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

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Chapter 4 – Milk and dairy products as part of the diet 129 variation in the incidence and prevalence of osteoporosis is difficult to determine because of problems with definition and diagnosis; the most useful way of comparing osteoporosis prevalence between populations is to use fracture rates in older people (WHO and FAO, 2003). Since osteoporosis is usually not life-threatening, quantitative data from developing countries are scarce (WHO and FAO, 2003). However, the consensus is that rates are many times higher in affluent developed countries than in sub-Saharan Africa and Asia. Osteoporosis is most common in Caucasian women living in temperate climates and least common in Africans (WHO and FAO, 2003). Diet appears to have only a moderate relationship to osteoporosis, but calcium and vitamin D are both important, at least in older populations (WHO and FAO, 2003). Diets low in dairy products have been associated with increased risk of osteoporosis: bone resorption rates increased after just six weeks of an intervention designed to protect heart health by increasing fruit, vegetable and grain consumption while decreasing meat and dairy consumption (which recorded significant decreases in dairy servings per day and calcium and vitamin D from food) (Merrill and Aldana, 2009). A meta-analysis of nine studies reported lower BMD of the spine and hip in vegans than in those who consume milk (Ho-Pham, Nguyen, and Nguyen, 2009). Retrospective studies show that low milk consumption (less than one serving of milk/week) in childhood was associated with a doubling of hip fracture in American postmenopausal women, independent of current milk or calcium intake (Kalkwarf, Khoury, and Lanphear, 2003). However, no association was found between adolescent milk intake and the risk of osteoporotic fractures in these women. Higher calcium intakes throughout life (more than 800 mg/day) were found to significantly reduce the odds of osteoporosis defined by BMD by 25 percent in relatively healthy postmenopausal Caucasian women, as did higher current calcium and vitamin D intakes (Nieves et al., 2008). However, calcium and vitamin D intake did not significantly reduce the odds of any fracture. The authors ascribe a number of different reasons for this result, including insufficient power (despite large sample of 76 507 and 2 056 new fractures in three years, there were only 337 hip fractures), the multifactorial etiology of falls and fracture or the need for even higher levels of vitamin D or calcium in postmenopausal women (Nieves et al., 2008). Regular consumption of cheese and milk as well as chicken, egg, fruit and tea was protective against osteoporosis risk in Iranian women (Keramet et al., 2008). Milk avoidance is also associated with increased risk of fracture in children (Goulding et al., 2004; Konstantynowicz et al., 2007). A milk-free diet (to avoid cow-milk allergy) has been associated with increased fracture risk in girls (Konstantynowicz et al., 2007), although the authors reported that it is unclear if this association is due to the illness, calcium deficit or a deficit in other milk nutrients. Based on their results, the authors concluded that the contribution of milk-free diet to fracture liability among children and adolescents is modest. In another study, 50 children (3–13 years) who had avoided drinking cow milk for prolonged periods were compared with those in a birth cohort of more than 1 000 children from the same city (Goulding et al., 2004). Children who avoided milk did not use calciumrich food substitutes appropriately and had low dietary calcium intakes and low BMD values, and many were overweight. Significantly more of the milk avoiders experienced more total fractures than the birth cohort population, all of the frac-
130 Milk and dairy products in human nutrition tures occurring before puberty, leading the authors to conclude that young children avoiding milk are prone to fracture. Results of meta-analysis of trials studying the effects of calcium with or without vitamin D on fracture prevention are mixed, depending on exclusion criteria, dose, and baseline age and calcium and vitamin D status (Tang et al., 2007; Bischoff- Ferrari et al., 2007; Boonen et al., 2007). Tang et al. (2007) found that in trials that reported fracture as an outcome (17 trials, n=52 625), treatment was associated with a 12 percent risk reduction in fractures of all types (risk ratio = 0.88, 95 percent CI: 0.83–0.95; P=0.0004). The reduction in fracture risk was significantly greater (24 percent) in trials in which the compliance rate was high (P
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MILK dairy products in and human nu
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cover photo credits front: © EADD/
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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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x 2.5 Per capita energy intake from
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xii Preface Billions of people arou
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xiv The publication serves a variet
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xvi (Research Assistant Professor,
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xviii Permissions granted by extern
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xx FPCM fat and protein-corrected m
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xxii Contributors Anthony Bennett j
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xxiv from the National University o
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xxvi Award 2010 along with colleagu
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2 Milk and dairy products in human
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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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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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Table 3.6 (continued) Riboflavin Vi
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Chapter 4 - Milk and dairy products
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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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Table 5.2 (continued) Claim type Ar
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243 Chapter 6 Safety and quality Ma
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Chapter 6 - Safety and quality 245
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276 Milk and dairy products in huma
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Table 7.1 (continued) Country/organ
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Table 7.1 (continued) 308 Country/o
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