Milk in Spain and the History of Diet Change: The Political Economy of Dairy Consumption Since 1950

In barely three generations the Spanish diet has changed beyond recognition. The traditional concerns around nutritional health and scarcity have been mostly left behind, but they have given way to new problems linked to excess.In this book Fernando Collantes shows how the dairy industry has been central to this societal shift. From widespread calcium deficiency in the 1950s to the more recent, and controversial, turn to highly processed foods, it provides a recent history of diet change in Spain. Probing the reasons behind why this shift has occurred, and how, it shows that when it comes to food society, politics, economics and the law are intrinsically linked. Taking the reader beyond the world of food,Milk in Spain and the History of Diet Changecombines qualitative and quantitative methods to position diet change within the broader debate on consumer society and ‘the good life’. Contrasting two models of food consumption, it shows that unless public policy takes the challenge of affluence seriously, the food system can become an obstacle to a better society.

Milk in Spain and the history of diet change: The political economy of dairy consumption since 1950

BackgroundPeople with prediabetes can postpone or even reverse progression to type 2 diabetes (T2D) by making dietary changes. This study aimed to examine the association of changes in consumption of total and specific types of dairy products with the subsequent risk of incident T2D among individuals with prediabetes.MethodThis cohort study included 639 individuals (50% female, mean age 47.3 years) of the Tehran Lipid and Glucose Study (TLGS) who had prediabetes at baseline. We assessed 3-year changes in the consumption of dairy products using a food frequency questionnaire. Using multivariable logistic regression, odds ratios (OR) and 95% confidence intervals (CI) were calculated for the association of changes in intake of total and subtypes of dairy products during a 3-year interval with the risk of incident T2D in the subsequent 3 years.ResultsAfter almost 9 years of follow-up, the incidence of T2D was 25.2%. Compared with individuals whose intake remained relatively stable over 3 years, those who decreased consumption of total dairy (> 0.5 servings/day) had a higher T2D risk (OR = 1.56; 95% CI: 1.02 to 2.41). Increasing low-fat dairy consumption by 0.50 serving/d was associated with a lower risk of T2D (OR = 0.56; 95% CI: 0.35 to 0.90) compared with stable consumption. Those who increased consumption of low-fat milk (OR = 0.59; 95% CI: 0.37 to 0.92) and low-fat yogurt (OR = 0.55; 95% CI: 0.33 to 0.93) had a lower risk of T2D than those who were relatively stable in their consumption. Replacing low-fat milk and yogurt with regular cheese was associated with 66 and 47% higher risk of T2D, respectively.ConclusionIn individuals with prediabetes, increasing consumption of low-fat dairy, low-fat milk, and low-fat yogurt had reduced risk of subsequent T2D. These data suggest a role of low-fat dairy products in the prevention of T2D among prediabetes patients.

Background: In prehistoric societies, especially in the Neolithic period, the study of the palaeodiet assumes special importance as it is one of the points in human history characterised by important changes in diet. In this context, the study of food intolerances is even more significant. Methods: Some of the individuals studied were analysed from a genetic point of view, while a systematic literature review was performed from a genetic perspective, verifying the persistence or absence of lactase in adulthood, and information from necropolises regarding the presence of biomarkers linked to possible consumption of dairy products was analysed. Results: The results indicate a clear majority of individuals with hypolactasia in adulthood, although in a Pyrenean necropolis, studied here for the first time, the lactase persistence allele was already detected. Dairy consumption was also verified to be widespread in very early Neolithic periods. Conclusions: From a population perspective, this study enables a deeper understanding of past populations’ daily lives, expanding our perspective on their dietary patterns. From an evolutionary standpoint, it illuminates a pivotal point in human history and evolution within the European context, where past and modern dairy consumption, particularly cheese, has profound implications for both present and past economies.

