Dietary patterns and changes in frailty status: the Rotterdam study
Dietary patterns and changes in frailty status: the Rotterdam study
Sandra C. M. de Haas 0 1 2 3
Ester A. L. de Jonge 0 1 2 3
Trudy Voortman 0 1 2 3
Jolien Steenweg‑de Graaff 0 1 2 3
Oscar H. Franco 0 1 2 3
M. Arfan Ikram 0 1 2 3
Fernando Rivadeneira 0 1 2 3
Jessica C. Kiefte‑de Jong 0 1 2 3
Josje D. Schoufour 0 1 2 3
Josje D. Schoufour 0 1 2 3
0 Department of Internal Medicine, University Medical Centre, Erasmus MC , P.O. Box 2040, 3000 CA Rotterdam , The Netherlands
1 VU University Amsterdam , Amsterdam , The Netherlands
2 Department of Epidemiology, University Medical Centre, Erasmus MC , P.O. Box 2040, 3000 CA Rotterdam , The Netherlands
3 Department of Global Public Health, Leiden University College The Hague , P.O. Box 13228, 2501 EE The Hague , The Netherlands
Purpose To determine the associations between a priori and a posteriori derived dietary patterns and a general state of health, measured as the accumulation of deficits in a frailty index. Methods Cross-sectional and longitudinal analysis embedded in the population-based Rotterdam Study (n = 2632) aged 45 years. Diet was assessed at baseline (year 2006) using food frequency questionnaires. Dietary patterns were defined a priori using an existing index reflecting adherence to national dietary guidelines and a posteriori using principal component analysis. A frailty index was composed of 38 health deficits and measured at baseline and follow-up (4 years later). Linear regression analyses were performed using adherence to each of the Vol.:(011233456789)
Dietary patterns; Diet quality; Elderly; Frailty; Frailty index
-
Sandra C. M. de Haas and Ester A. L. de Jonge contributed
equally to this manuscript.
dietary patterns as exposure and the frailty index as
outcome (all in Z-scores).
Results Adherence to the national dietary guidelines was
associated with lower frailty at baseline (β −0.05, 95% CI
−0.08, −0.02). Additionally, high adherence was associated
with lower frailty scores over time (β −0.08, 95% CI −0.12,
−0.04). The PCA revealed three dietary patterns that we
named a “Traditional” pattern, high in legumes, eggs and
savory snacks; a “Carnivore” pattern, high in meat and
poultry; and a “Health Conscious” pattern, high in whole
grain products, vegetables and fruit. In the cross-sectional
analyses adherence to these patterns was not associated
with frailty. However, adherence to the “Traditional”
pattern was associated with less frailty over time (β −0.09,
95% CI −0.14, −0.05).
Conclusion No associations were found for adherence to
a “healthy” pattern or “Carnivore” pattern. However, Even
in a population that is relatively young and healthy,
adherence to dietary guidelines or adherence to the Traditional
pattern could help to prevent, delay or reverse frailty levels.
Introduction
Although there is no complete consensus on the
conceptualization of frailty, experts agree that frailty is a state
of increased vulnerability to adverse health outcomes [
1
].
The frailty index, developed by Mitnitski and Rockwood,
appraises frailty as the accumulation of health-related and
age-related deficits [
2
]. The included deficits cover a broad
range of health aspects including cognition, disabilities,
laboratory abnormalities, and comorbidities [
3
]. Several
studies, among different age-categories and populations,
show that a high frailty index score is associated with an
increased risk for disability, falls, hospitalization, and
mortality [
4–7
]. Prevention of frailty is important because it
is difficult to recover from a frail state to a non-frail state
[8]. One important modifiable factor that might either
positively or negatively influences frailty is diet.
Most research on nutrition and frailty or overall health
status has focussed on single nutritional components [
9
],
such as macronutrients and micronutrients. Although these
studies have provided valuable knowledge towards possible
nutritional strategies to prevent frailty (e.g., high protein
intake [
10, 11
], people do not eat single nutritional
components but meals, combined into patterns. Dietary
pattern approaches take into account the totality of the diet
and allow for possible interactions and synergetic effects of
nutritional components [12]. One way to define a person’s
dietary pattern is via a priori approach, studying
adherence to existing dietary guidelines or recommendations in
relation to health outcomes. Alternatively, an a posteriori
approach allows the identification of naturally occurring
dietary patterns of populations [
13
]. The advantage of an
a priori approach is that it allows for comparison between
studies. The a posteriori approach has the advantage that
can identify new dietary patterns, which could lead to
improvements of current dietary guidelines. Taking into
account both complementary approaches provides most
insight into a possible association between dietary patterns
and frailty.
Although a few previous studies evaluated dietary
pattern (...truncated)