Other countries are taking note, when will the U.S. get it right?
By Sherry Bunting
BRUSSELS — A new double-blind randomized study of children consuming whole fat vs. low fat milk and dairy reinforces the already accumulated evidence that the choice should be allowed, especially for children, according to Professor Therese O’Sullivan in nutrition and dietetics at the Edith Cowan University in western Australia.
“The Milky Way Study suggests healthy children can safely consume whole fat dairy without concern. Future dietary guidelines can and should recommend either whole or reduced fat dairy,” O’Sullivan confirmed as she presented the study’s results during the Nutrition and Health Symposium organized by the International Dairy Federation in Brussels, Belgium last Thursday (May 12).
The virtual event was attended by over 200 nutrition and health professionals from all over the world. They heard from eight experts and two moderators from various regions of the world, focusing on the role dairy plays across life stages. The first five sessions of the daylong event focused on the role of dairy in maternal diets and for children and teens. The last half focused on aging adults.
The Milky Way Study is deemed the first ‘direct dairy intervention’ study, and it supports the already accumulating evidence that children should be able to choose whole fat milk and dairy as there is no scientific or health reason not to let them choose, O’Sullivan indicated.
The study was costly and time intensive as a double-blind randomized intervention in which the whole fat dairy group consumed more milkfat during the study than their normal consumption had been before the study, and the low fat dairy group consumed less.
Continual testing during the study period showed no statistical differences in key health and nutrition biomarkers except the whole fat milk group’s BMI percentile declined during the study period. This is a key result because this is the first “intervention” study to test “causation” in what the already accumulated evidence shows.
The push by dietary guidelines to limit milkfat in countries like the U.S. and Australia was mentioned during panel discussion in relation to the Milky Way Study, supporting studies, and meta-analysis, with experts noting these guidelines need revisited.
“There is no evidence to suggest that moving to low fat dairy helps,” O’Sullivan said, noting there were no significant differences between the whole fat and low fat study groups when it came to the children’s daily caloric intake, blood pressures, blood cholesterol and lipids, cardiometabolic disease — or any other measure.
However, O’Sullivan did observe a slight trend toward a reduction in BMI (body mass index) percentile in the study group consuming whole fat milk and dairy vs. low-fat milk and dairy.
As the primary researcher on the Milky Way Study, O’Sullivan found it interesting that the daily calorie intakes of both groups were equal, even though the group of children consuming whole fat milk and dairy were getting more calories in their dairy servings because the fat was left in.
“This showed us that as the calories came out of milk in the low fat group, the kids replaced those calories with something else,” O’Sullivan reported.
The sodium intakes were also higher in the low-fat milk group, suggesting the “replacement calories” came from snacks.
O’Sullivan noted that another “very interesting finding was that we didn’t see any improvement in blood lipids in the low fat group that we would expect to see based on the theory of saturated fat increasing lipids,” she said.
Bottom line, she noted: “Whole milk and dairy had a neutral or beneficial effect on cardiovascular (biomarkers) with no difference in lipids, and a small decrease in LDL (bad cholesterol) in the whole fat dairy group.”
She also observed that as the calories came out of the milk in the low fat group, the children were coming up in their consumption of other foods that – depending on their choices — could have an impact on lipid profiles.
(This basically supports the tenet that whole fat milk and dairy is satiating, satisfying, and because it is nutrient dense, children may be less likely to keep ‘searching’ for needed nutrition via salty, sweet and high-carb snacks. The Milky Way study supports what many have long said should be changed in dietary guidelines to increase and make more flexible the saturated fat limits and return the choice of whole fat milk and dairy to schools and daycare centers.)
“High fat dairy foods are not detrimentally affecting adults, children or adolescents,” said O’Sullivan in discussing supporting research and meta-analysis. She noted that her three-month Milky Way Study could be repeated for 12 months for more data, but that it is in line with other evidence.
During the panel discussion, nutrition experts talked about some of the issues in vegan / vegetarian dietary patterns, noting that even when given vitamin and mineral supplements, studies show children and teens could not get their levels where they needed to be in many cases, especially true for B12 and calcium, key nutrients found in milk.
