Novel Healthy Eating Index to Examine Daily Food Guides Adherence and Frailty in Older Taiwanese

Kian-Yuan Lim; I-Chen Chen; Yun-Chun Chan; In-Fai Cheong; Yi-Yen Wang; Zi-Rong Jian; Shyh-Dye Lee; Chi-Chun Chou; Feili Lo Yang

doi:10.3390/nu13124210

Novel Healthy Eating Index to Examine Daily Food Guides Adherence and Frailty in Older Taiwanese

Nutrients. 2021 Nov 24;13(12):4210. doi: 10.3390/nu13124210.

Authors

Kian-Yuan Lim¹, I-Chen Chen², Yun-Chun Chan², In-Fai Cheong², Yi-Yen Wang², Zi-Rong Jian², Shyh-Dye Lee³, Chi-Chun Chou⁴, Feili Lo Yang^{1

2}

Affiliations

¹ Ph.D. Program in Nutrition and Food Science, College of Human Ecology, Fu Jen Catholic University, New Taipei City 242062, Taiwan.
² Department of Nutritional Science, College of Human Ecology, Fu Jen Catholic University, New Taipei City 242062, Taiwan.
³ Department of Family Medicine, Fu Jen Catholic University Hospital, New Taipei City 243089, Taiwan.
⁴ Department of Otorhinolaryngology, Yonghe Cardinal Tien Hospital, New Taipei City 234408, Taiwan.

Abstract

This study was conducted to investigate the adherence of Daily Food Guides (DFGs) among older Taiwanese, and the relationship of dietary quality and frailty. 154 functional independent older adults who were retirement home residents or community dwellers involved in congregate meal services were recruited. DFGs adherence was measured using a novel Taiwanese Healthy Index (T-HEI). Dietary quality was further assessed using Dietary Approach to Stop Hypertension (DASH) and Mediterranean Diet Score (MDS). Frailty was defined using modified Fried's criteria. Of the total participants, 12.3% were considered non-frail individuals, while 77.3% were prefrail, and 10.4% were frail. Compared to non-frail participants, prefrail and frail individuals indicated significantly lower adherence to DFGs (p_trend = 0.025). Intake of dark or orange vegetables (p_trend = 0.010), whole grains (p_trend = 0.007), as well as nuts and seeds (p_trend = 0.029) by non-frail individuals were significantly higher than the levels by prefrail and frail individuals. Linear regression model adjusted for age, gender, and functional ability showed that T-HEI was inversely associated with frailty status (β = -0.16 ± 0, p = 0.047), but additional adjustment for nutritional status attenuated the association (β = -0.14 ± 0, p = 0.103). A similar relationship was observed for DASH but not MDS (DASH: β = -0.18 ± 0.01, p = 0.024; MDS: β = -0.06 ± 0.02, p = 0.465). After adjustment for confounders, the association was not observed. However, the distribution of whole grains component in both DASH and MDS was significantly higher in non-frail than prefrail and frail individuals, indicating the importance of whole grains intake in frailty prevention. In conclusion, higher adherence to DFGs and better dietary quality were associated with a lower prevalence of frailty. Higher nutrient-dense foods intake such as whole grains, dark or orange vegetables, nuts, and seeds mark a watershed in frailty prevention.

Keywords: dietary adequacy; dietary quality; nutrient-dense; oldest-old; whole grains.

MeSH terms

Aged
Aged, 80 and over
Diet, Healthy / statistics & numerical data*
Female
Frail Elderly / statistics & numerical data*
Frailty / epidemiology*
Guideline Adherence / statistics & numerical data*
Humans
Independent Living / statistics & numerical data*
Male
Nutrition Policy
Nutrition Surveys
Prevalence
Taiwan / epidemiology

Grants and funding

MOST 106-2321-B-030-001, MOST 107-2321-B-030-001/Ministry of Science and Technology (MOST), Taiwan