Fermented milk products supply substrates to the organisms that reside in the gut; however, the nature of the metabolites produced from these substrates is often strain dependent. Milk naturally contains bioactive peptides that are released during gastrointestinal digestion; however, the concentration of these peptides is higher in fermented dairy.
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This is due to fermentation with proteolytic starter cultures such as LAB, in addition to proteolytic enzymes released in the dairy matrix that are capable of further breaking down proteins into bioactive peptides. Nevertheless, there may be common pathways that are similar among dairy peptides regardless of strain. One such pathway involves regulation of various metabolic and immune system genes.
Indeed, it has recently been demonstrated that the ingestion of both probiotic yogurt and acidified milk resulted in modulation of inflammatory and glycolytic genes. Furthermore, gene expression was consistent with measured biomarkers. These findings imply that yogurt peptides may contribute to immune regulation of the microbiota and epithelial dynamics of the gut structure.
Many bacterial strains used in food fermentation produce bioactive peptides that are of particular interest because of their antimicrobial properties, especially S. These peptides tend to be stable in foods, acting as preservatives, and are also stable in blood and serum. Although the specific mechanisms of LAB proteolysis and peptide antimicrobial activity have yet to be exposed, 77 numerous peptides with antimicrobial activity have been reported, regardless of strain specificity. Investigation into strain-specific effects would help optimize the selection of the most efficient strains. The authors of this review hypothesize that antibacterial peptides derived from proteins during milk fermentation are a contributing factor in helping to maintain a healthy gut microbiome, thereby reducing diet-induced gut dysbiosis and thereby the cardiometabolic diseases associated with systemic inflammation.
The premise for this hypothesis is that, regardless of strain, LAB-derived peptides have antimicrobial activity that works through various mechanisms. ACE-inhibitory peptides have yet to be quantified in commercial fermented milks; thus it remains to be determined whether physiological doses of this peptide can be obtained through dietary consumption. Lactobacillus and Streptococcus species used in yogurt production are thought to be the most effective genera to produce the bioactive fatty acid CLA. Compared with milk, LAB fermentation can increase the concentrations of this fatty acid, making products like yogurt or kefir a potential source of dietary CLA.
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Still, the content of CLA in milk can be highly variable and is dependent upon ruminant diet and breed, and increased concentration through fermentation is dependent on bacterial strains used. Immunomodulatory potential of EPS produced by LAB have been demonstrated but are strain specific and not well understood. The increased viscosity contributes to a food matrix that helps protect degradation of live bacteria during passage through the gastrointestinal system, enhancing the viability and delivery of ferments to the gut.
Although there are variations in protein distinct peptide profiles and milk-fat composition among different animal milks, generally nonbovine milks from goats, sheep, buffalo, yaks, or camels are all nutrient-rich foods that can be included in any healthy dietary pattern. In addition to its better digestibility, goat milk contains higher concentrations of short- and medium-chain fatty acids, minerals zinc, iron, magnesium, and calcium , and oligosaccharides, making it more suitable for infant formula.
Plant-based, fermented, nondairy products that are liquid or semisolid are also positioned as alternatives for consumers with lactose intolerance, milk allergies, and concerns over cholesterol. These products may be deficient in 1 or several nutrients—namely, calcium and protein—and high in simple carbohydrates.
Greater yogurt consumption is consistently associated with women compared with men in the majority of populations worldwide and across age groups. This has been observed in American, 37 Spanish, 42 Mediterranean, 38 Irish, and Canadian 21 populations. These differences in yogurt or fermented dairy consumption can easily be attributed to different dietary behaviors practiced by women and the overall tendency for women to follow more a healthful diet than men.
However, there are also biological sex differences that may result in notable differences in the potential physiological impacts of yogurt consumption on various health parameters. A recent study found that, although yogurt consumption has a positive linear association to bacterial fecal count of Lactobacillus and Lactobacillus gasseri in both men and women, there was a negative association with Lactobacillus sakei , Enterobacteriaceae, and Staphylococcus in men, and a positive association with Lactobacillus casei in women.
To defend the hypothesis that fermented milks are beneficial to cardiometabolic disease outcomes and bridge the gaps between observational and mechanistic studies, 4 assumptions are often made: 1 fermented dairy has unique properties that are distinct from nonfermented dairy products; 2 bioactive metabolites are released from all dairy products fermented with LAB; 3 yogurt contributes live bacteria to the gut microbiota regardless of viability in the feces; and 4 a physiological dose is equivalent to as little as 1—2 portions or less of yogurt per day.
Unfortunately, studies involving animals or humans to date have focused on high doses of specific strains, often probiotic strains rather than fermentation cultures, and generalizations cannot be made across all bacterial cultures.
