, and fibre, protein and total energy intakes. The ORs were not significantly lower for CRP thresholds >3, >4, and >5 mg/L and were not significantly greater in daily consumers than in occasional consumers.Conclusion We observed independent associations between the consumption of yoghurt or probiotics and lower levels of inflammation in patients with CKD. There was no evidence of a dose-effect relationship.Clinical Trial Registration[https://www.clinicaltrials.gov/ct2/show/NCT03381950], identifier [NCT03381950].
... Adequate dairy intake is related to several benefits specific to this age group [30]. The addition of nutrient-rich dairy proteins may improve physical performance and attenuate loss of muscle strength, thereby helping to prevent sarcopenia in the elderly population and reduce the risk of hypertension [31], mortality, and major cardiovascular disease events [32]. However, this depends on the type of dairy product and the quantity ingested. ...
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Dietary habits are determinants in the development of a range of conditions and age-related diseases. We explored the associations of sociodemographic, health-related indicators, and health behavioral factors on dietary guideline compliance in elderly Chileans. We used a cross-sectional design using the publicly available database from the last Chilean National Health Survey (2016–17). The sample of 1831 older adults (≥60 y) from a national representative sample. The dependent variable was compliance with Food Guidelines (FG) (daily consumption of water, dairy, and fruits and vegetables; and weekly consumption of legumes and fish). The independent variables included sociodemographic, health-related, and behavioral factors. Over half (51.8%) of the sample was female and 85.7% belonged to the 60–79 age group. Satisfactory compliance to FG was observed in 3.9% of the sample. In the adjusted analysis, for those between 60 and 79 y, marital status was the only significant variable associated with FG noncompliance (PR: 1.34; 95%CI: 1.04–1.71). For those over 80 y, income of >2 minimum wages (PR: 0.10; 95%CI: 0.02–0.61), living alone (PR: 1.72; 95%CI: 1.20–2.47), and self-reported cardiovascular disease (PR: 0.63; 95%CI: 0.43–0.93) were associated with FG noncompliance. We observed low FG compliance among elderly Chilean adults, especially in the oldest group. Factors associated with the FG compliance was different between age groups.
... A notable example is the consumption of dairy products containing micro-and macronutrients (e.g., proteins, calcium, magnesium, potassium, vitamins) that may reduce inflammation and reduce CVD risk [73,74]. The balanced nutrients within "whole food" or "full fat" dairy consumption may help explain why dairy intake is often reported to have a neutral or favorable effect on CVD risk, even when some of the fatty acids in dairy foods are saturated fats [75][76][77][78]. 9. Intake of foods rich in omega-3 fatty acids is associated with reduced CVD risk [79] and meta-analyses suggest supplements containing a combination of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) may also reduce CVD events [80,81]. ...
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The “American Society for Preventive Cardiology (ASPC) Top Ten CVD Risk Factors 2022 Update” is a summary document regarding CVD risk factors. This “ASPC Top Ten CVD Risk Factors 2022 Update” provides summary tables of ten things to know about 10 CVD risk factors and builds upon the foundation of annual versions of “ASPC Top Ten CVD Risk Factor” published since 2020. This 2022 version provides the perspective of ASPC members and includes updates to sentinel references (applicable guidelines and select reviews) for each CVD risk factor section. The ten CVD risk factors include unhealthful dietary intake, physical inactivity, dyslipidemia, pre-diabetes/diabetes, high blood pressure, obesity, considerations of select populations (older age, race/ethnicity, and sex differences), thrombosis (with /smoking as a potential contributor to thrombosis), kidney dysfunction and genetics/familial hypercholesterolemia. Other CVD risk factors may be relevant, beyond the CVD risk factors discussed here. However, it is the intent of the “ASPC Top Ten CVD Risk Factors 2022 Update” to provide a succinct tabular overview of things to know about ten of the most common CVD risk factors applicable to preventive cardiology and provide easy access to applicable guidelines and sentinel reviews.
... Food habits are also controversial. Several studies have shown that high fat intake has no signi cant relation to heart attacks or cardiovascular disease [5,6]. Science columnist Healey claimed that high saturated fat in the diet reduces strokes by 20% in his article "Is there more to a healthy-heart diet than cholesterol?" ...
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Objective Nutritional therapy, integrative and functional medicine, and psychiatry are areas of medicine where there has been limited research on the cause of disease and nutritional therapy. Modern medicine treats the medical cause, not the symptoms. All medicines are toxic in some way. Now, healthcare professionals are recommending food as medicine. Methods For this review, an extensive search was performed in electronic databases and in scientific publications. Boolean search methods were used in search engines such as Google Scholar, PubMed, Mendley, and other scientific databases. Search engines use terms such as food, metabolic disorder, cardiovascular disorder, food and/or functional food, etc. We reviewed the latest findings on food and metabolic disorders, especially those related to cardiovascular disease. Results Scientific research suggests that fruit and vegetables in a regular diet will reduce the risk of coronary heart disease and heart failure. Nature provides a large number of dietary options in the appropriate combination that can improve our health and cure metabolic disorders. It has been shown that a vegetarian diet and a Mediterranean diet have significant impact on the gut microbiome and cardiovascular disease risk. Conclusions A healthy lifestyle with a proper diet is essential in addition to traditional drug treatment for improving the lipid profile of cardiac patients. To develop effective targeted therapies, we need to further study molecular and cellular mechanisms of CVD. Genetic, inflammatory, nutritional, and immune factors can be studied to determine the pathogenesis of cardiometabolic syndrome
... Dairy products, rich of essential amino acids, calcium and fat, carries various beneficial effects on human health (Bhupathi et al., 2020) and are beneficial to avoiding major cardiovascular disease events and mortality (Dehghan et al., 2018). However the possible role of the total dairy consumption in mental disorders among adults remained remarkably uncertain and came to inconsistent results (Hockey et al., 2020). ...
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Background Knowledge remains limited about dairy consumption and childhood depression and social anxiety, which is our purpose. Methods A cross-sectional study including children and adolescents aged 7–17 years was conducted in 2020 in Beijing. Depression and social anxiety were assessed using the Children's Depression Inventory and the social anxiety scale for children. Habitual dairy consumption was defined as ≥6 days/week. Multivariate linear and logistic regression models were employed to analyze the associations between dairy consumption and depression and social anxiety. Subgroup analyses were conducted to test the robustness of the main results. Results A total of 1353 participants were included, with a mean age of 12.06 (SD = 3.10) years old. There were 53.58 % habitual dairy consumers and nearly 11.01 % consumed of ≤1 day/week. The prevalence of depression and social anxiety was 14.04 % and 29.64 %. Compared to participants with less dairy intake, the scores of depression and social anxiety in habitual dairy consumers decreased by 1.725 (95 % CI: −2.939, −0.512) and 1.083 (95 % CI: −1.821, −0.345). Correspondingly, habitual dairy consumption was inversely correlated with depression (OR = 0.602, 95%CI: 0.369–0.982) and social anxiety (OR = 0.622, 95%CI: 0.418–0.923). Such inverse associations were more pronounced in younger participants, those without siblings, with higher parental education and higher consumption of fruits or vegetables. Limitations Conclusions about causality remain speculative due to the cross-sectional design. Conclusions Habitual dairy consumption is inversely associated with childhood depression and social anxiety. A potential attempt could be implemented when recommending dairy products as an adjuvant therapy for childhood mental disorders.
... The content of healthy molecules in milk and dairy products is of fundamental importance, since several consumers have adopted a dairy-free diet due to suggested associations between milk and dairy products with obesity and coronary diseases [21]. However, in this regard, the data are conflicting, as a growing number of studies have demonstrated [22,23] that milk and dairy products have beneficial effects and an inverse association with cardiovascular disease (CVD) [24]. ...
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In the present study, we aimed at assessing the influence of breed and feeding system on the bovine milk profile of betaines and carnitines and milk capacity in counteracting the inflammatory endothelial cell (EC) damage induced by interleukin (IL)-6. In the first experimental design, two breeds were chosen (Holstein vs. Modicana) to investigate the biomolecule content and antioxidant capacity in milk and dairy products. In the second experimental design, two feeding systems (pasture vs. total mixed ratio) were tested only in Holstein to evaluate the possible effect on the functional profile of milk and dairy products. Finally, the bulk milk from the two experimental designs was used to evaluate the efficacy of preventing IL-6-induced endothelial inflammatory damage. Results showed that Modicana milk and whey had higher biomolecule content and antioxidant activity compared to Holstein milk (p < 0.01). Milk from Holstein fed TMR showed higher concentration of γ-butyrobetaine, δ-valerobetaine (p < 0.01), and l-carnitine (p < 0.05). Similarly, whey from Holstein fed TMR also showed higher content of δ-valerobetaine, glycine betaine, l-carnitine, and acetyl-l-carnitine (p < 0.01) compared to the Holstein fed pasture. Conversely, the antioxidant activity of milk and dairy products was not affected by the feeding system. In ECs, all milk samples reduced the IL-6-induced cytokine release, as well as the accumulation of reactive oxygen species (ROS) and the induction of cell death, with the most robust effect elicited by Modicana milk (p < 0.01). Overall, Modicana milk showed a higher content of biomolecules and antioxidant activity compared to Holstein, suggesting that the breed, more than the feeding system, can positively affect the health-promoting profile of dairy cattle milk.
