Milk and Milk Substitutes

Dietary Guidelines for Americans, 2020-2025 recommendations include all fluid, dry, or evaporated milk, including lactose-free and lactose-reduced products and fortified soy beverages (soy milk), buttermilk, yogurt, kefir, frozen yogurt, dairy desserts and cheeses. Most choices should be fat-free or low-fat.[1]

The recommendation for dairy intake for adults with 2000-kcal/d diet is 3 cup-equivalents/d (710 mL-equivalents/d). The dairy group contributes many nutrients, including high-quality protein, calcium, phosphorus, vitamin A, vitamin D (in products fortified with vitamin D), riboflavin, vitamin B-12, potassium, zinc, choline, magnesium, and selenium.[2]

Milk and Milk Substitutes

Although strong associations between saturated fat intake and occurrence of cardiovascular disease have been reported[3], a review of observational studies found no relation between milk fat and risk of cardiovascular disease, coronary artery disease, or stroke[4].

In the Malmo Diet and Cancer cohort, there was a decreased risk of incident type 2 diabetes with a high intake of high-fat but not for low-fat dairy products[5]. In the Observation of Cardiovascular Risk Factors in Luxembourg Study, whole-fat dairy food intake was inversely associated with obesity prevalence[6]. In addition, longitudinal evaluation of milk type consumed and weight status in pre-schoolers found that 1% skim milk drinkers had higher BMI z scores than 2% whole milk drinkers. However, this may reflect the choice whereby parents give overweight/obese children low-fat milk to drink[7].

Milk intake has been linked to various health outcomes, including a decreased risk of diabetes (low-fat milk only)[8], colon cancer[9] [10], cognitive disorders[11], and stroke[12], and no increased risk of coronary artery disease (CAD) and mortality[13]. In a meta-analysis in an adult population, there was no significant association between low-fat or whole milk intake and fatal prostate cancer[14]. However, results from a recent meta-analysis of 11 population-based cohort studies in adults reported that whereas intake of total dairy products had no significant impact on increased all-cancer mortality risk, an increase of whole milk (1 serving/d) contributed to elevated prostate cancer mortality risk significantly[15]. Research has linked dairy intake to improved bone health, especially in children and adolescents[16].

A consumer study found that the majority of adults surveyed believed alternative milk products are nutritionally equivalent to cow milk[17]. The nutrient density of such milk substitutes can vary considerably depending on the raw material used, processing, fortification with vitamins and minerals, and addition of other ingredients such as sugars and oils. Soy milk is currently the only plant-based milk substitute that approximates the protein content of cow milk and is comparable in quality[18]. Furthermore, calcium is the only nutrient from milk substitutes to be tested for equivalent bioavailability to cow milk, which was reported to be similar[19]. To date, there is insufficient evidence to support health benefits of certain plant-based milk substitutes above those of cow milk.2


[1] U.S. Department of Agriculture and U.S. Department of Health and Human Services. Dietary Guidelines for Americans, 2020-2025, 9th Edition. December 2020. Available at,

[2] Mario G Ferruzzi, Jirayu Tanprasertsuk, Penny Kris-Etherton, Connie M Weaver, and Elizabeth J Johnson: Perspective: The Role of Beverages as a Source of Nutrients and Phytonutrients,

[3] Sacks FM, Lichtenstein AH, Wu JHY, Appel LJ, Creager MA, Kris-Etherton PM, Miller M, Rimm EB, Rudel LL, Robinson JG et al. .. Dietary fats and cardiovascular disease: a Presidential Advisory from the American Heart Association. Circulation. 2017;136:e1–23. [PubMed] [Google Scholar]

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[5] Ericson U, Hellstrand S, Brunkwall L, Schulz C-A, Sonestedt E, Wallström P, Gullberg B, Wirfält E, Orho-Melander M. Food sources of fat may clarify the inconsistent role of dietary fat intake for incidence of type 2 diabetes. Am J Clin Nutr. 2015;101:1065–80. [PubMed] [Google Scholar]

[6] Crichton GE, Alkerwi A. Whole-fat dairy food intake is inversely associated with obesity prevalence: findings from the Observation of Cardiovascular Risk Factors in Luxembourg study. Nutr Res. 2014;34:936–43. [PubMed] [Google Scholar]

[7] Scharf RJ, Demmer RT, DeBoer MD. Longitudinal evaluation of milk type consumed and weight status in preschoolers. Arch Dis Child. 2013;98:335–40. [PMC free article] [PubMed] [Google Scholar]

[8] Aune D, Norat T, Romundstad P, Vatten LJ. Dairy products and the risk of type 2 diabetes: a systematic review and dose-response meta-analysis of cohort studies. Am J Clin Nutr. 2013;98:1066–83. [PubMed] [Google Scholar]

[9] Vieira AR, Abar L, Chan DSM, Vingeliene S, Polemiti E, Stevens C, Greenwood D, Norat T. Foods and beverages and colorectal cancer risk: a systematic review and meta-analysis of cohort studies, an update of the evidence of the WCRF-AICR Continuous Update Project. Ann Oncol. 2017;28:1788–802. [PubMed] [Google Scholar]

[10] Ralston RA, Truby H, Palermo CE, Walker KZ. Colorectal cancer and nonfermented milk, solid cheese, and fermented milk consumption: a systematic review and meta-analysis of prospective studies. Crit Rev Food Sci Nutr. 2014;54:1167–79. [PubMed] [Google Scholar]

[11] Wu L, Sun D. Meta-analysis of milk consumption and the risk of cognitive disorders. Nutrients. 2016;8(12):824. [PMC free article] [PubMed] [Google Scholar]

[12] de Goede J, Soedamah-Muthu SS, Pan A, Gijsbers L, Geleijnse JM. Dairy consumption and risk of stroke: a systematic review and updated dose-response meta-analysis of prospective cohort studies. J Am Heart Assoc. 2016;5(5):e002787. [PMC free article] [PubMed] [Google Scholar]

[13] Mullie P, Pizot C, Autier P. Daily milk consumption and all-cause mortality, coronary heart disease and stroke: a systematic review and meta-analysis of observational cohort studies. BMC Public Health. 2016;16:1236. [PMC free article] [PubMed] [Google Scholar]

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[15] Lu W, Chen H, Niu Y, Wu H, Xia D, Wu Y. Dairy products intake and cancer mortality risk: a meta-analysis of 11 population-based cohort studies. Nutr J. 2016;15:91. [PMC free article] [PubMed] [Google Scholar]

[16] Dror DK, Allen LH. Dairy product intake in children and adolescents in developed countries: trends, nutritional contribution, and a review of association with health outcomes. Nutr Rev. 2014;72:68–81. [PubMed] [Google Scholar]

[17] Jackson C, Chen E. “Milk” product labeling in the U.S. New York: Ipsos; 2018; [cited 19 November, 2018]. Available from: [Google Scholar]

[18] Hajirostamloo B. Comparison of nutritional and chemical parameters of soymilk and cow milk. Int J Nutr Food Eng. 2009;3:455–7. [Google Scholar]

[19] Zhao Y, Martin BR, Weaver CM. Calcium bioavailability of calcium carbonate fortified soymilk is equivalent to cow's milk in young women. J Nutr. 2005;135:2379–82. [PubMed] [Google Scholar]

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