Consumption of milk, but not other dairy products, is associated with height among US preschool children in NHANES 1999–2002

A review of dairy food intake for improving health among black infants, toddlers, and young children in the US

Adequate nutrition is paramount for proper growth and musculoskeletal, neurocognitive, and immunological development in infants, toddlers, and young children. Among breastfeeding mother-child dyads, this critical window of development, is impacted by both maternal and offspring dietary patterns. For mothers, their dietary patterns impact not only their own health and well-being, but also the nutrition of their breast milk - which is recommended as the sole source of food for the first 6 months of their infant's life, and as a complementary source of nutrition until at least 2 years of age. For infants and toddlers, the breast milk, formulas, and first foods they consume can have both short-term and long-term effects on their health and well-being - with important impacts on their taste perception, microbiome composition, and immune function. According to dietary intake data in the US, infants and young children meet a greater number of nutrient requirements than older children and adults, yet numerous disparities among socially disadvantaged racial/ethnic groups still provide significant challenges to achieving adequate nutrition during these early life stages. For example, Black children are at greater risk for disparities in breastfeeding, age-inappropriate complementary feeding patterns, nutrient inadequacies, food insecurity, and obesity relative to most other racial/ethnic groups in the US. For infants who do not receive adequate breast milk, which includes a disproportionate number of Black infants, dairy-based infant formulas are considered the next best option for meeting nutritional needs. Fermented dairy foods (e.g., yogurt, cheese) can serve as ideal first foods for complementary feeding, and cow's milk is recommended for introduction during the transitional feeding period to help meet the nutrient demands during this phase of rapid growth and development. Low dairy intake may put children at risk for multiple nutrient inadequacies and health disparities - some of which may have lifelong consequences on physical and mental health. A burgeoning body of research shows that in addition to breast milk, cow's milk and other dairy foods may play critical roles in supporting physical growth, neurodevelopment, immune function, and a healthy gut microbiome in early life. However, most of this research so far has been conducted in White populations and can only be extrapolated to Black infants, toddlers, and young children. Therefore, to better understand and support the health and development of this population, greater research and education efforts on the role of milk and dairy products are urgently needed. This review presents the current evidence on health disparities faced by Black children in the US from birth to four years of age, and the role that dairy foods can play in supporting the normal growth and development of this vulnerable population.

The Role of Cow's Milk Consumption in Breast Cancer Initiation and Progression

PURPOSE OF REVIEW

This review evaluates cow milk's impact on breast carcinogenesis by linking recent epidemiological evidence and new insights into the molecular signaling of milk and its constituents in breast cancer (BCa) pathogenesis.

RECENT FINDINGS

Recent prospective cohort studies support the association between cow's milk consumption and the risk of estrogen receptor-α-positive (ER+) BCa. Milk is a complex biological fluid that increases systemic insulin-like growth factor 1 (IGF-1), insulin and estrogen signaling, and interacting hormonal promoters of BCa. Further potential oncogenic components of commercial milk include exosomal microRNAs (miR-148a-3p, miR-21-5p), bovine meat and milk factors, aflatoxin M1, bisphenol A, pesticides, and micro- and nanoplastics. Individuals with BRCA1 loss-of-function mutations and FTO and IGF1 gain-of-function polymorphisms enhancing IGF-1/mTORC1 signaling may be at increased risk for milk-induced ER+ BCa. Recent prospective epidemiological and pathobiochemical studies identify commercial milk consumption as a critical risk factor of ER+ BCa. Large meta-analyses gathering individuals of different ethnic origins with milk derived from dairy cows of varying genetic backgrounds and diverse feeding procedures as well as missing data on thermal processing of milk (pasteurization versus ultra-heat treatment) make multi-national meta-analyses unsuitable for BCa risk estimations in susceptible populations. Future studies are required that consider all vulnerable periods of breast carcinogenesis to cow's milk exposure, beginning during the perinatal period and puberty, since these are the most critical periods of mammary gland morphogenesis. Notwithstanding the need for better studies including detailed information on milk processing and vulnerable periods of human breast carcinogenesis, the available evidence suggests that dietary guidelines on milk consumption may have to be reconsidered.

Effect of a Fortified Dairy-Based Drink on Micronutrient Status, Growth, and Cognitive Development of Nigerian Toddlers- A Dose-Response Study

Malnutrition results in a high prevalence of stunting, underweight, and micronutrient deficiencies. This study investigated the effect of a multi-nutrient fortified dairy-based drink on micronutrient status, growth, and cognitive development in malnourished [height-for-age z-score (HAZ) and/or weight-for-age z-score (WAZ) < -1 SD and >-3 SD] Nigerian toddlers (n = 184, 1-3 years). The product was provided in different daily amounts (200, 400, or 600 ml) for 6 months. At baseline and endline, venous blood and urine samples were collected to determine micronutrient status. Bodyweight, height, waist, and head circumference were measured, and corresponding Z-scores were calculated. The Bayley-III Screening Test was used to classify the cognitive development of the children. In a modified per-protocol (PP) population, the highest prevalence's of micronutrient deficiencies were found for vitamin A (35.5%) and selenium (17.9%). At endline, there were no significant improvements in iodine, zinc, vitamin B12, and folate status in any of the three groups. Regarding vitamin D status (25OHD), consumption of 600 and 400 ml resulted in an improved status as compared to baseline, and in a difference between the 600- and 200-ml groups. Consumption of 600 ml also increased vitamin A and selenium status as compared to baseline, but no differences were found between groups. Within the groups, WAZ, weight-for-height z-score (WHZ), and BMI-for-age z-score (BAZ) improved, but without differences between the groups. For HAZ, only the 600 ml group showed improvement within the group, but it was not different between groups. For the absolute weight, height, and head circumference only trends for differences between groups were indicated. Cognition results did not differ between the groups. Within groups, all showed a decline in the per cent of competent children for receptive language. To study the effects of a nutritional intervention on linear growth and cognition, a longer study duration might be necessary. Regarding the improvement of micronutrient status, 600 ml of fortified dairy-based drink seems most effective.

Clinical Trial Registration

https://clinicaltrials.gov/ct2/show/NCT03411590?term=NCT03411590.&draw=2&rank=1, identifier: NCT03411590.

