Whole Milk for Healthy Kids Act of 2023
Floor Speech
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Mr. THOMPSON of Pennsylvania. Mr. Chairman, I thank the chairwoman for her leadership and support.
Mr. Chairman, I rise today in strong support of my legislation, the Whole Milk for Healthy Kids Act, that supports students and dairy farmers across America.
Milk is an essential building block for a well-rounded and balanced diet, offering 13 essential nutrients and numerous health benefits.
Out-of-touch Federal regulations have imposed dietary restrictions on the types of milk students have access to in school meals.
Our ranking member is a dear friend of mine, and we have worked together. I have been here for 15 years and him a little longer. We have a great relationship and have had a lot of bipartisan bills together, like we marked up yesterday.
Mr. Chair, I have to say, the only special interest here is our kids. It is our kids who have been cheated out of the nutrition that they need. Case studies have shown that the rate of obesity and being overweight increased dramatically after access to whole milk and flavor was taken out of the schools in 2007-2008, which was a baseline. In 2010, a Democrat-led initiative demonized milk fat. In 2020-2021, there was a study of that same cohort, and obesity has gone up without this beverage.
Mr. Chairman, regarding my good friend from Louisiana, who just spoke, everybody is entitled to their own opinion but not their own facts. The facts are that it is the underlying law that was passed back in 2010 by a Democratic House and signed by a Democratic President that, quite frankly, required a physician prescription for health reasons.
That is a good part of the law, and we didn't touch that. We didn't address that in this bill, so I am not sure why he is talking about it. It is not germane to the topic we are talking about today. That is the underlying law.
The bottom line is that students and parents do have choice. There is a mechanism to honor that. The only choice they don't have, though, is access to the most nutritious beverage, which is whole milk-- specifically, whole milk and flavor.
Mr. Chair, I appreciate the gentleman from Louisiana sharing how much waste there was and what that amounts to in cartons and half pints and what it amounts to in dollars. That is because of the taste experience. It is not that these kids are throwing the milk away because it is unhealthy for them. It is just a terrible taste experience when you are drinking low-fat or nonfat milk.
Students have been limited to fat-free or reduced-fat milk since the Healthy, Hunger-Free Kids Act was enacted in 2010.
While some of my friends on the other side of the aisle have argued that we should not reform individual aspects of child nutrition, it was that legislation more than a decade ago that singled out milk for regulation, which is why we are here today.
There are several reasons why these top-down regulations are harmful to students and school districts that are forced to comply with them.
First, we have seen students opt out of consuming milk altogether if they don't have access to a variety that they enjoy. According to the ``Scientific Report of the 2020 Dietary Guidelines Advisory Committee,'' more than two-thirds of school-age children failed to meet the recommended levels of dairy. No kidding. We took out most nutrition and most taste and made it inaccessible to them.
Let's face it, the only way to benefit from milk's essential nutrients is to consume it. We are not force-feeding anybody anything. This is about choice. When students turn away from milk, they often opt for far less healthy alternatives that are highly caffeinated, sugar- sweetened, or lack key nutrients.
These regulations also perpetuate baseless claims that milk is bad for our kids. Research has shown time and time again that whole and 2 percent milk are not responsible for childhood obesity and other health concerns. In fact, these beverages are so nutritious that research shows positive health outcomes for kids who consume whole milk.
Mr. Chairman, I include in the Record academic studies from researchers around the world, including from top institutions such as Boston University and Tufts, who have studied the health effects of full-fat dairy. [From the American Journal of Clinical Nutrition] Whole Milk Compared With Reduced-Fat Milk and Childhood Overweight: a Systematic Review and Meta-Analysis Introduction
Childhood obesity has tripled in the past 40 y, with nearly 1 in 3 North American children now overweight or obese (1-3). Over the same period, consumption of whole-fat cow-milk has halved (4). The American Academy of Pediatrics and the Canadian Paediatric Society recommend that children switch from whole- fat cow-milk (3.25%) to reduced-fat cow-milk (0.1 to 2%) at 2 y of age to limit fat intake and minimize the risk of childhood obesity (5, 6). European (7), British (8), and Australian (9) health authorities have provided similar recommendations. Healthcare providers (10) and families (11) frequently follow this guideline, and school and child-care nutrition policies (12-14) often reflect them. Since 1970 whole-cow-milk availability has dropped by 80% in North America, whereas reduced-fat milk purchases have tripled (15, 16).
