Publisher Health

Q. I’m lactose intolerant, but still enjoy milk in cereal and coffee. What is the best alternative, nondairy milk to drink?A. The bottom line is that a variety of alternative drinks can provide similar nutrition to cow’s milk, so other than personal preference, it comes down to how you define “best.”Cow’s milk is naturally high in protein, calcium and a variety of other important vitamins and minerals. Through fortification, it also offers vitamins A and D.If the goal is to enjoy a product as similar to cow’s milk as possible, then lactose-free cow’s milk or soy milk may be your best bets. “A diagnosis of lactose intolerance actually doesn’t mean you have to fully avoid cow’s milk dairy products,” said Alicia Romano, a registered dietitian at the Frances Stern Nutrition Center at Tufts Medical Center, and a spokeswoman for the Academy of Nutrition and Dietetics. Lactose is the sugar that’s naturally present in milk and other dairy products in varying degrees; milk has the most, hard cheeses have the least, Ms. Romano said. People who are lactose intolerant don’t produce enough lactase, the enzyme that helps you digest lactose.Lactose intolerance affects approximately 25 to 40 percent of adults globally. Tens of millions of Americans are thought to be lactose intolerant, which can cause cramping, diarrhea and bloating when they eat lactose-containing foods. Lactose intolerance is particularly common in African Americans, Ashkenazi Jews, Latinos and American Indians, affecting up to 80 percent or more of some groups. From a nutritional perspective, Ms. Romano recommends lactose-free milk as the first alternative to consider because the nutritional profile is the same as regular milk, with lactase enzyme added to it. But there is a wide variety of healthy nondairy, plant-based alternatives available as well.“If you’re looking for a milk alternative that’s most similar in a side-by-side comparison, that ounce by ounce has the most similar nutritional value, then unsweetened, fortified soy milk is your best bet,” Ms. Romano said. “It lines up with calcium, vitamin D, other nutrients, calories — the profile is almost identical.”Other good options can be various nut milks and oat milk.Aileen Son for The New York Times“Soy and nut milk have healthier fat profiles than cow’s milk,” Dr. Walter Willett, a professor of epidemiology and nutrition at the Harvard T.H. Chan School of Public Health, said. Coconut milk, like cow’s milk, is high in saturated fat, which raises cholesterol levels. Soy milk and the various nut milks without added sugar — such as almond, walnut, peanut, cashew, hazelnut or macadamia nut milk — as well as hemp and flax milks are higher in heart-healthy unsaturated fats, and also tend to have fewer calories than cow’s milk. Oat milk, without added sugar, is high in fiber, and calories are comparable to cow’s milk.Soy milk is one of the only nondairy alternatives that matches cow’s milk’s eight grams of protein per cup. But protein deficiency is not a concern in the United States, Dr. Willett said, especially for adults. If, however, you are looking to get a significant amount of protein from milk, check the labels on different products, as amounts vary widely among the alternatives to cow’s milk.Both Ms. Romano and Dr. Willett also suggest checking labels to look for alternatives that are fortified with calcium and vitamin D, which may help with bone health. “We definitely need vitamin D,” Dr. Willett said, though we probably don’t need the high levels of calcium that many Americans think they need. “When we look at dairy directly, we don’t see that high dairy consumption reduces fracture rates in terms of the evidence,” he said.They also advise watching out for lots of added sugar in flavored milk alternatives. Ideally there would be no added sugar in the product, but generally aim for below 10 grams per serving.One last consideration: the planet. “It’s important to look at everything through both a health lens and an environmental lens at this point in time,” Dr. Willett said. Dairy production is tied to high levels of greenhouse gas emissions and requires a lot of water. “So for the environmental footprint, alternative milks are actually desirable.”Sophie Egan is the author of “How to Be a Conscious Eater: Making Food Choices That Are Good for You, Others, and the Planet” (Workman, 2020).