Milk and dairy consumption is positively associated with height in adolescents: results from the Israeli National Youth Health and Nutrition Survey

PURPOSE

Milk consumption is associated with increased height primarily in early childhood. However, in adolescents, data are scarce with inconsistent results. Since height is a proxy for overall health and well-being, this study evaluated the association of dairy intake with height in adolescents.

METHODS

Students in 7th-12th grades, participating in the 2015-2016 Israeli Health and Nutrition Youth Survey, a school-based cross-sectional study, completed self-administered questionnaires, including a semi-quantitative food frequency questionnaire (n = 3529, 48% males, 15.2 ± 1.6 years). Anthropometric measurements were also performed. Dairy servings were calculated as the calcium equivalent of 1 cup of milk, and consumption was divided into four categories from very low (< 1 serving/day) to high (3 + servings/day). BMI- and Height-for-age z scores (HAZs) were calculated according to WHO growth standard; relatively short stature (RSS) was defined as HAZ < - 0.7 SD (< 25th percentile). Multivariable linear and logistic regression analyses were performed to evaluate the association of dairy intake with HAZ and prevalence of RSS, respectively.

RESULTS

Median consumption of dairy products was 2 servings/day, 1.4 from unsweetened products (milk, cheese and yogurt). Controlling for age, sex, BMI-z-score and socioeconomic status, each increment of unsweetened dairy intake was associated with on average 0.04 higher HAZ (equivalent to 0.3-0.4 cm, p < 0.05), and with reduced risk for RSS: OR 0.90, 95%CI: 0.84, 0.97, p < 0.01. No such associations were found with sweetened dairy products.

CONCLUSION

Consumption of unsweetened dairy products (3-4 servings/day) appears to contribute to achieving growth potential in adolescents. Intervention studies are necessary to determine the causal relationship between dairy intake and linear growth.

Longitudinal Associations between Intake of Fruit and Vegetables and Height Attainment from Preschool to School Entry

To examine associations between fruit and vegetable intake in young childhood and height attainment during preschool and at school entry. Data for this study was based on "The Healthy Start" primary intervention study, which included 635 obesity-prone children, (58% boys), from the greater Copenhagen area, with a mean (SD) age of 4.0 (1.1) years (age range 2-6 years) at baseline. In the current study, 553 children (57% boys) were included with information on dietary intake at baseline and height measured at baseline (preschool age), and 511 children (56.8% boys) with the height measured at school entry (~6 years old). Height was measured by trained health professionals during the intervention and by school nurses at school entry. Information on intakes of fruit and vegetables, separately and combined, was gathered with four-day dietary records reported by parents. Participants were grouped into tertiles for their intakes at baseline. Compared to boys with low consumption, those with a moderate and high intakes of fruit and vegetables (F&V) had a greater attained height at preschool of 1.3 cm (95% confidence interval (CI): 0.3; 2.3) and at school entry of 2.4 cm (95% CI: 0.8; 3.9) and 1.8 cm (95% CI: 0.2; 3.4), respectively, also after adjustment for differences in age, body mass index (BMI), and total energy intake. Additional adjustment for mid-parental height and parents' education did not alter the significant associations between moderate consumption of F&V and attained height at preschool and school entry. There was no association among girls. Our results showed that a moderate consumption of F&V was directly associated with higher attainment in height at preschool and school entry in boys. From a public health perspective, it should be prioritized to continue developing intervention programs to improve fruit and vegetable intake.

[Health risks related to milk consumption: a critical evaluation from the medical perspective]

BACKGROUND

Recent epidemiological studies associate the consumption of non-fermented cow's milk, but not fermented milk products, with an increased risk of diseases of civilization.

OBJECTIVES

Presentation of epidemiological and pathophysiological data on health risks associated with milk consumption.

METHOD

Selective PubMed surveys between 2005-2020 considering epidemiological studies which clearly differentiate between non-fermented versus fermented milk and its potential health risks.

RESULTS

Epidemiological studies confirm a correlation between milk consumption and birthweight, linear growth during puberty, acne vulgaris, type 2 diabetes mellitus, prostate cancer, breast cancer, hepatocellular carcinoma, non-Hodgkin lymphoma, Parkinson's disease and over-all mortality. In comparison to milk consumption, the intake of fermented milk/milk products exhibits neutral to beneficial health effects, which are explained by attenuated mTORC1 signaling due to bacterial fermentation of milk.

CONCLUSIONS

Long-term persistent consumption of non-fermented milk, but not fermented milk/milk products, might increase the risk of diseases of civilization. The avoidance of milk, especially pasteurized fresh milk, may enhance the prevention and reduce the recurrence of common Western diseases of civilization.

Lifetime Impact of Cow's Milk on Overactivation of mTORC1: From Fetal to Childhood Overgrowth, Acne, Diabetes, Cancers, and Neurodegeneration

The consumption of cow's milk is a part of the basic nutritional habits of Western industrialized countries. Recent epidemiological studies associate the intake of cow's milk with an increased risk of diseases, which are associated with overactivated mechanistic target of rapamycin complex 1 (mTORC1) signaling. This review presents current epidemiological and translational evidence linking milk consumption to the regulation of mTORC1, the master-switch for eukaryotic cell growth. Epidemiological studies confirm a correlation between cow's milk consumption and birthweight, body mass index, onset of menarche, linear growth during childhood, acne vulgaris, type 2 diabetes mellitus, prostate cancer, breast cancer, hepatocellular carcinoma, diffuse large B-cell lymphoma, neurodegenerative diseases, and all-cause mortality. Thus, long-term persistent consumption of cow's milk increases the risk of mTORC1-driven diseases of civilization. Milk is a highly conserved, lactation genome-controlled signaling system that functions as a maternal-neonatal relay for optimized species-specific activation of mTORC1, the nexus for regulation of eukaryotic cell growth, and control of autophagy. A deeper understanding of milk´s impact on mTORC1 signaling is of critical importance for the prevention of common diseases of civilization.

