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American Academy of Pediatrics Calls for Restricting Soda in Schools
 Concern about health problems associated with consuming too many sodas and other sweetened beverages led the American Academy of Pediatrics (AAP) to issue a new policy statement urging health professionals to help eliminate sweetened drinks such as soda and fruit drinks in schools.
Potential health problems associated with high intake of sweetened drinks include the development of overweight and obesity as a result of increased calories in the diet; displacement of milk consumption resulting in low calcium intake; and dental caries and erosion of tooth enamel as a result of soda’s high sugar content and acidity, respectively.
   The AAP recommends replacing sweetened drinks with real fruit and vegetable juices, water, and lowfat white or flavored milk. The policy notes that as intake of sweetened drinks rises – usually between the third and eighth grades – milk consumption decreases. Milk is the primary source of calcium in the diets of children and adolescents. If efforts are not taken to improve calcium intake during childhood and adolescence, maximal peak bone mass will not be reached. Research shows that a 5% to 10% deficit in peak bone mass may lead to a 50% greater lifetime prevalence of hip fractures.
   In this policy statement, the AAP encourages pediatricians to help educate school authorities, patients, and patients’ parents about the potential health consequences of soda consumption. The AAP’s policy statement also recommends the creation of a school nutrition advisory council made up of parents, community and school officials, food service representatives, and health professionals including physicians, school nurses, dietitians, and dentists. This school nutrition advisory council could be a component of a school district’s health advisory council. Students’ health and nutrition should be the foundation of nutrition policies in schools.
   New! Healthy Food and Beverages Policy developed by the Michigan Action for Healthy Kids Coalition and adopted by the Michigan State Board of Education. To view the policy, visit www.udim.org and click on Michigan Team Nutrition.

Teenage Girls Should Not Avoid Dairy When Dieting
Many teenage girls often mistakenly forgo dairy products due to concerns that these foods may be “fattening.” Yet, a new long-term study published in the International Journal of Obesity shows that teenage girls can maintain a healthy weight and include dairy products in their diets. No evidence was found that dairy food consumption is associated with higher body mass index or an increase in percentage of body fat during adolescence. The researchers say that this study, which followed 178 normal weight preadolescent girls between 8 and 12 years of age until they were four years past menarche, is the first in children to analyze the relationship between dairy food intake and body weight or fatness over time.
   Dairy food consumption was measured at entry and exit and annually during the course of the study. Results were reported as daily servings of dairy foods, percentage of daily calories from dairy foods, and daily calcium intake from dairy foods. In addition, the percentage of calories contributed by both low-fat and full-fat dairy foods was assessed. 
   No significant relationship was found between: 
       l the number of daily servings of dairy foods, the percent daily calories, or the calcium from dairy foods and body mass index. 
       l daily servings of dairy foods or percentage of daily calories from dairy foods and percent body fat. 
       l percent of calories from low-fat or regular dairy foods and body mass index or percent body fat. 
   The findings reinforce the fact that adolescent girls should keep dairy in their diets. They also dispel the myth that milk and other dairy foods may be fattening. Dispelling this myth is particularly important given the health benefits of calcium-rich dairy products, especially during adolescence, which is the window of opportunity for maximizing peak bone mass. Research has shown that consuming the calcium required during adolescence positively affects bone mass and may help reduce the risk for osteoporosis in later years. Dairy foods are the primary source of calcium for children and adolescents. Nearly nine out of 10 teenage girls do not consume recommended dietary calcium intakes, largely because of their low dairy intake. The daily recommended dietary intake for calcium for girls aged 12 to 18 years is 1,300 mg—the equivalent of four servings of milk, cheese, or yogurt daily. 
   Recognizing emerging research demonstrating that calcium—and dairy calcium even more so—lowers body weight or fat, the researchers call for more studies to examine the role of calcium/dairy in body weight regulation.
   For more information on the benefits of dairy foods in weight management, visit www.3aday.org for tips and quick and easy recipe ideas and www.nationaldairycouncil.org for the Healthy Weight Education Kit. 

