Numerous epidemiological studies reported that yogurt consumption may be used as a new biomarker of a healthy lifestyle. What could explain the health benefits of yogurt? At the 5th Yogurt Summit, held in Buenos Aires (Argentina) on October 18th, Dr André Marette (Laval University, Québec) presented up-to-date evidence on bioactive compounds produced during fermentation.

1. Yogurt intake and prevention of
cardiometabolic diseases: The
role of fermentation products
André Marette
Yogurt in Nutrition Initiative (YINI) USA
Buenos Aires, Argentina
October 18, 2017

2. Obesity and type 2 diabetes
take epidemic proportion

3. White and Marette 2008, Human Kinetics Publishers

4. Insulin
resistance
T2D
b-cells
CVD
Spreading of
inflammation
Vascular dysfunction
Atherosclerosis
NAFLD
What is the origin of
in obesity-linked cardiometabolic diseases ?
Metabolic
inflammation
LPSmetabolites
gut hormones
nutrients
Adapted from Cani: Nat Rev Endo 2011

5. Dysbiosis and metabolic endotoxemia
Chassaing B et al, 2015
Microbial encroachment
Thinner mucus layer

6. Mozaffarian D, et al
N Engl J Med. 2011
364(25):2392-404.

7. Compilation of
scientific literature on
yogurt and its roles in
nutrition and health

8. Yogurt consumption and healthy habits
Panahi et al. 2017

9. Adiposity
Type 2
diabetes
Hypertension
Cardiovascular
disease
Metabolic
syndrome
Cross-sectional
studies
√ √ √ √ √
Prospective
cohort studies
√ √ √ √ √
Meta-analyses
(prospective
cohorts)
None > 3 None ≥ 1 ≥ 1
Clinical studies Few None None Few None
Level of
evidence
Low Strong† Low Moderate Low
Conclusions
+ + ? = ?
Level of evidence of the effects of yogurt on
cardiometabolic diseases

10. Systematic review of the association between dairy
product consumption and risk of cardiovascular-
related clinical outcomes (Drouin-Chartier et al. 2016)

11. Yogurt vs type 2 diabetes
1. Strong consistent evidence from multiple meta-analyses of
an inverse association between yogurt consumption and
type 2 diabetes risk
2. Daily yogurt consumption in the context of a healthy diet
may help prevent type 2 diabetes
3. BUT, no RCT; therefore, cannot determine causal link
4. Mechanisms not identified, is it related to:
- specific nutrients (e.g. high protein, dairy fat, calcium…)
- fermentation products and bacteria
- something about the yogurt matrix, or
- only indirect (healthy lifestyle and dietary patterns)

12. Vitamins and
minerals
(calcium and
vitamin D)
Protein
(whey and casein)
Fermented milk
(lactic acid
bacteria)
Lipids
(bioactive fatty acids)
• 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 lactose digestion
• Improved nutrient bioavailability and
digestion
• Increased pH (Bifidobacteria)
• Increased concentration of CLA
• Release of bioactive peptides
• Increase in lactate : immunomodulation
• Maintenance of gut microbiota
• Release of microbial-derived products
• B vitamins: folate, riboflavin, B12
• Amino acids (eg g-aminobutyric
acid)
• Polysaccharides (immune and
prebiotic activies
Yogurt
matrix
Adapted from Fernandez
et al. Adv Nutr 2017
(In press)
Marco et al. Current
Opinion in Biotechnology
2017, 44:94–102

13. Yogurt and reduced cardiometabolic risk
High quality
protein growth
and maintenance
of muscle mass
Wide range of fatty
acids and lactose
wich provides energy
High quantity of Ca and P main
constituents of bone mineral and
contribute to bone health
Other nutrients (e.g. K, Mg, vit A, B, Zc 
essential for health)
Probiotic
bacteria
What are the putative mechanisms of action underlying the beneficial of
fermented milk products on cardiometabolic health ?
small peptides
from fermentation
with metabolic and
CVD effects
• 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. Casein and whey bioactive peptides
Intestinal transit and energy expenditure
Amino acid/nutrient release and absorption
Microbiota interaction
Digestive system
Anti-hypertensive by ACE inhibition
(angiotensine-converting enzyme)
Vasodilators release
Anti-thrombotic
Vascular system
Sympathetic nervous
activity
Satiety signals
Nervous system
Anticholesterolemic
Insulin sensitivity and
glucose tolerance
Metabolic system
Macrophages stimulation
Proliferation and maturation
of immune cells
Immune system
Cardiovascular diseases
Diabetes
Obesity
Fight against cadiometabolic diseases
Fernandez et al. Adv Nutr 2017 (In press)

15. CONCLUSIONS
▸ Different types of dairy products have specific effects on
glucose and lipid metabolism
▸ Fermented dairy products generally exert greater metabolic
and anti-inflammatory effects.
▸ These immunometabolic effects are associated with
taxonomic changes in the gut microbiota.
▸ Peptides released during fermentation may explain some of
the health benefits of yogurt consumption on cardiometabolic
diseases.

16. Collaborators
Université Laval
Denis Roy
Yves Pouliot
Sylvie Gauthier
Patrick Mathieu
Jose Luis M. Gonzalez
Agriculture/Agri-Food Canada
Martin Lessard
Mylène Blais
Michaël Bouchard
Université de Sherbrooke
Claude Asselin
TransBioTech
Yvan Boutin
Students/Res. Ass.
Noémie Daniel
Lais Rossi Perazza
Mélanie Le Barz
Geneviève Pilon
Marie-Julie Dubois
Thibault Varin
Philippe St-Pierre
Christine Dion
Christine Dallaire
Valérie Dumais
Joanie Dupont-Morissette
Partners