Growth and Development of Preschool Children (12-60 Months): A Review of the Effect of Dairy Intake

Undernutrition in young children is a global health issue. The ability to meet energy and nutrient needs during this critical stage of development is necessary, not only to achieve physical and mental potential but also socio-economic achievement later in life. Given ongoing discussions regarding optimization of dietary patterns to support achievement of the Sustainable Development Goals established by the United Nations, it is important to identify foods/food groups that have shown efficacy in reducing the negative impacts of undernutrition in young children. This narrative review addresses the impact of dairy intake, with a focus on linear growth, cognitive development and weight gain in early childhood (12-60 months). The impact of country economic status is also examined, to help elucidate regional specific recommendations and/or future research needs. Overall, the body of research addressing this age group is somewhat limited. Based on the data available, there is a positive association between dairy intake and linear growth. The impact of milk or dairy products on cognitive development is less clear due to a lack of evidence and is a gap in the literature that should be addressed. Regarding the impact on body weight, the majority of evidence suggests there is either no association or an inverse association between milk intake by preschool children on overweight and obesity later in life. This evidence is exclusively in high income countries, however, so additional work in lower income countries may be warranted.

Association between Dairy Intake and Linear Growth in Chinese Pre-School Children

Stunting remains a major public health issue for pre-school children globally. Dairy product consumption is suboptimal in China. The aim of this study was to investigate the relationship between dairy intake and linear growth in Chinese pre-school children. A national representative survey (Chinese Nutrition and Health Surveillance) of children aged under 6 years was done in 2013. Stratified multistage cluster sampling was used to select study participants. A food frequency questionnaire was used to collect dietary information. We calculated height-for-age Z-scores (HAZs) and estimated stunting using the 2006 WHO growth standard. In total, 12,153 children aged two to four years old (24 to <60 months) were studied from 55 counties in 30 provinces in China. Approximately 39.2% (4759/12,153) of those children consumed dairy at least once per day, 11.9% (1450/12,153) consumed dairy at least once in the last week, and nearly half (48.9%, 5944/12,153) did not have any dairy in the last week. The HAZ was −0.15 ± 1.22 and the prevalence of stunting was 6.5% (785/12,153). The HAZ for children who consumed dairy at least once per day or per week was 0.11 points or 0.13 points higher than the children without dairy intake. The risk of stunting for children who consumed dairy at least once per day was 28% lower than the children without dairy intake in the last week, and the risk was similar between weekly dairy consumption and no dairy consumption (AOR: 1.03, 95% CI: 0.74–1.42) after adjusting for potential confounders, including socioeconomic characteristics, lifestyle, health status, and the intake frequency of other foods. Dairy intake was significantly associated with a higher HAZ and a lower risk of stunting for children aged 2–4 years old in China. The proportion of dairy intake was still low in Chinese pre-school children. The promotion of dairy consumption might be an effective and feasible measurement for improving linear growth in Chinese pre-school children.

Food groups intake in relation to stunting among exceptional children

Background

Although several studies have examined the link between different food groups intake and stunting among children, no study, to our knowledge, was done on exceptional children. The aim of this study was assessed the association of dietary intake and stunting in Iranian exceptional children.

Methods

This cross-sectional study was conducted on 470 exceptional children (226 mentally retarded, 182 deaf and 62 blind children), aged 5–15 years. Height was measured using standard tool. Stunting was defined as height-for-age z-score of <-1. A validated dietary habit questionnaire was applied to assess dietary intakes.

Results

Mean age of children was 10.02 ± 2.04 years. Stunting was prevalent among 50.6% of children. Compared with children in the lowest category of dairy consumption, those in the highest category had lower odds of stunting. This association remained significant even after adjusting for covariates (OR: 0.50, 95% CI: 0.29–0.87). In addition, moderate consumption of egg (1–3 time/wk) was inversely associated with stunting either before or after controlling for potential confounders (OR: 0.36, 95% CI: 0.21–0.64). Such finding was also seen among mentally retarded children (OR: 0.38, 95% CI: 0.16–0.89). No other significant association was seen between intakes of other food groups (including meat, fruits and vegetables) and stunting.

Conclusions

We found that higher intake of dairy products and egg was associated with lower risk of stunting. However, intakes of other food groups including meat, fruits and vegetables were not significantly related to stunting.

North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition Position Paper: Plant-based Milks

Parents and caretakers are increasingly feeding infants and young children plant-based "milk" (PBM) alternatives to cow milk (CM). The US Food and Drug Administration currently defines "milk" and related milk products by the product source and the inherent nutrients provided by bovine milk. Substitution of a milk that does not provide a similar nutritional profile to CM can be deleterious to a child's nutritional status, growth, and development. Milk's contribution to the protein intake of young children is especially important. For almond or rice milk, an 8 oz serving provides only about 2% or 8%, respectively, of the protein equivalent found in a serving of CM. Adverse effects from the misuse of certain plant-based beverages have been well-documented and include failure to gain weight, decreased stature, kwashiorkor, electrolyte disorders, kidney stones, and severe nutrient deficiencies including iron deficiency anemia, rickets, and scurvy. Such adverse nutritional outcomes are largely preventable. It is the position of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) Nutrition Committee, on behalf of the society, that only appropriate commercial infant formulas be used as alternatives to human milk in the first year of life. In young children beyond the first year of life requiring a dairy-free diet, commercial formula may be a preferable alternative to cow's milk, when such formula constitutes a substantial source of otherwise absent or reduced nutrients (eg, protein, calcium, vitamin D) in the child's restricted diet. Consumer education is required to clarify that PBMs do not represent an equivalent source of such nutrients. In this position paper, we provide specific recommendations for clinical care, labelling, and needed research relative to PBMs.

Age of cow milk introduction and growth among 3-5-year-old children

OBJECTIVE

To evaluate the association between the age of cow milk introduction and childhood growth.

DESIGN

A secondary analysis of a prospective cohort study.

SETTING

Toronto, Canada.

PARTICIPANTS

Healthy children <5 years of age enrolled in the TARGet Kids! practice-based research network. The primary exposure was the age of cow milk introduction. The primary outcome was height-for-age z-score. Secondary outcomes were volume of cow milk consumed (cups/d) and BMI z-score. Outcomes were measured at the last visit before 5 years of age. Multiple linear regression was used to examine these relationships.

RESULTS

Among 1981 children, introduction of cow milk at a younger age was associated with greater height by 3-5 years of age (P < 0·001). Each month earlier that cow milk was introduced was associated with 0·03 higher height-for-age z-score unit (95 % CI -0·05, -0·02) or 0·1 cm (95 % CI -0·15, -0·12 cm). At 4 years of age, the height difference between a child introduced to cow milk at 9 v. 12 months was 0·4 cm (95 % CI -0·45, -0·35 cm). There was no association between the timing of cow milk introduction and volume of cow milk consumed per day or BMI z-score.

