*3.3. Frailty*

3.3.1. Frailty Association with Sociodemographic and Health-Related Factors

Sociodemographic, health, and nutritional characteristics of the study sample according to the frailty status are represented in Table 3. Factors associated with frailty included higher age, female gender, and lower educational level (<7 years at school); the latter was not associated to frailty in men.

**Table 3.** Sociodemographic and health-related factors associated with frailty in total sample and stratified by gender.



**Table 3.** *Cont.*

Abbreviations: BMI: body mass index; WC: waist circumference; WHTR: waist to height ratio; HSG: handgrip strength; MNA-SF: Mini-Nutritional Assessment-Short Form. Numeric variables are represented as median (interquartile range). Categorical variables are represented as *N* (%).

> Taking more than five medications, having more than one disease, more than one age-related condition, and having a higher WHTR was associated with frailty in the total sample and in women. In men, only multimorbidity was found to be associated with frailty, whereas no association with health and anthropometric parameters was observed.

> Regarding nutritional status evaluated by MNA-SF, we identified a significant association with frailty, with a higher prevalence of poor nutritional status (malnutrition and risk of malnutrition) among frail individuals in both genders.

3.3.2. Frailty and Dietary Patterns

> Table 4 displays the dietary patterns and food intake associated with frailty.

**Table 4.** Dietary patterns, food, and nutrient intake associated with frailty in the total sample and stratified by gender.



**Table 4.** *Cont.*

Abbreviations: WDP: Westernized dietary pattern. HI-MEDDP: high-intake Mediterranean dietary pattern. MOD-Med: moderate-intake Mediterranean dietary pattern. Kcal/d: calories per day. Calories/kg BW: calories per kg body weight. Protein/kg BW: proteins per kg body weight. Numeric variables are represented as median (interquartile range). Categorical variables are represented as *N* (%).

> Individuals adopting the MOD-MEDDP accounted for 67.2% of the non-frail group compared to 21.7% and 11%, for the HI-MEDDP and WDP, respectively. Nonetheless, in the univariate analysis, dietary patterns seemed to be associated with frailty status only in women. Women adopting the WDP accounted for 5% of the non-frail group compared to 17.1% of the frail group, and women adopting the MOD-MEDDP accounted for 63.1% of the non-frail group compared to 40% of the frail group.

> Concerning nutrients, median caloric, carbohydrates, and protein intakes were higher in the non-frail compared to frail group, in the total population, and in men. Median g of protein/kg BW was found to be significantly higher in the non-frail group, only in the overall population.

> The multivariate logistic regression analysis performed in the total sample (Table 5), included 327 individuals with complete set of data each, and fulfilling all criteria of inclusion. Within the total sample, in the first model, independent factors associated with frailty, included age above 75 years, female gender, and low level of education. When anthropometric and nutritional status parameters were added in the second model, factors associated with frailty were age above 75 years, WHTR > 0.718 and poor nutritional status compared to normal nutritional status. In the third model, when health-related parameters were added to the analysis, factors associated with frailty included age, WHTR > 0.718, poor nutritional status, polypharmacy, multimorbidity, and age-related conditions. In the final model, by adding dietary patterns, independent factors comprised age above 75 years, WHTR > 0.718, poor nutritional status, polypharmacy, age-related conditions, and WDP.

> The multivariate association between dietary patterns and frailty is described in Table 6. In the overall sample, no association was observed between dietary patterns and frailty prevalence. After adjusting for main confounders, women adopting the WDP, compared to those adopting the MOD-MEDDP, exhibited a higher prevalence of frailty, in the first and second models, as well as in the fully adjusted model (odds ratio ((OR) 11.54, 95% confidence interval (CI) (2.02–65.85)). In men, similar results were observed: adopting a WDP was associated with a higher prevalence of frailty only in the fully adjusted model, ((OR) 6.63, 95% (CI) (1.82–24.21)), when compared to the MOD-MEDDP. Finally, the HI-MEDDP was not significantly associated with frailty prevalence, in the overall sample, nor in men compared with following a MOD-MEDDP.


**Table 5.** Binary logistic regression models of frail vs. non-frail for the total sample.

> Note: Bold values are statistically significant, *p* < 0.05.

**Table 6.** Multivariate associations between dietary patterns and frailty prevalence. Beirut 2021, *N* = 327.


Model 1: model adjusted for age, gender, educational level. Model 2: model 1 further adjusted for nutritional status, and WHTR. Model 3: model 2 further adjusted for polypharmacy and age-related conditions.
