Abstract 1 of 5 Journal of the American College of Nutrition, Vol. 28, No.

Supplement_1, 73S-81S (2009) Published by the American College of Nutrition

ORIGINAL RESEARCH

The Role of Dairy in Meeting the Recommendations for Shortfall Nutrients in the American Diet
Theresa A. Nicklas, DrPH, Carol E. O'Neil, PhD, RD and Victor L. Fulgoni, III, PhD
USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, 1100 Bates Avenue; Baylor College of Medicine, Houston, Texas (T.A.N.) Louisiana State University AgCenter, Baton Rouge, Louisiana (C.E.O'N.) Nutrition Impact, LLC, 9725 D Drive North, Battle Creek, Michigan (V.L.F.) Address correspondence to: Theresa A. Nicklas, DrPH, USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, 1100 Bates Avenue, Baylor College of Medicine, Houston, Texas 77030. E-mail: tnicklas@bcm.tmc.edu

Background: The 2005 Dietary Guidelines Advisory Committee (DGAC) recognized calcium, potassium and magnesium, all found in high levels in dairy foods, among the shortfall nutrients in both children and adults diets. Objective: The objectives were to determine: 1) the percentage of the population with intakes greater than the Adequate Intakes (AI) for calcium and potassium and the percentage of the population with inadequate magnesium intake (based on Estimated Average Requirement [EAR]) and 2) the impact of various levels of dairy consumption on intake of calcium, potassium and magnesium. Design: Secondary analysis of data from the 1999-2004 NHANES. Subjects/Setting: Participants 2 years of age and older. Main Outcome Measures: Percentage of the population meeting current recommendations for calcium, potassium and magnesium. Statistical Analyses Performed: Percentage of EAR/AI for nutrients was calculated based on age/gender specific values. All analyses were weighted using the NHANES six-year sample weights and adjusted for the complex sample design of NHANES with the statistical package SUDAAN. Results: The most recent NHANES data demonstrated that a significant proportion of the American population did not meet recommendations for calcium, potassium, and magnesium. Less than 3% of the population consumed the recommended level or more of potassium. Only 30% of the US population 2 years of age and older obtained the recommended level of calcium or

more and 55% consumed less than the EAR for magnesium. Recommending 34 servings from the dairy group for all people greater than 9 years of age may be necessary in order to ensure adequate intake of calcium and magnesium, assuming the current diet remains the same. More than 4 servings of dairy would be needed to meet the potassium recommendation at all ages. Conclusions: For those individuals who do not consume dairy products, we need to better understand the barriers to consuming specific dairy products. In addition, more research is needed to examine whether food-based recommendations are practical, feasible and cost effective to meet nutrient needs. Key words: dairy intake, calcium, potassium, magnesium, NHANES, DRI, short fall nutrients

Abstract 2 of 5 Journal of the American College of Nutrition, Vol. 28, No. Supplement_1, 82S-90S (2009) Published by the American College of Nutrition

REVIEW

Dairy and Bone Health

Robert P. Heaney, MD
Creighton University, Omaha, Nebraska Address correspondence to: Robert P. Heaney, MD, Creighton University, 2500 California St., Omaha, NE 68178. E-mail: rheaney@creighton.edu

Bone health is the resultant of bone mass, bone architecture, and body mechanics. Nutrition supports all three components, with the principal nutrients concerned being calcium, protein, and vitamin D. Potassium, magnesium, zinc, and several vitamins are also involved to varying extents. Given modern food sources, it is difficult to devise a diet that is "bone healthy" without including three servings of dairy per day, not just because of dairy calcium, but dairy protein and potassium as well. Key words: bone, osteoporosis, milk, dairy foods, bone mass, calcium, vitamin D, potassium

Abstract 3 of 5 Journal of the American College of Nutrition, Vol. 28, No. Supplement_1, 91S-102S (2009) Published by the American College of Nutrition

REVIEW

Milk Products, Insulin Resistance Syndrome and Type 2 Diabetes

Angelo Tremblay, PhD and Jo-Anne Gilbert, MSc
Division of Kinesiology, Laval University, Quebec City, CANADA Address correspondence to: Angelo Tremblay, Laval University, Quebec City, Quebec, G1K 7P4 CANADA. Email: angelo.tremblay@kin.msp.ulaval.ca

