8/3/2019 Despre Produsele Lactate

1/4

Should dairy be recommended as part of a healthy vegetarian diet?

Point13

Connie M Weaver

ABSTRACT

A benefit-risk evaluation of the evidence for including dairy foods in

the diet is presented. For many persons dairy products provide a sub-

stantial portion of essential nutrients, but especially calcium, potas-

sium, and magnesium. Dietary supplements and fortified foods can

be alternative sources of these nutrients, although other components

of dairy foods such as amino acid composition and conjugated lino-

leic acid may be instrumental in the benefits associated with dairy

product consumption for bone health and reduced risk of stroke, met-abolic syndrome, and some cancers. Newer evidence shows that

protein-induced calciuria does not have a detrimental effect on net cal-

cium retention, and the concentrations of hormones in milk are not

outside of the range of endogenous concentrations. Increased dietary

protein, including from milk, can elevate serum concentrations of

insulin-like growth factor I, which has an unknown relation to can-

cer. The concern over consumption of milk leading to increased risk

of prostate cancer through reduction of serum 1,25-dihydroxyvitamin

D, a potent anti-prostate cancer hormone, has been resolved with new

evidence that local production of this hormone is independent of diet.

Overall, evidence suggests that being a lactovegetarian has greater

health benefits and reduced health risks than being a vegan. Am

J Clin Nutr 2009;89(suppl):1634S7S.

INTRODUCTION

A decision to consume dairy products, as with any food group,

can be guided by a benefit-risk analysis. This review considers the

merits and concerns of dairy products as foods based on peer-

reviewed literature and does not address preferences, beliefs, or

other issues such as production practices. The evidence that led to

the recommendation of 3 cups (720 mL) of milk and milk

products daily by the 2005 Dietary Guidelines for Americans

Committee is reviewed. The most touted risks of consumingdairy

foods include protein-induced calciuria, the presence of hor-mones and steroids, increased risk of prostate cancer, and the

presence of lactose and saturated fats. Dairy foods void of lactose

and fat are widely available; therefore, these issues are not

discussed.

BENEFITS

Rich package of nutrients

Milk and milk products are recommended to be consumed

daily at amounts of 3 cups milk or the equivalent for most energy

patterns by the 2005 Dietary Guidelines for Americans (1). The

percentage of the requirements set by the Dietary Reference

Intakes of the Institute of Medicine provided by 3 cups low-fat

milk for women aged 3150 y is given in Table 1. In the food

patterns, milk and milk products contribute .10% of the re-

quirements of many nutrients, including riboflavin, vitamin

B-12, vitamin A, thiamin, calcium, phosphorus, magnesium,

zinc, potassium, protein, and carbohydrates (1). The nutrients

most at risk if milk products are excluded are calcium, potas-sium, and magnesium. For a woman aged 1950 y, calcium and

magnesium recommendations are met with the food guide pat-

tern in MyPyramid. However, without milk products, only 44%

of calcium and 57% of magnesium recommendations are met.

For potassium, the proportion of the recommended intakes with

milk products is 73% compared with 57% without milk prod-

ucts. MyPyramid is based on minimal changes to the typical

American diet in an attempt to achieve nutrient recommendations

without exceeding energy needs. An analysis of the National

Health and Examination Survey 20012002 showed that it is

impossible to meet calcium recommendations for adolescents

while meeting other nutrient recommendations with a dairy-free

diet within the current US dietary pattern (2). Although a numberof calcium-fortified foods are available and many with good cal-

cium bioavailability (3), they are not selected in sufficient quan-

tities to correct the calcium shortfall created by excluding dairy

products.The calcium-fortifiedfood thatmost closely matches the

nutrient profile of milk is calcium-fortified soymilk (Table 1); this

product is now allowed in the special supplemental nutrition

program for Women, Infants, and Children (WIC). Calcium bio-

availability can be as good as milk depending on how it is man-

ufactured (4). Substitution of 3 cups milk with calcium-fortified

soymilk in the food patterns would constitute a substantial de-

viation from the typical American diet and has not been evaluated

for overall health to provide comparable evidence to milk as

discussed below. Can fruit and vegetables be increased instead ofmilk to provide potassium and calcium? One-half cup orange

vegetables or fruit only provides 213 mg potassium compared

1From the Department of Foods and Nutrition, Purdue University, West

Lafayette, IN.2 Presented at the symposium, Fifth International Congress on Vegetar-

ian Nutrition, held in Loma Linda, CA, March 46, 2008.3

No reprints available. Address correspondence to CM Weaver, Depart-

ment of Foods and Nutrition, Purdue University, 700 W State Street, West

Lafayette, IN 47907-2059. E-mail: weavercm@purdue.edu.

