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What can growing up milk contribute to toddler diets?

Limited studies exist which examine the role that fortified milk drinks can play in addressing nutritional inadequacies in toddler diets. Growing up milks are milks that have been specifically fortified with nutrients that are often lacking in a toddler’s diet such as iron and vitamin D1,2.

The importance of vitamin D has recently been highlighted by Public Health England3 which recommends all babies under 1 year should have a daily 8.5 to 10 microgram vitamin D supplement to ensure they get enough. However, children who have more than 500ml of infant formula a day do not need any additional vitamin D as formula is already fortified. It should be noted that compliance with supplements can be an issue and national data shows that less than 1 in 10 toddlers take a vitamin supplement4.

Alternatives to supplementation such as growing up milks should be examined to evaluate whether they are also effective at addressing the nutritional inadequacies in a toddler’s diet.

Study design

A study conducted by Walton and Flynn5 entitled ‘Nutritional adequacy of diets containing growing up milks or unfortified cow’s milk in Irish children’ sought to examine this question in children aged 12-24 months.

The study used data from a cross-sectional study of Irish children, the National Pre-School Survey (2010-2011) and divided them into two groups: ‘Consumers of growing up milk’ (n=29) and ‘Non-consumers of growing up milk’ (n= 56).

Food and beverage intake data was collected using a 4-day weighted food diary and included at least one weekend day. Mean daily intakes (MDI) for macro and micronutrients were analysed and compared to reference nutrient intakes (RNI).

 

What were the key findings?

Milks made significant contributions of macronutrients and some micronutrients in both toddler groups, however, consumers of growing up milk had higher mean dietary intakes of some nutrients including vitamin D and iron.

The differences in micronutrient intakes between the two groups are largely attributable to the increased levels of certain vitamins and minerals in growing up milk.

It is recognised that there are inadequate intakes of iron and vitamin D in young children across European countries1,2. Walton and Flynn found that 95% of the ‘Non-consumers of growing up milk’ group and 31% of ‘Consumers of growing up milk’ had vitamin D intakes below the Reference Nutrient Intake (RNI) of 7µg/day6.

These findings demonstrate the necessity for healthcare professionals to increase parental awareness of vitamin D requirements for toddlers and ensure that toddlers are provided with either a supplement or fortified milk combined with a diet high in vitamin D.

Percentage of toddlers with intakes of vitamin D below the RNI

Differences in iron intake were equally apparent between the two groups.

Nearly 60% of toddlers on the cow’s milk only group were found to have iron intakes below the Estimated Average Requirement (EAR) of 6.9mg/day6. Interestingly, all toddlers in the ‘Consumers of growing up milk’ group met their EAR for iron, indicating that growing up milks can play an important role in changing dietary intake for some toddlers.

Percentage of toddlers with intakes of Iron below the EAR

Do these results show a role for growing up milk?

Currently a limited number of studies exist evaluating the efficacy of the contribution that growing up milks can make to a toddler’s diet. Whilst this study has a relatively small sample size, the positive results can be viewed as a platform for further research.

Both groups analysed in this study had a higher socioeconomic status (SES) compared to the general population and arguably, this could infer the dietary intakes examined do not reflect those of lower SES groups.

However, studies have shown that those in lower SES groups consume diets that are lower in micronutrients and as such fortified milk may play a more important role in these groups7.

The results of this study further highlight that vitamin and mineral deficiencies remain a growing concern for toddlers in the United Kingdom. If left unaddressed these may lead to long term developmental issues in young children8,9.

The findings from this study show that using a fortified growing up milk can play a valuable role in supporting toddler diets.

  1. Gordon CM et al. Prevalence of Vitamin D Deficiency Among Healthy Infants and Toddlers. Arch Pediatr Adolesc Med 2008; 162: 505-12.
  2. Szymlek-Gay EA et al. Food-Based Strategies Improve Iron Status in Toddlers: A Randomized Controlled Trial. Am J Clin Nutr 2009; 90: 1541-51.
  3. Public Health England: New Advice on Vitamin D [July 2016] Available At: https://www.gov.uk/government/news/phe-publishes-new-advice-on-vitamin-d [Accessed: November 2016]
  4. Bates B et al. NDNS Results of Years 1-4 (Combined) [Online] 2014. Available At: https://www.gov.uk/government/statistics/national-diet-and-nutrition-survey-results-from-years-1-to-4-combined-of-the-rolling-programme-for-2008-and-2009-to-2011-and-2012 [Accessed Nov 2016].
  5. Walton J, Flynn A. Nutritional Adequacy of Diets Containing Growing Up Milks or Unfortified Cow’s Milk In Irish Children (Aged 12–24 Months). Food Nutr Res2013; 57: 21836.
  6. Department of Health UK. Dietary Reference Values for Food Energy and Nutrients for the United Kingdom: Report of the Panel on Dietary Reference Values of the Committee on Medical Aspects of Food Policy. London: Stationery Office, 1991.
  7. Darmon N, Drewnowski A. Does Social Class Predict Diet Quality? Am J Clin Nutr 2008;87.5: 1107-1117.
  8. Madan N et al. Developmental and Neurophysiologic Deficits in Iron Deficiency in Children. Indian J Pediatr 2011; 78(1):58-64.
  9. Holick M F. Sunlight and Vitamin D for Bone Health and Prevention of Autoimmune Diseases, Cancers and Cardiovascular Disease. Am J Clin Nutr2004; 80(6 Suppl): 1678–88.