Rationale of the association between Mediterranean diet and the risk of frailty in older adults and systematic review and meta-analysis.

Nicola Veronese, Mario Barbagallo, Ligia J Dominguez, Carolina Donat-Vargas, Carmen Sayon-Orea, Maria Barberia-Latasa, Jimena Rey-Garcia, Fernando Rodríguez-Artalejo, Pilar Guallar-Castillón, Miguel Àngel Martínez-González

Journal: Experimental gerontology 2023;177():112180

PMID: 37087024

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Plain Language Summary

Frailty is a disease associated with advanced age and is characterised by reduced strength and physical functioning. Malnutrition plays a role in frailty and a healthy eating pattern has been shown to reduce the risk of frailty. The Mediterranean diet (MD) has been shown in previous meta-analyses to be associated with incidence of frailty. This new meta-analysis of 11 cohort studies aimed to update the previous data on the association of MD and frailty incidence. The results showed that adherence to MD was associated with lower incidence of frailty. It was concluded that close adherence to a MD decreased the incidence of frailty. This study could be used by healthcare professionals to understand that a MD; i.e., a diet high in vegetables, fruits, lean meats, and extra-virgin olive oil, may decrease the risk for frailty. This recommendation is based on results from association studies, which do not indicate a definite causal relationship and other factors may be involved.

Abstract

Frailty is a geriatric syndrome whose frequency is increasing in parallel with population aging and is of great interest due to its dire consequences: increased disability, hospitalizations, falls and fractures, institutionalization, and mortality. Frailty is multifactorial but nutritional factors, which are modifiable, play a crucial role in its pathogenesis. Epidemiologic evidence supports that high-quality dietary patterns can prevent, delay or even reverse the occurrence of frailty. In order to add new knowledge bridging the gap as the main purpose of the present article we performed a comprehensive review of the rationale behind the association of MedDiet with frailty and a systematic review and meta-analysis updating the latest ones published in 2018 specifically examining the relationship of Mediterranean diet (MedDiet) and incident frailty. Adding the updated information, our results confirmed a robust association of a higher adherence to MedDiet with reduced incident frailty. Key components of the MedDiet, i.e., abundant consumption of vegetables and fruit as well as the use of olive oil as the main source of fat, all of which have been associated with a lower incidence of frailty, may help explain the observed benefit. Future well-designed and sufficiently large intervention studies are needed to confirm the encouraging findings of the current observational evidence. Meanwhile, based on the existing evidence, the promotion of MedDiet, a high-quality dietary pattern, adapted to the conditions and traditions of each region, and considering lifelong and person-tailored strategies, is an open opportunity to reduced incident frailty. This could also help counteract the worrying trend towards the spread of unhealthy eating and lifestyle models such as those of Western diets that greatly contribute to the genesis of chronic non-communicable diseases and disability.

Address: Faculty of Medicine and Surgery, "Kore" University of Enna, 94100 Enna, Italy; Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, 90100 Palermo, Italy. Electronic address: [email protected].; Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, CIBERESP (CIBER of Epidemiology and Public Health), 28029 Madrid, Spain; IMDEA-Food Institute, CEI UAM+CSIC, 28049 Madrid, Spain; Unit of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, 171 77 Stockholm, Sweden.; Department of Preventive Medicine and Public Health, University of Navarra-IDISNA, 31008 Pamplona, Spain; CIBER Fisiopatologia de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, 28029 Madrid, Spain; Public Health Institute, 31003, Navarra, Spain.; Department of Preventive Medicine and Public Health, University of Navarra-IDISNA, 31008 Pamplona, Spain; CIBER Fisiopatologia de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, 28029 Madrid, Spain.; Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, 90100 Palermo, Italy.; Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, CIBERESP (CIBER of Epidemiology and Public Health), 28029 Madrid, Spain; Internal Medicine Department, Hospital Universitario Ramón y Cajal, IRyCIS, 28034 Madrid, Spain.; Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, CIBERESP (CIBER of Epidemiology and Public Health), 28029 Madrid, Spain; IMDEA-Food Institute, CEI UAM+CSIC, 28049 Madrid, Spain.; Department of Preventive Medicine and Public Health, University of Navarra-IDISNA, 31008 Pamplona, Spain; CIBER Fisiopatologia de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, 28029 Madrid, Spain; Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA 02115, USA.

DOI: 10.1016/j.exger.2023.112180