Importance Postnatal cytomegalovirus (CMV) infection can cause serious morbidity and mortality in very low-birth-weight (VLBW) infants. The primary sources of postnatal CMV infection in this population are breast milk and blood transfusion. The current risks attributable to these vectors, as well as the efficacy of approaches to prevent CMV transmission, are poorly characterized.
Conclusions and Relevance Transfusion of CMV-seronegative and leukoreduced blood products effectively prevents transmission of CMV to VLBW infants. Among infants whose care is managed with this transfusion approach, maternal breast milk is the primary source of postnatal CMV infection.
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In this randomized, controlled, double-blinded study, the team examined the effects of increasing protein concentration and increasing the proportion of whey protein in milk consumed with a high-carbohydrate breakfast cereal on blood glucose, feelings of satiety, and food consumption later in the day. Digestion of the whey and casein proteins naturally present in milk releases gastric hormones that slow digestion, increasing feelings of fullness. Digestion of whey proteins achieves this effect more quickly, whereas casein proteins provide a longer lasting effect.
Although the team only found a modest difference in food consumption at the lunch meal when increasing whey protein at breakfast, they did find that milk consumed with a high-carbohydrate breakfast reduced blood glucose even after lunch, and high-protein milk had a greater effect. Milk with an increased proportion of whey protein had a modest effect on pre-lunch blood glucose, achieving a greater decrease than that provided by regular milk.
According to Dr. Goff and colleagues, \"This study confirms the importance of milk at breakfast time to aid in the slower digestion of carbohydrate and to help maintain lower blood sugar levels. Nutritionists have always stressed the importance of a healthy breakfast, and this study should encourage consumers to include milk.\"
Cardiovascular disease (CVD) is a group of disorders that affects the heart and blood vessels and is the leading cause of mortality worldwide. In 2008, CVD accounted for 17.5 million deaths worldwide; CVD mortality has been projected to rise to 23.6 million by 2030.1 CVD risk factors consist of non-modifiable (that is, age, gender and family history) and modifiable (that is, hypertension, hyperlipidemia, physical inactivity, overweight and obesity) risk factors.2 The latter category is mainly related to an unhealthy lifestyle and diet.3 Certain foods or their components are widely used in the prevention and/or management of disease, particularly in CVD.4 As mentioned, hypertension is a modifiable risk factor of CVD. Therefore, any component of foods that possesses hypotensive effects on blood pressure (BP) may act as a potential therapeutic in the prevention or management of CVD. Milk proteins have been suggested to have hypotensive properties.5 A number of clinical trials have been carried out to evaluate the effect of milk proteins from whole foods and supplements on BP.6, 7, 8, 9, 10, 11, 12, 13 However, the sample size of these trials was small, the quality and duration of trials varied widely, and, most importantly, the effect of milk proteins on BP was not clarified. Therefore, we conducted a meta-analysis of randomized controlled trials (RCTs) to provide insight into and robust evidence concerning the overall impact of milk proteins on BP.
Milk proteins from whole foods or supplements were considered the intervention arm in this meta-analysis. In cases in which the multi-arm interventions included milk proteins with other agents (that is, vitamin D, calcium and lycopene) and plain milk proteins (that is, plain milk and whey protein isolate), we used plain milk proteins as the intervention arm.8, 9 The net changes of each outcome in the intervention and control groups were reported as differences between mean values at baseline and post intervention. If necessary, standard errors, confidence intervals (CIs) and P values were converted to s.d. for the analysis. s.d. for changes from baseline in each group were obtained. Studies with no reported s.d. values had their values imputed using a standard formula.17 If only s.d. for the baseline and final values were provided, we computed s.d. for net changes using the method proposed by Follmann et al.18 in which a correlation coefficient of 0.5 was assumed. We calculated s.d. values in studies by Pal et al.7 and Figueroa et al.11 using reported standard error values.
