What is the question?

• What is the relationship between dairy milk and milk alternative consumption and growth, body composition, and risk of obesity? The populations of interest for this question include children and adolescents, adults and older adults, and pregnancy and postpartum.

Why was this question asked?

• This systematic review was conducted by the 2025 Dietary Guidelines Advisory Committee as part of the process to develop the Dietary Guidelines for Americans, 2025-2030.

How was this question answered?

• The Committee conducted a systematic review to answer this question with support from the USDA Nutrition Evidence Systematic Review team. This review updated an existing review that was conducted by the 2020 Dietary Guidelines Advisory Committee.

What is the answer to the question?

Children and adolescents

• Total milk consumption by younger children may be associated with favorable growth and body composition, and lower risk of obesity during childhood. This conclusion statement is based on evidence graded as limited.
• A conclusion statement cannot be drawn about the relationship between total milk consumption by older children and adolescents and growth, body composition, and risk of obesity because of substantial concerns with directness, consistency, and risk of bias in the body of evidence.
• Consumption of higher-fat dairy milk compared to lower-fat dairy milk by younger children may be associated with favorable growth and body composition, and lower risk of obesity during childhood. This conclusion statement is based on evidence graded as limited.
• A conclusion statement cannot be drawn about the relationship between consumption of milk with different fat content by older children and adolescents and growth, body composition, and risk of obesity because of substantial concerns with consistency, quantity, and risk of bias in the body of evidence.
• A conclusion statement cannot be drawn about the relationship between consumption of sweetened milk by younger children and growth, body composition, and risk of obesity because there is no evidence available.
• There may not be a relationship between consumption of sweetened milk by older children and adolescents and growth, body composition, and risk of obesity. This conclusion statement is based on evidence graded as limited.
• A conclusion statement cannot be drawn about the relationship between consumption of milk alternatives by children and adolescents and growth, body composition, and risk of obesity because there is not enough evidence available.

Adults and older adults

• Total milk consumption by adults and older adults is not associated with measures of body composition or risk of obesity. This conclusion statement is based on evidence graded as moderate.
• A conclusion statement cannot be drawn about the relationship between consumption of milk with different fat content by adults and older adults and body composition and risk of obesity because of substantial concerns with directness, consistency, and an absence of trial data in the body of evidence.
• A conclusion statement cannot be drawn about the relationship between consumption of sweetened milk by adults and older adults and body composition and risk of obesity because there is no evidence available.
• A conclusion statement cannot be drawn about the relationship between consumption of milk alternatives by adults and older adults and body composition and risk of obesity because there is not enough evidence available.

Pregnancy and postpartum

• A conclusion statement cannot be drawn about the relationship between milk consumption during pregnancy and adequacy of gestational weight gain because there is not enough evidence available.
• A conclusion statement cannot be drawn about the relationship between milk consumption during postpartum and postpartum weight change because there is no evidence available.

How up-to-date is this systematic review?

• Conclusion statements from this review are based on articles published between January 2000 and May 2023.

Background

This systematic review was conducted by the 2025 Dietary Guidelines Advisory Committee as part of the process to develop the Dietary Guidelines for Americans, 2025-2030. The U.S. Departments of Health and Human Services (HHS) and Agriculture (USDA) appointed the 2025 Dietary Guidelines Advisory Committee (Committee) in January 2023 to review evidence on high priority scientific questions related to diet and health. Their review forms the basis of their independent, science-based advice and recommendations to HHS and USDA, which is considered as the Departments develop the next edition of the Dietary Guidelines. As part of that process, the Committee conducted a systematic review with support from USDA’s Nutrition Evidence Systematic Review (NESR) team to answer the following question: What is the relationship between dairy milk and milk alternative consumption and growth, body composition, and risk of obesity? This review is an update to an existing review that was conducted by the 2020 Dietary Guidelines Advisory Committee.

