A proinflammatory diet is associated with increased odds of frailty after 12-year follow-up in a cohort of adults

Am J Clin Nutr. 2022 Feb 9;115(2):334-343. doi: 10.1093/ajcn/nqab317.

Abstract

Background: Frailty occurs in 10-15% of community-living older adults and inflammation is a key determinant of frailty. Though diet is a modulator of inflammation, there are few prospective studies elucidating the role of diet-associated inflammation on frailty onset.

Objectives: We sought to determine whether a proinflammatory diet was associated with increased odds of frailty in adults from the Framingham Heart Study (FHS).

Design and methods: This study was nested in a prospective cohort that included individuals without frailty. Diet was assessed in 1998-2001 using a valid FFQ, and frailty was measured in 2011-2014. FFQ-derived energy-adjusted dietary inflammatory index (E-DII®) scores were computed, with higher E-DII scores indicating a more proinflammatory diet. Frailty was defined as fulfilling ≥3 of 5 Fried Phenotype criteria. Information on potential mediators, serum IL-6 and C-reactive protein was obtained in 1998-2001. Logistic regression estimated ORs and 95% CIs for E-DII (as continuous and in quartiles) and frailty onset adjusting for relevant confounders.

Results: Of 1701 individuals without frailty at baseline (mean ± SD age: 58 ± 8 y; range: 33-81 y; 55% female), 224 developed frailty (13% incidence) over ∼12 y. The mean ± SD E-DII score was -1.95 ± 2.20; range: -6.71 to +5.40. After adjusting for relevant confounders, a 1-unit higher E-DII score was associated with 16% increased odds of developing frailty (95% CI: 1.07, 1.25). In categorical analyses, participants in the highest (proinflammatory) compared with lowest quartile of E-DII had >2-fold increased odds of frailty (ORquartile4vs.1: 2.22; 95% CI: 1.37, 3.60; P-trend < 0.01). IL-6 and C-reactive protein were not major contributors in the pathway.

Conclusions: In this cohort of middle-aged and older adults, a proinflammatory diet was associated with increased odds of frailty over ∼12 y of follow-up. Trials designed to increase consumption of anti-inflammatory foods for frailty prevention are warranted.

Keywords: aging; community-based; diet; epidemiology; food frequency questionnaire; frailty; inflammation; prospective cohort study.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • C-Reactive Protein / analysis
  • Diet / adverse effects*
  • Diet / statistics & numerical data
  • Diet Surveys
  • Female
  • Follow-Up Studies
  • Frailty / epidemiology
  • Frailty / etiology*
  • Humans
  • Independent Living / statistics & numerical data*
  • Inflammation
  • Interleukin-6 / blood
  • Logistic Models
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Odds Ratio
  • Prospective Studies
  • Risk Factors

Substances

  • IL6 protein, human
  • Interleukin-6
  • C-Reactive Protein