Advances in Nutrition: An International Review Journal current issue

Role of Functional Fortified Dairy Products in Cardiometabolic Health: A Systematic Review and Meta-analyses of Randomized Clinical Trials

ABSTRACTThere is insufficient evidence on the role of functional fortified dairy products in improving health and in preventing risk factors associated with noncommunicable chronic diseases. This systematic review was conducted to summarize effects of the consumption of fortified dairy products on biomarkers of cardiometabolic risk. MEDLINE and SCOPUS databases were used to perform searches to include studies published up to 30 April 2018. Randomized clinical trials with human subjects consuming dairy products fortified with phytosterols, FAs, vitamins or minerals and relating this consumption with cardiometabolic health were included in this review. Risk of bias assessment according to Cochrane guidelines was performed to determine the quality of the trials. Forty-one studies were finally selected for this synthesis; the selected studies tested dairy products fortified with the following nutrients and bioactive components: phytosterols (n = 31), FAs (n = 8), and vitamin D (n = 2). We found that the consumption of phytosterol-fortified dairy, led to an overall LDL cholesterol reduction of −0.36 (−0.41, −0.31) mmol/L, P < 0.001; this decrease was mainly related to the dosage. Likewise, consumption of ω-3 FA-fortified dairy products resulted in a plasma LDL cholesterol reduction of −0.18 (−0.27, −0.09) mmol/L as well as a decrease of −0.18 (−0.32, −0.05) mmol/L in triacylglycerols (TG). Performing meta-analyses of the consumption of dairy products fortified with vitamin D or FAs other than ω-3 FAs and biomarkers of cardiometabolic risk was not possible because of the few available publications. Our results indicate that consumption of dairy products fortified with phytosterols and ω-3 FAs can lead to a reduction of LDL cholesterol and consumption of fortified dairy products fortified with ω-3 FAs can reduce TG concentration. However, more studies with homogeneous designs are needed to determine the advantages of using dairy products as fortification vehicles to prevent cardiometabolic risk.

Milk and Dairy Product Consumption and Risk of Mortality: An Overview of Systematic Reviews and Meta-Analyses

ABSTRACTThe effect of dairy product consumption on health has received substantial attention in the last decade. However, a number of prospective cohort studies have shown contradictory results, which causes uncertainty about the effects of dairy products on health. We conducted an overview of existing systematic reviews and meta-analyses to examine the association between dairy product consumption and all-cause mortality risk. A literature search was conducted in MEDLINE (via PubMed), EMBASE, the Cochrane Central Database of Systematic Reviews, and the Web of Science databases from their inception to April, 2018. We evaluated the risk of bias of each study included using the AMSTAR 2 tool. The risk ratios (RRs) for each meta-analysis were displayed in a forest plot for dose-response and for high compared with low dairy consumption. The initial search retrieved 2154 articles; a total of 8 meta-analyses were finally included after applying the inclusion and exclusion criteria. The number of included studies in each meta-analysis ranged from 6 to 26 cohort studies, which reported data from 6–28 populations. The sample sizes varied across studies from 24,466 participants reporting 5092 mortality cases to 938,817 participants reporting 126,759 mortality cases. After assessing the risk of bias, 25% of the studies were categorized as acceptable, 25% as good, and 50% as very good. The RRs reported by the meta-analyses ranged from 0.96 to 1.01 per 200 g/d of dairy product consumption (including total, high-fat, low-fat, and fermented dairy products), from 0.99 to 1.01 per 200–244 g/d of milk consumption, and from 0.99 to 1.03 per 10–50 g/d of cheese consumption. The RR per 50 g/d of yogurt consumption was 0.97 (95% CI: 0.85, 1.11). In conclusion, dairy product consumption is not associated with risk of all-cause mortality. This study was registered in PROSPERO as CRD42018091856.

Introduction and Executive Summary of the Supplement, Role of Milk and Dairy Products in Health and Prevention of Noncommunicable Chronic Diseases: A Series of Systematic Reviews

