Association between Diet Quality and Frailty Prevalence in the Physicians' Health Study.
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ABSTRACT: Objectives
Limited data suggest that a healthy diet is associated with a lower risk of frailty. We sought to assess the relationship between three measures of diet quality and frailty among male physicians.Design
Cross-sectional analysis of a cohort study.Setting
Physicians' Health Study.Participants
A total of 9861 initially healthy US men, aged 60 years or older, who provided data on frailty status and dietary habits.Measurements
A cumulative deficit frailty index (FI) was calculated using 33 variables encompassing domains of comorbidity, functional status, mood, general health, social isolation, and change in weight. Diet quality was measured using the Alternative Healthy Eating Index (aHEI), Mediterranean Diet Score (MDS), and Dietary Approaches to Stop Hypertension (DASH).Results
The FI identified 38% of physicians as non-frail, 44% as pre-frail, and 18% as frail. Multinomial logistic regression models adjusted for age, smoking status, and energy intake showed that compared with the lowest aHEI quintiles, those in the highest quintiles had lower odds of frailty and pre-frailty compared with non-frailty (odds ratio [OR] for frailty = .47; 95% confidence interval [CI] = .39-.58; for pre-frailty: OR = .75; CI = .65-.87). Exercise did not modify this association (P interaction >.1). Similar relationships were observed for DASH and MDS quintiles with frailty and pre-frailty. Restricted cubic splines showed an inverse dose-response relationship of diet quality scores with odds of frailty and pre-frailty.Conclusion
Cross-sectional data show an inverse dose-response relationship of diet quality with pre-frailty and frailty. Future longitudinal studies are needed to investigate whether healthier diet is a modifiable risk factor for frailty. ClinicalTrials.gov identifier: NCT00000500. J Am Geriatr Soc 68:770-776, 2020.
SUBMITTER: Ward RE
PROVIDER: S-EPMC7156335 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:BackgroundChronic inflammation may lead to frailty, however the potential for anti-inflammatory medications such as aspirin to prevent frailty is unknown. We sought to examine the association between long-term aspirin use and prevalent frailty.MethodsWe included 12 101 men ≥60 years who participated in the Physicians' Health Study I, a completed aspirin randomized controlled trial (1982-1989). Annual questionnaires collected self-reported data on daily aspirin use, lifestyle, and clinical variables. Average aspirin use was summed into 2 categories: ≤60 days/year and >60 days/year. Frailty was assessed using a 33-item index 11 years after trial completion. A score of ≥0.21 was considered frail. Propensity score inverse probability of treatment weighting was used for statistical control of confounding. Logistic regression models estimated odds of frailty as a function of categories of average aspirin use.ResultsMean age was 70.5 years (range 60-101). Following an average of 11 ± 0.6 years of follow-up, aspirin use was reported as ≤60 days/year for 15%; 2413 participants (20%) were frail. Frequency of aspirin use was associated with smoking, alcohol consumption, hypertension, and cardiovascular disease, but negatively associated with bleeding and Coumadin use. The odds ratio (95% confidence intervals) for frailty was 0.85 (0.76-0.96) for average aspirin use >60 days/year versus aspirin use ≤60 days/year. Results were similar using an alternate definition of frailty.ConclusionsLong-term regular aspirin use is inversely associated with frailty among older men, even after consideration of multimorbidity and health behaviors. Work is needed to understand the role of medications with anti-inflammatory properties on aging.
