That yogurt might have a beneficial effect on consumers’ health is a generally held assumption. Now recent epidemiological studies reported that yogurt consumption has positive effects on public health diseases such as obesity or type 2-diabetes. But how exactly is this impact to be defined? Which conditions does yogurt help to prevent? What are the underlying mechanisms? YOGURT: A DAILY PARTNER FOR HEALTH” is the title of an international symposium, where experts have provided answers to these questions by presenting data from a broad range of recent studies, that show the importance of this research field for health care. Prof. Seppo Salminen (University of Turku / Finland) unveiled dietary guidelines for dairy and yogurt consumption and the growing interest in evidence-based recommendations by government bodies. The symposium, which was organized by the Yogurt in Nutrition Initiative for a Balanced Diet (YINI) will be held Monday, November 10, 2014 (5-7 pm) as part of the III World Congress of Public Health Nutrition in Las Palmas de Grand Canarias (9-12 November 2014). More info on www.yogurtinnutrition.com

1. Yogurt & fermented milks
in daily nutrition: from science to
guidelines and recommendations
Seppo Salminen
Seppo Salminen
University of Turku
Faculty of Medicine
Functional Foods Forum
Turku, Finland

2. Seppo Salminen

3. 100 MOST IMPORTANT SPECIES FOR HUMAN
Seppo Salminen
EVOLUTION

4. 100 MOST IMPORTANT MATTERS FOR
HUMAN EVOLUTION
Lactobacillus (5th most important)!
Food preservation
Preserving intestinal integrity and
barrier
Seppo Salminen Seppo Salminen

5. What is the first recommended
food for humans?
Seppo Salminen

6. BREASTMILK RECOMMENDED FOR
Seppo Salminen
INFANTS
Bacteria in human milk
lactic acid bacteria
bifidobacteria
70
60
50
40
30
20
10
0
Sweden Israel South Africa Japan Peru South Korea Denmark
Bifidobacteria
Lactic Acid Bacteria
Sinkiewicz and Nordström 2008

7. Seppo Salminen
Food and Bacteria
! Yogurt, viili, sourmilk and sour cream,
cheese, salami, fermented vegetables
(kim-chi, fermented cucumber), fermented
oat products, sauerkraut…
! Tendency to sterilize and pasteurize food
! Products with added bacteria or probiotics
& new technologies for food
Seppo Salminen

8. Background
The term ‘probiotic’ is a health claim.
Stating ‘contains probiotic’ (or similar) on a product … implies that the product
contains a substance that may be beneficial for health…. For this reason, the
term ‘probiotic’, when used on a food label, is considered to be a health
claim.
Any terms that imply probiotic activity are health claims and are not
permitted. For example if terms like ‘live’ or ‘active’ are used to describe bacteria,
these imply a probiotic function and therefore are considered to be health claims.
You can give the name of the bacteria in the list of ingredients.
Live/Active Probiotic Health claim
http://www.fsai.ie/faqs/probiotic_health_claims.html

9. Consensus Panel on scope and
appropriate use of the term ‘probiotic’
Seppo Salminen

10. Seppo Salminen
Guidelines for Health
Professionals
! Several meta-analyses
! Yogurt and probiotics studied
! Probiotics are recommended

11. 2012
Limited weak evidence – second in the second line – however grade B
recommendations

12. 2013

13. EVIDENCE-BASED GUIDELINES: PROBIOTICS
• Important especially in cases of acute
gastroenteritis: specific probiotics reduce
risk and shorten duration (ESPGHAN)
• Recommendation for probiotics: acute
gastroenteritis, antibiotic side effects, IBS
(World Gastroenterology Association)
• Specific probiotics prevent antibiotic side-effects
(Several learned bodies)

14. Evidence-Based Guidelines
Probiotics/Acute Gastroenteritis
ESPGHAN/ESPID 2008
NICE 2009
• A. Guarino
• R. Khanna
• F. Albano
• M. Lakhanpaul
• S. Ashkenazi
• S. Burman-Roy
• D. Gendrel
• S. Murphy
• H. Hoekstra
• R. Shamir
• H. Szajewska
Szajewska 2012

15. Seppo Salminen
Guidelines for Health
Professionals
! Yogurt studies suggest a potential benefit
! Two meta-analyses published on yogurt

16. Meta-analysis of yogurt and GI challenges
Bernadeta Patro-Gołąb , Raanan Shamir , Hania Szajewska 2014
Effect of yogurt consumption on acute gastroenteritis (continuous data).
Yogurt for treating acute gastroenteritis in children: Systematic review and meta-analysis
Clinical Nutrition, 2014
Seppo Salminen

17. Meta-analysis of yogurt and GI challenges
Effect of yoghurt consumption on weight gain.
Bernadeta Patro-Gołąb , Raanan Shamir , Hania Szajewska 2014
Yogurt for treating acute gastroenteritis in children: Systematic review and meta-analysis
Clinical Nutrition, 2014
Seppo Salminen

