Advertisement

Dairy Food Intake Is Not Associated with Frailty in Adults from the Framingham Heart Study

  • Anna C. Siefkas
    Affiliations
    Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
    Search for articles by this author
  • Courtney L. Millar
    Affiliations
    Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts

    Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
    Search for articles by this author
  • Alyssa B. Dufour
    Affiliations
    Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts

    Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
    Search for articles by this author
  • Douglas P. Kiel
    Affiliations
    Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts

    Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
    Search for articles by this author
  • Paul F. Jacques
    Affiliations
    Nutritional Epidemiology Program, Jean Mayer US Department of Agriculture Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts

    Friedman School of Nutrition, Tufts University, Boston, Massachusetts
    Search for articles by this author
  • Marian T. Hannan
    Affiliations
    Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts

    Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts

    Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
    Search for articles by this author
  • Shivani Sahni
    Correspondence
    Address correspondence to: Shivani Sahni, PhD, Marcus Institute for Aging Research, Hebrew SeniorLife, 1200 Centre St, Roslindale, MA 02131.
    Affiliations
    Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts

    Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
    Search for articles by this author
Published:September 11, 2022DOI:https://doi.org/10.1016/j.jand.2022.09.012

      Abstract

      Background

      Nutrients, including protein, calcium, and fat may be associated with risk of frailty, yet specific contributions from whole dairy foods rich in these nutrients remain understudied.

      Objective

      To determine associations between dairy intake (milk, yogurt, cheese, total (milk + yogurt + cheese), low-fat and high-fat dairy, and servings per week) and frailty onset and frailty phenotype components.

      Design

      Prospective cohort study. All dairy intake exposures (servings per week) were assessed via a food frequency questionnaire.

      Participants and setting

      Participants (aged 33 to 86 years) from the Framingham Offspring Study who were not frail at baseline (1998-2001) completed a food frequency questionnaire and had 1 or 2 follow-up frailty assessments (2005-2008 and 2011-2014) were included.

      Main outcome measures

      Frailty was defined as the presence of ≥3 Fried frailty phenotype components: unintentional weight-loss, exhaustion, slowness (gait speed), weakness (grip strength), and low physical activity. Individuals with zero to two components were considered nonfrail.

      Statistical analyses performed

      Repeated measures logistic regression estimated odds ratios and 95% CIs for frailty onset. Logistic (exhaustion and weight loss) and linear regression (gait speed, grip strength, and physical activity) estimated the association between baseline dairy intake and each frailty component at follow-up, adjusting for baseline values for age, sex, energy intake (residual analysis), current smoking, and multivitamin use. Models were further adjusted for health status in a secondary analysis.

      Results

      Mean baseline age ± SD was 61 ± 9 years (range = 33 to 87 years), and 54% were women. Of 2,550 nonfrail individuals at baseline, 8.8% (2005-2008) and 13.5% (2011-2014) became frail. Higher yogurt intake was associated with decreased odds of frailty (odds ratio 0.96, 95% CI 0.93 to 0.99; P = 0.02). Each additional serving of yogurt (β ± SE) .004 ± .001; P < 0.01) and low-fat dairy (β ± SE) .001 ± .0006; P = 0.04) was associated with significantly faster follow-up gait speed. Dietary intakes of high-fat dairy were associated with increased odds of frailty (odds ratio 1.02, 95% CI 1.00 to 1.04; P = 0.05), but the P value was of borderline significance. No associations were observed for other dairy foods. After adjusting for health status, the associations of high-fat dairy and yogurt with frailty became nonsignificant, although the magnitudes of the associations did not change. The association between yogurt and gait speed decreased in magnitude after adjusting for health status (β ± SE) .002 ± .001; P = 0.01).