| S-EPMC8140052 | biostudies-literature
Project description:The effects of social frailty on diet and nutrition are under-investigated. Our study aimed to assess the association between social frailty and diet quality, diet quantity, and nutrition over a 3-year period in community-dwelling older Japanese adults. This prospective cohort study recruited individuals aged ≥60 years from a community college and followed up 666 participants annually. Social frailty was determined using a 4-item questionnaire. Diet quantity (energy and macronutrient intake) and diet quality (dietary diversity score and Diet Quality Index-International) were assessed using a food frequency questionnaire. Nutrition was evaluated using the Mini-Nutritional Assessment (MNA). Out of the 666 participants (56.5% women), 250 (37.5%) were categorized as having social prefrailty or frailty. Regarding diet quantity, energy intake (β = -1.59kcal/kg/day, p < 0.01) and nutrient intake (protein intake, β = -0.08g/kg/day; fat intake, β = -0.06g/kg/day; carbohydrate intake, β = -0.18g/kg/day; fiber intake, β = -0.01g/kg/day; all p < 0.05) were lower in men with social prefrailty or frailty than in men with social robustness. Dietary diversity score (β = -0.25, p = 0.01) and MNA score (β = -0.32, p = 0.04) decreased in men with social prefrailty or frailty. However, these associations were not observed in women. Social frailty is associated with lower dietary intake, poor diet quality, and poor nutrition among community-dwelling older men. Future studies are required to determine the benefits of sex-specific interventions targeting social frailty on nutritional outcomes.
| S-EPMC7551288 | biostudies-literature
Project description:Frailty is a major challenge facing the aging world. The phenotype of the frail subject is still far from being satisfactorily defined. We report data on mood, cognition, and quality of life (QoL) in relation to anamnestic factors, health, and socio-economic status in the FRASNET geriatric population (1204 subjects in stable health conditions), which is an observational cohort study that includes fairly balanced groups of Italian frail (421, 35%), pre-frail (449, 37.3%) and robust (334, 27.7%) subjects. A conditional inference tree analysis revealed a substantial influence of psychological variables on frailty. The physical indicator of QoL (Short Form Survey-36-Physical Component Summary, SF-36-PCS) was the predominant variable in the full model (threshold at 39.9, p < 0.001): higher frailty was found in subjects with a caregiver and lower SF-36-PCS. Frailty was also associated with the mental indicator of QoL (Short Form Survey-36-Mental Component Summary, SF-36-MCS), depression (Geriatric Depression Scale, GDS-15), leisure activities, and level of education. In support of the prominent role of inflammation in aging and mental illness, the SF-36-PCS score was correlated with the blood concentration of C-X-C motif chemokine ligand 10 (CXCL10) (r Pearson -0.355, p = 0.015), a critical signal in cell senescence and inflammaging, while the rs7567647 variant in FN1 gene encoding a glycoprotein in the extracellular matrix was significantly associated with frailty in a multivariable model (p = 0.0006). The perception of health-related QoL and subclinical depression contribute to frailty. Their assessment could improve the identification of older patients at increased risk of adverse outcomes.
| S-EPMC9779617 | biostudies-literature
Project description:Diet quality indices score dietary intakes against recommendations, whereas dietary patterns consider the pattern and combination of dietary intakes. Studies evaluating both methodologies in relation to cardiometabolic health in a nationally representative sample are limited. The aim of the present study was to investigate the relationship between diet quality, dietary patterns and markers of cardiometabolic health in Australian adults.Dietary data, using two 24-h dietary recalls, were collected from adults in the cross-sectional Australian Health Survey 2011-2013 (n?=?2121; 46.4 (SE 0.48) years). Diet quality was estimated using the Dietary Guideline Index (DGI). Dietary patterns (DPs), derived using reduced rank regression, were estimated using fiber density, SFA: PUFA and total sugars intake as intermediate markers. Multi-variable adjusted linear regression analyses were used to examine associations between diet quality and DPs and blood biomarkers, body mass index, waist circumference, diastolic and systolic blood pressure and an overall cardiometabolic risk score.DGI was associated with lower glucose (coef -?0.009, SE 0.004; P-trend?=?0.033), body mass index (coef -?0.017, SE 0.007; P-trend?=?0.019) and waist circumference (coef -?0.014, SE 0.005; P-trend?=?0.008). Two dietary patterns were derived: dietary pattern-1 was characterized by higher intakes of pome fruit and wholegrain bread, while dietary pattern-2 was characterized by higher intakes of added sugars and tropical fruit. Dietary pattern-1 was associated with lower body mass index (coef -?0.028, SE 0.007; P-trend<?0.001) and waist circumference (coef -?0.017, SE 0.005; P-trend?=?0.001). There was a trend towards lower cardiometabolic risk score. Dietary pattern-2 was associated with lower HDL-cholesterol (coef -?0.026, SE 0.012; P-trend?=?0.028). There was a trend towards lower diastolic blood pressure. No associations with other markers were observed.Better diet quality and healthier dietary patterns were primarily associated with favorable anthropometric markers of cardiometabolic health. Findings support the need for comparison of whole-diet based methodologies that take into consideration the interactions between foods and nutrients. Longitudinal studies are warranted to better understand causal relationships between diet and cardiometabolic health.
