prof. andré marette yini symposium n&g 2017 amsterdam
TRANSCRIPT
Is yogurt associated with reduced cardiometabolic risk factors in
children?
Dr André MaretteLaval Hospital, Heart and Lung Institute, Institute for Nutrition and Functional Foods (INAF),Université LavalQuébec, Canada
Is yogurt consumption associated with reduced
cardiometabolic risk in children
Divulgation of potential conflicts
Consultation and honorarium• Danone Nutricia• Thetis Pharma• Valbiotis
Funding• CIHR, CDA, HSFC, FRQ, CRIBIQ • JA DeSève Fondation • Pfizer (Chair CIHR/industry)• Danone Nutricia• Thetis Pharma• Fédération des Producteurs Acéricoles du Québec• Dairy Farmers of Canada
“Toxic” food and unhealthy lifestyle
Cardiometabolic diseases
Diet-related diseases Prevalence of “severe”
obesity is increasing in children
Putting children at risk for “adult” diseases Type 2 diabetes Dyslipidemia Hypertension Metabolic syndrome
Preventable and manageable Healthy diet and lifestyle
behaviors learned in childhood
Kumar and Kelly (2017) Mayo Clinic Proceedings
What makes yogurt an interesting research topic?
High quality protein growth and maintenance of muscle mass
Source of Ca, vitamin D and P contribute to bone health
Nutrient rich food profile contributes to intakes of essential nutrients for health
Lipids and lactose energy source
Pairs well with other healthy foods potential for increased intake of fruits, vegetables and grains
Source of bioactive lipids and peptides di- and tri-peptides, CLA, short- and medium-chain fatty acids that contribute to protection against cardiometabolic risk factors
Live cultures improve lactose tolerance, increase concentrations of some nutrients (eg. CLA and bioactive peptides)
Number of publications on “yogurt” indexed in PubMed over the last 100
years
Total = 3296Probiotic yogurt = 644Yogurt consumption = 837Yogurt and weight = 431Yogurt and health = 897Microbiota and yogurt = 92
Macronutrient profile of common yogurts
Children aged 4-6 y
Children aged 7-11 y
Percent contribution of 100 g of commonly consumed yogurts to the reference nutrient intakes for energy, fat, carbohydrates and protein in children.
Based on the dietary reference values for children from the British Nutrition Foundation and Public Health England Composition of foods integrated dataset
% RNI
% RNI
Melissa Fernandez, Mauro Fisberg, and André MaretteChapter: Role of yogurt in the nutrition and health of children and adolescents. In book entitled "Yogurt in Health and Disease Prevention". Ed. Nagendra Shah, Elsevier 2017 In press
Yogurt’s contribution to the dietary reference values for
mineral and vitamin in children and adolescents
• Excellent source of iodine, vitamin B12, phosphorus, calcium, riboflavin and thiamin for children and adolescents
• Source of folate, magnesium, potassium and selenium
• Provides negligible amounts of iron, niacin and vitamin B6
• Concentrated source of nutrients for children
• Yogurt is an excellent vehicle for vitamin D fortification
Thiam
in
Riboflavin
B12Fo
late
Calcium
Phosphorus
Magnesi
um
Potasium
Selen
iumIodine
0
5
10
15
20
25
30
35
40
45
50
4-6 yo 7-10 yo11-14 yo15-18 yo
Based on the dietary reference values for children from the British Nutrition Foundation and Public Health England Composition of foods integrated dataset
% contribution of 100g low-fat fruit yogurt
IS YOGURT CONSUMPTION ASSOCIATED WITH BODY WEIGHT
GAIN IN CHILDREN AND ADOLESCENTS?