... The content of vitamins A, D and E in skimmed milk is reduced, but such milk still provides the same amount of protein, calcium and vitamins B as whole milk. When recommending low-fat milk to adolescents and adults, we are primarily guided by the desire to limit animal fats in the diet, especially saturated fatty acids, which have antiatherosclerotic and anti-cancer effects [12,13]. These recommendations mainly apply to milk fat in the form of butter, and this is dictated by the high content of saturated fatty acids in milk fat, such as: lauric, myristic, palmitic and cholesterol. ...
Article
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Milk is an exceptional nutritional product that has been used for many millennia in human nutrition. Milk is a source of many valuable nutrients, including calcium, vitamin B, an especially significant amount of vitamin B2 and fat-soluble vitamins, such as A, D and E. Milk is an attractive product for fortification as it has a high nutritional density in a small volume and a relatively low price. Research shows positive health effects of drinking milk and consuming dairy products. Even more health benefits can be obtained from consuming fortified dairy products. A literature review, current nutritional recommendations, medical recommendations and an analysis of the market situation all recommend introducing milk enriched with minerals in combination with vitamins to the market. This concept corresponds to the current market demand and may supplement the missing and expected range of fortified milk and the correct number of recipients.
... P = 0.0001), and stroke (HR, 0.66; 95% CI, 0.53À0.82; P = 0.0003) [81]. ...
Article
Nutrition labels advise consumers about the nutritional value of packaged foods and their contribution to the overall composition of the diet. They have been proposed as an instrument for the promotion of healthy diets and the primary prevention of obesity and diet-related non-communicable diseases (NCDs). In this opinion paper, we discuss the ability of front-of-pack nutrition labels (FOPNLs) to improve health status, the concern about focusing on single nutrients/foods rather than on eating patterns to prevent obesity and NCDs, and the strength of positive messages compared to negative ones to promote a healthy and sustainable diet. Though nutrition science investigates individual foods or nutrients, when communicating to the public most of the significant evidence of the favorable health effect largely depends on dietary patterns and not in a single food component or individual nutrient. Therefore, we suggest that a new tool based on positive communication should be developed and implemented in order to highlight the importance of the diet as a complex matrix.
... As for dairy intake in Israel, the mean intake in our study is 402 ± 385 g per day. This value is higher than the estimated intake in Europe and North America, where the average daily intake is 364.8 g per day according to the PURE study (35). Since most dairy products consumed in Israel are domestically produced, and the production system is based on non-grazing cows, production can occur in a relatively small area (19,27). ...
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Providing a growing global population with healthy and sustainable diets is an immediate challenge. In the current study, estimates were obtained for the environmental footprints (land, water, and greenhouse gas (GHG) emissions) in association with the Mediterranean diet (MED) and the EAT-Lancet reference diet, which represents a healthy diet derived from sustainable food systems. We used a newly developed Sustainable Healthy Diet (SHED) index that was validated for the Israeli population by Tepper et al. in 2020. Methods: A group of 525 participants were recruited via social media, email, and phone. Demographic characteristics, quality of life, and answers to the SHED-index questionnaire were obtained. Dietary assessment was performed using the 116-item Food Frequency Questionnaire (FFQ), which was developed for the Israeli population. Adherence to the MED was calculated using a 9-point score. Adherence to the EAT-Lancet reference diet was assessed through the consumption of 14 food components. The environmental pressure of these dietary patterns was determined based on the "footprint family indicators," which include land, water, and carbon footprints per unit of agricultural and food products. We assigned values for each food comprising the FFQ and calculated the environmental load for each dietary pattern. Statistical analyses were performed using the R package version 4.1.1 to compare environmental footprint values according to tertiles of the MED score, EAT-Lancet score, and SHED score. Results: The participants (n = 525) were 49% women, educated (82% had academic education), and physically active, and only 13% were smokers. The highest tertiles of adherence to the MED, adherence to the EAT-Lancet reference diet, and the SHED index were associated with the lowest GHG emissions and land use, as well as higher water use. Meat consumption contributed the most to land use, while dairy contributed the most to GHG emissions, and fruits contributed the most to water use. Conclusions: Our analysis reveals that animal protein is the highest contributor to GHG emissions and land use, while fruits and vegetables contribute the most to water consumption. Nevertheless, most of the fruits and vegetables are grown using treated wastewater, which reduces environmental pressure. Given these findings, we suggest that MED and EAT-Lancet dietary patterns should be included in national dietary guidelines.
... In contrast, the results of two exclusive components of DASH diet were as expected. Dairy products showed consistent and substantial benefits on both obesity and metabolic health, which was in line with previous studies, especially in populations with generally low consumption of dairy products (40,41) . The sodium component score showed no association with obesity but a positive association with MHO because sodium mainly influences blood pressure, which is an important component of metabolic health. ...
Article
Metabolically healthy obesity (MHO) might be an alternative valuable target in obesity treatment. We aimed to assess whether alternative Mediterranean (aMED) diet and Dietary Approaches to Stop Hypertension (DASH) diet were favorably associated with obesity and MHO phenotype in a Chinese Multi-Ethnic population. We conducted this cross-sectional analysis using the baseline data of the China Multi-Ethnic Cohort (CMEC) study that enrolled 99 556 participants from seven diverse ethnic groups. Participants with self-reported cardiometabolic diseases were excluded to eliminate possible reverse causality. Marginal structural logistic models were used to estimate the associations, with confounders determined by directed acyclic graph (DAG). Among 65 699 included participants, 11.2% were with obesity. MHO phenotype was present in 5.7% of total population and 52.7% of population with obesity. Compared with the lowest quintile, the highest quintile of DASH diet score had 23% decreased odds of obesity (OR = 0.77, 95% CI: 0.71-0.83, P trend <0.001), and 27% increased odds of MHO (OR = 1.27, 95% CI: 1.10-1.48, P trend =0.001) in population with obesity. However, aMED diet showed no obvious favorable associations. Further adjusting for BMI did not change the associations between diet scores and MHO. Results were robust to various sensitivity analyses. In conclusion, DASH diet rather than aMED diet is associated with reduced risk of obesity and presents BMI-independent metabolic benefits in this large population-based study. Recommendation for adhering to DASH diet may benefit the prevention of obesity and related metabolic disorders in Chinese population.
... Recent evidence suggests dairy products do not adversely affect the risk of cardiovascular disease (CVD) (Soedamah-Muthu et al., 2011;Fontecha et al., 2019;Chen et al., 2021) and that consumption may lower risk of mortality, CVD and stroke (Qin et al., 2015;Dehghan et al., 2018). However, some consumers have negative health perceptions of milk fat (Vargas-Bello-Pérez et al., 2020) or concerns regarding weight control, and as a result, nutrition claims such as lighter and fat free are frequently displayed on the FoP labels of dairy products. ...
Article
Consumer interest in Grass-Fed dairy products is increasing with some consumer groups willing to pay a premium for dairy labelled as Grass-Fed. The aim of this study was to examine the effect of the term Grass-Fed on a label in combination with claims on fat content, on consumer perceptions of Cheddar cheese in Irish and US participants. Consumers from Ireland (n = 345) and the United States (n = 432) completed an anonymous online survey and were presented with one of two sets of cheese label images, either Regular-Fat and Regular-Fat-Grass-Fed or Lighter-Fat and Lighter-Fat-Grass-Fed. Participants were asked to rate expected sensory characteristics and perceived healthiness and naturalness, based on each label. Participants then selected a portion of each cheese that they would be likely to consume on a slice of toast for lunch, from 100 portion size images ranging from 1.2 g to 120 g. Inclusion of a Grass-Fed claim on a cheese label did not influence sensory expectations of cheese, but perceived healthiness and naturalness were higher, in both cohorts. The Lighter-Fat claim had a negative influence on sensory expectations, with consumers in both cohorts reporting a lower expected liking and flavour intensity. In the Irish cohort, a Lighter-Fat claim enhanced perceived healthiness. The front-of-pack claim had no impact on portion selection in US consumers. Irish consumers, however, chose a larger portion for the Lighter-Fat cheese compared to the Regular-Fat-Grass-Fed cheese. Inclusion of Grass-Fed on the label alongside information on Regular-Fat or Lighter-Fat may enhance consumers’ perceptions of healthiness and naturalness, without compromising sensory expectations. Products with Lighter labels may be chosen in larger portions, with potential implications for consumers who choose them as part of a weight-control strategy.
... Previous reports are not up-to-date, 21,22 reported on only a few ASF subtypes, 23 used crude national estimates of food availability or expenditure 23 that may not reflect dietary intakes, 24 or are focused on select countries, regions, or age groups. [25][26][27][28][29] Furthermore, global consumption levels among children or by education attainment and urban versus rural residence have not been previously reported. ...
... g/day among Chinese adults aged 45 to 74 years during 1999-2010 [22]. Dairy product intake is much lower in China than in America and European countries and is below the recommendation of the Chinese Dietary Guideline in 2016 for adults (300 g/day) [6,23], which causes an insufficient intake of multiple nutrients, such as calcium and protein [22]. Previous studies showed that the effect of dairy products on health partially depended on the diet quality of people. ...
