Dairy foods help prevent fractures, falls in older adults

Eating dairy foods to improve calcium and protein intakes is a suitable intervention for reducing the risk of falls and fractures in older adults, particularly those residing in a care institution, suggests a study.

“A high calcium and high protein nutritional intervention reduced the risk of falls and fractures,” the researchers said. “This intervention was tailored to the preferences of the residents and was successfully delivered through the food service using regular retail milk, yoghurt, and cheese incorporated into existing menus.”

Sixty residential aged care facilities in Australia were included in this 2-year cluster randomized controlled trial that examined 7,195 permanent residents (mean age 86.0 years, 68 percent female).

The researchers stratified facilities by location and organization, with 30 facilities randomized to provide residents with additional milk, yoghurt, and cheese that contained 562 mg/day calcium and 12 g/day protein, achieving a total intake of 1,142 mg calcium/day and 69 g/day protein (1.1 g/kg body weight). The remaining facilities served as controls and retained their menus, with residents consuming 700 mg/day calcium and 58 g/day protein (0.9 g/kg body weight).

Analysis of data from 27 intervention and 29 control facilities revealed a total of 324 fractures (135 hip fractures), 4,302 falls, and 1,974 deaths. The intervention reduced the risk of all fractures by 33 percent (121 vs 203; hazard ratio [HR], 0.67, 95 percent confidence interval [CI], 0.48–0.93; p=0.02), hip fractures by 46 percent (42 vs 93; HR, 0.54, 95 percent CI, 0.35–0.83; p=0.005), and falls by 11 percent (1,879 vs 2,423; HR, 0.89, 95 percent CI, 0.78–0.98; p=0.04). [BMJ 2021;375:n2364]

The risk reduction reached statistical significance at 5 months for hip fractures (p=0.02) and 3 months for falls (p=0.004). Mortality, on the other hand, did not change between the two groups (900 vs 1,074; HR, 1.01, 95 percent CI, 0.43–3.08).

“This nutritional intervention produced two unanticipated novel observations. The risk reduction for falls and fractures was detected by 3 and 5 months, respectively, and the relative risk reduction for fractures was similar to that found in trials using potent antiresorptive therapy to treat people at high risk due to osteoporosis,” the researchers said.

“The two most likely explanations for each of these observations is a risk reduction for falls and slowing progression of bone fragility,” they added.

The increase in insulin-like growth factor 1 was confined to the intervention group, while the appendicular lean mass decreased in the control group only. This is consistent with the view that protein intakes of 1–1.5 g/kg/day is necessary to prevent protein catabolism and preserve or increase muscle mass in older adults, especially those at risk of frailty. [J Am Med Dir Assoc 2013;14:542-559]

Mortality was unchanged between groups. Of note, some studies reported that milk consumption could increase the risk of death, but consumption of yoghurt and cheese (fermented foods) was associated with lower mortality and favourable blood lipid profiles. [BMJ 2014;349:g6015; Lancet 2018;392:2288-2297; Eur J Clin Nutr 2002;56:843-849]

“In summary, ageing of the population is associated with a greater number of older adults needing full time institutionalized care. These individuals are often malnourished,” the researchers said. [Br J Nutr 2017;117:142-147]

“In conclusion, this nutritional intervention has widespread implications as a public health measure for fracture prevention in the aged care setting and potentially in the wider community,” they added.