In the present study, using nationally representative samples, we aimed to report changes in intake of Milk & Alternatives in the Canadian population (≥ 2 years) from 2004 to 2015. Overall, both the proportion of Canadians consuming Milk & Alternatives and the number of servings consumed per day significantly decreased from 2004 to 2015. Prevalence of meeting recommendations for Milk & Alternatives food group among Milk & Alternatives consumers significantly decreased from 28.3% in 2004 to 24.4% in 2015. Milk & Alternatives were major contributors to calcium, vitamin D, and vitamin B12 intakes in the diet of Canadians in both time points. Milk & Alternatives consumers obtained about 68 and 56% more saturated fat than non-consumers in 2004 and 2015, respectively.
From 2004 to 2015, the proportion of Canadians consuming Milk & Alternatives significantly decreased from 89.5 to 87.7% and the number of servings consumed per day dropped from 1.9 to 1.7. According to the data provided by the USDA, the per capita dairy product availability in the United States increased about 9%, from 595 pounds in 2000 to 646 pounds in 2018 . This increase was mainly due to an increase in cheese consumption. However, the per capita consumption of fluid milk including whole milk reduced-fat milk, skim milk, flavoured milk, buttermilk, and other types of milk decreased about 26%, from 197 pounds in 2000 to 146 pounds in 2018 . Using two cross-sectional national surveys conducted in France (e’tude Individuelle Nationale sur les Consommations Alimentaires), Lioret et al. found that the overall intake of dairy products decreased by 10 and 12%, respectively, in French children aged 3–10 years and 11–14 years between 1999 and 2007. This downward trend in consumption of dairy products was mainly due to the marked decrease in consumption of milk . Further, our results revealed that Immigrants to Canada were more likely to be Milk & Alternatives non-consumers. The sociodemographics of immigrants is changing over time and culture is playing an important role in food preference. Further investigation is required to look into dietary laws and cultural preferences of the Immigrant population in Canada.
The decrease in consumption of Milk & Alternatives between 2004 and 2015 mainly resulted from significant decreases in the percent of plain milk consumers (from 70.2 to 56.1%) and the number of daily servings of plain milk (from 1.2 to 0.9 cups) and flavoured milk (from 1.49 to 1.29 cups). Recent evidence suggests that there is a general tendency toward decreasing the consumption of milk in developed countries [5,6,7]. Using data from National Health and Nutrition Examination Survey (NHANES), Bleich et al. reported that the percentage of US adults (≥20 years) consuming milk decreased from 44.2–54.9% in 2003–04 to 35.2–44.8% in 2013–14. During this time period, the per capita consumption of milk calorie among US adults also decreased from 73 to 102 kcal to 62–68 kcal . The percentage of US adolescents (12–19 years) consuming milk and the per capita consumption of milk calories among adolescents also decreased from 56.3 to 51.7% and 145 kcal to 105 kcal, respectively, between 2003 and 04 and 2013–14 . Further, according to a report by the USDA, Americans aged 13 and over tended to drink 0.8 cups of fluid milk per day in 1977–78, which decreased to 0.6 cups per day in 2007–08 .
Our results revealed that between 2004 and 2015, the proportion of Canadian children aged 2–5 years and 6–12 years who reported consuming plain milk decreased from 87.4 to 81.3% and from 81.4 to 71.2%, respectively. The proportion of Canadian children aged 6–12 years who reported consuming flavoured milk increased from 7.5% in 2004 to 11.1% in 2015. Consistent with our findings, Bleich et al. reported that from 2003 to 04 to 2013–14 the percentage of US children aged 2–5 years and 6–11 years consuming milk decreased from 84.6 to 78.4% and from 76.4 to 72.6%, respectively . Between 2003 and 04 and 2013–14, the per capita consumption of milk calories among US children aged 2–5 years and 6–11 years also decreased from 230 kcal to 157 kcal and from 202 kcal to 140 kcal, respectively . Further, fluid milk intake in preadolescent children decreased from 1.7 cups per day in 1977–1978 to 1.2 cups per day in 2007–2008 . Using data from three US nationally representative dietary recall surveys, Lasater et al. found that consumption of flavoured milk containing added sugar (high fat plus low fat) among US children increased significantly from 29 kcal/day to 68 kcal/day . Similarly, the percentage of US children < 1–5 years of age consuming flavoured milk was relatively low during 1976–1980 and 1988–1994, but increased to 14% during the NHANES 2001–2006 .
