Chocolate and Other Flavoured Milk, Diet Quality and Health
Consistent evidence indicates that chocolate milk helps to improve diet quality for children and adolescents without any increase in added sugars and in caloric intakes, or any adverse effect on weight.
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. These findings are substantiated by the recent scientific statement from the American Heart Association on dietary sugars intake and cardiovascular health. Furthermore, a growing body of evidence suggests that chocolate milk may be an ideal post-exercise recovery beverage for physically active adults and athletes.
The conclusions from the 2009 scientific statement from the American Heart Association regarding dietary sugars and cardiovascular health included the following:1
- When “sugars are added to otherwise nutrient-rich foods, such as sugar-sweetened dairy products like flavoured milk and yogurts and sugar-sweetened cereal, the quality of children’s and adolescents’ diets improves, and in the case of flavoured milks, no adverse effects on weight status were found”;
- Increases in the intake of soft drinks, fruit drinks, desserts, sugars, jellies, candy and ready-to-eat cereals largely account for the increased energy intake from sugars and added sugars;
- The form in which added sugars are consumed appears to be an important modifier of the impact on diet quality. Soft drinks, sugar and sweets are more likely to have a negative impact on diet quality, whereas dairy foods, milk drinks, and pre-sweetened cereals may have a positive impact.
Data from the 1999-2002 National Health and Nutrition Examination Surveys were used to compare nutrient intakes and body measures among 7,557 children and adolescents (aged 2 to 18 years) who drink:2
- flavoured milk (with or without plain milk),
- exclusively plain milk,
- no milk.
The results showed the following:
- Children and adolescents who included flavoured milk in their diets reported significantly higher total milk intakes than consumers of exclusively plain milk (p < 0.05);
- Intakes of vitamin A, calcium, phosphorus, magnesium, potassium, and saturated fat (adjusted for energy intake and age) were generally comparable among milk drinking groups, whereas intakes by milk non-drinkers were significantly lower (p < 0.05);
- Intake of added sugars did not differ between flavoured milk drinkers and milk non-drinkers;
- The body mass index measures of milk drinkers (plain and flavoured milk) were comparable to or lower than measures of non-drinkers (p < 0.05).
A randomized controlled trial of 98 overweight and obese Chilean children (aged 8 to 10 years) examined the impact on body composition of delivering flavoured milk beverages to the homes of overweight and obese children to displace sugar-sweetened beverages:3
- For those who received the milk (intervention group), milk consumption increased by a mean (± SEM) of 452.5 ± 37.7 g/d (p < 0.0001) and consumption of sugar-sweetened beverages decreased by 711.0 ± 33.7 g/d (p < 0.0001);
- For those who did not receive the milk (control group), milk consumption did not change, and consumption of sugar-sweetened beverages increased by 71.9 ± 33.6 g/d (p = 0.04);
- Changes in percentage body fat did not differ between groups;
- The mean (± SEM) accretion of lean body mass was greater (p = 0.04) in the intervention (0.92 ±0.10 kg) than in the control group (0.62 ± 0.11 kg);
- The increase in height was also greater (p = 0.01) in the intervention group (2.50 ± 0.21 cm) than in the control group (1.77 ± 0.20 cm) for boys but not for girls.
The 1994-96 and 1998 U.S. Department of Agriculture Continuing Survey of Food Intakes by Individuals (CSFII) were used to examine the diets of 3,038 U.S. children aged 6 to 17 years in order to determine associations between intakes of the primary food and beverage sources of added sugars and intakes of key nutrients and food groups:4
- The consumption of sweetened dairy products (i.e., flavoured milks, flavoured yogurts, ice creams, and puddings) was positively associated with calcium intakes for children and adolescents (p < 0.05);
- The consumption of pre-sweetened cereals increased the children’s and adolescents’ likelihood of meeting recommendations for the essential shortfall nutrients, which are calcium, folate, and iron;
- The consumption of sugar-sweetened beverages (i.e., non-diet soft drinks, non-diet fruit drinks/ades) sugars and sweets, and sweetened grain products decreased their likelihood of meeting the Dietary References Intakes (DRIs) for these nutrients;
- The consumption of sweetened dairy products and pre-sweetened cereals was positively associated with the number of dairy servings consumed per day for both age groups.