First published online March 25, 2009; doi: 10.3945/ajcn.2009.26736O.

1634S Am J Clin Nutr 2009;89(suppl):1634S7S. Printed in USA. 2009 American Society for Nutrition

byguesto

nFebruary1,2012

www.ajcn.org

D

ownloadedfrom

http://-/?-http://www.ajcn.org/http://www.ajcn.org/http://www.ajcn.org/http://www.ajcn.org/http://www.ajcn.org/http://www.ajcn.org/http://www.ajcn.org/http://www.ajcn.org/http://www.ajcn.org/http://www.ajcn.org/http://www.ajcn.org/http://www.ajcn.org/http://www.ajcn.org/http://www.ajcn.org/http://-/?-

8/3/2019 Despre Produsele Lactate

2/4

with382mg ina cup ofmilk and,50 mg calcium compared with

305 mg in 1 serving of milk (5).

Dairy products provide the best package for addressing

nutrients limited in the diets of many Americans. Dairy products

provide an important source of nutrients for high-risk groups,

including low-income Americans. The major programs supported

by the federal government, such as the National School Lunch

Program, the Child and Adult Care Feeding Program, the

Summer Feeding Program, the Food Stamp Program, and WICbenefit from the nutrient profile of dairy foods. Approximately

12% of expenditures under the Food Stamp Program were for

dairy foods in 2005 (6).

Of the shortfall nutrients most affected by excluding dairy

products from the diet, calcium and potassium deserve additional

comment for possible consequences to health. Potassium re-

quirements increased considerably with the 2004 revision of the

Dietary Reference Intakes (7). The basis for the increased re-

quirements was the blood pressure-lowering effects detected

in .20 trials. Calcium intakes of most populations fall short of

the requirements of their respective countries, and this is espe-

cially problematic during rapid bone growth (8). Calcium intake

explained 12.3% of the variance in calcium retention, almost asmuch as the effect of race (13.7%) in a metabolic study of black

and white adolescent girls (9). Quantifying the effect of a single

nutrient on an outcome cannot be determined from observational

studies in which so many confounders affecting calcium re-

tention are at play. In the controlled feeding study of Braun et al

(9) all other nutrients were constant, and the crossover design

accounted for physical activity and season and the contribution

of individual variation. In observational studies, race effects are

fairly easy to quantify because there is limited confusion for

classification, but dietary nutrient estimation is poorly estimated

and can vary considerably over time.

Calcium should be consumed in adequate quantities to meet

demands for growth and obligatory losses. Approximately 1300mg Ca/d is needed for a female adolescent to meet the demand for

skeletal growth; for losses in urine, sweat, and endogenous se-

cretion; and to adjust for average calcium absorption efficiency

(7). The ability to adapt to low calcium intakes is incomplete. In

girls, urinary calcium excretion was 66 6 10 mg/d on a low

calcium intake (386 6 14 mg/d), half of that on the recommended

calcium intake (1222 6 42 mg/d) (10). Nevertheless, calcium

absorption increased from 249 6 29 to 587 6 35 mg/d, and

calcium retention increased from 131 6 14 to 349 6 32 mg/d

when calcium intake was raised to near recommended amounts.

Thus, chronic dietary calcium deficiency eventually depletes bone.

Dairy and bone health

Dairy products have been positively associated with bone

health, largely but not exclusively, because of their calcium

content. Calcium comprises one-third of bone mineral content

(BMC). Low calcium intake leads to increased bone remodelingand increased risk of hip fracture. At the time the 2005 Dietary

Guidelines for Americans Committee reviewed the evidence for

a relation between intake of milk products and BMC or bone

mineral density, all 7 of the randomized, controlled trials and 25

of the 32 observational studies showed a positive relation in 1

skeletal sites (1). A particularly persuasive study reported that

low milk consumption during childhood, determined retrospec-

tively, was associated with a doubling of hip fracture in a rep-

resentative US sample of postmenopausal women (11).

