Primer on nutrition and health of dairy ingredients Cindy - - PDF document

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2019 ADPI Dairy 360

Primer on nutrition and health of dairy ingredients

Cindy Schweitzer, PhD

Principal, Schweitzer Consulting LLC ADPI Center of Excellence Dairy 360 Short Course on Dairy Ingredients May 10, 2019

2019 ADPI Dairy 360

Nutrition & hea ealth top

• pics
• Nutrient composition of dairy ingredients
• Focus on protein: amino acids, protein quality
• Lactose
• Health benefits of dairy ingredients
• Additional resources

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Path thway to

• dai

dairy ry ingredie ients:

Sep Separatio ion of

• f milk

ilk components

Complex mixture of highly bioavailable nutrients:

• Proteins
• Carbohydrates (lactose)
• Fat
• Minerals
• Vitamins

Whole milk Skim milk Casein powder Whey powder Skim milk powder Cream Buttermilk

Other than whole milk powder, most dairy ingredients have a composition that is different from milk

2019 ADPI Dairy 360

Typical dairy ry in ingredient nutrient composition

Milk powders Values in percent (%) Component Whole milk Skim MPC 42 MPC 85 WPC 34 WPC 80 WPI Caseinate MCC 42 Caseinate MCC 90 Permeate Protein 26 36 42 85 ≥ 34 ≥ 80 ≥ 90 ≥ 41.5 ≥ 89.5 3.5 Lactose 37 51 47 3.2 ≤ 52 ≤ 8 ≤ 1 ≤ 51 ≤ 1 82 Ash (minerals) 6 8.2 6.5 6.6 ≤ 8 ≤ 4 ≤ 3 ≤ 6 ≤ 8 8.5 Fat 27 0.8 1.0 1.4 ≤ 4.5 ≤ 8 ≤ 1 ≤ 1.25 ≤ 3 < 1 Moisture 4 4.0 3.5 3.8 ≤ 4.5 ≤ 4.5 4.5 ≤ 5 ≤ 7 4.5

USDEC, Reference Manual for US Milk Powders and Microfiltered Ingredients, 2019 www.thinkusadairy.org

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Da Dairy ry proteins: com

• mplex mixt

xture

Caseins 80%

A1-casein A2-casein B-casein κ-casein

Whey 20%

Β-Lactoglobulin Α-Lactalbumin Serum Albumin Immunoglobulins Lactoferrin

• Milk powders (whole, skim, MPCs) contain casein & whey

Caseins:

• A1/A2 casein health effects
• Precipitate during cheese making
• More slowly digested
• Carriers of minerals
• Health benefits of bioactive peptides (i.e., lower blood

pressure) Whey proteins:

• Two major fractions: β-lactoglobulin and α-lactalbumin
• Water soluble after casein precipitation
• Fast digestion “fast protein”
• Specific physiologic functions (lactoferrin,

immunoglobulins)

USDEC, Reference Manual for US Milk Powders and Microfiltered Ingredients, 2019

2019 ADPI Dairy 360

Ca Casein con

• ntroversy: A1 vs A2

Premise:

• A1 casein increases risk of noncommunicable diseases compared to A2
• A2 has positive effects on digestive health

Systematic review:

• Associations between A1 and health effects in humans
• Searched 5 databases, 3 clinical trial registries
• 15 randomized controlled trials: No significant differences
• 2 case-control studies: No significant differences
• 6 ecological studies: A1 exposure associated with adverse health outcomes
• Quality of evidence: moderate for digestive symptoms, low, very low for all other outcomes

Conclusion:

• Moderate certainty for adverse digestive health effects of A1 compared to A2

Kullenberg de Gaudry 2019

Ongoing human clinical trials needed to clarify

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Foc

• cus on
• n protein nutrition

Proteins:

• Structural constituents of foods and human tissues
• Daily requirement for growth, maintenance and repair
• Recommended Dietary Allowances (RDA) determine adequate amounts of

essential nutrients to meet the known requirements of healthy people

• Protein RDA for adults: 0.8 g/kg; ~50 g/day

Amino acids:

• Building blocks of protein
• 9 Essential or indispensable amino acids: not synthesized by the body, must be

provided by food

• Indispensable amino acids (IAAs):
• Histidine, Isoleucine, Leucine, Lysine, Methionine, Phenylalanine, Threonine,

Tryptophan, Valine

• Leucine: key amino acid in whey proteins, stimulates muscle protein synthesis

RDAs by age groups: http://www.who.int/nutrition/publications/nutrientrequirements/WHO_TRS_935/en/

2019 ADPI Dairy 360

What is is protein quality?

