Directory UMM :Data Elmu:jurnal:N:Nutrition And Food Science:Vol30.Issue2.2000:

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Drinks for young

children: the dental and

nutritional benefits of

milk

Anita Wells

Tooth decay is a serious problem in young children. In the UK, 43 per cent of all five-year-olds have decayed, missing or filled teeth (Pittset al., 1999). Tooth decay causes pain, infection, disfigurement and sleepless nights for both parents and children. Although twice daily tooth brushing with fluoride toothpaste and regular visits to the dentist help to prevent tooth decay, it is also important to consider dietary factors that influence dental health.

The British Nutrition Foundation Oral Health Task Force recently concluded that sugars are the most important dietary cause of dental caries (British Nutrition Foundation, 1999). They recommended that sugary foods and drinks should be limited to mealtimes and that schools and teachers should provide and encourage the use of non-cariogenic snacks and drinks between meals (British Nutrition Foundation, 1999).

The National Diet and Nutritional Survey of children aged 1-4 years (Gregoryet al., 1995) revealed that intakes of non-milk extrinsic sugars (NMES) by the young children sampled provided 18.7 per cent of food energy, almost double the recommended maximum level (10 per cent) (Department of Health, 1991). One of the main sources of NMES was non-diet soft drinks such as fruit squashes and carbonated beverages, which provided almost one-third of the total NMES intake. Children with dental decay had higher intakes of confectionery and soft drinks than those without caries experience (Hinds and Gregory, 1995). Soft drinks were consumed by 86 per cent of young children up to 16 times a day. Over half of the young children who consumed soft drinks did so more than once a day, and 15 per cent consumed them more than three times a day.

Dental and health professionals have become concerned about the high level of dental caries in young children. In 1999 the Health Education Authority launched an initiative, ``Smiling for Life'', aimed at supporting childcarers in promoting good nutrition and oral health practices in pre-schools as well as promoting partnership with parents to improve their children's eating habits to keep their teeth healthy. One of the areas targeted for change was the type of drinks that are offered between meals. The Health Education Authority's consensus position on between-meal drinks is that ``milk

The author

Anita Wellsis a Nutrition Manager at the National Dairy Council, London, UK.

Keywords

Children, Nutrition, Health, Milk

Abstract

Tooth decay is a serious problem in young children. In the UK nearly halfofall five-year-olds have decayed, missing or filled teeth. Non-milk extrinsic sugars (NMES) provide young children with about 19 per cent oftheir food energy, almost double the recommended amount. One of the main sources ofNMES is non-diet soft drinks such as fruit squashes and carbonated beverages. Dental experts recommend that sugary food and drinks should be limited to meal times and that non-cariogenic drinks such as milk and water should be consumed between meals. However, milk does not just benefit young children's teeth; unlike soft drinks, it also plays a pivotal role in ensuring that young children consume a nutritionally adequate diet. Children aged 3-4 years obtain at least one-fifth of their total intake ofprotein, vitamin A, riboflavin, vitamin B12, calcium, phosphorus, potassium, zinc and iodine from

milk. The only nutrient that is supplied to a greater extent from other beverages is vitamin C.

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Nutrition & Food Science

Volume 30 . Number 2 . 2000 . pp. 76±79

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and water are the safest drinks for teeth between meals'' (Watt, 1999).

This view is consistent with other expert groups such as the Committee on Medical Aspects of Food Policy (Department of Health, 1989) and the British Nutrition Foundation Task Force on Oral Health (British Nutrition Foundation, 1999). Although milk contains lactose, this form of sugar is the least cariogenic among those commonly found in food. Furthermore, the high concentrations of calcium and

phosphorus found in milk help to prevent damage to tooth enamel (Rugg-Gunn, 1993).

