Yogurt consumption and abdominal obesity reversion in the PREDIMED study

Highlights

• Specific role of yogurt on obesity is not fully understood.

• Consumption of whole-fat yogurt was associated with changes in waist circumference.

• Whole-fat yogurt consumption was associated with higher probability of reversion of central obesity.

• Low-fat yogurt had no beneficial effects in management of abdominal obesity in elderly people at cardiovascular risk.

Abstract

Background and aims

Evidence on the association yogurt consumption and obesity is not conclusive. The aim of this study was to prospectively evaluate the association between yogurt consumption, reversion of abdominal obesity status and waist circumference change in elderly.

Methods and results

4545 individuals at high cardiovascular risk were prospectively followed. Total, whole-fat and low-fat yogurt consumption were assessed using food frequency questionnaires. Generalized estimating equations were used to analyze the association between yogurt consumption and waist circumference change (measured at baseline and yearly during the follow-up). Logistic regression models were used to evaluate the odds ratios (ORs) and 95% CIs of the reversion rate of abdominal obesity for each quintile of yogurt consumption compared with the lowest quintile. After multivariable adjustment, the average yearly waist circumference change in the quintiles of whole-fat yogurt consumption was: Q1: 0.00, Q2: 0.00 (−0.23 to 0.23), Q3: −0.15 (−0.42 to 0.13), Q4: 0.10 (−0.21 to 0.42), and Q5: −0.23 (−0.46 to −0.00) cm; p for trend = 0.05. The ORs for the reversion of abdominal obesity for whole-fat yogurt consumption were Q1: 1.00, Q2: 1.40 (1.04–1.90), Q3: 1.33 (0.94–1.89), Q4: 1.21 (0.83–1.77), and Q5: 1.43 (1.06–1.93); p for trend = 0.26.

Conclusion

Total yogurt consumption was not significantly associated with reversion of abdominal obesity status and a lower waist circumference. However, consumption of whole-fat yogurt was associated with changes in waist circumference and higher probability for reversion of abdominal obesity. Therefore, it seems that whole-fat yogurt has more beneficial effects in management of abdominal obesity in elderly population at high cardiovascular risk.

Introduction

Dairy products provide high-quality proteins and diverse essential nutrients, whose consumption is considered marker of diet quality [1]. Thus, most dietary guidelines recommend dairy food consumption, typically 2–3 servings per day and it is frequent to advise preferring low-fat dairy [2].

Yogurt is a nutrient-dense probiotic food and could play a role in improving the nutritional status and health in older adults [3]. Besides, yogurt consumption may be associated with a more beneficial cardio-metabolic risk profile in overweight/obese individuals [4]. Overweight and obesity are the fifth leading risk factor for deaths globally, being the burden of obesity particularly relevant in old age, due to accumulating co-morbidities and changes in body composition [5]. Worldwide, obesity has more than doubled since 1980, and in 2014, 11% of men and 15% of women aged 18 years and older were obese [6]. In Spain, according to the ENRICA Study [7] and EXERNET multicentre study [8] prevalence of abdominal obesity affected, respectively, 62% and 56% of persons aged 65 and over. Evidence suggests that abdominal obesity measures, such as waist circumference, show information independent to measures of general obesity and should be used in clinical practice [9].

The relationship between dairy consumption and obesity parameters has been investigated with controversial results. Evidence from prospective cohort studies suggests a protective, but limited, effect of dairy consumption on risk of overweight and obesity [10], [11], [12]. In 2008, a review of 49 clinical trials found no effect of dairy consumption in weight loss [13]. Results from randomized control trials have been recently summarized in three meta-analyses. Abargouei et al. [14], concluded that increased dairy intake without energy restriction, might not lead to a significant change in weight, or body composition, whereas when combined with energy restriction, inclusion of dairy products modestly reduced weight (−0.61 kg), fat mass (−0.72 kg) and waist circumference (−2 cm). Furthermore, Chen et al. [15] concluded, that dairy products may have modest benefits in facilitating weight loss but in short term or energy-restricted studies. In contrast, Benatar et al. [16] found that increasing in both whole and low fat dairy products, without other dietary intervention, was associated with a modest weight gain.

These controversial results may be partially related with the lack of agreement in defining dairy products in relation to total fat [17]. Among dairy products, yogurt has received more attention, but yogurt, and even other dairy foods, may be allocated into the low or whole/high-fat categories or both. Besides, definition of yogurt consumption levels and bacterial cultures included, also varied across studies [18], [19], [20]. A recent systematic review concerning the role of yogurt in weigh management, has concluded that there is association with lower BMI, lower body weight/weight gain, smaller waist circumference and lower body fat in epidemiological studies. Although RCTs suggest weight reduction effects, do not permit determination of a cause/effect relationship [21].

In this context, few studies have prospectively assessed the specific associations between whole-fat versus low-fat yogurt consumption and waist circumference change and abdominal obesity in adults [4], [22], [23]. In this context, we aimed to prospectively examine the relationship between yogurt consumption (total, whole-fat or low-fat) and average yearly waist circumference change and the reversion of abdominal obesity in an older population of the PREDIMED Study.