Prospective Association between Milk Intake and Adiposity in Preschool-Aged Children

doi:10.1016/j.jada.2009.12.025

Journal of the American Dietetic Association

Volume 110, Issue 4, April 2010, Pages 563-570

https://doi.org/10.1016/j.jada.2009.12.025 Get rights and content

Abstract

Objective

To determine whether the quantity and type of milk (whole, reduced fat, or 1%/nonfat) consumed at age 2 years is associated with adiposity at age 3 years.

Design

We assessed milk and dairy intake at age 2 years with food frequency questionnaires completed by mothers. Our primary outcomes were body mass index (BMI; calculated as kg/m²), z score and overweight at age 3 years, defined as BMI for age and sex ≥85th percentile.

Subjects/setting

Eight-hundred and fifty-two preschool-aged children in the prospective US cohort Project Viva.

Statistical analyses

Linear and logistic regression models, adjusting for maternal BMI and education, paternal BMI, and child age, sex, race/ethnicity, intake of energy, nondairy beverages, television viewing, and BMI z score at age 2 years were used.

Results

At age 2 years, mean milk intake was 2.6 (standard deviation 1.2) servings per day. Higher intake of whole milk at age 2, but not reduced-fat milk, was associated with a slightly lower BMI z score (−0.09 unit per daily serving [95% confidence interval: −0.16 to −0.01]) at age 3 years; when restricted to children with a normal BMI (5th to <85th percentile) at age 2 years, the association was null (−0.05 unit per daily serving [95% confidence interval: −0.13 to 0.02]). Intake of milk at age 2 years, whether full- or reduced-fat, was not associated with risk of incident overweight at age 3 years. Neither total milk nor total dairy intake at age 2 years was associated with BMI z score or incident overweight at age 3 years.

Conclusion

Neither consuming more dairy products, nor switching from whole milk to reduced-fat milk at age 2 years, appears likely to prevent overweight in early childhood.

Section snippets

Study Population: Project Viva

From April 1999 to July 2002, we enrolled participants into Project Viva, a longitudinal prebirth cohort of mother−offspring pairs in the Boston, MA, area (24). Recruitment for Project Viva was conducted at eight obstetric practices within Harvard Vanguard Medical Associates, a multispecialty, managed-care group practice. Women with singleton pregnancies were study-eligible if they entered prenatal care within the first 22 weeks of gestation, intended to continue their obstetric care at Harvard

Results

At age 2 years, the mean total milk intake was 2.6 (standard deviation [SD] 1.2) servings per day, and mean total dairy intake was 4.3 (SD 1.5) servings per day. Of the 852 children, 452 (53.1%) predominantly drank whole milk, 226 (26.5%) drank reduced-fat milk, and 174 (20.4%) drank 1%/nonfat milk. At age 3, 222 (26.1%) had a BMI ≥85th percentile and 76 children (8.9%) had a BMI ≥95th percentile. Among 113 children at age 2 years with BMI ≥85th percentile, 81 (72%) had a BMI ≥85th percentile

Discussion

In this prospective cohort analysis, we found that cow's milk intake at age 2 years, whether full- or reduced-fat, was not associated with incident overweight at age 3 years. Intake of total dairy products at age 2 was not associated with incident overweight or BMI z score at age 3 years. We did find that higher intake of whole milk at age 2 years was associated with a modest −0.09 unit decrement in BMI z score at age 3 years, after controlling for energy intake, 2-year BMI z score, and other

Conclusions

Our findings suggest that a higher intake of milk, whether full- or reduced-fat, is unlikely to prevent development of obesity among preschool-aged children. Milk intake, however, may offer other health benefits, including provision of calcium, vitamin D, and other nutrients.

S. Y. Huh is an instructor in pediatrics, Harvard Medical School, and the Division of Gastroenterology and Nutrition, Children's Hospital Boston, Boston, MA.

