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Fung TT, Rossato SL, Chen Z, Khandpur N, Rodriguez-Artalejo F, Willett WC, Struijk EA, Lopez-Garcia E. Ultraprocessed foods, unprocessed or minimally processed foods, and risk of frailty in a cohort of United States females. Am J Clin Nutr 2024; 120:232-239. [PMID: 38750726 DOI: 10.1016/j.ajcnut.2024.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 05/03/2024] [Accepted: 05/07/2024] [Indexed: 05/28/2024] Open
Abstract
BACKGROUND Ultraprocessed foods (UPFs) and poor diet quality have been associated with frailty but existing studies had relatively short follow-up time. It is also unclear whether the association of UPF was primarily due to its correlation with poorer diet quality. OBJECTIVES We examined the association between unprocessed or minimally processed foods (UMFs) and UPF and risk of frailty and explored whether the association with UPF was mainly driven by poor diet quality. METHODS In total, 63,743 nonfrail females aged 60+ y from the Nurses' Health Study (cohort study) were followed up for ≥26 y. Diet was assessed every 4 y by food frequency questionnaires. UPF and UMF intakes were calculated using the Nova classification. Diet quality was estimated using the Alternate Healthy Eating Index (AHEI) 2010. The association of UMF and UPF with risk of frailty was examined using multivariable adjusted Cox proportional hazard model. RESULTS During the follow-up period, we recorded 15,187 incident cases of frailty. The hazard ratio (HR) of frailty for the highest compared with the lowest quintile of UMFs (servings per day) was 0.86 (95% CI: 0.83, 0.95; P-trend < 0.001). However, this was no longer statistically significant after adjustment for AHEI-2010. UPFs (servings per day) was directly associated with risk of frailty, even after adjustment for AHEI-2010 (1.31; 95% CI: 1.23, 1.39; P-trend < 0.001). Among those at the highest category of the AHEI-2010, UPFs remained directly associated with frailty (HR comparing top with bottom quintile: 1.40; 95% CI:1.24, 1.57; P-trend < 0.001). For UPF components, we found a higher frailty risk with each serving per day of artificial and sugar-sweetened beverages; fat, spreads, and condiments; yogurt and dairy-based desserts; and other UPFs. However, processed whole grains were not associated with frailty. CONCLUSIONS Higher intake of UPF is associated with a higher risk of frailty in older females. This is not explained by a lower diet quality contributed by UPFs.
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Affiliation(s)
- Teresa T Fung
- Department of Nutrition, Simmons University, Boston, MA, United States; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States.
| | - Sinara L Rossato
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States; Laboratory of Research and Extension in Epidemiolgy (Lapex-Epi), Institute of Geography Universidade Federal de Uberlândia. Uberlândia, Brazil
| | - Zhangling Chen
- Department of Cardiology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China; Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Neha Khandpur
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States; Department of Division of Human Nutrition and Health, Wageningen University, Netherlands; Faculty of Public Health, University of Sao Paulo, Brazil
| | - Fernando Rodriguez-Artalejo
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid-Idi Paz, Madrid, Spain
| | - Walter C Willett
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States; Channing Division of Network Medicine, Department of Medicine, Brigham & Women's Hospital and Harvard Medical School, Boston, MA, United States
| | - Ellen A Struijk
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid-Idi Paz, Madrid, Spain; CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain
| | - Esther Lopez-Garcia
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid-Idi Paz, Madrid, Spain; CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain; Instituto Madrileño De Estudios Avanzado-Food Institute, Campus de Excelencia Internacional Universidad Autónoma de Madrid+Centro Superior de Investigaciones Científicas, Madrid, Spain
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Beydoun MA, Noren Hooten N, Fanelli-Kuczmaski MT, Maino Vieytes CA, Georgescu MF, Beydoun HA, Freeman DW, Evans MK, Zonderman AB. Growth Differentiation Factor 15 and Diet Quality Trajectory Interact to Determine Frailty Incidence among Middle-Aged Urban Adults. J Nutr 2024; 154:1652-1664. [PMID: 38479650 PMCID: PMC11130674 DOI: 10.1016/j.tjnut.2024.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 03/05/2024] [Accepted: 03/08/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND Elevated plasma growth differentiation factor 15 (GDF15) and poor diet quality may be associated with increased frailty incidence, although their interactive associations have not been assessed in urban middle-aged adults. OBJECTIVES We aimed to examine GDF15 and its interactive association with diet quality in relation to frailty incidence among a sample of middle-aged urban adults. METHODS The relationship between GDF15 and diet quality trajectories in relation to incident frailty was examined in a longitudinal study of participants in the Healthy Aging in Neighborhoods of Diversity across the Life Span (2004-2017). Serum GDF15 concentration and frailty incidence were primary exposure and outcome, respectively. Group-based trajectory models were used to assess diet quality trajectories (≤3 visits/participant, N = 945, N' = 2247 observations) using the Healthy Eating Index 2010 version (HEI-2010), Dietary Inflammatory Index, and mean adequacy ratio (MAR). Cox proportional hazards models were used, testing interactive associations of GDF15 and diet quality trajectories with frail/prefrail incidence (N = 400 frailty-free at first visit, N' = 604 observations, n = 168 incident frail/prefrail). RESULTS Both elevated GDF15 and lower diet quality trajectories were associated with a lower probability of remaining nonfrail (≤13 y follow-up). Among females, the "high diet quality" HEI-2010 trajectory had a hazard ratio (HR) of 0.15 [95% confidence interval (CI): 0.04, 0.54; P = 0.004; fully adjusted model] when compared with the "low diet quality" trajectory group. Among males only, there was an antagonistic interaction between lower HEI-2010 trajectory and elevated GDF15. Specifically, the HR for GDF15-frailty in the higher diet quality trajectory group (high/medium combined), and among males, was 2.69 (95% CI: 1.06, 6.62; P = 0.032), whereas among the lower diet quality trajectory group, the HR was 0.94 (95% CI: 0.49, 1.80; P = 0.86). Elevated GDF15 was independently associated with frailty among African American adults. CONCLUSIONS Pending replication, we found an antagonistic interaction between GDF15 and HEI-2010 trajectory in relation to frailty incidence among males.
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Affiliation(s)
- May A Beydoun
- Laboratory of Epidemiology and Population Sciences, NIA/NIH/IRP, Baltimore, MD, United States.
| | - Nicole Noren Hooten
- Laboratory of Epidemiology and Population Sciences, NIA/NIH/IRP, Baltimore, MD, United States
| | | | | | - Michael F Georgescu
- Laboratory of Epidemiology and Population Sciences, NIA/NIH/IRP, Baltimore, MD, United States
| | - Hind A Beydoun
- VA National Center on Homelessness Among Veterans, U.S. Department of Veterans Affairs, Washington, DC, United States; Department of Management, Policy, and Community Health, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - David W Freeman
- Department of Oncological Sciences, School of Medicine, University of Utah, Salt Lake City, UT, United States
| | - Michele K Evans
- Laboratory of Epidemiology and Population Sciences, NIA/NIH/IRP, Baltimore, MD, United States
| | - Alan B Zonderman
- Laboratory of Epidemiology and Population Sciences, NIA/NIH/IRP, Baltimore, MD, United States
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Li X, Wang Q, Ma T, Chang X, Xue Y, Zhang Y, Liu W, Zhang Y, Zhao Y. Dietary inflammatory index, dietary total antioxidant capacity, and frailty among older Chinese adults. J Nutr Health Aging 2024; 28:100168. [PMID: 38341967 DOI: 10.1016/j.jnha.2024.100168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 01/18/2024] [Indexed: 02/13/2024]
Abstract
OBJECTIVES Frailty is an age-related syndrome associated with poor health outcomes. Studies in developed countries indicate that the dietary inflammatory index (DII) and dietary total antioxidant capacity (DTAC) are important dietary factors influencing the risk of frailty in older adults. However, few studies have explored the association between DII, DTAC, and frailty among older Chinese adults. The objective of the current study was to examine whether DII and DTAC were associated with pre-frailty or frailty among older Chinese adults. DESIGN A cross-sectional study. SETTING Community-based. PARTICIPANTS We included 6414 participants aged ≥60 years. MEASUREMENTS Dietary intake was assessed using a validated food frequency questionnaire (FFQ). The DII and energy-adjusted DII (E-DII) were calculated using food parameters. DTAC was estimated using two widely adopted antioxidant scores: DTAC based on ferric reducing antioxidant power and dietary antioxidant quality score (DAQS) obtained from vitamins (vitamins A, C, and E) and minerals (zinc and selenium) with antioxidant functions. Frailty was assessed using the frailty index (FI) calculated from 28 health-related deficits. Individuals were classified as robust (FI ≤ 0.10), pre-frailty (FI > 0.10 to <0.25), or frailty (FI ≥ 0.25). Multiple logistic regression models were used to evaluate the associations of DII and DTAC with pre-frailty and frailty. RESULTS After adjusting for confounding factors, individuals in the highest DII quintile (Q5) were more likely to have pre-frailty (odds ratio [OR] = 1.56; 95% confidence interval [CI]: 1.25-1.93; P for trend <0.001) than those in the lowest Q1. A similar positive association was detected for E-DII and pre-frailty. A significant association was found between DII and frailty. Compared with the lowest Q1, the highest Q5 of DTAC was negatively correlated with pre-frailty (OR = 0.66; 95% CI: 0.52-0.84; P for trend <0.001) and frailty (OR = 0.71; 95% CI: 0.50-0.1.03; P for trend <0.001). The DAQS yielded results similar to pre-frailty results (OR = 0.72; 95% CI: 0.58-0.89; P < 0.001). There was no evidence suggesting an association between DAQS and frailty. CONCLUSIONS More proinflammatory diets were linked to higher pre-frailty risk, whereas higher levels of dietary antioxidants were associated with lower pre-frailty and frailty risk among older Chinese adults.
