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Irena Rogelj
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UDC 637.1:641.1:614.3
ISSN 1330-9862 plenary lecture
(FTB-1021)
Irena Rogelj
University of Ljubljana, Biotechnical Faculty, Institute of Dairying,
Groblje 3, SI-1230 Dom`ale, Slovenia
Received: February 1, 2000
Accepted: May 3, 2000
Summary
Scientific progress in nutrition, medical and food sciences is having an increasingly
profound impact on consumer's approach to nutrition. There is a growing awareness that
many chronic diseases are caused by unbalanced diet. In addition to disease prevention,
the role of food as an agent for improving health has been proposed and a new class of
food, so called functional food, has come into being. This term is used to indicate a food
that contains some health-promoting components and not only traditional nutrients. From
this point of view we could argue that milk and many dairy products belong to the family
of functional food replete with bioactive peptides, probiotic bacteria, antioxidants, highly
absorbable calcium, conjugated linoleic acid and other biologically active components. Al-
though evaluation of the benefits or risks of foods normally does not entail the same ex-
tensive examination as that required of drugs, this does not negate the need for sound sci-
entific information before making conclusions and recommendations to the consumers.
This paper reviews and discusses some of the latest findings regarding the role of milk
and dairy products in nutrition and health.
Key words: milk, dairy products, functional food, nutrition, health
Introduction
An increasing amount of scientific evidence con- consequence term has no exact definition. It is usually
firms that many chronic diseases such as cancer, osteo- described as »food which promote health beyond pro-
porosis, coronary heart disease and hypertension are viding basic nutrition«. Roberfroid (1) indicated that
connected to an unbalanced diet. The diet-health mes- food is functional if it contains a food component that
sage has reached consumers and the food industry. Con- affects one or a limited number of functions in the body
sumers are beginning to believe that diet has a powerful and Head et al. (2) stated that functional food could be
influence on health and wellbeing and the food industry naturally occurring food, not just enriched or modified
has taken advantage of new possibilities. Progress in food. In the light of such statements one may say that
food processing and biotechnology has enabled the food the best known examples of functional food are fer-
industry to create food with special characteristics and mented milks containing probiotic bacteria. Milk itself is
in addition to disease prevention, the role of food as an much more than the sum of its nutrients. The develop-
agent for improving health has been proposed. New ment of an infant's immature physiological functions is
terms such as probiotics, prebiotics, synbiotics and func- very dependent on milk and therefore is logical that
tional food have been created to describe food products milk is a natural source of a variety of beneficial nutri-
with special characteristics. ents and biologically-active compounds with a potential
Functional Food is a new chapter in nutrition sci- impact on human health. Besides, probiotic bacteria ben-
ence. There are many aspects of functional food and as a eficially affect the host improving the properties of in-
* Corresponding author; Phone: ++386 (0)1 7217 800; Fax: ++386 (0)1 7214 074; E-mail: irena.rogelj@bfro.uni-lj.si
144 IRENA ROGELJ: Milk, Dairy Products, Nutrition and Health, Food technol. biotechnol. 38 (2) 143–147 (2000)
testinal microbial balance (3). Probiotic effects include result, even if it is not necessary, they resort to consum-
alleviation of intestinal disorders such as lactose intoler- ing low-fat products and preparations which reduce
ance, acute gastroenteritis due to rotavirus and other en- cholesterol. On the other hand, there are only a few peo-
teric pathogens, adverse effects of pelvic radiotherapy, ple who know what probiotics are, not to mention func-
constipation, inflammatory bowel disease, and food al- tional food. The great majority of consumers opt for this
lergy (4). food mainly because they read "bio" or "natural" on the
Besides functional food, on the market we also find label, and assume it is therefore likely to be healthier.