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Background: The current literature reports inconsistent associations between dairy product intake and fracture. This study assessed the association between dairy product intake and the risk of fracture among Chinese adults and examined the mediation effects of height and body mass index (BMI) on the association. Methods: Data in 1997-2015 from the China Health and Nutrition Survey were used. Dietary data were collected by a 24-hour dietary recall, and occurrences of fracture were obtained by self-report of participants. Cumulative average intake of daily dairy products was calculated by the sum of the dairy product intake and divided by the total waves of participating in the surveys before fracture. Cox proportion hazard regressions were performed to explore the associations between dairy product intake and the risk of fracture. Mediation analysis models were established to examine the mediation effects of height and BMI on the associations. Results: A total of 14,711 participants were included. Dairy product intake of 0.1-100 g/day was associated with a decreased risk of fracture, while no association was observed among participants with dairy product intake of >100 g/day. The indirect effects of dairy product intake on the fracture mediated by height and BMI were much smaller than the direct effects. Conclusions: Dairy product intake with 0.1-100 g/day is associated with a lower risk of fracture, and the association is mainly a direct result of nutrients in dairy products and much less a result of the mediation effects of height or BMI. Dairy product intake of 0.1-100 g/day might be a cost-effective measure for Chinese adults to decrease fracture incidence.
Thesis
L’hypertension artérielle (HTA) est l’un des principaux facteurs de risque de maladies cardiovasculaires. Elle touche près d’un adulte sur trois dans le monde et occupe la première place en termes d’années de vie en bonne santé perdues chez les femmes, et la deuxième chez les hommes derrière le tabagisme. La prévalence de l’HTA, comme l’incidence, varient entre différentes zones géographiques mais également selon le statut socioéconomique. Ces inégalités territoriales et socioéconomiques sont cependant encore mal comprises. Or, peu de travaux se sont penchés sur ces inégalités en France et les études d’incidence de l’HTA restent rares. Dans ce contexte, l’objectif principal de cette thèse est d’estimer et d’expliquer les inégalités territoriales et sociales dans l’HTA. Les données de deux cohortes ont été exploitées : la cohorte française CONSTANCES qui regroupe des individus âgés de 18 à 69 ans et recrutés depuis 2012 (n=63 000) et la cohorte américaine HRS qui inclut des adultes de plus de 50 ans suivi depuis le début des années 90 (n=17 000). Ce travail met en évidence l’existence d’une part, de fortes disparités territoriales et d’autre part, d’inégalités sociales marquées de prévalence de l’HTA en France. Des inégalités sociales importantes sont également observées dans l’incidence de l’HTA aux Etats-Unis. Cependant, les déterminants comportementaux et anthropométrique pris en compte n’expliquent que partiellement les inégalités observées. Par ailleurs, l’ampleur des inégalités et la forme des associations entre statut socioéconomique, facteurs comportementaux et anthropométrique, et HTA diffèrent entre les hommes et les femmes. Ces travaux apportent de nouveaux éléments pour une meilleure identification des populations les plus vulnérables et des leviers d’action efficaces pour la prévention de l’HTA et la réduction des inégalités dans l’HTA.
Article
Background The importance of the composition of an energy-restricted diet in the treatment of metabolic syndrome (MetS) is unknown. Objectives This study aimed to investigate the benefits of a novel dietary treatment (50% calorie restriction diet composed of yogurt, fruit, and vegetables (CR-YD)) on MetS mice. Methods Forty 7-week-old male C57BL/6 J mice were randomly assigned to 4 groups (n = 10/group) that consumed for 14week ad libitum a normal diet (ND, 10:70:20% energy from fat: carbohydrate: protein) or a high-fat diet (HFD, 60:20:20) or the HFD for 12week followed by 2week of consuming at 50% calorie-restriction the HFD (CR-HFD) or YD (CR-YD, 21.2: 65.4: 13.4% energy). Body weight, fat deposition, hepatic steatosis, serum concentrations of inflammatory biomarkers, and glucose homeostasis were assessed. Fecal microbiota transplantation (FMT) was used to validate the roles of gut microbiota in MetS. Results The HFD group had 50% greater body weight and 475% greater fat deposition than the ND group (P < 0.05). Compared with the HFD group, the CR-HFD and CR-YD groups had 22% and 31% lower body weight and 49% and 75% less fat deposition, respectively (P < 0.05). Compared with the CR-HFD group, the CR-YD group had 11% lower body weight, 96% less fat deposition, 500% less hepatic steatosis, 75% lower glucose, 450% greater hepatic Akkermansia (P < 0.05). The CR-YD group also had 50% lower histopathology scores, and 1.35-fold higher levels of Claudin4 than the CR-HFD group (P < 0.05). HFD + CR-YD fecal group had 10.6% lower body weight, 119% lower steatosis, and 17.9% lower glucose (P < 0.05) than HFD + CR-HFD fecal group. Conclusions Compared with CR alone, the CR-YD diet has a better therapeutic effect in mice with HFD-induced MetS.
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Objective To identify, systematically, the interventions based on environmental determinants to improve the nutritional and physical activity (PA) habits available in Colombia. Design A scoping review was performed according to the guidelines of the Joanna Briggs Institute. Study selection All studies about intervention programmes for PA and nutritional behaviours in Colombia were included. Methods Searches in Medline/PubMed, Embase, Cochrane, Scielo and Lilacs, using MeSH, Decs and Emtree terms, were performed up to August 2020. Additionally, a manual search was made in specialised national journals. An internet documentary search of the official websites on policies and programmes by departmental, district and municipal secretariats was also performed. Two reviewers independently screened titles and abstracts. Then, the full texts were reviewed to select documents to be included. Data management relevant information from selected documents and articles was extracted. A descriptive analysis was considered. Results Sixty-seven documents and 70 published articles were found. The programmes were identified in 13 initiatives, 7 in the area of PA and 6 with a nutrition focus. They were on physical and social environmental modifications such as the ‘ muévete ’ (‘get moving’) programmes in Bogota, Quindio and Cartagena; a modification of ‘ ciclovía ’; or bicycle path programmes as well as nutrition programmes in schools, universities and companies. Conclusion This scoping review identified national programmes and policies in Colombia in the area of nutrition and PA from the environmental perspective in different scenarios: from schools to workplaces and communities. The need to implement such programmes from public and private institutions is also noted, promoting the practice of PA and healthy eating in every scenario in the national territory. New research to determine the impact of these programmes is essential to get a glimpse of the effects of these programmes and the implications for public health.
Article
Background: Low 24 h urinary potassium excretion, reflecting low potassium intake, is associated with premature mortality in the general population. Objectives: Whether urinary potassium excretion is associated with all-cause mortality in patients with type 2 diabetes is unknown. Methods: We performed a prospective cohort study in 654 patients with type 2 diabetes of the Diabetes and Lifestyle Cohort Twente (DIALECT). Sex-specific tertiles of 24 h urinary potassium excretion were analysed in a multivariable Cox regression model with all-cause mortality. The outpatient program of the hospital uses a continuous surveillance system by the municipal registry of death to ensure up-to-date information on the patient's status (alive or deceased). Food frequency questionnaires were used to study associations between urinary potassium excretion and food products. Results: Urinary potassium excretion at baseline was 84 ± 25 mmol·day-1 in males and 65 ± 22 mmol·day-1 in females, corresponding to estimated potassium intakes of 4250 ± 1270 mg·day-1 and 3300 ± 875 mg·day-1. During median follow-up for 5.2 [interquartile range 2.7 - 7.9] years, 96 participants died. In a fully adjusted model, patients in the lowest sex-specific tertile had a higher risk of all-cause mortality, compared with patients in the highest sex-specific tertile (HR: 2.09; 95% CI: 1.06, 4.10; P = 0.03). Patients in the lowest sex-specific tertile consumed less fruits and vegetables, dairy, coffee, and potato products compared with patients in the highest sex-specific tertile (all P < 0.05). Conclusions: Low potassium intake is associated with a higher risk of all-cause mortality in Dutch patients with type 2 diabetes. Intervention studies are needed to determine whether potassium supplementation improves longevity in patients with type 2 diabetes.
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Dairy production provides high-quality, healthful nutrients to people on a planet soon to be inhabited by over 9 billion people. In doing so, it is ever more important to continuously improve the care of dairy animals, safeguard the environment we all share, and reliably produce nutritious food while maintaining the economic viability of the people working in dairy agriculture. In this paper, we review some associations between dairy consumption and human health along with the many interconnections between people, dairy animals, plants, and our shared environment. Understanding these relationships is an example of one health at work. In the US, total dairy consumption is at its highest point in the last 50 years, while many objective measures of cow health (eg, subclinical mastitis) have never been better since they have been recorded. Further, indications of food safety such as violative antibiotic residues in milk have never been lower. Dairy foods provide essential nutrients such as protein, vitamin B12, and calcium, while there is also evidence that they are protective against chronic conditions such as cardiovascular disease. Finally, the environmental footprint of dairy production in the US, as measured by metrics such as carbon dioxide–equivalent emissions intensity per unit of dairy nutrient, is the lowest it has ever been. The companion Currents in One Health by Nguyen et al, AJVR , January 2023, discusses some additional animal welfare and environmental impact implications of modern dairy production management in detail.
