Perspective: Seeing the Forest Through the Trees: The Importance of Food Matrix in Diet Quality and Human Health.

Poor nutrition is linked to morbidity and mortality globally. The nutrition transition toward diets composed of high amounts of ultraprocessed foods that are more refined, calorie-dense, and poor in nutrients is considered a factor in the rise of diet-related metabolic diseases in low- and middle-income countries. Historically, nutrition strategies aimed at mitigating metabolic diseases linked to suboptimal diets have targeted isolated nutrients such as fats; however, they overlook the complexity and importance of whole foods and food matrices, which can lead to unintended consequences such as avoidance of nutrient-dense foods. Dairy foods, such as milk, cheese, and yogurt, are underconsumed nutrient-dense foods that often fall in the cross-hairs of reductionist nutrition strategies because of their contribution of calories, saturated fat, and sodium to the diet. This article highlights dairy foods as an example for exploring the complex matrices of food, nutrients, and other bioactive components that are associated with improved nutrient status and reduced risk of metabolic diseases while considering a holistic approach to improving diet quality and human health.

The prevalence of self-reported lactose intolerance and the consumption of dairy foods among African American adults are less than expected.

OBJECTIVE: To determine the self-reported incidence of lactose intolerance and its influence on dairy choices among African American adults. DESIGN, SETTING, AND PARTICIPANTS: An online survey closely matched to the 2000 US Census was administered to a nationally representative sample of African Americans (2016 adults) and a comparison sample of the general population (1084 adults). Statistical analyses performed included pairwise t tests for proportion conducted on percent responses at the 95% confidence level. RESULTS: African Americans were more likely to eat fewer dairy foods, experience physical discomfort after consumption, and believe they were lactose intolerant. While 49% of African Americans had ever experienced "some type of physical discomfort" after eating dairy foods, 24% believed they were lactose intolerant. Within this group, 85% of African Americans would be willing to consume more dairy products if they could avoid lactose intolerance symptoms. CONCLUSIONS AND IMPLICATIONS: Dairy food, calcium, and vitamin D intake in African Americans and the general population are below US recommendations. Deficiencies of these nutrients are associated with chronic diseases that disproportionately affect African Americans. In the United States, dairy foods are the primary source of calcium and vitamin D, and lactose intolerance can be a significant barrier to dairy food intake. However, self-described lactose intolerance is less than commonly reported in African American populations. Low dairy intake may reflect concerns about lactose intolerance, other factors such as learned food habits and cultural preferences. Nutrition recommendations for African Americans and the general population should focus on the health benefits of dairy foods, provide culturally sensitive dietary options, and strategies to increase tolerance.

The Complementary Roles for Plant-Source and Animal-Source Foods in Sustainable Healthy Diets.

There are approximately 100 countries with food-based dietary guidelines throughout the world, each of which aims to encompass the cultural, geographical, and health considerations unique to their country of origin. Common themes throughout these guides emphasize diverse and balanced intake of food groups from both plant- and animal-sources. With the globally recognized need to shift to more sustainable food systems, several countries and international food and health organizations have begun to incorporate sustainability recommendations into their dietary guidance. These sustainability recommendations are often based on food source (i.e., eat more plant-source and fewer animal-source foods), yet food source may not be the only useful or informative comparator for assessing healthy and sustainable diets. The purpose of this narrative review is to examine the roles of plant-source foods and animal-source foods in the context of sustainable healthy diets-with an emphasis on the contributions of the most commonly recommended food groups from global food-based dietary guidelines (i.e., fruits, vegetables, and dairy foods). Overall, plant and animal agriculture have complementary and symbiotic roles in healthy and sustainable food systems, and these abilities are largely dependent on various contextual factors (e.g., geography, production practices, processing methods, consumption patterns)-not just on whether the food originated from the plant or animal kingdom.

Food Systems Transformation for Child Health and Well-Being: The Essential Role of Dairy.