      Conclusions

      Dietary intakes of yogurt were modestly associated with reduced frailty onset and dietary intakes of high-fat dairy had a borderline association with increased odds of frailty, but other dairy food intakes showed no association in this study of healthy adults. Some dairy food intakes were modestly associated with follow-up gait speed. However, effect sizes were small, and the clinical importance of these associations remains undetermined.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of the Academy of Nutrition and Dietetics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Gustavson A.M.
        • Falvey J.R.
        • Jankowski C.M.
        • Stevens-Lapsley J.E.
        Public health impact of frailty: role of physical therapists.
        J Frailty Aging. 2017; 6: 2-5https://doi.org/10.14283/jfa.2017.1
        • Fried L.P.
        • Tangen C.M.
        • Walston J.
        • et al.
        Frailty in older adults: evidence for a phenotype.
        J Gerontol A Biol Sci Med Sci. 2001; 56: M146-M156https://doi.org/10.1093/gerona/56.3.m146
        • Ensrud K.E.
        • Ewing S.K.
        • Taylor B.C.
        • et al.
        Frailty and risk of falls, fracture, and mortality in older women: the study of osteoporotic fractures.
        J Gerontol A Biol Sci Med Sci. 2007; 62: 744-751https://doi.org/10.1093/gerona/62.7.744
        • United Nations
        Department of Economic and Social Affairs, Population Division. World population ageing 2015.
        2015
        • León-Muñoz L.M.
        • 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: 899-903https://doi.org/10.1016/j.jamda.2014.06.013
        • Kobayashi S.
        • Asakura K.
        • Suga H.
        • Sasaki S.
        High protein intake is associated with low prevalence of frailty among old Japanese women: a multicenter cross-sectional study.
        Nutr J. 2013; 12: 164https://doi.org/10.1186/1475-2891-12-164
        • Michelon E.
        • Blaum C.
        • Semba R.D.
        • Xue Q.L.
        • Ricks M.O.
        • Fried L.P.
        Vitamin and carotenoid status in older women: associations with the frailty syndrome.
        J Gerontol A Biol Sci Med Sci. 2006; 61: 600-607https://doi.org/10.1093/gerona/61.6.600
        • Hernández Morante J.J.
        • Gómez Martínez C.
        • Morillas-Ruiz J.M.
        Dietary factors associated with frailty in old adults: a review of nutritional interventions to prevent frailty development.
        Nutrients. 2019; 11: 102https://doi.org/10.3390/nu11010102
        • Bartali B.
        • Frongillo E.A.
        • Bandinelli S.
        • et al.
        Low nutrient intake is an essential component of frailty in older persons.
        J Gerontol A Biol Sci Med Sci. 2006; 61: 589-593https://doi.org/10.1093/gerona/61.6.589
        • Sandoval-Insausti H.
        • Pérez-Tasigchana R.F.
        • López-García E.
        • García-Esquinas E.
        • Rodríguez-Artalejo F.
        • Guallar-Castillón P.
        Macronutrients intake and incident frailty in older adults: a prospective cohort study.
        J Gerontol A Biol Sci Med Sci. 2016; 71: 1329-1334https://doi.org/10.1093/gerona/glw033
        • Beasley J.M.
        • LaCroix A.Z.
        • Neuhouser M.L.
        • et al.
        Protein intake and incident frailty in the Women's Health Initiative observational study.
        J Am Geriatr Soc. 2010; 58: 1063-1071https://doi.org/10.1111/j.1532-5415.2010.02866.x
        • Schoufour J.D.
        • Overdevest E.
        • Weijs P.J.M.
        • Tieland M.
        Dietary protein, exercise, and frailty domains.
        Nutrients. 2019; 11: 2399https://doi.org/10.3390/nu11102399
        • Alexandrov N.V.
        • Eelderink C.
        • Singh-Povel C.M.
        • Navis G.J.
        • Bakker S.J.L.
        • Corpeleijn E.
        Dietary protein sources and muscle mass over the life course: The Lifelines Cohort Study.
