• J. Intern. Med. · Nov 2021

    Associations between nutritional frailty and 8-year all-cause mortality in older adults: The Salus in Apulia Study.

    • Roberta Zupo, Fabio Castellana, Vito Guerra, Rossella Donghia, Ilaria Bortone, Chiara Griseta, Luisa Lampignano, Vittorio Dibello, Madia Lozupone, Hélio José Coelho-Júnior, Vincenzo Solfrizzi, Gianluigi Giannelli, Giovanni De Pergola, Heiner Boeing, Rodolfo Sardone, and Francesco Panza.
    • Unit of Data Sciences and Technology Innovation for Population Health, National Institute of Gastroenterology "Saverio de Bellis", Research Hospital, Castellana Grotte, 70013 Bari, Italy.
    • J. Intern. Med. 2021 Nov 1; 290 (5): 1071-1082.

    IntroductionPreventive nutritional management of frailty, a multidimensional intermediate status in the ageing process, may reduce the risk of adverse health-related outcomes. We investigated the ability of a measure combining physical frailty with nutritional imbalance, defined as nutritional frailty, to predict all-cause mortality over a period of up to 8 years.MethodsWe analysed data on 1,943 older adults from the population-based 'Salus in Apulia Study'. Physical frailty was operationalized using Cardiovascular Health Study criteria and cognitive frailty by combining physical frailty with cognitive impairment. A novel five-item construct was built to assess the extent of nutritional imbalance identified with a machine learning algorithm. Cox models and Kaplan-Meier survival probability analyses of physical frailty, nutritional imbalance (two or more of the following: low body mass index, low skeletal muscle index, ≥2.3 g/day sodium intake, <3.35 g/day potassium intake and <9.9 g/day iron intake), cognitive frailty and the novel nutritional frailty phenotype (physical frailty plus nutritional imbalance) were applied to assess all-cause mortality risk, adjusted for age, sex, education and multimorbidity.ResultsThe overall prevalence of nutritional frailty was 4.52% (95% confidence interval, CI:3.55-5.44), being more frequent in males. Subjects with nutritional frailty were at higher risk for all-cause mortality [hazard ratio (HR):2.31; 95%CI:1.41-3.79] than those with physical frailty (HR:1.45,95% CI:1.0-2.02), nutritional imbalance (HR:1.39; 95%CI:1.05-1.83) and cognitive frailty (HR:1.06; 95%CI:0.56-2.01).ConclusionsEfforts to identify, manage and prevent frailty should include the nutritional domain. The nutritional frailty phenotype may highlight major nutritional determinants that could drive survival and health trajectories in older adults.© 2021 The Association for the Publication of the Journal of Internal Medicine.

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