Professor André Marette of the Physiology and Endocrinology Department at the Laval University in Canada explains the impact on health markers: “Is yogurt associated with reduced cardio-metabolic risk factors in children?“. During this talk, he evaluated the role of yogurt as a nutrient-dense snack and its influence in reducing the risk of developing diabetes and obesity.

1. Is yogurt associated with reduced
cardiometabolic risk factors in children?
Dr André Marette
Laval Hospital, Heart and Lung Institute,
Institute for Nutrition and Functional Foods (INAF),
Université Laval
Québec, Canada
Is yogurt consumption associated with
reduced cardiometabolic risk in children

2. Divulgation of potential conflicts
Consultation and honorarium
• Danone Nutricia
• Thetis Pharma
• Valbiotis
Funding
• CIHR, CDA, HSFC, FRQ, CRIBIQ
• JA DeSève Fondation
• Pfizer (Chair CIHR/industry)
• Danone Nutricia
• Thetis Pharma
• Fédération des Producteurs Acéricoles du Québec
• Dairy Farmers of Canada

3. “Toxic” food and unhealthy lifestyle

4. Cardiometabolic diseases
 Diet-related diseases
 Prevalence of “severe”
obesity is increasing in
children
 Putting children at risk for
“adult” diseases
 Type 2 diabetes
 Dyslipidemia
 Hypertension
 Metabolic syndrome
 Preventable and manageable
 Healthy diet and lifestyle
behaviors learned in childhood
Kumar and Kelly (2017) Mayo Clinic Proceedings

5. What makes yogurt an interesting
research topic?
High quality
protein
growth and
maintenance
of muscle
mass
Source of Ca, vitamin D and P
 contribute to bone health
Nutrient rich food
profile  contributes to
intakes of essential
nutrients for health
Lipids and lactose 
energy source
Pairs well with other healthy foods  potential for
increased intake of fruits, vegetables and grains
Source of bioactive lipids
and peptides  di- and
tri-peptides, CLA, short-
and medium-chain fatty
acids that contribute to
protection against
cardiometabolic risk
factors
Live cultures improve
lactose tolerance,
increase concentrations
of some nutrients (eg.
CLA and bioactive
peptides)

6. Number of publications on “yogurt” indexed in
PubMed over the last 100 years
Total = 3296
Probiotic yogurt = 644
Yogurt consumption = 837
Yogurt and weight = 431
Yogurt and health = 897
Microbiota and yogurt = 92

7. Macronutrient profile of common yogurts
Children aged 4-6 y
Children aged 7-11 y
Percent contribution of 100 g of commonly
consumed yogurts to the reference nutrient
intakes for energy, fat, carbohydrates and
protein in children.
Based on the dietary reference values for children from
the British Nutrition Foundation and Public Health
EnglandComposition of foods integrated dataset
% RNI
% RNI
Melissa Fernandez, Mauro Fisberg, and André Marette
Chapter: Role of yogurt in the nutrition and health of children
and adolescents. In book entitled "Yogurt in Health and Disease
Prevention". Ed. Nagendra Shah, Elsevier 2017 In press

8. Yogurt’s contribution to the dietary
reference values for mineral and vitamin in
children and adolescents
• Excellent source of iodine,
vitamin B12, phosphorus,
calcium, riboflavin and
thiamin for children and
adolescents
• Source of folate, magnesium,
potassium and selenium
• Provides negligible amounts
of iron, niacin and vitamin B6
• Concentrated source of
nutrients for children
• Yogurt is an excellent vehicle
for vitamin D fortification
0
5
10
15
20
25
30
35
40
45
50
4-6 yo
7-10 yo
11-14 yo
15-18 yo
Based on the dietary reference values for children from the British Nutrition Foundation and
Public Health EnglandComposition of foods integrated dataset
% contribution of 100g
low-fat fruit yogurt

9. ISYOGURT CONSUMPTION ASSOCIATED
WITH BODY WEIGHT GAIN IN CHILDREN AND
ADOLESCENTS?

10. Long-term association between dairy consumption
and risk of childhood obesity: a systematic review
and meta-analysis of prospective cohort studies
(Lu et al. Eur. J. Clin. Nutr. 2016)
46 011 children and adolescents with an average 3-year follow-up
38% less likely to have
childhood overweight/obesity
the risk of overweight/obesity
was 13% lower with each
serving of dairy/day

