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. 2021 Mar 16;19(1):64.
doi: 10.1186/s12916-021-01918-5.

Relationship between diet quality scores and the risk of frailty and mortality in adults across a wide age spectrum

Kulapong Jayanama  1   2 , Olga Theou  2   3   4 , Judith Godin  2 , Leah Cahill  4   5 , Nitin Shivappa  6   7   8 , James R Hébert  6   7   8 , Michael D Wirth  6   7   8   9 , Yong-Moon Park  10 , Teresa T Fung  5   11 , Kenneth Rockwood  12   13
Affiliations

Relationship between diet quality scores and the risk of frailty and mortality in adults across a wide age spectrum

Kulapong Jayanama et al. BMC Med. .

Abstract

Background: Beyond intakes of total energy and individual nutrient, eating patterns may influence health, and thereby the risk of adverse outcomes. How different diet measures relate to frailty-a general measure of increased vulnerability to unfavorable health outcomes-and mortality risk, and how this might vary across the life course, is not known. We investigated the associations of five dietary indices (Nutrition Index (NI), the energy-density Dietary Inflammatory Index (E-DII™), Healthy Eating Index-2015 (HEI-2015), Mediterranean Diet Score (MDS), and Dietary Approaches to Stop Hypertension (DASH)) with frailty and mortality.

Methods: We included 15,249 participants aged ≥ 20 years from the 2007-2012 cohorts of the National Health and Nutrition Examination Survey (NHANES). The NI combined 31 nutrition-related deficits. The E-DII is a literature-derived dietary index associated with inflammation. The HEI-2015 assesses adherence to the Dietary Guidelines of Americans. The MDS represents adherence to the traditional Mediterranean diet. DASH combines macronutrients and micronutrients to prevent hypertension. Frailty was evaluated using a 36-item frailty index. Mortality status was ascertained up to December 31, 2015.

Results: Participants' mean age was 47.2 ± 16.7 years and 51.7% were women. After adjusting for age, sex, race, educational level, marital and employment status, smoking, BMI, and study cohort, higher NI and E-DII scores and lower HEI-2015, MDS, and DASH scores were individually significantly associated with frailty. All dietary scores were significantly associated with 8-year mortality risk after adjusting for basic covariates and frailty: NI (hazard ratio per 0.1 point, 1.15, 95%CI 1.10-1.21), E-DII (per 1 point, 1.05, 1.01-1.08), HEI-2015 (per 10 points, 0.93, 0.89-0.97), MDS (per 1 point, 0.94, 0.90-0.97), and DASH (per 1 point, 0.96, 0.93-0.99). The associations of E-DII, HEI-2015, and MDS scores with 8-year mortality risk persisted after additionally adjusting for NI.

Conclusions: NI, E-DII, HEI-2015, MDS, and DASH scores are associated with frailty and 8-year mortality risk in adults across all ages. Nevertheless, their mechanisms and sensitivity to predict health outcomes may differ. Nutrition scores have the potential to include measures of both consumption and laboratory and physical measures of exposure.

Keywords: Dietary indices; Dietary score; Frailty; Frailty index; Mortality; Nutrition.

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Conflict of interest statement

Dr. James R. Hébert owns controlling interest in Connecting Health Innovations LLC (CHI), a company that has licensed the right to his invention of the dietary inflammatory index (DII®) from the University of South Carolina in order to develop computer and smart phone applications for patient counseling and dietary intervention in clinical settings. Drs. Nitin Shivappa and Michael Wirth are employees of CHI. The subject matter of this paper will not have any direct bearing on that work, nor has that activity exerted any influence on this project.

Dr. Kenneth Rockwood is Chief Science Officer of DGI Clinical, which in the last 5 years has contracts with pharma and device manufacturers (Baxter, Baxalta, Shire, Hollister, Nutricia, Roche, Otsuka) on individualized outcome measurement. In 2017, he attended an advisory board meeting with Lundbeck and in 2019 another with Nutricia. Otherwise, any personal fees are for invited guest lectures and academic symposia, received directly from event organizers, chiefly for presentations on frailty. He is Associate Director of the Canadian Consortium on Neurodegeneration in Aging, which is funded by the Canadian Institutes of Health Research, and with additional funding from the Alzheimer Society of Canada and several other charities.

Other authors declare no potential competing interests.

Figures

Fig. 1
Fig. 1
Bivariate scatter plots and linear regression lines between each pair of the dietary scores. Higher NI and E-DII scores and lower HEI-2015, MDS, and DASH scores represent worse dietary pattern/intake
Fig. 2
Fig. 2
Relationship between dietary scores and frailty. Here we present frailty index predictive values with 95% confidence interval for each level of dietary scores. Regression models were adjusted for basic covariates (age, sex, race, education level, marital status, employment status, smoking, study cohort, and body mass index). Higher Nutrition Index and Energy-density Dietary Inflammatory Index scores and lower Healthy Eating Index-2015, Mediterranean Diet Score, and Dietary Approaches to Stop Hypertension scores represent worse dietary pattern/intake
See this image and copyright information in PMC

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