Journal of Obesity & Weight Loss Category: Medical Type: Research Article
Milk Consumption and Health Beliefs and Its Relation to BMI in College Students
- Charles Platkin1*, Ming Chin Yeh2, Patricia Estrella2, Caitlin MacShane2, Deborah Allinger2, Rebecca Elbaum2, Melissa Keeney2, Barbara Brumaru2, Katarzyna Wyka3
- 1 Nutrition And Food Science Program, School Of Urban Public Health, Hunter College, City University Of New York School Of Public Health, Silberman Building, 2180 Third Avenue RM 528, New York, NY 10035, United States
- 2 Nutrition And Food Science Program, School Of Urban Public Health, Hunter College, City University Of New York School Of Public Health, Manhattan, United States
- 3 Epidemiology And Biostatistics Program, School Of Urban Public Health, Hunter College, Manhattan, United States
*Corresponding Author:Charles Platkin
Nutrition And Food Science Program, School Of Urban Public Health, Hunter College, City University Of New York School Of Public Health, Silberman Building, 2180 Third Avenue RM 528, New York, NY 10035, United States
Received Date: Nov 06, 2015 Accepted Date: Dec 08, 2015 Published Date: Dec 24, 2015
Methods: In 2013, a paper and electronic survey was conducted to assess personal health information, type of milk consumed, its typical serving size, and frequency of consumption. A series of statements pertaining to milk consumption and health was assessed using a five-point Likert scale. The survey was conducted between May 1 and August 5, 2013 and recruited participants from a multi-ethnic population of students and employees of an urban college.
Results: Participants (n = 553) were 66.7% female, mean age was 23.75 years (SD = 7.40) and mean BMI was 23.61 (SD = 5.11). Participants most commonly consumed skim and low-fat milk (44.9%) several times a week (51.7%) in a serving size of ½-1 cup (68.8%). Females consumed more milk alternatives (p = 0.003), with lower frequently (p < 0.001) and in smaller serving sizes (p = 0.025). African Americans, Asians and Hispanics reported drinking larger serving sizes compared to other race/ethnic groups (p = 0.011). Majority of respondents agreed that milk is good for one’s health (74.5%), a good source of protein (62.6%), a good source of calcium (87.4%), and needed for stronger bones (77.3%). Significant associations were observed between alternative milk consumption and weaker beliefs in all milk beliefs statements (p < 0.001). There were no significant differences between those who reported consuming whole, chocolate or flavored milk and skim or low fat milk. Males more strongly believed that milk is a good source of protein (p = 0.045) and Whites expressed more disagreement with milk health belief statements. BMI was not associated with milk consumption or health beliefs about milk.
Conclusion: Our findings showed that this group of college age students tended to consume skim or low-fat milk. Gender differences were observed in consumption and health beliefs of milk. No racial/ethnic differences were observed in type of milk consumption, yet differed in agreement of milk health belief statements. No association was observed between BMI and type of milk consumption, or between BMI and milk health beliefs. Further research should be conducted to control confounding factors in order to confirm whether milk consumption or health beliefs and BMI are not related.
MILK CONSUMPTION AND HEALTH STATUS
A diet high in calcium have been demonstrated to decrease intracellular calcium concentrations, activate lipolysis, repress lipogenesis, and subsequently, reduce body fat deposition and increase thermogenesis . In an obese rat model study, a high-calcium diet was shown to retard fat accumulation and weight gain, while the opposite effect was observed in low-calcium diets . Furthermore, a randomized cross-over trial found that a breakfast containing high-calcium, high-vitamin D dairy led to an increase in fat oxidation rate and diet-induced thermogenesis in adults .
Other components in dairy products may also play a role in body weight regulation. Conjugated linoleic acid has been shown to reduce body fat accumulation in several animal models . Dairy products also contain bioactive components whose combined efforts with calcium mitigate adiposity . The proteins in dairy products, specifically whey protein in conjunction with bioactive peptides and amino acids, may suppress appetite, increase satiety, and regulate food intake .