11. Association between yogurt consumption and
adiposity indicators in children
(Zhu et al. Eur J Nutr. 2015)
Variable N Difference P - value
Body weight 4,370 -0.3 kg 0.65
BMI 4,342 0.1 kg/m2 0.64
Waist circumference 4,278 -0.2 cm 0.76
33%
67%
Frequency of yogurt consumption in a cohort of American
children 2-18 y (NHANES 2003 and 2006)
Frequent yogurt consumers
(at least once a week; median
= 2/week)
Infrequent yogurt consumers
(less than once a week;
median = 1-6/year)
No differences in
adiposity indicators
between frequent and
infrequent yogurt
consumers

12. Association between yogurt consumption and
obesity among U.S. Children aged 8–18 years
(Keast et al, Nutrients 2015)
Variable N Difference P - value
Body weight 3786 -1.7 kg NS
BMI 3786 -0.7 kg/m2 <0.05
Waist circumference 3786 -2.5 cm <0.05
8%
92%
Frequency of yogurt consumption in a cohort of American
children 8-18 y (NHANES 2005-2008)
Frequent yogurt consumers
(at least once out of 2 24-h
dietary recalls)
Non yogurt consumers (not at
all mentioned in 24 hour
dietary recalls)
Significantly lower BMI
and waist circumference
in yogurt consumers
compared to non-
consumers

13. ISYOGURT CONSUMPTION ASSOCIATED
WITH CARDIOMETABOLIC RISK FACTORS IN
CHILDREN AND ADOLESCENTS?

14. Systematic review of the associations between dairy
product consumption and risk of cardiometabolic
outcomes in the adult population
(Drouin-Chartier et al. Adv Nutr 2016)

15. Association between yogurt consumption and
the lipid profile in U.S. children
(Zhu et al. Eur J Nutr. 2015)
Variable N Difference P - value
Total cholesterol 3,272 -2.2 mg/dL 0.17
HDL cholesterol 3,272 -1.3 mg/dL 0.06
LDL cholesterol 1,265 -0.2 mg/dL 0.94
Triglycerides 1,266 -0.5 mg/dL 0.93
Non-HDL cholesterol 3,272 -0.9 mg/dL 0.58
Ratio of total cholesterol to HDL cholesterol 3,272 0.01 0.84
Differences in lipid profiles between frequent and
infrequent yogurt consumers (children 2-18 y)
No differences in the lipid profile between frequent and infrequent yogurt consumers

16. Association between yogurt consumption and
blood prsssure in U.S. children
(Zhu et al. Eur J Nutr. 2015)
Variable N Difference P - value
Systolic 2,868 -0.5 mmHg 0.45
Diastolic 2,868 -1.6 mg/dL 0.11
Differences in blood pressure between frequent and
infrequent yogurt consumers (children 2-18 y)
No differences in blood pressure between frequent and infrequent yogurt consumers

17. Associations between yogurt consumption and
type 2 diabetes risk factors in U.S. children
(Zhu et al. Eur J Nutr. 2015)
Variable N Difference P - value
Glucose (mmol/L) 930 -0.02 mmol/L 0.64
Insulin (pmol/L) 913 -13.6 pmol/L <0.001
HOMA-IR (homeostatic model
assessment of insulin resistance)
913 -0.61 <0.001
QUICKI (Quantitative insulin sensitivity
check index)
913 0.007 mg/dL 0.03
Differences in type 2 diabetes risk factors between frequent
and infrequent consumers (children 2-18 y)
Significantly better metabolic profiles in frequent consumers compared to
infrequent yogurt consumers

