mickey rubin. Презентация в рамках сессии о влиянии молочных...

The role of dairy foods in dietary guidelines in the western world

Mickey Rubin, PhD

National Dairy Council (U.S.)

World Dairy Summit 2016

Food-based dietary guidance

• Food-based dietary guidance is often based on a system of food groupings which can aid in achieving adequate intakes of vitamins, minerals and macronutrients

• These dietary guidelines generally recommend diets be made up of a variety of nutrient-dense foods

• As a result, dairy foods are a common element of many food-based dietary guidelines throughout the Western world

• While dairy is one of several common elements among dietary guidelines, these common elements can be presented in various ways due to diversity in review methodology as well as how the recommendations are presented to the public.

FAO Database of Dietary Guidelines Around the World

Nutrient Requirements vs. Health Outcomes

• Historically, the role of dairy foods in dietary guidelines has been based on the need to meet nutrient requirements

• Dairy foods are a source of numerous short-fall nutrients of and nutrients of public health concern

Underconsumed NutrientsVitamin A, vitamin D, vitamin E, vitamin C, folate, calcium,

magnesium, fiber and potassium

Nutrients of ConcernVitamin D, calcium, potassium

and fiber

Dietary Guidelines for Americans 2015

Nutrient Requirements vs. Health Outcomes

• In recent years, some dietary recommendations have shifted – at least in part – to recommendations based less on nutrients and more on health outcomes

• This has resulted in some recommendations to be more “food-focused” rather than “nutrient-focused”

Dietary Guidelines for Americans Advisory Committee Report 2015

“Moderate evidence also indicates that intake of milk and milk products is associated with a reduced risk of cardiovascular disease and type 2 diabetes and with lower blood pressure in adults.”

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


Nutrient Requirements vs. Health Outcomes vs. Dietary Patterns

• Another recent evolution in dietary guidance has been a focus dietary patterns rather than specific foods

• Based on the concept that people do not eat individual nutrients, nor do people consume entire food groups in isolation, but rather in combination

• The components of the eating pattern can have interactive and potentially cumulative effects on health


Three case studies on dietary guidelines that are based on more than meeting nutrient needs

• Dietary Guidelines for Americans• Dutch Dietary Guidelines• Australian Dietary Guidelines

United States: Dietary Guidelines for Americans (2015)


“Higher intake of vegetables, fruits, whole grains, low- or non-fat dairy, seafood, legumes, and nuts; moderate intake of alcohol (among adults); lower intake of red and processed meat; and low intake of sugar-sweetened foods and drinks and refined grains.”

• A focus on dietary patterns actually had the consequence of neglecting specific health outcome benefits associated with specific food groups such as dairy

• There were no evaluations of specific foods and health outcomes• According to the advisory report, characteristics of dietary patterns

associated with positive health outcomes include:

United States: Dairy Servings Vary by Diet Pattern

Healthy US-style Pattern

Healthy Mediterranean-style

Pattern

Healthy Vegetarian

Pattern

3 servings LF/FF dairy foods per day



The Netherlands: Dutch Dietary Guidelines 2015


“Nutrient metrics for the prevention of chronic diseases have major

limitations; for example, total protein, fat and carbohydrate intake are

not related to chronic diseases, and individual nutrients, for example,

fatty acids and sodium, have limited effects. Increasing evidence from

controlled trials on risk factors and prospective cohort studies shows

that specific foods and dietary patterns substantially affect chronic

disease risk.Therefore, the 2015 Dutch dietary guidelines are

completely food-based.”

Committee Dutch Dietary Guidelines 2015


• Based on 29 systematic reviews of meta-analyses in PubMed

summarizing randomized controlled trials and prospective cohort

studies on nutrients, foods and food patterns and the risk of 10

major chronic diseases:

• CHD, stroke, heart failure, diabetes, breast cancer, colorectal

cancer, lung cancer, COPD, dementia and depression

• The committee also selected three causal risk factors for

cardiovascular diseases or diabetes:

• Systolic blood pressure, low-density lipoprotein cholesterol

and body weight

Australia Dietary Guidelines (2013)


• Five key evidence sources for the guidelines

• Previous dietary guidelines and supporting documentation

• The Evidence Report – a systematic literature review

• The NRV – Nutrient reference values for Australia and New Zealand

• Food Modeling System - range of computer-generated diets that

translate the NRVs into dietary patterns to describe some types,

combinations and amounts of foods that can deliver nutrient

requirements for each age and gender group

• Key authoritative government reports – ex. A review on pregnant and

breastfeeding women


Evaluation of dietary patterns:


Evaluation of dairy foods:


•Enjoy a wide variety of nutritious foods from these five groups every day:

• plenty of vegetables, including different types and colours, and legumes/beans

• fruit

• grain (cereal) foods, mostly wholegrain and/or high cereal fibre varieties, such

as breads, cereals, rice, pasta, noodles, polenta, couscous, oats, quinoa and

barley

• lean meats and poultry, fish, eggs, tofu, nuts and seeds, and legumes/beans

• milk, yoghurt, cheese and/or their alternatives, mostly reduced fat (reduced fat

milks are not suitable for children under the age of 2 years).

•And drink plenty of water.

•Limit intake of foods containing saturated fat, added salt, added sugars and alcohol.

•Encourage, support and promote breastfeeding.

•Care for your food; prepare and store it safely.

Summary• An evaluation of three of the most recent dietary guidelines from Western countries

reveals a focus beyond simply fulfilling nutrient requirements• While nutrients provided by dairy foods (e.g., calcium) have historically been the

principle reason for their prominent feature in dietary guidelines, there are now additional proof points that must be considered

• e.g., association with chronic diseases and how foods interact in a dietary pattern• Given the evidence for dairy’s role in reducing risk of several non-communicable

diseases (CVD, type 2 diabetes, etc.), this change can be viewed as favorable for maintaining dairy’s role in guidelines and health dietary patterns

• However, the de-emphasis on nutrients such as calcium may result in some unintended consequences

• e.g., de-emphasis of servings needed to achieve nutrient requirement

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mickey rubin. Презентация в рамках сессии о влиянии молочных...

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