Milk-and-Dairy-Products-in-Human-Nutrition-FAO

162
Milk and dairy products in human nutrition
allergies. Casein content of cow milk is approximately double that of human milk.
In addition, the predominant type of casein differs between cow milk and human
milk: human milk has a higher content of β-casein, which is more sensitive to peptic
hydrolysis than α S -casein, particularly α S1 -casein, which predominates in cow milk.
Milk allergens are known to preserve their biologic activity even after boiling,
pasteurization, ultra-high-temperature processing and evaporation for the production
of powdered infant formula (Fiocchi et al., 2010). Prevention of CMA largely
relies on avoidance of all food products containing cow-milk proteins. Milk from
some other species may also need to be avoided: milk allergens of various mammalian
species cross-react, with high sequence homology among cow-, sheep- and
goat-milk proteins (Fiocchi et al., 2010). The recent guidelines issued by the World
Allergy Organization state that goat, sheep, and buffalo milk should not be used as
a substitute for children with cow-milk allergy as they can expose patients to severe
reactions (Fiocchi et al., 2010). Camel milk can be considered a valid substitute
for children more than two years old. Mare and donkey milks can be considered
as valid cow-milk substitutes, in particular (but not exclusively) for children with
delayed-onset CMA.
4.11 Current national recommendations
for milk and dairy consumption
Milk and dairy product recommendations for 42 countries are shown in Table 4.7.
As national food-based dietary guidelines are designed to reflect factors such as local
food availability, cost, nutritional status, consumption patterns and food habits,
recommendations vary widely. Twenty-six countries recommend the consumption
of low-fat or non-fat milk. Specified fat content varies from 0.1–1.5 percent fat in the
Bulgarian guidelines to 1.5–2.5 percent in New Zealand, with most stringent specifications
in Denmark (maximum 0.7 percent fat). Some countries, such as Argentina,
Australia, New Zealand, Philippines and the United Kingdom exclude children from
low-fat recommendations, although the age up to which high-fat dairy is recommended
for children varies: 2 years in Australia and the United Kingdom, 5 years in
New Zealand and 12 years in Philippines. According to WHO (2004), semi-skimmed
milk may be acceptable for feeding non-breastfed children more than 12 months old.
However, skimmed milk is not recommended as a major food source during the first
two years of life because it does not contain essential fatty acids, lacks fat-soluble
vitamins and has a high potential renal solute load in relation to energy. A few countries
(Bulgaria, France, Norway and Turkey) mention choosing salt-reduced dairy
products when possible, while avoiding sugar-added products is mentioned in the
guidelines from Cuba, Ireland, Malaysia, Norway and the United States.
Some countries, including Chile, France, Norway, Oman and the United Kingdom,
either specifically mention that cow milk should not be given to infants below
one year of age or that recommendations apply to children of more than one year
of age, while other countries recommend exclusive breastfeeding up to six months
of age (Cuba, Dominican Republic, El Salvador, France, India and Nepal). Some
give specific recommendations for various vulnerable groups such as pregnant and
breastfeeding women or the elderly.
Most countries recommend at least one serving of milk daily, with some countries
recommending up to three servings per day. Notable exceptions include El Salvador