CONCLUSIONS

Earlier introduction of cow milk was associated with greater height but not with weight status in children aged 3-5 years. Further research is needed to understand the casual relationship between earlier cow milk consumption and childhood height. These findings may be important for paediatricians and parents when considering when to introduce cow milk.

Association between milk consumption and child growth for children aged 6-59 months

Apart from high levels of energy, proteins, micro- and macronutrients, milk contains calcium and the insulin-like growth factor-1 that are of major relevance for children’s development and growth. Using Demographic and Health Survey data between 1990 and 2017 with information on milk consumption and anthropometric measurements from all low- and middle-income countries available, we investigate whether milk consumption in childhood is associated with stunting, wasting, and underweight. We specify logistic regression models and adjust for a range of covariates and fixed effects on the primary sampling unit level. We analyze heterogeneity in the association by wealth quintiles and age groups and present country-specific estimates. The final samples for wasting, underweight and stunting include 668.463, 693.376, and 673.177 observations of children aged 6 to 59 months, respectively. Our results suggest that milk consumption is associated with a reduced probability of being underweight of 1.4 percentage points (95% confidence interval −0.02, −0.01) and a reduced probability of being stunted of 1.9 percentage points (95% confidence interval −0.02, −0.01). The association for wasting is not robust. The association is stronger for children from wealthier households, which might indicate that milk consumption is a proxy for better overall nutrition or socio-economic status.

Pastoral community practices, microbial quality and associated health risks of raw milk in the milk value chain of Nakasongola District, Uganda

The informal milk value chain in Uganda controls most of the raw marketed milk, albeit of poor quality. A study was conducted to assess the milk handling practices, the bacterial quality and the associated health concerns of raw milk along the informal milk value in Nakasongola District. The cross-sectional study used both qualitative and quantitative methods to obtain information from key players. The qualitative data was categorized and presented into emerging themes. Bacterial contamination of 200 milk samples was determined by morphological and biochemical tests. The antibiotic susceptibility test was done by the disc diffusion method.

Hand milking was carried out mainly by men (92.5%), and most never or rarely practised hand washing (67.5%) during milking. Milk was mainly delivered to mobile milk-collecting centres located under tree shades (50%). The quality of raw milk was affected by poor hygienic, handling and transportation practices. Most participants (75%) were aware of the dangers of drinking raw milk and the requirements to transport milk in metallic cans. Viable bacterial counts above the recommended limit were recorded in 76 samples (38%) that included Staphylococcus aureus (46%), coagulase-negative Staphylococcus (29%), Escherichia coli (12%), Streptococcus agalactiae (8%) and Salmonella spp. (5%). The overall antibiotic resistance was 45% (34/76), which included resistant isolates of S. aureus (17/34), coagulase-negative Staphylococcus (11/22), S. agalactiae (3/6), Salmonella spp. (2/4) and E. coli (2/9).

The raw milk contaminated with antibiotic drug-resistant bacterial pathogens is of public health concern. Thus, measures to improve the quality of milk need to be designed for the pastoral community in Nakasongola district.

Selection of Target Nutrients for the Nutritional Standards of School Lunches in Korea

The purpose of this study was to select target nutrients to be included in the nutritional standards of school lunches in Korea. The dietary intake data for children and adolescents aged 6–17 years old from the Korea National Health and Nutrition Examination Survey VI were analyzed for eight groups based on gender and age (6–8, 9–11, 12–14, and 15–17 years old). First, the usual intake of 3091 subjects was estimated and assessed to identify nutrients with insufficient or excessive intake prevalence. Along with the nutrients identified by the assessment, the energy and nutrients prioritized in the meal planning procedure of the 2015 Dietary Reference Intakes for Koreans were the initial candidates; these nutrients and energy include the percentages of energy from carbohydrates, protein, and fat; vitamin A; riboflavin; niacin; vitamin C; calcium; phosphorus; sodium; and iron. Phosphorus was excluded as a result of there being little evidence of clinical symptoms caused by its insufficient intake. Sodium was excluded because reliable data on added salt were not available among the school lunch recipes in Korea. Therefore, energy; the percentages of energy from carbohydrates, protein, and fat; vitamin A; riboflavin; niacin; vitamin C; calcium; and iron were selected to be included in the nutritional standards for school lunches in Korea.

Household dairy production and child growth: Evidence from Bangladesh

Research from richer countries finds that dairy consumption has strong positive associations with linear growth in children, but surprisingly little evidence exists for developing countries where diets are far less diversified. One exception is a recent economics literature using the notion of incomplete markets to estimate the impacts of cattle ownership on children's milk consumption and growth outcomes in Eastern Africa. In addition to external validity concerns, an obvious internal validity concern is that dairy producers may systematically differ from non-dairy households, particularly in terms of latent wealth or nutritional knowledge. We re-examine these concerns by applying a novel double difference model to data from rural Bangladesh, a country with relatively low levels of milk consumption and high rates of stunting. We exploit the fact that a cow's lactation cycles provide an exogenous source of variation in household milk supply, which allows us to distinguish between a control group of households that do not own cows, a treatment group that own cows that have produced milk, and a placebo group of cow-owning households that have not produced milk in the past 12 months. We find that household dairy production increases height-for-age Z scores by 0.52 standard deviations in the critical 6-23 month growth window, though in the first year of life we find that household dairy supply is associated with a 21.7 point decline in the rate of breastfeeding. The results therefore suggest that increasing access to dairy products can be extremely beneficial to children's nutrition, but may need to be accompanied by efforts to improve nutritional knowledge and appropriate breastfeeding practices.

Evaluation of a Free Milk in Schools Program in New Zealand: Effects on Children's Milk Consumption and Anthropometrics

BACKGROUND

While dietary sources of calcium are important for bone health, the intake of milk and milk products decreases as children get older. A free milk in schools program may mitigate this decrease in milk consumption. We evaluated the Fonterra Milk for schools program (a free milk initiative) by determining changes in children's milk consumption and anthropometric measures over a 2-year period.

