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Cow’s milk fat and child adiposity: a prospective cohort study



International guidelines recommend children aged 9 months to 2 years consume whole (3.25%) fat cow’s milk, and children older than age 2 years consume reduced (0.1–2%) fat cow’s milk to prevent obesity. The objective of this study was to evaluate the longitudinal relationship between cow’s milk fat (0.1–3.25%) intake and body mass index z-score (zBMI) in childhood. We hypothesized that higher cow’s milk fat intake was associated with lower zBMI.


A prospective cohort study of children aged 9 months to 8 years was conducted through the TARGet Kids! primary care research network. The exposure was cow’s milk fat consumption (skim (0.1%), 1%, 2%, whole (3.25%)), measured by parental report. The outcome was zBMI. Height and weight were measured by trained research assistants and zBMI was determined according to WHO growth standards. A linear mixed effects model and logistic generalized estimating equations were used to determine the longitudinal association between cow’s milk fat intake and child zBMI.


Among children aged 9 months to 8 years (N = 7467; 4699 of whom had repeated measures), each 1% increase in cow’s milk fat consumed was associated with a 0.05 lower zBMI score (95% CI −0.07 to −0.03, p < 0.0001) after adjustment for covariates including volume of milk consumed. Compared to children who consumed reduced fat (0.1–2%) milk, there was evidence that children who consumed whole milk had 16% lower odds of overweight (OR = 0.84, 95% CI 0.77 to 0.91, p < 0.0001) and 18% lower odds of obesity (OR = 0.82, 95% CI 0.68 to 1.00, p = 0.047).


Guidelines for reduced fat instead of whole cow’s milk during childhood may not be effective in preventing overweight or obesity.

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Fig. 1: Participant flow diagram.
Fig. 2: The relationship between cow’s milk fat and zBMI in children aged 9 months to 8 years, adjusted for clinically relevant covariates.


  1. Abarca-Gómez L, Abdeen ZA, Hamid ZA, et al. 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. The Lancet. 2017;390:2627–42.

    Article  Google Scholar 

  2. Bancej C, Jayabalasingham B, Wall RW, Rao DP, Do MT, de Groh M, et al. Evidence brief—trends and projections of obesity among Canadians. Health Promot Chronic Dis Prev Can. 2015;35:109–12.

    Article  CAS  Google Scholar 

  3. Public Health Agency of Canada. Actions taken and future directions 2011: curbing childhood obesity: a federal, provincial and territorial framework for action to promote healthy weights. Government of Canada. Ottawa, ON; 2011.

  4. Harcombe Z. Dietary fat guidelines have no evidence base: where next for public health nutritional advice? Br J Sports Med. 2017;51:769–74.

    Article  Google Scholar 

  5. Lott M, Callahan E, Welker Duffy E, Story M, Daniels S. Healthy Beverage Consumption in Early Childhood: Recommendations from Key National Health and Nutrition Organizations. Consensus Statement. Durham, NC: Healthy Eating Research, 2019. Available at

  6. Gidding SS, Dennison BA, Birch LL, Daniels SR, Gillman MW, Lichtenstein AH, et al. Dietary recommendations for children and adolescents: a guide for practitioners. Pediatrics. 2006;117:544–59.

    Article  Google Scholar 

  7. Canadian Pediatric Society. Feeding your baby in the first year: Canadian Pediatric Society. 2014. Accessed May 2020.

  8. National Health Service. What to feed young children UK. 2016.

  9. Maillot M, Rehm CD, Vieux F, Rose CM, Drewnowski A. Beverage consumption patterns among 4-19 y old children in 2009-14 NHANES show that the milk and 100% juice pattern is associated with better diets. Nutr J. 2018;17:54.

    Article  Google Scholar 

  10. Garriguet D. Beverage consumption of children and teens. Statistics Canada, Catalogue no. 82-003-XPE. Health Reports. 2008;19:4.