Long-term association between dairy consumption and risk of childhood
obesity: a systematic review and meta-analysis of prospective cohort studies
(Lu et al. Eur. J. Clin. Nutr. 2016)46 011 children and adolescents with an average 3-year follow-up
38% less likely to havechildhood overweight/obesity
the risk of overweight/obesity was 13% lower with
each serving of dairy/day
Association between yogurt consumption and adiposity
indicators in children (Zhu et al. Eur J Nutr. 2015)
Variable N Difference P - value
Body weight 4,370
-0.3 kg 0.65
BMI 4,342
0.1 kg/m2 0.64
Waist circumference
4,278
-0.2 cm 0.76
33%
67%
Frequency of yogurt consumption in a cohort of American children 2-18 y (NHANES 2003
and 2006)
Frequent yogurt consumers (at least once a week; median = 2/week)
Infrequent yogurt consumers (less than once a week; median = 1-6/year)
No differences in adiposity indicators between frequent and infrequent yogurt consumers
Association between yogurt consumption and obesity among U.S. Children aged 8–18 years
(Keast et al, Nutrients 2015)
Variable N Difference P - value
Body weight 3786 -1.7 kg NSBMI 3786 -0.7 kg/m2 <0.05Waist circumference
3786 -2.5 cm <0.05
9%
92%
Frequency of yogurt consumption in a cohort of American children 8-18 y (NHANES 2005-
2008)
Frequent yogurt consumers (at least once out of 2 24-h dietary recalls)
Non yogurt consumers (not at all men-tioned in 24 hour dietary recalls)
Significantly lower BMI and waist circumference in yogurt consumers compared to non-consumers
IS YOGURT CONSUMPTION ASSOCIATED WITH
CARDIOMETABOLIC RISK FACTORS IN CHILDREN AND ADOLESCENTS?
Systematic review of the associations between dairy product consumption and risk of cardiometabolic outcomes in the
adult population (Drouin-Chartier et al. Adv Nutr 2016)
Association between yogurt consumption and the lipid profile in
U.S. children (Zhu et al. Eur J Nutr. 2015)
Variable N Difference
P - value
Total cholesterol 3,272 -2.2 mg/dL
0.17
HDL cholesterol 3,272 -1.3 mg/dL
0.06
LDL cholesterol 1,265 -0.2 mg/dL
0.94
Triglycerides 1,266 -0.5 mg/dL
0.93
Non-HDL cholesterol 3,272 -0.9 mg/dL
0.58
Ratio of total cholesterol to HDL cholesterol
3,272 0.01 0.84
Differences in lipid profiles between frequent and infrequent yogurt consumers (children 2-18 y)
No differences in the lipid profile between frequent and infrequent yogurt consumers
Association between yogurt consumption and blood prsssure in
U.S. children (Zhu et al. Eur J Nutr. 2015)
Variable N Difference P - valueSystolic 2,868 -0.5 mmHg 0.45Diastolic 2,868 -1.6 mg/dL 0.11
Differences in blood pressure between frequent and infrequent yogurt consumers (children 2-18 y)
No differences in blood pressure between frequent and infrequent yogurt consumers
Associations between yogurt consumption and type 2 diabetes
risk factors in U.S. children (Zhu et al. Eur J Nutr. 2015)
Variable N Difference P - value
Glucose (mmol/L) 930 -0.02 mmol/L
0.64
Insulin (pmol/L) 913 -13.6 pmol/L
<0.001
HOMA-IR (homeostatic model assessment of insulin resistance)
913 -0.61 <0.001
QUICKI (Quantitative insulin sensitivity check index)
913 0.007 mg/dL
0.03
Differences in type 2 diabetes risk factors between frequent and infrequent consumers (children 2-18 y)
Significantly better metabolic profiles in frequent consumers compared to infrequent yogurt consumers
What could be driving these associations?
