Bovine milk in human nutrition – a review
Lipids in Health and Disease
Bovine milk in human nutrition - a review
Anna Haug 1
Arne T Hstmark 0
Odd M Harstad 1
0 Section of Preventive Medicine and Epidemiology, University of Oslo , Oslo , Norway
1 Department of Animal and Aquacultural Sciences, Norwegian University of Life Sciences , Aas , Norway
Milk and milk products are nutritious food items containing numerous essential nutrients, but in the western societies the consumption of milk has decreased partly due to claimed negative health effects. The content of oleic acid, conjugated linoleic acid, omega-3 fatty acids, short- and medium chain fatty acids, vitamins, minerals and bioactive compounds may promote positive health effects. Full-fat milk has been shown to increase the mean gastric emptying time compared to half-skimmed milk, thereby increasing the gastrointestinal transit time. Also the low pH in fermented milk may delay the gastric emptying. Hence, it may be suggested that ingesting full-fat milk or fermented milk might be favourable for glycaemic (and appetite?) regulation. For some persons milk proteins, fat and milk sugar may be of health concern. The interaction between carbohydrates (both natural milk sugar and added sugar) and protein in milk exposed to heat may give products, whose effects on health should be further studied, and the increasing use of sweetened milk products should be questioned. The concentration in milk of several nutrients can be manipulated through feeding regimes. There is no evidence that moderate intake of milk fat gives increased risk of diseases.
Bovine milk and dairy products have long traditions in
human nutrition. The significance of milk is reflected in
our northern mythology where a cow named Audhumla
was evolved from the melting ice. She had horn and milk
was running as rivers from her teats. This milk was the
food for Ymer, the first creature ever existing .
The consumption of milk and milk products vary
considerably among regions; of drinking milk from about 180 kg
yearly per capita in Island and Finland to less than 50 kg
in Japan and China . In the western societies, the
consumption of milk has decreased during the last decades
. This trend may partly be explained by the claimed
negative health effects that have been attributed to milk
and milk products. This criticism has arisen especially
because milk fat contains a high fraction of saturated fatty
acids assumed to contribute to heart diseases, weight gain
and obesity .
The association between food and health is well
established  and recent studies have shown that modifiable
risk factors seem to be of greater significance for health
than previously anticipated . Prevention of disease may
in the future be just as important as treatment of diseases.
Indeed, many consumers of today are highly aware of
health-properties of food, and the market for healthy food
and food with special health benefits is increasing.
Milk is a complex food made up of components, which
per se may have negative or positive health effects,
respectively. Milk composition can be altered by the feeding
regime. The main aim of this review is to discuss effects of
milk components that are of particular interest for human
health, and to give an overview of the potential for
manipulation of bovine milk by feeding regimes to the lactating
cows, thus giving improved nutritional composition of
the milk for human consumption.
Milk composition in general
Bovine milk contains the nutrients needed for growth and
development of the calf, and is a resource of lipids,
proteins, amino acids, vitamins and minerals. It contains
immunoglobulins, hormones, growth factors, cytokines,
nucleotides, peptides, polyamines, enzymes and other
bioactive peptides. The lipids in milk are emulsified in
globules coated with membranes. The proteins are in
colloidal dispersions as micelles. The casein micelles occur as
colloidal complexes of protein and salts, primarily
calcium . Lactose and most minerals are in solution. Milk
composition has a dynamic nature, and the composition
varies with stage of lactation, age, breed, nutrition, energy
balance and health status of the udder. Colostrums differ
considerably to milk; the most significant difference is the
concentration of milk protein that may be about the
double in colostrum compared to later in lactation . The
change in milk composition during the whole lactation
period seems to match the changing need of the growing
infant, giving different amounts of components
important for nutrient supply, specific and non-specific host
defence, growth and development. Specific milk proteins
are involved in the early development of immune
response, whereas others take part in the
non-immunological defence (e.g. lactoferrin). Milk contains many
different types of fatty acids . All these components make
milk a nutrient rich food item.
Components in milk and their health effects
In average, milk contains about 33 g total lipid (fat)/l 
(Table 1). Triacylglycerols, which account for about 95 %
of the lipid fraction, are composed of fatty acids of
different length (424 C-atoms) and saturation . Each
triacylglycerol molecule is built with a fatty acid combination
giving the molecule liquid form at body temperature.
Other milk lipids are diacylglycerol (about 2% of the lipid
fraction), cholesterol (less than 0.5 %), phospholipids
(about 1%), and free fatty acids (FFA) accounting to less
than 0.5% of total milk lipids . Increased levels of FFA
in milk might result in off-flavours in milk and dairy
products, and the free volatile short-chain fatty acids
contribute to the characteristic flavours of ripened cheese.
Saturated fatty acids
More than half of the milk fatty acids are saturated,
accounting to about 19 g/l whole milk  (Table 1). The
specific health effects of individual fatty acids have been
extensively studied [10-13]. Butyric acid (4:0) is a
wellknown modulator of gene function, and may also play a
role in cancer prevention . Caprylic and capric acids
(8:0 and 10:0) may have antiviral activities, and caprylic
acid has been reported to delay tumour growth .
Lauric acid (12:0) may have antiviral and antibacterial
functions , and might act as an anti caries and anti plaque
agent . Interestingly, Helicobacter pylori can in fact be
killed by this fatty acid . Another interesting
observation is that capric and lauric acid are reported to inhibit
COX-I and COX-II . Stearic acid (18:0) does not seem
to increase serum cholesterol concentration, and is not
It would appear, accordingly, that some of the saturated
fatty acids in milk have neutral or even positive effects on
health. In contrast to this, the saturated fatty acids lauric-,
myristic-(14:0) and palmitic (16:0) acid have low-density
lipoprotein (LDL)- and high-density lipoprotein- (HDL)
cholesterol-increasing properties . High intake of
these acids raises blood cholesterol levels , and diets
rich in saturated fat have been regarded to contribute to
development of heart diseases, weight gain and obesity
. Association between consumption of milk and milk
products and serum total cholesterol, LDL cholesterol and
HDL cholesterol has been reported . High cholesterol
levels are a risk factor for coronary heart disease (CHD),
with LDL cholesterol and a high ratio between LDL and
HDL cholesterol enhancing the risk of CHD [19,20].
Several intervention studies have shown that diets
containing low-fat dairy products have been associated with
favourable changes in serum cholesterol [21-23].
However, milk fat consumption has been shown to have less
pronounced effects on serum lipids than could be
expected from the fat content [24,25]. To our knowledge
epidemiological cohort studies does not show a higher
risk for diseases in persons with high intakes of dairy fat,
as also shown by Elwood et al. ; cohort studies
provide no convincing evidence that milk is harmful. On the
contrary, several studies have found a lack of association
between milk consumption and CHD [27-30]. Two
Swedish studies have shown that cardiovascular risk factors
were negatively associated with intake of milk fat [31,32].
A Norwegian study suggests that intake of dairy fat or
some other component of dairy products, as reflected by
C15:0 as marker in adipose tissue may protect persons at
increased risk from having a first myocardial infarction
(MI), and that the causal effects may rely on other factors
than serum cholesterol . It has been shown that 34
grams dairy fat per day gives no negative effect on odds
ratio for myocardial infarction . As reported by
Sjogren et al. , fatty acids typically found in milk
products were associated with a more favourable LDL profile in
a data from USDA Food Composition Data .
b Dietary reference intake (DRI) for men and women .
healthy men (i.e., fewer small, dense LDL particles), and
they concluded that men with high intakes of milk
products had an apparently beneficial and reduced
distribution of the harmful small, dense LDL particles .
A Canadian 13 year follow up study analysed plasma LDL
sub fractions with different density, and showed that
cardiovascular risk was largely related to accumulation of
small, dense LDL particles . The small, dense LDL
particles are also reported to be associated with
hypertriglyceridemia , insulin resistance , the metabolic
syndrome and increased risk for CHD [39,40]. Saturated
fatty acids increase the serum concentration of both
LDLand HDL cholesterol. In a metaanalysis of 60 selected
trials Mensink et al.  reported that saturated fatty acids
gave an unchanged ratio between total cholesterol and
HDL cholesterol if carbohydrates replaced saturated fatty
acids. It was shown by Hostmark et al.  that an index
reflecting the LDL/HDL balance, ATH-index = (total
cholesterol-HDL)*apoB/(apoA*HDL), improved the
discrimination between controls and subjects with coronary
artery stenosis. Unlike this, the distribution of total
cholesterol was similar in controls and patients, as evaluated
by coronary angiography. In keeping with these early
results, in the INTERHEART case-control study on risk
factors associated with myocardial infarction in 52 countries,
an increase in apo B/apo A1 ratio was shown to be the
strongest risk factor for myocardial infarction . ApoB/
apo A1 was found to be a stronger risk factor than total
cholesterol alone, or ratio between LDL and HDL
cholesterol (Yusuf, personal information).
Increased levels of C-reactive protein (CRP) have been
associated with inflammation , and CRP is recognized
as a risk factor for CHD and metabolic syndrome [42,43].
Fredrikson et al.  found, however, no significant
association between CRP and intake of saturated fat. These
studies are in agreement with others .
The increase in HDL cholesterol caused by the saturated
fatty acids lauric-, myristic- and palmitic acid  has
beneficial effects as the reverse cholesterol transport is
increased . HDL can also act as an antioxidant and
prevent oxidation of LDL particles in the blood, and it may
protect against infections and against toxins from
Unsaturated fatty acids
Oleic acid (18:1c9) is the single unsaturated fatty acid
with the highest concentration in milk accounting to
about 8 g/litre whole milk  (Table 1). Accordingly milk
and milk products contribute substantially to the dietary
intake of oleic acid in many countries. In Norway about a
quarter of the average intake of oleic acid comes from
milk and milk products . Oleic acid is considered to be
favourable for health, as diets with high amounts of
monounsaturated fatty acid will lower both plasma
cholesterol, LDL-cholesterol and triacylglycerol
concentrations , and replacement of saturated fatty acids with
cis-unsaturated fatty acids reduces risk for coronary artery
disease . Several studies also indicate a cancer
protective effect of oleic acid, but the data are not fully
Fatty acids are the main building material of cell
membranes. The unsaturated fatty acids are reactive as they
may give oxidative stress with free radicals and secondary
peroxidation products (different aldehydes such as
malonedialdehyde and 4-hydroxynonenale) that may be
harmful to proteins and DNA in the cells [48,49]. This
may contribute to cancer  and to mitochondrial aging
processes caused by mutations in mitochondrial DNA
. The enzyme lechitin/cholesterol acyl transferace
(LCAT), having an important role in reverse cholesterol
transport, is sensitive to oxidative stress  and it is also
inhibited by minimally oxidized LDL . Oleic acid is
more stable to oxidation than the omega-3 and omega-6
fatty acids, and it can partly replace these fatty acids in
both triacylglycerols and membranelipids. A high ratio
between oleic acid and polyunsaturated fatty acids will
protect lipids in i.e. LDL towards attack from oxidative
stressors such as cigarette smoke, ozone and other
oxidants. Studies have shown that a diet rich in
monounsaturated/polyunsaturated fatty acids give better protection
against atheromatosis and CVD than a diet rich in
polyunsaturated fatty acids [52,53].