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Introduction: The association of dairy products with cardiovascular disease and mortality risk remains heavily debated. We aimed to investigate the association between intake of total dairy and dairy products and the risk of acute myocardial infarction (AMI), stroke, and cardiovascular and all-cause mortality. Methods: We included 1929 patients (80% men, mean age 62 years) with stable angina pectoris from the Western Norway B-vitamin Intervention Trial. Dietary data were obtained via a 169-item food frequency questionnaire. Risk associations were estimated using Cox proportional hazard regression models adjusted for relevant covariates. Non-linear associations were explored visually. Results: The mean (± SD) dairy intake in the study population was 169 ± 108 g/1000 kcal. Median follow-up times were 5.2, 7.8 and 14.1 years for stroke, AMI, and mortality, respectively. Higher intake of total dairy and milk were positively associated with stroke risk (HR [95%CI]: 1.14 [1.02, 1.27] and 1.13 [1.02, 1.27], cardiovascular mortality (1.06 [1.00, 1.12] and 1.07 [1.01, 1.13]) and all-cause mortality (1.07 [1.03, 1.11] and 1.06 [1.03, 1.10]) per 50 g/1000 kcal. Higher cheese intake was inversely associated with AMI risk (0.92 [0.83, 1.02]) per 10 g/1000 kcal. Butter was associated with increased AMI risk (1.10 [0.97, 1.24]), and all-cause mortality (1.10 [1.00, 1.20] per 5 g/1000 kcal. Conclusion: Higher dairy and milk consumption were associated with increased risk of mortality and stroke. Cheese was associated with decreased, and butter with increased, risk of AMI. Dairy is a heterogenous food group with divergent health effects and dairy products should therefore be investigated individually.
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Introduction: Given that some plant-based foods, such as potatoes, adversely affect cardiovascular disease (CVD) risk factors, this study was performed to assess the association between plant dietary patterns and these risk factors. Methods: This cross-sectional study was conducted among 371 healthy 18 to 50 year-old Iranian women. Participant dietary intake was assessed using a validated food frequency questionnaire. Nineteen food groups were ranked in deciles and received scores from 1 to 10. An overall plant-based dietary index (PDI), a healthy plant-based dietary index (hPDI), and an unhealthy plant-based dietary index (uPDI) were calculated. Results: Participants who scored in the top tertile of the PDI or uPDI consumed less fat and protein and more carbohydrates, compared to women in the lowest tertile (P < 0.05). There was no significant variation in macronutrient consumption between the highest and lowest tertiles of hPDI. Participants who scored in the highest tertile of PDI had lower low density cholesterol level (LDL) (79.61 ± 14.36 mg dL−1 vs. 83.01 ± 14.96 mg/dL−1, P = 0.021). In addition, higher adherence to uPDI was associated with higher triglyceride (TG) levels compared to participants with lower adherence (101.5 ± 56.55 mg/dL−1 vs. 97.70 ± 56.46 mg dL−1, P < 0.0001). Here was no significant association between PDI, hPDI and uPDI and CVD risk factors in regression model. Conclusion: We found no significant association between plant-based dietary indices and CVD risk factors in women, except for LDL-C and TG. Future cohort studies are needed to confirm these findings.
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Background and aims Reducing dietary cholesterol is generally acceptable for the prevention of cardiovascular disease (CVD). Eggs are nutrient-dense and common food items across the world, while rich in cholesterol. The potential effects of egg intake on cardiovascular health remain uncertainty and have been under debate in past decades. Methods and results A nationwide cohort of 20,688 participants ages 16–110 years without CVD at baseline were derived from China Family Panel Studies. Egg consumption was assessed by a semi-quantitative food frequency questionnaire. We adopted stratified Cox proportional hazards model with random intercepts for provinces to evaluate associations of egg intake with CVD incidence. During a median follow-up of 6.0 years, we identified 2395 total CVD incidence and mean egg consumption was 3 times/week. Egg intakes were associated lower risks of CVD incidence in the multivariate-adjusted model. Compared with the non-consumers, the corresponding HRs (95% confidence interval) for total CVD events were 0.84 (0.74 to 0.94) for 1–2 times per week, 0.78 (0.69 to 0.88) for 3–6/week, and 0.83 (0.72 to 0.95) for ≥7/week. Similar relationships were found in hypertension. Approximately non-linear relationships were observed between egg consumption with total CVD and hypertension incidence, identifying the lowest risk in 3–6 times/week. Subgroup analyses estimated lower risks of total CVD and hypertension in females only, with significant effect modification by sex (P for interaction = 0.008 and 0.020). Conclusion Egg consumption may be associated with lower risks of CVD incidence among Chinese adults. Our findings could have implications in CVD prevention and might be considered in the development of dietary guidelines.
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High-amylose maize starch (HAMS) can provide dietary fiber to foods. In this study, we investigated the effects of three HAMSs (Gelose 50, Hylon VII, and NAFU50) on the functionality of casein (CA) and/or whey protein (WP) networks in acidified milk gels using normal maize starch (NMS) as a control thickener. When compared with NMS, HAMSs performed better in increasing the resistant starch content (RS), storage modulus, loss modulus, and complex viscosity of all the milk gels. The results are attributed to the retention of the starch granular integrity of HAMSs during the preparation of the milk gels, as observed by microscopy. HylonVII exhibited the highest RS and viscosity in all milk gel systems, especially in WP gels (71.8% RS and >3000 Pa.s at 1 Hz viscosity). Our data provide support for the potential of using HAMS to develop healthier yogurt products using functional thickeners from natural sources.
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Front-of-pack labels (FOPL) aim at communicating to consumers the health value of food items in support of public health policies. Two main types can be discerned: “directive and semi-directive” FOPL using colour schemes (e.g., Nutri-Score) and “informative” FOPL (e.g., Nutrinform Battery). “Directive” approaches tend to show a “wear out effect” and, in addition, they suffer from various underlying conceptual problems. Usually, their nutritional scores are calculated using changing, arbitrary algorithms and involve a reductionist set of parameters of debateable validity. Thus, they overstate the effects of selected nutritional factors, such as saturated fat and energy, while overlooking the food matrix and the more holistic aspects of nourishment. Moreover, they do not reflect the portion that is actually consumed, ignore the preparation steps at home, and fail to serve as a useful basis for composing a healthy diet. Also, so long as the nutritional formulations match the algorithmic standards, they tend to allow ultra-processed products. Altogether this might confuse and mislead consumers. Overconfidence in "green"-coloured labels could even result in unbalanced dietary choices, whereas avoidance of “red” products may eliminate certain foods from the diet that are rich in essential nutrients (e.g., cheese), leading to opposite results than aimed for. The latter is particular relevant to vulnerable populations, such as the young, pregnant women, and older adults, or for individuals with specific needs. Taken together, “directive” FOPL such as Nutri-Score contradict the declared intent of the European Commission to empower consumers to undertake healthy and balanced diets based on easy accessible and robust information. Although “informative" systems usually also keep the focus on a few selected nutritional parameters, they have the merit of being less paternalizing and obviate the need to classify foods as "healthy" or "unhealthy". They also focus their attention on the individual portions that are consumed (even if the definition of portion size remains contentious). Given the importance of dietary patterns, rather than individual foods or nutrients, “directive” FOPL of the Nutri-Score type represent a regretful case of “nutritionism”. Finally, attempts to associate the adoption of a FOPL with an improvement in the health status are few and mainly applied in virtual settings; none of which are longitudinal nor have they been able to identify a causal link.
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The high decline in liquid milk consumption in Western countries has been compensated by the increased consumption of processed dairy products and the rapidly increasing number of new plant-based beverages constantly introduced in the market, advertised as milk substitutes and placed on shelves near milk products. To provide better understanding about the nutritional value of these drinks compared with cow’s milk, 27 plant-based drinks of 8 different species and two milk samples were purchased from two big retailers in Switzerland, and their composition regarding protein, carbohydrate, fat, vitamin, and mineral contents and residue load [glyphosate, aminomethylphosphonic acid (AMPA), and arsenic] was analyzed quantitatively and qualitatively. Energy and nutrient intakes were calculated and compared with the dietary reference values for Germany, Austria and Switzerland (D-A-CH). In addition, the digestible indispensable amino acid score (DIAAS) was calculated to estimate the quality of the proteins. Milk contained more energy; fat; carbohydrate; vitamins C, B2, B12, and A; biotin; pantothenic acid; calcium; phosphorus; and iodine than most plant-based drinks. Soy drinks provided slightly more protein and markedly more vitamins B1 and B6, folic acid, and vitamins E and D2 (with supplemented vitamin D2) and K1, magnesium, manganese, iron, and copper than milk and the other plant-based drinks. However, with the exception of cow’s milk and soy drinks, which had > 3% protein, most milk alternatives contained ≤ 1% protein; therefore, they cannot be considered good protein sources. In regard to protein quality, milk was outstanding compared with all plant-based drinks and exhibited higher calculated DIAASs. Our results show that the analyzed plant-based drinks are not real alternatives to milk in terms of nutrient composition, even if the actual fortification is taken into account. Improved fortification is still an issue and can be optimized using the most bioavailable and soluble derivatives. Complete replacement of milk with plant-based drinks without adjusting the overall diet can lead to deficiencies of certain important nutrients in the long term.