ABSTRACTMilk and dairy products contain multiple nutrients and contribute significantly to meet the nutritional requirements for protein, calcium, magnesium, phosphorus, potassium, zinc, selenium, vitamin A, riboflavin, vitamin B-12, and pantothenic acid. However, consumption of dairy is decreasing and moving away from the advised level in many countries and the potential benefits of milk and dairy products for health have come under question. This, in spite that numerous studies report health benefits associated with dairy consumption. The present supplement aims to assess and summarize scientific evidence regarding the impact of dairy intake on health and all-cause mortality, and on the prevention of diverse chronic diseases, mainly from meta-analyses of observational studies and randomized controlled trials (RCTs). There seem to positive associations between moderate maternal milk intake during pregnancy and infant birth weight, length and bone mineral content during childhood. Moreover, consumption of dairy products in older subjects may reduce the risk of frailty and decrease the risk for sarcopenia. The highest consumption of dairy products did not show a clear association with total osteoporotic fracture and hip fracture risk; however, a diminished risk of vertebral fracture was found. Analysis of the differences between high and low dairy consumption and for dose-response found no association between dairy product consumption and risk of all-cause mortality. Total and low-fat dairy consumption is associated with a reduced risk of developing metabolic syndrome and current evidence supports that consumption of dairy does not adversely affect the risk of cardiovascular outcomes and may even have a subtle protective effect. Moreover, evidence has been provided of an inverse association between the consumption of dairy products and ischemic heart disease and myocardial infarction. Also, the evidence suggests that dairy consumption, particularly low-fat dairy and yogurt is associated with a lower risk of type 2 diabetes. Likewise, moderate compared with medium consumption of dairy is associated lower risk for colorectal and bladder cancer and has no association with prostate cancer. Finally, consumption of milk or dairy products did not show a proinflammatory effect on healthy subjects, overweight/obese individuals, or individuals with other metabolic abnormalities, and fortification of dairy products with phytosterols and ω-3 fatty acids seems to be a good approach to improve cardiometabolic risk biomarkers. In conclusion, the systematic reviews and meta-analyses of the present supplement support adequate milk consumption at various stages of life and in the prevention/control of various noncommunicable chronic diseases.

Milk and Dairy Product Consumption and Prostate Cancer Risk and Mortality: An Overview of Systematic Reviews and Meta-analyses

ABSTRACTMilk and dairy product consumption has been associated with an increase in prostate cancer risk; however, discrepancies have been observed in the literature. This first overview of systematic reviews and meta-analyses was carried out with the main objective of compiling and discussing the evidence generated to date related to milk and dairy product consumption and prostate cancer risk and mortality. A systematic search in MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, and the Web of Science (from inception to 30 April 2018) was conducted. The inclusion criteria were as follows: adult men, meta-analyses of longitudinal studies, dairy product consumption, and risk of prostate cancer or related outcomes. The AMSTAR2 checklist was used to evaluate methodological quality. The synthesis methods included dairy product exposure (high compared with low consumption or dose-response), dairy product type (total dairy products, milk, cheese, yogurt, and others), and prostate cancer outcomes (total, nonadvanced, and advanced prostate cancer and mortality) displayed in forest plots. Six meta-analyses were identified. These studies reported on the analysis of the 2 to 32 cohorts (up to 848,395 subjects/38,107 cases; 4–28 y of follow-up) and 2 case-control meta-analyses (12,435 subjects). The meta-analysis quality was valued as mostly “good” according to the AMSTAR2 criteria. All RRs of high compared with low consumption (dose-response) for total prostate cancer ranged from 1.68 to 1.09 (1.07 per 400 g/d) for total dairy products, 1.50 to 0.92 (1.06 to 0.98 per 200 g/d) for milk (whole, low-fat, and skim milk considered separately), and 1.18 to 0.74 (1.10 per 50 g/d) for cheese. RRs have decreased since the first meta-analysis. Statistical heterogeneity generates uncertainty in the observed results (up to I2 = 77.1%). In conclusion, although there are some data indicating that higher consumption of dairy products could increase the risk of prostate cancer, the evidence is not consistent. This review was registered with PROSPERO as CRD42018094737.

Effects of Milk and Dairy Products on the Prevention of Osteoporosis and Osteoporotic Fractures in Europeans and Non-Hispanic Whites from North America: A Systematic Review and Updated Meta-Analysis

