JACN Did you know that you can get alerts when a new issue is online?
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Services
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Marshall, T. A.
Right arrow Articles by Levy, S. M.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Marshall, T. A.
Right arrow Articles by Levy, S. M.
Journal of the American College of Nutrition, Vol. 24, No. 1, 65-75 (2005)
Published by the American College of Nutrition

Diet Quality in Young Children Is Influenced by Beverage Consumption

Teresa A. Marshall, PhD, Julie M. Eichenberger Gilmore, PhD, Barbara Broffitt, MS, Phyllis J. Stumbo, PhD and Steven M. Levy, DDS, MPH

Department of Preventive and Community Dentistry, University of Iowa College of Dentistry (T.A.M., J.M.E., B.B., S.M.L.)
Clinical Research Center, University of Iowa Roy H. and Lucille A. Carver College of Medicine (P.J.S.), University of Iowa, Iowa City, Iowa

Address reprint requests to: Teresa A. Marshall, PhD, Assistant Professor, Department of Preventive and Community Dentistry, University of Iowa College of Dentistry, N335 Dental Science Building, Iowa City, IA 52242. E-mail: teresa-marshall{at}uiowa.edu


   ABSTRACT
TOP
 ABSTRACT
INTRODUCTION
 METHODS
 RESULTS
 CONCLUSION
 ACKNOWLEDGMENTS
 REFERENCES
 
Background: Replacement of milk with sugar-containing beverages could affect calcium intake and overall diet quality.

Objective: To describe dairy food, 100% juice and added sugar beverage intakes, contributions of dairy foods to diet quality, and effects of beverages on diet quality in young children.

Methods: We surveyed participants in the Iowa Fluoride Study (n = 645) at ages 1, 2, 3, 4 and 5 years and calculated intakes for 1–5 years (i.e. weighted averages). Nutrient, dairy food and beverage intakes were obtained from 3-day diaries; nutrient adequacy ratios were calculated as the nutrient intake to Recommended Dietary Allowance/Adequate Intake ratio; and dairy-dependent percentages were calculated as fractions of total diet nutrient adequacy ratios (truncated at 1) not met by non-dairy foods.

Results: Milk intakes were inversely associated with intakes of juice drinks (2, 4, 5 and 1–5 years), soda pop (2, 3, 4, 5 and 1–5 years) and added sugar beverages (2, 3, 4, 5 and 1–5 years). Dairy dependent fractions of 1–5 year nutrient adequacy ratios were 68% for calcium and 61% for vitamin D. Higher 1–5 year calcium adequacy was predicted by higher energy, higher other dairy and lower added sugar beverage intakes while higher vitamin D adequacy was predicted by higher energy and higher other dairy intakes. Overall diet quality was predicted by higher energy, higher other dairy, lower 100% juice and lower added sugar beverage intakes.

Conclusions: Dairy foods remain an important source of calcium and vitamin D, while added sugar beverages and, to a lesser extent, 100% juice decrease diet quality of young children.

Key words: diet quality, milk, juice, soda pop, AI = adequate intake, CSFII = Continuing Survey of Food Intakes by Individuals, IFS = Iowa Fluoride Study, MAR = mean adequacy ratio, NAR = nutrient adequacy ratio, RDA = recommended dietary allowance, USDA = United States Department of Agriculture


   INTRODUCTION
TOP
 ABSTRACT
 INTRODUCTION
METHODS
 RESULTS
 CONCLUSION
 ACKNOWLEDGMENTS
 REFERENCES
 
Dairy foods, particularly fluid milk, are recognized as the primary source of dietary calcium and vitamin D and an important source of protein, phosphorous, riboflavin, potassium, magnesium, vitamin B-12 and vitamin B-6 in Americans’ diets. Although the consumption of milk and other dairy foods has served historically as a marker of diet quality [1,2], the contribution of milk and other dairy foods to the diet quality of young children has not been thoroughly examined in contemporary diets. Newell et al. [1] reported that consumption of dairy foods was more strongly associated with the total diet mean adequacy ratio than consumption of other food groups in Kansas fifth grade students. Among adolescent females participating in the United States Department of Agriculture’s (USDA) 1987–88 Nationwide Food Consumption Survey, diets of milk consumers contained significantly more calcium, riboflavin, folate and vitamin A than diets of nonconsumers [2].

