[Congressional Record Volume 169, Number 205 (Wednesday, December 13, 2023)]
[House]
[Pages H6889-H6907]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
WHOLE MILK FOR HEALTHY KIDS ACT OF 2023
General Leave
Ms. FOXX. Mr. Speaker, I ask unanimous consent that all Members may
have 5 legislative days in which to revise and extend their remarks and
to insert extraneous material on H.R. 1147.
The SPEAKER pro tempore (Mr. Donalds). Is there objection to the
request of the gentlewoman from North Carolina?
There was no objection.
The SPEAKER pro tempore. Pursuant to House Resolution 922 and rule
XVIII, the Chair declares the House in the Committee of the Whole House
on the state of the Union for the consideration of the bill, H.R. 1147.
The Chair appoints the gentleman from Tennessee (Mr. DesJarlais) to
preside over the Committee of the Whole.
{time} 1355
In the Committee of the Whole
Accordingly, the House resolved itself into the Committee of the
Whole House on the state of the Union for the consideration of the bill
(H.R. 1147) to amend the Richard B. Russell National School Lunch Act
to allow schools that participate in the school lunch program under
such Act to serve whole milk, with Mr. DesJarlais in the chair.
The Clerk read the title of the bill.
The CHAIR. Pursuant to the rule the bill is considered read the first
time.
General debate shall be confined to the bill and shall not exceed 1
hour equally divided and controlled by the chair and ranking minority
member of the Committee on Education and the Workforce or their
respective designees.
The gentlewoman from North Carolina (Ms. Foxx) and the gentleman from
Virginia (Mr. Scott) each will control 30 minutes.
The Chair recognizes the gentlewoman from North Carolina.
Ms. FOXX. Mr. Chair, I yield myself such time as I may consume.
Mr. Chair, I rise in strong support of H.R. 1147. It is Christmastime
across America. For many, the season brings with it the annual return
of cherished Christmas traditions, such as leaving milk and cookies out
for Santa Claus and his reindeer to enjoy.
As for my family, our traditional choice of dairy has always been
whole milk. We want only the most nutritious option for Santa.
The nutrients in whole milk, like protein, calcium, and vitamin D,
provide the fuel Santa needs to travel the whole globe in one night.
Whole milk is the unsung hero of his Christmas journey.
Protein helps build and repair Santa's muscles. Hoisting heavy sacks
of gifts up and down the chimney is no easy task.
Calcium is vital for strong bones. It is calcium that keeps Santa
strong and sturdy as he dashes from rooftop to rooftop.
Vitamin D is essential to a strong immune system. Santa absolutely
needs one as he braves the cold, wintry night. You see, it is not just
the magic of the season that helps Santa deliver presents worldwide, it
is also the fortifying nutrients in whole milk.
Reflecting on Christmas traditions this year begs the question: If
whole milk is a good option to fuel Santa's extraordinary Christmas Eve
journey, then why isn't it an option for American schoolchildren in
their lunchrooms?
That is why I support Representative G.T. Thompson's Whole Milk For
Healthy Kids Act, a bill allowing unflavored and flavored whole milk to
be offered in school cafeterias.
Since 2012, the National School Lunch and Breakfast Program has
allowed only low-fat and fat-free milk options for American
schoolchildren. This means 2 percent and whole milk have been excluded
from the daily diets of an entire generation of kids.
The USDA intends to finalize another rule which will further limit
milk options. Anti-milk advocates advance one main argument against
whole milk: that whole milk is bad for kids.
{time} 1400
Rather, milk has 13 essential nutrients that are needed for children
to live healthy lives and succeed in school. It is an essential
ingredient to growth and development. Research shows that whole milk is
associated with a neutral or lower risk of heart disease and obesity.
Moreover, the USDA contradicts itself by limiting milk options for
young children. On one hand, it recognizes that children are at risk of
underconsuming dairy, yet on the other, it creates policies that will
only exacerbate the problem.
If Americans have learned anything from these past 3 years, it is
that scientific authorities tend to contradict themselves. The truth is
that whole milk is a significant source of vital nutrients for
children's growth and development. The Federal bureaucracy should never
stand between your children and a nutritious lunch.
The Whole Milk for Healthy Kids Act isn't about advocating for one
type of milk over another. It is about providing parents, schools, and
food service providers with the option to choose what is best for our
children's nutrition.
This act does not aim to diminish the importance of other milk
varieties. Rather, it seeks to restore the availability of a wholesome,
natural option that has been a staple for generations. This bill is
about choice. It is a chance to empower parents and schools to make
informed choices about what goes into our children's diets.
Whether it is a nutritional foundation for Santa's journey or your
child's math homework, let's not discount the benefits of whole milk.
Mr. Chair, I reserve the balance of my time.
Mr. SCOTT of Virginia. Mr. Chair, I yield myself such time as I may
consume.
Mr. Chair, I rise in opposition to H.R. 1147, the Whole Milk for
Healthy Kids Act.
School meals are critical to reducing child hunger and providing
children with the healthy food they need. Milk, offered as part of
these meals, can help deliver essential nutrients that are vital to a
child's development. That is why it is so important that we provide
students with the most nutritious milk options.
Child nutrition standards for school meals, including milk options,
are guided by the science-based Dietary Guidelines for Americans, or
the DGAs, which are periodically updated based on recommendations from
child nutrition experts and input from the public.
The latest DGAs, along with the American Heart Association, American
Academy of Pediatrics, the Physicians Committee for Responsible
Medicine, the Academy of Nutrition and Dietetics, and over a dozen
other public
[[Page H6890]]
health advocates, agree that fat-free and low-fat milk are the
healthiest options for children.
Regrettably, H.R. 1147 attempts to legislate nutrition standards and
disregard the evidence-based recommendations made by the DGAs.
Furthermore, the bill would undermine the Biden administration's
ongoing rulemaking to better align school nutrition standards with the
latest science.
This bill would allow schools participating in the National School
Lunch Program to offer whole milk and reduced-fat milk, violating the
current science-based standards that protect children's health.
Whole milk contains far more saturated fat, cholesterol, and calories
than fat-free and low-fat milk. Conversely, fat-free and low-fat milk
options offer the same vital nutrients, including calcium, vitamin D,
vitamin A, protein, and potassium, as whole milk.
Nutrition standards must be guided by scientists, not politicians. If
someone wants to offer one study or another to be considered, use the
DGA process, not the political process. This bill needlessly inserts
politics into a science-based process.
Lastly, I am disappointed by the majority's decision to depart from
precedent by moving a child nutrition bill outside of a comprehensive
child nutrition reauthorization. Rather than improve our Nation's child
nutrition programs holistically, the majority has decided to prioritize
interfering with evidence-based nutrition standards for our children's
school meals.
For that reason, Mr. Chair, I oppose the bill, and I reserve the
balance of my time.
Ms. FOXX. Mr. Chair, I would just like to tell my colleague something
that I think will be easy to remember about why we are doing this.
Scientists/experts built the Titanic, and amateurs built the ark.
Mr. Chair, I yield 2 minutes to the gentleman from Wisconsin (Mr.
Grothman).
Mr. GROTHMAN. Mr. Chair, I thank Ms. Foxx for making Biblical
allusions. Last week, we were here talking about National Bible Week.
One of the phrases that you run across again and again as you read the
Bible is that God promised Abraham a land flowing of milk and honey. I
will let the body decide what type of milk the Lord was promising
Abraham. I think I know.
As somebody who has been drinking milk my whole life, I can tell you
a better tasting milk, and a milk that I think is more likely to be
consumed, is whole milk. For some reason, the current administration is
waging war on milk. The USDA's current restrictions on school lunches
are limiting nutritious options for kids. This comes at a time when it
is found that 90 percent of Americans do not eat enough dairy to meet
the dietary recommendations.
Drinking milk leads to better bone health and lower risk for type 2
diabetes and cardiovascular disease. Additionally, milk stands as a
leading and accessible source of nine essential nutrients that children
often fall short of.
Proposed guidelines such as limiting milk options by age group and
counting milk fat against weekly saturated allowance threaten to
deprive students of essential nutrients.
It is crucial that students have access to the nutritional benefits
of milk. With these restrictions, they might choose to forgo milk
entirely, if you have to drink the less tasty 1 percent, or even worse,
fat-free milk.
These proposed restrictions ignore several recent research studies
examining the effect of higher fat milk consumption which found that it
is associated with lower childhood obesity and concluded that dietary
guidelines that recommend reduced-fat milk versions might not provide a
benefit in lowering the risk of childhood obesity, which we are all
for.
I implore each of you to consider the Whole Milk for Healthy Kids Act
of 2023 as a commonsense solution to ensure that we have healthy
children.
Mr. Chair, I ask my fellow Members to vote ``yes'' on H.R. 1147.
Mr. SCOTT of Virginia. Mr. Chair, I yield such time as he may consume
to the gentleman from Louisiana (Mr. Carter).
Mr. CARTER of Louisiana. Mr. Chair, I thank Ranking Member Scott for
his time and leadership in this matter.
I rise today in opposition to this bill. Monday night, the Rules
Committee considered my amendment, amendment No. 16, to H.R. 1147,
which would have provided an alternative, a healthy alternative to our
young people, people that cannot digest milk.
I heard my colleagues on the other side of the aisle suggest that
this was a choice. Well, if there were a choice, then why not add soy
as a choice. Soy gives the equivalent of the nutritional values as
whole milk, but it does not have the negative impact that whole milk
has on a large swath of people in our community.
I will tell you those numbers. Ninety-five percent of Native
Americans have lactose intolerance. Ninety percent of African Americans
are lactose intolerant. Sixty-five percent of Latino Americans are, in
fact, lactose intolerant. Asian Americans, 90 percent. These are real
numbers. This is not about taste. This is not about profit. This is not
about bottom line. This is not about a powerful lobby. This is about
the safety, nutrition, and well-being of our young people.
We cannot ignore the impact that ingesting or attempting to digest
things that your body cannot and what impact it has on one's ability to
concentrate or do well in the classroom.
My colleagues and I formed a diverse group, represented by chairs of
the Congressional Hispanic Caucus, the Asian Pacific American Caucus,
and a vice chair of the Congressional Black Caucus respectively. We all
firmly believe that the full House should be allowed to debate this
important measure, making sure that we were given the opportunity on
the floor to debate this amendment. I believe if given the opportunity
to be heard, even the other side could have and would have been able to
support.
What is most perplexing is how this amendment aligns with the purpose
of the underlying bill, to expand choice and to deliver healthy
beverages to the school counter. Our amendment is based on the text of
my bill, H.R. 1619, the ADD SOY Act. It amends the Richard B. Russell
National School Lunch Program to strike the onerous ``milk note''
requirement and to stipulate that the USDA reimburse school districts
to make a plant-based dietary alternative that is nutritionally
equivalent to cow's milk available in school. Yes, a choice, a real
choice.
When Congress enacted the milk mandate 80 years ago, the United
States was less diverse, and we did not understand the exact science
surrounding lactose intolerance. Between 70 to 90 percent of African
Americans today are lactose intolerant. Ninety percent of Asians, 95
percent of Native Americans, and 65 percent of Latinos are, in fact,
lactose intolerant.
The National Institutes of Health reports the majority of all people
have reduced ability to digest lactose after infancy, and it adds that
it is also very common in people from West Africa, Arab, Jewish, Greek,
and Italian descent.
Currently, if a student wants a nutritionally equivalent alternative
to milk, they need to get a doctor's note or parent's note to obtain a
plant-based beverage. Oftentimes, parents are working two jobs.
Oftentimes, unfortunately, parents don't pay as much attention or are
as in tune and have an opportunity to get to the school or even have
healthcare to go to a doctor to get a note. Should that child still be
punished and forced to drink something that their body simply cannot
digest?
How do you concentrate in the classroom when you are drinking and
attempting to digest something that your body cannot? What happens to
that child when they belly up to the desk and have to study or pay
attention but their body is telling them that they have eaten something
that does not agree with them? It causes a problem. It causes ridicule.
It causes the ability or inability to concentrate and perform at their
highest level. Because of this high barrier to entry, kids often don't.
Many skip school or don't do well in school as an alternative.
If 75 percent of African Americans are lactose intolerant, which is
true in my family, why should three-quarters of kids have to get a
note. It is not a medical disability to be African American. It is not
a medical disability to be Vietnamese American. It is not a disability
to be Native American. It is not a disability to be Latino.
Lactose intolerance is genetic. This isn't complicated. Kids should
be given
[[Page H6891]]
a healthy fluid beverage option that doesn't make them sick. Our
amendment would have provided a sensible solution. Allow the USDA to
reimburse school districts for soy milk, which so far is the only
plant-based milk that has been recognized under the latest formulation
of the 2020 American Dietary Guidelines to be healthy and nutritionally
equivalent to cow's milk.
Moreover, there is a primary reason that more than half of all milk
given to children is thrown into a cafeteria trash can unused, carton
after carton after carton of discarded cartons of milk that have never
been opened. At some point kids realize it isn't good for them and they
don't drink it. Whatever nutritional value you thought you were
affording by giving milk doesn't happen if young people can't consume
or digest it.
Many kids don't want milk because it makes them sick. According to
the USDA, 29 percent of cartons of cow milk served in our schools are
thrown into the garbage unopened. This comes out to be somewhere around
$300 million in annual waste of taxpayer funds for milk cartons. It is
clear that not only is it a food waste issue but a failure on the NSLP
to supply food to kids that are consumed and meet their daily
nutritional requirement. The present rate of food waste and taxpayer
losses is not acceptable.
{time} 1415
Mr. Chair, I ask whether my Republican colleagues think it is a good
policy. Is that good stewardship of our tax dollars? Is that delivering
good health outcomes for all kids?
If they believe it is, then they should agree and recognize that
adding a true alternative is a good thing. I remind my colleagues that
it is not a medical condition to be Black, Latino, Asian, Jewish, or
other ethnicities.
This is an issue of racial equity and inclusion, as well as
tightening government spending and waste. It is both a matter of
squandering tax dollars and a matter of fairness. The kids who have the
least and who have the most difficulty raising their voices are being
denied a food staple that they simply cannot stand.
We must fix this. Let us strive to do better for the next generation
and equip them with the nutritional sustenance at the lunch counter
that can give them an opportunity to not just survive but thrive.
Mr. Chair, I implore you to think about the children. Don't think
about the profits. Don't think about the lobby. Don't think about the
efforts of a winner or loser. Let's put children first.
Let's make sure that we, as a Congress, recognize the value of
fighting for those who have not been given the opportunity to fight for
themselves.
Add soy. Create true alternatives. Do not force people to digest
things that their bodies simply cannot.
Mr. Chair, it is for this reason and this reason solely that I cannot
support this measure without true alternatives.
Ms. FOXX. Mr. Chairman, I yield myself 1 minute.
Mr. Chairman, we are very concerned about waste. One of the reasons
there is so much waste is because whole milk is not allowed, and
children don't like the taste of skim milk.
We are putting children first. We are not excluding soy drink. It is
not milk. It is a plant-based food. It isn't milk, so you can't call it
soy milk. You can call it soy drink.
It was under our first African-American President in this country
that this was designed this way. The First Lady pushed through these
rules and regulations to exclude whole milk, which, by the way, my
colleague says has an enormous amount more fat.
The fat content of whole milk is about 3\1/2\ percent. We are
foisting on children 1\1/2\ percent milk, which doesn't have a very
good taste to many of them. We are excluding them from 3\1/2\ percent.
We do not exclude soy drink. This is about inclusion and equity. We
want people to be able to drink the kind of milk they want to drink.
Mr. Chairman, I yield 2 minutes to the gentleman from Pennsylvania
(Mr. Smucker).
Mr. SMUCKER. Mr. Chairman, I rise in support of H.R. 1147, the Whole
Milk for Healthy Kids Act, and I urge my colleagues to support this
bipartisan, bicameral, and ``udderly'' fantastic bill.
I proudly represent Pennsylvania's 11th District, which is one of the
largest dairy producers in the Northeast. In 2022, 1,300 Lancaster
County farms produced 2.1 billion pounds of milk.
I have visited many of those farms, and I have had many discussions
with local school administrators about the importance of child
nutrition. We all agree that milk is a key vehicle for delivering
protein, potassium, calcium, phosphorus, and vitamins A and D,
especially for children.
Let's not skim over the facts here. Whole milk is truly the cream of
the crop in delivering these key vitamins and nutrients to growing
children.
Sadly, our Nation's kids are not consuming enough dairy. We have seen
a decline in receiving those essential vitamins and nutrients since we
banned whole milk in our schools. We can only begin to ``cow-culate''
the impact that has on their long-term health.
Let's not curdle away the opportunity to expand dairy consumption in
our Nation's schools and ensure our children are getting the nutrients
necessary to grow strong bones and teeth.
Mr. Chairman, all milk puns aside, I urge my colleagues to support
this legislation. Expanding the universe of options for children to
consume vital nutrients and vitamins is important for their long-term
health. It also helps these kids be prepared for school, develop into
adulthood, and cultivate a 21st century workforce.
Mr. Chairman, healthy kids and supporting our dairy farmers are
``moo-tually'' important.
Mr. SCOTT of Virginia. Mr. Chair, I yield myself such time as I may
consume.
Mr. Chairman, we received a letter from the National Alliance for
Nutrition and Activity, which says in part that the passing of H.R.
1147 ``would be a departure from the longstanding tradition of
establishing food and nutrition standards for Federal child nutrition
programs based upon the findings of independent reviewers and the
scientific community. There are evidenced-based strategies to increase
school meal consumption--and, by extension, potentially school milk
consumption--that do not involve weakening nutrition standards. Changes
to school nutrition standards should be guided by the Dietary
Guidelines, not special interests, and as such, we strongly urge you to
put children's interests first and uphold the science-based process and
oppose the Whole Milk for Healthy Kids Act of 2023. Our children
deserve no less.''
It is signed by the Academy of Nutrition and Dietetics, Advocates for
Better Children's Diets, American Academy of Pediatrics, American Heart
Association, American Public Health Association, Ann & Robert H. Lurie
Children's Hospital of Chicago, Balanced, Center for Biological
Diversity, Center for Science in the Public Interest, Chef Ann
Foundation, Friends of the Earth, Healthy Food America, Healthy Schools
Campaign, Life Time Foundation, National WIC Association, and Public
Health Institute.
Mr. Chair, I include in the Record a letter from the National
Alliance for Nutrition and Activity.
National Alliance for
Nutrition & Activity,
December 11, 2023.
Hon. Virginia Foxx,
Chair, House Committee on Education and the Workforce, House
of Representatives.
Hon. Robert ``Bobby'' Scott,
Ranking Member, House Committee on Education and the
Workforce, House of Representatives.
Dear Chairwoman Foxx and Ranking Member Scott: The
undersigned members of the National Alliance for Nutrition
and Activity, the nation's largest nutrition advocacy
coalition, strongly urge you to oppose H.R. 1147/S. 1957, the
Whole Milk for Healthy Kids Act of 2023. H.R. 1147/S. 1957
would allow school meals to offer full-fat (whole) and
reduced-fat flavored and unflavored milk, and arbitrarily
exempt full-fat and reduced-fat milk from current saturated
fat limits in school meals, both of which are inconsistent
with the recommendations of the 2020-2025 Dietary Guidelines
for Americans (DGAs).