From 2004 to 2015, the proportion of Canadians consuming cheese remained relatively unchanged (55.1% vs 53.5%), but the number of daily servings of cheese rose significantly from 0.7 to 0.8. In addition, the proportion of Canadians consuming yogurt increased significantly from 14.2% in 2004 to 20.4% in 2015 but the number of daily servings did not change significantly. The global cheese consumption increased at a rate of ~ 1.5% per annum between 1990 and 2000 and 2.5% between 2000 and 2007  but remained relatively unchanged between 2007 and 2013 . In the United States, cheese and yogurt contributed significantly to the overall increase in dairy product availability over time . The per capita consumption of cheese (other than cottage cheese) in the US population increased from 29.6 pounds per person in 2000 to 34.2 pounds per person in 2018. During this time period, the per capita consumption of yogurt increased from 6.5 pounds per person to 13.4 pounds per person . Per capita cheese consumption across the European Union increased from 16.7 kg/person/annum in 2007  to 17.9 kg/person/annum in 2014 . In Finland, the consumption of cheese more than doubled during the last few decades and the consumption of yogurt showed an upward trend . The per capita consumption of yogurt has increased in recent decades because many consumers associate yogurt with good health .
From 2004 to 2015, the prevalence of meeting recommendations for Milk & Alternatives food group among Milk & Alternatives consumers significantly decreased from 28.3 to 24.4%. In a study conducted in a Canadian university community (653 staff members, 2490 students), more than 49% of staff members and about 46% of students did not meet the recommendations for Milk & Alternatives . Kolahdooz et al. conducted a study in a sample of Alberta’s multi-ethnic youths aged 11–23 years and found that the percentage of youths not meeting recommendations for Milk & Alternatives was 81.7% for Indigenous, 73.3% for African & Middle Eastern, 78.6% for Asian and 63.5% for European youths . Results from a longitudinal study conducted in a sample of Canadian grade 9–12 students (ages 13–18 years) showed that only a quarter of students (24.9%) met the recommendations for Milk & Alternatives at both time points . These results clearly suggest that the majority of Canadians do not consume minimum daily recommended servings of Milk & Alternatives.
Despite their low energy contribution (12.3% of energy), Milk & Alternatives contributed 45.8% of calcium, 39.9% of vitamin D, and 36.0% of vitamin B12 to the diet of the Canadian population in 2015. Milk & Alternatives were among the top sources of vitamin A, phosphorus and riboflavin. Using data from the 4 cycles of continuous NHANES 2001–2002, 2003–2004, 2005–2006, and 2007–2008, Drewnowski showed that milk and milk products contributed 10–13% of total energy intake, 47% of calcium intake, 42% of retinol intake and 65% of vitamin D intake in US children and adults. Milk and milk products were also major sources of riboflavin, phosphorus, and vitamin B12 in the US diet . A nationwide cross-sectional survey (2008–09) conducted in the Brazilian population aged ≥10 years showed that dairy products accounted for 6.1% of daily energy, 37.9% of calcium, 35.9 of vitamin D, 18.7% of riboflavin, and 17.0% of phosphorus . Vissers et al. assessed the contribution of dairy products to the intake of micronutrients in the Dutch population. Dairy products contributed 73% of calcium, 58% of vitamin B12, and 39% of zinc in young Dutch children. In adults and elderly subjects, dairy products contributed 65–68% of calcium, 44–46% of vitamin B12 and 28–31% of zinc . Dairy products were the top sources of calcium (45.6%), iodine (29.8%) and riboflavin (28.2%), and the second most important source of phosphorus (24.7%), zinc (19.6%), retinol (16.5%), vitamin B12 (14.5%), and vitamin D (14.3%) in French adults (18–79 years). Moreover, dairy products were the first source of calcium (53.2%), iodine (39.7%), riboflavin (38.4%), phosphorus (31%), and potassium (21.4%), and the second major source of zinc (24.7%), vitamins B5 (24.6%), retinol (24.1%), vitamin B12 (22.6%), and vitamin D (18.7%) in French children (3–17 years) .
