Table 1.

Aspects of school milk programs on bone health.

Study Reference (n = 10)	Participant Descriptions	Study Details	Bone Health Findings
Kohri et al., 2016 [5]	Intervention Group: n = 329, 153 boys and 176 girls; mean age: 9.3 ± 0.4 years for boys, 9.3 ± 0.4 years for girls. Control Group: n = 484, 262 boys and 222 girls; mean age: 9.2 ± 0.4 years for boys, 9.2 ± 0.4 years for girls.	4-year observational study: School lunch with milk designed to provide 50% of the recommended dietary allowance for calcium. (Kinki region, Japan)	Significant increase in calcium intake for intervention group compared to control group (P < 0.001), and significant increase in bone area ratio in intervention group compared to control group (P < 0.01 for boys, P < 0.05 for girls).
Zhu et al., 2008 [6]	Intervention Groups: n = 110 girls in calcium (Ca) milk group, n = 112 girls in calcium fortified with vitamin D (CaD) milk group; mean age: 10.1 ± 0.4 years at baseline for Ca milk group, 10.1 ± 0.4 years at baseline for CaD milk group. Control Group: n = 123 girls; mean age: 10.1 ± 0.3 years at baseline.	2-year randomized control study: Ca milk group received school milk supplying 560 mg calcium per school day, and CaD milk group received milk supplying 560 mg calcium fortified with 5–8 mcg vitamin D per school day. (Beijing, China)	Significant increase in calcium intake for both intervention groups (Ca milk and CaD milk) groups compared to control group (P < 0.001), significant increase in vitamin D intake in CaD milk group compared to Ca milk group and control group (P < 0.001), and significant increase in bone mineral density (BMD) for both intervention groups compared to control group for the total body (P < 0.05) and legs (P < 0.05).
Zhu et al., 2005 [7]	Intervention Groups: n = 177 girls in calcium (Ca) milk group, n = 210 girls in calcium fortified with vitamin D (CaD) milk group; mean age: 10.1 ± 0.4 years at baseline for Ca milk group, 10.1 ± 0.3 years at baseline for CaD milk group. Control Group: n = 219 girls; mean age: 10.0 ± 0.3 years at baseline.	2-year randomized control study: Ca milk group received school milk supplying 560 mg calcium per school day, and CaD milk group received milk supplying 560 mg calcium fortified with 5–8 mcg vitamin D per school day for 2 years. (Beijing, China)	Significant increase in calcium intake for both intervention groups (Ca milk and CaD milk) groups compared to control group (P < 0.001). Bone mineral measures significantly increased for both intervention groups compared to control group in periosteal diameter, cortical thickness, and medullary diameter (P < 0.05). And bone metabolism measures significantly improved for the CaD group compared to control group with a significant decrease in bone alkaline phosphatase (BAP) at 1 year and in parathyroid hormone (PTH) at 1 and 2 years (P < 0.05).
Du et al., 2004 [8]	Intervention Groups: n = 207 girls in calcium (Ca) milk group, n = 240 girls in calcium fortified with vitamin D (CaD) milk group; mean age: 10.1 ± 0.4 years at baseline for Ca milk group, 10.1 ± 0.3 years at baseline for CaD milk group. Control Group: n = 234 girls; mean age: 10.0 ± 0.3 years at baseline.	2-year randomized control study: Ca milk group received school milk supplying 560 mg calcium per school day, and CaD milk group received milk supplying 560 mg calcium fortified with 5–8 mcg vitamin D per school day for 2 years. (Beijing, China)	Significant increase in calcium intake for both intervention groups (Ca milk and CaD milk) groups compared to control group (P < 0.01), significant increase in vitamin D intake in CaD milk group compared to Ca milk group and control group (P < 0.01). And significant increases in bone growth with anthropometric and bone mineral measures for both intervention groups compared to control group in height, sitting height, weight, body weight (P < 0.0005), and in total body bone mineral content (BMC) (P < 0.05) and bone mineral density (BMD) (P < 0.0005), with those in the CaD milk group being significantly higher than Ca milk group (P < 0.01).
Marsh et al., 2018 [9]	Participants: n = 511, 244 boys and 266 girls (1 unidentified); mean age: 8.5 ± 0.61 years for all participants at baseline.	2-year intervention study: Assessment of participants of the “Milk for Schools Program” measured at baseline, 1-year follow-up, and 2-year follow-up. (Auckland, New Zealand)	Portion of children meeting guidelines for milk and milk product consumption significantly increased from baseline (72%) to 2-year follow-up (94%) (P < 0.001).
Lee et al., 2019 [10]	Participant Group: n = 346, 167 boys and 179 girls; mean age: 14.1 ± 0.1 years for boys, 13.9 ± 0.1 years for girls. Non-Participant Group: n = 346, 153 boys and 193 girls; mean age: 13.8 ± 0.0 years for boys, 13.5 ± 0.0 years for girls.	Cross-Sectional Study: Questionnaires were administered to boys and girls who did or did not participate in school milk programs. (Incheon City and Daejeon City, South Korea)	Boys and girls who participated in school milk programs had significantly higher milk and dairy product consumption (P < 0.001).
Lee et al., 2018 [11]	Intervention Group: n = 274 girls; mean age: 13.2 ± 0.47 years at end of study. Control Group: n = 164 girls; mean age: 13.3 ± 0.45 years at end of study.	18-month randomized control study: The “Adequate Calcium Today (ACT)" intervention consisted of six (6) lessons of 50 min each 2 weeks apart, consisting of videos and games to motivate increased consumption of calcium-rich foods using the “No Bones About It” program, with measures at baseline, 12-month follow-up, and 18-month follow-up. (United States)	No significant differences between the intervention and control groups at the end of study.
Pampaloni et al., 2015 [12]	Participants: n = 156, 74 boys and 82 girls at end of study; age 9–10 years at baseline.	7-month intervention study: An educational program featuring “Mister Bone®" on a website encompassing online games educating and promoting bone health. (Florence, Italy)	Significant increase in calcium and vitamin D (P < 0.05) and milk consumption (P < 0.05) for both boys and girls and end of study.
Keshtkar et al., 2015 [13]	Participants: n = 468, age 15–19 year old boys and girls.	30-day intervention study: Each school was randomly assigned to administer 200 mL of either: 1) whole milk, 2) milk fortified with 600 IU vitamin D per 1,000 mL, or 3) milk fortified with 1,000 IU vitamin D per 1,000 mL. Blood samples taken at baseline and at end of study to measure bone biomarkers. (Tehran, Iran)	None provided.
Neyestani et al., 2014 [14]	Participants: n = 410, age 9–12 years old boys and girls.	12-week randomized control study: Each school was randomly assigned to administer either: 1) 200 mL of milk fortified with 500 mg calcium and 100IU vitamin D, 2) 200 mL of plain milk with 240 mg calcium and no detectable vitamin D, 3) 200 mL of orange juice fortified with 500 mg calcium and 100 IU vitamin D, 4) 200 mL of plain orange juice with 180 mg naturally-occurring calcium and no detectable vitamin D, 5) supplement tablet of 500 mg calcium and 200 IU vitamin D, or 6) placebo tablet of 500 mg starch. Blood samples taken at baseline and at end of study to measure bone biomarkers. (Tehran, Iran)	Significant increase in serum vitamin D (P < 0.001) between intervention groups receiving fortified or supplemental vitamin D compared to control groups receiving placebo counterparts.