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Background & Aims Diet modification is a major component of non-pharmacological coronary heart disease (CHD) prevention. Few studies have examined the association between consumption of different dairy products with subclinical coronary artery disease. We sought to examine whether milk, yogurt, or cheese consumption is associated with calcified atherosclerotic plaques in the coronary arteries. Methods We cross-sectionally examined 2278 participants from the National Heart, Lung, and Blood Institute Family Heart Study. Dairy consumption was assessed by a semiquantitative food frequency questionnaire. Coronary artery calcium (CAC) was estimated by cardiac computed tomography. We used an Agatston score of ≥100 to indicate prevalent CAC and fitted multivariable logistic regression to calculate adjusted odds ratios. Results Mean age was 58±13 years and 45% were male. The frequency of milk (≤1/week, 2-4/week, and ≥5/week; 22%, 14%, and 64%, respectively), yogurt (almost never, <1/week, and ≥1/week; 54%, 20%, and 26%, respectively), and cheese consumption (<1/week, 1/week, 2-4/week, and ≥5/week; 15%, 17%, 41%, and 27%, respectively) varied in the cohort. We observed an inverse association of cheese consumption with prevalent CAC: odds ratio (95% CI) of 0.63 (0.42-0.94) when comparing cheese intake of ≥5 servings/week with <1/week, adjusting for sex, age, body mass index, cigarette pack years, presence of CHD, family income, and education (p for linear trend 0.007). In contrast, there was no association between yogurt or milk consumption and CAC (p for linear trend 0.51 and 0.87, respectively). Conclusion Our data suggest that cheese consumption but not yogurt or milk is associated with a lower odds of CAC in men and women.
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The potential cardiovascular (CV) benefits of many trending foods and dietary patterns are still incompletely understood, and scientific inquiry continues to evolve. In the meantime, however, a number of controversial dietary patterns, foods, and nutrients have received significant media attention and are mired by “hype.” This second review addresses some of the more recent popular foods and dietary patterns that are recommended for CV health to provide clinicians with current information for patient discussions in the clinical setting. Specifically, this paper delves into dairy products, added sugars, legumes, coffee, tea, alcoholic beverages, energy drinks, mushrooms, fermented foods, seaweed, plant and marine-derived omega-3-fatty acids, and vitamin B12.
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Introduction: Conflicting results in the literature exist on the role of dairy products in the context of a Nordic Healthy Diet (NHD). Two recent Swedish studies indicate both negative and positive associations with total mortality when comparing key dairy products. There is no consensus about how to include these foods into the NHD. Purpose: To study consumption of cheese and milk products (milk, sour milk and unsweetened yoghurt) by 70-year-old Swedes in relation to all-cause mortality. Methods: Cox proportional hazard models, adjusted for potential confounders and stratified by follow-up duration, were used to assess the prediction of all-cause mortality by the above foods. The associations of fat from cheese and milk products with mortality were tested in separate models. Results: Cheese intake inversely predicted total mortality, particularly at high protein intakes, and this association decreased in strength with increasing follow-up time. Milk products predicted increased mortality with stable HRs over follow-up. The association between milk products and mortality was strongly influenced by the group with the highest consumption. Fat from cheese mirrored the protective association of cheese intake with mortality, whereas fat from milk products predicted excess mortality, but only in an energy-adjusted model. Conclusion: Based on our results, it may be argued that the role of dairy products in the context of a Nordic healthy diet should be more clearly defined by disaggregating cheese and milk products and not necessarily focusing on dairy fat content. Future epidemiological research should consider dairy products as disaggregated food items due to their great diversity in health properties.
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Background: The relationship between macronutrients and cardiovascular disease and mortality is controversial. Most available data are from European and North American populations where nutrition excess is more likely, so their applicability to other populations is unclear. Methods: The Prospective Urban Rural Epidemiology (PURE) study is a large, epidemiological cohort study of individuals aged 35-70 years (enrolled between Jan 1, 2003, and March 31, 2013) in 18 countries with a median follow-up of 7·4 years (IQR 5·3-9·3). Dietary intake of 135 335 individuals was recorded using validated food frequency questionnaires. The primary outcomes were total mortality and major cardiovascular events (fatal cardiovascular disease, non-fatal myocardial infarction, stroke, and heart failure). Secondary outcomes were all myocardial infarctions, stroke, cardiovascular disease mortality, and non-cardiovascular disease mortality. Participants were categorised into quintiles of nutrient intake (carbohydrate, fats, and protein) based on percentage of energy provided by nutrients. We assessed the associations between consumption of carbohydrate, total fat, and each type of fat with cardiovascular disease and total mortality. We calculated hazard ratios (HRs) using a multivariable Cox frailty model with random intercepts to account for centre clustering. Findings: During follow-up, we documented 5796 deaths and 4784 major cardiovascular disease events. Higher carbohydrate intake was associated with an increased risk of total mortality (highest [quintile 5] vs lowest quintile [quintile 1] category, HR 1·28 [95% CI 1·12-1·46], ptrend=0·0001) but not with the risk of cardiovascular disease or cardiovascular disease mortality. Intake of total fat and each type of fat was associated with lower risk of total mortality (quintile 5 vs quintile 1, total fat: HR 0·77 [95% CI 0·67-0·87], ptrend<0·0001; saturated fat, HR 0·86 [0·76-0·99], ptrend=0·0088; monounsaturated fat: HR 0·81 [0·71-0·92], ptrend<0·0001; and polyunsaturated fat: HR 0·80 [0·71-0·89], ptrend<0·0001). Higher saturated fat intake was associated with lower risk of stroke (quintile 5 vs quintile 1, HR 0·79 [95% CI 0·64-0·98], ptrend=0·0498). Total fat and saturated and unsaturated fats were not significantly associated with risk of myocardial infarction or cardiovascular disease mortality. Interpretation: High carbohydrate intake was associated with higher risk of total mortality, whereas total fat and individual types of fat were related to lower total mortality. Total fat and types of fat were not associated with cardiovascular disease, myocardial infarction, or cardiovascular disease mortality, whereas saturated fat had an inverse association with stroke. Global dietary guidelines should be reconsidered in light of these findings. Funding: Full funding sources listed at the end of the paper (see Acknowledgments).
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Introduction: There is no global consensus on the relationship of dairy products with cardiovascular diseases. This study was conducted to evaluate the effect of the consumption of dairy products on cardiovascular diseases, including stroke and coronary heart disease (CHD). Methods: Important electronic databases such as the Scopus, Science Direct, and PubMed were evaluated up to September 2014. All prospective cohort studies that evaluated the relationship between dairy products consumption and cardiovascular diseases were included regardless of their publication date and language. The study participants were evaluated regardless of age, sex, and ethnicity. The STROBE checklist was used to assess quality of the study. Two investigators separately selected the studies and extracted the data. The designated effects were risk ratio (RR) and hazard ratio (HR). The random effect model was used to combine the results. Results: Meta-analysis was performed on 27 studies. There were 8648 cases of cardiovascular diseases (CVD), 11806 cases of CHD, and 29300 cases of stroke. An inverse association was found between total dairy intake and CVD (RR=0.90, 95% CI: 0.81-0.99) and stroke (RR=0.88, 95% CI: 0.82-0.95) while no association was observed between total dairy intake and CHD. The total diary intake was associated with decreased mortality of stroke (RR=0.80, 95% CI: 0.76-0.83) although it had no association with its incidence (RR=0.96, 95% CI: 0.88-1.04). Conclusion: This is the first meta-analysis of the relationship of total dairy intake with CVD. This study showed an inverse relationship between total dairy intake and CVD while no relationship was found for CHD. Considering the limited number of studies in this regard, more studies are required to investigate the effect of different factors on the association of dairy intake and CVD.
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Objective To examine whether previous observed inverse associations of dairy intake with systolic blood pressure and risk of hypertension were causal. Design Mendelian randomization study using the single nucleotide polymorphism rs4988235 related to lactase persistence as an instrumental variable. Setting CHARGE (Cohorts for Heart and Aging Research in Genomic Epidemiology) Consortium. Participants Data from 22 studies with 171 213 participants, and an additional 10 published prospective studies with 26 119 participants included in the observational analysis. Main outcome measures The instrumental variable estimation was conducted using the ratio of coefficients approach. Using meta-analysis, an additional eight published randomized clinical trials on the association of dairy consumption with systolic blood pressure were summarized. Results Compared with the CC genotype (CC is associated with complete lactase deficiency), the CT/TT genotype (TT is associated with lactose persistence, and CT is associated with certain lactase deficiency) of LCT-13910 (lactase persistence gene) rs4988235 was associated with higher dairy consumption (0.23 (about 55 g/day), 95% confidence interval 0.17 to 0.29) serving/day; P<0.001) and was not associated with systolic blood pressure (0.31, 95% confidence interval −0.05 to 0.68 mm Hg; P=0.09) or risk of hypertension (odds ratio 1.01, 95% confidence interval 0.97 to 1.05; P=0.27). Using LCT-13910 rs4988235 as the instrumental variable, genetically determined dairy consumption was not associated with systolic blood pressure (β=1.35, 95% confidence interval −0.28 to 2.97 mm Hg for each serving/day) or risk of hypertension (odds ratio 1.04, 0.88 to 1.24). Moreover, meta-analysis of the published clinical trials showed that higher dairy intake has no significant effect on change in systolic blood pressure for interventions over one month to 12 months (intervention compared with control groups: β=−0.21, 95% confidence interval −0.98 to 0.57 mm Hg). In observational analysis, each serving/day increase in dairy consumption was associated with −0.11 (95% confidence interval −0.20 to −0.02 mm Hg; P=0.02) lower systolic blood pressure but not risk of hypertension (odds ratio 0.98, 0.97 to 1.00; P=0.11). Conclusion The weak inverse association between dairy intake and systolic blood pressure in observational studies was not supported by a comprehensive instrumental variable analysis and systematic review of existing clinical trials.
