Milk-and-Dairy-Products-in-Human-Nutrition-FAO

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103 Chapter 4 Milk and dairy products as part of the diet Connie Weaver 1 , Ramani Wijesinha-Bettoni 2 , Deirdre McMahon 2 and Lisa Spence 3 1 Distinguished Professor and Head of the Department of Nutrition Science, Purdue University, West Lafayette, Indiana, USA; 2 Nutrition Consultant, Nutrition Division, Food and Agriculture Organization of the United Nations (FAO), Rome, Italy; 3 Principal Scientist, Global Nutrition, Innovation & Commercial Development, Tate & Lyle, Hoffman Estates, IL, USA Abstract This chapter reviews the health aspects of cow milk and dairy products in the human diet. The first section presents milk as a source of macro- and micronutrients, and nutrient composition of milk with respect to nutritional requirements is discussed. The section on dairy in growth and development considers effects on children’s linear growth; milk’s role in treatment of undernutrition; milk in the diets of well-nourished children; and secular trend of increasing adult height. Possible mechanisms for growth-stimulating effects of milk are presented. The section on bone health looks at dietary factors that affect bone health, with emphasis on calcium, vitamin D and protein. Studies looking at the effects of milk/calcium on bone mineral density are presented, followed by findings on the effects of dairy on osteoporosis, fracture and rickets. Anticariogenic properties of milk and dairy products are also considered. The relationship between dairy intake, weight gain and obesity development is considered, which includes the association between dairy intake and weight status, and dairy as part of a weight loss strategy. The role of dairy in metabolic syndrome and type 2 diabetes is also covered. In the section on cardiovascular disease (CVD) and dairy, we consider the effects of dietary fat on CVD, and look at studies that support reducing animal products and the argument for low-fat versus high-fat dairy products. Results from recent review studies on milk/dairy consumption with respect to CVD are presented. Other dairy products and risk of CVD are also briefly visited. The role of dairy products and calcium at different cancer sites are discussed, drawing on the findings of the World Cancer Research Fund (WCRF)/American Institute for Cancer Research (AICR). Milk hypersensitivity, attributed to either lactose malabsorption or cow milk allergy is discussed. Finally, the role of dairy in the dietary recommendations of 42 countries is discussed, and the wide variation in guidelines regarding the type of dairy (e.g. low- vs. high-fat, and dairy products such as milk, butter, etc.) and amount and frequency of consumption noted.
104 Milk and dairy products in human nutrition Keywords: Milk, dairy, bone, dental caries, obesity, metabolic syndrome, cardiovascular disease, cancer, milk hypersensitivity 4.1 Introduction Milk and dairy foods are nutrient-dense foods supplying energy and significant amounts of protein and micronutrients. The inclusion of dairy products adds diversity to plant-based diets. However, the role of milk and dairy products in human nutrition has been increasingly debated in recent years, both in the scientific literature and in popular science literature. The primary role of milk is to nourish the infants of a species. The consumption of animal milk is a by-product of animal domestication, which occurred about 10 000 years ago. For early humans, the advantages of milk consumption and its effects on growth and bone health were likely to have been of considerable importance while its effects on chronic diseases later in life had limited relevance to reproduction and survival. In contrast, for contemporary human populations, while childhood growth and bone strength are important for health, it is the effects of milk and dairy consumption on individual well-being and on chronic diseases and their associated economic costs that are of greater relevance (Elwood et al., 2008). Milk is a complex food containing numerous nutrients. Most of the constituents in milk do not work in isolation, but rather interact with other constituents. Often, they are involved in more than one biological process, sometimes with conflicting health effects, depending on the process in question. One such example is milk fat. The traditional diet-heart paradigm, developed in the 1960s and 1970s, held that consumption of fat, and saturated fat in particular, raised total cholesterol and low-density lipoprotein (LDL) cholesterol levels, leading to coronary heart disease (CHD) (Mozaffarian, 2011). Some of the evidence that is often cited to support reduced consumption of animal fat will be briefly discussed in Section 4.8. Currently, many national and international bodies recommend consumption of lower-fat dairy foods. However, the scientific rationale behind this recommendation is still debated. As one author says, “Due to the small rise in blood cholesterol with milk drinking, the debate on milk has never achieved a reasonable balance on the evaluation of risks and benefits” (Elwood et al., 2010). It is also important to remember that dietary fats, in addition to being a concentrated energy source, serve as an important delivery medium for fat-soluble vitamins and contain various fatty acids (e.g. conjugated linoleic acid [CLA]) and bioactive factors beneficial to health (e.g. triacylglycerols and phospholipids) (German and Dillard, 2006; Kris-Etherton, Fleming and Harris, 2010). Similarly, to consider even saturated fatty acids (SFAs) as one uniform group of fats may be an over-simplification (FAO and WHO, 2010; Feinman, 2010), since individual fatty acids (FAs) have specific functions depending on their chain length. This chapter summarizes the available evidence on the relationship between dairy consumption and health. The majority of published papers (including much of the epidemiological evidence) relate to milk; therefore, this chapter deals primarily with milk, with other dairy products being covered in less detail. With few exceptions, we comment on the findings of the most recent review papers, which included both systematic reviews and narrative reviews, rather than on individual studies. As it was not possible to conduct a systematic review of the literature because of the broad scope of material covered in this chapter, where appropriate we have referred
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iv 2.7 Emerging issues and challeng
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vi 5.2 Dairy components 209 5.2.1 M
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viii 9.2 Key trends and emerging is
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xii Preface Billions of people arou
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xvi (Research Assistant Professor,
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xviii Permissions granted by extern
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xxii Contributors Anthony Bennett j
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11 Chapter 2 Milk availability: Cur
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Chapter 2 - Milk availability: Curr
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Table 2.5 Volume and share of milk
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41 Chapter 3 Milk and dairy product
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Table 3.1 Proximate composition of
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Table 3.2 (continued) Vitamins Ribo
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Table 3.4 Mineral composition in mi
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Annex Table 4.7 Milk and dairy prod
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207 Chapter 5 Dairy components, pro
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Annex Table 5.2 EU register of dair
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243 Chapter 6 Safety and quality Ma
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