Healthy Ageing with Dairy Foods

The Fractures Trial is the first of its kind. This study explored how the food served at aged care facilities impacts the health of its residents.

Specifically, this trial investigated how increasing intake of milk, cheese and yoghurt impacted on a variety of health outcomes including fractures, falls, bone health, heart health, muscle strength and function.

Across two years, the food service teams at 30 aged care facilities across Victoria, Australia added additional dairy foods to their menu. Examples included serving cheese and crackers at morning tea and fortifying desserts such as cheesecake with skim milk powder. Meanwhile, an additional 30 facilities continued with their usual menu, setting the stage for a powerful comparison.

Well? The proof was in the (fortified) pudding. Scientific papers have been published from the Fractures Trial, with the most recent titled ‘Dietary Sources of Calcium and Protein Reduce Hip Fractures and Falls in Institutionalised Older Adults: a Cluster-Randomised Controlled Trial’. The paper was published in the British Medical Journal.

Compared to the group who continued with their regular menu, the intervention group:

• increased their dairy intakes from 2 to 3.5 serves
• increased calcium and protein intakes significantly
• reduced their risk of falls by 11%
• reduced their risk of all fractures and hip fractures 33% and 46%, respectively.

Let’s first look at the bigger picture. Around 7% of older adults live in residential aged care; a number which is projected to grow in line with Australia’s ageing population.

A 2016 publication from the Fractures Trial found that 68% of those in Australian residential aged care are malnourished or at risk of malnutrition;—a serious concern, as malnutrition is directly linked to a higher risk of falls and fractures. In fact, aged care residents are the source of 30% of all hip fractures. These are confronting statistics, highlighting the urgent need for effective interventions.

These findings are so important because they shine a light on a long-overlooked problem—and a solution that’s within reach. There has never been such a large, well-designed trial specifically investigating dairy intake and health of older adults. The study showed that improving calcium and protein intakes using dairy foods is a readily accessible intervention that reduces risk of falls and fractures commonly occurring in aged-care residents.

The results of the study provide compelling scientific evidence that can be used to improve the health of high-risk populations such as older adults in aged care.

These types of well-designed trials are important for driving real-world change— informing dietary guidelines and guiding good clinical practice including aged care and food provision policies.

The study was funded by dairy organisations in Australia, The United States and Europe and product was provided by a dairy company. Funding was also received from The University of Melbourne and Austin Health. While the dairy industry partly funded the trial, this did not impact the results of the study in any way. The dairy organisations played no role in the design, execution, analyses, interpretation of the data, writing of the manuscript or any other aspect of the study.

Few studies have explored whether whole foods can help reduce fracture risk. Most research has focused on single-nutrient supplements, like calcium or vitamin D. This is the first randomised controlled trial to show that increasing dairy intake can directly benefit aged-care residents by lowering their risk of fractures.

Could the same results be achieved using supplements? Dairy foods are natural sources of bone and muscle friendly nutrients including calcium and high-quality protein in a form that’s well absorbed by the body. These nutrients are likely behind the link between dairy foods and better bone health outcomes.

Supplements can be useful, especially for high-risk populations but they’re not always easy to take and can be expensive.

On the other hands, dairy foods are widely available, palatable, safe and affordable. In this study, increasing dairy intake provided an effective and practical way for aged-care residents to meet their nutritional needs—without the barriers that often come with supplements.

The study looked at calcium and protein levels that were consumed from total intakes of milk, cheese and yoghurt, rather than individual types. Benefits would therefore be achieved from consuming any combination of these foods, as long as enough dairy is consumed. They key is to choose the options that best fit into your daily routine and that you enjoy the most. After all, the best nutrition is the kind you’ll stick with!

Milk, cheese and yoghurt contain a unique package of nutrients housed within complex structures. Dairy foods are natural sources of bone and muscle-friendly nutrients, including calcium and high-quality protein in a form that’s easily absorbed by the body.

Dairy plays a key role in optimising musculoskeletal health at every stage of life. It supports growth in childhood, rapid development during adolescence and the maintenance of bone and muscle in adulthood. As we age, it helps slow down the natural loss of muscle and bone, making it particularly important in later years.

Great question. The link comes down to protein. Milk, cheese, yoghurt and milk powder provide high-quality protein that helps maintain muscle strength.

In the control group (no additional dairy), participants lost muscle in their arms and legs. In contrast, those in the dairy group maintained their muscle mass.

Additionally, dairy foods (particularly milk) contain the amino acid known as leucine, which is known as a potent stimulus for muscle protein synthesis.

This new study showed that increasing dairy serves is an achievable strategy to improving the health of older residents. If residents struggled to consume increased dairy serves, average intakes would remain low and the researchers wouldn’t have observed any changes.

But the results speak for themselves. Not only was the increase possible but it was also effective.

Importantly, this study showed that these changes were able to be sustained over a long period of time (two years).

In aged care, it’s important that foods are varied, appealing, tasty, high in protein and energy and offered in small portions to ensure they’re easy to eat.

The intervention was conducted in aged care residents due to their high risk for falls and fractures. As a result of their health status, they have often entered aged care because of an injury or fracture from a prior fall. Having such a large number of high-risk elderly in the one location meant the study could test the anti-fracture efficacy of dairy foods at the recommended intake level. Aged-care facilities provided a controlled environment, where falls and fractures were closely monitored. Food was also provided to residents, making it easier to track compliance and measure intake.

This study demonstrated that falls and fractures can be reduced when residents consume the recommended daily intake of dairy. While the focus was on aged care residents, this is a health message extends beyond just aged care and to older adults in the community who may also be at risk of falls and fractures.

With 99% of older Australians not meeting dairy recommendations—and an ageing population on the rise—it is more important than ever to apply these findings to public health strategies for fracture and falls risk prevention.