Received: 18 July 2019 Accepted: 17 December 2019

DOI: 10.1111/ijpo.12612

ORIGINAL RESEARCH

Associations between milk fat content and obesity,

1999 to 2016

Michelle J. White MD, MPH1 | Sarah C. Armstrong MD2 |

Melissa C. Kay RD, MPH, MS, PhD1,3 | Eliana M. Perrin MD, MPH1 |
Asheley Skinner PhD4

1
Department of Pediatrics, Duke Center for
Childhood Obesity Research, Duke University, Summary
Durham, North Carolina Background: The relationship between milk fat content and body mass index (BMI)
2
Department of Pediatrics, Community and
remains unclear. The objective of this study was to determine if milk fat content is
Family Medicine, Duke Clinical Research
Institute, Duke Center for Childhood Obesity associated with obesity in children, adolescents and young adults.
Research, Duke University, Durham, North
Methods: We used repeated cross sections of National Health and Nutrition Exami-
Carolina
3
Duke Global Health Institute, Global Digital nation Survey (NHANES), 1999 to 2016. Using logistic regression, we measured
Health Science Center, Duke University, associations between first milk consumed after formula/breast milk (whole, 2%, 1%,
Durham, North Carolina
4
or fat-free) and weight status (≥85th to <95th BMI percentile, overweight; ≥95th
Department of Population Health Sciences,
Duke Clinical Research Institute, Duke Center BMI percentile, obesity) among children 2 to 6 years (n = 8367). We also assessed
for Childhood Obesity Research, Duke
associations between current milk type and weight status among those 2 to 20 years
University, Durham, North Carolina
of age (n = 26 750).
Correspondence
Results: Children 2 to 6 years with obesity were less likely to have been weaned to
Michelle J. White, MD, MPH, Department of
Pediatrics, Duke Center for Childhood Obesity whole milk versus healthy weight children (adjusted odds ratio [aOR], 0.77; 95% CI,
Research, Duke University, 2301 Erwin
0.60-0.98; P = .031). Individuals 2 to 20 years with overweight or obesity were less
Rd. Durham, NC 27705.
Email: michelle.white@duke.edu likely to drink whole milk as their current milk and more likely to drink fat-free or 1%
milk compared with healthy weight children.
Conclusions: Whole milk consumers are less likely to have obesity. It is unclear
whether this relationship is causal or a reflection of United States Department of
Agriculture recommendations. Further examination of the factors that influence milk
choice among diverse cohorts would lend clarity to this important issue.

KEYWORDS

milk, NHANES, nutrition, obesity, overweight

1 | I N T RO DU CT I O N meeting nutrient requirements.2,3 The most recent Dietary Guidelines

Beverages, specifically milk, are a significant source of calories and
1
nutrients in the diets of young children. Milk consumption is associ-
ated with better diet quality in children and a higher likelihood of
Abbreviations: AAP, American Academy of Pediatrics; AHA, American Heart Association;
aOR, adjusted odds ratio; BMI, body mass index; FPL, federal poverty level; NHANES,
National Health and Nutrition Examination Survey; SSB, sugar-sweetened beverages;
WIC, women, infants, and children.
for Americans recommend children ages 2 to 5 years consume 2 to
3 cups of milk or dairy products daily.4 Given the rising prevalence of
obesity, these guidelines, along with the American Academy of Pediat-
rics (AAP) and American Heart Association (AHA) recommend low-fat
or reduced-fat varieties in place of whole (4%) milk for those aged
2 years and older.4,5 Because whole milk represents a significant
source of total and saturated fat, particularly in children, decreasing
the consumption of milk fat decreases caloric intake from milk while

Pediatric Obesity. 2020;e12612. wileyonlinelibrary.com/journal/ijpo © 2020 World Obesity Federation 1 of 8