Methods

• The Committee conducted a systematic review using the methodology of the USDA NESR team. The Committee first developed a protocol. The intervention or exposure of interest was beverage pattern consumption in children, adolescents, adults, older adults, and pregnancy and postpartum. The comparators were consumption of or adherence to a different beverage pattern and different levels of consumption of or adherence to a beverage pattern. The outcomes were Growth (in children, adolescents) including: height, weight, weight-for-age, stunting, failure to thrive, wasting, BMI-for-age, body circumferences (arm, neck, thigh); Body composition (in children, adolescents, adults, older adults) including: skinfold thickness, fat mass, ectopic fat, fat-free mass or lean mass, waist circumference, waist-to-hip-ratio; Risk of obesity (in children, adolescents, adults, older adults) including: BMI, underweight, normal weight, overweight and/or obesity, weight loss and maintenance (in adults and older adults); and Pregnancy and postpartum-related weight change including: gestational weight gain and postpartum weight change. Additional inclusion criteria were established for the following study characteristics: a) use randomized or non-randomized controlled trial, prospective or retrospective cohort, nested case-control, or Mendelian randomization study designs, b) be published in English in peer-reviewed journals, c) be from countries classified as high or very high on the Human Development Index, and d) enroll participants with a range of health statuses. The review excluded intervention studies less than 12 weeks in duration in children, adolescents, adults, and older adults.
• NESR librarians conducted a literature search in PubMed, Embase, CINAHL, and Cochrane to identify articles published between January 2000 and May 2023. Two NESR analysts independently screened all electronic results, and the reference lists of included articles based on the pre-determined criteria. The results of the search were combined with included articles from the existing review.
• NESR analysts extracted data from each included article, with a second analyst verifying accuracy of the extraction. Two NESR analysts independently conducted a formal risk of bias assessment, by study design, for each included article, then reconciled any differences in the assessment. The Committee qualitatively synthesized the evidence from all included articles identified in the updated literature search and from the existing review according to the synthesis plan, with attention given to the overarching themes or key concepts from the findings, similarities and differences between studies, and factors that may have affected the results. The Committee developed conclusion statements and graded the strength of evidence based on its consistency, precision, risk of bias, directness and generalizability.

Results

Children and adolescents: Total milk

Conclusion statements and grades

• Total milk consumption by younger children may be associated with favorable growth and body composition, and lower risk of obesity during childhood. This conclusion statement is based on evidence graded as limited. (Grade: Limited)
• A conclusion statement cannot be drawn about the relationship between total milk consumption by older children and adolescents and growth, body composition, and risk of obesity because of substantial concerns with directness, consistency, and risk of bias in the body of evidence. (Grade: Grade Not Assignable)

Summary of the evidence

• Thirty-four articles examined for total milk in children and adolescents. Five were randomized controlled trials (RCT), 1 was a non-randomized controlled trial (NRCT), and 28 were prospective cohort studies (PCS).

Younger children age 2-5 years

• Thirteen PCS examined total milk intake in younger children age 2-5 years.
• Studies with significant findings all showed a beneficial association between increased total milk intake and favorable growth, body composition, and risk of obesity outcomes. However, a large proportion of the studies showed null results.
• The size of study groups was small in some studies, and variation around the effect estimates ranged from narrow to wide across studies.
• Few studies were designed and conducted well.
• The populations, interventions/exposures, comparators, and outcomes that were examined 
  directly represent those of interest in this review.
• The evidence may not apply to the U.S. population.

Older children and adolescents

• Five RCT, 1 NRCT, and 15 PCS examined total milk intake in older children and adolescents.
• The 2025 Committee was not able to draw a conclusion because of substantial concerns with directness, consistency, and risk of bias in the body of evidence.

Children and adolescents: Milk by fat content

Conclusion statements and grades

• Consumption of higher-fat dairy milk compared to lower-fat dairy milk by younger children may be associated with favorable growth and body composition, and lower risk of obesity during childhood. This conclusion statement is based on evidence graded as limited. (Grade: Limited)
• A conclusion statement cannot be drawn about the relationship between consumption of milk with different fat content by older children and adolescents and growth, body composition, and risk of obesity because of substantial concerns with consistency, quantity, and risk of bias in the body of evidence. (Grade: Grade Not Assignable)

Summary of the evidence

• Eleven PCS examined milk by fat content in children and adolescents.

Younger children age 2-5 years

• Six PCS examined milk by fat content in younger children age 2-5 years. 
  There was a mix of findings between those showing a relationship between higher-fat milk and favorable outcomes and those showing no relationship.
• The body of evidence was small, and the size of study groups was small in some studies.
• Few studies were designed and conducted well.
• The populations, interventions/exposures, comparators, and outcomes that were examined directly represent those of interest in this review, but there was a lack of trial data.
• The evidence applies to the U.S. population.

Older children and adolescents

• Five PCS examined milk by fat content in older children and adolescents.
• The 2025 Committee was not able to draw a conclusion because of substantial concerns with consistency, quantity, and risk of bias in the body of evidence.

Children and adolescents: Milk by sweetener content

Conclusion statements and grades

• A conclusion statement cannot be drawn about the relationship between consumption of sweetened milk by younger children and growth, body composition, and risk of obesity because there is no evidence available. (Grade: Grade Not Assignable)
• There may not be a relationship between consumption of sweetened milk by older children and adolescents and growth, body composition, and risk of obesity. This conclusion statement is based on evidence graded as limited.  (Grade: Limited)

Summary of the evidence

Younger children age 2-5 years

• No articles examined milk by sweetener content in younger children age 2-5 years. 
• The 2025 Committee was not able to draw a conclusion because there was no evidence available.  