This study employed an interdisciplinary approach to assess the impact of agricultural production modifications and dietary changes on ammonia emissions, health outcomes and health inequalities. Statistical and econometric methods were applied to analyse agricultural emission trends and dietary patterns. Spatial data analysis and numerical modelling techniques were used to simulate the dispersion and transformation of atmospheric pollutants. Health impact modelling estimated mortality and morbidity outcomes under various policy scenarios, while cost-effectiveness and cost-benefit analyses supported decision-making. A participatory approach involving multistakeholder engagement was utilised to enhance policy relevance and implementation feasibility. A systematic scoping review of academic studies on agricultural-derived air pollution and clinically coded outcomes revealed very limited research on this topic, which presents an inconsistent picture as to whether agricultural-derived particulate matter affects health. Key findings indicate that dietary modifications have greater potential health benefits than direct reductions in particulate matter exposure from ammonia emissions. Small reductions in meat and dairy consumption, supported by taxation and subsidies, could help achieve environmental and health targets. A 20% meat and dairy tax, coupled with a 20% subsidy on fruits and vegetables, could reduce meat consumption by 21.5% and increase fruit and vegetable intake by up to 13.5%. These dietary shifts also significantly lower greenhouse gas emissions and water use. While ammonia's environmental effects are well documented, its direct health impacts remain uncertain. Epidemiological studies suggest a possible association between ammonium-derived particulate matter and increased mortality and cardiorespiratory diseases, though findings are inconsistent. Toxicological assessments indicate limited intrinsic toxicity of ammonium nitrate and sulfate. A 'high-ambition mitigation' scenario integrating ammonia reduction measures with dietary shifts could prevent 67,000 premature deaths and 270,000 cases of respiratory diseases over 30 years. Notably, older adults and lower-income populations would experience the greatest health benefits. Most farm-based ammonia reduction strategies demonstrated net economic benefits, with only a few measures having limited abatement potential. Additionally, reduced greenhouse gas emissions further amplified the benefits of each scenario. Despite robust modelling techniques and multistakeholder engagement, several limitations exist. The direct health effects of ammonia-derived particulate matter remain an area of uncertainty, necessitating further epidemiological research. Additionally, while economic and environmental benefits were quantified, behavioural responses to policy interventions - such as consumer acceptance of dietary changes - require further exploration. The study primarily focused on UK-specific data, limiting generalisability to other regions with different agricultural practices and policy landscapes. Finally, unintended consequences of dietary shifts on food security and cultural preferences were not fully explored, indicating the need for future research to refine policy recommendations. The Assessing Mitigation Pathways to Realise Public Health Benefits of Air Pollutant Emission Reductions from Agriculture project provides a comprehensive, interdisciplinary framework for evaluating integrated policy measures. It underscores the importance of sustainable agricultural and dietary transitions in achieving cobenefits for public health and environmental sustainability, while emphasising the need for continued research to address remaining uncertainties. More detailed spatial and temporal analyses are required to fully understand the potential importance of significant local sources on human health in specific areas/times of year. There is a need to better align evidence of studies, such as Assessing Mitigation Pathways to Realise Public Health Benefits of Air Pollutant Emission Reductions from Agriculture, with toxicological studies which suggest that (pure) ammonium nitrate and sulfate have only very modest toxicity. This study is registered as PROSPERO CRD42020172116. This award was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (NIHR award ref: NIHR129440) and is published in full in Public Health Research; Vol. 14, No. 3. See the NIHR Funding and Awards website for further award information.

