Children who avoid drinking cow milk have low dietary calcium intakes and poor bone health.

Am J Clin Nutr. 2002 Sep;76(3):675-80.

Children who avoid drinking cow milk have low dietary calcium intakes and poor bone health.

Black RE, Williams SM, Jones IE, Goulding A.



Information concerning the adequacy of bone mineralization in children who customarily avoid drinking cow milk is sparse.


The objective was to evaluate dietary calcium intakes, anthropometric measures, and bone health in prepubertal children with a history of long-term milk avoidance.


We recruited 50 milk avoiders (30 girls, 20 boys) aged 3-10 y by advertisement. We measured current dietary calcium intakes with a food-frequency questionnaire and body composition and bone mineral density with dual-energy X-ray absorptiometry and compared the results with those of 200 milk-drinking control children.


The reasons for milk avoidance were intolerance (40%), bad taste (42%), and lifestyle choice (18%). Dietary calcium intakes were low (443 +/- 230 mg Ca/d), and few children consumed substitute calcium-rich drinks or mineral supplements. Although 9 children (18%) were obese, the milk avoiders were shorter (P < 0.01), had smaller skeletons (P < 0.01), had a lower total-body bone mineral content (P < 0.01), and had lower z scores (P < 0.05) for areal bone mineral density at the femoral neck, hip trochanter, lumbar spine, ultradistal radius, and 33% radius than did control children of the same age and sex from the same community. The z scores for volumetric (size-adjusted) bone mineral density (g/cm(3)) were -0.72 +/- 1.17 for the lumbar spine and -0.72 +/- 1.35 for the 33% radius (P < 0.001). Twelve children (24%) had previously broken bones.


In growing children, long-term avoidance of cow milk is associated with small stature and poor bone health. This is a major concern that warrants further study.


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