Malnutrition, in all its forms, during the critical stages of child growth and development can have lifelong impacts on health and well-being. While most forms of malnutrition can be prevented with simple dietary interventions, both undernutrition and overnutrition remain persistent and burdensome challenges for large portions of the global population, especially for young children who are dependent on others for nourishment. In addition to dietary factors, children's health also faces the growing challenges of climate change, environmental degradation, pollution, and infectious disease. Food production and consumption practices both sit at the nexus of these issues, and both must be significantly transformed if we are to achieve the 2030 Sustainable Development Goals. Food sources (i.e., animal-source foods vs. plant-source foods), food production practices, the effects of food processing, the impacts of a more globalized food system, and food loss and waste have all been receiving growing attention in health and sustainability research and policy discussions. Much of this work points to recommendations to reduce resource-intensive animal-source foods, heavily processed foods, and foods associated with excessive waste and pollution, while simultaneously increasing plant-source options. However, some of these recommendations require a little more nuance when considered in the context of issues such as global child health. All types of foods can play significant roles in providing essential nutrition for children across the globe, and for improving the well-being and livelihoods of their families and communities. Dairy foods provide a prime example of this need for nuance, as both dairy production practices and consumption patterns vary greatly throughout the world, as do their impacts on child health and food system sustainability. The objective of this narrative review is to highlight the role of dairy in supporting child health in the context of food system sustainability. When considering child health within this context it is recommended to take a holistic approach that considers all four domains of sustainability (health, economics, society, and the environment) to better weigh trade-offs, optimize outcomes, and avoid unintended consequences. To ensure that children have access to nutritious and safe foods within sustainable food systems, special consideration of their needs must be included within the broader food systems transformation narrative.

Global Review of Dairy Recommendations in Food-Based Dietary Guidelines.

At present, there are ~100 countries with national food-based dietary guidelines. While the intent of these guidelines is to inform national-level dietary recommendations, they also tie into global health and sustainable development initiatives, since diet and nutrition are linked to outcomes for all 17 United Nations Sustainable Development Goals. Therefore, key messaging in food-based dietary guidelines plays an important role in both national and global health efforts. However, this type of national-level dietary guidance is not standardized and varies considerably from country to country, and from food group to food group. The main objective of this review is to provide a novel look at dairy food group messaging within global food-based dietary guidelines, focusing specifically on nutrient-based and health-based messaging. Dairy-based messaging from 94 national food-based dietary guidelines was reviewed and grouped by region, with an emphasis on messaging regarding dairy's contribution to nutrients of public health concern for both underconsumption and overconsumption. The results showed that most nutrient-based dairy messaging relating to underconsumption was focused on calcium, followed by vitamin D, iodine, potassium, and protein; whereas messaging related to overconsumption was focused on saturated fat, added sugars, and salt. Health-based messaging specific to dairy food intake typically coalesced around three types of health outcomes: (1) bone, teeth, and muscle, (2) cardiometabolic, and (3) gut and immune. Although a fundamental concept of food-based dietary guidelines is to provide dietary guidance in a manner that is both "food-based," and in the context of "dietary" patterns, most food-based dietary guidelines still express the health value of dairy foods (and potentially other foods groups) solely in terms of their nutrient content - and often times only in the context of a single nutrient (e.g., calcium).

It is time for a positive approach to dietary guidance using nutrient density as a basic principle.

The consumption of nutrient-dense foods and beverages, which would ultimately be identified by a scientifically validated nutrient density profiling system, should be instituted as a nutrition platform in the Dietary Guidelines as a part of a larger educational effort to help people choose more nutrient-dense foods and as the guiding principle for consumers to plan healthful diets. By consciously choosing more nutrient-dense foods and beverages, Americans will be in a better position to meet their nutrient requirements without overconsuming energy. An objective, science-based, and validated nutrient density profiling system is needed to characterize foods based on their nutrient composition and this concept should be integrated into the Dietary Guidelines. This article sets forth guiding principles for the development and implementation of a nutrient density profiling system based on the current knowledge of diet and health and recommends that the development of a nutrient density profiling system include testing for effectiveness against accepted measures of diet quality, such as the Healthy Eating Index, and measurable public health markers, such as blood lipids and blood pressure.

Contribution of dairy products to dietary potassium intake in the United States population.

