A Closer Look at Flavored Milk

Chocolate and other flavored milks are a growing trend with a variety of new options available in colorful, graband- go plastic containers. Flavored milks are particularly popular with children and teenagers, yet some school nutrition professionals and administrators have been reluctant to offer flavored milks to school-aged children. This paper provides an overview of studies documenting the nutritional contributions of flavored milk and the current evidence to support its role in children's diets.

Flavored milk can help children get the calcium they need.
Children who drink flavored milk are more likely to meet daily calcium recommendations compared to their peers who do not drink flavored milk.¹

Flavored milk can be a nutrient-rich replacement for soft drinks and fruit drinks.
Children who drink flavored milk tend to drink fewer nutrient-void sodas and sugary fruit drinks.¹

Flavored milk contributes only small amounts of added sugars to children 's diets.
Sodas and fruit drinks are the number one source of added sugars in the diets of U.S. children and adolescents, while flavored milk provides only a small fraction (< 2%) of the total added sugars consumed.² Children who drink flavored milk have no higher intakes of added sugars compared to children who do not drink flavored milk.¹

Children who drink flavored milk have nutritionally superior diets.
Children who consume sweetened dairy products (including flavored milks) get more calcium, consume less added sugars and saturated fat and are more likely to meet recommendations for calcium, folate and iron compared to those who consume sugar-sweetened beverages such as sodas and fruit drinks.³

Flavored milk provides essential nutrients.
Flavored milk provides the same nine essential nutrients as unflavored milk, including three of the five nutrients identified as "nutrients of concern" for children in the 2005 Dietary Guidelines for Americans - calcium, magnesium and potassium.⁴ Milk is the number one source of calcium, magnesium, potassium and phosphorus in children's diets.²

Research indicates that children who drink flavored milk:
- Drink more milk and get more calcium and other critical nutrients
- Do not have higher total intakes of added sugars or total fat
- Drink fewer nutrient-poor sodas and fruits drinks compared to children who do not drink flavored milk.¹

Offering flavored milk can help children maintain their milk-drinking habits.
As students get older they may start choosing sodas and other empty-calorie beverages in place of milk. Studies suggest that flavored milk can be an effective strategy to avoid this switch.⁵ In one study, children who were offered flavored milk drank more milk overall and fewer soft drinks.¹

Limiting the types of milk offered in schools could likely decrease milk consumption.
Seventy percent of milk sold in schools is flavored milk. Studies suggest that fewer choices of milk mean fewer kids will drink milk.⁵ When flavored milk is offered in schools, overall milk consumption increases.

Flavored milk can be part of an eating plan that supports healthy weight.
Offering flavored milk encourages increased milk consumption and adequate calcium intake. Some observational studies suggest adequate milk consumption is associated with healthier weights in children.^6-8 While flavored milk provides more calories compared to unflavored milk, the extra calories can easily fit into a child's "discretionary calorie allowance" as identified in the U.S. Dietary Guidelines.^4,9

The amount of added sugars in flavored milk is significantly less than the amount in soft drinks. About 40% of the sugar in flavored milk is naturally occurring lactose (10 grams per 8 ounces), yet all of the sugars in nutrient-poor sodas are added sugars.

One study reported that children who regularly drank sodas and other low-nutrient, sugar-sweetened beverages were more likely to become overweight or obese compared to children who do not drink these beverages.¹⁰

Flavored Milks May Ease Lactose Intolerance A few studies suggest that flavored milk may be more easily digested by those who are sensitive to lactose.^11,12 Some researchers have suggested that the cocoa added to chocolate milk may help slow the emptying of food (including lactose) from the stomach -- making this beverage better tolerated compared to unflavored milk. One study found that many individuals with lactose intolerance could comfortably drink two cups of milk a day when consumed in small servings with meals.¹³ Lactose-reduced or lactose-free milks also are widely available.

Sodas and fruit drinks make up 13% of a teen's total calories -- that's more than any other single food, including cakes, cookies and other sugary foods.²

The American Academy of Pediatrics recommends restricting the sale of sweetened drinks in schools to help prevent some of the health problems associated with too many sodas and sweetened beverages.¹⁴ The Academy recommends replacing sweetened drinks in school vending machines with real fruit juices, water and lowfat white or flavored milk. The policy statement also notes that as sweetened drink consumption rises, milk consumption declines and milk is the primary source of calcium in the diets of children and adolescents.