Given that cow-milk is consumed daily by 88% of children aged 1 to 3 y and by 76% of children aged 4 to 8 y in Canada (17) and is a major dietary source of energy, protein, and fat for children in North America (17, 18), understanding the relation between cow-milk fat and risk of overweight or obesity is important. Systematic reviews and meta-analyses on the relation between total dairy consumption and child adiposity have had conflicting findings. According to these studies, higher cow-milk intake in children is associated with taller height and better bone and dental health (19-21). Although these studies evaluated total dairy consumption, they did not consider cow-milk fat specifically. The objectives of this study were to systematically review and meta-analyze the relation between whole-fat (3.25%) relative to reduced-fat (0.1 to 2%) cow-milk and adiposity in children. Methods
A systematic review and meta-analysis of the literature was conducted. The study was designed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA-P) (22) and registered as a PROSPERO systematic review and meta-analysis (registration number: CRD42018085075). inclusion criteria Types of studies
Studies included in the search were original works published in English in a peer-reviewed journal. Cross- sectional, cohort, case-control, and longitudinal studies, as well as intervention trials, both controlled and not controlled, were included in the search strategy. There were no restrictions on date or length of follow-up. Population
Studies that included healthy children aged 1-18 y with
The primary exposure was cow-milk fat, categorized as skim (0.1% fat), 1% fat, 2% fat, or whole or homogenized (3.25% fat). Measures of exposure included FFQ, multiday food record, 24-h food recall, or any other validated or nonvalidated measurement tool. Dietary pattern analyses were not included. Outcomes
The primary outcome was childhood adiposity. These measures included BMI z-score (zBMI), BMI, weight for age, body fat mass, lean body mass, waist circumference, waist-to-hip ratio, body fat percentage. skinfold thickness, and prevalence of overweight or obesity as defined by the WHO (23), CDC (24), or International Obesity Task Force (IOTF)(25) cutoffs. When sufficient information was not available in the full text publication, study authors were contacted by email to obtain additional data. Meta-analysis
Meta-analysis included studies that reported the number of children who consumed whole (3.25%), 2%, 1%, or skim (0.1%) milk regularly (a priori defined as typically, daily, or
A comprehensive search strategy was developed by a research librarian (NT) with expertise in systematic reviews. From inception to August 2019, Embase, CINAHL (Cumulative Index to Nursing and Allied Health Literature), MEDLINE, Scopus, and the Cochrane Library were searched on March 23, 2018 and updated on August 2, 2019 using Medical Subject Headings (MeSH) and keywords (see Supplemental Methods for search strategies). Data extraction, management, and analysis Study selection
To evaluate study eligibility 2 reviewers (MA and SMV) independently reviewed study titles, abstracts, and full texts if needed. Both reviewers applied inclusion and exclusion criteria and differences were examined and resolved by consensus, which was achieved 100% of the time. Full-text articles were retrieved for potentially eligible studies and reviewed. Characteristics of included full-text studies were summarized. Data extraction
Two reviewers (MA and SMV) extracted data from eligible studies using standardized data extraction tables adapted from the Cochrane Data Extraction Template (26). Differences were resolved by consensus 100% of the time. Data management
Covidence (27) software was used to select studies, review results, and resolve discrepancies between reviewers. All included study records were kept in spreadsheet format. Data synthesis
Studies included in the analysis were described according to a standardized coding system that captured key elements of each study including descriptors of the study setting, population size and age (mean and range), exposure or intervention, comparator group, method of data collection, outcome measures, type of analysis, and results. Risk of bias and study quality assessment