References (47)

D.R. Thompson et al.
Childhood overweight and cardiovascular disease risk factors: The National Heart, Lung, and Blood Institute Growth and Health Study
J Pediatr
(2007)
J. Steinberger et al.
Adiposity in childhood predicts obesity and insulin resistance in young adulthood
J Pediatr
(2001)
C.D. Frary et al.
Children and adolescents' choices of foods and beverages high in added sugars are associated with intakes of key nutrients and food groups
J Adolesc Health
(2004)
T.A. Nicklas et al.
Children's food consumption patterns have changed over two decades (1973-1994): The Bogalusa heart study
J Am Diet Assoc
(2004)
P.K. Newby et al.
Beverage consumption is not associated with changes in weight and body mass index among low-income preschool children in North Dakota
J Am Diet Assoc
(2004)
W.H. Dietz et al.
Introduction: The use of body mass index to assess obesity in children
Am J Clin Nutr
(1999)
C.B. Ebbeling et al.
Childhood obesity: Public-health crisis, common sense cure
Lancet
(2002)
R.H. Striegel-Moore et al.
Correlates of beverage intake in adolescent girls: The National Heart, Lung, and Blood Institute Growth and Health Study
J Pediatr
(2006)
R. Novotny et al.
Dairy intake is associated with lower body fat and soda intake with greater weight in adolescent girls
J Nutr
(2004)
T. Okada
Effect of cow milk consumption on longitudinal height gain in children
Am J Clin Nutr
(2004)

G.M. Chan et al.

Effects of dairy products on bone and body composition in pubertal girls

J Pediatr

(1995)

K. Zhu et al.

Growth, bone mass, and vitamin D status of Chinese adolescent girls 3 y after withdrawal of milk supplementation

Am J Clin Nutr

(2006)

R. Rajeshwari et al.

Secular trends in children's sweetened-beverage consumption (1973 to 1994): The Bogalusa Heart Study

J Am Diet Assoc

(2005)

D.S. Ludwig et al.

Relation between consumption of sugar-sweetened drinks and childhood obesity: A prospective, observational analysis

Lancet

(2001)

M.B. Zemel

Role of calcium and dairy products in energy partitioning and weight management

Am J Clin Nutr

(2004)

L.M. Fiorito et al.

Girls' dairy intake, energy intake, and weight status

J Am Diet Assoc

(2006)

C.L. Ogden et al.

High body mass index for age among US children and adolescents, 2003-2006

JAMA

(2008)

R.J. Kuczmarski et al.

2000 CDC Growth Charts for the United States: Methods and development

Vital Health Stat

(2002)

S.R. Daniels et al.

Overweight in children and adolescents: Pathophysiology, consequences, prevention, and treatment

Circulation

(2005)

C. Maffeis et al.

Insulin resistance and the persistence of obesity from childhood into adulthood

J Clin Endocrinol Metab

(2002)

T.T. Huang et al.

Dairy intake, obesity, and metabolic health in children and adolescents: Knowledge and gaps

Nutr Rev

(2005)

G. Barba et al.

Inverse association between body mass and frequency of milk consumption in children

Br J Nutr

(2005)

B.R. Carruth et al.

The role of dietary calcium and other nutrients in moderating body fat in preschool children

Int J Obes Relat Metab Disord

(2001)

Cited by (59)