Contemporary dietary patterns suggest that milk intakes have declined while sugared beverage intakes (e.g., 100% juice, juice drinks, soda pop) have increased [3–10]. Cavadini et al. [4] compared survey data collected by the USDA in 1965 and 1996, and reported that decreased milk intakes were accompanied by increased soft drink and non-citrus juice intakes in adolescents aged 11–18 years. Coincident with declining milk intakes, calcium intakes have declined and are lower than recommended Adequate Intakes (AI) [4,6–11]. Among children aged 2–17 years participating in the 1994–96 Continuing Survey of Food Intakes by Individuals (CSFII), milk intake was positively associated with recommended intakes of vitamin A, folate, vitamin B-12, calcium and magnesium, and 100% juice intake with recommended intakes of vitamin C and folate [12]. However, soda pop intake was inversely associated with recommended intakes of vitamin A, calcium and magnesium in these children [12]. Harnack et al. [7] reported that preschool- and school-aged children with high (≥9 oz/day) soda intakes had higher energy intakes and lower protein, riboflavin, folate, vitamin A, vitamin C, calcium and phosphorus intakes than nonconsumers participating in the 1994 CSFII. Research relying on national survey data is cross-sectional in design and relies on groups with broad age ranges. The study design does not permit following these children over time, so it is not possible to gain insight into changing habits during early childhood.

Fisher et al. [6] reported that beverage intakes of 5-year-old girls paralleled their mothers’ beverage habits, and that soft drink intakes were inversely related to both milk and calcium intakes in daughters and mothers. Contemporary longitudinal studies of young children’s diets [13–15] have examined associations between sugared beverage intakes and growth and have reported milk intakes, but have not investigated relationships among sugared beverage, milk and calcium intakes. Although one would expect that associations observed in older children occur in younger children, evidenced-based research describing the effects of contemporary beverage patterns on calcium intake and overall diet quality at multiple ages during early childhood is lacking. Knowledge of longitudinal beverage choices, including how early beverage choices influence later beverage choices, could be important to establish guidelines for life-long healthy eating habits.

The purposes of this paper are to describe patterns of milk, other dairy food and sugared beverage intakes, the contribution of dairy foods to diet quality, and the extent to which concurrent consumption of sugared beverages influences diet quality in a longitudinal cohort of young children. We hypothesize that dairy products are the primary contributor of calcium and vitamin D and a significant contributor of riboflavin, folate and vitamin A to young children’s diets, and that replacement of milk by sugar-containing beverages is associated with lower intakes of these nutrients.


   METHODS
TOP
 ABSTRACT
 INTRODUCTION
 METHODS
RESULTS
 CONCLUSION
 ACKNOWLEDGMENTS
 REFERENCES
 
Subjects
Subjects were participants in the Iowa Fluoride Study (IFS), a longitudinal investigation of dietary and non-dietary fluoride exposures and the relationships between fluoride exposures and dental fluorosis and caries [16–21]. Mothers of newborn infants were recruited from 1992 to 1995 for their children’s participation. Subjects who participated in dental examinations at 5 years of age, and whose parents completed 3-day food and beverage diaries are the focus of this report (n = 645). The Institutional Review Board at the University of Iowa approved all components of the IFS; written informed consent was obtained from mothers at recruitment and at examination.

Design Overview
Parents were mailed IFS questionnaires and 3-day food and beverage diaries when their children were 6 weeks of age, 3, 6, 9 and 12 months of age, every 4 months through 3 years of age and every 6 months thereafter. IFS questionnaires were designed to obtain information regarding their children’s beverage intake, general health and oral health behaviors.

Diet Analyses
Three-day food and beverage diaries completed at 1, 2, 3, 4 and 5 years of age are the focus of the present analyses. Annual diaries were evaluated individually and cumulatively using area-under-the-curve analyses. If the subject did not return a specific 3-day food and beverage diary (e.g., 24 month), then the previous diary (e.g., 20 month) was substituted. If this diary was also missing, then the subsequent diary (e.g., 28 month) was substituted for the yearly diary. If neither was available, then that subject was omitted for that year. Inclusion in combined age 1–5 area-under-the-curve analysis required a minimum of 4 diaries including the 1- and 5-year diaries or suitable substitutions. Area-under-the-curve was calculated using the trapezoidal rule to estimate the lifetime mean intake. When data were missing for a year, then the trapezoidal segment covered two years. For instance, a subject with milk intakes at 1, 2, 3 and 5 y, respectively, has a 1–5 year weighted average milk intake calculated from the 1–2-year mean intake, the 2–3 year mean intake and twice the 3–5 year mean intake.