Milk fat is rich in oleic acid (about 25 % oleic acid) and it
has a very high ratio oleic acid/polyunsaturated fatty
acids. A diet rich in milk fat therefore may help to increase
this ratio in the total dietary fatty acids. A high intake of
meat from i.e. sheep may be expected to have similar
effect. This might partly explain why mortality by cardiac
disease has been lower in Iceland compared to the other
Scandinavian countries , and the average age of living
has been higher  despite of higher intake of saturated
fat (coming from both mutton and milk).
The concentration of PUFA in milk is about 2 g/l , and
the main PUFA in milk are linoleic- (18:2 omega-6) and
alpha-linolenic (18:3 omega-3) acid (Table 1). These fatty
acids may be converted to fatty acids with 20 carbon
atoms, i.e. arachidonic acid (20:4 omega-6) and
eicosapentaenoic acid, (EPA) (20:5 omega-3), and further
converted to eicosanoids; metabolically very active
compounds with local functions. Eicosanoids derived
from linoleic acid, via arachidonic acid, may enhance
blood platelet aggregation and thereby increase the
coronary risk, in contrary to eicosanoids produced form the
long omega-3 fatty acids . EPA has the ability to
partially block the conversion of the omega-6 fatty acids to
harmful eicosanoids, thereby reducing the cardiovascular
risk and inhibiting tumour genesis. PUFA may also affect
signal transduction and gene expression [57,58]. It is
conceivable therefore that the type of fatty acid in the
membrane governs several metabolic functions.
It has been argued that the Mesolithic man had a ratio of
14:1 between the omega-6 and omega-3 fatty acids,
against now in most European diets 1014:1 .
Eskimos, and some populations in Japan, having a high intake
of omega-3 fatty acids, also have a low rate of coronary
heart diseases, and of some cancers . Conceivably,
protection against cardiovascular diseases and cancer
would be related to the ratio of EPA plus oleic acid to
omega-6 fatty acids in the diet, and hence in the body.
In milk the ratio between omega-6 and omega-3- fatty
acids is low and favourable compared to most other
nonmarine products (Table 1). This ratio is greatly influenced
by the feeding regime, and may with favourable feeding
be as low as 2:1 (see later). Comparing the omega-6 to
omega-3 ratio in milk in the Nordic countries, Thorsdottir
et al.  has reported the lowest ratio in Iceland: 2.1:1,
compared to 4.7:1 in milk from the other Nordic
countries. It has been suggested that the higher supply of
omega-3 fatty acids from milk in Iceland might explain
the lower prevalence of type-2 diabetes and CHD
mortality in Iceland compared to the other Nordic countries
. A Norwegian study showed reduced risk of
premenopausal breast cancer with milk intake . With proper
feeding regime, milk and meat from ruminants can in fact
be the main source of omega-3 fatty acids in the human
diet, as is the case in France .
According to the above considerations a favourable meal
should be rich in oleic acid, and have a low ratio between
omega-6 fatty acids and omega-3 fatty acids, perhaps near
12:1. Indeed, milk fat fits into this description probably
better that any other food item.
Conjugated linoleic acid (CLA)
Bovine milk, milk products and bovine meat are the main
dietary sources of the cis9, trans 11 isomer of conjugated
linoleic acid (9c,11t-CLA) . In most cases this isomer
is the most abundant CLA-isomer in bovine milk .
Minor amounts of other geometrical and positional
isomers of CLA also occur in milk (such as the 7t, c9 and 10t,
12c-CLA), with different biological effects [65,66]. Milk
content of 9c,11t-CLA vary considerably (see later), but
may constitute about 0,6 % of the fat fraction [67,68].
The health effects of CLA have been discussed .
Administration of 9c,11t CLA has shown to modulate
plasma lipid concentration in both human and animal
models [70,71]. Some studies [70-72] but not all 
have shown that addition of CLA isomer mixtures (9c,11t
and 10t,12c) to a diet affects plasma lipids. Studies have
shown that especially 9c,11t-CLA can improve plasma
cholesterol status [70,71]. In a study with healthy men
Tricon et al.  found a significant reduction in plasma
total cholesterol concentration by 9c,11t-CLA. The results
concerning the effects of CLA on serum triglycerides are
controversial [66,70,74,75]. Tricon et al.  observed a
decrease in serum triglycerides by 9c,11t-CLA compared
to 10t,12c-CLA in humans, and Roche et al. found serum
triglycerides and unesterified FA to be decreased by
9c,11t-CLA in ob/ob-mice .
In experimental animals CLA has been shown to have
anticarcinogenic effects . Prospective data from a
Swedish study suggest that high intakes of high-fat dairy
foods and CLA may reduce the risk of colorectal cancer
. The knowledge of CLA's effects in metabolism and
the reported anti-proliferative and pro-apoptotic effect of
CLA on various types of cancer cells  makes CLA to an
interesting, and possible therapeutic agent in nutritional
cancer therapy. The mechanisms by which CLA might
affect metabolism are many. It is suggested that CLA
competes with arachidonic acid in the cyclooxygenase
reaction, resulting in reduced concentration of prostaglandins
and tromboxanes in the 2-series . CLA may suppress
the gene expression of cyclooxygenase , and reduce
the release of pro-inflammatory cytokines such as
TNFalpha and interleukines in animals . CLA also
activates the PPARs transcription factors , and CLA may
reduce the initial step in NF-kappa B activation and
thereby reduce cytokines, adhesions molecules and other
stress-induced molecules .
Trans vaccenic acid (VA)
The main trans 18:1 isomer in milk fat is vaccenic acid,
(18:1, 11t, VA), but trans double bounds in position 4 to
16 is also observed in low concentrations in milk fat .
The amount of VA in milk fat may vary; constituting 1.7%
, or 46 % of the total fatty acid content .
Typically, the concentration of VA may be about 24% when
the cows are on fresh pasture and about 12 % on indoor
feeding . Normally, naturally increase in 9c,11t-CLA
in milk also results in increased concentration of VA .
VA has a double role in metabolism as it is both a trans
fatty acid and a precursor for 9c,11t-CLA. As demonstrated
by Kay et al.  approximately 90 % of 9c,11t-CLA in
milk fat was produced endogenously involving
delta-9desaturation of VA. Vaccenic acid can be converted to
9c,11t-CLA in rodents , pigs  and humans .
Trans fatty acids have been shown to increase blood lipids
. Industrially produced trans fat are shown to increase
the risk of coronary heart disease as they have adverse
influence on the ratio of LDL on HDL, and on Lp(a)
[44,91]. It has been questioned if VA has these same
adverse effects. In one study with hamster, Meijer et al.
 found that VA was more detrimental to
cardiovascular risk than elaidic acid (18:1, 9t) due to a more
increasing effect on LDL/HDL cholesterol ratio. Furthermore,
Clifton et al.  showed that VA was an independent
predictor of a first myocardial infarction. In contrast to
this, it has been shown by Willett et al.  that trans fat
from animals did not give an increased risk for CHD. As
recently demonstrated by Tricon et al , a combination
of naturally increased concentration of VA and
9c,11tCLA in milk fat did not result in detrimental effects on
most cardiovascular disease risk parameters. However, it
remains to clarify if VA has unhealthy effects on blood
Phospholipids and glycosphingolipids
Phospholipids and glycosphingolipids accounts to about
1% of total milk lipids . These lipids contain relatively
larger quantities of polyunsaturated fatty acids than the
triacylglycerols. They have functional roles in a number of
reactions, such as binding cations, help to stabilize
emulsions, affect enzymes on the globule surface, cell-cell
interactions, differentiation, proliferation, immune
recognition, transmembrane signalling and as receptors for
certain hormones and growth factors . Gangliosides are
one of these components found in milk. Gangliosides
(with more than one sialic acid moiety) are mainly found
in nerve tissues, and they have been demonstrated to play
important roles in neonatal brain development, receptor
functions, allergies, for bacterial toxins etc .
Bovine milk contains about 32 g protein/l  (Table 1).
The milk protein has a high biological value, and milk is
therefore a good source for essential amino acids. In
addition, milk contains a wide array of proteins with
biological activities ranging from antimicrobial ones to those
facilitating absorption of nutrients, as well as acting as
growth factors, hormones, enzymes, antibodies and
immune stimulants [95,96]. The nitrogen in milk is
distributed among caseins, whey proteins and non-protein
nitrogen. The casein content of milk represents about
80% of milk proteins. Caseins biological function is to
carry calcium and phosphate and to form a clot in the
stomach for efficient digestion. The milk whey proteins
are globular proteins that are more water soluble than
caseins, and the principle fractions are beta-lactoglobin,
alpha-lactalbumin, bovine serum albumin and
immunoglobulins. Whey is the liquid remaining after milk has
been curdled to produce cheese, and it is used in many
products for human consumption, such as ricotta and
brown cheese, and concentrated whey is an additive to
several products e.g. bread, crackers, pastry and animal
feed. The rate at which the amino acids are released during
digestion and absorbed into the circulation may differ
among the milk proteins, and whey proteins are
considered as rapid digested protein that gives high
concentrations of amino acids in postprandial plasma . The
benefit of drinking whey has been known for centuries,
and two ancient proverbs from the Italian city of Florence
say, "If you want to live a healthy and active life, drink
whey" and, "If everyone was raised on whey, doctors
would be bankrupt" .
Some of the milk proteins (e.g. secretory
immunoglobulin A, lactoferrin, 1-antitrypsin, -casein and lactalbumin)
may be relatively resistant to digestive enzymes, and the
whole protein or peptides derived from it, may exert their
function in the small intestine before being fully digested
As several bioactive proteins and peptides derived from
milk proteins are potential modulators of various
regulatory processes in the body, some of these are produced on
an industrial scale, and are considered for application as
ingredients in both 'functional foods' and pharmaceutical
preparations. Although the physiological significance of
several of these substances is not yet fully understood,
both the mineral binding and cytomodulatory peptides
derived from bovine milk proteins are now claimed to be
health enhancing components that can be used to reduce
the risk of disease or to enhance a certain physiological
function . Milk protein composition may differ
among breeds . For example the concentration of
beta-casein A1 is low in milk from cows in Iceland and in
New Zealand. It has been speculated that this proteins
may have a role in the development of diabetes and
cardiac disease . However, later it was concluded in a
review article that there is no convincing evidence that the
A1 beta-casein of cow milk has any adverse effect in
Milk peptides and blood pressure
Several studies has suggested that there is an association
between milk consumption and blood pressure; as
hypertension is inversely related to milk consumption in some
epidemiological- and intervention studies . It has
been suggested that some milk peptides have
antihypertensive effects, both by inhibiting angiotensin-converting
enzyme, having opoid-like activities, antithrombotic
properties and by binding minerals .
