Eating well in midlife helps avoid frailty in later life

Healthy eating may be key to achieving a favourable outcome in physical function and capacity in older age, with a recent study from Singapore showing that people who maintain a high-quality diet from midlife onwards are less likely to become frail through their senior years.

In a cohort of 12,580 participants from the Singapore Chinese Health Study, wherein diet quality was assessed using the Dietary Approaches to Stop Hypertension (DASH) diet score, the highest vs lowest quartile of DASH scores was associated with lower odds of physical frailty both at baseline (1993-1998, mean age 53 years; odds ratio [OR], 0.85, 95 percent confidence interval [CI], 0.73–0.99) and at follow-up 3 (2014-2016, mean age 73 years; OR, 0.49, 95 percent CI, 0.41–0.58). [Nutr J 2024;23:57]

The association of physical frailty with baseline DASH score quartiles was mainly driven by the statistically significant associations with weakness and exhaustion, whereas the association with follow-up 3 DASH score quartiles was robust and statistically significant across all criteria of physical frailty, the investigators noted.

When changes in DASH scores were examined, the odds of physical frailty were 26-percent lower among participants with ‘consistently high’ DASH scores (<3-percent change, with DASH scores above the median at both timepoints) relative to those with consistently low DASH scores (<3-percent change, with DASH score below or within the median at both timepoints; OR, 0.74, 95 percent CI, 0.59–0.94).

Likewise, in a joint analysis of DASH score tertiles at baseline and follow-up 3, participants who remained in the highest vs lowest DASH score tertile at both time points had the lowest odds of physical frailty (OR, 0.59, 95 percent CI, 0.48–0.73).

“More importantly, an improvement in diet quality could still lower the risk of physical frailty. A large improvement (>10-percent change in DASH scores), achieved by a 1-quintile change in three to four DASH components,” was associated with 22-percent lower odds of physical frailty (OR, 0.78, 95 percent CI, 0.64–0.95), the investigators said.

“Alternatively, if the participants had a moderate diet quality (middle DASH tertile) at baseline, an improvement to the highest DASH tertile at follow-up 3 was able to lower their risk of physical frailty (OR, 0.61, 95 percent CI, 0.48–0.76). Furthermore, even if the participants had started out with a poor diet quality at baseline (lowest DASH tertile), by substantially improving their diet quality to the highest DASH tertile at follow-up 3, they could still achieve a lower risk of frailty compared to their counterparts who maintained a poor diet quality throughout (OR, 0.68, 95 percent CI, 0.51–0.91),” they added.

Diet quality, based on the DASH criteria, can be improved from poor to excellent by making small changes, such as adding two daily servings of vegetables, half a serving of fruit and nuts/legumes, and cutting back on sugary drinks by 0.2 servings per day, as the investigators pointed out.

“Our findings suggest that midlife is an opportune time for interventions or health promotion to encourage adoption of healthy or high-quality dietary patterns to prevent or delay onset of age-related conditions that includes physical frailty in late life,” they continued.

The investigators explained that the DASH diet may help reduce frailty risk in several ways. Firstly, it promotes a healthy eating pattern linked to lower risks of heart disease, diabetes, and cancer, all of which can contribute to frailty. Secondly, the rich sources of antioxidants in fruits and vegetables from the DASH diet may help combat the damage linked to frailty. Finally, the dairy component of the DASH diet might contribute by providing protein and essential vitamins for muscle health.