On each diary, parents were asked to record the types and quantities of all foods and beverages consumed by their children for one weekend day and two weekdays. Detailed information was requested regarding beverages, including brand names, types of preparation, and sources of water used in preparation. All entries from the 3-day food and beverage diaries were coded and verified by registered dietitians to create a Food and Beverage Intake Table. Human milk intake was estimated using models of mean intakes [22]. Total dietary intake was estimated at 4.6 oz/kg/day at 12 months. The volume of infant foods and beverages consumed was subtracted from this volume, and the remainder was estimated to be breast milk. The percentage of subjects consuming any human was 9.8%, 1.9%, 1.6%, 0.7% and 0.0% at 1, 2, 3, 4 and 5 years of age, respectively.

Dairy foods and all beverages were coded according to food type (e.g., fluid milk, cheese, 100% juice, juice drink, water). When possible, dairy products added to foods were coded separately—broccoli with cheese sauce was coded as two foods, ’broccoli‘ and ’cheese sauce.‘ For foods having cheese or milk as an ingredient (e.g., lasagna, cheeseburger), the dairy component was estimated from ingredient weights. Calcium and vitamin D intakes from these foods were assigned to dairy foods; all other nutrient intakes from these foods (e.g., protein, zinc) were attributed to non-dairy foods. Dairy foods were the primary source of calcium and vitamin D in mixed dishes, but not necessarily the primary source of other nutrients. This conservative approach systematically underestimates the contribution of dairy foods to these nutrients. Dairy foods include milk, cheese, yogurt and dairy desserts. Added sugar beverages include juice drinks, regular soda pop, powdered beverages and sports drinks.

A Nutrient Table was created from nutrient data obtained from the USDA (Nutrient Database for Standard Reference 12, Agriculture Research Service), the Minnesota Nutrient Database (Nutrition Coding Center NDS-R, Version 4.01; Minneapolis, MN) and manufacturers’ data. A relational database (Microsoft Access, version SR-1; Redmond, WA) was used to link the Food and Beverage Intake Table and the Nutrient Table for calculation of food and nutrient intakes. Weighted averages based on weekend and weekday consumption were calculated to reflect average consumption over a week.

Diet quality indices were created using the Dietary Reference Intakes [11] as a reference for adequacy of nutrient intakes [23–24]. The nutrient adequacy ratio (NAR) for a given nutrient is the ratio of an individual’s mean daily intake to the age-specific Recommended Dietary Allowance (RDA) or AI, if an RDA was not available. The mean adequacy ratio (MAR) is the average of an individual’s NARs and is an index of overall diet quality [23–24]. The MAR was calculated from NARs for protein, 11 vitamins (thiamin, riboflavin, niacin, folate, pantothenic acid, vitamin B-6, vitamin B-12, vitamin C, vitamin A, vitamin D, vitamin E) and 7 minerals (calcium, copper, iron, magnesium, phosphorous, selenium, zinc). NARs were truncated at 1 for calculation of the MAR to prevent an excess intake of one nutrient from compensating for inadequate intakes of other nutrients.

NARs and MARs were calculated for all foods and beverages (i.e., total diet), all non-dairy foods and beverages (i.e., non-dairy diet) and all dairy foods and beverages (i.e., dairy diet). NARs were truncated at 1.0 to distinguish between adequate and greater than adequate intakes to prevent an overestimation of dairy dependence. Dairy-dependent percentages of total diet NARs and MARs were calculated to determine the dietary significance of dairy foods after considering the nutrient contributions of non-dairy foods and beverages. Dairy-dependent percentages were calculated as follows: (total diet NAR – non-dairy NAR) otal diet NAR * 100.

Statistical Analysis
Cross sectional analyses of data collected at 1, 2, 3, 4, 5 years and for 1–5 years were completed using SAS (SAS, version 8.01, Cary, NC, 2000). Subject characteristics (i.e., gender, birth order, household income, parental age and parental education) were categorized and presented as percentages. Food, beverage and nutrient intakes and NARs were reported as medians (25th, 75th percentiles). The sign test was used to identify changes in sequential yearly trends in food, beverage and nutrient intakes. Spearman correlation coefficients were used to identify associations between dairy foods and beverage intakes. General linear regression models were used to describe the relationships among milk, other dairy foods (e.g., cheese, yogurt, dairy desserts), 100% juice, added sugar beverages (e.g., juice drinks, regular soda pop, regular powdered beverages, sports drinks) and energy intakes and NARs. A p-value of <0.05 was considered statistically significant.