Risk of bias was assessed using the Newcastle-Ottawa Scale (NOS) (28) for nonrandomized analyses, which expresses the risk of bias on a numerical scale ranging from 0 to 9; scores <7 are considered low risk. (NOS criteria can be found in Table 2.) The NOS-guided review included an examination of participant selection, comparability of children consuming whole or reduced-fat milk, and exposure and outcome measure ascertainment. To allow sufficient follow-up time for a meaningful change in adiposity to occur, the minimum acceptable follow-up time was prespecified as 1 y. Study comparability, defined as whether studies adjusted for similar confounding variables, was specified a priori as studies that adjusted for important characteristics including: birth weight or baseline weight (for prospective cohort studies), milk volume consumed, and parent BMI. Studies that adjusted for each of these factors were awarded 2 points, whereas 1 point was allocated if adjustment was performed using angle4 other covariates. Reports were assigned 1 point for ascertainment of exposure only when structured interviews or medical records were used for data collection. Risk of bias was assessed by 2 reviewers (MA and SMV) and consensus was achieved 100% of the time. Statistical analysis
For each study, participant information, design, and results were summarized. We derived crude ORs and extracted adjusted ORs, whenever available, for overweight or obesity among children who consumed whole (3.25%) milk, compared with children who consumed reduced-fat (0.1-2%) milk regularly. A random effects model based on the restricted maximum likelihood estimator was decided a priori and used to separately pool crude and adjusted ORs of overweight or obesity. Each study was included as a random effect to account for between-study variation in this model. Sensitivity analyses were performed using the Knapp-Hartung method and inverse-variance weights. Because prospective cohort studies can reveal different relations than cross- sectional studies, we performed a subgroup analysis according to study design. Additionally, we analyzed studies in subgroups according to risk of bias (high compared with low) and age (1-5 y, 6-11 y, and 12-18 y). Subgroup analyses were accompanied by tests for interaction between each subgroup and the main effect from the random-effects metaregression, by using an interaction term in metaregression models for study design (cross-sectional compared with prospective cohort), risk of bias (high compared with low), and age group (1-5 y, 6-11 y, and 12-18 y). Heterogeneity across included studies was estimated using the I\2\ statistic. Heterogeneity was considered low (<40%), moderate (40-60%), or high (>60%). Publication bias was assessed using a funnel plot and Egger test.
Finally, we conducted a dose-response metaregression to quantify the association between percentage of fat in cow- milk consumed and the odds of overweight or obesity. Only studies that reported group-specific odds for angle3 types of cow-milk fat were included in this analysis. For the dose-response analysis, we first used a fixed-effect approach to estimate the dose-response relations within each study. Then, we used a random-effects approach to combine across studies the dose-response estimates that were generated in the first step for each study to obtain regression coefficients, and their respective standard errors. R software version 3.2.2 was used for all analyses, using the ``metafor'' package. Results
The database search identified 5862 potentially eligible studies. After exclusion of duplicates (n = 1861), 4001 reports underwent title and abstract review. Studies that did not meet inclusion criteria (n = 3915) were removed resulting in 86 published studies that underwent full text review. Reasons for exclusion included wrong exposure, wrong outcome, wrong patient population, dietary pattern analysis only, or wrong study design such as case reports or editorials. Twenty-eight studies met all inclusion criteria. Of these, 20 were cross-sectional and 8 were prospective cohort studies. No interventional studies were identified. Most studies (n = 23) compared consumption of whole milk (3.25% fat) with reduced-fat milk (0.1%, 1%, or 2% fat). Four studies (36-39) compared whole and 2% milk with 1% and skim milk. One study compared whole milk with 2% milk.
Nineteen studies used zBMI, 4 prospective cohort studies used percentage body fat change, and 5 studies used overweight or obesity categories as the primary adiposity outcome. Three studies used 2008 WHO growth standards, 14 studies used 2000 CDC growth standards, 7 used 2000 IOTF growth standards, and 4 studies either did not specify or used other standards for zBMI measurement.