One attendee asked why saturated fats are always ‘the bad guys’ in the dietary guidelines, wondering if there was any associated health risk effect in going from the whole fat to the low fat in the first place.
“Similar to other studies, we saw the kids were good at regulating their food intake to appetite and as we take away the fat, they replace it with something else for the calories to be the same,” O’Sullivan replied. “In one group, they ate more tortillas, in another we noticed sodium intakes went up, suggesting they ate more snack foods (when the fat was removed from the milk and dairy).”
She reminded attendees that there are also other types of fats in milk, including Omega 3 fatty acids.
“Kids do not have much Omega 3 in their diets because they are not as likely to be eating oily fish,” said O’Sullivan. “In the low fat group (in the Milky Way Study), when Omega 3 status went low, they were not replacing it.”
This means the whole fat milk group had an advantage in maintaining Omega 3 status also.
O’Sullivan explained that researchers looked at the membranes of the red blood cells and saw the long chain fats were also down, so if they stayed on that (low fat) diet, and did not have increased Omega somewhere else in the diet, “they may have a health impact down the line.”
An attendee from India noted their government is planning to introduce milk into the supplemental feeding programs for children, with milk programs in schools, beginning with elementary schools.
Increasingly, the global focus is on milk in schools, and this means the type of milk recommended by government dietary guidance is so important.
Attendees also wanted to know “How much saturated fat would be recommended daily for children?”
(In the U.S., schools, daycares and other institutional settings are required to keep calories from saturated fat below 10% of total calories of the meal with the milk included, and of the milk as a competing a la carte beverage, with no attention paid to nutrient density.)
O’Sullivan indicated the answer lies in looking more at the food source of the saturated fat and the level of nutrients accompanying it.
“We need food-focused dietary guidelines,” she said, noting the evidence shows it’s important to change the focus from ‘dietary’ saturated fat ‘levels’ to looking at “the whole food matrix, the overall matrix of the food and the nutrients when the saturated fat is contained in that matrix.”
Good nutrition is key for health and wellbeing throughout life and can help us live our lives to the fullest, said Symposium organizers. They noted that dairy products are nutrient-rich and are a source of protein, B vitamins, iodine, calcium, phosphorus, vitamin A, zinc and potassium – making them an excellent choice for nutritional needs at all ages and stages of life. The unique combination of nutrients and bioactive factors, and how they interact with each other in the dairy matrix, combine to produce the overall effect on health.
In fact, during panel discussion, some noted there is so much emphasis now on maternal nutrition and the first 1000 days of life, whereas not enough attention has been paid to children and teens.
“Intervention is required in the three later phases: middle childhood (5-9 years), when infection and malnutrition constrain growth; adolescent growth spurt (10-14 years) and the adolescent phase of growth, brain maturation and consolidation (15-19 years) if a child is to achieve his full potential as an adult – an important but often overlooked area being the diet”, noted Professor Seema Puri from Delhi University, India.
Professor Lisanne Du Plessis from Stellenbosch University, South Africa explained that food-based dietary guidelines are a key way to provide healthy eating guidance in every life stage.
However, she said, only a few countries such as South Africa, Kenya and Nigeria have guidelines tailored to the specific nutritional needs of children.
In fact, this was a glaring concern in the Australian and U.S. guidelines — given the emphasis on avoiding milkfat leaving children and teens missing out on the key nutrients if they didn’t consume the required low-fat and fat-free products.
Talking about what type of milk children can and should drink seemed like a basic area of discussion that needs intervention.
“Changing to reduced-fat dairy does not result in improvements to markers of adiposity (high body mass index) or cardiometabolic disease risk in healthy children,” O’Sullivan stated.
Contrary to popular belief, she said, “there are no additional health benefits to consuming low-fat or fat-free dairy for children.”
Not only did conclusions from the Milky Way Study back this up, but also comparisons to other supporting evidence were shared.