   RESULTS
TOP
 ABSTRACT
 INTRODUCTION
 METHODS
 RESULTS
CONCLUSION
 ACKNOWLEDGMENTS
 REFERENCES
 
Characteristics of the 645 subjects meeting inclusion criteria and their families at enrollment in the IFS are provided in Table 1. Ninety-eight percent of the mothers were Caucasian, which is similar to the racial distribution of Iowa (i.e., 95.4% white) [25]. Forty-three percent of subjects were first children. Parents were well-educated with 46% of mothers and 41% of fathers having a bachelor’s degree or more education, and most were economically stable for 1992–1995 with 48% of households having baseline incomes greater than $40,000.


View this table:
[in this window]
[in a new window]
  		Table 1. Demographic Characteristics at Enrollment*

 
Median (25th, 75th) daily intakes of dairy foods, 100% juice, added sugar beverages and sugar-free beverages at each year of age and for 1–5 years are presented in Table 2. Intakes of total dairy foods and, specifically, fluid milk remained relatively stable as children aged; intakes of cheese increased between 1 and 2 years of age (p < 0.01) and then remained stable; and intakes of dairy desserts increased from 4 to 5 years of age (p < 0.01). Fewer than 25% of children consumed yogurt at any age (data not shown). Intakes of 100% juice increased between 1 and 2 years of age (p < 0.01) and gradually declined thereafter (p < 0.06). Intakes of added sugar beverages increased steadily between 1 and 4 years of age (p < 0.01). Intakes of juice drinks were 0 at all ages, but overall consumption increased between 1 and 2 years (p < 0.01). Intakes of regular soda pop increased steadily between 1 and 5 years of age (p < 0.01). Fewer than 25% of children consumed powdered beverages, sports drinks and sugar-free soft drinks at any age, except for powdered beverages whose median intake at 5 years was 0 (0, 12) g (data not shown). Intakes of water increased between 1 and 2 years (p < 0.01) and between 4 and 5 years of age (p < 0.01).


View this table:
[in this window]
[in a new window]
  		Table 2. Median* Daily Intakes of Dairy Foods, 100% Juice, Added Sugar Beverages and Sugar-Free Beverages at 1, 2, 3, 4, and 5 Years and for 1–5 Years{dagger}

 
Median (25th, 75th) daily intakes of nutrients at each year of age and for 1–5 years are presented in Table 3. Intakes of energy and all nutrients except vitamins C, A and D increased with age with most yearly increases being statistically significant (p < 0.05).


View this table:
[in this window]
[in a new window]
  		Table 3. Median*Daily Nutrient Intakes at 1, 2, 3, 4, 5 Years and for 1–5 Years{dagger}

 
Associations between dairy foods and beverages were explored using Spearman correlation coefficients at 1, 2, 3, 4, 5 and for 1–5 years. Milk intakes for 1–5 years were not associated with other dairy foods (r = 0.06, p = 0.26), 100% juice (r = –0.06, p = 0.24) or water (r = –0.04, p = 0.44), but were inversely associated with intakes of juice drinks (r = –0.14, p < 0.01), soda-pop (r = –0.15, p < 0.001) and added sugar beverages (r = –0.19, p < 0.001). Similarly, milk intakes were inversely associated with 100% juice at 2 years; juice drinks at 2, 4 and 5 years, soda-pop at 2, 3, 4, and 5 years and added sugar beverages at 2, 3, 4, and 5 years of age (p < 0.05; data not shown).

Median (25th, 75th) NARs and MARs based on all foods and beverages (total diet), non-dairy foods and beverages (non-dairy diet) and dairy foods and beverages (dairy diet), and the median (25th, 75th) percentages of total diet NARs that depended on intake of dairy foods (dairy-dependent percentages) are presented in Tables 4a (1 year), 4b (2 year), 4c (3 year), 4d (4 year), 4e (5 year) and 4f (1–5 years). Although 1–5 year dairy NARs (Table 4f were greater than 0.50 for protein, riboflavin, vitamin B-12, magnesium and zinc, the non-dairy NARs were 1.00 and the dairy-dependent percentages of the total diet NARs were 0 for these nutrients. One through 5 year dairy NARs were greater than 0.50, non-dairy NARs ranged from 0.31–0.64, and dairy dependent percentages of the total diet NARs were 34%, 61%, and 68%, respectively, for pantothenic acid, vitamin D, and calcium. The contribution of dairy foods to the yearly MARs (Tables 4a–(e) ranged from 0.42–0.50, with 10–14% of the yearly total diet MAR dependent on dairy foods. Dairy-dependent percentages of total diet NARs increased after 3 years for pantothenic acid, vitamin A, calcium, and magnesium (p < 0.001).