    Google Scholar 

  11. Thorning TK, Bertram HC, Bonjour JP, de Groot L, Dupont D, Feeney E, et al. Whole dairy matrix or single nutrients in assessment of health effects: current evidence and knowledge gaps. Am J Clin Nutr. 2017;105:1033–45.

    Article  CAS  Google Scholar 

  12. Moreno LA, Bel-Serrat S, Santaliestra-Pasias A, Bueno G. Dairy products, yogurt consumption, and cardiometabolic risk in children and adolescents. Nutr Rev. 2015;73(Suppl 1):8–14.

    Article  Google Scholar 

  13. Vanderhout SM, Aglipay M, Torabi N, Juni P, da Costa BR, Birken CS, et al. Whole milk compared with reduced-fat milk and childhood overweight: a systematic review and meta-analysis. Am J Clin Nutr. 2019;111:266–79.

    Article  Google Scholar 

  14. O'Sullivan TA, Schmidt KA, Kratz M. Whole-fat or reduced-fat dairy product intake, adiposity, and cardiometabolic health in children: a systematic review. Adv Nutr. 2020;11:928–50.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Dror DK. Dairy consumption and pre-school, school-age and adolescent obesity in developed countries: a systematic review and meta-analysis. Obes Rev. 2014;15:516–27.

    Article  CAS  Google Scholar 

  16. Louie JC, Flood VM, Hector DJ, Rangan AM, Gill TP. Dairy consumption and overweight and obesity: a systematic review of prospective cohort studies. Obes Rev. 2011;12:e582–92.

    Article  CAS  Google Scholar 

  17. Vanderhout SM, Birken CS, Parkin PC, Lebovic G, Chen Y, O’Connor DL, et al. Relation between milk-fat percentage, vitamin D, and BMI z score in early childhood. Am J Clin Nutr. 2016;104:1657–64.

    Article  CAS  Google Scholar 

  18. Carsley S, Borkhoff CM, Maguire JL, et al. Cohort Profile: The Applied Research Group for Kids (TARGet Kids!). International Journal of Epidemiology. 2015;44:776–88.

  19. Statistics Canada. Canadian Community Health Survey—annual component (CCHS). Ottawa: Statistics Canada; 2013.

    Google Scholar 

  20. Centers for Disease Control and Prevention. Third National Health and Nutrition Examination (NHANES III). [Video]. Pittsburgh, PA: Centers for Disease Control and Prevention and National Center for Health Statistics; 2003.

    Google Scholar 

  21. Guideline: assessing and managing children at primary health-care facilities to prevent overweight and obesity in the context of the double burden of malnutrition. Updates for the Integrated Management of Childhood Illness (IMCI). Geneva: World Health Organization; 2017. Licence: CC BY-NC-SA 3.0 IGO.

  22. Satkunam M, Anderson LN, Carsley S, Maguire JL, Parkin PC, Sprague AE, et al. Severe obesity in children 17 to 24 months of age: a cross-sectional study of TARGet Kids! and Better Outcomes Registry & Network (BORN) Ontario. Can J Public Health. 2018;109:489–97.

    Article  Google Scholar 

  23. Carsley S, Pope EI, Anderson LN, Tremblay MS, Tu K, Birken CS, et al. Temporal trends in severe obesity prevalence in children and youth from primary care electronic medical records in Ontario: a repeated cross-sectional study. CMAJ Open. 2019;7:E351–9.

    Article  Google Scholar 

  24. Carsley SE, Anderson LN, Plumptre L, Parkin PC, Maguire JL, Birken CS. Severe obesity, obesity, and cardiometabolic risk in children 0 to 6 years of age. Child Obes. 2017;13:415–24.

    Article  Google Scholar 

  25. Eny KM, Chen S, Anderson LN, Chen Y, Lebovic G, Pullenayegum E, et al. Breastfeeding duration, maternal body mass index, and birth weight are associated with differences in body mass index growth trajectories in early childhood. Am J Clin Nutr. 2018;107:584–92.

    Article  Google Scholar 

  26. van Buuren S. mice Package for R. 2019.