Milk does not just benefit young children's teeth, it also plays a pivotal role in ensuring that young children consume a nutritionally adequate diet. The National Diet and Nutritional Survey of children aged 1-4 years (Gregory et al., 1995) highlighted the valuable contribution that milk makes to dietary intakes of protein and micronutrients by pre-school children. Children aged 3-4 years obtained at least one-fifth of their total intake of protein, vitamin A, riboflavin, vitamin B12, calcium, phosphorus, potassium,

zinc and iodine from milk. The only nutrient that was supplied to a greater extent from other beverages was vitamin C (Table I).

Whole milk is suitable as a main drink from the age of one year and semi-skimmed milk may be gradually introduced from the age of two, as long as the child is eating well and consuming a variety of different foods

(Department of Health, 1994). After the age of one, it is suggested that children consume a minimum of 350ml of milk or two servings of dairy products per day (Department of Health, 1994). Large volumes of milk (over 600ml) should be discouraged as they reduce a child's appetite for other foods (Department of Health, 1994).

A total of 350ml of whole milk provides useful amounts of a wide range of nutrients for a child aged between one and three years (Table II).

Milk provided through the Welfare Foods Scheme plays a particularly important role in preventing nutritional deficiencies among pre-school children. Families who receive Income Support or income-based Jobseekers' Allowance are entitled to seven pints a week of whole or semi-skimmed milk for each child under the age of five years. Children under five years are entitled to receive one-third of a pint of milk free of charge on each day they attend approved day care facilities such as pre-schools and childminders for two hours or more.

Milk and dairy products are the main source of calcium in the UK diet. Milk provided 51per cent of the calcium in the National Diet and Nutritional Survey of children aged 1-4 years (Gregoryet al.,

Table ISources ofnutrients in the diet ofBritish 3- to 4-year-olds

Nutrient

Per cent supplied from milk

Per cent supplied from other drinksa

Protein 20 1

Vitamin A 23 4

Riboflavin 36 2.5

Vitamin B6 18 11.5

Vitamin B12 34.5 9

Vitamin C 5 51.5

Vitamin D 4.5 0

Note: a Other drinks include fruit juices, carbonated soft drinks, fruit squashes, tea and coffee

Source:Gregoryet al. (1995)

Table IINutrients provided by 350ml ofwhole milk for a one- to three-year-old child

Nutrient

Vitamin B2 105

Niacin 35

Vitamin B6 30

Vitamin B12 280

Folate 30

Source: Royal Society ofChemistry and MAFF (1991) and Department ofHealth (1991)

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Drinks for young children: the dental and nutritional benefits of milk Anita Wells

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1995). Bone mineral content and bone mineral density increase from infancy and peak in early adulthood. Childhood is a critical time in bone development and during this time it is important that the calcium needs of the growing skeleton are met (Department of Health, 1998).

Poor iron status is particularly common in young children. The National Diet and Nutrition Survey of children aged 1- 4 years indicated that one in 12 young children were anaemic and 16 per cent of the under year-olds and 4 per cent of the over four-year-olds sampled consumed less iron than the lower reference nutrient intake (LRNI), the amount judged to be enough for only the 2-3 per cent of the population with low needs (Gregory et al., 1995). Short-term studies indicate that adding calcium salts or food that is rich in calcium to a meal has an adverse effect on iron absorption. As a result, it has sometimes been suggested that a high intake of milk is a contributory factor in the development of poor iron status. However, this conclusion is derived from the results of studies in which iron absorption was

measured after a single meal or over just a few days. The results of a recent five-week dietary intervention study demonstrate that young children absorb a similar amount of iron from a high-calcium diet (1,180mg/day) to that from a lower calcium diet (500mg/day) (Ames, 1999). This observation is consistent with other long-term studies in infants (Dalton et al., 1997), adolescent girls (Illich-Ernst et al., 1998) and adults (Minihane and Fairweather-Tait, 1998). Providing advice about good dietary sources of iron is a more straightforward strategy to tackle the

important issue of poor iron status. The attention focused on poor iron status should not obscure advice about the importance of obtaining adequate dietary calcium,

particularly to young children who have yet to achieve peak bone mass.

