Lack of Association between Insufficient Intake of Multiple Vitamins and Frailty in Older Adults Who Consume Sufficient Energy and Protein: A Nationwide Cross-Sectional Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Data Source and Study Population
2.2. Definition of Frailty
2.3. Nutrient Intake and Classification
2.4. Sociodemographic Variables
2.5. Statistical Analyses
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- Denic, A.; Glassock, R.J.; Rule, A.D. Structural and Functional Changes With the Aging Kidney. Adv. Chronic Kidney Dis. 2016, 23, 19–28. [Google Scholar] [CrossRef] [PubMed]
- Fried, L.P.; Tangen, C.M.; Walston, J.; Newman, A.B.; Hirsch, C.; Gottdiener, J.; Seeman, T.; Tracy, R.; Kop, W.J.; Burke, G. Frailty in older adults: Evidence for a phenotype. J. Gerontol. Ser. A Biol. Sci. Med. Sci. 2001, 56, M146–M157. [Google Scholar] [CrossRef]
- Ensrud, K.E.; Ewing, S.K.; Taylor, B.C.; Fink, H.A.; Stone, K.L.; Cauley, J.A.; Tracy, J.K.; Hochberg, M.C.; Rodondi, N.; Cawthon, P.M. Frailty and risk of falls, fracture, and mortality in older women: The study of osteoporotic fractures. J. Gerontol. Ser. A Biol. Sci. Med. Sci. 2007, 62, 744–751. [Google Scholar] [CrossRef] [PubMed]
- Shamliyan, T.; Talley, K.M.; Ramakrishnan, R.; Kane, R.L. Association of frailty with survival: A systematic literature review. Ageing Res. Rev. 2013, 12, 719–736. [Google Scholar] [CrossRef] [PubMed]
- Balboa-Castillo, T.; Struijk, E.A.; Lopez-Garcia, E.; Banegas, J.R.; Rodríguez-Artalejo, F.; Guallar-Castillon, P. Low vitamin intake is associated with risk of frailty in older adults. Age Ageing 2018, 47, 872–879. [Google Scholar] [CrossRef] [PubMed]
- Son, J.; Kim, S.; Won, C.; Choi, H.; Kim, B.; Park, M. Physical frailty predicts medical expenses in community-dwelling, elderly patients: Three-year prospective findings from living profiles of older people surveys in Korea. Eur. Geriatr. Med. 2015, 6, 412–416. [Google Scholar] [CrossRef]
- Kang, M.-g.; Kim, O.S.; Hoogendijk, E.O.; Jung, H.-W. Trends in Frailty Prevalence Among Older Adults in Korea: A Nationwide Study from 2008 to 2020. J. Korean Med. Sci. 2023, 38, e157. [Google Scholar] [CrossRef] [PubMed]
- Park, S.K. Frailty in Korean patients with chronic obstructive pulmonary disease, using data from the Korea National Health and Nutrition Examination Survey, 2015 and 2016. Appl. Nurs. Res. 2021, 59, 151417. [Google Scholar] [CrossRef] [PubMed]
- Kim, H.; Lee, E.; Lee, S.-W. Association between oral health and frailty: Results from the Korea National Health and Nutrition Examination Survey. BMC Geriatr. 2022, 22, 369. [Google Scholar] [CrossRef] [PubMed]
