-
General characteristic of the study population and distribution of the samples are outlined in Table 1. A total of 28, 250 children and adolescents aged 6-17 years old were included in this analysis, with 14, 168 boys (50.2%) and 14, 082 girls (49.8%) after data cleaning. Samples of the four age groups (6-8, 9-11, 12-14, and 15-17) were 6, 523/23.1%, 7, 090/25.1%, 7, 585/26.9%, and 7, 052/25.0%, respectively. Proportions of the five household income levels were significantly different, among which the proportion of household incomes of 5, 000-9, 999 CNY was highest (24.6%) and of 15, 000-19, 999 CNY lowest (12.0%).
Table 1. Characteristics across Categories of Frequencies of Dairy Consumption^
Sample Characteristics Sample Size, n(%) Dairy Consumption Frequency, n(%) Z/H Value (P Value) 0/week ≤ 1/week 2-6/week ≥ 1/day Total dairy 28, 250 (100.0) 3, 568 (12.6) 4, 095 (14.5) 10, 380 (36.7) 10, 207 (36.1) Gender 0.7521 (0.4520)* Boys 14, 168 (50.2) 1, 914 (13.5) 2, 016 (14.2) 5, 059 (35.7) 5, 179 (36.6) Girls 14, 082 (49.8) 1, 654 (11.7) 2, 079 (14.8) 5, 321 (37.8) 5, 028 (35.7) Age (y) 147.0331 (< 0.0001)# 6-8 6, 523 (23.1) 740 (11.3) 779 (11.9) 2, 401 (36.8) 2, 603 (39.9) 9-11 7, 090 (25.1) 840 (11.8) 924 (13.0) 2, 615 (36.9) 2, 711 (38.2) 12-14 7, 585 (26.9) 1, 004 (13.2) 1, 254 (16.5) 2, 701 (35.6) 2, 626 (34.6) 15-17 7, 052 (25.0) 984 (14.0) 1, 138 (16.1) 2, 663 (37.8) 2, 267 (32.1) Residential area 3431.0373 (< 0.0001)# Large city 6, 785 (24.0) 357 (5.3) 402 (5.9) 2, 033 (30.0) 3, 993 (58.9) Small-medium city 8, 131 (28.8) 886 (10.9) 829 (10.2) 3, 209 (39.5) 3, 207 (39.4) General rural area 8, 353 (29.6) 1, 186 (14.2) 1, 542 (18.5) 3, 379 (40.5) 2, 246 (26.9) Poor rural area 4, 981 (17.6) 1, 139 (22.9) 1, 322 (26.5) 1, 759 (35.3) 761 (15.3) Annual family income (CNY)a 1035.3793 (< 0.0001)# < 5, 000 4, 473 (21.2) 935 (20.9) 912 (20.4) 1, 552 (34.7) 1, 074 (24.0) 5, 000-9, 999 5, 196 (24.6) 748 (14.4) 962 (18.5) 1, 936 (37.3) 1, 550 (29.8) 10, 000-14, 999 4, 390 (20.8) 478 (10.9) 597 (13.6) 1, 668 (38.0) 1, 647 (37.5) 15, 000-19, 999 2, 539 (12.0) 232 (9.1) 267 (10.5) 1, 004 (39.5) 1, 036 (40.8) ≥ 20, 000 4, 530 (21.4) 385 (8.5) 354 (7.8) 1, 604 (35.4) 2, 187 (48.3) Fluid milk 28, 249 (100.0) 11, 752 (41.6) 3, 425 (12.1) 6, 725 (23.8) 6, 347 (22.5) Yogurt 28, 224 (100.0) 8, 455 (29.9) 7, 695 (27.2) 8, 260 (29.2) 3, 834 (13.6) Note.^Values are number (percentage) unless otherwise indicated; aThe sample size with completed frequency and income information was 21, 128; *Z value for the Wilcoxon Test; #H value for the Kruskal-Wallis H Test; CNY, China Yuan. -
Of the children and adolescents enrolled, 36.1% consumed total dairy food more than once per day (≥ 1/day), with decreased seen with age. This proportion in large cities, small-medium cities, general rural areas and poor rural areas were 58.9%, 39.4%, 26.9%, and 15.3%, respectively (P < 0.05). This proportion in the five income levels (< 5, 000, 5, 000-9, 999, 10, 000-14, 999, 15, 000-19, 999, and ≥ 20, 000) were 24.0%, 29.8%, 37.5%, 40.8%, and 48.3%, respectively (P < 0.05). Approximately 12.6% children did not consume dairy food (0/week). No significant differences were observed in dairy food consumption frequency between boys and girls (Table 1).