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Affiliation(s)
- Xiaoxia Li
- School of Public Health of Ningxia Medical University, Yinchuan 750004, China; NHC Key Laboratory of Metabolic Cardiovascular Diseases Research, Ningxia Medical University, Yinchuan 750004, China; Key Laboratory of Environmental Factors and Chronic Disease Control, School of Public Health of Ningxia Medical University, Yinchuan 750004, China
| | - Qingan Wang
- School of Public Health of Ningxia Medical University, Yinchuan 750004, China; NHC Key Laboratory of Metabolic Cardiovascular Diseases Research, Ningxia Medical University, Yinchuan 750004, China; Key Laboratory of Environmental Factors and Chronic Disease Control, School of Public Health of Ningxia Medical University, Yinchuan 750004, China
| | - Tao Ma
- School of Public Health of Ningxia Medical University, Yinchuan 750004, China; Key Laboratory of Environmental Factors and Chronic Disease Control, School of Public Health of Ningxia Medical University, Yinchuan 750004, China
| | - Xiaoyu Chang
- School of Public Health of Ningxia Medical University, Yinchuan 750004, China
| | - Yixuan Xue
- School of Public Health of Ningxia Medical University, Yinchuan 750004, China; Key Laboratory of Environmental Factors and Chronic Disease Control, School of Public Health of Ningxia Medical University, Yinchuan 750004, China
| | - Yadi Zhang
- School of Public Health of Ningxia Medical University, Yinchuan 750004, China; Key Laboratory of Environmental Factors and Chronic Disease Control, School of Public Health of Ningxia Medical University, Yinchuan 750004, China
| | - Wanlu Liu
- School of Public Health of Ningxia Medical University, Yinchuan 750004, China; NHC Key Laboratory of Metabolic Cardiovascular Diseases Research, Ningxia Medical University, Yinchuan 750004, China; Key Laboratory of Environmental Factors and Chronic Disease Control, School of Public Health of Ningxia Medical University, Yinchuan 750004, China
| | - Yuhong Zhang
- School of Public Health of Ningxia Medical University, Yinchuan 750004, China; NHC Key Laboratory of Metabolic Cardiovascular Diseases Research, Ningxia Medical University, Yinchuan 750004, China; Key Laboratory of Environmental Factors and Chronic Disease Control, School of Public Health of Ningxia Medical University, Yinchuan 750004, China.
| | - Yi Zhao
- School of Public Health of Ningxia Medical University, Yinchuan 750004, China; NHC Key Laboratory of Metabolic Cardiovascular Diseases Research, Ningxia Medical University, Yinchuan 750004, China; Key Laboratory of Environmental Factors and Chronic Disease Control, School of Public Health of Ningxia Medical University, Yinchuan 750004, China.
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Huang L, Chen H, Gao M, Shen J, Tao Y, Huang Y, Lv R, Xie R, Lv X, Xu X, Xu X, Yuan C. Dietary factors in relation to the risk of cognitive impairment and physical frailty in Chinese older adults: a prospective cohort study. Eur J Nutr 2024; 63:267-277. [PMID: 37930363 DOI: 10.1007/s00394-023-03260-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 09/27/2023] [Indexed: 11/07/2023]
Abstract
PURPOSE The study aimed to investigate the independent associations of dietary factors with cognitive impairment (CI) and physical frailty (PF) among Chinese older adults. METHODS This study included 10,734 participants (mean age = 78.7 years) free of CI and PF at baseline from the Chinese Longitudinal Health Longevity Survey. Dietary intake was collected using a simplified food frequency questionnaire every 3-4 years. The Chinese version Mini-Mental State Examination was used to assess cognition function, participants with a score below 18 were defined as CI. PF was defined using the activities of daily living, instrumental activities of daily living, and functional limitation-related questions. The outcome was defined as the first onset of either CI or PF. Competing risk models were used to estimate the corresponding hazard ratios (HRs) and the 95% confidence intervals (95% CIs). RESULTS During the study follow-up (mean = 8.1 years), a total of 1220 CI cases and 1451 PF cases were newly identified. Higher frequency of fruits intake was associated with a lower hazard of CI (HR = 0.75, 95% CI 0.58-0.97), whereas higher intake of preserved vegetables demonstrated an opposite association (HR = 1.23, 95% CI 1.07-1.42). In terms of PF, we observed a lower risk associated with higher meat and poultry intake (HR = 0.72, 95% CI 0.61-0.88). In particular, a significant protective association of fish and aquatic products intake with PF was observed among participants with ≥ 28 natural teeth (HR = 0.52, 95% CI 0.27-0.99). CONCLUSION Our findings suggest divergent roles of major dietary factors in the development of CI and PF among Chinese older adults.
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Affiliation(s)
- Liyan Huang
- School of Public Health, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310058, Zhejiang, China
| | - Hui Chen
- School of Public Health, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310058, Zhejiang, China
| | - Mengyan Gao
- School of Public Health, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310058, Zhejiang, China
| | - Jie Shen
- School of Public Health, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310058, Zhejiang, China
| | - Yang Tao
- School of Public Health, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310058, Zhejiang, China
| | - Yuhui Huang
- School of Public Health, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310058, Zhejiang, China
| | - Rongxia Lv
- School of Public Health, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310058, Zhejiang, China
| | - Renxiang Xie
- School of Public Health, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310058, Zhejiang, China
| | - Xiaozhen Lv
- Beijing Dementia Key Lab, National Clinical Research Center for Mental Disorders, NHC Key Laboratory of Mental Health (Peking University), Peking University Institute of Mental Health (Sixth Hospital), Beijing, 100191, China
| | - Xin Xu
- School of Public Health, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310058, Zhejiang, China
| | - Xiaolin Xu
- School of Public Health, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310058, Zhejiang, China.
| | - Changzheng Yuan
- School of Public Health, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310058, Zhejiang, China.
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA.
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5
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Zhang H, Li W, Wang Y, Dong Y, Greenwood DC, Hardie LJ, Cade JE. Mediterranean diet associated with lower frailty risk: A large cohort study of 21,643 women admitted to hospitals. J Nutr Health Aging 2024; 28:100001. [PMID: 38267161 DOI: 10.1016/j.jnha.2023.100001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 11/06/2023] [Accepted: 11/07/2023] [Indexed: 01/26/2024]
Abstract
BACKGROUND Mediterranean diet is traditionally considered as a healthy dietary pattern, while its association with frailty has not been confirmed. This study investigated associations between Mediterranean diet and risk of frailty among women admitted to hospitals in England from an older-aged women's cohort study. METHODS A modified Mediterranean diet was evaluated from a validated 217-item food frequency questionnaire. Incident frailty was determined using a hospital frailty risk score based on linkage to Hospital Episode Statistics up to March 2019. Cox proportional hazard models were conducted to estimate hazard ratios (HR) and 95% confidence intervals (CI). Further subgroup analyses stratified by age and body mass index (BMI), and sensitivity analyses were additionally explored. RESULTS Over a mean follow-up of 13 years, there were 14,838 (68.6%) cases of frailty out of 21,643 individuals included in this study. Compared with low adherence to Mediterranean diet, moderate adherence was associated with 5% (HR = 0.95, 95%CI: 0.91, 0.99) lower risk of frailty, with high adherence associated with even lower risk (HR = 0.89, 95%CI: 0.85, 0.94). The magnitude of above associations remained consistent in subgroups stratified by age and BMI, except the association between moderate adherence and risk of frailty was attenuated in the ≥60-year (HR = 0.99, 95%CI: 0.93, 1.06) and the BMI > 24.9 kg/m2 (HR = 0.97, 95%CI: 0.91, 1.03) subgroups. CONCLUSIONS Adherence to Mediterranean diet was associated with lower risk of frailty. The better the adherence, the greater the magnitude of the protective association. Older and overweight women may potentially benefit from greater adherence to the Mediterranean diet regarding frailty prevention.
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Affiliation(s)
- Huifeng Zhang
- Clinical Nutrition Department, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Road, Xi'an 710061, China; Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds LS2 9JT, UK.
| | - Weimin Li
- Clinical Nutrition Department, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Road, Xi'an 710061, China.
| | - Youfa Wang
- Global Health Institute, School of Public Health, Xi'an Jiaotong University, Xi'an 710116, China.
| | - Yuanyuan Dong
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds LS2 9JT, UK.
| | - Darren C Greenwood
- Leeds Institute for Data Analytics, Faculty of Medicine and Health, University of Leeds, Leeds LS2 9JT, UK.
| | - Laura J Hardie
- Division of Clinical and Population Sciences, Leeds Institute of Cardiovascular and Metabolic Medicine, School of Medicine, University of Leeds, Leeds LS2 9JT, UK.
| | - Janet E Cade
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds LS2 9JT, UK.
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Barrera A, Rezende LFM, Sabag A, Keating CJ, Rey-Lopez JP. Understanding the Causes of Frailty Using a Life-Course Perspective: A Systematic Review. Healthcare (Basel) 2023; 12:22. [PMID: 38200928 PMCID: PMC10778671 DOI: 10.3390/healthcare12010022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 12/16/2023] [Accepted: 12/18/2023] [Indexed: 01/12/2024] Open
Abstract
(1) Background: Few studies have examined risk factors of frailty during early life and mid-adulthood, which may be critical to prevent frailty and/or postpone it. The aim was to identify early life and adulthood risk factors associated with frailty. (2) Methods: A systematic review of cohort studies (of at least 10 years of follow-up), using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA). A risk of confounding score was created by the authors for risk of bias assessment. Three databases were searched from inception until 1 January 2023 (Web of Science, Embase, PubMed). Inclusion criteria were any cohort study that evaluated associations between any risk factor and frailty. (3) Results: Overall, a total of 5765 articles were identified, with 33 meeting the inclusion criteria. Of the included studies, only 16 were categorized as having a low risk of confounding due to pre-existing diseases. The long-term risk of frailty was lower among individuals who were normal weight, physically active, consumed fruits and vegetables regularly, and refrained from tobacco smoking, excessive alcohol intake, and regular consumption of sugar or artificially sweetened drinks. (4) Conclusions: Frailty in older adults might be prevented or postponed with behaviors related to ideal cardiovascular health.
