Mediterranean diet and physical functioning trajectories in Eastern Europe: Findings from the HAPIEE study

Mediterranean Diet and Change in Physical Function Over Time In Older Women

The Mediterranean diet has been linked to preserving physical function, but studies on its impact on physical function decline in older adults have shown mixed results. This longitudinal study used a large sample of community-dwelling older women from the Women's Health Initiative Long Life Study to examine this relationship. We assessed 4516 older women (mean age at baseline = 78.97), including a subsample of 849 women who reported currently having diabetes. Data on physical function, measured by the SF-36 Physical Function subscale, were collected annually from 2012-2019. Adherence to the Mediterranean diet was measured using alternative Mediterranean diet (aMED) scores between 2012 and 2013. Results indicated that higher aMED scores were associated with better physical function at baseline in the general sample (4.89 to 8.23 points) and in the diabetes subsample (5.37 to 8.97 points) over eight years. However, adherence to the Mediterranean diet did not affect the rate of physical function decline. Future research should include longitudinal dietary assessments, a broader age range, and detailed information on diabetes duration.

A Mobile Intervention Designed Specifically for Older Adults With Frailty to Support Healthy Eating: Pilot Randomized Controlled Trial

BACKGROUND

Frailty, a common geriatric syndrome, predisposes older adults to functional decline. No medications can alter frailty's trajectory, but nutritional interventions may aid in supporting independence.

OBJECTIVE

This paper presents a pilot randomized controlled trial to investigate the feasibility and efficacy of a mobile health intervention, "Olitor," designed to enhance adherence to the Mediterranean diet among older adults with frailty, requiring no external assistance.

METHODS

The study sample consisted of 15 participants aged 66-77 (mean 70.5, SD 3.96) years randomized into intervention (n=8; 8 females; mean 72.4, SD 4.8 years) and control groups (n=7; 6 females, 1 male; mean 70.0, SD 3.9 years). The intervention involved a patient-facing mobile app called "Olitor" and a secure web-based administrative dashboard. Participants were instructed to use the app at least weekly for 3 months, which provided feedback on their food choices, personalized recipe recommendations, and an in-app messaging feature. Using Mann-Whitney tests to compare change scores and Hedges g statistics to estimate effect sizes, the primary efficacy outcomes were adherence to the Mediterranean diet score and insulin resistance measures. Secondary outcomes included retention as a measure of feasibility, engagement level and user app quality ratings for acceptability, and additional metrics to evaluate efficacy. Models were adjusted for multiple comparisons.

RESULTS

The findings demonstrated a significant improvement in the Mediterranean diet adherence score in the intervention group compared to the control (W=50.5; adjusted P=.04) with median change scores of 2 (IQR 2-4.25) and 0 (IQR -0.50 to 0.50), respectively. There was a small and insignificant reduction in homeostasis model assessment of insulin resistance measure (W=23; adjusted P=.85). Additionally, there were significant increases in legume intake (W=54; adjusted P<.01). The intervention's effect size was large for several outcomes, such as Mediterranean diet adherence (Hedges g=1.58; 95% CI 0.34-2.67) and vegetable intake (Hedges g=1.14; 95% CI 0.08-2.21). The retention rate was 100%. The app's overall quality rating was favorable with an average interaction time of 12 minutes weekly.

CONCLUSIONS

This pilot study revealed the potential of the mobile intervention "Olitor" in promoting healthier eating habits among older adults with frailty. It demonstrated high retention rates, significant improvement in adherence to the Mediterranean diet, and increased intake of recommended foods. Insulin resistance showed a minor nonsignificant improvement. Several secondary outcomes, such as lower extremity function and Mediterranean diet knowledge, had a large effect size. Although the app's behavior change features were similar to those of previous digital interventions, the distinctive focus on theory-informed mechanistic measures involved in behavioral change, such as self-regulation, self-efficacy, and expected negative outcomes, may have enhanced its potential. Further investigations in a more diverse and representative population, focusing on individuals with impaired insulin sensitivity, are warranted to validate these preliminary findings.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05236712; https://clinicaltrials.gov/study/NCT05236712.

