Food consumption is associated with frailty in edentulous older adults: evidence from the ELSI-Brazil study

Ygnatios, Nair Tavares Milhem; Lima-Costa, Maria Fernanda; Torres, Juliana Lustosa

doi:10.1590/1413-81232023287.12032022

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ARTICLE • Ciênc. saúde coletiva 28 (7) • July 2023 • https://doi.org/10.1590/1413-81232023287.12032022 linkcopy

Food consumption is associated with frailty in edentulous older adults: evidence from the ELSI-Brazil study

Consumo alimentar está associado à fragilidade em adultos mais velhos edêntulos: evidências do estudo ELSI-Brasil

Authorship SCIMAGO INSTITUTIONS RANKINGS

This cross-sectional study aimed to evaluate the association between food consumption (meat, fish, and fruits and vegetables), anthropometric indicators (body mass index, waist circumference, and waist-to-height ratio), and frailty; and to verify whether these associations vary with edentulism. We used data from 8,629 participants of the Brazilian Longitudinal Study of Aging (ELSI-Brazil) (2015-16). Frailty was defined by unintentional weight loss, weakness, slow walking speed, exhaustion, and low physical activity. Statistical analyses included multinomial logistic regression. Of the participants, 9% were frail and 54% pre-frail. Non-regular meat consumption was positively associated with pre-frailty and frailty. Non-regular fish consumption, and underweight were associated only with frailty. Models with interactions reveled a marginal interaction between meat consumption and edentulism (p-value = 0.051). After stratification, non-regular meat consumption remained associated with frailty only in edentulous individuals (OR = 1.97; 95%CI 1.27-3.04). Our results highlight the importance of nutritional assessment, oral health, and public health-promoting policies to avoid, delay and/or reverse frailty in older adults.

Key words:
Anthropometry; Eating; Frailty

Variable	Total %	Non-frailty %	Pre-frailty %	Frailty %	p-value *
Food consumption indicators
Non-regular meat consumption	23.9	19.7	26.0	29.5	< 0.001
Non-regular fish consumption	55.6	53.5	55.8	62.9	0.002
Non-regular fruit and vegetable consumption	20.0	16.5	21.8	23.9	< 0.001
Anthropometric indicators
Body mass index ¹					< 0.001
Adequate weight	31.3	31.2	31.3	32.3
Underweight	7.4	5.6	7.4	15.5
Overweight	61.3	63.2	61.3	52.2
Elevated waist circumference	62,6	62.5	63.6	56.4	0.007
Elevated waist-to-height ratio	70,2	70.4	71.3	62.2	0.001
Sociodemographic characteristics
Sex female	53.7	50.8	55.3	56.2	0.007
Age					< 0.001
50-59	48.3	55.7	47.3	23.7
60-69	29.9	31.0	29.6	27.1
70-79	15.4	11.3	16.3	26.6
80 years and over	6.4	2.0	6.8	22.6
Living with a partner	64.9	69.7	63.2	56.1	< 0.001
Education (years)					< 0.001
< 8	63.6	54.0	67.3	81.3
8-11	28.2	34.7	25.7	16.6
≥ 12	8.2	11.3	7.0	2.1
Per capita household income					< 0.001
1^st tertile (poorest)	31.6	26.8	33.7	39.0
2^nd tertile	32.9	32.0	33.0	36.4
3^rd tertile (richest)	35.5	41.2	33.3	24.6
Health-related characteristics
Current smoking	17.0	16.0	17.6	17.8	0.235
Self-rated health					< 0.001
Excellent/very good or good	43.8	56.3	38.9	20.6
Fair	44.8	39.4	48.5	45.4
Bad/very bad	11.4	4.3	12.6	34.0
Number of chronic conditions					< 0.001
None	18.2	23.1	16.1	10.3
One	27.2	30.0	26.4	20.8
Two or more	54.6	46.9	57.5	68.9
Activity limitations	7.6	2.0	7.3	32.2	< 0.001
Edentulism	29.0	23.5	29.9	46.6	< 0.001
Total (n) ²	8,629	3,117	4,655	857