  27. O’Brien R. A caution regarding rules of thumb for variance inflation factors. Qual Quant. 2007;41:673–90.

    Article  Google Scholar 

  28. Hojsgaard SHU, Yan J. Package ‘geepack’. 1.2-1 ed. 2016.

  29. Touloumis A. multgee: GEE Solver for Correlated Nominal or Ordinal Multinomial Responses. 1.6.0 ed. 2017.

  30. Pinheiro JBD, DebRoy S, Sarkar D, Heisterkamp S, Van Willigen B. Package ‘nlme’. 3.1-141 ed. 2019.

  31. Bates DMM, Bolker B, Walker S, Christensen RHB, Singmann H, Daj B, et al. Package ‘lme4’. 1.1-12 ed. 2019.

  32. R Core Team. R: a language and environment for statistical computing. Vienna, Austria: R Foundation for Statistical Computing; 2014.

  33. Brown T, Moore TH, Hooper L, Gao Y, Zayegh A, Ijaz S, et al. Interventions for preventing obesity in children. Cochrane Database Syst Rev. 2019;7:CD001871.

    PubMed  Google Scholar 

  34. Hoelscher DM, Kirk S, Ritchie L, Cunningham-Sabo L,Academy Positions Committee.Position of the academy of nutrition and dietetics: interventions for the prevention and treatment of pediatric overweight and obesity. J Acad Nutr Diet. 2013;113:1375–94.

    Article  Google Scholar 

  35. Sacks FM, Lichtenstein AH, Wu JHY, Appel LJ, Creager MA, Kris-Etherton PM, et al. Dietary fats and cardiovascular disease: a presidential advisory from the American Heart Association. Circulation. 2017;136:e1–23.

    Article  Google Scholar 

  36. Critch JN, Canadian Paediatric Society; Nutrition and Gastroenterology Committee. Nutrition for healthy term infants, six to 24 months: an overview. Paediatr Child Health. 2014;19:547–52.

    PubMed  PubMed Central  Google Scholar 

  37. NHMRC (National Health and Medical Research Council). Infant Feeding Guidelines: Summary. Canberra: National Health and Medical Research Council. 2013.

  38. Allen RE, Myers AL. Nutrition in toddlers. Am Fam Physician. 2006;74:1527–32.

    PubMed  Google Scholar 

  39. Obarzanek E, Hunsberger SA, Van Horn L, Hartmuller VV, Barton BA, Stevens VJ, et al. Safety of a fat-reduced diet: the Dietary Intervention Study in Children (DISC). Pediatrics. 1997;100:51–9.

    Article  CAS  Google Scholar 

  40. Niinikoski H, Viikari J, Ronnemaa T, Helenius H, Jokinen E, Lapinleimu H, et al. Regulation of growth of 7- to 36-month-old children by energy and fat intake in the prospective, randomized STRIP baby trial. Pediatrics. 1997;100:810–6.

    Article  CAS  Google Scholar 

  41. Hendrie GA, Golley RK. Changing from regular-fat to low-fat dairy foods reduces saturated fat intake but not energy intake in 4-13-y-old children. Am J Clin Nutr. 2011;93:1117–27.

    Article  CAS  Google Scholar 

  42. Kavezade SAM, Asemi M, Salehi-Abargouei A. The effects of whole milk compared to skim milk and apple juice consumption in breakfast on appetite and energy intake in obese children: a three-way randomized crossover clinical trial. BMC Nutr. 2018;4:1–10.

    Article  Google Scholar 

  43. Montmayeur, J.-P. Fat Detection: Taste, Texture, and Post Ingestive Effects (1st ed.). CRC Press, Boca Raton. 2009.

  44. Naslund E, Bogefors J, Skogar S, Gryback P, Jacobsson H, Holst JJ, et al. GLP-1 slows solid gastric emptying and inhibits insulin, glucagon, and PYY release in humans. Am J Physiol. 1999;277:R910–6.