METHODS

The evaluation was conducted in children aged 7-9 years in a representative sample of primary schools participating in the free milk program, in Auckland, New Zealand. The primary outcome was the proportion of children meeting the New Zealand guidelines for dairy and milk product consumption over 7 days (≥2 servings per day). Changes in anthropometric measures were also assessed as secondary outcomes.

RESULTS

Nine schools (N = 511 children) participated in the evaluation. The proportion of children meeting the New Zealand guidelines for milk and milk product consumption over 7 days increased significantly from baseline to 2 years' follow-up (72% vs 94%; p < .001). Body mass index z scores did not change significantly between baseline and 2 years' follow-up.

CONCLUSIONS

The Fonterra Milk for Schools initiative appears to be an effective way of increasing milk/milk product consumption behaviors in school-aged children.

An Electronic Questionnaire Survey Evaluating the Perceived Prevalence and Practices of Lactose Intolerance in 1 to 5 Year Old Children in South East Asia

PURPOSE

Lactose intolerance (LI) is perceived to be frequent in Asia and has been reported to have considerable impact on dietary intake, nutritional status and the quality of life. We aimed to gather information from healthcare professionals on the perceived incidence, diagnosis and management of LI in 1 to 5 year old children in Southeast Asia.

METHODS

An anonymous electronic survey was sent randomly among healthcare professionals registered in the database of the pediatric societies in Thailand, Indonesia, and Singapore between June and October 2016.

RESULTS

In total, 259 health care professionals responded of which 45.5% (n=118) were from Thailand, 37.4% (n=97) from Indonesia and 16.9% (n=44) from Singapore. Of the participants who responded (n=248), primary LI prevalence among children 1 to 3 years of age was estimated to be less than 5% by 56.8%. However, about 18.9% (n=47) answered they did not know/unsure. Regarding secondary LI, 61.6% of respondents (n=153) estimated the prevalence to be less than 15%. But again, 10.8% (n=27) answered they did not know or unsure. Rotavirus gastroenteritis was ranked as the top cause for secondary LI. There was considerable heterogeneity in the diagnostic methods used. The majority of respondents (75%) recommended lactose-free milk to manage primary and secondary LI.

CONCLUSION

More education/training of pediatricians on this topic and further epidemiological studies using a more systematic approach are required.

Does ownership of improved dairy cow breeds improve child nutrition? A pathway analysis for Uganda

The promotion of livestock production is widely believed to support enhanced diet quality and child nutrition, but the empirical evidence for this causal linkage remains narrow and ambiguous. This study examines whether adoption of improved dairy cow breeds is linked to farm-level outcomes that translate into household-level benefits including improved child nutrition outcomes in Uganda. Using nationwide data from Uganda’s National Panel Survey, propensity score matching is used to create an unbiased counterfactual, based on observed characteristics, to assess the net impacts of improved dairy cow adoption. All estimates were tested for robustness and sensitivity to variations in observable and unobservable confounders. Results based on the matched samples showed that households adopting improved dairy cows significantly increased milk yield—by over 200% on average. This resulted in higher milk sales and milk intakes, demonstrating the potential of this agricultural technology to both integrate households into modern value chains and increase households’ access to animal source foods. Use of improved dairy cows increased household food expenditures by about 16%. Although undernutrition was widely prevalent in the study sample and in matched households, the adoption of improved dairy cows was associated with lower child stunting in adopter household. In scale terms, results also showed that holding larger farms tends to support adoption, but that this also stimulates the household’s ability to achieve gains from adoption, which can translate into enhanced nutrition.

Association between noncow milk beverage consumption and childhood height

Background: Cow milk consumption in childhood has been associated with increased height, which is an important measure of children's growth and development. Many parents are choosing noncow milk beverages such as soy and almond milk because of perceived health benefits. However, noncow milk contains less protein and fat than cow milk and may not have the same effect on height.Objective: We sought to determine whether there is an association between noncow milk consumption and lower height in childhood and assess whether cow milk consumption mediates the relation between noncow milk consumption and height.Design: This was a cross-sectional study of 5034 healthy Canadian children aged 24-72 mo enrolled in the Applied Research Group for Kids cohort. The primary exposure was the volume of noncow milk consumption (number of 250-mL cups per day). The primary outcome was height, which was measured as height-for-age z score. Multivariable linear regression was used to determine the association between noncow milk consumption and height. A mediation analysis was conducted to explore whether cow milk consumption mediated the association between noncow milk consumption and height.Results: There was a dose-dependent association between higher noncow milk consumption and lower height (P < 0.0001). For each daily cup of noncow milk consumed, children were 0.4 cm (95% CI: 0.2, 0.8 cm) shorter. In the mediation analysis, lower cow milk consumption only partially mediated the association between noncow milk consumption and lower height. The height difference for a child aged 3 y consuming 3 cups noncow milk/d relative to 3 cups cow milk/d was 1.5 cm (95% CI: 0.8, 2.0 cm).Conclusions: Noncow milk consumption was associated with lower childhood height. Future research is needed to understand the causal relations between noncow milk consumption and height.

Dietary patterns of early childhood and maternal socioeconomic status in a unique prospective sample from a randomized controlled trial of Prenatal DHA Supplementation

BACKGROUND

Dietary habits established in early childhood and maternal socioeconomic status (SES) are important, complex, interrelated factors that influence a child's growth and development. The aim of this study was to define the major dietary patterns in a cohort of young US children, construct a maternal SES index, and evaluate their associations.

METHODS

The diets of 190 children from a randomized, controlled trial of prenatal supplementation of docosahexaenoic acid (DHA) were recorded at 6-mo intervals from 2-4.5 years by 24-h dietary recall. Hierarchical cluster analysis of age-adjusted, average daily intake of 24 food and beverage groups was used to categorize diet. Unrotated factor analysis generated an SES score from maternal race, ethnicity, age, education, and neighborhood income.

RESULTS

We identified two major dietary patterns: "Prudent" and "Western." The 85 (45%) children with a Prudent diet consumed more whole grains, fruit, yogurt and low-fat milk, green and non-starchy vegetables, and nuts and seeds. Conversely, those with a Western diet had greater intake of red meat, discretionary fat and condiments, sweet beverages, refined grains, French fries and potato chips, eggs, starchy vegetables, processed meats, chicken and seafood, and whole-fat milk. Compared to a Western diet, a Prudent diet was associated with one standard deviation higher maternal SES (95% CI: 0.80 to 1.30).