In a review conducted by Zemel and Miller , it was found that in non-caloric restrictive diets that included three or more servings of dairy helped to significantly reduce adiposity in obese humans. Furthermore, it has been suggested that increasing calcium or dairy intake may help in the regulation of body weight and possible weight gain . However, a review of prospective cohort studies done by Louie et al.,  found that the evidence of consuming dairy food for a protective effect on weight status was inconclusive. Similarly, other review studies have found that neither dairy products nor calcium supplementation impact body weight status [9,17].
This study attempts to further clarify the relationship between BMI and milk consumption, focusing on gender and race/ethnic differences and health beliefs about milk. Specifically, the objectives of this study are to evaluate:
1) Milk consumption by gender and race/ethnicity, including milk type, serving size and frequency of milk consumption,
2) The relationship between health beliefs about milk and its consumption and BMI in college students.
Study design and survey development
Individual characteristics and attributes
Milk consumption and health beliefs
|Characteristic||n||M (SD) or %|
|$0 - $29,999||174||32.8|
|$30,000 - $49,999||126||23.8|
|$50,000 - $69,999||80||15.1|
|$70,000 or more||150||28.3|
|Underweight (BMI < 18.5)||37||7.1|
|Normal (18.5 ≤ BMI ≤ 24.9)||343||66.1|
|Overweight (25 ≤ BMI ≤ 29.9)||89||17.1|
|Obese (MBI ≥ 30)||50||9.6|
|1-2 times per week||102||27.8|
|3 or more times per week||135||36.8|
|Neither healthy nor unhealthy||146||27.2|
Milk consumption overall and by gender and race/ethnicity
|Overall n=553||Male n=182||Female n=371||White n=195||African-American n=46||Hispanic n=107||Asian n=126||Other/Mixed n=78|
|Don’t drink milk||12.5||9.4||13.8||0.009||12.9||19.6||11.2||11.3||9||0.295|
|Type of milk usually consumed||0.003||0.331|
|Whole milk/Chocolate or flavored milk||35.5||43.3||31.1||28.4||40.5||35.8||41.8||38|
|Skim milk/Low fat milk/ Milk alternativea||39.4||44.5||45.6||47.3||43.2||49.5||41.8||40.8|
|Typical serving size||0.025||0.011|
|1/2 cup - 1 cup||68.8||75.8||65.7||60.0a||81.1b||74.2b||75.9b||64.3a|
|In beverages (i.e. coffee, tea)||31.3||24.2||34.3||40||18.9||25.8||24.1||35.7|
|Frequency milk drinking||<.001||0.614|
|Several times a week||51.7||55.8||60||52.1||64.9||63.2||59.6||62.9|
|Other dairy productsb||0.855|
|Several times a week||61.3||59.8||62.2||58||52.8||69.5||63.3||66.2|
Note: a: Milk alternatives include products such as soy, almond, rice and coconut milk,b: Other dairy products include cheese, yogurt, ice cream, butter, cottage cheese and cream cheese, c,d: p-values for gender differences and race/ethnic differences were based on bivariate 2x2 χ2 tests with Bonferroni correction. Pair wise comparisons with different alphabetical subscripts differ significantly (p < .05) (bolded)
There were significant gender differences in type of milk consumed, serving size and frequency, with females preferring milk alternatives (23.3% vs. 12.2%, χ2 (1, N = 482) = 11.37, p = 0.003), smaller serving size (½ -1 cup 65.7% vs. 75.8%, χ2 (1, N = 473) = 5.05, p = 0.025), and less frequent milk consumption (daily 15.9% vs. 31.9%, χ2 (1, N = 478) = 20.77, p < 0.001). The use of calcium supplements and other dairy products was not statistically different between genders (Table 2).
The lowest consumption of whole milk, chocolate, or flavored milk was reported by Whites (28.4%), followed by Hispanics (35.8%), other/mixed (38%), African Americans (40.5%) and Asians (41.8%), however, these differences were not statistically significant (Table 2). Likewise, there were no statistically significant differences in frequency of milk consumptions, however African Americans, Asians and Hispanics reported drinking ½-1 cup more often than Whites and Other/Mixed race/ethnic groups (χ2 (1, N = 473)= 13.01, p = 0.011).
