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Boosting children’s calcium intakeHow MILO and MILK can helpPresenting new data by Nutrition Research Australia from a 2011 secondary analysis of the Australian National Children’s Nutrition and Physical Activity Survey.
Information for Healthcare Professionals
2
60% of children aged 9-16 yrs are not meeting the estimated average requirement (EAR) for calcium in Australia (figure 1). Calcium was identified as a key nutrient of concern in the 2007 Children’s Nutrition and Physical Activity Survey.1
Calcium requirements are not being met 1
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40
20
02 to 3 4 to 8 9 to 13 14 to 16
% o
f chi
ldre
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Age (years)
*Estimate of nutrient intakes derived from 2 days of intake data collected by 24-hour recall at both CAPI and follow-up CATI.1
3
Calcium is essential for maintaining strong bones. Childhood and adolescent years are when bones are growing, developing and strengthening the most.2
A recent study looking at peak bone mineral density among children by Boot et al found that bone mineral density peaks between 18-23 years (figure 2).3
Calcium: Critical for early bone health
1.5
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1.0
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0.74 6 8 10 12 14 16 18 20 22 24 26 28 30 32
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/cm
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/cm
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1.5
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0.74 6 8 10 12 14 16 18 20 22 24 26 28 30 32
Age (years) Age (years)
Boys Girls1.5
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0.74 6 8 10 12 14 16 18 20 22 24 26 28 30 32
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0.74 6 8 10 12 14 16 18 20 22 24 26 28 30 32
Age (years) Age (years)
Boys Girls
Adapted from Boot et al. Bone 2010; 46: 336-341.
Milk is considered one of the world’s most ‘complete’ foods and the most significant contributor to dietary calcium.
Australian research shows that dairy foods such as milk contribute to more than half of a child’s dietary calcium, iodine and vitamin A intakes and about a quarter of their protein, riboflavin, phosphorous, potassium and zinc intakes.4
How to boost calcium intake
Table 1. Australian and international bodies recognise the positive role of flavoured milk in the diet to assist with milk consumption.5-10
Figure 1. Percentage of children meeting estimated average requirements (EAR) for calcium.1*
Figure 2. Total body bone mineral density (BMD) by age in males and females.3
Australian Dietary Guidelines (ADG)
The Australian Dietary Guidelines acknowledge that adding small amounts of sugar to nutrient dense foods (such as milk) can increase palatability and nutrient intake.5
Dairy Australia A growing body of research suggests that flavoured milk is an effective way for children to get milk and calcium in their diet.10
Dairy Nutrition Canada There is consistent evidence from several studies suggesting that the inclusion of chocolate or flavoured milk in the diets of children and adolescents has an overall beneficial impact on diet quality with no adverse effect on weight.6
Dairy Council of California Recent studies have shown the health benefits of flavoured milk and that children who consume flavoured milk are more likely to reach their daily recommended intake of calcium.7
American Heart Association When sugars are added to otherwise nutrient-rich foods, such as dairy products like flavoured milk and yogurts, the quality of children’s and adolescents’ diets improve, and in the case of flavoured milk, no adverse effects on weight status were found.8
Murphy et al (2008) US Research
Flavoured milk drinkers have a higher daily milk intake, greater intake of key nutrients including calcium, don’t consume more added sugar and are no heavier than non-milk drinkers.9
Johnson et al (2002) US Research
Flavoured milk drinkers have a higher daily milk intake, greater intake of key nutrients including calcium and the same percentage of energy intake (total fat and added sugars) as non-flavoured milk drinkers.10
Older girls (12-16 yrs) appeared to be most at risk of not meeting dietary requirements for calcium (82-89% did not meet EAR).1
There is growing evidence nationally and internationally showing that flavoured milk is an effective way for children to get extra milk and calcium in their diet.2,5-10
Methodology
In 2011, Nutrition Research Australia, an independent nutrition research company, was commissioned by Nestlé to conduct a secondary analysis of the 2007 Australian National Children’s Nutrition and Physical Activity Survey.
Dietary data were collected using a standardised, computer-based, 24-hour recall methodology over two days. A total of 4,487 children aged 2-16 years were included in the analysis.
Secondary analysis key findings
Figure 4. Energy intake and BMI by milk drinking status.*
20.0
18.0
16.0
14.0
12.0
10.0
18.7
9,000
8,000
7,000 6,000
5,000
Non-consumers of milk Plain milk drinkers MILO + milk drinkers
18.7 18.78,413
7,4417,497
–––– Energy ° BMI *Adjusted for total energy intake, age and gender.
These findings are being submitted for scientific publication. Main Findings from the 2007 Australian National Children’s Nutrition and Physical Activity Survey can be found at: http://www.health.gov.au/internet/main/publishing.nsf/Content/66596E8FC68FD1A3CA2574D50027DB86/$File/childrens-nut-phys-survey.pdf
Figure 5. Prevalence of overweight or obesity by milk drinking status.*
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0% o
verw
eigh
t or o
bese
Mea
n BM
I, kg
/m2
Mean daily energy intake, KJ/d.