Among the observational studies, less confounding occurs in

those that compare milk avoiders with milk consumers within

the same population. Such studies are available in both children

and adults. In New Zealand children, the fracture risk of milkavoiders was 34.8% compared with 13.0% for matched birth

cohorts (12). In 300 white, Hispanic, and Asian sixth grade

girls from 2 states, perceived milk intolerance was inversely

related to BMC of several bone sites (P 0.009 for the lumbar

spine and trends for total hip, femoral neck, and total body) (13).

In that study, measured lactose maldigestion was unrelated to

bone because those who did not know they were maldigesters

were not avoiding dairy product consumption. In Finnish adults,

fracture incidence from 1980 to 1989 in 11,619 women was

found to be associated with lactose intolerance. The risk of

lower body fractures excluding ankle was 2 times greater for

women claiming lactose intolerance than for women without

lactose intolerance (odds ratio: 2.15; 95% CI: 1.53, 3.04) (14).Another type of useful observational study is one within similar

cultures, but dairy husbandry is practiced in one location and not

in neighboring locations. Such studies have shown bone benefits

to the dairy-consuming regions in Yugoslavia (15) and China

(16). Vegetarians who include milk in their diet should not have

compromised bone health. However, vegans who exclude dairy

products in their diets have higher fracture risk according to data

from the European Prospective Investigation into Cancer and

Nutrition study (17).

TABLE 1

Nutrients provided by 3 cups low-fat (1%) milk compared with 3 cups calcium-fortified soy milk for women aged 3150 y1

Cow mi lk Calci um-fortified soy mi lk

Difference between soy milk

and cow milk

Calcium (mg) 871 6 872

1104 6 110 233

Phosphorus (mg) 695 6 99 675 6 96 220

Protein (g) 24.7 6 54 22.1 6 48 22.63

Potassium (mg) 1098 6 23 675 6 14 2423

Magnesium (mg) 81 6 25 117 6 37 36

Riboflavin (mg) 1.35 6 123 1.58 6 144 0.23

Vitamin D (IU) 380 6 95 360 6 90 220

1Nutrient value source: Agricultural Research Service (ARS) Nutrient Database for Standard References, release 161

(US Department of Agriculture; http://www.nal.usda.gov/fnic/foodcomp/Data/SR16/sr16.html).2

Mean 6 SD (all such values).

DAIRY FOODS: PRO 1635S

byguesto

nFebruary1,2012

www.ajcn.org

Downloadedfrom

http://-/?-http://www.ajcn.org/http://www.ajcn.org/http://www.ajcn.org/http://www.ajcn.org/http://www.ajcn.org/http://www.ajcn.org/http://www.ajcn.org/http://www.ajcn.org/http://www.ajcn.org/http://www.ajcn.org/http://www.ajcn.org/http://www.ajcn.org/http://www.ajcn.org/http://www.ajcn.org/http://-/?-

8/3/2019 Despre Produsele Lactate

3/4

Dairy and other health benefits

Health benefits of dairy consumption beyond bone health

considered by the 2005 Dietary Guidelines for Americans

Committee included hypertension, insulin resistance syndrome

(IRS), and stroke. Important evidence that supported including

3 cups milk or milk products daily came from the Cardia Study,

a 10-y longitudinal study of 3157 black and white adults aged 18

30 y from 4 US cities (18). Each daily serving of dairy productslowered the risk of developing IRS, characterized by obesity,

hyperinsulinemia, insulin resistance, and hypertension, by 21%.

Best results were achieved with 3 servings dairy consumed

daily. A prospective study of stroke on 2403 men aged 2024 y

showed a hazard ratio of 0.64 (95% CI: 0.39, 1.06) with 2 cups

milk consumed daily and 0.37 (95% CI: 0.15, 0.90) if subjects

had a prior vascular event (19).

RISKS

Protein-induced calciuria

Much malignment of milk products as a source of calcium has

been directed at the 8 g protein/cup that milk adds to the Westerndiet, which is already excessive in protein. The concern is linked

to protein-induced calciuria that has been associated with bone

loss (20). Many studies have confirmed the calciuria effect, but

several laboratories have shown that overall calcium retention is

unaffected by protein amount or type (2123). The rich content

of aromatic amino acids in milk may make this protein source

especially important for enhancing calcium absorption (24). The

benefits or risk of dietary protein probably depends on the

dietary calcium-to-protein ratio that is comparable between

lactovegetarians and omnivores (25).

