Abstract
ObjectiveDietary guidance emphasizes plain low-fat and skim milk over whole, reduced-fat, and flavored milk (milk eligible for replacement [MER]). The objective of this study was to evaluate the population-level impact of such a change on energy, macronutrient and nutrient intakes, and diet cost. DesignCross-sectional modeling study. SettingData from the 2001–2002 and 2003–2004 National Health and Nutrition Examination Survey. ParticipantsA total of 8,112 children aged 2–19 years. Main Outcome MeasuresEnergy, macronutrient, and micronutrient intake before and after replacement of MER with low-fat or skim milk. AnalysisSurvey-weighted linear regression models. ResultsMilk eligible for replacement accounted for 46% of dairy servings. Among MER consumers, replacement with skim or low-fat milk would lead to a projected reduction in energy of 113 (95% confidence interval [CI], 107–119) and 77 (95% CI, 73–82) kcal/d and percent energy from saturated fat by an absolute value of 2.5% of total energy (95% CI, 2.4–2.6) and 1.4% (95% CI, 1.3–1.5), respectively. Replacement of MER does not change diet costs or calcium and potassium intake. ConclusionsSubstitution of MER has the potential to reduce energy and total and saturated fat intake with no impact on diet costs or micronutrient density. The feasibility of such replacement has not been examined and there may be negative consequences if replacement is done with non-nutrient–rich beverages.
Highlights
Milk is an important source of calcium, vitamin D, and potassium, all of which were identified as nutrients of concern by the 2010 Dietary Guidelines for Americans (DGA).[1,6,7]
No differences were observed for calcium or potassium and diet costs were modestly but not significantly decreased
If higher-fat milk were replaced with other beverages or no beverages, it is likely that calcium, potassium, and vitamin D intake would be reduced
Summary
Milk and milk products are important components of a healthy diet and their consumption is recommended by numerous dietary guidelines and professional organizations.[1,2,3] Milk and dairy consumption during childhood is important for achieving bone health later in life.[4,5] Milk is an important source of calcium, vitamin D, and potassium, all of which were identified as nutrients of concern by the 2010 Dietary Guidelines for Americans (DGA).[1,6,7] children aged 2–8 years generally consume adequate amounts of calcium, adolescents aged 9–18 years fail to meet calcium recommendations and no age group comes close to meeting the threshold for adequate potassium intake.[6,8,9]Journal of Nutrition Education and Behavior Volume 47, Number 1, 2015 milk consumption has a number of benefits, in light of the obesity epidemic, concerns regarding excess energy and fat intake have emerged. National dietary guidelines and recommendations from professional organizations, including the 2005 and 2010 DGA and the American Academy of Pediatrics, recommend that children aged $ 2 years (and adults) consume low-fat (1% fat) and skim milk (0% fat) rather than whole (3.25% to 4%) or reduced-fat (2% fat) milk.[1,2,3] Revisions to the Women, Infants, and Children standard food package finalized in March, 2014 allow whole milk for children aged < 2 years but only lowfat and skim for children aged $ 2 years and women.[10] Despite these recommendations and numerous policy changes, consumption of low-fat and skim milk is low among children and adolescents. Driving the higher consumption of higher-fat (and flavored) milk is a strong preference for the higher fat content of unflavored milk (and the sweetness of flavored milk).[12,13,14] Because relatively few children currently consume lowfat and skim milk, evaluations should examine the maximum effect of recommendations to shift consumption from whole, reduced-fat, and flavored milk toward skim and low-fat milk, it is unlikely that any intervention could entirely shift consumption toward the recommended milk
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