Association of cow’s milk intake in early childhood with adiposity and cardiometabolic risk in early adolescence
2022, American Journal of Clinical Nutrition
Prior studies have provided conflicting evidence regarding associations of pediatric milk consumption with subsequent adiposity.
We aimed to estimate associations of the consumption frequency and fat content of early childhood milk intake with early adolescent adiposity and cardiometabolic risk.
We analyzed data collected prospectively from 796 children in Project Viva, a Boston-area prebirth cohort. Parents reported the frequency (times/day) and fat content [higher-fat: whole (3.25%) or 2% milk; lower-fat: 1% or skim milk] of cow’s milk consumed in early childhood (mean, 3.2 years) via food-frequency questionnaires. We measured adiposity and cardiometabolic markers in early adolescence (mean, 13.2 years) and conducted multivariable regressions to assess associations adjusted for baseline parental and child sociodemographic, anthropometric, and dietary factors.
In early childhood, mean milk intake was 2.3 times/day (SD, 1.2 times/day), and 63% of children drank primarily higher-fat milk. The early childhood BMI z-score (BMIz) was inversely associated with the fat content of milk consumed in early childhood. After adjustment for baseline parent and child factors, early childhood intake of higher-fat compared with lower-fat milk was associated with lower adiposity; however, the 95% CIs for most adiposity outcomes—except for the odds of overweight or obesity (OR, 0.60; 95% CI, 0.38–0.93)—crossed the null after adjustment for the baseline child BMIz and BMIz change between ages 2 and 3 years. Early childhood consumption of higher-fat milk (compared with lower-fat milk) was not associated with adverse cardiometabolic outcomes. The frequency of cow’s milk consumption in early childhood was not associated with adiposity or cardiometabolic risk in early adolescence.
Consumption of higher-fat cow’s milk in early childhood was not associated with increased adiposity or adverse cardiometabolic health over a decade later. Our findings do not support current recommendations to consume lower-fat milk to reduce the risk of later obesity and adverse cardiometabolic outcomes. This trial was registered at clinicaltrials.gov as NCT02820402.
Whole milk compared with reduced-fat milk and childhood overweight: A systematic review and meta-analysis
2020, American Journal of Clinical Nutrition
The majority of children in North America consume cow-milk daily. Children aged >2 y are recommended to consume reduced-fat (0.1–2%) cow-milk to lower the risk of obesity.
To evaluate the relation between cow-milk fat consumption and adiposity in children aged 1–18 y.
Embase (Excerpta Medica Database), CINAHL (Cumulative Index to Nursing and Allied Health Literature), MEDLINE, Scopus, and Cochrane Library databases from inception to August 2019 were used. The search included observational and interventional studies of healthy children aged 1–18 y that described the association between cow-milk fat consumption and adiposity. Two reviewers extracted data, using the Newcastle–Ottawa Scale to assess risk of bias. Meta-analysis was conducted using random effects to evaluate the relation between cow-milk fat and risk of overweight or obesity. Adiposity was assessed using BMI z-score (zBMI).
Of 5862 reports identified by the search, 28 met the inclusion criteria: 20 were cross-sectional and 8 were prospective cohort. No clinical trials were identified. In 18 studies, higher cow-milk fat consumption was associated with lower child adiposity, and 10 studies did not identify an association. Meta-analysis included 14 of the 28 studies (n = 20,897) that measured the proportion of children who consumed whole milk compared with reduced-fat milk and direct measures of overweight or obesity. Among children who consumed whole (3.25% fat) compared with reduced-fat (0.1–2%) milk, the OR of overweight or obesity was 0.61 (95% CI: 0.52, 0.72; P < 0.0001), but heterogeneity between studies was high (I² = 73.8%).
Observational research suggests that higher cow-milk fat intake is associated with lower childhood adiposity. International guidelines that recommend reduced-fat milk for children might not lower the risk of childhood obesity. Randomized trials are needed to determine which cow-milk fat minimizes risk of excess adiposity. This systematic review and meta-analysis was registered with PROSPERO (registration number: CRD42018085075).
The role of dairy products in the development of obesity across the lifespan
2020, Milk and Dairy Foods: Their Functionality in Human Health and Disease
The prevalence of obesity has reached epidemic proportions globally, and the trend is especially alarming in children and adolescents. Dairy products provide a range of nutrients that are important to health but contribute to overconsumed nutrients such as fat and saturated fat. Data from existing reviews on the role of dairy products in the development of obesity in childhood and adulthood are inconsistent. This chapter reviews the totality of evidence and the justification for the current approach of limiting dairy in the diet to reduce or prevent obesity or weight gain. The majority of data available from longitudinal and intervention studies in adults provide evidence of neutral associations between intakes of milk and other dairy products, and body weight and adiposity measures. Similar results were found for children and adolescents, while there is limited data for older adults. Although the mechanisms have not been clearly elucidated, they include effects on energy and fat balance, fatty acid absorption, appetite, and the metabolic activity of gut microbiota. In conclusion, although inconsistencies exist, there is little evidence to support the justification for limiting dairy in the diet on the grounds that they may promote obesity.
Whole-fat or reduced-fat dairy product intake, adiposity, and cardiometabolic health in children: A systematic review
2020, Advances in Nutrition