A new study has found that greater body fat is a risk factor for reduced cognitive function, such as processing speed, in adults.
Even when the researchers took cardiovascular risk factors (such as diabetes or high blood pressure) or vascular brain injury into account, the association between body fat and lower cognitive scores remained. This suggests other not yet confirmed pathways that linked excess body fat to reduced cognitive function.
In the study, 9,166 participants were measured by bioelectrical impedance analysis to assess their total body fat.
As well, 6,733 of the participants underwent magnetic resonance imaging (MRI) to measure abdominal fat packed around the organs known as visceral fat, and the MRI also assessed vascular brain injury — areas in the brain affected by reduced blood flow to the brain.
The results were published today in JAMA Network Open.
“Our results suggest that strategies to prevent or reduce having too much body fat may preserve cognitive function,” said lead author Sonia Anand, a professor of medicine of McMaster University’s Michael G. DeGroote School of Medicine and a vascular medicine specialist at Hamilton Health Sciences (HHS). She is also a senior scientist of the Population Health Research Institute of McMaster and HHS.
She added that “the effect of increased body fat persisted even after adjusting for its effect on increasing cardiovascular risk factors like diabetes and high blood pressure, as well as vascular brain injury, which should prompt researchers to investigate which other pathways may link excess fat to reduced cognitive function.”
Co-author Eric Smith, a neurologist, scientist and an associate professor of clinical neurosciences at the University of Calgary, said that “preserving cognitive function is one of the best ways to prevent dementia in old age. This study suggests that one of the ways that good nutrition and physical activity prevent dementia may be by maintaining healthy weight and body fat percentage.”
Smith is head of the brain core lab for the two population cohorts used for this new analysis- the Canadian Alliance for Healthy Hearts and Minds (CAHHM) and PURE Mind- a sub-study of the large, international Prospective Urban Rural Epidemiological (PURE) study.
The participants were in the age range of 30 to 75 with an average age of about 58. Just over 56% were women; they all lived in either Canada or Poland. The majority were White European origin, with about 16% other ethnic backgrounds. Individuals with known cardiovascular disease were excluded.
The CAHHM study was funded by the Canadian Partnership Against Cancer, Heart and Stroke Foundation of Canada, and Canadian Institutes of Health Research (CIHR). The PURE-Mind study was funded from multiple sources including the Population Health Research Institute, CIHR, and Heart and Stroke Foundation.
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Black patients diagnosed with dilated cardiomyopathy (DCM) of unknown cause are more likely to have family members at risk of developing the heart muscle disease than families of white patients, according to results of a multi-site study led by researchers at The Ohio State University Wexner Medical Center and College of Medicine.
Researchers studied the prevalence and risk of familial DCM in Black and white patients and their family members, noting most studies have included only whites even though Blacks with DCM have a higher risk of heart failure-related hospitalization and death. Researchers believe most of idiopathic, or unknown cause, DCM has a genetic basis.
Using mathematical modeling techniques, researchers estimated that 30% of patients with DCM seen at a typical advanced heart failure program in the U.S. had at least one first-degree family member (child, sibling or parent) with DCM. When broken down by self-identified race, an estimated 39% of Black patients and 28% of white patients had at least one first-degree family member with DCM. The study was published today in the Journal of the American Medical Association.
“Integrating Black families into this DCM study was critically important because most information has only been available for white patients. Our study shows that families of Black patients are at greater risk for DCM than those of white patients. We don’t yet understand all of the reasons for this. It could be from differences in genetics, comorbidities or social determinants of health. This analysis, which only included clinical information, was unable to clarify that, but the genetic analysis being completed now will soon be available,” said Dr. Ray Hershberger, a cardiologist and division director of human genetics at the Ohio State Wexner Medical Center and a researcher at the Dorothy M. Davis Heart and Lung Research Institute. Hershberger is the senior author of the study and heads up the DCM Consortium, which is composed of 25 leading academic U.S. heart failure/heart transplant programs that contributed to the study.
The five-year study enrolled 1,220 patients with DCM, of which 44% were women, 43% were Black and 8% were Hispanic, along with 1,693 of their first-degree relatives. DCM is a condition in which the heart muscle weakens and the left ventricle enlarges. It’s the most common cause of patients needing a heart transplant and responsible for about half of heart failure cases that result from a weakened left ventricle. Prior information has suggested that 1 in 250 Americans have DCM.
DCM can occur in family members at almost any age but the typical onset is mid 40s. The severity of the condition can vary within families, with some family members exhibiting minor symptoms while others may die of heart failure or an arrhythmia causing sudden cardiac death. Symptoms include shortness of breath with exertion, fatigue, edema of the legs and feet, an irregular heartbeat or lethal arrhythmias.
The study estimated that about 1 in 5 first-degree family members of patients with idiopathic DCM were at risk of getting the condition during their lifetime.
“DCM can be silent for months to years before symptoms begin. Eventually heart failure may develop, which is late-phase disease. Since medical treatment has been shown to mitigate asymptomatic DCM, guidelines have recommended that, with a diagnosis of DCM, the patient’s first-degree family members undergo clinical screening including an echocardiogram so that early asymptomatic DCM can be found and treatment initiated before progression to late-phase disease,” Hershberger said. “For the first time, this study gives us hard numbers on how to counsel family members on their risk of developing DCM, and especially so for family members of Black patients with DCM.”
In 2014, Greg Ruf, 57, of Dublin was diagnosed with DCM and has been raising awareness since then about the disease that led to him having a heart transplant last July at Ohio State’s Richard M. Ross Heart Hospital. Nine family members have been identified with gene mutations known to cause DCM.
“There’s a million plus people in the United States that are dealing with this and unfortunately many don’t know. It’s really important to prevent death in your family or advanced disease by getting tested and dealing with this thing head on,” Ruf said.
The study is the first of a series based on findings by the DCM Consortium. The study also examined the genetics of patients with DCM, which will be published later in 2022.

