October 2012 Issue

Dairy’s Role in School Nutrition
By Constance Brown-Riggs, MSEd, RD, CDE, CDN
Today’s Dietitian
Vol. 14 No. 10 P. 40

Making low-fat dairy foods part of school meals will improve the health of our children today and in the years to come.

This month, nutrition professionals across the country will celebrate National School Lunch Week—a key observance in a year that has cast a spotlight on healthful school meals and, in particular, low-fat dairy products in the promotion of overall health.

In the United States, more than one-third of children and adolescents aged 2 to 19 are overweight or obese, putting them at risk of preventable diseases such as diabetes and heart disease. Part of the reason for this health crisis is that many of these children aren’t meeting the recommended daily servings of dairy foods, fruits, vegetables, and whole grains. Their intakes of key nutrients, including potassium, calcium, magnesium, phosphorus, and vitamins A, C, D, E, and K, are at suboptimal levels, according to the 2010 Dietary Guidelines for Americans.

Childhood hunger poses another threat to the health of this population, with “more than 25 million children in our nation’s elementary and middle schools coming to school hungry,” says Deborah Beauvais, RD, district supervisor of school nutrition in Rochester, New York. These children live in households that can’t put enough food on the table.

This conundrum, involving overfed and undernourished children, prompted those who developed the Dietary Guidelines to focus on kids and find ways to encourage them to eat more healthful foods and dairy products.

The Power of Dairy—and Breakfast
Milk and other dairy products provide calcium, potassium, phosphorus, protein, vitamin A, and vitamin D—five of the key nutrients of concern outlined in the 2010 Dietary Guidelines. To help children close these nutrient gaps, the guidelines specifically call for an increased intake of low-fat and fat-free milk and milk products, recommending that children aged 4 to 8 increase their intake from 2 cups per day to 2 1/2 cups. The recommendation of 3 cups per day remains for children aged 9 and older.

Schools are in a unique position to impact children’s food choices—including their dairy intake—because many rely on school meals as their major source of nourishment. According to the USDA, in 2010, more than 31.7 million children participated in the National School Lunch Program and 11.6 million in the School Breakfast Program. The new Nutritional Standards for School Meals, developed to ensure students have healthful breakfasts and lunches each day, require that either fat-free flavored milk or low-fat or fat-free white milk be offered with each school meal.

No one would argue that eating lunch is important, but there’s substantial evidence that eating breakfast is associated with the health and well-being of children and adolescents. Children who eat breakfast tend to get more nutrients than those who don’t, and those who skip breakfast are less likely to make up the nutrient deficits at other meals during the day.1

Breakfast is the perfect opportunity to include low-fat dairy in the diet, so dairy is a core component of the School Breakfast Program. To boost her students’ chances of getting all the nutritional benefits of dairy, Carol Ann Grodski, RD, food service director of the Babylon and Islip school districts in New York, offers yogurt, string cheese, and Colby jack cheese omelets.

What’s noteworthy about the School Breakfast Program is that menu choices must derive no more than 30% of calories from fat and less than 10% of calories from saturated fat. In addition, breakfasts must provide one-quarter of the Recommended Dietary Allowance (RDA) for calories, protein, calcium, iron, and vitamins A and C. Local school authorities make decisions about which foods to serve and how they’re prepared, according to the USDA. Table 1 provides the minimum daily breakfast servings of sample foods that meet these requirements for all age groups.

As with school breakfasts, school lunches must meet the Dietary Guidelines concerning the percentage of calories from fat and saturated fat. Moreover, school lunches must provide one-third of the RDA for calories, protein, calcium, iron, and vitamins A and C. And, like the breakfast program, local school authorities make decisions about what foods appear on the menu and how they’re prepared.

Flavored Milk Under Fire
With childhood obesity at an all-time high and the focus on sweetened beverages as a possible cause, many school districts have eliminated flavored milk. However, the elimination of flavored milk from school meals has been met with unintended negative consequences.

Several studies show that when flavored milk is eliminated from school meals, there’s a decrease in milk consumption. “When we eliminated flavored milk in our K-1 school, we saw an immediate decline in the consumption of milk, and it never recovered that school year,” Grodski says.

A study of 58 elementary and secondary schools in seven school districts across the nation found that when flavored milk was eliminated, student milk consumption dropped an average of 35%. The decline was the result of fewer students selecting milk and more waste. The study results indicate that the essential nutrients lost from decreased milk consumption are substantial and not easily replaced by other foods. In fact, replacing lost nutrients with other foods would add more calories and fat than what was being reduced.2

Flavored milk has the potential to close the gap between a child’s actual and recommended milk intake. Like white milk, flavored milk is a rich source of calcium, protein, phosphorus, riboflavin, potassium, niacin, and vitamins A, B12, and D. Nearly 70% of the milk children choose to drink in the National School Lunch Program is flavored milk.

