Dairy Research Bulletin – November 2019 - California Dairy Research Foundation

Hello and welcome to the November 2019 bulletin. The Dairy Research Bulletin delivers a brief synopsis of the most current Human, Animal, and Environmental dairy research that is going on in the World, and also that which is of special interest to California dairy producers and consumers alike.

If you would like to peruse the most pertinent dairy research from months past, then visit the Dairy Research Bulletin Archive

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Selected Articles on Social Responsibility, Environmental Management, and Sustainability

California’s methane super-emitters. Duren RM, Thorpe AK, Foster KT, Rafiq T, Hopkins FM, Yadav V, Bue BD, Thompson DR, Conley S, Colombi NK, Frankenberg C, McCubbin IB, Eastwood ML, Falk M, Herner JD, Croes BE, Green RO, Miller CE. Nature. 2019 Nov;575(7781):180-184.

Methane is a powerful greenhouse gas and is targeted for emissions mitigation by the US state of California and other jurisdictions worldwide. However, data on point-source emissions are sparse and typically lack sufficient spatial and temporal resolution to guide their mitigation and to accurately assess their magnitude.
The aim of this study was to survey more than 272,000 infrastructure elements in California using an airborne imaging spectrometer that can rapidly map methane plumes.
The researchers conducted five campaigns over several months from 2016 to 2018, spanning the oil and gas, manure-management and waste-management sectors, resulting in the detection, geolocation and quantification of emissions from 564 strong methane point sources.
The researchers estimate net methane point-source emissions in California to be 0.618 teragrams per year, equivalent to 34-46 per cent of the state’s methane inventory for 2016.
The largest methane emitters in California are a subset of landfills, which exhibit persistent anomalous activity. Methane point-source emissions in California are dominated by landfills (41 per cent), followed by dairies (26 per cent) and the oil and gas sector (26 per cent).
This data have enabled the identification of the 0.2 per cent of California’s infrastructure that is responsible for these emissions. Sharing these data with collaborating infrastructure operators has led to the mitigation of anomalous methane-emission activity.

Preweaning cost of bovine respiratory disease (BRD) and cost-benefit of implementation of preventative measures in calves on California dairies: The BRD 10K study. Dubrovsky SA, Van Eenennaam AL, Aly SS, Karle BM, Rossitto PV, Overton MW, Lehenbauer TW, Fadel JG. J Dairy Sci. 2019 Nov 20. pii: S0022-0302(19)31016-1.

Bovine respiratory disease (BRD) is a multifactorial disease that is estimated to affect 22% of preweaned dairy calves in the United States and is a leading cause of preweaning mortality in dairy calves.
The goal of this paper was to develop an estimate of the cost of BRD based on longitudinal treatment data from a study of BRD with a cohort of 11,470 preweaned dairy calves in California.
Additionally, a cost-benefit analysis was performed for 2 different preventative measures for BRD, an increase of 0.47 L of milk per day for all calves or vaccination of all dams with a modified live BRD vaccine, using differing assumptions about birth rate and number of calves raised per year.
Average short-term cost of BRD per affected calf was $42.15, including the use of anti-inflammatory medications in the treatment protocols across all management conditions. A cost-benefit analysis examined different herd scenarios for a range of cumulative incidences of BRD from 3 to 25%.
Increasing milk fed was financially beneficial in all scenarios above a 3% cumulative incidence of BRD. Use of a modified live vaccine in dams during pregnancy, examining only its value as a form of BRD prevention in the calves raised on the farm, was only financially beneficial if the cumulative incidence of BRD exceeded 10 to 15% depending on the herd size and whether the dairy farm was raising any bull calves.
The cost-benefit analysis, under the conditions studied, suggests that producers with high rates of BRD may benefit financially from implementing preventative measures, whereas these preventative measures may not be cost effective to implement on dairy farms with very low cumulative incidences of BRD.

Risk factors affecting dairy cattle protective grouping behavior, commonly known as bunching, against Stomoxys calcitrans (L.) on California dairies. El Ashmawy WR, Williams DR, Gerry AC, Champagne JD, Lehenbauer TW, Aly SS. PLoS One. 2019 Nov 7;14(11):e0224987.