ABSTRACTNutrition plays an important role in bone health. The aim of our study was to update the evidence regarding dairy intake, osteoporotic fracture (OF) risk, and prospective bone mass density (BMD) evolution assessed by dual-energy X-ray absorptiometry in Europeans and non-Hispanic whites from North America. A systematic search was conducted in MEDLINE, EMBASE, and Scopus for papers published from 1 January, 2000 to 30 April, 2018. The eligibility criteria were as follows: healthy adults; measurable dairy exposure; hip, vertebral, wrist or OF as outcomes; and cohort or case-control studies. Two independent investigators conducted the search and the data extraction. A pooled analysis was conducted with random-effects models. Publication bias and meta-regression were considered. Ten cohort studies relating to OF risk were selected for meta-analysis. Three papers reporting BMD changes associated with dairy intake could not be aggregated in the meta-analysis. The pooled HRs of the highest compared with the lowest levels of dairy intake were 0.95 (95% CI: 0.87, 1.03; I2 = 82.9%; P-heterogeneity < 0.001) for OF at any site; 0.87 (95% CI: 0.75, 1.01; I2 = 86.7%; P-heterogeneity < 0.001) for hip fractures; and 0.82 (95% CI: 0.68, 0.99; I2 = 0.0%; P-heterogeneity = 0.512) for vertebral fractures. Concerning BMD, the selected studies described a 1.7–3% lower hip BMD in young and postmenopausal women with poor intake of milk in their youth, a positive relationship between baseline milk ingestion and the percentage of trochanter BMD change in elderly people, and a positive correlation between milk consumption and BMD change at the radius in women aged >65 y. In conclusion, in the studied population, the highest consumption of dairy products did not show a clear association with the total OF or hip fracture risks; however, a diminished risk of vertebral fracture could be described. The results regarding BMD change were heterogeneous and did not allow for a definitive conclusion.

Effects of Milk and Dairy Product Consumption on Pregnancy and Lactation Outcomes: A Systematic Review

ABSTRACTPregnancy and lactation are considered critical periods in a female's life. Thus, the maternal diet must provide sufficient energy and nutrients to meet the mother's higher than usual requirements as well as the needs of the growing fetus. The maternal diet must enable the mother to provide stores of nutrients required for adequate fetal development, and good health and quality of life in infancy and later adulthood. Among the food and beverage groups, milk and dairy products can play a very important role in achieving these targets due to their high nutrient density and bioavailability, as well as their availability and widespread consumption.The objective of this study was to evaluate the influence of maternal milk and dairy consumption on pregnancy and lactation outcomes in healthy women. This report mainly focuses on the effects of the mother's intake of dairy products on infant birth weight and length, fetal femur length, head circumference, gestational weight gain, preterm birth, spontaneous abortion, breast milk consumption, and human milk nutritional value. A systematic review of available studies published up to May 2018 was conducted. A preliminary broad search of the literature yielded 5,695 citations. Four of the investigators independently selected studies for inclusion according to predefined eligibility criteria. Thirty-seven full-text articles were evaluated for potential inclusion, and 17 studies were finally included. Six were prospective cohort studies, 3 were intervention studies, 3 were retrospective cohort studies, 3 were cross-sectional studies, and 2 were case-control studies. Although the number and types of studies prevent definite conclusions, there appears to be a trend that maternal milk intake during pregnancy is positively associated with infant birth weight and length. The lack of studies prevents any conclusions being drawn related to preterm deliveries, spontaneous abortion, and lactation.

Effects of Dairy Product Consumption on Height and Bone Mineral Content in Children: A Systematic Review of Controlled Trials

ABSTRACTThere is a physiological basis for the roles of selected nutrients, especially proteins, calcium, and vitamin D, in growth and development, which are at a maximum during the pediatric period. Milk and dairy products are particularly rich in this group of nutrients. The present systematic review summarizes the available evidence relating dairy product intake with linear growth and bone mineral content in childhood and adolescence. A search was conducted in the MEDLINE (via PubMed) and SCOPUS databases following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and included intervention-controlled clinical trials with dairy products in children from 1 January, 1926 to 30 June, 2018. The risk of bias for each study was assessed using the Cochrane methodology. The number of study participants, the type of study and doses, the major outcomes, and the key results of the 13 articles included in the review are reported. The present systematic review shows that supplementing the usual diet with dairy products significantly increases bone mineral content during childhood. However, the results regarding a possible relation between dairy product consumption and linear growth are inconclusive.

Milk and Dairy Product Consumption and Bladder Cancer Risk: A Systematic Review and Meta-Analysis of Observational Studies