Dietary Patterns and the Risk of Sarcopenia: A Systematic Review and Meta-Analysis

The purpose of this systematic review is to examine the relationship between dietary patterns and sarcopenia using a protocol developed for use by the 2020 Dietary Guidelines Advisory Committee, and to conduct a meta-analysis to summarize the evidence. Multiple electronic databases were searched for studies investigating sarcopenia risk factors or risk of sarcopenia and dietary patterns. Eligible studies were 1) peer-reviewed controlled trials or observational trials, 2) involving adult or older-adult human subjects who were healthy and/or at risk for chronic disease, 3) comparing the effect of consumption or adherence to dietary patterns (measured as an index/score, factor or cluster analysis; reduced rank regression; or a macronutrient distribution), and 4) reported on measures of skeletal muscle mass, muscle strength, muscle performance, and/or risk of sarcopenia. Thirty-eight publications met all inclusion criteria for qualitative synthesis. Thirteen observational studies met inclusion criteria for meta-analysis. Higher adherence to a healthy dietary pattern was associated with a decreased risk of gait speed reduction (OR = 0.58; 95% CI: 0.18, 0.97). The association between healthy dietary pattern adherence and other intermediate markers or risk of sarcopenia was not statistically significant. The majority of individual studies were judged as "serious" risk of bias and analysis of the collective evidence base was suggestive of publication bias. Studies suggest a significant association between healthy dietary patterns and maintenance of gait speed with age, an intermediate marker of sarcopenia risk, but the evidence base is limited by serious risk of bias, within and between studies. Further research is needed to understand the association between healthy dietary patterns and risk of sarcopenia.

The Association between Poor Diet Quality, Physical Fatigability and Physical Function in the Oldest-Old from the Geisinger Rural Aging Study

More perceived physical fatigability and poor diet quality are associated with impairments in physical function in older adults. However, the degree to which more perceived fatigability explains the association between poor diet quality and low physical function is unknown. We examined this relationship in 122 (66F, 56M) of the oldest-old participants from the Geisinger Rural Aging Study (GRAS). We used 24-h dietary recalls to assess the Healthy Eating Index (HEI), the Pittsburgh Fatigability Scale (PFS, 0–50) to assess perceived physical fatigability, and the PROMIS Physical Function 20a* to assess physical function. We grouped participants into three age categories: 80–84 (n = 51), 85–89 (n = 51), and 90+ (n = 20) years. Multiple linear regression revealed that a lower HEI was associated with higher PFS Physical score after adjusting for age group, sex, body mass index, and the number of medical conditions (p = 0.001). Several macro- and micro-nutrient intakes were also lower in those reporting more (≥15) compared to less (<15) perceived physical fatigability. Mediation analysis revealed that PFS Physical scores explained ~65% (p = 0.001) of the association between HEI total score and PROMIS19 Physical Function score. Poor diet quality may contribute to more perceived physical fatigability, which could exacerbate impairments in the oldest-old’s physical function.

Are legume-based recipes an appropriate source of nutrients for healthy ageing? A prospective cohort study

Although legumes are rich in protein and fibre, and low in saturated fat and Na, traditional legume-based recipes include substantial amounts of processed meat, salt and potatoes, which could counteract the potential benefits of legumes. This prospective study aimed to assess the longitudinal association of consumption of different types of legumes, and traditional legume-based recipes, with unhealthy ageing in older adults. Data were taken from 2505 individuals aged ≥60 years from the Seniors-ENRICA cohort. Habitual legume consumption was assessed in 2008-2010 with a validated diet history. Unhealthy ageing was measured in the 2013, 2015 and 2017 follow-up waves, with a fifty-two-item multidimensional health deficit accumulation index (DAI) which ranges from 0 (best) to 100 (worst health). The mean age was 68·7 years, with 53·1 % of women. Among study participants, 78·4 % reported consumption of legumes, with a mean intake of 57·9 g/d. Multivariable-adjusted linear regression models did not show an association between total legume consumption and the DAI over a 7-year follow-up (non-standardised coefficient for the second and highest v. the lowest tertile of consumption: 0·94 (95 % CI -0·30, 2·17) and 0·18 (95 % CI -1·07, 1·43), respectively; Ptrend = 0·35). Similar results were observed for the 3-year and 5-year follow-ups and, separately, for lentils, beans, chickpeas and traditional legume-based recipes. According to the results obtained, consumption of legumes and traditional legume-based recipes is not associated with unhealthy ageing and can be part of a healthy diet in old age.