Branched chain amino acids and other amino acids
Milk is especially rich in essential amino acids and
branched chain amino acids. There is evidence that these
amino acids have unique roles in human metabolism; in
addition to provide substrates for protein synthesis,
suppress protein catabolism and serve as substrates for
gluconeogenesis, they also trigger muscle protein synthesis and
promote protein synthesis [105,106]. Essential amino
acids are shown to be more important than non-essential
amino acids in muscle protein synthesis , and the
branched chain amino acid leucine in particular triggers
muscle protein synthesis which is sensed by the
insulinsignalling pathway . The stimulated insulin
secretion caused by milk, is suggested to be caused by milk
proteins, and as shown by Nilsson et al.  a mixture of
leucine, isoleucine, valine, lysine and threonine resulted
in glycemic and insulinemic response resembling the
response seen after ingestion of whey. A combination of
milk with a meal with high glycaemic load (rapidly
digested and absorbed carbohydrates) may stimulate
insulin release and reduce the postprandial blood glucose
concentration . A reduction in postprandial blood
glucose is favourable, and it is epidemiological evidence
suggesting that milk may lower risk of diseases related to
insulin resistance syndrome .
The concentration of taurine is high in breast milk (about
18 mg/l) and in colostrum from cow, but in regular
bovine milk it is not high; about 1 mg/l . Goat milk
is however very rich in taurine: 4691 mg/l . Taurine
is an essential amino acid for preterm neonates, and
specific groups of individuals are at risk for taurine deficiency
and may benefit from supplementation, e.g. patients
requiring long-term parenteral nutrition (including
premature and newborn infants); diabetes patients, those
with chronic hepatic, heart or renal failure [111,112]. It is
suggested that during parenteral nutrition,
supplementation of 50 mg taurine per kg body weight may be required
Taurine is the most abundant intracellular amino acid in
humans. It may be synthesized in the body from
methionine and cysteine, but in healthy individuals the diet is the
usual source of taurine. It is implicated in numerous
biological and physiological functions: bile acid conjugation
and cholestasis prevention, antiarrhythmic/inotropic/
chronotropic effects, central nervous system
neuromodulation, retinal development and function,
endocrine/metabolic effects and antioxidant/anti-inflammatory
properties . Taurine has been shown to have
endothelial protective effects , it may function
principally as a negative feedback regulator, helping to
dampen immunological reactions before they cause too
much damage to host tissues or to the leukocytes
themselves , and it is shown to be analgesic [112,116].
Fresh milk may be a good source of glutathione, a
tripeptide of the sulphur amino acid cysteine, plus glycine and
glutamic acid. In the organism glutathione has the role as
an antioxidant. Glutathione can be oxidized forming
GSSG (oxidized glutathione), and in this reaction it may
remove reactive oxygenspecies (ROS), thereby regulating
the level of ROS in the cells. Glutathione participates in
regulation of insulin production in the pancreatic cells, as
ROS inhibit expression of the pro insulin gene.
Glutathione appears to have different important roles in
leukocytes, as a growth factor, as an anti-apoptotic factor in
leukocytes and to regulate the pattern of cytokine
secretion . GSH, moreover, is also central for
antioxidative defence in the lungs, which may be very important in
connection with lower respiratory infections including
Minerals, vitamins and antioxidants
Milk contains many minerals, vitamins and antioxidants.
The antioxidants have a role in prevention of oxidation of
the milk, and they may also have protective effects in the
milk-producing cell, and for the udder. Most important
antioxidants in milk are the mineral selenium and the
vitamins E and A. As there are many compounds that may
have antioxidative function in milk, measurement of total
antioxidative capacity of milk may be a useful tool .
The calcium concentration in bovine milk is about 1 g/l
(Table 1). Dairy products provide more than half of the
calcium in the typical American diet , and daily intake
of milk and milk products thus has a central role in
securing calcium intake. In human nutrition adequate calcium
intake is essential. Getting enough calcium in the diet
gives healthy bones and teeth, and it may also help
prevent hypertension, decrease the odds of getting colon or
breast cancer, improve weight control and reduce the risk
of developing kidney stones .
The selenium concentration in body fluids and tissues are
directly related to selenium intake. The selenium
concentration in Scandinavian food is low, and the
concentration in Norwegian bovine milk is about 11 ug/l (own
results, 2006), and 37 ug/l in the US . For plant
products the situation is even worse; the selenium
concentration in wheat flour (whole grain) is less than 20 ug/kg in
Norwegian wheat (own results), compared to 707 ug/kg
in the US .
Selenium is important in human health; it has a role in
the immune- and antioxidant system and in DNA
synthesis and DNA repair . Selenoprotein P is an
antioxidative defence enzyme having similar function as the
selenoenzyme phospholipid hydro peroxide glutathione
peroxidase (Gpx-4) inside the cells and it also protects
LDL towards peroxidation [121,122]. A strong negative
correlation between the concentration of selenium and
the concentration of plasma lipid peroxidation products
has been reported in a Canadian study . These
observation are in line with epidemiological observations from
USA, where a strong negative correlation between
mortality of ischemic cardiac disease and hypertension among
men and women in the age group 5564 years comparing
states with different selenium intake [124,125].
Selenium protects against many (but not all) types of
cancer . There are indications that selenium may protect
against asthma, and that low selenium intake may worsen
the asthma symptoms . Selenium deficiency has
even been linked to adverse mood states . Selenium
is also a component of enzymes involved in metabolism
of thyroid hormone.
As selenium is of fundamental importance to human
health, the low selenium availability in Scandinavian soil
is of concern. Different strategies can be used to increase
human selenium intake, and addition of selenium-rich
yeast to the feed of domestic animals is one option.
Recommended daily intake of selenium is 55 ug , and the
optimal selenium concentration in bovine milk may be
discussed. If milk contains about 50100 ug selenium/l, it
would be a good selenium source.
The recommended iodine intake is 150 ug/d for adults
. Accordingly, a daily intake of 0.5 litres milk with an
average content of 160 ug iodine/l meets about 50% of
the requirement (Table 1). However, it is important to
underline the great seasonal variation in iodine content of
milk (see later).
Magnesium is ubiquitous in foods, and milk is a good
source, containing about 100 mg/l milk .
Recommended intake is 400 mg/day for men and 310 mg/day
for women . Magnesium has many functions in the
body, participating in more than 300 reactions.
Magnesium deficiency has been linked to atherosclerosis, as
studies have shown that deficiency may give oxidative
stress . Magnesium may also have a role in reducing
asthma, and experimental studies of persons with asthma
suggest that magnesium infusion may have a place in the
acute treatment of asthma . A possible mechanism
may be that magnesium together with taurine dampens
the signaling effects of a too high calcium release inside
the cells [111,130]. Magnesium deficiency may occur
following kidney disease and after use of some diuretic
drugs. Magnesium deficiency in elderly is observed, and
may be a result of poor appetite or unbalanced diet.
Zinc is an essential part of several enzymes and
metalloproteins. Zinc has several functions in the body, in DNA
repair, cell growth and replication, gene expression,
protein and lipid metabolism, immune function, hormone
activity, etc . Milk is a good zinc source; containing
about 4 mg/l . Recommended intake is 8 and 11 mg/
day for adult female and male . The bioavailability of
zinc is better from milk than from vegetable food , and
inclusion of milk in the diet may improve total
bioavailability of zinc .
Vitamin E concentration in milk is about 0,6 mg/l 
(Table 1), but may increase 34 folds by proper feeding
regimes (see later). Recommended intake is 15 mg/day
. Vitamin E is not a single compound; it includes
tocoferols and tocotrienols. In whole milk, alpha-tocopherol is
the major form of vitamin E (>85%); gamma-tocopherol
and alpha-tocotrienol are present to a lesser extent, about
4 % each of the sum of tocoferols and tocotrienols .
Observational studies indicate that high dietary intake of
vitamin E are associated with decreased risk for cancer and
coronary heart disease, and that vitamin E can stimulate
Tcells and increase the immune defence system. Milk seems
to be a food item favouring absorption and transportation
of vitamin E from ingested food into the chylomicrons
Milk is a good source of retinoids, containing 280 ug/l 
(Table 1). Recommended daily intake is 700900 ug/day
. Vitamin A has a role in vision, proper growth,
reproduction, and immunity, cell differentiation, in
maintaining healthy bones as well as skin and mucosal membranes
Bovine milk contains 50 ug folate/l . Studies indicate
that 5-methyl-tetrahydrofolate is the major folate form in
milk . Recommended intake of folate is 400 ug/day
for adults . Many scientists believe that folate
deficiency is the most prevalent of all vitamin deficiencies .
It is generally accepted that folate supplementation (400
ug/day) before conception and during the first weeks of
pregnancy reduces the risk of neural tube defects. A recent
study has shown that higher total folate intake was
associated with a decreased risk of incident hypertension,
particularly in younger women . In addition, folates may
have a protective role to play against coronary heart
disease and certain forms of cancer, but sufficient evidence is
not yet available . The complexity of the folate
metabolism suggest that different metabolites of folate are
involved in different reactions, and that dihydrofolate and
5-methyl-tetrahydrofolate are the active compounds in
growth-inhibition in colon cancer cells .
The bioavailability of folate varies . Folate-binding
proteins occur in unprocessed milk, pasteurised milk,
spray-dried skim milk powder and whey . Animal
and human studies have suggested that these components
enhance food folate bioavailability, and it is shown that
inclusion of cow milk in the diet enhanced the
bioavailability of food folate . In a population-based study,
the consumption of milk and yogurt were inversely
associated with serum total homocysteine concentrations, and
the authors explained this association by intakes of folate
and riboflavin .
Milk is a good source of riboflavin, 1.83 mg riboflavin/l
milk (Table 1). Daily recommended intake is 1.1 and 1.3
mg for women and men, respectively . Riboflavin is
part of two important coenzymes participating in a
numerous metabolic pathways in the cell. It has a role in
the antioxidant performance of glutathione peroxidase
and DNA repair via the ribonucleotid reductase pathway.
Milk is also a good source of vitamin B12, being 4.4 ug/l
. The daily recommendation is 2.4 g . Vitamin B12
is found only in animal foods, and plays a central role in
folate and homocysteine metabolism, by transferring
methyl groups. Vitamin B12 deficiency may cause
megaloblastic anaemia and breakdown of the myelin sheath.
Bacterial flora of milk
Milk samples from normal healthy mammary glands
contain many strains of bacteria . To prevent diseases
caused by pathogenic bacteria in milk and to lengthen the
shelf life of milk, treatment such as cooling and
pasteurization or membrane filtration is needed. To preserve milk,
addition of selective, well-documented strains of starter
cultures for fermentation is a method that has been used
Historically, the seasonal variation in milk production
made it necessary to preserve milk. The Nordic countries
including Iceland have a long tradition for using
fermented milk, and the consumption of fermented milk is
about 20 kg per person .
During fermentation bacteria and yeasts convert lactose in
the milk to various degradation products depending on
the species present. Lactobacilli and streptococci give rice
to lactic acid and monosaccarides (especially galactose).
Bifidobacteria give rice to lactic acid, acetic acid and
monosaccarides, while yeasts, present only in some few
fermented milk products, produce CO2 and ethanol .
