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The global perspective of sustainability in food systems is being formalized into national dietary guidelines across the world.  

Sustainability in food systems is a global issue in need of a global solution beyond localized approaches. It is a reality that food systems within a country have a global impact that cannot be ignored. Moving forward, it is likely that nutrition guidelines will provide criteria for food systems based not only on promoting health but also on preserving finite environmental and economic resources. 

Several countries around the globe—including Brazil, Germany, Qatar, Sweden and, most recently, Canada—have already incorporated sustainability into their national guidelines. Other countries have taken steps to consider sustainability; however, the extent to which sustainability is addressed in national policies is inconsistent.

The interrelated issues of obesity, undernutrition and climate change have recently been elevated and coined as the term “global syndemic” in a report published in The Lancet.3 Among international scientists, there is no question that these three issues require simultaneous mobilization from multiple sectors across all corners of the world. Yet, too often measures being used to evaluate each dimension of the syndemic can be myopic and thus lead to overly simplified solutions. For example, climate change is largely measured by greenhouse gas emissions while health is predominately measured by body mass index (BMI). While these tools have long been validated as effective in research, they may be too narrow to approach the interconnected dimensions of the global syndemic. 

Implications: There is an opportunity for stakeholders at all levels of the food supply chain, health care and public and private sectors to collaborate on effective solutions by sharing data, technologies and innovations to help the global food system become more sustainable and efficient while making nutritious food available for all and supporting optimal health. 

Increasingly, children’s nutritional needs for growth and development are overshadowed by other health and environmental concerns.

From legislative policies to consumer guidance, the push to transform food systems is often driven by issues of the environment. Sustaining the environment is critical; equally important is addressing the inequities of health and food access. If food environment changes are motivated by a narrow view, the nutritional needs of vulnerable groups, particularly children, may not be adequately addressed. 

Over the last few years there has been an increase in policies that elevate environment-friendly food choices within institutions. School districts and hospitals are incorporating more plant-based menu options into cafeterias. Restaurants and other foodservice establishments are moving toward more vegan options and joining sustainable eating social campaigns. These changes are being embraced for their benefits to the environment and the health of the population. Consideration for the nutritional needs of children, which differ from the population as a whole, is essential for solutions that support healthy, sustainable eating patterns while also meeting nutrient needs of children during critical growth windows. 

When factoring in nutrition-related health concerns for children, obesity is often the priority issue, and growth and development needs can be overlooked. Children need a wide variety of nutrients to support their bone health, muscle development, cognitive function and other aspects of growth. When these critical nutritional needs of children are not prioritized, foods that provide key nutrients can be ignored in solutions. Data show that most American children are not meeting the recommendations for one or more of the following food groups: vegetables, fruits and dairy.1,6 All provide important nutrients that support optimal health as well as success in school. 

Milk and dairy foods, consumed within the recommended amounts in children’s diets, contribute essential nutrients that are important during this critical stage of bone mass growth and cognitive development. A prospective survey showed children with cow’s milk allergies are at particularly high risk of poor growth.8 These findings suggest a risk of sub-optimal growth when dairy is not included as a part of childhood eating patterns.

Implications: While there is more than one way to meet dietary needs for individual nutrients such as protein and calcium, the amount and variety of foods that must be consumed to match the nutrition package and affordability provided by dairy milk may be difficult to achieve for many children, especially those who experience food insecurity. The decline in milk consumption in children warrants concern for nutritional inadequacy, which could deepen with a push toward vegan-forward eating patterns. With many children and adolescents being overweight and undernourished, access to nutritious and wholesome foods, as well as nutrition education, is essential to help children reach their full health potential as adults.

New research is expanding on the understanding of dairy as a functional food by characterizing how fermented dairy foods provide health benefits to the microbiome, prevent chronic diseases and more.

Dairy foods have been fermented by populations around the globe for centuries. Over the past few decades, science has uncovered how the process of fermentation transforms milk into derivatives with functional health benefits. 

Different dairy foods may be composed of similar nutrients; however, the nutrients are contained in structures, known as a food’s nutrient matrix, that present unique biological properties. Modern science is beginning to reveal how the food matrix may play an important mechanistic role in the association between individual dairy foods and chronic disease risk.14 Consistent with advancing knowledge in personalized nutrition, there may be dairy foods that could benefit individuals at key times across the life span. For example, milk provides nutrients essential to bone and lean muscle development,15 while appealing to the taste preferences of children. For adults, fermented dairy foods may aid in chronic disease prevention, while older adults could benefit from the high-quality protein and textures found in dairy products that are easier to swallow than other solid foods. 

New studies are starting to demonstrate a beneficial effect of whole dairy foods—particularly fermented dairy foods such as yogurt, cheese and kefir—on metabolic health, body weight and chronic disease risk. This may be due to dairy foods’ unique package of nutrients that work together to facilitate digestion, absorption and interaction of nutrients and other bioactive compounds within the body. This holistic view of the food matrix can be defined as the interconnectedness of the many nutrients that make up a specific food, which then controls the delivery and bioavailability of the nutrients within the human body.16 Research suggests that different types of dairy foods may provide distinct health benefits. One such study looked at fermented compared to non-fermented dairy foods and risk of coronary heart disease. Adults in the study with the highest intake of fermented dairy had 27 percent lower risk of coronary heart disease.17 Emerging research looking at the association between dietary patterns and cognition in older adults found that the Mediterranean-DASH-diet Intervention for Neurodegenerative Delay (MIND) diet, which includes fermented foods such as yogurt, kefir and miso, may have positive effects of preserving cognition and reducing dementia risk.18 Additional prospective and experimental research is needed to confirm the findings of observational studies to inform the use of fermented dairy in clinical practice for disease prevention.