https://doi.org/10.1111/ijpo.12612
2 of 8
preserving its nutritional benefits as a source of protein, calcium, and
vitamin D.6,7 In March 2014, the Special Supplemental Nutrition Pro-
gram for Women, Infants, and Children (WIC), a US federal assistance
programme for low-income women and children, aligned their food
packages with the Dietary Guidelines for Americans and made 1% and
fat-free milk the standard issue for women and for children older than
8
2 years of age. Whole and 2% milk are available by physician
recommendation only.
Research indicates beverage type, such as sugar-sweetened bev-
erages (SSBs), is associated with child weight status; but when it
comes to milk, results are mixed. Some studies demonstrate low con-
sumption of milk in childhood is a risk factor for obesity,9-12 while
others indicate the opposite.13,14 A recent comprehensive review
found no evidence that milk consumption contributes to obesity risk
among adolescents; however, the authors note less evidence to sup-
port this conclusion among children less than 8 years of age.15 A
study of the association of dairy and adiposity in China, one of the
few non-Western nations represented in this literature, similarly
found no association between dairy consumption and weight status
among adolescents.16 However, heterogeneity in study design, popu-
lation, and definition of exposures and outcomes make comparisons
difficult. Of concern, trends in beverage consumption in the United
States show that many children are not consuming milk regularly,
while approximately two-thirds of children consume SSBs.17
Replacing SSBs with milk has positive effects on weight status.18
However, recent results suggest consumption of milk decreases with
19
age, while SSB consumption increases.
Among young children who drink milk, the association between
milk fat content and later risk of obesity is important yet unclear. A
small number of studies have examined the association between milk
fat content and weight in children with mixed results; some report no
association between whole milk and weight, while others report an
inverse association.20-26 The dearth of evidence, particularly among
young children, and the heterogeneity in how milk intake is assessed
and obesity risk is defined make it difficult to draw definitive conclu-
sions regarding the effects of milk fat content on childhood obesity
risk. Furthermore, the effect of the first milk fat content introduced
after formula or breast milk on subsequent risk of obesity is unknown.
The goals of this study were to use a nationally representative sample
to investigate the association between (a) first milk fat content and
weight status in early childhood and (b) current milk fat content and
weight status among children, adolescents, and young adults.
2 | P A T I E NT S A N D M E TH O D S
2.1 | Data source
We examined data from repeated cross sections of the National
Health and Nutrition Examination Survey (NHANES), 1999 to 2016.
NHANES is a stratified, multistage probability sample of the US popu-
lation, conducted throughout the year at 15 geographic sites selected
annually. It includes data from a physical examination, laboratory
WHITE ET AL.
testing, and a detailed in-home interview. Two populations in the
NHANES sample were used for this study, based on ages at which
specific questions are included in the NHANES interview. To deter-
mine the relationship between a child's first milk fat content after
weaning and weight status, we included only children aged 2 to
6 years reflecting the target age range for this question. To determine
the relationship between current milk fat content and weight status,
we included children, adolescents, and young adults aged 2 to
20 years.
2.2 | Weight status
Weight status was defined using body mass index (BMI) percentiles
calculated from measured height and weight using age and sex-
specific percentile ranges. We defined weight categories for children
aged 2 to 17 according to the recommended cut-points from the
Centers for Disease Control as follows: <5th percentile, under-
weight; 5th to <85th percentile, healthy weight; ≥85th to <95th
percentile, overweight; ≥95th to <120% of the 95th percentile, class
I obesity; ≥120% to 140% of the 95th percentile, class II obesity;
and ≥140% of the 95th percentile, class III obesity.27 For adults
aged 18 to 20, adult BMI cut-offs were used as follows: <18.5,
underweight; 18.5 to <25.0, healthy weight; 25.0 to <30.0, over-
weight; 30.0 to <35.0, class I obesity; 35.0 to <40, class II obesity;
and >40, class III obesity.27
2.3 | Milk fat content
Milk fat content and milk consumption frequency are asked as part
of the diet behaviour and nutrition interview component within the
NHANES survey. We defined milk fat content as whole (4%), 2%,
1%, fat free, and “other.” “Other” may include flavoured milk of vari-
able milk fat content as NHANES does not distinguish between
these; thus, we excluded “other” milk type from our analyses. First
milk fat content was defined as the first type of milk offered after
weaning from breast milk or formula. First milk fat content is asked
retrospectively to parents of children aged 2 to 6 (“What type of
milk was [subject] first fed on a daily basis?”). Current milk fat con-
tent was defined as the primary type of milk consumed over the
past 30 days among children, adolescents, and young adults aged
2 to 20. We excluded individuals who consumed no milk (approxi-
mately 4% of the survey population) in order to allow appropriate
comparisons among milk fat levels. The frequency of milk consump-
tion, daily or less than once per day, was also included in our analy-
sis of current milk fat content among children, adolescents, and
young adults aged 2 to 20. Parents responded for children aged
2 to 11; children 12 and older responded for themselves. Categories
for comparison among milk types were selected based on current
dietary recommendations.4 Thus, we compare whole milk to all
reduced fat milk types (fat-free, 1%, and 2%) and whole and 2% to
lower fat milk types (1% and fat-free).4
WHITE ET AL. 3 of 8

