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Biomarker-calibrated nutrient intake and healthy diet index associations with mortality risks among older and frail women from the Women's Health Initiative.
Am J Clin Nutr. 2017 06; 105(6):1399-1407.AJ

Abstract

Background:

Although studies to date have confirmed the association between nutrition and frailty, the impact of dietary intake and dietary patterns on survivorship in those with frailty is yet to be examined in a well-powered cohort with validated frailty status. Moreover, previous studies were limited by measurement error from dietary self-reports.

Objective:

We derived biomarker-calibrated dietary energy and protein intakes to address dietary self-report error. Using these data, we then evaluated the association of mortality in older women with frailty and dietary intake and healthy diet indexes, such as the alternate Mediterranean Diet (aMED), the Dietary Approaches to Stop Hypertension (DASH) score, and the Dietary Inflammatory Index (DII).

Design:

The analytic sample included 10,034 women aged 65-84 y with frailty and complete dietary data from the Women's Health Initiative Observational Study. Frailty was assessed with modified Fried's criteria. Dietary data were collected by food-frequency questionnaire.

Results:

Over a mean follow-up period of 12.4 y, 3259 (31%) deaths occurred. The HRs showed progressively decreased rates of mortality in women with higher calibrated dietary energy intakes (P-trend = 0.003), higher calibrated dietary protein intakes (P-trend = 0.03), higher aMED scores (P-trend = 0.006), and higher DASH scores (P-trend = 0.02). Although the adjusted point estimates of HRs (95% CIs) for frail women scoring in the second, third, and fourth quartiles on DII measures were 1.15 (1.03, 1.27), 1.28 (1.15, 1.42), and 1.24 (1.12, 1.38), respectively, compared with women in the first quartile, no overall effect was observed across quartiles (P-trend = 0.35). Subgroup analyses by chronic morbidity or smoking status or by excluding women with early death did not substantially change these findings.

Conclusions:

The current study highlights the importance of nutrition in older, frail women. Diet quality and quantity should be considered in managing persons with frailty.

Authors+Show Affiliations

School of Nursing and ozasl@uw.edu.Faculty of Health Science and Social Welfare, University of Haifa, Haifa, Israel.Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC.Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC.Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC.Department of Nutrition and Epidemiology, Harvard University, Cambridge, MA.Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC.Department of Biostatistics, University of Washington, Seattle, WA.Division of Preventive Medicine, University of Alabama, Birmingham, AL.College of Education and Human Ecology, Ohio State University, Columbus, OH.College of Public Health, University of Iowa, Iowa City, IA; and.College of Public Health, University of Iowa, Iowa City, IA; and.Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28424183

Citation

Zaslavsky, Oleg, et al. "Biomarker-calibrated Nutrient Intake and Healthy Diet Index Associations With Mortality Risks Among Older and Frail Women From the Women's Health Initiative." The American Journal of Clinical Nutrition, vol. 105, no. 6, 2017, pp. 1399-1407.
Zaslavsky O, Zelber-Sagi S, Hebert JR, et al. Biomarker-calibrated nutrient intake and healthy diet index associations with mortality risks among older and frail women from the Women's Health Initiative. Am J Clin Nutr. 2017;105(6):1399-1407.
Zaslavsky, O., Zelber-Sagi, S., Hebert, J. R., Steck, S. E., Shivappa, N., Tabung, F. K., Wirth, M. D., Bu, Y., Shikany, J. M., Orchard, T., Wallace, R. B., Snetselaar, L., & Tinker, L. F. (2017). Biomarker-calibrated nutrient intake and healthy diet index associations with mortality risks among older and frail women from the Women's Health Initiative. The American Journal of Clinical Nutrition, 105(6), 1399-1407. https://doi.org/10.3945/ajcn.116.151530
Zaslavsky O, et al. Biomarker-calibrated Nutrient Intake and Healthy Diet Index Associations With Mortality Risks Among Older and Frail Women From the Women's Health Initiative. Am J Clin Nutr. 2017;105(6):1399-1407. PubMed PMID: 28424183.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Biomarker-calibrated nutrient intake and healthy diet index associations with mortality risks among older and frail women from the Women's Health Initiative. AU - Zaslavsky,Oleg, AU - Zelber-Sagi,Shira, AU - Hebert,James R, AU - Steck,Susan E, AU - Shivappa,Nitin, AU - Tabung,Fred K, AU - Wirth,Michael D, AU - Bu,Yunqi, AU - Shikany,James M, AU - Orchard,Tonya, AU - Wallace,Robert B, AU - Snetselaar,Linda, AU - Tinker,Lesley F, Y1 - 2017/04/19/ PY - 2016/12/20/received PY - 2017/03/24/accepted PY - 2017/4/21/pubmed PY - 2017/8/2/medline PY - 2017/4/21/entrez KW - aging KW - biomarker KW - frailty KW - inflammation KW - mortality SP - 1399 EP - 1407 JF - The American journal of clinical nutrition JO - Am J Clin Nutr VL - 105 IS - 6 N2 - Background: Although studies to date have confirmed the association between nutrition and frailty, the impact of dietary intake and dietary patterns on survivorship in those with frailty is yet to be examined in a well-powered cohort with validated frailty status. Moreover, previous studies were limited by measurement error from dietary self-reports.Objective: We derived biomarker-calibrated dietary energy and protein intakes to address dietary self-report error. Using these data, we then evaluated the association of mortality in older women with frailty and dietary intake and healthy diet indexes, such as the alternate Mediterranean Diet (aMED), the Dietary Approaches to Stop Hypertension (DASH) score, and the Dietary Inflammatory Index (DII).Design: The analytic sample included 10,034 women aged 65-84 y with frailty and complete dietary data from the Women's Health Initiative Observational Study. Frailty was assessed with modified Fried's criteria. Dietary data were collected by food-frequency questionnaire.Results: Over a mean follow-up period of 12.4 y, 3259 (31%) deaths occurred. The HRs showed progressively decreased rates of mortality in women with higher calibrated dietary energy intakes (P-trend = 0.003), higher calibrated dietary protein intakes (P-trend = 0.03), higher aMED scores (P-trend = 0.006), and higher DASH scores (P-trend = 0.02). Although the adjusted point estimates of HRs (95% CIs) for frail women scoring in the second, third, and fourth quartiles on DII measures were 1.15 (1.03, 1.27), 1.28 (1.15, 1.42), and 1.24 (1.12, 1.38), respectively, compared with women in the first quartile, no overall effect was observed across quartiles (P-trend = 0.35). Subgroup analyses by chronic morbidity or smoking status or by excluding women with early death did not substantially change these findings.Conclusions: The current study highlights the importance of nutrition in older, frail women. Diet quality and quantity should be considered in managing persons with frailty. SN - 1938-3207 UR - https://www.unboundmedicine.com/medline/citation/28424183/Biomarker_calibrated_nutrient_intake_and_healthy_diet_index_associations_with_mortality_risks_among_older_and_frail_women_from_the_Women's_Health_Initiative_ L2 - https://academic.oup.com/ajcn/article-lookup/doi/10.3945/ajcn.116.151530 DB - PRIME DP - Unbound Medicine ER -