a group of foods described as »lesser evil foods«, which Unfortunately, at this point I would like to stress
include foods with the negative properties removed that we, the genuine experts, are partly to blame for this
(foods free of or with reduced levels of fat, cholesterol, because we often tend to look only through our own
salt or sugar). Many products that might be considered eyes, forgetting that our discoveries are merely a small
functional already exist in nature, although their health piece of the mosaic which will ultimately – and only
benefits have not ever been emphasized (5,6). when all the pieces are put together – explain the signif-
icance of a specific foodstuff in our diet. To take an ex-
ample: consumers are familiar only with the harmful ef-
The Diet-Health Message fects of milk fat, while it is much less known that
and it’s Perception by Consumers scientists are currently discovering the important roles
Consumers have got the message about the relation- played by a number of ingredients in milk fat, such as
ship between diet and health and believe that the three conjugated linoleic acid, butyric acid, anti-oxidants, and
most important factors contributing to health are diet, vitamins soluble in fat. Additionally, it is possible that
exercise and genetic factors. In European research determinants of healthful effects of dairy product are
programme performed in 1993 it was found that diet multifactorial, for example due to live bacteria and other
was perceived to be the most important factor, cited by components of fermented milk such as highly absorb-
70 % of respondents in Germany, 68 % of UK respon- able calcium, conjugated linoleic acid and bioactive pep-
dents and 55 % of French respondents, well ahead of ex- tides. Isolation of a single component may not yield the
ercise and genetic factors (6). positive benefits of a whole food. Important nutritional
qualities of milk are the wide range of nutrients it con-
An increasing number of people believe that specific tains and the good balance of its nutrients. I would like
foodstuffs contain active substances which reduce the therefore to define the value of dairy foods in a healthy
danger of illness and which generally contribute to the diet above all in the light of complex interactions be-
improvement of one’s health. These foods are attractive tween milk components and their combined effect on
to modern men and women who desire to reach old age organism. Three common chronic diseases will be taken
in a healthy and vital state. But are modern individuals by way of example.
sufficiently, and especially, correctly informed?
An excessively simplistic interpretation of scientific
findings regarding the link between diet and health can
lead to entirely mistaken judgements or conclusions, Milk, Dairy Products and
based either on fear or on hope. It is interesting that in Cardiovascular Disease
popular magazines the number of articles which discuss
the harmful effects of foodstuffs or (even more often) Coronary heart disease (CHD), the most common
their ingredients, and which therefore scare the reader, and serious form of cardiovascular disease, is the lead-
is much higher than the number of articles dealing with ing cause of death in developed industrialized countries.
the healthy and beneficial effects of food, and which are Many risk factors, both genetic and environmental, con-
aimed at raising public awareness. This most likely re- tribute to the development of this disease. It is evident
sults from the fact that the area of education is the re- that diet is an important modifiable risk factor. Obesity,
sponsibility of experts, who usually find it difficult to dietary fat quantity, saturated fatty acids and cholesterol
present generally complex scientific findings in a simple are on a black list of risk factors and as a consequence
and concise manner. This particularly applies to multi- milk and dairy products are also often listed, particu-
-disciplinary fields of interest such as food. On the other larly those with increased fat content (7,8). However,
hand, articles which discuss the harmful effects of "tox- there is little evidence from scientific studies that dairy
icity" and the danger of consuming specific foodstuffs foods contribute to an atherogenic blood profile when
are frequently written by unqualified persons; this is re- consumed in usual amounts. An interesting epidemio-
flected in the factual errors (the result of misconcep- logical study presented by Gurr (9) had shown that peo-
tions, rather than misprints) which often pervade arti- ple who regularly consumed milk were much less likely
cles written by these authors and which point to their to suffer a heart attack than those who did not. His in-
lack of knowledge. terpretation of such results was that »the biological basis
It is also interesting that alarming statements such for this observation is unknown and it may be due to
as those on the harmfulness of milk fat and proteins factors in the lifestyle of people who choose to drink
tend to stick in people's minds more than positive state- milk regularly, rather than to a protective factor in milk
ments, as, for example, explanations of probiotic bacte- as such«. In my opinion there are protective factors in
ria. I am firmly convinced that most people are familiar milk and possible mechanisms which could explain
with the harmful effects of fats and cholesterol, and with such observations. I will try to find and present some of
the link between them and coronary heart disease. As a them.