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Background: Dietary guidelines recommend avoiding foods high in saturated fat. Yet, emerging evidence suggests cardiometabolic benefits of dairy products and dairy fat. Evidence on the role of butter, with high saturated dairy fat content, for total mortality, cardiovascular disease, and type 2 diabetes remains unclear. We aimed to systematically review and meta-analyze the association of butter consumption with all-cause mortality, cardiovascular disease, and diabetes in general populations. Methods and findings: We searched 9 databases from inception to May 2015 without restriction on setting, or language, using keywords related to butter consumption and cardiometabolic outcomes. Prospective cohorts or randomized clinical trials providing estimates of effects of butter intake on mortality, cardiovascular disease including coronary heart disease and stroke, or diabetes in adult populations were included. One investigator screened titles and abstracts; and two reviewed full-text articles independently in duplicate, and extracted study and participant characteristics, exposure and outcome definitions and assessment methods, analysis methods, and adjusted effects and associated uncertainty, all independently in duplicate. Study quality was evaluated by a modified Newcastle-Ottawa score. Random and fixed effects meta-analysis pooled findings, with heterogeneity assessed using the I2 statistic and publication bias by Egger's test and visual inspection of funnel plots. We identified 9 publications including 15 country-specific cohorts, together reporting on 636,151 unique participants with 6.5 million person-years of follow-up and including 28,271 total deaths, 9,783 cases of incident cardiovascular disease, and 23,954 cases of incident diabetes. No RCTs were identified. Butter consumption was weakly associated with all-cause mortality (N = 9 country-specific cohorts; per 14g(1 tablespoon)/day: RR = 1.01, 95%CI = 1.00, 1.03, P = 0.045); was not significantly associated with any cardiovascular disease (N = 4; RR = 1.00, 95%CI = 0.98, 1.02; P = 0.704), coronary heart disease (N = 3; RR = 0.99, 95%CI = 0.96, 1.03; P = 0.537), or stroke (N = 3; RR = 1.01, 95%CI = 0.98, 1.03; P = 0.737), and was inversely associated with incidence of diabetes (N = 11; RR = 0.96, 95%CI = 0.93, 0.99; P = 0.021). We did not identify evidence for heterogeneity nor publication bias. Conclusions: This systematic review and meta-analysis suggests relatively small or neutral overall associations of butter with mortality, CVD, and diabetes. These findings do not support a need for major emphasis in dietary guidelines on either increasing or decreasing butter consumption, in comparison to other better established dietary priorities; while also highlighting the need for additional investigation of health and metabolic effects of butter and dairy fat.
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Background: Flavonoids have been implicated in the prevention of cardiovascular disease; however, their mechanisms of action have yet to be elucidated, possibly because most previous in vitro studies have used supraphysiological concentrations of unmetabolized flavonoids, overlooking their more bioavailable phenolic metabolites. Objective: We aimed to explore the effects of phenolic metabolites and their precursor flavonoids at physiologically achievable concentrations, in isolation and combination, on soluble vascular cellular adhesion molecule-1 (sVCAM-1). Method: Fourteen phenolic acid metabolites and 6 flavonoids were screened at 1 μM for their relative effects on sVCAM-1 secretion by human umbilical vein endothelial cells stimulated with tumor necrosis factor alpha (TNF-α). The active metabolites were further studied for their response at different concentrations (0.01 μM–100 μM), structure-activity relationships, and effect on vascular cellular adhesion molecule (VCAM)-1 mRNA expression. In addition, the additive activity of the metabolites and flavonoids was investigated by screening 25 unique mixtures at cumulative equimolar concentrations of 1 μM. Results: Of the 20 compounds screened at 1 μM, inhibition of sVCAM-1 secretion was elicited by 4 phenolic metabolites, of which protocatechuic acid (PCA) was the most active (−17.2%, P = 0.05). Investigations into their responses at different concentrations showed that PCA significantly reduced sVCAM-1 15.2–36.5% between 1 and 100 μM, protocatechuic acid-3-sulfate and isovanillic acid reduced sVCAM-1 levels 12.2–54.7% between 10 and 100 μM, and protocatechuic acid-4-sulfate and isovanillic acid-3-glucuronide reduced sVCAM-1 secretion 27.6% and 42.8%, respectively, only at 100 μM. PCA demonstrated the strongest protein response and was therefore explored for its effect on VCAM-1 mRNA, where 78.4% inhibition was observed only after treatment with 100 μM PCA. Mixtures of the metabolites showed no activity toward sVCAM-1, suggesting no additive activity at 1 μM. Conclusions: The present findings suggest that metabolism of flavonoids increases their vascular efficacy, resulting in a diversity of structures of varying bioactivity in human endothelial cells.
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Background: Conflicting evidence exists regarding the association between saturated fatty acids (SFAs) and type 2 diabetes. In this longitudinal case-cohort study, we aimed to investigate the prospective associations between objectively measured individual plasma phospholipid SFAs and incident type 2 diabetes in EPIC-InterAct participants. Methods: The EPIC-InterAct case-cohort study includes 12,403 people with incident type 2 diabetes and a representative subcohort of 16,154 individuals who were selected from a cohort of 340.234 European participants with 3·99 million person-years of follow-up (the EPIC study). Incident type 2 diabetes was ascertained until Dec 31, 2007, by a review of several sources of evidence. Gas chromatography was used to measure the distribution of fatty acids in plasma phospholipids (mol%); samples from people with type 2 diabetes and subcohort participants were processed in a random order by centre, and laboratory staff were masked to participant characteristics. We estimated country-specific hazard ratios (HRs) for associations per SD of each SFA with incident type 2 diabetes using Prentice-weighted Cox regression, which is weighted for case-cohort sampling, and pooled our findings using random-effects meta-analysis. Findings: SFAs accounted for 46% of total plasma phospholipid fatty acids. In adjusted analyses, different individual SFAs were associated with incident type 2 diabetes in opposing directions. Even-chain SFAs that were measured (14:0 [myristic acid], 16:0 [palmitic acid], and 18:0 [stearic acid]) were positively associated with incident type 2 diabetes (HR [95% CI] per SD difference: myristic acid 1·15 [95% CI 1·09-1·22], palmitic acid 1·26 [1·15-1·37], and stearic acid 1·06 [1·00-1·13]). By contrast, measured odd-chain SFAs (15:0 [pentadecanoic acid] and 17:0 [heptadecanoic acid]) were inversely associated with incident type 2 diabetes (HR [95% CI] per 1 SD difference: 0·79 [0·73-0·85] for pentadecanoic acid and 0·67 [0·63-0·71] for heptadecanoic acid), as were measured longer-chain SFAs (20:0 [arachidic acid], 22:0 [behenic acid], 23:0 [tricosanoic acid], and 24:0 [lignoceric acid]), with HRs ranging from 0·72 to 0·81 (95% CIs ranging between 0·61 and 0·92). Our findings were robust to a range of sensitivity analyses. Interpretation: Different individual plasma phospholipid SFAs were associated with incident type 2 diabetes in opposite directions, which suggests that SFAs are not homogeneous in their effects. Our findings emphasise the importance of the recognition of subtypes of these fatty acids. An improved understanding of differences in sources of individual SFAs from dietary intake versus endogenous metabolism is needed. Funding: EU FP6 programme, Medical Research Council Epidemiology Unit, Medical Research Council Human Nutrition Research, and Cambridge Lipidomics Biomarker Research Initiative.
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Background: More than 80% of deaths from cardiovascular disease are estimated to occur in low-income and middle-income countries, but the reasons are unknown. Methods: We enrolled 156,424 persons from 628 urban and rural communities in 17 countries (3 high-income, 10 middle-income, and 4 low-income countries) and assessed their cardiovascular risk using the INTERHEART Risk Score, a validated score for quantifying risk-factor burden without the use of laboratory testing (with higher scores indicating greater risk-factor burden). Participants were followed for incident cardiovascular disease and death for a mean of 4.1 years. Results: The mean INTERHEART Risk Score was highest in high-income countries, intermediate in middle-income countries, and lowest in low-income countries (P<0.001). However, the rates of major cardiovascular events (death from cardiovascular causes, myocardial infarction, stroke, or heart failure) were lower in high-income countries than in middle- and low-income countries (3.99 events per 1000 person-years vs. 5.38 and 6.43 events per 1000 person-years, respectively; P<0.001). Case fatality rates were also lowest in high-income countries (6.5%, 15.9%, and 17.3% in high-, middle-, and low-income countries, respectively; P=0.01). Urban communities had a higher risk-factor burden than rural communities but lower rates of cardiovascular events (4.83 vs. 6.25 events per 1000 person-years, P<0.001) and case fatality rates (13.52% vs. 17.25%, P<0.001). The use of preventive medications and revascularization procedures was significantly more common in high-income countries than in middle- or low-income countries (P<0.001). Conclusions: Although the risk-factor burden was lowest in low-income countries, the rates of major cardiovascular disease and death were substantially higher in low-income countries than in high-income countries. The high burden of risk factors in high-income countries may have been mitigated by better control of risk factors and more frequent use of proven pharmacologic therapies and revascularization. (Funded by the Population Health Research Institute and others.).