Beliefs about milk and milk consumption
1) Good for one’s health (74.5%),
2) A good source of protein (62.6%),
3) A good source of calcium (87.4%), and
4) is needed for stronger bones (77.3%).
|Overall n=553||Male n=182||Female n=371||White n=195||African-American n=46||Hispanic n=107||Asian n=126||Other/Mixed n=78|
|Statement||% Yes||% Yes||Mean rank||% Yes||Mean rank||% Yes||Mean rank||% Yes||Mean rank||% Yes||Mean rank||% Yes||Mean rank||% Yes||Mean rank|
|Milk is good for your health||74.5||75.5||191.4||75.7||180.1||63.9||206.0a||86.4||150.6b||85||158.8b||79.8||173.7ab||76.6||190.0ab|
|Milk helps with weight loss||16.2||17.8||246.7||15.8||270.1*||11.3||290.7a||15.2||239.5ab||15.1||258.1ab||21.8||243.5b||22.1||237.8b|
|Milk is a good source of protein||62.6||71.1||205.8||59.1||229.6||57.5||237.4||69.6||199.4||59.4||228.1||67.7||210.6||70.1||205.1|
|Drinking milk helps prevent heart disease||23.2||24||255.7||23.6||249.5||19.5||270.9||15.2||260||21.7||234||29.8||233.5||29.9||247.4|
|Milk is a good source of calcium||87.4||88.3||153.2||89.1||148.5||87||149.9||89.1||151.3||87.7||152.7||91.8||145.1||89.6||153.5|
|Milk is needed for stronger bones||77.3||78.3||158.8||77.2||158.4||69.6||169.4||80.4||150.1||81||151.7||86.8||140.3||75||169.6|
|Skim milk is healthier than whole or low-fat milk||42.8||42.1||225.6||44.7||225.5||40.3||244.4a||40||232.5ab||51.9||196.5b||46||213.2ab||38.7||231.0ab|
|It is important to consume the recommended 3 servings of dairy per day||43.5||46.1||233.3||43.3||235.8||33.7||272.4a||45.7||219.2ab||45.3||216.7b||54.1||195.7b||52.6||227.2ab|
Much lower endorsement rates were observed for statements regarding skim milk being healthier than whole or low-fat milk (42.8%) and the importance to consume the recommended 3 servings of dairy per day (43.5%). Lastly, fewer than a quarter of respondents agreed with the statement that drinking milk helps prevent heart disease (23.6%) and that milk helps with weight loss (16.2%). Notably, respondents who consumed skim/low-fat milk or milk alternatives generally reported a higher level of disagreements with all statements. Statistically significant associations were observed between consuming milk alternatives and weaker beliefs in all milk statements (all p < 0.001). There were no significant differences between those who reported consuming whole, chocolate or flavored milk and skim or low fat milk.
Beliefs about milk were similar among females and males regarding all statements (all p > 0.05), except that males expressed a stronger belief that milk is a good source of protein (U = 18465.5, p = 0.045) and that milk helps with weight loss (U = 27486.5, p = 0.071).
Racial/ethnic differences in milk health beliefs were the strongest regarding statements about milk being good for one’s health (χ2 (4, N = 367) = 18.83, p = 0.001), whether milk helps with weight loss (χ2 (4, N = 523) = 13.62, p = 0.009), whether skim milk is healthier than whole milk or low-fat milk (χ2 (4, N = 449) = 10.80, p = 0.029), and whether it is important to consume the recommended 3 servings of dairy per day (χ2 (4, N = 468) = 28.20, p < 0.001). Pairwise comparisons revealed that Whites generally reported more disagreement with all statements, particularly in contrast to:
1) African-Americans and Hispanics regarding milk being good for one’s health,
2) Asians and Other/Mixed regarding milk helping with weight loss,
3) Hispanics regarding the belief that skim milk is healthier than whole milk or low-fat milk,
4) Hispanics and Asians regarding the importance to consume the recommended 3 servings of dairy per day (all p < 0.05).
BMI and milk consumption and milk health beliefs
MILK CONSUMPTION, MILK HEALTH BELIEFS AND BMI
In this study, no significant racial/ethnic differences were observed in the type of milk consumed. This was in contrast to other studies that found that Whites consumed more low-fat dairy products than other racial/ethnic groups and other racial/ethnic groups consumed more high-fat dairy products [27,28]. Furthermore, we found that African-Americans, Asians, and Hispanics consumed more milk in serving sizes of ½-1 cup compared to Whites or other groups, which is in contrast to other studies that found intake to be greater among Whites [29-32].
