European Journal of Clinical Nutrition (2017) 71, 573–579

© 2017 Macmillan Publishers Limited, part of Springer Nature. All rights reserved 0954-3007/17
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REVIEW
Yogurt, diet quality and lifestyle factors
S Panahi1, MA Fernandez2,3,4, A Marette2,4,5 and A Tremblay1,3,4

Yogurt consumption has been associated with healthy dietary patterns and lifestyles, better diet quality and healthier metabolic
profiles. Studies have shown that frequent yogurt consumers do not only have higher nutrient intakes, but also an improved diet
quality, which includes higher consumption of fruits and vegetables, whole grains, and dairy compared with low or non-consumers
indicating better compliance with dietary guidelines. Recent epidemiological and clinical evidence suggests that yogurt contributes
to better metabolic health because of its effects on the control of body weight, energy homeostasis and glycemic control.
Furthermore, yogurt consumers have been shown to be more physically active (⩾ 2 h/week), smoke less, have higher education
and knowledge of nutrition compared with non-consumers. Thus, yogurt consumption may be considered a signature of a healthy
diet through its nutritional content, impact on metabolic health including the control of energy balance, body weight and glycemia
and its relationships with healthier behaviors and lifestyle factors.

European Journal of Clinical Nutrition (2017) 71, 573–579; doi:10.1038/ejcn.2016.214; published online 2 November 2016

INTRODUCTION represent the overall combination of foods regularly consumed,

It is a matter of general belief that there are no detectable effects
of a single food that could be sufficient enough to produce a
change in the metabolic profile of individuals in a free-living
context. However, recent studies have emphasized specific
beneficial effects of yogurt consumption on body weight and
glycemic control.1–5 In a study examining the relationship
between the effects of consumption of specific foods and long-
term body weight changes, yogurt was found to predict a
decrease in body weight over time.6 More recently, Chen et al.7
analyzed the relationship between dairy food consumption and
the proneness to type 2 diabetes in three large cohorts of men
and women. Although there were no associations between dairy
consumption and the proneness to diabetes, a detailed analysis of
specific dairy foods showed that yogurt consumption predicted a
significantly lower risk of developing diabetes across the three
cohorts. In the same study, a meta-analysis of 14 prospective
cohorts showed a marginally lower risk of type 2 diabetes with
higher dairy consumption and a consistent inverse association
between yogurt consumption and type 2 diabetes risk.7 These
observations are concordant with numerous population studies
documenting the relationship between calcium and/or dairy
consumption and the predisposition towards glucose intolerance
and type 2 diabetes over time.8–11 Yogurt possesses unique
physical and physiological properties that may impact body
weight and glycemic control. Furthermore, the relative energy and
nutrient content and contribution of yogurt to the overall diet
suggest its nutrients largely contribute to nutrient requirements
and provides a strong contribution to the regulation of energy
metabolism. However, it is also important to examine yogurt
consumption in the context of the overall diet.
Healthy dietary patterns high in fruits and vegetables, low-fat
dairy, lean meats and pulses have been the cornerstone of obesity
prevention and diet-related chronic diseases. Dietary patterns
which collectively produce synergistic health effects.12 Growing
evidence suggests that energy balance and metabolic regulation
are a consequence of multiple complex effects, particularly diet
quality.12 Potential mechanisms for the control of energy balance
and metabolism may include calorie-dependent and -indepen-
dent effects of various types of foods on satiety, food intake,
glycemic response, visceral adiposity, brain reward systems,
energy expenditure and the gut microbiome.13–17 Based on these
influences, when consumed over years, certain foods may
promote a healthier body weight and contribute to improved
metabolic control.