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Affiliation(s)
- Antonio Barrera
- Faculty of Health Sciences, Universidad Internacional de Valencia (VIU), 46002 Valencia, Spain;
| | - Leandro F. M. Rezende
- Department of Preventive Medicine, Escola Paulista de Medicina, Universidade Federal de Sao Paulo, Sao Paulo 04023-900, SP, Brazil;
| | - Angelo Sabag
- Discipline of Exercise and Sport Science, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia;
| | | | - Juan Pablo Rey-Lopez
- Faculty of Health Sciences, Universidad Internacional de Valencia (VIU), 46002 Valencia, Spain;
- Facultad de Deporte, UCAM Universidad Catolica de Murcia, 30107 Murcia, Spain;
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Zhang H, Li W, Wang Y, Dong Y, Greenwood DC, Hardie LJ, Cade JE. Foods, Nutrients, and Risk of In-Hospital Frailty in Women: Findings from a Large Prospective Cohort Study. Nutrients 2023; 15:4619. [PMID: 37960271 PMCID: PMC10650049 DOI: 10.3390/nu15214619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 10/18/2023] [Accepted: 10/23/2023] [Indexed: 11/15/2023] Open
Abstract
Frailty is increasingly prevalent worldwide because of aging populations. Diet may play a role as a modifiable risk factor. This study aimed to investigate associations between dietary factors and risk of frailty in the UK Women's Cohort admitted to hospitals in England. Consumption of foods and nutrients was estimated using a validated 217-item food frequency questionnaire at baseline. Incident frailty was assessed via a hospital frailty risk score based on linkage with hospital episode statistics. Out of 25,186 participants admitted to hospitals, 6919 (27%) were identified with frailty and 10,562 (42%) with pre-frailty over a mean follow-up of 12.7 years. After adjustment for confounding, we observed a 12% increase in risk of frailty with each additional 10 g/MJ intake of total meat (HR = 1.12, 95%CI: 1.07, 1.17), with the highest risk observed for processed meats (HR = 1.45, 95%CI: 1.21, 1.73). Similar associations were observed with pre-frailty. Vegetable intake was associated with slightly lower risk of frailty (HR = 0.98, 95%CI: 0.97, 1.00). There was no evidence of association between most nutrient intakes and in-hospital frailty risk. Overall, our findings suggest that reducing consumption of meat, especially processed meat, in adults may be beneficial regarding the development of frailty.
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Affiliation(s)
- Huifeng Zhang
- Clinical Nutrition Department, The First Affiliated Hospital of Xi’an Jiaotong University, 277 Yanta West Road, Xi’an 710061, China;
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds LS2 9JT, UK; (Y.D.); (J.E.C.)
| | - Weimin Li
- Clinical Nutrition Department, The First Affiliated Hospital of Xi’an Jiaotong University, 277 Yanta West Road, Xi’an 710061, China;
| | - Youfa Wang
- Global Health Institute, School of Public Health, Xi’an Jiaotong University, Xi’an 710116, China
| | - Yuanyuan Dong
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds LS2 9JT, UK; (Y.D.); (J.E.C.)
| | - Darren C. Greenwood
- Leeds Institute for Data Analytics, Faculty of Medicine and Health, University of Leeds, Leeds LS2 9JT, UK;
| | - Laura J. Hardie
- Division of Clinical and Population Sciences, Leeds Institute of Cardiovascular and Metabolic Medicine, School of Medicine, University of Leeds, Leeds LS2 9JT, UK;
| | - Janet E. Cade
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds LS2 9JT, UK; (Y.D.); (J.E.C.)
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8
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Kuczmarski MF, Beydoun MA, Georgescu MF, Noren Hooten N, Mode NA, Evans MK, Zonderman AB. Pro-Inflammatory Diets Are Associated with Frailty in an Urban Middle-Aged African American and White Cohort. Nutrients 2023; 15:4598. [PMID: 37960250 PMCID: PMC10648548 DOI: 10.3390/nu15214598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 10/24/2023] [Accepted: 10/27/2023] [Indexed: 11/15/2023] Open
Abstract
Diet quality is a modifiable risk factor for frailty, but research on the association of frailty with dietary inflammatory potential is limited. The objective was to determine associations between diet quality assessed by the dietary inflammatory index (DII) with frailty status over time. Participants with both dietary and frailty data from the longitudinal Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study were used (n = 2901, 43.5% male, 43.8% African American, 48.5 y mean baseline age, with a mean 8.7 y of follow-up). Group-based trajectory modeling identified two frailty (remaining non-frail or being pre-frail/frail over time) and three diet quality trajectory groups (high or medium pro-inflammatory and anti-inflammatory potentials). Multiple logistic regression found both medium pro-inflammatory and anti-inflammatory DII trajectory groups, compared to the high pro-inflammatory group, were positively associated with being non-frail over time for the overall sample, both sexes and races. Kaplan-Meier curves and log-rank test revealed anti-inflammatory DII scores were associated with lower risk for being pre-frail or frail. No longitudinal relationship existed between frailty status at baseline and annualized DII change, a check on reverse causality. This study contributes to our current knowledge providing longitudinal evidence of the link between anti-inflammatory DII score with lower frailty risk.
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Affiliation(s)
- Marie Fanelli Kuczmarski
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, National Institutes of Health, Baltimore, MD 21224, USA; (M.A.B.); (M.F.G.); (N.N.H.); (N.A.M.); (M.K.E.); (A.B.Z.)
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Rey-García J, Donat-Vargas C, Sandoval-Insausti H, Banegas JR, Dominguez LJ, Rodríguez-Artalejo F, Guallar-Castillón P. Less favourable food consumption ratings in the Five-Color Nutri-Score are associated with incident frailty in older adults. Age Ageing 2023; 52:afad142. [PMID: 37566560 DOI: 10.1093/ageing/afad142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND The Nutri-Score front-of-package labelling classifies food products according to their nutritional quality, so healthier food choices are easier when shopping. This study prospectively assesses the association of a diet rated according to the Nutri-Score system and incident frailty in community-dwelling older adults. METHODS Cohort study with 1,875 individuals aged ≥60 recruited during 2008-2010 in Spain. At baseline, food consumption was assessed using a validated dietary history. Food was categorised into five Nutri-Score labels (A/green-best quality; B, C, D, E/red-worst quality) utilising an algorithm established in 2017 and currently in use. For each participant, a Five-Color Nutri-Score Dietary Index (5-CNS DI) in grams per day per kilogram was calculated. The 5-CNS DI sums up the grams per day of food consumed times their corresponding nutritional quality value (from A rated as 1 to E rated as 5) and divided by weight in kilograms. From baseline to December 2012, incident frailty was ascertained based on Fried's criteria. Statistical analyses were performed with logistic regression adjusted for main confounders. RESULTS After a mean follow-up of 3.5 years, 136 cases of frailty were identified. The multivariable-adjusted odds ratios (95% confidence interval) of incident frailty across increasing quartiles of the 5-CNS DI were 1, 1.51 (0.86-2.68), 1.56 (0.82-2.98) and 2.32 (1.12-4.79); P-trend = 0.033. The risk of frailty increased by 28% (3-58%) with a 10-unit increment in this dietary index. Similar results were found with the Nutri-Score algorithm modified in 2022. CONCLUSIONS consumption of a diet with less favourable Nutri-Score ratings doubles the risk of frailty among community-dwelling older adults.
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Affiliation(s)
- Jimena Rey-García
- Internal Medicine Department, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - Carolina Donat-Vargas
- ISGlobal-Institut de Salut Global de Barcelona, Barcelona, Spain
- Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain
| | - Helena Sandoval-Insausti
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
- CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - José R Banegas
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
- CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain
| | - Ligia J Dominguez
- Faculty of Medicine and Surgery, Kore University of Enna, Enna, Italy
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Palermo, Italy
| | - Fernando Rodríguez-Artalejo
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
- CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain
- IMDEA-Food Institute, CEI UAM+CSIC, Madrid, Spain
| | - Pilar Guallar-Castillón
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
- CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain
- IMDEA-Food Institute, CEI UAM+CSIC, Madrid, Spain
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10
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Duan Y, Qi Q, Cui Y, Yang L, Zhang M, Liu H. Effects of dietary diversity on frailty in Chinese older adults: a 3-year cohort study. BMC Geriatr 2023; 23:141. [PMID: 36918767 PMCID: PMC10012609 DOI: 10.1186/s12877-023-03875-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 03/06/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Frailty has emerged as a global health burden with increased population aging. A diverse diet is essential for an adequate and balanced supply of nutrients. However, limited evidence supports the relationship between dietary diversity and frailty. We therefore assessed the associations of dietary diversity with the risk of frailty. METHODS We used the Chinese Longitudinal Healthy Longevity Survey to analyze a prospective cohort of Chinese older adults. A total of 1948 non-frail older adults were included in the final sample. Participants were categorized into groups with high or low dietary diversity scores (DDSs) using a food frequency questionnaire. A Generalized Estimating Equation were used to estimate risk ratios (RRs) and 95% confidence intervals (CIs) for determining frailty incidence. RESULTS Among 1,948 participants, 381 had frailty with the prevalence of 19.56% during the 3-year follow-up period. Compared with the low DDS group, the high DDS group exhibited a lower risk of frailty (RR, 0.72; 95% CI: 0.57-0.91). Compared with those with a consistently low DDS, the RR of participants with a consistently high DDS for frailty was 0.56 (95% CI: 0.42-0.74). Moreover, meat, beans, fish, nuts, fresh fruits, and fresh vegetables were inversely associated with frailty. In stratified analysis, a consistently high DDS, compared with a consistently low DDS, reduced the risk of frailty for people aged 65-79 years and those living in town and rural areas. CONCLUSION This study found a prospective association between dietary diversity and frailty among Chinese older adults. These findings stressed that it is important to improve dietary diversity for older adults to promote healthy ageing, particularly for young older adults and in town and rural areas.
