Latest studies confirm association of yogurt consumption with less weight gain over time and a reduced risk of becoming overweight or obese. The potential benefits of yogurt consumption to reduce weight gain over time have been confirmed in several recently-reported studies discussed today (1,2). Scientists have found that regular yogurt consumption is associated with less weight gain and a reduced risk of becoming overweight or obese. Speaking to public health officials at the III World Congress of Public Health Nutrition in Spain, Professor Frans J Kok from the Division of Human Nutrition at Wageningen University in the Netherlands, underlined the potentially unique role of daily yogurt consumption for weight management. However, he also highlighted the need for randomized controlled trials and mechanistic studies to help understand how this might occur.

1. Yogurt as part of Healthy Diet and Weight Management
III World Congress
Public Health Nutrition 2014
Frans J Kok, Wageningen University, The Netherlands

2. Nutrient composition of Yogurt
•Rich in protein, vitamins B2, B6, B12, Ca, K, Zn and Mg.
•Nutrients more concentrated than in milk (ranging from 20% to >100%).
•Acidity of yogurt increases bioavailability, e.g. calcium.
•More lactic acid and galactose but less lactose.
•Probiotics in yogurt (lactobacilli, bifido’s) with possible health benefits
Tzatziki
Tarator
Matzoon
Turkey Greece Armenia Bulgaria
Cacik
Yogurt

3. Wang H et al. Nutr Res 2013
Framingham Offspring Cohort (1998-2001) and Generation Three Cohort (2002-2005)
Prevalence of nutrient inadequacy and yogurt consumption non consumer consumer (n = 3016) (n = 3510) Median energy contribution from yogurt (% kcal) 0 2.07 Prevalence of nutrient inadequacy Vitamin B1 24.8 13.1 Vitamin B2 11.2 3.4 Vitamin B6 17.6 8.2 Vitamin B12 6.1 2.4 Calcium 72.5 52.9 Folate 14.8 6.9 Magnesium 65.5 39.1 Vitamin C 25.6 14.1 Zinc 27.8 12.9 Phosphorus 4.1 1.2 Vitamin A 36.7 18.0 Percentage of population with usual intakes above AI Potassium 4.7 11.4 Fiber 10.1 22.4

4. Wang H et al. Nutr Res 2013 Yogurt consumption & diet quality Nonconsumers (n=3016) Consumers (n=3510) P trend P con vs non- con Low- intake (n=1758) High- intake (n=1752) Median energy% from yogurt (%kcal) 0 2.07 1.11 5.70 DGAI score 8.05 9.14 8.78 9.53 Potassium (g) Model 1 2.93 3.22 3.12 3.34 <.001 <.001 Model 2 3.08 3.20 3.15 3.26 <.001 <.001 Fiber (g) Model 1 15.14 17.03 16.80 17.28 <.001 <.001 Model 2 16.65 16.83 17.21 16.34 .002 .11 For DGAI (Dietary Guidelines Adherence Index) score, model adjusted for age, sex, PAI score, smoking, BMI. Model 1 adjusted for age, sex, energy intake, PAI score, smoking, BMI, use of dietary supplements. Model 2 adjusted for covariates in model 1 and DGAI score. Similar analyses also performed for other minerals/vitamins. Significant for vitamins A, B2, B12, C, and D and for Ca, Mg, and Zn

5. Wang H et al. Nutr Res 2013
Yogurt consumption & metabolic factors
Non consumers
(n=3016)
Consumers
(n=3510)
P for
trend
P con vs
non-con
Low-intake
(n=1758)
High-intake
(n=1752)
Total cholesterol
(mg/dl)
194.9 195.0 195.0 195.0 .97 .97
HDL cholesterol
(mg/dl)
53.2 53.0 53.1 52.9 .53 .70
Triglycerides
(mg/dL)
109.9 107.8 108.8 106.8 .10 .20
Glucose
(mg/dL)
98.4 97.5 97.8 97.1 .01 .02
Insulin
(pmol/L)
82.8 82.1 82.8 81.4 .12 .40
Systolic blood
pressure (mmHg)
121.3 120.4 120.4 120.3 .12 .02
Diastolic blood
pressure (mmHg)
74.7 74.6 74.5 74.6 .91 .49
HOMA-IR 3.37 3.31 3.34 3.28 .04 .15
Adjusted for age, sex, PAI score, total energy intake, smoking status, DGAI score, use of supplements and BMI.