View this table:
[in this window]
[in a new window]
  		Table 4a. Total Diet, Non-Dairy Diet and Dairy Diet NARs and Percentage of NARs Dependent on Intake of Dairy Foods at 1 Year of Age*

 

View this table:
[in this window]
[in a new window]
  		Table 4b. Total Diet, Non-Dairy Diet and Dairy Diet NARs and Percentage of NARs Dependent on Intake of Dairy Foods at 2 Years of Age*

 

View this table:
[in this window]
[in a new window]
  		Table 4c. Total Diet, Non-Dairy Diet and Dairy Diet NARs and Percentage of NARs Dependent on Intake of Dairy Foods at 3 Years of Age*

 

View this table:
[in this window]
[in a new window]
  		Table 4d. Total Diet, Non-Dairy Diet and Dairy Diet NARs and Percentage of NARs Dependent on Intake of Dairy Foods at 4 Years of Age*

 

View this table:
[in this window]
[in a new window]
  		Table 4e. Total Diet, Non-Dairy Diet and Dairy Diet NARs and Percentage of NARs Dependent on Intake of Dairy Foods at 5 Years of Age*

 

View this table:
[in this window]
[in a new window]
  		Table 4f. Total Diet, Non-Dairy Diet and Dairy Diet NARs and Percentage of NARs Dependent on Intake of Dairy Foods for 1–5 Years*

 
Milk was the primary dairy food consumed, and the milk-dependent percentages for vitamin D and calcium were similarly calculated. Milk-dependent percentages of total diet NARs for vitamin D were 60%, 58%, 58%, 55%, 53% and 58%, respectively, for ages 1, 2, 3, 4, 5 and for 1–5 years. Milk-dependent percentages of total diet NARs for calcium were 37%, 34%, 30%, 47%, 43% and 40%, respectively for ages 1, 2, 3, 4, 5 and for 1–5 years.

General linear models that included intakes of total energy, milk, other dairy foods, 100% juice, and other sugar beverages were used to identify associations among these variables and NARs (not truncated), and to predict the variation in NARs explained by the models for 1–5 years Table 5. Energy was associated with intakes of both milk (r = 0.254, p < 0.001) and other dairy foods (r = 0.332; p < 0.001). In general, energy demonstrated strong, statistically significant, positive associations with each NAR. Milk intakes demonstrated weak, but statistically significant, inverse associations with several NARs. In contrast, other dairy foods demonstrated strong, statistically significant, positive associations with protein, riboflavin, pantothenic acid, vitamin B-12, vitamin D, calcium, magnesium, phosphorous and zinc. One-hundred-percent juice demonstrated a strong, statistically significant, positive association with the vitamin C NAR, and strong statistically significant, negative associations with multiple other NARs and the MAR. Other sugar beverages were inversely associated with most NARs and the MAR. Models including energy, milk, other dairy foods, 100% juice and other sugar beverages explained a significant percentage of the variance in each NAR and the MAR.


View this table:
[in this window]
[in a new window]
  		Table 5. Results of General Linear Regression Models* to Predict 1 Through 5 Year Total Diet Nutrient Adequacy Ratios (NARs){dagger}

 

   DISCUSSION
 
Food groups include foods of similar origin with common nutrient profiles. Some nutrients are distributed among multiple groups, while others are concentrated within a single group. Consumption of a nutrient rich food may not impact nutrient intake or overall diet quality because other foods could have contributed those nutrients to the diet. For example, dairy foods are an excellent source of protein, calcium, and vitamin B-12; contribute 20.6%, 76.8% and 17.8%, respectively, of the available nutrients to the U.S. food supply [26]; and are the source of 14.9%, 55.1% and 17.5%, respectively, of the consumed nutrient by U.S. adults [27]. Such a comment might be misleading, though, as mean intakes of U.S. adult women and men greatly exceeded the RDA for protein (127% and 154% RDA, respectively) and vitamin B-12 (212% and 335% RDA, respectively), but not for calcium (77% and 107% RDA, respectively) [28].

Recognizing the challenges in defining the contribution of dairy foods to diet quality, we chose to evaluate the contribution of dairy foods to individual NARs and MARs and to determine the portion of NARs and MARs that depended on dairy food consumption. Dairy associated NARs and MARs acknowledge the wide range and quantity of nutrients available from dairy foods, while the dairy-dependent percentages offer a conservative estimate of dairy foods’ role in the diet and recognize contributions of other nutrient dense foods and beverages.