A clinical report from the American Academy of Pediatrics suggests flavored milks (reduced fat or fat-free) with modest amounts of added sweeteners are "generally recommended" to help optimize the bone health and calcium intakes of children and adolescents.²³

Role of Milk on Body Fat and Weight
While the majority of studies examining the relationship of milk and dairy foods on weight have been conducted with adults, researchers have found that dairy intake may play a role in promoting a healthy weight or preventing unhealthy weight gain among children and adolescents. Some studies have shown that a higher intake of dairy foods, including milk, is associated with lower body weight and fat among children and adolescents.^6-8

While flavored milk contains additional calories compared to unflavored milk (about 60 more calories per serving), these extra calories can be offset by consuming less higher-calorie foods or soft drinks. Research indicates that teens who drink flavored milk tend to drink fewer sugary sodas and fruit drinks, which are the primary source of calories in their diet. ²

In a recent study of Asian and Caucasian adolescent girls (ages 9-14), those who drank milk instead of soft drinks weighed less and had less body fat, particularly around the middle.⁷ One extra serving of milk a day was associated with lower body fat, while soda intake was associated with greater body weight. The girls who drank an extra can of a soft drink a day were nearly four pounds heavier. The researchers concluded that decreasing soda and increasing dairy consumption among girls may help maintain body fat and weight during adolescence.

Milk consumed at school plays a critical role in helping children meet their needs for calcium and other key nutrients. One study found that children who consume milk at the noontime meal have higher intakes of key nutrients, including calcium. In fact, only those children drinking milk at lunch met their recommended daily intake of calcium.²⁶

Studies have shown that kids drink more milk when schools offer it in various flavors and containers. When approximately 400 elementary school children in Pennsylvania were provided with an option of chocolate milk in school meals, more milk was consumed and intake of nutrients such as calcium and riboflavin increased.²⁷

Similarly, when 6th grade students in an elementary school in New York City were provided with 1% lowfat chocolate milk as part of the National School Lunch Program, children's milk and nutrient intakes increased, including calcium, riboflavin and phosphorus.²⁸

Recently, two large pilot studies were conducted to examine the effects of offering flavored milk on overall milk consumption and milk sales.^5,29 The results clearly indicate that if students have a variety of milk flavors to choose from, they?ll drink more milk.

In one study, the School Nutrition Association and National Dairy Council partnered with 146 schools serving 100,000 students in 18 school districts in 12 different markets. Serving a variety of flavored milks in fun new packaging on the lunch line, a la carte, and in vending machines made milk the definite beverage of choice. Milk consumption increased by 37%, milk sales increased by 18%, and nearly 5% more students went through the lunch line.²⁹

In the other study, conducted in the St. Louis area, almost 300 schools with approximately 165,000 students added new flavors of milk in colorful packaging. In the first 10 weeks, flavored milk sales increased an average of almost 20% per school and overall milk sales increased as much as 14% per school.⁵

A study of factors influencing milk drinking behaviors found that milk flavor and packaging were frequently cited as important factors influencing milk consumption.³⁰ The availability of different types and flavors of milk was also recognized as an opportunity for children to practice decision making and create a sense of personal control.

Kids drink more milk when schools offer it in plastic, re-sealable containers in different sizes, various flavors and merchandising locations, such as vending machines and a la carte.