Eighteen (36, 38, 39, 41-45, 47-49, 51, 52, 57, 58, 60, 63, 65) studies reported that higher cow-milk fat was associated with lower child adiposity. Ten studies (37, 40, 46, 50, 53- 56, 59, 61) reported no association between cow-milk fat and child adiposity. Risk-of-bias assessment
Risk of bias assessed using the NOS suggested that 1 of 8 prospective cohort studies and 0 of 20 cross-sectional studies were low risk of bias. Common limitations that increased risk of bias included cross-sectional study design, nonstandardized dietary assessments that were either study specific or not validated, lack of adjustment for clinically important covariates (including volume of milk consumed, parent BMI, and child adiposity assessed prior to the outcome), and study duration too short to detect a meaningful change in adiposity (defined a priori as 1 y). Association between cow-milk fat and child overweight or obesity
Fourteen (38, 42-44, 46, 47, 49, 51, 52, 57, 58, 60, 62, 65) studies met the meta-analysis inclusion criteria; 11 were cross-sectional and 3 were prospective cohort studies. All studies included in the meta-analysis compared whole (3.25% fat) milk with reduced-fat (0.1-2%) milk consumption, allowing an OR to be calculated. A total of 20,897 healthy children aged 1-18 y were included in the meta-analysis. Children were from 7 countries (United States, United Kingdom, Canada, Brazil, Sweden, New Zealand, and Italy). Anthropometric standards used to determine overweight or obesity categories included the WHO, CDC, or IOTF growth standards in 6, 5, and 3 studies respectively.
Crude analysis of all 14 studies revealed that among children who consumed whole milk compared with reduced-fat milk, the pooled OR for overweight or obesity was 0.61 (95% CI: 0.52, 0.72; P < 0.0001). Heterogeneity measured by the I\2\ statistic was 73.8% (P < 0.0001 ). A sensitivity analysis using inverse-variance weights did not reveal different results. Subgroup analysis by study design revealed no significant interaction between cross-sectional and prospective cohort studies. For the 11 cross-sectional studies (n = 9413), the pooled OR of overweight or obesity was 0.56 (95% CI: 0.46, 0.69; P = 0.0001), and for the 3 prospective cohort studies (n = 11,484) it was 0.76 (95% CI: 0.63, 0.92; P = 0.006).
Risk of bias (high compared with low) and age group were also not significant modifiers of the relation between cow- milk fat and child adiposity. Analyses of 5 studies (49, 51, 52, 57, 58) that reported adjusted ORs did not show differences between crude and adjusted estimates (adjusted OR: 0.53; 95% CI: 0.44, 0.63; crude OR: 0.55; 95% CI: 0.46, 0.66). Results of the sensitivity analysis using the Knapp- Hartung method to pool the 14 studies (crude OR: 0.62; 95% CI: 0.52, 0.73) were similar to the main results (crude OR: 0.61; 95% CI: 0.52, 0.72)). Publication bias, visualized using a funnel plot was difficult to ascertain given the high heterogeneity (I\2\ = 73.8%) and relatively low number of included studies.
Data were available from 7 studies (38, 39, 44, 52, 57, 58, 65) which included 14,582 children aged 2 to 11 y, and demonstrated a linear association between higher cowmilk fat and lower child adiposity. For each 1% higher cowmilk fat consumed, the overall crude OR for overweight or obesity was 0.75 (95% CI: 0.65, 0.87; P = 0.004; t\2\ = 0.01; I\2\ = 64%). discussion
This systematic review and meta-analysis has identified that relative to reduced-fat cow-milk, whole-fat cow-milk consumption was associated with lower odds of childhood overweight or obesity. The direction of the association was consistent across a range of study designs, settings, and age groups and demonstrated a dose effect. Although no clinical trials were identified, existing observational research suggests that consumption of whole milk compared with reduced-fat milk does not adversely affect body weight or body composition among children and adolescents. To the contrary, higher milk fat consumption appears to be associated with lower odds of childhood overweight or obesity.
Findings from the present study suggest that cow-milk fat, which has not been examined in previous meta-analyses, could play a role in the development of childhood overweight or obesity. Several mechanisms have been proposed that might explain why higher cow-milk fat consumption could result in lower childhood adiposity. One theory involves the replacement of calories from less healthy foods, such as sugar-sweetened beverages, with cow-milk fat. Consumption of beverages high in added sugar has been associated with increased risk of overweight and obesity during childhood. Other theories involve satiety mechanism such that higher milk fat consumption might induce satiety through the release of cholecystokinin and glucagon-like peptide 1 thereby reducing desire for other calorically dense foods. Another possibility is that lower satiety from reduced-fat milk could result in increased milk consumption causing higher weight gain relative to children who consume whole milk, as observed in the study by Berkey et al.