All children Non-consumers Plain milk MILO + milk of milk drinkers drinkers
2327
21 21
60
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10
0% o
f chi
ldre
n m
eetin
g th
e
EAR
for C
a (a
ged
9-16
y)
All children Non-consumers Plain milk MILO + milk of milk drinkers drinkers
40
15
3854
Figure 3. Percentage of children aged 9-16 years meeting the Estimated Average Requirement (EAR) for calcium (Ca) by milk drinking status.*
Research findings
KEY FINDING 1: MILO + milk drinkers consumed significantly more total milk and calcium than both plain milk drinkers and non-consumers of milk (table 2).
KEY FINDING 2: MILO + milk drinkers were more likely to meet the EAR for calcium than plain milk drinkers and non-consumers of milk (P<0.001) (figure 3).
KEY FINDING 3: Despite having higher energy (KJ) and total sugar intake, MILO + milk drinkers were no heavier (BMI and waist circumference) than both plain milk drinkers and non-consumers of milk (figure 4). MILO + milk drinkers had similar total fat, saturated fat, protein and carbohydrate intakes as plain milk and non-milk consumers.
KEY FINDING 4: There was no significant difference in prevalence of overweight/obesity between each category of milk drinking status (P>0.05), adjusted for total energy intake, age and gender (figure 5).
Table 2. Total daily milk, calcium and sugar intake by milk drinking status.*
•Milkwasdefinedasfluidcow’smilkandexcludedevaporated,condensed,powdered,sheep’s,goat’sandsoybeverages.
•Milkdrinkingstatuswasdefinedas: – Non-consumers of milk: children who had a total milk intake of 0g/day. – Plain milk drinkers: children who reported (on any one day of recall) drinking plain milk as a beverage and who did
not consume any flavoured milk, including MILO + milk, as a beverage. – MILO + milk drinkers: children who drank MILO and milk.
*Significant difference between milk drinking status groups (p<0.001)
*No significant difference was observed between groups (p>0.05)
Different superscripts (x,y) indicate a significant difference between milk drinking status groups (p<0.01)
Milk drinking status n** Total milk intake* (g/day) Total calcium intake (mg/day) Total sugar intake (g/day)
Non-consumers of milk 511 0 ± 0x 645 ± 12x 110 ± 1.4x
Plain milk drinkers 1432 388 ± 5.3y 942 ± 7.6y 118 ± 0.9y
MILO + milk 720 417 ± 6.7z 991 ± 9.7z 125 ± 1.1z
* Average of two days of recall; adjusted for total energy intake, age and gender.** n=2663 of 4487 as these data are findings from a larger analysis of the survey.Different superscripts x,y,z, represent significant differences between milk drinking status groups (P<0.001). Data are mean ± standard error.
y
x x
4 5
For children aged 9-16 years:
•MILO+milkdrinkersweremore likely to meet EAR for calcium than non-consumers of milk and plain milk drinkers.
The results of the secondary analysis showed that MILO + milk drinkers:
3 drank more milk
3 had higher total calcium intake
3 but were not heavier
… than plain milk drinkers.
MILO + milk is a ‘nutrient-dense’ food drink. MILO + milk can fit into a healthy, well-balanced eating pattern and contribute to daily calcium needs.
Boost the calcium of milk by nearly 70% with MILO for strong bones
Nutritional information for Australian MILO
3 Calcium content varies between different milk varieties and brands, so the calcium content of ‘milk’ has been referenced as regular cow’s milk from NUTTAB 2006.11
3 The calcium in MILO is from milk solids and is also from fortification with tricalcium phosphate, a source of calcium that has been shown to be well absorbed12. The calcium recommended dietary intake (RDI) takes into consideration variation in calcium bioavailability from different food sources and daily calcium losses13 therefore, children should aim to meet their age and gender specific RDI for calcium.
3 The total sugars in a glass of MILO + milk ranges between 19.0 to 20.1g, depending on the type of milk used. Only 3.8g of this is sucrose (table sugar) from the MILO powder, which is less than one teaspoon of ‘added sugar’ in a glass of MILO + milk. 5.5g comes from the natural milk sugar lactose, maltose (from malt extract) and the very small amount of galactose present in MILO powder. The remaining 9.7 to 10.8g of sugar (>50%) in a glass of MILO + milk comes from the milk alone.