ABSTRACTSome studies have reported that milk and dairy product consumption reduces bladder cancer incidence, whereas others have reported null or opposite findings. This meta-analysis of 26 cohort and case-control studies has been conducted to pool the risk of the association between milk and dairy products and bladder cancer. A systematic search in MEDLINE, EMBASE, and the Web of Science (from inception to 30 April 2018) was conducted. Random-effects models were used to compute pooled estimates of RR for high or medium compared with low consumption of milk and dairy. Sensitivity analyses were conducted. Subgroup analyses were performed based on type of dairy, gender, geographic location, and type of study design. Random-effects meta-regression was used to evaluate other confounding factors. Overall, medium compared with low consumption was associated with lower pooled risk of bladder cancer for total dairy products (RR = 0.90; 95% CI: 0.81, 0.98), milk (RR = 0.90; 95% CI: 0.82, 0.98), and fermented dairy products (RR = 0.87; 95% CI: 0.79, 0.96). The inverse association for milk consumption was stronger in Asians (RR = 0.79; 95% CI: 0.59, 0.98) and in cohort design studies (RR = 0.85; 95% CI: 0.71, 0.99). Moreover, high compared with low consumption was significantly associated with a lower pooled risk for milk (RR = 0.89; 95% CI: 0.81, 0.98) and fermented dairy products (RR = 0.78; 95% CI: 0.61, 0.94). However, high compared with low consumption of whole milk was significantly associated with a higher risk (RR = 1.21; 95% CI: 1.04, 1.38). The statistical heterogeneity was considerable. In conclusion, the present meta-analysis suggests a decreased risk of bladder cancer associated with medium consumption of total dairy products and with medium and high consumption of milk and fermented dairy products. An increased risk of bladder cancer was observed with high consumption of whole milk. Interpretations of the results should be made with caution. This review was registered at as CRD42018097020.

Dairy Product Consumption in the Prevention of Metabolic Syndrome: A Systematic Review and Meta-Analysis of Prospective Cohort Studies

ABSTRACTPrevious meta-analyses have associated dairy products with a lower risk of metabolic syndrome (MetS). Since then, new studies evaluating not only total dairy but also different subtypes have been published in this field. The objective of the present work was to systematically review and meta-analyze the epidemiologic studies regarding the associations between the consumption of total dairy products and subtypes (milk, yogurt, and cheese) and the incidence of MetS. Relevant studies were identified through Medline and Cochrane databases. Eligible studies were prospective cohort studies that examined the association between dairy product consumption and/or different subtypes of dairy and the risk of MetS. Random-effects or fixed-effects models were assigned to calculate the pooled RR estimates with 95% CIs. From the 2994 identified articles, 12 and 11 studies were included for the qualitative and quantitative synthesis, respectively. After comparing the highest with the lowest categories, total dairy product consumption was inversely associated with the risk of MetS (9 study comparisons; RR: 0.73; 95% CI: 0.64, 0.83). Low-fat dairy and total yogurt consumption were inversely associated with the risk of MetS (low-fat dairy: 2 study comparisons; RR: 0.77; 95% CI: 0.65, 0.91; total yogurt consumption: 4 study comparisons; RR: 0.74; 95% CI: 0.66, 0.82). The linear RR per 1 serving of yogurt/d was 0.77 (95% CI: 0.60, 1.00). Low-fat yogurt and whole-fat yogurt were inversely associated with the risk of MetS (low-fat yogurt: 2 study comparisons; RR: 0.72; 95% CI: 0.62, 0.84; whole-fat yogurt: 2 study comparisons; RR: 0.81; 95% CI: 0.70, 0.94). Total milk consumption was inversely associated with the risk of MetS (6 study comparisons; RR: 0.79; 95% CI: 0.64, 0.97). Whole-fat dairy consumption was not associated with MetS risk. Our findings suggest that the consumption of total and low-fat dairy products, milk, and yogurt is inversely associated with the risk of MetS. The study protocol is available at as CRD42018082480.

Milk and Dairy Product Consumption and Cardiovascular Diseases: An Overview of Systematic Reviews and Meta-Analyses

ABSTRACTMilk and dairy products containing milk fat are major food sources of saturated fatty acids, which have been linked to increased risk of cardiovascular-related clinical outcomes such as cardiovascular disease (CVD), coronary heart disease (CHD), and stroke. Therefore, current recommendations by health authorities advise consumption of low-fat or fat-free milk. Today, these recommendations are seriously questioned by meta-analyses of both prospective cohort studies and randomized controlled trials (RCTs) reporting inconsistent results. The present study includes an overview of systematic reviews and meta-analyses of follow-up studies, an overview of meta-analyses involving RCTs, and an update on meta-analyses of RCTs (2013–2018) aiming to synthesize the evidence regarding the influence of dairy product consumption on the risk of major cardiovascular-related outcomes and how various doses of different dairy products affect the responses, as well as on selected biomarkers of cardiovascular disease risk, i.e., blood pressure and blood lipids. The search strategies for both designs were conducted in the MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Web of Science databases from their inception to April 2018. From the 31 full-text articles retrieved for cohort studies, 17 met the eligibility criteria. The pooled risk ratio estimated for the association between the consumption of different dairy products at different dose-responses and cardiovascular outcomes (CVD, CHD, and stroke) showed a statistically significant negative association with RR values <1, or did not find evidence of significant association. The overview of 12 meta-analyses involving RCTs as well as the updated meta-analyses of RCTs did not result in significant changes on risk biomarkers such as systolic and diastolic blood pressure and total cholesterol and LDL cholesterol. Therefore, the present study states that the consumption of total dairy products, with either regular or low fat content, does not adversely affect the risk of CVD.

