Nutrients from dairy foods difficult to replace in diets

By Maria Perno Goldie, RDH, MS
As we begin the new year, many of us are focused on diet and nutrition. Nutrients from dairy foods are difficult to replace in diets of Americans. This is not good news for those that are allergic to dairy, lactose intolerant, or vegan. However, there are options! It seems that many Americans do not meet calcium, potassium or vitamin D recommendations, due to their diet. While some non-dairy foods can help people meet calcium recommendations, they do not provide the same nutrient package as dairy, according to a new study.(1) Shortages of nutrients such as potassium, protein and phosphorus can occur without dairy.

To test this hypothesis, MyPyramid dietary pattern modeling exercises and analyses of data from the National Health and Nutrition Examination Survey 2003-2006 were conducted in individuals of at least 2 years of age. The effect of adding or removing one serving of dairy, removing all dairy, and replacing dairy with nondairy calcium sources was evaluated in this study.(1) Dietary pattern modeling indicated that at least three servings of dairy foods are needed to help individuals meet recommendations for nutrients, such as calcium and magnesium, and four servings may be needed to help some groups meet potassium recommendations. A calcium-equivalent serving of dairy requires 1.1 servings of fortified soy beverage, 0.6 serving of fortified orange juice, 1.2 servings of bony fish, or 2.2 servings of leafy greens. The replacement of dairy with calcium-equivalent foods changes the general nutritional profile of the diet and affects nutrients including protein, potassium, magnesium, phosphorus, riboflavin, vitamins A, D and B12. Similar modeling exercises using consumption data from the National Health and Nutrition Examination Survey also demonstrated that nondairy calcium replacement foods are not a nutritionally equivalent substitute for dairy products. The conclusion of the study was that calcium replacement foods are not a nutritionally equivalent substitute for dairy foods and consumption of a calcium-equivalent amount of some nondairy foods is improbable. However, the authors stated it is possible to meet calcium intake recommendations without consuming dairy foods.

In order to provide dietary guidance that will be relevant, it should highlight foods that are nutrient rich, affordable, and appealing. Analyses of dietary surveys on what is consumed in America can now be complemented by analyses of nutrient density as well as nutrient cost.(2) One study aimed to investigate the contribution of nine food groups to energy and nutrient intakes and to assess the relative cost of selected nutrients by major food group. Research on the nutritive value and cost of U.S. foods was made possible by the merging of the U.S. Department of Agriculture (USDA) Food and Nutrition Database for Dietary Studies (FNDDS 2.0) with the USDA food prices database.

The results showed that milk and milk products contributed 47% of calcium, 42% of retinol, and 65% of vitamin D to the diets of children and adults. This was notwithstanding their low calorie contribution of 10%–13% of energy. Milk and milk products were among the best sources of riboflavin, phosphorous, and vitamin B12. Cost analyses demonstrated that milk and milk products were by far the lowest-cost source of dietary calcium and were among the lowest-cost sources of riboflavin and vitamin B12. Vegetables and fruit were the lowest-cost sources of vitamin C, whereas dry beans and legumes were the lowest-cost sources of fiber. The conclusion was that nutrients-per-calorie and nutrient cost metrics can help identify affordable nutrient-rich foods.

Regarding guidance from the United States Department of Agriculture (USDA), all fluid milk products and many foods made from milk are considered part of this food group. Most Dairy Group choices should be fat-free or low-fat. Foods made from milk that retain their calcium content are part of the group, and those made from milk that have little to no calcium, such as cream cheese, cream, and butter, are not. Calcium-fortified soymilk (soy beverage) is also part of the Dairy Group.

The amount of food from the Dairy Group needed depends on age. Recommended daily amounts are shown in the chart below. See what counts as a cup in the Dairy Group.(3)

For someone with a food allergy, proteins in certain foods trigger an abnormal immune response. Common food allergies include those to milk, eggs, fish, crustacean shellfish, tree nuts, wheat, peanuts, and soybeans. In comparison, food intolerances are due to the inability of the body to digest or metabolize a food component. For example, lactose intolerance is caused by a deficiency of the enzyme lactase that breaks down the sugar lactose in milk and milk products.(4) There are tips for vegetarians, those that are lactose intolerant, and vegans. A vegetarian eating pattern can be a healthy option. The key is to consume a variety of foods and the right amount of foods to meet your calorie and nutrient needs.(5) Go to www.dietaryguidelines.gov and check appendices 8 and 9 of the Dietary Guidelines for Americans, 2010 for vegetarian adaptations of the USDA food patterns at 12 calorie levels. A Lacto-ovo Vegetarian Adaptation and a Vegan Adaptation of the USDA Food Patterns can be found there.(6) Bottom line, eat healthy no matter which diet you choose. Resources abound for all age groups and lifestyles. As health care professionals, we are sometimes in a position to guide patients. Information for Health Care Professionals is available.(7)References
1. Fulgoni VL, Keast DR, Auestad N, and Quann EE. Nutrients from dairy foods are difficult to replace in diets of Americans: food pattern modeling and an analyses of the National Health and Nutrition Examination Survey 2003-2006. Nutrition Research, Volume 31, Issue 10, Pages 759-765, October 2011. 2. Drewnowski A. The Contribution of Milk and Milk Products to Micronutrient Density and Affordability of the U.S. Diet. J Am Coll Nutr October 2011 vol. 30 no. 5 Supplement 1 422S-428S) They reviewed dietary intake data by the four cycles of the continuous National Health and Nutrition Examination Survey (NHANES 2001–2002, 2003–2004, 2005–2006, and 2007–2008.3. www.choosemyplate.gov/food-groups/dairy-amount.html.4. FAQs. ChooseMyPlate.gov. www.choosemyplate.gov/faqs.html. 5. www.choosemyplate.gov/food-groups/downloads/TenTips/DGTipsheet8HealthyEatingForVegetarians.pdf. 6. health.gov/dietaryguidelines/dga2010/dietaryguidelines2010.pdf. 7. www.choosemyplate.gov/information-healthcare-professionals.html.