Biomarker-calibrated nutrient intake and healthy diet index associations with mortality risks among older and frail women from the Women's Health Initiative

Oleg Zaslavsky; Shira Zelber-Sagi; James R Hebert; Susan E Steck; Nitin Shivappa; Fred K Tabung; Michael D Wirth; Yunqi Bu; James M Shikany; Tonya S Orchard; Robert B Wallace; Linda Snetselaar; Lesley F Tinker

doi:10.3945/ajcn.116.151530

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Biomarker-calibrated nutrient intake and healthy diet index associations with mortality risks among older and frail women from the Women's Health Initiative

Journal article

Open access

Peer reviewed

Biomarker-calibrated nutrient intake and healthy diet index associations with mortality risks among older and frail women from the Women's Health Initiative

Oleg Zaslavsky, Shira Zelber-Sagi, James R Hebert, Susan E Steck, Nitin Shivappa, Fred K Tabung, Michael D Wirth, Yunqi Bu, James M Shikany, Tonya S Orchard, …

The American journal of clinical nutrition, Vol.105(6), pp.1399-1407

06/2017

DOI: 10.3945/ajcn.116.151530

PMCID: PMC5445680

PMID: 28424183

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Abstract

Although studies to date have confirmed the association between nutrition and frailty, the impact of dietary intake and dietary patterns on survivorship in those with frailty is yet to be examined in a well-powered cohort with validated frailty status. Moreover, previous studies were limited by measurement error from dietary self-reports. We derived biomarker-calibrated dietary energy and protein intakes to address dietary self-report error. Using these data, we then evaluated the association of mortality in older women with frailty and dietary intake and healthy diet indexes, such as the alternate Mediterranean Diet (aMED), the Dietary Approaches to Stop Hypertension (DASH) score, and the Dietary Inflammatory Index (DII). The analytic sample included 10,034 women aged 65-84 y with frailty and complete dietary data from the Women's Health Initiative Observational Study. Frailty was assessed with modified Fried's criteria. Dietary data were collected by food-frequency questionnaire. Over a mean follow-up period of 12.4 y, 3259 (31%) deaths occurred. The HRs showed progressively decreased rates of mortality in women with higher calibrated dietary energy intakes ( trend = 0.003), higher calibrated dietary protein intakes ( trend = 0.03), higher aMED scores ( trend = 0.006), and higher DASH scores ( trend = 0.02). Although the adjusted point estimates of HRs (95% CIs) for frail women scoring in the second, third, and fourth quartiles on DII measures were 1.15 (1.03, 1.27), 1.28 (1.15, 1.42), and 1.24 (1.12, 1.38), respectively, compared with women in the first quartile, no overall effect was observed across quartiles ( trend = 0.35). Subgroup analyses by chronic morbidity or smoking status or by excluding women with early death did not substantially change these findings. The current study highlights the importance of nutrition in older, frail women. Diet quality and quantity should be considered in managing persons with frailty.

Biomarkers

Dietary Proteins - administration & dosage

Women's Health

Diet, Mediterranean

Diet Surveys

Healthy Diet

Humans

Middle Aged

Risk Factors

Feeding Behavior

Survival Rate

Frail Elderly

Energy Intake

Inflammation - etiology

Cause of Death

Diet

Female

Aged

Dietary Proteins - therapeutic use

Details

Title: Subtitle: Biomarker-calibrated nutrient intake and healthy diet index associations with mortality risks among older and frail women from the Women's Health Initiative
Creators: Oleg Zaslavsky - School of Nursing and ozasl@uw.edu
Shira Zelber-Sagi - Faculty of Health Science and Social Welfare, University of Haifa, Haifa, Israel
James R Hebert - Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC
Susan E Steck - Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC
Nitin Shivappa - Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC
Fred K Tabung - Department of Nutrition and Epidemiology, Harvard University, Cambridge, MA
Michael D Wirth - Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC
Yunqi Bu - Department of Biostatistics, University of Washington, Seattle, WA
James M Shikany - Division of Preventive Medicine, University of Alabama, Birmingham, AL
Tonya S Orchard - The Ohio State University
Robert B Wallace - College of Public Health, University of Iowa, Iowa City, IA; and
Linda Snetselaar - College of Public Health, University of Iowa, Iowa City, IA; and
Lesley F Tinker - Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
Resource Type: Journal article
Publication Details: The American journal of clinical nutrition, Vol.105(6), pp.1399-1407
DOI: 10.3945/ajcn.116.151530
PMID: 28424183
PMCID: PMC5445680
NLM abbreviation: Am J Clin Nutr
ISSN: 1938-3207
eISSN: 1938-3207
Publisher: United States
Grant note: P30 DK017047 / NIDDK NIH HHS R44 DK103377 / NIDDK NIH HHS K99 CA207736 / NCI NIH HHS
Language: English
Date published: 06/2017
Academic Unit: Epidemiology; Fraternal Order of Eagles Diabetes Research Center; Injury Prevention Research Center; Internal Medicine
Record Identifier: 9983995176902771

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