IRENA ROGELJ: Milk, Dairy Products, Nutrition and Health, Food technol. biotechnol. 38 (2) 143–147 (2000) 145
Milk fat has often been characterized as containing macological therapy for these diseases, people are en-
a high proportion of saturated fatty acids but it needs to couraged to change their lifestyle from »harmful to
be added that only three of them, representing about healthy«. This means weight reduction if overweight, in-
one third of the milk fatty acids, are cholesterolemic. creased physical activity, limited alcohol and sodium in-
These are lauric (12:0), myristic (14:0) and palmitic (16:0) take and adequate consumption of calcium, potassium,
acid (10–12). Furthermore, milk and dairy products con- and magnesium. Current scientific evidence indicates
tain components with at least a protective if not hypo- that it is not only an excess of one electrolyte (sodium)
holesterolemic effect such as calcium, linoleic acid, con- in our diets but rather inadequate levels of several, that
jugated linoleic acid (CLA), antioxidants and lactic acid produce hypertension. An adequate intake of calcium,
bacteria or probiotic bacteria. Calcium plays an impor- potassium, and magnesium have now been documented
tant role in mediating vascular contraction and vasodila- to reduce blood pressure. Therefore, there is nothing
tation, muscle contraction, nerve transmission and glan- surprising in the results found in several clinical trials
dular secretion (13). There are more and more proof that that the effect of milk on blood pressure was greater
linoleic acid is beneficial in reducing CHD risk in hu- and more rapid than that of calcium alone (7,24). Milk
man subjects, and some evidence that CLA protects and dairy products are meaningful sources of all three
against the development of early arterial lipid accumu- nutrients along with bioactive peptides termed casoki-
lation and helps regulate body weight and fat distribu- nins or ACE – I peptides with a potential to reduce
tion (14–16). It is well established that a raised level of blood pressure due to their ability to inhibit angioten-
serum cholesterol does not adequately explain the incre- sin-I-converting enzyme (ACE) and block conversion of
ased risk of CHD or the relationship between diet and angiotensin I to angiotensin II, a potent vasoconstrictor
CHD. Several lines of evidence indicate that the devel- (25–27).
opment of atherosclerosis is related to free radical pro-
cesses, lipid peroxidation and oxidative modifications of
low density lipoproteins (LDL). LDL is the principal car- Milk, Dairy Products and Colon Cancer
rier of cholesterol but its atherogenic potential arises Colorectal cancer is one of the leading causes of
from an increase in the number of LDL particles and not cancer morbidity and mortality in the Western countries
from its cholesterol content per se. The oxidation of LDL and it is thought to be caused by an interaction between
promotes the final deposition of cholesterol in the arte- dietary factors and genetic predisposition. Diet is esti-
rial wall. It has been shown that LDL particles are more mated to be responsible for 30 to 60 percent of all can-
susceptible to oxidative modification than larger and cers but the role of diet in cancer etiology is difficult to
lighter ones (17). Fortunately, the cell possesses highly elucidate because food contains components that may
efficient protective mechanisms, including antioxidants either cause or prevent cancer. Epidemiological studies
such as a-tocopherol, ascorbat, b-carotene, glutathione, indicate that increased consumption of fat, meat, and to-
and metal-binding proteins such as transferrin and en- tal calories and low intake of foliate, fiber, and calcium
zymes such as superoxide dismutase and catalase (18). enhance the risk of colon cancer but there are also sev-
The majority of this substances could be found also in eral scientific proofs supporting the protective role of
milk and milk products. milk products (7,28,29). The components in dairy foods
Although probiotics, in the form of fermented milk which may protect against colon cancer are above all
products, have the reputation of cholesterol-lowering calcium and vitamin D, probiotic lactic acid bacteria, a
properties in humans, no conclusive evidence is avail- class of fatty acids known as conjugated derivatives of
able, with many studies giving conflicting results. The linoleic acid (LCA) and bioactive peptides derived from
conflicting reports may be explained by factors such as milk proteins (28,30–35).
differences in experimental design, species and strains A potential mechanism for the protective effect of
of bacteria used as well as lifestyle and genetic or bio- calcium against colon cancer was suggested from animal
chemical variability within and between human popula- studies. Dietary fat increases levels of bile acids and free
tion (19–22). fatty acids in the colonic lumen which damage the co-
Advances in genetics and molecular biology indi- lonic epithelium and promote epithelial proliferation.
cate that susceptibility to chronic diseases such as coro- Calcium binds and precipitates unconjugated bile acids
nary artery disease, hypertension, diabetes, osteoporosis and free fatty acids and thus its cytotoxicity is dimin-
and cancer is to a great extent genetically determined. ished (36,37). However, Bostick et al. (38) reported the
Studies in the United States have shown that 50 % of the results of a randomized, double-blind, placebo-control-
variance in plasma cholesterol concentration is geneti- led clinical study which did not support this thesis. 193
cally determined (23). subjects with a history of sporadic adenomatous polyps
were treated with placebo (n = 66) or 1.0 g calcium (n =
64) or 2.0 g calcium (n = 63) daily for 6 months. Rectal
Milk, Dairy Products and Hypertension biopsies were obtained at the beginning of the trial and
at 1, 2 and 6 months. They did not find any significant
Hypertension is another modern day problem and difference in the rate of cell proliferation between the
again both genetic and environmental factors influence calcium groups and the placebo group. On the other
blood pressure. People with high blood pressure are at hand, when the daily calcium intake was increased via
increased risk of coronary heart disease, stroke, and kid- dairy foods the results were positive (28). These obser-
ney failure. Because of the high cost of the medicines vations indicated the need for the studies that used di-
and potential adverse side effects associated with phar- etary calcium for a longer period of time. On the basis