Our results suggest that, while dairy foods provide more than 50% of the NARs for protein, riboflavin, vitamin B-12, magnesium and zinc, young children do not rely on dairy foods for adequate intakes of these nutrients. However, young children do rely on dairy foods to achieve adequate intakes of pantothenic acid, vitamin D and calcium, and this reliance increases with age for pantothenic acid and calcium. The increased reliance on dairy foods for adequate intakes after 3 years of age suggests that dairy foods contribute a greater percentage as nutrient requirements increase (i.e., most RDAs and AIs increase at 4 years). The observed increase in consumption of added sugar beverages of limited nutrient density at this time could be associated with lower intakes of nutrient dense foods, thus diluting the contribution of non-dairy foods to diet quality and emphasizing the contribution of dairy foods. Similarly, Kant et al. [29] reported that increased numbers of low nutrient-dense foods consumed were associated with decreased intakes of dairy foods and micronutrients, including vitamin B-12, folate, calcium and magnesium in both boys and girls, aged 8–18 years participating in the third National Health and Nutrition Examination Survey, 1988–1994.

Median daily intakes of milk and other dairy foods were slightly less than USDA’s Food Guide Pyramid recommendation of 2 servings/d [30]. This finding supports observations by Munoz et al. [31] who reported that 67% of children participating in the 1989–1991 CSFII did not consume the recommended number of dairy foods servings. Furthermore, overall milk intakes were not related to other dairy food intakes in our study, suggesting that children who don’t drink milk are not compensating with other dairy foods. Our subjects’ milk intakes (327–364 g/d or 11.3–12.5 oz/d) were similar to intakes reported by Skinner et al. (11.1–12.2 oz/d) [15] for children ranging from 27–72 months of age and Dennison et al. (9.8–11.0 oz/d) [32] for 2-year and 5-year old children.

We believe that we are the first to comprehensively investigate associations among dairy foods, 100% juice, added sugar beverages and overall diet quality in a young cohort. The relationships that we observed among beverage intakes are consistent with and expand upon results from national surveys [4–5,7–12]. Although milk was the primary dairy product consumed by our subjects and contributed a greater quantity of nutrients to the diet than other dairy foods, other dairy foods were a better predictor of nutrient adequacy than milk. Beginning as early as 2 years of age, milk intakes of our subjects were inversely associated with total added sugar beverages, as well as juice drinks and soda-pop. The cumulative consumption of added sugar beverages was inversely associated with overall diet quality, as well as adequacy of multiple nutrient intakes. Milk intakes were inversely associated with 100% juice at age 2 only; and cumulative consumption was positively associated with adequacy of vitamin C, but negatively associated with adequacy of multiple other nutrients. Harnack et al. [7], using data from the 1994 CSFII, reported that preschool children with higher soda-pop intakes had lower milk and micronutrient intakes, but they did not explore associations among milk, 100% juice and micronutrient intakes. Likewise, Skinner et al. [14] reported that milk intakes were negatively associated with soda-pop, but not 100% juice intakes; and that folate and vitamin C intakes were higher and vitamin D intake lower in children consuming ≥12 oz 100% juice at 24–32 months.

This study has several limitations inherent to dietary studies. First, all data were parent or caregiver (e.g., babysitter) reported, and recorded intakes could reflect attitudes about what should be consumed as opposed to what was consumed. The children were generally from middle income, educated families, and are not representative of children throughout Iowa or the United States.


   CONCLUSION
TOP
 ABSTRACT
 INTRODUCTION
 METHODS
 RESULTS
 CONCLUSION
ACKNOWLEDGMENTS
 REFERENCES
 
Our results support our hypothesis that intakes of milk and other dairy foods are associated with adequate intakes of multiple nutrients, including calcium and vitamin D, and that milk intakes are inversely associated with added sugar beverage intakes. Intakes of 100% juice were not associated with calcium or vitamin D intakes, but intakes of added sugar beverages were negatively associated with calcium intakes. Both 100% juice and added sugar beverage intakes were negatively associated with adequate intakes of multiple nutrients and overall diet quality.


   ACKNOWLEDGMENTS
TOP
 ABSTRACT
 INTRODUCTION
 METHODS
 RESULTS
 CONCLUSION
 ACKNOWLEDGMENTS
REFERENCES
 
Supported by grants from the National Dairy Council, the National Institute of Dental and Craniofacial Research (RO1-DE09551 and RO1-DE12101) and the General Clinical Research Centers Program, National Center for Research Resources (MO1-RR00059). The National Dairy Council, the National Institute of Dental and Craniofacial Research and the General Clinical Research Centers Program did not participate in the design, conduct, interpretation or analysis of the study; the National Dairy Council reviewed the manuscript prior to submission. The manuscript’s contents are solely the responsibility of the authors and do not necessarily represent the official views of the National Dairy Council, the National Institute of Dental and Craniofacial Research or the General Clinical Research Centers.