Children who consumed fluid and yogurt more than once per day (≥ 1/day) was 22.5% and 13.6%, respectively. About 41.6% children did not consume fluid milk and 29.9% children didn't consume yogurt (Table 1).
-
The average quantity of dairy consumption was 126.7 g/day in Chinese children and adolescents aged 6-17. Children who consumed more than 300 g/day of dairy food were 9.4%. The proportion of children consuming this level of dairy food was 18.8% in large cities and 2.7% in poor rural areas. The proportions of children consuming more than 200 g/day of dairy food were 29.9%, 27.5%, 25.7%, and 24.4% in the four age groups (6-8, 9-11, 12-14, and 15-17) and 44.9%, 29.7%, 18.8%, and 11.0% in the four area types (the large city, small-medium city, general rural area and poor rural area) (P < 0.05). These proportions increased with average annual household income (P < 0.05) (Table 2).
Table 2. Characteristics across Categories of Amount of Dairy Consumption^
Sample Characteristics Sample Size, n(%) Amount (g) n (%) by Distribution of Dairy Consumption Amounts Z/H Value (P Value) 0g 1-99 g 100-199 g 200-299 g ≥300g Total dairy 28, 210(100.0) 126.7 3, 568(12.6) 11, 532 (40.9) 5, 544 (19.7) 4, 918 (17.4) 2, 648 (9.4) Gender 0.4311(0.6664)* Boys 14, 114(50.1) 128.2 1, 914(13.5) 5, 645(39.9] 2, 694(19.0) 2, 550(18.0) 1, 341 (9.5) Girls 14, 066 (49.9) 125.2 1, 654(11.8) 5, 887 (41.9) 2, 850(20.3) 2, 368(16.8) 1, 307(9.3) Age (y) 69.4352 (< 0.0001)# 6-8 6, 509 (23.1) 135.1 740(11.4) 2, 544(39.1) 1, 277(19.6) 1, 343(20.6) 605 (9.3) 9-11 7, 088 (25.1) 127.8 840(11.9) 2, 809(39.6) 1, 486(21.0) 1, 328(18.7) 625 (8.8) 12-14 7, 572 (26.8) 124.6 1, 004(13.3) 3, 169 (41.9) 1, 453 (19.2) 1, 234(16.3) 712(9.4) 15-17 7, 041 (25.0) 122.9 984(14.0) 3, 010 (42.7) 1, 328(18.9) 1, 013(14.4) 705(10.0) Residential area 3082.6510 (< 0.0001)# Large city 6, 770(24.0) 190.1 357(5.3) 1, 819(26.9) 1, 557(23.0) 1, 766(26.1) 1, 271 (18.8) Small-medium city 8, H7 (52.8) 138.5 886 (10.9) 3, 030(37.3) 1, 790(22.1) 1, 593(19.6) 818(10.1) General rural area 8, 344(29.6) 99.8 1, 186(14.2) 3, 994 (47.9) 1, 591(19.1) 1, 147(13.7) 426(5.1) Poor rural area 4, 979 (17.6) 66.2 1, 139(22.9) 2, 689 (54.0) 606(12.2) 412(8.3) 133(2.7) Annual family income (CNY)a 815.3618 (< 0, 0001)# < 5, 000 4, 469 (21.2) 93.1 935 (20.9) 2, 050 (45.9) 632(14.1) 567(12.7) 285 (6.4) 5, 000-9, 999 5, 192 (24.6) 107.8 748 (14.4) 2, 416(46.5) 883(17.0) 785 (15.1) 360 (6.9) 10, 000-14, 999 4, 385 (20.8) 129.6 478 (10.9) 1, 811(41.3) 842(19.2) 887 (20.2) 367 (8.4) 15, 000-19, 999 2, 533 (12.0) 139.7 232(9.2) 968 (38.2) 558(22.0) 514(20.3) 261(10.3) ≥20, 000 4, 518(21.4) 160.1 385 (8.5) 1, 482(32.8) 1, 048(23.2) 979(21.7) 624(13.8) Fluid milk 28, 249 (100.0) 76.4 11, 752 (41.6) 7, 867(27.8) 3, 382 (12.0) 4, 455(15.8) 793 (2.8) Yogurt 28, 244(100.0) 45.8 8, 455(29.9) 15, 156(53.7) 2, 915(10.3) 1, 443 (5.1) 275 (1.0) Note. ^Values are number (percentage) unless otherwise indicated; aThe sample size with completed amount and income information was 21, 097; *Z value for the Wilcoxon Test; #H value for the Kruskal-Wallis H Test; CNY, China Yuan. The average quantity of fluid milk and yogurt were only 76.4 g/day and 45.8 g/day in Chinese children and adolescents (Table 2).