6. Surveys in Italy and France
•Italy: INRAN-SCAI 2005-06 (n=2831, age ≥18 y, 3 conseq. days)
- Mean intake of yogurt 21 g/d (24% intake of 88 g/d)
- Likelihood consumption higher for 18-64 vs. ≥65 y, Northern/Central vs. Southern regions, higher (≥2 h/w) vs lower (<2 h/w) physical activity.
- Smokers (30%) and eating out less likely to consume yogurt.
- Yogurt consumers showed better diet quality (PanDiet score)
•France: CCAF 2010 (n=948, aged 25-64 y, 7 days food records)
- High consumers (>6 servings*/w, 176 g/d) had better diet quality,
- Consumed more fruits and cereal products and less ready-to-eat meals,
- Had higher sugar intake but similar energy intake and BMI
Turrini A et al. Faseb J 2014, Lecerf JM et al. Faseb J 2014
* Yogurt and fermented milks, fresh cheeses, petit-suisse

7. Association yogurt and obesity cross-sectional analysis
•Australia (n=720 overweight/obese ♀♂)¹
Yogurt consumption inversely associated with %body fat, abdominal fat, waist (WC) and hip circumference (HC) (all p<0.05)
•Korea (n=7173 adults aged 19-64 y)²
High frequency of yogurt intake inversely associated with obesity.
OR=0.77; 95% CI = 0.59-1.00 for ≥1 time/day vs. 0 (p for trend = 0.01)
¹Murphy KJ et al. Nutrients 2013;
²Lee H et al. PlosOne 2014

8. Mozaffarian D et al. N Engl J Med 2011
4-y Δ weight 0.4 kg less for each yogurt serving/d; similar association seen in all 3 cohorts
Change in Diet
and Long-Term Weight Gain

9. ΔWeight 0.09 kg/y less for ≥3 servings/wk vs <1 serving/wk (P = 0.03)
Wang H et al. Int J Obes 2014 Annualized change of weight & yogurt consumption Framingham Heart Study Offspring Cohort, n=3440, 11683 observations) <1 servings 1 - < 3 servings ≥3 servings Ptrend Yogurt (servings/week) 0 (0, 0.74) 1.74 (1.00, 2.99) 3.74 (3.00, 24.50) N 5720 1432 1091 Age-adjusted Model 0.14±0.01 0.12±0.03 0.02±0.03 0.002 Multivariate model 0.16±0.02 0.15±0.03 0.07±0.04 0.03 Adjusted for sex, age, smoking status, physical activity, and baseline weight, average total energy intake and DGAI score.

10. Wang H et al. Int J Obes 2014
Annualized change of waist circumference & yogurt consumption Framingham Heart Study Offspring Cohort, n=3440, 11683 observations) <1 servings 1- < 3 servings ≥3 servings Ptrend Yogurt (servings/week) 0 (0, 0.74) 1.74 (1.00, 2.99) 3.74 (3.00, 24.50) N 5720 1432 1091 Age-adjusted Model 0.68±0.02 0.68±0.04 0.58±0.04 0.06 Multivariate model 0.71±0.02 0.70±0.04 0.57±0.04 0.008 Adjusted for sex, age, smoking status, physical activity, and baseline weight, average total energy intake and DGAI score.