A meta-analysis by Rebholz et al.23 suggests that dietary protein intake from animals and vegetables leads to lower BP. There are several reasons why we need to specifically examine the effect of milk proteins and BP. Milk and dairy products are widely consumed around the world on a daily basis. Moreover, it is generally accepted that milk protein is the most commonly used protein supplement. Furthermore, intact milk proteins and milk-protein-derived peptide supplementations have been shown to reduce BP.5 Thus, further evidence of the impact of milk proteins on BP is needed.
Subgroup analyses showed that participants who consumed higher doses of milk proteins had greater reductions in BP than participants who consumed lower doses. It is possible that a higher overall protein intake did lead to this beneficial effect.33, 34, 35, 36, 37 Moreover, higher dietary protein intake (particularly from tryptophan-rich foods such as milk) may also contribute to increased amino acid tryptophan levels, which have been shown to reduce BP in animal studies.38, 39 Unfortunately, we could not provide a dose recommendation for the prevention of hypertension in this meta-analysis. Future observational studies conducted on both normotensive and hypertensive populations are required to determine the appropriated dose of milk proteins.
Interestingly, when we further stratified the data by type of protein intake, there was no noteworthy change in the BP of participants who consumed milk protein from whole foods. In contrast, those who consumed milk proteins from supplements experienced significant reductions in BP. These findings were reasonable because both casein and whey protein supplements are in concentrated form and therefore contain more protein and peptides than regular milk. As mentioned, higher dietary protein intake may help reduce BP. Thus, we hypothesized that the higher the intake of protein and bioactive peptides, the stronger the hypotensive effect on BP will be.
Unsurprisingly, significant reductions in BP were observed in trials with younger participants, whereas no noteworthy change was observed in trials with older participants. It has been suggested that the rise in BP is an inevitable consequence of aging.41 When we looked more closely at the daily dose of milk proteins in these groups, we found that the dose of milk proteins in the older participants was lower than in the younger participants. Based on these findings, we hypothesized that the beneficial effects of milk proteins in older participants might only occur with higher doses.
There are several limitations to this meta-analysis. First, the sample sizes of the individual trials were relatively small, which limited the capacity of randomization to minimize the potential influences of confounding factors. Second, the validity of our meta-analysis depended upon the quality of the individual studies. Although all studies were randomized, parallel trials, the allocation concealment, quality of randomization, details of withdrawals and details of BP measurement were not always reported. Third, only seven studies were eligible for this meta-analysis, all of which were conducted in participants with specific medical conditions, such as hypercholesterolemia, overweight and obese with metabolic syndrome, which may limit the generalization of the findings. Fourth, the included studies were predominantly conducted in Western populations, which are known to have higher milk and dairy product intake compared with other populations. Therefore, these findings may not be completely generalizable to other populations, particularly those consuming very low levels of milk proteins. Finally, the format in which the data were reported in each study varied widely (for example, two of the included studies reported standard errors instead of s.d.), which made data extraction difficult and may have influenced the extracted result. Therefore, results from our meta-analysis should be interpreted with caution. Despite these limitations, to date, few RCTs have investigated the effect of milk proteins on BP. Thus, this current meta-analysis provides a comprehensive overview of the previous published literature addressing the effect of milk proteins on BP. This analysis also highlights the need for further interventions to investigate the effect of milk proteins on BP and hypertension, which may help scientists, policy makers and the industry determine the value of milk protein as an effective strategy for hypertension prevention or adjuvant antihypertensive therapy.
In contrast to the antihypertensive medications that often cause negative side effects on health,42, 43 with proper dosage, food-derived proteins with hypotensive properties are relatively safer for consumption by individuals with a variety of other disease conditions. Although it is too early to recommend milk proteins as a supplement or alternative to pharmaceutical medications for hypertension, this meta-analysis provides further evidence that milk proteins slightly but significantly lower both systolic and diastolic BP. Future large-scale, long-term, well-design