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BMC Medicine
Published in: BMC Medicine 1/2015

Open Access 01-12-2015 | Research article

Major dietary patterns and risk of frailty in older adults: a prospective cohort study

Authors: Luz M León-Muñoz, Esther García-Esquinas, Esther López-García, José R Banegas, Fernando Rodríguez-Artalejo

Published in: BMC Medicine | Issue 1/2015

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Abstract

Background

There is emerging evidence of the role of certain nutrients as risk factors for frailty. However, people eat food, rather than nutrients, and no previous study has examined the association between dietary patterns empirically derived from food consumption and the risk of frailty in older adults.

Methods

This is a prospective cohort study of 1,872 non-institutionalized individuals aged ≥60 years recruited between 2008 and 2010. At baseline, food consumption was obtained with a validated diet history and, by using factor analysis, two dietary patterns were identified: a ‘prudent’ pattern, characterized by high intake of olive oil and vegetables, and a ‘Westernized’ pattern, with a high intake of refined bread, whole dairy products, and red and processed meat, as well as low consumption of fruit and vegetables. Participants were followed-up until 2012 to assess incident frailty, defined as at least three of the five Fried criteria (exhaustion, weakness, low physical activity, slow walking speed, and unintentional weight loss).

Results

Over a 3.5-year follow-up, 96 cases of incident frailty were ascertained. The multivariate odds ratios (95% confidence interval) of frailty among those in the first (lowest), second, and third tertile of adherence to the prudent dietary pattern were 1, 0.64 (0.37–1.12), and 0.40 (0.2–0.81), respectively; P-trend = 0.009. The corresponding values for the Westernized pattern were 1, 1.53 (0.85–2.75), and 1.61 (0.85–3.03); P-trend = 0.14. Moreover, a greater adherence to the Westernized pattern was associated with an increasing risk of slow walking speed and weight loss.