Every year, nearly 5 million Americans are evaluated for traumatic brain injury in emergency departments across the country.
These injuries can happen in many different ways — from car crashes and military conflict to falls and everyday activities — and they’re diagnosed in around 2% of all United States emergency department visits.
Awareness of the magnitude of TBIs has increased over the last several decades, particularly in sports and the military. But a group of experts from across the nation say the country’s current system of care is often failing to meet the needs of the individuals, families and communities affected by traumatic brain injury.
“We as physicians are frustrated that there are significant limitations to what we can do for our patients for an injury that has real-life, debilitating consequences,” said Frederick Korley, M.D., Ph.D., associate professor of emergency medicine at Michigan Medicine. “There are many important, structural changes that need to be made to provide better care for patients who often go through a prolonged recovery process.”
Korley is part of a select team of researchers who recently authored a report analyzing the health care system’s response to TBI for the National Academies of Sciences, Engineering, and Medicine. The study, funded by the U.S. Department of Defense, found that the lack of a comprehensive framework for classification, care and research poses significant burdens for everyone involved — leading to needless death, squandered human potential and soaring costs. Their report contains numerous recommendations for improving TBI care and research.
TBI classification
When those near-5 million Americans arrive at the ER each year to be evaluated for brain injuries, they are placed into one of three categories: mild, moderate or severe.

To find treatments for connective tissue disorders like fibrosis, scientists need models that can replicate the structure and function of human tissue when it’s healthy as well as when it isn’t, and react to drugs just like diseased human tissue would. But most models are based on animals and present significant limitations.
A new laboratory test model developed by Brown University researchers uses human cells and replicates not only the structure of human tissue, but also its mechanics.
The researchers describe the model in an Advanced Science study published on Tuesday, Feb. 1.
“This model gives researchers a new tool to not only explore the underlying mechanisms of fibrosis and inherited diseases of the extracellular matrix but to also test potential treatments for them,” said senior author Jeff Morgan, a Brown University professor of pathology and laboratory medicine, and of engineering.
That development is crucial, Morgan added, because there are no cures for fibrosis, and disorders of the extracellular matrix like Ehlers-Danlos syndrome and Marfan syndrome are in need of new treatments.
Framing the issue
Key to the functionality of the new model is that it does not include an external artificial “scaffold” for the cells; it uses a novel approach in which cells are harnessed to make their own natural extracellular matrix.