-
The proportions for stunting and wasting children were 2.2% and 7.6% in Chinese children and adolescents, respectively, with higher proportions in boys (2.4% and 8.8%) than in girls (2.0% and 6.4%) (P < 0.05). The 15-17 years old group had the highest stunting and wasting percentage with 2.9% and 8.1%, respectively (P < 0.05). The stunting and wasting proportions decreased with the development of cities and the increase of income level (P < 0.05). Proportions of stunting and wasting both decreased with the dairy consumption frequency (P < 0.05). These two proportions with a consumption of '≥ 1 /day' were 1.6% and 6.5%, while that with no dairy consumption ('0/week') were 3.9% and 9.3%. These trends in the quantity were almost the same as that in frequency (P < 0.05) (Table 3).
Table 3. Nutritional Characteristics of the Different Study Groups^
After adjustment for area, age, residential area development, average annual household income, consumption frequency of grains, meat and eggs, status of physical activity and sedentary time, dairy consumption frequency was negatively associated with stunting and wasting for boys, and only with stunting for girls. The relative risk (OR with 95% confidence interval) of stunting with total dairy consumption frequency of ≥ 1/day among boys was 0.616 (0.417-0.912) compared to 0/week. The relative risk of wasting was 0.738 (0.590-0.924) among boys in the ≥ 1/day frequency group. For the frequency of 2-6/week group and the quantity of 1-99 g group among girls, the relative risk of stunting was 0.570 (0.376-0.862) and 0.560 (0.379-0.830). There were no significant association between wasting and total dairy consumption among girls (Table 4).
Table 4. Association between Total Dairy Consumption and Nutrition Status in Boys and Girls^
For boys, the consumption frequency of fluid milk was negatively associated with stunting, and the relative risk of stunting with consumption frequency of fluid milk of 2-6/week was 0.663 (0.461-0.951) comparing to 0/week (Supplementary Table 1 available in www.besjournal.com). The consumption of yogurt was negatively with stunting for girls, and with wasting for boys (Supplementary Table S2 available in www.besjournal.com).
Table Supplementary Table 1. Association between Fluid Milk Consumption and Nutrition Status in Boys and Girls^
Table Supplementary Table 2. Association between Yogurt Consumption and Nutrition Status in Boys and Girls^
-
Of this study population of children, 10.7% were overweight and 5.9% obese. The proportion of boys who were overweight (12.6%) or obese (7.8%) were both higher than that of girls who were overweight (8.8%) or obese (4.0%) (P < 0.05). In the 9-11 age group, 12% were overweight, which was the most within the four age groups (6-8, 9-11, 12-14, and 15-17). The highest proportion of obesity was 9.6% and within the 6-8 age group. As the development of cities expanded and income of families increased, the proportion of overweight and obese children rose (P < 0.05). The proportion of obese children went up with the frequency of dairy food consumption. Obesity proportions within the four age groups for dairy consumption frequency were 5.1%, 5.2%, 5.6%, and 6.8%, and that of the five quantity groups were 5.1%, 5.4%, 6.4%, 6.5%, and 6.8% (P < 0.05). The overweight proportion with quantity followed the same trend (Table 3).
