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

Chapter 7 – Milk and dairy programmes affecting nutrition 293
one was classified as observational/formative level studies, one as adequacy level,
two as plausibility level and three as probability level. The available evidence,
however, does not allow conclusions to be drawn about the added value of the milk
in the foods for achieving positive nutrition outcomes. Only one study in Malawi
provided evidence that increasing the proportions of milk powder (from 10 percent
to 25 percent) increased rates of recovery from severe acute malnutrition and
weight and height gains (Oakley et al., 2010). Programme evaluations and studies
of RUTF and RUSF with relatively strong designs and methods have demonstrated
that milk powder added to blended foods improved recovery rates and weight gain
among malnourished children (Matilsky et al., 2009), prevented wasting (Isanaka
et al., 2009; Defourny et al., 2009) and promoted growth, motor development and
micronutrient nutrition (Adu-Afarwuah et al., 2007; Adu-Afarwuah et al., 2008).
One important challenge for this programme type is cost. Milk powder added
in even small percentages (10–15 percent) has been shown to double the cost of the
food. Further, the shelf-life of a food may be shortened depending on the kind of
milk powder added. Skimmed-milk powder may be a more practical alternative to
whole-milk powder because of its longer shelf life (Hoppe et al., 2008). For these
reasons, more studies are needed to understand the added value of milk in blended
foods for achieving positive nutrition outcomes.
7.7 Key messages
Milk and dairy programmes hold promise for improving human nutrition. Micronutrient
deficiencies arising from poor-quality diets and infectious disease remain
widely prevalent in poor populations. Milk, as an ASF, is an efficient vehicle for
delivering several critical micronutrients and improving growth of young children.
Evidence from well-designed evaluations and studies of milk programming
remains limited. Of the 29 evaluations and studies reviewed, only six met the
probability level of inference, i.e. were able to demonstrate a causal link between a
milk intervention and nutrition outcome, and eight met the plausibility level with
quasi-experimental designs. Clearly, there is a need for better-designed process and
impact evaluations, cost-effectiveness analyses and careful consideration of the dual
burden of under- and overnutrition.
Lessons learned from dairy production and agriculture programmes show the
importance of multisectoral interventions targeting women and strategies introducing
small livestock species and improved breeds, establishing market linkages and
increasing awareness about the nutritional importance of milk. Nutrition objectives
are needed more generally in dairy production and agriculture programmes.
School-based milk programmes have demonstrated positive impacts on growth,
body composition and micronutrient status, but the issue of appropriate levels
of fat and added sugar and flavouring in milk need to be addressed. Evidence of
efficacy is strongest for fortified-milk programming, showing improvements in
iron and vitamin D nutrition in particular. Issues of limited market access, cost and
questionable effects on zinc nutrition remain. Milk added to blended foods has been
used in programming for decades, but the isolated effect of the milk ingredient is
largely unknown.
In conclusion, milk and dairy programming offers many opportunities moving
forward. Animal milk, rich in bio-available nutrients, delivered to young children