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Clear guidelines on the health effects of dairy food are important given the high prevalence of obesity, cardiovascular disease and diabetes, and increasing global consumption of dairy food. To evaluate the effects of increased dairy food on cardio metabolic risk factors. Searches were performed until April 2013 using MEDLINE, Science Direct, Google,Embase, the Cochrane Central Register of Controlled Trials, reference lists of articles, and proceedings of major meetings. Randomized controlled studies with healthy adults randomized to increased dairy food for more than one month without additional interventions. A standard list was used to extract descriptive, methodological and key variables from all eligible studies. If data was not included in the published report corresponding authors were contacted. 20 studies with 1677 participants with a median duration of dietary change of 26 (IQR 10-39) weeks and mean increase in dairy food intake of 3.6 (SD 0.92) serves/day were included. There was an increase in weight with low (+0.82, 0.35 to 1.28 kg, p<0.001) and whole fat dairy food (+0.41, 0.04 to 0.79kg, p=0.03), but no significant change in waist circumference (-0.07 , -1.24 to 1.10 cm) ; HOMA -IR (-0.94 , -1.93 to 0.04 units); fasting glucose (+1.32 , 0.19 to 2.45 mg/dl) ; LDL-c (1.85 ,-2.89 to 6.60 mg/dl); HDL-c (-0.19 , -2.10 to 1.71 mg/dl); systolic BP (-0.4, -1.6 to 0.8 mmHg); diastolic BP (-0.4 , -1.7 to 0.8 mmHg) or CRP (-1.07 , -2.54 to 0.39 mg/L). Changes in other cardio-metabolic risk factors were similar for low and whole fat dairy interventions. Most clinical trials were small and of modest quality. . Increasing whole fat and low fat dairy food consumption increases weight but has minor effects on other cardio-metabolic risk factors. Australian New Zealand Clinical Trials Registry ACTRN12613000401752, http://www.anzctr.org.au. NTX/10/11/115.
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Although dietary recommendations have focused on restricting saturated fat (SF) consumption to reduce cardiovascular disease (CVD) risk, evidence from prospective studies has not supported a strong link between total SF intake and CVD events. An understanding of whether food sources of SF influence these relations may provide new insights. We investigated the association of SF consumption from different food sources and the incidence of CVD events in a multiethnic population. Participants who were 45-84 y old at baseline (n = 5209) were followed from 2000 to 2010. Diet was assessed by using a 120-item food-frequency questionnaire. CVD incidence (316 cases) was assessed during follow-up visits. After adjustment for demographics, lifestyle, and dietary confounders, a higher intake of dairy SF was associated with lower CVD risk [HR (95% CI) for +5 g/d and +5% of energy from dairy SF: 0.79 (0.68, 0.92) and 0.62 (0.47, 0.82), respectively]. In contrast, a higher intake of meat SF was associated with greater CVD risk [HR (95% CI) for +5 g/d and a +5% of energy from meat SF: 1.26 (1.02, 1.54) and 1.48 (0.98, 2.23), respectively]. The substitution of 2% of energy from meat SF with energy from dairy SF was associated with a 25% lower CVD risk [HR (95% CI): 0.75 (0.63, 0.91)]. No associations were observed between plant or butter SF and CVD risk, but ranges of intakes were narrow. Associations of SF with health may depend on food-specific fatty acids or other nutrient constituents in foods that contain SF, in addition to SF.
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Nutritional assessment by diet analysis is a two-stepped process consisting of evaluation of food consumption, and conversion of food into nutrient intake by using a food composition database, which lists the mean nutritional values for a given food portion. Most reports in the literature focus on minimizing errors in estimation of food consumption but the selection of a specific food composition table used in nutrient estimation is also a source of errors. We are conducting a large prospective study internationally and need to compare diet, assessed by food frequency questionnaires, in a comparable manner between different countries. We have prepared a multi-country food composition database for nutrient estimation in all the countries participating in our study. The nutrient database is primarily based on the USDA food composition database, modified appropriately with reference to local food composition tables, and supplemented with recipes of locally eaten mixed dishes. By doing so we have ensured that the units of measurement, method of selection of foods for testing, and assays used for nutrient estimation are consistent and as current as possible, and yet have taken into account some local variations. Using this common metric for nutrient assessment will reduce differential errors in nutrient estimation and improve the validity of between-country comparisons.
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Background: Controversy has emerged about the benefits compared with harms of dairy fat, including concerns over long-term effects. Previous observational studies have assessed self-reported estimates of consumption or a single biomarker measure at baseline, which may lead to suboptimal estimation of true risk. Objective: The aim of this study was to investigate prospective associations of serial measures of plasma phospholipid fatty acids pentadecanoic (15:0), heptadecanoic (17:0), and trans-palmitoleic (trans-16:1n-7) acids with total mortality, cause-specific mortality, and cardiovascular disease (CVD) risk among older adults. Design: Among 2907 US adults aged ≥65 y and free of CVD at baseline, circulating fatty acid concentrations were measured serially at baseline, 6 y, and 13 y. Deaths and CVD events were assessed and adjudicated centrally. Prospective associations were assessed by multivariate-adjusted Cox models incorporating time-dependent exposures and covariates. Results: During 22 y of follow-up, 2428 deaths occurred, including 833 from CVD, 1595 from non-CVD causes, and 1301 incident CVD events. In multivariable models, circulating pentadecanoic, heptadecanoic, and trans-palmitoleic acids were not significantly associated with total mortality, with extreme-quintile HRs of 1.05 for pentadecanoic (95% CI: 0.91, 1.22), 1.07 for heptadecanoic (95% CI: 0.93, 1.23), and 1.05 for trans-palmitoleic (95% CI: 0.91, 1.20) acids. Circulating heptadecanoic acid was associated with lower CVD mortality (extreme-quintile HR: 0.77; 95% CI: 0.61, 0.98), especially stroke mortality, with a 42% lower risk when comparing extreme quintiles of heptadecanoic acid concentrations (HR: 0.58; 95% CI: 0.35, 0.97). In contrast, heptadecanoic acid was associated with a higher risk of non-CVD mortality (HR: 1.27; 95% CI: 1.07, 1.52), which was not clearly related to any single subtype of non-CVD death. No significant associations of pentadecanoic, heptadecanoic, or trans-palmitoleic acids were seen for total incident CVD, coronary heart disease, or stroke. Conclusions: Long-term exposure to circulating phospholipid pentadecanoic, heptadecanoic, or trans-palmitoleic acids was not significantly associated with total mortality or incident CVD among older adults. High circulating heptadecanoic acid was inversely associated with CVD and stroke mortality and potentially associated with higher risk of non-CVD death.
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A growing body of nutritional science highlights the complex mechanisms and pleiotropic pathways of cardiometabolic effects of different foods. Among these, some of the most exciting advances are occurring in the area of flavonoids, bioactive phytochemicals found in plant foods; and in the area of dairy, including milk, yogurt, and cheese. Many of the relevant ingredients and mechanistic pathways are now being clarified, shedding new light on both the ingredients and the pathways for how diet influences health and well-being. Flavonoids, for example, have effects on skeletal muscle, adipocytes, liver, and pancreas, and myocardial, renal, and immune cells, for instance, related to 5'-monophosphate-activated protein kinase phosphorylation, endothelial NO synthase activation, and suppression of NF-κB (nuclear factor-κB) and TLR4 (toll-like receptor 4). Effects of dairy are similarly complex and may be mediated by specific amino acids, medium-chain and odd-chain saturated fats, unsaturated fats, branched-chain fats, natural trans fats, probiotics, vitamin K1/K2, and calcium, as well as by processing such as fermentation and homogenization. These characteristics of dairy foods influence diverse pathways including related to mammalian target of rapamycin, silent information regulator transcript-1, angiotensin-converting enzyme, peroxisome proliferator-activated receptors, osteocalcin, matrix glutamate protein, hepatic de novo lipogenesis, hepatic and adipose fatty acid oxidation and inflammation, and gut microbiome interactions such as intestinal integrity and endotoxemia. The complexity of these emerging pathways and corresponding biological responses highlights the rapid advances in nutritional science and the continued need to generate robust empirical evidence on the mechanistic and clinical effects of specific foods.
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Background: Physical activity has a protective effect against cardiovascular disease (CVD) in high-income countries, where physical activity is mainly recreational, but it is not known if this is also observed in lower-income countries, where physical activity is mainly non-recreational. We examined whether different amounts and types of physical activity are associated with lower mortality and CVD in countries at different economic levels. Methods: In this prospective cohort study, we recruited participants from 17 countries (Canada, Sweden, United Arab Emirates, Argentina, Brazil, Chile, Poland, Turkey, Malaysia, South Africa, China, Colombia, Iran, Bangladesh, India, Pakistan, and Zimbabwe). Within each country, urban and rural areas in and around selected cities and towns were identified to reflect the geographical diversity. Within these communities, we invited individuals aged between 35 and 70 years who intended to live at their current address for at least another 4 years. Total physical activity was assessed using the International Physical Activity Questionnaire (IPQA). Participants with pre-existing CVD were excluded from the analyses. Mortality and CVD were recorded during a mean of 6·9 years of follow-up. Primary clinical outcomes during follow-up were mortality plus major CVD (CVD mortality, incident myocardial infarction, stroke, or heart failure), either as a composite or separately. The effects of physical activity on mortality and CVD were adjusted for sociodemographic factors and other risk factors taking into account household, community, and country clustering. Findings: Between Jan 1, 2003, and Dec 31, 2010, 168 916 participants were enrolled, of whom 141 945 completed the IPAQ. Analyses were limited to the 130 843 participants without pre-existing CVD. Compared with low physical activity (<600 metabolic equivalents [MET] × minutes per week or <150 minutes per week of moderate intensity physical activity), moderate (600-3000 MET × minutes or 150-750 minutes per week) and high physical activity (>3000 MET × minutes or >750 minutes per week) were associated with graded reduction in mortality (hazard ratio 0·80, 95% CI 0·74-0·87 and 0·65, 0·60-0·71; p<0·0001 for trend), and major CVD (0·86, 0·78-0·93; p<0·001 for trend). Higher physical activity was associated with lower risk of CVD and mortality in high-income, middle-income, and low-income countries. The adjusted population attributable fraction for not meeting the physical activity guidelines was 8·0% for mortality and 4·6% for major CVD, and for not meeting high physical activity was 13·0% for mortality and 9·5% for major CVD. Both recreational and non-recreational physical activity were associated with benefits. Interpretation: Higher recreational and non-recreational physical activity was associated with a lower risk of mortality and CVD events in individuals from low-income, middle-income, and high-income countries. Increasing physical activity is a simple, widely applicable, low cost global strategy that could reduce deaths and CVD in middle age. Funding: Population Health Research Institute, the Canadian Institutes of Health Research, Heart and Stroke Foundation of Ontario, Ontario SPOR Support Unit, Ontario Ministry of Health and Long-Term Care, AstraZeneca, Sanofi-Aventis, Boehringer Ingelheim, Servier, GSK, Novartis, King Pharma, and national and local organisations in participating countries that are listed at the end of the Article.