2.4 | Statistical analysis T A B L E 1 Demographic characteristics of children 2 to 6 years

from National Health and Nutrition Examination Survey (NHANES),
1999-2016 (n = 8367)
We used logistic regression to determine association between initial
milk fat content and child BMI percentile and current milk fat content Percentage, %
and BMI percentile. Adjusted analyses for first milk fat content Age in years
included race, age, income, and NHANES cycle as covariates. Adjusted 2 20.1
analyses for current milk fat content included race, age, income, milk 3 19.5
consumption frequency, and NHANES cycle as covariates. All analyses
4 21.1
were adjusted to account for survey design according to National
5 19.1
Center for Health Statistics recommendations and were performed
6 20.2
using Stata 14.2 (StataCorp, College Station, TX). The present analysis
Male 50.4
was deemed exempt from further review by the IRB under federal reg-
Race/ethnicity
ulation 45CFR§46.101(b), as it used only deidentified secondary data.
Non-Hispanic White 55.5
Non-Hispanic Black 14.0

3 | RESULTS Hispanic 22.5

Non-Hispanic, other or multiracial 8.0
3.1 | Population characteristics: First milk fat Percent of federal poverty level
content <100% 26.8
100-199% 25.5
First milk consumed after formula/breast milk was asked of parents of 200-299% 15.6
children aged 2 to 6 years (n = 8367). This sample had nearly equal pro-
300-399% 10.5
portions of children at each year of age; approximately half of children
400-499% 8.1
were male (Table 1). Approximately, 56% of children were non-Hispanic
>500% 13.4
White, 14.0% non-Hispanic Black, 22.5% Hispanic, and 8.0% non-
Weight status
Hispanic other or multiracial. Twenty-seven percent of children had
Underweight/healthy weight 75.5
household incomes less than the federal poverty level (FPL); one quarter
Overweight 12.9
had overweight or obesity. Approximately three quarters of children drank
whole milk as their first milk fat content, while 16.1% drank 2% milk. Class I obesity 9.3
Class II obesity 1.8
Class III obesity 0.4
3.2 | First milk fat content and weight status First milk fat content
Fat free 0.9
Children with class I obesity were less likely to have whole milk as their 1% 1.9
first milk fat content compared with healthy weight individuals (adjusted 2% 16.1
odds ratio [aOR], 0.77; 95% CI, 0.60-0.98; P = .031) (Table 2). Over-
Whole 77.1
weight, class II, and class III obesity were not associated with first
Other 4.1
milk fat content. Non-Hispanic Black individuals were less likely to be
weaned to whole milk compared with non-Hispanic Whites (aOR, 0.80;
95% CI, 0.66-0.96; P = .018). By income level, children in homes with FPL, and 34.1% had overweight or obesity. Seventy-three percent of
incomes of 500% or more of the FPL were twice as likely to be weaned participants drank milk at least once daily; only 4% never consumed
to whole milk than children in homes with incomes less than the FPL. milk. The largest proportions of children and young adults who drank
milk reported primarily drinking 2% or whole milk. The proportions
drinking fat-free milk and 1% milk were 11.8% and 10.3%, respec-
3.3 | Population characteristics: Current milk fat tively. Only 3.8% reported drinking “other” milk types, which may
content include flavoured, sweetened milk.

The sample of children and young adults aged 2 to 20 years old

included 26 750 individuals (Table 3). The weighted distributions
reflected the US population: approximately 20% were aged 2 to
5 years old, 32.4% were aged 6 to 11, and 46.8% were aged 12 to 20.
Half were male, 14.0% were non-Hispanic Black, and 20.4% were His-
panic. A quarter of participants had household incomes less than the
3.4 | Current milk fat content and weight status
Children, adolescents, and young adults with overweight or obesity
(all classes) were less likely to drink whole milk and more likely to
drink 1% or fat-free milk compared with healthy weight children
4 of 8 WHITE ET AL.