Epidemiological studies suggest that dairy consumption is
linked to healthy dietary patterns, behaviors and lifestyle factors
and is associated with a reduced risk for metabolic diseases
including obesity and type 2 diabetes.8,18,19 Among the dairy
foods, yogurt has been of recent interest because of its high
nutrient density including the presence of calcium, magnesium
and protein, lactic acid bacteria, which may affect gut microbiota
and its ability to replace consumption of less healthy foods.20
Short-term clinical trials of yogurt and its components have been
shown to increase satiety, reduce food intake and improve
glycemic control.21–25 Dietary patterns such as the Meditteranean
and Dietary Approaches to Stop Hypertension recommend low-fat
dairy products such as yogurt as part of a healthy diet, which may
lead to an improvement in a range of risk factors for metabolic
diseases. After adjustment for the Nutrient-Rich Foods Index, a
marker of diet quality, consumers of yogurt have been shown to
have better anthropometric profiles, eating behaviors, physical
activity and metabolic health parameters that may help to prevent
a positive energy balance compared with yogurt non-consumers
(Panahi et al. unpublished data).
Several lifestyle factors also appear to interact with the diet and
its components to influence body weight and metabolic control

1
Department of Kinesiology, Université Laval, Québec City, Québec, Canada; 2Institute of Nutrition and Functional Foods, Université Laval, Québec City, Québec, Canada; 3School
of Nutrition, Université Laval, Québec City, Québec, Canada; 4Centre de Recherche de l`Institut de Cardiologie et de Pneumologie de Québec, Québec City, Québec, Canada and
5
Department of Medicine, Faculty of Agricultural and Food Sciences, Université Laval, Québec City, Québec, Canada. Correspondence: A Tremblay, Department of Kinesiology,
Université Laval, PEPS, Room 0234, 2300, rue de la Terrasse, Québec City, QC G1V 0A6, Canada.
E-mail: angelo.tremblay@kin.ulaval.ca
Received 24 May 2016; revised 19 September 2016; accepted 26 September 2016; published online 2 November 2016
 Yogurt, diet and lifestyle
S Panahi et al
574
including education, income, race/ethnicity, social norms and
network, local food availability, sleep quality and duration,
television viewing and physical activity.6,26,27 In some regions of
the world, yogurt has been suggested to be a marker of an overall
healthy diet and thus, consumption is higher among those with a
higher education19 and income.28 Thus, the question remains
whether the apparent improvements in health benefits are solely
attributed to yogurt consumption alone or whether the lifestyle
factors have a role between yogurt consumers and non-
consumers. Yogurt is readily available, accessible, a good source
of high-quality nutrients, simple to incorporate and a recom-
mended component of the diet; however, few studies have
examined yogurt as part of a healthy dietary pattern and its
interaction with other lifestyle factors, which may affect the
metabolic profile of individuals (Figure 1). The potential role of
yogurt as a marker of a healthy diet and lifestyle will be described
in this review by discussing the nutritional content of yogurt, its
impact on cardiometabolic health (obesity and type 2 diabetes)
and its relationship with sociodemographic and lifestyle factors.
Furthermore, an overview of current gaps and future perspectives
will be discussed.
YOGURT AND ITS NUTRITIONAL CONTENT
Within the dairy products food group, yogurt is a nutrient-dense
food with high digestibility, bioavailability of nutrients and
contains lactic acid bacteria, which may affect gut microbiota. It
is a complex mixture of proteins (whey protein and casein in the
ratio of 20:80), fats (saturated, mono- and poly-unsaturated fatty
acids) and carbohydrate (lactose), providing high-quality nutrients,
which have a wide range of bioactivities.29 Although milk and
yogurt are similar in their nutrient composition, these unique
properties may provide additional health benefits. The nutritional
content of yogurt varies depending on the processing method
and ingredients used. Yogurt is distinct from other common fresh
dairy products as it is a by-product of milk fermentation, and
contains live and active bacteria.30 Compared with milk, plain
yogurt is higher in specific nutrients including calcium, potassium
and protein as a result of the manufacturing and fermentation
processes, which produce a more concentrated dairy product.31
As recently described in a review by Panahi and Tremblay32, the
relative energy and nutrient content and contribution of a
recommended serving of yogurt (175 g) to the overall diet
Figure 1. The potential relationship between yogurt consumption, diet and lifestyle factors.
European Journal of Clinical Nutrition (2017) 573 – 579
suggests that the % daily intake of these nutrients largely
contributes to nutrient requirements. In the absence of dairy
consumption, it is difficult for individuals to meet the require-
ments for several nutrients, particularly for North American diets.
