People tend to become more fragile with age. But frailty syndrome – functional decline that makes simple everyday activities a challenge – is not a normal part of aging. Rather, it is associated with lifestyle factors such as diet.
In a recent study, poor quality diets were associated with greater risk of becoming weak and fragile. Challenging conventional wisdom, the US research found that diet quality was more important than food quantity or protein intake.
The study involved more than 2,000 adults aged between 71 and 80 years who were categorised as “robust” or “pre-frail” at the study’s outset. Over four years of monitoring, 277 of overall participants became frail, and 629 of those who were robust became frail or pre-frail.
While protein and energy intake made no difference, eating poor quality diets almost certainly led to frailty (92% higher incidence) while medium quality diets conferred a 40 percent greater risk of becoming frail compared to good quality diets.
With aging, muscle mass and strength and bone density naturally wane to some degree. But this can be accelerated by inadequate mobility and poor nutrition, leading to sarcopenia, osteoporosis or a combination of these – now named osteosarcopenia.
This can result in frailty syndrome. It has been proposed that the syndrome can be identified if someone experiences three or more of the following: weight loss, exhaustion, weakness, slowness and inactivity (some of which can also be signs of malnutrition).
Recognising frailty syndrome can help inform treatment, but ideally it’s best for people to take measures to avoid going downhill so quickly and compromising quality of life rather than aging gracefully.
Diet and nutrition
What causes it has been a subject of debate; nutritional factors typically linked to lower risk of sarcopenia, osteoporosis and frailty have included high protein intake, energy (calories), and vitamin D and calcium levels.
Accordingly, treating the conditions and underlying malnutrition has traditionally been treated first and foremost by increasing protein and energy intake – which may include recommending custards and other sweet desserts that are otherwise nutritionally bereft.
Given that the new research on diet quality suggests that attention to healthy foods is paramount for prevention, what does this mean?
The paper cited four other studies that found the Mediterranean diet reduced frailty risk. This is an eating pattern high in plant foods such as fruit, vegetables and legumes and healthy fats contained in extra virgin olive oil, nuts and seeds. It is low in processed foods, confectionary and red meat.
There is plenty of scope to include healthy energy and protein options in this type of diet – also providing an abundance of other nutrients such as calcium and vitamin D (although supplementation may be needed to boost vitamin D in any event – best to check levels with a GP), thereby ticking all boxes.
This includes generous amounts of extra virgin olive oil for cooking and salads, a handful of nuts every day, avocado, salmon, eggs, and full fat dairy products such as yoghurt and cheese.