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. 2018 Oct 26;16(1):188.
doi: 10.1186/s12916-018-1176-6.

Frailty, nutrition-related parameters, and mortality across the adult age spectrum

Kulapong Jayanama  1   2 , Olga Theou  2   3 , Joanna M Blodgett  4 , Leah Cahill  2   5 , Kenneth Rockwood  6   7
Affiliations

Frailty, nutrition-related parameters, and mortality across the adult age spectrum

Kulapong Jayanama et al. BMC Med. .

Erratum in

Abstract

Background: Nutritional status and individual nutrients have been associated with frailty in older adults. The extent to which these associations hold in younger people, by type of malnutrition or grades of frailty, is unclear. Our objectives were to (1) evaluate the relationship between individual nutrition-related parameters and frailty, (2) investigate the association between individual nutrition-related parameters and mortality across frailty levels, and (3) examine whether combining nutrition-related parameters in an index predicts mortality risk across frailty levels.

Methods: This observational study assembled 9030 participants aged ≥ 20 years from the 2003-2006 cohorts of the National Health and Nutrition Examination Survey who had complete frailty data. A 36-item frailty index (FI) was constructed excluding items related to nutritional status. We examined 62 nutrition-related parameters with established cut points: 34 nutrient intake items, 5 anthropometric measurements, and 23 relevant blood tests. The 41 nutrition-related parameters which were associated with frailty were combined into a nutrition index (NI). All-cause mortality data until 2011 were identified from death certificates.

Results: All 5 anthropometric measurements, 21/23 blood tests, and 19/34 nutrient intake items were significantly related to frailty. Although most nutrition-related parameters were directly related to frailty, high alcohol consumption and high levels of serum alpha-carotene, beta-carotene, beta-cryptoxanthin, total cholesterol, and LDL-c were associated with lower frailty scores. Only low vitamin D was associated with increased mortality risk across all frailty levels. Seventeen nutrition-related parameters were associated with mortality in the 0.1-0.2 FI group, 11 in the 0.2-0.3 group, and 16 in the > 0.3 group. Overall, 393 (5.8%) of the participants had an NI score less than 0.1 (abnormality in ≤ 4 of the 41 parameters examined). Higher levels of NI were associated with higher mortality risk after adjusting for frailty and other covariates (HR per 0.1: 1.19 [95%CI 1.133-1.257]).

Conclusions: Most nutrition-related parameters were correlated to frailty, but only low vitamin D was associated with higher risk for mortality across levels of frailty. As has been observed with other age-related phenomena, even though many nutrition-related parameters were not significantly associated with mortality individually, when combined in an index, they strongly predicted mortality risk.

Keywords: Dietary intake; Frailty; Frailty index; Mortality; NHANES; Nutrition.

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Conflict of interest statement

Ethics approval and consent to participate

The protocols of NHANES were approved by the institutional review board of the National Center for Health Statistics, Centers for Disease Control and Prevention (CDC). Written informed consent was obtained from each participant before participation in this study.

Consent for publication

Not applicable.

Competing interests

All authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Association between abnormal nutritional-related parameters and frailty. a Nutrient intakes. b Anthropometric measurements. c Blood tests. HDL-c, high-density lipoprotein cholesterol; LDL-c, low-density lipoprotein cholesterol; MCV, mean corpuscular volume. All analyses were adjusted for age, sex, race, energy intake, educational level, marital status, employment status, smoking, and study cohort except for energy, energy per weight, and dietary fiber per energy which were not adjusted for energy intake
Fig. 2
Fig. 2
Association between abnormal nutritional-related parameters and mortality across levels of frailty. a Nutrient intakes. N/A, results are not available due to low sample sizes and mortality rate. b Anthropometric measurements. c Blood tests. FI, frailty index. All analyses were adjusted for age, sex, race, energy intake, educational level, marital status, employment status, smoking, and study cohort except for energy and energy per weight which were not adjusted for energy intake. *p value < 0.05
Fig. 3
Fig. 3
Percentage of participants in each level of nutritional index score by frailty level. The percentages are weighted
Fig. 4
Fig. 4
Association between nutritional index and mortality across levels of frailty. FI, frailty index; NI, nutritional index. All analyses were adjusted for age, sex, race, educational level, marital status, employment status, smoking, and study cohort except for energy and energy per weight which were not adjusted for energy intake. *p value < 0.05
Fig. 5
Fig. 5
Combined effect of frailty and nutrition on mortality. FI, frailty index; NI, nutritional index. All analyses were adjusted for age, sex, race, educational level, marital status, employment status, smoking, and study cohort
See this image and copyright information in PMC

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