Influence of Changes in Diet Quality on Unhealthy Aging: The Seniors-ENRICA Cohort

BACKGROUND

Whether adopting a better diet in late life influences the aging process is still uncertain. Thus, we examined the association between changes in diet quality and unhealthy aging.

METHODS

Data came from 2042 individuals aged ≥60 years recruited in the Seniors-ENRICA cohort in 2008-2010 (wave 0) and followed-up in 2012 (wave 1) and 2015 (wave 2). Diet quality was assessed with the Mediterranean Diet Adherence Screener (MEDAS), the Mediterranean Diet Score (MDS), and the Alternate Healthy Eating Index-2010 (AHEI-2010) at waves 0 and 1. Unhealthy aging was measured using a 52-item health deficit accumulation index with 4 domains (functional, self-rated health/vitality, mental health, and morbidity/health services use) at each wave. An increase in dietary indices represents a diet improvement, and a lower deficit accumulation index indicates a health improvement.

RESULTS

Compared with participants with a >1-point decrease in MEDAS or MDS, those with a >1-point increase showed lower deficit accumulation from wave 0 to wave 2 (multivariate β, -1.49 [95% confidence interval (CI), -2.88 to -0.10], P-trend = .04 for MEDAS; and -2.20 [95% CI, -3.56 to -0.84], P-trend = .002 for MDS) and from wave 1 to wave 2 (-1.34 [95% CI, -2.60 to -0.09], P-trend = .04 for MEDAS). Also, participants with a >5-point increase in AHEI-2010 showed lower deficit accumulation from wave 0 to wave 1 (-1.15 [95% CI, -2.01 to -0.28], P-trend = .009) and from wave 0 to wave 2 (-1.21 [95% CI, -2.31 to -0.10], P-trend = .03) than those with a >5-point decrease. These results were mostly due to a strong association between improved diet quality and less functional deterioration.

CONCLUSIONS

In older adults, adopting a better diet was associated with less deficit accumulation, particularly functional deterioration. Improving dietary habits may delay unhealthy aging. Our results have clinical relevance because we have observed that the deficit accumulation index decreases an average of 0.74 annually.

The Alternative Healthy Eating Index and Physical Function Impairment in Men

OBJECTIVES

Physical function is increasingly recognized as integral to healthy aging, in particular as a core component of mobility and independent living in older adults. Thus, it is important to identify strategies for the prevention of physical function decline.

DESIGN

Longitudinal cohort study.

SETTING AND PARTICIPANTS

A total of 12,658 men from the Health Professionals Follow-Up Study were followed from 2008-2012.

MEASUREMENTS

We examined the association between the Alternative Healthy Eating Index-2010 (AHEI), a measure of diet quality combining 11 dietary components (vegetables, fruits, nuts and legumes, red and processed meats, sugar-sweetened beverages and fruit juices, alcohol, whole grains, omega-3 fatty acids, polyunsaturated fatty acids, trans fatty acids, sodium), and impairment in physical function, as measured by the SF-36. Multivariable logistic regression models were used to estimate the odds ratios (OR) and 95% confidence intervals (CI) of impairment in physical function.

RESULTS

In the multivariable-adjusted model, each 10-point increase in total AHEI score was associated with a 10% lower odds of impairment in physical function (OR=0.90, 95% CI: 0.86,0.95), and in the categorical analysis, men with AHEI scores in the top quintile had a 26% lower odds (OR=0.74, 95% CI:0.63,0.86) compared with men in the bottom quintile. For individual AHEI components, higher intake of vegetables (p-trend=0.01), nuts and legumes (p-trend<0.01), polyunsaturated fatty acids (p-trend<0.01) and lower intake of red and processed meats (p-trend=0.03) and sugar-sweetened beverages (p-trend=0.01) were significantly associated with lower odds of physical impairment. For specific foods, higher consumption of lettuce, broccoli, blueberries, peanuts, walnuts and other nuts were associated with lower odds of impairment.

CONCLUSIONS

In this large cohort of older men, better overall diet quality was significantly associated with a lower odds of impairment in physical function. Given the value of physical function to healthy aging and quality of life, this may represent a particularly compelling public health rationale for older men to improve their diet.