Written by: Sandeep Ravindran, Ph.D. | Issue # 106 | 2022
- Older adults are often malnourished, which can contribute to their increased risk of falls and fractures.
- A new study of more than 7000 residents of 60 aged-care facilities in Australia found that a nutritional intervention that increased the amount of dairy foods reduced the risk of falls and fractures.
- Participants in the intervention group receiving more dairy consumed, on average, higher protein and calcium than the control group on their usual diets.
- The findings suggest that nutritional interventions with dairy foods could serve as a public health measure for fracture prevention in aged care settings and potentially even in the broader community.
We change in many ways as we grow old. In addition to external signs of aging such as white hair and wrinkles, our body also experiences less obvious changes, such as loss of muscle and bone mass.
These changes to muscle and bone are exacerbated by the fact that older individuals who need institutionalized care are often malnourished and lack adequate protein and calcium. This can in turn contribute to their increased risk of falls and fractures [1-4].
“My work was in aged care because their falls and fracture risk are the highest and their intake is the worst,” says Dr. Sandra Iuliano of the University of Melbourne. “We wondered, can we have good clinical outcomes by just improving the food that they’re eating?” she says.
When designing a nutritional intervention, Iuliano focused on dairy foods as they are a good low-cost source of protein and calcium and can be easily consumed by the elderly. “The reason we chose the dairy food group is because it’s high in calcium and high in protein, and we were looking at falls and fracture reduction, so it was a natural kind of choice for us,” she says. Previous research showed that consumption of milk, yogurt, and cheese, foods rich in calcium and protein, slows bone loss [5,6].
In a new study of 7195 residents of 60 aged-care facilities in Australia conducted over two years, Iuliano found that supplementation using high calcium, high protein dairy foods reduced the risk of falls and fractures . The nutritional intervention was tailored to residents’ preferences and consisted of regular retail milk, yogurt, and cheese incorporated into existing menus. “All we used is milk, yogurt and cheese, any combination, any fat content, and we looked at what the residents were eating and then enhanced what they were eating,” says Iuliano.
The study found that the dairy foods nutritional intervention was associated with a 33% reduction in risk of fractures of any type, a 46% reduction in risk of hip fractures, and an 11% reduction in risk of falls relative to controls. “The risk reduction is a combination of fewer falls and less bone loss,” says Iuliano. “All but one of the fractures resulted from a fall and we reduced falls, and if they don’t fall, they’re unlikely to fracture,” she says.
Residents in facilities that received the dairy foods intervention maintained their bone and muscle to a greater extent than those in facilities that didn’t receive the intervention. “There was deterioration in bone and muscle that we saw in the controls, but we didn’t see that in the intervention group,” says Iuliano. “That’s probably the beauty of it, because the dairy had both the calcium and the high-quality protein, so we’re doing two things at once with tackling muscle as well as tackling bone,” she says.
There was no difference in all-cause mortality between the intervention and control groups, but the intervention does have the potential to improve quality of life. “They don’t live longer, but they live fracture-free and potentially falls-free,” says Iuliano.
Taking residents’ preferences into account was important for compliance, a key to this kind of public health intervention. “Any intervention is only useful if there’s good compliance, so the food has to taste good, and having foods they know and foods they like was the key,” says Iuliano. “It’s about what residents like, and how we can increase their dairy intake and put good choices in their diet,” she says.
Dairy foods offered a lot of flexibility in how they could be incorporated into the facilities’ menus, with both sweet and savory options. “All day we try to enable choices throughout the whole menu, so that way someone that doesn’t eat breakfast cereal with milk, there’s a choice somewhere else for them,” says Iuliano. “Some places just loved cheese and they just ate cheese a lot, and other places we could fortify milk and that doubled their intake just through the fortification, so it was very tailored to the facility and to the residents,” she says.
The long-term nature of the study bodes well for introducing such interventions as public health policy. “Two years per facility, that’s a long time, and the longevity shows that it can be sustainable,” says Iuliano. “This is showing that this can be easily entrenched into policy and practice,” she says.
Such food-based interventions could provide public health benefits at reasonable cost. “It’s cost-effective,” says Iuliano. “You’re reducing the cost of a fracture, which is extremely expensive from a public health point of view, whereas the cost of the intervention, the food, wasn’t expensive,” she says.
Food-based interventions may also be more palatable than therapeutic interventions. “We’re giving them foods that they know but they’re gaining a clinical benefit from it, and it’s like, I’d much rather have a piece of cheese than a tablet if I had to,” she says.
Follow-up studies could combine dairy food interventions with other interventions such as exercise. “We might get an even better effect,” says Iuliano. She also envisions similar interventions working in other parts of the world.
- Prince MJ, Wu F, Guo Y, Gutierrez Robledo LM, O’Donnell M, Sullivan R, Yusuf S. The burden of disease in older people and implications for health policy and practice. Lancet. 2015 Feb 7;385(9967):549-62.
- Australian Institute of Health and Welfare 2018. Hip fracture incidence and hospitalisations in Australia 2015–16. Cat. no. PHE 226. Canberra: AIHW.
- Iuliano S, Poon S, Wang X, Bui M, Seeman E. Dairy food supplementation may reduce malnutrition risk in institutionalised elderly. Br J Nutr. 2017 Jan;117(1):142-7.
- Rose G. Sick individuals and sick populations. 1985. Bull World Health Organ. 2001;79(10):990-6.
- Moschonis G, Katsaroli I, Lyritis GP, Manios Y. The effects of a 30-month dietary intervention on bone mineral density: the Postmenopausal Health Study. Br J Nutr. 2010 Jul;104(1):100-7.
- Heaney RP, McCarron DA, Dawson-Hughes B, Oparil S, Berga SL, Stern JS, Barr SI, Rosen CJ. Dietary changes favorably affect bone remodeling in older adults. J Am Diet Assoc. 1999 Oct;99(10):1228-33.
- Iuliano S, Poon S, Robbins J, Bui M, Wang X, De Groot L, Van Loan M, Zadeh AG, Nguyen T, Seeman E. Effect of dietary sources of calcium and protein on hip fractures and falls in older adults in residential care: cluster randomised controlled trial. BMJ. 2021 Oct 20;375:n2364.