Nutr Res Pract.  2024 Dec;18(6):829-844. 10.4162/nrp.2024.18.6.829.

Daily consumption of specific categories of fruit and vegetables negatively correlated with frailty: findings from the US National Health and Nutrition Examination Survey

• Zhang X
• Lai J
• Jin Z
• Wu Y
• Zhao K

• KMID: 2562370
• DOI: http://doi.org/10.4162/nrp.2024.18.6.829

Abstract

BACKGROUND/OBJECTIVES
The specific impact of different fruit and vegetable consumption categories on frailty is not completely understood. This study examined the relationships between the daily consumption of fruit and vegetables and frailty in a large general population.
SUBJECTS/METHODS
This study used the data from the US National Health and Nutrition Examination Survey (2005–2020). Two intermittent 24-h dietary recalls were used to evaluate fruit and vegetable consumption. Frailty was assessed using the frailty index. Logistic regression, stratified analyses, and restricted cubic spline models were used to examine these associations.
RESULTS
A higher daily intake of citrus, melons, and berries (odds ratio [OR], 0.77; 95% confidence interval [CI], 0.65–0.92), other fruit (OR, 0.74; 95% CI, 0.62–0.88), intact fruit (OR, 0.71; 95% CI, 0.60–0.84), dark-green vegetables (OR, 0.71; 95% CI, 0.60–0.83), and total vegetables (OR, 0.80; 95% CI, 0.66–0.96), along with a lower fruit juice intake (OR, 0.81; 95% CI, 0.69–0.96), were associated with a reduced risk of frailty in adults aged 18 yrs and older. Further analysis showed that the daily consumption of citrus melons and berries, other fruit, intact fruit, fruit juice, and tomatoes and tomato products were inversely associated with frailty in adults under 60 yrs and females. Dark green vegetables were inversely correlated with frailty in individuals aged 40–60 yrs and over 60 yrs, regardless of sex.
CONCLUSION
The daily consumption of most types of fruit, dark green vegetables, and tomatoes and tomato products may reduce the risk of frailty in American adults, particularly for individuals under 60 yrs of age and females.

Keyword

Frailty; nutrients; fruit; vegetable; nutrition surveys

Figure

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  Fig. 1 Flowchart of participant selection.NHANES, National Health and Nutrition Examination Survey.

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  Fig. 2 Restricted cubic spline model of the association between (A) intact fruit intake and frailty; (B) citrus, melons, and berries intake and frailty; (C) other fruits intake and frailty; (D) total fruit intake and frailty; (E) fruit juice intake and frailty, (F) total vegetables intake and frailty. The red line and shaded area represent the estimated log ORs and their 95% CIs, respectively. The lowest level of daily intake was used as the reference.OR, odds ratio; CI, confidence interval.

Reference

1. Dent E, Martin FC, Bergman H, Woo J, Romero-Ortuno R, Walston JD. Management of frailty: opportunities, challenges, and future directions. Lancet. 2019; 394:1376–1386. PMID: 31609229.

2. Fabrício DM, Chagas MH, Diniz BS. Frailty and cognitive decline. Transl Res. 2020; 221:58–64. PMID: 32045578.

3. Crocker TF, Brown L, Clegg A, Farley K, Franklin M, Simpkins S, Young J. Quality of life is substantially worse for community-dwelling older people living with frailty: systematic review and meta-analysis. Qual Life Res. 2019; 28:2041–2056. PMID: 30875008.

4. Hoogendijk EO, Afilalo J, Ensrud KE, Kowal P, Onder G, Fried LP. Frailty: implications for clinical practice and public health. Lancet. 2019; 394:1365–1375. PMID: 31609228.

5. Gordon EH, Peel NM, Hubbard RE, Reid N. Frailty in younger adults in hospital. QJM. 2023; 116:845–849. PMID: 37467071.

6. Kehler DS, Ferguson T, Stammers AN, Bohm C, Arora RC, Duhamel TA, Tangri N. Prevalence of frailty in Canadians 18-79 years old in the Canadian Health Measures Survey. BMC Geriatr. 2017; 17:28. PMID: 28107813.

7. Li CM, Lin CH, Li CI, Liu CS, Lin WY, Li TC, Lin CC. Frailty status changes are associated with healthcare utilization and subsequent mortality in the elderly population. BMC Public Health. 2021; 21:645. PMID: 33794860.

8. Viljanen A, Salminen M, Irjala K, Korhonen P, Wuorela M, Isoaho R, Kivelä SL, Vahlberg T, Viitanen M, Löppönen M, et al. Frailty, walking ability and self-rated health in predicting institutionalization: an 18-year follow-up study among Finnish community-dwelling older people. Aging Clin Exp Res. 2021; 33:547–554. PMID: 32306371.

9. Peng Y, Zhong GC, Zhou X, Guan L, Zhou L. Frailty and risks of all-cause and cause-specific death in community-dwelling adults: a systematic review and meta-analysis. BMC Geriatr. 2022; 22:725. PMID: 36056319.