- Bartali, B.; Frongillo, E.A.; Bandinelli, S.; Lauretani, F.; Semba, R.D.; Fried, L.P.; Ferrucci, L. Low nutrient intake is an essential component of frailty in older persons. J. Gerontol. Ser. A Biol. Sci. Med. Sci. 2006, 61, 589–593. [Google Scholar] [CrossRef]
- Schoufour, J.D.; Franco, O.H.; Kiefte-de Jong, J.C.; Trajanoska, K.; Stricker, B.; Brusselle, G.; Rivadeneira, F.; Lahousse, L.; Voortman, T. The association between dietary protein intake, energy intake and physical frailty: Results from the Rotterdam Study. Br. J. Nutr. 2019, 121, 393–401. [Google Scholar] [CrossRef]
- De Groot, C.P.; van den Broek, T.; van Staveren, W. Energy intake and micronutrient intake in elderly Europeans: Seeking the minimum requirement in the SENECA study. Age Ageing 1999, 28, 469–474. [Google Scholar] [CrossRef]
- Coelho-Júnior, H.J.; Rodrigues, B.; Uchida, M.; Marzetti, E. Low protein intake is associated with frailty in older adults: A systematic review and meta-analysis of observational studies. Nutrients 2018, 10, 1334. [Google Scholar] [CrossRef]
- Wu, S.-Y.; Lee, S.-C.; Yeh, N.-H.; Wang, C.-F.; Hung, S.-Y.; Wu, S.-J.; Pan, W.-H. Dietary Characteristics of Elders with Frailty and with Mild Cognitive Impairment: Cross-Sectional Findings and Implications from the Nutrition and Health Survey in Taiwan 2014–2017. Nutrients 2022, 14, 5216. [Google Scholar] [CrossRef]
- Castaneda-Gameros, D.; Redwood, S.; Thompson, J.L. Low nutrient intake and frailty among overweight and obese migrant women from ethnically diverse backgrounds ages 60 years and older: A mixed-methods study. J. Nutr. Educ. Behav. 2017, 49, 3–10.e1. [Google Scholar] [CrossRef]
- Chen, L.-K.; Woo, J.; Assantachai, P.; Auyeung, T.-W.; Chou, M.-Y.; Iijima, K.; Jang, H.C.; Kang, L.; Kim, M.; Kim, S.; et al. Asian Working Group for Sarcopenia: 2019 Consensus Update on Sarcopenia Diagnosis and Treatment. J. Am. Med. Dir. Assoc. 2020, 21, 300–307.e2. [Google Scholar] [CrossRef]
- Won, C.W.; Lee, S.; Kim, J.; Chon, D.; Kim, S.; Kim, C.-O.; Kim, M.K.; Cho, B.; Choi, K.M.; Roh, E. Korean frailty and aging cohort study (KFACS): Cohort profile. BMJ Open 2020, 10, e035573. [Google Scholar] [CrossRef]
- Ministry of Health and Welfare (KR); The Korean Nutrition Society. Dietary Reference Intakes for Koreans 2020; Ministry of Health and Welfare: Sejong, Republic of Korea, 2020.
- World Health Organization Western Pacific Region. The Asia-Pacific Perspective: Redefining Obesity and Its Treatment; International Obesity TaskForce: London, UK, 2000; pp. 15–21. [Google Scholar]
- Lorenzo-López, L.; Maseda, A.; de Labra, C.; Regueiro-Folgueira, L.; Rodríguez-Villamil, J.L.; Millán-Calenti, J.C. Nutritional determinants of frailty in older adults: A systematic review. BMC Geriatr. 2017, 17, 108. [Google Scholar] [CrossRef]