OBJECTIVE: Adequate dietary potassium intake is associated with a reduced risk of cardiovascular and other chronic diseases. The Dietary Guidelines for Americans 2005 identifies milk and milk products as a major contributor of dietary potassium and lists dairy products, along with fruits and vegetables, as food groups to encourage. This paper further examines the impact of dairy consumption on the potassium intake of the United States (US) population. METHODS: Using data from the National Health and Nutrition Examination Survey (NHANES) 1999-2002 we determined potassium intakes for various age groups of individuals who met the recommended number of dairy servings compared to those who did not. We also examined the impact of dairy servings consumed on mean and median potassium intakes and compared intakes to the age-appropriate Adequate Intakes (AI). RESULTS: For all age groups, mean and median potassium intakes did not meet the respective AI. Mean potassium intakes were significantly greater in those subjects who met dairy intake recommendations compared to those who did not for all age groups. Mean and median potassium intakes increased with increasing dairy intake but were below current intake recommendations for all age groups analyzed. For adults age 19 to 50, 16.1% consumed the recommended number of dairy servings per day. For those 51 and older, 10.7% met current dairy intake recommendations. CONCLUSIONS: Consumption of dairy products is below current recommendations which contributes in part to suboptimal dietary potassium intakes among a large proportion of the US population. Since adequate potassium intake is associated with decreased risk of chronic disease, consumption of a variety of potassium-rich foods, including fruits, vegetables and low-fat and fat free dairy products, should continue to be encouraged.

Dairy consumption and related nutrient intake in African-American adults and children in the United States: continuing survey of food intakes by individuals 1994-1996, 1998, and the National Health And Nutrition Examination Survey 1999-2000.

OBJECTIVE: To establish the first baseline of dairy and related nutrient intake in African Americans, an at-risk population of public health concern in the United States. To document dairy consumption in African Americans by age and sex during 1994-1998 and 1999-2000 and compare it with concomitant dairy, calcium, and related nutrient intakes in non-African-American adults and children. DESIGN: Duplicate and single 24-hour recalls were analyzed to determine dietary intake during the Continuing Survey of Food Intakes by Individuals 1994-1996, 1998 (CSFII), and the National Health and Nutrition Examination Survey 1999-2000 (NHANES), respectively. SUBJECTS: African Americans and non-African Americans of all ages who participated in CSFII 1994-1996, 1998, and in NHANES 1999-2000; both surveys are a stratified random sample of the total civilian, noninstitutionalized US population. STATISTICAL ANALYSIS: Dairy food and nutrient intake per day were quantified according to age, sex, and ethnicity/race from CSFII 1994-1996, 1998, and NHANES 1999-2000. For NHANES, mean intakes from 1-day food records were sample-weighted, and standard errors estimated by the Taylor linearization method of SUDAAN (version 9.0, 2004, RTI International, Research Triangle Park, NC). Usual daily intakes of calcium, magnesium, and phosphorus were based on 2-day intake data from CSFII 1994-1996, 1998, and calculated using Software for Intake Distribution from Iowa State University. The percentage of individuals categorized as not meeting the Estimated Average Requirement for magnesium and phosphorus were calculated in the same way. RESULTS: CSFII 1994-1996, 1998, and NHANES 1999-2000 data both show that African Americans in all age groups consume fewer mean servings per day of total dairy, milk, cheese, and yogurt than non-African Americans, and have lower mean intakes of calcium, magnesium, and phosphorus. Significant differences were seen for men and women. CONCLUSIONS: In this analysis, young African-American women did not meet Dietary Reference Intakes for phosphorus, and all African Americans did not meet Dietary Reference Intakes for calcium and magnesium. African Americans in all age groups did not meet dairy recommendations from the 2005 US Dietary Guidelines and the 2004 National Medical Association Consensus Report on the role of dairy and dairy nutrients in the diet of African Americans.

From nutrition scientist to nutrition communicator: why you should take the leap.

Media reports about new nutrition research are abundant, but they may confuse the public when unqualified sources are quoted, findings are reported out of context, or results appear to contradict previous studies. The nutrition scientist who conducts the research is best qualified to communicate the findings accurately and within context. Yet, some nutrition scientists hesitate to speak out in the media because of barriers such as a lack of time, media skills, and support from administrators or fear that their results will be miscommunicated or sensationalized. Scientists who do grant media interviews enjoy benefits such as positively affecting the public's eating habits, influencing health and nutrition policy, and receiving heightened attention to their work, which can lead to future research funding. Scientists who want to improve their media skills can seek support from their institution's public relations professionals and can learn from continuing education opportunities at conferences and self-study through articles and other resources.

