Low dairy consumption linked to increased rate of child stunting - research

According to the World Health Organization (WHO), a child is considered stunted if their growth has been impaired due to malnutrition, causing them to be too short for their age. Stunted children fail to reach their physical and cognitive potential and the condition is also a risk factor to child mortality. The highest prevalence of child stunting is in parts of Africa, South and South East Asia and Central America, according to UNICEF, WHO and World Bank data (https://ourworldindata.org/stunting-definition?tab=chart​).

A group of researchers from the International Food Policy Research Institute carried out a multi-country analysis to demonstrate if an increase in milk consumption was associated with significant reductions in stunting. Their findings would be of interest to policymakers, particularly in global regions where stunting is more prevalent.

The researchers used WHO data on stunting prevalence which they merged with FAO Food Balance Sheet estimates of domestic food supply, with milk being the main variable of interest. To achieve more accurate estimates of child milk consumption relative to FBS milk supply, the researchers also examined the association between dairy consumption prevalence in children 6-23 months from the Demographic and Health Surveys and FBS milk supply; they found strong correlation between milk supply and consumption.

The analysis also controlled for several additional variables, including nutrient-rich food groups such as non-dairy animal source foods and fruit and vegetables; average income; access to improved sanitation facilities and drinking water, and more.

The highest stunting prevalence was in South East Asia, South Asia and Sub-Saharan Africa, while the lowest rate was recorded in Eastern Asia.

While South East Asia and Sub-Saharan Africa had the lowest per capital milk supply, which could explain the high rates of child stunting, this isn’t the case for South Asia, where India – the largest dairy producer in the world – is located. The researchers noted however that other factors, such as poor water, sanitation and hygiene conditions and other dietary factors could explain the high rates of stunting in that region. “Moreover, dairy consumption children in countries such as India remains far from universal: the 2015–16 DHS suggested only half of children consumed dairy in the past 24 h,” the paper noted.

Most regions apart from Sub-Saharan Africa (SSA) had experienced reductions in stunting prevalence, the study highlighted. All regions except SSA also saw an increase in milk supply since 1960, with the most rapid growth in milk consumption taking place in Southeast Asia and China as well as Central Asia and South Asia. Higher income was also associated with lower stunting rates and higher milk supply.

While certain limitations apply to this study, the authors argued that collectively, ‘this body of evidence warrants a much greater priotization of dairy development in national food and nutritional strategies’.

“Dairy development strategies need to be adapted to local circumstances, considering factors like the agro-ecological potential for dairy production (which is influence by temperature and livestock diseases) as well as whether a population has strong traditions or strong demand for dairy. In countries with weaker traditions, there are important success stories in South-East Asia which other countries can learn from,” the authors reflected.

The low and medium-income countries with strong traditions in dairy production and consumption, such as South Asia and Eastern Africa, modernization and marketing ‘is critical’ according to the paper. “In these countries dairy herds are large in aggregate, but very small at the household level, often highly subsistence oriented, and highly unspecialized in the sense that cattle are used to provide milk but also traction, transport and other services,” the authors wrote. “Expanding production and consumption is certainly possible…but requires a combination of expanding access to markets…, improving the genetic makeup of the livestock herd, providing access to veterinary services, scaling up processing and storage technologies, building a suitable business environment for commercial dairy firms, and providing appropriate regulation and monitoring of food safety both for public health reasons as well as consumer trust.”

The researchers stated that ‘there is clearly tremendous scope’ for public policies and public-private partnerships to scale up dairy consumptions in regions of low milk consumption, such as Sub-Saharan Africa and South East Asia.

The researchers also acknowledge longstanding concerns about dairy products. Cow’s milk is a complement to breastmilk, not a substitute, and they argued that nutrition education campaigns should promote exclusive breastfeeding in the first five months after birth, and then an appropriate mix of breastfeeding and complementary feeding – including dairy – from six months onwards.

“As for climate change impacts, the dairy sector actually produces a lot of high-quality protein relative to its greenhouse gas emissions,” said Beliyou Haile, former IFPRI research fellow and one of the authors of the study. “So while there is a climate cost, there’s also a large nutritional benefit to dairy production.”

The authors also noted that emissions from dairy are much lower compared to beef, despite the two sectors often being lumped together in climate change discussions. Moreover, efficiency improvements in dairy production could simultaneously reduce emissions and make dairy products more affordable for the poor, the paper argued.

Lactose intolerance is another barrier they discussed, though it primarily only affects adult populations in countries with no history of dairy consumption, rather than young children. "Vietnam has no dairy traditions at all, but has been able to rapidly increase consumption of dairy products among young children, and reduce stunting,” noted Headey, “going from zero to hero in just a few decades.”

Concluding, the authors wrote: “We believe this study, along with the existing body of evidence linking milk consumption to reduced risks of stunting, justifies greater investments in dairy production – and potentially trade reforms – for the objectives of reducing stunting risks as well as micronutrient deprivation in developing countries.”

Source:
Growth in milk consumption and reductions in child stunting: Historical evidence from cross-country panel data
Headey, D., Haile, B.
Published: 20 June 2023
DOI: 10.1016/j.foodpol.2023.102485