Bunching is the term used to describe the protective aggregating behavior of cattle against the painful bites of stable flies (Stomoxys calcitrans), where cattle gather in a group with their heads to the center of the group and their tails to the outside to reduce stable fly attack. Both sexes of the stable fly feed on blood, and their painful bites negatively impact cattle health, productivity and welfare.
A longitudinal study was conducted from April to July 2017 to estimate the stable fly activity on 20 California dairies (average herd size = 2466 ± 1050), to determine stable fly activity that induced bunching, and to evaluate the association between management and environmental factors, and cattle bunching.
Stable fly activity was recorded weekly using trap counts and leg counts. Cattle bunching at the dairy level was predicted by mean trap counts of ≥150 flies/trap/week, while bunching at the pen level was predicted by mean leg counts >1 fly/leg/cow or mean trap counts >50 flies/trap/week for traps closest to the pen.
Additional risk factors predicting cattle bunching at the dairy level were study week (May/June vs July), presence of crops adjacent to dairy >2 sides, and feeding wet distillers grain.
Additional risk factors predicting cattle bunching at the pen level were study week (May/June vs July), ambient temperature ≤30°C, pen design (freestall vs open dry lot or bedded pack), production status (lactating/dry vs close-up), presence of crops surrounding cattle pens, feeding rations containing molasses.
Cattle bunching was reduced at the pen level by relative humidity >50%, and when the cattle pen was surrounded by other cattle pens or was bordered by a main road. At the dairy level, removal of manure along fence lines of cattle pens was protective against cattle bunching.

Dairy farm soil presents distinct microbiota and varied prevalence of antibiotic resistance across housing areas. Liu J, Zhao Z, Avillan JJ, Call DR, Davis M, Sischo WM, Zhang A. Environ Pollut. 2019 Nov;254(Pt B):113058.

Dairy cattle of different ages experience different living conditions and varied frequency of antibiotic administration that likely influence the distribution of microbiome and resistome in ways that reflect different risks of microbial transmission.
To assess the degree of variance in these distributions, fecal and soil samples were collected from six distinct housing areas on commercial dairy farms (n = 7) in Washington State.
The results indicated that the microbiota differed between different on-farm locations in feces and soil, and in both cases, the microbiota of dairy calves was often distinct from others.
Thirty-two specific antibiotic resistance genes were widely distributed on dairies, of which several clinically relevant antibiotic resistance genes (including cfr, cfrB, and optrA) were identified for the first time at U.S. dairies.
Overall, antibiotic resistance genes were observed more frequently in feces and soil from dairy calves and heifers than from hospital, fresh, lactation and dry pens. Furthermore, in an extended analysis with 14 dairies, environmental soils in calf pens had the most antibiotic-resistant Escherichia coli followed by heifer and hospital pens.
All soil E. coli isolates (n = 1,905) are resistant to at least 4 different antibiotics, and further analysis indicated that florfenicol-resistant E.coli is probably shared across geographically-separated farms.
This study identified a discrete but predictable distribution of antibiotic resistance genes and organisms, which is important for designing mitigation for higher risk areas on dairy farms.

Bacterial concentrations in bedding and their association with dairy cow hygiene and milk quality. Robles I, Kelton DF, Barkema HW, Keefe GP, Roy JP, von Keyserlingk MAG, DeVries TJ. Animal. 2019 Nov 26:1-15.

