Dairy food intake is not associated with frailty in adults from the Framingham Heart Study

Authors: SIEFKAS, ANNA - Harvard School Of Public Health; COURTNEY, MILLAR - Harvard Medical School; DUFOUR, ALYSSA - Harvard Medical School; KIEL, DOUGLAS - Harvard Medical School; JACQUES, PAUL - Jean Mayer Human Nutrition Research Center On Aging At Tufts University; HANNAN, MARIAN - Hebrew Senior Life; SHIVANI, SAHNI - Harvard Medical School

Submitted to: Journal of the Academy of Nutrition and Dietetics
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 9/7/2022
Publication Date: 9/12/2022
Citation: Siefkas, A., Courtney, M.L., Dufour, A.B., Kiel, D., Jacques, P.F., Hannan, M.T., Shivani, S. 2022. Dairy food intake is not associated with frailty in adults from the Framingham Heart Study. Journal of the Academy of Nutrition and Dietetics. https://doi.org/10.1016/j.jand.2022.09.012.
DOI: https://doi.org/10.1016/j.jand.2022.09.012

Interpretive Summary: Frailty can result in a greater risk for poor outcomes, such as falls, fractures, and disability. As the aging population in the United States grows, it is important to better understand the factors that put elderly individuals at higher risk for frailty. Dietary intake of protein and calcium are linked to frailty, yet specific contributions from whole dairy foods rich in these nutrients remain understudied. The objective of this study was to examine whether intake of dairy foods is associated with frailty. Our results, which were based on an examination of over 2,500 non-frail individuals in a cohort study who were followed for 10+ years, showed that greater intake of yogurt was associated with a moderate reduction in becoming frail. Furthermore, participants with higher intake of yogurt and low-fat dairy were able to walk faster over a specified distance. Intake of high-fat dairy was only slightly associated with becoming frail, and other dairy foods were not associated with risk of frailty. This study emphasizes the importance of continued research on protein intake and frailty.

Technical Abstract: Background: Nutrients including protein, calcium, and fat may be associated with risk of frailty, yet specific contributions from whole dairy foods rich in these nutrients remain understudied. Objective: To determine associations between dairy intake [milk, yogurt, cheese, total (milk+yogurt+cheese), low-fat, and high-fat dairy, servings/week] and frailty onset and frailty phenotype components. Design: Prospective cohort study. All dairy intake exposures (servings/week) were assessed via a food frequency questionnaire (FFQ). Journal Pre-proo Participants/setting: Participants (aged 33-86 years) from the Framingham Offspring Study who were not frail at baseline (1998-2001), completed a FFQ and had 1 or 2 follow-up frailty assessments (2005-2008, 2011-14) were included. Main outcome measures: Frailty was defined as the presence of 3 Fried frailty phenotypecomponents: unintentional weight-loss, exhaustion, slowness (gait speed), weakness (grip strength), and low physical activity. Individuals with 0-2 components were considered non-frail. Statistical analyses performed: Repeated measures logistic regression estimated odds ratios (OR) and 95% confidence intervals (CI) for frailty onset. Logistic (exhaustion and weight loss) and linear regression (gait speed, grip strength, and physical activity) estimated the association between baseline dairy intake and each frailty component at follow-up, adjusting for baseline values for age, sex, energy intake (residual analysis), current smoking, and multivitamin use. Models were further adjusted for health status in a secondary analysis. Results: Mean baseline age (+ or -SD) was 61 years (+ or -9, range 33-87), and 54% were female. Of 2,550 non-frail individuals at baseline, 8.8% (2005-2008) and 13.5% (2011-2014) became frail. Higher yogurt intake was associated with decreased odds of frailty [OR = 0.96 (95% CI: 0.93- 0.99), p = 0.02]. Each additional serving of yogurt [ (SE): 0.004 (0.001), p < 0.01] and low-fat dairy [ (SE): 0.001 (0.0006), p = 0.04] was associated with significantly faster follow-up gait speed. Dietary intakes of high-fat dairy were associated with increased odds of frailty [OR = 1.02 (95% CI: 1.00-1.04), p = 0.05], but the p-value was of borderline significance. No associations were observed for other dairy foods. After adjusting for health status, the associations of high-fat dairy and yogurt with frailty became non-significant, although the magnitudes of the associations did not change. The association between yogurt and gait speed decreased in magnitude after adjusting for health status [ (SE): 0.002 (0.001), p = 0.01]. Conclusion: Dietary intakes of yogurt were modestly associated with reduced frailty onset and dietary intakes of high-fat dairy had a borderline association with increased odds of frailty, but other dairy food intakes showed no association in this study of healthy adults. Some dairy food intakes were modestly associated with follow-up gait speed. However, effect sizes were small, and the clinical importance of these associations remains undetermined.