Consumption of Milk Beverages Reduces Iron, Vitamin A, Vitamin C, Calcium, and B Vitamins Inadequacies in Pakistani School-Aged Children from Sindh and Punjab: A Diet Modeling Study

Background: Only 47% of households in Pakistan's Sindh and Punjab provinces are food secure. More than 80% of 5-9 y old children are below recommended intakes of calcium, iron, zinc, and vitamin A and vitamin D. Although 89% consume dairy products daily, only 3% comply with Pakistan's recommended dairy consumption of 2-3 servings/d.

Objectives: The objectives of this study were to evaluate the theoretical impact of substituting or adding fortified milk and/or buffalo milk in the diets of Pakistani school-aged children to address nutrient inadequacy.

Methods: Dairy consumption and nutrient intakes were calculated using dietary data collected from 5842 children via a 24-h diet recall in the School-age Children Health and Nutrition Survey conducted in Sindh and Punjab provinces of Pakistan between 2019 and 2020. Given daily intakes documented in the School-age Children Health and Nutrition Survey, 2 modeling scenarios were applied to test the impact on nutrient intakes of 1) substituting current milk (buffalo, cow, and goat) consumption (volume by volume) with a fortified milk beverage and 2) adding a fortified milk beverage or buffalo milk to current consumption to meet dairy consumption recommendations.

Results: The hypothetical substitution of current milk consumption with fortified milk lowered nutrient inadequacies for vitamin C (by 86%), vitamin A (by 45%), thiamin (by 26%), riboflavin (by 14%), vitamin B6 (by 13%), calcium (by 8%), and iron (by 7%), compared to baseline (relative percent reduction). Among children consuming <2 dairy servings/d, theoretically adding buffalo milk had a positive contribution to calcium, phosphorous, zinc, vitamin A, vitamin C, riboflavin, niacin, and folate; theoretically adding fortified milk additionally reduced inadequacies of iron, thiamin, vitamin B6, and greatly reduced vitamin C inadequacy.

Conclusions: Buffalo milk and fortified milk each have their own value in closing nutrient gaps. Increasing their consumption can be integrated into a multi-pronged public health strategy (including fortified foods, ensuring food security, and diet diversity) to tackle nutrient inadequacies in children.