- Michelon, E.; Blaum, C.; Semba, R.D.; Xue, Q.-L.; Ricks, M.O.; Fried, L.P. Vitamin and carotenoid status in older women: Associations with the frailty syndrome. J. Gerontol. Ser. A Biol. Sci. Med. Sci. 2006, 61, 600–607. [Google Scholar] [CrossRef] [PubMed]
- Degroot, C.; Vanstaveren, W.; Dirren, H.; Hautvast, J. Longitudinal changes in the intake of energy and macronutrients of elderly Europeans. Eur. J. Clin. Nutr. 1996, 50, S67–S76. [Google Scholar]
- Sharma, Y.; Popescu, A.; Horwood, C.; Hakendorf, P.; Thompson, C. Prevalence of hypovitaminosis C and its relationship with frailty in older hospitalised patients: A cross-sectional study. Nutrients 2021, 13, 2117. [Google Scholar] [CrossRef]
- Semba, R.D.; Bartali, B.; Zhou, J.; Blaum, C.; Ko, C.-W.; Fried, L.P. Low serum micronutrient concentrations predict frailty among older women living in the community. J. Gerontol. Ser. A Biol. Sci. Med. Sci. 2006, 61, 594–599. [Google Scholar] [CrossRef]
- Pilleron, S.; Weber, D.; Pérès, K.; Colpo, M.; Gomez-Cabrero, D.; Stuetz, W.; Dartigues, J.-F.; Ferrucci, L.; Bandinelli, S.; Garcia-Garcia, F.J.; et al. Patterns of circulating fat-soluble vitamins and carotenoids and risk of frailty in four European cohorts of older adults. Eur. J. Nutr. 2019, 58, 379–389. [Google Scholar] [CrossRef]
- Cheng, X.; Hu, Y.; Ruan, Z.; Zang, G.; Chen, X.; Qiu, Z. Association between B-vitamins intake and frailty among patients with chronic obstructive pulmonary disease. Aging Clin. Exp. Res. 2023, 35, 793–801. [Google Scholar] [CrossRef]
- Dent, E.; Lien, C.; Lim, W.S.; Wong, W.C.; Wong, C.H.; Ng, T.P.; Woo, J.; Dong, B.; de la Vega, S.; Poi, P.J.H. The Asia-Pacific clinical practice guidelines for the management of frailty. J. Am. Med. Dir. Assoc. 2017, 18, 564–575. [Google Scholar] [CrossRef]
- Khor, P.Y.; Vearing, R.M.; Charlton, K.E. The effectiveness of nutrition interventions in improving frailty and its associated constructs related to malnutrition and functional decline among community-dwelling older adults: A systematic review. J. Hum. Nutr. Diet. 2022, 35, 566–582. [Google Scholar] [CrossRef]
- de Jong, N.; Paw, M.J.C.A.; de Graaf, C.; van Staveren, W.A. Effect of dietary supplements and physical exercise on sensory perception, appetite, dietary intake and body weight in frail elderly subjects. Br. J. Nutr. 2000, 83, 605–613. [Google Scholar] [CrossRef]
Characteristics | Total (n = 665) | Non-Frail (n = 592) | Frail (n = 73) | p-Value |
---|---|---|---|---|
Age, years | 72.0 (0.2) | 71.7 (0.2) | 74.5 (0.6) | <0.001 |
65–74 years, % | 67.5 (2.0) | 70.6 (2.1) | 41.0 (6.8) | <0.001 |
≥75 years, % | 32.5 (2.0) | 29.4 (2.1) | 59.0 (6.8) | |
Sex, women, % | 45.3 (2.1) | 43.1 (2.2) | 64.3 (6.1) | 0.002 |
Education level ≤9 years, % | 66.5 (2.5) | 63.8 (2.7) | 88.9 (4.1) | <0.001 |
