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

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.

FIGURE 1

Flowchart of participants from the Framingham Offspring Study of the primary analytic sample for analyses on the MSDPS and antioxidants with long-term frailty onset. Abbreviation: MSDPS, Mediterranean-style dietary pattern score.

FIGURE 2

Association of tertiles of the MSDPS with long-term-frailty onset in adults from the Framingham Offspring Study after ∼11 years. The model was adjusted for baseline age, sex, energy intake, current smoking, and multivitamin supplement use (n = 2384). A P value < 0.05 was considered statistically significant. Abbreviation: MSDPS, Mediterranean-style dietary pattern score.