Children who avoid drinking cow milk have low dietary calcium intakes and poor bone health1–3

Background: Information concerning the adequacy of bone mineralization in children who customarily avoid drinking cow milk is sparse. Objective: The objective was to evaluate dietary calcium intakes, anthropometric measures, and bone health in prepubertal children with a history of long-term milk avoidance. Design: 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. Results: 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/cm3) were 0.72 ± 1.17 for the lumbar spine and 0.72 ± 1.35 for the 33% radius (P < 0.00l). Twelve children (24%) had previously broken bones. Conclusions: 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. Am J Clin Nutr 2002;76:675–80.