Effects of Milk and Dairy Product Consumption on Type 2 Diabetes: Overview of Systematic Reviews and Meta-Analyses

ABSTRACTDairy product consumption has been related to type 2 diabetes (T2D) incidence, although data from epidemiological studies have shown mixed results regarding the association of dairy products and T2D risk. This overview of systematic reviews and meta-analyses aimed to examine the scientific literature available on the association between dairy product consumption and T2D risk. A literature search was conducted in the MEDLINE (via PubMed), EMBASE, Cochrane Central Database of Systematic Reviews, and Web of Science databases from their inception to April, 2018. Forest plots summarized the risk ratios (RRs) reported by meta-analyses on high compared with low and dose–response dairy product consumption. The risk of bias was assessed using the AMSTAR2 tool. We included 12 meta-analyses, reporting data from 4–22 cohort studies and from 4–23 populations. The participants’ ages ranged from 20 to 88 y, and participants were followed up for from 4 to 30 y. Studies included 64,227–566,875 participants and reported 4810–44,474 cases of T2D. Most studies reported an inverse association between T2D incidence and dairy product consumption, especially for 1) total dairy products (range: 0.86–0.91), 2) low-fat dairy products (range: 0.81–0.83), 3) low-fat milk (RR: 0.82), and 4) yogurt (range: 0.74–0.86). Dose–response analyses showed a decreased T2D risk for 1) 200–400 g/d of total dairy products (range: 0.93–0.97) and 2) 200 g/d of low-fat dairy products (range: 0.88–0.91). Total dairy product consumption is associated with a lower risk of T2D, especially for yogurt and low-fat dairy consumption. The association with cheese is moderate. Moreover, dose–response analyses showed that the risk of T2D decreased by each unit increase in consumption of total dairy products and low-fat dairy products.

Association Between Dairy Product Consumption and Colorectal Cancer Risk in Adults: A Systematic Review and Meta-Analysis of Epidemiologic Studies

ABSTRACTDairy product consumption may decrease colorectal cancer (CRC) risk, but very few studies have evaluated the association between different types of dairy products and CRC location. The aim of this systematic review and meta-analysis was to examine the associations between dairy product consumption and CRC incidence. Summary RRs and ORs with 95% CIs were estimated. A total of 15 cohort studies and 14 case-control studies comprising a total of >22,000 cases were included in the quantitative synthesis. The cohort studies showed a consistent significant decrease in CRC risk associated with higher consumption of total dairy products (RR: 0.80; 95% CI: 0.70, 0.91) and total milk (RR: 0.82; 95% CI: 0.76, 0.88) compared with the CRC risk associated with lower consumption. These studies also showed a significant protective association between low-fat milk consumption and CRC (RR: 0.76; 95% CI: 0.66, 0.88), but only for colon cancer (RR: 0.73; 95% CI: 0.61, 0.87). Cheese consumption was inversely associated with the risk of CRC (RR: 0.85; 95% CI: 0.76, 0.96) and proximal colon cancer (RR: 0.74; 95% CI: 0.60, 0.91). No significant associations with CRC were found for the consumption of low-fat dairy products, whole milk, fermented dairy products, or cultured milk. Most of these associations were not supported by the case-control studies. In conclusion, high consumption of total dairy products and total milk was associated with a lower risk of developing CRC at any anatomic location, including the proximal and distal colon and the rectum. Low-fat milk consumption was associated with a lower risk of CRC, but this association was restricted to colon cancer. Cheese consumption was associated with the prevention of CRC, specifically proximal colon cancer. Further studies on larger samples and with longer follow-up periods, along with appropriately designed and executed clinical trials, are warranted to determine whether dairy product consumption affects CRC development.