Background & AimsLimited observational evidence suggests that a higher intake of high-fat dairy may be associated with lower prediabetes risk, while opposite associations have been observed for low-fat milk intake. This study aimed to examine associations between baseline and changes in dairy consumption, risk of prediabetes, and glycaemic status. Methods7,521 participants from the prospective UK Fenland study were included (mean age 48.7±2.0 years, 51.9% female). Dairy intake was measured using self-reported food frequency questionnaires. Associations with prediabetes risk and glycaemic status were analysed using Poisson regression models adjusted for social demographics, health behaviours, family history of diabetes and food group intake. ResultsAt a mean follow-up of 6.7±2.0 years, 290 participants developed prediabetes (4.3%). Most dairy products were not significantly associated with prediabetes risk. A higher baseline intake of high-fat dairy (RRservings/day 1.20, 95%CI 1.03-1.39) and high-fat milk (RRservings/day 1.22, 1.01-1.47) were associated with higher prediabetes risk. Conversely, low-fat milk was associated with lower prediabetes risk (RRservings/day 0.86, 0.75-0.98). In the analyses evaluating dietary changes over time, increases in high-fat milk were inversely associated with risk of progressing from normoglycaemia to prediabetes or type 2 diabetes. ConclusionsThis population-based study showed that most dairy products not associated with prediabetes risk or progression in glycaemic status. Positive associations of high-fat dairy, high-fat milk, and the inverse association of low-fat milk with prediabetes risk found were inconsistent with prior literature and suggestive of the need for future research on environmental, behavioural, and biological factors that explain the available evidence.

Dietary changes can substantially reduce greenhouse gas emissions in Great Britain. Guidelines recommend reducing meat and dairy consumption while increasing plant-based foods, but household purchasing habits achieving these shifts are not well understood. Here we analysed food purchase data from ~30,000 British households (2012–2019), identifying 709 households that reduced their dietary greenhouse gas emissions by 34%. Using latent class analysis, we identified two distinct clusters among these households: plant-based adopters who reduced meat and dairy, adopting healthier diets; and households replacing meat with dairy and convenience foods, showing less healthy dietary changes. Plant-based adopters typically had higher education, higher incomes, were older (45+ years), and smaller in size. Households shifting toward dairy and convenience foods were older and smaller. Supporting healthy and sustainable diets requires targeted policies to enhance affordability, availability, and convenience of nutritious plant-based foods.

Why were products such as meat or milk relatively unimportant in the diet of European Mediterranean populations up until the 1960s? Conventional wisdom has it that this was a consequence of the environmental and macroeconomic conditions prevailing in the region, which basically involved aridity and economic backwardness. This article examines the case of dairy products in Spain in the 1950s and early 1960s; it then proposes a modified view in which environmental and macroeconomic factors are considered in conjunction with the political economy of the food chain and consumer agency. Even after considering the environmental constraints to production of cow’s milk and the obstacle posed by low household incomes, dairy consumption could have grown faster than it did. While consumer response to increased purchasing power was relatively passive, a rise in the relative price of milk cancelled out some of the income effect derived from rapid economic growth. This suggests that, in line with conventional wisdom, there were both supply-side and demand-side obstacles to increasing consumption of dairy products. Contrary to conventional wisdom, in this case supply-side obstacles were not primarily related to dairy farming but to other links in the chain, particularly commercial intermediation, while demand-side obstacles were not primarily quantitative, but qualitative.

The African American (AA) population is disproportionately impacted by chronic disease as well as many of the leading causes of preventable death, including hypertension, obesity, heart disease, stroke, and type 2 diabetes. In the AA community of Kane County, Illinois, the incidence of chronic disease is particularly high. A standardized Zoom-based group program that gives participants the knowledge, skills, and support to adopt a whole-food plant-based diet has been shown to rapidly improve health. The results of a cohort analysis were analyzed to assess the effectiveness of this program within an AA community characterized by a high burden of chronic illnesses. Participants were recruited from a network of 12 AA churches in Illinois to participate in Rochester Lifestyle Medicine Institute's "15-Day Whole-Food Plant-Based (WFPB) Jumpstart" program. The medically-facilitated 15-Day Jumpstart program provided WFPB nutrition education, coaching, and cooking demonstrations during seven 1 and 2-h Zoom sessions. Participants underwent pre- and post- metabolic screenings to assess for changes in their weight, vital signs, blood sugar, and cholesterol measurements. Changes in diet, biometrics, and patient-centered outcomes from baseline to the end of the program were assessed via paired t-tests for the normally distributed measures, and a Wilcoxon signed rank test for measures that were not normally distributed. Twenty-one AA adults participated. Ten of 16 who provided results had hypertension, 5 had diabetes, 5 had pre-diabetes, and 5 had hyperlipidemia. Participants ate more vegetables (median 2 servings at baseline vs. 3 during the program), greens (1 vs. 3), fruit (2 vs. 3), whole grains (1 vs. 2), and legumes (1 vs. 2). They decreased their consumption of meat, eggs and dairy, added fat, processed foods, and high-fat plant foods (p < 0.05 for each comparison). Participants reported significantly better energy (median 5 at baseline vs. 9 during the program, on a 10-point scale), sleep (7 vs. 8.5), and mood (8 vs. 9). Average weight loss was 5.8 pounds (199.9 to 194.1, p < 0.001), systolic blood pressure dropped from 129.7 to 119.9 (p = 0.02), and total cholesterol dropped from 185.1 to 147.9 (p < 0.001). All participants who provided data reported an intent to continue eating at least a partially WFPB diet following the program. The 15-Day WFPB Jumpstart program led to significant changes in diet, resulting in improvement in several chronic disease measures in this AA community. This rapid improvement can reinforce behavior change. Further large-scale implementation is needed to confirm these preliminary results and to understand whether behaviors and outcomes are sustained.

