Milk and Dairy Foods’ Important Role in School Meal Programs

Key messaging & research summaries that highlight why dairy foods are critical to supporting the health of children & communities

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Milk and Dairy Foods Support Children’s Optimal Growth and Development 

• Evidence continues to show that dairy foods like milk, yogurt and cheese offer a unique and essential package of nutrients that work together to provide multiple health benefits, including optimal growth and development in children and reduced risk of developing chronic diseases such as type 2 diabetes and heart disease.^1,2 The wide variety of milk and dairy foods available provides many options to meet personal needs, tastes and preferences.
  
• Children who do not meet the daily recommended servings of dairy milk, yogurt and cheese may have inadequate intakes of important nutrients and protein necessary for optimal growth and development.³ 
  
• Milk is an important source of unique and essential nutrients that contribute to overall health in children’s eating patterns, but by age 6, most children are not meeting the recommended daily servings from the Dairy food group.⁴ Poor eating patterns, especially in early childhood, can continue as habits in adulthood, increasing the risk for becoming overweight and developing chronic conditions such as heart disease.
• Milk, cheese and yogurt provide many unique and essential nutrients needed for good health. Consuming the recommended amount of dairy foods can help close the gap on some nutrient intakes, including nutrients of concern such as calcium, vitamin D, magnesium and vitamin A.⁵  
• Leading health experts agree water and plain milk are the only recommended beverages for children 1 to 5 years of age. Plant-based alternatives are not recommended as a suitable replacement for dairy milk due to their wide variability in nutrient content, limited evidence of bioavailability and impact on diet quality and health outcomes.⁶

Milk and Dairy Foods Improve Diet Quality

• Dietary recommendations and guidelines for the public that restrict single nutrients or food components without focusing on diet quality, could unintentionally limit access to and consumption of nutritious foods like milk and dairy foods, which nourish children and communities. 
  
• The food matrix concept embraces the importance of considering whole foods, alongside the individual components they contain. This is particularly important in relation to public health policy. Dietary guidance should be based on an evaluation of the health effects of whole foods, including dairy, not just single nutrients such as sugar and sodium.
  
• In addition to providing unique and essential nutrients needed throughout life, dairy foods contain other unique non-vitamin and non-mineral components, known as bioactive compounds, embedded within its food matrix, which have health promoting effects. Restricting sources of high-quality foods like milk, cheese and yogurt is likely to have an unintended, negative impact on children’s health, which can have life-long consequences.
  
• With the exception of fortified soy beverages, drinks made with almonds and other nuts, rice or coconuts often contain little to no protein and lack other key nutrients important to support optimal growth. Dairy milk has the most balanced distribution of energy from carbohydrates, protein and fat, coupled with a unique nutrient package that can be difficult to replace in a healthy dietary pattern.
  
• Sodium is a mineral that can be naturally occurring or added to foods. Reducing sodium from non-nutrient dense foods is recommended. However, sodium can also be found in wholesome, nutritious foods such as milk, cheese and yogurt which are currently under-consumed in children’s diets. Although dairy foods are a source of sodium in the U.S. diet, they are also nutrient-dense foods that contribute protein, calcium, phosphorus and vitamin A, supporting optimal health.
• Research shows that the Healthy Hunger Free Kids Act nutrition standards improved school meal contribution to diet quality over time by increasing dairy, fruit and whole grain intake. Additionally, ithelped shrink the gap in diet quality between kids from different income levels and racial/ethnic groups. In the study, dairy was the biggest contributor to improved diet quality.²³ 

Milk and Dairy Foods Support Nutrition Security 

• Diet quality during childhood affects children’s ability to succeed in school and life, and it impacts future health outcomes such as the likelihood of developing a chronic disease. Yet many children in California lack access to nutrition education, nutritious foods and support for optimal nutrition, which puts them at a disadvantage. Milk is a required and vital part of school meals because it is nutrient dense, affordable, easy to consume and highly palatable, helping children meet their daily nutrient needs.
  
• School meal programs play an important role as a community solution for nutrition adequacy, and this supports not only a child’s health but their ability to learn as well. Research suggests that eating nutrient-dense foods that are made readily available in school meal programs—like fruits, vegetables and dairy products—is associated with improved academic and health outcomes among children and adolescents.⁹ 
• Nutrition security is defined as “a situation that exists when people, at all times, have physical, social, and economic access to sufficient, safe, and nutritious food that meets their dietary needs and food preferences for an active and healthy life.” School nutrition programs are a source of nutrition security for children in their community, supporting health equity as children are able to consume more nutrient-dense foods at school, regardless of race, ethnicity or household income.
  • Dairy is an important component of school meals, providing key nutrients that contribute to nutrition security, especially for children and families living in under-served communities. Milk, cheese and yogurt provide essential nutrients—calcium, vitamin D and potassium—that support optimal growth, bone health and overall health but are currently under-consumed by most children.
    
