Metabolic Health: The impact of Dairy Matrix Arne Astrup, MD, DMSc - - PowerPoint PPT Presentation

▶
metabolic health the impact of dairy matrix arne astrup
SMART_READER_LITE
LIVE PREVIEW

Metabolic Health: The impact of Dairy Matrix Arne Astrup, MD, DMSc - - PowerPoint PPT Presentation

Feb 24, 2024 244 likes •749 views

Department of Nutrition, Exercise and Sports Metabolic Health: The impact of Dairy Matrix Arne Astrup, MD, DMSc Head of department & professor 1 November 2017 dato og Enhedens Dias 1 Department of Nutrition, Exercise and Sports en

slide-1
SLIDE 1

dato og ”Enhedens

Department of Nutrition, Exercise and Sports

1 November 2017 Dias 1

Metabolic Health: The impact

  • f Dairy Matrix

Arne Astrup, MD, DMSc Head of department & professor

slide-2
SLIDE 2

en dato og ”Enhedens

Department of Nutrition, Exercise and Sports

1 November 2017 Dias 2

EFSA: As low as possible

slide-3
SLIDE 3

“People don’t want to hear the truth because they don’t want their illusions destroyed.” Friedrich Nietzsche

slide-4
SLIDE 4

The lipid hypothesis and CHD

HIGH BLOOD CHOLESTEROL ATHEROSCLEROSIS SATURATED FAT CHD

?

slide-5
SLIDE 5

Systematic Reviews (Meta-analysis) Randomized Controlled Trials Other Controlled Trials Prospective Cohort studies Case – Control studies High Low

Hierarchy in Scientific Evidence

Prevalence studies Ecological studies Animal studies

slide-6
SLIDE 6

Department of Nutrition, Exercise and Sports

BMJ 2015;351:h3978 | doi:10.1136/bmj.h3

Similar conclusion in a previous meta-analysis of prospective cohort studies and CVD. (Siri-Tarino et al.,Am J Clin Nutr 2010;91:535–46)

slide-7
SLIDE 7

en dato og ”Enhedens

Department of Nutrition, Exercise and Sports

Ann Intern Med. 2014;160:398-406

slide-8
SLIDE 8

en dato og ”Enhedens

Department of Nutrition, Exercise and Sports

1 November 2017 Dias 8

slide-9
SLIDE 9

en dato og ”Enhedens

Department of Nutrition, Exercise and Sports

1 November 2017

slide-10
SLIDE 10

en dato og ”Enhedens

Department of Nutrition, Exercise and Sports

1 November 2017 Dias 10

Due to the very different biological effect of different saturated fatty acids, and the impact of food matrix we need to analyze foods separately, and not to lump all saturated fats into one group.

slide-11
SLIDE 11

en dato og ”Enhedens

Can we predict the health effects of foods based on the information on the label ? Or just by the content of saturated fat ?

Department of Nutrition, Exercise and Sports

Recognition of the food matrix

slide-12
SLIDE 12

en dato og ”Enhedens

01/11/2017 12

Every 2 dL increase in milk intake is associated with a 6 % reduction in cardiovascular disease

slide-13
SLIDE 13

en dato og ”Enhedens

Milk and all-cause mortality

01/11/2017 13

slide-14
SLIDE 14

Department of Nutrition, Exercise and Sports

1 November 2017 Dias 14

slide-15
SLIDE 15

Department of Nutrition, Exercise and Sports

Dias 15

Updated meta-analysis on milk and total mortality

slide-16
SLIDE 16

en dato og ”Enhedens

Department of Nutrition, Exercise and Sports

slide-17
SLIDE 17

en dato og ”Enhedens

Meat and CVD

The latest meta-analysis of observational studies on meat intake and CVD and cancer mortality found that:

  • The highest category of processed meat consumption had a

18% higher risk of mortality from CVD

  • There was no association between total red meat intake,

white meat intake and CVD/cancer mortality

Department of Nutrition, Exercise and Sports

Dairy and CVD

The latest meta-analysis on dairy and CVD found:

  • An inverse association between dairy intake and CVD and

stroke

  • No association between dairy intake and CHD

Qin et al., Asia Pac J Clin Nutr. 2015;24(1):90-100

slide-18
SLIDE 18

en dato og ”Enhedens

=

We need to study foods – not nutrients!