146 IRENA ROGELJ: Milk, Dairy Products, Nutrition and Health, Food technol. biotechnol. 38 (2) 143–147 (2000)
23. A. P. Simopoulos, Nutr. Rev. 57 (1999) S10. 35. G. H. McIntosh, P. J. Royle, R. K. LeLeu, G. O. Regester,
24. D. A. McCarron, Bull. Int. Dairy Fed. 336 (1998) 28. M. A. Johnson, R. L. Grinsted, R. S. Kenward, G. W.
25. T. Takano, Bull. Int. Dairy Fed. 8 (1998) 375. Smithers, Int. Dairy J. 8 (1998) 425.
26. O. Masuda, Y. Nakamura, T. Takano, J. Nutr. 126 (1996) 36. M. J. Wargovich, P. M. Lynch, B. Liven, Am. J. Clin. Nutr.
3063. 54 (1991) 202.
27. R. Sugai, Bull. Int. Dairy Fed. 336 (1998) 17. 37. J. R. Lupton, X. Q. Chen, W. Frolich, G. L. Schoeffler, M. L.
28. S. Mobarhan, Nutr. Rev. 57 (1999) 124. Peterson, J. Nutr. 124 (1994) 188.
29. P. W. Parodi, Aust. J. Dairy Technol. 53 (1998) 37. 38. R. M. Bostick, L. Fosdick, J. R. Wood, J. Natl. Cancer Inst.
30. C. F. Garland, F. C. Garland, E. D. Goreham, Am. J. Clin. 87 (1995) 1307.
Nutr. 54 (1991) 193. 39. R. van der Meer, I. M. J. Bovee-Oudenhoven, A. L. A.
31. R. M. Bostick, J. D. Potter, T. A. Sellers, D. R. McKenzie, L. Sesink, J. H. Kleibeuker, Int. Dairy J. 8 (1998) 163.
H. Kushi, A. R. Folsom, Am. J. Epidemiol. 128 (1988) 504.
40. B. Glinghammer, M. Venturi, I. R. Rowland, J. J. Rafter,
32. S. Salminen, A. C. Ouwehand, E. Isolauri, Int. Dairy J. 8 Am. J. Clin. Nutr. 66 (1997) 1277.
(1998) 563.
41. B. R. Goldin, Br. J. Nutr. 80 (1998) S203.
33. H. Hove, H. Nørgaard, P. B. Mortensen, Eur. J. Clin. Nutr.
53 (1999) 339. 42. P. W. Parodi, Aust. J. Dairy Technol. 54 (1999) 103.
34. A. C. Ouwehand, P. V. Kirjavainen, C. Shortt, S. Salminen, 43. F. L. Schanbacher, R. S. Talhouk, F. A. Murray, L. I.
Int. Dairy J. 9 (1999) 43. Gherman, L. B. Willett, Int. Dairy J. 8 (1998) 393.
Sa`etak
Znanstveni napredak u prehrani, medicinskim znanostima i znanostima o hrani pobu-
|uje sve ve}e zanimanje potro{a~a za prehranu. Sve je vi{e spoznaja o tome da su mnoge
kroni~ne bolesti uzrokovane neuskla|enom prehranom. Osim za{tite od bolesti, predla`e
se da hrana bude ~initelj pobolj{anja zdravlja, pa se takva vrsta hrane svrstava u skupinu
nazvanu funkcionalnom hranom. Taj se pojam koristi kako bi se ozna~ila vrsta hrane koja
sadr`ava neke tvari {to pobolj{avaju zdravlje, a ne samo tradicionalne hranjive sastojke.
Stoga predla`emo da se mlijeko i mlije~ni proizvodi ubroje u skupinu funkcionalne hrane
bogate bioaktivnim peptidima, probioti~kim bakterijama, antioksidansima, kalcijem koji se
izvrsno apsorbira, konjugiranom linolenskom kiselinom i drugim biolo{ki aktivnim sas-
tojcima. Iako procjena prednosti ili rizika unosa odre|ene vrste hrane normalno ne pod-
lije`e istim iscrpnim ispitivanjima, kao {to se to zahtijeva kod lijekova, to ne umanjuje
potrebu bitnih znanstvenih rezultata prije nego se donesu zaklju~ci i preporuke potro-
{a~ima. U radu je dan pregled i rasprava o najnovijim dostignu}ima o utjecaju mlijeka i
mlije~nih proizvoda na prehranu i zdravlje.