Different bacterias may be used for fermentation, giving
products of special flavour and aroma, and with several
potential health beneficial metabolites . The bacteria
contain cell wall components that bind Toll-like receptors
on dendritic cells (and also other leucocytes) found in the
mucosa of the small intestine and colon, thus stimulating
the Th1 immune response . It has been shown that
fermented milk stimulates the Th1 immune response, and
down-regulates the Th2 immune response . The
immune system may thus be strengthened against cancer,
virus infections and allergy . Bacterial DNA has also
a similar effect, binding to Toll-like receptor-9 .
Some bacteria can also improve the intestinal microbial
balance, and the fermented milk may have positive health
effects both in the digestive channel and in metabolism.
During the fermentation of milk, lactic acid and other
organic acids are produced and these increase the
absorption of iron. If fermented milk is consumed at mealtimes,
these acids are likely to have a positive effect on the
absorption of iron from other foods . Lactic acid is
also a poorer substrate for growth of pathogenic bacteria
than glucose and lactose .
The low pH in fermented milk may also delay the gastric
emptying from the stomach into the small intestine and
thereby increase the gastrointestinal transit time .
Also, full-fat milk has been shown to increase the mean
gastric emptying half-time compared to half-skimmed
milk , and accordingly it might be favourable to
gastric emptying and thus may have an effect on appetite
Intolerance to milk components
The public "belief" that milk causes an inflammatory
process and an increase in mucus production has not been
confirmed [152,153]. It has been shown that respiratory
symptoms was not associated with milk intake , and
concluded that consumption of milk does not seem to
exacerbate the symptoms of asthma, but in a few cases
people with cow's milk allergy may have asthma-like
symptoms after milk consumption . However in
cells from another tissue; mucin producing cells of gastric
mucosa, alpha-lactalbumin stimulates mucin synthesis
and secretion .
Most milk proteins, even proteins present at low
concentrations, are potential allergens. A person may be allergic
to casein or whey proteins or to both. Milk allergy may
arise in small children (03 years) and it is estimated that
25% of the children has milk allergy . After the age
of three years it is no longer a problem for most children.
Milk allergy reactions may either be of the type 'rapid
onset' or the 'slower-onset' type. The rapid type comes
suddenly with symptoms of e.g. wheezing, vomiting,
anaphylaxis. The slower-onset reactions are more common
and symptoms develop over a period of hours or days
after ingesting milk, and may include loose stool,
vomiting, fussiness, reduced weight gain etc. As these symptoms
are more general, this type is difficult to diagnose.
Cow's milk allergy may be treated by completely avoiding
milk proteins. Epitopes on milk proteins have been
shown to be both conformational and linear epitopes,
widely spread throughout the protein molecules. Due to
the great variability and heterogeneity of the human IgE
response, no single allergen or particular structure has
been found to be a major part of milk allergenicity .
An interesting study from Germany showed that the
children of farmers had less allergy, in spite of the fact that
these children were drinking more whole- milk than other
children not living on farms.
Intolerance to milk proteins
There has been speculation if milk proteins may have a
role in Attention Deficit Hyperactivity Disorder (ADHD),
autism, depressions and schizophrenia in some cases.
There are major supports to the hypothesis that ADHD
may be linked to increased levels of neuroactive peptides
and increased urinary peptide levels [158,159]. A diet free
of milk, milk products and gluten may in many cases give
reduced ADHD symptoms . Further, opioid peptides
derived from food proteins (exorphins) have been found
in urine of autistic patients . This area of
investigation is important and large scale, good quality
randomised controlled trials are needed.
The lactose concentration in bovine milk is about 53 g/l
. People often confuse a milk allergy with lactose
intolerance, but they are not the same thing. Lactose
intolerance is common in many adults throughout the world,
and is caused by deficiency of intestinal lactase
(hypolactasia). Lactose maldigestion occurs in about 75 % of the
worldwide population and about 25 % of the US
population . In Scandinavian counties it varies between 2%
and 18% . Avoiding all lactose is seldom necessary, and
persons with hypolactasia can usually ingest limited
amounts of milk without having annoying symptoms.
Individual differences in gut micro flora may be one
reason for large variations in amounts of milk that is
tolerated. To ingest milk with a meal may also improve
tolerance. Instead of drinking regular milk, fermented
milk may be an option, because fermented milk contains
less lactose than fresh milk, and that it also may contain
bacterial lactase that may be activated when the fermented
milk reaches the gut .
Digestion of lactose in the intestine, and fermentation of
milk gives increased concentrations of galactose.
Galactose is catabolized by the Leloir pathway by
phosphorylation at position 1, and then converted to UDP-galactose
and glucose-1-phosphate . Defects in enzymes in
this pathway may result in galactosemia in humans, and
early onset cataract. In young women ovarian failure at a
very early age has been observed following galactose
accumulation. Cramer et al.  studied the relation
between age-specific fertility rates, the prevalence of adult
hypolactasia and per capita milk consumption. They
found that fertility at high ages is lower with high per
capita consumption of milk and greater ability to digest its
lactose component. These demographic data thus add to
existing evidence that dietary galactose may deleteriously
affect ovarian function.
The level of galactose in fermented milk products depends
on growth conditions of the different organisms and
fermentation time, and for example after 24 h fermentation,
the concentration of galactose has been reported to about
20 g/litre . A study in rats showed that
administration of galactose in the form of lactose seemed to be less
toxic than when galactose was fed . High levels of
galactose as well as glucose may cause glycation of
proteins, form advanced glycation end products, and the
activation of polyol metabolism. This may accelerate
generation of reactive oxygen species (ROS) and increases
in oxidative chemical modification of lipids, DNA, and
proteins in various tissues.
Possible concerns of milk in current use
Within modern societies the milk has to be treated in
different ways to keep for several days. This processing
includes steps that may be of concern. In fresh milk each
lipid globule is surrounded by apical plasma membrane
from the mammary epithelial cell. It is not known
whether the milk homogenisation, when the fat globules
with their globule membrane are broken up into many
new small lipid droplets with just a small fragment of the
originating membrane, might have health implications.
Proteins and peptides are heat sensitive, and their
bioactivity may be reduced by pasteurisation of milk. Heating
of milk may also result in the formation of potentially
harmful new products i.e. when carbohydrates in milk
react with proteins . Also the amount of some
vitamins and antioxidants may be reduced by heating.
Glutathione may easily be destroyed during storage .
The glutathione concentration in human breast milk was
reduced by 81, 79 and 73 % by storage at either -20
degrees C, 4 degrees C or at room temperature for 2 h,
respectively . To treat milk in a way that preserves the
vitamins, proteins and peptides is therefore an important
task and a challenge for the dairy industry. Some dairies
now membrane filtrate the milk in stead of pasteurisation,
and application of non-thermal processing technologies
may give health benefits.
Further improvements of the nutritional quality
of bovine milk
Several components in bovine milk which are of great
importance in human nutrition may be significantly
altered by the feeding regime . The principal effects
of feeding on milk content of these components are
summarized and briefly discussed below.
Fat content and composition
The fatty acids of bovine milk are derived from two
sources. The first source is fatty acids supplied to the udder
by the blood, composed of fatty acids absorbed from the
intestine and mobilized from the adipose fat tissue,
mainly palmitic acid (16:0), stearic acid (18:0) and longer
chained fatty acids. The second source is derived from
circulating blood acetate and butyrate produced during
fermentation in the rumen (de novo synthesis), and fatty acids
up till 14 carbon atoms are synthesised in the udder.
Palmitic acid in milk originates from both de novo synthesis
and from circulating blood. Due to the extensively
biohydrogenation of dietary unsaturated fatty acids in the
rumen, the supply of these fatty acids to the udder is low.
However, in the udder desaturation of fatty acids like
12:0, 14:0, 16:0 and 18:0 take place, and the products
being 12:1, 14:1, 16:1 and 18:1, respectively. The
preferred substrate for the desaturating enzyme;
delta-9desaturase, is stearic acid. Therefore is bovine milk a
relatively good source of oleic acid (18:1, cis 9). The udder
enzymes can not make double bonds in omega-3 and
omega-6 positions. Consequently, milk content of
linoleic acid and alpha-linolenic acid depends on the supply
of these to the udder.
Conjugated linoleic acid (9c,11t-CLA) in milk originates
from two sources. A small part originates from incomplete
biohydrogenation of linoleic acid in the rumen which are
absorbed from the small intestine transported to the
udder and included in the fat synthesis. Most of the
9c,11t-CLA originates, however, from vaccenic acid which
is an intermediate from biohydrogenation of unsaturated
fatty acids in the rumen. After absorption and
transportation by the blood to the udder, a portion of the vaccenic
acid is desaturated by delta-9-desaturase to CLA. There is
a close positive correlation between milk content of
vaccenic acid and 9c,11t-CLA [86,169].
The effect of feed on milk fat content and fatty acid
composition is comprehensively discussed [68,170-172].
There are large variations in fat synthesis in the udder, and
the fat content and fatty acid composition are the most
modifiable of the main components in milk. Some
feeding strategies to obtain milk with altered fatty acid
composition are summarized in Table 2. There are seasonal
variations for the major fatty acids [67,82]. Milk from
grazing dairy cows contain significantly higher proportion
of oleic acid than milk produced on traditional indoor
feeding composed of concentrates and conserved
roughages . Typically, CLA content in milk produced on
pasture is at least twice of that obtained by indoor feeding
[67,82]. Moreover, the proportion of alpha-linolenic acid
increases more than linoleic acid, resulting in a lower ratio
between omega-6 and omega-3 fatty acids. Milk fat from
cows fed an in-door diet consisting of conserved grass and
concentrate have a ratio between omega-6 and omega-3
fatty acids of about 4:1 [67,82], but in summer when the
cows are out on pasture and have a high intake of grass the
ratio may be reduced to about 2:1 [8,67,82,172]. These
positive effects of pasture on the fatty acid composition of
Acetic-and butyric acid for de novo synthesis
Long unsaturated FA
Acetic-and butyric acid for de novo synthesis.
Amino acid supply
Table 2: Components in bovine milk and their chances to be modified according to feeding strategies, substrates involved in their
synthesis and feeding strategies that may be used
Substrates involved in synthesis
milk are mainly attributed to the high content of
polyunsaturated fatty acids, especially alpha-linolenic acid, in
grasses at early stage of maturity .
Protein content and composition
In general, milk protein content is relatively unresponsive
to feeding factors. However, under most conditions,
energy-, but also protein supply, is feed related factors
with most pronounced effect on milk protein content
(Table 2). Milk protein content may be negatively
influenced by high intake of dietary fat by the lactating cow
. Thus, there may be a conflict between milk fatty
acid composition and protein content. The feeding regime
has only small impact on the proportion of the different
types of milk proteins and consequently the amino acid
composition , and will therefore not be further
discussed in this review. However, heat treatment of dairy
products leads to structural changes of proteins and main
whey proteins are modified to lactulosyl residues .
Content of minerals
Bovine milk contain a vide range of minerals . Milk
concentrations of some minerals that are of special
importance in human nutrition are given in Table 2. The
calcium concentration in milk is relatively constant, with
some variations throughout lactation. Most of the calcium
is in the aqueous compartment and it is primarly (65%)
associated with casein . The calcium concentration
in milk is relatively constant because milk content of
casein is unresponsive to feeding factors. Milk content of
magnesium and zinc also show only small variations.