        Nutrients. 2018; 10: 1471https://doi.org/10.3390/nu10101471
        • Coelho-Junior H.J.
        • Marzetti E.
        • Picca A.
        • Cesari M.
        • Uchida M.C.
        • Calvani R.
        Protein intake and frailty: a matter of quantity, quality, and timing.
        Nutrients. 2020; 12: 2915https://doi.org/10.3390/nu12102915
      1. National Nutrient Database for Standard Reference. Release 28. US Dept of Agriculture; 2015.
        • Landi F.
        • Calvani R.
        • Tosato M.
        • et al.
        Anorexia of aging: risk factors, consequences, and potential treatments.
        Nutrients. 2016; 8: 69https://doi.org/10.3390/nu8020069
        • Manson J.E.
        • Bassuk S.S.
        Invited commentary: the Framingham Offspring Study—a pioneering investigation into familial aggregation of cardiovascular risk.
        Am J Epidemiol. 2017; 185: 1103-1108https://doi.org/10.1093/aje/kwx068
        • Tsao C.W.
        • Vasan R.S.
        Cohort profile: The Framingham Heart Study (FHS): overview of milestones in cardiovascular epidemiology.
        Int J Epidemiol. 2015; 44: 1800-1813https://doi.org/10.1093/ije/dyv337
        • Willett W.C.
        • Reynolds R.D.
        • Cottrell-Hoehner S.
        • Sampson L.
        • Browne M.L.
        Validation of a semi-quantitative food frequency questionnaire: comparison with a 1-year diet record.
        J Am Diet Assoc. 1987; 87: 43-47
        • Feskanich D.
        • Willett W.C.
        • Colditz G.A.
        Calcium, vitamin D, milk consumption, and hip fractures: a prospective study among postmenopausal women.
        Am J Clin Nutr. 2003; 77: 504-511https://doi.org/10.1093/ajcn/77.2.504
        • Rimm E.B.
        • Giovannucci E.L.
        • Stampfer M.J.
        • Colditz G.A.
        • Litin L.B.
        • Willett W.C.
        Reproducibility and validity of an expanded self-administered semiquantitative food frequency questionnaire among male health professionals.
        Am J Epidemiol. 1992; 135 (discussion 1127-1136): 1114-1126
        • Salvini S.
        • Hunter D.J.
        • Sampson L.
        • et al.
        Food-based validation of a dietary questionnaire: the effects of week-to-week variation in food consumption.
        Int J Epidemiol. 1989; 18: 858-867https://doi.org/10.1093/ije/18.4.858
        • Zong G.
        • Li Y.
        • Wanders A.J.
        • et al.
        Intake of individual saturated fatty acids and risk of coronary heart disease in US men and women: two prospective longitudinal cohort studies.
        BMJ. 2016; 355: i5796https://doi.org/10.1136/bmj.i5796
        • US Dept of Agriculture
        What foods are included in the Dairy Group? 2021.
        https://www.myplate.gov/eat-healthy/dairy
        Date accessed: June 11, 2021
        • US Dept of Agriculture
        2015 Dietary Guidelines for Americans Policy Document.
        • Orme J.G.
        • Reis J.
        • Herz E.J.
        Factorial and discriminant validity of the Center for Epidemiological Studies Depression (CES-D) scale.
        J Clin Psychol. 1986; 42: 28-33https://doi.org/10.1002/1097-4679(198601)42:1<28::aid-jclp2270420104>3.0.co;2-t
        • Hruby A.
        • Sahni S.
        • Bolster D.
        • Jacques P.F.
        Protein intake and functional integrity in aging: The Framingham Heart Study Offspring.
        J Gerontol A Biol Sci Med Sci. 2020; 75: 123-130https://doi.org/10.1093/gerona/gly201
        • Millar C.L.
        • Costa E.
        • Jacques P.F.
        • et al.
        Adherence to the Mediterranean-style diet and high intake of total carotenoids reduces the odds of frailty over 11 years in older adults: results from the Framingham Offspring Study.
        Am J Clin Nutr. 2022; https://doi.org/10.1093/ajcn/nqac130
        • Millar C.L.
        • Dufour A.B.