Comparison of bacterial counts among common bedding types used for dairy cows, including straw, is needed. There is concern that the microbial content of organic bedding is elevated and presents risks for dairy cow udder health and milk quality.
The objectives of this study were to investigate:
1. % dry matter and bacterial counts (Streptococcus spp., all gram-negatives and specifically Klebsiella spp.) in different types of bedding sampled, and to investigate housing and farm management factors associated with % dry matter and bacterial counts;
2. if bedding type was associated with hygiene of cow body parts (lower-legs, udder, upper-legs and flank) and housing and management factors associated with hygiene;
3. bedding types associated with higher bacterial counts in cow milk at the farm level and bulk tank milk and management factors that were associated with highest BCs.
Seventy farms (44 free-stall and 26 tie-stall) in Ontario, Canada were visited 3 times, 7 days apart from October 2014 to February 2015. At each visit, composite samples of unused and used bedding were collected for % dry matter determination and bacterial culture.
Bedding classification for each farm were: new sand (n = 12), straw and other dry forage (n = 33), wood products (shavings, sawdust; n = 17) and recycled manure solids (RMSs)-compost, digestate (n = 8).
In used bedding, across all bedding samples, sand was driest, compared to straw and wood, and RMS; higher % dry matter was associated with lower Streptococcus spp. count. Streptococcus spp. and all Gram-negative bacteria counts increased with increasing days since additional bedding was added. Klebsiella spp. counts in used bedding were lower for wood products (5.9 ln cfu/mL) compared to all other bedding types.
Mean cow somatic cell count tended to be higher on farms with narrower stalls. Farms with mattress-based stalls had a higher prevalence of cows with dirty udders compared to those using a deep bedding system (often inorganic sand). Wider stalls were associated with lower bulk milk bacteria count. Lower % dry matter of used bedding was associated with higher bulk milk bacteria count.
In conclusion, bedding management may have a profound impact on milk quality, bacterial concentrations in the bedding substrates, and cow hygiene.

Inactivation of milk-borne pathogens by blue light exposure. Dos Anjos C, Sellera FP, de Freitas LM, Gargano RG, Telles EO, Freitas RO, Baptista MS, Ribeiro MS, Lincopan N, Pogliani FC, Sabino CP. J Dairy Sci. 2019 Nov 20. pii: S0022-0302(19)31026-4.

Milk is a highly nutritious food that also provides an excellent medium for growth of pathogenic microorganisms. Thus, dairy industry focuses most of their processes and costs on keeping contamination levels as low as possible.
Thermal processes for microbial decontamination may be effective; however, they cannot provide excellent organoleptic, nutritional, and decontamination properties simultaneously. In this scenario, microbial inactivation by exposure to blue light is a promising alternative method in the food industry due to its intrinsic antimicrobial properties free of any thermal effect.
This study aimed to determine the inactivation kinetics induced by blue light (λ = 413 nm) against Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa, Salmonella Typhimurium, and Mycobacterium fortuitum cells suspended in whole milk or saline solution. The researchers also performed a series of optic spectroscopies to investigate possible degradation of milk components.
All species were sensitive to photoinactivation suspended either in saline solution or milk. Inactivation kinetics differs significantly depending on the suspension medium and each species is differently affected. All bacterial species tested presented more than 5 log10 of inactivation within less than 2 h of irradiation (720 J/cm2).
Infrared spectroscopy did not reveal any significant alteration in any of the milk constituents (e.g., sugars, proteins, and lipids). Riboflavin (vitamin B2) was the only significantly degraded constituent found. Therefore, the researchers concluded that microbial inactivation performed by blue light presents extraordinary potential for processes in the dairy industry.

Transitioning from conventional to automatic milking: Effects on the human-animal relationship. Wildridge AM, Thomson PC, Garcia SC, Jongman EC, Kerrisk KL. J Dairy Sci. 2019 Nov 20. pii: S0022-0302(19)31024-0.

There are several differences in how an automatic milking system (AMS) and a conventional milking system (CMS) are managed, where the effect of milking system type on the human-animal relationship has remained unexplored.
A survey and observations from 5 Australian dairy farms transitioning from CMS to AMS were taken twice, 1 year apart, before and after transition to an AMS. The farmers completed a survey and had all farmer-cow interactions documented for 3 days.
The survey findings showed 4 out of 5 farms had less interaction time after AMS transition. This was caused by a reduction in milk harvesting tasks. As a result, an approximate 27% decline was observed in avoidance distances of cows from an AMS compared with the CMS.
A handling test was performed on 4 of the 5 farms before and after AMS transition, where the farmers were asked to move a selection of cows through a gate one at a time. In the AMS more vocal effort was required to move the cows, and the cows responded with a reduced occurrence of running past the farmer and reduced occurrence of slipping in an attempt to avoid the farmers compared with the CMS.
Overall, results show that farmers spent less time interacting with cows in the AMS, and that cows were less fearful around people as seen by reduced avoidance distances and reduced stress responses to close handling.