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Affiliation(s)
- Ying Duan
- School of Public Health, Bengbu Medical College, No.2600 Donghai Ave, Bengbu, 233030, China
| | - Qi Qi
- School of Public Health, Bengbu Medical College, No.2600 Donghai Ave, Bengbu, 233030, China
| | - Yan Cui
- School of Public Health, Bengbu Medical College, No.2600 Donghai Ave, Bengbu, 233030, China
| | - Ling Yang
- School of Public Health, Bengbu Medical College, No.2600 Donghai Ave, Bengbu, 233030, China
| | - Min Zhang
- School of Health Management, Bengbu Medical College, Bengbu, Anhui, China
| | - Huaqing Liu
- School of Public Health, Bengbu Medical College, No.2600 Donghai Ave, Bengbu, 233030, China.
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11
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Disentangling the Complexity of Nutrition, Frailty and Gut Microbial Pathways during Aging: A Focus on Hippuric Acid. Nutrients 2023; 15:nu15051138. [PMID: 36904138 PMCID: PMC10005077 DOI: 10.3390/nu15051138] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 02/16/2023] [Accepted: 02/23/2023] [Indexed: 02/26/2023] Open
Abstract
Hippuric acid (HA) is a metabolite resulting from the hepatic glycine conjugation of benzoic acid (BA) or from the gut bacterial metabolism of phenylalanine. BA is generally produced by gut microbial metabolic pathways after the ingestion of foods of vegetal origin rich in polyphenolic compounds, namely, chlorogenic acids or epicatechins. It can also be present in foods, either naturally or artificially added as a preservative. The plasma and urine HA levels have been used in nutritional research for estimating the habitual fruit and vegetable intake, especially in children and in patients with metabolic diseases. HA has also been proposed as a biomarker of aging, since its levels in the plasma and urine can be influenced by the presence of several age-related conditions, including frailty, sarcopenia and cognitive impairment. Subjects with physical frailty generally exhibit reduced plasma and urine levels of HA, despite the fact that HA excretion tends to increase with aging. Conversely, subjects with chronic kidney disease exhibit reduced HA clearance, with HA retention that may exert toxic effects on the circulation, brain and kidneys. With regard to older patients with frailty and multimorbidity, interpreting the HA levels in the plasma and urine may result particularly challenging because HA is at the crossroads between diet, gut microbiota, liver and kidney function. Although these considerations may not make HA the ideal biomarker of aging trajectories, the study of its metabolism and clearance in older subjects may provide valuable information for disentangling the complex interaction between diet, gut microbiota, frailty and multimorbidity.
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12
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Wang XM, Zhong WF, Li ZH, Chen PL, Zhang YJ, Ren JJ, Liu D, Shen QQ, Yang P, Song WQ, Liang F, Nan Y, Xiang JX, Wu YR, Lv YB, Gao X, Kraus VB, Shi XM, Mao C. Dietary diversity and frailty among older Chinese people: evidence from the Chinese Longitudinal Healthy Longevity Study. Am J Clin Nutr 2023; 117:383-391. [PMID: 36811562 DOI: 10.1016/j.ajcnut.2022.11.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 10/26/2022] [Accepted: 11/22/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Dietary diversity is widely advocated as a means to promote health, but little is known regarding whether the beneficial effects still apply in older adults. OBJECTIVE To examine the association between the dietary diversity score (DDS) and frailty among older Chinese adults. METHODS A total of 13,721 adults aged ≥65 y without frailty at baseline were enrolled. The DDS at baseline was constructed based on 9 items of a food frequency questionnaire. We used 39 self-reported health items to construct a frailty index (FI), with FI ≥ 0.25 indicating frailty. Cox models with restricted cubic splines were used to evaluate the dose-response relationships of DDS (continuous) with frailty. In addition, Cox proportional hazard models were used to examine the association between DDS (categorized as scores ≤4, 5-6, 7, and ≥8) and frailty. RESULTS During the mean follow-up of 5.94 y, 5250 participants met the criteria for frailty. Each 1-unit increase in DDS corresponded to a 5% lower risk of frailty (hazard ratio [HR]; 0.95; 95% CI: 0.94, 0.97]. Compared with participants with DDS ≤4 points, those with a DDS of 5-6, 7, and ≥8 points exhibited a lower frailty risk, with HRs of 0.79 (95% CI: 0.71, 0.87), 0.75 (95% CI: 0.68, 0.83), and 0.74 (95% CI: 0.67, 0.81), respectively (P-trend < 0.001). Protein-rich food items, such as meat; eggs; and beans, were associated with protective effects against frailty. In addition, a significant association was observed between higher consumption of 2 high-frequency foods, tea and fruits, and lower risk of frailty. CONCLUSIONS A higher DDS was associated with a lower risk of frailty among older Chinese adults. This study highlights the importance of a diverse diet as a potential modifiable behavioral factor for preventing frailty in older Chinese adults.
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Affiliation(s)
- Xiao-Meng Wang
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, Guangdong, China
| | - Wen-Fang Zhong
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, Guangdong, China
| | - Zhi-Hao Li
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, Guangdong, China
| | - Pei-Liang Chen
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, Guangdong, China
| | - Yu-Jie Zhang
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, Guangdong, China
| | - Jiao-Jiao Ren
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, Guangdong, China
| | - Dan Liu
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, Guangdong, China
| | - Qiao-Qiao Shen
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, Guangdong, China
| | - Pei Yang
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, Guangdong, China
| | - Wei-Qi Song
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, Guangdong, China
| | - Fen Liang
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, Guangdong, China
| | - Ying Nan
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, Guangdong, China
| | - Jia-Xuan Xiang
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, Guangdong, China
| | - Yin-Ru Wu
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, Guangdong, China
| | - Yue-Bin Lv
- National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xiang Gao
- Nutritional Epidemiology Lab, Pennsylvania State University, Philadelphia, PA, USA; and
| | - Virginia Byers Kraus
- Duke Molecular Physiology Institute and Division of Rheumatology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Xiao-Ming Shi
- National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China.
| | - Chen Mao
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, Guangdong, China.
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13
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Murphy CH, Duggan E, Davis J, O'Halloran AM, Knight SP, Kenny RA, McCarthy SN, Romero-Ortuno R. Plasma lutein and zeaxanthin concentrations associated with musculoskeletal health and incident frailty in The Irish Longitudinal Study on Ageing (TILDA). Exp Gerontol 2023; 171:112013. [PMID: 36336250 DOI: 10.1016/j.exger.2022.112013] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 10/20/2022] [Accepted: 10/31/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Lutein and zeaxanthin are diet-derived carotenoids that are proposed to help mitigate frailty risk and age-related declines in musculoskeletal health via their anti-oxidant and anti-inflammatory properties. Therefore, this study aimed to investigate the association between lutein and zeaxanthin status and indices of musculoskeletal health and incident frailty among community-dwelling adults aged ≥50 years in the Irish Longitudinal Study on Ageing (TILDA). METHODS Cross-sectional analyses (n = 4513) of plasma lutein and zeaxanthin concentrations and grip strength, usual gait speed, timed up-and-go (TUG), probable sarcopenia (defined as grip strength <27 kg in men, <16 kg in women), and bone mass (assessed using calcaneal broadband ultrasound stiffness index) were performed at Wave 1 (2009-2011; baseline). In the longitudinal analyses (n = 1425-3100), changes in usual gait speed (at Wave 3, 2014-2015), grip strength (Wave 4, 2016) and TUG (at Wave 5, 2018), incident probable sarcopenia (at Wave 4) and incident frailty (Fried's phenotype, Frailty Index, FRAIL Scale, Clinical Frailty Scale-classification tree, at Wave 5) were determined. Data were analysed using linear and ordinal logistic regression, adjusted for confounders. RESULTS Cross-sectionally, plasma lutein and zeaxanthin concentrations were positively associated with usual gait speed (B [95 % CI] per 100-nmol/L higher concentration: Lutein 0.59 [0.18, 1.00], Zeaxanthin 1.46 [0.37, 2.55] cm/s) and inversely associated with TUG time (Lutein -0.07 [-0.11, -0.03], Zeaxanthin -0.14 [-0.25, -0.04] s; all p < 0.01), but not with grip strength or probable sarcopenia (p > 0.05). Plasma lutein concentration was positively associated with bone stiffness index (0.54 [0.15, 0.93], p < 0.01). Longitudinally, among participants who were non-frail at Wave 1, higher plasma lutein and zeaxanthin concentrations were associated lower odds of progressing to a higher frailty category (e.g. prefrailty or frailty) by Wave 5 (ORs 0.57-0.89, p < 0.05) based on the Fried's phenotype, FRAIL Scale and the Clinical Frailty Scale, and in the case of zeaxanthin, Frailty Index. Neither plasma lutein nor zeaxanthin concentrations were associated with changes in musculoskeletal indices or incident probable sarcopenia (p > 0.05). CONCLUSION Higher plasma lutein and zeaxanthin concentrations at baseline were associated with a reduced likelihood of incident frailty after ~8 years of follow up. Baseline plasma lutein and zeaxanthin concentrations were also positively associated with several indices of musculoskeletal health cross-sectionally but were not predictive of longitudinal changes in these outcomes over 4-8 years.