School meal standards, by law, must be aligned with the
Dietary Guidelines for Americans, which are reviewed and
revised every five years. The DGAs recommend full-fat (whole)
milk only for children under the age of two, and fat-free and
low-fat milk after that. In addition, the DGAs recommend
saturated fat should account for less than 10 percent of
calories per day. As such, both the National School Lunch
Program (NSLP) and School Breakfast Program (SBP) meal
patterns allow only fat-free and low-fat milk and require
that less than 10 percent of calories in the meal come from
saturated fat over the week. Earlier this year, the U.S.
Department of Agriculture (USDA) proposed
[[Page H6892]]
updates to the school nutrition standards to more closely
align with the 2020-2025 DGAs, which did not change the
saturated fat limit nor increase the milkfat allowed to be
served in school meals. Singling out milk--in this case,
whole and reduced-fat milk--to be exempt from the
recommendations of the Dietary Guidelines is a slippery slope
for allowing--special interests to carve out exemptions in
school meal program rules. Allowing the change in the service
of whole and reduced-fat milk will negate the progress that
has been made in the planning and service of healthier foods
to children in schools.
Milk is an important part of a well-balanced diet. Milk
contains nutrients of concern, such as vitamin D and calcium.
However, unlike fat-free and low-fat milk, full-fat milk
contains too much saturated fat to be part of a healthy food
pattern. According to USDA data, one cup of whole milk
contains around 4.5 grams of saturated fat. Full fat milk is
so high in saturated fat that the government prohibits its
labels from claiming that calcium can reduce the risk of
osteoporosis; fat-free and low-fat milk, however, can make
these claims. By allowing full-fat milk in lunch and
adjusting saturated fat allowances accordingly, H.R. 1147/S.
1957 would allow an additional 4.5 grams of saturated fat
daily in school meals beyond the science-based limit that is
currently in place.
School meal nutrition standards were strengthened
significantly in 2012. These updates were an overwhelming
success, particularly for children in who are part of
households with fewer financial resources. A 2021 study found
that school meals are the single most healthy source of
nutrition for children--more nutritious than grocery stores,
restaurants, worksites, and others. Yet even with the current
nutrition standards that limit saturated fat in school meals,
most children, on average, still consume more saturated fat
than is recommended. According to the DGA, more than 80
percent of children ages 5-8 years, more than 85 percent of
youth ages 9-13, and over 75 percent of youth ages 14-18
consume too much saturated fat. Allowing full-fat milk in
schools would only worsen this problem.
The fat content of school milk is neither the cause nor the
solution to the decades-long decline in fluid milk
consumption in the United States and the struggles of the
dairy industry. According to a 2013 Economic Research Service
(ERS) report, younger generations consume less milk than
preceding generations, but this trend is not exclusive to
schoolchildren. According to the ERS economists,
``individuals born in the 1970s, for example, drank less milk
in their teens, 20s, and 30s than individuals born in the
1960s did at the same age points. Those born in the 1980s and
1990s, in turn, appear likely to consume even less fluid milk
in their adulthood than those born in the 1970s.'' Rather
than acknowledging the fact that 36 percent of Americans
experience lactose malabsorption, (with African Americans,
American Indians, Asian Americans, and Hispanics/Latinos
experiencing at higher rates than non-Hispanic White
Americans), H.R. 1147 perpetuates the cumbersome requirement
that students must obtain a doctor's note documenting a
disability to receive a substitute for fluid milk, while
arbitrarily increasing access to the less-healthy full-fat
milk.
We thank you for your attention to this matter. Passing
H.R. 1147/S. 1957 would be a departure from the long-standing
tradition of establishing food and nutrition standards for
federal child nutrition programs based upon the findings of
independent reviewers and the scientific community. There are
evidence-based strategies to increase school meal
consumption--and by extension, potentially school milk
consumption--that do not involve weakening nutrition
standards. Changes to school nutrition standards should be
guided by the Dietary Guidelines, not special interests, and
as such, we strongly urge you to put children's interests
first and uphold the science-based process and oppose the
Whole Milk for Healthy Kids Act of 2023. Our children deserve
no less.
Signed,
Academy of Nutrition and Dietetics, Advocates for Better
Children's Diets, American Academy of Pediatrics,
American Heart Association, American Public Health
Association, Ann & Robert H. Lurie Children's Hospital
of Chicago, Balanced, Center for Biological Diversity,
Center for Science in the Public Interest, Chef Ann
Foundation, Friends of the Earth, Healthy Food America,
Healthy Schools Campaign, Life Time Foundation,
National WIC Association, Public Health Institute.
Mr. SCOTT of Virginia. Mr. Chairman, I reserve the balance of my
time.
Ms. FOXX. Mr. Chairman, I yield 5 minutes to the gentleman from
Pennsylvania (Mr. Thompson), the author of this legislation.
Mr. THOMPSON of Pennsylvania. Mr. Chairman, I thank the chairwoman
for her leadership and support.
Mr. Chairman, I rise today in strong support of my legislation, the
Whole Milk for Healthy Kids Act, that supports students and dairy
farmers across America.
Milk is an essential building block for a well-rounded and balanced
diet, offering 13 essential nutrients and numerous health benefits.
Out-of-touch Federal regulations have imposed dietary restrictions on
the types of milk students have access to in school meals.
Our ranking member is a dear friend of mine, and we have worked
together. I have been here for 15 years and him a little longer. We
have a great relationship and have had a lot of bipartisan bills
together, like we marked up yesterday.
Mr. Chair, I have to say, the only special interest here is our kids.
It is our kids who have been cheated out of the nutrition that they
need. Case studies have shown that the rate of obesity and being
overweight increased dramatically after access to whole milk and flavor
was taken out of the schools in 2007-2008, which was a baseline. In
2010, a Democrat-led initiative demonized milk fat. In 2020-2021, there
was a study of that same cohort, and obesity has gone up without this
beverage.
Mr. Chairman, regarding my good friend from Louisiana, who just
spoke, everybody is entitled to their own opinion but not their own
facts. The facts are that it is the underlying law that was passed back
in 2010 by a Democratic House and signed by a Democratic President
that, quite frankly, required a physician prescription for health
reasons.
That is a good part of the law, and we didn't touch that. We didn't
address that in this bill, so I am not sure why he is talking about it.
It is not germane to the topic we are talking about today. That is the
underlying law.
The bottom line is that students and parents do have choice. There is
a mechanism to honor that. The only choice they don't have, though, is
access to the most nutritious beverage, which is whole milk--
specifically, whole milk and flavor.
Mr. Chair, I appreciate the gentleman from Louisiana sharing how much
waste there was and what that amounts to in cartons and half pints and
what it amounts to in dollars. That is because of the taste experience.
It is not that these kids are throwing the milk away because it is
unhealthy for them. It is just a terrible taste experience when you are
drinking low-fat or nonfat milk.
Students have been limited to fat-free or reduced-fat milk since the
Healthy, Hunger-Free Kids Act was enacted in 2010.
While some of my friends on the other side of the aisle have argued
that we should not reform individual aspects of child nutrition, it was
that legislation more than a decade ago that singled out milk for
regulation, which is why we are here today.
There are several reasons why these top-down regulations are harmful
to students and school districts that are forced to comply with them.
First, we have seen students opt out of consuming milk altogether if
they don't have access to a variety that they enjoy. According to the
``Scientific Report of the 2020 Dietary Guidelines Advisory
Committee,'' more than two-thirds of school-age children failed to meet
the recommended levels of dairy. No kidding. We took out most nutrition
and most taste and made it inaccessible to them.
Let's face it, the only way to benefit from milk's essential
nutrients is to consume it. We are not force-feeding anybody anything.
This is about choice. When students turn away from milk, they often opt
for far less healthy alternatives that are highly caffeinated, sugar-
sweetened, or lack key nutrients.
These regulations also perpetuate baseless claims that milk is bad
for our kids. Research has shown time and time again that whole and 2
percent milk are not responsible for childhood obesity and other health
concerns. In fact, these beverages are so nutritious that research
shows positive health outcomes for kids who consume whole milk.
Mr. Chairman, I include in the Record academic studies from
researchers around the world, including from top institutions such as
Boston University and Tufts, who have studied the health effects of
full-fat dairy.
[From the American Journal of Clinical Nutrition]
Whole Milk Compared With Reduced-Fat Milk and Childhood Overweight: a
Systematic Review and Meta-Analysis
Introduction
Childhood obesity has tripled in the past 40 y, with nearly
1 in 3 North American children now overweight or obese (1-3).
Over the
[[Page H6893]]
same period, consumption of whole-fat cow-milk has halved
(4). The American Academy of Pediatrics and the Canadian
Paediatric Society recommend that children switch from whole-
fat cow-milk (3.25%) to reduced-fat cow-milk (0.1 to 2%) at 2
y of age to limit fat intake and minimize the risk of
childhood obesity (5, 6). European (7), British (8), and
Australian (9) health authorities have provided similar
recommendations. Healthcare providers (10) and families (11)
frequently follow this guideline, and school and child-care
nutrition policies (12-14) often reflect them. Since 1970
whole-cow-milk availability has dropped by 80% in North
America, whereas reduced-fat milk purchases have tripled (15,
16).
Given that cow-milk is consumed daily by 88% of children
aged 1 to 3 y and by 76% of children aged 4 to 8 y in Canada
(17) and is a major dietary source of energy, protein, and
fat for children in North America (17, 18), understanding the
relation between cow-milk fat and risk of overweight or
obesity is important. Systematic reviews and meta-analyses on
the relation between total dairy consumption and child
adiposity have had conflicting findings. According to these
studies, higher cow-milk intake in children is associated
with taller height and better bone and dental health (19-21).
Although these studies evaluated total dairy consumption,
they did not consider cow-milk fat specifically. The
objectives of this study were to systematically review and
meta-analyze the relation between whole-fat (3.25%) relative
to reduced-fat (0.1 to 2%) cow-milk and adiposity in
children.
Methods
A systematic review and meta-analysis of the literature was
conducted. The study was designed according to the Preferred
Reporting Items for Systematic Reviews and Meta-Analyses
guidelines (PRISMA-P) (22) and registered as a PROSPERO
systematic review and meta-analysis (registration number:
CRD42018085075).
inclusion criteria
Types of studies
Studies included in the search were original works
published in English in a peer-reviewed journal. Cross-
sectional, cohort, case-control, and longitudinal studies, as
well as intervention trials, both controlled and not
controlled, were included in the search strategy. There were
no restrictions on date or length of follow-up.
Population
Studies that included healthy children aged 1-18 y with
10 human subjects were considered. Studies that
examined undernourished or disease populations (other than
asthma) were excluded.
Exposures
The primary exposure was cow-milk fat, categorized as skim
(0.1% fat), 1% fat, 2% fat, or whole or homogenized (3.25%
fat). Measures of exposure included FFQ, multiday food
record, 24-h food recall, or any other validated or
nonvalidated measurement tool. Dietary pattern analyses were
not included.
Outcomes
The primary outcome was childhood adiposity. These measures
included BMI z-score (zBMI), BMI, weight for age, body fat
mass, lean body mass, waist circumference, waist-to-hip
ratio, body fat percentage. skinfold thickness, and
prevalence of overweight or obesity as defined by the WHO
(23), CDC (24), or International Obesity Task Force
(IOTF)(25) cutoffs. When sufficient information was not
available in the full text publication, study authors were
contacted by email to obtain additional data.
Meta-analysis
Meta-analysis included studies that reported the number of
children who consumed whole (3.25%), 2%, 1%, or skim (0.1%)
milk regularly (a priori defined as typically, daily, or
4 times per week), as well as the number of
children from each of these groups who were classified as
either healthy weight, or overweight or obese (overweight and
obese were included as 1 category) assessed using BMI
standardized according to the WHO (23), CDC (24), or IOTF
(25) criteria.
search methods
A comprehensive search strategy was developed by a research
librarian (NT) with expertise in systematic reviews. From
inception to August 2019, Embase, CINAHL (Cumulative Index to
Nursing and Allied Health Literature), MEDLINE, Scopus, and
the Cochrane Library were searched on March 23, 2018 and
updated on August 2, 2019 using Medical Subject Headings
(MeSH) and keywords (see Supplemental Methods for search
strategies).
Data extraction, management, and analysis
Study selection
To evaluate study eligibility 2 reviewers (MA and SMV)
independently reviewed study titles, abstracts, and full
texts if needed. Both reviewers applied inclusion and
exclusion criteria and differences were examined and resolved
by consensus, which was achieved 100% of the time. Full-text
articles were retrieved for potentially eligible studies and
reviewed. Characteristics of included full-text studies were
summarized.
Data extraction
Two reviewers (MA and SMV) extracted data from eligible
studies using standardized data extraction tables adapted
from the Cochrane Data Extraction Template (26). Differences
were resolved by consensus 100% of the time.
Data management
Covidence (27) software was used to select studies, review
results, and resolve discrepancies between reviewers. All
included study records were kept in spreadsheet format.
Data synthesis
Studies included in the analysis were described according
to a standardized coding system that captured key elements of
each study including descriptors of the study setting,
population size and age (mean and range), exposure or
intervention, comparator group, method of data collection,
outcome measures, type of analysis, and results.
Risk of bias and study quality assessment
Risk of bias was assessed using the Newcastle-Ottawa Scale
(NOS) (28) for nonrandomized analyses, which expresses the
risk of bias on a numerical scale ranging from 0 to 9; scores
<7 are considered low risk. (NOS criteria can be found in
Table 2.) The NOS-guided review included an examination of
participant selection, comparability of children consuming
whole or reduced-fat milk, and exposure and outcome measure
ascertainment. To allow sufficient follow-up time for a
meaningful change in adiposity to occur, the minimum
acceptable follow-up time was prespecified as 1 y. Study
comparability, defined as whether studies adjusted for
similar confounding variables, was specified a priori as
studies that adjusted for important characteristics
including: birth weight or baseline weight (for prospective
cohort studies), milk volume consumed, and parent BMI.
Studies that adjusted for each of these factors were awarded
2 points, whereas 1 point was allocated if adjustment was
performed using angle4 other covariates. Reports
were assigned 1 point for ascertainment of exposure only when
structured interviews or medical records were used for data
collection. Risk of bias was assessed by 2 reviewers (MA and
SMV) and consensus was achieved 100% of the time.
Statistical analysis
For each study, participant information, design, and
results were summarized. We derived crude ORs and extracted
adjusted ORs, whenever available, for overweight or obesity
among children who consumed whole (3.25%) milk, compared with
children who consumed reduced-fat (0.1-2%) milk regularly. A
random effects model based on the restricted maximum
likelihood estimator was decided a priori and used to
separately pool crude and adjusted ORs of overweight or
obesity. Each study was included as a random effect to
account for between-study variation in this model.
Sensitivity analyses were performed using the Knapp-Hartung
method and inverse-variance weights. Because prospective
cohort studies can reveal different relations than cross-
sectional studies, we performed a subgroup analysis according
to study design. Additionally, we analyzed studies in
subgroups according to risk of bias (high compared with low)
and age (1-5 y, 6-11 y, and 12-18 y). Subgroup analyses were
accompanied by tests for interaction between each subgroup
and the main effect from the random-effects metaregression,
by using an interaction term in metaregression models for
study design (cross-sectional compared with prospective
cohort), risk of bias (high compared with low), and age group
(1-5 y, 6-11 y, and 12-18 y). Heterogeneity across included
studies was estimated using the I\2\ statistic. Heterogeneity
was considered low (<40%), moderate (40-60%), or high (>60%).
Publication bias was assessed using a funnel plot and Egger
test.
Finally, we conducted a dose-response metaregression to
quantify the association between percentage of fat in cow-
milk consumed and the odds of overweight or obesity. Only
studies that reported group-specific odds for
angle3 types of cow-milk fat were included in this
analysis. For the dose-response analysis, we first used a
fixed-effect approach to estimate the dose-response relations
within each study. Then, we used a random-effects approach to
combine across studies the dose-response estimates that were
generated in the first step for each study to obtain
regression coefficients, and their respective standard
errors. R software version 3.2.2 was used for all analyses,
using the ``metafor'' package.
Results
The database search identified 5862 potentially eligible
studies. After exclusion of duplicates (n = 1861), 4001
reports underwent title and abstract review. Studies that did
not meet inclusion criteria (n = 3915) were removed resulting
in 86 published studies that underwent full text review.
Reasons for exclusion included wrong exposure, wrong outcome,
wrong patient population, dietary pattern analysis only, or
wrong study design such as case reports or editorials.
Twenty-eight studies met all inclusion criteria. Of these, 20
were cross-sectional and 8 were prospective cohort studies.
No interventional studies were identified. Most studies (n =
23) compared consumption of whole milk (3.25% fat) with
reduced-fat milk (0.1%, 1%, or 2% fat). Four studies (36-39)
compared whole and 2% milk with 1% and skim milk. One study
compared whole milk with 2% milk.
Nineteen studies used zBMI, 4 prospective cohort studies
used percentage body fat change, and 5 studies used
overweight or obesity categories as the primary adiposity
outcome. Three studies used 2008 WHO growth standards, 14
studies used 2000 CDC growth
[[Page H6894]]
standards, 7 used 2000 IOTF growth standards, and 4 studies
either did not specify or used other standards for zBMI
measurement.
Eighteen (36, 38, 39, 41-45, 47-49, 51, 52, 57, 58, 60, 63,
65) studies reported that higher cow-milk fat was associated
with lower child adiposity. Ten studies (37, 40, 46, 50, 53-
56, 59, 61) reported no association between cow-milk fat and
child adiposity.
Risk-of-bias assessment
Risk of bias assessed using the NOS suggested that 1 of 8
prospective cohort studies and 0 of 20 cross-sectional
studies were low risk of bias. Common limitations that
increased risk of bias included cross-sectional study design,
nonstandardized dietary assessments that were either study
specific or not validated, lack of adjustment for clinically
important covariates (including volume of milk consumed,
parent BMI, and child adiposity assessed prior to the
outcome), and study duration too short to detect a meaningful
change in adiposity (defined a priori as 1 y).
Association between cow-milk fat and child overweight or obesity
Fourteen (38, 42-44, 46, 47, 49, 51, 52, 57, 58, 60, 62,
65) studies met the meta-analysis inclusion criteria; 11 were
cross-sectional and 3 were prospective cohort studies. All
studies included in the meta-analysis compared whole (3.25%
fat) milk with reduced-fat (0.1-2%) milk consumption,
allowing an OR to be calculated. A total of 20,897 healthy
children aged 1-18 y were included in the meta-analysis.
Children were from 7 countries (United States, United
Kingdom, Canada, Brazil, Sweden, New Zealand, and Italy).