Received October 24, 2003. Revised May 7, 2004.
   REFERENCES
TOP
 ABSTRACT
 INTRODUCTION
 METHODS
 RESULTS
 CONCLUSION
 ACKNOWLEDGMENTS
 REFERENCES
 

  1. Newell GK, Vaden AG, Aitken EF, Dayton AD: Food consumption and quality of diets of Kansas elementary students.J Am Diet Assoc85 :939 –945,1985 .[Medline]
  2. Fleming KH, Heimbach JT: Consumption of calcium in the US: food sources and intake levels.J Nutr124 :1426S –1430S,1994 .
  3. Thomas LF, Keim KS, Long EM, Zaske JM: Factors related to low milk intake of 3- to 5-year-old children in child care settings.J Am Diet Assoc96 :911 –912,1996 .[Medline]
  4. Cavadini C, Siega-Riz AM, Popkin BM: US adolescent food intake trends from 1965 to 1996.Arch Dis Child83 :18 –24,2000 .[Abstract/Free Full Text]
  5. Nielson SJ, Siega-Riz AM, Popkin BM: Trends in energy intake in US between 1977 and 1996: similar shifts seen across age groups.Obes Res10 :370 –378,2002 .[Medline]
  6. Fisher JO, Mitchell DC, Smiciklas-Wright H, Birch LL: Maternal milk consumption predicts the tradeoff between milk and soft drinks in young girls’ diets.J Nutr131 :246 –250,2000 .
  7. Harnack L, Stang J, Story M: Soft drink consumption among US children and adolescents: nutritional consequences.J Am Diet Assoc99 :436 –441,1999 .[Medline]
  8. Guenther PM: Beverages in the diets of American teenagers.J Am Diet Assoc86 :493 –499,1986 .[Medline]
  9. French SA, Lin BH, Guthrie JF: National trends in soft drink consumption among children and adolescents age 6 to 17 years: prevalence, amounts, and sources, 1977/1978 to 1994/1998.J Am Diet Assoc103 :1326 –1331,2003 .[Medline]
  10. Lin BH, Guthrie J, Blaylock JR:The diets of America’s children: influences of dining out, household characteristics, and nutrition knowledge .1996 . ERSAER746; AER 746. Website www.ers.usda.gov/publications/aer746/ Accessed 7/02
  11. Standing Committee on the Scientific Evaluation of Dietary Reference Intakes, Food and Nutrition Board, Institute of Medicine.Dietary Reference Intakes: Applications in Dietary Assessment. National Academy Press, Washington, DC.2000 . Available at: <http://www4.nas.edu/IOM/IOMHome.nsf/Pages/FNB+Reports> Accessed 8/5/02.
  12. Ballew C, Kuester S, Gillespie C: Beverage choices affect adequacy of children’s nutrient intakes.Arch Pediatr Adolesc154 :1148 –1152,2000 .[Abstract/Free Full Text]
  13. Carruth BR, Skinner JD: The role of dietary calcium and other nutrients in moderating body fat in preschool children.Int J Obes25 :559 –566,2001 .
  14. Skinner JD, Carruth BR, Moran J, Houck K, Coletta F: Fruit juice intake is not related to children’s growth.Pediatrics103 :58 –64,1999 .[Abstract/Free Full Text]
  15. Skinner JD, Carruth BR: A longitudinal study of children’s juice intake and growth: the juice controversy revisited.J Am Diet Assoc101 :432 –437,2001 .[Medline]
  16. Van Winkle S, Levy SM, Kiritsy MC, Heilman JR, Wefel JS, Marshall T: Water and formula fluoride concentrations: significance for infants fed formula.Pediatr Dent17 :305 –310,1995 .[Medline]
  17. Kiritsy MC, Levy SM, Warren JJ, Guha-Chowdhury N, Heilman JR, Marshall T: Assessing fluoride concentrations of juices and juice-flavored drinks.J Am Dent Assoc127 :895 –902,1996 .[Abstract/Free Full Text]
  18. Heilman JR, Kiritsy MC, Levy SM, Wefel JS: Fluoride levels of carbonated soft drinks.J Am Dent Assoc130 :1593 –1599,1999 .[Abstract/Free Full Text]
  19. Warren JJ, Levy SM, Kanellis MJ: Prevalence of dental fluorosis in the primary dentition.J Public Health Dent61 :87 –91,2001 .[Medline]
  20. Levy SM, Warren JJ, Davis CS, Kirchner L, Kanellis MJ, Wefel JS: Patterns of fluoride intake from birth to 36 months.J Public Health Dent61 :70 –77,2001 .[Medline]
  21. Warren JJ, Levy SM, Kanellis MJ: Dental caries in the primary dentition: assessing prevalence of cavitated and noncavitated lesions.J Public Health Dent62 :109 –114,2002 .[Medline]
  22. Fomon SJ: ’Nutrition of Normal Infants.’ St. Louis: Mosby,1993 .
  23. Guthrie HA, Scheer JC: Validity of a dietary score for assessing nutrient adequacy.J. Am Diet Assoc78 :240 –245,1981 .[Medline]
  24. Krebs-Smith SM, Smiciklas-Wright H, Guthrie HA, Krebs-Smith J: The effects of variety in food choices on dietary quality.J Am Diet Assoc87 :897 –903,1987 .[Medline]
  25. Iowa Census Data Tables: State of Iowa.State Library of Iowa . http://www.silo.lib.ia.us/specialized-services/datacenter/browse/state.html. Accessed 3/04.
  26. Weaver CS, Heaney RP Calcium. In Shils ME, Olson JA, Shike M, Ross AC (eds): ’Modern Nutrition in Health and Disease,‘ 9th ed. Philadelphia: Lippincott, Williams & Wilkins, pp141 –156,1998 .
  27. Subar AF, Krebs-Smith SM, Cook A, Kahle LL: Dietary sources of nutrients among US adults, 1989 to 1991.J Am Diet Assoc98 :537 –547,1998 .[Medline]
  28. Enns CW, Goldman JD, Cook A: Trends in food and nutrient intakes by adults: NFCS 19778, CSFII 1989–91, and CSFII 1994–5.Fam Econ Nutr Rev10 :2 –15,1997 .
  29. Kant AK: Reported consumption of low-nutrient-density foods by American children and adolescents: nutritional and health correlates, NHANES III, 1988–1994.Arch Pediatr Adolesc Med.157 :789 –796,2003 .[Abstract/Free Full Text]
  30. United States Department of Agriculture, Food and Nutrition Information Center (2001) Food Guide Pyramid. Available at: http://www.nal.usda.gov/fnic/ Accessed May 5,2003 .
  31. Munoz KA, Krebs-Smith SM, Ballard-Barbash R, Cleveland LE: Food intakes of US children and adolescents compared with recommendations.Pediatrics100 :323 –329,1997 .[Abstract/Free Full Text]
  32. Dennison BA, Rockwell HL, Baker SL: Excess fruit juice consumption by preschool-aged children is associated with short stature and obesity.Pediatrics99 :15 –22,1997 .[Abstract/Free Full Text]