Dietary guidelines such as Canada’s Food Guide recommends
consumption of 2–4 servings of dairy products per day depending
on age.33 Thus, taking into account the overall diet of each
individual, consuming at least one serving of yogurt per day may
help to increase the intake of many shortfall nutrients such as
calcium, magnesium and potassium to meet dietary requirements.
In the National Health and Nutrition Examination Survey
(NHANES 2005–2008) investigating associations between yogurt
and dairy consumption and energy, macronutrient and micro-
nutrient intakes in US children, yogurt consumers (defined as
consuming 41 serving of yogurt on one or both 24-h food recalls)
had higher intakes of calcium, vitamin D, protein and potassium
and lower intakes of total and saturated fats (% daily energy)
compared with non-consumers.31 Although greater dairy con-
sumption was associated with higher caloric and saturated fat
intakes, yogurt consumption was not associated with higher
energy intakes. This may have been due to the wide range of fat
contents found in dairy products such as cheese, ice cream and
fluid milk. Furthermore, the use of 24-h dietary recalls may not
reflect habitual yogurt intakes, rely on memory and is susceptible
to over and under-reporting. In a cross-sectional study examining
whether yogurt consumption was associated with better diet
quality and metabolic profile among US adults (n = 6526)
participating in the Framingham Heart Study Offspring (1998–
2001) and Third Generation (2002–2005) cohorts, found that
yogurt consumers had higher potassium intakes and were 47%,
55%, 48%, 38% and 34% less likely to have inadequate intakes of
vitamins B2, B12, calcium, magnesium and zinc, respectively
(based on Dietary Reference Intakes).34 Another study, identifying
dietary insufficiencies and excesses in American children aged
2–11, found that their diets consisted of extra energy, sugars and
sodium but insufficient vitamin D, calcium and potassium. It was
suggested that substituting one serving of low sugar, whole milk
yogurt, paired with fruits or vegetables, for current snacks would
increase children’s consumption of valuable nutrients without
adding excess sugar or energy.35 Thus, consumption of yogurt
may improve nutrient adequacy and contribute to better overall
diet quality.36,37
© 2017 Macmillan Publishers Limited, part of Springer Nature.

YOGURT, DIETARY PATTERNS AND DIET QUALITY
Dietary patterns are of importance as they consider multiple
aspects and dimensions of diet simultaneously (that is, total diet).
Rather than using the single food or nutrient approach, they have
the potential to capture interactions that may occur between
nutrients and other food components, which may help in the
development of dietary-based guidelines. One of the main
methods of assessing dietary patterns is the use of dietary indices
or scores determined by a priori dietary guidelines and
recommendations.38 Diet indices represent a measure of healthy
eating patterns and are known as either diet quality or healthy
eating indices. The two most common diet scores include the
Health Eating Index and Diet Quality Index based on the US
dietary guidelines; however, there are others including Mediterra-
nean Diet Scores, Recommended Foods Score, Dietary Guidelines
Adherence Index and Nutrient-Rich Foods Index.38,39 Some of
these scores assess dietary quality on the basis of foods or food
groups, nutrients or combination of nutrients and foods. Although
using dietary scores have their limitations including the potential
lack of variation in population dietary intakes, and that few
individuals consume optimal diets (which may be a problem when
assessing associations between diet and health outcomes), they
indirectly assess intakes of nutrient and non-nutrient components
in foods and contribute to food-based dietary guidelines.
Dietary guidelines for Americans suggest higher intakes of fat-
free and low-fat milk and milk products although this is currently
debatable given that more studies are now demonstrating inverse
associations between consumption of higher fat dairy products
and cardiometabolic diseases such as obesity and type 2
diabetes.40,41 Furthermore, Canada’s Food Guide recommends
consumption of 2–4 servings of dairy products per day depending
on age. However, there are no recommendations for yogurt as a
separate food item. Low-fat and fat-free yogurts represent a large
proportion of the yogurt available and consumed in the United
States. They may be displacing other energy-dense foods or larger
portions in the diet or yogurt consumption may simply be a
marker for a more healthful dietary pattern. In US adults
participating in the Framingham Heart Study Offspring (1998–
2001) and Third Generation (2002–2005) cohorts, yogurt con-
sumers had a significantly higher Dietary Guidelines Adherence
Index score than non-consumers suggesting that consumers who
adhered to key dietary guidelines adherence recommendations
were more likely to have a better overall diet quality.34 In a study
estimating the number of portions of different milk-based food
categories fitting into nutritionally adequate diets using individual
diet modeling and data from adults in the 1999 French Enquête
Individuelle et Nationale sur les Consommations Alimentaires
survey (n = 1171), it was found that across milk-based food
categories, the optimization of the diet increased yogurts (+60%)
and milk (+17%) and decreased cheeses ( −48%) without a change
to milk desserts.42 Cheeses represented one out of two consumed
portions of milk-based products in observed diets, whereas in
modeled diets cheeses, milk and yogurts each represented about
one portion per day.42 Data from the NHANES (2003–2006)
assessed diet quality by the healthy eating index-2005 using one
24-h dietary recall and found that frequent yogurt consumers had
significantly better diet quality than infrequent consumers and
consumed more fruits, whole grains and milk suggesting better
compliance to the recommendations of the dietary guidelines
adherence.43 In many of these studies, the types of yogurt (for
example, high-fat or low-fat, sweetened or unsweetened, plain,
probiotic) and quantities consumed were not assessed. However,
for yogurt, the classication of 'high fat' versus 'low-fat' may be
arbitrary as the fat content remains low compared with other dairy
products such as hard cheeses or ice cream. Furthermore, other
confounding factors such as physical activity, smoking, socio-
economic and cultural considerations were not taken into
© 2017 Macmillan Publishers Limited, part of Springer Nature.
Yogurt, diet and lifestyle
S Panahi et al
575
Table 1. Differences between female yogurt consumers and non-
consumers for nutrients in which yogurt is not a primary source in the
Québec Family Studya
Variable Yogurt consumption P-valueb
Non-consumers Consumers
(0 servings/day) ( ⩾ 1 servings/day)
Women
N 62 21
Pantothenic acid (mg/day) 4.1 ± 1.7 5.5 ± 1.8 0.003
Folic acid (mg/day) 167 ± 69 219 ± 81 0.01
Iron (mg/day) 14 ± 4 16 ± 6 0.03
Manganese (mg/day) 0.7 ± 0.6 1.5 ± 2.6 0.02
Copper (mg/day) 1.0 ± 0.8 1.2 ± 1.0 0.03
a
Panahi et al.32 (unpublished data). bThe model was adjusted for age,
physical activity and % body fat. Data are means ± s.d.
account. In the INFOGENE study, yogurt consumption was found
to be a significant contributor to the Prudent dietary pattern,
which was also characterized by higher intakes of fruits and
vegetables, nuts, non-hydrogenated fats, legumes, fish and other
seafood, whereas the Western dietary pattern was characterized
by higher intakes of fried foods, certain condiments such as
sauces, ketchup or salt, processed meats, refined grains, snacks,
red meats, high-fat dairy products such as ice cream, cream,
regular soft drinks and alcohol.4
Consuming yogurt improves the overall nutritional quality of
the diet. Yogurt is suggested to be a major contributor of nutrients
such as calcium; however, in the Québec Family Study, women
who were consumers of yogurt (⩾ 1 servings/day) also had higher
intakes of nutrients for which yogurt is generally not a rich source
or a source at all including pantothenic acid, folic acid, copper,
manganese and iron after adjustment for age, physical activity
and % body fat (Table 1). Thus, yogurt consumers have a better
intake of micronutrients even if yogurt is not a source of those
nutrients.
YOGURT AND LIFESTYLE CHARACTERISTICS
Higher-quality diets including whole grains, lean meats, fish, low-
fat dairy products and fresh fruits and vegetables have been
associated with greater affluence, whereas energy-dense diets
that are low in nutrients are consumed by individuals of lower
socioeconomic status and more limited economic means.44
Recent studies have documented various lifestyle characteristics
in yogurt consumers that have the potential to partly explain the
reduced proneness to obesity and type 2 diabetes in these
individuals including physical activity, smoking, level of education,
nutrition knowledge and socioeconomic status (Table 2).