CONCLUSIONS

We found two major dietary patterns of young US children and defined a single, continuous axis of maternal SES that differed strongly between groups. This is an important first step to investigate how child diet, SES, and prenatal DHA supplementation interact to influence health outcomes.

TRIAL REGISTRATION

NCT00266825 . Prospectively registered on December 15, 2005.

Divergent associations of height with cardiometabolic disease and cancer: epidemiology, pathophysiology, and global implications

Among chronic non-communicable diseases, cardiometabolic diseases and cancer are the most important causes of morbidity and mortality worldwide. Although high BMI and waist circumference, as estimates of total and abdominal fat mass, are now accepted as predictors of the increasing incidence of these diseases, adult height, which also predicts mortality, has been neglected. Interestingly, increasing evidence suggests that height is associated with lower cardiometabolic risk, but higher cancer risk, associations supported by mendelian randomisation studies. Understanding the complex epidemiology, biology, and pathophysiology related to height, and its association with cardiometabolic diseases and cancer, is becoming even more important because average adult height has increased substantially in many countries during recent generations. Among the mechanisms driving the increase in height and linking height with cardiometabolic diseases and cancer are insulin and insulin-like growth factor signalling pathways. These pathways are thought to be activated by overnutrition, especially increased intake of milk, dairy products, and other animal proteins during different stages of child development. Limiting overnutrition during pregnancy, early childhood, and puberty would avoid not only obesity, but also accelerated growth in children-and thus might reduce risk of cancer in adulthood.

Relationships between milk consumption and academic performance, learning motivation and strategy, and personality in Korean adolescents

BACKGROUND/OBJECTIVES

A healthy diet has been reported to be associated with physical development, cognition and academic performance, and personality during adolescence. This study was performed to investigate the relationships among milk consumption and academic performance, learning motivation and strategies, and personality among Korean adolescents.

SUBJECTS/METHODS

The study was divided into two parts. The first part was a survey on the relationship between milk consumption and academic performance, in which intakes of milk and milk products and academic scores were examined in percentiles among 630 middle and high school students residing in small and medium-sized cities in 2009. The second part was a survey on the relationships between milk consumption and learning motivation and strategy as well as personality, in which milk consumption habits were collected and Learning Motivation and Strategy Test (L-MOST) for adolescents and Total Personality Inventory for Adolescents (TPI-A) were conducted in 262 high school students in 2011.

RESULTS

In the 2009 survey, milk and milk product intakes of subjects were divided into a low intake group (LM: ≤ 60.2 g/day), medium intake group (MM: 60.3-150.9 g/day), and high intake group (HM: ≥ 151.0 g/day). Academic performance of each group was expressed as a percentile, and performance in Korean, social science, and mathematics was significantly higher in the HM group (P < 0.05). In the 2011 survey, the group with a higher frequency of everyday milk consumption showed significantly higher "learning strategy total," "testing technique," and "resources management technique" scores (P < 0.05) in all subjects. However, when subjects were divided by gender, milk intake frequency, learning strategy total, class participation technique, and testing technique showed significantly positive correlations (P < 0.05) in boys, whereas no correlation was observed in girls. Correlations between milk intake frequency and each item of the personality test were only detected in boys, and milk intake frequency showed positive correlations with "total agreeability", "organization", "responsibility", "conscientiousness", and "intellectual curiosity" (P < 0.05).

CONCLUSION

Intakes of milk and milk products were correlated with academic performance (Korean, social science, and mathematics) in Korean adolescents. In male high school students, particularly, higher milk intake frequency was positively correlated with learning motivation and strategy as well as some items of the personality inventory.

Ethnicity and child health in northern Tanzania: Maasai pastoralists are disadvantaged compared to neighbouring ethnic groups

The Maasai of northern Tanzania, a semi-nomadic ethnic group predominantly reliant on pastoralism, face a number of challenges anticipated to have negative impacts on child health, including marginalisation, vulnerabilities to drought, substandard service provision and on-going land grabbing conflicts. Yet, stemming from a lack of appropriate national survey data, no large-scale comparative study of Maasai child health has been conducted. Savannas Forever Tanzania surveyed the health of over 3500 children from 56 villages in northern Tanzania between 2009 and 2011. The major ethnic groups sampled were the Maasai, Sukuma, Rangi, and the Meru. Using multilevel regression we compare each ethnic group on the basis of (i) measurements of child health, including anthropometric indicators of nutritional status and self-reported incidence of disease; and (ii) important proximate determinants of child health, including food insecurity, diet, breastfeeding behaviour and vaccination coverage. We then (iii) contrast households among the Maasai by the extent to which subsistence is reliant on livestock herding. Measures of both child nutritional status and disease confirm that the Maasai are substantially disadvantaged compared to neighbouring ethnic groups, Meru are relatively advantaged, and Rangi and Sukuma intermediate in most comparisons. However, Maasai children were less likely to report malaria and worm infections. Food insecurity was high throughout the study site, but particularly severe for the Maasai, and reflected in lower dietary intake of carbohydrate-rich staple foods, and fruits and vegetables. Breastfeeding was extended in the Maasai, despite higher reported consumption of cow's milk, a potential weaning food. Vaccination coverage was lowest in Maasai and Sukuma. Maasai who rely primarily on livestock herding showed signs of further disadvantage compared to Maasai relying primarily on agriculture. We discuss the potential ecological, socioeconomic, demographic and cultural factors responsible for these differences and the implications for population health research and policy.