T A B L E 2 Adjusted oddsa of first milk

1% or fat-
Wholeb P (95% CI) freec P (95% CI)
fat content for children 2 to 6 years from
National Health and Nutrition
Weight status Examination Survey (NHANES), 1999 to
Healthy weight REF REF 2016 (n = 8076)
Overweight 0.99 .928 (0.79-1.24) 1.20 .493 (0.72-2.00)
Class I obesity 0.77 .031 (0.60-0.98) 1.58 .092 (0.93-2.67)
Class II obesity 0.69 .074 (0.46-1.04) 2.02 .251 (0.61-6.75)
Class III obesity 1.26 .574 (0.57-2.79) 0.63 .667 (0.08-5.12)
Race/ethnicity
Non-Hispanic White REF REF
Non-Hispanic Black 0.80 .018 (0.66-0.96) 0.75 .235 (0.46-1.21)
Hispanic 0.99 .897 (0.81-1.20) 1.04 .882 (0.65-1.65)
Non-Hispanic, other 1.25 .152 (0.92-1.70) 0.39 0.013 (0.19-0.82)
Percent of federal poverty
level
<100% a REF REF
100-199% 1.04 .718 (0.83-1.30) 0.84 .548 (0.48-1.47)
200-299% 0.94 .660 (0.72-1.23) 1.37 .291 (0.76-2.45)
300-399% 0.92 .586 (0.70-1.23) 1.30 .445 (0.66-2.59)
400-499% 1.36 .104 (0.94-1.96) 1.17 .708 (0.50-2.73)
>500% 2.06 <.001 (1.45-2.92) 1.08 .849 (0.50-2.30)
NHANES year
1999-2000 REF REF
2001-2002 1.18 .576 (0.66-2.11) 1.05 .933 (0.30-3.72)
2003-2004 0.96 .874 (0.58-1.58) 0.83 .718 (0.29-2.35)
2005-2006 0.84 .522 (0.49-1.43) 1.03 .958 (0.40-2.61)
2007-2008 1.14 .619 (0.67-1.96) 0.48 .238 (0.14-1.63)
2009-2010 1.09 .731 (0.66-1.80) 1.16 .720 (0.52-2.56)
2011-2012 1.19 .499 (0.72-1.97) 0.71 .459 (0.29-1.77)
2013-2014 0.97 .895 (0.59-1.60) 1.01 .987 (0.43-2.37)
2015-2016 0.94 .829 (0.54-1.63) 1.67 0.271 (0.67-4.20)

Note: Bold face indicates statistically significant association (p < 0.05).

a
Adjusted for age, race/ethnicity, income, and NHANES cycle.
b
Versus 2%, 1%, or fat-free.
c
Versus 2% or whole.

(Table 4). Compared with non-Hispanic White children, non-Hispanic
Black, Hispanic, and non-Hispanic other children were more likely to
drink whole milk and less likely to drink 1% or fat-free milk. Compared
with individuals below the FPL, individuals from all other income
groups were less likely to drink whole milk.
4 | DISCUSSION
Both first and current milk fat content were associated with weight
status. Children aged 2 to 6 years of age who had class I obesity were
less likely to have been weaned to whole milk. Among those 2 to
20 years old, individuals with overweight or obesity were less likely
to consume whole milk and more likely to consume milk with lower
fat content compared with those with a healthy weight. There were
also differences in first milk and current milk consumption by race/
ethnicity and income. These findings expand the evidence base of
previous studies describing an inverse relationship between milk fat
consumption and weight status using a large, nationally representa-
tive sample.
There are at least two possible interpretations for our findings on
the relationship between weight status and milk consumption. The
first is that children and families are following AAP and AHA recom-
mendations to consume lower fat varieties of milk when at risk for
overweight and obesity. Similar to previous cross-sectional analyses
of milk fat content and weight status, associations between milk fat
content and subsequent weight status may be a result of physician or
parent concern for the child's weight status, which may influence the
decision to consume whole versus reduced fat varieties of milk.20,23,28
Greater concern for overweight or obesity is associated with a change
WHITE ET AL. 5 of 8

T A B L E 3 Demographic characteristics of children and adolescents consumption and the rising obesity prevalence in the latter decades of
2 to 20 years from National Health and Nutrition Examination Survey the 20th century.29,30 Prior longitudinal research indicates that high pro-
(NHANES), 1999 to 2016 (n = 26 750)
tein, low-fat intake in early childhood may lead to higher BMI; however,
Percentage, it remains unclear whether the relationship between a specific food or
% beverage, such as reduced fat milk and obesity is truly causal.31,32 Longi-
Age in years tudinal assessment of dietary patterns, weight, and the motivations
2-5 20.8 behind dietary choices among large, diverse cohorts of children are nec-
6-11 32.4 essary to disentangle the relationship between milk and weight status.
12-20 46.8 First milk content after weaning may be important in obesity pre-
Male 51.5 vention because early dietary practices influence subsequent dietary