The concentration of selenium in bovine milk is related to
selenium concentration in the feed, and there are great
variations worldwide. In South Dakota the selenium
concentration in milk is reported to be between 160 and 1300
ug/l, whereas the concentrations in milk from
low-selenium regions may be from 5 to 30 ug/l , as in
Scandinavia and northern Europe. A Swedish study showed
Pasture, well preserved silages, concentrates with
naturally high content, mineral supplementation
Pasture, well preserved silages, concentrates with
naturally high content, mineral supplementation
that the average selenium concentration in milk was 14
ug/l and the concentration was more than doubled after
supplementation with 3 mg selenium daily from
selenium-enriched yeast .
As much as about 25 percent of the iodine intake may be
excreted in milk . Therefore, milk content of iodine
also varies depending on the iodine content and
availability in the feeds used. A study on milk and milk products
in Norway , showed that milk from the summer
season had significantly lower iodine concentration (88 ug/
l) compared with milk from the winter season (232 ug/l).
This is explained by the use of more supplementary feeds
enriched with iodine during the winter season. Dairy
products supply much of the dietary intake of iodine; in
Norway the most , and in US the second most  of
the iodine intake.
Content of vitamins
Vitamins are not synthesized in the udder. Milk content of
the fat-soluble vitamins A and E reflects their content in
the feed (Table 2). In general, the content of these
vitamins in feed plants decrease with maturity and are higher
in fresh than conserved material. There are therefore
regional and seasonal variations in these vitamins due to
feeding regimes , with the highest concentrations in
fresh grasses at early stage of maturity. For example a study
in Finland shows that the concentration of vitamin E in
milk is 34 times higher during summer than in winter
. Enriching the supplementary feeds with proper
sources of these vitamins may increase the milk content
during the winter season.
All vitamins of the B-complex (riboflavin and vitamin B12,
in Table 2) are synthesized by the rumen microbes,
normally in sufficient amounts to cover the animal's needs.
Milk content of B-vitamins are, however, relatively
unrelated to their intake because the amount synthesized by
the rumen microbes are unregulated according to the
amount ingested .
Summing up: Improvements of the nutritional
quality of bovine milk
Different countries have different health challenges. In
Norway the following modifications of milk composition
may be most relevant:
Secure a low omega-6 to omega-3 ratio, close to 2/1.
Increase the proportion of oleic acid to 25%30% of
milk fat at the expense of palmitic acid.
Secure a low proportion of vaccenic acid
Increase the selenium concentration in milk
Secure a constant content of iodine.
Consumption of 0.5 litre milk daily supplies a significant
amount of many of the nutrients that are required daily.
Milk components take part in metabolism in several ways;
by providing essential amino acids, vitamins, minerals
and fatty acids, or by affecting absorption of nutrients.
Milk fat is diverse with a wide-ranging spectrum of fatty
acids and lipids. Milk fat has been notified for decades,
but as discussed in this review a moderate intake of milk
fat has no negative health effects, on the contrary, many
milk fat component have important roles in the body.
Milk protein is especially rich in amino acids that
stimulates muscle synthesis, and some proteins and peptides in
milk have positive health effect e.g. on blood pressure,
inflammation, oxidation and tissue development.
Fermented milk has special health-promoting properties, e.g.
stimulation of immune response and protection against
cancer, virus and allergy, and fermented milk and full-fat
milk may also delay gastric emptying from the stomach
and possibly have an effect on appetite regulation. For
some individuals, milk proteins, fat or milk sugar may
cause health problems. Heat treatment of milk may also
result in reduction of bioactive compounds and
formation of potentially harmful products of carbohydrates and
proteins. Milk can be significantly altered by changing the
feeding regimes. Content of several fatty acids such as c9,
t11-CLA and the ratio between omega-6 and omega-3
fatty acids are affected by the amount of grass and
supplemental feeds (concentrate) in the diet. Milk content of
several vitamins and minerals are also influenced by the
cow's diet. Iodine and selenium are examples of trace
elements that may be added to the feed, and thereby milk
can be a good food source of these elements.
Milk contains many important nutrients.
The increasing consumption of milk products added
sugar and sugar containing jams should be questioned.
It is possible to adjust feeding regimes to develop milk
with increased content of healthy components such as
selenium, iodine and some fatty acids.
1. Bringsvar TA : En kjempe s stor som hele verden . Gyldendal norsk forlag A/S, Norway 1985 .
2. Saxelin M , Korpela R , Mayra-Makinen A : Introduction: classifying functional dairy products . In Functional dairy products Edited by: Mattila-Sandholm T, Saarela M . Woodhead Publishing Limited, UK ; 2003 : 1 - 16 .
3. Utviklingen i norsk kosthold: Rapport fra Sosial og helsedirektoratet , Norway 2003 .
4. Insel P , Turner RE , Ross D : Nutrition Second edition. American dietetic association, Jones and Bartlett , USA ; 2004 .
5. Yusuf S , Hawken S , Ounpuu S , Dans T , Avezum A , Lanas F , McQueen M , Budaj A , Pais P , Varigos J , Lisheng L : Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study . Lancet 2004 , 364 : 937 - 52 .
6. Keenan TW , Patton S : The structure of milk . In Handbook of milk composition Edited by: Jensen RG. Academic Press, USA; 1995 : 5 - 50 .
7. Ontsouka CE , Bruckmaier RM , Blum JW : Fractionized milk composition during removal of colostrum and mature milk . J Dairy Sci 2003 , 86 : 2005 - 11 .
8. Jensen RG , Newburg DS : Bovine milk lipids . In Handbook of milk composition Edited by: Jensen RG. Academic Press, USA; 1995 : 543 - 575 .
9. USDA National Nutrient Database for Standard Reference [http://www.nal.usda.gov/fnic/foodcomp/Data/]. ( accessed September 3 , 2007 )
10. Grundy SM : Influence of stearic acid on cholesterol metabolism relative to other long-chain fatty acids . Am J Clin Nutr 1994 , 60 : 986S - 990S .
11. Thormar H , Isaacs EE , Kim KS , Brown HR : Interaction of visna virus and other enveloped viruses by free fatty acids and monoglycerides . Ann N Y Acad Sci 1994 , 724 : 465 - 71 .
12. German JB : Butyric acid: a role in cancer prevention . Nutr Bull 1999 , 24 : 293 - 9 .
13. Mensink RP , Zock PL , Kester AD , Katan MB : Effects of dietary fatty acids and carbohydrates on the ratio of serum total to HDL cholesterol and on serum lipids and apolipoproteins: a meta-analysis of 60 controlled trials . Am J Clin Nutr 2003 , 77 : 1146 - 55 .
14. Sun CQ , O'Connor CJ , Roberton AM : The antimicrobial properties of milkfat after partial hydrolysis by calf pregastric lipase . Chem Biol Interact 2002 , 140 : 185 - 98 .
15. Schuster GS , Dirksen TR , Ciarlone AE , Burnett GW , Reynolds MT , Lankford MT : Anticaries and antiplaque potential of free-fatty acids in vitro and in vivo. Pharmacol Ther Dent 1980 , 5 : 25 - 33 .
16. Sun CQ , O'Connor CJ , Roberton AM : Antibacterial actions of fatty acids and monoglycerides against Helicobacter pylori . FEMS Immunol Med Microbiol 2003 , 36 : 9 - 17 .
17. Henry GE , Momin RA , Nair MG , Dewitt DL : Antioxidant and cyclooxygenase activities of fatty acids found in food . J Agric Food Chem 2002 , 50 : 2231 - 4 .
18. Chi D , Nakano M , Yamamoto K : Milk and milk products consumption in relationship to serum lipid levels: a communitybased study of middle-aged and older population in Japan . Cent Eur J Public Health 2004 , 12 : 84 - 7 .
19. Mensink RP , Katan MB : Effect of dietary fatty acids on serum lipids and lipoproteins: a metaanalysis of 27 trials . Arterioscler Thromb 1992 , 12 : 911 - 19 .
20. Hegsted DM , Ausman LM , Johnson JA , Dallal GE : Dietary fat and serum lipids . Am J Clin Nutr 1993 , 57 : 875 - 83 .
21. Sandstrom B , Marckmann P , Bindslev N : An eight-month controlled study of a low-fat high-fibre diet: effects on blood lipids and blood pressure in healthy young subjects . Eur J Clin Nutr 1992 , 46 : 95 - 109 .
22. Marckmann P , Sandstrom B , Jespersen J : Low-fat, high-fiber diet favorably affects several independent risk markers of ischemic heart disease: observations on blood lipids, coagulation, and fibrinolysis from a trial of middle-aged Danes . Am J Clin Nutr 1994 , 59 : 935 - 9 .
23. Seidel C , Deufel T , Jahreis G : Effects of fat-modified dairy products on blood lipids in humans in comparison with other fats . Ann Nutr Metab 2005 , 49 : 42 - 8 .
24. Bosaeus I : Milk and cholesterol . Vr Fda 1991 , 43 : 98 - 101 .
25. Eichholzer M , Stahelin H : Is there a hypocholesterolemic factor in milk and milk products? Int J Vitam Nutr Res 1993 , 63 ( 3 ): 158 - 167 .
26. Elwood PC , Pickering JE , Hughes J , Fehily AM , Ness AR : Milk drinking, ischaemic heart disease and ischaemic stroke . Evidence from cohort studies. Eur J Clin Nutr 2004 , 58 : 718 - 24 .
27. Sthelin HB : Nutritional factors Correlating with Cardivascular Disease: Results of the Basel Study . Nutrition and Cardiovascular Risks . Bibl Nutr Dieta . Basel, Karger 1992 , 49 : 24 - 35 .
28. Willett WC , Stampfer MJ , Manson JE , Colditz GA , Speizer FE , Rosner BA , Sampson LA , Hennekens CH : Intake of trans fatty acids and risk of coronary heart disease among women . The Lancet 1993 , 341 : 581 - 35 .
29. Fehily AM , Yarnell JW , Sweetnam PM , Elwood PC : Diet and incident ishaemic heart disease: The Caerpilly study . British Journal of Nutrition 1993 , 69 : 303 - 14 .
30. Ness AR , Smith GD , Hart C : Milk, coronary heart disease and mortality . J Epidemiol Community Health 2000 , 55 : 379 - 82 .
31. Smedman AE , Gustafsson IB , Berglund LG , Vessby BO : Pentadecanoic acid in serum as a marker for intake of milk fat: relations between intake of milk fat and metabolic risk factors . Am J Clin Nutr 1999 , 69 : 22 - 9 .
32. Warensjo E , Jansson JH , Berglund L , Boman K , Ahren B , Weinehall L , Lindahl B , Hallmans G , Vessby B : Estimated intake of milk fat is negatively associated with cardiovascular risk factors and does not increase the risk of a first acute myocardial infarction. A prospective case-control study . Br J Nutr 2004 , 91 : 635 - 42 .
33. Biong AS , Veierod MB , Ringstad J , Thelle DS , Pedersen JI : Intake of milk fat, reflected in adipose tissue fatty acids and risk of myocardial infarction: a case-control study . Eur J Clin Nutr 2006 , 60 : 236 - 44 .