This article has been cited by other articles:


Home page
 Journal of the American Dental AssociationHome page
S. Lim, W. Sohn, B. A. Burt, A. M. Sandretto, J. L. Kolker, T. A. Marshall, and A. I. Ismail
Cariogenicity of Soft Drinks, Milk and Fruit Juice in Low-Income African-American Children: A Longitudinal Study
J Am Dent Assoc, July 1, 2008; 139(7): 959 - 967.
[Abstract] [Full Text] [PDF]

Home page
 AMERICAN JOURNAL OF LIFESTYLE MEDICINEHome page
C. E. O'Neil and T. A. Nicklas
A Review of the Relationship Between 100% Fruit Juice Consumption and Weight in Children and Adolescents
American Journal of Lifestyle Medicine, July 1, 2008; 2(4): 315 - 354.
[Abstract] [PDF]

Home page
 Am. J. Public HealthHome page
L. R. Vartanian, M. B. Schwartz, and K. D. Brownell
Effects of Soft Drink Consumption on Nutrition and Health: A Systematic Review and Meta-Analysis
Am J Public Health, April 1, 2007; 97(4): 667 - 675.
[Abstract] [Full Text] [PDF]

Home page
 Journal of the American Dental AssociationHome page
T. A. Marshall, J. M. Eichenberger-Gilmore, M. A. Larson, J. J. Warren, and S. M. Levy
Comparison of the intakes of sugars by young children with and without dental caries experience
J Am Dent Assoc, January 1, 2007; 138(1): 39 - 46.
[Abstract] [Full Text] [PDF]

This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Services
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Marshall, T. A.
Right arrow Articles by Levy, S. M.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Marshall, T. A.
Right arrow Articles by Levy, S. M.

HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS