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Developed in conjunction with The American Academy of Family
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Dairy Council Digest Archives
Health Benefits of Dairy Foods for Minorities
Dairy's Role in Reducing Risks for Major Chronic Diseases Threatening Minorities
Hypertension . A diet rich in dairy foods helps to reduce the risk for hypertension among minorities, particularly African Americans, a high-risk group (9,10,39,40). African Americans develop hypertension earlier in life and experience greater severity and increased mortality rates from hypertension-related sequelae than their White counterparts (5,41). In general, the prevalence of hypertension in Hispanics and American Indians is similar to that in Whites (5,40). Lower rates of hypertension are reported in Asian/Pacific Islanders than in Japanese Americans or Whites (5).
Genetic and lifestyle factors likely contribute to the disparity in hypertension between African Americans and Whites (31,42). A low intake of dairy food nutrients (e.g., calcium, potassium, magnesium) may contribute to African Americans' high risk for hypertension (8-10,31,40). The DASH combination diet, a low fat dietary pattern emphasizing fruits and vegetables (i.e., 8 to 10 servings/day) and lowfat dairy products (i.e., 3 servings/day, predominantly lowfat milk) has been demonstrated to be particularly effective in lowering blood pressure in African Americans (9,10). Systolic blood pressure decreased by 6.8 mm Hg in African Americans consuming the DASH combination diet compared to 3.0 mm Hg in Whites (10). These reductions in blood pressure were achieved without a decrease in sodium intake or weight loss (9,10).
The finding that African Americans are particularly responsive to the blood pressure-lowering effects of the DASH diet, a low fat diet rich in lowfat dairy foods, fruits, and vegetables, indicates that hypertension need not be an inevitable characteristic of this minority group.
The excessive hypertension in African Americans may be explained in part by multiple dietary inadequacies (31). Substantial scientific evidence indicates that increasing intake of calcium or calcium-rich dairy foods lowers blood pressure (43-46). Studies specifically involving African Americans support calcium's hypotensive effect (47,48). Diastolic blood pressure decreased by an average of 1.9mm Hg in African American adolescents who consumed 1,500mg calcium/day for eight weeks (48). The calcium-induced reduction in blood pressure was greater (i.e., 4.9 mm Hg) in teens with the lowest calcium intakes (48). Calcium, particularly by interacting with other nutrients in foods such as dairy foods, favorably affects blood pressure (41,48). In a recent investigation of 180 urban minority adolescents at risk for hypertension, blood pressure was lower in those who had higher intakes of a combination of nutrients, including calcium, potassium, magnesium, and vitamins (49).
African Americans' low potassium intake may also contribute to their high risk for hypertension (31,50-52). Increasing potassium intake for three weeks in African Americans whose typical intake of this nutrient was low (32 to 35 mmol/ day) reduced systolic and diastolic blood pressures by 6.9 and 2.5mm Hg, respectively (51). Potassium's hypotensive effect appears to be greater in African Americans than in Whites and in those who habitually consume low rather than high potassium intakes (51,52). The high potassium level of the DASH diet may explain some of this diet's effectiveness in reducing African Americans' blood pressure.
Stroke . The incidence of, and mortality from, stroke vary among different racial and ethnic groups. African Americans have a 2.4-fold and Hispanics a two-fold increase in age-adjusted stroke incidence compared to Whites (53). After adjusting for age, deaths from stroke are almost 80% higher in African Americans than in Whites (4).
Intake of dairy foods, by increasing dietary calcium, potassium, and magnesium, has been demonstrated to reduce risk for stroke (54,55). An inverse association between calcium intake and in particular dairy calcium (e.g., milk, yogurt, hard cheeses, ice cream) was found in a study of 86,000 middle-aged women (98% white) who participated in the Nurses' Health Study (54). Potassium and magnesium in milk may also be important in reducing stroke risk (56,57). Milk and other dairy products provide 18.4% of the potassium and 15.8% of the magnesium available in the U.S. food supply (21). According to a recent study, a low intake of dietary potassium predicted stroke mortality in African American men who overall consumed less dietary potassium than White men (56). The U.S. Food and Drug Administration has approved a health claim regarding intake of potassium-containing foods and reduced risk of high blood pressure and stroke on the labels of qualified foods (e.g., non-fat milk and some yogurts) (58). Dietary intake of magnesium is also associated with reduced risk of stroke (57).