Yogurt consumption has been shown to be more common
among healthier, leaner, more highly educated individuals from
higher socioeconomic levels and more widespread among
women.45 Results from the INRAN-SCAI (2005–2006) survey on a
sample of Italian households (n = 2798) showed that yogurt
consumers demonstrated healthier behaviors compared with
non-consumers.46 Higher intakes were reported by individuals
with higher levels of education, those practicing ⩾2 h of sporting
activities, those with a good knowledge of the food–health
relationship and accustomed to reading food labels.46 In a
population-based cross-sectional health survey examining factors
associated with the probability and amounts of yogurt intake in
Brazilian adults and the elderly, higher yogurt intakes were
positively associated with per capita family income and being a
non-smoker although level of education of the head of the
European Journal of Clinical Nutrition (2017) 573 – 579
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576
Table 2. Relevant studies outlining lifestyle characteristics of yogurt consumers

Type N Diet quality Lifestyle factors Findings Study

indices used

Cross- 532 (428 adults NA Sociodemographic (sex, age, race, Yogurt intake associated with smoking Possa et al. 47
sectional aged 20–59 years education), economic (household (OR: 1.98), female sex (OR: 2.12), and
health and 104 elderly income) and lifestyle factors (smoking, age 20-39 years (OR: 3.11); Per capita
survey aged 460 years in physical activity, alcohol use), presence family income and being a non-
Brazil) of chronic conditions (hypertension, smoker were positively associated with
diabetes, osteoporosis), the amount of yogurt consumption
anthropometric (body weight, height) (coefficients, 0.61and 3.73)
Cross- 6526 (aged 5–70 DGAI score Age, physical activity, smoking Yogurt consumers smoked less Wang et al. 34
sectional years in United compared with non-consumers
States)
Cross- 2798 (aged 18–97 NA Sociodemographics, smoking and Yogurt intake associated with higher D`Addezio et al.46
sectional years in Italy) alcohol habits, physical activity, levels of education (P = 0.004), those
dieting, out-of-home eating, interest who practiced ⩾ 2 h/week of sporting
for nutrition information activities (P = 0.046), those with a good
knowledge of food–health relationship
(P = 0.012) and accustomed to reading
food labels (P = 0.002)
Cross- 5124 (aged 2–18 HEI score Sex, race, age, income-to-poverty ratio, Compared with infrequent consumers, Zhu et al.43
sectional years in United physical activity a higher percentage of frequent
States) yogurt consumers were Hispanic or
non-Hispanic whites, were younger
children aged 2–11 years, lived in
wealthier households and met the
physical activity recommendations (all
P o0.05)
Cross- 664 (aged 18–55Prudent Sex, education, matrimonial status, Consumers of yogurt were mainly Cormier et al.4
sectional years in Canada)
and personal income women (P = 0.008); Consumption of
Western yogurt was higher among those with a
Dietary university education and those who
Pattern were married/common-law, but not
score significant
Prospective 8516 (aged 18–101 NA Age, sex, physical activity, smoking, The highest category of total yogurt Martinez-
cohort years in Spain) years of university education, marital consumption (⩾7 servings per week) Gonzalez et al.18
status included a higher proportion of
women and participants were more
physically active (Po0.001), smoked
less (Po0.001) and were less likely to
be married (Po0.001)
Prospective 8063 (aged 18–101 NA Age, sex, physical activity, smoking, On average, participants in the highest Sayon-Orea et al.
64
cohort years in Spain) sitting time, TV watching, alcohol category of total yogurt consumption
consumption ( ⩾ 7 servings per week) were more
physically active (Po0.001), less likely
to be current smokers (Po 0.001),
spent less hours sitting (P = 0.06) and
consumed less alcohol (Po0.001)
Abbreviations: DGAI, Dietary Guidelines Adherence Index; HEI, Healthy Eating Index; NA, not applicable; OR, odds ratio.

