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

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Chapter 5 – Dairy components, products and human health 219 Tanzania (Irvine, Hummelen and Hekmat, 2011). Data from the 24-hour dietary recall conducted during the study suggested that consumers of probiotic yoghurt had higher total energy and protein intakes and were more likely to achieve the recommended daily intakes of vitamin A, riboflavin, folate and calcium. However, the authors remarked that the results of this study need to be further substantiated because of limits imposed by the observational, retrospective study design (Irvine, Hummelen and Hekmat, 2011). Consumption of probiotic yoghurt was also associated with an increase in CD4 count 50 among consumers living with HIV in Tanzania (Irvine et al., 2010). Dols et al. (2011), in a randomized double-blind study on the impact of probiotic yoghurt on HIV-positive women, found that yoghurt has the potential to transfer health benefits to the gut and participants revealed better appetite and less stomach gas. Anukam et al. (2008) suggested that yoghurt supplemented with Lactobacillus rhamnosus and Lactobacillus reuteri resolved moderate diarrhoea, flatulence and nausea in adult female patients with HIV/AIDS in Nigeria. Reports suggest that some of the bacteria present in fermented milk products may cause adverse health effects. Enterococci are ubiquitous LAB that occur in fermented milk and dairy products. Some strains of enterococci are the subject of food safety concern 51 because of their ability to produce biogenic amines and the risk of transferring antibiotic resistance genes to intestinal microorganisms and food-associated pathogenic bacteria. Although low levels of biogenic amines are not considered to be a serious risk, they may have physiological and toxic effects when consumed in excessive amounts. Some strains of enterococci are opportunistic pathogens that may cause human disease (Mathur and Singh, 2005; Foulquié Moreno et al., 2006; Jamaly et al., 2010; Li et al., 2011). 5.3.2 Fortified milk and dairy products Food fortification has been defined as “the practice of deliberately increasing the content of an essential micronutrient, i.e. vitamins and minerals (including trace elements) in a food, so as to improve the nutritional quality of the food supply and provide a public health benefit with minimal risk to health” (WHO and FAO, 2006). Fortification has a long history of use in developed countries to address deficiencies of vitamins A and D and several B vitamins (thiamine, riboflavin and niacin), iodine and iron, and milk is an effective delivery vehicle of fat-soluble vitamins and minerals (WHO and FAO, 2006). 52 The virtual elimination of childhood rickets in Canada and the United States has been largely attributed to fortification of milk with vitamin D, a practice that commenced as far back as the 1930s (WHO and FAO, 2006). However, as discussed in Chapter 4 (Section 4.4.7), a recent resurgence of the disease has been recorded in a number of countries, particularly among older children and adolescents in communities of recent immigrants, possibly as a result of the combined effect of low dietary calcium intakes and vitamin D deficiency (Pettifor, 2008). High rates 50 CD4 count is a measure of immunity and indicates the stage of HIV disease. Keeping CD4 count high can reduce complications of HIV disease. 51 Food safety issues related to milk and dairy products are discussed in Chapter 6. 52 Evidence from five selected fortified milk programmes are examined in Chapter 7.
220 Milk and dairy products in human nutrition of hypovitaminosis D have been reported in Canada and the United States and evidence from cross-sectional studies suggest that the mass fortification of milk with vitamin D has not achieved its objective in reducing this prevalence (Calvo, Whiting and Barton, 2004). A number of reasons have been suggested. The concentration of vitamin D may not be sufficient to increase the concentration of 25-hydroxyvitamin D in blood, and milk and dairy consumption may be decreasing (O’Mahony et al., 2011). In particular, some ethnic groups, including Asian immigrants to the United Kingdom and African-Americans in the United States, both of which are at greater risk of vitamin D deficiencies possibly because of ethno-cultural, environmental and genetic factors, may consume less milk and dairy products than other groups (Shaw and Pal, 2002; Calvo, Whiting and Barton, 2004; Alemu and Varnam, 2012). Studies suggest that milk enriched with plant sterols shows promise in terms of reducing CVD risk factors (Madsen, Jensen and Schmidt, 2007; Hansel et al., 2007; Mannarino et al., 2009; Bañuls et al., 2010). Plant sterols, such as β-sitosterol and campesterol, are naturally occurring compounds that are found in all foods of plant origin, including vegetable oils, nuts, cereal grains and legumes. Plant sterols are reported to reduce the plasma level of LDL-cholesterol but the precise mechanism of action is not fully understood (Rudkowska, 2010). Although plant sterols/stanols have received acceptance by the European Union (EU) (EFSA, 2009b) and FDA (FDA, 2009), discussions are ongoing regarding the risk of overdosing with these ingredients, and their use is limited in industry. JECFA (2009) concurred with EFSA (2009b): “In general there seems so far to be little over-consumption of food products with added plant sterols, rather some consumers don’t eat enough of the products to gain a real benefit. Modelling showed that consumption on more than three occasions per day or daily consumption of two or more products each at their respective recommended intake level was necessary to exceed a daily intake of 3 grams of plant sterols” (JECFA, 2009). FDA recommends a therapeutic phytosterol dose of 2–3 g/day and that plant sterols and stanol intakes should not exceed 3 g/day. “The dose above 3 g/day is not advised for a lack of considerably increased hypocholesterolemic effect and the threat of side-effects as a result of interfering with the absorption of fat-soluble vitamins, mostly β-carotene” (Bartnikowska, 2009). Multiple micronutrient fortification Fortification with multiple micronutrients has demonstrated positive results amongst different subgroups. A positive nutritional impact has been reported from adding vitamin C (ascorbic acid) to iron to enhance iron absorption. For example, in Chile, milk fortified with iron and vitamin C was found to reduce the prevalence of anaemia in infants and young children (WHO and FAO, 2006). A fermented-milk beverage supplemented with iron (3 mg iron/80 ml) and containing Lactobacillus acidophilus was found to increase nutrient intake and improve the nutritional status of preschool children in Brazil (Silva et al., 2008). Indeed, the absorption of iron appears to be enhanced by fermentation, presumably because of the presence of organic acids, including lactic acid (Özer and Kirmaci, 2010). A study of Indonesian children aged 6–59 months demonstrated that those receiving fortified milk were less likely to be anaemic than those receiving fortified noodles (Semba et al., 2010). Iron-fortified milk was deemed to be effective at reducing the rates of anaemia in Mexican children aged 10–30 months (Villalpando et al., 2006; Rivera et al., 2010).
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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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103 Chapter 4 Milk and dairy produc
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Chapter 4 - Milk and dairy products
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Table 4.1 Nutrient content of full
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Table 4.2 Contents of selected nutr
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Table 4.4 Summary of recent review
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Table 4.4 (continued) Reference Die
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Chapter 6 - Safety and quality 269
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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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