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Research

Consumption of non–cow’s milk beverages and serum vitamin D levels in early childhood

Grace J. Lee, Catherine S. Birken, Patricia C. Parkin, Gerald Lebovic, Yang Chen, Mary R. L’Abbé and Jonathon L. Maguire; for the TARGet Kids! Collaboration
CMAJ November 18, 2014 186 (17) 1287-1293; DOI: https://doi.org/10.1503/cmaj.140555
Grace J. Lee
Departments of Nutritional Sciences (Lee, L’Abbé), Paediatrics (Birken, Parkin) and Health Policy, Management and Evaluation (Lebovic), University of Toronto; Department of Paediatrics (Lee, Maguire) and the Applied Research Centre at the Li Ka Shing Knowledge Institute (Lebovic, Chen, Maguire), St. Michael’s Hospital; Department of Paediatric Medicine and the Paediatric Outcomes Research Team (Birken, Parkin), The Hospital for Sick Children, Toronto, Ont.
BASc
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Catherine S. Birken
Departments of Nutritional Sciences (Lee, L’Abbé), Paediatrics (Birken, Parkin) and Health Policy, Management and Evaluation (Lebovic), University of Toronto; Department of Paediatrics (Lee, Maguire) and the Applied Research Centre at the Li Ka Shing Knowledge Institute (Lebovic, Chen, Maguire), St. Michael’s Hospital; Department of Paediatric Medicine and the Paediatric Outcomes Research Team (Birken, Parkin), The Hospital for Sick Children, Toronto, Ont.
MD MSc
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Patricia C. Parkin
Departments of Nutritional Sciences (Lee, L’Abbé), Paediatrics (Birken, Parkin) and Health Policy, Management and Evaluation (Lebovic), University of Toronto; Department of Paediatrics (Lee, Maguire) and the Applied Research Centre at the Li Ka Shing Knowledge Institute (Lebovic, Chen, Maguire), St. Michael’s Hospital; Department of Paediatric Medicine and the Paediatric Outcomes Research Team (Birken, Parkin), The Hospital for Sick Children, Toronto, Ont.
MD
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Gerald Lebovic
Departments of Nutritional Sciences (Lee, L’Abbé), Paediatrics (Birken, Parkin) and Health Policy, Management and Evaluation (Lebovic), University of Toronto; Department of Paediatrics (Lee, Maguire) and the Applied Research Centre at the Li Ka Shing Knowledge Institute (Lebovic, Chen, Maguire), St. Michael’s Hospital; Department of Paediatric Medicine and the Paediatric Outcomes Research Team (Birken, Parkin), The Hospital for Sick Children, Toronto, Ont.
PhD
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Yang Chen
Departments of Nutritional Sciences (Lee, L’Abbé), Paediatrics (Birken, Parkin) and Health Policy, Management and Evaluation (Lebovic), University of Toronto; Department of Paediatrics (Lee, Maguire) and the Applied Research Centre at the Li Ka Shing Knowledge Institute (Lebovic, Chen, Maguire), St. Michael’s Hospital; Department of Paediatric Medicine and the Paediatric Outcomes Research Team (Birken, Parkin), The Hospital for Sick Children, Toronto, Ont.
MA MSc
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Mary R. L’Abbé
Departments of Nutritional Sciences (Lee, L’Abbé), Paediatrics (Birken, Parkin) and Health Policy, Management and Evaluation (Lebovic), University of Toronto; Department of Paediatrics (Lee, Maguire) and the Applied Research Centre at the Li Ka Shing Knowledge Institute (Lebovic, Chen, Maguire), St. Michael’s Hospital; Department of Paediatric Medicine and the Paediatric Outcomes Research Team (Birken, Parkin), The Hospital for Sick Children, Toronto, Ont.
PhD
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Jonathon L. Maguire
Departments of Nutritional Sciences (Lee, L’Abbé), Paediatrics (Birken, Parkin) and Health Policy, Management and Evaluation (Lebovic), University of Toronto; Department of Paediatrics (Lee, Maguire) and the Applied Research Centre at the Li Ka Shing Knowledge Institute (Lebovic, Chen, Maguire), St. Michael’s Hospital; Department of Paediatric Medicine and the Paediatric Outcomes Research Team (Birken, Parkin), The Hospital for Sick Children, Toronto, Ont.
MD MSc
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  • For correspondence: [email protected]
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Figures

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  • Figure 1:
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    Figure 1:

    Selection of patients for the study.

