Lasten maitovalmisteiden kulutus ja maidontuotannon ja -prosessoinnin muutokset Suomessa

Maidontuotanto Suomessa on muuttunut viimeisten kuudenkymmenen vuoden aikana. Maitokarjaroduissa, lehmien ruokinnassa, maidon keräilyssä ja kuljetuksessa on tapahtunut merkittäviä muutoksia. Myös maitovalmisteiden prosessointi on kehittynyt. Lisäksi maitovalmisteita kulutetaan nykyään eri tavoin kuin ennen. Esimerkiksi rasvattoman maidon ja juustojen kulutus on lisääntynyt, kun taas maidon kokonaiskulutus on vähentynyt huomattavasti. Tässä maisterintutkielmassa luokiteltiin DIPP (Diabetes Prediction And Prevention) -ravintotutkimuksessa kerätyn aineiston maitovalmisteet homogenointi- ja kuumennuskäsittelyn mukaan. Luokkien luonnissa ajateltiin kuumennuksen tai homogenoinnin vaikutusta maidon proteiineihin ja rasvaan. Luokittelu tehtiin kirjallisuuteen sekä teollisuuden esittämiin tietoihin perustuen. Maitovalmisteet luokiteltiin homogenointitiedon mukaan johonkin seuraavista ryhmistä: homogenoitu, homogenoimatosn, rasvaton; ja kuumennuskäsittelytiedon mukaan johonkin seuraavista ryhmistä: normaalisti pastöroitu tai sitä lievemmin lämpökäsitelty, korkeapastöroitu <100°C:ssa, korkeapastöroitu tai steriloitu ≥100°C:ssa. Kuuden kuukauden ikäisten (n=1305), yksivuotiaiden (n=1513) ja kolmivuotiaiden (n=1326) lasten maitovalmisteiden kulutusta tarkasteltiin sekä klassista päivitettyä DIPP-ravintotutkimuksessa käytettyä maitovalmisteiden luokittelua että uusia prosessointiluokitteluja käyttäen. Lasten todettiin kuluttavan erityisesti ensimmäisen ikävuotensa aikana runsaasti korkeissa lämpötiloissa prosessoituja maitovalmisteita. Kuuden kuukauden ikäiset lapset kuluttivat eniten korkeapastöroituja tai steriloituja ≥100°C:ssa ja homogenoituja maitovalmisteita. Taustamuuttujat kuten imetys, äidin koulutus ja lasten asuinseutu (Pohjois-Pohjanmaa/Pirkanmaa) olivat yhteydessä maitovalmisteiden kulutukseen sekä klassista että prosessointiluokittelua käytettäessä. Tämä tutkielma tuo uutta tietoa lasten maitovalmisteiden kulutuksesta. Prosessointiin perustuvaa luokittelua voidaan käyttää myös jatkotutkimuksissa, kun tarkastellaan, voiko jollakin tietyllä tavalla käsiteltyjen maitovalmisteiden kulutuksella olla yhteys tyypin 1 diabeteksen puhkeamiseen.Milk production in Finland has changed during the latest decades. There are significant changes in cattle breeding, cattle feeding, milk collecting and transportation. Also processing of milk products has been developed. In addition, milk products are consumed in a different way than before. For example the consumption of fat-free milk and cheeses has increased whereas overall consumption of milk has decreased. In this master’s thesis milk products of DIPP (Diabetes Prediction And Prevention) nutrition study were classified based on their homogenization and heat-treatment. Creating the classification, the effects of heat-treatment or homogenization on milk proteins and fat globules were considered. The classification was done using information provided by literature and by major dairy manufacturers. Milk products were classified in one of the following groups based on the homogenization information: homogenized, non-homogenized, fat-free; and in one of the following groups based on the heat-treatment information: normally pasteurized or milder heat treatment, high pasteurized at < 100°C, high pasteurized or sterilized at ≥100°C. Milk consumption of children at the age of 6 months (n=1305), 1 year (n=1513) and 3 years (n=1326) was observed using both the updated classical DIPP - milk product classification and the newly created processing based classifications. It was observed that children used a lot of strongly heated milk-based products especially during their first year. At the age of six months mostly high pasteurized or sterilized at ≥100°C and homogenized milk products were used. Background variables such as breastfeeding, mother’s education and children’s living area (Pohjois-Pohjanmaa/ Pirkanmaa) were associated with milk product consumption both when using classical and process based classifications. This study introduces new information about children’s milk product consumption. The process based classification can also be used later when observing whether consumption of some specific kind of milk products can lead to appearance of type 1 diabetes

