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Eating yogurt plus more fruits, vegetables reduces hip fracture risk in women

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November 13, 2017

Women who consumed a large amount of milk but little fruits and vegetables had a higher risk for hip fracture than those who consumed large amounts of fermented milk, such as yogurt, combined with large amounts of fruits and vegetables, study data show.

Liisa Byberg, PhD, associate professor in the department of surgical sciences at Uppsala University in Sweden, and colleagues evaluated data from the Swedish Mammography Cohort study on 38,071 women born between 1914 and 1948 to determine how milk and fermented milk combined with fruit and vegetables are associated with hip fracture. Participants originally completed food frequency and lifestyle questionnaires from 1987 to 1990 and updated the information in 1997.

During a mean follow-up of 22 years, 5,827 women presented with hip fracture at a median age of 80.4 years. A dose-response pattern was observed between hip fracture risk and milk intake per 200 mL glass of milk (multivariable-adjusted HR = 1.07; 95% CI, 1.04-1.1). A higher consumption of fermented milk per 200 mL per day decreased the rates for hip fracture (multivariable-adjusted HR = 0.89; 95% CI, 0.86-0.92), and hip fracture rates also decreased with a higher consumption of fruits of vegetables.

“Irrespective of whether the women were low or high consumers of fruits and vegetables, we found higher hip fracture rates with increasing consumption of milk,” the researchers wrote.

Compared with participants who drank less than one glass of milk and ate at least five servings of fruits and vegetables per day, those who consumed at least three glasses of milk and less than two servings of fruits and vegetables per day had an increased risk for hip fracture (multivariable-adjusted HR = 2.49; 95% CI, 2.03-3.05). Drinking more milk — at least three glasses — and eating more vegetables ( 5 servings per day) did not greatly reduce the risk (HR = 2.14; 95% CI, 1.69-2.71). The HRs for hip fracture were 2.02 (95% CI, 1.79-2.29) for participants who consumed one to two glasses of milk with less than two servings of fruits and vegetables per day and 1.16 (95% CI, 1.03-1.35) for those who consumed at least five servings of fruits and vegetables and one to two glasses of milk per day.

“In contrast, increasing consumption of fermented milk was associated with a lower rate of hip fracture in each category of fruit and vegetable intake,” the researchers wrote.

Compared with participants who ate little fermented milk, fruits and vegetables, those who consumed at least two servings of fermented milk and at least five servings of fruit and vegetables had a decreased HR for hip fracture (0.81; 95% CI, 0.68-0.97).

“Our observational results in this population of Swedish women question the value of recommending high consumption of milk in the prevention of fragility fractures,” the researchers wrote. “However, the results show that moderate intakes of fermented milk in combination with a high intake of fruits and vegetables are associated with lower hip fracture rates.” – by Amber Cox

Disclosures: The authors report no relevant financial disclosures.

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Jeri Nieves
Perspective

In the Swedish mammography cohort, dietary data, assessed by food frequency questionnaire, were used to determine the role of dairy products and fruit and vegetable intake in hip fracture risk in 5,827 incident hip fractures. Hip fracture rates were highest in those with a high consumption of milk combined with a low consumption of fruits and vegetables, whereas hip fracture rates were lowest among women with a high intake of fermented milk and high intakes of fruits and vegetables. Although, they state that they “question the value of recommending high consumption of milk in the prevention of fragility fractures,” the increased risk of hip fracture with increasing milk intake is not confirmed in U.S. cohorts (Sahni S, et al. J Bone Miner Res. Aug 2014;doi:10.1002/jbmr.2219; Feskanich D, et al. Osteoporos Int. 2017;doi:10.1007/s00198-017-4285-8). In fact, in the Framingham study, greater intakes of milk and milk plus yogurt lowered the risk for hip fracture, and in a combined analysis of two U.S. cohorts, each serving of milk per day was associated with a significantly lower risk for hip fracture in men and women combined. Furthermore, two earlier meta-analyses have shown no association between milk and hip fracture risk (Bischoff-Ferrari HA, et al. J Bone Miner Res. 2011;doi:10.1002/jbmr.279. Bolland MJ, et al. BMJ. 2015;doi:10.1136/bmj.h4580) with no indication of increased risk. I would suggest that we look at the diet as a whole; and in this Swedish Cohort, more closely following a healthy diet, consisting of fish, cereals and whole grain bread, poultry, eggs, pasta and rice, fruits, vegetables and fermented milk led to a 31% lower hip fracture rate (Lemming EW, et al. Eur J Epidemiol. 2017;doi:10.1007/s10654-017-0267-6). Perhaps we should accentuate the positive aspects of this healthy diet that may protect against hip fractures and wait for further data before suggesting a reduction in milk intake.

Jeri W. Nieves, PhD

Associate Professor of Clinical Epidemiology
Columbia University
Director, Bone Density Testing and Clinical Research
Clinical Research Center
Helen Hayes Hospital

Disclosure: Nieves reports she receives grants from Eli Lilly and the NIH.