Milk and Dairy Product Consumption and Inflammatory Biomarkers: An Updated Systematic Review of Randomized Clinical Trials

ABSTRACTMilk and dairy products contribute ≤14% of the caloric intake in developed countries. Recent evidence has shown controversial results with regard to the role of dairy products in deleterious processes such as inflammation. The increasing number of studies on the anti- and proinflammatory effects of milk and dairy products in the past 5 y reflects the growing interest in this area of research. The aim of this systematic review was to evaluate the scientific evidence provided in the past 5 y on the effects of milk and dairy products on inflammatory biomarkers provided by randomized clinical trials. The search strategy was conducted in Medline (via PubMed) and Scopus (which includes EMBASE and the Web of Science) databases and included articles from 1 January 2012 to 30 April 2018. The risk of bias was assessed using the Cochrane methodology. The number of study participants, type of study, doses, and the key results are reported. The following primary outcomes were considered for inclusion: circulating concentrations of C-reactive protein, interleukins, cytokines, and vascular adhesion molecules or expression of proinflammatory genes in peripheral blood mononuclear cells; however, the primary outcomes considered were not limited to these. Sixteen studies (15 articles) included in this systematic review reported on healthy individuals and subjects who were overweight or obese and who had metabolic syndrome or type 2 diabetes. The consumption of milk or dairy products did not show a proinflammatory effect in healthy subjects or individuals with metabolic abnormalities. The majority of studies documented a significant anti-inflammatory effect in both healthy and metabolically abnormal subjects, although not all the articles were of high quality. This review was registered on PROSPERO (International Prospective Register of Systematic Reviews) at as CRD42018094535.

Effect of Milk and Other Dairy Products on the Risk of Frailty, Sarcopenia, and Cognitive Performance Decline in the Elderly: A Systematic Review

ABSTRACTNutrition is a modifiable factor potentially related to aging. Milk and other dairy products may contribute to the prevention of physical and cognitive impairment. We conducted a systematic review to investigate the effectiveness of dairy product intake for preventing cognitive decline, sarcopenia, and frailty in the elderly population. A systematic search for publications in electronic databases [MEDLINE via PubMed, Embase, Scopus, the Cochrane Central Register of Controlled Trials (CENTRAL), and the Cochrane Database of Systematic Reviews] from 2009 to 2018 identified observational and interventional studies in English and Spanish that tested the relation between dairy product consumption and cognitive decline, sarcopenia, and frailty in community-dwelling older people. We assessed the participants, the type of exposure or intervention, the outcomes, and the quality of evidence. We screened a total of 661 records and included 6 studies (5 observational prospective cohort studies and 1 randomized controlled trial). Regarding cognitive impairment, the relation cannot be firmly established. Consumption of milk at midlife may be negatively associated with verbal memory performance. In older women, high intakes of dairy desserts and ice cream were associated with cognitive decline. On the other hand, 1 study demonstrated a significant inverse relation between dairy intake and development of Alzheimer disease among older Japanese subjects. The consumption of dairy products by older people may reduce the risk of frailty, especially with high consumption of low-fat milk and yogurt, and may also reduce the risk of sarcopenia by improving skeletal muscle mass through the addition of nutrient-rich dairy proteins (ricotta cheese) to the habitual diet. Despite the scarcity of evidence on the topic, our systematic review shows that there are some positive effects of dairy products on frailty and sarcopenia, whereas studies concerning cognitive decline have contradictory findings.

Assessing the Impact of Animal Husbandry and Capture on Anemia among Women and Children in Low- and Middle-Income Countries: A Systematic Review

ABSTRACTAnimal husbandry and capture (AHC) may mitigate anemia among women and children by supplying a source of micronutrient-rich animal source foods (ASF), yet may concurrently increase exposure to anemia-inducing pathogens such as Plasmodium spp., helminths, and enteropathogens. We conducted a systematic literature review to assess the relation between AHC and anemia among women of reproductive age, school-aged children, and children aged <5 y in low- and middle-income countries (LMICs). We used a 2-stage screening process, in which 1 reviewer searched 4 databases (PubMed, Web of Science, EMBASE, and Global Health) with predetermined search terms for relevant articles. Two reviewers then independently screened studies using a priori exclusion criteria, yielding a total of 23 articles included in the final review. We evaluated evidence from observational studies assessing animal-dependent livelihoods and livestock ownership, and interventions that promoted livestock and fish production. We found little consistency in anemia outcomes across the several AHC exposures and population groups. Poultry production interventions had modest benefits on anemia among women and children, although whether these improvements were a result of increased ASF consumption, or a result of the combined treatment study design could not be determined. Observational studies identified chicken ownership, and no other livestock species, as a risk factor for anemia among young children. However, there was limited evidence to evaluate pathways underlying these associations. Studies tended to rely on self-reported fever and diarrhea to assess illness, and no study directly assessed linkages between AHC, pathogen burden, and anemia. Thus, there is insufficient evidence to conclude whether AHC improves or worsens anemia among women and children in LMICs. Given the current interest in promoting animal production among low-income households, future studies with robust measures of livestock ownership, ASF consumption, pathogen burden, and anemia status are needed to understand the nuances of this complex and potentially contradictory relation.