Significant gender differences were also observed in terms of type of milk preference, serving size and frequency of consumption. Females consumed more milk alternatives and in smaller serving sizes compared to males. This is in contrast to other studies that found no significant gender differences in non-milk drinkers and milk drinkers . We also found females consumed milk less frequently than men, which has been seen in other studies [34,35]. In fact, Hiza and Gerrior  found that women consumed significantly less servings of milk than men did (1.3/day vs 1.6/day). Additionally, a cross-sectional study done by Touvier et al.,  found that 36.2% of men vs 26.5% of women were more likely to exceed the 3-a-day dairy recommendation, however, only 35% of the participants did meet the recommendation.
In this study, participants believed that milk was beneficial for one’s health, good source of calcium, good source of protein, and needed for stronger bones, which has been seen in other studies [38-41]. Overall, there was a trend for greater disagreement on whether milk prevented heart disease, helps with weight loss, skim milk being healthier than whole milk or low-fat milk, and the importance of consuming 3 servings of dairy per day. Participants who chose milk alternatives significantly believed less in all milk belief statements compared to other milk drinkers, which is in contrast to studies that found that non-dairy milk were viewed as more beneficial and more likely to prevent disease . Although statistically insignificant, participants who consumed whole, chocolate, or flavored milks believed in previous statements more strongly. Participants may view that these milks as more wholesome as observed in an intervention study conducted by Weiss and colleagues, whose participants indicated whole milk’s higher healthfulness by referring to it as “vitamin D” milk .
We found gender and racial/ethnic differences in milk health beliefs. Compared to males, females significantly disagreed that milk is a good source of protein. In contrast, a cross-sectional study found men to be less convinced of milk’s nutritional benefits and women having more positive belief of milk’s health benefits . Yet, other studies have shown no differences between genders in perceptions of milk’s beneficial health benefits . There was a stronger disagreement amongst Whites compared to other racial/ethnic groups to whether milk was good for one’s health, helped with weight loss, skim milk being healthier than whole milk or low-fat milk, or the importance of consuming 3 servings of dairy per day.
This study did not find a significant link between milk consumption, regardless of its fat content, and BMI in urban college students. Likewise, this null association between dairy consumption and BMI has been observed in cross-sectional studies [26,44,45], prospective studies [46-49] and randomized controlled trials . This is in contrast to previous studies that have found an inverse association with dairy consumption and BMI [51,52] or even a positive association .
The literature on the relationship between dairy fat intake and BMI or body fat composition has yielded inconsistent results. In a cross-sectional study conducted by Murphy et al.,  dairy food intake, mainly reduced fat milk, was inversely associated with BMI in overweight/obese adults. Conversely, a review done by Kratz et al.,  determined that high-fat dairy consumption was associated with favorable weight outcomes, while low-fat dairy consumption was positively correlated with weight gain. It is possible we did not observe any effects on BMI due to the low dairy intake, as reasoned by the authors of a cross-sectional study of college-aged Japanese adults  or other BMI-confounding factors not assessed in this study.
This study also found no relationship between milk beliefs and BMI indicating that milk health beliefs may not predict the outcome of BMI. In one study using the theory of reasoned action to predict milk consumption in women, the authors reasoned that behavior of drinking milk was a combination of intention, beliefs and sensory evaluation with intention and behavior having the highest correlation . However, they pointed out that there is a more complex thought process involved in drinking lower-fat milks . It is reasonable to assume there is a more complex interaction between BMI and milk consumption that we were not able to capture in this study. Furthermore, one should note that most dairy-weight loss research is conducted on overweight/obese subjects, while our population may be more concerned with weight maintenance.
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Citation:Platkin C, Yeh MC, Estrella P, MacShane C, Allinger D, et al. (2015) Milk Consumption and Health Beliefs and Its Relation to BMI in College Students. J Obes Weight Loss 1: 002.
Copyright: © 2015 Charles Platkin, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.