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

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Chapter 7 – Milk and dairy programmes affecting nutrition 277 7.2 Sources and approach to the review A comprehensive review of the peer-reviewed and grey literature was conducted to identify milk programmes affecting the nutrition of populations in developing countries. “Milk programme” was defined as an intervention introduced into a defined population over a certain period of time that involved milk and affected nutrition in some manner. Databases searched included: Proquest; PubMed Central; Science Direct; and Scopus. Coverage was global, although most records were in English. In addition, web pages from several international agencies and nongovernmental organizations were searched for grey literature, monographs and evaluations. Both simple and multifield/advanced searches were used. The following criteria were used to decide whether to include a programme in the study: 1) milk or dairy products were part of the intervention; 2) nutrition, and in some cases health and anthropometry of participants, was affected through the diet; 3) the study was intended to inform programming (observational/formative) or included an evaluation that allowed the possibility of inferring adequacy, plausibility or probability (see following paragraph); and 4) the programme context was a developing country. Programmes were classified into four levels of inference, to indicate quality of design and methods. These were, in ascending order of rigour: 1) observational/ formative; 2) adequacy; 3) plausibility; and 4) probability (Habicht, Victora and Vaughan, 1999). Observational/formative includes those results and findings that are intended to inform programming strategies or are later used to do so. No conclusions may be drawn on intervention impact. Adequacy includes studies or evaluations assessing only whether expected changes occurred. There is usually no control group, but at least two surveys or measures over time and space are carried out to assess change. The next level of inference is plausibility, in which factors operating to influence outcome beyond the programme intervention may be considered. Some form of control group (historical, internal or external) is generally used in these quasi-experimentally designed evaluations. The highest level of inference possible is probability, where the evaluation design is likely to be able to demonstrate causality. Programme intervention may be linked to outcomes with a low probability of confounding, bias or chance. Randomized controlled trials (RCTs) have been the gold standard for this inference, though different techniques and evaluation designs are becoming more widely accepted to establish attribution (Victora, Habicht and Bryce, 2004). Table 7.1 (see Annex) summarizes the programmes reviewed in each of the four categories. Programmes are organized alphabetically by country name within regions and then chronologically by date if there was more than one programme or study per country. 7.3 Dairy production and agriculture programmes Nutrition is most likely to be affected by dairy production programming via two pathways: increased milk availability from production leading to increased direct consumption; and improved access to higher-quality foods as a result of increased income (Figure 7.1). Whether diet improves as a result of increases in income depends on the recipient’s understanding the need for good nutrition; if they do not, the additional income may be used to buy more of the same foods or foods of lesser quality. Other possible negative effects of dairy production on nutrition
278 Milk and dairy products in human nutrition figure 7.1 Impact pathways for various types of milk and dairy programmes affecting nutrition a. Dairy production and agriculture programmes Food availability Milk available Household milk consumption Child milk consumption Food access Sale of livestock products Income Purchase of healthy foods Nutrition improves (anthropometry, body composition, micronutrient status) Livestock production (gender + nutrition education components) Access to healthcare Health improves Labor demands for caregivers Diversion of milk to sales Nutrition worsens (stunting, micronutrient deficiencies) Exposure to zoonoses b. School-based milk programmes School-based milk programmes Availability of healthy milk products in schools Demand for milk Child consumption of milk Local dairy production Economic development Nutrition improves (body composition, micronutrient status) Availability of flavored or other unhealthy milk products in schools (with added sugar) Inappropriate targeting Overconsumption Nutrition worsens (obesity, chronic disease)
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MILK dairy products in and human nu
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cover photo credits front: © EADD/
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iv 2.7 Emerging issues and challeng
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vi 5.2 Dairy components 209 5.2.1 M
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viii 9.2 Key trends and emerging is
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x 2.5 Per capita energy intake from
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xii Preface Billions of people arou
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xiv The publication serves a variet
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xvi (Research Assistant Professor,
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xviii Permissions granted by extern
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xx FPCM fat and protein-corrected m
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xxii Contributors Anthony Bennett j
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xxiv from the National University o
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xxvi Award 2010 along with colleagu
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11 Chapter 2 Milk availability: Cur
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Chapter 2 - Milk availability: Curr
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Table 2.5 Volume and share of milk
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41 Chapter 3 Milk and dairy product
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Chapter 3 - Milk and dairy product
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Table 3.1 Proximate composition of
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Table 3.2 (continued) Vitamins Ribo
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Table 3.4 Mineral composition in mi
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103 Chapter 4 Milk and dairy produc
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Chapter 4 - Milk and dairy products
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Table 4.1 Nutrient content of full
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Table 4.4 Summary of recent review
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Annex Table 4.7 Milk and dairy prod
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Table 4.7 (continued) Region and co
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207 Chapter 5 Dairy components, pro
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328 Milk and dairy products in huma
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