Anthropometric standards used to determine overweight or
obesity categories included the WHO, CDC, or IOTF growth
standards in 6, 5, and 3 studies respectively.
Crude analysis of all 14 studies revealed that among
children who consumed whole milk compared with reduced-fat
milk, the pooled OR for overweight or obesity was 0.61 (95%
CI: 0.52, 0.72; P < 0.0001). Heterogeneity measured by the
I\2\ statistic was 73.8% (P < 0.0001 ). A sensitivity
analysis using inverse-variance weights did not reveal
different results. Subgroup analysis by study design revealed
no significant interaction between cross-sectional and
prospective cohort studies. For the 11 cross-sectional
studies (n = 9413), the pooled OR of overweight or obesity
was 0.56 (95% CI: 0.46, 0.69; P = 0.0001), and for the 3
prospective cohort studies (n = 11,484) it was 0.76 (95% CI:
0.63, 0.92; P = 0.006).
Risk of bias (high compared with low) and age group were
also not significant modifiers of the relation between cow-
milk fat and child adiposity. Analyses of 5 studies (49, 51,
52, 57, 58) that reported adjusted ORs did not show
differences between crude and adjusted estimates (adjusted
OR: 0.53; 95% CI: 0.44, 0.63; crude OR: 0.55; 95% CI: 0.46,
0.66). Results of the sensitivity analysis using the Knapp-
Hartung method to pool the 14 studies (crude OR: 0.62; 95%
CI: 0.52, 0.73) were similar to the main results (crude OR:
0.61; 95% CI: 0.52, 0.72)). Publication bias, visualized
using a funnel plot was difficult to ascertain given the high
heterogeneity (I\2\ = 73.8%) and relatively low number of
included studies.
Data were available from 7 studies (38, 39, 44, 52, 57, 58,
65) which included 14,582 children aged 2 to 11 y, and
demonstrated a linear association between higher cowmilk fat
and lower child adiposity. For each 1% higher cowmilk fat
consumed, the overall crude OR for overweight or obesity was
0.75 (95% CI: 0.65, 0.87; P = 0.004; t\2\ = 0.01; I\2\ =
64%).
discussion
This systematic review and meta-analysis has identified
that relative to reduced-fat cow-milk, whole-fat cow-milk
consumption was associated with lower odds of childhood
overweight or obesity. The direction of the association was
consistent across a range of study designs, settings, and age
groups and demonstrated a dose effect. Although no clinical
trials were identified, existing observational research
suggests that consumption of whole milk compared with
reduced-fat milk does not adversely affect body weight or
body composition among children and adolescents. To the
contrary, higher milk fat consumption appears to be
associated with lower odds of childhood overweight or
obesity.
Findings from the present study suggest that cow-milk fat,
which has not been examined in previous meta-analyses, could
play a role in the development of childhood overweight or
obesity. Several mechanisms have been proposed that might
explain why higher cow-milk fat consumption could result in
lower childhood adiposity. One theory involves the
replacement of calories from less healthy foods, such as
sugar-sweetened beverages, with cow-milk fat. Consumption of
beverages high in added sugar has been associated with
increased risk of overweight and obesity during childhood.
Other theories involve satiety mechanism such that higher
milk fat consumption might induce satiety through the release
of cholecystokinin and glucagon-like peptide 1 thereby
reducing desire for other calorically dense foods. Another
possibility is that lower satiety from reduced-fat milk could
result in increased milk consumption causing higher weight
gain relative to children who consume whole milk, as observed
in the study by Berkey et al.
Cow-milk fat might offer cardiometabolic benefits. The
types of fat found in cow-milk, including trans-palmitoleic
acid, could be metabolically protective. Higher circulating
trans-palmitoleic acid has been associated with lower
adiposity, serum LDL cholesterol and triglyceride
concentrations, and insulin resistance, and higher HDL
cholesterol in several large adult cohort studies. However,
diets that replace dairy fat with unsaturated fatty acids
might also offer cardiometabolic protection.
Confounding by indication and reverse causality are
plausible alternate explanations. Parents of children who
have lower adiposity might choose higher-fat milk to increase
weight gain. Similarly, parents of children who have higher
adiposity might choose lower-fat milk to reduce the risk of
overweight or obesity. The majority of children included in
this systematic review were involved in prospective cohort
studies, in which the potential for reverse causality is
lower than in cross-sectional studies. Results from these
11,484 children were consistent with the overall findings.
Two of the included prospective cohort studies attempted to
address confounding by indication by adjusting for baseline
BMI; 1 of these repeated the statistical analysis only among
participants with normal-weight BMI values, with similar
findings. Clinical trial data would have provided better
evidence for the directionality of this relation; however,
none were available.
This study had a number of strengths. The meta-analysis
included a large, diverse sample of children from around the
world. The number of potentially eligible studies was
maximized by the comprehensive search strategy and contact
with authors to obtain missing data. Also, study selection,
data collection, and risk of bias assessment were performed
by 2 independent reviewers, which improved accuracy and
consistency. All studies included in the meta-analysis used
trained individuals to obtain anthropometric measurements,
and weight status was standardized using growth reference
standards (WHO, CDC, and IOTF). Using metaregression
techniques, differences in study design, risk of bias, and
age group were taken into account. Finally, a dose-response
meta-analysis was conducted, which demonstrated a linear
relation between higher cow-milk fat and lower child
adiposity.
This study had a number of limitations. First, included
studies were all observational. Only 1 study in this analysis
was considered to have low risk of bias, and all studies in
the meta-analysis had high risk of bias. Risk of bias
included cross-sectional designs and lack of adjustment for
clinically important covariates. For example, cow-milk volume
was accounted for in only 11 of 28 studies in the systematic
review, and in 5 of 14 studies in the meta-analysis.
Adjustment for volume in future studies would allow for a
clearer understanding of whether higher cow-milk fat protects
against higher adiposity, or reduced-fat cow-milk increases
adiposity. However, among these studies. comparison of
adjusted compared with crude odds demonstrated consistent
findings. Residual confounding by variables not accounted for
in the individual analyses is also possible; this is a common
limitation for meta-analyses of observational studies.
Heterogeneity was relatively high (I\2\ = 73.8%), which might
have been attributable to a variety of factors including
varied methods of ascertainment of exposure and outcome, and
differences in study design and follow-up duration. Although
subgroup analyses of prospective cohort studies revealed
results comparable to the overall metaregression, these
comparisons might not have had sufficient power to detect
clinically meaningful differences. However, 11,484 children
were involved in prospective cohort studies making large
differences in effect size unlikely. Although only studies
with standardized dietary measurements were included,
measurement error was possible due to recall bias or lack of
validation of dietary assessment tool. Error in adiposity
measurement could also have introduced bias. although weights
and heights were measured by trained individuals and
standardized protocols were used in all studies included in
the meta-analysis. Differences in adiposity measurement
(i.e., body fat percentage, zBMl, BMI), and different growth
standards could have contributed to heterogeneity. For
example, use of the WHO rather than IOTF or CDC standards
could have resulted in a greater proportion of overweight or
obese children being reported. Future studies using WHO
growth standards, which are believed to represent optimal
child growth, would help to minimize heterogeneity and
overcome these limitations. Consideration for relevant
outcomes such as cardiovascular risk should be included in
future analyses to understand other effects of cow-milk fat.
Publication bias was also possible as demonstrated by a
funnel plot and Egger test.
In conclusion, observational evidence supports that
children who consume whole milk compared with reduced-fat
milk have lower odds of overweight or obesity. Given that the
majority of children in North America consume cow-milk on a
daily basis, clinical trial data and well-designed
prospective cohort studies involving large, diverse samples,
using standardized exposure and outcome measurements, and
with long study duration would help determine whether the
observed association between higher milk at consumption and
lower childhood adiposity is causal.
[[Page H6895]]
[From the American Journal of Clinical Nutrition]
Dairy Foods, Dairy Fat, Diabetes, and Death: What Can Be Learned From 3
Large New Investigations?
(By Dariush Mozaffarian)
Dairy products are a major component of most diets,
contributing 10% of calories in the United States.
Surprisingly, for such a major share of the food supply,
their health effects remain remarkably uncertain,
insufficiently studied, and controversial. Dietary guidelines
on dairy remain largely based on theoretical considerations
about isolated nutrients (e.g., theorized benefits of calcium
or vitamin D; theorized harms of total fat or saturated fat)
or short-term dietary pattern studies of surrogate markers,
rather than on the mounting evidence on how milk, cheese,
yogurt, butter, and other dairy foods relate to major
clinical endpoints. Such evidence on health outcomes is
crucial, because dairy products appear to be a heterogeneous
class with complex effects dependent upon the interplay of
diverse nutrients and processing characteristics (e.g.
probiotics, fermentation, milk fat globule membrane, and
more).
In this issue of the Journal, 3 new publications report on
dairy consumption and risk of type 2 diabetes or mortality.
Ardisson Korat et al. evaluated estimated dairy fat
consumption and onset of diabetes in 3 cohorts of US health
professionals. After adjustment for other risk factors,
higher dairy fat intake, in comparison with carbohydrate, was
associated with lower diabetes risk in 1 cohort of middle-
aged women, and was not significantly associated with
diabetes in the other 2 cohorts or among all 3 cohorts
combined. In subgroup analyses, dairy fat intake was
associated with lower risk of diabetes at younger ages (<65
y) and in women, the 2 subgroups among whom 70-80% of
diabetes cases occurred--although these interactions by age
and sex did not achieve statistical significance. When dairy
fat was statistically compared with carbohydrate from whole
grains, the latter was associated with lower risk of diabetes
(per 5% energy, 7% lower risk), whereas, compared with other
animal fats (largely form red meat and poultry) or with
carbohydrate from refined grains, dairy fat consumption was
associated with lower risk of diabetes (per 5% energy, 4-17%
lower risk). Dairy fat consumption was not associated with
incident diabetes when compared with vegetable fat,
polyunsaturated fat (total, v 6, or v 3), or monounsaturated
fat from plant sources. Because dairy fat in these cohorts
was associated with several unhealthy lifestyle factors,
including higher BMI, more current smoking, less physcial
activity, fewer fruits and vegetables, and a less healthy
overall dietary pattern, this suggests that residual
confounding, if present--the major limitation of
observational cohorts such as this one--would tend to cause
bias toward dairy fat appearing more harmful (less
beneficial) than it actually may be.
These findings add to a growing body of literature which
call into question the soundness of conventional dietary
recommendations to avoid dairy fat. As noted by Ardisson
Korat et al., dairy fat contains a complex mix of different
SFAs, other unsaturated and conjugated fatty acids, and other
constituents, each with varying biological effects.
Physiologic effects of dairy fat further vary according to
content of milk fat globule membrane, which alters
cholesterol absorption and perhaps skeletal muscle responses
to exercise. Also, cheese, the major source of dairy fat in
most diets, is a fermented food and a rich source of
menoquinones which may improve insulin secretion and
sensitivity through osteocalcin-related pathways. In a recent
pooling project of de novo individual-level analyses from 16
prospective cohort studies across 4 continents (including 2
of the 3 US cohorts evaluated by Ardisson Korat et al.),
objective blood biomarkers of odd-chain saturated fats and
trans-palmitoleic acid, each found in dairy fats, were
associated with significantly lower risk of diabetes.
Together with these prior findings, the new results by
Ardisson Korat et al. provide little support for metabolic
harms of dairy fat, and indeed suggest potential benefits
amoung younger adults, among women, and as a replacement for
other animal fats or refined carbohydrates.
A second report in this issue of the Journal assessed how
changes in dairy foods, assessed using serial questionnaires,
related to incident diabetes in the same 3 US cohorts of
health professionals. After multivariable adjustment,
participants who decreased their total dairy intake by >1
serving/d over a 4-year period experienced 11% higher
incidence of diabetes, compared with stable intake. Among
dairy subtypes, changes in low-fat milk, whole milk, and
cream were not significantly associated with diabetes,
whereas decreases in ice cream, increases in some types of
cheese, and decrease in yogurt were each associated wih
higher risk. Several factors complicate the interpretation of
this analysis. Foremost, none of these findings were
symmetrical for increases compared with decreases in intake:
i.e., when decreased consumption of total dairy or a dairy
subtype was linked to diabetes risk, increased consumption
was not linked in the opposing direction, and vice versa.
This counters expected biology and the important Bradford
Hill criterion of dose-response, which for example has been
evidenced in these cohorts for dietary changes and long-term
weight gain. In addition, results for each of the dairy
subtypes appeared generally inconsistent across the 3
cohorts, with little uniformity (I \2\ values were not
reported). Some of the findings counter expected causal
biology--e.g., that decreasing ice cream increases diabetes--
raising concern for reverse causation. The dietary instrument
was also variably reliable for assessing different dairy
foods: for example, as compared with multiple dietary
records, the FFQ reliably measured consumption of yogurt (r =
0.97), but not hard cheese (r = 0.38). In light of the 26
prior cohort studies which have reported on dairy consumption
and incident diabetes, in sum suggesting lower risk from
total dairy and especially yogurt consumption, the internal
inconsistencies of the present findings for changes in dairy
foods raise more questions than they answer.
In the third publication in this issue, Pala et al.
investigated dairy consumption and death from cancer,
cardiovascular disease, and all causes in a community-based
Italian cohort. After adjustment for other risk factors,
compared with no consumption, moderate milk intake
(200 g or 6.5 ounces per day) was associated with
25% lower mortality, largely owing to 50% lower
cardiovascular mortality, but consumption at higher levels
was not associated with lower risk. Findings were similar for
low-fat comparew with whole-fat milk. Intakes of yogurt,
cheese, and butter were not significantly associated with
mortality. As the authors concluded, the lack of linear dose-
response for milk raises questions about the validity of the
observed benefits, but none of the findings support the
hypothesis that milk, yogurt, cheese, or butter consumption
increases mortality.
The global pandemics of obesity and type 2 diabetes,
together with high rates of cardiovascular disease and
cancer, have stimulated a new popular frenzy around healthier
eating. Although the resulting attention on diet-related
health impacts, economic burdens, and corresponding policy
solutions has been positive, the craze of competing popular
diets and their proponents have simultaneously fueled
confusion, controversy, and skepticism. For example, ignoring
the preponderance of evidence, some popular books and social
media headlines claim that dairy foods are toxic. At the same
time, prevailing dietary guidelines exacerbate the confusion,
remaining mired in outdated conceptual frameworks and
hesitating to acknowledge new paradigms of complexity.
As is always true in science, these 3 new investigations
cannot by themselves definitively eliminate confusion or
answer all questions. Yet, these studies aimed to address
crucial questions on dairy and health in large and well-
designed prospective cohorts. Together, the findings provide
little support that consumption of total dairy, dairy
subtypes, or dairy fat is harmful, and they continue to build
the case for possible benefits. As recently reviewed, the
dizzyingly complex characteristics and molecular effects of
different dairy foods belie any simplistic overall summary or
synopsis. These 3 new studies highlight this complexity and
the urgent need for additional long-term prospective studies,
interventional trials, and mechanistic investigations of
dairy foods and health.
Mr. THOMPSON of Pennsylvania. Mr. Chairman, these studies show, among
other things, that full-fat dairy foods have little to no association
with high blood pressure, cardiovascular disease, type 2 diabetes,
obesity, blood pressure, or cholesterol.
In fact, several of these studies show that full-fat foods help
improve or lower negative health outcomes for children who drink more
full-fat dairy beverages.
The Acting CHAIR (Mr. Fulcher). The time of the gentleman has
expired.
Ms. FOXX. Mr. Chair, I yield an additional 2 minutes to the gentleman
from Pennsylvania.
Mr. THOMPSON of Pennsylvania. Mr. Chairman, additionally, since whole
milk was removed from school lunchrooms, the childhood obesity rate has
increased, according to the CDC and several case studies. Whole milk is
not the problem.
For our children to excel in the classroom and beyond, they must have
access to more nutritious options, not fewer.
The Whole Milk for Healthy Kids Act will allow schools participating
in the National School Lunch Program to serve all varieties of flavored
and unflavored milk, including whole milk.
It is important to remember that this legislation does not require
any student to drink, or any school to serve, whole milk. Rather, this
legislation simply gives schools the flexibility to serve a broader
variety of milk in the school lunchroom.
Additionally, if students have a documented medical condition or
disability that prohibits them from safely or comfortably consuming
milk, schools are required to offer them an alternative beverage. This
legislation would not change that standard.
Mr. Chair, I am proud to have 134 bipartisan cosponsors from 44
States.
[[Page H6896]]
The bottom line is the Whole Milk for Healthy Kids Act is about
ensuring students have the necessary nutrients to learn and grow.
Mr. SCOTT of Virginia. Mr. Chairman, may I inquire as to how much
time is remaining on both sides.
The Acting CHAIR. The gentleman from Virginia has 17\1/2\ minutes
remaining. The gentlewoman from North Carolina has 13\1/2\ minutes
remaining.
Mr. SCOTT of Virginia. Mr. Chair, I yield myself such time as I may
consume.
Mr. Chairman, the gentleman from Pennsylvania and I have enjoyed
working together on many different bills, but on this bill, we happen
to disagree. He has presented evidence on the floor that, instead of
being considered by Members of Congress, really ought to be considered
by the experts in the normal scientific process.
{time} 1430
If the schoolchildren get the benefit of his studies, then tell it to
the experts and not the politicians. I would hope that we would stick
with the scientific process, as we are doing. Let's stick with the DGAs
and not the political process in changing the process by trying to
convince Members of Congress who are subject to political pressures on
one side or another. So I would hope that we would stick to that
process and not the political process.
If we have studies, then show it to the experts and not the
politicians.
Mr. Chair, I reserve the balance of my time.
Ms. FOXX. Mr. Chair, I yield 2 minutes to the gentlewoman from
Illinois (Mrs. Miller), who is the vice chair of the Education and the
Workforce Committee.
Mrs. MILLER of Illinois. Mr. Chair, I thank Ms. Foxx for yielding.
Mr. Chairman, I thank Chairman Thompson and Chairwoman Foxx for
sponsoring this important legislation.
I rise in support of H.R. 1147, the Whole Milk for Healthy Kids Act.
This crucial legislation recognizes the nutritional benefits of whole
milk for our children.
As a result of the radical Obama Administration policies led by
Michelle Obama, only fat-free and low-fat milks can be served in school
meals.
H.R. 1147 would end this practice and allow schools to serve whole
milk. Whole milk is a rich source of essential nutrients, including
calcium and vitamin D, which are vital for developing strong bones and
a healthy immune system.
Studies have also shown that whole milk can contribute to healthier
weight in children. I raised my seven children on whole-fat milk, and
they are all within normal weights. I also have recognized that
children who have high-fat diets stay full longer.
I am proud to support this bill on behalf of parents, and I want to
thank America's dairy farmers for producing milk for our families.
Ms. FOXX. Mr. Chair, I include in the Record two scientific articles.
