Dietary patterns and changes in frailty status: the Rotterdam study

European Journal of Nutrition, Jul 2017

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 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.

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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)


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Sandra C. M. de Haas, Ester A. L. de Jonge, Trudy Voortman, Jolien Steenweg-de Graaff, Oscar H. Franco, M. Arfan Ikram, Fernando Rivadeneira, Jessica C. Kiefte-de Jong, Josje D. Schoufour. Dietary patterns and changes in frailty status: the Rotterdam study, European Journal of Nutrition, 2017, pp. 1-11, DOI: 10.1007/s00394-017-1509-9