11. Quebec Family Study (n=248, age ≥18 y)¹
6-y Δ yogurt not associated with Δ weight
1 serving/d increase associated with 0.42 cm increase in WC
¹Drapeau V et al. Am J Clin Nutr 2004, ²Vergnaud A et al. Am J Clin Nutr 2008
SU.VI.MAX trial (n=2267, age >45 y)²
♂BMI ≥ 25: 6-y Δ weight 1.1 kg less and Δ WC 1.3 cm less for >1.1 vs <0.2 servings/d (P = 0.01 and P = 0.03)
♀BMI < 25: 6-y Δ weight 0.7 kg more for >1.3 vs <0.4 servings/d (P = 0.04)

12. SUN cohort study in Spain
(n=8516, mean age 37.1, SD: 10.8 y, median follow-up: 6.6 y)
Martinez-Gonzales MA et al. Nutr, Metab, Cardiovasc Dis 2014
Hazard Ratio (95%CI) of incident overweight/obesity
according to yogurt consumption.
Consumption of total yogurt (servings per week)
0–2 >2–<5 5–<7 7 >7
p for
trend
Total yogurt
1
1.08
(0.96-1.21)
0.99
(0.84–1.16)
0.86
(0.74–0.99)
0.80
(0.68–0.94)
0.001
Whole-fat yogurt
1
1.05
(0.94–1.18)
0.75
(0.59–0.96)
0.81
(0.70–0.94)
0.62
(0.47–0.82)
<0.001
Low-fat yogurt
1
1.22
(1.07–1.40)
1.25
(0.96–1.63)
0.92
(0.76–1.11)
0.84
(0.61–1.15)
0.601
Adjusted for: sex, age, physical activity, hours of TV watching, hours spent sitting down,
smoking status, snacking between meals, following a special diet, total energy intake, and
adherence to the Mediterranean diet, marital status, and years of education and baseline body
mass index.

13. SUN cohort
Cubic spline analysis to account for non-linear association
Hazard ratio for
overweight/obesity
Interaction between fruit and yogurt consumption

14. Randomized Controlled Trials
• Only 2 RCTs: one significant benefit of yogurt (Zemel MB
2005), the other (Thomas DT 2011) equivocal.
Limitations: comparable dairy control group,
energy-restricted trials, length of follow-up
•Systematic review Yogurt and Weight management (70 papers retrieved). Expected at EB 2015 in Boston

15. Yogurt may facilitate appetite control through:
Replacement of less healthy foods
Specific effects of some nutrients
Effects of food matrix
Vector of microorganisms
VS.

16. Effect on satiety: liquid yogurt vs chocolate bars
Chapelot D, Payen F. Br J Nutr 2010

17. Yogurt may facilitate appetite control through:
Replacement of less healthy foods
Specific effects of some nutrients
Effects of food matrix
Vector of microorganisms

18. Afternoon snack of yogurt, hunger, fullness, and delayed subsequent eating in healthy women
The 160-kcal snack not fully compensated despite lower energy intake at dinner time (HP surplus of +83 kcal, MP +90 kcal, LP +60 kcal)
Douglas SM et al. Appetite 2013

19. Yogurt may facilitate appetite control through:
Replacement of less healthy foods
Specific effects of some nutrients
Effects of food matrix
Vector of microorganisms
β glucan

20. Lluch A et al. Food Quality and Preference 2010
Towards the design of satiating yogurt

21. Appetite, satiety and ad libitum dinner intake following consumption of afternoon snacks (Randomized cross-over trial in 20 healthy women)
Ortinau LC et al. Nutr J 2014
30 min delay
P<0.05
P=0.08

22. Yogurt may facilitate appetite control through:
Replacement of less healthy foods
Specific effects of some nutrients
Effects of food matrix
Vector of microorganisms

23. Intestinal Microbiota Composition in Obesity
Bacteroidetes Firmicutes Proteobacteria
Verdam FJ et al. Obesity 2013
15/19 9/9
- Energy-harvest capacity of microbiota
- Influence of gut function/distant tissues
through regulation of immune system

24. Effect of Lactobacillus rhamnosus CGMCC1.3724 supplementation on weight loss and maintenance in n=126 obese men and women.
Sanchez et al. Br J Nutr 2013
* P < 0.05
12-week moderate energy restriction with or without probiotic supplementation

25. Key messages
1.Yogurt fits well in a healthy diet.
2.RCTs with yogurt needed to understand its role in weight management.
3.Probiotics in yogurt may beneficially interact with gut microbiota.