TABLE 2.
Studies assessing the role of flavored milk in child and adolescent nutrient status and diet quality
| Reference | Objective(s) | Design | Sample | Relevant results | Cost of flavored milk consumption | Benefit of flavored milk consumption |
|---|---|---|---|---|---|---|
| Murphy et al. 2008 [5] | Compare nutrients intakes and body measure among children and adolescents drinking flavored milk (with or without plain milk), exclusively plain milk, and no milk | Cross-sectional analysis of NHANES 1999–2002 | n = 7557 children and adolescents 2–18 y of age | Flavored milk intake was associated with higher total milk intake (P < 0.05). Vitamin A, calcium, phosphorus, magnesium, potassium, and saturated fat (adjusted for energy intake and age) were comparable among milk drinking groups; higher than milk nondrinkers (P < 0.05). Added sugars intake did not differ between flavored milk drinkers and milk nondrinkers. BMI of milk drinkers was comparable with or lower than milk nondrinkers (P < 0.05) | ND | Higher nutrient intake and comparable added sugars and BMI than milk nondrinkers |
| Fulgoni and Quann, 2012 [9] | Assess beverage consumption trends in children | Cross-sectional analyses of 1976–1980, 1988–1994, and 2001–2006 NHANES | n = 3398 American children <1–5 y of age | Flavored milk consumption increased to 14% and fruit juice increased to more than 50% of the population from first to third NHANES survey (P < 0.001). Milk was consistently the largest contributor of calories, calcium, phosphorus, magnesium, and potassium to the American diet | Contributes more energy than other beverages to the American Diet | Contributes more micronutrients than other beverages to the American diet |
| Fayet et al. 2013 [12] | Determine associations among milk drinking (plain or flavored) and milk and nutrient intakes in children | Cross-sectional analysis of 2007 Australian National Children’s Nutrition and Physical Activity Survey | n = 4487 Australian children and adolescents 2–16 y of age | Milk drinking (plain or flavored) was associated with higher total milk, calcium, phosphorus, magnesium, potassium, and iodine intake in and were more likely to meet the EAR for calcium in comparison with milk nondrinkers (P < 0.05). Flavored milk drinkers were more likely to meet the EAR for calcium than exclusive plain milk drinkers, with 9–16-y olds being 1.7 times more likely to meet the EAR for calcium than exclusive plain milk drinkers (P < 0.01). Flavored milk drinkers had higher intakes of total sugar and energy than exclusive plain milk drinkers (P < 0.05). NS difference between BMI, WC or PA levels between flavored and exclusive plain milk drinkers | Higher total sugar and energy intake | Higher micronutrient intake compared with white milk drinkers and milk nondrinkers Greater likelihood of meeting calcium recommendations compared with white milk drinkers and milk nondrinkers No impact on body weight or composition despite greater sugar and energy intake than white milk drinkers |
| Nicklas et al. 2013 [15] | Assess the contribution of flavored and white milk to the diets of American children and adolescents | Cross-sectional analysis of NHANE 2003–2006 | n = 7332 children and adolescents 2–18 y of age | Flavored and white milk contributed, respectively, 2%–6% total energy; 3%–12% saturated fats; 1%–3% sodium; and 4%–0% added sugars. White milk contributed 21% vitamin A; 54% vitamin D; 29% calcium; 17% potassium; 12% magnesium; and 19% phosphorus, which exceeded 10% of total intake. Flavored milk contributed 5% vitamin A; 11% vitamin D; 6% calcium; 4% potassium; 3% magnesium; and 4% phosphorus | ND | Contributed nutrients to the diet |
| Nicklas et al. 2017 [6] | Assess the contribution of flavored milk to the diets of American children and adolescents | Cross-sectional analysis of NHANES 2001–2012 | n = 20,329 American children and adolescents 2–18 y of age | 3564 participants were flavored milk consumers. Flavored milk consumers consumed more milk; ages 2–3 had higher SFA intake; and ages 14–18 had higher percent energy from SFA than flavored milk nonconumers. Flavored milk consumers had a lower mean percentage meeting AI for fiber and higher percentage meeting the EAR for calcium. Consumers 4–8 and 9–13 had higher mean percentage meeting the EAR for magnesium | Higher SFA and percent energy from SFA intake and lower fiber intake than flavored milk nonconsumers | Higher calcium and magnesium intake than flavored milk nonconsumers |
| Lepicard et al. 2017 [14] | Analyze the nutritional quality of children’s breakfasts in France | Cross-sectional analysis | n = 529 French children 9–11 y of age | Breakfast provided 22.9% of recommended daily energy with the most frequently consumed food being flavored milk (50.5%). 83% of breakfast consumers consumed flavored milk. When adjusted for energy, the foods contributing most to total nutrient intake were RTEC, milk, flavored milk, and fruits | ND | Contributed nutrients to the diet |
| Romo-Palafox et al. 2018 [19] | Ascertain the relationship between beverage selection and dietary quality of packed lunches for preschool children using the HEI-2010 | Cross-sectional analysis | n = 607 foods packed by parents | Milk and flavored milk made up 14% and 3.7%, respectively, of beverages packed by parents. Lunches with plain milk had the highest HEI scores (59.3) followed by lunches with 100% fruit juice (56.9) and flavored milk (53.2) | ND | Indicator of diet quality |