household was inversely associated with yogurt intakes.47
In addition, smokers had lower Health Eating Index scores as
evident from their lower consumption of fruits, vegetables and
dairy products and diets high in sugar and fat compared with non-
smokers. The socioeconomic factor of per capita family income
was positively associated with higher yogurt intakes as consump-
tion in the group with the higher income is twice that the lower
income group. One of the potential factors limiting yogurt intake
by populations with lower socioeconomic status is the perceived
high price of these products although some evidence suggests
that yogurt possesses a reasonable cost to nutrient-density ratio.48
Furthermore, individuals with a higher socioeconomic status may
have greater knowledge of nutrition and be more concerned
about their health contributing to the positive association
between amount of yogurt intake and household income. In
middle-income countries, yogurt consumption may be an
indicator of higher socioeconomic status. For example, although
yogurt consumption in Brazil is low, it increased more than
sevenfold between 1974 and 2003.45 Currently, 40% of Brazilians
consume dairy products, but only 6% consume yogurt.45
Yogurt consumers have been suggested to have better lifestyle
and eating behaviors that may help to prevent a positive energy
balance and metabolic diseases compared with non-consumers. In
the Québec Family Study comparing the profile of yogurt
consumers and non-consumers in a cross-sectional sample of
Québec men and women and over a mean follow-up of 6 years,
found that female yogurt consumers reported better dietary
macronutrient composition, higher mean physical activity partici-
pation and better eating behaviors (that is, less disinhibition)
compatible with body weight stability compared with non-
consumers when adjusted for age (Panahi et al., unpublished
data). The benefits of regular yogurt consumption may have a
wider influence on global healthy behaviors. These results
complement other research findings demonstrating that yogurt
consumers are more physically active (⩾ 2 h/week) and 30% less
likely to smoke compared with non-consumers.47 Thus, the

European Journal of Clinical Nutrition (2017) 573 – 579 © 2017 Macmillan Publishers Limited, part of Springer Nature.

lifestyle habits of yogurt consumers may predispose them to
better metabolic health not only because of the nutrient content
of the food, but also due to the characteristics of other lifestyle
factors.
YOGURT AND CARDIOMETABOLIC HEALTH
Most research has included yogurt within a large category of dairy
products and few have examined yogurt as a separate food item
on overall health and metabolism. However, emerging research
has demonstrated that yogurt may have positive effects on gut
microbiota,49,50 bone health,51 cardiovascular disease,52 type 2
diabetes7,11 and components of the metabolic syndrome such as
abdominal obesity.2,40,53
Epidemiological studies have shown that consuming dairy
products such as milk and yogurt is associated with a beneficial
role in metabolic regulation.8,18,19,54 In a prospective study of two
large cohorts, an increase in yogurt intake (1 serving/day) was
associated with a loss of 0.82 lb during a 4-year period.6
Furthermore, individuals with a habitual intake of 3 servings/
week had a smaller annual weight gain ( −0.10 ± 0.04 kg) than
those consuming o 1 serving/week.34 In a cross-sectional study
examining the relationship between diet quality and metabolic
profile in the Framingham Heart Study Offspring (1998–2001) and
Third Generation (2002–2005) cohorts, yogurt consumption (⩾1
serving per week) was associated with lower concentrations of
fasting glucose and insulin, homeostatic model assessment of
insulin resistance, systolic blood pressure, circulating triglycerides
and better diet quality suggesting that yogurt is a good source of
several macronutrients and micronutrients that may help to
maintain metabolic well being.34 However, observational studies
have not been consistent. In many of these studies, the inverse
associations between yogurt consumption and incidence of
obesity and type 2 diabetes have been attributed to dietary
patterns. Furthermore, the wide range of composition in yogurt
products, including their protein and sugar contents, and variety
of yogurt products available have not been considered. Diverse
study populations, ethnicities and methods of intake measure-
ment that do not measure habitual intake may also have
contributed to the inconsistent results. Furthermore, dietary
patterns characterized by high intakes of yogurt and dairy
products combined with higher intakes of whole grains, fruits
and vegetables, are also negatively associated with the risk of
weight gain and obesity54,55 and the incidence of type 2
diabetes.56,57 Epidemiological studies are primarily based on
subjective food recalls and in clinical studies, foods or food
components are usually part of the diet. As a result, the role of
yogurt and its potential physiologic mechanisms underlying the
observed effects cannot be isolated. Although many studies
demonstrate favorable associations between yogurt and body
weight, differences in diet quality among countries and other
confounding factors such as physical activity, lifestyle, amount of
yogurt consumption and other dietary factors need to be
considered. Furthermore, for better elucidating the benefits of
yogurt, the dietary patterns and diet quality that are associated
with yogurt consumption should be taken into account.