        • Shivappa N.
        • et al.
        A proinflammatory diet is associated with increased odds of frailty after 12-year follow-up in a cohort of adults.
        Am J Clin Nutr. 2022; 115: 334-343https://doi.org/10.1093/ajcn/nqab317
        • Kannel W.B.
        • Sorlie P.
        Some health benefits of physical activity. The Framingham Study.
        Arch Intern Med. 1979; 139: 857-861
        • Rumawas M.E.
        • Dwyer J.T.
        • McKeown N.M.
        • Meigs J.B.
        • Rogers G.
        • Jacques P.F.
        The development of the Mediterranean-style dietary pattern score and its application to the American diet in the Framingham Offspring Cohort.
        J Nutr. 2009; 139: 1150-1156https://doi.org/10.3945/jn.108.103424
        • Folstein M.F.
        • Folstein S.E.
        • McHugh P.R.
        “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician.
        J Psychiatr Res. 1975; 12: 189-198https://doi.org/10.1016/0022-3956(75)90026-6
        • Willett W.C.
        • Howe G.R.
        • Kushi L.H.
        Adjustment for total energy intake in epidemiologic studies.
        Am J Clin Nutr. 1997; 65 (discussion 1229S-1231S): 1220S-1228Shttps://doi.org/10.1093/ajcn/65.4.1220S
        • Govindaraju D.R.
        • Adrienne Cupples L.
        • Kannel W.B.
        • et al.
        Genetics of the Framingham Heart Study population.
        Adv Genet. 2008; 62: 33-65https://doi.org/10.1016/s0065-2660(08)00602-0
        • Rahi B.
        • Pellay H.
        • Chuy V.
        • Helmer C.
        • Samieri C.
        • Féart C.
        Dairy product intake and long-term risk for frailty among French elderly community dwellers.
        Nutrients. 2021; 13: 2151https://doi.org/10.3390/nu13072151
        • Lana A.
        • Rodriguez-Artalejo F.
        • Lopez-Garcia E.
        Dairy consumption and risk of frailty in older adults: a prospective cohort study.
        J Am Geriatr Soc. 2015; 6318521860https://doi.org/10.1111/jgs.13626
        • Otsuka R.
        • Tange C.
        • Tomida M.
        • et al.
        Dietary factors associated with the development of physical frailty in community-dwelling older adults.
        J Nutr Health Aging. 2019; 23: 89-95https://doi.org/10.1007/s12603-018-1124-3
        • Bandeen-Roche K.
        • Seplaki C.L.
        • Huang J.
        • et al.
        Frailty in older adults: a nationally representative profile in the United States.
        J Gerontol A Biol Sci Med Sci. 2015; 70: 1427-1434https://doi.org/10.1093/gerona/glv133
        • Collard R.M.
        • Boter H.
        • Schoevers R.A.
        • Oude Voshaar R.C.
        Prevalence of frailty in community-dwelling older persons: a systematic review.
        J Am Geriatr Soc. 2012; 60: 1487-1492https://doi.org/10.1111/j.1532-5415.2012.04054.x
        • McLean R.R.
        • Mangano K.M.
        • Hannan M.T.
        • Kiel D.P.
        • Sahni S.
        Dietary protein intake is protective against loss of grip strength among older adults in the Framingham Offspring Cohort.
        J Gerontol A Biol Sci Med Sci. 2016; 71: 356-361https://doi.org/10.1093/gerona/glv184
        • Coelho-Júnior H.J.
        • Milano-Teixeira L.
        • Rodrigues B.
        • Bacurau R.
        • Marzetti E.
        • Uchida M.
        Relative protein intake and physical function in older adults: a systematic review and meta-analysis of observational studies.
        Nutrients. 2018; 10: 1330https://doi.org/10.3390/nu10091330
        • Mangano K.M.
        • Sahni S.
        • Kiel D.P.
        • Tucker K.L.
        • Dufour A.B.
        • Hannan M.T.
        Dietary protein is associated with musculoskeletal health independently of dietary pattern: the Framingham Third Generation Study.
        Am J Clin Nutr. 2017; 105: 714-722https://doi.org/10.3945/ajcn.116.136762
        • Radavelli-Bagatini S.
        • Zhu K.