Hormones

The presence of steroid hormones in milk has been of concern

to some. The concentration of 17b-estradiol in 206 samples of

whole cow milk was reported (26). The 17b-estradiol concen-

tration averaged 1.4 6 0.2 pg/mL (range: 022.9 pg/mL). A

1-cup serving of milk would average 330 pg and the 3 cups

recommended in the food guidance system for most energy

amounts would contain ,1 ng. To compare against endogenous

production of 17b-estradiol in humans, a prepubertal girl pro-

duces 400 ng/d and an adult woman in late pregnancy is as

high as 37.8 mg/d. Thus, the presence of 17b-estradiol is very

low, and skim milk would be even lower. 17b-estradiol is fat

soluble and is consistent with finding a significant correlation of

serum 17b-estradiol with milk fat content (r 0.20, P , 0.01).

The concentrations of hormones in milk from cows given

recombinant bovine somatotropin, a biotech-derived growth hor-

mone, to increase milk production is indistinguishable from con-

centrations in untreated cows(27).Nevertheless, consumer demand

for milk not treated with recombinant bovine somatotropin is

increasing which will undoubtedly increase the cost of milk.

Prostate cancer

Although some epidemiologic studies have shown a relation

between dairy consumption and prostate cancer risk (28), more

recent studies have shown no relation or a reduction of risk with

dairy consumption (29, 30) which may vary with fat content (31).

Among the proposed mechanisms for a relation between dairy

consumption and prostate cancer are the presence of estrogens

(discussed earlier), the presence of insulin-like growth factor I

(IGF-I), and calcium suppression of 1,25-dihydroxyvitamin D

production. Oral IGF-I is not absorbed (32). Increased dietary

protein can increase serum IGF-I concentrations (33), but cal-

cium can suppress the production of parathyroid hormone that

up-regulates IGF-I synthesis, so the relation of dairy product

consumption to cancer risk is unclear. Low calcium intakes leadto falling serum calcium concentrations that lead to activation of

vitamin D to restore serum calcium concentrations to normal.

1,25-Dihydroxyvitamin D is associated with decreased pro-

liferation and apoptosis and with protection against prostate

cancer. However, local production of 1,25-dihydroxyvitamin D

by 1a hydroxylase in the prostate is independent of dietary

calcium concentration (34). Furthermore, milk is fortified with

vitamin D in the United States and has another chemoprotective

constituent, conjugated linoleic acid.

CONCLUSIONS

Milk is the most economical source of many limiting nutrients,especially calcium, potassium, and magnesium. Milk and milk

products have protective effects for bone disorders,IRS, andstroke.

Observational studies show protective, neutral, and negative effects

with various cancers. The main concerns brought against including

milk products in the diet lack strong andmechanistic support. Some

previous concerns, including protein-induced calciuria and the

presence of 17b-estradiol,have recentlybeenresolved. Veganshave

reduced bone mineral density, increased incidence of fracture, and

other health risks compared with omnivores or lactovegetarians.

[Other articles in this supplement to the Journal include references

3561. See the article by Lanou (49) for the counterpoint.]

CMW has a research grant from the National Dairy Council. She is a mem-

ber of advisory boards for the National Osteoporosis Foundation, the Inter-

national Life Science Institute for North America, Wyeth Global Nutrition,

Pharmavite, Cadbury, and GTC Nutrition.

REFERENCES1. US Department of Health and Human Services and US Department

of Agriculture. Dietary Guidelines for Americans, 2005. 6th ed. Wash-ington, DC: US Government Printing Office, 2005. Available from:

www.healthierus.gov/dietaryguidelines (cited 12 September 2006).2. Gao X, Wilde PE, Lichtenstein AH, Tucker KL. Meeting adequate in-

take for dietary calcium without dairy foods in adolescents aged 9 to 18years (National Health and Nutrition Examination Survey 2001-2001).J Am Diet Assoc 2006;106:175965.

3. Braun M, Weaver CM. A call to evaluate the impact of calcium-fortifiedfoods and beverages. Nutr Today 2006;41:407.

4. Zhao Y, Martin BR, Weaver CM. Calcium bioavailability of calciumcarbonate fortified soymilk is equivalent to cows milk in young women.