Consuming dairy products such as yogurt has been associated
with a beneficial role in metabolic regulation.8,18,19,54 Its nutrients
have been shown to directly contribute to the nutrient density of
the diet. Population studies have demonstrated that the diet
composition of yogurt consumers is characterized by an increased
intake of calcium, magnesium and protein, which have a critical
role in homeostasis. Although the number of long- and short-term
randomized controlled trials is still modest, some clinical trials
have shown a beneficial effect of yogurt consumption on appetite
and glycemic control.21,58 Yogurt is also important because of its
impact on concomitant energy intake and its influence on
appetite and glycemic control. A study examining the effects of
© 2017 Macmillan Publishers Limited, part of Springer Nature.
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low-, moderate- or high-protein yogurt snacks on appetite control
and subsequent energy intake in healthy women (n = 15) found
that a yogurt snack with a high-protein content (24 g) reduced
hunger, increased fullness and delayed the onset of eating
compared with lower protein snacks suggesting that a small, high-
protein afternoon snack regimen may delay or prevent subse-
quent snacking or over-eating later in the day.21 However, in this
study it was unclear if the effects were attributed to the yogurt
itself or the functional protein that was added. A similar study
assessing the impact of protein composition and/or fiber
enrichment of consuming yogurt as a snack on appetite
sensations and energy intake in healthy men (n = 20) found that
although appetite sensations were not influenced by variations in
the protein composition or the fiber enrichment, a reduced
energy intake was observed during the ad libitum lunch after the
high whey protein yogurt.58
THE SUPPORT OF LABORATORY STANDARDIZED STUDIES
Even if there are some consistencies in the conclusions emerging
from epidemiological studies emphasizing benefits of yogurt
consumption, it remains relevant to rely on intervention studies
that demonstrate the causality between two variables. In this
regard, physiological studies that have tested the acute effects of
yogurt consumption on energy intake, appetite sensations and
glycemia are worth considering. In a previously mentioned study
in healthy men, yogurt with a higher content of whey protein
decreased subsequent ad libitum energy intake compared with
control yogurt formulation.58 Furthermore, high-protein afternoon
yogurt snacks (14 g protein/25 g carbohydrate/0 g fat) were also
found to increase satiety and reduce subsequent food intake in
healthy women compared with high-fat snacks such as crackers
(0 g protein/19 g carbohydrate/9 g fat) and chocolate (2 g protein/
19 g carbohydrate/9 g fat).59 A study comparing isovolumetric
amounts (250 g) of plain yogurt, plain yogurt with honey,
strawberry yogurt, skim milk and orange juice as mid-morning
snacks on food intake, satiety and pre- and post-meal blood
glucose and serum insulin in healthy males found that pre-meal
glucose responses were attenuated in a dose-dependent manner
to the increasing protein and decreasing sugars in dairy.22
However, the contribution of dairy products to post-meal glucose
control and to satiety and food intake was independent of their
protein to carbohydrate ratio and physical form in healthy men.22
THE PRICE TO BE PAID FOR YOGURT CONSUMPTION
Although it may be deemed reasonable to consider plain yogurt
as the optimal formulation of this food, it is probably not the
formulation that is the most attractive for consumers. This raises
the question of the dilemma between palatability and function-
ality of foods. Yogurt is perceived as a healthy food because of the
presence of live and active cultures; however, artificial sweeteners,
sugar and flavors are universally used by the food industry to
improve taste, attractiveness and acceptance by consumers.
Yogurt manufacturers are working to decrease the amount of
sugars in yogurt, but this raises an additional question as to what
is a reasonable compromise in yogurt sweetening to increase
palatability while maintaining its optimal functionality. In a study
comparing isovolumetric amounts (250 g) of plain yogurt, plain
yogurt with honey, strawberry yogurt, skim milk and orange juice
as mid-morning snacks on food intake, satiety, and glycemia,
strawberry yogurt was rated more palatable than plain yogurt.22
However, no associations were found between palatability of the
treatments, food intake and glycemia at the subsequent meal
suggesting that sweetening of yogurt improved palatability but
did not negatively affect glycemic response.