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Affiliation(s)
- Caoileann H Murphy
- The Irish Longitudinal Study of Ageing, Trinity College Dublin, Dublin, Ireland; Teagasc Food Research Centre, Ashtown, Dublin, Ireland.
| | - Eoin Duggan
- The Irish Longitudinal Study of Ageing, Trinity College Dublin, Dublin, Ireland; Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - James Davis
- The Irish Longitudinal Study of Ageing, Trinity College Dublin, Dublin, Ireland; Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Aisling M O'Halloran
- The Irish Longitudinal Study of Ageing, Trinity College Dublin, Dublin, Ireland; Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Silvin P Knight
- The Irish Longitudinal Study of Ageing, Trinity College Dublin, Dublin, Ireland; Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Rose Anne Kenny
- The Irish Longitudinal Study of Ageing, Trinity College Dublin, Dublin, Ireland; Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | | | - Roman Romero-Ortuno
- The Irish Longitudinal Study of Ageing, Trinity College Dublin, Dublin, Ireland; Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland
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14
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Sotos-Prieto M, Struijk EA, Fung TT, Rodríguez-Artalejo F, Willett WC, Hu FB, Lopez-Garcia E. Association between the quality of plant-based diets and risk of frailty. J Cachexia Sarcopenia Muscle 2022; 13:2854-2862. [PMID: 36177985 PMCID: PMC9745455 DOI: 10.1002/jcsm.13077] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 07/11/2022] [Accepted: 08/18/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The Mediterranean diet and other dietary patterns rich in fruits and vegetables have been linked to lower risk of frailty in older adults. However, not all plant-based diets are necessarily healthful, and no previous study has evaluated the role of the quality of plant-based dietary patterns in frailty risk. Our aim was to assess the association between plant-based diet quality and risk of frailty. METHODS Prospective cohort consisted with 82 234 women aged ≥60 years from the Nurses' Health Study, who were followed from 1990 through 2014. The dates of analysis were April 14 to June 23, 2021. Dietary data were collected every 4 years using a validated semi-quantitative food frequency questionnaire. The plant-based diet quality was assessed with two indices (range 18-90 points): (a) healthful plant-based diet index (hPDI), where healthy plant foods (whole grains, fruits, vegetables, nuts, legumes, vegetable oils and tea/coffee) received positive scores, while less healthy plant foods (fruit juices, sweetened beverages, refined grains, potatoes, and sweets/desserts) and animal foods received reverse scores; and (b) unhealthful plant-based diet index (uPDI) where positive scores were given to less healthy plant foods and reverse scores to healthy plant foods and animal foods. Frailty incidence was assessed every 4 years, being defined as having three or more of the following five criteria from the FRAIL scale: fatigue, low strength, reduced aerobic capacity, having ≥5 illnesses and weight loss ≥5%. Multivariable-adjusted Cox proportional-hazards models were used to estimate hazard ratios (HRs) and their 95% confidence interval (CI). RESULTS We identified 12 910 incident cases of frailty over 1 176 401 person-year follow-up. In the multivariable analysis, the hPDI was inversely associated with the risk of frailty (hazard ratio [HR] for the highest vs. lowest quintile: 0.77, 95% confidence interval: 0.72-0.81; P trend <0.001). In addition, a 10-unit increment in the hPDI was associated with a relative 15% lower risk of frailty. Conversely, a direct association was found between the uPDI and risk of frailty (HR highest vs. lowest quintile: 1.24 [1.17, 1.32], P trend <0.001). These associations were consistent for each frailty criterion, among participants with no frailty criteria at baseline, after excluding participants with diabetes, cancer and cardiovascular disease at baseline, for alternative versions of the plant-based diet indices (PDIs), in subgroup analysis by categories of potential confounders, and in latency analysis. CONCLUSIONS A healthful plant-based diet was associated with lower risk of frailty whereas an unhealthful plant-based diet was associated with higher risk.
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Affiliation(s)
- Mercedes Sotos-Prieto
- Department of Preventive Medicine and Public Health, School of Medicine, Autonomous University of Madrid, Madrid, Spain.,CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain.,Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,IMDEA-Food Institute, CEI UAM+CSIC, Madrid, Spain
| | - Ellen A Struijk
- Department of Preventive Medicine and Public Health, School of Medicine, Autonomous University of Madrid, Madrid, Spain.,CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain
| | - Teresa T Fung
- Department of Nutrition, Simmons University, Boston, MA, USA.,Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Fernando Rodríguez-Artalejo
- Department of Preventive Medicine and Public Health, School of Medicine, Autonomous University of Madrid, Madrid, Spain.,CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain.,IMDEA-Food Institute, CEI UAM+CSIC, Madrid, Spain
| | - Walter C Willett
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Frank B Hu
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Esther Lopez-Garcia
- Department of Preventive Medicine and Public Health, School of Medicine, Autonomous University of Madrid, Madrid, Spain.,CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain.,IMDEA-Food Institute, CEI UAM+CSIC, Madrid, Spain
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15
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Teresa T. Fung, ScD, RD, Receives 2022 Monsen Award. J Acad Nutr Diet 2022. [DOI: 10.1016/j.jand.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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16
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Zhang XM, Jiao J, Guo N, Zhu C, Li Z, Lv D, Wang H, Jin J, Wen X, Zhao S, Wu X, Xu T. The association between cognitive impairment and 30-day mortality among older Chinese inpatients. Front Med (Lausanne) 2022; 9:896481. [PMID: 36091678 PMCID: PMC9449351 DOI: 10.3389/fmed.2022.896481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 07/29/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Although the association between cognitive impairment and mortality has been widely described among community-dwelling older adults, this association in hospitalized patients was limited. Objectives This study's purpose was to explore the association between cognitive impairment and 30-day mortality after adjustment of factors among Chinese in-patients. Methods This was a large-scale prospective study based on a cohort of patients aged 65 years and older, whose cognitive function was assessed using the Mini-Cog instrument, followed up at 30-days for mortality. Multivariate logistic regression models were used to assess the association between cognitive impairment and 30-day mortality. Results There were 9,194 inpatients in our study, with an average age of 72.41 ± 5.72. The prevalence of cognitive impairment using the Mini-Cog instrument was 20.5%. Multivariable analyses showed that patients with cognitive impairment have an increased risk of 30-day mortality, compared to those with normal cognitive function (OR = 2.83,95%CI:1.89–4.24) in an unadjusted model. In the fully adjusted model, Patients with cognitive impairment had an increased risk of 30-day mortality compared to those with normal cognitive function in the completely adjusted model (OR = 1.76,95% CI: 1.14–2.73). Additionally, this association still existed and was robust after performing a stratified analysis of age, gender, frailty and depression, with no significant interaction (P > 0.05). Conclusions Our study found that older Chinese in-patients with cognitive impairment have a 1.76-fold risk of 30-day mortality compared to patients with normal cognitive function, suggesting that clinicians and nurses need to early implement cognitive function screening and corresponding interventions to improve clinical outcomes for older in-patients.
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Affiliation(s)
- Xiao-Ming Zhang
- Department of Nursing, Peking Union Medical College Hospital (Dongdan Campus), Chinese Academy of Medical Sciences - Peking Union Medical College, Beijing, China
| | - Jing Jiao
- Department of Nursing, Peking Union Medical College Hospital (Dongdan Campus), Chinese Academy of Medical Sciences - Peking Union Medical College, Beijing, China
- *Correspondence: Jing Jiao
| | - Na Guo
- Department of Nursing, Peking Union Medical College Hospital (Dongdan Campus), Chinese Academy of Medical Sciences - Peking Union Medical College, Beijing, China
| | - Chen Zhu
- Department of Nursing, Peking Union Medical College Hospital (Dongdan Campus), Chinese Academy of Medical Sciences - Peking Union Medical College, Beijing, China
| | - Zhen Li
- Department of Nursing, Peking Union Medical College Hospital (Dongdan Campus), Chinese Academy of Medical Sciences - Peking Union Medical College, Beijing, China
| | - Dongmei Lv
- Department of Nursing, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Hui Wang
- Department of Nursing, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Jingfen Jin
- Department of Nursing, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Xianxiu Wen
- Department of Nursing, Sichuan Provincial People's Hospital, Chengdu, China
| | - Shengxiu Zhao
- Department of Nursing, Qinghai Provincial People's Hospital, Xining, China
| | - Xinjuan Wu
- Department of Nursing, Peking Union Medical College Hospital (Dongdan Campus), Chinese Academy of Medical Sciences - Peking Union Medical College, Beijing, China
- Xinjuan Wu
| | - Tao Xu
- Department of Epidemiology and Statistics, Peking Union Medical College, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences and School of Basic Medicine, Beijing, China
- Tao Xu
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17
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Maroto-Rodriguez J, Delgado-Velandia M, Ortolá R, Carballo-Casla A, García-Esquinas E, Rodríguez-Artalejo F, Sotos-Prieto M. Plant-based diets and risk of frailty in community-dwelling older adults: the Seniors-ENRICA-1 cohort. GeroScience 2022; 45:221-232. [PMID: 35781859 PMCID: PMC9886709 DOI: 10.1007/s11357-022-00614-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 06/22/2022] [Indexed: 02/03/2023] Open
Abstract
Frailty is a geriatric syndrome that leads to increased risk of hospitalization, disability, and death. The effect of plant-based diets defined by the quality of their plant foods is unclear. Our objective is to study the association between two plant-based diet indices and the occurrence of frailty among community-dwelling older adults in Spain. We analyzed data from 1880 individuals aged ≥ 60 years from the Spanish Seniors ENRICA-1 cohort. We used a validated diet history to build two indices: (a) the healthful Plant-based Diet Index (hPDI) where healthy plant foods received positive scores, whereas less-healthy plant foods and animal foods received reverse scores; and (b) the unhealthful Plant-based Diet Index (uPDI), with positive scores to less-healthy plant foods and reverse scores to animal and healthy plant foods. Incident frailty was defined with the Fried phenotype. Study associations were summarized with odds ratios (OR) and 95% confidence intervals (CI) obtained from multivariable logistic models. After 3.3 years of follow-up, 136 incident frailty cases were ascertained. Comparing the highest vs. the lowest tertile of adherence, the OR [95% CI] for frailty was 0.43 (0.25-0.74; p-trend = .003) for the hPDI, and 2.89 (1.73-4.84; p-trend < .001) for the uPDI. Higher consumption of healthy plant foods was inversely associated with frailty (0.39 [0.23-0.66; p-trend < 0.001]); higher consumption of unhealthy plant foods was associated with higher frailty risk (2.40 [1.23-4.71; p-trend = .01]). In older adults, the hPDI was associated with lower risk of frailty, while the opposite was found for the uPDI.
