title: Macronutrients, diet quality, and frailty in older men.
abstract: BACKGROUND
  Frailty, a phenotype of multisystem impairment and expanding vulnerability, is associated with higher risk of adverse health outcomes not entirely explained by advancing age. We investigated associations of macronutrients, dietary fiber, and overall diet quality with frailty status in older community-dwelling men.
  
  
  METHODS
  Participants were 5,925 men aged ≥ 65 years enrolled in the Osteoporotic Fractures in Men (MrOS) study at six U.S. centers. Diet was assessed at baseline with a food frequency questionnaire. We assessed frailty status (robust, intermediate, or frail) at baseline and at a second clinic visit (a mean of 4.6 years later) using a slightly modified Cardiovascular Health Study frailty index. We used multinomial logistic regression to assess associations between macronutrient intake, dietary fiber, and the Diet Quality Index Revised with frailty status at baseline and at the second clinic visit.
  
  
  RESULTS
  At baseline, 2,748 (46.4%) participants were robust, 2,681 (45.2%) were intermediate, and 496 (8.4%) were frail. Carbohydrate, fat, protein, and dietary fiber showed no consistent associations with frailty status. Overall diet quality exhibited fairly consistent associations with frailty status. The Diet Quality Index Revised was inversely associated with frail status relative to robust status at the baseline visit (odds ratio for Q5 vs Q1 = 0.44, 95% confidence interval: 0.30, 0.63; p for trend < .0001) and at the second clinic visit (odds ratio for Q5 vs Q1 = 0.18, 95% confidence interval: 0.03, 0.97; p for trend = .0180).
  
  
  CONCLUSIONS
  Overall diet quality was inversely associated with prevalent and future frailty status in this cohort of older men.
authors.affiliation: Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham. jshikany@uabmc.edu.
authors.forename: James M
authors.initials: JM
authors.lastname: Shikany
authors.affiliation: Division of Epidemiology, Department of Family and Preventive Medicine, University of California, San Diego School of Medicine.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Barrett-Connor
authors.affiliation: Division of Epidemiology & Community Health, University of Minnesota School of Public Health, Minneapolis.
authors.forename: Kristine E
authors.initials: KE
authors.lastname: Ensrud
authors.affiliation: California Pacific Medical Center Research Institute, San Francisco.
authors.forename: Peggy M
authors.initials: PM
authors.lastname: Cawthon
authors.affiliation: Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham.
authors.forename: Cora E
authors.initials: CE
authors.lastname: Lewis
authors.affiliation: Columbia University Medical Center, New York.
authors.forename: Thuy-Tien L
authors.initials: TT
authors.lastname: Dam
authors.affiliation: Division of Epidemiology, Public Health & Preventive Medicine, Oregon Health & Science University, Portland.
authors.forename: Jackilen
authors.initials: J
authors.lastname: Shannon
authors.affiliation: Department of Biostatistics, School of Public Health, University of Alabama at Birmingham.
authors.forename: David T
authors.initials: DT
authors.lastname: Redden
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004032:Diet / Q000592:standards*; D005247:Feeding Behavior; D016330:Frail Elderly; D015577:Geriatric Assessment / Q000379:methods*; D006304:Health Status; D006801:Humans; D015994:Incidence; D008297:Male; D009752:Nutritional Status / Q000502:physiology*; D058866:Osteoporotic Fractures / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D014481:United States / Q000453:epidemiology
keywords: Epidemiology.; Frailty; Nutrition