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. 2020 Mar 2;11(4):928–950. doi: 10.1093/advances/nmaa011

TABLE 2.

Summary of research examining dairy intake by fat content with cardiometabolic factors in children1

Study and reference Subjects Outcomes2 Exposure variables Confounders considered Conclusions3
TRIALS (2 studies)
Hendrie and Golley, 2011 (43)Randomized controlled trial: 12-wk intervention to switch to reduced-fat dairy or not; follow-up at 24 wk Australian children 8.6 ± 3.0 y (4–13 y), 40% F n = 145Consuming ≥2 svs/d of whole-fat dairy at baseline

  • TC

  • HDL-C

  • LDL-C

  • TG

 Whole-fat (>2% for milk and yogurt, ≥25% for cheese) and reduced-fat (≤2% for milk and yogurt, <25% cheese) dairy at baseline, 12 wk, and 24 wk from 3 × 24-h diet recalls. Clustering of children within families, age, sex, baseline BMI-z, family income, parental education, parental BMI, baseline energy. Switching from whole- to reduced-fat dairy did not result in significant changes to TC, HDL-C, or TG at 12 wk. Small reduction in LDL-C at 24 wk (12 wk post-intervention).*
Villalpando et al., 2015 (44)Double-blind controlled trialSchool provided 2 × 200 mL milk/d for 4 mo Mexican children from 13 boarding schools11 ± 3 y (6–16 y), (% F not specified)n = 462Usual consumers of whole-fat dairy at baseline

  • TG

  • TC

  • HDL-C

  • LDL-C

  • VLDL-C

  • TC:HDL

  • ApoB, apoA-1

  • Lp(a)

  • ApoB:apoA-1

 Milk provided was either 3%, 2%, or 0.5% fat.130/462 subjects completed diet interview at 2 mo and 3 mo after baseline. Clustering within schools.Age, sex, BMI. Switching from whole-to skim milk resulted in decreased LDL-C*, TC**, apoB**, but also decreased HDL-C.** No change to total:HDL-C.Switching from whole- to reduced-fat milk decreased LDL-C*, apoA-1*, apoB.** No change in TC:HDL-C or apoB:apoA-1.
OBSERVATIONAL: PROSPECTIVE (3 studies)
Raine StudyO'Sullivan et al., 2016 (51)3-y follow-up Australian adolescents14 ± 0.2 y at baseline, 54% Fn = 860

  • MetS4

  • Low or high metabolic risk5

  • TC:HDL-C

  • HDL-C

  • LDL-C

  • BP

  • HOMA-IR

  • CRP

 Whole-fat and reduced-fat dairy (given as svs/d) as assessed by 212-item semiquantitative FFQ at baseline and follow-up. Reduced-fat classifications: milk <3%, cheese <16%, butter <50%, ice cream <7%, yogurt <3%, dairy dessert/custard <3%, cream <30%. Age, energy intake, dietary misreporting status, aerobic fitness, maternal age, breastfeeding, dietary patterns, and BMI where appropriate; family factors, income, medical history also investigated.Whole-fat (svs/d) and reduced-fat dairy (svs/d) considered together in models.Separate analysis by sex. In boys: increases in whole- and reduced-fat dairy both associated with reduction in diastolic BP*; reduced-fat dairy intake also associated with reduction in HDL-C* and increased TC:HDL-C*In girls: no significant associations.
AGAHLSte Velde et al., 2011 (53) 23-y follow-up at these time points: 14, 15, 16, 21, 27, 32, and 36 y Dutch teenagers∼13 y at baseline, 53% Fn = ≥3746 At 36 y, above or below median for nonfasting:● HDL-C● BP Reduced-fat (≤2%) or whole-fat dairy (>2%) from dietitian diet history interview for preceeding 4 weeks. Sex, energy intake, physical activity, smoking status. Adults with TG above the median had higher intakes of reduced-fat dairy at 16 y compared with those below the median.* Adults with HbA1c above the median had higher median intakes of whole-fat dairy at 14 y, compared with

