The Time to Change Children’s Dietary Habits Is Now, Say Experts at the Second Yoghurt Summit

On 4 September 2018, the Second Yoghurt Summit was held as a satellite symposium before the start of the Nutrition Congress 2018 in Muldersdrift. The theme of the summit, Realising Children’s Potential, connected the dots that the time to act is now to correct South Africa’s documented micronutrient deficiencies 1 and the energy excess that presents as overweight children. The purpose of the summit was clear: to review and evaluate the strength of current scientific knowledge regarding the health benefits of yoghurt, particularly in the capacity that good nutrition has in protecting children against future non-communicable disease. The summit, attended by 120 key opinion leaders and healthcare professionals, consisted of scientific exchanges by two international and two local speakers. The presenters reinforced the challenges, both direct and indirect, that healthcare professionals face in the ever-evolving science of nutrition.

“Yoghurt is more than the sum of its individual parts,” said Dr. André Marette, Scientific Director at the Institute of Nutrition and Functional Foods, Laval University, Quebec.  Studies suggest that regular yoghurt eaters have healthier eating behaviours and a better lifestyle. Yoghurt consumption has been associated with eating less fast food, fried food, fried chips, processed meat, red meat, pizzas, soft drinks and alcohol, and being more physically active. 2,3 This lends to the support for yoghurt as part of a healthy diet in combating obesity, 4 improving cardiometabolic health, 5 and reducing risk of type 2 diabetes. 6 In 2013, 382 million people had diabetes globally and this number is expected to rise to 592 million by 2035. 7 In particular, type 2 diabetes in South Africa is on the rise 8with diet and lifestyle factors being large contributors to this condition. Several studies have consistently shown an inverse association between yoghurt consumption and type 2 diabetes. 6,9,10

Continuing from this, Professor Angelo Tremblay, Department of Kinesiology at the Laval University in Quebec, highlighted how less traditional determinants of obesity, such as short sleep duration, low calcium and dairy intake, insufficient vitamin intake, and suboptimal feeding behaviours, can affect weight. His presentation shone light on available epidemiological evidence indicating the positive effects of yoghurt consumption in weight. 4,6,11,12 Along with the influence on gut microbiota 11 and the role of calcium and protein in dairy positively impacting appetite reducing hormones like peptide tyrosine tyrosine (PYY), 12 yoghurt consumption has also been associated with reduced hunger and enhanced feelings of fullness 12 and glycaemic stability. 6 The yoghurt matrix is a mediator that favourable impacts lower body mass index (BMI), smaller waist circumference, and lower body fat. 4 The substitution of yoghurt, an energy-controlled food of high nutritional value, for foods high in energy and low in nutrients may also contribute to the evident weight loss. He concluded that sufficient research may justify that yoghurt plays a role in encouraging metabolic fitness.

For these reasons, it is not a simple task to separate out the benefits of yoghurt from all the other accompanying healthy lifestyle choices this group of the population makes. As Marette points out, more studies are required to confirm a cause and effect relationship regarding the health benefits of yoghurt. Regardless, the overall findings are encouraging and despite the lack of concrete evidence we should remember “absence of proof does not equal proof of absence”.

Lastly, Lebo Matshego-Roda, a local nutritionist and researcher at the University of South Africa (UNISA) took the audience back to their youth with a reminder of the health status of South African children. South African children are not eating enough dairy, 13 calcium, 1 fruit and vegetables, 14 and have high intakes of sugar-sweetened drinks. 13 Along with this, breakfast skipping 15 and being inactive SA-13,14 are all factors that synergistically contribute to the alarming statistic that 14% of children aged 6 – 14 years are overweight or obese. 15 These statistics are on the rise 16 and, unfortunately, it is these unfavourable factors where the origin of many non-communicable diseases can be found. Matshego-Roda drew attention to the fact that obesity in children, as is also the case with adults, is associated with hypertension, dyslipidaemia, chronic inflammation, and hyperinsulinemia. 17 In a recent cross-sectional analysis using data from the National Diet and Nutrition Survey in the UK (n=1687), researchers found that yoghurt consumption is associated with higher nutrient intake, diet quality and favourable metabolic profile in children. 18 This and other studies 19,20,21,22 support role of yoghurt as part of a healthier eating pattern associated with greater intake of specific shortfall nutrients and lower body fat in young children. This supports and promotes the South African food-based dietary guideline to have milk, maas and yoghurt every day. 23