| S-EPMC5809905 | biostudies-other
Project description:Objectives: Diet quality may be a key modifiable factor for the prevention of non-communicable disease. We aimed to investigate the association between diet quality and prevalence of obesity, dyslipidemia, and insulin resistance among Filipino immigrant women in Korea. Methods: A total of 413 participants from the 2014-2016 baseline population of the Filipino Women's Diet and Health Study (FiLWHEL) were examined. Individual dietary intakes were evaluated through 24-h recalls and then converted into two dietary quality assessments: Minimum Dietary Diversity for Women (MDD-W) developed by the Food and Agriculture Organization (FAO) and the Data Derived Inflammation Index (DDII) originally developed by our group. Fasting blood levels of triglycerides, high-density lipoprotein cholesterols, glucose, and insulin were measured. We used logistic regression models for odds ratios (ORs) with 95% confidence intervals (CIs). Results: We found a statistically significant association between MDD-W scores and decreased prevalence of abdominal obesity; ORs (95% CIs) of the 3rd vs. 1st tertiles were 0.58 (0.36-0.94; p for trend = 0.029). Increased DDII was associated with elevated prevalence of dyslipidemia and insulin resistance; ORs (95% CIs) of the 5th vs. 1-3rd quintiles were 6.44 (2.56-16.20) for triglycerides (TG), 3.90 (1.92-7.90) for low-density lipoprotein (LDL) cholesterol, 3.36 (1.81-6.24) for total cholesterol (TC), 6.25 (2.53-15.41) for abnormal TG/HDL ratios, 3.59 (1.96-6.59) for HbA1c, 2.61 (1.11-6.17) for fasting blood glucose levels, 9.67 (4.16-22.48) for insulin levels, and 9.73 (4.46-21.25) for homeostasis model assessment of insulin resistance (HOMA-IR) (p for trend <0.001 for all, except 0.033 for fasting blood glucose). Conclusions: Greater dietary diversity was inversely associated with the prevalence of abdominal obesity in Filipino immigrant women. Proinflammatory scores based on diet and lifestyle factors were associated with an increased prevalence of dyslipidemia and insulin resistance. Further, epidemiological studies on the relationship between dietary acculturation and chronic disease are warranted.
| S-EPMC8281297 | biostudies-literature
Project description:BackgroundStroke survivors are known to have poorer health-related quality of life (HRQoL) than the general population, but less is known about characteristics associated with HRQoL decreasing through time following a stroke. This study aims to examine how in-hospital frailty is related to HRQoL from 3 to 18 months post stroke.MethodSix hundred twenty-five participants hospitalised with stroke were included and followed up at 3 and/or 18 months post stroke. Stroke severity was assessed the day after admission with the National Institutes of Health Stroke Scale (NIHSS). A modified Fried phenotype was used to assess in-hospital frailty; measures of exhaustion, physical activity, and weight loss were based on pre-stroke status, while gait speed and grip strength were measured during hospital stay. HRQoL at 3- and 18-months follow-up were assessed using the five-level version of the EuroQol five-dimensional descriptive system (EQ-5D-5L) and the EuroQol visual analogue scale (EQ-5D VAS). We conducted linear mixed effect regression analyses unadjusted and adjusted for sex, age, and stroke severity to investigate the association between in-hospital frailty and post-stroke HRQoL.ResultsMean (SD) age was 71.7 years (11.6); mean NIHSS score was 2.8 (4.0), and 263 (42.1%) were female. Frailty prevalence was 10.4%, while 58.6% were pre-frail. The robust group had EQ-5D-5L index and EQ-5D VAS scores at 3 and 18 months comparable to the general population. Also at 3 and 18 months, the pre-frail and frail groups had significantly lower EQ-5D-5L indices than the robust group (p < 0.001), and the frail group showed a larger decrease from 3 to 18 months in the EQ-5D-5L index score compared to the robust group (- 0.056; 95% CI - 0.104 to - 0.009; p = 0.021). There were no significant differences in change in EQ-5D VAS scores between the groups.ConclusionThis study on participants mainly diagnosed with mild strokes suggests that robust stroke patients have fairly good and stable post-stroke HRQoL, while post-stroke HRQoL is impaired and continues to deteriorate among patients with in-hospital frailty. This emphasises the importance of a greater focus on frailty in stroke units.Trial registrationClinicalTrials.gov ( NCT02650531 ).