Dietary guidelines commonly recommend that children aged >2 y consume reduced-fat dairy products rather than regular- or whole-fat dairy. In adults, most studies have not found the consumption of whole-fat dairy products to be associated with increased cardiometabolic or adiposity risk. Associations in children could differ due to growth and development. We systematically reviewed the literature in indexed, peer-reviewed journals to summarize pediatric studies (children aged from 2 to 18 y) assessing associations between whole- and reduced-fat dairy intake and measures of adiposity as well as biomarkers of cardiometabolic disease risk, including the serum lipid profile, blood pressure, low-grade chronic inflammation, oxidative stress, and measures of glucose homeostasis. For the purposes of this review, a “whole-fat” dairy product was defined as a product with the natural fat content, whereas a “reduced-fat” dairy product was defined as a product with some or all of the fat removed (including “low-fat” and “skim” versions). A total of 29 journal articles met our criteria for inclusion. The majority were conducted in the United States and were prospective or cross-sectional observational studies, with only 1 randomized controlled trial. Studies were consistent in reporting that whole-fat dairy products were not associated with increased measures of weight gain or adiposity. Most evidence indicated that consumption of whole-fat dairy was not associated with increased cardiometabolic risk, although a change from whole-fat to reduced-fat dairy improved outcomes for some risk factors in 1 study. Taken as a whole, the limited literature in this field is not consistent with dietary guidelines recommending that children consume preferably reduced-fat dairy products. High-quality randomized controlled trials in children that directly compare the effects of whole-fat compared with reduced-fat dairy intake on measures of adiposity or biomarkers of cardiometabolic disease risk are needed to provide better quality evidence in this area.
Cow milk does not affect adiposity in growing piglets as a model for children
2019, Journal of Dairy Science
Citation Excerpt :
This has led to a decrease in milk consumption as well as a recommendation from the American Academy of Pediatrics that children should drink skim or 1% milk instead of 2% or whole milk, especially if there is a family history of obesity (Daniels and Greer, 2008; Ludwig and Willett, 2013). More recently, studies have found a negative correlation between the consumption of whole milk and incidence of childhood obesity (Huh et al., 2010; Vanderhout et al., 2016). Several studies have also demonstrated that dairy fat is negatively associated with obesity in adults (Zemel, 2005).
The effect of milk consumption on childhood obesity is unclear and a direct demonstration of an association is needed. In the present study, we used piglets as a model for prepubertal children to determine the effect of milk on adipose tissue. Two studies were conducted: study 1 with 5-wk-old male piglets (n = 8) and study 2 with 8- to 9-wk-old male piglets (n = 12). The piglets were fed a normal growing diet and randomly assigned to receive daily either 750 mL of whole cow milk or an isocaloric maltodextrin solution (control). For approximately 12 wk, body weight, feed intake, and subcutaneous back fat thickness were determined ultrasonographically and recorded. At euthanasia, back and neck fat thicknesses were measured and samples of back fat were collected for adipose histology. In study 1, but not study 2, piglets receiving milk grew more and ate more compared with control. In study 1, both back fat and neck fat thickness were greater in the milk-fed piglets and they had a higher frequency of small adipocytes and a lower frequency of intermediate and large adipocytes compared with controls. In study 2, control pigs had a significantly greater frequency of intermediate adipocytes but the milk-fed piglets tended to have a higher frequency of the largest adipocytes. In conclusion, milk has no apparent causal or consistent effect on adipose tissue in growing piglets.
Full fat milk consumption protects against severe childhood obesity in Latinos
2017, Preventive Medicine Reports
Citation Excerpt :
The small number of studies examining this question have either found no association between full-fat milk consumption and weight (O'Connor et al., 2006; Berkey et al., 2005) or have found that full-fat milk consumption is protective against excess weight (Huh et al., 2010; Scharf et al., 2013; Bigornia et al., 2014; Vanderhout et al., 2016). Huh et al. found that higher intake of whole milk at age 2 was associated with a slightly lower BMI-z score at age 3 with no such association found for reduced fat milk (Huh et al., 2010). Similarly, a study of participants in the Early Childhood Longitudinal Study found that children who consumed 2% or whole milk were less likely to be overweight at ages 2 and 4 than those who consumed skim or low-fat milk (Scharf et al., 2013).
Consumption of non- or low-fat dairy products is recommended as a strategy to lower the risk of childhood obesity. However, recent evidence suggests that consumption of whole fat dairy products may, in fact, be protective against obesity. Our objective was to determine the association between milk fat consumption and severe obesity among three-year-old Latino children, a population with a disproportionate burden of obesity and severe obesity. 24-hour-dietary recalls were conducted to determine child intake in San Francisco based cohort recruited in 2006–7. Mother-child dyads were weighed and measured. The 24-hour recall data was analyzed to determine participants' consumption of whole milk, 2% milk, and 1% milk. The milk consumption data was used to calculate grams of milk fat consumed. The cross-sectional association between milk fat intake and severe obesity (BMI ≥ 99th percentile) was determined using multivariable logistic regression. Data were available for 145 children, of whom 17% were severely obese. Severely obese children had a lower mean intake of milk fat (5.3 g vs. 8.9 g) and fewer drank any milk (79% versus 95% for not severely obese children (p < 0.01)). Among the potential confounders assessed, maternal BMI and maternal marital status were associated with severe obesity and were included in a multivariate model. In the multivariate model, higher milk fat consumption was associated with lower odds of severe obesity (OR 0.88 CI 0.80–0.97). Higher milk fat consumption is associated with lower odds of severe obesity among Latino preschoolers. These results call into question recommendations that promote consumption of lower fat milk.