Lastly, creative parenting expert Nikki Bush unpacked the realities of parenting in this modern world. Time-starved parents have just 2 – 3 hours per day with their children, which may lead to negative attention-seeking behaviour from children. “Children use food as a form of control,” says Bush. “Refusing to eat is less about striving for independence and more about striving to control that which feels out of control. Children manipulate and seek attention when things feel out of control and the main areas in which they do this are with eating, toileting, and going to sleep. These are warning signs that they are not feeling secure in some way.

Bush reminded the audience that we negotiate too much with children around food. “If they know there are other choices, children go into negotiation mode, and they usually win.  We get overemotional about children and eating issues. If they don’t want to eat something we need to remain calm and direct them to bread and water in the kitchen. This makes what is in front of them a lot more attractive. Where parents make a fuss there is room for children to manipulate them. Parents should avoid overcompensating with food by offering too many food choices. If you do, you allow children to manipulate you, putting them in control. Children like and need the security of boundaries and limited choices.”

Bush concluded the Yoghurt Summit with practical ideas on how to raise healthy eaters. Be invitational by bringing children into the kitchen to help with the cooking. They are far more likely to eat what they have helped to prepare because they are proud of their efforts.  Encouraging children to get involved in shopping for food is a great way to help them to buy in to their own nutritional process. Eat together with your children from a young age. Mealtimes can become moments of belonging and togetherness that have the power to create emotional bonds and warm fuzzy memories, not just because of the ritual of eating, but because of the time spent together.

Acknowledgements

In September 2018, the South African Yoghurt in Nutrition Initiative (SAYINI) hosted the 2nd South African Yoghurt Summit, Realising Children’s Potential, where local and international speakers shared emerging science on the role of nutrition in raising healthy children. SAYINI aims to uncover scientific data related to yoghurt, stimulate new research and identify gaps in our understanding on the health effects of this food category, and to disseminate this information to relevant healthcare professionals and the public.