Effect of milk and milk products consumption on physical growth and bone mineral density in Korean adolescents

This study was conducted to investigate the relationship among the current status of calcium intake from milk and milk products, physical growth and bone mineral density in 664 male and female middle school and high school students aged 15-17 years. In the study, the current status of calcium intake from milk and milk products was analyzed, and the height, body composition, and bone mineral density of the right heel bone (calcaneus) were measured. The daily calcium intake of milk and milk products was calculated as the 'dairy equivalent of calcium', which is the calcium content in 200 mL of white milk. The cutoffs of tertiles of the dairy equivalent of calcium were calculated and then the subjects were categorized into 3 groups according to the tertiles, Q1 group (lower intake group), Q2 group (middle intake group) and Q3 group (upper intake group). The daily calcium intake of milk and milk products in Q1, Q2 and Q3 groups was 16.2 mg, 99.7 mg, and 284.0 mg, respectively, and the ratio of milk and milk product consumption to the daily total calcium intake was 5.4%, 27.4%, and 49.7%, respectively. The ratio of total calcium intake to the daily recommended intake in study subjects was 30.5% in Q1, 42.3% in Q2, and 60.7% in Q3, with significant differences (P < 0.05). Height, body weight, BMI, and % of body fat in three tertile groups (Q1, Q2 and Q3) were not significantly different. However, the T scores for bone mineral density in female students in three tertile groups (Q1, Q2 and Q3) was significantly different (P < 0.05). The study showed that the intake of milk and milk products in adolescents, particularly in girls, can improve the bone mineral density without increasing body weight, and thus confirmed that milk intake is important in adolescence.

Intake of dairy products, calcium, magnesium, and phosphorus in childhood and age at menarche in the Tehran Lipid and Glucose Study

Purpose

Studies indicate that milk intake is associated with insulin-like growth factor 1 (IGF-1) concentrations and height in childhood, whether milk and other dairy products promote puberty remains unclear. This study aimed to investigate influences of pre-pubertal intakes of milk, yogurt and cheese on menarcheal age in Tehranian girls. The associations of total dietary calcium (Ca), magnesium (Mg), and phosphorus (P) with menarcheal age were also examined.

Methods

This prospective study was conducted on 134 pre-pubertal girls, aged 4-12 years at baseline, who participated in the Tehran Lipid and Glucose Study (TLGS), and were followed for a median of 6.5 years. Dietary intakes were determined at initiation of the study using two non-consecutive 24-h dietary recalls and the age of menarche was documented during the follow-up. Logistic regression was used to calculate the risk of reaching menarche ≤ 12 years according to pre-pubertal levels of dairy or mineral intakes.

Results

The risk of earlier menarche was higher in girls with higher intakes of milk [OR: 2.28 (95% CI: 1.03–5.05)], Ca [OR: 3.20 (95%CI: 1.39–7.42)], Mg [OR: 2.43 (95% CI: 1.12–5.27)] and P [OR: 3.37 (95 % CI: 1.44–7.87) after controlling for energy and protein intake, interval between the age at study initiation and the age of menarche, and maternal age at menarche (Model 1). Girls in the middle tertile of cheese intakes had a lower risk of reaching menarche ≤ 12 years than those in the lowest tertile after controlling for covariates in model 1. These associations remained significant after further adjustment of BMI Z-score at baseline. The relationship of Ca, Mg, and P with menarche remained after further adjustment for height Z-score at baseline, whereas the association between milk and cheese intakes became non-significant.

Conclusions

Pre-pubertal intake of milk, but not cheese and yogurt, may hasten age at menarche.

National trends in beverage consumption in children from birth to 5 years: analysis of NHANES across three decades

Background

Given the epidemic of childhood obesity, it is crucial to assess food and beverage intake trends. Beverages can provide a large number of calories and since consumption patterns seem to develop at a young age we examined beverage consumption trends over three decades. The objective of this study was to assess the beverage (milk, fruit juice, fruit drinks, tea, soy beverages, and soft drinks) consumption trends in children <1-5 years of age.

Methods

Data from individuals ages <1-5 years participating in the National Health and Nutrition Examination Survey (NHANES) from 1976–1980, 1988–1994 and 2001–2006 were used to assess beverage consumption and associated calorie and nutrient intakes.

Results

During the NHANES 1976–1980 and 1988–1994 periods, approximately 84–85% of children were consuming milk, whereas only 77% were consuming milk during NHANES 2001–2006. Flavored milk intake was relatively low, but increased to 14% during the last decade (p < 0.001). Fruit juice consumption increased dramatically during NHANES 2001–2006 to more than 50% of the population compared to about 30% in the older surveys (p < 0.001). No significant changes were observed in fruit drink intake across all three decades with 35-37% of this population consuming fruit drinks. At least 30% of children consumed soft drinks. Milk was the largest beverage calorie contributor in all three decades surveyed and was the primary contributor of calcium (52-62%), phosphorus (37-42%), magnesium (27-28%), and potassium (32-37%). Fruit juice and fruit drinks each provided 8-10% of calories with soft drinks providing 5-6% of calories. Fruit juice was an important provider of potassium (16-19%) and magnesium (11%). Fruit drinks provided less than 5% of nutrients examined and soft drinks provided very little of the nutrients evaluated.

Conclusions

Given concerns about childhood obesity and the need to meet nutrition requirements, it is prudent that parents, educators and child caretakers replace some of the nutrient poor beverages young children are currently consuming with more nutrient dense sources like low-fat and fat-free milk.

Dairy products and physical stature: a systematic review and meta-analysis of controlled trials

The positive relationship between per capita availability of dairy products and average height found in historical studies (for instance in nineteenth century Bavaria, Prussia and France; Baten, 2009) does not necessarily indicate a causal relationship. Historical studies usually apply non-experimental methods that may produce substantial bias. Modern experimental controlled studies may provide high quality evidence supporting a causal relationship between consumption of dairy products and physical growth. This paper provides a systematic review and meta-analysis of controlled trials investigating the effect of supplementing usual diet with dairy products on physical growth. Twelve studies provided sufficient, independent data for meta-analysis. Seven studies were conducted since the 1990s. The other studies were conducted between 1926 and 1980. Studies were conducted in Europe, USA, China, Northern Vietnam, Kenya, Indonesia and India. Many studies had some internal validity problems such as lack of randomisation or dissimilarity of groups at baseline regarding height and age, which affects the quality of evidence. Meta-analysis and sensitivity analysis showed that the most likely effect of dairy products supplementation is 0.4 cm per annum additional growth per ca 245 ml of milk daily. Meta-regression analysis indicated that milk might have more effect on growth than other dairy products while lower height-for-age and being a teenager increased the effect of supplementation. In conclusion, there is moderate quality evidence that dairy products supplementation stimulate linear growth supporting hypotheses that changing levels of consumption of dairy products in the 19th and 20th centuries contributed to trends in height.

