Abstract
Objective
Inflammation is key risk factor for several conditions in the elderly. However, the
relationship between inflammation and frailty is still unclear. We investigated whether
higher dietary inflammatory index (DII) scores were associated with higher incidence
of frailty in a cohort of North Americans.
Design
Longitudinal, with a follow-up of 8 years.
Setting
Osteoarthritis Initiative.
Participants
A total of 4421 participants with, or at high risk of, knee osteoarthritis.
Measurements
DII scores were calculated using the validated Block Brief 2000 Food-Frequency Questionnaire
and categorized into sex-specific quartiles. Frailty was defined as 2 out of 3 of
the criteria of the Study of Osteoporotic Fracture study (ie, weight loss, inability
to rise from a chair 5 times, and poor energy). The strength of the association between
baseline DII score and incident frailty was assessed through a Cox's regression analysis,
adjusted for potential baseline confounders, and reported as hazard ratios.
Results
A total of 4421 community-dwelling participants (2564 female participants; mean age:
61.3 years) without frailty at baseline were identified from the Osteoarthritis Initiative.
During 8 years of follow-up, 356 individuals developed frailty (8.2%). Using Cox's
regression analysis, adjusting for 11 potential confounders, participants with the
highest DII score (quartile 4) had a significantly higher risk of experiencing frailty
(hazard ratio 1.37; 95% confidence interval 1.01–1.89; P = .04) compared with participants with the lowest DII score (quartile 1). The association
between DII score and frailty was significant only in men.
Conclusions
Higher DII scores, indicating a more proinflammatory diet, are associated with higher
incidence of frailty, particularly in men.
Keywords
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Article info
Publication history
Published online: September 21, 2017
Footnotes
The OAI is a public-private partnership comprised of 5 contracts (N01-AR-2-2258; N01-AR-2-2259; N01-AR-2-2260; N01-AR-2-2261; N01-AR-2-2262) funded by the National Institutes of Health, a branch of the Department of Health and Human Services, and conducted by the OAI Study Investigators. Private funding partners include Merck Research Laboratories; Novartis Pharmaceuticals Corporation, GlaxoSmithKline; and Pfizer, Inc. Private sector funding for the OAI is managed by the Foundation for the National Institutes of Health. This article was prepared using an OAI public use data set and does not necessarily reflect the opinions or views of the OAI investigators, the NIH, or the private funding partners. NS and JRH were supported by the United States National Institute for Diabetes, Digestive and Kidney Diseases (grant no. R44DK103377). The sponsors had no role in the design, methods, subject recruitment, data collection, analysis, or preparation of this article.
Dr Hébert owns controlling interest in Connecting Health Innovations LLC (CHI), a company planning to license the right to his invention of the dietary inflammatory index (DII) from the University of South Carolina to develop computer and smart phone applications for patient counseling and dietary intervention in clinical settings. Dr Shivappa is an employee of CHI.
Identification
Copyright
© 2017 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
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- The Pathophysiology of Frailty: Why Sex Is So ImportantJournal of the American Medical Directors AssociationVol. 19Issue 1
- PreviewAlthough a decade has passed since the elegant theory of “inflammaging” was proposed,1 the precise pathophysiological pathways that lead to frailty, as opposed to “healthy” aging, remain elusive. Elevated inflammatory markers have been associated with frailty in cross-sectional studies of older adults.2 A leading hypothesis is that persistent low-grade inflammation causes frailty via catabolic effects of proinflammatory cytokines on muscle.3 The inflammatory milieu is also thought to influence the progression of age-related diseases, which in turn contribute to the development of frailty.
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