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Affiliation(s)
- Javier Maroto-Rodriguez
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid and IdiPaz (Instituto de Investigación Sanitaria Hospital Universitario La Paz), Calle del Arzobispo Morcillo, 4, 28029, Madrid, Spain
| | - Mario Delgado-Velandia
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid and IdiPaz (Instituto de Investigación Sanitaria Hospital Universitario La Paz), Calle del Arzobispo Morcillo, 4, 28029, Madrid, Spain
- CIBERESP (CIBER of Epidemiology and Public Health), Av. Monforte de Lemos, 3-5, 28029, Madrid, Spain
| | - Rosario Ortolá
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid and IdiPaz (Instituto de Investigación Sanitaria Hospital Universitario La Paz), Calle del Arzobispo Morcillo, 4, 28029, Madrid, Spain
- CIBERESP (CIBER of Epidemiology and Public Health), Av. Monforte de Lemos, 3-5, 28029, Madrid, Spain
| | - Adrián Carballo-Casla
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid and IdiPaz (Instituto de Investigación Sanitaria Hospital Universitario La Paz), Calle del Arzobispo Morcillo, 4, 28029, Madrid, Spain
- CIBERESP (CIBER of Epidemiology and Public Health), Av. Monforte de Lemos, 3-5, 28029, Madrid, Spain
| | - Esther García-Esquinas
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid and IdiPaz (Instituto de Investigación Sanitaria Hospital Universitario La Paz), Calle del Arzobispo Morcillo, 4, 28029, Madrid, Spain
- CIBERESP (CIBER of Epidemiology and Public Health), Av. Monforte de Lemos, 3-5, 28029, Madrid, Spain
| | - Fernando Rodríguez-Artalejo
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid and IdiPaz (Instituto de Investigación Sanitaria Hospital Universitario La Paz), Calle del Arzobispo Morcillo, 4, 28029, Madrid, Spain
- CIBERESP (CIBER of Epidemiology and Public Health), Av. Monforte de Lemos, 3-5, 28029, Madrid, Spain
- IMDEA-Food Institute, CEI UAM+CSIC, Ctra. de Canto Blanco 8, E. 28049, Madrid, Spain
| | - Mercedes Sotos-Prieto
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid and IdiPaz (Instituto de Investigación Sanitaria Hospital Universitario La Paz), Calle del Arzobispo Morcillo, 4, 28029, Madrid, Spain.
- CIBERESP (CIBER of Epidemiology and Public Health), Av. Monforte de Lemos, 3-5, 28029, Madrid, Spain.
- IMDEA-Food Institute, CEI UAM+CSIC, Ctra. de Canto Blanco 8, E. 28049, Madrid, Spain.
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Boston, MA, 02115, USA.
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Ruangsuriya J, Wongpoomchai R, Srichairatanakool S, Sirikul W, Buawangpong N, Siviroj P. Guava Fruit and Acacia pennata Vegetable Intake Association with Frailty of Older Adults in Northern Thailand. Nutrients 2022; 14:nu14061192. [PMID: 35334846 PMCID: PMC8954598 DOI: 10.3390/nu14061192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 03/10/2022] [Accepted: 03/10/2022] [Indexed: 12/04/2022] Open
Abstract
As Thailand moves toward an aging society, frailty has become a concern amongst northern Thai elderly. The causes of frailty are multifactorial and include genetic, environmental, and socio-economic factors; diet is of particular interest. A cross-sectional study was conducted from September to October 2017 to investigate what kind of diets normally consumed by 350 Thai elders were associated with frailty using a questionnaire and frailty determination by Fried’s phenotype followed by phytochemical analyses of the diets. The multivariable logistic regression analysis demonstrated a significant positive association between certain foods and lower frailty. Guava fruit and Acacia pennata vegetable consumption had lower odds of frailty, which were 0.52 times (95% CI 0.28−0.96, p = 0.037) and 0.42 times (95% CI 0.21−0.83, p = 0.012) when adjusted for the potential confounders. The phytochemical analyses of guava fruit showed a significantly higher amount of total flavonoids (p < 0.001), total phenolic compounds (p = 0.002), and antioxidant capacity, including DPPH (p < 0.001), ABTS (p < 0.001), and FRAP (p = 0.002) when compared to those of banana. Acacia pennata vegetable contained a significantly higher amount of total phenolic compounds (p = 0.012) when compared to those of lettuce. These findings may assist in health promotion programs of frailty prevention by encouraging an increase in consumption of either guava fruit or Acacia pennata vegetable among Thai elderly.
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Affiliation(s)
- Jetsada Ruangsuriya
- Department of Biochemistry, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (J.R.); (R.W.); (S.S.)
- Functional Food Research Center for Well-Being, Science and Technology Research Institute, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Rawiwan Wongpoomchai
- Department of Biochemistry, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (J.R.); (R.W.); (S.S.)
- Functional Food Research Center for Well-Being, Science and Technology Research Institute, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Somdet Srichairatanakool
- Department of Biochemistry, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (J.R.); (R.W.); (S.S.)
| | - Wachiranun Sirikul
- Department of Community Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand;
- Center of Data Analytics and Knowledge Synthesis for Health Care, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Nida Buawangpong
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand;
| | - Penprapa Siviroj
- Department of Community Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand;
- Correspondence:
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19
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Sotos-Prieto M, Struijk EA, Fung TT, Rimm EB, Rodriguez-Artalejo F, Willett WC, Hu FB, Lopez-Garcia E. Association between a lifestyle-based healthy heart score and risk of frailty in older women: a cohort study. Age Ageing 2022; 51:afab268. [PMID: 35136897 PMCID: PMC8826375 DOI: 10.1093/ageing/afab268] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Evidence on the comprehensive role of lifestyle in frailty risk is scarce. To assess the association between a lifestyle-based Healthy Heart Score (HHS), which estimates the 20-year risk of cardiovascular disease (CVD), and risk of frailty among older women. METHODS Prospective cohort study in 121,700 nurses from the USA participating at the Nurses' Health Study. This study included 68,416 women aged ≥60 year with a follow-up from 1990 to 2014. The HHS was computed using the gender-specific beta-coefficients of the nine lifestyle factors, including current smoking, high body mass index, low physical activity, lack of moderate alcohol intake and unhealthy diet. Frailty incidence was assessed every 4 years from 1992 to 2014 as having ≥3 of the following five criteria from the FRAIL scale: fatigue, low strength, reduced aerobic capacity, having ≥5 illnesses and weight loss ≥5%. RESULTS During 22 years of follow-up, 11,041 total incident cases of frailty were ascertained. Compared to women in the lowest quintile of the HHS (lowest estimated CVD risk), the multivariable-adjusted hazard ratio of frailty across quintiles was: Q2:1.67 (95% confidence interval 1.53, 1.82); Q3: 2.34 (2.15, 2.53); Q4: 3.54 (3.28, 3.83) and Q5: 5.92 (5.48, 6.38); P-trend > 0.001. Results were consistent for each frailty criterion, among participants with 0 frailty criteria at baseline, when using only baseline exposure or in 6-year-, 10-year- and 14-year-exposure lagged analyses, and after excluding participants with diabetes and CVD at baseline. CONCLUSIONS The HHS, based on a set of modifiable-lifestyle factors, is strongly associated with risk of frailty in older women.
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Affiliation(s)
- Mercedes Sotos-Prieto
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, and IdiPaz (Instituto de Investigación Sanitaria Hospital Universitario La Paz), Madrid, Spain
- CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- IMDEA-Food Institute, CEI UAM+CSIC, Madrid, Spain
| | - Ellen A Struijk
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, and IdiPaz (Instituto de Investigación Sanitaria Hospital Universitario La Paz), Madrid, Spain
- CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain
| | - Teresa T Fung
- Department of Nutrition, Simmons University, Boston, MA, USA
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Eric B Rimm
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham & Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Fernando Rodriguez-Artalejo
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, and IdiPaz (Instituto de Investigación Sanitaria Hospital Universitario La Paz), Madrid, Spain
- CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain
- IMDEA-Food Institute, CEI UAM+CSIC, Madrid, Spain
| | - Walter C Willett
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham & Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Frank B Hu
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham & Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Esther Lopez-Garcia
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, and IdiPaz (Instituto de Investigación Sanitaria Hospital Universitario La Paz), Madrid, Spain
- CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain
- IMDEA-Food Institute, CEI UAM+CSIC, Madrid, Spain
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20
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Guan M. Associations of fruit & vegetable intake and physical activity with poor self-rated health among Chinese older adults. BMC Geriatr 2022; 22:10. [PMID: 34979973 PMCID: PMC8722069 DOI: 10.1186/s12877-021-02709-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 12/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite the existing literature highlights the central roles of sociodemographic factors, fruit & vegetable (F&V) intake, and physical activities for maintaining good health, less is known about the associations in the Chinese context. This study attempted to explore the associations of servings of F&V intake and levels of physical activities with poor self-rated health (SRH) among Chinese older adults. METHODS Data were drawn from the Study on Global Ageing and Adult Health-China (SAGE-China) issued by the World Health Organization and included 7560 respondents aged ≥60 years in China. After screening out the potential confounding factors, multiple logistic regression models were adopted to explore the associations of sociodemographic factors, servings of F&V intake, and levels of physical activities with poor SRH. RESULTS Among the sample, nearly a quarter reported poor health status. There were significant gender differences in the case of servings of F&V intake and levels of physical activities. Logistic regressions indicated that higher fruit intake was associated with lower likelihood of vigorous level of physical activity as compared to zero intake. Likewise, higher vegetable intake (≥10 servings) was associated with a higher likelihood of vigorous & moderate level of physical activity when compared to lower intake (≤ 4 servings). Higher fruit intake was associated with a lower likelihood of poor SRH. Similarly, vegetable intake (5 servings: AOR = 0.69, 95%CI: 0.58-0.83; 6-9 servings: AOR = 0.72, 95%CI: 0.59-0.87) was significantly associated with poor SRH. Additionally, vigorous level of physical activity (AOR = 0.79, 95%CI: 0.65-0.97) and vigorous fitness/leisure (AOR = 0.57, 95%CI: 0.39-0.84) were significantly associated with poor SRH. CONCLUSION This study suggested that older adults with high fruit intake had lower probability of performing vigorous & moderate level of physical activity, while those with high vegetable intake had higher probability of performing vigorous & moderate level of physical activity. Likewise, the older adults with high F&V intake and higher probability of performing vigorous level of physical activity, walk/bike activity, and vigorous/moderate fitness/leisure had less likelihood to face the risk for poor SRH outcomes. The appropriate servings of F&V intake and levels of physical activity should be highlighted.
