Whole-Fat or Reduced-Fat Dairy Product Intake, Adiposity, and Cardiometabolic Health in Children: A Systematic Review

Abstract

Dietary guidelines commonly recommend that children aged >2 y consume reduced-fat dairy products rather than regular- or whole-fat dairy. In adults, most studies have not found the consumption of whole-fat dairy products to be associated with increased cardiometabolic or adiposity risk. Associations in children could differ due to growth and development. We systematically reviewed the literature in indexed, peer-reviewed journals to summarize pediatric studies (children aged from 2 to 18 y) assessing associations between whole- and reduced-fat dairy intake and measures of adiposity as well as biomarkers of cardiometabolic disease risk, including the serum lipid profile, blood pressure, low-grade chronic inflammation, oxidative stress, and measures of glucose homeostasis. For the purposes of this review, a “whole-fat” dairy product was defined as a product with the natural fat content, whereas a “reduced-fat” dairy product was defined as a product with some or all of the fat removed (including “low-fat” and “skim” versions). A total of 29 journal articles met our criteria for inclusion. The majority were conducted in the United States and were prospective or cross-sectional observational studies, with only 1 randomized controlled trial. Studies were consistent in reporting that whole-fat dairy products were not associated with increased measures of weight gain or adiposity. Most evidence indicated that consumption of whole-fat dairy was not associated with increased cardiometabolic risk, although a change from whole-fat to reduced-fat dairy improved outcomes for some risk factors in 1 study. Taken as a whole, the limited literature in this field is not consistent with dietary guidelines recommending that children consume preferably reduced-fat dairy products. High-quality randomized controlled trials in children that directly compare the effects of whole-fat compared with reduced-fat dairy intake on measures of adiposity or biomarkers of cardiometabolic disease risk are needed to provide better quality evidence in this area.

Age and time trends of dairy intake among children and adolescents of the DONALD study

“…We observed further time trends in LFD and HSD w%TD. There was an initially strong increase of LFD w%TD, similar to the aforementioned former evaluation of DONALD study data [14] 3) of food-based dietary guidelines in Europe recommended consumption of two to three servings of low-fat dairy products per day [37], these recommendations have been relativized in terms of fat content in some countries, such as Germany and Austria, as recent studies provide hints of potential health benefits from consumption of full-fat dairy products [38][39][40][41][42]. Currently, the effect of fat content in consumed dairy products on body weight in children is being studied in the Cow's Milk Fat Obesity pRevention Trial (CoMFORT) [43].…”

Global Review of Dairy Recommendations in Food-Based Dietary Guidelines

“…Notably, two recent systematic reviews focused on inflammation (which has been hypothesized to be the underlying cause of several chronic disease states), found neutral to beneficial effects of higher total dairy intake on inflammatory markers (32,33). Similarly, a growing number of systematic reviews have also consistently found neutral to beneficial effects of dairy intake on body composition and overall cardiometabolic health -with the most beneficial effects on biomarkers such as adiposity, serum lipids, blood pressure, and insulin resistance, being attributed to fermented, fortified, and/or low-fat dairy foods (34)(35)(36)(37)(38)(39).…”

Whole-fat dairy products do not adversely affect adiposity or cardiometabolic risk factors in children in the Milky Way Study: a double-blind randomized controlled pilot study

“…Our RCT shows in addition no significant differences in body fat percentage or FMI, all in direct opposition to the so-called “adiposity hypothesis.” Our data are further supported by the observational evidence. A systematic review and meta-analysis of observational studies reported lower odds of child overweight or obesity (OR: 0.61; 95% CI: 0.52, 0.72; P < 0.0001) with regular intake of whole-fat milk ( 41 ); a systematic review of observational and intervention studies found no associations between whole-fat dairy products and increased child body weight or adiposity ( 42 ), while a comprehensive analysis of the evidence-base in children found little evidence for the influence of dairy fat content on body fatness ( 43 ).…”

“…Fasting serum glucose and lipids in both Milky Way Study groups were not differentially affected by the dairy intervention: not even a trend was apparent. Likewise, in an Australian child cluster education intervention ( 65 ), reducing dairy fat did not significantly affect adjusted serum lipids after 12 wk, while in Mexican boarding schools ( 78 ), changing to reduced-fat or skim milk for 4 mo did not significantly affect serum triglycerides or total:HDL cholesterol ratios, because both total- and HDL-cholesterol concentrations reduced ( 42 ). In contrast, a significant relative change in LDL (−0.28 mmol/L) in the skim milk group ( 78 ) may have been influenced by intervention-related dietary changes, as explored below.…”