[From the Friedman School of Nutrition Science and Policy]
Dairy Foods, Obesity, and Metabolic Health: The Role of the Food Matrix
Compared with Single Nutrients
(By Dariush Mozaffarian)
Introduction
Conventional dietary guidelines from around the globe have
focused on individual nutrients to maintain and improve
health and prevent disease. This is due to the historical
focus, developed in the last century, on single nutrients in
relation to clinical nutrient deficiency diseases. However,
this reductionist approach is inappropriate for translation
to chronic diseases.
A look back at the history of modern nutrition science
provides important perspectives on the origins of the
reductionist approach to nutrition. In 1747, the British
sailor and physician James Lind tested whether citrus fruits
prevented scurvy, but it was not until 1932 that vitamin C
was actually isolated, synthesized, and proven to be the
relevant ingredient. The period of the 1930s to 1950s was a
golden era of vitamin discovery, when all the major vitamins
were identified, isolated, and synthesized, and shown to be
the active constituents of foods relevant for nutrient
deficiency diseases such as pellagra (niacin), beriberi
(thiamine), rickets (vitamin D), and night blindness (vitamin
A). This scientific focus on nutrient deficiencies coincided
with global geopolitics, in particular the Great Depression
and World War II, which accentuated concerns about
insufficient food and nutrients. For example, the birth of
RDAs was at the National Nutrition Conference on Defense in
1941, which focused on identifying the individual nutrients
needed to prevent nutrient deficiencies in order to have a
population ready for war. Together, these scientific and
historical events led to the concept of food as a delivery
system for calories and specific isolated nutrients.
It was not until the 1980s that modern nutrition science
began to meaningfully consider nutrition in association with
chronic diseases, such as obesity, type 2 diabetes,
cardiovascular disease (CVD), and cancer. Intuitively, the
reductionist paradigm that had been so successful in reducing
the prevalence of nutrient deficiency diseases was extended
to chronic diseases. Thus, saturated fat became ``the'' cause
of heart disease, whereas now, excess calories and fat are
``the'' causes of obesity.
What recent advances in nutrition science have
demonstrated, however, is that although a single-nutrient
focus works well for prevention of deficiency diseases, such
as scurvy or beriberi, this approach generally fails for
chronic diseases such as coronary artery disease (CAD),
stroke, type 2 diabetes, or obesity. For such complex
conditions, the focus should be on foods.
Calories in/Calories out
The US obesity epidemic is a recent phenomenon, starting in
the mid-1980s, and the rise of obesity globally is even more
recent. The strategies to address this epidemic have not yet
caught up with advances in nutrition science. Most current
dietary recommendations and policies across the globe remain
calorie and fat focused, recommending foods based on these
reductionist metrics rather than their complex, empirically
determined effects on health. For example, nearly all
guidelines recommend low-fat or nonfat dairy foods to reduce
calories, total fat, and saturated fat in the diet, based on
the theory that this will help maintain a healthy weight and
reduce the risk of CVD. This is seen, for example, in the
2015-2020 US Dietary Guidelines; National School Lunch
Program, NIH Dietary Guidelines for Kids; and CDC Diabetes
Prevention Program.
However, foods are not simply a collection of individual
components, such as fat and calories, but complex matrices
that have correspondingly complex effects on health and
disease. Recommendations based on calorie or fat contents
fail to consider the complex effects of different foods,
independent of their calories, on the body's multiple,
redundant mechanisms for weight control, from the brain to
the liver, the microbiome, and hormonal and metabolic
responses. This growing evidence indicates that different
foods, calorie-for-calorie, have different effects on the
risk of long-term weight gain and success of weight
maintenance.
Dairy Foods and Weight
Although dairy products contribute cents10
percent of all calories in the US diet, until recently,
little direct research had evaluated the health effects of
different dairy foods. The complex ingredients and matrices
of different dairy foods, from milk to yogurt to cheese,
appear to have varying effects on weight.
Although considerable research has focused on optimal diets
for weight loss among obese individuals (secondary
prevention), fewer studies have evaluated determinants of
gradual weight gain (primary prevention). Among nonobese US
adults, the average weight gain is centslb (0.45
kg) per year. This represents a very slow, modest increment,
but when sustained over many years, this small annual weight
gain drives the obesity epidemic. This gradual pace also
makes it difficult, if not impossible, for individuals to
identify specific causes or remedies.
To identify specific dietary factors associated with long-
term weight gain, we performed prospective investigations
among 3 separate cohorts that included 120,877 US men and
women who were free of chronic disease and not obese at
baseline. We examined weight gain every 4 y, for up to 24 y
of follow-up, and its association with the increased intake
of individual foods. Within each 4-y period, participants
gained an average of 3.35 lb. On the basis of increased daily
servings of different foods, those strongly linked to weight
gain were generally carbohydrate-rich, including potato chips
(per daily serving, 1.69 lb greater weight gain every 4 y),
other potatoes/fries (1.28 lb), sugar-sweetened beverages
(1.00 lb), sweets (0.65 lb), and refined grains (0.56 lb).
Other foods were not linked to weight gain, even when then
intake was increased, including cheese, low-fat milk, and
whole milk. Other foods were actually related to less weight
gain: the more they were consumed, the less weight was
gained. This included vegetables (-0.22 lb), whole grains
(-0.37 lb), fruits (-0.49 lb), nuts (-0.57 lb), and yogurt
(-0.82 lb) When sweetened vs. plain yogurt were evaluated,
each was associated with relative weight loss, although when
sweetened, about half the benefit was lost.
What could explain these findings? We hypothesize that
different foods have varying effects on multiple redundant
mechanisms for weight gain, including effects on hunger and
fullness, glucose, insulin and other hormonal responses, de
novo fat synthesis by the liver, gut microbiome responses;
and the body's metabolic rate.
Based on these findings, certain foods, when consumed over
the long term can have relatively neutral effects on weight,
others promote weight gain, whereas still others promote
weight loss.
Interestingly, although we found that cheese, low-fat milk,
and whole-fat milk were each unassociated with weight change,
[[Page H6897]]
there is evidence that dairy foods may promote healthier body
composition. Consistent with our findings, a systematic
review and meta-analysts of 37 randomized clinical trials
with 184,802 participants, which assessed the effect of dairy
consumption on weight and body composition, found that
overall, dairy consumption had little effect on BMI. Body
composition, however, changed significantly. Dairy
consumption led to a reduction in fat mass (0.23 kg) and an
increase in lean body mass (0.37 kg). Overall, high-dairy
intervention increased body weight (0.01, 95 percent CI:
-0.25, 0.26), and lean mass (0.37, 95 percent CI: 0.11,
0.62); decreased body fat (-0.23, 95 percent CI: -0.48, 0.02)
and waist circumference (-1.37 95 percent CI: -2.28, -0.46).
In subgroup analyses, such effects appeared larger in
trials also having energy restriction, but such subgroup
findings should be interpreted cautiously The types and
frequency of dairy products consumed varied among these
trials, making it difficult to make distinctions in this
meta-analysis about the effects of different types of dairy
products such as low-fat or whole fat, or milk, yogurt, or
cheese. When viewed in combination with our long-term
observational findings, the joint results suggest that dairy
foods do not promote weight gain, that dairy consumption may
reduce body fat and augment muscle mass, and that the type of
dairy product (milk compared with cheese compared with
yogurt) may be more important for preventing long-term weight
gain than the dairy fat content.
Dairy Foods, Probiotics, and the Microbiome
Many pathways appear relevant to the concept that foods
cannot be judged on calorie content alone for risk of
obesity. Among these, the gut microbiome is particularly
interesting. Substantial evidence demonstrates that the
quality of the diet strongly influences the gut microbiome.
Among different factors, probiotics have been studied for
their effect on the microbiome; as well as potential benefits
of fermented foods, which may be greater than the sum of
their individual microbial, nutritive, or bioactive
components.
For example, in an experimental model, mice genetically
predisposed to obesity were provided control diets or a
``fast-food'' chow with and without probiotic-containing
yogurt or a single probiotic (Lactobacillus reuteri) in
water. Without probiotics, mice on the fast-food chow gained
significant weight. However, the addition of either
probiotic-containing yogurt or water prevented this weight
gain. Crucially, the probiotics did not appear to reduce the
amount of calories consumed; rather, the benefits appeared
related to changes in microbiome function and inflammatory
pathways. The results support weight benefits of probiotics
and, more importantly, provide empiric evidence that
challenges the widely accepted conventional wisdom that
the effects of different foods on obesity depend largely
on their calories.
Consistent with this animal experiment, a recent systematic
review and meta-analysis of 15 randomized controlled trials
examined the effects of probiotics, either in foods or as
supplements, on body weight and composition in overweight and
obese subjects. Administration of probiotics significantly
reduced body weight percent (-0.60 kg), BMI (-0.27 kg/m\2\),
and fat percentage (0.60 percent), compared with placebo. A
separate meta-analysis of randomized clinical trials
demonstrated that consumption of probiotics in foods or
supplements significantly improves blood glucose, insulin,
and insulin resistance. The trials in these two meta-analyses
were neither long-term nor large--in all, a total of about
1,000 subjects were included in each meta-analysis, with
trial durations ranging from 3 to 24 wk and with varying
designs in terms of controls, disease conditions, and
composition of probiotic preparations evaluated. Nonetheless,
together with observational and experimental evidence, these
studies provide compelling evidence to support weight and
metabolic benefits of foods rich in probiotics.
Dairy Foods, CVD, and Diabetes
Although an important risk factor for type 2 diabetes and
CVD, growing research suggests that specific foods may also
directly alter disease risk. In a meta-analysis of 29
prospective cohort studies including 938,465 participants who
experienced 93,158 deaths, 28,419 incident CAD events, and
25,416 incident CVD events, neither total dairy nor milk
consumption was significantly associated with total
mortality, CAD, or CVD. Notably, findings were similar when
total whole-fat dairy, or low-fat dairy were separately
evaluated. In contrast, the intake of fermented dairy
products (predominantly cheese, plus yogurt and fermented
milk) was associated with modestly lower risk of total
mortality and CVD, with about 5 percent lower risk of each
per 50 g daily serving. In addition, the consumption of
cheese alone, the dairy product with the highest amount of
dairy fat, was associated with a significantly lower risk of
both CAD and stroke.
In the Multi-Ethnic Study of Atherosclerosis cohort,
including 5209US adults with Caucasian, Asian, black, and
Hispanic backgrounds, different food sources of saturated fat
were analyzed for their relation with subsequent CVD risk,
adjusted for sociodemographics, medical history, and other
dietary and lifestyle factors. A higher intake of saturated
fat from dairy sources was associated with significantly
lower CVD risk (per each 5 g/d, RR = 0.79, 95 percent CI =
0.68, 0.92), whereas a higher intake of saturated fat from
meat sources was associated with higher CVD risk (per each 5
g/d, RR = 1.26, 95 percent CI = 1.02, 1.54). Intakes of
saturated fat from other sources, such as butter and plant
oils/foods, were too low to identify any associations.
These findings suggest that saturated fat from different
food sources may have varying effects on CVD risk. This may
partly relate, for example, to differences in the types of
saturated fatty acids in meat compared with dairy. Compared
with meat, dairy has a greater proportion of short-chain and
medium-chain saturated fatty acids, with correspondingly less
palmitic and stearic acids. Compared with their longer chain
fatty acids, growing evidence suggests that shorter and
medium-chain triglycerides have different physiology,
including potential benefits on metabolic risk, weight gain,
obesity, and the gut microbiome.
In addition, cardiometabolic effects of different dairy
foods appear to vary depending on other characteristics, such
as fermentation or the presence of probiotics. The large
European Investigation into Cancer and Nutrition (EPIC)
cohort across 8 European countries evaluated the consumption
of different dairy foods and risk of diabetes among 340,234
participants with 12,403 new cases of diabetes during follow-
up. In the fully adjusted model including adjustment for
estimated dietary calcium, magnesium, and vitamin D, the
consumption of milk (low-fat and whole-fat) was not
significantly associated with type 2 diabetes. Individuals
who consumed more yogurt or thick fermented milk experienced
a nonsignificant tend toward lower risk (across quintiles: RR
= 0.89, 95 percent CI = 0.77, 1.03; P-trend = 0.11), whereas
individuals who consumed more cheese had significantly lower
risk of diabetes (RR = 0.83, 95 percent CI = 0.70, 0.98, P-
trend = 0.003). A higher combined intake of fermented dairy
products (cheese, yogurt, and thick fermented milk) was also
associated with a lower risk of diabetes (RR = 0.85, 95
percent CI = 0.73, 0.99, P-trend = 0.02).
Similarly, in the Malmo Diet and Cancer Cohort following
26,930 participants over 14 y, different food sources of fat
and saturated fat had very different associations with
incidence of diabetes. Overall, low-fat dairy consumption was
associated with a higher risk of diabetes (across quintiles:
RR = 1.14, 95 percent CI = 1.01, 1.28; P-trend = 0.01),
whereas whole-fat dairy consumption was associated with a
substantially lower risk RR = 0.77, 95 percent CI = 0.68,
0.87, P-trend < 0.001). However, relations varied further by
subtype. For example, nonfermented, low-fat milk was
associated with higher risk; nonfermented, whole-fat milk was
not associated with risk; and fermented, whole-fat milk was
associated with lower risk. Cheese intake showed a
nonsignificant trend toward lower risk (RR = 0.92, 95 percent
CI = 0.81, 1.04; P-trend = 0.21), whereas red meat intake was
associated with significantly higher risk (RR = 1.36, 95
percent CI = 1.20, 1.55; P-trend < 0.001). When estimated
intakes of individual fatty acids were evaluated, intakes of
saturated fatty acids with 4-10 carbons, lauric acid (12:0),
and myristic acid (14:0) were associated with decreased risk
(P-trend = 0.01).
In addition to the consumption of whole foods such as milk,
cheese, or yogurt, significant amounts of dairy fat can be
consumed as relatively ``hidden'' ingredients in creams,
sauces, cooking fats, bakery desserts, and mixed dishes such
as casseroles containing butter, milk, or cheese. Self-
reported questionnaires may miss many of these sources,
leading to inaccurate measurement of true dairy fat
consumption in individuals. Biomarkers can partly reduce this
mismeasurement. In a global consortium combining de novo
individual-level analyses across 63,602 participants in 16
separate cohort studies, higher blood concentrations of odd-
chain saturated fatty acids (15:0, 17:0) and a natural
ruminant trans fatty acid (trans-16:1n-7), objective
circulating biomarkers of dairy fat consumption, were
evaluated in relation to onset of diabetes. Each fatty acid
was associated with lower incidence of diabetes, with 20-35%
lower risk across the interquintile range of blood
concentrations. It is unclear whether such lower risk is
related to direct health benefits of specific dairy fatty
acids, or to other aspects of foods rich in dairy fat. For
example, the major source of dairy fat in most diets is
cheese, a fermented food rich in vitamin K2 (menoquinone)
which is converted from vitamin K by the action of bacteria.
Menoquinone, which cannot be separately synthesized by
humans, is linked to lower risk of type 2 diabetes in
prospective observational studies, with supportive
experimental evidence for potential benefits on glucose
control and insulin sensitivity. The biologic mechanisms that
could explain metabolic and diabetes benefits of dairy foods
and dairy fat have been recently reviewed.
Based on all the evidence, the relation of dairy foods to
obesity, CVD, and diabetes does not consistently differ by
fat content, but rather appears to be more specific to food
type. In particular, neither low-fat nor whole milk appear
strongly related to either risks or benefits, whereas cheese
and yogurt (as well as other fermented dairy such as
fermented milk) may each be beneficial. These findings
suggest that health effects of dairy may depend on multiple
complex characteristics, such as probiotics, fermentation,
and processing, including homogenization and the presence or
absence of milk fat globule membrane.
[[Page H6898]]
Holistic Dietary Recommendations
Conventional dietary guidelines generally recommend 2-3
daily servings of low-fat or nonfat dairy foods, without
regard of type (yogurt, cheese, milk); largely based on
theorized benefits of isolated nutrients for bone health
(e.g., calcium, vitamin D) and theorized harms of isolated
nutrients for obesity and CAD (e.g., total fat, saturated
fat, total calories). Advances in science indicate that
updated dietary guidelines must incorporate the empirical
evidence on health effects of different dairy products on
weight, body composition, CVDs, and diabetes. These findings
suggest that recommendations for milk, cheese, and yogurt
should be considered separately, based on their differing
relations with clinical outcomes. These findings further
suggest that whole-fat dairy foods do not cause weight gain;
that overall dairy consumption increases lean body mass and
reduces body fat; that yogurt consumption and probiotics
reduce weight gain; that fermented dairy consumption
including cheese is linked to lower CVD risk; and that
yogurt, cheese, and even dairy fat may protect against type 2
diabetes.
Based on the current science, dairy consumption is part of
a healthy diet, and intakes of probiotic-containing yogurt
and fermented dairy products such as cheese should be
especially encouraged. Based on little empiric evidence that
low-fat dairy products are better for health, and at least
emerging research suggesting potential benefits of foods rich
in dairy fat, the choice between low-fat compared with whole-
fat dairy should be left to personal preference, pending
further research. Such recommendations are consistent with a
growing focus on and understanding of the importance of foods
and overall diet patterns, rather than single isolated
nutrients.
____
[From the European Journal of Clinical Nutrition, Dec. 11, 2017]
Effect of Whole Milk Compared With Skimmed Milk on Fasting Blood Lipids
in Healthy Adults: a 3-Week Randomized Crossover Study
(By Sara Engel, Mie Elhauge, and Tine Tholstrup)
Introduction
Dairy is a source of saturated fat (SFA) and dietary
recommendations for choosing low-fat dairy products are
mainly based on predicted effects of macronutrients, such as
SFA, which are known to increase LDL cholesterol
concentration in the blood. However, there is disagreement
between dietary guidelines and results from meta-analysis of
prospective cohort studies reporting no association between
dairy and risk of cardiovascular disease (CVD) and an inverse
association with type 2 diabetes (T2D). A meta-analysis
including studies comparing diets of equal SFA content from
cheese and butter reported a beneficial effect of cheese on
LDL cholesterol. Moreover, a comparison between regular and
reduced fat cheese found no difference in effect on LDL
cholesterol and risk markers of the metabolic syndrome,
although a significantly higher SFA content in the regular
fat cheese diet. This could suggest that the expected effect
on LDL cholesterol was mediated by a combination of nutrients
or bioactive components in the cheese matrix. Every day,
people make a choice between whole milk and skimmed milk in
the super market. Thus, a comparison between these high and
low-fat dairy products is a real-life practical issue for the
consumer that makes it possible to further examine the effect
of milk fat on health. Two studies compared milk with
different fat content and found no difference in changes in
LDL and HDL cholesterol; one between two control diets with
semi-skimmed and skimmed milk (1.9 vs. 0.3%) and another
between whole milk and skimmed milk (3.4 vs. 0.2%) but with
only eight participants and therefore underpowered. Current
evidence from randomized controlled trials (RCTs) indicate
that milk consumption has no effect on risk of T2D in terms
of fasting insulin and glucose concentrations, although not
consistently. The aim of this study was to investigate the
effects of whole milk compared with skimmed milk on serum
total, LDL, and HDL cholesterol, and triacylglycerol
concentration and secondarily on glucose and insulin
concentrations in healthy subjects. We hypothesized that
whole milk would increase fasting blood cholesterol
concentration moderately compared to skimmed milk.