SFA SFA Calcium Casein (peptides and amino acids) Bacteria (starter and non-starter) The effect of saturated fat is attenuated by cheese!

slide-19
SLIDE 19

en dato og ”Enhedens

Updated meta-analysis of fermented dairy and CVD and mortality

NOTE: Weights are from random effects analysis Overall (I-squared = 94.4%, p = 0.000) Fortes Praagman Dalmeijer Engberink Van Aerde Goldbohm Michaelsson Bonthuis Michaelsson Goldbohm Praagman Mann Goldbohm Michaelsson Bonthuis Soedamah-Muthu author Goldbohm Michaelsson Kahn 2000 2015 2012 2009 2013 2011 2014 2010 2014 2011 2015 1997 2011 2014 2010 2013 year 2011 2014 1984 Cheese Cheese Fermented dairy Cheese Fermented dairy High-fat fermented dairy Cheese Yoghurt Soured milk and yogurt High-fat fermented dairy Fermented dairy (without cheese) Cheese Low-fat fermented dairy Soured milk and yogurt High-fat cheese Fermented dairy exposure Low-fat fermented dairy Cheese Cheese Women/Men Women/Men Women/Men Women/Men Women/Men Men Men Women/Men Women Women Women/Men Women/Men Men Men Women/Men Women/Men gender Women Women Women/Men 0.98 (0.97, 0.99) 1.30 (0.36, 4.68) 1.00 (0.96, 1.04) 1.00 (0.98, 1.01) 0.95 (0.90, 1.00) 1.00 (0.98, 1.01) 0.97 (0.95, 0.99) 0.98 (0.96, 0.99) 1.08 (0.96, 1.20) 1.00 (0.99, 1.00) 0.97 (0.95, 1.00) 1.00 (0.99, 1.01) 1.02 (0.90, 1.17) 1.00 (0.99, 1.01) 1.00 (0.99, 1.00) 0.93 (0.68, 1.27) 0.92 (0.87, 0.98) risk (95% CI) 1.00 (1.00, 1.01) 0.88 (0.86, 0.89) 0.99 (0.94, 1.04) Relative 100.00 0.01 3.46 7.99 2.62 7.62 6.64 7.36 0.73 9.16 5.58 8.90 0.51 8.86 9.19 0.10 2.00 Weight 8.82 7.66 2.77 % 0.98 (0.97, 0.99) 1.30 (0.36, 4.68) 1.00 (0.96, 1.04) 1.00 (0.98, 1.01) 0.95 (0.90, 1.00) 1.00 (0.98, 1.01) 0.97 (0.95, 0.99) 0.98 (0.96, 0.99) 1.08 (0.96, 1.20) 1.00 (0.99, 1.00) 0.97 (0.95, 1.00) 1.00 (0.99, 1.01) 1.02 (0.90, 1.17) 1.00 (0.99, 1.01) 1.00 (0.99, 1.00) 0.93 (0.68, 1.27) 0.92 (0.87, 0.98) risk (95% CI) 1.00 (1.00, 1.01) 0.88 (0.86, 0.89) 0.99 (0.94, 1.04) Relative 100.00 0.01 3.46 7.99 2.62 7.62 6.64 7.36 0.73 9.16 5.58 8.90 0.51 8.86 9.19 0.10 2.00 Weight 8.82 7.66 2.77 % 1 .3 .75 1 1.5 2

relative risk

Total 29 cohort studies are available for meta-analysis. Inverse associations were found between total fermented (included sour milk products, yogurt or cheese) with mortality (RR 0.98, 95% CI: 0.97- 0.99; I2=94.4%) and risk of CVD (RR 0.98, 95% CI: 0.97-0.99; I2=87.5%). Also stratified analysis of total fermented dairy of cheese shown a lower 2% lower risk of CVD (RR 0.98, 95% CI: 0.95-1.00; I2=82.6%). No associations were found for total dairy, high-fat/ low-fat dairy or milk with the health outcomes.

