Time to consider more than just calcium? The impact on protein, riboflavin, vitamin B12 and iodine intake of replacing cows' milk with plant-based milk-like drinks-an Australian usual intake dietary modelling study.

Purpose: Most plant-based milk-like (PBML) drinks sold in Australia are not fortified with riboflavin, vitamin B12 or iodine. Reduced dairy intake is often recommended for planetary health and the 2013 Australian Dietary Guidelines advise that PBML drinks are a suitable replacement for cows' milk if calcium fortified. We investigated the likely population-wide impacts on riboflavin, vitamin B12, iodine and protein usual intakes of replacement of cows' milk with PBML drinks.

Methods: We used computer simulation modelling of data from the 2011-12 National Nutrition and Physical Activity Survey (n = 11,925 persons aged 2 + years). Cows' milk was replaced with PBML drinks and the likely impacts on usual intakes of riboflavin, vitamin B12, iodine and protein were assessed across eight age groups (National Cancer Institute method). A usual intake below the Estimated Average Requirement (EAR) was defined as inadequate.

Results: Replacement of cows' milk with unfortified PBML drinks would likely lead to an increased proportion of older women (71 + years) with an inadequate riboflavin intake (from 20 to 31%), of older men and females aged 14 + years with an inadequate vitamin B12 intake (from < 1 to 9%, from 5-8 to 11-17%, respectively), and an increased proportion of males and females (2 + years) with an inadequate iodine intake (from 2 to 5%, from 8 to 16%, respectively). Effects on protein adequacy were more minor except for older adults.

Conclusion: Replacement of cows' milk with most types of Australian PBML drinks has the potential to adversely impact riboflavin, vitamin B12, iodine and protein intake adequacy within the Australian population and future recommendations should consider all population groups and a range of nutrients, not just calcium.