Older children and adolescents

• Three PCS examined milk by sweetener content in older children and adolescents. 
• The direction of results was similar across studies with the removal of unadjusted outcome data.  
• The body of evidence was very small.
• Some studies were designed and conducted well.
• The populations, interventions/exposures, comparators, and outcomes that were examined directly represent those of interest in this review, but there was a lack of trial data.
• The evidence may not apply to the U.S. population.

Children and adolescents: Milk alternatives

Conclusion statement and grade

• A conclusion statement cannot be drawn about the relationship between consumption of milk alternatives by children and adolescents and growth, body composition, and risk of obesity because there is not enough evidence available. (Grade: Grade Not Assignable)

Summary of the evidence

• One NRCT examined consumption of milk alternatives in children and adolescents.
• The 2025 Committee was not able to draw a conclusion because there was not enough evidence available.

Adults and older adults: Total milk

Conclusion statement and grade

• Total milk consumption by adults and older adults is not associated with measures of body composition or risk of obesity. This conclusion statement is based on evidence graded as moderate. (Grade: Moderate)

Summary of the evidence

• Twenty-five articles examined total milk intake in adults. Eight were RCTs, and 17 were PCS.
• Most studies showed a null relationship, though the small number of significant findings were inconsistent in direction.
• The size of study groups was small in some studies.
• Some studies were designed and conducted well.
• The populations, interventions/exposures, comparators, and outcomes that were examined directly represent those of interest in this review.
• The evidence may not apply to the U.S. population.

Adults and older adults: Milk by fat content

Conclusion statement and grade

• A conclusion statement cannot be drawn about the relationship between consumption of milk with different fat content by adults and older adults and body composition and risk of obesity because of substantial concerns with directness, consistency, and an absence of trial data in the body of evidence. (Grade: Grade Not Assignable)

Summary of the evidence

• Fourteen PCS examined milk by fat content in adults and older adults.
• The 2025 Committee was not able to draw a conclusion because of substantial concerns with directness, consistency, and an absence of trial data in the body of evidence.

Adults and older adults: Milk by sweetener content

Conclusion statement and grade

• A conclusion statement cannot be drawn about the relationship between consumption of sweetened milk by adults and older adults and body composition and risk of obesity because there is no evidence available. (Grade: Grade Not Assignable)

Summary of the evidence

• No articles examined milk by sweetener content in adults and older adults.
• The 2025 Committee was not able to draw a conclusion because there was no evidence available.

Adults and older adults: Milk alternatives

Conclusion statement and grade

• A conclusion statement cannot be drawn about the relationship between consumption of milk alternatives by adults and older adults and body composition and risk of obesity because there is not enough evidence available. (Grade: Grade Not Assignable)

Summary of the evidence

• One RCT examined consumption of milk alternatives in adults and older adults.
• The 2025 Committee was not able to draw a conclusion because there was not enough evidence available.

Pregnancy

Conclusion statement and grade

• A conclusion statement cannot be drawn about the relationship between milk consumption during pregnancy and adequacy of gestational weight gain because there is not enough evidence available. (Grade: Grade Not Assignable)

Summary of the evidence

• Two PCS examined consumption of milk during pregnancy.
• The 2025 Committee was not able to draw a conclusion because there was not enough evidence available.

Postpartum

Conclusion statement and grade

• A conclusion statement cannot be drawn about the relationship between milk consumption during postpartum and postpartum weight change because there is no evidence available. (Grade: Grade Not Assignable)

Summary of the evidence

• No articles examined milk intake during postpartum.
• The 2025 Committee was not able to draw a conclusion because there was no evidence available.

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Suggested citation: Raynor HA, Deierlein AL, Gardner CD, Giovannucci E, Taylor CA, Hoelscher DM, Anderson CAM, Booth SL, Fung TT, Stanford FC, Talegawkar SA, Tobias DK, Kingshipp BJ, Cole NC, Webster A, Higgins M, Butera G, Terry N, Obbagy J. Dairy Milk and Milk Alternatives and Growth, Body Composition, and Risk of Obesity: A Systematic Review. November 2024. U.S. Department of Agriculture, Food and Nutrition Service, Center for Nutrition Policy and Promotion, Nutrition Evidence Systematic Review. Available at: https://doi.org/10.52570/NESR.DGAC2025.SR03