34. Biong AS : Dairy products and myocardial infarction . In PhD thesis Faculty of Medicine , University of Oslo, Norway; 2007 .
35. Sjogren P , Rosell M , Skoglund-Andersson C , Zdravkovic S , Vessby B , de Faire U , Hamsten A , Hellenius ML , Fisher RM : Milk-derived fatty acids are associated with a more favorable LDL particle size distribution in healthy men . J Nutr 2004 , 134 : 1729 - 35 .
36. St-Pierre AC , Cantin B , Dagenais GR , Mauriege P , Bernard PM , Despres JP , Lamarche B : Low-density lipoprotein subfractions and the long-term risk of ischemic heart disease in men: 13- year follow-up data from the quebec cardiovascular study . Arterioscler Thromb Vasc Biol 2005 , 25 : 553 - 9 .
37. Picard S : Lipoprotein glyco-oxidation . Diabete Metab 1995 , 21 : 89 - 94 .
38. Goff DC Jr, D' Agostino RB Jr, Haffner SM , Otvos JD : Insulin resistance and adiposity influence lipoprotein size and subclass concentrations. Results from the Insulin Resistance Atherosclerosis Study . Metabolism 2005 , 54 : 264 - 70 .
39. Lamarche B , Lemieux I , Despres JP : The small, dense LDL phenotype and the risk of coronary heart disease: epidemiology, patho-physiology and therapeutic aspects . Diabetes Metab 1999 , 25 : 199 - 211 .
40. Tonstad S , Hjermann I : A high risk score for coronary heart disease is associated with the metabolic syndrome in 40-yearold men and women . J Cardiovasc Risk 2003 , 10 : 129 - 35 .
41. Hostmark AT , Osland A , Simonsen S , Levorstad K : Lipoproteinrelated coronary risk factors in patients with angiographically defined coronary artery disease: relation to number of stenosed arteries . J Intern Med 1990 , 228 : 317 - 21 .
42. Ridker PM : High-sensitivity C-reactive protein, inflammation, and cardiovascular risk: from concept to clinical practice to clinical benefit . Am Heart J 2004 , 148 : S19 - 26 .
43. Fredrikson GN , Hedblad B , Nilsson JA , Alm R , Berglund G , Nilsson J : Association between diet, lifestyle, metabolic cardiovascular risk factors, and plasma C-reactive protein levels . Metabolism 2004 , 53 : 1436 - 42 .
44. Lichtenstein AH , Erkkila AT , Lamarche B , Schwab US , Jalbert SM , Ausman LM : Influence of hydrogenated fat and butter on CVD risk factors: remnant-like particles, glucose and insulin, blood pressure and C-reactive protein . Atherosclerosis 2003 , 171 : 97 - 107 .
45. German JB , Dillard CJ : Saturated fats: what dietary intake ? Am J Clin Nutr 2004 , 80 : 550 - 9 .
46. Kris-Etherton PM , Pearson TA , Wan Y , Hargrove RL , Moriarty K , Fishell V , Etherton TD : High-monounsaturated fatty acid diets lower both plasma cholesterol and triacylglycerol concentrations . Am J Clin Nutr 1999 , 70 : 1009 - 15 .
47. Ip C : Review of the effects of trans fatty acids, oleic acid, n-3 polyunsaturated fatty acids, and conjugated linoleic acid on mammary carcinogenesis in animals . Am J Clin Nutr 1997 , 66 : 1523S - 1529S .
48. Bartsch H , Nair J : Oxidative stress and lipid peroxidationderived DNA-lesions in inflammation driven carcinogenesis . Cancer Detect Prev 2004 , 28 : 385 - 91 .
49. Bartsch H , Nair J , Owen RW : Exocyclic DNA adducts as oxidative stress markers in colon carcinogenesis: potential role of lipid peroxidation, dietary fat and antioxidants . Biol Chem 2002 , 383 : 915 - 21 .
50. Pamplona R , Portero-Otin M , Sanz A , Requena J , Barja G : Modification of the longevity-related degree of fatty acid unsaturation modulates oxidative damage to proteins and mitochondrial DNA in liver and brain . Exp Gerontol 2004 , 39 : 725 - 33 .
51. Bielicki JK , Forte TM , McCall MR : Gas-phase cigarette smoke inhibits plasma lecithin-cholesterol acyltransferase activity by modification of the enzyme's free thiols . Biochim Biophys Acta 1995 , 1258 : 35 - 40 .
52. De Lorgeril M , Renaud S , Mamelle N , Salen P , et al.: Mediterranean alpha-linolenic acid-rich diet in secondary prevention of coronary heart disease . Lancet 1994 , 343 : 1454 - 59 .
53. Nicolosi RJ , Woolfrey B , Wilson TA , Scollin P , et al.: Decreased aortic early atherosclerosis and associated risk factors in hypercholesterolemic hamsters fed a high- or mid-oleic acid oil compared to a high-linoleic acid oil . J Nutr Biochem 2004 , 15 : 540 - 47 .
54. Alfthan G , Aro A , Gey KF : Plasma homocysteine and cardiovascular disease mortality . Lancet 1997 , 349 : 397 .
55. Anonymous : International longevity comparisons . Stat Bull Metrop Insur Co 1992 , 73 : 10 - 15 .
56. Haug A , Hallaq H , Leaf A : Potential antiatherogenic effects of omega-3 fatty acids . In Thrombosis, an update Edited by: Neri Serneri GG, Gensini GF , Abbate R , Prisco D . Scientific press, Florence; 1992 : 361 - 372 .
57. Jump DB , Clarke SD : Regulation of gene expression by dietary fat . Annu Rev Nutr 1999 , 19 : 63 - 90 .
58. Bagga D , Wang L , Farias-Eisner R , Glaspy JA , Reddy ST : Differential effects of prostaglandin derived from omega-6 and omega-3 polyunsaturated fatty acids on COX-2 expression and IL-6 secretion . Proc Natl Acad Sci USA 2003 , 100 : 1751 - 6 .
59. Bartsch H , Nair J , Owen RW : Dietary polyunsaturated fatty acids and cancers of the breast and colorectum: emerging evidence for their role as risk modifiers . Carcinogenesis 1999 , 20 : 2209 - 18 .
60. Thorsdottir I , Hill J , Ramel A : Omega-3 fatty acid supply from milk associates with lower type 2 diabetes in men and coronary heart disease in women . Prev Med 2004 , 39 : 630 - 34 .
61. Hjartaker A , Laake P , Lund E : Childhood and adult milk consumption and risk of premenopausal breast cancer in a cohort of 48,844 women - the Norwegian women and cancer study . Int J Cancer 2001 , 93 : 888 - 93 .
62. w3-FA in food intake in France [http://www.afssa.fr/ Object.asp? IdObj=16034&Pge=0&CCH=050411131233:26:4&cwSID =BD23E41A64B54ECEB776487C408F5062&AID =0]
63. Wahle KW , Heys SD , Rotondo D : Conjugated linoleic acids: are they beneficial or detrimental to health? Prog Lipid Res 2004 , 43 : 553 - 87 .
64. Delmonte P , Kataok A , Corl BA , Bauman DE , Yurawecz MP : Relative retention order of all isomers of cis/trans conjugated linoleic acid FAME from the 6,8- to 13,15-positions using silver ion HPLC with two elution systems . Lipids 2005 , 40 : 509 - 14 .
65. Ding ST , McNeel RL , Mersmann HJ : Modulation of adipocyte determination and differentiation-dependent factor 1 by selected polyunsaturated fatty acids . In Vitro Cell Dev Biol Anim 2002 , 38 : 352 - 7 .
66. Roche HM , Noone E , Sewter C : Isomer-dependent metabolic effects of conjugated linoleic acid: insights from molecular markers sterol regulatory element-binding protein-1c and LXRalpha . Diabetes 2002 , 51 : 2037 - 44 .
67. Stene O , Thuen E , Lindstad P , Haug A : Innhold av konjugert linolsyre (CLA) i mjlk fra kyr i to ulike produksjonssystemer . Husdyrforsksmtet, Norway 2002 : p557 - 60 .
68. Bell JA , Griinari JM , Kennelly JJ : Effect of safflower oil, flaxseed oil, monensin, and vitamin E on concentration of conjugated linoleic acid in bovine milk fat . J Dairy Sci 2006 , 89 : 733 - 48 .
69. Terpstra AH : Effect of conjugated linoleic acid on body composition and plasma lipids in humans: an overview of the literature . Am J Clin Nutr 2004 , 79 : 352 - 61 .
70. Tricon S , Burdge GC , Kew S , Banerjee T , Russell JJ , Jones EL , Grimble RF , Williams CM , Yaqoob P , Calder PC : Opposing effects of cis-9, trans-11 and trans-10, cis-12 conjugated linoleic acid on blood lipids in healthy humans . Am J Clin Nutr 2004 , 80 : 614 - 20 .
71. Valeille K , Gripois D , Blouquit MF , Souidi M , Riottot M , Bouthegourd JC , Serougne C , Martin JC : Lipid atherogenic risk markers can be more favourably influenced by the cis-9, trans-11-octadecadienoate isomer than a conjugated linoleic acid mixture or fish oil in hamsters . Br J Nutr 2004 , 91 : 191 - 9 .
72. Gavino VC , Gavino G , Leblanc MJ , Tuchweber B : An isomeric mixture of conjugated linoleic acids but not pure cis-9, trans-11- octadecadienoic acid affects body weight gain and plasma lipids in hamsters . J Nutr 2000 , 130 : 27 - 9 .
73. Benito P , Nelson GJ , Kelly DS , Bartolini G , Schmidt PC , Simon V : The effect of conjugated linoleic acid on plasma lipoproteins and tissue fatty acid composition in humans . Lipids 2001 , 36 : 229 - 36 .
74. Thomas Yeung CH , Yang L , Huang Y , Wang J , Chen ZY : Dietary conjugated linoleic acid mixture affects the activity of intestinal acyl coenzyme A: cholesterol acyltransferase in hamsters . Br J Nutr 2000 , 84 : 935 - 41 .
75. Ostrowska E , Cross RF , Muralitharan M , Bauman DE , Dunshea FR : Effects of dietary fat and conjugated linoleic acid on plasma metabolite concentrations and metabolic responses to homeostatic signals in pigs . Br J Nutr 2002 , 88 : 625 - 34 .
76. Ha YL , Grimm NK , Pariza MW : Anticarcinogens from fried ground beef: heat-altered derivatives of linoleic acid . Carcinogenesis 1987 , 8 : 1881 - 7 .
77. Larsson SC , Bergkvist L , Wolk A : High-fat dairy food and conjugated linoleic acid intakes in relation to colorectal cancer incidence in the Swedish Mammography Cohort . Am J Clin Nutr 2005 , 82 : 894 - 900 .
78. Ochoa JJ , Farquharson AJ , Grant I , Moffat LE , Heys SD , Wahle KW : Conjugated linoleic acids (CLAs) decrease prostate cancer cell proliferation: different molecular mechanisms for cis -9, trans-11 and trans-10, cis-12 isomers. Carcinogenesis 2004 , 25 : 1185 - 91 .