10. Poursalehi D, Lotfi K, Saneei P. Adherence to the Mediterranean diet and risk of frailty and pre-frailty in elderly adults: a systematic review and dose-response meta-analysis with GRADE assessment. Ageing Res Rev. 2023; 87:101903. PMID: 36871780.

11. Zhai H, Wang Y, Jiang W. Fruit and vegetable intake and the risk of chronic obstructive pulmonary disease: a dose-response meta-analysis of observational studies. BioMed Res Int. 2020; 2020:3783481. PMID: 32219131.

12. Madsen H, Sen A, Aune D. Fruit and vegetable consumption and the risk of hypertension: a systematic review and meta-analysis of prospective studies. Eur J Nutr. 2023; 62:1941–1955. PMID: 37106252.

13. Zurbau A, Au-Yeung F, Blanco Mejia S, Khan TA, Vuksan V, Jovanovski E, Leiter LA, Kendall CW, Jenkins DJ, Sievenpiper JL. Relation of different fruit and vegetable sources with incident cardiovascular outcomes: a systematic review and meta-analysis of prospective cohort studies. J Am Heart Assoc. 2020; 9:e017728. PMID: 33000670.

14. Ghoreishy SM, Asoudeh F, Jayedi A, Mohammadi H. Fruit and vegetable intake and risk of frailty: a systematic review and dose response meta-analysis. Ageing Res Rev. 2021; 71:101460. PMID: 34534684.

15. Pilleron S, Weber D, Pérès K, Colpo M, Gomez-Cabrero D, Stuetz W, Dartigues JF, Ferrucci L, Bandinelli S, Garcia-Garcia FJ, et al. Patterns of circulating fat-soluble vitamins and carotenoids and risk of frailty in four European cohorts of older adults. Eur J Nutr. 2019; 58:379–389. PMID: 29380043.

16. Urpi-Sarda M, Andres-Lacueva C, Rabassa M, Ruggiero C, Zamora-Ros R, Bandinelli S, Ferrucci L, Cherubini A. The relationship between urinary total polyphenols and the frailty phenotype in a community-dwelling older population: the InCHIANTI study. J Gerontol A Biol Sci Med Sci. 2015; 70:1141–1147. PMID: 25838546.

17. León-Muñoz LM, Guallar-Castillón P, López-García E, Rodríguez-Artalejo F. Mediterranean diet and risk of frailty in community-dwelling older adults. J Am Med Dir Assoc. 2014; 15:899–903. PMID: 25127502.

18. Otsuka R, Tange C, Tomida M, Nishita Y, Kato Y, Yuki A, Ando F, Shimokata H, Arai H. Dietary factors associated with the development of physical frailty in community-dwelling older adults. J Nutr Health Aging. 2019; 23:89–95. PMID: 30569075.

19. Fung TT, Struijk EA, Rodriguez-Artalejo F, Willett WC, Lopez-Garcia E. Fruit and vegetable intake and risk of frailty in women 60 years old or older. Am J Clin Nutr. 2020; 112:1540–1546. PMID: 33022693.

20. U.S. Department of Agriculture, Agricultural Research Service. USDA Food and Nutrient Database for Dietary Studies [Internet]. Washington, D.C.: Agricultural Research Service;cited 2023 November 23. Available from: https://www.ars.usda.gov/northeast-area/beltsville-md-bhnrc/beltsville-human-nutrition-research-center/food-surveys-research-group/docs/fped-methodology/.

21. Yang Y, Zhang D, Yuan G, Wu Y, Huang X. Association between nut consumption and frailty in the elderly: a large sample cross-sectional study. J Hum Nutr Diet. 2023; 36:1845–1856. PMID: 37448140.

22. Hakeem FF, Bernabé E, Sabbah W. Association between oral health and frailty among American older adults. J Am Med Dir Assoc. 2021; 22:559–563.e2. PMID: 32859517.

23. Pang S, Miao G, Zhou Y, Duan M, Bai L, Zhao X. Association between coffee intake and frailty among older American adults: a population-based cross-sectional study. Front Nutr. 2023; 10:1075817. PMID: 36819700.

24. Kojima G, Taniguchi Y, Urano T. Fruit and vegetable consumption and incident frailty in older adults: a systematic review and meta-analysis. J Frailty Aging. 2022; 11:45–50. PMID: 35122090.

25. Ruangsuriya J, Wongpoomchai R, Srichairatanakool S, Sirikul W, Buawangpong N, Siviroj P. Guava fruit and Acacia pennata vegetable intake association with frailty of older adults in Northern Thailand. Nutrients. 2022; 14:1192. PMID: 35334846.

26. Sotos-Prieto M, Struijk EA, Fung TT, Rodríguez-Artalejo F, Willett WC, Hu FB, Lopez-Garcia E. Association between the quality of plant-based diets and risk of frailty. J Cachexia Sarcopenia Muscle. 2022; 13:2854–2862. PMID: 36177985.