	Pre-frailty
	Crude analysis OR (95%CI)	Model 1 OR (95%CI)	Model 2 OR (95%CI)	Fully adjusted Model OR (95%CI)
Food consumption indicators
Meat consumption
Regular	1.00	1.00	1.00	1.00
Non-regular	1.29 (1.09-1.52)*	1.26 (1.06-1.48)*	1.21 (1.02-1.42)*	1.22 (1.03-1.44)*
Fish consumption
Regular	1.00	1.00	1.00	1.00
Non-regular	1.08 (0.95-1.22)	1.04 (0.92-1.19)	1.07 (0.95-1.20)	1.06 (0.94-1.20)
Fruit and vegetable consumption
Regular	1.00	1.00	1.00	1.00
Non-regular	1.23 (1.02-1.49)*	1.20 (0.99-1.46)	1.18 (0.97-1.43)	1.17 (0.96-1.42)
Body mass index ¹
Adequate weight	1.00	1.00	1.00	1.00
Underweight	1.32 (1.08-1.61)*	1.13 (0.92-1.38)	1.27 (1.03-1.56)*	1.11 (0.90-1.37)
Overweight	0.97 (0.87-1.09)	1.06 (0.94-1.20)	0.92 (0.81-1.04)	1.00 (0.89-1.13)
	Frailty
Food consumption indicators
Meat consumption
Regular	1.00	1.00	1.00	1.00
Non-regular	1.60 (1.27-2.02)*	1.69 (1.31-2.18)*	1.30 (0.99-1.69)	1.44 (1.10-1.89)*
Fish consumption
Regular	1.00	1.00	1.00	1.00
Non-regular	1.49 (1.20-1.84)*	1.36 (1.09-1.70)*	1.40 (1.14-1.73)*	1.38 (1.11-1.72)*
Fruit and vegetable consumption
Regular	1.00	1.00	1.00	1.00
Non-regular	1.23 (0.92-1.65)	1.18 (0.86-1.61)	1.17 (0.85-1.61)	1.16 (0.81-1.65)
Body mass index ¹
Adequate weight	1.00	1.00	1.00	1.00
Underweight	2.64 (1.94-3.59)*	1.71 (1.21-2.42)*	2.43 (1.69-3.49)*	1.74 (1.17-2.58)*
Overweight	0.81 (0.68-0.96)*	1.09 (0.91-1.30)	0.72 (0.60-0.86)*	0.97 (0.80-1.18)

	Pre-frailty		Frailty
	Crude analysis OR (95%CI)	Fully adjusted Model OR (95%CI)	Crude analysis OR (95%CI)	Fully adjusted Model OR (95%CI)
Food consumption indicators
Meat consumption
Regular	1.00	1.00	1.00	1.00
Non-regular	1.29 (1.09-1.52)*	1.22 (1.03-1.44)*	1.56 (1.23-1.99)*	1.41 (1.07-1.86)*
Fish consumption
Regular	1.00	1.00	1.00	1.00
Non-regular	1.07 (0.94-1.22)	1.06 (0.94-1.20)	1.49 (1.20-1.84)*	1.40 (1.11-1.75)*
Fruit and vegetable consumption
Regular	1.00	1.00	1.00	1.00
Non-regular	1.24 (1.03-1.50)*	1.17 (0.96-1.42)	1.25 (0.93-1.69)	1.17 (0.82-1.66)
Waist circumference
Adequate	1.00	1.00	1.00	1.00
Elevated	1.07 (0.95-1.20)	1.05 (0.93-1.20)	0.80 (0.65-0.98)*	0.87 (0.68-1.11)
Food consumption indicators
Meat consumption
Regular	1.00	1.00	1.00	1.00
Non-regular	1.28 (1.09-1.51)*	1.22 (1.03-1.44)*	1.58 (1.25-2.00)*	1.42 (1.08-1.87)*
Fish consumption
Regular	1.00	1.00	1.00	1.00
Non-regular	1.07 (0.94-1.22)	1.06 (0.94-1.20)	1.48 (1.19-1.83)*	1.39 (1.11-1.74)*
Fruit and vegetable consumption
Regular	1.00	1.00	1.00	1.00
Non-regular	1.24 (1.03-1.50)*	1.17 (0.95-1.42)	1.26 (0.94-1.70)	1.17 (0.82-1.67)
Waist-to-height ratio
Adequate	1.00	1.00	1.00	1.00
Elevated	1.05 (0.92-1.20)*	1.13 (0.97-1.30)	0.69 (0.55-0.87)*	0.95 (0.71-1.28)

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[TFN1] ¹ Body mass index cutoffs: For those aged up to 60 years, “underweight” (< 18.5 kg/m²), “adequate weight” (18.5 to 24.9 kg/m²), and “overweight” (> 24.9 kg/m²); For those aged 60 years and over, “underweight” (< 22.0 kg/m²), “adequate weight” (22.0 to 27.0 kg/m²), and “overweight” (> 27.0 kg/m²). ² Number of interviewees, not including corrections according to sampling parameters. * p-value based on the Pearson’s chi-square test with Rao-Scott correction.

[TFN2] Source: Authors.