  • Figure 2:
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    Figure 2:

    Unadjusted association between consumption of non–cow’s milk beverages and serum 25-hydroxyvitamin D (25[OH]D) levels among children 1 to 6 years of age.

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    Figure 3:

    Adjusted* association between total consumption of non–cow’s milk beverages and serum 25(OH)D (25-hydroxyvitamin D) levels among children drinking only non–cow’s milk and among those drinking both non–cow’s milk and cow’s milk products. *Adjusted for age, sex, body mass index z score, vitamin D supplementation, margarine consumption, level of skin pigmentation, outdoor play time, season, and cow’s milk consumption as an effect modifier. Screened areas = 95% confidence intervals.

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    Figure 4:

    Adjusted* association between daily consumption of non–cow’s milk beverages and daily consumption of cow’s milk. *Adjusted for age and sex.

Tables

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    Table 1:

    Baseline characteristics of children who participated in the study and nonparticipants

    CharacteristicParticipants n = 2831*Nonparticipants
    n = 1692
    Only cow’s milk
    n = 1950
    Only non–cow’s milk
    n = 146
    Both
    n = 157
    Neither
    n = 215
    Age, yr, mean ± SD3.0 ± 1.42.9 ± 1.53.3 ± 1.31.7 ± 1.22.7 ± 1.5
    Sex, male, no. (%)1025 (52.6)76 (52.1)88 (56.1)109 (50.7)850 (50.2)
    BMI z score, median (IQR)0.23 (−0.44 to 0.88)0.10 (−0.70 to 0.58)0.32 (−0.34 to 0.84)−0.11 (−0.90 to 0.51)0.19 (−0.48 to 0.88)
    No. of cups† per day, mean ± SD
     Non–cow’s milk–1.8 ± 1.11.1 ± 0.8–0.2 ± 0.6
     Cow’s milk2.0 ± 1.1–1.7 ± 1.1–1.7 ± 1.2
    Margarine consumption, no. (%)587 (30.1)22 (15.1)43 (27.4)35 (16.3)336 (19.9)
    Vitamin D supplementation, no. (%)1020 (52.3)92 (63.0)93 (59.2)123 (57.2)600 (35.5)
    Skin pigmentation,‡ no. (%)
     Light (type I or II)1003 (51.4)68 (46.6)83 (52.9)97 (45.1)592 (35.0)
     Medium (type III or IV)766 (39.3)68 (46.6)63 (40.1)92 (42.8)855 (50.5)
     Dark (type V or VI)107 (5.5)9 (6.2)6 (3.8)17 (7.9)66 (3.9)
    Outdoor play, h/wk, mean ± SD5.0 ± 2.35.1 ± 2.15.2 ± 2.24.5 ± 2.54.6 ± 2.4
    Serum 25(OH)D level, nmol/L, median (IQR)81 (67 to 100)78 (62 to 96)76 (63 to 93)74 (61 to 98)NA
    Serum 25(OH)D level < 50 nmol/L, no. (%)92 (4.7)16 (11.0)11 (7.0)16 (7.4)NA
    • Note: 25(OH)D = 25-hydroxyvitamin D, BMI = body mass index, IQR = interquartile range, NA = not available, SD = standard deviation.

    • ↵* 363 children not included because of missing data on milk intake (imputed for analysis).

    • ↵† 1 cup = 250 mL.

    • ↵‡ Determined with use of the Fitzpatrick scale.