slide-20
SLIDE 20

en dato og ”Enhedens

Favors a high cheese intake Prospective studies of cheese intake and risk of CVD, CHD and stroke

Chen et al. (2016) Eur J Nutr., Aug 12

slide-21
SLIDE 21

en dato og ”Enhedens

Effects of cheese on CVD risk factors & Mechanisms

  • Obesity
  • Type 2 diabetes
  • Blood lipids
  • The cheese food matrix

and mechanisms

Department of Nutrition, Exercise and Sports

1 November 2017 Dias 21

slide-22
SLIDE 22

Run-in

Am J Clin Nutr 2011;94:1479–84

slide-23
SLIDE 23

en dato og ”Enhedens

Calcium in cheese and lipid metabolism

23

control milk cheese P diet

slide-24
SLIDE 24

en dato og ”Enhedens

Suggested mechanisms

  • Reduction in fat digestibility/absorption

by calcium

  • Precipitation of calcium and fatty acids

in insoluble fatty acid soaps

  • Precipitation of calcium and phosphate

in amorphous calcium phosphate

  • Possibly also increased fecal excretion
  • f bile acids

Lorenzen JK, Astrup A. Am. J. Clin. Nutr. (2007)

slide-25
SLIDE 25

en dato og ”Enhedens

slide-26
SLIDE 26

en dato og ”Enhedens

Department of Nutrition, Exercise and Sports

1 November 2017 Dias 26

Due to the very different biological effect of different saturated fatty acids, and the impact of food matrix we need to analyze foods separately, and not to lump all saturated fats into one group.

slide-27
SLIDE 27

en dato og ”Enhedens

Conclusions

  • The totality of evidence i.e. meta-analyses of both observational

studies and RCT’s cannot find any harmful effects of cheese on body fat, metabolic syndrome, type 2 diabetes, or CVD.

  • Cheese does not exert the detrimental effects on blood lipids and

blood pressure as previously predicted by its sodium and saturated fat content.

  • Cheese exerts beneficial effects on LDL-cholesterol, blood pressure

and postprandial triglycerides as compared to butter.

  • The effects of cheese on body composition, diabetes and CVD risks

can be attributed to the food matrix with nutrients i.e. protein, calcium, SCFA from fermentation, and perhaps peptides, phospholipids.

  • A diet including cheese should be recommended for all to prevent

and manage type 2 diabetes and cardiovascular disease.

slide-28
SLIDE 28

en dato og ”Enhedens

TRUE ?

slide-29
SLIDE 29

en dato og ”Enhedens

BACK UP SLIDES

Department of Nutrition, Exercise and Sports

1 November 2017 Dias 29

slide-30
SLIDE 30

en dato og ”Enhedens

Future dietary recommendations should look at whole foods, not single nutrients, and not be based in indirect evidence (predictions from nutrient labels labels)

Department of Nutrition, Exercise and Sports

slide-31
SLIDE 31

en dato og ”Enhedens

Recent intervention studies from our department

Department of Nutrition, Exercise and Sports

slide-32
SLIDE 32

en dato og ”Enhedens

Department of Nutrition, Exercise and Sports

1 November 2017 Dias 32

slide-33
SLIDE 33

en dato og ”Enhedens

Department of Nutrition, Exercise and Sports

1 November 2017 Dias 33

Table 1 Nutrient composition of the three diets, normalized per 10 MJ. 1

Diet Control Milk Cheese Energy (kJ)b 10,007 (9,266) 10,012 (10,603) 10,006 (10,651) Energy density (kJ/g) 5.5 5.7 5.4 Weight (g) 1,838 1,742 1,859 Fat (E%)b 31.7 (28.9) 31.6 (28.3) 31.5 (27.5) SFA (g) MUFA (g) PUFA (g) 45.1 25.1 6.6 46.5 23 5.7 47.1 24.5 6.5 Carbohydrate (E%) 52.9 52.9 52.9 Protein (E%) 15.4 15.5 15.6 Dietary fiber (g) 19.2 20.3 18.4 Total calcium (mg) Dairy calcium (mg) 362 1,143 781 1,172 810

1 The nutrient content (without water) was estimated using the Dankost 3000 dietary assessment software (Danish

Catering Center, Herlev, Denmark). b The energy and fat contents were measured. E%, energy percentage; SFA, saturated fatty acids; MUFA, mono unsaturated fatty acids; PUFA, poly unsaturated fatty acids.