Osteoporosis . Emerging findings indicate that risk for osteoporosis among many minority populations is underestimated (59). According to preliminary data reported in late 1999 from the National Osteoporosis Risk Assessment (NORA) program, which involves 204,000 postmenopausal women in the U.S. aged 50 years and older, 65.1% of Asian, 58.9% of Native American, and 55.5% of Hispanic women have low bone mineral densities (59). Osteoporosis was identified in 8.2%, 9.5%, and 4.3% of these three groups, respectively (59). Over half (50.5%) of White women had low bone density and 5.2% were osteoporotic. African American women had the lowest rates of low bone density (38%) with 4% diagnosed with osteoporosis (59). Although African American women in general are at lower risk for osteoporosis than other minorities, between 80 and 95% of fractures in African American women over age 64 are due to osteoporosis (60). Also, African American women who sustain osteoporosis-related fractures suffer increased disability and decreased survival compared to white women (60,61). As the African American population ages, osteoporosis in this minority group is expected to rise further (62).
To develop effective interventions to improve minorities' calcium and overall nutritional status, health professionals should understand minorities' cultural beliefs and dietary practices.
Compared to Whites, African American women's relatively low risk for osteoporosis and osteoporotic-related fractures is largely attributed to their greater bone mineral density at all skeletal sites, which is due to their higher peak bone mass, reached by early adulthood, and their slightly lower rate of bone loss after menopause (61-63). Other explanations for African American women's lower risk for osteoporotic fractures include their larger muscle mass, reduced rates of bone turnover, differences in calcium metabolism (e.g., decreased urinary calcium), higher prevalence of obesity, and bone geometry (i.e., shorter hip axis) (62,63).
Figure 3 Weight Status of Individuals 20 Years and Older (16)
The few investigations that have examined calcium's effect on bone health in minority groups such as African Americans and Asians demonstrate that increasing dietary calcium intake increases bone mass in these populations similar to that for Whites (64,65). Adequate intake of vitamin D, regular physical activity, and smoking cessation are also important lifestyle interventions to reduce the risk for osteoporosis (60,61,66).
Scientific evidence indicates that consuming an adequate intake of calcium or calcium-rich foods such as milk and other dairy products throughout life reduces the risk for osteoporosis (8,66,67). Milk and other dairy products are not only a major source of calcium, but they provide other essential nutrients such as vitamin D (if fortified) which increases calcium absorption (21,68). With the exception of vitamin D-fortified milk products and breakfast cereals, few other foods contain vitamin D (68). Although vitamin D can be obtained through exposure of the skin to sunlight, increased skin pigmentation (i.e., melanin) reduces ultraviolet radiation-mediated synthesis of vitamin D3 (69). As such, intake of dietary sources of vitamin D, such as vitamin D-fortified milk, may make the difference in whether or not dark skinned minorities meet their needs for vitamin D.
Obesity . Overweight and obesity are prevalent among minorities such as African Americans, Hispanics, and Native Americans, particularly women (4,5,16, Figure 3). Identifying the cause(s) of overweight/obesity among minorities is an area of active investigation (70).
Increasing intake of calcium, especially from dairy foods, may help to reduce minorities' risk for obesity (71). Zemel et. al. (71) observed that when obese African American males increased their dietary calcium intake from approximately 400 to 1,000mg/day by consuming two cups of yogurt/day for one year, their body fat decreased by 4.0 kg. Subsequent observations from experimental animal and human epidemiological studies also indicate that calcium and particularly dairy foods help to control body fat (71).
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