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

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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
294 Milk and dairy products in human nutrition may prevent micronutrient deficiencies and stunted growth. Evidence also shows that milk programming can stimulate local production and simultaneously address malnutrition and poverty. Finally, the prevailing positive public perception of the nutritional advantages of milk in some contexts such as pastoralist and school communities offers fertile grounds for programming. With future investment and careful planning, milk programming can make an important contribution to improving nutrition and development around the world. Disclosure statement The author declares that no financial or other conflict of interest exists in relation to the content of the chapter. References Adu-Afarwuah, S., Lartey, A., Brown, K.H., Zlotkin, S., Briend, A. & Dewey, K.G. 2007. Randomized comparison of 3 types of micronutrient supplements for home fortification of complementary foods in Ghana: effects on growth and motor development. Am. J. Clin. Nutr., 86(2): 412–420. Adu-Afarwuah, S., Lartey, A., Brown, K.H., Zlotkin, S., Briend, A. & Dewey, K.G. 2008. Home fortification of complementary foods with micronutrient supplements is well accepted and has positive effects on infant iron status in Ghana. Am. J. Clin. Nutr., 87(4): 929–938. Ahmed, M., Jabbar, M. & Ehui, S. 2000. Household-level economic and nutritional impacts of market oriented dairy production in the Ethiopian Highlands. Food Nutr. Bull., 21(4): 460–465. Alderman, H. 1987. Cooperative dairy development in Karnataka, India: an assessment. Research Report 64. Washington, DC, International Food Policy Research Institute. Allen, L.H. 2003. Interventions for micronutrient deficiency control in developing countries: Past, present and future. J. Nutr., 133(11): 3875S–3878S. Ayalew, W., Gebriel, Z.W. & Kassa, H. 1999. Reducing vitamin A deficiency in Ethiopia: linkages with a women-focused dairy goat farming project. Research Report Series 4. Washington, DC, International Center for Research on Women. Ayele, Z. & Peacock, C. 2003. Improving access to and consumption of animal source foods in rural households. The experiences of a women-focused goat development program in the highlands of Ethiopia. J. Nutr., 133: 3981S–3986S. Berti, P.R., Krasevec, J. & FitzGerald, S. 2004. A review of the effectiveness of agriculture interventions in improving nutrition outcomes. Public Health Nutr., 7(5): 599–609. Bhutta, Z.A., Ahmed, T., Black, R.E., Counsens, S., Dewey, K., Giugliani, E., Haider, B., Kirkwood, B., Morris, S.S., Sachdev, H.P. & Shekar, M. 2008. Maternal and child undernutrition. What works Interventions for maternal and child undernutrition and survival. Lancet, 371(9610): 417–440. Black, R.E., Allen, L.H., Bhutta, Z.A., Caulfield, L.E., de Onis, M., Ezzati, M., Mathers, C. & Rivera, J. 2008. Maternal and child undernutrition. Global and regional exposures and health consequences. Lancet, 371(9608): 243–260. Brown, K.H., Engle-Stone, R., Krebs, N.F. & Peerson, J.M. 2009. Dietary intervention strategies to enhance zinc nutrition. Promotion and support of breastfeeding for infants and young children. Food Nutr. Bull., 30(1): 144S–171S.
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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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2 Milk and dairy products in human
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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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Table 3.6 (continued) Riboflavin Vi
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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 4.2 Contents of selected nutr
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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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Chapter 5 - Dairy components, produ
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Annex Table 5.2 EU register of dair
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