As high sugar intake has been associated with increased risk for
obesity and type 2 diabetes, there has been some concern about
European Journal of Clinical Nutrition (2017) 573 – 579
 Yogurt, diet and lifestyle
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578
the addition of sugar to yogurt. However, previous studies
examining various types of sugars on metabolic control have
shown that not all sugars are the same.60 Additional research is
required to further characterize the ideal concentration of sugar
that allows the optimal compromise between palatability and
functionality and a yogurt, which contains a minimum amount of
added sugar. Furthermore, recent studies suggest that dairy fat
and full-fat dairy products may confer health benefits compared
with non-fat or low-fat products.61,62 Choosing a whole milk
yogurt in place of a non-fat yogurt may also decrease the need for
added sugars to increase palatability, as the fat in yogurt provides
flavor and increases satiety.35 Overall, it is important to emphasize
that moderation is a key component contributing to a healthy
dietary pattern and nutrition education may be one of the pillars
to decrease added sugar consumption.63
FUTURE PERSPECTIVES
Given the relatively low yogurt consumption in various countries,
increasing yogurt intake may be promising in helping to achieve
greater adequacy for some of the shortfall nutrients and maintain
metabolic well-being as part of a healthy, energy-balanced dietary
pattern. Low consumption of yogurt may represent a missed
opportunity to contribute to healthy eating habits, as yogurt
provides an excellent source of highly bioavailable protein and
calcium and is a source of probiotics that are believed to provide a
range of health benefits.
Observational studies examining the effect of yogurt as part of a
healthy diet and yogurt and various health outcomes exist;
however, there are some factors to consider. It is important to
better control for differences in diet and lifestyle. For example,
confounding factors including physical activity, lifestyle habits
such as smoking and alcohol and yogurt intake levels need to be
considered. Population studies in which appropriate adjustments
can be performed for diet quality and food-related behaviors as
potential factors observed between consumers and non-
consumers of yogurt are needed. Furthermore, as is the case
with many other functional foods, it is important to examine
whether the benefits of yogurt are a result of its independent
effects or whether other factors have a role. Thus, long-term
clinical trials need to be designed to provide a more realistic
assessment of yogurt's health benefits and that are ecologically
valid and will lead to dietary recommendations. There is also a lack
of studies examining yogurt types including low-fat, full-fat, plain,
fruit, Greek and probiotic- and sugar-containing yogurts. Future
studies should consider the overall diet and its composition since
many studies have considered energy, type and amount of yogurt,
timing (for example, snack, part of a meal) and frequency of
consumption as factors. It is also important to target populations
with a high risk for metabolic diseases including individuals with
obesity, type 2 diabetes or cardiovascular disease. Studies should
also include children and older adults to assess differences in the
contribution of yogurt to various health outcomes including body
weight and glycemic control among these age groups.
CONCLUSION
Yogurt consumption may be considered a signature of a healthy
diet through its nutritional content, impact on metabolic health
including the regulation of energy balance, body weight and
glycemia and its relationships with healthier behaviors and
lifestyle factors.
CONFLICT OF INTEREST
Angelo Tremblay serves on the Yogurt in Nutrition Initiative for Health Advisory
Board for Danone Institute International and on the board of the Danone Institute of
Canada. His research has been funded, in part, by Dairy Farmers of Canada, the Dairy
European Journal of Clinical Nutrition (2017) 573 – 579
Research Institute of the United States, Wyeth Consumer Healthcare and Nestlé.
André Marette is a consultant for Danone Nutricia Research. Shirin Panahi and Angelo
Tremblay have received an honorarium from Danone Nutricia Research.
ACKNOWLEDGEMENTS
The research of Angelo Tremblay is partly funded by the Canada Research Chair in
Environment and Energy Balance. André Marette’s research was partly funded by a
CIHR/Pfizer Research Chair on the pathogenesis and cardiovascular diseases. Shirin
Panahi is the recipient of a postdoctoral fellowship from the Canadian Diabetes
Association.
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