References
  1. Labadarios D et al. The National Food Consumption Survey (NFCS): South Africa, 1999. Public Health Nutrition. 1999;8(5),533–543.
  2. Cormier H, Drapeau V, Perusse L, Volh M. Association between yogurt consumption, dietary patterns, and cardio-metabolic risk factors. European Journal of Nutriton.2015. DOI 10.1007/s00394-015-0878-1
  3. DÁddezio L, Lorenza M, Sette A, Turrini A. Sociodemographic and lifestyle characteristics of yogurt consumers in Italy: Results from the INRAN-SCAI 2005-06 survey. Mediterranean Journal of Nutrition and Metabolism,2015;8(2):119-129.  
  4. Eales J, Lenoir-Wijnkoop I, King S, Wood W, Kok FJ, Shamir R et al. Is consuming yoghurt associated with weight management outcomes? Results from a systematic review. International Journal of Obesity.2016; 40:731–746.
  5. Fernandez MA, Panahi SDaniel NTremblay AMarette A. Yogurt and Cardiometabolic Diseases: A Critical Review of Potential Mechanisms.Adv Nutr.2017;15(6):812-829.
  6. Panahi S, Tremblay A. The Potential Role of Yoghurt in Weight Management and Prevention of Type 2 Diabetes. Journal of the American College of Nutrition;2016;35(8):717-731.
  7. Guariguata LWhiting DRHambleton A, Beagley JLinnenkamp UShaw JE. Global estimates of diabetes prevalence for 2013 and projections for 2035.Diabetes Res Clin Pract.2014;103(2):137-49.
  8. Nojilana B, Bradshaw D, Pillay-van Wyk V, Msemburi W, LaubscherR, Somdyala NIM, et al. Emerging trends in non-communicable disease mortality in South Africa, 1997 – 2010. South African Medical Journal 2016;106(5):477-484.
  9. Forouhi Association between consumption of dairy products and incident type 2 diabetes–insights from the European Prospective Investigation into Cancer study. Nutr Rev.2015;73(S1):15-22.
  10. Mohamadshahi M, Veissi M, Haidari FShahbazian HKaydani GAMohammadi F.Effects of probiotic yogurt consumption on inflammatory biomarkers in patients with type 2 diabetes. 2014;4(2):83-8.
  11. Pei RMartin DADiMarco DMBolling BW. Evidence for the effects of yogurt on gut health and obesity. Crit Rev Food Sci Nutr.2017; 24;57(8):1569-1583.
  12. Jones KWEller LKParnell JADoyle-Baker PKEdwards ALReimer RA. Effect of a dairy- and calcium-rich diet on weight loss and appetite during energy restriction in overweight and obese adults: a randomized trial. Eur J Clin Nutr.2013;67(4):371-6.
  13. Reddy SP, James S, Sewpaul R, Koopman F, Funani NI, Sifunda S, Josie J, Masuka P, Kambaran NS, Omardien RG. Umthente Uhlaba Usamila. The South African Youth Risk Behaviour Survey, 2011.
  14. Draper C, Basset S, de Villiers A, Lambert E, and the HAKSA Writing Group. Results from South Africa’s 2014 Report Card on Physical Activity for Children and Youth. Journal of Physical Activity and Health; 2014: 11(S1), S98-S104.
  15. Hoosain E, Dwane N, Reddy P, Jacobs L, Shisana O, Labadarios D, et al. The South African National Health and Nutrition Examination Survey, 2012: SA-NHANES-1. Cape Town: HSRC Press; 2013. (Available from: www.hsrc.ac.za/en/researchoutputs/view/6493.)
  16. Sartorius BSartorius KTaylor MAagaard-Hansen JDukhi NDay C, et al. Rapidly increasing body mass index among children, adolescents and young adults in a transitioning population, South Africa, 2008-15. Int J Epidemiol. Doi: 10.1093/ije/dyx263.
  17. Xu S, Xue Y. Paediatric obesity: causes, symptoms and prevention (a review). Experimental nd Therapeutic Medicine.2016;11:15-20.
  18. Hobbs DAGivens DILovegrove JA. Yogurt consumption is associated with higher nutrient intake, diet quality and favourable metabolic profile in children: a cross-sectional analysis using data from years 1-4 of the National diet and Nutrition Survey, UK. European Journal of Nutrition. Doi: 10.1007/s00394-017-1605-x.
  19. Keast DR, Hill Gallant KM, Albertson AM, Gugger CK, Holschuh NM. Associations between Yoghurt, Dairy, Calcium, and Vitamin D Intake and Obesity among U.S. Children Aged 8–18 Years: NHANES, 2005–2008. Nutrients 2015, 7, 1577-1593.
  20. Marette A, Picard-Deland A. Yogurt consumption and impact on health: focus on children and cardiometabolic risk. American Journal of Clinical Nutrition.2014;99(suppl):1243S–7S.
  21. Williams EB, Hooper B, Spiro A, Stanner S. The contribution of yoghurt to nutrient intakes across the life course. British Nutrition Foundation Nutrition Bulletin. 2015;40:9–32.
  22. Zhu Y, Wang H, Hollis JH, Jacques PF. The associations between yoghurt consumption, diet quality, and metabolic profiles in children in the USA. Eur J Nutr (2015) 54:543–550.
  23. Vorster HH, Wenhold FAM, Wright HH, Wentzel-Viljoen E, Venter CS, Vermaak M. “Have milk, maas or yoghurt every day”: a food-based dietary guideline for South Africa. South African Journal of Clinical Nutrition, 2003;26(3):S57-S65.