Modification of effects of saturated fat by calcium

4Supported by The Danish Council for Strategic Research in Health, Food and Welfare, Danish

Dairy Research Foundation.

Soerensen, Thorning, Astrup, Kristensen & Lorenzen

slide-34
SLIDE 34

en dato og ”Enhedens

Department of Nutrition, Exercise and Sports

* *

Am J Clin Nutr Doi:10.3945/ajcn.115.109116

No differences in LDL-C or triglycerides between diets

slide-35
SLIDE 35

en dato og ”Enhedens

Department of Nutrition, Exercise and Sports

1 November 2017 Dias 35

slide-36
SLIDE 36

en dato og ”Enhedens

Department of Nutrition, Exercise and Sports

1 November 2017 Dias 36

slide-37
SLIDE 37

en dato og ”Enhedens

Diets

Department of Nutrition, Exercise and Sports

1 November 2017 Dias 37

slide-38
SLIDE 38

en dato og ”Enhedens

Study intervention and population

Department of Nutrition, Exercise and Sports

1 November 2017 Dias 38

slide-39
SLIDE 39

en dato og ”Enhedens

Camenbert does not adversely affect blood lipids or blood pressure

Department of Nutrition, Exercise and Sports

1 November 2017 Dias 39

slide-40
SLIDE 40

en dato og ”Enhedens

Department of Nutrition, Exercise and Sports

1 November 2017 Dias 40

“Our efforts are dramatically changing the way doctors treat chronic diseases such as diabetes, heart disease, obesity, and cancer.” (PCRM Website 5th Sept 2015)

slide-41
SLIDE 41

en dato og ”Enhedens

Department of Nutrition, Exercise and Sports

Evidence based information ?

slide-42
SLIDE 42

en dato og ”Enhedens

Conclusions on dairy and cancer

  • According to WCRF reports and the latest meta-analyses,

consumption of milk and dairy products probably protects against colorectal cancer, bladder cancer, gastric cancer, and breast cancer.

  • Dairy intake does not seem to be associated with risk of

pancreatic cancer, ovarian cancer, or lung cancer, whereas the evidence for prostate cancer risk is inconsistent.

  • In women, dairy offers significant and robust health

benefits in reducing the risk of the common and serious colorectal cancer and possibly also the risk of breast cancer.

  • In men, the benefit of the protective effect of milk and

dairy on the common and serious colorectal cancer is judged to outweigh a potentially increased risk of prostate cancer.

Department of Nutrition, Exercise and Sports

1 November 2017 Dias 42

slide-43
SLIDE 43

en dato og ”Enhedens

Department of Nutrition, Exercise and Sports

1 November 2017 Dias 43

Figure 1. Overall effect/association between dairy intake and health outcomes. ↓favorable effect/association; ↑adverse effect/association; → no effect/association.

slide-44
SLIDE 44

en dato og ”Enhedens

Department of Nutrition, Exercise and Sports

1 November 2017 Dias 44

slide-45
SLIDE 45

en dato og ”Enhedens

Saturated fat

Is saturated fat independent on the food matrix?

slide-46
SLIDE 46

en dato og ”Enhedens

Dairy and body weight regulation

slide-47
SLIDE 47

en dato og ”Enhedens

Department of Human Nutrition

Effect of high vs low dairy on fat loss

slide-48
SLIDE 48

en dato og ”Enhedens

Department of Human Nutrition

Effect of high vs low dairy on fat free mass

slide-49
SLIDE 49

en dato og ”Enhedens

Effects of cheese on CVD risk factors & Mechanisms

  • Obesity
  • Type 2 diabetes
  • Blood lipids
  • The cheese food matrix

and mechanisms

Department of Nutrition, Exercise and Sports

1 November 2017 Dias 49

slide-50
SLIDE 50

en dato og ”Enhedens

Beneficial effect of cheese on HDL-cholesterol

Department of Nutrition, Exercise and Sports

1 November 2017 Dias 50