Consumption of differently processed milk products in infancy and early childhood and the risk of islet autoimmunity

Several prospective studies have shown an association between cows’ milk consumption and the risk of islet autoimmunity and/or type 1 diabetes. We wanted to study whether processing of milk plays a role. A population-based birth cohort of 6081 children with HLA-DQB1-conferred risk to type 1 diabetes was followed until the age of 15 years. We included 5545 children in the analyses. Food records were completed at the ages of 3 and 6 months and 1, 2, 3, 4 and 6 years, and diabetes-associated autoantibodies were measured at 3–12-month intervals. For milk products in the food composition database, we used conventional and processing-based classifications. We analysed the data using a joint model for longitudinal and time-to-event data. By the age of 6 years, islet autoimmunity developed in 246 children. Consumption of all cows’ milk products together (energy-adjusted hazard ratio 1·06; 95 % CI 1·02, 1·11; P = 0·003), non-fermented milk products (1·06; 95 % CI 1·01, 1·10; P = 0·011) and fermented milk products (1·35; 95 % CI 1·10, 1·67; P = 0·005) was associated with an increased risk of islet autoimmunity. The early milk consumption was not associated with the risk beyond 6 years. We observed no clear differences based on milk homogenisation and heat treatment. Our results are consistent with the previous studies, which indicate that high milk consumption may cause islet autoimmunity in children at increased genetic risk. The study did not identify any specific type of milk processing that would clearly stand out as a sole risk factor apart from other milk products.Peer reviewe

A novel processing-based classification and conventional food grouping to estimate milk product consumption in Finnish children

As more information is needed about the health aspects of milk processing; we classified milk products based on their homogenisation and heat-treatment history in the following inclusive classes: (i) homogenised, (ii) non-homogenised, (iii) fat-free; and (i) low-pasteurised or less heat-treated, (ii) high-pasteurised at cows’ milk products (median consumption 511 g d−1); at 3 y most of the consumed milk products were low-pasteurised or less heat-treated and homogenised. In contrast to children aged 3 y, almost all milk products consumed by infants aged 6 months were pasteurised at high temperature or sterilised.</p

Consumption of differently processed milk products and the risk of asthma in children

Background Consumption of unprocessed cow's milk has been associated with a lower risk of childhood asthma and/or atopy. Not much is known about differently processed milk products. We aimed to study the association between the consumption of differently processed milk products and asthma risk in a Finnish birth cohort. Methods We included 3053 children from the Finnish Type 1 Diabetes Prediction and Prevention (DIPP) Nutrition Study. Asthma and its subtypes were assessed at the age of 5 years, and food consumption by food records, at the age of 3 and 6 months and 1, 2, 3, 4, and 5 years. We used conventional and processing (heat treatment and homogenization)-based classifications for milk products. The data were analyzed using a joint model for longitudinal and time-to-event data. Results At the age of 5 years, 184 (6.0%) children had asthma, of whom 101 (54.9%) were atopic, 75 (40.8%) were nonatopic, and eight (4.3%) could not be categorized. Consumption of infant formulas [adjusted hazard ratio (95% confidence intervals) 1.15 (1.07, 1.23), p < .001] and strongly heat-treated milk products [1.06 (1.01, 1.10), p = .01] was associated with the risk of all asthma. Consumption of all cow's milk products [1.09 (1.03, 1.15), p = .003], nonfermented milk products [1.08 (1.02, 1.14), p = .008], infant formulas [1.23 (1.13, 1.34), p < .001], and strongly heat-treated milk products [1.08 (1.02, 1.15), p = .006] was associated with nonatopic asthma risk. All these associations remained statistically significant after multiple testing correction. Conclusions High consumption of infant formula and other strongly heat-treated milk products may be associated with the development of asthma