27. Shimizu C, Wakita Y, Inoue T, Hiramitsu M, Okada M, Mitani Y, Segawa S, Tsuchiya Y, Nabeshima T. Effects of lifelong intake of lemon polyphenols on aging and intestinal microbiome in the senescence-accelerated mouse prone 1 (SAMP1). Sci Rep. 2019; 9:3671. PMID: 30842523.

28. Marcos-Pérez D, Sánchez-Flores M, Proietti S, Bonassi S, Costa S, Teixeira JP, Fernández-Tajes J, Pásaro E, Laffon B, Valdiglesias V. Association of inflammatory mediators with frailty status in older adults: results from a systematic review and meta-analysis. Geroscience. 2020; 42:1451–1473. PMID: 32803650.

29. Soysal P, Isik AT, Carvalho AF, Fernandes BS, Solmi M, Schofield P, Veronese N, Stubbs B. Oxidative stress and frailty: a systematic review and synthesis of the best evidence. Maturitas. 2017; 99:66–72. PMID: 28364871.

30. El Assar M, Angulo J, Rodríguez-Mañas L. Frailty as a phenotypic manifestation of underlying oxidative stress. Free Radic Biol Med. 2020; 149:72–77. PMID: 31422077.

31. Kochlik B, Stuetz W, Pérès K, Pilleron S, Féart C, García García FJ, Bandinelli S, Gomez-Cabrero D, Rodriguez-Mañas L, Grune T, et al. Associations of fat-soluble micronutrients and redox biomarkers with frailty status in the FRAILOMIC initiative. J Cachexia Sarcopenia Muscle. 2019; 10:1339–1346. PMID: 31436047.

32. Oei S, Millar CL, Nguyen Lily TN, Mukamal KJ, Kiel DP, Lipsitz LA, Hannan MT, Sahni S. Higher intake of dietary flavonols, specifically dietary quercetin, is associated with lower odds of frailty onset over 12 years of follow-up among adults in the Framingham Heart Study. Am J Clin Nutr. 2023; 118:27–33. PMID: 37061164.

33. Ganapathy A, Nieves JW. Nutrition and sarcopenia-what do we know? Nutrients. 2020; 12:1755. PMID: 32545408.

34. Sies H, Stahl W. Vitamins E and C, beta-carotene, and other carotenoids as antioxidants. Am J Clin Nutr. 1995; 62:1315S–1321S. PMID: 7495226.

35. Sagar NA, Pareek S, Sharma S, Yahia EM, Lobo MG. Fruit and vegetable waste: bioactive compounds, their extraction, and possible utilization. Compr Rev Food Sci Food Saf. 2018; 17:512–531. PMID: 33350136.

36. Zhang Z, Zeng X, Li M, Zhang T, Li H, Yang H, Huang Y, Zhu Y, Li X, Yang W. A prospective study of fruit juice consumption and the risk of overall and cardiovascular disease mortality. Nutrients. 2022; 14:2127. PMID: 35631268.

37. Tor-Roca A, Garcia-Aloy M, Mattivi F, Llorach R, Andres-Lacueva C, Urpi-Sarda M. Phytochemicals in legumes: a qualitative reviewed analysis. J Agric Food Chem. 2020; 68:13486–13496. PMID: 33169614.

38. Muzquiz M, Varela A, Burbano C, Cuadrado C, Guillamón E, Pedrosa MM. Bioactive compounds in legumes: pronutritive and antinutritive actions. Implications for nutrition and health. Phytochem Rev. 2012; 11:227–244.

39. Coelho-Júnior HJ, Rodrigues B, Uchida M, Marzetti E. Low protein intake is associated with frailty in older adults: a systematic review and meta-analysis of observational studies. Nutrients. 2018; 10:1334. PMID: 30235893.

40. Morillas-Ruiz JM, Villegas García JA, López FJ, Vidal-Guevara ML, Zafrilla P. Effects of polyphenolic antioxidants on exercise-induced oxidative stress. Clin Nutr. 2006; 25:444–453. PMID: 16426710.

41. Feart C. Nutrition and frailty: current knowledge. Prog Neuropsychopharmacol Biol Psychiatry. 2019; 95:109703. PMID: 31325470.

42. Freedman LS, Commins JM, Moler JE, Willett W, Tinker LF, Subar AF, Spiegelman D, Rhodes D, Potischman N, Neuhouser ML, et al. Pooled results from 5 validation studies of dietary self-report instruments using recovery biomarkers for potassium and sodium intake. Am J Epidemiol. 2015; 181:473–487. PMID: 25787264.

43. Brussaard JH, Löwik MR, Steingrímsdóttir L, Møller A, Kearney J, De Henauw S, Becker W. EFCOSUM Group. A European food consumption survey method--conclusions and recommendations. Eur J Clin Nutr. 2002; 56(Suppl 2):S89–S94. PMID: 12082521.