On-farm use of disease alerts generated by precision dairy technology. Eckelkamp EA, Bewley JM. J Dairy Sci. 2019 Nov 20. pii: S0022-0302(19)31030-6.

Wearable precision dairy monitoring (PDM) technologies currently used to detect estrus may provide insight into disease detection. However, the incorporation of PDM into farm management and its perceived usefulness for dairy producers have not been explored.
The objective of this research was to assess the perceived usefulness producers attributed to alerts from a daily generated alert list designed to identify sick or injured cows or cows that experienced a major management change.
Data from 1,171 cows on 4 commercial farms in Kentucky were collected from October 2015 to October 2016. Each cow was equipped with 2 PDM technologies: a leg tag (measuring activity in steps/d and lying time in h/d) and a neck collar (measuring eating time in h/d). Alerts were generated based on an individual cow’s decrease of ≥30% in activity, lying, and eating time compared with each cow’s 10-d moving mean.
Over the year, 24,012 cow alerts were generated (eating time, n = 9,543; lying time, n = 9,777; activity, n = 1,590; or a combination of behaviors, n = 3,102).
Producers were more likely to completely ignore alerts over time. Producers were more likely to perceive cow alerts to be true and visually check cows when ≤20 alerts occurred per day, cows were fresh or in early lactation, alerts occurred during the work week, or when cow alerts were for eating time, activity, or a combination of multiple behaviors.
Behavioral disease alerts must be improved and correspond to an actionable change for producers to use them. Incorporating herd management software, creating and managing alerts by lactation stage, and focusing on behaviors producers already find useful could improve future alert utilization.

Integrated Process for Bioenergy Production and Water Recycling in the Dairy Industry. Leandro MJ, Marques S, Ribeiro B, Santos H, Fonseca C. Microorganisms. 2019 Nov 9;7(11). pii: E545.

Dairy industries have a high environmental impact, with very high energy and water consumption and polluting effluents. To increase the sustainability of these industries it is urgent to implement technologies for wastewater treatment allowing water recycling and energy savings.
In this study, dairy wastewater was processed by 1) ultrafiltration and nanofiltration or 2) ultrafiltration and reverse osmosis (UF/RO) and retentates from the second membrane separation processes were assessed for bioenergy production.
Lactose-fermenting yeasts were tested in direct conversion of the retentates (lactose-rich streams) into bioethanol. Two Kluyveromycesstrains efficiently fermented all the lactose, with ethanol yields higher than 90% (>0.47 g/g yield).
Under severe oxygen-limiting conditions, the marxianusPYCC 3286 strain reached 70 g/L of ethanol, which is compatible with energy-efficient distillation processes. In turn, the RO permeate is suitable for recycling into the cleaning process.
The proposed integrated process, using UF/RO membrane technology, could allow water recycling (RO permeate) and bioenergy production (from RO retentate) for a more sustainable dairy industry.

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Selected Articles on Dairy Intake and Human Health

Changes in dairy product consumption and risk of type 2 diabetes: results from 3 large prospective cohorts of US men and women. Drouin-Chartier JP, Li Y, Ardisson Korat AV, Ding M, Lamarche B, Manson JE, Rimm EB, Willett WC, Hu FB. Am J Clin Nutr. 2019 Nov 1;110(5):1201-1212.