  • TG, HbA1c

  • Adapted MetS status7

 those below the median.* No significant associations with other outcomes.
TARGet Kids!8 Wong et al., 2019 (71)Annual follow-up Canadian children 4±2 y (2–8 y), 47% Fn = 2890 at baseline.Only 32% completed ≥2 visits (<4% completed ≥4 visits)

  • Nonfasting non-HDL-C9

  • “High-risk” cut point of 3.75 mmol/L also applied10

 Questionnaire asked parents to

  1. Report type of milk typically consumed by child: skim, 1%, 2%, or whole (3.25%);

  2. Select how many cups the child consumes in a typical day

 Age, sex, BMI z-score, daily free play, breastfeeding duration, mother's ethnicity, family income, parental history of CVD. Further adjusted for typical volume of milk consumed. Increase in milk fat percentage was associated with a slight increase in non-HDL-C in unadjusted** and adjusted* analysis. Milk fat was not associated with increased odds of having high non-HDL-C.
OBSERVATIONAL: CROSS-SECTIONAL (5 studies)
CASPIAN-IVFallah et al., 2016 (59) Iranian school children 12 ± 3 y (6–18 y), 49% Fn = 13,486

  • Elevated BP based on pediatric cut-points11

 Modified questionnaire12 used to assess whole-fat or low-fat milk type (not further defined) usually consumed. Sex, age, physical activity, screen time, BMI, birth weight, milk type in infancy, family history of hypertension, and frequency of other food groups consumed; plus frequency of milk consumption. Usual consumption of whole-fat milk was not associated with odds of elevated BP in boys or girls.
TLGSGhotboddin Mohammadi et al., 2015 (72) Iranian children15 ± 3 y (10–19 y), 53% Fn = 785 Low- and high-fat dairy (undefined) from a 168-item 1-y semiquantitative FFQ. Age, sex, energy, BMI included in models of total dairy but no confounders specified for reduced- or whole-fat dairy analysis. Type of dairy products consumed was not associated with odds of MetS.
Hirschler et al., 2009 (60) Argentinian children and adolescents 10 ± 2 y (5–14 y), 52% Fn = 365

  • BP

  • HDL-C

  • HOMA-IR

  • Insulin

  • TG

 3 categories of whole-fat milk consumption (≤1, 2–3, or ≥4 svs/d),14 from pediatrician interview with mother. Only for HOMA-IR model: physical activity, television viewing, sugar-sweetened beverage intake, parental education, sex, age, HDL-C, systolic BP. Whole-fat milk associated with lower HOMA-IR in adjusted models.*Unadjusted associations across intake groups:

  • Systolic BP (inverse)**

  • HDL nonsignificant

  • HOMA-IR (inverse)*

  • Insulin (inverse)*

  • TG nonsignificant
Samuelson et al., 2007 (73) Swedish adolescents ∼15 y, 55% Fn = 93

  • TG

  • TC

  • Insulin

  • ApoB (n = 50)

  • ApoA-1 (n = 49)

  • ApoB:apoA-1

 Serum cholesterol ester fatty acid composition (%) for 15:0 and trans-16:1n–7. Proportion of dietary fatty acids adjusted for energy intake (from 7-d weighed food records) for trans-16:1n–7. BMI, physical activity, vegetable and juice intake, separate by gender. Serum 15:0% associated with lower:

  • TC*(F and M)

  • ApoA-1**(F)

  • ApoB*(M)

  • ApoB:apoA-1*(M)
Serum % 16:1n–7 associated with higher:● TG*(F)● ApoB*(M)● ApoB:apoA-1*(M)Dietary % 16:1n–7 associated with lower:● TG*(F)
Wang et al., 2011 (74) US adolescents∼15 y, 43% Fn = 305

  • Serum adiponectin

  • CRP

  • Cytokines (IL-6 and TNF-α)

