title: Lower nutritional status and higher food insufficiency in frail older US adults.
abstract: Frailty is a state of decreased physical functioning and a significant complication of ageing. We examined frailty, energy and macronutrient intake, biomarkers of nutritional status and food insufficiency in US older adult (age ≥ 60 years) participants of the Third National Health and Nutrition Examination Survey (n 4731). Frailty was defined as meeting ≥ 2 and pre-frailty as meeting one of the following four-item criteria: (1) slow walking; (2) muscular weakness; (3) exhaustion and (4) low physical activity. Intake was assessed by 24 h dietary recall. Food insufficiency was self-reported as 'sometimes' or 'often' not having enough food to eat. Analyses were adjusted for sex, race, age, smoking, education, income, BMI, other co-morbid conditions and complex survey design. Prevalence of frailty was highest among people who were obese (20·8 %), followed by overweight (18·4 %), normal weight (16·1 %) and lowest among people who were underweight (13·8 %). Independent of BMI, daily energy intake was lowest in people who were frail, followed by pre-frail and highest in people who were not frail (6648 (se 130), 6966 (se 79) and 7280 (se 84) kJ, respectively, P< 0·01). Energy-adjusted macronutrient intakes were similar in people with and without frailty. Frail (adjusted OR (AOR) 4·7; 95 % CI 1·7, 12·7) and pre-frail (AOR 2·1; 95 % CI 0·8, 5·8) people were more likely to report being food insufficient than not frail people. Serum albumin, carotenoids and Se levels were lower in frail adults than not frail adults. Research is needed on targeted interventions to improve nutritional status and food insufficiency among frail older adults, while not necessarily increasing BMI.
authors.affiliation: School of Biological and Population Health Sciences, Oregon State University, Waldo 316, Corvallis, OR 97331, USA. ellen.smit@oregonstate.edu
authors.forename: Ellen
authors.initials: E
authors.lastname: Smit
authors.forename: Kerrie M
authors.initials: KM
authors.lastname: Winters-Stone
authors.forename: Paul D
authors.initials: PD
authors.lastname: Loprinzi
authors.forename: Alice M
authors.initials: AM
authors.lastname: Tang
authors.forename: Carlos J
authors.initials: CJ
authors.lastname: Crespo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001835:Body Weight; D002338:Carotenoids / Q000097:blood; D004032:Diet; D002149:Energy Intake; D005260:Female; D005523:Food Supply; D016330:Frail Elderly / Q000706:statistics & numerical data; D015577:Geriatric Assessment; D006801:Humans; D008297:Male; D044342:Malnutrition / Q000453:epidemiology*; D008875:Middle Aged; D015596:Nutrition Assessment; D009749:Nutrition Surveys; D009752:Nutritional Status; D009765:Obesity / Q000453:epidemiology; D016017:Odds Ratio; D050177:Overweight / Q000453:epidemiology; D015995:Prevalence; D012016:Reference Values; D012643:Selenium / Q000097:blood; D057566:Self Report; D012709:Serum Albumin / Q000378:metabolism; D013851:Thinness / Q000453:epidemiology; D014481:United States / Q000453:epidemiology
chemical_list: D012709:Serum Albumin; D002338:Carotenoids; D012643:Selenium