The nutritional benefits of milk are sometimes unjustly dismissed because of concerns over the energy content. The energy content of semi-skimmed milk is similar to that of fruit drinks and carbonated beverages. There is also a growing body of evidence to suggest that milk consumption is not

associated with excessive weight gain in young children. Dennison and colleagues (1997) compared the heights and weights of pre-school children who consumed varying

amounts of milk and orange juice. There was no difference in body size according to milk intake, but consumption of large amounts of fruit juice (more than 341ml per day) was associated with short stature and obesity (Dennisonet al., 1997).

Some parents withdraw milk from their child's diet owing to fears of allergy. Allergy to cow's milk is relatively rare. Studies using blind milk-challenges as the means of diagnosis (rather than simply recording information from parents) suggest that cow's milk allergy affects approximately 2 per cent of babies (Hùst and Halken, 1990).

Restricting a child's diet without dietetic advice may lead to nutritional deficiencies and poor growth. If an allergy to cow's milk protein is diagnosed, it is important that exclusion is as complete as possible and that the patient is regularly reviewed by a State Registered Dietitian. Most children with a genuine cow's milk protein allergy cannot tolerate goat's milk or sheep's milk. Furthermore, a substantial proportion of babies who are allergic to milk proteins also become allergic to soya-based formulas (Hùst, 1997). Unlike foods such as peanuts and fish, abnormal reactions to cow's milk protein tend to be short-lived. Hùst (1997) observed that there was a remission rate of 45-55 per cent at one year, 60-75 per cent at two years and 85-90 per cent at three years. Consequently most children will be symptom free and reinstated on cow's milk by the time they go to school.

In conclusion, milk is able to make an important contribution to the dietary intake of young children. Unlike other drinks, it supplies important amounts of a wide range of essential nutrients while also being safe for teeth between meals. To communicate these messages to the parents of young children, the National Dairy Council has recently

produced a new booklet.Smile ± Your

Five-minute Guide to Cheeky Grinshas been written in collaboration with the Health Education Authority and contains information about how to select a healthy diet for one- to five-year-olds, easy-to-prepare recipes and advice on suitable drinks for children. To obtain a free copy, please write to ``Smile (Nutrition & Food Science)'', The National Dairy Council, 5-7 John Princes Street, London W1M 0AP. Alternatively, fax 0207/0171 408 1353; or e-mail [email protected]

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British Nutrition Foundation (1999),Oral Health: Diet and Other Factors, British Nutrition Foundation, London. Dalton, M.A.et al. (1997), ``Calcium and phosphorus

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Dennison, B.A.et al. (1997), ``Excess fruit juice consumption by pre-school-aged children is associated with short stature and obesity'', Pediatrics, Vol. 99, pp. 15-22.

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Hùst, A. (1997), ``Cow's milk allergy'',Journal ofthe Royal Society ofMedicine, Vol. 90 (suppl. 30), pp. 34-9.

Hùst, A. and Halken, S. (1990), ``A prospective study ofcow's milk allergy in Danish infants during the first three years of life'',Allergy, Vol. 45, pp. 587-96.

Illich-Ernst, J.Z.et al. (1998), ``Iron status, menarche, and calcium supplementation in adolescent girls'', American Journal ofClinical Nutrition, Vol. 68, pp. 880-7.

Minihane, A.M. and Fairweather-Tait, S.J. (1998), ``Effect ofcalcium supplementation on daily nonheme-iron absorption and long-term iron status'',American Journal ofClinical Nutrition, Vol. 68, pp. 96-102. Pitts, N.et al. (1999), ``The dental caries experience

of5-year-old children in the United Kingdom'',Surveys co-ordinated by the British Association for the Study ofCommunity Dentistry, Community Dental Health, Vol. 16, pp. 50-6.

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