Methods
Subjects
Subjects were recruited through postings on the Internet
and around university campus area in Copenhagen. A total of
25 subjects were screened through telephone calls, 19 were
assessed for eligibility, 18 were enrolled in the study, and
1 subject dropped out after randomization. Exclusion criteria
were: previous or current CVD, diabetes, or other severe
chronic disease: BMI (in kg/m\2\) <18.5 and >30; age <20
years and >70 years; pregnancy or planning of pregnancy
during study period; excessive physical activity (>10 h/wk);
milk allergy or lactose intolerance; blood donation <1 mo
prior to and during study period; use of supplements, lipid-
lowering medication, as well as medicine that might affect
study outcomes; known or suspected abuse of alcohol,
medication, or drugs; blood pressure >140/90 mmHg; and
inability to follow study protocol. After receiving oral and
written information about the study all subjects gave their
informed consent in writing and completed a lifestyle
questionnaire including questions about current and previous
disease.
Study design
The study was a crossover RCT. The two intervention periods
of whole milk and skimmed milk (in random order) were 3 weeks
long with no wash-out period, as the lipids in the blood are
known to adjust after 2 weeks. The study was not blinded as
the appearance of the test beverages could not be concealed.
However, analyses of blood samples as well as statistics were
done blinded. Sample size was based on a previous study on
dairy fat in which butter significantly increased LDL
cholesterol compared with olive oil (control) (difference in
concentration 0.17 mmol/L). Thus with a standard deviation
(SD) of 0.19 mmol/L, a total of 12 subjects had to be
included in order to detect a similar difference (assuming a
significance level of 5 and 80% power). The study was carried
out at the Department of Nutrition, Exercise, and Sports,
Faculty of Science, University of Copenhagen, Frederiksberg,
Denmark from 3 October to 17 December 2015. The study was
approved by the Municipal Ethical Committee of Copenhagen
(Report H-15011908) and conducted according to the Helsinki
Declaration.
Intervention
The test foods were provided to the study subjects,
consisting of 0.5 L conventional skimmed milk (0.1%, Arla
Foods, Denmark) and whole milk (3.5%, Arla Foods, Denmark)
from cows and from the same season. The energy content and
macronutrient composition of the milks are shown in Table 1.
Subjects were instructed not to consume yogurt, ice-cream, or
milk besides the test milk. For other dairy products such as
cheese and butter and for cooking oils subjects were
instructed to keep the same dietary pattern throughout the
intervention. Apart from the test foods and restrictions in
dairy intake the remaining diet was self-selected and
study subjects were asked to maintain their usual diets
and their regular level of physical activity throughout
the intervention periods. Subjects were instructed in how
to substitute the test foods for food items from their
habitual diets (usually the milk they normally drank).
Weekly subjects visited the department to collect the milk
and for weighing and follow-up making sure they adhered to
the test diet and kept a stable body weight during
intervention periods. Compliance was measured as a
percentage of milk consumed according to a diary kept
throughout the intervention compared with the milk handed
out. Subjects completed 3-d dietary records the last week
of each period and were instructed to include 1 weekend
day and 2 weekdays to take account of differences in
nutrient intake. Dietary intake was assessed using Dankost
Pro dietary assessment software (Dankost).
Clinical investigations
Fasting blood samples were taken at baseline, after 3 weeks
and after 6 weeks. Prior to the blood sampling subjects
fasted (12 h) and were asked to refrain from smoking (12 h),
extreme sports (36 h), alcohol or medicine (24 h). Blood
samples were drawn for assessment of following: serum lipids
(total, LDL, and HDL cholesterol and triacylglycerol),
insulin, and plasma glucose. Samples for assessment of blood
lipids and insulin were collected into dry tubes, and samples
for glucose were collected into tubes with a 1 3 mL-fluoride
citrate mixture. To coagulate blood samples were stored at
room temperature for 30 min. Further, blood samples for
assessment of blood lipid and insulin concentrations were
centrifuged at 2754 g for 10 min at 4 deg.C and stored at
-80 deg.C until the concentration was analyzed. For glucose,
samples were centrifuged at 2754 g for 10 min at 20 deg.C
and stored at -80 deg.C until the concentration was
analyzed. LDL and HDL cholesterol concentrations were
assessed by enzymatic colorimetric procedure (ABX Pentra LDL
Direct CP and ABX Pentra HDL Direct CP, respectively; Horiba
ABX). Concentration of total cholesterol was assessed by
enzymatic photometric test (CHOD-PAP from ABX Pentra
Cholesterol CP). Triacylglycerol and glucose concentrations
were assessed by enzymatic colorimetric procedure (ABX Pentra
Triglycerides CP and ABX Pentra Glucose HK CP; Horiba ABX,
respectively). Blood lipid concentration was analyzed on an
ABX Pentra 400 Chemistry Analyzer (Horiba ABX). Interassay
CVs for total, LDL and HDL cholesterol, triacylglycerol, and
glucose were 2.2, 2.7, 2.0, 2.6, and 2.5%, respectively.
Intra-assay CVs for total, LDL and HDL cholesterol,
triacylglycerol, and glucose were 0.9, 0.7, 1.2, 3.8, and
1.1%, respectively. Insulin concentrations were assessed by
the solid-phase enzyme-labeled chemiluminescent immunometric
assay with an Immunlite 2000 XPi (Siemens Medical Solutions
Diagnostics). Interassay and intra-assay CVs for insulin were
3.5 and 4.2%, respectively.
Insulin resistance was evaluated by using homeostasis model
assessment--insulin resistance (HOMA-IR) with the following
formula: HOMA-IR = Fasting serum insulin (U/mL)
fasting plasma glucose (mmol/L)/22.5.
Fasting body weight was measured at baseline, 3 and 6 weeks
to the nearest 0.1 kg wearing light clothing and having
emptied their bladder in advance. Height, body weight for BMI
calculation, and waist circumference were also measured at
screening. Height was measured without shoes to the nearest
0.5 cm with a wall-mounted
[[Page H6899]]
stadiometer (Seca) and waist circumference was measured
horizontally at the midpoint between the bottom rib and the
top of the hip bone.
Statistical analysis
Statistical differences for outcome measures were analyzed
with linear mixed models that incorporated systematic effects
of period and treatment and their interaction. Approximate F-
tests were used to evaluate the interaction between time and
treatment and if non-significant to evaluate a time-
independent treatment effect. Baseline values and relevant
covariates: sex, age, waist circumference, and baseline-BMI
were included. Subject-specific random effects were included
to account for inter-subject variability and to adjust for
non-specific differences that could not be explained by the
explanatory variables included. For dietary records
statistical differences were based on paired t-test or
Wilcoxon Signed Rank test for non-parametric variables.
Treatment differences were reported in terms of unadjusted
mean levels with corresponding standard errors. All models
were validated by graphical assessment of normal quantile
plots and residual vs. fitted plots. When departure was
detected logarithmic transformation of the variables were
made. Variance homogeneity was visually inspected and showed
similar variance. Concentration of glucose and insulin were
correlated to blood lipid responses using Pearson correlation
test or Spearman correlation test for non-parametric
variables. A two-tailed P-value < 0.05 was considered
significant. The statistical software R version 3.1.3 2015
was used for all statistical evaluations.
Results
Subjects
Of the 18 recruited subjects, 1 dropped out in the first
period because of inability to follow study protocol.
Baseline characteristics of the 17 subjects who completed the
study are outlined in Table 2. No difference was observed in
body weight during the intervention between whole milk and
skimmed milk periods (P = 0.59). The compliance for intake of
milk during the first and second period was 99.7 and 98.5%,
respectively.
Blood lipids
Results from fasting blood lipid measurements at the end of
each period are listed in Table 3. HDL cholesterol was
significantly higher with whole milk than with skimmed milk
(P < 0.05). There were no significant differences between the
periods for any of the other blood lipids. For total
cholesterol there was a tendency for a higher concentration
with whole milk than with skimmed milk (P = 0.06).
Insulin and glucose
Results of glucose and insulin concentrations measured at
the end of each period as well as calculated HOMA values are
listed in Table 3. There were no significant differences
between the periods for any of these outcomes. However,
correlation analysis with skimmed milk showed that insulin
and LDL cholesterol were moderately positively correlated (r
= 0.54, P < 0.05) and with whole milk that glucose and HDL
cholesterol were moderately negatively correlated (r = 0.52,
P < 0.05).
Dietary intake
Total energy intake was significantly higher with whole
milk than with skimmed milk (P < 0.05). Fat intake (in grams
and percentage of energy) was significantly higher with whole
milk than with skimmed milk (P < 0.001). Also, the intake of
saturated, monounsaturated, and polyunsaturated fat
was significantly higher with whole milk than with skimmed
milk (P<0.001, P<0.05, and P<0.05, respectively). Intake
of carbohydrate was significantly higher with skimmed milk
than with whole milk (P<0.01). There were no differences
between the periods for intake of protein, calcium,
alcohol, and dietary fiber.
Discussion
In the present study we showed that a daily intake of 0.5 L
whole milk for 3 weeks did not increase LDL cholesterol
compared to an equal intake of skimmed milk in healthy
subjects. Moreover, although small, a significant increase in
HDL cholesterol concentration was shown with whole milk
compared to skimmed milk, which was significantly,
moderately, and negatively correlated with glucose
concentration. None of the other outcome measurements showed
a difference between the periods. The increase in HDL
cholesterol following intake of whole milk was expected due
to the higher content of SPAs known to increase HDL and LDL
cholesterol concentrations. The Nordic Nutrition
Recommendations as well as the American Dietary Guidelines
advice that SFA should be limited to less than 10E%, due to
the predicted effect on LDL cholesterol. In comparison, the
amount of SFAs in the whole milk diet was almost 5 E% above
and in the skimmed milk diet close to recommendation (14.4
and 11.3 E%, respectively), according to the dietary records.
Thus, the result of no difference in LDL cholesterol was
unexpected and opposite to the dietary guidelines and our
hypothesis, despite of the dominating macronutrient content
of SFA with whole milk. Studies of the association between
HDL cholesterol concentration and CVD has shown that HDL is
protective. However, it is necessary to be cautious when
interpreting low concentration of HDL cholesterol as a CVD
risk factor. Mendelian randomization studies have shown that
genetically decreased HDL cholesterol was not associated with
increased risk of myocardial infarction, questioning the
causality of an association between low HDL concentration and
CVD. Still, HDL cholesterol concentration, as a marker of
cardiovascular health, should be taken into consideration
when interpreting the effect of dairy or SFAs in the diet.
Our results are in line with two previous intervention
studies from 2009 and 1994 comparing milk of different fat
content that also showed no effect on total and LDL
cholesterol concentration after 12 months and 6 weeks with
similar milk intake (500 and 660 ml/d, respectively);
however, contrary to our results also no effect on HDL
cholesterol. Fonolla et al. compared semi-skimmed milk and
skimmed milk and therefore a smaller difference in milk fat
(1.9 vs. 0.3%), which could explain the lack of difference in
HDL cholesterol compared to the present study. Steinmetz et
al., the more comparable study and of good quality, also
compared skimmed milk with whole milk in a crossover design,
but in a background diet designed to meet the AHA
recommendations. Steinmetz et al. reported a significantly
higher concentration of total and LDL cholesterol with whole
milk compared to skimmed milk. However, the statistical
analysis was not adjusted for baseline measurements, and thus
not adjusted for differences between periods, and in addition
the sample size was small (n = 8). Still, the analysis of
difference in change from baseline between the two diets was
also reported which showed no difference between total and
LDL cholesterol, in line with our results. Nevertheless, the
study reported higher Apolipoprotein B concentrations with
whole milk compared to skimmed milk known to be a predictor
of cardio metabolic risk.
Although the dietary records showed a significantly higher
energy intake with whole milk compared to skimmed milk, it
seems that the study subjects compensated for the extra
energy with whole milk by lowering their intake of
carbohydrate which was significantly lower compared to
skimmed milk. The content of calcium and protein were similar
in the two milk types, but whole milk has a higher content of
milk fat globule membranes (MFGM), which encloses the fat. A
possible matrix effect of MFGMs was suggested in a recent
study showing an impaired lipoprotein profile after a butter
oil diet, low in MFGMs, compared with a whipping cream diet,
high in MFGMs. One proposed mechanism, based on a mice study,
is through lowering of cholesterol absorption by inhibition
of cholesterol micellar solubility possibly due to presence
of sphingomyelin in MFGM fragments. Thus, one could speculate
that an expected higher LDL cholesterol concentration after
whole milk may be modified by a dairy matrix effect of MFGM.
The strength of the present RCT was the imitation of real-
life settings by not matching the diets for energy content or
macronutrient composition, which made it possible to directly
compare whole milk and skimmed milk as whole foods. The free-
living design of the study was a limitation, thus allowing
the presence of potential confounding by other lifestyle and
dietary factors. However, the crossover design minimizes this
potential confounding as study subjects were their own
control,
In conclusion, the results indicate that intake of 0.5 L/d
of whole milk does not adversely affect fasting blood lipids,
glucose, or insulin compared to skimmed milk in healthy
adults. Moreover, intake of whole milk increased HDL
cholesterol concentration compared to skimmed milk. These
findings suggest that if the higher energy content is taken
into account, whole milk can be considered as part of a
healthy diet among the normocholesterolemic population.
Ms. FOXX. Mr. Chairman, I yield 1\1/2\ minutes to the gentleman from
Tennessee (Mr. Rose).
Mr. ROSE. Mr. Chair, today I rise in support of the Whole Milk for
Healthy Kids Act which will allow schools to offer both unflavored and
flavored whole milk for students.
Whole milk provides children with 13 essential nutrients for growth,
development, immunity, and brain function. Whole milk also serves as
the top source of protein, calcium, potassium, and vitamin D for
children.
I am a proud cosponsor of this vital legislation, and I thank my good
friend, Chairman Thompson, for introducing this commonsense bill.
For too long, poor Federal policy has kept whole milk out of our
school cafeterias. This commonsense legislation puts the health and
well-being of our children first. As the father of two young sons
myself, I am proud to support this bill, and I urge my colleagues to
join me in doing so.
Also as a father, I would note that I see every day the illustration
of how my children react to whole milk versus skim milk. I would just
give that firsthand impression.
I also would say the science supports it.
Mr. Chairman, I include in the Record these scientific studies, as
well.
[[Page H6900]]
Comparison of the DASH (Dietary Approaches to Stop Hypertension) Diet
and a Higher-Fat DASH Diet on Blood Pressure and Lipids and
Lipoproteins: A Randomized Controlled Trial
INTRODUCTION
The Dietary Approaches to Stop Hypertension (DASH) dietary
eating pattern, which emphasizes fruit and vegetables, low-
fat dairy foods, and whole grains, is one of the most widely
prescribed dietary modifications for reducing blood pressure
(BP) and cardiovascular disease risk. Notably, in the Nurses'
Health Study, self-reported greater adherence to a DASH-style
diet was associated with a lower risk of coronary artery
disease and stroke. Because LDL cholesterol is lower with the
consumption of the DASH diet than with a typical Western diet
due in part to its limitation of saturated fatty acids, it is
believed that its lower saturated fat content may contribute
to reduced risk of cardiovascular disease.
The degree of dietary adherence strongly determines the
efficacy of dietary interventions. A recent review of 9
trials of the DASH diet with objective measures of compliance
reported poorer adherence when dietary advice rather than
foods was provided. A common reason for low adherence or high
attrition is the difficulty of following prescribed diets. In
the original DASH trial, lack of menu variety was a primary
reason for lapses in dietary adherence. This suggests the
potential value of providing options for the DASH diet that
permit variation in macronutrient composition while
preserving benefits on BP and lipid risk factors.
One such variation is the substitution of fat for
carbohydrate. Appel et al. reported that the replacement of
10% of energy from carbohydrate with unsaturated fat
(primarily monounsaturated) in a DASH-like diet resulted in a
reduction in triglycerides and an increase in HDL
cholesterol, with no change in LDL cholesterol, and a further
reduction in the Framingham risk score. There is evidence
that long-term compliance to diets with reduced saturated fat
is poor, even with intensive counseling, and that moderate-
fat diets may yield better dietary adherence than low-fat
diets. Furthermore, the mean intake of individuals who
consumed the DASH diet in the ENCORE (Exercise and Nutrition
Interventions for Cardiovascular Health) study failed to meet
the low total fat and saturated fat targets.
The effects on lipids and BP of replacing carbohydrates
with saturated fats within a DASH-like diet have not been
reported, to our knowledge. In the present study we tested
the effects of substituting full-fat dairy products for
nonfat and low-fat dairy foods (thereby increasing saturated
fat from 8% to 14% of energy) in conjunction with a reduction
of 12% of energy in carbohydrate, primarily from sugars.
METHODS
Study design and diets
A 3-period randomized crossover study in free-living
participants was conducted between August 2011 and December
2013 at our clinical research center in Berkeley, California.
The participants consumed a 1-wk run-in diet, consisting of a
mixture of 2 or 3 d of each experimental diet, and then
consumed in random order a control diet, a standard DASH
diet, and a higher-fat, lower-carbohydrate modification of
the DASH diet (HF-DASH diet) for 3 wk each. Each experimental
diet was separated by a 2-wk washout period, during which
participants ate their own foods but continued to abstain
from alcohol. Participants were assigned their diet sequence
in randomly determined blocks of 3, 6, 9, or 12 individuals
by using a uniform random-number generator. Diet sequences
were kept in sealed envelopes and assigned to the participant
by the study nutritionist 1-2 d before starting the first
experimental diet. Participants were blinded to diet order,
but because of the nature of the diets they were likely able
to identify each diet. Clinic personnel were not blinded to
diet order. Laboratory personnel and investigators were
blinded to diet order, and unblinding was performed after
data collection before analysis. Participants met with study
staff weekly for counseling, to receive study foods, and to
be weighed. At the end of each experimental diet,
participants visited the clinic on 2 consecutive days for
clinical and laboratory measurements. In addition, a fasting
blood sample was taken after each washout period to document
a return to baseline for standard lipid and BP measurements.
Study population
Participants included generally healthy men and women >21 y
of age with an average diastolic BP between 80 and 95 mm Hg
and systolic BP <160 mm Hg for 2 screening visits. Exclusion
criteria included the following: use of nicotine products or
recreational drugs, history of coronary artery disease,
diabetes, or other chronic disease, use of hormones or
medications known to affect lipid metabolism or BP; use of
dietary supplements within the past 3 mo; unwillingness to
refrain from alcoholic beverages during the study; BMI (in
kg/m\2\) 35; total and LDL cholesterol >95th percentile for
sex and age; fasting triglycerides >500 mg/dL; fasting
glucose 126 mg/dL; and abnormal thyroid-stimulating hormone
concentration. Participants were recruited primarily through
our database of previous study participants, Internet
advertisements, and community health events. The protocol was
reviewed and approved by the Institutional Review Board of
Children's Hospital and Research Center Oakland. All
participants provided written informed consent.