“I believe the benefits of flavored milk outweigh the risk of students not drinking milk at all,” says Regina Dunne, RD, director of the child nutrition program at Smithtown Central School District in New York. Studies show that consuming low-fat or fat-free flavored milk can help children increase their intake of milk’s nutrients. Each 8-oz serving of flavored milk provides 42% of the calcium recommended for children aged 1 to 3, 33% of the calcium needs of kids aged 4 to 8, and 23% of the required calcium intake for those aged 9 to 18.3

Dairy Innovations and Trends
New standards and guidelines for school meals—as well intentioned as they may be—are good only if students eat the foods with which they’re presented. That’s why taste and enjoyment are important. To improve the taste of dairy products, food companies have reformulated flavored milk and cheeses to meet both children’s preferences and the new school meal standards. Here are some of the changes they’ve made:

• Flavored milk: Since 2006, the dairy industry has reduced by 38% added sugars in chocolate milk offered in schools. The average flavored milk in the 2011-2012 school year was just 31 kcal more than white milk.4 When Beauvais’ school district switched to fat-free flavored milk, she found “the acceptance was great. Children really only noticed that the color of the carton changed.”

• Cheese: According to the National Dairy Council, during the 2009-2010 school year, almost two-thirds of the cheese the USDA distributed was reduced fat, lite, or part skim, representing a 12% reduction in fat from previous years. Several manufacturers have formulated reduced-sodium processed cheese and blended cheese for commodity purchase, which contain 200 to 300 mg of sodium per 28-g serving.5

• Healthier pizza: Because pizza is an all-time favorite among children, some schools have introduced a more healthful option from Domino’s. Created specifically for school lunch programs, Domino’s Smart Slice pizza is comprised of a whole grain crust, reduced-fat and -sodium mozzarella cheese and pepperoni, and reduced-sodium pizza sauce. Domino’s delivers the pizza hot and fresh to more than 2,000 schools around the country. “Pizza is going through a huge transformation,” Grodski says. The Smart Slice has become a “kid-friendly product that’s a favorite on the menu.”

In addition to offering low-sodium and low-fat dairy products, school nutrition directors are using dairy to leverage food and beverage trends while providing nutritious, appealing options for students. Beauvais offers smoothies as a way to include dairy in the breakfast meal. “Our school makes fruit smoothies with low-fat yogurt, 1/2 cup of orange juice, and 1/2 cup of fruit the students choose. When it’s all blended together, it makes two 1-cup [servings] of nutrition-packed yummy smoothies.”

Studies show that offering milk in plastic resealable containers in various sizes and flavors and served ice cold can increase milk sales by 15% and 22% in elementary and secondary schools, respectively.6 Bottled fat-free chocolate and strawberry milk have been on the menu in Anne Arundel County public schools in Maryland for the past four years before the new regulations debuted. “In the 2009-2010 school year, we switched to bottled milk, which was received favorably by our students,” explains Jodi Risse, RD, supervisor for the division of food and nutrition services. “They like the look of it; they like the taste of it; and it stays cold for them.”

Healthful Bagged Lunch
As much as the National School Lunch Program has improved school lunch offerings, not all schools participate. As a result, some parents prefer their children bring their own lunch to school. Dietitians can use the following tips to help parents prepare bagged lunches that include low-fat and fat-free dairy products and other healthful fare that meets the new school nutrition standards:

• Focus on eating nutrient-rich foods instead of what not to eat. Suggest parents teach children to choose 100% fruit juice; brightly colored fruits; fortified and fiber-rich whole grain foods; low-fat or fat-free milk, cheese, and yogurt; and lean meats, poultry, fish, eggs, beans, and nuts.7

• Discuss the basics of a healthful lunch box. A boxed lunch can include one serving of vegetables or a salad and one serving of fruit (fresh, canned, or dried), one serving of whole grains, and low-fat or fat-free milk or other dairy item, such as a low-fat cheese stick, a yogurt cup, or cottage cheese. The lunch also can contain one serving of meat, chicken, fish, eggs, peanut butter, beans, or another protein source.8

Prepare Lunch Together
One way to encourage children to eat a more healthful lunch is to involve them in the preparation. Consider the following tips:

• Recommend parents ask their children to make healthier sandwiches by switching from bologna, salami, pastrami, corned beef, and other fatty meats to low-fat alternatives such as lean turkey, chicken breast, or low-fat cheese. Suggest they use a thinner layer of peanut butter and substitute jelly with banana or thin apple slices.
• Advise parents to make salads more colorful. Start with a base of dark greens, then top with brightly colored veggies such as diced peppers, sliced cucumber, tomatoes, and carrots along with low-fat mozzarella. Recommend they buy bags of lettuce or precut carrots to save time in the kitchen, and make extra salad for dinner so they can easily pack the leftovers for their child’s lunch the next day.