Background Sustainability and health concerns are driving dietary shifts globally, including changes in consumption of dairy products. Dairy provides essential micronutrients e.g., calcium, iodine, and B12 vitamin, and are a source of high-quality protein. They have also been associated with increased risk of diseases. We estimated the health risk-benefit balance of changes in dairy consumption in the Danish population, formulated as three possible consumption scenarios. Methods We applied a risk-benefit assessment approach to compare the health impact of current consumption with the impact of three alternative scenarios (AS) of dairy consumption. We accounted for beneficial and adverse health impacts associated with dairy and micronutrients and estimated disability adjusted life years (DALY) caused or prevented by the theoretical changes in consumption. Data were collected from the Danish food consumption survey, literature and the Global Burden of Disease Study. Results Results showed that a decrease in consumption of dairy in the overall population from current intake to 270 g/day (AS1) would lead to a loss of 4,865 healthy years annually (3,434; 6,344). The health outcomes contributing more were intellectual disability (men) and type 2 diabetes (women). Negative impacts were larger in men than women. Decreasing consumption would also lead to a higher proportion of women below recommended intake of iodine and of children of calcium. In contrast, increasing consumption to 500g/day (AS2) or to estimated optimal consumption for each health outcome (AS3) would lead to a health benefit (3,853 and 11,354 DALYs averted, respectively). We will present results of scenario analyses and discuss impact of assumptions. Conclusions Our estimates emphasize the need to quantify impacts of dietary changes, including health risks and benefits. They will be useful to inform public health policies that consider both sustainability and health impacts of dietary transitions. Key messages • We estimate that the Danish population will loose approximately 5000 healthy life years annually if dairy intake is decreased from the current level. • We argue that our assessment provide quantitative evidence of the trade-offs of shifts in dairy product intake.

IntroductionHyperuricemia is a strong risk factor for gout. The incidence of gout and hyperuricemia has increased recently, which is thought to be, in part, due to changes in diet and lifestyle. Objective of this study was to investigate the association between plasma urate concentration and: a) food items: dairy, sugar-sweetened beverages (SSB) and purine-rich vegetables; b) related nutrients: lactose, calcium and fructose.MethodsA total of 2,076 healthy participants (44% female) from a population-based case-control study in Scotland (1999–2006) were included in this study. Dietary data was collected using a semi-quantitative food frequency questionnaire (FFQ). Nutrient intake was calculated using FFQ and composition of foods information. Urate concentration was measured in plasma.ResultsMean urate concentration was 283.8±72.1 mmol/dL (females: 260.1±68.9 mmol/dL and males: 302.3±69.2 mmol/dL). Using multivariate regression analysis we found that dairy, calcium and lactose intakes were inversely associated with urate (p = 0.008, p = 0.003, p = 0.0007, respectively). Overall SSB consumption was positively associated with urate (p = 0.008), however, energy-adjusted fructose intake was not associated with urate (p = 0.66). The intake of purine-rich vegetables was not associated to plasma urate (p = 0.38).ConclusionsOur results suggest that limiting purine-rich vegetables intake for lowering plasma urate may be ineffectual, despite current recommendations. Although a positive association between plasma urate and SSB consumption was found, there was no association with fructose intake, suggesting that fructose is not the causal agent underlying the SSB-urate association. The abundant evidence supporting the inverse association between plasma urate concentration and dairy consumption should be reflected in dietary guidelines for hyperuricemic individuals and gout patients. Further research is needed to establish which nutrients and food products influence plasma urate concentration, to inform the development of evidence-based dietary guidelines.

The etiology of colorectal disease revolves around genetic and environmental factors, particularly diet. A meta-analysis in the 7 July 2004 issue of the Journal of the National Cancer Institute suggested that consuming more dairy products and calcium may reduce colorectal cancer risk, but epidemiologic studies on this link have yielded inconsistent results. One explanation for this inconsistency may be the timing of exposure: cancer develops over decades, and early-life exposures to carcinogens and growth factors could be a critical factor. A new study designed to address this possibility has found that adults who consumed more dairy during childhood may have a greater risk of developing colorectal cancer in adulthood. The results appear in the December 2007 issue of the American Journal of Clinical Nutrition. Colorectal cancer is among the leading causes of mortality in developed countries; according to the National Cancer Institute, about 630,000 deaths were expected to occur worldwide in 2007. Even moderate changes in diet and lifestyle could prevent at least 70% of all colorectal cancer cases, according to a review in the December 2002 Gastroenterology Clinics of North America. The main culprits appear to be excessive caloric intake, as well as frequent consumption of red meat, processed meats, alcohol, and refined carbohydrates. The historical cohort study employed data from the Carnegie Survey, conceptualized by Sir John Boyd Orr, which recorded food consumption patterns in 1,343 English and Scottish families from 1937 to 1939. The survey was designed to investigate the long-range impact of children’s diet, growth, living conditions, and health on adult cardiovascular disease. Dietary data were obtained using a 7-day household inventory; also, weighed inventories of all foods in the household were conducted at the start and end of the survey period. The average follow-up time for adults included in this study was 65 years; 4,374 individuals were available for follow-up between 1948 and 2005. Daily intake of dairy products ranged from less than 0.5 cup at the lowest level to nearly 2 cups at the highest; liquid milk constituted 94% of the dairy intake. Those individuals who grew up in families reporting the highest levels of dairy consumption showed a nearly threefold increase in the risk of colorectal cancer compared with those from families reporting the lowest intake. The elevated risk remained even after the researchers adjusted the data for potential confounders such as socioeconomic status and meat, fruit, and vegetable intake. No other cancers were significantly affected by higher dairy intakes. “The mechanisms underlying these associations remain unknown, but there is increasing evidence that nutrition early in life can have long-lasting programming effects,” says lead author Jolieke C. van der Pols, an epidemiologist at the University of Queensland. For example, childhood dairy intake appears to be inversely associated with adulthood concentrations of insulin-like growth factor 1 (IGF-1), a key player in the development and progression of colorectal cancer. But it’s the effect of early dairy intake on childhood (rather than on adult) concentrations of IGF-1 that may be the important mediator of colorectal cancer risk. The findings seem perplexing given previous research showing an association between high dairy/calcium consumption and lower risk of colorectal cancer in adulthood. “In adults, this protection occurs despite the increase in growth factors, which would be expected to increase risk,” says epidemiologist Edward Giovannucci of the Harvard School of Public Health. “It is possible, though not proven, that the increase in growth factors early in life may be more important for colorectal cancer risk.” Giovannucci asserts that the new findings are biologically plausible and warrant efforts to replicate these findings in other populations and settings. Andrew Szilagyi, a gastroenterologist and assistant professor of medicine at McGill University School of Medicine, points out the lack of data on adult dietary intakes in the Boyd Orr cohort. “We do not know any aspects of dietary intake in adulthood,” Szilagyi says. “Nor do we know that the adults who developed colorectal cancer were also the very children in the families that indeed had higher dairy intakes.” In light of the fact that most studies have reported a protective effect of dairy products, it is important to determine the extent to which the former diet was continued into adulthood, he notes. The milk consumption levels identified as posing a significant cancer risk in the Boyd Orr cohort are similar to current average intakes for U.S. children. Nonetheless, the researchers assert that it would be premature to consider altering current guidelines for children’s nutrition. “Dairy products are important contributors to children’s intake of protein, vitamins, and minerals,” says van der Pols. “Because this is only the first study to show associations between childhood dairy consumption and risk of cancer in adulthood, more evidence is needed before any firm conclusions can be drawn.”

Changes in dairy product consumption and risk of type 2 diabetes: results from 3 large prospective cohorts of US men and women

Background: The existing body of literature suggests that modifiable lifestyle behaviors such as alcohol consumption and dietary behaviors were linked to viral hepatitis B/C and liver cancer. So far, most of the liver cancer awareness campaigns and behavioral interventions have focused on preventive behaviors such as screening, vaccination, and early diagnosis. Not enough efforts have been made to raise awareness of behavioral mechanism of liver cancer prevention, especially in the medically underserved populations. Methods: We used the community-based participatory research (CBPR) approach to implement an education initiative regarding the promotion of liver cancer among the African, Asian, and Hispanic populations within the Philadelphia metropolitan area and New York City. In this study, we used data from the pre-education surveys and follow-up assessments at 6 months post-education to assess the changes in dietary behaviors and alcohol consumption among participants. Results: The study sample includes 344 participants recruited through community-based organizations. The sample consists of 31 African Americans, 174 Asian Americans, and 139 Hispanic Americans. Among the African Americans participants, the consumption of scores such as fruits (2.710 to 3.581) and poultry (2.613 to 3.677) increased significantly, while vegetables and red meats decreased. In Asian Americans, the consumption of non-refined cereals (3.362 to 4.282), red meats (2.655 to 3.195), and dairy (2.851 to 3.701) products decreased. Lastly, among the Hispanic American participants poultry (2.173 to 3.554), dairy products (2.101 to 3.863), and olive oil (3.022 to 3.849) increased, as well as the consumption of alcohol. Conclusion: This community-based educational imitative generated different impacts in the three populations, further highlighting the needs for more targeted, culturally tailored efforts in health promotion among these underprivileged communities. Citation Format: Tamar Tertulien, Ellen J. Kim, Wenyue Lu, Steven Zhu, Nathaly Rubio-Torio, Evelyn González, Marilyn A. Fraser, Ming-Chin Yeh, Lin Zhu, Grace X. Ma, Olorunseun O. Ogunwobi, Yin Tan. Reducing liver cancer risk through dietary change: Positive results from a community-based educational initiative in three racial/ethnic groups [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr C069.

The initial movement of herders and livestock into the eastern steppe is of great interest, as this region has long been home to pastoralist groups. Due to a paucity of faunal remains, however, it has been difficult to discern the timing of the adoption of domesticated ruminants and horses into the region, though recent research on ancient dairying has started to shed new light on this history. Here we present proteomic evidence for shifts in dairy consumption in the Altai Mountains, drawing on evidence from sites dating from the Early Bronze to the Late Iron Age. We compare these finds with evidence for the rise of social complexity in western Mongolia, as reflected in material remains signaling population growth, the establishment of structured cemeteries, and the erection of large monuments. Our results suggest that the subsistence basis for the development of complex societies began at the dawn of the Bronze Age, with the adoption of ruminant livestock. Investments in pastoralism intensified over time, enabling a food production system that sustained growing populations. While pronounced social changes and monumental constructions occurred in tandem with the first evidence for horse dairying, ~1350 cal BCE, these shifts were fueled by a long-term economic dependence on ruminant livestock. Therefore, the spread into the Mongolian Altai of herds, and then horses, resulted in immediate dietary changes, with subsequent social and demographic transformations occurring later.