Whether changes in dairy product consumption are related to subsequent risk of type 2 diabetes (T2D) remains unknown.
In this study, the researchers evaluated the association of long-term changes in dairy product consumption with subsequent risk of T2D among US men and women.
The researchers followed up with 34,224 men in the Health Professionals Follow-Up Study (1986-2012), 76,531 women in the Nurses’ Health Study (1986-2012), and 81,597 women in the Nurses’ Health Study II (1991-2013).
Results of the 3 cohorts showed that decreasing total dairy intake by >1.0 serving/d over a 4-year period was associated with an 11% (95% CI: 3%, 19%) higher risk of T2D in the subsequent 4 year compared with maintaining a relatively stable consumption.
Increasing yogurt consumption by >0.5 serving/d was associated with an 11% (95% CI: 4%, 18%) lower T2D risk, whereas increasing cheese consumption by >0.5 serving/d was associated with a 9% (95% CI: 2%, 16%) higher risk compared with maintaining stable intakes.
Substituting 1 serving/d of yogurt or reduced-fat milk for cheese was associated with a 16% (95% CI: 10%, 22%) or 12% (95% CI: 8%, 16%) lower T2D risk, respectively.
Overall, increasing yogurt consumption was associated with a moderately lower risk of T2D, whereas increasing cheese consumption was associated with a moderately higher risk among US men and women. This study suggests that substituting yogurt or reduced-fat milk for cheese is associated with a lower risk of T2D.

Associations of dairy product consumption with mortality in the European Prospective Investigation into Cancer and Nutrition (EPIC)-Italy cohort. Pala V, Sieri S, Chiodini P, Masala G, Palli D, Mattiello A, Panico S, Tumino R, Frasca G, Fasanelli F, Ricceri F, Agnoli C, Grioni S, Krogh V. Am J Clin Nutr. 2019 Nov 1;110(5):1220-1230.

The relation of dairy product consumption to health and mortality is controversial.
In this study, the researchers investigated associations of consumption of various dairy products with mortality in the Italian cohort of the European Prospective Investigation into Cancer and Nutrition (EPIC)-Italy study.
After a median follow-up of 14.9 years, 2468 deaths were identified in 45,009 participants: 59% from cancer and 19% from cardiovascular disease. No significant association of consumption of any dairy product with mortality was found in the fully adjusted models.
A 25% reduction in risk of all-cause mortality was found for milk intake from 160 to 120 g/d, but not for the highest (>200 g/d) category of intake when compared with non-consumption.
In this Italian cohort characterized by low to average milk consumption, the researchers found no evidence of a dose-response association between milk consumption and mortality and also no association of consumption of other dairy products investigated with mortality.

Association between dairy intake and fracture in an Australian-based cohort of women: a prospective study. Aslam H, Holloway-Kew KL, Mohebbi M, Jacka FN, Pasco JA. BMJ Open. 2019 Nov 21;9(11):e031594.

Given the inconsistent evidence on dairy consumption and risk of fracture, the researchers assessed the association between milk/total dairy consumption and major osteoporotic fracture in women from the Geelong Osteoporosis Study.
Women aged ≥50 years (n=833) were followed from baseline (1993-1997) to date of first fracture, death or 31 December 2017, whichever occurred first. Dairy consumption was assessed by self-report at baseline and the follow-up phases.
During follow-up (11,507 person-years), 206 women had a major osteoporotic fracture.
Consuming >500 mL/d of milk was not significantly associated with increased risk for major osteoporotic fracture. Non-milk drinkers and consumption of ≥800 g/d total dairy had marginally higher risk for major osteoporotic fracture compared with consuming <250 mL/d of milk and 200-399 g/d of total dairy, respectively.
Milk consumption was inversely associated with serum hsCRP and CTx, but total dairy consumption was not associated with these serum markers.
Higher milk consumption did not increase the risk for major osteoporotic fracture in older women. However, a trend for increased major osteoporotic fracture was detected in zero milk and higher total dairy consuming women.

Impact of whole dairy matrix on musculoskeletal health and aging-current knowledge and research gaps. Geiker NRW, Mølgaard C, Iuliano S, Rizzoli R, Manios Y, van Loon LJC, Lecerf JM, Moschonis G, Reginster JY, Givens I, Astrup A. Osteoporos Int. 2019 Nov 14.