J Nutr 2005;135:237992.5. Marcoe K, Juan WY, Yamini S, Carlson A, Britten P. Development of

food group composites and nutrient profiles for the MyPyramid FoodGuidance System. J Nutr Educ Behav 2006;38(suppl):S93107.

6. Palacios OM, Nicholls J, Green R, Miller GD. Invited editorial: Theimportance of dairy foods in helping impoverished people in the UnitedStates. J Dairy Sci 2007;90:491723.

7. Institute of Medicine. Dietary Reference Intakes for calcium, phos-phorus, magnesium, vitamin D, and fluoride. Washington, DC: Standing

Committee on the Scientific Evaluation of Dietary Reference Intakes,Food and Nutrition Board, National Academy Press, 1997.

8. Looker AC. Dietary calcium: recommendations and intakes around theworld. In: Weaver CM, Heaney RP, eds. Calcium in human health.Totowa, NJ: Humana Press, 2006:10527.

1636S WEAVER

byguesto

nFebruary1,2012

www.ajcn.org

Downloadedfrom

http://-/?-http://www.ajcn.org/http://www.ajcn.org/http://www.ajcn.org/http://www.ajcn.org/http://www.ajcn.org/http://www.ajcn.org/http://www.ajcn.org/http://www.ajcn.org/http://www.ajcn.org/http://www.ajcn.org/http://www.ajcn.org/http://www.ajcn.org/http://www.ajcn.org/http://www.ajcn.org/http://-/?-

8/3/2019 Despre Produsele Lactate

4/4

9. Braun M, Palacios C, Wigertz K, et al. Racial differences in skeletalcalcium retention in adolescent girls on a range of controlled calciumintakes. Am J Clin Nutr 2007;85:165763.

10. Abrams SA, Griffin IJ, Hicks PD, Gunn SK. Pubertal girls only partiallyadapt to low dietary calcium intakes. J Bone Miner Res 2004;19:75963.

11. Kalkwarf HJ, Khoury JC, Lanphear BP. Milk intake during childhood

and adolescence, adult bone density, and osteoporotic fractures in USwomen. Am J Clin Nutr 2003;77:25765.

12. Goulding A, Rockell JE, Black RE, Grant AM, Jones IE, Williams SM.Children who avoid drinking cows milk are at increased risk for pre-

pubertal bone fractures. J Am Diet Assoc 2004;104:2503.13. Matlik L, Savaiano D, McCabe G, VanLoan M, Blue CL, Boushey CJ.

Perceived milk intolerance is related to bone mineral content in 10- to

13-year-old female adolescents. Pediatrics 2007;120:e66977.14. Honkanen R, Kroger H, Alhava E, Turpeinen P, Tuppurainen M,

Saarikoski S. Lactose intolerance associated with fractures of weight-bearing bones in Finnish women aged 38-57 years. Bone 1997;21:4737.

15. Matkovic V, Kostial K, Simonovic I, Buzina R, Brodarec A, NordinBEC. Bone status and fracture rates in two regions of Yugoslavia. Am J

Clin Nutr 1979;32:5409.16. Hu J-F, Zhao X-H, Jia J-B, Parpia B, Campbell TC. Dietary calcium and

bone density among middle-aged and elderly women in China. Am JClin Nutr 1993;58:21927.

17. Appleby P, Roddam A, Allen N, Key T. Comparative fracture risk invegetarians and nonvegetarians in EPIC-Oxford. Eur J Clin Nutr 2007;61:14006.

18. Pereira MA, OReilly E, Augustsson K, et al. Dietary fiber and risk ofcoronary heart disease: a pooled analysis of cohort studies. Arch Intern

Med 2004;164:3706.19. Elwood PC, Pickering JE, Fehily AM, Hughes J, Ness AR. Milk

drinking, ischaemic heart disease and ischaemic stroke. I. Evidence fromcohort studies. Eur J Clin Nutr 2004;58:7117.

20. Sellmeyer DE, Stone KL, Sebastian A, Cummings SR. A high ratio ofdietary animal to vegetable protein increases the rate of bone loss andthe risk of fracture in postmenopausal women. Study of OsteoporoticFractures Research Group. Am J Clin Nutr 2001;73:11827.

21. Kerstetter JE, OBrien KO, Caseria DM, Wall DE, Insogna KL. The

impact of dietary protein on calcium absorption and kinetic measures ofbone turnover in women. J Clin Endocrinol Metab 2005;90:2631.