Conclusions

In older adults, a prudent dietary pattern showed an inverse dose-response relationship with the risk of frailty while a Westernized pattern had a direct relationship with some of their components. Clinical trials should test whether a prudent pattern is effective in preventing or delaying frailty.
Literature
1.
2.
Collard RM, Boter H, Schoevers RA, Oude Voshaar RC. Prevalence of frailty in community-dwelling older persons: a systematic review. J Am Geriatr Soc. 2012;60:1487–92.CrossRefPubMed
3.
Santos-Eggimann B, Cuénoud P, Spagnoli J, Junod J. Prevalence of frailty in middle-aged and older community-dwelling Europeans living in 10 countries. J Gerontol A Biol Sci Med Sci. 2009;64:675–81.CrossRefPubMed
4.
Woods NF, LaCroix AZ, Gray SL, Aragaki A, Cochrane BB, Brunner RL, et al. Frailty: emergence and consequences in women aged 65 and older in the Women’s Health Initiative Observational Study. J Am Geriatr Soc. 2005;53:1321–30.CrossRefPubMed
5.
Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K. Frailty in elderly people. Lancet. 2013;381:752–62.CrossRefPubMed
6.
Bartali B, Frongillo EA, Bandinelli S, Lauretani F, Semba RD, Fried LP, et al. Low nutrient intake is an essential component of frailty in older persons. J Gerontol A Biol Sci Med Sci. 2006;61:589–93.CrossRefPubMedPubMedCentral
7.
Beasley JM, LaCroix AZ, Neuhouser ML, Huang Y, Tinker L, Woods N, et al. Protein intake and incident frailty in the Women’s Health Initiative observational study. J Am Geriatr Soc. 2010;58:1063–71.CrossRefPubMedPubMedCentral
8.
Hu FB. Dietary pattern analysis: a new direction in nutritional epidemiology. Curr Opin Lipidol. 2002;13:3–9.CrossRefPubMed
9.
Guallar-Castillón P, Rodríguez-Artalejo F, Tormo MJ, Sánchez MJ, Rodríguez L, Quirós JR, et al. Major dietary patterns and risk of coronary heart disease in middle-aged persons from a Mediterranean country: the EPIC-Spain cohort study. Nutr Metab Cardiovasc Dis. 2012;22:192–9.CrossRefPubMed
10.
Trichopoulou A, Costacou T, Bamia C, Trichopoulos D. Adherence to a Mediterranean diet and survival in a Greek population. N Engl J Med. 2003;348:2599–608.CrossRefPubMed
11.
da Silva R, Bach-Faig A, Raidó Quintana B, Buckland G, Vaz de Almeida MD, Serra-Majem L. Worldwide variation of adherence to the Mediterranean diet, in 1961–1965 and 2000–2003. Public Health Nutr. 2009;12(9A):1676–84.CrossRefPubMed
12.
León-Muñoz LM, Guallar-Castillón P, López-García E, Rodríguez-Artalejo F. Mediterranean diet and risk of frailty in community-dwelling older adults. J Am Med Dir Assoc. 2014;15(12):899–903.CrossRefPubMed
13.
Shikany JM, Barrett-Connor E, Ensrud KE, Cawthon PM, Lewis CE, Dam TT, et al. Macronutrients, diet quality, and frailty in older men. J Gerontol A Biol Sci Med Sci. 2014;69:695–701.CrossRefPubMed
14.
Talegawkar SA, Bandinelli S, Bandeen-Roche K, Chen P, Milaneschi Y, Tanaka T, et al. A higher adherence to a Mediterranean-style diet is inversely associated with the development of frailty in community-dwelling elderly men and women. J Nutr. 2012;142:2161–6.CrossRefPubMedPubMedCentral
15.
Bollwein J, Diekmann R, Kaiser MJ, Bauer JM, Uter W, Sieber CC, et al. Dietary quality is related to frailty in community-dwelling older adults. J Gerontol A Biol Sci Med Sci. 2013;68:483–89.CrossRefPubMed
16.
Zbeida M, Goldsmith R, Shimony T, Vardi H, Naggan L, Shahar DR. Mediterranean diet and functional indicators among older adults in non-Mediterranean and Mediterranean countries. J Nutr Health Aging. 2014;18:411–8.CrossRefPubMed
17.
Shahar DR, Houston DK, Hue TF, Lee JS, Sahyoun NR, Tylavsky FA, et al. Adherence to Mediterranean diet and decline in walking speed over 8 years in community-dwelling older adults. J Am Geriatr Soc. 2012;60:1881–8.CrossRefPubMedPubMedCentral
18.
Rodríguez-Artalejo F, Graciani A, Guallar-Castillón P, León-Muñoz LM, Zuluaga MC, López-García E, et al. Rationale and methods of the study on nutrition and cardiovascular risk in Spain (ENRICA). Rev Esp Cardiol. 2011;64:876–82.CrossRefPubMed
19.
EPIC Group of Spain. Relative validity and reproducibility of a diet history questionnaire in Spain. I. Foods. EPIC Group of Spain. European Prospective Investigation into Cancer and Nutrition. Int J Epidemiol. 1997;26:S91–9.CrossRef