| O’Neil et al. 2018 [16] | Determine the food sources of energy, nutrients of public health concern, and nutrients to limit with a focus on dairy foods | Cross-sectional analysis of NHANES 2011–2014 | n = 5876 children and adolescents 2–18 y of age | Milk was the first, second, and fourth leading source of energy in children 2–5; 6–11, and 12–18 y of age (8.9%; 6%; and 5.7%), respectively. Milk and flavored milk were the first and third leading source of calcium in children 2–5 y (36.2% and 7.6%) and 6–11 y (22.2% and 8.2%), respectively. Milk was the leading source of calcium (22.7%) in 12–18-y olds. Milk and flavored milk were the first and second food sources of vitamin D in 2–5-y olds (55.7% and 12%) and 6–11-y olds (46.7% and 15.2%, respectively). Milk was the leading source of vitamin D (51.3%) in 12–18-y olds. Milk was the leading source of potassium in 2–5-y olds (21.1%) and 12–18-y olds (12.4%), respectively; milk and flavored milk were the first and third leading sources of potassium (15.6% and 5.7%, respectively) in 6–11-y olds. Milk and flavored milk were not leading contributors of % added sugars. Milk was the first food source of SFA (18.4%) in 2–5-y olds; second in 6–11-y olds (10.1%); and second for 12–18-y olds (10%) | Leading source of saturated fat in the diet | Leading source of 3 of 4 nutrients of public health concern in the diet |
| Fayet-Moore et al. 2019 [13] | Assess associations among milk drinking and milk, dairy, and micronutrients intakes compared with milk consumption from other sources or milk avoidance among children and adolescents | Cross-sectional secondary analysis of 2011–2012 Australian National Nutrition and Physical Activity Survey | n = 2812 Australian children and adolescents 2–18 y of age | Flavored and plain milk drinkers had higher total daily milk (480 g; 95% CI: 459, 501 g and 445 g, 95% CI: 427, 462 g, respectively) and calcium (1049 ± 18 mg and 980 ± 15 mg, respectively) intakes than all other groups. Plain and flavored milk drinkers and nondrinkers of milk had the lowest prevalence of SSB intake (P < 0.001) | ND | Higher micronutrient intake compared with milk nondrinkers Lower SSB intake compared with milk nondrinkers |
| Leme et al. 2019 [20] | Identify most commonly consumed foods by adolescents contributing to percentage of total energy, added sugars, SFA, sodium and total gram intake per day | Cross-sectional analysis of data from NHANES 2011–2014 | n = 3156 adolescents 10–19 y of age | Leading sources of total energy were SSB (7.8%); sweet bakery products (6.9%); and mixed dishes-pizza (6.6%). Highest food sources of total gram amount consumed were plain water (33.1%); SSB (15.8%); milk (7.2%). Three highest food sources of added sugars were SSB (42.1%); sweet bakery products (12.1%); and coffee and tea (7.6%) | ND | ND |
| Kassis et al. 2022 [21] | Estimate the usual intakes of fiber, iron, zinc, calcium, folate, vitamin D, and vitamin A and the top foods that contribute to them among children in the UAE | Cross-sectional analysis | n = 1102 children 6–11.9 y of age | Main contributors to iron intake were infant/young child formula and infant cereal in children under 4 y, and fortified grains and meat/fish for children over 4 y. Vitamin D was inadequate across all age groups. Top sources of vitamin D were fortified milks | ND | Source of nutrients of concern |
| Gopinath, et al. 2014 [22] | Assess dairy intake and determine predictors of adequate dairy consumption during adolescence | Prospective analysis from semiquantitative FFQ | n = 634 Australian children and adolescents 12–17 y of age | Mean total dairy intake decreased from 1.62 servings per day at age 12 to 1.40 servings per day at age 17 (P < 0.0001). Consumption of ≥3 total dairy servings per day decreased from 8.5% of 12-y olds to 6.2% of 17-y olds (P < 0.005). Participants whose parents had higher education were 85% more likely to have higher than median intakes of dairy during the 5 y (OR = 1.85; 95% CI: 1.18, 2.91). ≥2 servings/wk of flavored milk consumption was associated with ∼5 fold greater likelihood of maintaining intakes of dairy foods above the median during adolescence | ND | Increased likelihood of maintaining dairy consumption during adolescence |
| Quann and Adams, 2013 [23] | Quantify the impact of changes in flavored milk availability on school children’s milk consumption | Intervention | n = 49 elementary schools | Removal of flavored milk on 1 to all days of the week was associated with 26% reduction in milk sales and 11.4% increase in the percentage of milk discarded, resulting in and estimated 37.4% decrease in milk consumption | ND | Increase milk consumption |
| Thompson et al. 2020 [24] | Examine the effect of policy that removed chocolate milk from secondary schools on students’ milk consumption and estimated milk-related nutrient intake | Intervention |
n = 3158 secondary school students in 6th–12th grade, pre-policy n = 2966 students secondary school students in 6th–12th grade, post-policy |
Proportion of students selecting milk declined 13.6% from 89.5% pre-policy to 75.9% post-policy (95% CI: 10.8%, 16.4%, P < 0.05). Proportion of milk wasted remained stable with 37.1% pre-policy to 39.3% post-policy (95% CI: −0.2%, 4.6%, P < 0.05). Average per-student milk consumption declined by 1oz per student from 4.8 oz pre-policy to 3.8 oz post-policy (95% CI: −1.1, −0.7 oz, P < 0.05). NS reductions observed for intake of calcium, protein, or vitamin D from milk. Estimated added sugars from milk declined by 3.1 g per student (95% CI: −3.2 g, −2.9 g, P < 0.05) | Increased intake of added sugars | Increased consumption of milk |
Abbreviations: EAR, estimated average requirement; HEI, Healthy Eating Index; PA, physical activity; RTEC, ready-to-eat cereals; SSB, sugar-sweetened beverage; WC, waist circumference.