Dairy products are included in dietary guidelines worldwide, as milk, yoghurt, and cheese are good sources of calcium and protein, vital nutrients for bones and muscle mass maintenance. A low peak bone mass has consequences later in life, including increased risk of osteoporosis and fractures.
Currently, more than 200 million people worldwide suffer from osteoporosis, with approximately 9 million fractures yearly. This poses a tremendous economic burden on health care. Between 5% and 10% of the elderly suffer from sarcopenia, the loss of muscle mass and strength, further increasing the risk of fractures due to falls.
Evidence from interventional and observational studies support that fermented dairy products in particular exert beneficial effects on bone growth and mineralization, attenuation of bone loss, and reduce fracture risk.
The effect cannot be explained by single nutrients in dairy, which suggests that a combined or matrix effect may be responsible similar to the matrix effects of foods on cardiometabolic health.
Recently, several plant-based beverages and products have become available and marketed as substitutes for dairy products, even though their nutrient content differs substantially from dairy. Some of these products have been fortified, in efforts to mimic the nutritional profile of milk, but it is unknown whether the additives have the same bioavailability and beneficial effect as dairy.
This article concludes that the dairy matrix exerts an effect on bone and muscle health that is more than the sum of its nutrients, and the researchers suggest that whole foods, not only single nutrients, need to be assessed in future observational and intervention studies of health outcomes.

Consumption of Meat and Dairy Products Is Not Associated with the Risk for Rheumatoid Arthritis among Women: A Population-Based Cohort Study. Sundström B, Ljung L, Di Giuseppe D. Nutrients. 2019 Nov 19;11(11). pii: E2825.

Diet has gained attention as a risk factor for the development of rheumatoid arthritis, especially with regards to food of animal origin, such as meat and dairy products.
By using data from national patient registers and dietary data from a large prospective population cohort, the Swedish Mammography Cohort, the researchers aimed to investigate whether the consumption of meat and dairy products had any impact on the risk of subsequent development of rheumatoid arthritis.
During 12 years of follow-up (January 2003-December 2014; 381, 456 person-years), 368 patients with a new diagnosis of rheumatoid arthritis were identified. No associations between the development of rheumatoid arthritis and the consumption of meat and meat products or the total consumption of milk and dairy products were observed.
In conclusion, in this large prospective cohort of women, no associations were observed between dietary intake of meat and dairy products and the risk of rheumatoid arthritis development.

Dairy products influence gut hormone secretion and appetite differently: A randomized controlled crossover trial. Hansson P, Holven KB, Øyri LKL, Brekke HK, Gjevestad GO, Rehfeld JF, Raza GS, Herzig KH, Ulven SM. J Dairy Sci. 2019 Nov 20. pii: S0022-0302(19)31029-X.

Little is known about how dairy products with different nutrient contents and food matrices affect appetite sensation and gut hormone secretion.
The objective of this study was to investigate how appetite sensation and gut hormone secretion in healthy adults are affected by meals with the same amount of fat but from different dairy products.
Forty-seven healthy adults (70% women) were recruited to a randomized controlled crossover study with 4 dairy meals consisting of butter, cheese, whipped cream, or sour cream, corresponding to 45 g (approximately 60 energy percent) of fat.
Plasma samples were collected for analysis of cholecystokinin (CCK), pancreatic polypeptide (PP), peptide YY (PYY), and ghrelin concentrations at 0, 2, 4, and 6 hours after the meals. Hunger, satiety, and appetite sensations were measured with a visual analogue scale (VAS) immediately after finishing the meals and at 4 and 6 hours postprandially.
Intake of cheese induced a higher level of plasma PP over 6 hours compared with butter or whipped cream, and a higher level of plasma CCK over 6 hours compared with whipped cream. Intake of cheese increased postprandial plasma PP and CCK concentrations and decreased appetite compared with whipped cream but not with sour cream.
Intake of whipped cream increased appetite at 4 hours compared with cheese or sour cream, and at 6 hours compared with cheese or butter. No significant meal effect was found for hunger, satiety, plasma PYY, or plasma ghrelin concentration.
These findings encourage further investigations of how different dairy products affect gut hormone secretion and appetite sensation.

Comparing the cost of essential nutrients from different food sources in the American diet using NHANES 2011-2014. Hess JM, Cifelli CJ, Agarwal S, Fulgoni VL 3rd. Nutr J. 2019 Nov 9;18(1):68.