  • Urinary F2-iso and 15-keto

 Serum phospholipids 15:0 and17:0.Also used 127-item FFQ to adjust for other diet factors. Age, gender, ethnicity, Tanner score, total energy intake, physical activity; diet factors: calcium, potassium, phosphorus, vitamins A and D, ω-3 fatty acids, protein, total flavonoids, and BMI if appropriate.Separate analysis by weight status. Serum 17:0 and 15:0 inversely associated with inflammation and oxidative stress** in overweight adolescents. IL-6 inversely related to 17:0 and 15:0 independent of weight status.**17:0 positively associated with adiponectin in overweight adolescents* but inversely associated in normal-weight adolescents.*No significant results for TNF-α.
1

AGAHLS, Amsterdam Growth and Health Longitudinal Study; BMI-z, BMI z-score; BP, blood pressure; CASPIAN, Childhood and Adolescence Surveillance and Prevention of Adult Noncommunicable diseases; CRP, C-reactive protein; CVD, cardiovascular disease; F2-iso, F2-isoprostanes; HbA1c, glycated hemoglobin; HDL-C, HDL cholesterol; HT, hypertension; LDL-C, LDL cholesterol; Lp(a), lipoprotein(a); MetS, metabolic syndrome; sv, serving; TARGet Kids!, The Applied Research Group for Kids; TC, total cholesterol; TG, triglyceride; TLGS, Tehran Lipid and Glucose Study; VLDL-C, VLDL cholesterol; WC, waist circumference; 15-keto, 15-keto-dihydro-PGF2alpha.

2

Fasting measures reported for blood results.

3

Significance level: **P < 0.01; *P < 0.05.

4

As defined by the International Diabetes Federation pediatric criteria (75).

5

Derived from the data using cluster analysis.

6

Numbers varied per follow-up: started with n = 634, finished with n = 374 with adult outcome measures. Exact numbers used at each follow-up not reported.

7

Metabolic syndrome was defined as the presence of ≥2/5, as adapted from 3/5 according to the definition, of the following components: WC >94 cm in M or >80 cm in F; TG concentration >150 m/dL (1.69 mmol/L); serum HDL-C <40 mg/dL (1.03 mmol/L) in M and <50 mg/dL (1.29 mmol/L) in F; systolic BP >130 mmHg and/or diastolic BP >85 mmHg; HbA1c >6.2% (76).

8

Although this study is reported as a longitudinal study, it was treated as cross-sectional for the purposes of this review because the relation between dairy fat intake and non-HDL-C was assessed cross-sectionally within the analyses (32% of subjects provided data from 2 visits, <4% from ≥4 visits): “…generalized estimating equations with an exchangeable correlation structure, which takes into account potential correlation within subjects with repeated measures.”

9

Calculated by subtracting HDL-C from TC.

10

Cut points were based on the US National Heart, Lung, and Blood Institute Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents (77).

11

Elevated BP was categorized as pre-HT and HT according to the Fourth Report of the Working Group on Blood Pressure Control in Children (78). Pre-HT was considered as either BP equal to or greater than the age- and gender-specific 90th percentile after adjusting for weight and height, or as BP ≥120/80 mmHg. When BP was equal to or greater than the age- and gender-specific 95th percentile value, it was considered as HT.

12

WHO Global school-based student health survey, filled out by students under the supervision of staff and the presence of ≥1 parent.

13

MetS defined as having ≥3 of the following components: fasting plasma glucose concentration ≥110 mg/dL; fasting serum TG ≥100 mg/dL; HDL-C <45 mg/dL for boys aged 15–19 y and <50 mg/dL for other people; WC >75th percentile for the age and sex of Iranian population; systolic and diastolic BP >90th percentile for age, sex, and height based on the recommendations of the National Heart, Lung and Blood Institute.

14

Recommended serving of milk per day was 2 cups for children aged 4 to 8 y, and 3 cups for children aged 9 to 18 y (67).