The lowest 25% quartile of income, % | 40.0 (2.5) | 38.3 (2.6) | 54.5 (6.7) | 0.021 |
Living alone, % | 17.6 (1.7) | 16.9 (1.7) | 23.5 (5.1) | 0.172 |
Current smoker, % | 10.4 (1.4) | 10.4 (1.4) | 10.9 (4.3) | 0.903 |
Frequent alcohol drinking, % | 25.3 (2.0) | 25.6 (2.2) | 22.2 (5.2) | 0.559 |
Low total MET per week,% | 59.8 (2.5) | 55.8 (2.6) | 92.9 (3.8) | <0.001 |
Body mass index, kg/m2 | 24.3 (0.1) | 24.3 (0.1) | 24.3 (0.4) | 0.935 |
Underweight (BMI < 18.5), % | 0.6 (0.3) | 0.3 (0.2) | 3.4 (1.9) | 0.038 |
Normal (18.5 ≤ BMI < 23), % | 33.8 (2.3) | 34.1 (2.4) | 31.4 (6.2) | |
Overweight (23 ≤ BMI < 25), % | 25.1 (2.0) | 25.3 (2.1) | 23.5 (5.9) | |
Obesity (25 ≥ besi, % | 40.4 (2.4) | 40.3 (2.5) | 41.7 (6.4) | |
Number of comorbidities ≥ 3, % | 13.4 (1.5) | 11.8 (1.6) | 26.5 (5.6) | 0.002 |
Characteristics | Total (n = 665) | Non-Frail (n = 592) | Frail (n = 73) | p-Value |
---|---|---|---|---|
Nutritional intake per day | ||||
Total energy, kcal | 2361.4 (22.5) | 2372.0 (23.3) | 2274.0 (62.6) | 0.133 |
Carbohydrate, g | 388.3 (4.8) | 389.6 (5.0) | 377.4 (14.4) | 0.422 |
Protein, g | 82.6 (1.0) | 83.1 (1.1) | 79.0 (3.6) | 0.274 |
Fat, g | 42.0 (1.1) | 42.0 (1.1) | 41.9 (4.8) | 0.985 |
Vitamin A, μg REs | 439.1 (24.9) | 422.2 (17.3) | 579.2 (178.1) | 0.381 |
Meet RNI, % | 16.7 (1.7) | 16.2 (1.7) | 20.6 (5.8) | |
Thiamine, mg | 1.62 (0.03) | 1.62 (0.03) | 1.66 (0.13) | 0.770 |
Meet RNI, % | 87.5 (1.6) | 87.6 (1.7) | 86.1 (4.7) | |
Riboflavin, mg | 1.70 (0.03) | 1.70 (0.03) | 1.63 (0.12) | 0.554 |
Meet RNI, % | 74.3 (2.0) | 74.1 (2.2) | 75.9 (5.2) | |
Niacin, mg NEs | 15.08 (0.3) | 15.16 (0.3) | 14.46 (1.0) | 0.502 |
Meet RNI, % | 56.6 (2.2) | 56.4 (2.4) | 58.1 (6.5) | |
Folate, μg DFEs | 434.5(8.5) | 439.8 (8.9) | 390.9 (24.3) | 0.059 |
Meet RNI, % | 51.6 (2.1) | 52.7 (2.2) | 42.5 (6.6) | |
Vitamin C, mg | 74.7 (3.5) | 76.0 (3.8) | 63.8 (6.7) | 0.112 |
Meet RNI, % | 21.1 (2.0) | 21.5 (2.1) | 18.1 (5.2) | |
Insufficient levels of vitamin intake | ||||
Mild, % | 17.5 (1.7) | 18.2 (1.8) | 12.2 (4.4) | 0.496 |
Moderate, % | 66.8 (2.1) | 66.1 (2.3) | 72.4 (5.7) | |
Severe, % | 15.7 (1.7) | 15.7 (1.8) | 15.4 (4.3) |
Frail | ||||
---|---|---|---|---|
Crude | Model 1 | Mode 2 | Mode 3 | |
Total | ||||
Mild | 1 | 1 | 1 | 1 |
Moderate | 1.62 (0.68–3.87) | 1.43 (0.59–3.47) | 1.19 (0.48–2.92) | 1.24 (0.49–3.10) |
Severe | 1.46 (0.52–4.05) | 1.06 (0.36–3.12) | 0.91 (0.30–2.68) | 0.82 (0.28–2.39) |
p for trend | 0.434 | 0.956 | 0.805 | 0.626 |
Male | ||||
Mild | 1 | 1 | 1 | 1 |
Moderate | 1.83 (0.60–5.55) | 1.39 (0.43–4.48) | 1.19 (0.36–3.88) | 1.36 (0.35–5.26) |
Severe | 2.08 (0.46–9.26) | 1.64 (0.35–7.66) | 1.62 (0.34–7.76) | 1.22 (0.21–7.08) |
p for trend | 0.300 | 0.525 | 0.550 | 0.819 |
Female | ||||
Mild | 1 | 1 | 1 | 1 |