Total protein content Amino acid profile Bioavailability/digestibility

A measure of a food’s ability to deliver amino acids

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Why doe

• es protein quality matter?

Milk proteins deliver the amino acid nutrients that match human requirements better than plant proteins.

10 20 30 40 50 60

Essential amino acids, percent

• f total protein

Van Vliet 2015

Delivering nutrient requirements Measurable physiological effects Reduced stunting, reduced frailty Milk proteins: essential amino acids Growth, body composition Health and wellbeing

2019 ADPI Dairy 360

Methods to

• determine protein quality
• Current approved method: Protein Digestibility-Corrected Amino Acid

Score (PDCAAS)

• based on amino acid requirements of humans, ability to digest protein and

absorb indispensable amino acids

• A high score (100) indicates a high quality: high content of

indispensable (essential) amino acids and high digestibility

• Dairy ingredients have scores in the 97-100 range, superior to most

plant proteins

• New method recommended by FAO: Digestible Indispensable Amino

Acid Score (DIAAS)

• more accurate assessment of amino acid availability
• distinguishes higher and lower quality protein sources
• not yet officially adopted, data collection on wide range of foods underway

FAO websithttp://www.fao.org/nutrition/requirements/proteins/en

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La Lact ctose

• Sugar found only in milk
• Slower digestion:
• prolonged energy supply
• lower glycemic index
• Promotes growth of beneficial lactic acid bacteria:
• protects against infections in colon
• Lactose intolerance: inability to break down the disaccharide,

lack of enzyme to split sugar

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Understanding lactose intolerance and cow’s milk allergy

Cow’s milk allergy Lactose Intolerance Immune-mediated reaction Mechanism Enzyme deficiency Peaks during 1st yr of life Onset of Symptoms 5-6 yrs Tends to remit in childhood (2-5 yrs) Resolution Irreversible Cow’s milk proteins Food Involved Lactose Edema of the lips, tongue, palate, nausea, abdominal pain, diarrhea Gastrointestinal Symptoms Abdominal pain, nausea, bloating, flatulence, diarrhea Skin, respiratory (nasal itch, shortness of breath), atopic eczema Extraintestinal Symptoms Headache, vertigo, memory impairment, lethargy Oral food challenge Diagnostic Test Lactose breath test Diet free of cow’s milk protein Dietary Treatment Low-lactose diet

Di Costanzo 2019

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He Health ben enefits of

• f dairy

ry in ingredients

• Weight loss and body composition
• Exercise and recovery
• Healthy aging
• Glucose management

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What is is th the evid vidence base for

• r mil

ilk and whey proteins com

• mpared to
• oth
• ther proteins?

Protein ingredient # Clinical trials* Adult body composition Weight loss Recovery Sarcopenia Healthy aging Blood glucose management Dairy 28 20 13 37 60 Soy 20 11 1 6 45 Pea 1 12 Wheat 1 1 22 Rice 2 1 1 2 Potato 1

*Trial quality not assessed USDEC 2018 Chalvon-Demersay 2017 PubMed search 2019

Strong evidence for health effects of milk proteins, limited for alternatives

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Da Dairy ry proteins en enhance wei eight los loss and bod

• dy

com

• mposition

Significant impact of milk proteins for weight loss & muscle retention and improved body composition

Meta-analysis:

• 21 clinical trials using dairy foods
• 6 clinical trials using whey or casein

supplements

• Compared to low dairy, plant

alternatives

• 18-50 yr old overweight/obese
• Energy restricted diets, 16 weeks
• 55 g/d average whey protein

(range 20-84 g)

Stonehouse 2018

Dairy proteins resulted in:

• 2 lbs greater weight loss
• 2.7 lbs greater fat loss
• 75% greater retention lean mass
• No effect with resistance training

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What is is th the evid vidence for alt lternative proteins, wei eight los loss or

• r bod
• dy composition?