    CAS  PubMed  Google Scholar 

  45. Helena Lindmark Månsson. Fatty acids in bovine milk fat, Food & Nutrition Research. 2008;52:1,1821.

  46. Haug A, Hostmark AT, Harstad OM. Bovine milk in human nutrition-a review. Lipids Health Dis. 2007;6:25.

    Article  Google Scholar 

  47. Mozaffarian D, Cao H, King IB, Lemaitre RN, Song X, Siscovick DS, et al. Trans-palmitoleic acid, metabolic risk factors, and new-onset diabetes in U.S. adults: a cohort study. Ann Intern Med. 2010;153:790–9.

    Article  Google Scholar 

  48. Racine NM, Watras AC, Carrel AL, Allen DB, McVean JJ, Clark RR, et al. Effect of conjugated linoleic acid on body fat accretion in overweight or obese children. Am J Clin Nutr. 2010;91:1157–64.

    Article  CAS  Google Scholar 

  49. Rolland-Cachera MF, Akrout M, Peneau S. Nutrient intakes in early life and risk of obesity. Int J Environ Res Public Health. 2016;13.

  50. Rolland-Cachera MF, Maillot M, Deheeger M, Souberbielle JC, Peneau S, Hercberg S. Association of nutrition in early life with body fat and serum leptin at adult age. Int J Obes. 2013;37:1116–22.

    Article  CAS  Google Scholar 

  51. Giudici KV, Rolland-Cachera MF, Gusto G, Goxe D, Lantieri O, Hercberg S, et al. Body mass index growth trajectories associated with the different parameters of the metabolic syndrome at adulthood. Int J Obes. 2017;41:1518–25.

    Article  CAS  Google Scholar 

  52. Monteiro PO, Victora CG, Barros FC, Monteiro LM. Birth size, early childhood growth, and adolescent obesity in a Brazilian birth cohort. Int J Obes Relat Metab Disord. 2003;27:1274–82.

    Article  CAS  Google Scholar 

  53. Ong KK, Ahmed ML, Emmett PM, Preece MA, Dunger DB. Association between postnatal catch-up growth and obesity in childhood: prospective cohort study. BMJ. 2000;320:967–71.

    Article  CAS  Google Scholar 

  54. Peneau S, Giudici KV, Gusto G, Goxe D, Lantieri O, Hercberg S, et al. Growth trajectories of body mass index during childhood: associated factors and health outcome at adulthood. J Pediatr. 2017;186:64–71 e1.

    Article  Google Scholar 

  55. Statistics Canada. Canadian Community Health Survey—Annual Component (CCHS): Government of Canada. 2014.

  56. Shields M, Tremblay MS. Canadian childhood obesity estimates based on WHO, IOTF and CDC cut-points. Int J Pediatr Obes. 2010;5:265–73.

    Article  Google Scholar 

  57. Dietz WH, Story MT, Leviton LC. Issues and implications of screening, surveillance, and reporting of children’s BMI. Pediatrics. 2009;124(Suppl 1):S98–101.

    Article  Google Scholar 

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Funding was provided by the Canadian Institutes of Health Research (CIHR) Institute of Human Development, Child and Youth Health (grant number MOP-333560). The funding agency had no role in study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the article for publication.

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Authors and Affiliations



SMV and JLM conceptualized and designed the research study, performed initial statistical analyses, drafted the manuscript, approved the final manuscript as submitted, and had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. CSB and DLO assisted in refining the study design, reviewed and revised the manuscript, and approved the final manuscript as submitted. KET and CDGKS reviewed and revised statistical analysis as well as the manuscript, and approved the final manuscript as submitted.

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Correspondence to Jonathon L. Maguire.

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Competing interests

JLM received an unrestricted research grant for a completed investigator-initiated study from the Dairy Farmers of Canada (2011–2012) and Ddrops provided non-financial support (vitamin D supplements) for an investigator-initiated study on vitamin D and respiratory tract infections (2011–2015). All other authors have no potential conflicts of interest.

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Vanderhout, S.M., Keown-Stoneman, C.D.G., Birken, C.S. et al. Cow’s milk fat and child adiposity: a prospective cohort study. Int J Obes 45, 2623–2628 (2021).

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