Adherence to the Mediterranean-style diet and high intake of total carotenoids reduces the odds of frailty over 11 years in older adults: results from the Framingham offspring study

Authors: MILLER, COURTNEY - Hebrew Senior Life; COSTA, ELISE - University Of North Carolina; JACQUES, PAUL - Jean Mayer Human Nutrition Research Center On Aging At Tufts University; DUFOUR, ALYSSA - Hebrew Senior Life; KIEL, DOUGLAS - Hebrew Senior Life; HANNAN, MARIAN - Hebrew Senior Life; SAHNI, SHIVANI - Hebrew Senior Life

Submitted to: The American Journal of Clinical Nutrition
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 5/6/2022
Publication Date: 1/19/2023
Citation: Miller, C.L., Costa, E., Jacques, P.F., Dufour, A.B., Kiel, D., Hannan, M.T., Sahni, S. 2023. Adherence to the Mediterranean-style diet and high intake of total carotenoids reduces the odds of frailty over 11 years in older adults: results from the Framingham offspring study. The American Journal of Clinical Nutrition. https://doi.org/10.1093/ajcn/nqac130.
DOI: https://doi.org/10.1093/ajcn/nqac130

Interpretive Summary: Frailty is a geriatric syndrome that is associated with greater risks of falls, fractures, disability, hospitalization, and mortality. Although the concept of frailty is well known, there are many factors that contribute to developing frailty, but the underlying biological mechanisms of frailty are still not well-understood. An improved understanding of the underlying causes of frailty is essential to develop novel interventions for prevention and treatment. Among many mechanisms being investigated are the possible roles of inflammation and oxidative stress. This study examined if consumption of a Mediterranean-style dietary pattern, which is known to reduce inflammation and oxidative stress, and dietary intake of antioxidant nutrients, including vitamin C, vitamin E, and total carotenoids, were related with frailty onset and worsening of frailty in middle-aged and older adults. This study demonstrated that adherence to a Mediterranean-style diet and higher total carotenoid intake were associated with frailty prevention, contributing important information on how a healthy diet might help limit frailty in older adults.

Technical Abstract: Background: The benefit of a Mediterranean-style diet in reducing frailty is not well established in older Americans. Objectives: We sought to determine associations of a Mediterranean-style dietary pattern and related antioxidants with frailty onset and worsening of the Fried phenotype in adults. Methods: This prospective study included 2384 nonfrail adults from the Framingham Offspring Study with a Mediterranean-style dietary pattern score (MSDPS) and data on antioxidant intakes (vitamin C, E, and total carotenoids) estimated from an FFQ at the index examination (1998-2001) and 1 prior examination (if available), as well as a frailty assessment at the index examination and at least 1 follow-up. Frailty onset was defined as =3 of 5 Fried frailty phenotype criteria at follow-up and the worsening of the Fried frailty phenotype was defined as an increased number of frailty criteria over follow-up (yes or no). Logistic regression with generalized estimating equations estimated ORs and 95% CIs, adjusting for confounders. Analyses were stratified by age (<60 and =60 years) for significant interactions.Results: The mean > SD age was 60 > 9 years (range, 33-86 years) and 55% were female. In adjusted models, a 1-unit higher MSDPS reduced the odds of frailty by 3% (OR, 0.97; 95% CI: 0.96-0.99). Each 10-mg higher total carotenoid and vitamin E intake reduced the odds of frailty by 16% (OR, 0.84; 95% CI: 0.73-0.98) and 1% (OR, 0.99; 95% CI: 0.98-1.00), respectively. No association with vitamin C (P = 0.36) was observed. The associations among participants aged <60 years of age were stronger for each 1-unit higher MSDPS (OR, 0.93; 95% CI: 0.89-0.96) and total carotenoid intake (OR, 0.59; 95% CI: 0.41-0.82) than those observed in older individuals [ORs, 0.98 (95% CI: 0.97-1.00) and 0.92 (95% CI: 0.79-1.08), respectively]. Conclusions: Our findings suggest that adherence to a Mediterranean-style diet and higher total carotenoid intake are associated with frailty prevention over time, particularly in adults <60 years. Keywords: Mediterranean diet; aging; carotenoids; dietary antioxidants; frailty; nutrition; prospective cohort study.