        • Lewis J.R.
        • Dhaliwal S.S.
        • Prince R.L.
        Association of dairy intake with body composition and physical function in older community-dwelling women.
        J Acad Nutr Diet. 2013; 113: 1669-1674https://doi.org/10.1016/j.jand.2013.05.019
        • Alemán-Mateo H.
        • Carreón V.R.
        • Macías L.
        • Astiazaran-García H.
        • Gallegos-Aguilar A.C.
        • Enríquez J.R.
        Nutrient-rich dairy proteins improve appendicular skeletal muscle mass and physical performance, and attenuate the loss of muscle strength in older men and women subjects: a single-blind randomized clinical trial.
        Clin Interv Aging. 2014; 9: 1517-1525https://doi.org/10.2147/cia.s67449
        • Hanach N.I.
        • McCullough F.
        • Avery A.
        The impact of dairy protein intake on muscle mass, muscle strength, and physical performance in middle-aged to older adults with or without existing sarcopenia: a systematic review and meta-analysis.
        Adv Nutr. 2019; 10: 59-69https://doi.org/10.1093/advances/nmy065
        • US Dept of Agriculture, National Agricultural Statistical Service
        Dairy Products 2019 Summary.
        2020
      2. Topic: Cheese market.
        • Stiemsma L.T.
        • Nakamura R.E.
        • Nguyen J.G.
        • Michels K.B.
        Does consumption of fermented foods modify the human gut microbiota?.
        J Nutr. 2020; 150: 1680-1692https://doi.org/10.1093/jn/nxaa077
        • Kok C.R.
        • Hutkins R.
        Yogurt and other fermented foods as sources of health-promoting bacteria.
        Nutr Rev. 2018; 76: 4-15https://doi.org/10.1093/nutrit/nuy056
        • Lim M.Y.
        • Hong S.
        • Kim J.H.
        • Nam Y.D.
        Association between gut microbiome and frailty in the older adult population in Korea.
        J Gerontol A Biol Sci Med Sci. 2021; 76: 1362-1368https://doi.org/10.1093/gerona/glaa319
        • Laclaustra M.
        • Rodriguez-Artalejo F.
        • Guallar-Castillon P.
        • et al.
        Prospective association between added sugars and frailty in older adults.
        Am J Clin Nutr. 2018; 107: 772-779https://doi.org/10.1093/ajcn/nqy028
      3. Volume sales share of yogurt in the United States as of 2018, by fat content.

      Biography

      A. Siefkas is a doctoral degree candidate, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA.

      Biography

      C. Millar is a postdoctoral research fellow, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, and a research fellow in medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.

      Biography

      A. Dufour is an assistant scientist II, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, and an instructor in medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.

      Biography

      D. Kiel is director of the Musculoskeletal Research Center and a senior scientist, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, and a professor of medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.

      Biography

      P. Jacques is a senior scientist, Nutritional Epidemiology Program, Jean Mayer, US Department of Agriculture Human Nutrition Research Center on Aging, Tufts University, Boston, MA, and a professor, Friedman School of Nutrition, Tufts University, Boston, MA.

      Biography

      M. Hannan is codirector of the Musculoskeletal Research Center and a senior scientist, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, and a professor of medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, and a professor of epidemiology, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA.

      Biography

      S. Sahni is director of the Nutrition Program and an associate scientist, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, and an associate professor of medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.