Cow-milk fat might offer cardiometabolic benefits. The types of fat found in cow-milk, including trans-palmitoleic acid, could be metabolically protective. Higher circulating trans-palmitoleic acid has been associated with lower adiposity, serum LDL cholesterol and triglyceride concentrations, and insulin resistance, and higher HDL cholesterol in several large adult cohort studies. However, diets that replace dairy fat with unsaturated fatty acids might also offer cardiometabolic protection.
Confounding by indication and reverse causality are plausible alternate explanations. Parents of children who have lower adiposity might choose higher-fat milk to increase weight gain. Similarly, parents of children who have higher adiposity might choose lower-fat milk to reduce the risk of overweight or obesity. The majority of children included in this systematic review were involved in prospective cohort studies, in which the potential for reverse causality is lower than in cross-sectional studies. Results from these 11,484 children were consistent with the overall findings. Two of the included prospective cohort studies attempted to address confounding by indication by adjusting for baseline BMI; 1 of these repeated the statistical analysis only among participants with normal-weight BMI values, with similar findings. Clinical trial data would have provided better evidence for the directionality of this relation; however, none were available.
This study had a number of strengths. The meta-analysis included a large, diverse sample of children from around the world. The number of potentially eligible studies was maximized by the comprehensive search strategy and contact with authors to obtain missing data. Also, study selection, data collection, and risk of bias assessment were performed by 2 independent reviewers, which improved accuracy and consistency. All studies included in the meta-analysis used trained individuals to obtain anthropometric measurements, and weight status was standardized using growth reference standards (WHO, CDC, and IOTF). Using metaregression techniques, differences in study design, risk of bias, and age group were taken into account. Finally, a dose-response meta-analysis was conducted, which demonstrated a linear relation between higher cow-milk fat and lower child adiposity.
This study had a number of limitations. First, included studies were all observational. Only 1 study in this analysis was considered to have low risk of bias, and all studies in the meta-analysis had high risk of bias. Risk of bias included cross-sectional designs and lack of adjustment for clinically important covariates. For example, cow-milk volume was accounted for in only 11 of 28 studies in the systematic review, and in 5 of 14 studies in the meta-analysis. Adjustment for volume in future studies would allow for a clearer understanding of whether higher cow-milk fat protects against higher adiposity, or reduced-fat cow-milk increases adiposity. However, among these studies. comparison of adjusted compared with crude odds demonstrated consistent findings. Residual confounding by variables not accounted for in the individual analyses is also possible; this is a common limitation for meta-analyses of observational studies. Heterogeneity was relatively high (I\2\ = 73.8%), which might have been attributable to a variety of factors including varied methods of ascertainment of exposure and outcome, and differences in study design and follow-up duration. Although subgroup analyses of prospective cohort studies revealed results comparable to the overall metaregression, these comparisons might not have had sufficient power to detect clinically meaningful differences. However, 11,484 children were involved in prospective cohort studies making large differences in effect size unlikely. Although only studies with standardized dietary measurements were included, measurement error was possible due to recall bias or lack of validation of dietary assessment tool. Error in adiposity measurement could also have introduced bias. although weights and heights were measured by trained individuals and standardized protocols were used in all studies included in the meta-analysis. Differences in adiposity measurement (i.e., body fat percentage, zBMl, BMI), and different growth standards could have contributed to heterogeneity. For example, use of the WHO rather than IOTF or CDC standards could have resulted in a greater proportion of overweight or obese children being reported. Future studies using WHO growth standards, which are believed to represent optimal child growth, would help to minimize heterogeneity and overcome these limitations. Consideration for relevant outcomes such as cardiovascular risk should be included in future analyses to understand other effects of cow-milk fat. Publication bias was also possible as demonstrated by a funnel plot and Egger test.