• Increase satiety and reduce short-term food intake
• Reduced appetite sensations• Increased gastric transit time
• Enhanced calcium transport• Insulintropic• Decrease plasma cholesterol,
triglycerides and fatty acids• ACE inhibitory bioactive peptides (blood
pressure control)
• Improved insulin sensitivity and blood glucose control
• PPAR agonist• Enhanced transport of fat soluble vitamins• Adipocyte cell differentiation inhibition• Anti-inflammatory• Plaque formation inhibition• Anti-obesogenic
• Decreased food intake and increased energy expenditure
• Increased fat-cell oxidation• Increased fat cell breakdown
• Anti-atherosclerotic• Anti-hyperlipidemic
• Normalize glucose tolerance and insulin secretion
• Reduced vascular smooth muscle intracellular calcium (lower blood pressure)
• Improved energy regulation and lipid storage
• Decreased fatty acid synthesis• Increased lipolysis
• Fecal fatty acid excretion• Induction of thermogenesis• Calcium-specific appetite control
• Improved nutrient bioavailability and digestion
• Increased PH• Increased concentration of CLA• Increased gut transit time
• Formation of smaller curds
• Increased viscosity• Maintenance of gut microbiota• Release of bioactive peptides• Improved lactose digestion
Vitamins and minerals
(calcium and vitamin D)
Protein(whey and casein)
Fermented milk
(lactic acid bacteria)
Lipids(bioactive fatty acids)
Yogurt matrix
Bioactive peptides
Bioactive peptides can be released from milk proteins through three known mechanisms:
1) hydrolysis with digestive enzymes (e.g., pepsin, trypsin, and chymotrypsin) 2) fermentation with proteolytic starter cultures 3) proteolysis with enzymes derived from microorganisms
Korhonen, J Funct Foods 2009
Intestinal transit and energy balance regulationAmino acid/nutrient release and absorption
Regulation of the gut microbiota
Digestive system
Casein- and whey-derived bioactive peptides
• Anti-hypertensive by ACE inhibition
• Vasodilators release• Anti-thrombotic
Vascular system
• Macrophages stimulation
• Proliferation and maturation of immune cells
• Metabolic endotoxemia
Immune system• Sympathetic
nervous activity and energy expenditure
• Gut-brain axis and satiety signals
Nervous system• Anticholesterolemic• Insulin sensitivity and
glucose tolerance • Gut-liver axis and lipid
metabolism
Metabolic system
• Obesity• Type 2 Diabetes • Cardiovascular
diseases• NAFLD
Fight against cardiometabolic diseases
Fernandez et al. (review under revision)
Bioactive peptides
BIOACTIVE LIPIDS
CLA PPAR activator (Parodi 2016) Anti-diabetic (Ryder et al. 2001) Anti-obesogenic (Ryder et al. 2001)
Short chain fatty acids (butyric acid) (Gao et al. 2009) Increased insulin sensitivity Increased thermogenic activity
Medium-chain fatty acids Anti-diabetic (Wein et al. 2009)
Yogurt ferments
Release bioactive molecules (Fernandez et al. 2015) Conjugated linoleic acid (CLA) Bioactive peptides Exopolysaccharides
Enhanced digestion (Pei et al 2015 and Allen et al. 1982) Improved lactose tolerance Low pH of yogurt – ideal for mineral absorption
Lactic acid bacteria (Pessione et al. 2012) Antagonist behavior with other bacteria Favors healthy gut microbiota
Increase concentrations of fermentable oligosaccharides Prebiotic action on the gut microbiota
Take home messages
There is a likely favorable or neutral association between yogurt intake and adiposity indicators in children and adolescents.
There is a favorable association between yogurt consumption and T2D risk in adults – one study suggests this relationship also holds for children and adolescents.
There is a neutral association between yogurt intake and the lipid profile or blood pressure in adults – while similar results have been reported in children and adolescents, more studies are clearly needed to confirm the adult data
Pre-clinical and clinical studies are needed to demonstrate the inverse relationships between yogurt intake and the incidence of obesity and T2D found in observational studies, and to unravel the underlying mechanisms
Acknowledgments
Mélissa FernandezÉliane Picard-Deland
Noémie DanielAngelo Tremblay
Shirin PanahiMauro Fisberg
Thank you [email protected]
l.caQuebec city, October 2017 !