22. Roughead ZK, Johnson LK, Lykken GI, Hunt JR. Controlled high meatdiets do not affect calcium retention or indices of bone status in healthypostmenopausal women. J Nutr 2003;133:10206.

23. Spence LA, Lipscomb ER, Cadogan J, et al. The effect of soy proteinand soy isoflavones on calcium metabolism and renal handling inpostmenopausal women: a randomized crossover study. Am J Clin Nutr

2005;81:91622.24. Dawson-Hughes B, Harris SS, Rasmussen HM, Dallal GE. Comparative

effects of oral aromatic and branched-chain amino acids on urine cal-cium excretion in humans. Osteoporosis Int 2007;18:95561.

25. Weaver CM, Proulx WR, Heaney R. Choices for achieving adequatedietary calcium with a vegetarian diet. Am J Clin Nutr 1999;70(suppl):

543S8S.26. Pape-Zambito DA, Magliaro AL, Kensinger RS. Concentrations of

17b-Estradiol in Holstein whole milk. J Dairy Sci 2007;90:330813.27. Vicini J, Etherton T, Kris-Etherton P, et al. Survey of retail milk con-

sumption as affected by label claims regarding farm managementpractices. J Am Diet Assoc 2008;108:1198203.

28. Wu K, Hu FB, Williett WC, Giovannuci E. Dietary patterns and risk of

prostate cancer. Cancer Res 2006;15:1677129. Park Y, MitrouPN, Kipnis V, Hollenbeck A, SchatzkinA, Leitzmann MF.

Calcium, dairy foods, and risk of incident and fatal prostate cancer: theNIH-AARP Diet and Health Study. Am J Epidemiol 2007;166:12709.

30. Neuhouser ML, Barnett MJ, Kristall AR, et al. (n26) PUFA increaseand dairy foods decrease prostate cancer risk in heavy smokers. J Nutr2007;137:18217.

31. Park S-Y, Murphy SP, Wilkens LR, et al. Calcium, vitamin D, and dairy

product intake and prostate cancer risk. Am J Epidemiol 2007;166:125969.

32. Larsson SC, Wolk K, Brismar K, Wolk A. Association of diet with se-rum insulin-like growth factor I in middle-aged and elderly men. Am JClin Nutr 2005;81:11637.

33. Heaney RP, McCarron DA, Dawson-Hughes B, et al. Dietary changesfavorably affect bone remodeling in older adults. J Am Diet Assoc 1999;99:122833.

34. Young MV, Schwartz GG, WangL, et al.The prostate 25-hydroxyvitamin

D-1alpha-hydroxylase is not influenced by parathyroid hormone and

calcium: implications for prostate cancer chemoprevention by vitamin D.

Carcinogenesis 2004;25:96771.35. Rajaram S, Sabate J. Preface. Am J Clin Nutr 2009;89(suppl):1541S2S.36. Jacobs DR Jr, Gross MD, Tapsell LC. Food synergy: an operational con-

cept for understanding nutrition. Am J Clin Nutr 2009;89(suppl):

1543S8S.37. Jacobs DR Jr, Haddad EH, Lanou AJ, Messina MJ. Food, plant food, and

vegetarian diets in the US dietary guidelines: conclusions of an expert

panel. Am J Clin Nutr 2009;89(suppl):1549S52S.38. Lampe JW. Interindividual differences in response to plant-based diets:

implications for cancer risk. Am J Clin Nutr 2009;89(suppl):1553S7S.39. Simon JA, Chen Y-H, Bent S. The relation ofa-linolenic acid to the risk

of prostate cancer: a systematic review and meta-analysis. Am J Clin

Nutr 2009;89(suppl):1558S64S.40. Pierce JP, Natarajan L, Caan BJ, et al. Dietary change and reduced breast

cancer events among women without hot flashes after treatment of

early-stage breast cancer: subgroup analysis of the Womens Healthy

Eating and Living Study. Am J Clin Nutr 2009;89(suppl):1565S71S.41. Newby PK. Plant foods and plant-based diets: protective against child-

hood obesity? Am J Clin Nutr 2009;89(suppl):1572S87S.42. Barnard ND, Cohen J, Jenkins DJA, et al. A low-fat vegan diet and a con-

ventional diabetes diet in the treatment of type 2 diabetes: a randomized,

controlled, 74-wkclinical trial. Am J Clin Nutr 2009;89(suppl):1588S96S.