Do High Protein Diets Increase the Risk for Osteoporosis?
No, not necessarily. A growing body of research suggests that eating a high protein diet does not harm bones if adequate dietary intakes of calcium and vitamin D are consumed. Although protein is essential for bone health, high intake of protein, especially purified protein, may increase urinary calcium loss. This calcium loss could potentially cause negative calcium balance, thereby increasing the risk of bone loss and osteoporosis. However, other nutrients in foods or the diet can offset protein's effects on calcium excretion.
   Findings from epidemiological studies point to protein's beneficial effect on the skeleton. One study found that increasing the protein intake of older adults with hip fractures, especially when adequate intakes of calcium and vitamin D were also consumed, reduced bone loss, improved muscle strength, and shortened their hospital stay. 
   Controversy regarding protein's effects on bone health may be explained by other nutrients in food sources of protein or the total diet. Researchers at Tufts University in Boston found that adequate dietary calcium helps to promote a favorable effect of dietary protein on the skeleton in older adults. Also, phosphorus (e.g., in milk, meat) and potassium (e.g., in milk, legumes, and grains) reduce urinary calcium loss, thereby offsetting protein-induced urinary calcium excretion. 
Protein exists in close association with other nutrients in the diet. For this reason, it is important to consider protein's role in bone health in the context of foods or the overall dietary pattern.
   Protein in dairy foods - milk, cheese, and yogurt - may be particularly beneficial for the skeleton because the calcium content of these foods is high in relation to their protein content and they provide other nutrients such as phosphorus, magnesium, zinc, and vitamins A, D, and K needed to build and maintain healthy bones. A number of studies suggest that milk's nutrient package has positive effects on bone health. These findings provide the scientific basis for the dairy industry's "3-A-Day of Dairy for Stronger Bones" marketing and education program. This program is supported by leading health and nutrition organizations such as the American Academy of Family Physicians, American Academy of Pediatrics, American Dietetic Association, and the National Medical Association.
   For more information about dietary protein and bone health, refer to the September-October 2003 issue of the Dairy Council Digest (www.nationaldairycouncil.org).

Flavored Milk, Kids and the Calcium Crisis
   MYTH: When it comes to nutrition, flavored milk doesn't make the grade for kids.

   FACT: Quite the contrary, children who drink flavored milk consume more milk and have higher calcium intakes without increasing their fat and added sugar intake according to new research published in the Journal of the American Dietetic Association. Considering that many children and most adolescents fail to meet current calcium recommendations, flavored milk such as chocolate and strawberry is a tasty, nutritious way to help ensure that today's youth get the calcium their growing bodies need.
   Researchers evaluated data from USDA's 1994-96 and 1998 Continuing Survey of Food Intakes of Individuals (CSFII) to determine the typical beverage intake of 3,888 school-aged children and adolescents (5 to 17 year olds). The results show that children who drink flavored milk consume fewer nutrient-void soft drinks and fewer fruit drinks (those containing less than 10% fruit juice) than children who don't drink flavored milk.
While many moms and other care providers may be concerned that flavored milk increases children's added sugar intake, this study shows that flavored milk boosts children's overall calcium intake, without increasing their total added sugar intake.
   Encouraging flavored milk consumption can help reverse the trend toward soft drink and fruit drink consumption, which are crowding out more nutritious beverages like milk and negatively impacting the quality of children's diets. Initial tests of milk vending machines in middle and high schools support the popularity of flavored milk, particularly chocolate milk, among students.
   For more information about flavored milk, visit www.nationaldairycouncil.org, click Health Professionals, Nutrition Library, Relevant Research, and then Flavored Milk in Perspective.

Does Drinking Milk During Childhood Lead to Better Bones Later in Life?
    The answer is yes, according to findings from a new study published in the American Journal of Clinical Nutrition. Researchers found that women who reported higher milk intake during childhood and adolescence had greater bone mass and lower risk of fractures as adults. Data were obtained from over 3,000 white women 20 years of age and older who participated in NHANES III (National Health and Nutrition Examination Survey III, 1988-1994). Information was obtained on women's hip bone density, past and current milk and dietary calcium intakes, and fracture history. 
    Bone mineral content of women ages 20 to 49 was nearly 6% lower in those with the lowest intake of milk (< 1 serving/week) than in those with the highest milk intake (> 1 serving/day) during childhood. Additionally, low milk intake during the teenage years was associated with a 3% reduction in hip bone mineral content and bone mineral density in these women. Among women aged 50 years and older, a two-fold greater risk of fractures was associated with low milk intake during childhood. The researchers suggest that this greater risk could account for 11% of osteoporotic fractures in this population. 
    The researchers point out that milk provides a variety of nutrients - calcium, vitamin D, phosphorus, protein, zinc and magnesium - that may favor bone mineralization. They also add that the findings of this study support efforts to increase milk intake during childhood and adolescence to protect bone health in later years. 
    In an accompanying editorial, the author states that "attention should be given to the potential for future effects of diminished milk intake on bone status and risk of fracture," particularly as there is "growing pressure on schools to stock vending machines with soda and other caloric beverages that lack calcium." 