We showed that Milk & Alternatives food group was a significant contributor to total fat and saturated fat intakes in the Canadian diet (18.3 and 31.2%, respectively, in 2004 and 17.3 and 28.6%, respectively in 2015). Further, Milk & Alternatives consumers obtained about 68 and 56% more saturated fat than non-consumers in 2004 and 2015, respectively. Milk & Alternatives, especially cheese, has been recognized as major sources of saturated fat in the diet of most populations [33, 36,37,38,39]. Using nationally representative data from the National Adult Nutrition Survey (NANS), Feeney et al. reported that dairy products and cheese contributed to near 20 and 8.3% of saturated fat intake in the Irish population, respectively . Data from the 2008–2009 Brazilian Household Budget Survey showed that dairy products accounted for 10.0% of total fat and 16.9% of saturated fat intake in the Brazilian population aged ≥10 years . Using data from the Western Australian Pregnancy Cohort (Raine) Study, O’Sullivan et al. reported that dairy products (excluding butter) contributed near 21% of total fat and 31.5% of saturated fat intake in Australian adolescents aged 13–15 years . Dairy products (excluding butter) accounted for 24 and 39%, respectively, of total fat and saturated fat intakes in US children and adolescents aged 2–18 years , and 20% of total fat and 34.6% of saturated fat intake in the Spanish population aged 2 to 24 years . The high contribution of dairy products to saturated fat intake together with the undesirable effects of saturated fat consumption on human health [40,41,42] may explain why people generally tend to decrease their dairy food intake. Further, in efforts to decrease saturated fat consumption, the new 2019 Canada’s Food Guide has eliminated the “Milk & Alternatives” food category and recommended only lower-fat dairy products as a subgroup of protein foods . However, this may accelerate the previously observed downward trend in dietary intakes of calcium and vitamin D [43, 44], and alter the nutritional profile of the diet of Canadians.
This study used nutrition data from two nationally representative surveys of the Canadian population, CCHS 2004 (Cycle 2.2) and 2015 CCHS-Nutrition. A major strength of this study was the opportunity to examine the changes in Milk & Alternatives consumption among Canadians, shortly after the introduction of new Canada’s food guide. We also acknowledge some limitations. First, changes to the food booklet have resulted in some portion size changes, especially in the case of beverages. For example, changes to the food portion size booklet resulted in a decrease of 39 mL (429 mL in 2004 vs 390 mL in 2015) and 55 mL (325 mL in 2004 vs 270 mL in 2015) in quantities of the 2 largest drinking glass options . Thus, caution should be taken when comparing the results of two surveys. Second, because the 2004 and 2015 data were analyzed separately, the comparisons were made by a 95% CI overlapping method. Third, data regarding Milk & Alternatives consumption was obtained using a 24-h recall, which is a self-report method subject to misreporting (i.e., overestimating or underestimating dietary intake). Fourth, our results indicate statistical significant differences, whether such differences are meaningful from clinical and public health perspectives warrants further investigation.
Study implications and usefulness
This study showed that there has been a decreasing trend in consumption of Milk & Alternatives in Canada from 2004 to 2015. Transition of Milk & Alternatives from one of the four food groups of 2007 Canada’s food guide to only a source of protein in the new Canada’s Food Guide (2019) may further exacerbate the observed downward trend in consumption of dairy products. Further, this decreasing trend may decrease the dietary intake of some major nutrients, in particular, calcium and vitamin D, and adversely affect the nutritional profile of the diet. In this regard, a recent study reported that the current Canada’s Food Guide Snapshot appears to be nutritionally inadequate in terms of calcium and vitamin D for Canadian youth . Therefore, in the face of new recommendations, policy-makers, stakeholders and consumers must take caution to ensure adequate intake of nutrients. The new Canada’s Food Guide has also recommended consuming fortified-soy beverages as a plant-based source of protein . Consumption of these plant-based milk alternatives can be considered as an option to prevent nutrient deficiencies in Milk & Alternatives non-consumers. This research serves as a baseline with which to compare future surveys on consumption of Milk & Alternatives, in the light of the recommendations of new Canada’s Food Guide.