43. Mangat I. Do vegetarians have to eat fish for optimal cardiovascular

protection? Am J Clin Nutr 2009;89(suppl):1597S601S.44. Willis LM, Shukitt-Hale B, Joseph JA. Modulation of cognition and

behavior in aged animals: role for antioxidant- and essential fatty

acidrich plant foods. Am J Clin Nutr 2009;89(suppl):1602S6S.45. Fraser GE. Vegetarian diets: what do we know of their effects on

common chronic diseases? Am J Clin Nutr 2009;89(suppl):1607S12S.46. Key TJ, Appleby PN, Spencer EA, Travis RC, Roddam AW, Allen NE.

Cancer incidence in vegetarians: results from the European Prospective

Investigation into Cancer and Nutrition (EPIC-Oxford). Am J Clin Nutr

2009;89(suppl):1620S6S.47. Key TJ, Appleby PN, Spencer EA, Travis RC, Roddam AW, Allen NE.

Mortality in British vegetarians: results from the European Prospective

Investigation into Cancer and Nutrition (EPIC-Oxford). Am J Clin Nutr

2009;89(suppl):1613S9S.48. Craig WJ. Health effects of vegan diets. Am J Clin Nutr 2009;89(suppl):

1627S33S.

49. Lanou AJ. Should dairy be recommended as part of a healthy vegetariandiet? Counterpoint. Am J Clin Nutr 2009;89(suppl):1634S7S.

50. Sabate J, Ang Y. Nuts and health outcomes: new epidemiologic evi-

dence. Am J Clin Nutr 2009;89(suppl):1643S8S.51. Ros E. Nuts and novel biomarkers of cardiovascular disease. Am J Clin

Nutr 2009;89(suppl):1649S56S.52. Rajaram S, Haddad EH, Mejia A, Sabate J. Walnuts and fatty fish in-

fluence different serum lipid fractions in normal to mildly hyper-

lipidemic individuals: a randomized controlled study. Am J Clin Nutr

2009;89(suppl):1657S63S.53. Lampe JW. Is equol the key to the efficacy of soy foods? Am J Clin Nutr

2009;89(suppl):1664S7S.54. Badger TM, Gilchrist JM, Pivik RT, et al. The health implications of

soy infant formula. Am J Clin Nutr 2009;89(suppl):1668S72S.55. Messina M, Wu AH. Perspectives on the soybreast cancer relation. Am

J Clin Nutr 2009;89(suppl):1673S9S.

56. Lonnerdal B. Soybean ferritin: implications for iron status of vegeta-rians. Am J Clin Nutr 2009;89(suppl):1680S5S.

57. Chan J, Jaceldo-Siegl K, Fraser GE. Serum 25-hydroxyvitamin D status

of vegetarians, partial vegetarians, and nonvegetarians: the Adventist

Health Study-2. Am J Clin Nutr 2009;89(suppl):1686S92S.58. Elmadfa I, Singer I. Vitamin B-12 and homocysteine status among vege-

tarians: a global perspective. Am J Clin Nutr 2009;89(suppl):1693S8S.59. Marlow HJ, Hayes WK, Soret S, Carter RL, Schwab ER, Sabate J. Diet

and the environment: does what you eat matter? Am J Clin Nutr 2009;

89(suppl):1699S703S.60. Carlsson-Kanyama A, Gonzalez AD. Potential contributions of food

consumption patterns to climate change. Am J Clin Nutr 2009;

89(suppl):1704S9S.61. Eshel G, Martin PA. Geophysics and nutritional science: toward a novel,

unified paradigm. Am J Clin Nutr 2009;89(suppl):1710S6S.

DAIRY FOODS: PRO 1637S

byguesto

nFebruary1,2012

www.ajcn.org

Downloadedfrom

http://www.ajcn.org/http://www.ajcn.org/http://www.ajcn.org/http://www.ajcn.org/http://www.ajcn.org/http://www.ajcn.org/http://www.ajcn.org/http://www.ajcn.org/http://www.ajcn.org/http://www.ajcn.org/http://www.ajcn.org/http://www.ajcn.org/http://www.ajcn.org/http://www.ajcn.org/