• Experts agree that school feeding programs have a positive effect on child and adolescent nutrition and health outcomes. Programs such as the National School Lunch Program and School Breakfast Program have been shown to increase diet quality among those who participate.^10,11
  • Research on the diet quality of school meals showed that children participating in the school meal program had higher intakes of vegetables, whole grains and dairy compared to students who did not participate.¹¹   
    
  • Students who ate school lunch daily had higher intakes of dairy and calcium compared with students who did not eat school lunch daily.¹⁰ 
    
• Research suggests that eating school breakfast every day is associated with healthier dietary intakes among U.S. schoolchildren, particularly increased intakes of fruits and vegetables, whole grains and dairy.¹²  
• In addition to improving overall nutrient intake, consumption of dairy foods, fruit and vegetables made readily available in school meal programs is linked with improved academic success and health among children and adolescents.⁹
  
• New research shows that U.S. schoolchildren are eating their healthiest meals at school. The study looked at patterns and trends in diet quality by food source and found that diet quality for foods served at schools improved significantly over the last decade.¹³ 
  
• School meal programs play a vital role in sustainable nutrition, ensuring wholesome, nutrient-dense foods are accessible, affordable and culturally relevant while also preserving environmental resources. Milk, cheese and yogurt which are readily available through school meal programs are healthy and appealing to students, which means more nutritious foods in children’s stomachs instead of filling up trash cans, supporting the health of children and the planet.

Flavored Milk in School Meals

• Milk is a required and vital part of school meals because it is nutrient-dense, affordable, easy to consume and highly palatable, helping children meet their daily nutrient needs; however, many students are not consuming the recommended number of daily servings of dairy.
  
• Continuing to offer choices and reducing barriers to access while also considering diet quality helps encourage consumption of milk and dairy foods in child nutrition programs.
  
• The wide variety of milk and dairy foods available provides many options to meet personal needs, tastes and preferences.
  
• Flavored and unflavored milk offer the same unique and essential package of nutrients that work together to provide multiple health benefits, including optimal growth and development in children and reduced risk of developing chronic diseases such as type 2 diabetes and heart disease.^14,15
  
• Flavored milk contributes only 4% of added sugars in the diets of children 2-18¹⁶ years  and is not associated with increased BMI.¹⁷
  
• Evidence from longitudinal and experimental studies in school, childcare, and home settings demonstrate that offering flavored milk can increase overall milk consumption among children and adolescents.¹⁸
  
• Research shows that drinking flavored milk is associated with improved diet quality; a 2021 study found that children (2-18 years) who drank flavored milk had significantly higher consumption of fiber, calcium, potassium, magnesium, phosphorus and vitamins D, A, B12 and riboflavin compared to non-flavored milk drinkers.¹⁹
  
• The American Academy of Pediatrics (AAP) Policy Statement on snacks, sweetened beverages, added sugars and schools supports the addition of small amounts of sugars to nutrient-dense foods like milk to increase consumption by children. The AAP uses flavored milk as an example of the balance needed to limit added sugars while still promoting nutrient-rich foods.²⁰
  
• The food matrix concept embraces the importance of considering whole foods, alongside the individual components they contain. This is particularly important in relation to public health policy. Dietary guidance should be based on an evaluation of the health effects of whole foods, including dairy, not just single nutrients such as sugar, sodium and fat.
  
• Research has shown that the removal of flavored milk from school meals significantly decreases consumption of total milk²¹, which could negatively impact children’s nutrient intake. Studies also show that flavored milk served in the school meal programs is wasted less than unflavored milk.²²  

REFERENCES

1. Dror DK, Allen LH. Dairy product intake in children and adolescents in developed countries: trends, nutritional contribution, and a review of association with health outcomes. Nutr Rev. 2014;72(2):68-81. doi: 10.1111/nure.12078.

2. Dehghan M, Mente A, Rangarajan S et al. Association of dairy intake with cardiovascular disease and mortality in 21 countries from five continents (PURE): a prospective cohort study. Lancet. 2018;392(10161):2288-2297. doi: 10.1016/S0140-6736(18)31812-9. 

3. Hess JM, Cifelli CJ, Fulgoni Iii VL. Energy and nutrient intake of americans according to meeting current dairy recommendations. Nutrients. 2020 Sep 30;12(10):3006. doi: 10.3390/nu12103006. 

4. Krebs-Smith SM, Guenther PM, Subar AF et al. Americans do not meet federal dietary recommendations. J Nutr. 2010;140(10):1832-8. doi: 10.3945/jn.110.124826.

5. Quann EE, Fulgoni VL, Auestad N. Consuming the daily recommended amounts of dairy products would reduce the prevalence of inadequate micronutrient intakes in the United States: diet modeling study based on NHANES 2007–2010. Nutr J. 2015;14(90). doi: 10.1186/s12937-015-0057-5.