Dairy Important in School Feeding Programs

  MYTH: Dairy foods should be eliminated from school feeding programs and national dietary guidelines.

   FACT: Strong scientific evidence supports the inclusion of dairy foods in school feeding programs and national dietary guidelines, state Tufts University researchers in a recent commentary published in the journal, Pediatrics. They add, “milk should be available to all who choose it and efforts to promote consumption among school-aged children should continue.”
    The researchers describe milk’s long-standing recognition as a nutrient-dense food for children, a staple in federal school feeding programs, and its consistent place in U.S. dietary guidance. They present scientific evidence disputing several myths promoted by special interest groups. These myths relate to milk consumption and type 1 diabetes, lactose intolerance, and the ability of children to achieve adequate amounts of calcium without consuming milk or milk products. 
    Regarding the argument that milk consumption in early childhood “causes” type 1 diabetes, the Tufts University researchers refer to a recent position paper issued by the Juvenile Diabetes Research Foundation. This paper concludes, “there is no compelling scientific evidence to support the claim that drinking cow’s milk increases the risk of type 1 diabetes in children or adults.”
    Regarding lactose intolerance (i.e., the inability to completely digest lactose, milk’s sugar, due to low levels of the enzyme, lactase), the researchers cite controlled scientific studies demonstrating that people who have difficulty digesting lactose can improve their tolerance by consuming at least some lactose-containing dairy foods. A large number of studies show that many lactase deficient individuals can comfortably consume 1 to 2 cups of milk when intake is evenly spaced throughout the day and milk is consumed with food. Also, hard cheeses and yogurt are well tolerated by individuals with lactose intolerance.
    The researchers discuss the difficulty in meeting calcium recommendations without including milk or milk products in the diet. They explain that milk and other dairy products provide over 70% of the calcium available in the U.S., that milk’s calcium is readily bioavailable to the body, and that children’s calcium recommendation (1,300 mg/day) can be met by 3 cups of milk (900 mg) with the rest consumed in a varied diet.  Most natural sources of calcium other than dairy foods (e.g., broccoli) tend to be unpopular with children.
    “A rational look at the risks and benefits of consuming milk and milk products suggests that the current guidelines to insure adequate calcium intake are grounded in strong science,” conclude the researchers.

African American Women and Osteoporosis
    MYTH: African American women don’t need to worry about osteoporosis.

    Although osteoporosis is less prevalent among African American women than women of other racial/ethnic groups (e.g., Asians, Hispanics, Caucasians), a substantial percentage of African American women are at risk for this disease. According to recent findings from the National Osteoporosis Risk Assessment (NORA) study, 32% of African American women had low bone mass (a predictor of fracture risk) and 4% had osteoporosis. 
    NORA is a longitudinal observational study of over 200,000 postmenopausal women aged 50 years and over with no previous diagnosis of osteoporosis. Participants’ bone mineral density was obtained using x-ray scans of the forearm, finger, or heal. Although most of the participants were Caucasians, this study is by far the largest investigation of osteoporosis among racial/ethnic minority women in the U.S. An unexpected finding was the large percentage of postmenopausal women with undiagnosed osteoporosis. Nearly 40% of all the women tested had low bone mass and an additional 7% had osteoporosis. 
    Unfortunately, few women in the U.S. consume recommended intakes of milk/dairy foods and calcium. African Americans’ low dairy food and calcium intake is blamed in part on their relatively high incidence of lactose maldigestion. However, studies indicate that African Americans and others with lactose maldigestion can comfortably consume a dairy-rich diet that meets calcium recommendations by using a few simple dietary strategies. These include drinking a glass of milk with a meal and consuming yogurt with “live, active cultures” and aged cheeses. 
    Given African Americans’ substantial risk for osteoporosis and their disproportionately high risk for other calcium deficiency-related diseases such as hypertension, stroke, and colon cancer, it is particularly important that they consume at least three servings a day of calcium-rich foods such as milk and other dairy products.