Logistic regression analysis showed that the association between total dairy consumption and obesity among boys and girls were significant after controlling for area, age, residential area development, average annual household income, consumption frequency of grains, meat and eggs, status of physical activity and sedentary time. The relative risk of obesity with the consumption quantity of 200-299 g in boys were 0.738 (0.555-0.981), and the relative risk of obesity with the consumption quantity of ≥ 300 g in girls was 0.561 (0.350-0.899) (Table 4). Similar relationship were found in the consumption of fluid milk in girls (Supplementary Table S1). There was no significant association between dairy consumption with overweight.
doi: 10.3967/bes2019.054
Dairy Consumption and Associations with Nutritional Status of Chinese Children and Adolescents
-
Abstract:
Objective This study aimed to describe frequency and quantity of total dairy consumption of Chinese children and adolescents and explore the associations between dairy consumption and nutrition status, including stunting, wasting, overweight, and obesity. Methods Participants included 28, 250 children and adolescents aged 6-17 years old. A food frequency questionnaire (FFQ) including 100 kinds of food was used to collect information about frequency and quantity of dairy consumption. Determination of stunting was with a height cutoff value for age and gender, and determination for wasting, overweight, and obesity was with BMI for age and gender. Results Of the total sample, 36.1% of children aged 6-17 reported consuming dairy food more than once per day (≥ 1/day). The average total dairy intake of all the participants was 126.7 g/day. For boys, dairy consumption had an inverse correlation with stunting and wasting after controlling for confounders. For girls, dairy consumption was negatively associated with stunting and obesity after controlling for confounders as above. Conclusion Dairy consumption in Chinese children and adolescents was relatively lower than that in developed countries, and was negatively associated with stunting and wasting for boys and with stunting and obesity for girls. -
Key words:
- Dairy consumption /
- Children and adolescents /
- Nutrition status /
- Association /
- China
-
Table 1. Characteristics across Categories of Frequencies of Dairy Consumption^
Sample Characteristics Sample Size, n(%) Dairy Consumption Frequency, n(%) Z/H Value (P Value) 0/week ≤ 1/week 2-6/week ≥ 1/day Total dairy 28, 250 (100.0) 3, 568 (12.6) 4, 095 (14.5) 10, 380 (36.7) 10, 207 (36.1) Gender 0.7521 (0.4520)* Boys 14, 168 (50.2) 1, 914 (13.5) 2, 016 (14.2) 5, 059 (35.7) 5, 179 (36.6) Girls 14, 082 (49.8) 1, 654 (11.7) 2, 079 (14.8) 5, 321 (37.8) 5, 028 (35.7) Age (y) 147.0331 (< 0.0001)# 6-8 6, 523 (23.1) 740 (11.3) 779 (11.9) 2, 401 (36.8) 2, 603 (39.9) 9-11 7, 090 (25.1) 840 (11.8) 924 (13.0) 2, 615 (36.9) 2, 711 (38.2) 12-14 7, 585 (26.9) 1, 004 (13.2) 1, 254 (16.5) 2, 701 (35.6) 2, 626 (34.6) 15-17 7, 052 (25.0) 984 (14.0) 1, 138 (16.1) 2, 663 (37.8) 2, 267 (32.1) Residential area 3431.0373 (< 0.0001)# Large city 6, 785 (24.0) 357 (5.3) 402 (5.9) 2, 033 (30.0) 3, 993 (58.9) Small-medium city 8, 131 (28.8) 886 (10.9) 829 (10.2) 3, 209 (39.5) 3, 207 (39.4) General rural area 8, 353 (29.6) 1, 186 (14.2) 1, 542 (18.5) 3, 379 (40.5) 2, 246 (26.9) Poor rural area 4, 981 (17.6) 1, 139 (22.9) 1, 322 (26.5) 1, 759 (35.3) 761 (15.3) Annual family income (CNY)a 1035.3793 (< 0.0001)# < 5, 000 4, 473 (21.2) 935 (20.9) 912 (20.4) 1, 552 (34.7) 1, 074 (24.0) 5, 000-9, 999 5, 196 (24.6) 748 (14.4) 962 (18.5) 1, 936 (37.3) 1, 550 (29.8) 10, 000-14, 999 4, 390 (20.8) 478 (10.9) 597 (13.6) 1, 668 (38.0) 1, 647 (37.5) 15, 000-19, 999 2, 539 (12.0) 232 (9.1) 267 (10.5) 1, 004 (39.5) 1, 036 (40.8) ≥ 20, 000 4, 530 (21.4) 385 (8.5) 354 (7.8) 1, 604 (35.4) 2, 187 (48.3) Fluid milk 28, 249 (100.0) 11, 752 (41.6) 3, 425 (12.1) 6, 725 (23.8) 6, 347 (22.5) Yogurt 28, 224 (100.0) 8, 455 (29.9) 7, 695 (27.2) 8, 260 (29.2) 3, 834 (13.6) Note.