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

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Chapter 7
Milk and dairy programmes
affecting nutrition
Lora L. Iannotti
Washington University in St. Louis, Brown School of Social Work, Institute for
Public Health, St Louis, MO, USA
Abstract
A systematic review was undertaken to examine the evidence for the effects of milk
and dairy programmes on nutrition. Twenty-nine evaluations and studies were
identified and rated based on quality of design and level of inference, in ascending
order: observational/formative (5); adequacy (10); plausibility (8); and probability
(6). The chapter describes the typical model, evidence for impact, and lessons
learned for four programme types: dairy production and agriculture programmes;
school-based milk programmes; fortified milk programmes; and milk powder and
blended foods. Dairy production programmes were found to be more effective than
traditional agriculture production interventions if strategies included: targeting
inputs to women; the introduction of small livestock; and communication about the
nutritional value of milk. School-based programmes improved body composition
and micronutrient status, but issues of appropriate levels of fat, added sugar and
flavouring in milk need to be addressed. Evidence for positive nutrition outcomes
was strongest from fortified milk programming, though issues of limited market
access, cost, and questionable effects on zinc nutrition remain. Finally, milk has been
added to blended foods for decades but the effect of the milk ingredient is largely
unknown. To conclude, dairy programming faces many challenges including the
need for higher-quality evaluations that assess cost-effectiveness and consideration
of the dual burden of under- and overnutrition. The findings demonstrate that milk
and dairy programmes can simultaneously improve nutrition and reduce poverty,
aided by the generally positive public perception of milk. With planning and investment,
milk may contribute to improving the health and well-being of many globally.
7.1 Introduction
Micronutrients are vitamins and minerals required by the body in small quantities
to sustain health and well-being. Deficiencies in some micronutrients, including
vitamin A, iodine, iron and zinc, contribute significantly to global burden of disease
(Black et al., 2008). Vitamin A deficiency affects 190 million preschool-aged children
and 19.1 million pregnant women (WHO, 2012), elevating the risk for night
blindness, infection and mortality (West, 2002). One-third of world’s population is
thought to be deficient in zinc, now known to increase diarrhoeal morbidity and
mortality (Hess et al., 2009). Iodine deficiency, the leading cause of mental retarda-