Effects of Milk and Milk-Product Consumption on Growth among Children and Adolescents Aged 6–18 Years: A Meta-Analysis of Randomized Controlled Trials

ABSTRACTAlthough studies have suggested that milk and milk-product consumption may influence growth during childhood and puberty, results are inconsistent. This meta-analysis was performed to evaluate the available evidence of randomized controlled trials (RCTs) assessing whether milk and milk-product consumption could affect growth and body composition among children and adolescents aged 6–18 y. PubMed, EMBASE, Web of Science, and The Cochrane Library databases were systematically searched for all RCTs published up to December 2017 that investigated milk and milk-product consumption (≥12 wk) on growth and body composition among participants (aged 6–18 y) without undernourishment or diseases. Study screening and data extraction by 2 reviewers followed established PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The Cochrane Collaboration's tool was used to assess the quality of the trials. Data were pooled using a random-effects model. Seventeen trials with 2844 children and adolescents were included. Milk and milk-product interventions resulted in a greater increase in body weight (0.48 kg; 95% CI: 0.19, 0.76 kg; P  =  0.001), lean mass (0.21 kg; 95% CI: 0.01, 0.41 kg; P  = 0.04), and attenuated gain in percentage body fat (−0.27%; 95% CI: −0.45%, −0.09%; P  = 0.003) compared with control groups. However, there were no significant changes in fat mass, height, or waist circumference in the intervention groups compared with the control groups (P ≥ 0.05). In subgroup analyses, the baseline weight and age, and the duration of intervention were associated with the efficacy of milk and milk-product intake on the change in lean mass, percentage body fat, and waist circumference, respectively (test for subgroup differences: P < 0.05). Children and adolescents aged 6–18 y consuming milk and milk products are more likely to achieve a lean body phenotype. This meta-analysis was registered in the International Prospective Register of Systematic Reviews (PROSPERO) as CRD42018086850.

Food Groups and Risk of Overweight, Obesity, and Weight Gain: A Systematic Review and Dose-Response Meta-Analysis of Prospective Studies

ABSTRACTThis meta-analysis summarizes the evidence of a prospective association between the intake of foods [whole grains, refined grains, vegetables, fruit, nuts, legumes, eggs, dairy, fish, red meat, processed meat, and sugar-sweetened beverages (SSBs)] and risk of general overweight/obesity, abdominal obesity, and weight gain. PubMed and Web of Science were searched for prospective observational studies until August 2018. Summary RRs and 95% CIs were estimated from 43 reports for the highest compared with the lowest intake categories, as well as for linear and nonlinear relations focusing on each outcome separately: overweight/obesity, abdominal obesity, and weight gain. The quality of evidence was evaluated with use of the NutriGrade tool. In the dose-response meta-analysis, inverse associations were found for whole-grain (RRoverweight/obesity: 0.93; 95% CI: 0.89, 0.96), fruit (RRoverweight/obesity: 0.93; 95% CI: 0.86, 1.00; RRweight gain: 0.91; 95% CI: 0.86, 0.97), nut (RRabdominal obesity: 0.42; 95% CI: 0.31, 0.57), legume (RRoverweight/obesity: 0.88; 95% CI: 0.84, 0.93), and fish (RRabdominal obesity: 0.83; 95% CI: 0.71, 0.97) consumption and positive associations were found for refined grains (RRoverweight/obesity: 1.05; 95% CI: 1.00, 1.10), red meat (RRabdominal obesity: 1.10; 95% CI: 1.04, 1.16; RRweight gain: 1.14; 95% CI: 1.03, 1.26), and SSBs (RRoverweight/obesity: 1.05; 95% CI: 1.00, 1.11; RRabdominal obesity: 1.12; 95% CI: 1.04, 1.20). The dose-response meta-analytical findings provided very low to low quality of evidence that certain food groups have an impact on different measurements of adiposity risk. To improve the quality of evidence, better-designed observational studies, inclusion of intervention trials, and use of novel statistical methods (e.g., substitution analyses or network meta-analyses) are needed.