20.
Guallar-Castillón P, Sagardui-Villamor J, Balboa-Castillo T, Sala A, Ariza Astolfi MJ, Sarrión Pelous MD, et al. Validity and reproducibility of a Spanish dietary history. PLoS One. 2014;9:e86074.CrossRefPubMedPubMedCentral
21.
Kleinbaum DG, Muller KE. Variable reduction and factor analysis. In: Applied Regression Analysis and Other Multivariable Methods. Boston, MA: PWS-Kent Publishing Company; 1988.
22.
Kim JO, Mueller CW. Factor Analysis: Statistical Methods and Practical Issues. Thousand Oaks, CA: Sage Publications, Inc.; 1978.CrossRef
23.
Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56:M146–56.CrossRefPubMed
24.
Ruiz-Grosso P, Loret de Mola C, Vega-Dienstmaier JM, Arevalo JM, Chavez K, Vilela A, et al. Validation of the Spanish Center for Epidemiological Studies Depression and Zung Self-Rating Depression Scales: a comparative validation study. PLoS One. 2012;7:e45413.CrossRefPubMedPubMedCentral
25.
Ottenbacher KJ, Branch LG, Ray L, Gonzales VA, Peek MK, Hinman MR. The reliability of upper- and lower-extremity strength testing in a community survey of older adults. Arch Phys Med Rehabil. 2002;83:1423–7.CrossRefPubMed
26.
Garcia-Garcia FJ, Gutierrez Avila G, Alfaro-Acha A, Amor Andres MS, De Lo Angeles De La Torre Lanza M, Escribano Aparicio MV, et al. The prevalence of frailty syndrome in an older population from Spain. The Toledo Study for Healthy Aging. J Nutr Health Aging. 2011;15:852–6
27.
Guralnik JM, Simonsick EM, Ferrucci L, Glynn RJ, Berkman LF, Blazer DG, et al. A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol. 1994;49:M85–94.CrossRefPubMed
28.
Gutiérrez-Fisac JL, Guallar-Castillón P, León-Muñoz LM, Graciani A, Banegas JR, Rodríguez-Artalejo F. Prevalence of general and abdominal obesity in the adult population of Spain, 2008–2010: the ENRICA study. Obes Rev. 2012;13:388–92.CrossRefPubMed
29.
Graciani A, Banegas JR, Guallar-Castillón P, Domínguez-Rojas V, Rodríguez-Artalejo F. Cognitive assessment of the non-demented elderly community dwellers in Spain. Dement Geriatr Cogn Disord. 2006;21:104–12.CrossRefPubMed
30.
Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist. 1969;9:179–86.CrossRefPubMed
31.
Hu FB, Rimm EB, Stampfer MJ, Ascherio A, Spiegelman D, Willett WC. Prospective study of major dietary patterns and risk of coronary heart disease in men. Am J Clin Nutr. 2000;72:912–21.PubMed
32.
Fung TT, Rimm EB, Spiegelman D, Rifai N, Tofler GH, Willett WC, et al. Association between dietary patterns and plasma biomarkers of obesity and cardiovascular disease risk. Am J Clin Nutr. 2001;73:61–7.PubMed
33.
Fung TT, Willett WC, Stampfer MJ, Manson JE, Hu FB. Dietary patterns and the risk of coronary heart disease in women. Arch Intern Med. 2001;161:1857–62.CrossRefPubMed
34.
McEvoy CT, Cardwell CR, Woodside JV, Young IS, Hunter SJ, McKinley MC. A posteriori dietary patterns are related to risk of type 2 diabetes: Findings from a systematic review and meta-analysis. J Acad Nutr Diet. 2014. [Epub ahead of print]
35.
Esmaillzadeh A, Kimiagar M, Mehrabi Y, Azadbakht L, Hu FB, Willett WC. Dietary patterns, insulin resistance, and prevalence of the metabolic syndrome in women. Am J Clin Nutr. 2007;85:910–8.PubMed
36.
López-García E, Schulze MB, Fung TT, Meigs JB, Rifai N, Manson JE, et al. Major dietary patterns are related to plasma concentrations of markers of inflammation and endothelial dysfunction. Am J Clin Nutr. 2004;80:1029–35.PubMed
37.
Akbaraly TN, Singh-Manoux A, Marmot MG, Brunner EJ. Education attenuates the association between dietary patterns and cognition. Dement Geriatr Cogn Disord. 2009;27:147–54.CrossRefPubMedPubMedCentral
38.
Kesse-Guyot E, Andreeva VA, Jeandel C, Ferry M, Hercberg S, Galan P. A healthy dietary pattern at midlife is associated with subsequent cognitive performance. J Nutr. 2012;142:909–15.CrossRefPubMed
39.
Akbaraly TN, Brunner EJ, Ferrie JE, Marmot MG, Kivimaki M, Singh-Manoux A. Dietary pattern and depressive symptoms in middle age. Br J Psychiatry. 2009;195:408–13.CrossRefPubMedPubMedCentral
40.
Lai JS, Hiles S, Bisquera A, Hure AJ, McEvoy M, Attia J. A systematic review and meta-analysis of dietary patterns and depression in community-dwelling adults. Am J Clin Nutr. 2014;99:181–97.CrossRefPubMed
41.