<sub>1. Johnson RK, Frary C, Wang MQ. The nutritional consequences of flavored milk consumption by school-aged children and adolescents
in the United States. Journal of the American Dietetic Association. 2002;102:853-856. 2. Murphy M, Douglass J, Latulippe M, Barr S, Johnson R, Frye C. Beverages as a source of energy and nutrients in diets of children and adolescents. The FASEB Journal 2005;A434,275.4.
3. Frary CD, Johnson RK, Wang MQ. Children and adolescents: choices of foods and beverages high in added sugars are associated with intakes of key nutrients and food groups. Journal of Adolescent Health. 2004;34:56-63.
4. Dietary Guidelines for Americans, 2005 (6th ed.). U.S. Department of Health and Human Services, U.S. Department of Agriculture. www.healthierus.gov/dietaryguidelines.
5. Improved School Milk Test. Milk Processor Education Program, St. Louis District Dairy Council, 2005. www.milkdelivers.org.
6. Moore LL, Singer M, Bradlee LM, Gao DI, Hood M, Ellison RC. Low intakes of dairy products in early childhood may increase body fat acquisition. Obesity Research. 2003;11(S): Abstract No.130.
7. Novotny R, Daida YG, Acharya S, Grove JS, Vogt TM. Dairy intake is associated with lower body fat and soda intake with greater weight in adolescent girls. Journal of Nutrition. 2004;134(8):1905-1909.
8. Phillips SM, Bandini LG, Cyr H, Colclough-Douglas S, Naumova E, Must A. Dairy food consumption and body weight and fatness studied longitudinally over the adolescent period. International Journal of Obesity. 2003;27(9):1106-1113.
9. U.S. Department of Agriculture, MyPyramid. www.mypyramid.gov.
10. Ludwig DS, Peterson KE, Gortmaker SL. Relation between consumption of sugar-sweetened drinks and childhood obesity: a prospective, observational analysis. The Lancet. 2001;357:505-508.
11. Lee CM, Hardy CM. Cocoa feeding and human lactose intolerance. American Journal of Clinical Nutrition. 1989;49:840-844.
12. Dehkordi N, Rao DR, Warren AP, Chawan CB. Lactose malabsorption as influenced by chocolate milk, skim milk, sucrose, whole milk, and lactic cultures. Journal of the American Dietetic Association. 1995;95:484-486.
13. Suarez FL, Savaiano D, Arbisi P, Levitt MD. Tolerance to the daily ingestion of two cups of milk by individuals claiming lactose tolerance. American Journal of Clinical Nutrition. 1997;65:1502-1506.
14. American Academy of Pediatrics Policy Statement. Soft Drinks in Schools. Pediatrics. 2004;113:152-154.
15. American Heart Association, American Stroke Association, Robert Wood Johnson Foundation. A Nation at Risk: Obesity in the United States. American Heart Association National Center: Dallas, June 2005.
16. Blum JW, Jacobsen DJ, Donnelly JE. Beverage consumption patterns in elementary school aged children across a two-year period. Journal of the American College of Nutrition. 2005;24:93-98.
17. Rajeshwari R, Yang SJ, Nicklas TA, Berenson GS. Secular trends in children?s sweetened beverage consumption (1973-1994): the Bogalusa Heart Study. Journal of the American Dietetic Association. 2005;105:208-214.
18. Marshall TA, Eichenberger-Gilmore JM, Broffitt B, Stumbo PJ, Levy SM. Diet quality in young children is influenced by beverage consumption. Journal of the American College of Nutrition. 2005;24(1):65-75.
19. Ogden CL, Carroll MD, Curtin LR, McDowell MA, Tabak CJ, Flegal KM. Prevalence of overweight and obesity in the United States, 1999-2004. Journal of the American Medical Association. 2006; 295:1549-1555.
20. Woodward-Lopez G, Davis Ritchie L, Gerstein DE, Crawford PB. Obesity: Dietary and Developmental Influences. CRC Press, Taylor & Francis Group, 2006.
21. Guthrie JF, Morton JF. Food sources of added sweeteners in the diets of Americans. Journal of the American Dietetic Association. 2000;100:43-51.
22. Striegel-Moore RH, Thompson D, Affenito SG, Franko DL, Obarzanek E, Barton BA, Schreiber GB, Daniels SR, Schmidt M, Crawford PB. Correlates of beverage intake in adolescent girls: The National Heart, Lung and Blood Institute Growth and Health Study. Journal of Pediatrics. 2006; 148:183-187.
23. Greer FR, Krebs, NF. Optimizing bone health and calcium intakes of infants, children and adolescents. Pediatrics. 2006;117:578- 585.
24. Skinner JD, Bounds W, Carruth BR, Ziegler P. Longitudinal calcium intake is negatively related to children?s body fat indexes. Journal of the American Dietetic Association. 2003;103:1626-1631.
25. Moore LL, Singer MR, Bradlee ML, Ellison RC. Dietary predictors of excess body fat acquisition during childhood. Circulation. 2004;109:5, Abstract No. 3.
26. Johnson RK, Panely C, Wang MQ. The association between noontime beverage consumption and the diet quality of school-aged children. Journal of Child Nutrition and Management. 1998;2:95-100. References
27. Guthrie HA. Effect of a flavored milk option on a school lunch program. Journal of the American Dietetic Association. 1977;77:35-40.
28. Kimbrough JR, Shanklin CW, Gench BE. Beverage choices offered by school food service programs. School Food Service Research Review. 1990;14(1):24-28.
29. Roper ASW. School Milk Pilot Study: Sales Test, September 2001-June 2002. Dairy Management Inc. and School Nutrition Association, www.nutritionexplorations.org.
30. Connors P, Bednar C, Klammer S. Cafeteria factors that influence milk-drinking behaviors of elementary school children: Grounded theory approach. Journal of Nutrition Education and Behavior. 2001;33:031-036.
31. Public Law 108-265, Child Nutrition and WIC Reauthorization Act of 2004, Sec. 204 (42 USC 1751 note).
32. National Dairy Council. Online survey of more than 4,000 moms who subscribe to 3aday.org e-newsletter. November 2005.
33. Annual School Milk Assessment, 2005-2006. Survey of 501 school food service directors representing 5,000 schools. Milk Processor Education Program and School Nutrition Association. Technical review provided by: Rachel K. Johnson, Ph.D., M.P.H., R.D. Dean and Professor of Nutrition College of Agriculture and Life Sciences The University of Vermont For additional information on milk's role in school wellness, visit milkdelivers.org and nutritionexplorations.org</sub>