| S-EPMC7931593 | biostudies-literature
Project description:BACKGROUND:The frailty syndrome is associated with higher risk of disability and death after accounting for multimorbidity. Therefore, the determinants of frailty need to be identified to ensure older adults live not only longer but also healthier lives. However, the effect of diet quality on frailty is mostly unknown. OBJECTIVES:We aimed to evaluate the alternate Mediterranean diet (AMED), the Dietary Approaches to Stop Hypertension (DASH) diet, and the alternate Healthy Eating Index-2010 (AHEI-2010) in association with frailty risk among older women. METHODS:We analyzed data from 71,941 women aged ≥60 y participating in the Nurses' Health Study. The AMED, DASH, and AHEI-2010 were computed from validated FFQs in 1990 and repeated every 4 y until 2010. Frailty was defined as having ≥3 of the following 5 criteria from the FRAIL scale: fatigue, reduced resistance, reduced aerobic capacity, having ≥5 illnesses, and weight loss ≥5%. The occurrence of frailty was assessed every 4 y. RESULTS:During follow-up we identified 11,564 incident cases of frailty. After adjusting for potential confounders, the RRs (95% CIs) of frailty per 1-SD increase in the AMED, DASH, and AHEI-2010 scores were 0.87 (0.85, 0.90), 0.93 (0.91, 0.95), and 0.90 (0.88, 0.92), respectively. All diet quality scores were associated with lower risk of the individual frailty criteria fatigue, reduced resistance, reduced aerobic capacity, and weight loss. Lower consumption of red and processed meat, a lower sodium intake, a higher ratio of monounsaturated to saturated fat, vegetables, and moderate alcohol intake were components of the diet quality scores independently associated with lower risk of frailty. CONCLUSIONS:Adherence to a healthy diet, as defined by the AMED, DASH, and AHEI-2010 scores, was associated with reduced risk of frailty in older women.
| S-EPMC7138663 | biostudies-literature
Project description:BackgroundPrimary health care (PHC) serves as the gatekeeper of health system and PHC physicians take on significant obligations to provide health care services in the pursuit of Universal Health Coverage (UHC). PHC physicians' health-related quality of life (HRQoL) can have a strong impact on patients, physicians and the health care system. Lifestyle interventions are found to be effective to improve HRQoL. The purpose of this study was to evaluate the association between lifestyle behaviors and HRQoL among PHC physicians, so that lifestyle intervention can be tailored by policy makers for health promotion.MethodsA survey covering 31 provinces and administrative regions in China was conducted in 2020 using a stratified sampling strategy. Data on sociodemographic characteristics lifestyle behaviors and HRQoL were collected by a self-administered questionnaire. HRQoL was measured through EuroQol-five dimension-five level (EQ-5D-5L) instrument. A Tobit regression model was performed to evaluate the association between sociodemographic characteristics, lifestyle behaviors and HRQoL.ResultsAmong 894 PHC physicians who completed the survey, Anxiety/Depression (AD) was the dimension with the most problems reported (18.1%). Regular daily routine (β = 0.025, 95%CI 0.004 to 0.045) and good sleep quality (β = 0.049, 95% CI = 0.029 to 0.069) were protective factors for HRQoL, while smoking (β = -0.027, 95% CI = -0.079 to -0.003) and frequency of eating breakfast (β = -0.041, 95%CI = -0.079 to -0.003) were negatively associated with HRQoL. Physical activity and alcohol drinking were not significantly associated with HRQoL.ConclusionThese findings suggest that tailored interventions on daily routine, improving sleep quality, and tobacco control among PHC physicians may be effective strategies to improve their HRQoL.