Infant feeding, gut permeability, and gut inflammation markers

Peer reviewe

Maidon prosessoinnin yhteys lasten tyypin 1 diabeteksen ja astman kehittymiseen

Cow’s milk has been associated with the development of both type 1 diabetes and asthma in children, although in different ways. Consumption of cow’s milk has been associated with an increased risk of the development of type 1 diabetes. On the other hand, several cross-sectional studies show that consumption of raw, unprocessed milk is associated with a decreased risk of asthma or atopy when compared to no consumption of raw milk or to consumption of sterilized milk. Little is known about differently processed milk products. The aim of this thesis was to study, in a birth cohort setting, whether the consumption of differently processed milk products is associated with the risk of islet autoimmunity or asthma in children. To study that, a novel processing-based classification of milk products was created in the national food composition database as part of this thesis. This classification was also used to evaluate children’s consumption of differently processed milk products, as such information was lacking. This thesis is based on the Finnish Type 1 Diabetes Prediction and Prevention (DIPP) Nutrition Study, comprising children genetically predisposed to type 1 diabetes born in Tampere or Oulu University hospitals from 1996 to 2004 (N=6081). The nutritional information of the participants was collected by food records at the age of 3 and 6 months, and 1, 2, 3, 4, 5, and 6 years. The consumption of milk products was calculated from the food records using the national food composition database. Each milk product item in the national food composition database was classified according to the adopted heat-treatment (low-pasteurized or less heated/high-pasteurized at <100°C/high-pasteurized at 100°C or sterilized) and homogenization (yes/no/fat-free). The classification was done principally based on literature. The study participants were followed for type 1 diabetes-related autoantibodies regularly until the age of 15 years. The primary outcome in the diabetes-related study was islet autoimmunity by the age of 6 years, defined as repeated positivity for islet cell autoantibodies and at least one biochemical antibody tested: insulin autoantibodies, antibodies to the 65 kD isoform of glutamic acid decarboxylase, and the tyrosine phosphatase-related islet antigen-2 molecule. The secondary outcome was islet autoimmunity by the age of 15 years. Of the 6081 children within the DIPP Nutrition Study, 4075 children were still in the DIPP follow-up at the age of 5 years, and of them 3781 participated in the DIPP Allergy and Asthma Study. The information on asthma was collected at the age of 5 years by using an ISAAC-based questionnaire. Outcomes in the asthma study were asthma, atopic asthma, and nonatopic asthma by the age of 5 years. Asthma was defined as doctor-diagnosed asthma plus wheeze or use of asthma medication during the preceding 12 months. Atopic asthma was defined as IgE-positive asthma, and nonatopic asthma as IgE-negative asthma. Joint models for longitudinal and time-to-event data were used as the statistical approach to study the association between consumption of differently processed milk products and islet autoimmunity and asthma. Almost all study participants [e.g., at the age of 3 years, 3401 of 3460 (98.3%)] consumed cow’s milk. During the first year of life, high-pasteurized at 100°C or sterilized milk products were consumed in higher amounts, while at ages 1–6 years low-pasteurized milk products were predominant. Homogenized milk products were consumed in higher amounts than nonhomogenized ones. Consumption of fat-free milk products increased by age. By the age of 6 years, islet autoimmunity developed in 246 (4.4%) of the 5545 children included in the analyses. High consumption of cow’s milk products was associated with an increased risk of islet autoimmunity [energy-adjusted hazard ratio (95% confidence intervals) 1.06 (1.02, 1.11)]. In addition, consumption of nonfermented [1.06 (1.01, 1.10)], fermented [1.35 (1.10, 1.67)], and