Dairy has been described as everything from a superfood to a poison; yet, arguments, assumptions, and data justifying these labels are not always clear. We used an issue-based information system, “dialogue mapping™,” to summarize scientific points of a live panel discussion on the putative effects of dairy on cardiovascular diseases (CVD) from a day-long session among experts in nutrition and CVD. Dialogue mapping captures relations among ideas to explicitly, logically, and visually connect issues/questions, ideas, pro/con arguments, and agreements, even if discussed at different times. Experts discussed two propositions: for CVD risk, consumption of full-fat dairy products 1) should be minimized, in part because of their saturated fat content, or 2) need not be minimized, despite their saturated fat content. The panel discussed the dairy-CVD relation through blood lipids, diabetes, obesity, energy balance, blood pressure, dairy bioactives, biobehavioral components, and other putative causal pathways. Associations and effects reported in the literature have varied by fat content of dairy elements considered, study design, intake methods, and biomarker versus disease outcomes. Two conceptual topics emerged from the discussion: 1) individual variability: whether recommendations should be targeted only to those at high CVD risk; 2) quality of evidence: whether data on dairy-CVD relations are strong enough for reliable conclusions—positive, negative, or null. Future procedural improvements for science dialog mapping include using singular rather than competing propositions for discussion.
Bibliographical noteFunding Information:
The following is current at least as of the initial submission of this manuscript. Brown: In the last twelve months, Dr. Brown has received travel expenses from University of Louisville; speaking fees from Kentuckiana Health Collaborative, and Rippe Lifestyle Institute, Inc.; and he has been involved in research for which his institution or colleagues have received grants from Dairy Management, Inc., National Cattleman's Beef Association, NIH, and the Sloan Foundation. Fontaine: In the last 3 years, Dr. Fontaine served on the scientific advisory board to Virta Health Corp and has stock options. He also serves on the scientific advisory board to Atkins Nutritionals, and has been involved in research for which his institution or colleagues have received grants from Dairy Management, Inc. Gibson: In the last 12 months, Mrs. Gibson has received travel expenses from TriNetX and support from NIH. Bier: In the last 3 years, Dr. Bier discloses travel, speaking, or advisory fees from International Life Sciences Institute; International Council on Amino Acid Science; Nutrition and Growth Solutions, Inc.; Ajinomoto, Co.; Lorenzini Foundation; CrossFit Foundation; International Glutamate Technical Committee; Nestle; Indiana University Bloomington; Mallinckrodt Pharmaceuticals; Soremartec/Ferrero Co.; Infant Nutrition Council of America; and The Israel Institute. Jacobs: Consultant to the California Walnut Commission. Kris-Etherton: Serves on the scientific advisory board to HumanN and Seafood Nutrition Partnership, and has held research grants with CA Walnut Commission, CA Strawberry Commission, Ocean Spray Cranberries, McCormick Science Institute, Hass Avocado Board, Alliance for Potato Research, The Peanut Institute, American Pistachio Growers, and ACH Foods. Maki: In the past 3 years—advisory boards for National Dairy Council and Beef Checkoff, research funding for Kellogg, General Mills, Hass Avocado Board, Almond Board of California, American Egg Board, Beef Checkoff, National Dairy Council, Alliance for Potato Research and Education, ACH Foods, Abbott Nutrition, Ingredion, and Kemin Industries. Teran-Garcia: USDA support and co-Investigator in a project sponsored by the Dairy Research Institute. Allison: Dr. Allison reports grants from NIH, outside the submitted work; and Dr. Allison has received personal payments or promises for same from: American Society for Nutrition; American Statistical Association; Biofortis; Columbia University; Fish & Richardson, P.C.; Frontiers Publishing; Henry Stewart Talks; IKEA; Indiana University; Laura and John Arnold Foundation; Johns Hopkins University; Law Offices of Ronald Marron; MD Anderson Cancer Center; Medical College of Wisconsin; National Institutes of Health (NIH); Sage Publishing; The Obesity Society; Tomasik, Kotin & Kasserman LLC; University of Alabama at Birmingham; University of Miami; Nestle; WW (formerly Weight Watchers International, LLC); California Walnut Commission. Donations to a foundation have been made on his behalf by the Northarvest Bean Growers Association. Dr. Allison is an unpaid member of the International Life Sciences Institute North America Board of Trustees. Dr. Allison’s institution, Indiana University, has received funds to support his research or educational activities from: National Cattleman’s Beef Association NIH; Alliance for Potato Research and Education; American Federation for Aging Research; Dairy Management Inc; Herbalife; Laura and John Arnold Foundation; Oxford University Press. Kaiser, Keitt, Gower, Shikany, Vorland, Beitz, Brenna, Miller, and St-Onge: Nothing further to disclose beyond participating in this project funded by Dairy Management Inc.
This study was supported by Dairy Management Inc. MG was supported in part by NIH National Center for Advancing Translational Sciences grant UL1TR001417. As a condition of participating in this project, all investigators and panelists agreed to either be acknowledged by name or serve as a coauthor. All coauthors have expressed an interest in being listed as a coauthor and met standard authorship guidelines. We also acknowledge the contributions of Drs. Victor Fulgoni, Peter Jones, Benoit Lamarche, and Theresa Nicklas. Preliminary results were presented at the Nutrition 2019 meeting (Brown et?al. 2019).
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- cardiovascular disease
- dialogue mapping