18. Conclusions
Yogurt starter cultures L. delbrueckii subsp. bulgaricus and S.
thermophilus, which are well specified for their use in yogurt
manufacturing by Codex Alimentarius Standard No. 243/2003.
Meta-analysis to assess exclusively the effect of Lactobacillus (any
species or strain) regardless its vehicle (yogurt, fermented milk, etc.)
Traditional yogurt also has been the subject of studies aimed at
comparing its effect to that of probiotic supplements or probiotic yogurt,
showing either a similar effect between groups or the advantage of
probiotic addition.
Single reports suggest that yogurt administration may be beneficial in
children with persistent diarrhea, useful in the treatment of lactose
intolerance associated with acute diarrhea, and beneficial as a preventive
agent against antibiotic-associated diarrhea.
Bernadeta Patro-Gołąb , Raanan Shamir , Hania Szajewska Yogurt for treating acute gastroenteritis in children:
Systematic review and meta-analysis. Clinical Nutrition 2014.

19. Seppo Salminen
19
Health Claims in European Union
based on
Regulation EC (No) 1924/2006 of the European
Parliament and of the Council of 20 December
2006 on nutrition and health claims made on
foods (revised January 2007)

20. Focus of EU Claim Regulation
! General population, healthy population
! Generally accepted science
! Scientific assessment of proposed claims
-causality
Seppo Salminen

21. Seppo Salminen

22. Bacteria and probiotics in
dietary guidelines
! Fermented foods (usually yoghurt and low-fat
yoghurt) appear in several dietary
guidelines
! US and France, specifically mention easily
digestable foods for the elderly and France
also for children
Seppo Salminen

23. Seppo Salminen
29 occurrences
for « yogurt » (in
112 pages, especially
for the low-fat version)
NO occurrences
for yogurt
probiotic
content/effect
A. Martin

24. http://www.cnpp.usda.gov/Publications/DietaryGuidelines/
2010/DGAC/Report/2010DGACReport-camera-ready-
Jan11-11.pdf
- Fermented
products?
- Specific health
benefits?

25. Yogurt and probiotics are absent in FBDG
targeting the General Population
Seppo Salminen
- Cultural reasons: bacteria often not
considered
- Scientific reasons: science is new
- Only lactose intolerance health claim
for the general population

26. Dietary Guidelines in EU
! Most EU member states mention yogurt in
dietary guidelines
! 5 EU member states mention yogurt in
dietary guidelines with reference to
bacteria
! Estonia, Germany, Italy, Poland, Spain
Seppo Salminen
Ebner et al., Beneficial Microbes, 2014

27. Seppo Salminen
Dietary Guidelines EU
! All 5 mention also probiotics
! Germany does not mention species of
probiotic bacteria
! Others mention Lactobacillus acidophilus,
Bifidobacterium, and/or L casei and L
reuteri
! All mention balancing intestinal microbiota
as one benefit
Ebner et al., Beneficial Microbes, 2014

28. Seppo Salminen
Dietary Guidelines
Outside EU
! Several guidelines mention both yoghurt
and bacteria
! Canada as an example
! Health claims in Canada for the general
population
Ebner et al., World Journal of Gastroenterology, 2014

29. The French Example
Seppo Salminen
What to do against digestive problems
(constipation, bloating, pain,…)?
Specific FBDG for elderly
(French Nutrition Health
Policy) for seniors and health
care professionals
« Eat yogurts: they
provide lactic bacteria
which can help you »
A. Martin, 2013

30. What to do in the future ?
Better define target groups which could
benefit the most of the intervention (benefit/
risk/cost/ease/…) as in France
General Children Adolescents Pregnant Elderly Low income
Population women populations
for good affordable for good affordable
nutrition nutrition
Seppo Salminen
For designing group specific FBDG?
Probiotics mentioned in
Workshop – NY June 2013
A. Martin

31. Seppo Salminen

32. Future Dietary guidelines
! Frequent yogurt consumption may contribute to
improved diet quality and a healthier insulin
profile (Zhu Y et al Eur J Nutr 2014)
! Women who reported habitual intake of probiotic
dairy products had a reduced risk of
spontaneous preterm delivery (Myhre et al Am J Clin
Nutr 2011)
! Consumption of probiotic milk products reduced
incidence of atopic eczema and rhino-conjunctivitis
by 36 months of age (Bertelsen et al
JACI 2014 )
Seppo Salminen

33. Summary of Today
! Positive influence of yogurt on adolescent
cardiovascular health
! Fermented dairy products linked with better diet
quality; negatively associated with long-term
weight gain
! Yogurt is part of a healthy diet, a nutrient-dense,
lower-calorie food to meet guidelines
! Prospects for public health and nutrition
recommendations on probiotics (Sanders et al Ann.
N.Y. Acad. Sci. 2014)
Seppo Salminen

34. Yogurt: dietary guidelines
Strengthening of barrier functions by
Lactobacillus
Seppo Salminen
High calcium
Lower levels of
lactose
Health claim in EU
Degradation of antigens
Pathogen reduction
Balancing
microbiota Carrier for probiotics

35. Seppo Salminen
Lactobacillus
Probiotics
Regulating
Inflammation
Yogurt fermented
milks
Redommended
Nutrition
Intestinal
microbiota
Health
Yogurt and health benefits benefit