A growing body of evidence suggests an inverse relationship between calcium and vitamin D status and dairy food intake and the development of the insulin resistance syndrome (IRS) and type 2 diabetes mellitus (t2DM). Observational studies show a consistent inverse association between dairy intake and the prevalence of IRS and t2DM. In a systematic review of the observational evidence, the odds for developing the IRS was 0.71 (95% CI, 0,570.89) for the highest dairy intake (34 servings/d) vs. the lowest intake (0.91.7 servings/d). Few interventional studies have been conducted to evaluate the effects of dairy food intake on the management of prevention of IRS or t2DM. Intervention studies that have examined the independent effects of dairy intake on specific metabolic components of the IRS including blood pressure and obesigenic parameters have shown favorable effects that support the observational findings albeit the results have been less consistent. Many metabolic and dietary factors appear to influence the degree to which dairy affects IRS metabolic parameters including calcium and vitamin D intake status, BMI, ethnicity and age. Overall, the intake of low-fat dairy products is a feature of a healthy dietary pattern which has been shown to contribute to a significant extent to the prevention of IRS. Key words: dairy, metabolic syndrome, calcium, hypertension, obesity

Abstract 4 of 5 Journal of the American College of Nutrition, Vol. 28, No. Supplement_1, 103S-119S (2009) Published by the American College of Nutrition

REVIEW

Milk Products, Dietary Patterns and Blood Pressure Management

Penny M. Kris-Etherton, PhD, Jessica A. Grieger, PhD, Kirsten F. Hilpert, PhD and Sheila G. West, PhD
Departments of Nutritional Sciences and Biobehavioral Health, The Pennsylvania State University, University Park, Pennsylvania

Address correspondence to: Penny Kris-Etherton, 110 Chandlee Laboratory, Department of Nutritional Sciences, Penn State University, University Park, PA, 16802. E-mail: pmk3@psu.edu

High blood pressure (BP) is a major risk factor for heart disease, stroke, congestive heart failure, and kidney disease. Inverse associations between dairy product consumption and systolic blood pressure (SBP) and diastolic blood pressure (DBP) have been observed in cross-sectional studies; some studies, however, have reported an inverse association with only one BP parameter, predominantly SBP. Randomized clinical trials examining the effect of calcium and the combination of calcium, potassium and magnesium provide evidence for causality. In these studies, reductions in BP were generally modest (1.27 to 4.6 mmHg for SBP, and 0.24 to 3.8 mmHg for DBP). Dairy nutrients, most notably calcium, potassium and magnesium, have been shown to have a blood pressure lowering effect. A low calcium intake increases intracellular calcium concentrations which increases 1,25-dihydroxyvitamin D3 and parathyroid hormone (PTH), causing calcium influx into vascular smooth muscle cells, resulting in greater vascular resistance. New research indicates that dairy peptides may act as angiotensin converting enzyme (ACE) inhibitors, thereby inhibiting the renin angiotensin system with consequent vasodilation. A growing evidence base shows that dairy product consumption is involved in the regulation of BP. Consequently, inclusion of dairy products in a heart healthy diet is an important focal point to attain BP benefits. Key words: dairy foods, milk, blood pressure, hypertension, potassium, calcium, magnesium, DASH diet

Abstract 5 of 5 Journal of the American College of Nutrition, Vol. 28, No. Supplement_1, 120S-129S (2009) Published by the American College of Nutrition

REVIEW

The Role of Dairy Foods and Dietary Calcium in Weight Management

Marta Van Loan, PhD
United States Department of Agriculture, Agriculture Research Service, Western Human Nutrition Research Center, University of California - Davis, Davis, California Address reprint requests to: Marta Van Loan, 430 West Health Sciences Drive, University of California - Davis, Davis, CA 95616. E-mail marta.vanloan@ars.usda.gov

Overweight and obesity are the foremost public health problems in the U.S., other industrialized countries, and is rapidly increasing in developing countries. Obesity is a multifaceted disease which requires multiple approaches to successfully combat its increase. Nutritional factors play a key role and include modification of energy balance, intake and expenditure, as well as other factors. Emerging scientific evidence over the past decade suggests that dairy foods may be

beneficial when included in a moderate energy restricted diet and possibly for weight maintenance as well. This paper provides a review of some of the scientific evidence that has examined the effect of dairy foods and dietary calcium on weight management. Topic areas presented are observational or retrospective studies with adults as well as children and adolescents; randomized clinical trials on body weight and composition, energy expenditure, substrate oxidation and fecal fat loss; research from animal and in vitro studies provide possible mechanisms of action. Key words: dairy, calcium, weight loss, weight management, obesity