Race/ethnicity practices into adulthood.33,34 Moreover, children with overweight and

obesity in early childhood are at higher risk of maintaining an
Non-Hispanic White 58.1
unhealthy weight.35,36 Milk choice may also affect other dietary
Non-Hispanic Black 14.0
choices.29,37,38 Recommendations regarding the initial milk fat content
Hispanic 20.4
chosen after weaning must consider evidence regarding the risk of
Non-Hispanic, other or multiracial 7.5
obesity and micronutrient needs as well as the potential for the
Percent of federal poverty level
replacement of milk with other beverages or foods.39
a
<100% 24.7 We found both racial/ethnic and socio-economic contrasts in cur-
100-199% 23.9 rent milk fat content mirroring previous findings in that non-Hispanic
200-299% 16.0 Black and Hispanic individuals aged 2 to 20 were more likely to con-
300-399% 12.2 sume whole milk compared with their non-Hispanic White counter-
400-499% 8.7 parts.40,41 While these differences may be attributable to decreased
>500% 14.5 neighbourhood access to reduced fat milk42 or personal preferences, it
Weight status is notable that the pattern of demographic differences in first milk fat

Underweight/healthy weight 65.9 content are different from those of current milk fat content indicating
that racial/ethnic and socio-economic differences in milk fat consump-
Overweight 16.7
tion evolve throughout childhood.42,43 Furthermore, our finding that
Class I obesity 11.6
children from wealthier homes were more likely to be weaned to whole
Class II obesity 4.0
milk compared with children from lower income homes may speak to
Class III obesity 2.1
the role WIC plays in determining milk selection. Lower income families
Milk consumption frequency
may have less access to whole milk as WIC is more likely to provide
Never 4.0 reduced fat milk in accordance with United States Department of Agri-
Less than once per week 6.0 culture recommendations. Notably, the relationship between milk fat
More than once per week but less than once per 16.8 content and income is reversed in our analysis of current milk fat con-
day
tent among children, adolescent, and young adults 2 to 20. In this popu-
Once a day or more 72.9 lation, increased income was associated with increased likelihood of
Varied 0.3 drinking reduced fat milk, similar to prior studies.40 One might hypothe-
Current milk consumed among those who drink milk size that the difference in these findings relates to the differing influ-
Whole 32.4 ences present in infancy compared with later life stages. Choice of milk
2% 41.8 fat content for older children, adolescents, and young adults likely
1% 11.8 reflects their own preferences and the availability of milk at school and

Fat free 10.3
Other 3.8
a
Adjusted for age, race/ethnicity, income, and NHANES cycle.
in dietary patterns in children, although it is unknown whether this
change is a result of physician or parent weight perceptions.28
Alternatively, our findings may indicate that the consumption of
low-fat milk may actually contribute to overweight and obesity, con-
tradicting the rationale for AAP and AHA recommendations regarding
the consumption of reduced fat milk for obesity prevention. US dietary
studies have noted the coincidental occurrence of changes in milk
home. Further examination of the role of milk fat consumption in deter-
mining the weight status of non-Hispanic Blacks, Hispanics, and lower
socio-economic status individuals is warranted as they bear a dispropor-
tionate burden of child and adult overweight and obesity.44,45
This study has several limitations. Because of the structure of the
NHANES survey, we were unable to account for flavoured (sugar-
sweetened) reduced fat milk consumption, which may contribute to
the association between overweight and obesity and consumption of
reduced fat milk. Our analysis also does not account for other aspects
of a child's diet beyond milk, which may contribute to child weight
status. NHANES relies on self-reported parent data that may not be
accurate for children attending day care or school and is vulnerable to
6 of 8 WHITE ET AL.

T A B L E 4 Adjusted oddsa of current milk Fat content for children and adolescents 2 to 20 years from National Health and Nutrition
Examination Survey (NHANES), 1999 to 2016 (n = 29 039)

Whole milkb P (95% CI) 1% or fat-freec P (95% CI)