18. What could be driving these
associations?

19. • Increase satiety and reduce short-term
food intake
• Reduced appetite sensations
• Increased gastric transit time
• Enhanced calcium transport
• Insulintropic
• Decrease plasma cholesterol,
triglycerides and fatty acids
• ACE inhibitory bioactive peptides (blood
pressure control)
• Improved insulin sensitivity and blood glucose
control
• PPAR agonist
• Enhanced transport of fat soluble vitamins
• Adipocyte cell differentiation inhibition
• Anti-inflammatory
• Plaque formation inhibition
• Anti-obesogenic
• Decreased food intake and increased
energy expenditure
• Increased fat-cell oxidation
• Increased fat cell breakdown
• Anti-atherosclerotic
• Anti-hyperlipidemic
• Normalize glucose tolerance and insulin
secretion
• Reduced vascular smooth muscle
intracellular calcium (lower blood pressure)
• Improved energy regulation and lipid
storage
• Decreased fatty acid synthesis
• Increased lipolysis
• Fecal fatty acid excretion
• Induction of thermogenesis
• Calcium-specific appetite control
• Improved nutrient bioavailability and
digestion
• Increased PH
• Increased concentration of CLA
• Increased gut transit time
• Formation of smaller
curds
• Increased viscosity
• Maintenance of gut microbiota
• Release of bioactive peptides
• Improved lactose digestion
Vitamins and
minerals
(calcium and
vitamin D)
Protein
(whey and casein)
Fermented
milk
(lactic acid
bacteria)
Lipids
(bioactive fatty acids)
Yogurt
matrix

20. Bioactive peptides
Bioactive peptides can be released from milk proteins through three
known mechanisms:
1) hydrolysis with digestive enzymes (e.g., pepsin, trypsin, and chymotrypsin)
2) fermentation with proteolytic starter cultures
3) proteolysis with enzymes derived from microorganisms
Korhonen, J Funct Foods 2009

21. Intestinal transit and energy balance regulation
Amino acid/nutrient release and absorption
Regulation of the gut microbiota
Digestive system
Casein- and whey-derived bioactive peptides
• Anti-hypertensive byACE
inhibition
• Vasodilators release
• Anti-thrombotic
Vascular system
• Macrophages stimulation
• Proliferation and maturation
of immune cells
• Metabolic endotoxemia
Immune system
• Sympathetic nervous
activity and energy
expenditure
• Gut-brain axis and
satiety signals
Nervous system
• Anticholesterolemic
• Insulin sensitivity and
glucose tolerance
• Gut-liver axis and lipid
metabolism
Metabolic system
• Obesity
• Type 2 Diabetes
• Cardiovascular diseases
• NAFLD
Fight against cardiometabolic diseases
Fernandez et al. (review under revision)
Bioactive peptides

22. BIOACTIVE LIPIDS
 CLA
 PPAR activator (Parodi 2016)
 Anti-diabetic (Ryder et al. 2001)
 Anti-obesogenic (Ryder et al. 2001)
 Short chain fatty acids (butyric acid) (Gao et al. 2009)
 Increased insulin sensitivity
 Increased thermogenic activity
 Medium-chain fatty acids
 Anti-diabetic (Wein et al. 2009)

23. Yogurt ferments
 Release bioactive molecules (Fernandez et al. 2015)
 Conjugated linoleic acid (CLA)
 Bioactive peptides
 Exopolysaccharides
 Enhanced digestion (Pei et al 2015 and Allen et al. 1982)
 Improved lactose tolerance
 Low pH of yogurt – ideal for mineral absorption
 Lactic acid bacteria (Pessione et al. 2012)
 Antagonist behavior with other bacteria
 Favors healthy gut microbiota
 Increase concentrations of fermentable oligosaccharides
 Prebiotic action on the gut microbiota

24. Take home messages
 There is a likely favorable or neutral association between yogurt intake and
adiposity indicators in children and adolescents.
 There is a favorable association between yogurt consumption andT2D risk in
adults – one study suggests this relationship also holds for children and
adolescents.
 There is a neutral association between yogurt intake and the lipid profile or
blood pressure in adults – while similar results have been reported in children
and adolescents, more studies are clearly needed to confirm the adult data
 Pre-clinical and clinical studies are needed to demonstrate the inverse
relationships between yogurt intake and the incidence of obesity andT2D
found in observational studies, and to unravel the underlying mechanisms

26. Acknowledgments
Mélissa Fernandez
Éliane Picard-Deland
Noémie Daniel
Angelo Tremblay
Shirin Panahi
Mauro Fisberg

27. Thank you !
andre.marette@criucpq.ulaval.ca
Quebec city, October 2017 !