Search terms:

• Soy protein, pea protein,

wheat protein, rice protein, potato protein AND weight loss, body composition

• Only clinical trials in humans

Protein Source # Clinical trials Weight loss Dairy 20 Soy 11 Pea Wheat 1 Rice 1 Potato

USDEC 2018 Pubmed search 2019

• Soy protein: inconsistent results,

15-56 g protein/d

• Wheat protein: no effect on weight

loss (Johnston 2017)

• Rice protein: 48 g rice protein or

whey protein increased lean body mass, muscle mass, strength and decreased fat mass (Joy 2013)

Alternative proteins cannot make similar claims about weight loss, muscle retention and body composition: lack of evidence

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Im Impact of

• f whey proteins, exercise and recovery

Whey protein has a modest enhancement of muscle recovery after resistance training, endurance sports

Protein + resistance training (RT):

• 20 g whey protein stimulates muscle protein synthesis, better than plant

proteins (Davies 2018)

• Improves body composition, toning: increases muscle mass, decreases fat

mass; no bulking in women (Bergia 2018)

• Meta-analysis of 13 clinical trials found whey protein ingestion before or

after RT enhances post-exercise recovery of muscle function* (Davies 2018)

• Whey protein supplementation during endurance sports reduces ratings of

fatigue and muscle soreness over 72 hours*(Saunders 2018) * results inconsistent among individual studies

2019 ADPI Dairy 360

What is is th the evid vidence for alt lternative proteins on

• n

recovery?

Limited evidence for alternative proteins effect on recovery after resistance training, endurance sports

Search terms:

• Soy protein, pea protein,

wheat protein, rice protein, potato protein AND recovery

• Only clinical trials in humans

Protein ingredient # Clinical trials Recovery Dairy 13 Soy 3 Pea Wheat Rice 1 Potato

Pubmed search 2019

• Soy drink and soy protein: superior

fluid recovery compared to sport drink (Desbrow 2014), modest improvement in performance (Upshaw 2016, Berg 2012)

• Rice protein: no difference in

recovery, soreness or readiness to train compared to whey protein (Joy 2013)

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Whey proteins support hea ealthy agi ging

Whey proteins: practical approach to improve muscle mass and function in elderly

Whey/dairy proteins + exercise:

• Slow decline in muscle loss
• Increase muscle mass, strength
• Improve physical function
• Older adults require more

protein: 1.0-1.2 g/kg body weight vs RDA 0.8 g/kg body weight

Robinson 2018 Mithral 2014

2019 ADPI Dairy 360

What is is th the evid vidence for alt lternative proteins and sarcopenia?

Limited evidence suggests alternative proteins may improve muscle mass and strength in elderly

Search terms:

• Soy protein, pea protein,

wheat protein, rice protein, potato protein AND sarcopenia

• Only clinical trials in humans

Protein ingredient Amount of ingredient = 2.7 g leucine # Clinical trials Sarcopenia Dairy (whey) 32 37 Soy 55 6 Pea 48 Wheat 55 1 Rice 47 Potato 41

• Soy protein: several studies show

increase in muscle protein synthesis

• r muscle strength, inconsistent

effects compared to milk proteins (Malthais 2016, Thomson 2016, Hashimoto 2015, Mitchell 2015, Lee 2015, Yang 2015)

• Wheat protein: in older men, 60 g/d

increased muscle protein synthesis similar to 35 g/d whey protein (Gorissen 2016)

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Whey proteins im improve glu glucose management

• 2015 US Dietary Guidelines recognized beneficial relationship between

dairy intake and risk of T2D

• > 25 short term clinical trials (< 24 hours) show pre- or with- meal whey

protein stimulates insulin response, reduces glucose levels, increases satiety (Fekete 2018)

• Only 3 long-term human clinical trials (4-12 weeks)
• Lower effective whey protein dose desired: 15 g/d vs 50 g/d (average)

(King 2018)

• In subjects with metabolic syndrome, no effect related to amount or

type of protein (Chalvon-Demersay 2017)

“Consumption of dairy foods provides numerous health benefits, including lower risk of diabetes, metabolic syndrome, cardiovascular disease and obesity”

Protein ingredient # Clinical trials Multiple comparisons Insulin-glucose responses Dairy 60 Soy 45 Pea 12 Wheat 22 Rice 2 Potato Chalvon-Demersay 2017

Can short-term studies predict long-term health?

2019 ADPI Dairy 360

Additional resources

www.thinkusadairy.org

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Summary

• Dairy ingredients: important source of high quality, bioavailable proteins,

many with very low/no lactose

• Considerable evidence that dairy proteins or whey can enhance weight

loss, body fat loss, improve body composition; maintain lean body mass during weight loss

• Whey proteins have modest enhancement of muscle recovery after

exercise

• Dairy proteins support healthy aging through muscle retention, mass and

strength; help to manage sarcopenia in elderly

• Short-term studies show whey proteins help manage blood glucose levels

2019 ADPI Dairy 360

Th Thank you

• u!

Questions?

Cschweitzerashton@gmail.com