Dietary provision
The Bionutrition Core of the University of California, San
Francisco, Clinical and Translational Science Institute
developed and prepared diets for a 3-d cycle menu at 5 levels
of energy intake (1800, 2100, 2600, 3100, and 3600 kcal).
Participants whose energy needs were between main-menu
calorie levels received unit foods (100 kcal) that matched
the macronutrient and mineral content of the experimental
diets. The control and DASH diets were designed to match the
characteristics of the diets used in the original DASH trial.
The higher-fat and lower-carbohydrate content of the HF-DASH
diet was achieved by replacing nonfat and low-fat dairy with
full-fat dairy products, mostly in the form of whole milk,
cheese, and yogurt, and by reducing sugars, mostly from fruit
juices, which constituted 59% of total fruit intake in the
DASH diet. The DASH and HF-DASH patterns were otherwise
developed by using similar recipes and foods, provided in
different amounts to meet each diet specification. As in the
original trial design, emphasis was placed on an abundance of
fruit and vegetables, increased whole grains and dairy
products; limited servings of meat, poultry, and fish, and
inclusion of nuts, seeds, and legumes several times weekly.
The nutrient composition of the diets was initially assessed
by using Nutrition Data System for Research Software (NDSR
2010; Nutrition Coordinating Center, University of Minnesota)
and validated by compositional analysis of g the 3-d cycle
menus (Covance Laboratories). The sodium, potassium,
magnesium, calcium, and fiber contents of the DASH and HF-
DASH patterns were similar; the diets differed only in the
amount of total fat, saturated fat, cholesterol, and
carbohydrate they provided.
Dietary control was achieved by providing participants with
2 standardized entrees and accompanying side dishes daily
(lunch, dinner, and some snacks), representing 50% of total
energy. Detailed menus, shopping lists, and food preparation
instructions were provided for the remaining food items
(mostly dairy, produce, and cereal products) to be purchased
and prepared at home. Participants were required to come to
the clinic weekly to pick up study foods, submit receipts
documenting study food purchases, and to meet with the
nutritionist to assess compliance with the dietary
protocol and adjust energy intake to maintain a stable
weight (within 3% of baseline, at 10 pounds
maximum). They were also required to maintain their usual
physical activity levels during the study and to monitor
daily steps by pedometer. Compliance was assessed by
measuring 24-h urinary potassium at the end of the second
week of each experimental diet. Twenty-four-hour urinary
sodium was measured as an indicator of sodium intake.
Experimental measurements
After each 3-wk dietary period, body weight and waist and
hip circumference were measured and the percentage of body
fat was assessed by bioimpedance (TBF 551 body-weight scale;
Tanita). BP was measured at the clinic by using a Dinamap
monitor (GE Pro 100 or Critikon Pro 300) after the second
week of each diet and on 2 consecutive days at the end of
each experimental diet, and the 3 values were averaged. At
each instance, BP was measured in a sitting position after 5
min rest 3 times, and the last 2 measurements were averaged.
Participants were also provided with a portable BP cuff
(Model BP791IT, Omron Healthcare, Inc) and were instructed to
self-measure BP twice in the morning and twice in the evening
for the last 7 d of each experimental dietary period. Data
were automatically recorded on the BP instrument and
downloaded for analyses. Urinary potassium and sodium were
measured in 24-h urine collections by an outside clinical
laboratory (Quest Diagnostics).
Fasting plasma samples collected on 2 consecutive days at
the end of each experimental dietary period were analyzed for
plasma lipids and lipoproteins, glucose, and insulin. Total
cholesterol, HDL cholesterol, triglycerides, and glucose were
measured by enzymatic end-point measurements with the use of
enzyme reagent kits (Ciba-Corning Diagnostics Corporation) on
an AMS Liasys 330 Clinical Chemistry Analyzer. LDL
cholesterol was calculated by using the Friedewald equation.
Total cholesterol, HDL cholesterol, and triglyceride
concentrations were monitored throughout by the CDC-National
Heart, Lung, and Blood Institute Lipid Standardization
Program. Apolipoprotein B (apoB) and apolipoprotein A-I (apo
A-I) were measured by immunoturbidimetric assays (Batton
Assay Systems; AMS Liasys 330 analyzer).
Lipoprotein particle concentrations and LDL peak diameter
were measured by gas-phase electrophoresis (ion mobility), as
previously described, with a modified procedure for initially
separating the lipoproteins from other plasma proteins.
Lipoprotein intervals were defined as previously described.
Statistical analysis
The primary objective was to compare the DASH and HF-DASH
diets for lipid and lipoprotein measurements. At 80% power,
an n of 36 would yield a minimum detectable difference
between diets of 0 14 mmol/L for LDL cholesterol (SD of
response = 0.30 mmol/L), 0.04 g/L for apoB (SD of response =
0.09 g/L), 0.03 mmol/L for HDL cholesterol (SD of response =
0.07 mmol/L), 4.1 mm Hg for systolic BP (SD of response = 8.6
mm Hg), and 2.2 mm Hg for diastolic BP (SD of response =
[[Page H6901]]
5.3 mm Hg). The detectable changes in BP were sufficient to
confirm the differences observed in the original DASH trial.
Treatment differences were determined by ANOVA for a 3-
treatment crossover design. Pairwise comparisons between
diets were adjusted by the Bonferroni method for 3 group
comparisons (HF-DASH diet compared with control diet, HF-DASH
diet compared with DASH diet, and DASH diet compared with
control diet), and P < 0.017 corresponding to an overall 2-
tailed P < 0.05 was considered significant. ANOVA and paired
t tests were used to compare triglycerides and total, LDL,
and HDL cholesterol after each of the 2 washout periods with
baseline to test for the effectiveness of the washout period
for normalizing plasma lipids. The analyses were restricted
to those subjects who completed all 3 diets.
RESULTS
Study participants
Thirty-six participants completed all 3 experimental diets
and are included in analyses. Fasting plasma triglycerides
and total, LDL, and HDL cholesterol measured after each of
the 2 washout periods showed no significant differences
between screening values and their values after the first or
second washout period (analyses not shown), indicative of
their return to baseline concentrations.
As expected, 24-h urinary potassium excretion was
significantly higher with the DASH and HF-DASH diets than
with the control diet (P < 0.0001 for both, adjusted for
period) and did not differ between the DASH and HF-DASH diets
(mean SE: HF-DASH diet, 81.5 3.5;
DASH diet, 83.5 3.5; and control diet, 50.5
3.5 mmol), consistent with good dietary
compliance. Urinary sodium excretion did not differ between
diets (mean SE: HF-DASH diets, 116.6
7.8; DASH diet, 119.3 7.8; and
control diet, 129.0 7.8 mmol; P = 0.49, adjusted
for period). Body weight remained stable throughout the study
and there were no differences by diet (mean SE:
HF-DASH diet, 79.7 0.1; DASH diet, 79.6
0,1; and control diet, 79.8 0.1 kg;
P-treatment = 0.62).
Effects of diets on BP
Table 3 presents the statistical evaluation of the
crossover design's treatment, period, and sequence effects
along with the adjusted treatment means and their SEs.
Significant treatment effects were observed for systolic and
diastolic BP, such that the DASH and HF-DASH diets produced
significant and comparable reductions relative to the control
diet, with no differences between the DASH and HF-DASH diets.
There were no significant sequence effects, but there were
significant carry-forward effects for both systolic and
diastolic BP and a significant period effect for systolic BP.
The carry-forward effect appeared to be due to lower systolic
and diastolic BP after the HF-DASH diet compared with the
DASH, control, or no previous diet. Mean BPs were, in fact,
lower at the end of the washout period after the HF-DASH diet
than after the other diets for systolic (mean
SE: -4.1 1.7 mm Hg; P = 0.02) and diastolic
(-0.9 1.1 mm Hg; P = 0.40) BPs. The carry-
forward effect did not appear to be the result of any
individual participant.
Both morning and evening systolic and diastolic BPs
measured by the participants at home were similarly reduced
with the DASH and HF-DASH diets compared with the control
diet, confirming the treatment effect of the DASH and HF-DASH
diets on BP. There were no significant sequence, period, or
carry-forward effects for home BP measurements.
Effects of diets on plasma lipids and lipoproteins
Significant treatment effects were observed for plasma
concentrations of triglycerides, total cholesterol, LDL
cholesterol, and HDL cholesterol, apo A-I, LDL peak diameter,
large and medium VLDL, intermediate-density lipoprotein
(IDL), and large LDL concentrations.
For the primary comparison of the DASH and HF-DASH diets,
the latter resulted in significantly lower plasma
triglycerides, large and medium VLDL concentrations, and
significantly higher LDL peak particle diameter. There were
no significant differences between the DASH and HF-DASH diets
for any other lipid or lipoprotein measurement after
Bonferroni correction.
Both the DASH and the HF-DASH diets significantly reduced
total cholesterol compared with the control diet. The DASH
diet also significantly decreased LDL cholesterol, HDL
cholesterol, apo A-I, IDL concentrations, large LDL
concentrations, and LDL peak diameter compared with the
control diet. Except for lower total cholesterol, none of the
lipid and lipoprotein measurements differed significantly
between the HF-DASH and control diets after Bonferroni
correction.
There were no significant sequence effects for any of the
lipid and lipoprotein variables examined. None of the
variables that showed a significant treatment effect
exhibited significant carry-forward or period effects.
DISCUSSION
The DASH diet, which was developed and validated as a means
for lowering BP, was formulated to include low-fat and nonfat
dairy foods. In this study, we tested whether the BP benefit,
as well as a favorable lipid and lipoprotein profile, could
be maintained by the HF-DASH diet that includes full-fat
dairy foods, with a corresponding increase in total and
saturated fat, and a reduction in carbohydrate achieved
primarily by reducing fruit juices and sugars, because sugar
intake is associated with detrimental effects on
cardiovascular disease risk factors. The HF-DASH diet lowered
both systolic and diastolic BP to an extent similar to the
DASH diet, indicating that the diet components responsible
for the BP reduction were retained in the HF-DASH diet.
Although the sodium content of the control diet was slightly
higher than that of the 2 experimental diets, this difference
was similar to that observed in the original DASH trial.
Furthermore, 24-h urine sodium measurements were similar on
all 3 diets, indicating that the BP reductions with the DASH
and HF-DASH diets were not attributable to lower sodium
intake.
When substituted for carbohydrates or unsaturated fats,
saturated fats have been consistently shown to increase LDL
cholesterol. We previously showed that with limitation of
carbohydrate intake, the increase in LDL cholesterol induced
by saturated fat is due primarily to large, cholesterol-rich
LDL particles and not small, dense LDL particles. Indeed, in
the present study, we found that the reduction in LDL
cholesterol with the DASH diet compared with the control diet
occurred in conjunction with lower concentrations of large
LDL particles as well as of IDL particles, which both
contribute cholesterol content to the standard LDL-
cholesterol measurement. However, despite a 6% of energy
higher saturated fat content to the HF-DASH diet compared
with the DASH diet, there were no significant differences in
LDL cholesterol or any of the LDL subclasses between these
diets. There may be features of the DASH diet that mitigate
the increase in LDL cholesterol that is typically observed
with higher saturated fat intake.
It is of interest that there was a significantly higher LDL
peak particle diameter with the HF-DASH diet compared with
the DASH diet. Although this difference was of relatively
small magnitude, it corresponded to a trend, albeit
nonsignificant, for relatively higher concentrations of
larger LDL particles and lower concentrations of smaller LDL
particles with the HF-DASH diet with no net difference in
total LDL particle concentrations. This change in the
distribution of LDL particles may be more easily detected by
the peak diameter than the individual subtractions. The shift
toward larger LDL particles with the HF-DASH diet may be
attributed at least in part to the lower carbohydrate content
of this diet compared with the DASH diet, because a shift
from smaller to larger LDL particles was previously shown to
correlate with reductions in plasma triglyceride and VLDL
concentrations resulting from reduced carbohydrate or sugar
intake. The reductions in triglycerides and VLDL particle
concentrations with the HF-DASH diet compared with the DASH
diet observed in the present study were relatively modest as
might be expected from the moderate difference in
carbohydrate content between the diets (43% compared with 55%
of energy). It is possible that these differences were not of
sufficient magnitude to elicit the significant reductions in
small, dense LDL particles as well as in apoB (an index of
LDL particle number) that have been observed previously with
more substantial reductions in carbohydrate intake.
The present study confirmed previous observations that the
DASH diet lowers HDL cholesterol, which is consistent with a
significant reduction in apo A-I compared with the control
diet. These changes were not observed with the HF-DASH diet,
although the differences between the effects of the HF-DASH
and DASH diets did not reach significance. The basis for the
reduction in HDL cholesterol with the DASH diet is not known,
although it is noteworthy that this effect was not associated
with a change in HDL particle concentrations, suggesting that
it may represent a change in HDL composition.
Other investigators have also tested modifications of the
DASH diet on BP or lipid risk factors. The OmniHeart trial
tested the replacement of 10% of energy from carbohydrate in
a DASH diet with 10% of energy from unsaturated, primarily
monounsaturated, fat or 10% of energy from protein. The
protein and monounsaturated fat diets yielded similar or
greater reductions in BP compared with the standard, high-
carbohydrate DASH diet. Replacing carbohydrate with
monounsaturated fat reduced total cholesterol and
triglycerides and increased HDL cholesterol with affecting
LDL cholesterol. Replacing carbohydrate with protein reduced
total, LDL, and HDL cholesterol and triglycerides. The Beef
in an Optimal Lean Diet Study found that the inclusion of
lean beef in a low-saturated-fat DASH-like diet resulted in
comparable effects on lipid and lipoprotein measures compared
with a standard DASH diet. Sayer et al. recently showed that
a DASH-style diet containing either lean pork or chicken and
fish similarly reduced BP. Together with results from the
present study, the above findings provide evidence that
aspects of the DASH diet can be modified without compromising
its benefits on BP or LDL-cholesterol lowering, offering
flexibility in food choices for individuals following the
DASH diet.
The crossover design of this trial was largely successful
in that lipids and lipoprotein returned to baseline
concentrations and there were no significant sequence effects
and no carry-forward effects for most of the variables. The
exceptions were the clinic measurements of systolic and
diastolic BPs, whose reductions showed significant carry-
forward on the HF-DASH diet, an unexpected and unexplained
effect because there was no such carry-forward effect for the
home BP measurements.
[[Page H6902]]
Strengths of our study include high dietary compliance as
measured by urinary biomarkers and lack of weight change as a
potential confounder. Limitations include a relatively small
sample size and a short intervention duration.
In conclusion, the results of this study indicate that
modification of the DASH diet to allow for more liberal total
and saturated fat intake in conjunction with moderate
limitation of carbohydrate intake, primarily from fruit
juices and sugars, results in lower concentrations of
triglycerides and VLDL particles, with no increases in total
or LDL cholesterol and no attenuation of the favorable BP
response to the standard DASH diet. Therefore the modified
HF-DASH diet studied here presents an effective alternative
to this widely recommended dietary pattern, with less-
stringent dietary fat constraints, which may promote even
broader implementation.
Mr. SCOTT of Virginia. Mr. Chairman, I reserve the balance of my
time.
Ms. FOXX. Mr. Chair, I yield 1\1/2\ minutes to the gentleman from
Pennsylvania (Mr. Joyce).
Mr. JOYCE of Pennsylvania. Mr. Chair, I thank Dr. Foxx for yielding.
Mr. Chair, I rise in support of the Whole Milk for Healthy Kids Act.
As a doctor, I know the benefits of whole milk, and I know that whole
milk can have benefits for Americans of all ages.
Whole milk is 96\1/2\ percent fat-free. According to a study that was
conducted that lasted for more than 15 years and was published in The
Lancet journal of medicine, individuals who consume more than two dairy
products each day have a lower risk of cardiovascular disease. There is
lower morbidity associated with those who have whole milk and whole
milk products in their diet.
The 13 essential nutrients that are found in milk are vital to the
development of bones, muscles, and even brain tissue in our Nation's
children.
By banning healthy milk products from our schools, misguided policies
that were crafted and implemented by the Obama administration, that has
led students to turn away from milk and dairy products and turn to
highly caffeinated and sugary drinks. Those drinks have very little
nutritional value.
Pennsylvania's 13th Congressional District is home to the most number
of dairy cows in our Commonwealth. Recently, I had the chance to visit
Galliker's Dairy Company in Johnstown, Pennsylvania.
For the past four generations, Galliker's has processed milk from 46
regional family dairy farms for retailers, grocery stores and schools
across the Northeast.
The Whole Milk for Healthy Kids Act will ensure that the whole and 2
percent milk processed at facilities like Galliker's will make its way
into school lunchrooms across the country.
Mr. Chair, I urge all of my colleagues to vote for nutrition by
supporting this legislation.
Mr. SCOTT of Virginia. Mr. Chair, I reserve the balance of my time.
Ms. FOXX. Mr. Chair, I yield 1\1/2\ minutes to the gentleman from
Wisconsin (Mr. Van Orden).
Mr. VAN ORDEN. Mr. Chair, I thank the gentleman from Louisiana for
painting a vivid and completely disingenuous picture of junior high
school students being held down and having milk forced down their
throats in a school cafeteria.
I will also take the opportunity--I can't believe I am doing this--
the milk fat content of whole milk is actually 3.25 percent making it
96.7 percent fat-free.
So when we look at the science, we read this definition: Milk means
the lacteal secretion practically free from colostrum obtained by the
complete milking of one or more healthy cows.
The reason soy milk is not in there is because it is not milk.
Neither is almond milk. Milk comes from a mammal.
Mr. Chair, I strongly support this bill, and I am looking forward to
having our children have healthy and nutritious choices in their
schools.
Mr. SCOTT of Virginia. Mr. Chair, I reserve the balance of my time.
Ms. FOXX. Mr. Chair, I yield 1\1/2\ minutes to the gentleman from New
York (Mr. Molinaro).
Mr. MOLINARO. Mr. Chair, I am proud to cosponsor the Whole Milk for
Healthy Kids Act, and I urge my colleagues to support its adoption.
After over 10 years of schools having to comply with a nonsensical
ban, I am excited to work on this bill to provide full-favor, nutrient-
dense milk to kids once again. Parents and physicians have known the
benefits of milk for generations. Nearly 70 percent of milk consumed at
home is whole or 2 percent because it actually tastes good. It is
packed with vitamins, and, most importantly, kids actually love it. I
know my four do.
Full-fat milk gives parents alternatives to soda that their kids
actually want to drink, but kids have been barred--strangely barred--
from having their favorite milk choices in schools.
The result has been a decline in milk consumption in schools, and
when kids are drinking less milk, they are losing out on nutrients that
are critical for their healthy development.
Milk is the top source of protein, calcium, phosphorus, and vitamin D
for kids. It provides seven of the 14 nutrients the American Academy of
Pediatrics recommends for brain development.