• Suggest parents make a cold pasta salad with whole wheat noodles leftover from the previous night’s dinner for a nutritious meal for lunch. Parents can include low-fat or fat-free cottage cheese with carrots, cherry tomatoes, fresh berries, or melon.

• Tell parents to buy only 100% fruit juice if they insist on buying juice for their kids. And if a child will drink only chocolate milk, allow him or her to do so. It’s better than drinking no milk at all.

• Encourage parents to buy low-fat or light yogurt instead of the full-fat, higher-in-calorie varieties targeted to children. If they prefer to avoid artificial sweeteners, suggest they pack fat-free plain yogurt mixed with fresh fruit. Low-fat string cheese or a few cubes of cheese with whole grain crackers also makes a good snack.

Teaching parents and children healthful eating habits they can easily put into practice, in addition to the improved dairy products and meals served in schools, will only enhance the health of our children today and in the years to come.

— Constance Brown-Riggs, MSEd, RD, CDE, CDN, is the national spokesperson for the Academy of Nutrition and Dietetics, specializing in African American nutrition, and author of the African American Guide to Living Well With Diabetes and Eating Soulfully and Healthfully With Diabetes.

 

References
1. Rampersaud GC, Pereira MA, Girard BL, Adams J, Metzl JD. Breakfast habits, nutritional status, body weight, and academic performance in children and adolescents. J Am Diet Assoc. 2005;105(5):743-760.

2. The impact on student milk consumption and nutrient intakes from eliminating flavored milk in schools. Milk Processor Education Program website. http://www.milkdelivers.org/files/resources/4-23-10-flav-impact-1-page-summary-final.pdf. Accessed July 30, 2012.

3. Why flavored milk is a nutritious choice for children. Dairy Council Digest. 2011;82(4). http://www.nationaldairycouncil.org/Research/DairyCouncilDigestArchives/Pages/dcd82-4Page1.aspx.

4. Kids drink up flavored milk with fewer calories! The Dairy Download.  http://www.nationaldairycouncil.org/PressandMedia/DairyDownloadNewsletter/Pages/Dairy
Download_2012_02.aspx. February 2012. Accessed July 25, 2012.

5. Cheese & nutrition. National Dairy Council website. http://www.nationaldairycouncil.org/SiteCollectionDocuments/education_materials/cheese/
Health%20Professional%20Cheese%20Nutrition%20Brochure%20Final.pdf

6. Encouraging milk consumption in schools. National Dairy Council website. http://www.nationaldairycouncil.org/SiteCollectionDocuments/child_nutrition/nutrition_
in_schools/Encouraging-Milk-Consumption-in-Schools.pdf. Accessed July 12, 2012.

7. Healthy food choices. Fuel Up to Play 60 website. http://school.fueluptoplay60.com/tools/nutrition-education/view.php?id=23945657. Accessed July 30, 2012.

8. Tips for a healthier lunch box. Alliance for a Healthier Generation website. Available at: http://www.healthiergeneration.org/parents.aspx?id=1634. Accessed August 5, 2012.

 

Table 1: Minimum Daily Breakfast Servings of Sample Foods for All Age Groups

Breakfast	Day 1 Sample	Day 2 Sample
Fruit (1 cup)	Fresh tangelo, assorted fruit juice (4 fl oz)	Fresh strawberries (1/2 cup), dried fruit mix (1/2 cup)
Grains (1 oz equivalent)	Whole grain cereal (1 bowl)	Toast (1 slice)
Milk (1 cup)	Low-fat milk (1 cup)	Fat-free flavored milk (1 cup)

Table adapted from the Nutrition Standards in the National School Lunch and School Breakfast Programs, www.gpo.gov/fdsys/pkg/FR-2012-01-26/pdf/2012-1010.pdf

[Side Bar]
New Food and Beverage Trends Boost Dairy Intake

Trend	Examples of Dairy Options
Customized food	Sandwich bars with variety of cheese options; salad bars with variety of cheese shreds and crumbles; bulk yogurt as an option on salad bars
Gourmet pizza	Gourmet pizza bar with choice of pizza by the slice (eg, Margherita, Hawaiian)
Smoothies	Fresh smoothies made from yogurt, milk, and fruit
Trendy yogurt	Yogurt “crunch cups” at elementary schools; Greek yogurt in middle and high schools; yogurt parfaits
Eating on the run	Grab-n-go breakfast, including egg and cheese wrap or package of fruit salad, yogurt, and muffin; prepackaged salads with cheese for lunch; for snack, 1 oz cheese packaged with fresh fruit

— Source: Observations from The National Dairy Council staff