Implications: With consensus from a growing number of studies, the current evidence base supports the need for health professionals to reaffirm the role of dairy foods in healthy eating patterns. This effort is critical to ensure that future nutrition guidance continues to recognize dairy foods as an important component of healthy eating patterns that promote optimal health and reduce chronic disease risk. Recommendations that do not acknowledge the unique package of nutrients and health-promoting benefits that milk, yogurt and cheese provide as part of healthy eating patterns could result in missed opportunities for optimal nutrition.

References
1. Scientific Report of the 2015 Dietary Guidelines Advisory Committee. Health.gov. https://health.gov/our-work/food-nutrition/2015-2020-dietary-guidelines/advisory-report. Updated April 1, 2019. Accessed April 1, 2019. 
2. Rose D, Heller MC, Roberto CA. Position of the Society for Nutrition Education and Behavior: the importance of including environmental sustainability in dietary guidance. J Nutr Educ Behav. 2019;51(1):3-15.e1. doi: 10.1016/j.jneb.2018.07.006 
3. Swinburn BA, Kraak VI, Allender S et al. The global syndemic of obesity, undernutrition, and climate change: the Lancet Commission report. Lancet. 2019;393(10173):791-846. doi:10.1016/S0140-6736(18)32822-8 
4. Rozga M, Handu D. Nutritional genomics in precision nutrition: an Evidence Analysis Center scoping review. J Acad Nutr Diet. 2019;119(3):507-515.e7. doi:10.1016/j.jand.2018.05.022 
5. Camp KM, Trujillo E. Position of the Academy of Nutrition and Dietetics: nutritional genomics. J Acad Nutr Diet. 2014;114(2):299312. doi:10.1016/j.jand.2013.12.001 
6. Food Availability (Per Capita) Data System: dietary recommendations and calorie consumption. US Department of Agriculture, Economic Research Service. https://www.ers.usda.gov/data-products/food-availability-per-capita-data-system/interactive-charts-and-highlights/. Updated October 29, 2018. Accessed March 18, 2019. 
7. Bradley BJ, Greene AC. Do health and education agencies in the United States share responsibility for academic achievement and health? A review of 25 years of evidence about the relationship of adolescents’ academic achievement and health behaviors.  J Adolesc Health. 2013;52(5):523-532. doi:10.1016/j.jadohealth.2013.01.008 
8. Meyer R, Wright K, Vieira MC et al. International survey on growth indices and impacting factors in children with food allergies.  J Hum Nutr Diet. 2019;32(2):175-184. doi:10.1111/jhn.12610 
9. Geserick M, Vogel M, Gausche R et al. Acceleration of BMI in early childhood and risk of sustained obesity. N Engl J Med. 2018;379(14):1303-1312. doi:10.1056/NEJMoa1803527 
10. Guide to Community Preventive Services. Health Equity: Center-Based Early Childhood Education. https://www.thecommunityguide.org/findings/promoting-health-equity-through-education-programs-and-policies-center-based-early-childhood. Updated April 16, 2019. Accessed April 16, 2019.  
11. Friedman-Krauss A, Bernstein S, Barnett WS. Early childhood education: three pathways to better health. National Institute of Early Education Research website. http://nieer.org/wp-content/uploads/2018/12/NIEER-Policy-Update_Health_2019.pdf. Published January 3, 2019. Accessed March 13, 2019. 
12.  Sharma SV, Vandewater V, Chuang RJ et al. Impact of the Coordinated Approach to Child Health Early Childhood Program for obesity prevention among preschool children: the Texas Childhood Obesity Research Demonstration Study. Child Obes. 2019;15(1):1-13. doi:10.1089/chi.2018.0010 
13. California Receives Nearly $11 Million Federal Early Childhood Education Grant. California Department of Education website. https://www.cde.ca.gov/nr/ne/yr19/yr19rel05.asp. Published January 16, 2019. Accessed March 18, 2019. 
14. Fernandez MA, Marette A. Novel perspectives on fermented milks and cardiometabolic health with a focus on type 2 diabetes. Nutr Rev. 2018;76:16-28. doi:10.1093/nutrit/nuy060 
15. Kang K, Sotunde OF, Weiler HA. Effects of milk and milk-product consumption on growth among children and adolescents aged 6–18 years: A meta-analysis of randomized controlled trials. Adv Nutr. 2019;10(2):250–261. doi:10.1093/advances/nmy081  
16. Fardet A, Rock E. Perspective: reductionist nutrition research has meaning only within the framework of holistic and ethical thinking. Adv Nutr. 2018;9(6):655-670. doi:10.1093/advances/nmy044 
17. Koskinen TT, Virtanen HEK, Voutilainen S, Tuomainen T, Mursu J, Virtanen JK. Intake of fermented and non-fermented dairy products and risk of incident CHD: the Kuopio Ischaemic Heart Disease Risk Factor Study. Br J Nutr. 2018;120(11):1288-1297. doi:10.1017/S0007114518002830 
18. McEvoy CT, Guyer H, Langa KM, Yaffe K. Neuroprotective diets are associated with better cognitive function: the Health and Retirement Study. J Am Geriatr Soc. 2017;65(8):1857-1862. doi:10.1111/jgs.14922