homogenized [1.07 (1.02, 1.12)] milk products were associated with an increased risk. No processing type stood out as a particular risk factor. Asthma developed in 184 (6.0%) of the 3053 children included in the analyses, by the age of 5 years. Asthma in 101 (54.9%) children was atopic, and in 75 (40.8%) children nonatopic. The asthma type of 8 (4.3%) children could not be categorized. Consumption of high-pasteurized at 100°C or sterilized milk products [adjusted hazard ratio (95% confidence intervals) 1.06 (1.01, 1.10)] including milk-based infant formulas [1.15 (1.07, 1.23)] was associated with an increased risk of asthma. Consumption of cow’s milk products [1.09 (1.03, 1.15)], nonfermented milk products [1.08 (1.02, 1.14)], infant formulas [1.23 (1.13, 1,34)], and high-pasteurized at 100°C or sterilized milk products [1.08 (1.02, 1.15)] were associated with an increased risk of nonatopic asthma. In parallel to several previous studies, the results of this thesis suggest that high consumption of cow’s milk and cow’s milk products is associated with the development of the two immunological diseases in children. Processing of milk did not play a significant role in the association to islet autoimmunity. The consumption of high-pasteurized at 100°C or sterilized milk products was associated with an increased risk of asthma. No such association was seen for low-pasteurized milk products. This implies that processing may change the immunological properties of milk and thus play a role in the development of immunological diseases. As milk and milk products are commonly used in substantial amounts by Finnish children, future studies are needed to confirm the results and to enlighten the mechanisms behind the associations.Lehmänmaidon kulutus on yhdistetty kohonneeseen tyypin 1 diabeteksen riskiin. Toisaalta prosessoimattoman raakamaidon kulutuksella on havaittu yhteys pienempään astman ja atopian riskiin. Väitöskirjan tarkoituksena oli tutkia, onko eri tavoin prosessoitujen maitovalmisteiden kulutus yhteydessä tyypin 1 diabeteksen tai astman kehittymiseen lapsilla. Väitöskirja pohjautuu suomalaiseen Tyypin 1 diabeteksen ennustaminen ja ehkäisy (DIPP) -ravitsemustutkimukseen, jossa on seurattu Tampereen ja Oulun yliopistollisissa sairaaloissa vuosina 1996–2004 syntyneitä lapsia. Lapsilta seurattiin diabeteksen esiastetta kuvaavien autovasta-aineiden ilmaantumista seeruminäytteisiin 3–12 kuukauden välein. Tieto astmasta kerättiin lomakkeella lapsen ollessa viisivuotias. Ravintotiedot kerättiin toistuvien ruokapäiväkirjojen avulla. Maitovalmisteiden kulutus laskettiin käyttäen kansallista elintarvikkeiden koostumustietokantaa, jonka maitovalmisteet luokiteltiin kuumennuskäsittelyn ja homogenoinnin perusteella. Lähes kaikki lapset käyttivät maitovalmisteita. Ensimmäisen ikävuoden aikana käytettiin eniten voimakkaasti lämpökäsiteltyjä (korkeapastöroituja ≥100°C:ssa tai steriloituja maitovalmisteita), kun taas 1–6 vuoden iässä pastöroituja maitovalmisteita käytettiin enemmän. Homogenoituja maitovalmisteita käytettiin suurempia määriä kuin homogenoimattomia. Rasvattomien maitovalmisteiden käyttö lisääntyi iän myötä. Runsas maitovalmisteiden kulutus oli yhteydessä kohonneeseen tyypin 1 esiasteen riskiin. Mikään prosessointityyppi ei erottunut erityisenä riskitekijänä suhteessa tyypin 1 diabeteksen esiasteeseen. Voimakkaasti lämpökäsiteltyjen maitovalmisteiden, joihin myös äidinmaidonkorvikkeet luokiteltiin, kulutus oli yhteydessä kohonneeseen astman riskiin. Atopian suhteen jaoteltuna äidinmaidonkorvikkeiden ja muiden voimakkaasti lämpökäsiteltyjen maitovalmisteiden kulutus oli yhteydessä korkeampaan ei-atooppisen astman riskiin, mutta ei atooppisen astman riskiin. Vastaavaa riskiyhteyttä ei nähty pastöroiduilla maitovalmisteilla. Tämä viittaa siihen, että prosessointi saattaa vaikuttaa maidon immunologisiin ominaisuuksiin. Koska suomalaiset lapset käyttävät maitoa ja maitovalmisteita runsaita määriä, tutkimusten on jatkossa tärkeää selventää yhteyksiä ja valottaa mekanismeja niiden takana

A novel processing-based classification and conventional food grouping to estimate milk product consumption in Finnish children