The bottom line is that limiting milk in schools reduces consumption
of essential nutrients, pushes kids towards sugary alternatives, and
has led to less healthy kids.
As the Representative for hundreds of family-owned dairy farms in New
York, and as a parent to four kids, I have one special interest: the
health standard of the kids growing up in our communities.
I am excited to take this long overdue action to repeal a ridiculous
ban. I am grateful to Chairman Thompson for his leadership to get the
full-fat milk back in schools.
Mr. Chair, I encourage my colleagues to vote for this bipartisan
bill.
Mr. SCOTT of Virginia. Mr. Chairman, I reserve the balance of my
time.
Ms. FOXX. Mr. Chair, I yield 2 minutes to the gentleman from
California (Mr. Costa), who is my classmate.
Mr. COSTA. Mr. Chair, I thank the gentlewoman and my classmate for
yielding.
Mr. Chair, let me speak in favor of this important bipartisan
legislation. The Whole Milk for Healthy Kids Act is an investment, I
believe, in our children's health and future.
This proposed legislation, let's be clear, does not change the
underlying law. For the 19 years that I have been on the House
Agriculture Committee, the school lunch and breakfast program has been
and should be a focus of attention by the House of Representatives and
the Congress.
Why?
It is because we provide the support for the school lunch and
breakfast programs.
And why else?
It is because we want our children to have the most nutrition
possible from lunch and breakfast.
In addition, we want to deal with issues of obesity and issues of
allergies. It is important for a healthy future.
Now, let me say that I know a little bit about this. My family and I
have been involved in the dairy business in California for three
generations, since the early 1920s. Dairy plays a critical role in the
nutritional diet of children as a leading food source for nutrients
that are critical for development and growth. We must provide healthy
nutrient-packed options that children will actually choose to consume,
ranging from nonfat to whole.
Milk provides 13 essential nutrients, as has been mentioned,
including three of the four nutrients of public health concern that
involve calcium, potassium, and vitamin D.
A few months ago I visited the Fresno Unified Nutrition Center.
Fresno Unified is the third largest school district in California with
73,000 students. They prepare 45,000 lunches a day and 15,000
breakfasts at 85 school centers. It is a big undertaking for this
nutritional program.
What we know is that for many of the kids, the breakfast or the lunch
they get is sometimes the best meal they get in a day, so, therefore,
we need to be focused on this. Our schools must be equipped with
nutritional school milk options. We must be available and flexible to
new scientific developments that are made.
The Acting CHAIR. The time of the gentleman has expired.
Ms. FOXX. Mr. Chair, I yield an additional 1 minute to the gentleman
from California.
Mr. COSTA. Mr. Chair, our schools must be equipped with nutritional
school milk options, and this is what this legislation attempts to try
to do.
When kids like their school milk options that are flavorful and
tasty, they
[[Page H6903]]
consume them in the levels that they should. When kids, I think, like
their choices for lunch or breakfast, America succeeds.
Let me close by saying that every body needs milk.
Mr. SCOTT of Virginia. I am prepared to close, and I reserve the
balance of my time.
Ms. FOXX. Mr. Chair, we are waiting for one more speaker to come, so
I will yield myself 1 minute.
Mr. Chairman, I want to reiterate some points that were made before.
We are not being driven by any special interest group lobby. We are
being driven by the special interest group of children. We want
children in school to have access to whole milk, which, as my
colleagues have pointed out, is 96.75 percent fat-free, but it provides
one of the most nutritious meals that children can have.
We are seeing tremendous waste in the schools. We are not excluding
soy drink. The policy that we are trying to overcome here by providing
whole milk to children was a policy passed under the Obama
administration. We are not trying to harm minorities in any way
whatsoever. We want everybody to have the choice to drink a soy drink,
whole milk, skim milk, 1 percent milk, whatever.
The Acting CHAIR. The time of the gentlewoman has expired.
Ms. FOXX. Mr. Chair, I yield an additional 15 seconds to myself.
Ms. FOXX. Mr. Chairman, this bill has been terribly mischaracterized
by our colleagues on the other side of the aisle. It is about healthy
choices for children.
Mr. Chair, I reserve the balance of my time.
Mr. SCOTT of Virginia. Mr. Chairman, may I inquire how much time is
remaining on both sides.
The Acting CHAIR. The gentleman from Virginia has 16\1/2\ minutes
remaining. The gentlewoman from North Carolina has 3\1/4\ minutes
remaining.
Mr. SCOTT of Virginia. Mr. Chair, I reserve the balance of my time.
{time} 1445
Ms. FOXX. Mr. Chair, I yield 1 minute to the gentleman from
Pennsylvania (Mr. Meuser).
Mr. MEUSER. Mr. Speaker, I thank Chairwoman Foxx very much for her
leadership on this very important issue.
Mr. Chair, kids love milk, but our schools have been prohibited from
providing children whole milk since 2010 and, frankly, it was based
upon false science.
Milk is a healthy choice for our children. It has 13 essential
nutrients that kids need--calcium, protein, iron, vitamin D, potassium,
and more. Compared to soda or iced tea, which kids will turn to without
a healthy alternative, a carton of milk has only one-third of the sugar
as a can of Coca-Cola.
We, as adults and Representatives, need to give our children and
grandchildren the options to make healthy choices. We need this
legislation to put whole milk back in our schools.
Mr. Chair, would you be surprised to know that whole milk is 96.75
percent fat free? To say whole milk is unhealthy for kids is, if you
will, ``udderly'' ridiculous.
Let's do the right thing by our children, families, and dairy farmers
by passing the Whole Milk for Healthy Kids Act. It is time to ask
American schoolchildren if they, once again, ``Got Milk?''
Mr. SCOTT of Virginia. Mr. Chair, I yield myself the balance of my
time.
Mr. Chair, I am disappointed that my Republican colleagues are
attempting to make school meals less healthy by ignoring the latest
science and undermining President Biden's work to strengthen school
meal nutrition.
The latest DGAs have already made clear that fat-free milk and low-
fat milk are the healthiest options for children. If anybody has
studies or research to the contrary, they should submit it to the
experts in the normal process rather than politicians.
This bill goes against the dairy industry's recent commitment to
ensuring students have access to the healthiest dairy options
consistent with the DGAs.
Mr. Chairman, we should be committed to ensuring that students have
access to the healthiest dairy options in accordance with science-based
guidelines, but H.R. 1147 contradicts this commitment by interfering
with the independent process that aligns child nutrition standards with
the latest science.
I am also disappointed that we are considering a bill that does
nothing to meaningfully address child nutrition or hunger. This is in
stark contrast to the comprehensive science-based reauthorization of
the Federal child nutrition programs that committee Democrats advanced
last Congress to, among other things, strengthen evidence-based
nutrition standards for school meals beyond just milk.
The bottom line is that Congress should not inject politics into
child nutrition standards at the expense of nutritious meals that our
children need to grow healthy.
Mr. Chair, I, therefore, urge my colleagues to oppose H.R. 1147, and
I yield back the balance of my time.
Ms. FOXX. Mr. Chair, I yield myself the balance of my time.
Mr. Chair, I have seen a lot of bills mischaracterized on this floor
in my time here, but I think this is one of the worst.
Passing the Whole Milk for Healthy Kids Act would be a critical step
toward empowering parents and securing our children's well-being. Whole
milk isn't just a beverage; it is a vital source of nutrients essential
for children's growth. Denying access to its calcium, vitamin D, and
protein threatens to inhibit their development.
To the anti-milk advocates, I have one thing to ask of you: What do
you have against milk?
If you scrutinize them closely, you might be convinced that Democrats
are waging a war on dairy. The Democrat administration has presided
over a 15 percent milk price increase in the grocery store.
A Democrat proposal, the Green New Deal, calls for the elimination of
cows for their so-called greenhouse gas emissions.
A Democrat policy is slashing the milk available to newborns through
the Special Supplemental Nutrition Program for women, infants, and
children by four quarts.
A Democrat interest group, PETA, has called milk a so-called white
supremacist symbol. How patently absurd.
Let's end the war on milk and pass the bill.
Together, we can ensure that our children have access to the
nutritional foundation they need to thrive and become the healthy,
vibrant leaders of tomorrow.
Mr. Chair, I urge all my colleagues to vote ``yes'' on this bill, and
I yield back the balance of my time.
The Acting CHAIR (Mr. Moolenaar). All time for general debate has
expired.
Pursuant to the rule, the bill shall be considered for amendment
under the 5-minute rule.
The amendment in the nature of a substitute recommended by the
Committee on Education and the Workforce, printed in the bill, shall be
considered as adopted. The bill, as amended, shall be considered as an
original bill for purpose of further amendment under the 5-minute rule
and shall be considered as read.
H.R. 1147
Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Whole Milk for Healthy Kids
Act of 2023''.
SEC. 2. WHOLE MILK PERMISSIBLE.
Section 9(a)(2) of the Richard B. Russell National School
Lunch Act (42 U.S.C. 1758(a)(2)) is amended--
(1) by amending subparagraph (A) to read as follows:
``(A) In general.--Lunches served by schools participating
in the school lunch program under this Act--
``(i) shall offer students a variety of fluid milk;
``(ii) may offer students flavored and unflavored whole,
reduced-fat, low-fat and fat-free fluid milk and lactose-free
fluid milk; and
``(iii) shall provide a substitute for fluid milk for
students whose disability restricts their diet, on receipt of
a written statement from a licensed physician that identifies
the disability that restricts the student's diet and that
specifies the substitute for fluid milk.''; and
(2) by adding at the end the following:
``(D) Saturated fat.--Milk fat included in any fluid milk
provided under subparagraph (A) shall not be considered
saturated fat for purposes of measuring compliance with the
allowable average saturated fat content of a meal under
section 210.10 of title 7, Code of Federal Regulations (or
successor regulations).''.
The Acting CHAIR. No further amendment to the bill, as amended, shall
be in order except those printed
[[Page H6904]]
in House Report 118-308. Each such further amendment may be offered
only in the order printed in the report, by a Member designated in the
report, shall be considered as read, shall be debatable for the time
specified in the report equally divided and controlled by the proponent
and an opponent, shall not be subject to amendment, and shall not be
subject to a demand for division of the question.
Amendment No. 1 Offered by Mrs. Luna
The Acting CHAIR. It is now in order to consider amendment No. 1
printed in House Report 118-308.
Mrs. LUNA. Mr. Chair, I have an amendment at the desk.
The Acting CHAIR. The Clerk will designate the amendment.
The text of the amendment is as follows:
Page 3, line 6, insert ``organic or non-organic'' before
``whole milk''.
Page 3, line 17, insert ``organic or non-organic'' after
``unflavored''.
The Acting CHAIR. Pursuant to House Resolution 922, the gentlewoman
from Florida (Mrs. Luna) and a Member opposed each will control 5
minutes.
The Chair recognizes the gentlewoman from Florida.
Mrs. LUNA. Mr. Chair, I yield myself such time as I may consume.
Mr. Chair, I am happy to be here today to draw attention to something
that is important to our children's health, parental choice, and the
many farmers across our Nation.
For years, America's school lunches have lagged behind other
countries' programs in terms of health and nutrition. European and
Asian students often have access to fresher and healthier meals than
students in the United States.
This problem has been worsened by the Federal Government's
overregulating what schools are allowed to serve our children, in
particular, preventing schools from offering whole milk to students.
The Whole Milk for Healthy Kids Act would allow students who
participate in the National School Lunch program to serve their
students whole milk, but my amendment goes a step further by ensuring
schools may also offer their students to use organic milk as well.
The food we give our children and where it comes from is incredibly
important. My amendment empowers parents and the ability that they have
to decide what is healthiest for their children.
As many parents know, high-quality nutrition is closely related to
better academic and behavioral outcomes in children. Allowing parents
to choose organic milk is a step in the right direction.
Studies have also found that organic milk contains more omega-3 fatty
acids and antioxidants than nonorganic milk, which helps with brain
function, heart health, and fighting disease, respectively.
Of course, it is vital that we also know where this milk comes from,
organic or not. Far too often, Congress listens to special interest and
big ag lobbyists and ignores the countless family farmers who are the
backbone of our country.
Our organic family farmers and the countless unseen families who feed
our Nation are invaluable to our country. These farmers work many long,
thankless hours to bring us nutrient-rich, high-quality milk.
Mr. Chair, on behalf of my family and I, I thank them. I am thankful
to be able to be here today to continue to empower and fight for our
children, and I thank those that are helping to bring organic milk to
our country.
Mr. Chair, I reserve the balance of my time.
Mr. SCOTT of Virginia. Mr. Chair, I claim the time in opposition to
the amendment.
The Acting CHAIR. The gentleman is recognized for 5 minutes.
Mr. SCOTT of Virginia. Mr. Chair, I yield myself such time as I may
consume.
Mr. Chair, nothing in this bill prevents schools from offering
organic milk under current law. As the main barrier for schools
offering organic milk is cost, nothing in this amendment provides
additional funding or support to help schools offer organic milk, if
they prefer.
Fundamentally, this amendment does not fix the flaws of the
underlying bill. It invites Congress to legislate on specific foods
served in school meals at the expense of evidence-based recommendations
from experts.
According to those experts, milk is the top source of saturated fat
in American diets. Whole and 2 percent milk can raise bad cholesterol,
the cause of heart disease, and contains more fat, saturated fat,
cholesterol, and calories than 1 percent and fat-free milk.
This has led to organizations such as the CDC to recommend nutrient-
rich 1 percent or fat-free milk instead of 2 percent or whole milk.
For children aged 2 and up, the inclusion of whole milk in the bill
disregards the healthy dietary patterns backed by the dietary
guidelines for Americans, the scientific, evidence-based comprehensive
set of nutrition recommendations.
Over 60 organizations have expressed concerns over attempts to bring
whole milk back into school meal programs. Regardless of whether milk
is organic, inclusion of whole milk in this bill is detrimental to
American youths' health and well-being, and the amendment fails to
alter that fact.
Mr. Chair, I oppose the underlying bill and oppose the amendment, and
I reserve the balance of my time.
Mrs. LUNA. Mr. Chair, may I inquire as to the time remaining.
The Acting CHAIR. The gentlewoman from Florida has 3 minutes
remaining.
Mrs. LUNA. Mr. Chair, I yield myself the balance of my time.
Mr. Chair, I hear a lot from my colleagues across the aisle on the
experts, but I also wonder how many people in Congress have had to use
National School Lunch programs; and, frankly, I have been one of those
people.
When I hear people speak in opposition to this saying that it is
going to hurt minorities, it is going to hurt those of us who have
actually had to use the program, I find it ironic. Frankly, I think
that we need more people in office that have had rougher upbringings to
bring a different lens and perspective.
To hear that whole milk is bad for children, to hear the arguments
against organic milk, and to hear the arguments that are coming from
across the aisle, I don't know that it represents, necessarily, the
best interests of the American people other than political spite.
Mr. Chair, I yield back the balance of my time.
Mr. SCOTT of Virginia. Mr. Chair, I yield back the balance of my
time.
The Acting CHAIR. The question is on the amendment offered by the
gentlewoman from Florida (Mrs. Luna).
The amendment was agreed to.
Amendment No. 2 Offered by Mr. Mills
The Acting CHAIR. It is now in order to consider amendment No. 2
printed in House Report 118-308.
Mr. MILLS. Mr. Chair, I have an amendment at the desk.
The Acting CHAIR. The Clerk will designate the amendment.
The text of the amendment is as follows:
Page 4, line 10, strike the period and quotation mark at
the end and insert the following:
``(E) Prohibition on certain purchases.--The Secretary
shall prohibit schools participating in the school lunch
program under this Act from purchasing or offering milk
produced by China state-owned enterprises.''.
The Acting CHAIR. Pursuant to House Resolution 922, the gentleman
from Florida (Mr. Mills) and a Member opposed each will control 5
minutes.
The Chair recognizes the gentleman from Florida.
Mr. MILLS. Mr. Chair, this amendment prohibits schools from
participating in the school lunch program under the act from purchasing
or offering milk produced by Chinese state-owned enterprises that may
be operating here within the United States or elsewhere.
As many of us know, in 2008, the melamine scandal exposed systemic
corruption and disregard for the safety standards within China's own
dairy industry. This scandal resulted in the death of six infants and
sickened thousands more, highlighting the devastating consequences of
lax regulations and unethical practices.
The evidence is clear: These enterprises pose a serious threat to our
consumers' health, our economic security, and our national interests.
We can't allow CCP enterprises to export their dangerous practices to
our school lunches.
[[Page H6905]]
This is an issue of maintaining American control of critical supply
chains. Chinese state-owned enterprises have no business being in our
schools.
Florida is one of the largest cattle producers in America, and there
is no way I will allow producers in my State to be compromised by the
CCP or the PRC. If we fail to act, we risk losing our family farms and
jeopardizing the livelihoods of thousands of Americans.
This is not about trade isolationism; it is about protecting our
children in schools from unsafe products, ensuring fair competition for
American producers, and safeguarding our national security.
The potential consequences of inaction are simply too great for me to
ignore. The quality and safety of food that we provide to our children
is paramount, and we cannot compromise on these standards. We must be
vigilant about our source and production practices of the products that
are present in our educational institutions and safeguard them from
adversaries that do not share our same interests.
{time} 1500
By prohibiting schools from purchasing or offering milk produced by
China's state-owned enterprises operating in the United States and
elsewhere, we aim to send a clear message about our commitment to
health and the safety of our children.
Last year, over 30 million schoolchildren relied on school lunches
for their nutrition. We have seen how the CCP has approached other
industries, and we cannot allow such an important sector to become
vulnerable in a time of crisis.
Therefore, I urge you to join me in preventing the CCP-supported
entities from infiltrating school lunches and a key American supply
chain. This is a necessary step to protect the health and well-being of
our citizens, safeguard our economy, and defend our national interests.
Let us send a clear message that we will prioritize the safety and
security of our Nation's schoolchildren above all else.
Mr. Chairman, I reserve the balance of my time.
Mr. SCOTT of Virginia. Mr. Chairman, I claim the time in opposition.
The Acting CHAIR. The gentleman is recognized for 5 minutes.
Mr. SCOTT of Virginia. Mr. Chairman, I yield myself such time as I
may consume.
Mr. Chairman, nobody disputes that the dairy industry is a crucial
part of domestic supply chains and provides an important economic
benefit to the tune of over $753 billion to the U.S. economy.
In 2022, just five States--California, Wisconsin, Idaho, Texas, and
New York--collectively produced more than 50 percent of the U.S. annual
milk supply.
School breakfast and school lunch programs are already required to
purchase domestic agricultural commodities and food products. Although
exemptions exist, milk is produced in sufficient quantities in the U.S.
and at competitive prices to severely restrict the ability of any
school to purchase foreign-produced milk.
To this end, the amendment does not fix the flaws in the underlying
bill and makes no meaningful improvements to buy-American policies.
We can make sure that Chinese milk is not breaching our supply chain
with continued monitoring and enforcement of present law. A recent
report found that Chinese seafood has been served in schools,
highlighting the need for additional diligence in enforcing present
law.
