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

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Milk and dairy products in human nutrition
offered in schools, including fat content and flavouring. Little evidence is available
as a basis for this kind of decision-making in developing countries. There is some
evidence from developed countries in different age groups, though, showing that
fat levels in milk do not markedly affect either the bio-availability of vitamin A and
E (Herrero-Barbudo et al., 2006) or plasma levels of polyunsaturated fatty acids
(Svahn et al., 2002). As with the dairy development and agriculture programmes,
there is a need for better-designed effectiveness evaluations of nutrition outcomes
with this programme type.
7.5 Fortified-milk programmes
Fortified foods can be a cost-effective way to deliver important nutrients. Milk
has been used in several large-scale programmes as a vehicle for fortification and
improving micronutrient nutrition in populations. Some barriers to nutrition
impacts from food fortification include: technology limitations and cost; nutrient–nutrient
interactions; bio-availability of some fortificants; acceptability and
palatability of fortified foods; and difficulty in fortifying widely consumed staples
such as rice (Allen, 2003). This section deals with efforts to modify the nutrient
content of milk in order to improve its nutritional quality and address particular
nutrient deficiency problems.
7.5.1 Latin America and the Caribbean
Much of the evidence for efficacy and effectiveness of milk fortification for improving
nutrition outcomes in the developing regions comes from Latin America.
Several countries in this region, including Chile and Mexico, have first studied the
potential for nutrition impacts from milk fortification and then translated the findings
into larger-scale programmes. These efforts focused on iron and zinc because
milk contains relatively small amounts of these nutrients, and iron and zinc deficiencies
are prevalent in vulnerable populations around the region.
One well-designed randomized, controlled study in Chile during the 1980s,
ranked at the highest level of probability inference, paved the way for later fortification
programmes (Stekel et al., 1988). This study compared iron nutrition and
anaemia outcomes among young children who had received a supplement of either
full-fat milk fortified with micronutrients (ferrous sulphate, ascorbic acid, vitamin
A and vitamin D) or non-fortified full-fat milk from 3 to 15 months of age. Data
collected during follow-up at 9 and 15 months of age demonstrated positive impacts
on markers of iron nutrition including transferrin saturation and serum ferritin, and
reduced prevalence of anaemia in the intervention group compared with the control
(Stekel et al., 1988). Other studies not included in this review have also found
positive effects of iron-fortified milk targeted to vulnerable population groups with
anaemia and low iron status (Iost et al., 1998; Virtanen et al., 2001).
The National Complementary Food Programme (NCFP) in Chile began as a
public milk-distribution programme during the 1920s (Uauy, Albala and Kain,
2001). The original goal was to promote growth and development early in life by
providing food supplements to pregnant women and children less than six years old.
Over the years, the programme has been strengthened through added technologies
such as fortification with iron (10 mg/litre), zinc (5 mg/litre), copper (0.5 mg/litre)
and vitamin C (70 mg/litre). In 2003, the programme was reaching over 872 000