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Background: The association between intake of fruits, vegetables, and legumes with cardiovascular disease and deaths has been investigated extensively in Europe, the USA, Japan, and China, but little or no data are available from the Middle East, South America, Africa, or south Asia. Methods: We did a prospective cohort study (Prospective Urban Rural Epidemiology [PURE] in 135 335 individuals aged 35 to 70 years without cardiovascular disease from 613 communities in 18 low-income, middle-income, and high-income countries in seven geographical regions: North America and Europe, South America, the Middle East, south Asia, China, southeast Asia, and Africa. We documented their diet using country-specific food frequency questionnaires at baseline. Standardised questionnaires were used to collect information about demographic factors, socioeconomic status (education, income, and employment), lifestyle (smoking, physical activity, and alcohol intake), health history and medication use, and family history of cardiovascular disease. The follow-up period varied based on the date when recruitment began at each site or country. The main clinical outcomes were major cardiovascular disease (defined as death from cardiovascular causes and non-fatal myocardial infarction, stroke, and heart failure), fatal and non-fatal myocardial infarction, fatal and non-fatal strokes, cardiovascular mortality, non-cardiovascular mortality, and total mortality. Cox frailty models with random effects were used to assess associations between fruit, vegetable, and legume consumption with risk of cardiovascular disease events and mortality. Findings: Participants were enrolled into the study between Jan 1, 2003, and March 31, 2013. For the current analysis, we included all unrefuted outcome events in the PURE study database through March 31, 2017. Overall, combined mean fruit, vegetable and legume intake was 3·91 (SD 2·77) servings per day. During a median 7·4 years (5·5-9·3) of follow-up, 4784 major cardiovascular disease events, 1649 cardiovascular deaths, and 5796 total deaths were documented. Higher total fruit, vegetable, and legume intake was inversely associated with major cardiovascular disease, myocardial infarction, cardiovascular mortality, non-cardiovascular mortality, and total mortality in the models adjusted for age, sex, and centre (random effect). The estimates were substantially attenuated in the multivariable adjusted models for major cardiovascular disease (hazard ratio [HR] 0·90, 95% CI 0·74-1·10, ptrend=0·1301), myocardial infarction (0·99, 0·74-1·31; ptrend=0·2033), stroke (0·92, 0·67-1·25; ptrend=0·7092), cardiovascular mortality (0·73, 0·53-1·02; ptrend=0·0568), non-cardiovascular mortality (0·84, 0·68-1·04; ptrend =0·0038), and total mortality (0·81, 0·68-0·96; ptrend<0·0001). The HR for total mortality was lowest for three to four servings per day (0·78, 95% CI 0·69-0·88) compared with the reference group, with no further apparent decrease in HR with higher consumption. When examined separately, fruit intake was associated with lower risk of cardiovascular, non-cardiovascular, and total mortality, while legume intake was inversely associated with non-cardiovascular death and total mortality (in fully adjusted models). For vegetables, raw vegetable intake was strongly associated with a lower risk of total mortality, whereas cooked vegetable intake showed a modest benefit against mortality. Interpretation: Higher fruit, vegetable, and legume consumption was associated with a lower risk of non-cardiovascular, and total mortality. Benefits appear to be maximum for both non-cardiovascular mortality and total mortality at three to four servings per day (equivalent to 375-500 g/day). Funding: Full funding sources listed at the end of the paper (see Acknowledgments).
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Background: A positive association between nonfermented milk intake and increased all-cause mortality was recently reported, but overall, the association between dairy intake and mortality is inconclusive. Objective: We studied associations between intake of dairy products and all-cause mortality with an emphasis on nonfermented milk and fat content. Design: A total of 103,256 adult participants (women: 51.0%) from Northern Sweden were included (7121 deaths; mean follow-up: 13.7 y). Associations between all-cause mortality and reported intakes of nonfermented milk (total or by fat content), fermented milk, cheese, and butter were tested with the use of Cox proportional hazards models that were adjusted for age, sex, body mass index, smoking status, education, energy intake, examination year, and physical activity. To circumvent confounding, Mendelian randomization was applied in a subsample via the lactase LCT-13910 C/T single nucleotide polymorphism that is associated with lactose tolerance and milk intake. Results: High consumers of nonfermented milk (≥2.5 times/d) had a 32% increased hazard (HR: 1.32; 95% CI: 1.18, 1.48) for all-cause mortality compared with that of subjects who consumed milk ≤1 time/wk. The corresponding value for butter was 11% (HR: 1.11; 95% CI: 1.07, 1.21). All nonfermented milk-fat types were independently associated with increased HRs, but compared with full-fat milk, HRs were lower in consumers of medium- and low-fat milk. Fermented milk intake (HR: 0.90; 95% CI: 0.86, 0.94) and cheese intake (HR: 0.93; 95% CI: 0.91, 0.96) were negatively associated with mortality. Results were slightly attenuated by lifestyle adjustments but were robust in sensitivity analyses. Mortality was not significantly associated with the LCT-13910 C/T genotype in the smaller subsample. The amount and type of milk intake was associated with lifestyle variables. Conclusions: In the present Swedish cohort study, intakes of nonfermented milk and butter are associated with higher all-cause mortality, and fermented milk and cheese intakes are associated with lower all-cause mortality. Residual confounding by lifestyle cannot be excluded, and Mendelian randomization needs to be examined in a larger sample.
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We investigated the association between dairy product consumption and all-cause, cardiovascular disease (CVD), and cancer mortality in the Golestan Cohort Study, a prospective cohort study launched in January 2004 in Golestan Province, northeastern Iran. A total of 42,403 men and women participated in the study and completed a diet questionnaire at enrollment. Cox proportional hazards models were used to estimate hazard ratios and 95% confidence intervals. We documented 3,291 deaths (1,467 from CVD and 859 from cancer) during 11 years of follow-up (2004-2015). The highest quintile of total dairy product consumption (versus the lowest) was associated with 19% lower all-cause mortality risk (hazard ratio (HR)?=?0.81, 95% confidence interval (CI): 0.72, 0.91; Ptrend?=?0.006) and 28% lower CVD mortality risk (HR =?0.72, 95% CI: 0.60, 0.86; Ptrend?=?0.005). High consumption of low-fat dairy food was associated with lower risk of all-cause (HR =?0.83, 95% CI: 0.73, 0.94; Ptrend?=?0.002) and CVD (HR =?0.74, 95% CI: 0.61, 0.89; Ptrend?=?0.001) mortality. We noted 11% lower all-cause mortality and 16% lower CVD mortality risk with high yogurt intake. Cheese intake was associated with 16% lower all-cause mortality and 26% lower CVD mortality risk. Higher intake of high-fat dairy food and milk was not associated with all-cause or CVD mortality. Neither intake of individual dairy products nor intake of total dairy products was significantly associated with overall cancer mortality. High consumption of dairy products, especially yogurt and cheese, may reduce the risk of overall and CVD mortality.
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Inverse associations between dairy consumption and CVD have been reported in several epidemiological studies. Our objective was to conduct a meta-analysis of prospective cohort studies of dairy intake and CVD. A comprehensive literature search was conducted to identify studies that reported risk estimates for total dairy intake, individual dairy products, low/full-fat dairy intake, Ca from dairy sources and CVD, CHD and stroke. Random-effects meta-analyses were used to generate summary relative risk estimates (SRRE) for high v . low intake and stratified intake dose–response analyses. Additional dose–response analyses were performed. Heterogeneity was examined in sub-group and sensitivity analyses. In total, thirty-one unique cohort studies were identified and included in the meta-analysis. Several statistically significant SRRE below 1.0 were observed, namely for total dairy intake and stroke (SRRE=0·91; 95 % CI 0·83, 0·99), cheese intake and CHD (SRRE=0·82; 95 % CI 0·72, 0·93) and stroke (SRRE=0·87; 95 % CI 0·77, 0·99), and Ca from dairy sources and stroke (SRRE=0·69; 95 % CI 0·60, 0·81). However, there was little evidence for inverse dose–response relationships between the dairy variables and CHD and stroke after adjusting for within-study covariance. The results of this meta-analysis of prospective cohort studies have shown that dairy consumption may be associated with reduced risks of CVD, although additional data are needed to more comprehensively examine potential dose–response patterns.