Torres SJ, Lautenschlager NT, Wattanapenpaiboon N, Greenop KR, Beer C, Flicker L, et al. Dietary patterns are associated with cognition among older people with mild cognitive impairment. Nutrients. 2012;4:1542–51.CrossRefPubMedPubMedCentral
42.
Jacka FN, Cherbuin N, Anstey KJ, Butterworth P. Dietary patterns and depressive symptoms over time: examining the relationships with socioeconomic position, health behaviours and cardiovascular risk. PLoS One. 2014;9:e87657.CrossRefPubMedPubMedCentral
43.
Schulze MB, Hoffmann K, Manson JE, Willett WC, Meigs JB, Weikert C, et al. Dietary pattern, inflammation, and incidence of type 2 diabetes in women. Am J Clin Nutr. 2005;82:675–84.PubMedPubMedCentral
44.
Stenholm S, Strandberg TE, Pitkälä K, Sainio P, Heliövaara M, Koskinen S. Midlife obesity and risk of frailty in old age during a 22-year follow-up in men and women: the Mini-Finland Follow-up Survey. J Gerontol A Biol Sci Med Sci. 2014;69:73–8.CrossRefPubMed
45.
Barzilay JI, Blaum C, Moore T, Xue QL, Hirsch CH, Walston JD, et al. Insulin resistance and inflammation as precursors of frailty: the Cardiovascular Health Study. Arch Intern Med. 2007;167:635–41.CrossRefPubMed
46.
Tang Z, Wang C, Song X, Shi J, Mitnitski A, Fang X, et al. Co-occurrence of cardiometabolic diseases and frailty in older Chinese adults in the Beijing Longitudinal Study of Ageing. Age Ageing. 2013;42:346–51.CrossRefPubMed
47.
Gale CR, Baylis D, Cooper C, Sayer AA. Inflammatory markers and incident frailty in men and women: the English Longitudinal Study of Ageing. Age (Dordr). 2013;35:2493–501.CrossRef
48.
Raji MA, Al Snih S, Ostir GV, Markides KS, Ottenbacher KJ. Cognitive status and future risk of frailty in older Mexican Americans. J Gerontol A Biol Sci Med Sci. 2010;65:1228–34.CrossRefPubMed
49.
Han ES, Lee Y, Kim J. Association of cognitive impairment with frailty in community-dwelling older adults. Int Psychogeriatr. 2014;26:155–63.PubMed
50.
Lohman M, Dumenci L, Mezuk B. Sex differences in the construct overlap of frailty and depression: evidence from the Health and Retirement Study. J Am Geriatr Soc. 2014;62:500–5.CrossRefPubMedPubMedCentral
51.
Robinson SM, Jameson KA, Batelaan SF, Martin HJ, Syddall HE, Dennison EM, et al. Diet and its relationship with grip strength in community-dwelling older men and women: the Hertfordshire cohort study. J Am Geriatr Soc. 2008;56:84–90.CrossRefPubMed
52.
53.
Gea A, Bes-Rastrollo M, Toledo E, Garcia-Lopez M, Beunza JJ, Estruch R, et al. Mediterranean alcohol-drinking pattern and mortality in the SUN (Seguimiento Universidad de Navarra) Project: a prospective cohort study. Br J Nutr. 2014;111:1871–80.CrossRefPubMed
54.
Pozzato G, Moretti M, Franzin F, Crocè LS, Lacchin T, Benedetti G, et al. Ethanol metabolism and aging: the role of “first pass metabolism” and gastric alcohol dehydrogenase activity. J Gerontol A Biol Sci Med Sci. 1995;50:B135–41.CrossRefPubMed
55.
Estruch R, Ros E, Salas-Salvadó J, Covas MI, Corella D, Arós F, et al. Primary prevention of cardiovascular disease with a Mediterranean diet. N Engl J Med. 2013;368:1279–90.CrossRefPubMed
56.
de Lorgeril M, Salen P, Martin JL, Monjaud I, Delaye J, Mamelle N. Mediterranean diet, traditional risk factors, and the rate of cardiovascular complications after myocardial infarction: final report of the Lyon Diet Heart Study. Circulation. 1999;99:779–85.CrossRefPubMed
57.
Allès B, Samieri C, Féart C, Jutand MA, Laurin D, Barberger-Gateau P. Dietary patterns: a novel approach to examine the link between nutrition and cognitive function in older individuals. Nutr Res Rev. 2012;25:207–22.CrossRefPubMed
58.
León-Muñoz LM, Guallar-Castillón P, Graciani A, López-García E, Mesas AE, Aguilera MT, et al. Adherence to the Mediterranean diet pattern has declined in Spanish adults. J Nutr. 2012;142:1843–50.CrossRefPubMed
59.
Metadata
Title
Major dietary patterns and risk of frailty in older adults: a prospective cohort study
Authors
Luz M León-Muñoz
Esther García-Esquinas
Esther López-García
José R Banegas
Fernando Rodríguez-Artalejo
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Medicine / Issue 1/2015
Electronic ISSN: 1741-7015
DOI
https://doi.org/10.1186/s12916-014-0255-6

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