    • View popup
    Table 2:

    Association between consumption of non–cow’s milk and 25-hydroxyvitamin D levels

    VariableUnadjusted analysisp value‡Adjusted analysis*p value‡
    % change in 25(OH)D level (95% CI)Change in median 25(OH)D level,† nmol/L (95% CI)% change in 25(OH)D level (95% CI)Change in median 25(OH)D level,† nmol/L (95% CI)
    Daily consumption of non–cow’s milk (per cup§)
     Drinks cow’s milk−4.7 (−8.4 to −0.8)−4.7 (−6.7 to −0.6)0.02−5.1 (−8.9 to −1.4)−4.2 (−7.1 to −1.1)0.008
     Does not drink cow’s milk−0.3 (−3.3 to 2.8)−0.2 (2.8 to 2.2)1.20.1 (−2.9 to 3.2)0.09 (−2.3 to 2.5)0.9
    Age (per additional year)−0.2 (−1.1 to 0.7)−0.2 (−0.9 to 0.5)0.6−0.8 (−1.7 to 0.1)−0.6 (−1.3 to 0.1)0.09
    Sex (male v. female)−0.04 (−2.6 to 2.6)−0.03 (−2.1 to 2.1)> 0.90.1 (−2.4 to 2.7)0.1 (−1.9 to 2.1)0.9
    BMI z score−0.2 (−1.5 to 1.0)−0.2 (−1.2 to 0.8)0.7−0.02 (−1.3 to 1.2)−0.02 (−1.0 to 0.99)> 0.9
    Cow’s milk consumption (no v. yes)−6.4 (−9.9 to −2.7)−5.1 (−7.9 to −2.2)< 0.001−8.1 (−12.2 to −3.4)−6.5 (−9.8 to −3.0)< 0.001
    Margarine consumption (no v. yes)−0.9 (−3.7 to 2.0)−0.7 (−3.0 to 1.6)0.6−1.3 (−4.2 to 1.6)−1.1 (−3.3 to 1.3)0.4
    Vitamin D supplementation (yes v. no)8.5 (5.7 to 11.3)6.8 (4.6 to 9.1)< 0.0018.9 (6.2 to 11.8)7.2 (4.9 to 9.4)< 0.001
    Skin pigmentation (v. type III or IV)
     Light (type I or II)1.8 (−0.9 to 4.6)1.5 (−0.7 to 3.7)0.21.3 (−1.4 to 4.1)1.0 (−1.1 to 3.3)0.4
     Dark (type V or VI)−14.0 (−18.6 to −9.0)−14.0 (−14.9 to 7.2)< 0.001−14.0 (−18.7 to −9.2)−14.0 (−15.0 to −7.4)< 0.001
    Seasonal effect¶
     Sine function1.3 (−0.5 to 3.1)1.0 (−1.2 to 0.3)0.20.4 (−1.4 to 2.3)0.3 (−1.1 to 1.8)0.6
     Cosine function−4.3 (−6.0 to −2.5)−3.4 (−4.8 to −2.0)< 0.001−4.7 (−6.6 to −2.8)−3.8 (−5.3 to −2.3)< 0.001
    Outdoor play (per additional hour)0.7 (0.2 to 1.3)0.6 (0.1 to 1.0)0.010.2 (−0.4 to 0.8)0.1 (−0.3 to 0.6)0.6
    • Note: 25(OH)D = 25-hydroxyvitamin D, CI = confidence interval, SD = standard deviation.

    • ↵* Adjusted for all other variables in the table.

    • ↵† Median level = 80.0 nmol/L.

    • ↵‡ p values (t test) represent significance of % change in 25(OH)D level.

    • ↵§ 1 cup = 250 mL.

    • ↵¶ The seasonal amplitude was 10% and peaked on June 26. Seasonal effect was tested using a likelihood ratio test and was statistically significant (p < 0.001).

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Canadian Medical Association Journal: 186 (17)
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Consumption of non–cow’s milk beverages and serum vitamin D levels in early childhood
Grace J. Lee, Catherine S. Birken, Patricia C. Parkin, Gerald Lebovic, Yang Chen, Mary R. L’Abbé, Jonathon L. Maguire
CMAJ Nov 2014, 186 (17) 1287-1293; DOI: 10.1503/cmaj.140555

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Consumption of non–cow’s milk beverages and serum vitamin D levels in early childhood
Grace J. Lee, Catherine S. Birken, Patricia C. Parkin, Gerald Lebovic, Yang Chen, Mary R. L’Abbé, Jonathon L. Maguire
CMAJ Nov 2014, 186 (17) 1287-1293; DOI: 10.1503/cmaj.140555
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