| S-EPMC10030863 | biostudies-literature
Project description:ObjectiveTo investigate the association between dietary patterns with frailty phenotypes in an elderly Chinese population.MethodsA cross-sectional study was performed in 780 Shanghai suburban elders aged 65-74 in 2019. Dietary data were collected using a food frequency questionnaire. Adherence to a priori dietary patterns, including the Chinese Healthy Eating Index (CHEI), Dietary Approaches to Stop Hypertension (DASH) diet and Mediterranean Diet (MD) were calculated. Three a posteriori dietary patterns were identified by factor analysis, namely, "protein-rich"; "vegetables"; and "sugar, oil, and condiments". Frailty was defined using the Fried frailty phenotype scale. Ordinal multiple logistic regression was applied to examine the associations between dietary patterns and frailty prevalence.ResultsThe prevalences of pre-frailty and frailty were 47.69% and 3.85%, respectively. Participants with a higher DASH score had a lower frailty prevalence in the sex- and age-adjusted models of the 780 subjects (OR = 0.97 (95% CI: 0.94-0.99), p < 0.05). The association slightly strengthened in the multivariate adjusted model of the 555 subjects after excluding the participants with chronic diseases may influence frailty (OR = 0.96 (95% CI: 0.92-1.00), p < 0.05). High "protein-rich" dietary pattern scores were negatively associated with frailty prevalence in the multivariate adjusted model of the 780 subjects (OR = 0.82 (95% CI: 0.69-0.98), p < 0.05). The association attenuated in the sex- and age-adjusted model of the 555 subjects (OR = 0.84 (95% CI: 0.69-1.00, p = 0.056).ConclusionA better diet quality as characterized by DASH and "protein-rich" was associated with a reduced prevalence of frailty in Shanghai suburban elders. The correlation of CHEI, MD or a posteriori dietary patterns with the development of frailty in Chinese older people remains to be explored.
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Project description:Rationale:Although short sleep duration has been linked to unhealthy dietary patterns, little is known about the association of obstructive sleep apnea (OSA), a disorder characterized by sleep fragmentation and diet. Study Objectives:Investigate associations between diet quality and OSA in the Multi-Ethnic Study of Atherosclerosis and assess whether reductions in slow-wave sleep (stage N3) and rapid eye movement (REM) sleep are potential mediators for these associations. Methods:A diverse population (N = 1813) completed a food frequency questionnaire and underwent Type 2 in-home polysomnography, which included measurement of N3 and REM sleep and apnea-hypopnea index (AHI). Moderate-to-more severe OSA was defined as having an AHI > 15 events/hr. Results:Participants were 53.9% female with a mean age of 68.3 (SD 9.1) years. Approximately 33.8% were categorized as having moderate-to-more severe OSA. In adjusted analyses, OSA was associated with lower intakes of whole grains, (β = -0.200, SE = 0.072, p < 0.01), higher intakes of red/processed meat, (β = -0.440, SE = 0.136, p < 0.01), and lower overall diet quality (β = -1.286, SE = 0.535, p = 0.02). Stage N3 sleep partially explained the associations between red/processed meat and overall diet quality score with OSA. Conclusions:Moderate-to-more severe OSA is associated with a less healthy dietary profile that is partially explained by reduced N3 sleep. These findings suggest the opportunity to target sleep quality in interventions aimed at improving cardio-metabolic risk factors in patients with OSA.
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