One reason that some Americans do not meet nutrient needs from healthy eating patterns is cost. Food cost affects how people eat, and healthy diets tend to be more expensive. Cost is also important for diet sustainability. Sustainable eating patterns must be both nutritionally adequate and affordable.
The objective of this study was to compare the cost of obtaining shortfall nutrients from different food groups to help identify cost-effective ways Americans can move towards healthy and sustainable eating patterns.
This analysis used dietary intake data from the National Health and Nutrition Examination Survey from 2011 to 2012 and 2013-2014 (n = 5,876 children 2-18 years and n = 9,953 adults 19-99 years).
The daily mean cost of food was $4.74 for children and $6.43 for adults. “Protein foods” and “mixed dishes” were the two most expensive food categories (43-45% of daily food costs), while “grains,” “fruits,” and “vegetables” combined accounted for ~ 18% of the daily cost, and “milk and dairy” accounted for 6-12% of total daily food costs in both adults and children.
“Milk and dairy” were the least expensive dietary sources of calcium and vitamin D in the American diet, while “grains” were the least expensive sources of iron and magnesium.
“Milk and dairy” were inexpensive sources of three of the four nutrients of public health concern (calcium, vitamin D, and potassium), while “grains” were the least expensive source of fiber. The results of this work reinforce the importance of consuming a variety of nutrient-rich foods for cost-effective, sustainable eating patterns.

Affordability of the EAT-Lancet reference diet: a global analysis. Hirvonen K, Bai Y, Headey D, Masters WA. Lancet Glob Health. 2019 Nov 7. pii: S2214-109X(19)30447-4.

The EAT-Lancet Commission drew on all available nutritional and environmental evidence to construct the first global benchmark diet capable of sustaining health and protecting the planet, but it did not assess dietary affordability.
In this study, the researchers used food price and household income data to estimate affordability of EAT-Lancet benchmark diets, as a first step to guiding interventions to improve diets around the world.
The researchers compared total diet cost per day to each country’s mean per capita household income, calculated the proportion of people for whom the most affordable EAT-Lancet diet exceeds total income, and also measured affordability relative to a least-cost diet that meets essential nutrient requirements.
The most affordable EAT-Lancet diets cost a global median of US$2.84 per day in 2011, of which the largest share was the cost of fruits and vegetables (31.2%), followed by legumes and nuts (18.7%), meat, eggs, and fish (15.2%), and dairy (13.2%). This diet costs a small fraction of average incomes in high-income countries but is not affordable for the world’s poor.
The researchers estimated that the cost of an EAT-Lancet diet exceeded household per capita income for at least 1.58 billion people. Data and analysis for the cost of healthier foods are needed to inform both local interventions and systemic changes.

Whey protein isolate supplementation improves body composition, muscle strength, and treatment tolerance in malnourished advanced cancer patients undergoing chemotherapy. Cereda E, Turri A, Klersy C, et al. Cancer Med. 2019 Nov;8(16):6923-6932.

In recent years, whey proteins (WP) have attracted increasing attention in health and disease for their bioactive functions.
The aim of this study was to evaluate the benefit of WP isolate (WPI) supplementation in addition to nutritional counseling in malnourished advanced cancer patients undergoing chemotherapy.
In a single-center, randomized and parallel-group controlled trial, 166 malnourished advanced cancer patients with mixed tumor entities candidate to or undergoing chemotherapy were randomly assigned to receive nutritional counseling with (N = 82) or without (N = 84) WPI supplementation (20 g/d) for 3 months.
The primary endpoint was the change in phase angle. Secondary endpoints included changes in standardized phase angle, fat-free mass index, body weight, muscle strength, and chemotherapy toxicity.
In patients with the primary endpoint assessed (modified intention-to-treat population), counseling plus WPI (N = 66) resulted in improved phase angle compared to nutritional counseling alone (N = 69).
WPI supplementation also resulted in improved standardized phase angle, fat-free mass index, body weight, muscle strength, and in a reduced risk of chemotherapy toxicity, particularly of severe events.
In malnourished advanced cancer patients undergoing chemotherapy, receiving nutritional counseling, a 3-month supplementation with WPI resulted in improved body composition, muscle strength, body weight, and reduced chemotherapy toxicity.