In another study using data from the 1994-96 and 1998 U.S. Department of Agriculture Continuing Survey of Food Intakes by Individuals (CSFII), total intake of milk, soft drinks, fruit drinks and fruit juice and their impact on diet quality was assessed in 3,888 school-aged children (5 to 11 years) and 1,125 adolescents (12 to 17 years):5
- Children who consumed flavoured milk had higher total milk intakes and lower soft drink and fruit drink intake but similar fruit juice intake compared with children who were non-consumers of flavoured milk;
- Children who consumed flavoured milk had higher calcium intakes but similar percent energy for total fat and added sugars compared with children who were non-consumers of flavoured milk.
The impact of removing flavoured milk from a U.S. school district was the subject of a study published as an abstract in 2009:6
- Total school milk purchases in the district were compared for a 3-month period before and after the elimination of flavoured milk;
- There was a reduction in milk purchases at all grade levels after the elimination of flavoured milk despite a 0.5% increase in enrolment;
- Total milk purchases in grades K-2 decreased by 63%; grades 3-5 by 62%; grades 6-8 by 50%; and grades 9-12 by 37%;
- The authors concluded that “the nutritional trade-off for the elimination of approximately 60 calories from added sugar is a reduction in foods that deliver important nutrients for children and adolescents such as calcium, potassium, and vitamin D, all nutrients encouraged by the 2005 US Dietary Guidelines.”
In an effort to combat childhood obesity, the Centers for Disease Control and Prevention published a report in 2009 describing the experience of New York City public schools with inclusion of sweetened chocolate milk. Recognizing that school milk provides an important source of protein, calcium, and vitamins such as A and D, New York City public schools phased out whole milk but retained low-fat and fat-free white milk and fat-free sweetened chocolate milk:7
- Sweetened chocolate milk sales remained stable, and this type of milk was the most popular, accounting for 61% of purchases in 2004 and 57% of purchases in 2009;
- Both white milk and chocolate milk drinkers who switched from whole to lower-fat or fat-free varieties of milk saved on total calories and fat during one year (7,089 calories and 922 g fat and 4,900 calories and 48 g fat for white and chocolate milk drinkers respectively).
Data from epidemiological studies and from a randomized controlled trial provide consistent evidence that the inclusion of chocolate and other flavoured milk in the diets of children and adolescents has benefits with respect to ensuring overall diet quality and does not appear to have a negative impact on body weight or intake of added calories and sugars.
Furthermore, given the fact that a large proportion of Canadians, including children and adolescents, are not meeting the minimum recommended intakes of milk products, flavoured milks, including chocolate milk, represent another option to help them meet recommend intakes of Milk and Alternatives.
Removing chocolate milk from schools may have a negative impact on the consumption of milk products and thus may exacerbate the current problem of inadequate milk product consumption by Canadian children and adolescents.
Canadian data and more randomized controlled trials, especially in the North American context, are needed.
- Johnson RK et al. Dietary sugars intake and cardiovascular health. A scientific statement from the American Heart Association. Circulation 2009;120(11):1011-20.
- Murphy MM et al. Drinking flavoured or plain milk is positively associated with nutrient intake and is not associated with adverse effects on weight status in US children and adolescents. J Am Diet Assoc 2008;108(4):631-9.
- Albala C et al. Effects of replacing the habitual consumption of sugar-sweetened beverages with milk in Chilean children. Am J Clin Nutr 2008;88(3):605-11.
- Frary CD et al. Children and adolescents’ choices of foods and beverages high in added sugars are associated with intakes of key nutrient and food groups. J Adolesc Health 2004;34(1):56-63.
- Johnson RK et al. The nutritional consequences of flavoured-milk consumption by school-aged children and adolescents in the United States.[J Am Diet Assoc 2002;102(6):853-6.
- Patterson J and Saidel M. The removal of flavored milk in schools results in a reduction in total milk purchases in all grades, K-12.J Am Diet Assoc 2009;109(9):A97.
- Center for Disease Control and Prevention. Effects of switching from whole to low-fat/fat-free milk in public schools – New York City 2004-2009. Morbidity and Mortality Weekly Report 2010; 59(3):70-73 .