6. Lott M, Callahan E, Welker Duffy E, Story M, Daniels S. Consensus statement: healthy beverage consumption in early childhood: recommendations from key national health and nutrition organizations. Healthy Eating Research website. https://healthyeatingresearch.org/research/consensus-statement-healthy-beverage-consumption-in-early-childhood-recommendations-from-key-national-health-and-nutrition-organizations/ . Published September 2019. Accessed March 5, 2021.

7. Patel AI et al. The association of flavored milk consumption with milk and energy intak, and obesity: a systematic review. Preventative Medicine, 2018; 111:151-162. doi: 10.1016/j.ypmed.2018.02.031

8. Committee on Nutrition. Snacks, sweetened beverages, added sugars, and schools. Pediatrics. 2015;135(3):575-583. doi:10.1542/peds.2014-3902

9. Bradley BJ, Greene AC. Do health and education agencies in the United States share responsibility for academic achievement and health? A review of 25 years of evidence about the relationship of adolescents’ academic achievement and health behaviors. J Adolesc Health. 2013;52(5):523-532. doi:10.1016/j.jadohealth.2013.01.008   

10. Au LE, Gurzo K, Gosliner W, Webb KL, Crawford BC, Ritchie LD. Eating school meals daily is associated with healthier dietary intakes: The Healthy Communities Study. J Acad Nutr Diet. 2018;118(8):1474-1481.doi: 10.1016/j.jand.2018.01.010

11. Fox MK, Gearan E. School Nutrition and Meal Cost Study. USDA website. https://www.fns.usda.gov/school-nutrition-and-meal-cost-study . Published April 23, 2019. Accessed March 5, 2021.

12. Ramsay SA, Bloch TD, Marriage B et al. Skipping breakfast is associated with lower diet quality in young US children. Eur J Clin Nutr. 2018;72:548-56. DOI: 10.1038/s41430-018-0084-3

13. Junxiu L, Micha R, Li Y. Trends in food sources and diet quality among US children and adults, 2003-2018. JAMA. 2021;4(4):e215262. doi:10.1001/jamanetworkopen.2021.5262.

14. Dror DK, Allen LH. Dairy product intake in children and adolescents in developed countries: trends, nutritional contribution, and a review of association with health outcomes. Nutr Rev. 2014;72(2):68-81. doi: 10.1111/nure.12078.

15. Dehghan M, Mente A, Rangarajan S et al. Association of dairy intake with cardiovascular disease and mortality in 21 countries from five continents (PURE): a prospective cohort study. Lancet. 2018;392(10161):2288-2297. doi: 10.1016/S0140-6736(18)31812-9.  

16. National Dairy Council. NHANES 2015-2018. Data Source: Centers for Disease control andPrevention, National Center for Health Statistics, National Health and Nutrition Examination Survey Data. Hyattsville, MD.

17. Cifelli CJ, Houchins JA, Demmer E, Fulgoni V. The relationship between flavored milk consumption, diet quality, body weight, and BMI z-Score among children and adolescents of different ethnicities.  The FASEB Journal;2016;30. doi: 10.1096/fasebj.30.1_supplement.1154.12. 

18. Patel AI et al. The association of flavored milk consumption with milk and energy intak, and obesity: a systematic review. Preventative Medicine, 2018; 111:151-162. doi: 10.1016/j.ypmed.2018.02.031.

19. Nicklas TA, Saab R, Fulgoni III VL. Is flavored milk really a bad beverage choice? The nutritional benefits of flavored milk outweigh the added sugars content. Acta Scientific Nutritional Health Acta  Scientific Publications; 2022;6:114–32.

20. Committee on Nutrition. Snacks, sweetened beverages, added sugars, and schools. Pediatrics. 2015;135(3):575-583. doi:10.1542/peds.2014-3902.

21. Cohen JFW, Richardson S, Rimm EB. Impact of the Updated USDA School Meal Standards, Chef-Enhanced Meals, and the Removal of Flavored Milk on School Meal Selection and Consumption. J Acad Nutr Diet. 2019 Sep;119(9):1511-1515. doi: 10.1016/j.jand.2019.04.003.

22. U.S. Department of Agriculture, Food and Nutrition Service, Office of Policy Support. School Nutrition and Meal Cost Study, Final Report Volume 4: Student Participation, Satisfaction, Plate Waste, and Dietary Intakes. Alexandria, VA: April 2019.

23. Smith TA, Lin BH, Guthrie J. School meal nutrition standards reduce disparities across income and race/ethnicity. Am J Prev Med. 2024. DOI:10.1016/j.amepre.2024.03.012

Why Is Milk an Important Part of School Meal Programs?

Megan Holdaway, RDN, discusses the important role of milk in school meal programs.

Watch here