(PTFS16-02-26) Statistical Modeling of Cow’s Milk Replacement With Plant-Based Milk Substitutes: Nutritional and Cost Consequences for WIC-Program Preschool Children (NHANES 2001-2018)

Objectives: To compare nutritional and cost changes due to incrementally removing or replacing milk with Plant-Based Milk Substitutes (PBMS) among US children participating in the Women, Infants, and Children (WIC) program.

Methods: This secondary analysis of National Health and Nutrition Examination Survey (NHANES) 2001-2018 dietary recall data included WIC-participating children (2-4 y, n = 1982). Modeling included removal or replacement of cow’s milk with PBMS by % increments (0 (baseline), 25, 50, 75, and 100). Total daily nutrient intakes, milk intake, and diet cost were estimated; nutrient composition data were obtained from the Food and Nutrient Database for Dietary Studies. For removal of milk models (RE-MM), selected % removal of milk nutrients and cost were subtracted from baseline levels. For replacement of milk models (REP-MM), after nutrients and cost of removed milk were subtracted, nutrients and cost of the PBMS replacement were added to baseline levels. Sample-weighted estimates and SE, adjusted for the complex design of NHANES using SUDAAN 11.0.3 / SAS 9.4, included mean (SE) nutrient intakes; % (SE) below the Estimated Average Requirement (< EAR) and above the Adequate Intake ( > AI), respectively, using the National Cancer Institute usual intake method; and mean (SE) change in diet cost.

Results: In the RE-MM, intakes of protein, vitamins A, D, B2, B12, choline, Ca, Mg, P, K, and diet cost change decreased at all % increments. At 25% RE-MM, a higher % than baseline was < EAR for vitamin D and Ca; at 100% RE-MM, a higher % was also < EAR for protein, vitamins A, B1, B6, and B12, Mg, P, and Zn, but a lower % was > AI for Na. In the 100% REP-MM with soy milk, from baseline, intakes of n-3 fats, folate, choline, Mg, Fe, and diet cost increased, while Ca and P decreased; a higher % was < EAR for vitamin D and Ca, but % < EAR for vitamin E was lower. In the 100% REP-MM with non-soy PBMS, from baseline, intakes of energy, protein, vitamins A, D, B1, B2, B6, and B12, choline, Mg, P, and Zn decreased, but diet cost increased, while % < EAR for vitamin E, Ca, and Fe was lower. All above results were significant at p < 0.05.

Conclusions: Reducing milk availability to WIC preschoolers may have significant adverse consequences. Swapping milk with PBMS does not replace its nutrient contributions and raises cost.

Funding Sources: National Dairy Council