As more information is needed about the health aspects of milk processing; we classified milk products based on their homogenisation and heat-treatment history in the following inclusive classes: (i) homogenised, (ii) non-homogenised, (iii) fat-free; and (i) low-pasteurised or less heat-treated, (ii) high-pasteurised at = 100 degrees C or sterilised. Milk product consumption of Finnish children was studied at the age of 6 months (n = 1305), 1 y (n = 1513), and 3 y (n = 1328) both using conventional food grouping and the novel processing-based grouping. At 6 months, more than three quarters of the children consumed cows' milk products (median consumption 511 g d(-1)); at 3 y most of the consumed milk products were low-pasteurised or less heat-treated and homogenised. In contrast to children aged 3 y, almost all milk products consumed by infants aged 6 months were pasteurised at high temperature or sterilised. (C) 2018 The Authors. Published by Elsevier Ltd.Peer reviewe

Effect of Early Feeding on Intestinal Permeability and Inflammation Markers in Infants with Genetic Susceptibility to Type 1 Diabetes : A Randomized Clinical Trial

Objectives To assess whether weaning to an extensively hydrolyzed formula (EHF) decreases gut permeability and/or markers of intestinal inflammation in infants with HLA-conferred diabetes susceptibility, when compared with conventional formula. Study design By analyzing 1468 expecting biological parent pairs for HLA-conferred susceptibility for type 1 diabetes, 465 couples (32 %) potentially eligible for the study were identified. After further parental consent, 332 babies to be born were randomized at 35th gestational week. HLA genotyping was performed at birth in 309 infants. Out of 87 eligible children, 73 infants participated in the intervention study: 33 in the EHF group and 40 in the control group. Clinical visits took place at 3, 6, 9, and 12 months of age. The infants were provided either EHF or conventional formula whenever breastfeeding was not available or additional feeding was required over the first 9 months of life. The main outcome was the lactulose to mannitol ratio (L/M ratio) at 9months. The secondary outcomes were L/M ratio at 3, 6, and 12 months of age, and fecal calprotectin and human beta-defensin 2 (HBD-2) levels at each visit. Results Compared with controls, the median L/M ratio was lower in the EHF group at 9 months (.006 vs.028; P = .005). Otherwise, the levels of intestinal permeability, fecal calprotectin, and HBD-2 were comparable between the two groups, although slight differences in the age-related dynamics of these markers were observed. Conclusions It is possible to decrease intestinal permeability in infancy through weaning to an extensively hydrolyzed formula. This may reduce the early exposure to dietary antigens.Peer reviewe

Consumption of differently processed milk products and the risk of asthma in children

Background Consumption of unprocessed cow's milk has been associated with a lower risk of childhood asthma and/or atopy. Not much is known about differently processed milk products. We aimed to study the association between the consumption of differently processed milk products and asthma risk in a Finnish birth cohort. Methods We included 3053 children from the Finnish Type 1 Diabetes Prediction and Prevention (DIPP) Nutrition Study. Asthma and its subtypes were assessed at the age of 5 years, and food consumption by food records, at the age of 3 and 6 months and 1, 2, 3, 4, and 5 years. We used conventional and processing (heat treatment and homogenization)-based classifications for milk products. The data were analyzed using a joint model for longitudinal and time-to-event data. Results At the age of 5 years, 184 (6.0%) children had asthma, of whom 101 (54.9%) were atopic, 75 (40.8%) were nonatopic, and eight (4.3%) could not be categorized. Consumption of infant formulas [adjusted hazard ratio (95% confidence intervals) 1.15 (1.07, 1.23), p < .001] and strongly heat-treated milk products [1.06 (1.01, 1.10), p = .01] was associated with the risk of all asthma. Consumption of all cow's milk products [1.09 (1.03, 1.15), p = .003], nonfermented milk products [1.08 (1.02, 1.14), p = .008], infant formulas [1.23 (1.13, 1.34), p < .001], and strongly heat-treated milk products [1.08 (1.02, 1.15), p = .006] was associated with nonatopic asthma risk. All these associations remained statistically significant after multiple testing correction. Conclusions High consumption of infant formula and other strongly heat-treated milk products may be associated with the development of asthma.Peer reviewe