Growing evidence for the benefits of yogurt consumption in preventing type 2 diabetes and other cardiometabolic risk factors. The importance of dairy as part of a balanced and healthy diet is widely recognised by health authorities and scientific experts worldwide. Now, evidence is mounting that consuming yogurt in particular as part of a healthy diet helps to prevent type 2 diabetes and other cardiometabolic risk factors, with one of the most recent studies suggesting that people who regularly eat yogurt are almost 30% less likely to develop type 2 diabetes than those who do not (1). Speaking to public health officials at the III World Congress of Public Health Nutrition in Spain, Dr André Marette from the Heart and Lung Institute of Laval Hospital in Quebec, Canada, said it was time to recognize the all-round health benefits of yogurt and encourage more people to eat yogurt on a daily basis.

1. Yogurt consumption and impact on type 2 diabetes and cardiometabolic risk factors
YOGURT: A DAILY PARTNER FOR HEALTH
III World Congress of Public Health Nutrition
Las Palmas de Grand Canarias,10 November 2014
André Marette, PhD Professor of Medicine, Scientific Director Institute of Nutrition and Functional Foods Université Laval

3. Our "toxic" sedentary environment…

4. Epidemiologic studies and meta-analysis on dairy products and yogurt consumption and risk of type 2 diabetes
•Prospective studies have shown that the consumption of dairy products, specifically low-fat dairy, has the potential to reduce the risk of T2D (Choi et al. Arch Intern Med. 2005; Liu et al. Diabetes Care.2006; Margolis et al. Journal of Nutr. 2011)
•A systematic review and meta-analysis of seven prospective studies found that increasing dairy intake by 1 serving per day was associated with a 5% reduced risk for T2D. The risk reduction was higher for low-fat dairy products. For subgroup analysis, a combined RR was 0.83 (95% CI, 0.74–0.93) for the intake of yogurt. (Tong et al. EJCN. 2011).
•Another meta-analysis showed that total dairy intake was associated with a 6% lower risk of T2DM per 200 g/day consumption. A significant inverse associations between intake of yogurt, low-fat dairy, low-fat milk and cheese and T2DM was observed (Gao et al.Plos One 2013)

5. •The meta-analysis of Aune et al. evaluated the effect of different types of dairy products on T2D risk (7 cohort studies with yogurt intake data, total of 19,082 cases among 254,892 participants)
•A significant inverse association was observed between intakes of dairy products, low-fat dairy products, and cheese and risk of T2D. A nonlinear association was observed between yogurt consumption and T2D risk.
Reference: Aune et al.AJCN.2013
Epidemiologic studies and meta-analysis on dairy products and yogurt consumption and risk of type 2 diabetes

6. Yogurt and T2D prevention: the EPIC-Norfolk Study
•A case-cohort study; n=4000; 892 cases of incident T2D; 11 years followed-up; 7-day food diary; adjustment made for several confounding factors
24% T2D risk
28% T2D risk with 80 g of Y/day or
4.5 x 125g/week
“It was observed that replacing a portion of snacks (crisps and other potato based snacks, bread/pastry type snacks) with a portion of yoghurt reduced the hazard of T2D by 47%, suggesting that some of the association may be attributed to not consuming unhealthy food when yogurt is an alternative.”
Reference: O’Connor et al. Diabetologia 2014
O’Connor et al. Diabetologia 2014

7. Some studies have shown that yogurt has a superior effect than other food,
beverages and snacks on satiety (Tsuchiya, et al. 2006); (Chapelot and Payen 2010)
Yogurt with higher protein content led to reduced hunger, increased fullness, and delayed subsequent eating compared to snacks containing lower protein (Douglas, et al. 2012).
Low-fat yogurt enriched with protein and fibers can significantly reduce short-term appetite compared to a non-enriched low-fat yogurt (Lluch, et al. 2010).
.
Breakfast 26
Lunch
15
Snack 23
Dinner 15
Survey of 10 expert colleagues:
When do you think that yogurt should be consumed to have the most impact on health ?

8. « American children aged two to 11 consume extra energy and sugars in their diets but insufficient
Vitamin D, calcium, and potassium. One way to address the insufficiencies and excesses of children’s
diets would be to change the nutrient density of children’s snacks. »
« Foods high in added sugars and energy currently dominate children’s snack choices. Substituting one serving of low sugar, whole milk yogurt, paired with fruit or vegetables, for current snacks would increase children’s consumption of valuable nutrients without adding excess sugar or energy »

9. A meta-analysis of prospective studies showed that participants with the highest intake of dairy products had a lower relative risk for incident T2D, all-cause deaths, ischaemic heart disease and stroke. High fat dairy was not associated with risk for CVD, T2D and mortality (Elwood et al. Lipids 2010).
The Rotterdam Study (4,235 Dutch participants aged 55 and over (17.3 years follow up) showed that total dairy, milk, low-fat dairy, and fermented dairy were NOT significantly related to incident stroke or fatal stroke. However, high-fat dairy was significantly inversely related to fatal stroke (Praagman et al. Eur J Nutr. Oct 2014)
Future studies that plan to assess the effect of dairy products on CVD risk should consider : 1) using a combination of multiple biomarkers and epidemiologic evidence using clinical endpoints is needed to substantiate the effects of diet on CVD risk. 2) using biological markers of dairy intakes, such of milk fat biomarkers, that can help reveal the association between dairy food consumption CVD risk (Astrup et al. AJCN 2014)
Studies specifically looking at the impact of yogurt intake on CVD risk are scarce
Epidemiologic studies and meta-analysis on dairy products and yogurt consumption and CVD risk

10. add Paul Jacques blood pressure paper
Yogurt consumption (>0 serving/week) was associated with lower levels of fasting glucose and lower systolic blood pressure. Data adjusted for age, sex, energy intake, physical activity, smoking, diet quality (DGAI) and BMI.
In addition high consumers of yogurt (upper the median of consumption) had also lower triglycerides, fasting insulin and HOMA-IR (insulin- resistance) than non-consumers.