^Values are number (percentage) unless otherwise indicated; aThe sample size with completed frequency and income information was 21, 128; *Z value for the Wilcoxon Test; #H value for the Kruskal-Wallis H Test; CNY, China Yuan. Table 2. Characteristics across Categories of Amount of Dairy Consumption^
Sample Characteristics Sample Size, n(%) Amount (g) n (%) by Distribution of Dairy Consumption Amounts Z/H Value (P Value) 0g 1-99 g 100-199 g 200-299 g ≥300g Total dairy 28, 210(100.0) 126.7 3, 568(12.6) 11, 532 (40.9) 5, 544 (19.7) 4, 918 (17.4) 2, 648 (9.4) Gender 0.4311(0.6664)* Boys 14, 114(50.1) 128.2 1, 914(13.5) 5, 645(39.9] 2, 694(19.0) 2, 550(18.0) 1, 341 (9.5) Girls 14, 066 (49.9) 125.2 1, 654(11.8) 5, 887 (41.9) 2, 850(20.3) 2, 368(16.8) 1, 307(9.3) Age (y) 69.4352 (< 0.0001)# 6-8 6, 509 (23.1) 135.1 740(11.4) 2, 544(39.1) 1, 277(19.6) 1, 343(20.6) 605 (9.3) 9-11 7, 088 (25.1) 127.8 840(11.9) 2, 809(39.6) 1, 486(21.0) 1, 328(18.7) 625 (8.8) 12-14 7, 572 (26.8) 124.6 1, 004(13.3) 3, 169 (41.9) 1, 453 (19.2) 1, 234(16.3) 712(9.4) 15-17 7, 041 (25.0) 122.9 984(14.0) 3, 010 (42.7) 1, 328(18.9) 1, 013(14.4) 705(10.0) Residential area 3082.6510 (< 0.0001)# Large city 6, 770(24.0) 190.1 357(5.3) 1, 819(26.9) 1, 557(23.0) 1, 766(26.1) 1, 271 (18.8) Small-medium city 8, H7 (52.8) 138.5 886 (10.9) 3, 030(37.3) 1, 790(22.1) 1, 593(19.6) 818(10.1) General rural area 8, 344(29.6) 99.8 1, 186(14.2) 3, 994 (47.9) 1, 591(19.1) 1, 147(13.7) 426(5.1) Poor rural area 4, 979 (17.6) 66.2 1, 139(22.9) 2, 689 (54.0) 606(12.2) 412(8.3) 133(2.7) Annual family income (CNY)a 815.3618 (< 0, 0001)# < 5, 000 4, 469 (21.2) 93.1 935 (20.9) 2, 050 (45.9) 632(14.1) 567(12.7) 285 (6.4) 5, 000-9, 999 5, 192 (24.6) 107.8 748 (14.4) 2, 416(46.5) 883(17.0) 785 (15.1) 360 (6.9) 10, 000-14, 999 4, 385 (20.8) 129.6 478 (10.9) 1, 811(41.3) 842(19.2) 887 (20.2) 367 (8.4) 15, 000-19, 999 2, 533 (12.0) 139.7 232(9.2) 968 (38.2) 558(22.0) 514(20.3) 261(10.3) ≥20, 000 4, 518(21.4) 160.1 385 (8.5) 1, 482(32.8) 1, 048(23.2) 979(21.7) 624(13.8) Fluid milk 28, 249 (100.0) 76.4 11, 752 (41.6) 7, 867(27.8) 3, 382 (12.0) 4, 455(15.8) 793 (2.8) Yogurt 28, 244(100.0) 45.8 8, 455(29.9) 15, 156(53.7) 2, 915(10.3) 1, 443 (5.1) 275 (1.0) Note. ^Values are number (percentage) unless otherwise indicated; aThe sample size with completed amount and income information was 21, 097; *Z value for the Wilcoxon Test; #H value for the Kruskal-Wallis H Test; CNY, China Yuan. Table 3. Nutritional Characteristics of the Different Study Groups^
Table 4. Association between Total Dairy Consumption and Nutrition Status in Boys and Girls^
Supplementary Table 1. Association between Fluid Milk Consumption and Nutrition Status in Boys and Girls^
Supplementary Table 2. Association between Yogurt Consumption and Nutrition Status in Boys and Girls^
-