A team of scientists from Scripps Research has conducted promising early tests of a new strategy that might one day be used to prevent or treat type 2 diabetes.
The scientists, whose results are reported in Nature Communications, tested an experimental compound called IXA4 in obese mice. They showed that the compound activates a natural signaling pathway that protects the animals from harmful, obesity-driven metabolic changes that would normally lead to diabetes.
“We were able to activate this pathway in both the liver and the pancreas with this one compound, and that added up to a significant overall improvement in metabolic health of obese animals,” says Scripps Research’s Luke Wiseman, PhD.
“This is the first time anyone has shown that a small molecule activating this pathway in this manner works to treat disease in a live animal,” adds Enrique Saez, PhD.
The study was a collaboration between the laboratories of Saez and Wiseman, who are both professors in the Department of Molecular Medicine at Scripps Research and co-senior authors on the new paper.
Type 2 diabetes remains a major public health problem: about 30 million people are estimated to have it in the U.S. alone. Driven largely by overweight and obesity, it features the loss of normal blood sugar regulation, and brings a multitude of health issues including higher risks of heart disease, stroke, kidney disease, nerve damage, retinal degeneration, and some cancers. There are many drugs for treating type 2 diabetes, but none that works well for every patient.

A new study from MIT suggests that the dozens of mutations in the spike protein of the Omicron variant help it to evade all four of the classes of antibodies that can target the SARS-CoV-2 virus that causes Covid-19.
This includes antibodies generated by vaccinated or previously infected people, as well as most of the monoclonal antibody treatments that have been developed, says Ram Sasisekharan, the Alfred H. Caspary Professor of Biological Engineering and Health Sciences and Technology (HST) at MIT.
Using a computational approach that allowed them to determine how mutated amino acids of the viral spike protein influence nearby amino acids, the researchers were able to get a multidimensional view of how the virus evades antibodies. According to Sasisekharan, the traditional approach of only examining changes in the virus’ genetic sequence reduces the complexity of the spike protein’s three-dimensional surface and doesn’t describe the multidimensional complexity of the protein surfaces that antibodies are attempting to bind to.
“It is important to get a more comprehensive picture of the many mutations seen in Omicron, especially in the context of the spike protein, given that the spike protein is vital for the virus’s function, and all the major vaccines are based on that protein,” he says. “There is a need for tools or approaches that can rapidly determine the impact of mutations in new virus variants of concern, especially for SARS-CoV-2.”
Sasisekharan is the senior author of the study, which appears this week in Cell Reports Medicine. The lead author of the paper is MIT HST graduate student Nathaniel Miller. Technical associate Thomas Clark and research scientist Rahul Raman are also authors of the paper.
Even though Omicron is able to evade most antibodies to some degree, vaccines still offer protection, Sasisekharan says.

As new coronavirus variants emerge and quickly spread around the globe, both the public and policymakers are faced with a quandary: maintaining a semblance of normality, while also minimizing infections. While digital contact tracing apps offered promise, the adoption rate has been low, due in part to privacy concerns.
At USC, researchers are advocating for a new approach to predict the chance of infection from Covid-19: combining anonymized cellphone location data with mobility patterns — broad patterns of how people move from place to place.
To produce “risk scores” for specific locations and times, the team used a large dataset of anonymous, real-world location signals from cell phones across the US in 2019 and 2020. The system shows a 50% improvement in accuracy compared to current systems, said the researchers.
“Our results show that it is possible to predict and target specific areas that are high-risk, as opposed to putting all businesses under one umbrella. Such risk-targeted policies can be significantly more effective, both for controlling Covid-19 and economically,” said lead author Sepanta Zeighami, a computer science Ph.D. student advised by Professor Cyrus Shahabi.
“It’s also unlikely that Covid-19 will be the last pandemic in human history, so if we want to avoid the chaos of 2020 and the tragic losses while keeping daily life as unaffected as possible when the next pandemic happens, we need such data-driven approaches.”
To address privacy concerns, the mobility data comes in an aggregated format, allowing the researchers to see patterns without identifying individual users. The data is not being used for contact tracing, identifying infected individuals, or where they are going, said the researchers.