79. Akahoshi A , Koba K , Ichinose F , Kaneko M , Shimoda A , Nonaka K , Yamasaki M , Iwata T , Yamauchi Y , Tsutsumi K , Sugano M : Dietary protein modulates the effect of CLA on lipid metabolism in rats . Lipids 2004 , 39 : 25 - 30 .
80. Iwakiri Y , Sampson DA , Allen KG : Suppression of cyclooxygenase-2 and inducible nitric oxide synthase expression by conjugated linoleic acid in murine macrophages . Prostaglandins Leukot Essent Fatty Acids 2002 , 67 : 435 - 43 .
81. Cheng WL , Lii CK , Chen HW , Lin TH , Liu KL : Contribution of conjugated linoleic acid to the suppression of inflammatory responses through the regulation of the NF-kappaB pathway . J Agric Food Chem 2004 , 52 : 71 - 8 .
82. Ledoux M , Chardigny J-M , Darbois M , Soustre Y , Sebedio J-L , Laloux L : Fatty acid composition of French butters with special emphasis on conjugated linoleic acid (CLA) isomers . J of food composition and analysis 2005 , 18 : 409 - 25 .
83. Precht D , Molktentin J : Rapid analysis of isomers of trans-octadecenoic acid in milk fat . Int Dairy J 1996 , 6 : 791 - 809 .
84. Roche JR , Petch S , Kay JK : Manipulating the dietary cation-anion difference via drenching to early-lactation dairy cows grazing pasture . J Dairy Sci 2005 , 88 : 264 - 76 .
85. Tricon S , Burdge GC , Jones EL , Russell JJ , El-Khazen S , Moretti E , Hall WL , Gerry AB , Leake DS , Grimble RF , Williams CM , Calder PC , Yaqoob P : Effects of dairy products naturally enriched with cis-9, trans-11 conjugated linoleic acid on the blood lipid profile in healthy middle-aged men . Am J Clin Nutr 2006 , 83 : 744 - 53 .
86. Kay JK , Mackle TR , Auldist MJ , Thomson NA , Bauman DE : Endogenous synthesis of cis-9, trans-11 conjugated linoleic acid in dairy cows fed fresh pasture . J Dairy Sci 2004 , 87 : 369 - 78 .
87. Santora J , Palmquist D , Rorhrig KL : Vaccenic acid is desaturated to conjugated linoleic acid in mice . J Nutr 2000 , 130 : 208 - 15 .
88. Glaser KR , Wenk C , Scheeder MR : Effects of feeding pigs increasing levels of C 18:1 trans fatty acids on fatty acid composition of backfat and intramuscular fat as well as backfat firmness . Arch Tierernahr 2002 , 56 : 117 - 30 .
89. Turpeinen AM , Mutanen M , Aro A , Salminen I , Basu S , Palmquist DL , Griinari JM : Bioconversion of vaccenic acid to conjugated linoleic acid in humans . Am J Clin Nutr 2002 , 76 : 504 - 10 .
90. Mensink RP , Katan MB : Effect of dietary trans fatty acids on high-density and low-density lipoprotein cholesterol levels in healthy subjects . N Engl J Med 1990 , 323 : 439 - 45 .
91. Ascherio A , Katan MB , Zock PL , Stampfer MJ , Willett WC : Trans fatty acids and coronary heart disease . N Engl J Med 1999 , 340 : 1994 - 8 .
92. Meijer GW , van Tol A , van Berkel TJ , Weststrate JA : Effect of dietary elaidic versus vaccenic acid on blood and liver lipids in the hamster . Atherosclerosis 2001 , 157 : 31 - 40 .
93. Clifton PM , Keogh JB , Noakes M : Trans fatty acids in adipose tissue and the food supply are associated with myocardial infarction . J Nutr 2004 , 134 : 874 - 9 .
94. Pan XL , Izumi T : Variation of the ganglioside compositions of human milk . Cow's milk and infant formulas. Early Hum Dev 2000 , 57 : 25 - 31 .
95. Korhonen HM , Pihlanto-Leppala A , Rantamaki P , Tupasela T : Impact of processing on bioactive proteins and peptides . Trends Food Sci Technol 1998 , 8 : 307 - 19 .
96. Clare DA , Swaisgood HE : Bioactive milk peptides: a prospectus . J Dairy Sci 2000 , 83 : 1187 - 95 .
97. Nilsson M , Holst JJ , Bjorck IM : Metabolic effects of amino acid mixtures and whey protein in healthy subjects: studies using glucose-equivalent drinks . Am J Clin Nutr 2007 , 85 : 996 - 1004 .
98. Ezine articles [http://ezinearticles.com/? Whey-Protein-Impor tance&id=2851]. (accessed August 30 , 2007 )
99. Lnnerdal B : Supplements. Preface . Am J Clin Nutr 2003 , 77 : 1535S - 1536S .
100. Meisel H , FitzGerald RJ : Biofunctional peptides from milk proteins: mineral binding and cytomodulatory effects . Curr Pharm 2003 , 9 ( 16 ): 1289 - 1295 .
101. Swaisgood HE : Protein and amino acid composition of bovine milk . In Handbook of milk composition Edited by: Jensen RG. Academic Press, USA; 1995 : 464 - 468 .
102. Birgisdottir BE , Hill JP , Harris DP , Thorsdottir I : Variation in consumption of cow milk proteins and lower incidence of Type 1 diabetes in Iceland vs the other 4 Nordic countries . Diabetes Nutr Metab 2002 , 15 : 240 - 5 .
103. Truswell AS : The A2 milk case: a critical review . Eur J Clin Nutr 2005 , 59 : 623 - 31 .
104. Jauhiainen T , Korpela R : Milk peptides and blood pressure . J Nutr 2007 , 137 : 825S - 9S .
105. Layman DK : The role of leucine in weight loss diets and glucose homeostatis . J Nutr 2003 , 133 : 261S - 267S .
106. Etzel MR : Manufacture and use of dairy protein fractions . J Nutr 2004 , 134 : 996S - 1002S .
107. Wolfe RR : Regulation of muscle protein by amino acids . J Nutr 2002 : 3219S - 3224S .
108. Frid AH , Nilsson M , Holst JJ , Bjorck IM : Effect of whey on blood glucose and insulin responses to composite breakfast and lunch meals in type 2 diabetic subjects . Am J Clin Nutr 2005 , 82 : 69 - 75 .
109. Pereira MA , Jacobs DR Jr, Van Horn L , Slattery ML , Kartashov AI , Ludwig DS : Dairy consumption, obesity, and the insulin resistance syndrome in young adults: the CARDIA Study . JAMA 2002 , 287 : 2081 - 9 .
110. Cataldi TR , Telesca G , Bianco G : Improved determination of taurine by high-performance anion-exchange chromatography with integrated pulsed amperometric detection (HPAECIPAD) . Anal Bioanal Chem 2004 , 378 : 804 - 10 .
111. Lourenco R , Camilo ME : Taurine: a conditionally essential amino acid in humans? An overview in health and disease . Nutr Hosp 2002 , 17 : 262 - 70 .
112. Li F , Obrosova IG , Abatan O , Tian D , Larkin D , Stuenkel EL , Stevens MJ : Taurine replacement attenuates hyperalgesia and abnormal calcium signaling in sensory neurons of STZ-D rats . Am J Physiol Endocrinol Metab 2005 , 288 : E29 - 36 .
113. Burger U , Gobel R : Taurine requirement of premature infants in parenteral nutrition . Monatsschr Kinderheilkd 1992 , 140 : 416 - 21 .
114. Fennessy FM , Moneley DS , Wang JH , Kelly CJ , Bouchier-Hayes DJ : Taurine and vitamin C modify monocyte and endothelial dysfunction in young smokers . Circulation 2003 , 107 : 410 - 5 .
115. Park E , Jia J , Quinn MR , Schuller-Levis G : Taurine chloramine inhibits lymphocyte proliferation and decreases cytokine production in activated human leukocytes . Clin Immunol 2002 , 102 : 179 - 84 .
116. Silva MA , Cunha GM , Viana GS , Rao VS : Taurine modulates chemical nociception in mice . Braz J Med Biol Res 1993 , 26 : 1319 - 24 .
117. Sprietsma JE : Modern diets and diseases: NO-zinc balance. Under Th1, zinc and nitrogen monoxide (NO) collectively protect against viruses , AIDS, autoimmunity, diabetes, allergies, asthma, infectious diseases, atherosclerosis and cancer. Med Hypotheses 1999 , 53 : 6 - 16 .
118. Cai J , Chen Y , Seth S , Furukawa S , Compans RW , Jones DP : Inhibition of influenza infection by glutathione . Free Radic Biol Med 2003 , 34 : 928 - 36 .
119. Lindmark-Mansson H , Akesson B : Antioxidative factors in milk . Br J Nutr 2000 , 84 (Suppl 1): S103 - 10 .
120. Dodig S , Cepelak I : The facts and controverses about selenium . Acta Pharm 2004 , 54 : 261 - 76 .
121. Saito Y , Sato N , Hirashima M , Takebe G , et al.: Domain structure of bi-functional selenoprotein P . Biochem J 2004 , 381 : 841 - 46 .
122. Traulsen H , Steinbrenner H , Buchzyk DP , Klotz LO : Selenoprotein P protects low-density lipoprotein against oxidation . Free Radic Res 2004 , 38 : 123 - 28 .
123. McDermid JM , Lalonde RG , Gray-Donald K , Baruchel S , et al.: Associations between dietary antioxidant intake and oxidative stress in HIV-seropositive and HIV-seronegative men and women . J Acquir Immune Defic Syndr 2002 , 29 : 158 - 64 .
124. Shamberger RJ , Tytko SA , Willis CE : Selenium and heart disease. In Trace Substances in Environmental Health-IX Edited by: Hemphill DD . University of Missouri, Columbia; 1975 : 15 - 22 .
125. Shamberger RJ , Willis CE , McCormack LJ : Selenium and heart disease . III. Blood selenium and heart mortality in 19 states. In Trace Substances in Environmental Health-XIII Edited by: Hemphill DD . University of Missouri, Columbia; 1979 : 59 - 63 .
126. Allam MF , Lucane RA : Selenium supplementation for asthma . Cochrane Database Syst Rev 2004 : CD003538 .
127. Rayman MP : The argument for increasing selenium intake . Proc Nutr Soc 2002 , 61 : 203 - 15 .
128. Hans CP , Chaudhary DP , Bansal DD : Magnesium deficiency increases oxidative stress in rats . Indian J Exp Biol 2002 , 40 : 1275 - 9 .
129. Cheuk DK , Chau TC , Lee SL : A meta-analysis on intravenous magnesium sulphate for treating acute asthma . Arch Dis Child 2005 , 90 : 74 - 7 .
130. Harada H , Tsujino T , Watari Y , Nonaka H , Emoto N , Yokoyama M : Oral taurine supplementation prevents fructose-induced hypertension in rats . Heart Vessels 2004 , 19 : 132 - 6 .