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Affiliation(s)
- Ming Guan
- Family Issues Center, Xuchang University, Road Bayi 88, Xuchang, Henan, China. .,International Issues Center, Xuchang University, Road Bayi 88, Xuchang, Henan, China. .,School of Business, Xuchang University, Road Bayi 88, Xuchang, Henan, China.
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21
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Fan Y, Zhang Y, Li J, Liu Y, Zhou L, Yu Y. Association between Healthy Eating Index-2015 and physical frailty among the United States elderly adults: the National Health and Nutrition Examination Survey (NHANES) 2011-2014. Aging Clin Exp Res 2021; 33:3245-3255. [PMID: 33978925 DOI: 10.1007/s40520-021-01874-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 04/28/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Diet plays an important role in the development of age-related chronic diseases. However, the association between diet quality assessed by Healthy Eating Index (HEI)-2015, the latest version of HEI, and physical frailty among the general United States (US) elderly adults remains unclear. AIMS The present study aims to explore the association between HEI-2015 and physical frailty in elderly adults using data from National Health and Nutrition Examination Survey (NHANES) 2011-2014. METHODS HEI-2015 scores were calculated from 2 days 24-h recall interviews. Physical frailty status was assessed by four criteria developed by Fried et al.: exhaustion, weakness, low body mass, and low physical activity, and then categorized into robust (0 criteria), pre-frail (1-2 criteria), or frail (3-4 criteria). The binary and multinomial logistic regressions were used to examine the odds of frailty status. RESULTS A total of 2345 participants aged 60 years or older were included. According to the 4-items frailty criteria, 51.1% participants were robust, 42.1% were pre-frail, and 6.8% were frail. Compared to the lowest HEI-2015 quartile, the elderly adults in the higher quartile had a lower odds of physical frailty (P < 0.05). Regarding the frailty criterion separately, higher HEI-2015 was associated with lower odds of exhaustion, weakness, low physical activity and unintentional weight loss, respectively (P < 0.05). Among 13 HEI-2015 components, adherence to the recommended intake of whole fruits and total vegetables components were less likely to be physically frail (P < 0.05). CONCLUSION Higher HEI-2015 was inversely associated with lower odds of physical frailty in the US elderly adults.
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Affiliation(s)
- Yameng Fan
- School of Public Health, Xi'an Jiaotong University, 76 West Yanta Road, Xi'an, 710061, China
| | - Yinyin Zhang
- School of Public Health, Xi'an Jiaotong University, 76 West Yanta Road, Xi'an, 710061, China
| | - Jiaqiao Li
- School of Public Health, Xi'an Jiaotong University, 76 West Yanta Road, Xi'an, 710061, China
| | - Yamei Liu
- School of Public Health, Xi'an Jiaotong University, 76 West Yanta Road, Xi'an, 710061, China
| | - Long Zhou
- School of Public Health, Xi'an Jiaotong University, 76 West Yanta Road, Xi'an, 710061, China.
- Department of Cardiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China.
| | - Yan Yu
- School of Public Health, Xi'an Jiaotong University, 76 West Yanta Road, Xi'an, 710061, China.
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22
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Ghoreishy SM, Asoudeh F, Jayedi A, Mohammadi H. Fruit and vegetable intake and risk of frailty: A systematic review and dose response meta-analysis. Ageing Res Rev 2021; 71:101460. [PMID: 34534684 DOI: 10.1016/j.arr.2021.101460] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 08/19/2021] [Accepted: 09/11/2021] [Indexed: 12/14/2022]
Abstract
PURPOSE This systematic review and dose-response meta-analysis of observational studies was conducted to summarize available findings on the association between fruits and vegetables (FVs) consumption and risk of frailty. METHODS Online databases including Medline, Scopus, and Embase were searched to detect related publications up to February 2021. Study selection and data extraction were performed by two investigators working in parallel. In most included studies, frailty was defined according to the Fried criteria. Overall, 14 articles with 18,616 subjects with frailty and 101,969 controls were included. To combined data, a random effect model was used. Dose-response associations were also evaluated. RESULTS Fourteen studies (10 cohorts and four cross-sectional) were included. Pooled effect size for the highest versus lowest category of FVs consumption showed an inverse association with risk of frailty (RR cohort = 0.65; 95% CI: 0.50-0.84; I2 = 81%, n = 7). Every one serving (200 g) per day increment in FVs intake was associated with a 14% lower risk of frailty. The risk of frailty decreased linearly up to FVs consumption of 3.5 servings/d, with flattening the curve at higher intake. Pooled analysis regarding fruits and vegetables separately did not indicate a significant association with the risk of frailty. Indeed, the results of the meta-analysis correspond only to the cohort studies. Based on the NutriGrade score, the quality of evidence for a protective effect of FV on frailty was "moderate". CONCLUSIONS FVs consumption was associated with a decreased risk of frailty. Further large-scale prospective cohort studies are needed to reach more confident conclusions.
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23
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Affiliation(s)
- Dawn C Schwenke
- Associate Chief of Staff/Research & Development, Research Service, VA Northern California Health Care System, Mather, California, USA
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24
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Ni Lochlainn M, Cox NJ, Wilson T, Hayhoe RPG, Ramsay SE, Granic A, Isanejad M, Roberts HC, Wilson D, Welch C, Hurst C, Atkins JL, Mendonça N, Horner K, Tuttiett ER, Morgan Y, Heslop P, Williams EA, Steves CJ, Greig C, Draper J, Corish CA, Welch A, Witham MD, Sayer AA, Robinson S. Nutrition and Frailty: Opportunities for Prevention and Treatment. Nutrients 2021; 13:2349. [PMID: 34371858 PMCID: PMC8308545 DOI: 10.3390/nu13072349] [Citation(s) in RCA: 84] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 06/28/2021] [Accepted: 07/07/2021] [Indexed: 02/07/2023] Open
Abstract
Frailty is a syndrome of growing importance given the global ageing population. While frailty is a multifactorial process, poor nutritional status is considered a key contributor to its pathophysiology. As nutrition is a modifiable risk factor for frailty, strategies to prevent and treat frailty should consider dietary change. Observational evidence linking nutrition with frailty appears most robust for dietary quality: for example, dietary patterns such as the Mediterranean diet appear to be protective. In addition, research on specific foods, such as a higher consumption of fruit and vegetables and lower consumption of ultra-processed foods are consistent, with healthier profiles linked to lower frailty risk. Few dietary intervention studies have been conducted to date, although a growing number of trials that combine supplementation with exercise training suggest a multi-domain approach may be more effective. This review is based on an interdisciplinary workshop, held in November 2020, and synthesises current understanding of dietary influences on frailty, focusing on opportunities for prevention and treatment. Longer term prospective studies and well-designed trials are needed to determine the causal effects of nutrition on frailty risk and progression and how dietary change can be used to prevent and/or treat frailty in the future.
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Affiliation(s)
- Mary Ni Lochlainn
- Department of Twin Research and Genetics, King’s College London, St Thomas’ Hospital, Westminster Bridge Road, London SE1 7EH, UK;
| | - Natalie J. Cox
- Academic Geriatric Medicine, Faculty of Medicine, University of Southampton, Tremona Road, Southampton SO17 1BJ, UK; (N.J.C.); (H.C.R.)
- National Institute for Health Research (NIHR) Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
| | - Thomas Wilson
- Institute of Biological, Environmental and Rural Sciences, Aberystwyth University, Aberystwyth SY23 3DA, UK; (T.W.); (J.D.)
| | - Richard P. G. Hayhoe
- Department of Epidemiology & Public Health, Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK; (R.P.G.H.); (A.W.)
- School of Allied Health, Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University, Chelmsford CM1 1SQ, UK
| | - Sheena E. Ramsay
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK; (S.E.R.); (N.M.)
| | - Antoneta Granic
- AGE Research Group, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne NE4 5PL, UK; (A.G.); (C.H.); (P.H.); (M.D.W.); (A.A.S.)
- NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust and Newcastle University, Newcastle upon Tyne NE4 5PL, UK
| | - Masoud Isanejad
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool L7 8TX, UK;
| | - Helen C. Roberts
- Academic Geriatric Medicine, Faculty of Medicine, University of Southampton, Tremona Road, Southampton SO17 1BJ, UK; (N.J.C.); (H.C.R.)
- National Institute for Health Research (NIHR) Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
| | - Daisy Wilson
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK; (D.W.); (C.W.)
| | - Carly Welch
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK; (D.W.); (C.W.)
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham and University of Nottingham, Birmingham B15 2TT, UK;
| | - Christopher Hurst
- AGE Research Group, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne NE4 5PL, UK; (A.G.); (C.H.); (P.H.); (M.D.W.); (A.A.S.)
- NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust and Newcastle University, Newcastle upon Tyne NE4 5PL, UK
| | - Janice L. Atkins
- Epidemiology & Public Health Group, University of Exeter Medical School, Exeter EX1 2LU, UK;
| | - Nuno Mendonça
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK; (S.E.R.); (N.M.)
- EpiDoC Unit, CEDOC, NOVA Medical School, Universidade Nova de Lisboa, 1150-082 Lisbon, Portugal
- Comprehensive Health Research Centre (CHRC), NOVA Medical School, Universidade Nova de Lisboa, 1169-056 Lisbon, Portugal
| | - Katy Horner
- School of Public Health, Physiotherapy and Sport Science and UCD Institute of Food and Health, University College Dublin, Belfield, Dublin 4, Ireland; (K.H.); (C.A.C.)
| | - Esme R. Tuttiett
- The Medical Research Council Versus Arthritis Centre for Integrated Research into Musculoskeletal Ageing and The Department of Oncology and Metabolism, The University of Sheffield, Sheffield S10 2RX, UK; (E.R.T.); (E.A.W.)
| | - Yvie Morgan
- EDESIA PhD Programme, University of East Anglia Norwich Research Park, Norwich NR4 7TJ, UK;
| | - Phil Heslop
- AGE Research Group, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne NE4 5PL, UK; (A.G.); (C.H.); (P.H.); (M.D.W.); (A.A.S.)
| | - Elizabeth A. Williams
- The Medical Research Council Versus Arthritis Centre for Integrated Research into Musculoskeletal Ageing and The Department of Oncology and Metabolism, The University of Sheffield, Sheffield S10 2RX, UK; (E.R.T.); (E.A.W.)
| | - Claire J. Steves
- Department of Twin Research and Genetics, King’s College London, St Thomas’ Hospital, Westminster Bridge Road, London SE1 7EH, UK;
| | - Carolyn Greig
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham and University of Nottingham, Birmingham B15 2TT, UK;
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham and NIHR Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham B15 2TT, UK
| | - John Draper
- Institute of Biological, Environmental and Rural Sciences, Aberystwyth University, Aberystwyth SY23 3DA, UK; (T.W.); (J.D.)
| | - Clare A. Corish
- School of Public Health, Physiotherapy and Sport Science and UCD Institute of Food and Health, University College Dublin, Belfield, Dublin 4, Ireland; (K.H.); (C.A.C.)
| | - Ailsa Welch
- Department of Epidemiology & Public Health, Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK; (R.P.G.H.); (A.W.)
| | - Miles D. Witham
- AGE Research Group, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne NE4 5PL, UK; (A.G.); (C.H.); (P.H.); (M.D.W.); (A.A.S.)
- NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust and Newcastle University, Newcastle upon Tyne NE4 5PL, UK
| | - Avan A. Sayer
- AGE Research Group, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne NE4 5PL, UK; (A.G.); (C.H.); (P.H.); (M.D.W.); (A.A.S.)
- NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust and Newcastle University, Newcastle upon Tyne NE4 5PL, UK
| | - Sian Robinson
- AGE Research Group, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne NE4 5PL, UK; (A.G.); (C.H.); (P.H.); (M.D.W.); (A.A.S.)
- NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust and Newcastle University, Newcastle upon Tyne NE4 5PL, UK
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Yaghi N, Yaghi C, Abifadel M, Boulos C, Feart C. Dietary Patterns and Risk Factors of Frailty in Lebanese Older Adults. Nutrients 2021; 13:2188. [PMID: 34202045 PMCID: PMC8308408 DOI: 10.3390/nu13072188] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 06/10/2021] [Accepted: 06/22/2021] [Indexed: 12/13/2022] Open
Abstract
Factors associated with frailty, particularly dietary patterns, are not fully understood in Mediterranean countries. This study aimed to investigate the association of data-driven dietary patterns with frailty prevalence in older Lebanese adults. We conducted a cross-sectional national study that included 352 participants above 60 years of age. Sociodemographic and health-related data were collected. Food frequency questionnaires were used to elaborate dietary patterns via the K-mean cluster analysis method. Frailty that accounted for 15% of the sample was twice as much in women (20%) than men (10%). Identified dietary patterns included a Westernized-type dietary pattern (WDP), a high intake/Mediterranean-type dietary pattern (HI-MEDDP), and a moderate intake/Mediterranean-type dietary pattern (MOD-MEDDP). In the multivariate analysis, age, waist to height ratio, polypharmacy, age-related conditions, and WDP were independently associated with frailty. In comparison to MOD-MEDDP, and after adjusting for covariates, adopting a WDP was strongly associated with a higher frailty prevalence in men (OR = 6.63, 95% (CI) (1.82-24.21) and in women (OR = 11.54, 95% (CI) (2.02-65.85). In conclusion, MOD-MEDDP was associated with the least prevalence of frailty, and WDP had the strongest association with frailty in this sample. In the Mediterranean sample, a diet far from the traditional one appears as the key deleterious determinant of frailty.
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Affiliation(s)
- Nathalie Yaghi
- Department of Nutrition & Dietetics, Faculty of Pharmacy, Saint Joseph University of Beirut, P.O. Box 17-5208 Mar Mikhael, Beirut 1104 2020, Lebanon; (N.Y.); (C.B.)
| | - Cesar Yaghi
- Department of Gastroenterology, Faculty of Medicine, Saint Joseph University of Beirut, P.O. Box 17-5208 Mar Mikhael, Beirut 1104 2020, Lebanon;
- Hotel-Dieu de France of Beirut University Hospital, P.O. Box 166830, Alfred Naccache Blvd, Beirut, Lebanon
| | - Marianne Abifadel
- Laboratory of Biochemistry and Molecular Therapeutics, Faculty of Pharmacy, Pôle Technologie-Santé, Saint Joseph University of Beirut, P.O. Box 17-5208 Mar Mikhael, Beirut 1104 2020, Lebanon;
| | - Christa Boulos
- Department of Nutrition & Dietetics, Faculty of Pharmacy, Saint Joseph University of Beirut, P.O. Box 17-5208 Mar Mikhael, Beirut 1104 2020, Lebanon; (N.Y.); (C.B.)
| | - Catherine Feart
- LEHA team, INSERM U1219, Université de Bordeaux, F-33000 Bordeaux, France
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Dairy Product Intake and Long-Term Risk for Frailty among French Elderly Community Dwellers. Nutrients 2021; 13:nu13072151. [PMID: 34201489 PMCID: PMC8308304 DOI: 10.3390/nu13072151] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 06/20/2021] [Accepted: 06/21/2021] [Indexed: 11/16/2022] Open
Abstract
Dairy products (DP) are part of a food group that may contribute to the prevention of physical frailty. We aimed to investigate DP exposure, including total DP, milk, fresh DP and cheese, and their cross-sectional and prospective associations with physical frailty in community-dwelling older adults. The cross-sectional analysis was carried out on 1490 participants from the Three-City Bordeaux cohort. The 10-year frailty risk was examined in 823 initially non-frail participants. A food frequency questionnaire was used to assess DP exposure. Physical frailty was defined as the presence of at least 3 out of 5 criteria of the frailty phenotype: weight loss, exhaustion, slowness, weakness, and low physical activity. Among others, diet quality and protein intake were considered as confounders. The baseline mean age of participants was 74.1 y and 61% were females. Frailty prevalence and incidence were 4.2% and 18.2%, respectively. No significant associations were observed between consumption of total DP or DP sub-types and frailty prevalence or incidence (OR = 1.40, 95%CI 0.65–3.01 and OR = 1.75, 95%CI 0.42–1.32, for a total DP consumption >4 times/d, respectively). Despite the absence of beneficial associations of higher DP consumption on frailty, older adults are encouraged to follow the national recommendations regarding DP.
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Fruit and Vegetable Consumption and Incident Prefrailty and Frailty in Community-Dwelling Older People: The English Longitudinal Study of Ageing. Nutrients 2020; 12:nu12123882. [PMID: 33353147 PMCID: PMC7766547 DOI: 10.3390/nu12123882] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 12/10/2020] [Accepted: 12/11/2020] [Indexed: 02/06/2023] Open
Abstract
Background: There is limited evidence in the literature regarding associations between fruit and vegetable consumption and risk of frailty. Objective: To examine associations between fruit and vegetable consumption and risk of incident frailty and incident prefrailty/frailty. Design: A prospective panel study. Setting and Subjects: 2634 non-frail community-dwelling men and women aged 60 years or older from the English Longitudinal Study of Ageing (ELSA). Methods: Fruit and vegetable consumption/day was measured using a self-completion questionnaire at baseline. Frailty status was measured at baseline and follow-up was based on modified frailty phenotype criteria. Four-year incident frailty was examined among 2634 robust or prefrail participants, and incident prefrailty/frailty was measured among 1577 robust participants. Results: Multivariable logistic regression models adjusted for age, gender, and other confounders showed that fruit and vegetable consumption was not associated with incident frailty risks among robust or prefrail participants. However, robust participants consuming 5–7.5 portions of 80 g per day (odds ratio (OR) = 0.56, 95% confidence interval (CI) = 0.37–0.85, p < 0.01) and 7.5–10 portions per day (OR = 0.46, 95%CI = 0.27–0.77, p < 0.01) had significantly lower risk of incident prefrailty/frailty compared with those consuming 0–2.5 portions/day, whereas those consuming 10 or more portions/day did not (OR = 1.10, 95%CI = 0.54–2.26, p = 0.79). Analysis repeated with fruit and vegetable separately showed overall similar results. Conclusions: Robust older adults without frailty who eat current U.K. government recommendations for fruit and vegetable consumption (5–10 portions/day) had significantly reduced risks of incident prefrailty/frailty compared with those who only eat small amount (0–2.5 portions/day). Older people can be advised that eating sufficient amounts of fruit and vegetable may be beneficial for frailty prevention.
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