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Milk–Does an Older Body Good?


Dairy is having a moment. Last month, we highlighted a study linking dairy fat to lower cardiovascular disease risk, and now, we’re discussing dairy’s role in reducing the risk of falls and fractures in older adults. One more positive study and dairy will insist on an invitation to next year’s Met Gala.

Australian researchers conducted a two-year randomized controlled trial of 7,195 residents (68% women, mean age 86 years) across 60 residential care facilities to determine whether consuming dairy to increase calcium and protein can stave off falls and fractures. At baseline, all participants took comparable vitamin D supplementation and consumed a daily average of 689 mg of calcium and 57 g of protein. While participants in the control facilities maintained their regular diet, those in the intervention facilities enjoyed an extra 3.5 servings of dairy each day, which increased their daily totals to 1,142 mg of calcium and 69 g of protein.

The extra servings of dairy in care homes led to the following:

  • An 11% relative risk reduction in cumulative incidence of falls (number needed to treat=20)
  • A 33% relative risk reduction in all fractures (46% for hip fractures specifically)
  • No difference in all-cause mortality
  • No additional weight gain (but those in the control group lost a modest amount of weight)

“Ice cream tonight!” chanted residents of one fictional long-term care facility. Unfortunately, this study didn’t examine the intake of butter, cream, or ice cream—the fun stuff—because they contain only trace amounts of calcium or protein, so we can’t confirm their link to fall prevention.

Nonetheless, these are welcome findings given the high prevalence of falls in care facilities and the easy access to dairy products as a means of increasing calcium and protein intake. Clinicians caring for this patient population may want to reassess their residents’ diets and consider adding dairy products when appropriate.

A Side of Plastics With That?


As if we needed another reason to avoid fast food, preliminary research suggests that traces of plastic in fast-food products are as ubiquitous as that feeling of regret 30 minutes later.

In the name of science, researchers from George Washington University ordered 64 items from the most popular nationwide fast-food chains. Food items included burgers, nuggets, fries, pizza, burritos—the good stuff. The researchers also ordered three pairs of handling gloves, to which the employees apparently did not even raise an eyebrow. The researchers tested the items for 11 chemicals, which fell under the umbrella of either ortho-phthalates (eg, DnBP and DEHP), with known toxicity, or replacement plasticizers (eg, DEHT), with unknown health implications.

Given the numerous opportunities for interaction with plastic in the fast-food supply chain, it is not surprising that all food products sampled contained either ortho-phthalates or replacement plasticizers. DnBP was found in 81% of the food; DEHP in 70%; and DEHT in 86%. As we may have guessed, the gloves also contained DEHT. Food items with meat showed the highest chemical concentrations, whereas cheese pizza showed the lowest.

“Why should we avoid eating plastic?” asked no one ever.

For starters, some ortho-phthalates have been linked to “adverse reproductive and metabolic outcomes across the life course.” They have also been tied to neurodevelopment disorders.

Making matters worse, the prevalence of fast-food options in residential areas where communities of color predominate make this a potential health equity issue.

These preliminary findings—while eye-opening—demand further study. More data may lead to “regulatory exposure reduction strategies” down the road. Until then, this study is yet another reason to encourage patients to cook at home when possible. But if food on the go is a must, ordering items lower on the food chain could mitigate the risk. As always, pizza wins—just hold the pepperoni.

COVID-19 Rapid-Fire Updates


Gut Reaction to Exercise Program


Recommending physical activity to patients has always been a no-brainer, much like choosing Morgan Freeman to narrate a movie. However, a new study on exercise in patients with obesity adds three more reasons to the list: increases in insulin sensitivity, reductions in visceral adiposity, and modest changes in three gut microbiome genera. For those who need a refresher, “genera” (plural of genus) is the taxonomic category that ranks above species and below family.

The study included only 14 participants (50% men), averaging 51 years of age and a BMI of 35.9 kg/m2. Each participant engaged in an eight-week exercise program consisting of 50 minutes of moderate-intensity exercise, two to four times a week.

Exercise led to the following observations:

  • Increased insulin sensitivity (3.8 mg/min/kg to 4.5 mg/min/kg; P=.007)
  • Decreased visceral adiposity (959 cm3to 897 cm3P=.02)
  • No changes in gut microbiota α- or β-diversity were observed
  • Modest increases in the amount of Ruminococcus gauvreauii, Lachnospiraceae FCS020 group, and Anaerostipes

These findings indicate that an exercise intervention program in patients with obesity “causes significant improvements in cardiovascular and metabolic health in the presence of modest changes in 3 gut microbiome genera.” And one of these genera, R gauvreauii, positively correlates with cardiorespiratory fitness and insulin sensitivity. According to the study’s authors, this suggests “a potential role for this acetate producer to cause improvement in insulin sensitivity in response to exercise.”

These findings provide even more evidence to support the benefits of exercise beyond simply burning calories. Although we found this study fascinating, we can’t help but wonder how much more interesting it would have sounded had Morgan Freeman read it to us.

Did You Know?

We know that worms make tasty fish bait and help nourish soil, but did you know that in the near future, worms may be able to add a “sniffs out cancer” bullet to their resume? Well, we’re speaking specifically of Caenorhabditis elegans, or tiny worms. Apparently, the smell of the chemicals in cancer cell secretions, cancer tissues, and urine from individuals with certain cancers is catnip to this nematode worm. A new study revealed that C elegans were more drawn to patients with very-early-stage pancreatic ductal adenocarcinoma than those without. Given the marked improvement in the survival of patients whose pancreatic cancer is caught earlier, these tiny worms offer exciting opportunities for more research.

Longest Follow-Up of Bone Density Changes


A quarter century is a long time. Just ask any Atlanta Braves fan who waited that long for this week’s World Series win. It’s also long enough, researchers believe, to see a clear picture of changes in bone mineral density (BMD) in postmenopausal women. The longest study to date on this topic recently released its 25-year findings, and the results are better than we expected.

Every five years, beginning in 1989, this study measured the BMD of the femoral neck of a group of women from the Kuopio Osteoporosis Risk Factor and Prevention (OSTPRE) study. Four generations of dual-energy x-ray absorptiometry (DXA) scanners were used to measure the BMD. In 2014, after 25 years of follow-up, the original group of 3,200 women had funneled down to 686.

Here’s what the results showed over the course of 25 years:

  • BMD at the femoral neck decreased by an average of 10% in postmenopausal women, whereas shorter studies had estimated >20% decreased
  • The yearly decrease in BMD was only 0.4%, far superior to the 1.6% previously suggested in shorter studies
  • Greater use of hormone replacement therapy as well as lower baseline BMI and greater weight gain during follow-up offered the strongest protection against BMD
  • The number of diseases, intake of vitamin D or calcium supplements, use of corticosteroids, or smoking, or consumption of alcohol did not play a significant role in bone loss

More to come as the 30-year measurements are currently underway. In the meantime, we’ll take solace in this study’s findings that the percentage of bone loss in postmenopausal women may not be as high as we had previously estimated.

Interested in more healthcare news? Here are some other articles we don’t want you to miss:

Morning Report is written by:

  • Alissa Scott, Lead Author
  • Aylin Madore, MD, MEd, Author and Editor
  • Shira Page, RN, NP, Author and Editor

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