11. Recent epidemiologic studies have shown that yogurt is associated with better diet quality and healthier dietary patterns
How yogurt consumption can reduce T2D and CVD risk ?
Wang H et al. Yogurt consumption is associated with better diet quality and metabolic profile in American men and women. Nutr Res. 2013 Jan;33(1):18-26
Zhu Y. et al. The associations between yogurt consumption, diet quality, and metabolic profiles in children in the USA. Eur J Nutr. 2014 Jul 18.
Kong et al. Dietary patterns differently associate with inflammation and gut microbiota in overweight and obese subjects. PLoS One. 2014 Oct 20;9(10):e109434. doi: 10.1371.

12. High quality protein growth and maintenance of muscle mass
High quantity of Ca and P bone health and metabolic effects
Many micronutrients (e.g. K,Mg, vit A, B, D, Zc  essential for health, some with preventive effects on T2D and CVD
Wide range of fatty acids, some with beneficial properties (trans-palmitoleic acid and phospholipid 15:0 are associated with reduced CVD risk)
Mozaffarian et al. trans-Palmitoleic acid, other dairy fat biomarkers, and incident diabetes: the Multi-Ethnic Study of Atherosclerosis (MESA). Am J Clin Nutr. 2013 Apr;97(4):854-61. doi: 10.3945/ajcn.112.045468. Epub 2013 Feb 13.
de Oliveira Otto et al. Biomarkers of dairy fatty acids and risk of cardiovascular disease in the Multi-ethnic Study of Atherosclerosis. J Am Heart Assoc. 2013 Jul 18;2(4):e000092. doi: 10.1161/JAHA.113.000092.

13. High quality protein growth and maintenance of muscle mass
High quantity of Ca and P bone health and metabolic effects
Many micronutrients (e.g. K,Mg, vit A, B, D, Zc  essential for health, some with preventive effects on T2D and CVD
Wide range of fatty acids, some with beneficial properties
small peptides from fermentation with metabolic and CV effects (BP lowering)
•Yogurt peptides could release gut hormones (GLPs) to augment insulin secretion from β-cells and slow the absorption of nutrients (Jakubowicz and Froy, 2012; Nilsson et al. 2004).
•Some RCTs and meta-analyses showed that some tripeptides derived from dairy proteins can decrease blood pressure possibly through ACE inhibition (Cicero et al. Am J Hypertens 2013;26:442–9; Turpeinen et al. . Ann Med 2013;45:51–6.)

14. High quality protein growth and maintenance of muscle mass
High quantity of Ca and P bone health and metabolic effects
Many micronutrients (e.g. K,Mg, vit A, B, D, Zc  essential for health, some with preventive effects on T2D and CVD
Wide range of fatty acids, some with beneficial properties
small peptides from fermentation with metabolic and CV effects
probiotics with anti-inflammatory effects
Obesity
Diabetes
Inflammation
CVD

15. We asked 10 experts what is (are) the most important constituent(s) in yogurt that can explain its nutritional and health properties vs other dairy products ?
Macro- nutrients 20
Micro- nutrients 22
Bacteria/ferment. products 26
EB 2014

16. Yogurt matrix: more than texture
Reference: Marette A. & Picard-Deland E. AJCN 2014
A systematic review by Sherzai et al. underline the importance of using dietary patterns and concluded that it is difficult to pinpoint specific nutrients such as fat, calcium or vitamin D as CVD risk factors due to synergistic interaction of nutrients
Sherzai A, Heim LT, Boothby C, Sherzai AD. Nutrition reviews. Aug 2012;70(8):423-435.

17. There are some observational studies on yogurt & diet quality and Y & health outcomes but future studies need to take more into account several issues:
better control for differences in lifestyle & diet.
lack of informations on Y types (low fat or not, plain vs + fruits, greek, + probiotics, etc...)
differences in individual responses and exposure time.
What are the major scientific gaps that need to be considered when investigating the impact of yogurt consumption on the incidence of T2D and CVD ?

18. There are some observational studies on yogurt & diet quality and Y & health outcomes but future studies need to take more into account several issues:
better control for differences in lifestyle & diet.
lack of informations on Y types (low fat or not, plain vs + fruits, greek, + probiotics, etc...)
differences in individual responses and exposure time.
Long-term RCT with hard clinical outcomes are needed for demonstrating that yogurt intake improves health outcomes and reduce disease risk. Few intervention studies are confounded by:
compare to a dairy control
dose-response
take into account different yogurt types
What are the underlying mechanisms for explaining the epidemiological observations suggesting yogurt is negatively associated with obesity, T2D and CVD risk factors. Mechanistic studies are needed:
to assess the role of probiotic Y on inflammatory changes related to obesity and MS.
to determine the role of Ca, vitamins and minerals vs other nutrients
to assess the effect of yogurt peptides on blood pressure & CVD risk
What are the major scientific gaps that need to be considered when investigating the impact of yogurt consumption on the incidence of T2D and CVD ?

19. Acknowledgments
Éliane Picard-Deland
Angelo Tremblay
Marie-Claude Vohl
Vicky Drapeau
Louis Pérusse
Hubert Cormier
Élisabeth Thifault
Véronique Garneau