Overcoming the barrier of lactose intolerance to reduce health disparities.

Federal health goals for the public have focused on reducing health disparities that exist between whites and various racial and ethnic groups. Many of the chronic diseases for which African Americans are at greater risk- hypertension, stroke, colon cancer, and obesity-may be exacerbated by a low intake of calcium and/or other dairy-related nutrients. For example, a low intake of dairy food nutrients, such as calcium, potassium, and magnesium, may contribute to the high risk of hypertension seen in African Americans. The Dietary Approaches to Stop Hypertension (DASH) study demonstrated that a low-fat diet rich in fruits and vegetables (8 to 10 servings) and low-fat dairy foods (3 servings) significantly reduced blood pressure-and was twice as effective in African-American participants. Calcium and dairy food consumption is particularly low among African-American, Hispanic, and Asian populations. Average intakes are near the threshold of 600 to 700 mg/day, below which bone loss and hypertension can result. Although lactose intolerance may be partly to blame for the low calcium intakes due to reduced dairy food consumption by minority populations, culturally determined food preferences and dietary practices learned early in life also play a role. The high incidence figures for primary lactose maldigestion among minority groups grossly overestimates the number who will experience intolerance symptoms after drinking a glass of milk with a meal. Randomized, double-blind, controlled clinical trials have demonstrated that by using a few simple dietary strategies, those who maldigest lactose (have low levels of the lactase enzyme) can easily tolerate a dairy-rich diet that meets calcium intake recommendations. Physicians and other health professionals can help their minority patients and the general public understand how to improve calcium nutrition by overcoming the surmountable barrier of lactose intolerance. At the same time they will be helping to reduce the incidence of calcium-related chronic diseases for which minority populations are at high risk.

Adequate nutrient intake can reduce cardiovascular disease risk in African Americans.

Cardiovascular disease kills nearly as many Americans each year as the next seven leading causes of death combined. The prevalence of cardiovascular disease and most of its associated risk factors is markedly higher and increasing more rapidly among African Americans than in any other racial or ethnic group. Improving these statistics may be simply a matter of improving diet quality. In recent years, a substantial and growing body of evidence has revealed that dietary patterns complete in all food groups, including nutrient-rich dairy products, are essential for preventing and reducing cardiovascular disease and the conditions that contribute to it. Several cardiovascular risk factors, including hypertension, insulin resistance syndrome, and obesity, have been shown to be positively influenced by dietary patterns that include adequate intake of dairy products. The benefits of nutrient-rich dietary patterns have been specifically tested in randomized, controlled trials emphasizing African American populations. These studies demonstrated proportionally greater benefits for African Americans without evidence of adverse effects such as symptoms of lactose intolerance. As currently promoted for the prevention of certain cancers and osteoporosis, regular consumption of diets that meet recommended nutrient intake levels might also be the most effective approach for reducing cardiovascular disease risk in African Americans.

Meeting and exceeding dairy recommendations: effects of dairy consumption on nutrient intakes and risk of chronic disease.

The 2010 Dietary Guidelines for Americans indicate the US population is experiencing an epidemic of overweight and obesity while maintaining a nutrient-poor, energy-dense diet associated with an increased risk of osteoarthritis, cardiovascular disease, and type 2 diabetes. To build upon the review of published research in the Report of the Dietary Guidelines Advisory Committee on the Dietary Guidelines for Americans, 2010, this article aims to review the scientific literature pertaining to the consumption of dairy foods and the effects of dairy consumption on nutrient intakes and chronic disease risk published between June 2010, when the report was released, and September 2011. PubMed was searched for articles using the following key words: dairy, milk, nutrient intake, bone health, body composition, cardiovascular disease, type 2 diabetes, and blood pressure. Evidence indicates that increasing dairy consumption to the recommended amount, i.e., three servings daily for individuals ≥9 years of age, helps close gaps between current nutrient intakes and recommendations. Consuming more than three servings of dairy per day leads to better nutrient status and improved bone health and is associated with lower blood pressure and reduced risk of cardiovascular disease and type 2 diabetes.

The Role of Dairy Products in Healthy Weight and Body Composition in Children and Adolescents.