Weight status
Healthy weight REF REF
Overweight 0.81 <.001 (0.73-0.90) 1.38 <.001 (1.20-1.59)
Class I obesity 0.71 <.001 (0.63-0.80) 1.35 <.001 (1.16-1.59)
Class II obesity 0.58 <.001 (0.49-0.69) 1.48 .001 (1.18-1.87)
Class III obesity 0.60 <.001 (0.47-0.77) 1.52 .042 (1.02-2.27)
Milk consumption
Drinks milk less than daily REF REF
Drinks milk daily 0.86 .001 (0.78-0.94) 1.10 .210 (0.95-1.26)
Race/ethnicity
Non-Hispanic White REF REF
Non-Hispanic Black 3.14 <.001 (2.73-3.60) 0.20 <.001 (0.16-0.25)
Hispanic 1.81 <.001 (1.57-2.10) 0.43 <.001 (0.36-0.52)
Non-Hispanic, other 1.61 <.001 (1.32-1.97) 0.54 <.001 (0.44-0.67)
Percent of federal poverty level
<100% a REF REF
100-199% 0.77 <.001 (0.68-0.88) 1.16 .120 (0.96-1.41)
200-299% 0.48 <.001 (0.41-0.55) 2.11 <.001 (1.67-2.66)
300-399% 0.42 <.001 (0.34-0.50) 2.45 <.001 (1.92-3.12)
400-499% 0.34 <.001 (0.28-0.42) 3.40 <.001 (2.75-4.20)
>500% 0.29 <.001 (0.24-0.36) 4.69 <.001 (3.77-5.82)
NHANES year
1999-2000 REF REF
2001-2002 0.93 .650 (0.67-1.29) 1.23 .240 (0.87-1.73)
2003-2004 0.94 .753 (0.66-1.36) 0.84 .410 (0.56-1.27)
2005-2006 0.59 .002 (0.42-0.82) 0.98 .901 (0.70-1.37)
2007-2008 0.52 <.001 (0.38-0.72) 1.15 .451 (0.80-1.66)
2009-2010 0.40 <.001 (0.30-0.54) 1.99 <.001 (1.51-2.62)
2011-2012 0.32 <.001 (0.23-0.44) 1.83 <.001 (1.32-2.54)
2013-2014 0.39 <.001 (0.29-0.53) 1.46 .039 (1.02-2.09)
2015-2016 0.45 <.001 (0.32-0.64) 1.31 .108 (0.94-1.82)

Note: Bold face indicates statistically significant association (p < 0.05).

a
Adjusted for age, race/ethnicity, daily milk consumption, income, and NHANES cycle.
b
Versus 2%, 1%, or fat free.
c
Versus 2% or whole.

recall bias and social desirability bias. Additionally, NHANES repre-
sents repeated cross-sectional data, limiting our ability to speak to
causation. Strengths of our study include the use of a nationally repre-
sentative sample with measured height and weight data. Also, the use
of multiple cycles of NHANES data reduces the likelihood of our find-
ings being the result of brief historical dietary trends.
5 | C O N CL U S I O N S
Current AAP and AHA recommendations promote consumption of
reduced fat milk after 2 years of age to prevent obesity. Existing food
provision guidelines have shifted milk consumption in US children
from whole milk to reduced fat milk. Our study highlights an associa-
tion between low-fat milk consumption and overweight/obesity in
children, adolescents, and young adults. We also demonstrate racial/
ethnic and socio-economic differences in milk consumption. Because
concern for risk of overweight or obesity may lead to a decision to
consume reduced fat milk, future studies should utilize a prospective
longitudinal design with a racially and socio-economically diverse
cohort to determine whether the relationship between milk fat con-
tent and weight status is causal. Cumulatively, our data demonstrate
that guidelines for milk consumption may be effective in promoting
reduced fat varieties of milk among those at risk of obesity. However,
WHITE ET AL.
our data also underscore the need for further examination of the rela-
tionship between milk fat content and weight status to inform dietary
recommendations.
CONF LICT OF IN TE RE ST
Dr. Sarah Armstrong has received a research grant from Astra Zeneca,
has a data safety monitor for Novo Nordisk, and has received a
speaker honorarium from Rhythm Pharmaceuticals.
AUTHORS C ON TRIBUTION
Dr White interpreted the analyses, drafted the initial manuscript, and
reviewed and revised the manuscript. Drs Armstrong and Perrin con-
ceptualized and designed the study and reviewed and revised the
manuscript. Dr Kay helped design the study, interpreted the data,
and reviewed and revised the manuscript. Dr Skinner conceptualized
and designed the study, performed and interpreted the analyses, and
reviewed and revised the manuscript. All authors approved the final
manuscript as submitted and agreed to be accountable for all aspects
of the work.
ORCID
Michelle J. White https://orcid.org/0000-0002-1944-1995
Melissa C. Kay https://orcid.org/0000-0002-9695-3126
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How to cite this article: White MJ, Armstrong SC, Kay MC,
Perrin EM, Skinner A. Associations between milk fat content
and obesity, 1999 to 2016. Pediatric Obesity. 2020;e12612.
https://doi.org/10.1111/ijpo.12612