Perspective: What Does Stunting Really Mean? A Critical Review of the Evidence

ABSTRACTThe past decade has seen an unprecedented increase in attention to undernutrition, and drastically reducing child stunting has become a global development objective. The strong focus on linear growth retardation and stunting has enabled successful advocacy for nutrition, but with this focus has come some confusion and misunderstanding about the meaning of linear growth retardation and stunting among researchers, donors, and agencies active in nutrition. Motivated by the belief that a sharp focus will further accelerate progress in reducing undernutrition, we critically reviewed the evidence. The global attention to stunting is based on the premise that any intervention aimed at improving linear growth will subsequently lead to improvements in the correlates of linear growth retardation and stunting. Current evidence and understanding of mechanisms does not support this causal thinking, with 2 exceptions: linear growth retardation is a cause of difficult births and poor birth outcomes. Linear growth retardation is associated with (but does not cause) delayed child development, reduced earnings in adulthood, and chronic diseases. We thus propose distinguishing 2 distinctly different meanings of linear growth retardation and stunting. First, the association between linear growth retardation (or stunting) and other outcomes makes it a useful marker. Second, the causal links with difficult births and poor birth outcomes make linear growth retardation and stunting outcomes of intrinsic value. In many cases a focus on linear growth retardation and stunting is not necessary to improve the well-being of children; in many other cases, it is not sufficient to reach that goal; and for some outcomes, promoting linear growth is not the most cost-efficient strategy. We appeal to donors, program planners, and researchers to be specific in selecting nutrition outcomes and to target those outcomes directly.

A Systematic Review of Principal Component Analysis–Derived Dietary Patterns in Japanese Adults: Are Major Dietary Patterns Reproducible Within a Country?

ABSTRACTPrincipal component analysis (PCA) has been widely used in nutritional epidemiology to derive dietary patterns. However, although PCA-derived dietary patterns are population-dependent, their reproducibility in different populations is largely unexplored. We aimed to investigate whether major dietary patterns are consistently identified among different populations within a country and, if so, how similar these dietary patterns are. We conducted a systematic review of PCA-derived dietary patterns in Japanese adults using PubMed and Web of Science for English articles and Ichushi-Web and CiNii databases for Japanese articles. We assessed the reproducibility of major dietary patterns using congruence coefficients (CCs), with values ≥0.80 considered to represent fair similarity. From 65 articles (80 studies) included in this review, 285 different dietary patterns were identified. Based on the names of these patterns, major dietary patterns were Western (n = 34), Japanese (n = 12), traditional (n = 10), traditional Japanese (n = 9), healthy (n = 18), and prudent (n = 9) patterns. When assessment was limited to high-quality data (i.e., studies based on a sample size ≥200 and use of a validated dietary assessment questionnaire or multiple-day dietary record), the median CC was low for Western (0.44), traditional (0.59), and traditional Japanese (0.31) patterns. Conversely, the median CC was 0.89 for healthy, 0.86 for prudent, and 0.80 for Japanese patterns; and the proportion of pairs with a CC ≥0.80 was 87.3%, 64.3%, and 50.0%, respectively. Characteristics shared among these 3 dietary patterns included higher intakes of mushrooms, seaweeds, vegetables, potatoes, fruits, pulses, and pickles. In conclusion, this systematic review showed that some of the major dietary patterns are relatively reproducible in different populations within a country, whereas others are not. This highlights the importance of careful interpretation of PCA-derived dietary patterns. Our findings in Japan should be confirmed in different countries and globally. This study was registered at as CRD42018087669.

Anti-Aggregatory Potential of Selected Vegetables—Promising Dietary Components for the Prevention and Treatment of Cardiovascular Disease

ABSTRACTIncreased blood platelet activation, especially platelet aggregation, plays an important function in cardiovascular disease; however, various dietary components may inhibit platelet activation. Recent clinical and epidemiologic studies indicate that both fruits and vegetables, and their products, contain various phytoprotective substances possessing biological properties such as antiplatelet and antioxidant effects that may work synergistically to ameliorate the effect of cardiovascular disease. In addition, the consumption of vegetables and their products may also play an important role in prevention. However, the mechanisms involved have not been clearly defined. Various studies clearly indicate that certain vegetables (e.g., onions, garlic, and tomatoes) have beneficial effects on blood platelet hyperactivity, an important cardiovascular risk factor, and hence may offer new prophylactic and therapeutic possibilities for the treatment of blood platelet hyperactivation and cardiovascular disease. This mini-review evaluates the current literature on the relationship between the consumption of onion (Allium cepa L.), garlic (Allium sativum L.), tomato (Solanum lycopersicum L.), and beetroot (Beta vulgaris L.), and blood platelet activation, which may have important implications for the prophylaxis and treatment of cardiovascular disease.