View all citing articles on Scopus

S. Y. Huh is an instructor in pediatrics, Harvard Medical School, and the Division of Gastroenterology and Nutrition, Children's Hospital Boston, Boston, MA.

S. L. Rifas-Shiman is a research associate, Obesity Prevention Program, Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA.

J. W. Rich-Edwards is an associate professor, Department of Epidemiology, Harvard School of Public Health, Boston, MA, and the Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital, Boston, MA.

E. M. Taveras is an assistant professor, Obesity Prevention Program, Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, and the Division of General Pediatrics, Children's Hospital Boston, Boston, MA.

M. W. Gillman is a professor, Obesity Prevention Program, Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA, and the Department of Nutrition, Harvard School of Public Health, Boston, MA.

View full text

ResearchOriginal ResearchProspective Association between Milk Intake and Adiposity in Preschool-Aged Children

Abstract

Objective

Design

Subjects/setting

Statistical analyses

Results

Conclusion

Section snippets

Study Population: Project Viva

Results

Discussion

Conclusions

J Pediatr

J Pediatr

J Adolesc Health

J Am Diet Assoc

J Am Diet Assoc

Am J Clin Nutr

Lancet

J Pediatr

J Nutr

Am J Clin Nutr

J Pediatr

Am J Clin Nutr

J Am Diet Assoc

Lancet

Am J Clin Nutr

J Am Diet Assoc

High body mass index for age among US children and adolescents, 2003-2006

JAMA

2000 CDC Growth Charts for the United States: Methods and development

Vital Health Stat

Overweight in children and adolescents: Pathophysiology, consequences, prevention, and treatment

Circulation

Insulin resistance and the persistence of obesity from childhood into adulthood

J Clin Endocrinol Metab

Dairy intake, obesity, and metabolic health in children and adolescents: Knowledge and gaps

Nutr Rev

Inverse association between body mass and frequency of milk consumption in children

Br J Nutr

The role of dietary calcium and other nutrients in moderating body fat in preschool children

Int J Obes Relat Metab Disord

Research
Original Research
Prospective Association between Milk Intake and Adiposity in Preschool-Aged Children