References: 1. 2007 Australian National Children’s Nutrition and Physical Activity Survey- Main Findings. The Commonwealth Department of Health and Ageing, the Department of Agriculture, Fisheries and Forestry, and the Australian Food and Grocery Council. 2. Dairy Australia www.dairyaustralia.com.au (May 2011) 3. Boot AM et al. Bone 2010; 46: 336-341. 4. Dairy Australia – Assessment of 2007 Dairy Intakes in Children, Secondary Analysis of the 2007 Australian National Children’s Nutrition and Physical Activity Survey by CSIRO, 2009. 5. Dietary Guidelines for Children and Adolescents in Australia. 2003. NHMRC. 6. www.dairynutrition.ca/scientific-evidence/chocolate-milk-and-health/chocolate-and-other-flavoured-milk-diet-quality-and-health 7. www.dairycouncilofca.org /Milk-Dairy/MilkFlavour.aspx 8. American Heart Association http://www.heart.org/HEARTORG/GettingHealthy/NutritionCenter/HealthyDietGoals/ Frequently-Asked-Questions-About-Sugar_UCM_306725_Article.jsp 9. Murphy et al. Drinking Flavoured or Plain Milk Improves Nutrient Intakes Without Adversely Affecting Body Weight. Journal American Dietetic Association 2008; 108: 631-639. 10. Johnson RK et al. The nutritional consequences of flavoured milk consumption by school aged children and adolescents in the United States. Journal American Dietetic Association 2002; 102(6): 853-856. 11. NUTTAB 2006 Common Liquids Reported per 100 ml. 12. L. Lopez-Huertas et al. Absorption of calcium from milks enriched with fructo-oligosaccharides, caseinophosphopeptides, tricalcium phosphate, and milk solids. American Journal of Clinical Nutrition 2006; 83: 310-316. 13. Nutrient Reference Values for Australia and New Zealand. Department of Health and Ageing. Canberra: Commonwealth of Australia, 2006. EMVMIL0008
6 7
Table 3. MILO – Current Nutritional Information as per Label.
PER 20gSERVING
SERVING SIZE: 20g PER 100gNUTRITION INFORMATION#
ENERGY PROTEINFAT, TOTAL -SATURATEDCARBOHYDRATE -SUGARSDIETARY FIBRESODIUMIRON
CALCIUM
MAGNESIUM
VITAMIN A
VITAMIN B1
VITAMIN B2
VITAMIN C
# All values specified are averages. RDI-Recommended Dietary Intake.*PERCENTAGE DAILY INTAKES ARE BASED ON AN AVERAGE ADULT DIETOF 8700kJ. YOUR DAILY INTAKES MAY BE HIGHER OR LOWER DEPENDING ON YOUR ENERGY NEEDS.
PER 20gWITH 200mL REDUCEDFAT (1.4%) MILK
3502.42.01.312.99.31.5186.0
160
36
110
0.5
0.3
19
kJgggggg
mgmg
%RDImg
%RDImg
%RDImcg
%RDImg
%RDImg
%RDImg
%RDI
173011.910.06.564.546.47.59032
820
180
530
2.5
1.5
95
77010.44.83.323.720.11.51306.05040050621914018
0.5550
0.66392050
(% DI*)
(9 %)(21 %)(7 %)(14 %)(8 %)(22 %)(5 %)(6 %)
PER 20gWITH 200mLSKIM (0.1%) MILK6509.82.21.423.119.51.51206.05040050601811014
0.5550
0.66392050
(% DI*)
(7 %)(20 %)(3 %)(6 %)(7 %)(22 %)(5 %)(5 %)
MILO + milk may help promote greater milk consumption and
increase calcium intake. Adding 20g of MILO to 200ml of milk boosts the
calcium by nearly 70%.
Did you know?
+ =200ml Plain Milk
240mg Calcium20g serve MILO
160mg CalciumMILO + Milk
400mg Calcium
3 A standard serve of MILO, 20g powder (approx. 3 heaped teaspoons) contains 160mg of calcium. Adding 20g of MILO to 200ml of milk increases the calcium by 67%, from 240mg to 400mg (table 3).
Nearly 70%more
Calcium
®
Nutrition Research Australia (NRA)NRA is an independent nutrition research company, with a focus on conducting research with scientific excellence, quality results and integrity. The company was created to facilitate the delivery of contract research services, from clinical trials, data analysis, scientific journal articles and consultation. Its goal is to engage the community, government, public health and industry in advancing nutrition and dietetic research in Australia.
Dr Flavia Fayet, (BSc. Honours, MNutrDiet, RNutr, APD, PhD), director of NRA, is a nutrition scientist and Accredited Practicing Dietitian. For more information about NRA: contact Dr Fayet: [email protected] or visit www.nraus.com
Nestlé Corporate NutritionNestlé has been providing good food for good living for over 100 years. We believe in making a long term commitment to the health and happiness of all Australians. We recognise the changing role that food and beverages are playing in people’s lives so much that we employ over 30 Dietitians who work on different products across all life stages and help improve the nutrition of our products.
For more information on milk and dietary calcium visit:
Milo www.milo.com.auNestlé Australia www.nestle.com.auNutrition Research Australia www.nraus.comDairy Australia www.dairyaustralia.com.auDairy Canada www.dairynutrition.caDairy Council of California www.dairycouncilofca.orgDept of Health & Ageing www.health.gov.auDietitians Association of Australia www.daa.asn.auFood Standards Australia & New Zealand www.foodstandards.gov.au