American Cancer Society Guidelines on nutrition and physical activity for cancer prevention: reducing the risk of cancer with healthy food choices and physical activity

The American Cancer Society (ACS) publishes Nutrition and Physical Activity Guidelines to serve as a foundation for its communication, policy, and community strategies and, ultimately, to affect dietary and physical activity patterns among Americans. These Guidelines, published approximately every 5 years, are developed by a national panel of experts in cancer research, prevention, epidemiology, public health, and policy, and they reflect the most current scientific evidence related to dietary and activity patterns and cancer risk. The ACS Guidelines focus on recommendations for individual choices regarding diet and physical activity patterns, but those choices occur within a community context that either facilitates or creates barriers to healthy behaviors. Therefore, this committee presents recommendations for community action to accompany the 4 recommendations for individual choices to reduce cancer risk. These recommendations for community action recognize that a supportive social and physical environment is indispensable if individuals at all levels of society are to have genuine opportunities to choose healthy behaviors. The ACS Guidelines are consistent with guidelines from the American Heart Association and the American Diabetes Association for the prevention of coronary heart disease and diabetes, as well as for general health promotion, as defined by the 2010 Dietary Guidelines for Americans and the 2008 Physical Activity Guidelines for Americans.

Lactase persistence and milk consumption are associated with body height in Swedish preadolescents and adolescents

BACKGROUND

Body height is a classic polygenic trait. About 80%-90% of height is inherited and 10%-20% owed to environmental factors, of which the most important ones are nutrition and diseases in preadolescents and adolescents.

OBJECTIVE

The aim of this study was to explore potential relations between the LCT (lactase) C>T-13910 polymorphism, milk consumption, and body height in a sample of Swedish preadolescents and adolescents.

DESIGN

In a cross-sectional study, using a random sample of preadolescents and adolescents (n = 597), dietary intakes were determined. Anthropometric measurements including sexual maturity (Tanner stage) and birth weight were assessed. Parental body height and socio-economic status (SES) were obtained by questionnaires. Genotyping for the LCT C>T-13910 polymorphism that renders individuals lactase persistent (LP) or lactase non-persistent (LNP) was performed by DNA sequencing. Stepwise backward multivariate linear regression was used.

RESULTS

Milk consumption was significantly and positively associated with body height (β = 0.45; 95% CI: 0.040, 0.87, p = 0.032). Adjustments were performed for sex, parental height, birth weight, body mass index (BMI), SES, and Tanner stage. This model explains 90% of the observed variance of body height (adjusted R(2) = 0.89). The presence of the -13910 T allele was positively associated with body height (β = 2.05; 95% CI: 0.18, 3.92, p = 0.032).

CONCLUSIONS

Milk consumption is positively associated with body height in preadolescents and adolescents. We show for the first time that a nutrigenetic variant might be able to explain in part phenotypic variation of body height in preadolescents and adolescents. Due to the small sample size further studies are needed.

Milk intake and total dairy consumption: associations with early menarche in NHANES 1999-2004

BACKGROUND

Several components of dairy products have been linked to earlier menarche.

METHODS/FINDINGS

This study assessed whether positive associations exist between childhood milk consumption and age at menarche or the likelihood of early menarche (<12 yrs) in a U.S sample. Data derive from the National Health and Nutrition Examination Survey (NHANES) 1999-2004. Two samples were utilized: 2657 women age 20-49 yrs and 1008 girls age 9-12 yrs. In regression analysis, a weak negative relationship was found between frequency of milk consumption at 5-12 yrs and age at menarche (daily milk intake β = -0.32, P<0.10; "sometimes/variable milk intake" β = -0.38, P<0.06, each compared to intake rarely/never). Cox regression yielded no greater risk of early menarche among those who drank milk "sometimes/varied" or daily vs. never/rarely (HR: 1.20, P<0.42, HR: 1.25, P<0.23, respectively). Among the 9-12 yr olds, Cox regression indicated that neither total dairy kcal, calcium and protein, nor daily milk intake in the past 30 days contributed to early menarche. Girls in the middle tertile of milk intake had a marginally lower risk of early menarche than those in the highest tertile (HR: 0.6, P<0.06). Those in the lowest tertiles of dairy fat intake had a greater risk of early menarche than those in the highest (HR: 1.5, P<0.05, HR: 1.6, P<0.07, lowest and middle tertile, respectively), while those with the lowest calcium intake had a lower risk of early menarche (HR: 0.6, P<0.05) than those in the highest tertile. These relationships remained after adjusting for overweight or overweight and height percentile; both increased the risk of earlier menarche. Blacks were more likely than Whites to reach menarche early (HR: 1.7, P<0.03), but not after controlling for overweight.

CONCLUSIONS

There is some evidence that greater milk intake is associated with an increased risk of early menarche, or a lower age at menarche.

Dairy and milk consumption and child growth: Is BMI involved? An analysis of NHANES 1999-2004

Humans are unique among mammals in that many consume cow's milk or other dairy products well beyond the traditional age of weaning. Milk provides various nutrients and bioactive molecules to support growth and development, and the question arises as to whether this dietary behavior influences growth parameters. There is evidence that milk makes positive contributions to growth in height, but its associations with other aspects of body size, such as body mass index (BMI), are not well-established. National Health and Nutrition Examination Survey (NHANES) data from 1999 to 2004 and multivariate regression analysis were used to test the hypothesis that milk (g) or total dairy product consumption (kJ) is associated with higher BMI percentile among US White, Black, and Mexican-American children of age 2-4 years (n = 1,493) and 5-10 years (n = 2,526). Younger children in the highest quartile of dairy intake had higher BMIs (beta = 7.5-8.0; P < 0.01) than those in the lowest two quartiles. Controlling for energy intake eliminated differences between QIV and QI. Among children of 5-10 years of age dairy intake had no relationship to BMI. Young children in the highest quartile of milk intake had higher BMIs than all lower quartiles (beta = 7.1-12.8; beta = 6.3-11.8 in energy-controlled models; P < 0.05). Among children of 5-10 years of age, those in QIV for milk intake had higher BMIs than those in QII (beta = 8.3; beta = 7.1 in energy-controlled model; P < 0.01). Controlling for total protein or calcium did not change the results. Milk had more consistent positive associations with BMI than did dairy products, and these were strongest among children of 2-4 years of age.