New Evidence: Mediterranean Diet Supports Healthy Aging

Like other healthy eating patterns, the Mediterranean diet is rich in sources of unsaturated fats, such as olive oil and nuts, and emphasizes whole grains, legumes, fish, fresh fruits and vegetables, and limits red and processed meat, refined grains and added sugar. Nutrition science has produced convincing evidence that this eating pattern is good for you.

“In a number of studies, the Mediterranean diet pattern has been associated with a range of health benefits,” says Dariush Mozaffarian, MD, DrPH, editor-in-chief of Tufts Health & Nutrition Letter. “It’s been linked to improved cardiovascular health and lower risk of type 2 diabetes and weight gain.”

Now, a new study has linked the Mediterranean diet pattern to lower risk of frailty, a cluster of health problems that robs older adults of their independence and quality of life. In the big picture, this finding lends additional weight to the principle that healthy aging follows healthy eating.

A Risky Condition: Among the telltale signs of frailty are slow walking speed, frequent exhaustion, physical inactivity (less than an hour a week), weakness (like difficulty rising from a chair), unintentional weight loss, poor balance, impaired vision and impaired memory and other mental skills. Some studies indicate that frailty affects about 10% of adults age 65 and older and 25% or more of people 85 and older.

Frailty leaves people more vulnerable to falls and fractures, disability, hospitalization, admission to a nursing home and premature death. Frailty is one reason why just a nasty case of the flu can turn into a life threatening illness in an elderly person.

As common as frailty is, it remains a challenge for doctors. “It’s somewhat of a mystery how to predict who will become frail,” says Suzanne Salamon, MD, associate chief for clinical geriatrics at Beth Israel Deaconess Medical Center in Boston. “Generally, people with multiple chronic diseases become frail, but others are still quite active and don’t fit the typical profile of a frail elder.”

Food and Frailty: Understanding what puts people at highest risk of frailty could allow doctors to intervene early and help older adults remain independent and active. One obvious question is what determines who develops frailty later in life. Diet is an obvious candidate. After all, if a healthy eating pattern—the totality of all the foods and beverages that a person consumes—can lower the risk of chronic conditions that contribute to frailty, like cardiovascular disease, couldn’t it also lower risk of developing frailty itself?

Some studies suggest it may. In one recent example, researchers in Taiwan published a study in the Journal of the American Geriatric Society (JAGS) that linked diet quality and frailty risk, using nationally representative data from the country’s ongoing health and nutrition survey. Over three years, adults 65 and older were less likely to develop frailty when their diet included generous servings of fruit, nuts and seeds, tea, vegetables, whole grains, milk and seafood.

Focus on the Mediterranean Diet: As evidence has mounted for the potential of healthy diets to support healthy aging, frailty researchers have taken notice. In a recent study, also in JAGS, researchers from University College London sorted through studies that focused on the Mediterranean eating pattern.

The researchers looked for studies that followed participants over time—an average of about 4 years—to see who became frail. The studies also had to include a way to put a hard number on how closely participants adhered to the Mediterranean eating pattern. Four studies passed the test. They involved a total of nearly 5,800 adults age 60 and older, still living independently in the community when the studies began. After pooling the results of all four, the researchers showed that the more closely people followed a Mediterranean eating pattern, the less likely they were to become frail.

But this doesn’t necessarily prove that healthy dietary patterns prevent frailty. “It is possible that those who follow a Mediterranean diet may be more health conscious on average, with better health overall and higher levels of physical activity,” says the study’s lead author Gotaro Kojima, MD. “The studies included did not all control for possible effects of physical activity or how healthy participants were at the beginning of the study. Therefore, there may be unmeasured factors that influenced the results.”

Kojima says it would be possible, although somewhat challenging, to conduct a clinical trial to check for a cause-and-effect connection between healthy dietary patterns and frailty. It would need to be long enough to detect effects of diet on the number of people who develop frailty, a process which takes years.

The Big Picture: The JAGS report is another step toward addressing the risk of frailty in older adults. “Research on the associations between nutrition and frailty is relatively recent—except for protein, which is known to help reduce frailty,” Kojima says.

But the recipe for preventing frailty with lifestyle is likely to include more than just nutrition, Salamon believes. “It would be great to think that a diet can prevent this syndrome, but it’s unlikely that’s the whole story,” Salamon says. “I think that the best we can do to prevent frailty is to keep ourselves healthy by not smoking, controlling blood pressure, drinking alcohol only in moderation, remaining socially engaged, maintaining a healthy weight and getting regular exercise. None of these are guaranteed to decrease the chance of becoming frail later in life, but it’s the best we have so far.”

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