[1] CDC IoNaFSC. China food composition. Beijing, China:Peking University Medical Press, 2004. [2] Levine RS. Milk, flavoured milk products and caries. Br Dent J, 2001; 191, 20. doi: 10.1038/sj.bdj.4801080 [3] Coudray B. The contribution of dairy products to micronutrient intakes in France. J Am Coll Nutr, 2011; 30, 410S-4S. doi: 10.1080/07315724.2011.10719984 [4] Keyou G, Fengying Z, Xiaoguang Y. Report on Chinese Residents'Nutrition and Health Status 2002. Beijing:People's Health Publishing House, 2006. [5] Zhenni Y, Lin Z, Guangyan C. China's Characteristics of Dairy Consumption and Mid-long-term Trend Prediction. Chinese Journal of Animal Science, 2016; 52, 46-9. (In Chinese) http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=zgxmzz201602010 [6] Loud KJ, Gordon CM. Adolescent bone health. Arch Pediatr Adolesc Med, 2006; 160, 1026-32. doi: 10.1001/archpedi.160.10.1026 [7] Merrilees MJ, Smart EJ, Gilchrist NL, et al. Effects of diary food supplements on bone mineral density in teenage girls. Eur J Nutr, 2000; 39, 256-62. doi: 10.1007/s003940070004 [8] Black RE, Williams SM, Jones IE, et al. Children who avoid drinking cow milk have low dietary calcium intakes and poor bone health. Am J Clin Nutr, 2002; 76, 675-80. doi: 10.1093/ajcn/76.3.675 [9] Lee WT, Leung SS, Leung DM, et al. A randomized double-blind controlled calcium supplementation trial, and bone and height acquisition in children. Br J Nutr, 1995; 74, 125-39. doi: 10.1079/BJN19950112 [10] Dibba B, Prentice A, Ceesay M, et al. Effect of calcium supplementation on bone mineral accretion in gambian children accustomed to a low-calcium diet. Am J Clin Nutr, 2000; 71, 544-9. doi: 10.1093/ajcn/71.2.544 [11] Drewnowski A. The contribution of milk and milk products to micronutrient density and affordability of the U. S. diet. J Am Coll Nutr, 2011; 30, 422S-8S. doi: 10.1080/07315724.2011.10719986 [12] Hoppe C, Molgaard C, Michaelsen KF. Cow's milk and linear growth in industrialized and developing countries. Annu Rev Nutr, 2006; 26, 131-73. doi: 10.1146/annurev.nutr.26.010506.103757 [13] Collaboration NCDRF. Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016:a pooled analysis of 2416 population-based measurement studies in 128. 9 million children, adolescents, and adults. Lancet, 2017; 390, 2627-42. doi: 10.1016/S0140-6736(17)32129-3 [14] Mazidi M, Banach M, Kengne AP. Lipid, Blood Pressure Meta-analysis Collaboration G. Prevalence of childhood and adolescent overweight and obesity in Asian countries:a systematic review and meta-analysis. Arch Med Sci, 2018; 14, 1185-203. doi: 10.5114/aoms.2018.79001 [15] Teegarden D, Zemel MB. Dairy product components and weight regulation:symposium overview. J Nutr, 2003; 133, 243S-4S. doi: 10.1093/jn/133.1.243S [16] Zemel MB, Miller SL. Dietary calcium and dairy modulation of adiposity and obesity risk. Nutr Rev, 2004; 62, 125-31. doi: 10.1111/nure.2004.62.issue-4 [17] Weaver CM, Boushey CJ. Milk——good for bones, good for reducing childhood obesity? J Am Diet Assoc, 2003; 103, 1598-9. doi: 10.1016/j.jada.2003.10.037 [18] Beck AL, Heyman M, Chao C, et al. Full fat milk consumption protects against severe childhood obesity in Latinos. Preve Med Rep, 2017; 8, 1-5. doi: 10.1016/j.pmedr.2017.07.005 [19] Dror DK, Allen LH. Dairy product intake in children and adolescents in developed countries:trends, nutritional contribution, and a review of association with health outcomes. Nutr Rev, 2014; 72, 68-81. doi: 10.1111/nure.12078 [20] Oakley E, Reinking J, Sandige H, et al. A ready-to-use therapeutic food containing 10% milk is less effective than one with 25% milk in the treatment of severely malnourished children. J Nutr, 2010; 140, 2248-52. doi: 10.3945/jn.110.123828 [21] Lien do TK, Nhung BT, Khan NC, et al. Impact of milk consumption on performance and health of primary school children in rural Vietnam. Asia Pac J Clin Nutr, 2009; 18, 326-34. [22] Zhao L, Ma G, Piao J, et al. Scheme of the 2010-2012 Chinese nutrition and health surveillance. Chinese Journal of Preventive Medicine, 2016; 50, 204-7. (In Chinese) http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=zhyfyx201603002 [23] Zhao WH, Huang ZP, Zhang X, et al. Reproducibility and Validity of a Chinese Food Frequency Questionnaire. Biomed Environ Sci, 2010; 23, 1-38. [24] National Health and Family Planning Commission of the People's Republic of China. Screening Standard For Malnutrition Of School-age Children And Adolescents (WS/T456-2014).