A study published in the journal PLOS Medicine is the first to examine in a realistic setting whether pictorial health warnings on sugary drinks — like juice and soda — influence which beverages parents buy for their children.
The findings are promising: The warnings reduced parental purchases of sugary drinks for their kids by 17%.
Researchers at the University of North Carolina at Chapel Hill’s Gillings School of Global Public Health ran the study in a unique laboratory — the “UNC Mini Mart.” The space is set up to mimic a convenience store shopping experience.
We created this store because we saw a major need for research that tests the impact of policies in an food store setting that is much more realistic. When people make choices about what food to buy, they are juggling dozens of factors like taste, cost, and advertising and are looking at many products at once,” says senior author Lindsey Smith Taillie, PhD, assistant professor in the Department of Nutrition at the Gillings School and a member of UNC’s Carolina Population Center (CPC). “Showing that warnings can cut through the noise of everything else that’s happening in a food store is powerful evidence that they would help reduce sugary drink purchases in the real world.”
Taillie’s co-authors from the Gillings School are lead author Marissa G. Hall, PhD, assistant professor in Gillings’ Department of Health Behavior and a member of both the CPC and UNC’s Lineberger Comprehensive Cancer Center (LCCC); and Anna H. Grummon, PhD, an alumna of the Gillings Department of Health Behavior who is now a David. E. Bell Fellow at Harvard University.
Their positive findings about the effects of image-based warning labels highlight a recent but ever-more-common approach to combatting the global struggle with obesity. Children in the United States and many other countries consume more than the recommended amount of sugary drinks, which increases their risk for obesity and diet-related chronic diseases, including Type 2 diabetes and heart conditions. There are pronounced disparities by race/ethnicity, with higher rates of sugary drink consumption and obesity among Black and Latino children compared to non-Latino white children, in part due to structural factors like targeted marketing.
Taillie has conducted research on warning labels and taxes on sugar-sweetened beverages and junk food in Chile, Mexico and South Africa. Hall researches the impact of warnings on tobacco and food as well as effectiveness of obesity prevention policies.
In their study, 326 parents (25% Black, 20% Latino) of children ages 2 to 12 years old participated in a randomized trial with 1) a pictorial warning arm (in which drink labels had images representing heart damage and Type 2 diabetes), and 2) a control arm (in which drinks labels displayed a barcode).
Participants were instructed to choose one drink and one snack for their child, along with one household good — this shopping list was designed to mask the purpose of the study. After shopping, participants completed a survey about their selections and left with their drink of choice and a cash incentive.
The picture warnings led to a 17% reduction in purchases of sugary drinks, with 45% of parents in the control arm buying a sugary drink for their child compared to 28% in the pictorial warning arm.
The warnings also reduced calories purchased from sugary drinks and led to parents feeling more in control of healthy eating decisions and thinking more about the harms of sugary drinks. The benefits of the picture warnings were similar according to parent characteristics, including race, ethnicity, and socioeconomic status, suggesting picture warnings could work equally well across diverse populations. But larger studies are needed to see how well warnings work for groups at highest risk of diet-related disease.
“We think the paper could be useful for policymakers in the U.S. and globally,” Hall says. “This evidence supports strong, front-of-package warnings to reduce sugary drink consumption in children.”

Obesity is associated with an increased risk of developing female reproductive disorders, however, the roles and mechanisms of obesity in the cause(s) of reproductive conditions are unclear. A study publishing February 1st in PLOS Medicine by Samvida Venkatesh at University of Oxford, United Kingdom and colleagues suggests an etiological link between obesity and a range of female reproductive conditions, but the extent of this link differs among conditions.
Female reproductive disorders are common conditions affecting the health and well-being of many. However, the role of obesity in the development of female reproductive conditions is under-studied. To investigate the causal associations between obesity, metabolic hormones, and female reproductive disorders, researchers conducted a Mendelian randomization study of 257,193 women of European ancestry aged 40-69. They accessed records from UK Biobank, a large-scale biomedical database containing the medical, environmental, and genetic information of participants. The researchers then created a statistical model to estimate the association of body mass index and waist-to-hip ratio with risk of numerous female reproductive conditions including endometriosis, heavy menstrual bleeding, pre-eclampsia, and infertility.
The researchers found observational associations between obesity and a range of female reproductive disorders, including uterine fibroids, polycystic ovary syndrome, heavy menstrual bleeding, and pre-eclampsia. They also found that some inherited genetic variation associated with obesity is also associated with female reproductive disorders, but the strength of those associations differed by type of obesity and reproductive condition. The study had several limitations, such as the low prevalence of female reproductive disorders among participants, and a lack of body mass index and waist-hip-ratio data prior to disease onset.
According to the authors, “We provide genetic evidence that both generalised and central obesity play an aetiological role in a broad range of female reproductive conditions, but the extent of this link differs substantially between conditions. Our results suggest a need to explore the mechanisms mediating the causal associations of overweight and obesity on gynaecological health to identify targets for disease prevention and treatment.”
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