Moderate | 1.56 (0.47–5.12) | 1.44 (0.43–4.76) | 1.14 (0.34–3.81) | 1.08 (0.32–3.66) |
Severe | 1.04 (0.27–4.02) | 0.89 (0.22–3.57) | 0.71 (0.18–2.82) | 0.59 (0.15–2.34) |
p for trend | 0.989 | 0.776 | 0.524 | 0.337 |
65–74 years | ||||
Mild | 1 | 1 | 1 | 1 |
Moderate | 1.04 (0.29–3.67) | 1.09 (0.31–3.85) | 0.89 (0.24–3.26) | 0.83 (0.22–3.12) |
Severe | 1.34 (0.32–5.50) | 1.10 (0.24–4.96) | 0.92 (0.20–4.18) | 0.75 (0.16–3.48) |
p for trend | 0.692 | 0.891 | 0.927 | 0.718 |
≥75 years | ||||
Mild | 1 | 1 | 1 | 1 |
Moderate | 2.09 (0.62–6.99) | 2.01 (0.59–6.83) | 1.71 (0.49–6.00) | 2.03 (0.57–7.18) |
Severe | 1.48 (0.33–6.54) | 1.30 (0.27–6.06) | 1.01 (0.20–4.95) | 0.88 (0.18–4.12) |
p for trend | 0.649 | 0.813 | 0.862 | 0.592 |
Insufficient Levels of Vitamin Intake | ||||
---|---|---|---|---|
Mild | Moderate | Severe | p for Trend | |
Frail | 1 | 1.24 (0.49–3.10) | 0.82 (0.28–2.39) | 0.626 |
Frail component | ||||
Unintentional weight loss | 1 | 1.21 (0.58–2.51) | 0.60 (0.23–1.55) | 0.302 |
Weakness | 1 | 0.95 (0.49–1.85) | 0.63 (0.25–1.60) | 0.325 |
Exhaustion | 1 | 0.55 (0.16–1.86) | 0.21 (0.01–2.73) | 0.171 |
Slowness | 1 | 0. 91(0.52–1.59) | 0.97 (0.49–1.92) | 0.945 |
Low physical activity | 1 | 1.24 (0.74–2.06) | 1.15 (0.56–2.32) | 0.674 |
Frail | ||||||
---|---|---|---|---|---|---|
Vitamin A | Thiamine | Riboflavin | Niacin | Folate | Vitamin C | |
Meet RNI | 1 | 1 | 1 | 1 | 1 | 1 |
NOT meet RNI | 0.55 (0.26–1.17) | 1.34 (0.58–3.09) | 0.66 (0.35–1.24) | 0.62 (0.34–1.14) | 1.19 (0.65–2.17) | 0.92 (0.42–2.03) |
p value | 0.125 | 0.479 | 0.200 | 0.127 | 0.555 | 0.850 |
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2024 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Park, S.-G.; Kim, H. Lack of Association between Insufficient Intake of Multiple Vitamins and Frailty in Older Adults Who Consume Sufficient Energy and Protein: A Nationwide Cross-Sectional Study. Nutrients 2024, 16, 2586. https://doi.org/10.3390/nu16162586
Park S-G, Kim H. Lack of Association between Insufficient Intake of Multiple Vitamins and Frailty in Older Adults Who Consume Sufficient Energy and Protein: A Nationwide Cross-Sectional Study. Nutrients. 2024; 16(16):2586. https://doi.org/10.3390/nu16162586
Chicago/Turabian StylePark, Seung-Guk, and Hyoeun Kim. 2024. "Lack of Association between Insufficient Intake of Multiple Vitamins and Frailty in Older Adults Who Consume Sufficient Energy and Protein: A Nationwide Cross-Sectional Study" Nutrients 16, no. 16: 2586. https://doi.org/10.3390/nu16162586
APA StylePark, S.-G., & Kim, H. (2024). Lack of Association between Insufficient Intake of Multiple Vitamins and Frailty in Older Adults Who Consume Sufficient Energy and Protein: A Nationwide Cross-Sectional Study. Nutrients, 16(16), 2586. https://doi.org/10.3390/nu16162586