In conclusion, observational evidence supports that children who consume whole milk compared with reduced-fat milk have lower odds of overweight or obesity. Given that the majority of children in North America consume cow-milk on a daily basis, clinical trial data and well-designed prospective cohort studies involving large, diverse samples, using standardized exposure and outcome measurements, and with long study duration would help determine whether the observed association between higher milk at consumption and lower childhood adiposity is causal. [From the American Journal of Clinical Nutrition] Dairy Foods, Dairy Fat, Diabetes, and Death: What Can Be Learned From 3 Large New Investigations? (By Dariush Mozaffarian)
Dairy products are a major component of most diets, contributing 10% of calories in the United States. Surprisingly, for such a major share of the food supply, their health effects remain remarkably uncertain, insufficiently studied, and controversial. Dietary guidelines on dairy remain largely based on theoretical considerations about isolated nutrients (e.g., theorized benefits of calcium or vitamin D; theorized harms of total fat or saturated fat) or short-term dietary pattern studies of surrogate markers, rather than on the mounting evidence on how milk, cheese, yogurt, butter, and other dairy foods relate to major clinical endpoints. Such evidence on health outcomes is crucial, because dairy products appear to be a heterogeneous class with complex effects dependent upon the interplay of diverse nutrients and processing characteristics (e.g. probiotics, fermentation, milk fat globule membrane, and more).
In this issue of the Journal, 3 new publications report on dairy consumption and risk of type 2 diabetes or mortality. Ardisson Korat et al. evaluated estimated dairy fat consumption and onset of diabetes in 3 cohorts of US health professionals. After adjustment for other risk factors, higher dairy fat intake, in comparison with carbohydrate, was associated with lower diabetes risk in 1 cohort of middle- aged women, and was not significantly associated with diabetes in the other 2 cohorts or among all 3 cohorts combined. In subgroup analyses, dairy fat intake was associated with lower risk of diabetes at younger ages (<65 y) and in women, the 2 subgroups among whom 70-80% of diabetes cases occurred--although these interactions by age and sex did not achieve statistical significance. When dairy fat was statistically compared with carbohydrate from whole grains, the latter was associated with lower risk of diabetes (per 5% energy, 7% lower risk), whereas, compared with other animal fats (largely form red meat and poultry) or with carbohydrate from refined grains, dairy fat consumption was associated with lower risk of diabetes (per 5% energy, 4-17% lower risk). Dairy fat consumption was not associated with incident diabetes when compared with vegetable fat, polyunsaturated fat (total, v 6, or v 3), or monounsaturated fat from plant sources. Because dairy fat in these cohorts was associated with several unhealthy lifestyle factors, including higher BMI, more current smoking, less physcial activity, fewer fruits and vegetables, and a less healthy overall dietary pattern, this suggests that residual confounding, if present--the major limitation of observational cohorts such as this one--would tend to cause bias toward dairy fat appearing more harmful (less beneficial) than it actually may be.
These findings add to a growing body of literature which call into question the soundness of conventional dietary recommendations to avoid dairy fat. As noted by Ardisson Korat et al., dairy fat contains a complex mix of different SFAs, other unsaturated and conjugated fatty acids, and other constituents, each with varying biological effects. Physiologic effects of dairy fat further vary according to content of milk fat globule membrane, which alters cholesterol absorption and perhaps skeletal muscle responses to exercise. Also, cheese, the major source of dairy fat in most diets, is a fermented food and a rich source of menoquinones which may improve insulin secretion and sensitivity through osteocalcin-related pathways. In a recent pooling project of de novo individual-level analyses from 16 prospective cohort studies across 4 continents (including 2 of the 3 US cohorts evaluated by Ardisson Korat et al.), objective blood biomarkers of odd-chain saturated fats and trans-palmitoleic acid, each found in dairy fats, were associated with significantly lower risk of diabetes. Together with these prior findings, the new results by Ardisson Korat et al. provide little support for metabolic harms of dairy fat, and indeed suggest potential benefits amoung younger adults, among women, and as a replacement for other animal fats or refined carbohydrates.