[2014-12-15] [25] Ministry of Health of the People's Republic of China. Technical Standard For Physical Examination For students (GB/T26343-2010).[2011-05-01] [26] Society CN. Dietary Guidelines of Chinese School-aged Children. Beijing, China:People's Health Publishing House, 2016. [27] Du WW, Wang HJ, Wang ZH, et al. Trend of milk consumption among Chinese children and adolescents aged 7 to 17 years old in 9 provinces from 1991 to 2006. Chinese Journal of Epidemiology, 2010; 31, 1349-52. (In Chinese) http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=zhlxbx201012006 [28] Pu YY, Zhang F, Wang H, et al. Systematic Review of the Implementation of School Milk Program in China and Its Impact on Growth and Development in School-aged Children. Journal of China Medical University, 2015; 44, 978-86. (In Chinese) [29] Zhang F, Hu X, Tian Z, et al. Literature research of the Nutrition Improvement Programme for Rural Compulsory Education Students in China. Public Health Nutr, 2015; 18, 936-43. doi: 10.1017/S1368980014001001 [30] Lasater G, Piernas C, Popkin BM. Beverage patterns and trends among school-aged children in the US, 1989-2008. Nutr J, 2011; 10, 103. doi: 10.1186/1475-2891-10-103 [31] Lioret S, Dubuisson C, Dufour A, et al. Trends in food intake in French children from 1999 to 2007:results from the INCA (etude Individuelle Nationale des Consommations Alimentaires) dietary surveys. Br J Nutr, 2010; 103, 585-601. doi: 10.1017/S0007114509992078 [32] Parker CE, Vivian WJ, Oddy WH, et al. Changes in dairy food and nutrient intakes in Australian adolescents. Nutrients, 2012; 4, 1794-811. doi: 10.3390/nu4121794 [33] Alexy U, Kersting M. Time trends in the consumption of dairy foods in German children and adolescents. Eur J Clin Nutr, 2003; 57, 1331-7. doi: 10.1038/sj.ejcn.1601696 [34] Striegel-Moore RH, Thompson D, Affenito SG, et al. Correlates of beverage intake in adolescent girls:the National Heart, Lung, and Blood Institute Growth and Health Study. J Pediatr, 2006; 148, 183-7. doi: 10.1016/j.jpeds.2005.11.025 [35] Evans AE, Springer AE, Evans MH, et al. A descriptive study of beverage consumption among an ethnically diverse sample of public school students in Texas. J Am Coll Nutr, 2010; 29, 387-96. doi: 10.1080/07315724.2010.10719856 [36] Goh DY, Jacob A. Children's consumption of beverages in Singapore:knowledge, attitudes and practice. J Paediatr Child Health, 2011; 47, 465-72. doi: 10.1111/jpc.2011.47.issue-7 [37] Keller KL, Kirzner J, Pietrobelli A, et al. Increased sweetened beverage intake is associated with reduced milk and calcium intake in 3-to 7-year-old children at multi-item laboratory lunches. J Am Diet Assoc, 2009; 109, 497-501. doi: 10.1016/j.jada.2008.11.030 [38] Mrdjenovic G, Levitsky DA. Nutritional and energetic consequences of sweetened drink consumption in 6-to 13-year-old children. J Pediatr, 2003; 142, 604-10. doi: 10.1067/mpd.2003.200 [39] Huang TT, McCrory MA. Dairy intake, obesity, and metabolic health in children and adolescents:knowledge and gaps. Nutr Rev, 2005; 63, 71-80. doi: 10.1111/nure.2005.63.issue-3 [40] Du WW, Zhang B, Wang HJ, et al. Milk consumption and effects on dietary nutrients and growth status among Chinese children in nine provinces (autonomous region) from 1991 to 2006. Chinese Journal of Preventive Medicine, 2011; 45, 313-7. (In Chinese) http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=zhyfyx201104006 [41] Zhang