Overweight and obesity are major public health concerns with approximately 32% and 17% of U.S. children aged 2 - 19 being classified as overweight or obese, respectively. While the cause of overweight and obesity is multi-factorial, changes in eating habits and physical activity patterns have been proposed as contributing factors to the obesity epidemic. For example, the displacement of nutrient rich foods and beverages with non-nutrient dense items may be influencing childhood obesity. Many children do not consume the recommended servings of the Food Groups to Encourage, i.e. low-fat and fat-free dairy foods, fruits, vegetables, and whole grains identified by the 2005 Dietary Guidelines for Americans which results in low intakes of calcium, potassium, fiber, magnesium, and vitamin E. While attention has focused primarily on reducing energy intake and/or increasing energy expenditure for weight maintenance, a promising beneficial role for dairy products in weight management has emerged. Most research has focused on adults, but there is evidence in children and adolescents indicating either a beneficial or neutral effect of dairy food consumption on body weight or body composition. The current review provides and assessment of the scientific evidence on the effects of dairy food consumption on body weight and body composition in children and adolescents.

Dairy components and risk factors for cardiometabolic syndrome: recent evidence and opportunities for future research.

Cardiometabolic syndrome (CMS), a cluster of metabolic abnormalities that increases the risk of cardiovascular disease (CVD) and type 2 diabetes, affects over one-third of American adults and accounts for billions of dollars in health care costs annually. Current evidence indicates an inverse association between consumption of dairy foods and risk of CMS and its related disease outcomes. Although the specific mechanism(s) underlying the beneficial effects of dairy consumption on the development of CMS, CVD, and type 2 diabetes have not been fully elucidated, there is evidence that specific components within dairy such as milkfat, vitamin D, calcium, magnesium, potassium, and whey proteins may be individually or collectively involved. Specifically, each of these dairy components has been implicated as having a neutral or beneficial effect on one or more elements of CMS, including the serum lipid profile, blood pressure, fasting glucose, and body composition. Although several mechanisms have been identified by which components in dairy may beneficially affect symptoms associated with CMS, further research is required to better understand how dairy and its components may contribute to metabolic health. The purpose of this review is to present the mechanisms by which specific dairy components modulate risk factors for CMS and identify opportunities for future research.

Determination of the optimal number of dairy servings to ensure a low prevalence of inadequate calcium intake in Americans.

BACKGROUND: Many Americans are not getting the recommended amounts of calcium in their diet. Since dairy foods provide most of the calcium in the diet, the number of recommended servings of dairy products may need to be revised. OBJECTIVE: 1. To determine the calcium intake of various age groups that met or exceeded the intake of dairy products recommended by the Food Guide Pyramid (FGP). 2. To determine the optimal level of dairy consumption that ensures a low prevalence of inadequate calcium (Ca) intake by Americans. METHODS: Using data from the Continuing Survey of Food Intake by Individuals, 1994-96, 1998, (CSFII) and the National Health and Nutrition Examination Survey, 1999-2000 (NHANES) we determined the calcium intake in individuals who met the recommended daily dairy servings as well as the minimum number of dairy servings required for the mean Ca intake of various age groups to exceed their respective Adequate Intakes (AI). RESULTS: Objective 1: Meeting or exceeding the FGP dairy recommendation led to calcium intakes that met recommended levels. However, very few individuals in all age groups met or exceeded the number of dairy servings recommended by FGP. Objective 2: Results indicated that in children 2-8 yrs, 2 dairy servings/d were required for the mean Ca intake (835 +/- 72 and 822 +/- 68 mg/d, in CSFII and NHANES IV, respectively) to exceed the AI. In children 9-18 yrs, 4 dairy servings/d) were required for the mean Ca intake of the group (1540 +/- 93 and 1518 +/- 86 mg/d) to exceed the AI. Similar data were observed in adults 19+ yrs, e.g., in adults 51+ yrs, 3 dairy servings/d were required for the mean Ca intake of the group (1241 +/- 53 and 1217 +/- 53 mg/d) to exceed the AI. CONCLUSION: Groups that met or exceeded the FGP dairy recommendations were more likely to have a mean calcium intake above the AI but had an average intake of about one serving higher than current recommendations. In individuals 9 yrs and older, 3-4 servings of dairy products are needed to meet or exceed the Ca AI and to ensure a low prevalence of inadequate Ca intake.