A second report in this issue of the Journal assessed how changes in dairy foods, assessed using serial questionnaires, related to incident diabetes in the same 3 US cohorts of health professionals. After multivariable adjustment, participants who decreased their total dairy intake by >1 serving/d over a 4-year period experienced 11% higher incidence of diabetes, compared with stable intake. Among dairy subtypes, changes in low-fat milk, whole milk, and cream were not significantly associated with diabetes, whereas decreases in ice cream, increases in some types of cheese, and decrease in yogurt were each associated wih higher risk. Several factors complicate the interpretation of this analysis. Foremost, none of these findings were symmetrical for increases compared with decreases in intake: i.e., when decreased consumption of total dairy or a dairy subtype was linked to diabetes risk, increased consumption was not linked in the opposing direction, and vice versa. This counters expected biology and the important Bradford Hill criterion of dose-response, which for example has been evidenced in these cohorts for dietary changes and long-term weight gain. In addition, results for each of the dairy subtypes appeared generally inconsistent across the 3 cohorts, with little uniformity (I \2\ values were not reported). Some of the findings counter expected causal biology--e.g., that decreasing ice cream increases diabetes-- raising concern for reverse causation. The dietary instrument was also variably reliable for assessing different dairy foods: for example, as compared with multiple dietary records, the FFQ reliably measured consumption of yogurt (r = 0.97), but not hard cheese (r = 0.38). In light of the 26 prior cohort studies which have reported on dairy consumption and incident diabetes, in sum suggesting lower risk from total dairy and especially yogurt consumption, the internal inconsistencies of the present findings for changes in dairy foods raise more questions than they answer.
In the third publication in this issue, Pala et al. investigated dairy consumption and death from cancer, cardiovascular disease, and all causes in a community-based Italian cohort. After adjustment for other risk factors, compared with no consumption, moderate milk intake (
The global pandemics of obesity and type 2 diabetes, together with high rates of cardiovascular disease and cancer, have stimulated a new popular frenzy around healthier eating. Although the resulting attention on diet-related health impacts, economic burdens, and corresponding policy solutions has been positive, the craze of competing popular diets and their proponents have simultaneously fueled confusion, controversy, and skepticism. For example, ignoring the preponderance of evidence, some popular books and social media headlines claim that dairy foods are toxic. At the same time, prevailing dietary guidelines exacerbate the confusion, remaining mired in outdated conceptual frameworks and hesitating to acknowledge new paradigms of complexity.
As is always true in science, these 3 new investigations cannot by themselves definitively eliminate confusion or answer all questions. Yet, these studies aimed to address crucial questions on dairy and health in large and well- designed prospective cohorts. Together, the findings provide little support that consumption of total dairy, dairy subtypes, or dairy fat is harmful, and they continue to build the case for possible benefits. As recently reviewed, the dizzyingly complex characteristics and molecular effects of different dairy foods belie any simplistic overall summary or synopsis. These 3 new studies highlight this complexity and the urgent need for additional long-term prospective studies, interventional trials, and mechanistic investigations of dairy foods and health.
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Mr. THOMPSON of Pennsylvania. Mr. Chairman, these studies show, among other things, that full-fat dairy foods have little to no association with high blood pressure, cardiovascular disease, type 2 diabetes, obesity, blood pressure, or cholesterol.
In fact, several of these studies show that full-fat foods help improve or lower negative health outcomes for children who drink more full-fat dairy beverages.
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Mr. THOMPSON of Pennsylvania. Mr. Chairman, additionally, since whole milk was removed from school lunchrooms, the childhood obesity rate has increased, according to the CDC and several case studies. Whole milk is not the problem.
For our children to excel in the classroom and beyond, they must have access to more nutritious options, not fewer.
The Whole Milk for Healthy Kids Act will allow schools participating in the National School Lunch Program to serve all varieties of flavored and unflavored milk, including whole milk.
It is important to remember that this legislation does not require any student to drink, or any school to serve, whole milk. Rather, this legislation simply gives schools the flexibility to serve a broader variety of milk in the school lunchroom.
Additionally, if students have a documented medical condition or disability that prohibits them from safely or comfortably consuming milk, schools are required to offer them an alternative beverage. This legislation would not change that standard.
Mr. Chair, I am proud to have 134 bipartisan cosponsors from 44 States. The bottom line is the Whole Milk for Healthy Kids Act is about ensuring students have the necessary nutrients to learn and grow.
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