I do not support the underlying legislation, and I oppose the
amendment as being unnecessary.
Mr. Chairman, I reserve the balance of my time.
Mr. MILLS. Mr. Chairman, it is interesting, and I understand that
facts, for whatever reason, seem to sink in a lot slower on the left
than they do in America's party, so I will say this once more.
In 2008, the melamine scandal exposed systemic corruption and
disregard for our complete safety in milk and other dairy products
produced by China, so it is interesting that the gentleman says they
are not actually weakening anything when they had infants and children
by the thousands who died or were sickened by their actual production
capacity capabilities or incapabilities.
Again, facts are a very finicky thing. They oftentimes slowly leak in
on the left, but you can't dispute that China's production of dairy has
been less safe and less put under the regulations of rigorous streams
than they do in American production with the FDA.
Mr. Chairman, I yield back the balance of my time.
Mr. SCOTT of Virginia. Mr. Chairman, I yield myself the balance of my
time to close.
I just reiterate that present law requires domestic purchase, and so
this is unnecessary. If Chinese milk has gotten into the supply, we
need to monitor that. It violates present law. To suggest that we are
ignoring science, the underlying bill ignores science. That is the
purpose of the underlying bill.
I hope that we reject this amendment and reject the underlying bill.
Mr. Chairman, I yield back the balance of my time.
The Acting CHAIR. The question is on the amendment offered by the
gentleman from Florida (Mr. Mills).
The amendment was agreed to.
Amendment No. 3 Offered by Mr. Tiffany
The Acting CHAIR. It is now in order to consider amendment No. 3
printed in House Report 118-308.
Mr. TIFFANY. Mr. Chair, I have an amendment at the desk.
The Acting CHAIR. The Clerk will designate the amendment.
The text of the amendment is as follows:
Page 4, line 10, strike the period and quotation mark at
the end and insert the following:
``(E) Limitation on authority.--The Secretary may not
prohibit any school participating in the school lunch program
under this Act from offering students the milk described in
subparagraph (A)(ii).''.
The Acting CHAIR. Pursuant to House Resolution 922, the gentleman
from Wisconsin (Mr. Tiffany) and a Member opposed each will control 5
minutes.
The Chair recognizes the gentleman from Wisconsin.
Mr. TIFFANY. Mr. Chair, first of all, merry Christmas.
My bipartisan amendment prevents the USDA from issuing any rule that
bans any of the milk covered in this bill, including chocolate milk.
This would ensure that all types and flavors of milk are available to
schoolchildren and not subject to bureaucratic rulemaking.
Some may ask why are we focusing on this issue. Unfortunately, it is
because the USDA has set its sights on getting rid of chocolate milk in
schools. It is now up to us to act.
This summer, it was reported that the Department of Agriculture is
considering a ban on chocolate milk in elementary and middle schools.
USDA issued a proposed rule that would set a new nutrition standard for
school meals. These new standards could limit the availability of
flavored milk, like chocolate and strawberry, in high schools while
children in elementary and middle schools would have no access at all.
For those of you with young children or grandchildren, go and ask
them what they think about USDA's new rule. I think I can speak for
most folks when saying that when I was young, chocolate milk was
usually the highlight of having lunch at school, but this new rule
would mean that roughly 30 million students who participate in the
USDA's school meal programs would no longer be able to have chocolate
milk, or any flavored milk for that matter.
According to the Journal of the American Dietetic Association,
removing flavored milk from schools resulted in a 62 to 63 percent
reduction in milk consumption by kids in kindergarten through fifth
grade, including a 50 percent reduction in sixth through eighth grades.
Milk is full of rich nutrients that support bone growth and
development, and millions of children enjoy drinking it. We should not
allow rules that would limit our children's access to delicious and
nutritious products like milk and its varieties covered in this great
bill.
Mr. Chair, I say to the USDA, come and take it.
I urge my colleagues to vote ``yes'' on this bipartisan amendment,
and I reserve the balance of my time.
Mr. SCOTT of Virginia. Mr. Chairman, I claim the time in opposition.
The Acting CHAIR. The gentleman is recognized for 5 minutes.
[[Page H6906]]
Mr. SCOTT of Virginia. Mr. Chairman, I yield myself such time as I
may consume.
Mr. Chairman, current law requires that school meals and beverages
offered under the school meal programs be consistent with the dietary
guidelines for Americans, the DGAs, which are drafted by an advisory
committee of experts. These are evidence-based recommendations set to
provide nutritional guidance to ensure children receive the most
nutritious meals possible.
This amendment would effectively undermine the unbiased evidence-
based guidelines of DGAs by prohibiting USDA from doing its work and
replacing that process with a process where evidence will be presented
to politicians and we get to decide the science. It is critical that
actual scientists and experts make the recommendations and guide the
process in determining options in schools and that regulations are
updated to align with current DGAs.
Experts, not Members of Congress, should be the ones determining the
nutrition standards to ensure that our children get the healthiest
meals possible.
This amendment, like the underlying bill, reinforces the precedent
for Congress to legislate on specific foods, at the behest of one
industry or another, that would be served in schools.
There is a reason that the school lunch program does not contain
specific nutrition standards for foods and beverages, and that is to
ensure that nutrition standards can adapt to the latest science and
expert recommendations. Both this amendment and the underlying bill
upset this policy and open the program to politicization in favor of
district interests and single-food lobbies over the health and well-
being of our children.
Dozens of organizations, including the Academy of Nutrition &
Dietetics, the American Academy of Pediatrics, American Heart
Association, and a lot of others have urged Congress not to interfere
with that process and to respect the science-based process.
For these reasons, I urge a ``no'' vote on the amendment, and I
reserve the balance of my time.
Mr. TIFFANY. Mr. Chairman, oh, those experts, those experts have done
us so well in the United States of America. Why are we $33 trillion in
debt? Why do we have childhood obesity that is off the charts at this
point?
Oh, those experts serve us so well, those experts that told us that
butter is not good for us. Remember that a number of decades ago?
Growing up on a dairy farm in western Wisconsin, I couldn't believe the
experts were telling us that butter is not good for us. Well, all of a
sudden, they are changing their tune on that.
They told us that we shouldn't possibly drink whole milk. They are
beginning to turn on that also and saying maybe that is good for our
children.
Yeah, the experts, they have done us so well.
The reason I bring this before the House of Representatives is I did
listen to experts, those people who run the school lunch programs.
I will never forget a day about a decade ago when I stopped at a
local gas station in northern Wisconsin, and a school lunch director
came up to me--I didn't even know her--she said, at that time, Senator
Tiffany, would you tell the Federal Government to get out of our school
lunch program? We are throwing away so much food.
Remember Michelle Obama's school lunch dictates that she put in
place? The school lunch director said, Don't do that to us. I had
multiple school lunch directors across northern Wisconsin, in my
district, asking the Federal Government to stay out of their school
lunch programs: We know what we are doing, we are trained in what we
are doing, and we see what happens in our schools.
Mr. Chair, I urge my colleagues to vote in favor of this amendment,
and I yield back the balance of my time.
Mr. SCOTT of Virginia. Mr. Chairman, I yield myself the balance of my
time to close.
I include in the Record a letter signed by dozens of organizations
opposing this changing the science and the process.
March 20, 2023.
Hon. Patty Murray,
Chair, Committee on Appropriations,
U.S. Senate, Washington, DC.
Hon. Martin Heinrich,
Chair, Committee on Appropriations, Subcommittee on
Agriculture, Rural Development, Food and Drug
Administration, and Related Agencies,
U.S. Senate, Washington, DC.
Hon. Susan Collins,
Ranking, Committee on Appropriations,
U.S. Senate, Washington, DC.
Hon. John Hoeven,
Ranking, Committee on Appropriations, Subcommittee on
Agriculture, Rural Development, Food and Drug
Administration, and Related Agencies,
U.S. Senate, Washington, DC.
Hon. Kay Granger,
Chair, Committee on Appropriations,
House of Representatives, Washington, DC.
Hon. Andy Harris,
Chair, Committee on Appropriations, Subcommittee on
Agriculture, Rural Development, Food and Drug
Administration, and Related Agencies,
House of Representatives, Washington, DC.
Hon. Rosa DeLauro,
Ranking, Committee on Appropriations,
House of Representatives, Washington, DC.
Hon. Sanford Bishop Jr.,
Ranking, Committee on Appropriations, Subcommittee on
Agriculture, Rural Development, Food and Drug
Administration, and Related Agencies,
House of Representatives, Washington, DC.
Dear Chairs Murray, Heinrich, Granger, and Harris, and
Ranking Members Collins, Hoeven, DeLauro, and Bishop: As you
craft the fiscal year (FY) 2024 Agriculture, Rural
Development, Food and Drug Administration, and Related
Agencies spending bill, the undersigned organizations urge
you to oppose any policy riders blocking implementation of
stronger nutrition standards in the National School Lunch and
School Breakfast Programs.
We strongly support the U.S. Department of Agriculture
(USDA)'s proposed rule to strengthen nutrition standards
consistent with the 2020 Dietary Guidelines for Americans
(``Child Nutrition Programs: Revisions to Meal Patterns
Consistent With the 2020 Dietary Guidelines for Americans'').
We must preserve and build on the progress schools and the
food industry have made over the past decade to meet science-
based nutrition standards. These improvements are an amazing
success story and one of the most important public health
achievements in a generation. For children in poverty, the
risk of obesity declined substantially each year after
implementation of stronger nutrition standards in 2012 such
that obesity prevalence would have been 47 percent higher in
2018 if the nutrition standards had not been updated.
Additionally, a 2021 study found that school meals are the
single most healthy source of nutrition for children--more
nutritious than grocery stores, restaurants, worksites, and
others. Research shows that children like the healthier
school meals and while food waste remains a problem in this
country, the amount of food wasted in schools has not changed
since the standards were updated in 2012, according to the
USDA's largest and nationally representative study of school
meals. For many children participating in the program, school
breakfast and lunch are the only meals they receive that day.
Despite the overwhelming success of the nutrition
standards, improvements are still needed to align school
meals with the Dietary Guidelines, which the current proposed
rule aims to do. The USDA issued a proposal that is
pragmatic, flexible, gradual, and most important--achievable.
The rule proposes, for the first time, to reduce added
sugars, with product-based limits for the top sources of
added sugars beginning School Year 2025-2026, and to phase
into a limit of added sugars averaged over the week beginning
School Year 2027-2028. These standards are critical: among
children, excessive intake of added sugars has been
associated with poor diet quality, cavities, and increased
risk of cardiovascular disease, yet more than 92 percent of
schools exceed the Dietary Guidelines limit for added sugars
for breakfast and 69 percent exceed it for lunch.
Further, sodium reduction is paramount to protect
children's health: nine out of ten children consume too much
sodium, putting them at risk of hypertension and
cardiovascular disease into adulthood. The USDA proposes new,
gradual 10-percent sodium reduction levels every two school
years for breakfast (through School Year 2027-2028) and lunch
(through School Year 2029-2030). The USDA also maintains at
least 80 percent of the weekly grains offered are whole
grain-rich.
The rule aims to align dietary patterns for sodium and
whole grains with the recommendations of the Dietary
Guidelines, but the USDA recognized that a gradual,
incremental approach to meeting those recommendations is more
feasible for schools and the food industry to implement. For
instance, children up to age 8 would still consume close to
their day's worth of sodium (83 percent) from just breakfast
and lunch combined. Sodium and whole grain-rich standards
have been the subject of many riders over the past decade,
causing confusion and stymying industry innovation and
improvements to children's health. The USDA has listened to
Congress; the proposals in this rule on sodium and whole
grains are within the spirit of those previous riders.
This gradual, incremental approach was crafted by the USDA
to be feasible for schools and the food industry. And these
standards are feasible. The largest food companies have many
K-12 products that meet
[[Page H6907]]
the USDA's proposed added sugars, sodium, and whole grain-
rich standards. Further, schools have been able to meet, and
in some cases, exceed the current nutrition standards during
the pandemic. In the first-of-its-kind study, a nationally
representative study of elementary schools found that meals
were meeting existing nutrition standards in 2022, and for
sodium, average sodium decreased and the vast majority of
schools were close to or already meeting future sodium-
reduction levels on par with this rule. There are plenty of
examples where schools have reduced sodium beyond the USDA's
requirements or provided more whole grains and still been
able to serve healthy, delicious, and culturally-relevant
foods to their students.
Opponents of the rule claim that the meal nutrition
standards cannot be strengthened due to labor shortages,
supply chain disruptions, and other issues facing school food
service programs. These are real challenges but require
different solutions than stalling progress for healthier
school meals. Over the past decade, the USDA and Congress
have learned that schools need the additional assistance to
meet stronger standards and they have also recognized current
pandemic-related constraints, and therefore have committed
millions of dollars to helping schools provide healthier
meals while weathering these challenges. In September 2022,
the USDA launched its $100 million Healthy Meals Incentive
Initiative with the stated goal of improving the nutritional
quality of school meals. Of that, $30 million is available
for small and rural schools and $50 million will go toward
working with food manufacturers on innovative solutions to
increase the availability of nutritious school foods.
Congress has also increased technical assistance funding each
year for the past three fiscal years (FY) ($1 million in FY
2021; $2 million in FY 2022 and 2023), with $1 million of
that funding being directed to assist with sodium
reduction efforts in FY 2022-2023. These investments will
be transformational, but the impact of inflation on school
nutrition programs means schools still struggle to make
ends meet. Therefore, increased meal reimbursement rates
will be critical to the future success of school meals
programs.
Beyond riders blocking implementation of the new proposed
standards, there are other ongoing attempts to undermine
evidence-based nutrition standards. For instance, the
proposed rule allows for potatoes to be served in breakfast
up to four out of the five school days, if a school chose to
serve vegetables in place of fruit in breakfast. Therefore
the existing breakfast potato rider--which allows schools to
serve potatoes before other vegetables at breakfast--does not
need to be included in the spending bill. Further, we are
similarly concerned about attempts to bring whole milk into
the school meals program. The Dietary Guidelines is explicit
in its recommendation that everyone 2 years and older should
limit their intake of saturated fat and choose fat-free or 1-
percent low-fat milk instead of 2-percent reduced-fat or
whole milk. The proposed rule reiterates this, while
providing flexibilities for flavored 1-percent milk. Yet
continued industry attempts to circumvent the science
persist.
Finally, there are evidence-based strategies to increase
school meal consumption that do not involve weakening
nutrition standards, for instance, enabling students to have
sufficient time to eat (at least 20 minutes of seat time)
with longer lunch periods, having recess before lunch,
serving lunch at an appropriate time of day, presenting food
in an appetizing and easily eaten way, making the cafeteria
inviting, and limiting competitive foods (snacks and
beverages sold in vending machines and a la carte) during the
school day. While some of these strategies cannot be
addressed at the federal level, we encourage you to support
these efforts.
In conclusion we urge you to oppose any riders that block
or weaken stronger nutrition standards for children.
Sincerely,
Academy of Nutrition & Dietetics; Advocates for Better
Children's Diets; Alianza Nacional de Campesinas, Inc.;
American Academy of Pediatrics; American Cancer Society
Cancer Action Network; American Heart Association; American
Institute for Cancer Research; American Public Health
Association; Ann and Robert H. Lurie Children's Hospital of
Chicago; Association of State Public Health Nutritionists;
Balanced; California Association of Food Banks; Center for
Digital Democracy; Center for Science in the Public Interest;
Chef Ann Foundation; Chilis on Wheels; Coalition for Healthy
School Food; Colorado Children's Campaign; Community Food
Advocates; Council on Black Health, Inc.; Cultiva la Salud;
DC Greens.
Dolores Huerta Foundation; Environmental Working Group;
FARE (Food Allergy Research and Education); Farm to Table-New
Mexico; Food Research & Action Center (FRAC); FoodCorps;
Friends of the Earth; From Now On Fund; Healthy Food America;
Healthy School Food Maryland; Healthy Schools Campaign; Hope
Community Services Youngstown; Illinois Public Health
Institute; Independent Restaurant Coalition; Interfaith
Center on Corporate Responsibility (ICCR); Johns Hopkins
Center for a Livable Future; Latino Farmers of the Southeast;
National Association of Pediatric Nurse Practitioners;
National Association of School Nurses; National Education
Association; National Farm to School Network; National League
for Nursing; National PTA; National WIC Association.
Nebraska Appleseed; North American Society for Pediatric
Gastroenterology, Hepatology and Nutrition; Northeast Ohio
Black Health Coalition; Northwest Coalition for Responsible
Investment; Office of Kat Taylor; Oklahoma Black Historical
Research Project, Inc.; Public Health Advocates; Public
Health Institute; Redstone Global Center for Prevention and
Wellness; Roots of Change; Rural Advancement Fund of the
National Sharecroppers Fund, Inc; Rural Coalition; Seventh
Generation Interfaith Coalition; Sisters of Charity of Saint
Elizabeth; Sisters of St. Francis of Philadelphia; Society
for Nutrition Education and Behavior; Society of Behavioral
Medicine; Springfield Food Policy Council; Stanford Medicine
Children's Health; The Laurie M. TIsch Center for Food,
Education and Policy, Teachers College, Columbia University;
The Praxis Project; Trust for America's Health; UnidosUS;
Union of Concerned Scientists; Urban School Food Alliance.
Mr. SCOTT of Virginia. Mr. Chair, this amendment would make it
impossible to update the science based on new evidence. We should be
basing our decisions on science, not what somebody tells us at the gas
station. I hope that we defeat the amendment and the underlying bill,
and I yield back the balance of my time.
The Acting CHAIR. The question is on the amendment offered by the
gentleman from Wisconsin (Mr. Tiffany).
The amendment was agreed to.
The Acting CHAIR. There being no further amendments, under the rule,
the Committee rises.
Accordingly, the Committee rose; and the Speaker pro tempore (Mr.
Kiley) having assumed the chair, Mr. Moolenaar, Acting Chair of the
Committee of the Whole House on the state of the Union, reported that
that Committee, having had under consideration the bill (H.R. 1147) to
amend the Richard B. Russell National School Lunch Act to allow schools
that participate in the school lunch program under such Act to serve
whole milk, and, pursuant to House Resolution 922, he reported the bill
back to the House with sundry further amendments adopted in the
Committee of the Whole.
The SPEAKER pro tempore. Under the rule, the previous question is
ordered.
Is a separate vote demanded on any amendment reported from the
Committee of the Whole? If not, the Chair will put them en gros.
The amendments were agreed to.
The SPEAKER pro tempore. The question is on the engrossment and third
reading of the bill.
The bill was ordered to be engrossed and read a third time, and was
read the third time.
The SPEAKER pro tempore. The question is on passage of the bill.
The question was taken; and the Speaker pro tempore announced that
the ayes appeared to have it.
Ms. FOXX. Mr. Speaker, on that I demand the yeas and nays.
The yeas and nays were ordered.
The SPEAKER pro tempore. Pursuant to clause 8 of rule XX, further
proceedings on this question will be postponed.
____________________