J, Wang D, Eldridge AL, et al. Urban-Rural Disparities in Energy Intake and Contribution of Fat and Animal Source Foods in Chinese Children Aged 4-17 Years. Nutrients, 2017; 9. [42] Yingli N. The Study on the Influence of Income on the Milk Consumption of Urban Residents. Chinese Agricultural Science Bulletin, 2009; 25, 332-7. (In Chinese) [43] Yi S, Yue Z, Yumei S. Dairy Product Industry Trust, Quality and Safety Perception and Consumer Behavior. Food and Nutrition in China, 2018; 24, 57-63. (In Chinese) http://d.old.wanfangdata.com.cn/Periodical/zgswyyy201807014 [44] Haibo S, Jingdong L. Regional difference of the factors affecting urban residents' dairy consumption:Based on panel data from 2002 to 2011 of China's eastern, central and western region. Journal of Hunan Agricultural University (Social Science), 2013; 14, 6. (In Chinese) [45] Barr SI. Associations of social and demographic variables with calcium intakes of high school students. J Am Diet Assoc, 1994; 94, 260-6. doi: 10.1016/0002-8223(94)90366-2 [46] Forshee RA, Storey ML. Total beverage consumption and beverage choices among children and adolescents. Int J Food Sci Nutr, 2003; 54, 297-307. doi: 10.1080/09637480120092143 [47] Fulgoni V, Nicholls J, Reed A, et al. Dairy consumption and related nutrient intake in African-American adults and children in the United States:continuing survey of food intakes by individuals 1994-1996, 1998, and the National Health And Nutrition Examination Survey 1999-2000. J Am Diet Assoc, 2007; 107, 256-64. doi: 10.1016/j.jada.2006.11.007 [48] Mensink GB, Kleiser C, Richter A. Food consumption of children and adolescents in Germany. Results of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS). Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz, 2007; 50, 609-23. [49] Novotny R, Boushey C, Bock MA, et al. Calcium intake of Asian, Hispanic and white youth. J Am Coll Nutr, 2003; 22, 64-70. doi: 10.1080/07315724.2003.10719277 [50] Sweeting HN. Gendered dimensions of obesity in childhood and adolescence. Nutr J, 2008; 7, 1. doi: 10.1186/1475-2891-7-1 [51] Leighton G, Clark ML. Milk Consumption And the Growth Of School Children:Second Preliminary Report on Tests To the Scottish Board Of Health. British Medical J, 1929; 1, 23-5. doi: 10.1136/bmj.1.3548.23 [52] Baker IA, Elwood PC, Hughes J, et al. A randomised controlled trial of the effect of the provision of free school milk on the growth of children. J Epidemiol Community Health, 1980; 34, 31-4. doi: 10.1136/jech.34.1.31 [53] Berkey CS, Rockett HR, Field AE, et al. Activity, dietary intake, and weight changes in a longitudinal study of preadolescent and adolescent boys and girls. Pediatrics, 2000; 105, E56. doi: 10.1542/peds.105.4.e56 [54] Wang W, Wu Y, Zhang D. Association of dairy products consumption with risk of obesity in children and adults:a meta-analysis of mainly cross-sectional studies. Ann Epidemiol, 2016; 26, 870-82e2. doi: 10.1016/j.annepidem.2016.09.005 [55] Louie JC, Flood VM, Hector DJ, et al. Dairy consumption and overweight and obesity:a systematic review of prospective cohort studies. Obes Rev, 2011; 12, e582-92. doi: 10.1111/obr.2011.12.issue-7 [56] Zemel MB, Shi H, Greer B, et al. Regulation of adiposity by dietary calcium. FASEB J, 2000; 14, 1132-8. doi: 10.1096/fasebj.14.9.1132 [57] Bonjour JP, Carrie AL, Ferrari S, et al. Calcium-enriched foods and bone mass growth in prepubertal girls:a randomized, double-blind, placebo-controlled trial. J Clin Invest, 1997; 99, 1287-94. doi: 10.1172/JCI119287 [58] Wiley AS. Dairy and milk consumption and child growth:Is BMI involved? An analysis of NHANES 1999-2004. Am J Hum Biol, 2010; 22, 517-25. doi: 10.1002/ajhb.v22:4