Future studies should focus on commercially available products in amounts that would normally be consumed in a typical diet and take advantage of advances in metabolomics to test the effects of long-term yogurt consumption on gene expression and shifts in microbiota diversity and gut integrity. Fermented milk consumption, primarily yogurt, has been studied in relation to various cardiometabolic disease states, and, for the most part, evidence shows favorable or neutral associations with health.
Of note, yogurt consumption is consistently and favorably associated with reduced risk of T2D, but the mechanisms of action have yet to be identified. The presence of the microbial cultures is the most plausible explanation for the differential effects of yogurt on T2D compared with nonfermented milk. Research into these mechanisms should be intensified to bridge the gap between observational and mechanistic studies and justify the development of clinical practice guidelines for fermented dairy consumption in T2D prevention.
Such efforts may ultimately provide science-based evidence necessary to convince public health authorities to make recommendations for the inclusion of fermented dairy in food-based dietary guidelines. Declaraton of interest. Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide.
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Advanced Search. Article Navigation. Close mobile search navigation Article Navigation. Volume Article Contents. Novel perspectives on fermented milks and cardiometabolic health with a focus on type 2 diabetes Melissa Anne Fernandez. Oxford Academic. Google Scholar.
E-mail: andre. Cite Citation. Permissions Icon Permissions. Abstract This review will explore the observational and mechanistic evidence supporting the hypothesis that fermented milk consumption has beneficial effects on metabolism. Table 1. The association between yogurt and MetS was uncertain.
Fermented dairy had a neutral association with T2D based on moderate-quality evidence. The association between fermented dairy and stroke was favorable and hypertension was neutral, based on moderate-quality evidence. Yogurt low-fat and high-fat was also associated with less risk of abdominal obesity, hypertriglyceridemia, low HDL, and high fasting glucose.
Associations attentuated for fermented dairy during sensitivity analyses. Open in new tab Download slide. Summary of cardiometabolic health research priorities for fermented milks. Abbreviation : T2D, type 2 diabetes.
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Measures and metrics of sustainable diets with a focus on milk, yogurt, and dairy products. Search ADS. Dietary and policy priorities for cardiovascular disease, diabetes, and obesity: a comprehensive review. Systematic review of the association between dairy product consumption and risk of cardiovascular-related clinical outcomes. Consumption of dairy foods and diabetes incidence: a dose-response meta-analysis of observational studies. Dairy consumption and risk of type 2 diabetes: 3 cohorts of us adults and an updated meta-analysis. Dairy products and the risk of type 2 diabetes: a systematic review and dose-response meta-analysis of cohort studies.
Yogurt and cardiometabolic diseases: a critical review of potential mechanisms. Perspective: randomized controlled trials are not a panacea for diet-related research. Whole dairy matrix or single nutrients in assessment of health effects: current evidence and knowledge gaps. Bioactive peptides derived from milk proteins and their health beneficial potentials: an update. The effect of yoghurt and its probiotics on blood pressure and serum lipid profile; a randomised controlled trial. The effects of probiotic and conventional yoghurt on lipid profile in women.
The effects of probiotic bacteria on glycaemic control in overweight men and women: a randomised controlled trial. Is consuming yoghurt associated with weight management outcomes? Results from a systematic review. Consumption of dairy products in relation to changes in anthropometric variables in adult populations: a systematic review and meta-analysis of cohort studies. Dairy consumption in association with weight change and risk of becoming overweight or obese in middle-aged and older women: a prospective cohort study. Yogurt consumption, body composition, and metabolic health in the Quebec Family Study.
Modifications in food-group consumption are related to long-term body-weight changes.
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Dairy products and total calcium intake at 13 years of age and its association with obesity at 21 years of age. Food sources of fat may clarify the inconsistent role of dietary fat intake for incidence of type 2 diabetes. Associations of dairy intake with incident prediabetes or diabetes in middle-aged adults vary by both dairy type and glycemic status.
A prospective study of dairy consumption in relation to changes in metabolic risk factors: the Hoorn Study.
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Consumption of yogurt, low-fat milk, and other low-fat dairy products is associated with lower risk of metabolic syndrome incidence in an elderly Mediterranean population. Association between yogurt consumption and the risk of metabolic syndrome over 6 years in the SUN Study. Dairy consumption is associated with a lower incidence of the metabolic syndrome in middle-aged and older Korean adults: the Korean genome and epidemiology study KoGES.
Consumption of yogurt and the incident risk of cardiovascular disease: a meta-analysis of nine cohort studies. Milk and dairy consumption and risk of cardiovascular diseases and all-cause mortality: dose-response meta-analysis of prospective cohort studies.
Dairy consumption and incidence of hypertension: a dose-response meta-analysis of prospective cohort studies. Longitudinal association of dairy consumption with the changes in blood pressure and the risk of incident hypertension: the Framingham Heart Study. Regular yogurt intake and risk of cardiovascular disease among hypertensive adults. Associations between yogurt, dairy, calcium, and vitamin D intake and obesity among U.