title: Consumption of non-cow's milk beverages and serum vitamin D levels in early childhood.
abstract: BACKGROUND
  Vitamin D fortification of non-cow's milk beverages is voluntary in North America. The effect of consuming non-cow's milk beverages on serum 25-hydroxyvitamin D levels in children is unclear. We studied the association between non-cow's milk consumption and 25-hydroxyvitamin D levels in healthy preschool-aged children. We also explored whether cow's milk consumption modified this association and analyzed the association between daily non-cow's milk and cow's milk consumption.
  
  
  METHODS
  In this cross-sectional study, we recruited children 1-6 years of age attending routinely scheduled well-child visits. Survey responses, and anthropometric and laboratory measurements were collected. The association between non-cow's milk consumption and 25-hydroxyvitamin D levels was tested using multiple linear regression and logistic regression. Cow's milk consumption was explored as an effect modifier using an interaction term. The association between daily intake of non-cow's milk and cow's milk was explored using multiple linear regression.
  
  
  RESULTS
  A total of 2831 children were included. The interaction between non-cow's milk and cow's milk consumption was statistically significant (p = 0.03). Drinking non-cow's milk beverages was associated with a 4.2-nmol/L decrease in 25-hydroxyvitamin D level per 250-mL cup consumed among children who also drank cow's milk (p = 0.008). Children who drank only non-cow's milk were at higher risk of having a 25-hydroxyvitamin D level below 50 nmol/L than children who drank only cow's milk (odds ratio 2.7, 95% confidence interval 1.6 to 4.7).
  
  
  CONCLUSIONS
  Consumption of non-cow's milk beverages was associated with decreased serum 25-hydroxyvitamin D levels in early childhood. This association was modified by cow's milk consumption, which suggests a trade-off between consumption of cow's milk fortified with higher levels of vitamin D and non-cow's milk with lower vitamin D content.
authors.affiliation: Departments of Nutritional Sciences (Lee, L'Abbé), Paediatrics (Birken, Parkin) and Health Policy, Management and Evaluation (Lebovic), University of Toronto; Department of Paediatrics (Lee, Maguire) and the Applied Research Centre at the Li Ka Shing Knowledge Institute (Lebovic, Chen, Maguire), St. Michael's Hospital; Department of Paediatric Medicine and the Paediatric Outcomes Research Team (Birken, Parkin), The Hospital for Sick Children, Toronto, Ont.
authors.forename: Grace J
authors.initials: GJ
authors.lastname: Lee
authors.affiliation: Departments of Nutritional Sciences (Lee, L'Abbé), Paediatrics (Birken, Parkin) and Health Policy, Management and Evaluation (Lebovic), University of Toronto; Department of Paediatrics (Lee, Maguire) and the Applied Research Centre at the Li Ka Shing Knowledge Institute (Lebovic, Chen, Maguire), St. Michael's Hospital; Department of Paediatric Medicine and the Paediatric Outcomes Research Team (Birken, Parkin), The Hospital for Sick Children, Toronto, Ont.
authors.forename: Catherine S
authors.initials: CS
authors.lastname: Birken
authors.affiliation: Departments of Nutritional Sciences (Lee, L'Abbé), Paediatrics (Birken, Parkin) and Health Policy, Management and Evaluation (Lebovic), University of Toronto; Department of Paediatrics (Lee, Maguire) and the Applied Research Centre at the Li Ka Shing Knowledge Institute (Lebovic, Chen, Maguire), St. Michael's Hospital; Department of Paediatric Medicine and the Paediatric Outcomes Research Team (Birken, Parkin), The Hospital for Sick Children, Toronto, Ont.
authors.forename: Patricia C
authors.initials: PC
authors.lastname: Parkin
authors.affiliation: Departments of Nutritional Sciences (Lee, L'Abbé), Paediatrics (Birken, Parkin) and Health Policy, Management and Evaluation (Lebovic), University of Toronto; Department of Paediatrics (Lee, Maguire) and the Applied Research Centre at the Li Ka Shing Knowledge Institute (Lebovic, Chen, Maguire), St. Michael's Hospital; Department of Paediatric Medicine and the Paediatric Outcomes Research Team (Birken, Parkin), The Hospital for Sick Children, Toronto, Ont.
authors.forename: Gerald
authors.initials: G
authors.lastname: Lebovic
authors.affiliation: Departments of Nutritional Sciences (Lee, L'Abbé), Paediatrics (Birken, Parkin) and Health Policy, Management and Evaluation (Lebovic), University of Toronto; Department of Paediatrics (Lee, Maguire) and the Applied Research Centre at the Li Ka Shing Knowledge Institute (Lebovic, Chen, Maguire), St. Michael's Hospital; Department of Paediatric Medicine and the Paediatric Outcomes Research Team (Birken, Parkin), The Hospital for Sick Children, Toronto, Ont.
authors.forename: Yang
authors.initials: Y
authors.lastname: Chen
authors.affiliation: Departments of Nutritional Sciences (Lee, L'Abbé), Paediatrics (Birken, Parkin) and Health Policy, Management and Evaluation (Lebovic), University of Toronto; Department of Paediatrics (Lee, Maguire) and the Applied Research Centre at the Li Ka Shing Knowledge Institute (Lebovic, Chen, Maguire), St. Michael's Hospital; Department of Paediatric Medicine and the Paediatric Outcomes Research Team (Birken, Parkin), The Hospital for Sick Children, Toronto, Ont.
authors.forename: Mary R
authors.initials: MR
authors.lastname: L'Abbé
authors.affiliation: Departments of Nutritional Sciences (Lee, L'Abbé), Paediatrics (Birken, Parkin) and Health Policy, Management and Evaluation (Lebovic), University of Toronto; Department of Paediatrics (Lee, Maguire) and the Applied Research Centre at the Li Ka Shing Knowledge Institute (Lebovic, Chen, Maguire), St. Michael's Hospital; Department of Paediatric Medicine and the Paediatric Outcomes Research Team (Birken, Parkin), The Hospital for Sick Children, Toronto, Ont. jonathon.maguire@utoronto.ca.
authors.forename: Jonathon L
authors.initials: JL
authors.lastname: Maguire
mesh_terms: D000818:Animals; D015415:Biomarkers / Q000097:blood; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004032:Diet / Q000009:adverse effects*; D004034:Diet Surveys; D005260:Female; D006801:Humans; D007223:Infant; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008892:Milk; D041941:Milk Substitutes; D014807:Vitamin D / Q000031:analogs & derivatives* / Q000097:blood; D014808:Vitamin D Deficiency / Q000097:blood / Q000175:diagnosis / Q000209:etiology*
chemical_list: D015415:Biomarkers; D014807:Vitamin D; C104450:25-hydroxyvitamin D