4/29/2019 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 opics • Nutrient composition of dairy ingredients • Focus on protein: amino acids, protein quality • Lactose • Health benefits of dairy ingredients • Additional resources 2019 ADPI Dairy 360 1
4/29/2019 Path thway to o dai dairy ry ingredie ients: Sep Separatio ion of of milk ilk components Complex mixture of highly Whole milk bioavailable nutrients: • Proteins • Carbohydrates (lactose) Cream • Fat Skim milk Buttermilk • Minerals • Vitamins Casein Whey Skim milk powder powder powder 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 Skim MPC 42 MPC WPC WPC WPI Caseinate Caseinate Permeate milk 85 34 80 MCC 42 MCC 90 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 2019 ADPI Dairy 360 2
4/29/2019 Da Dairy ry proteins: com omplex mixt xture Caseins Whey 80% 20% • Milk powders (whole, skim, MPCs) contain casein & whey Caseins: • A1/A2 casein health effects A1-casein Β -Lactoglobulin • Precipitate during cheese making • More slowly digested A2-casein Α -Lactalbumin • Carriers of minerals • Health benefits of bioactive peptides (i.e., lower blood pressure) B-casein Serum Albumin Whey proteins: • Two major fractions: β -lactoglobulin and α -lactalbumin • Water soluble after casein precipitation κ -casein Immunoglobulins • Fast digestion “fast protein” • Specific physiologic functions (lactoferrin, Lactoferrin immunoglobulins) USDEC, Reference Manual for US Milk Powders and Microfiltered Ingredients, 2019 2019 ADPI Dairy 360 Casein con Ca ontroversy: 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 2019 ADPI Dairy 360 3
4/29/2019 Foc ocus on on 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 2019 ADPI Dairy 360 4
4/29/2019 Why doe oes protein quality matter? Essential amino acids, percent of total protein 60 Milk proteins deliver the amino acid 50 nutrients that match human requirements 40 better than plant proteins. 30 20 10 0 Milk proteins: Growth, body Health and wellbeing essential amino acids composition Van Vliet 2015 Delivering nutrient Measurable Reduced stunting, requirements physiological effects reduced frailty 2019 ADPI Dairy 360 Methods to o 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 2019 ADPI Dairy 360 5
4/29/2019 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 2019 ADPI Dairy 360 Understanding lactose intolerance and cow’s milk allergy Cow’s milk allergy Lactose Intolerance Immune-mediated reaction Mechanism Enzyme deficiency Peaks during 1 st 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, Gastrointestinal Abdominal pain, nausea, nausea, abdominal pain, diarrhea Symptoms bloating, flatulence, diarrhea Skin, respiratory (nasal itch, Extraintestinal Headache, vertigo, memory shortness of breath), atopic eczema Symptoms 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 2019 ADPI Dairy 360 6
4/29/2019 He Health ben enefits of of dairy ry in ingredients • Weight loss and body composition • Exercise and recovery • Healthy aging • Glucose management 2019 ADPI Dairy 360 What is is th the evid vidence base for or mil ilk and whey proteins com ompared to o oth other proteins? Protein # Clinical trials* ingredient Adult body Weight Recovery Sarcopenia Blood glucose composition loss Healthy aging management Dairy 28 20 13 37 60 Soy 20 11 1 6 45 Pea 1 0 0 0 12 Wheat 0 1 0 1 22 Rice 2 1 1 0 2 Potato 1 0 0 0 0 *Trial quality not assessed USDEC 2018 Chalvon-Demersay 2017 PubMed search 2019 Strong evidence for health effects of milk proteins, limited for alternatives 2019 ADPI Dairy 360 7
4/29/2019 Da Dairy ry proteins en enhance wei eight los loss and bod ody com omposition Meta-analysis: • 21 clinical trials using dairy foods • 6 clinical trials using whey or casein supplements • Compared to low dairy, plant Dairy proteins resulted in: alternatives • 2 lbs greater weight loss • 18-50 yr old overweight/obese • 2.7 lbs greater fat loss • Energy restricted diets, 16 weeks • 55 g/d average whey protein • 75% greater retention lean mass (range 20-84 g) • No effect with resistance training Stonehouse 2018 Significant impact of milk proteins for weight loss & muscle retention and improved body composition 2019 ADPI Dairy 360 What is is th the evid vidence for alt lternative proteins, wei eight los loss or or bod ody composition? Protein # Clinical trials Source • Soy protein: inconsistent results, Weight loss 15-56 g protein/d Dairy 20 Search terms: • Wheat protein: no effect on weight • Soy protein, pea protein, Soy 11 loss (Johnston 2017) wheat protein, rice protein, • Rice protein: 48 g rice protein or Pea 0 potato protein AND weight whey protein increased lean body Wheat 1 loss, body composition mass, muscle mass, strength and Rice 1 • Only clinical trials in humans decreased fat mass (Joy 2013) Potato 0 USDEC 2018 Pubmed search 2019 Alternative proteins cannot make similar claims about weight loss, muscle retention and body composition: lack of evidence 2019 ADPI Dairy 360 2019 ADPI Dairy 360 8
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