131. Hansen M , Sandstrom B , Lonnerdal B : The effect of casein phosphopeptides on zinc and calcium absorption from high phytate infant diets assessed in rat pups and Caco-2 cells . Pediatr Res 1996 , 40 : 547 - 52 .
132. Kaushik S , Wander R , Leonard S , German B , Traber MG : Removal of fat from cow's milk decreases the vitamin E contents of the resulting dairy products . Lipids 2001 , 36 : 73 - 8 .
133. Hayes K , Pronczuk A , Perlman D : Vitamin E in fortified cow milk uniquely enriches human plasma lipoproteins . Am J Clin Nutr 2001 , 74 : 211 - 8 .
134. Forssen KM , Jagerstad MI , Wigertz K , Witthoft CM : Folates and dairy products: a critical update . J Am Coll Nutr 2000 , 19 : 100S - 110S .
135. Forman JP , Rimm EB , Stampfer MJ , Curhan GC : Folate intake and the risk of incident hypertension among US women . JAMA 2005 , 293 : 320 - 9 .
136. Staff AC , Holven K , Lken EB , Sygnestveit K , Vollset SE , Smeland S : Does folic acid have effects on other health problems than neural tube defects? Tidsskr Nor Laegeforen 2005 , 125 : 438 - 41 .
137. Akoglu B , Faust D , Milovic V , Stein J : Folate and chemoprevention of colorectal cancer: Is 5-methyl-tetrahydrofolate an active antiproliferative agent in folate-treated colon-cancer cells? Nutrition 2001 , 17 : 652 - 3 .
138. Institute of Medicine: Food and Nutrition Board . Op.Sit. 8 - 11 and Suitor CW , Bailay LB . Dietary folate equivalents:interpretation and application . J Am Diet Assoc 2000 , 100 : 88 - 94 .
139. Picciano MF , West SG , Ruch AL , Kris-Etherton PM , Zhao G , Johnston KE , Maddox DH , Fishell VK , Dirienzo DB , Tamura T : Effect of cow milk on food folate bioavailability in young women . Am J Clin Nutr 2004 , 80 : 1565 - 9 .
140. Ganji V , Kafai MR : Frequent consumption of milk, yogurt, cold breakfast cereals, peppers, and cruciferous vegetables and intakes of dietary folate and riboflavin but not vitamins B-12 and B-6 are inversely associated with serum total homocysteine concentrations in the US population . Am J Clin Nutr 2004 , 80 : 1500 - 7 .
141. Persson A : Clinical assessment of udder health status of sows at time of weaning with special reference to bacteriology and cytology in milk . Zentralbl Veterinarmed A 1997 , 44 : 143 - 58 .
142. Rossland E , Langsrud T , Granum PE , Sorhaug T : Production of antimicrobial metabolites by strains of Lactobacillus or Lactococcus co-cultured with Bacillus cereus in milk . Int J Food Microbiol 2005 , 98 : 193 - 200 .
143. Forchielli ML , Walker WA : The role of gut-associated lymphoid tissues and mucosal defence . Br J Nutr 2005 , 93 (Suppl 1): S41 - 8 .
144. Vinderola CG , Duarte J , Thangavel D , Perdigon G , Farnworth E , Matar C : Immunomodulating capacity of kefir . J Dairy Res 2005 , 72 : 195 - 202 .
145. Leblanc J , Fliss I , Matar C : Induction of a humoral immune response following an Escherichia coli O157:H7 infection with an immunomodulatory peptidic fraction derived from Lactobacillus helveticus-fermented milk . Clin Diagn Lab Immunol 2004 , 11 : 1171 - 81 .
146. Watson JL , McKay DM : The immunophysiological impact of bacterial CpG DNA on the gut . Clin Chim Acta 2006 , 364 ( 1- 2 ): 1 - 11 .
147. Branca F , Rossi L : The role of fermented milk in complementary feeding of young children: lessons from transition countries . Eur J Clin Nutr 2002 , 56 (Suppl 4): S16 - 20 .
148. O'Sullivan L , Ross RP , Hill C : Potential of bacteriocin-producing lactic acid bacteria for improvements in food safety and quality . Biochimie 2002 , 84 : 593 - 604 .
149. De Vrese M , Stegelmann A , Richter B , Fenselau S , Laue C , Schrezenmeir J : Probiotics - compensation for lactase insufficiency . Am J Clin Nutr 2001 , 73 ( 2 Suppl): 421S - 429S .
150. Vesa TH , Marteau PR , Briet FB , Boutron-Ruault MC , Rambaud JC : Raising milk energy content retards gastric emptying of lactose in lactose-intolerant humans with little effect on lactose digestion . J Nutr 1997 , 127 : 2316 - 20 .
151. Sanggaard KM , Holst JJ , Rehfeld JF , Sandstrom B , Raben A , Tholstrup T : Different effects of whole milk and a fermented milk with the same fat and lactose content on gastric emptying and postprandial lipaemia, but not on glycaemic response and appetite . Br J Nutr 2004 , 92 : 447 - 59 .
152. Pinnock CB , Graham NM , Mylvaganam A , Douglas RM : Relationship between milk intake and mucus production in adult volunteers challenged with rhinovirus-2 . Am Rev Respir Dis 1990 , 141 : 352 - 6 .
153. Wuthrich B , Schmid A , Walther B , Sieber R : Milk consumption does not lead to mucus production or occurrence of asthma . J Am Coll Nutr 2005 , 24 : 547S - 55S .
154. Ushida Y , Shimokawa Y , Toida T , Matsui H , Takase M : Bovine alphalactalbumin stimulates mucus metabolism in gastric mucosa . J Dairy Sci 2007 , 90 : 541 - 6 .
155. NAAF's faktaark . Melkeallergi 2007 [http://www.naaf.no/no/ Fakta/Mat/Nyttig_a_vite_ om_melkeallergi_-__NAAFs_faktaark/]. (accessed September 1 , 2007 )
156. Wal JM : Bovine milk allergenicity . Ann Allergy Asthma Immunol 2004 , 93 ( 5 Suppl 3 ): S2 - 11 .
157. Von Ehrenstein OS , von Mutius E , Illi S , Baumann L , Bhm O , von Kries R : Clin Exp Allergy 2000 , 30 : 187 - 93 .
158. Liu Y , Reichelt KL : A serotonin uptake-stimulating tetra-peptide found in urines from ADHD children . World J Biol Psychiatry 2001 , 2 : 144 - 8 .
159. Hellzen M , Larsson JO , Reichelt KL , Rydelius PA : Urinary peptide levels in women with eating disorders. A pilot study . Eat Weight Disord 2003 , 8 : 55 - 61 .
160. Reichelt KL , Knivsberg AM : Can the pathophysiology of autism be explained by the nature of the discovered urine peptides? Nutr Neurosci 2003 , 6 : 19 - 28 .
161. Kolars JC , Levitt MD , Aouji M , Savaiano DA : Yogurt - an autodigesting source of lactose . N Engl J Med 1984 , 310 : 1 - 3 .
162. Frey PA : The Leloir pathway: a mechanistic imperative for three enzymes to change the stereochemical configuration of a single carbon in galactose . FASEB J 1996 , 10 : 461 - 70 .
163. Cramer DW , Xu H , Sahi T : Adult hypolactasia, milk consumption, and age-specific fertility . Am J Epidemiol 1994 , 139 : 282 - 89 .
164. Zisu B , Shah NP : Effects of pH, temperature, supplementation with whey protein concentrate, and adjunct cultures on the production of exopolysaccharides by Streptococcus thermophilus 1275 . J Dairy Sci 2003 , 86 : 3405 - 15 .
165. Liu G , Shi F , Blas-Machado U , Duong Q , Davis VL , Foster WG , Hughes CL : Ovarian effects of a high lactose diet in the female rat . Reprod Nutr Dev 2005 , 45 : 185 - 92 .
166. Lund MN , Olsen K , Sorensen J , Skibsted LH : Kinetics and mechanism of lactosylation of alpha-lactalbumin . J Agric Food Chem 2005 , 53 : 2095 - 102 .
167. Ankrah NA , Appiah-Opong R , Dzokoto C : Human breastmilk storage and the glutathione content . J Trop Pediatr 2000 , 46 : 111 - 3 .
168. Jenkins TC , McGuire MA : Major advances in nutrition: impact on milk composition . J Dairy Sci 2006 , 89 : 1302 - 10 .
169. Mosley EE , Shafii Dagger B , Moate PJ , McGuire MA : cis-9, trans-11 conjugated linoleic acid is synthesized directly from vaccenic acid in lactating dairy cattle . J Nutr 2006 , 136 : 570 - 75 .
170. Palmquist DL , Beaulieu AD , Barbano DM : Feed and animal factors influencing milk fat composition . J Dairy Sci 1993 , 76 : 1753 - 71 .
171. Ekern A , Havrevoll , Haug A , Berg J , Lindstad P , Skeie S : Oat and barley based concentrate supplements for dairy cows . Acta Agric Scand ., Sect A , Animal Sci 2003 , 53 : 65 - 73 .
172. Chilliard Y , Ferlay A : Dietary lipids and forages interactions on cow and goat milk fatty acid composition and sensory properties . Reprod Nutr Dev 2004 , 44 : 467 - 92 .
173. Ward AT , Wittenberg KM , Froebe HM , Przybylski R , Malcolmson L : Fresh forage and solin supplementation on conjugated linoleic acid levels in plasma and milk . J Dairy Sci 2003 , 86 : 1742 - 50 .
174. Meltretter J , Seeber S , Humeny A , Becker CM , Pischetsrieder M : Site-Specific Formation of Maillard, Oxidation, and Condensation Products from Whey Proteins during Reaction with Lactose . J Agric Food Chem 2007 , 55 : 6096 - 103 .
175. Neville MC , Zhang P , Allen JC : Minerals, ions and trace elements in milk . In Handbook of milk composition Edited by: Jensen RG. Academic Press, USA; 1995 : 543 - 575 .
176. Casey CE , Smith A , Zhang P : Microminerals in human and animal milk . In Handbook of milk composition Edited by: Jensen RG. Academic Press, USA; 1995 : 543 - 575 .
177. Ortman K , Pehrson B : Effect of selenate as a feed supplement to dairy cows in comparison to selenite and selenium yeast . J Anim Sci 1999 , 77 : 3365 - 70 .
178. Crout NM , Voigt G : Modeling the dynamics of radioiodine in dairy cows . J Dairy Sci 1996 , 79 : 254 - 9 .
179. Dahl L , Opsahl JA , Meltzer HM , Julshamn K : Iodine concentration in Norwegian milk and dairy products . Br J Nutr 2003 , 90 : 679 - 85 .
180. Jensen RG : Fat soluble vitamins in bovine milk . In Handbook of milk composition Edited by: Jensen RG. Academic Press, USA; 1995 : 718 - 725 .
181. Syvaoja EL , Piironen V , Varo P , Koivistoinen P , Salminen K : Tocopherols and tocotrienols in Finnish foods: Dairy products and eggs . Milchwissenschaft 1985 , 40 : 467 - 69 .
182. McDonald P , Edwards RA , Greenhalgh JFD , Morgan CA: Animal nutrition . Sixth edition. Pearson , Prentice Hall , UK ; 2002 .