Daiki Watanabe1,2, Tsukasa Yoshida1,3,4,5, Hinako Nanri1, Yuya Watanabe1,6, Heiwa Date7, Aya Itoi1,8, Chiho Goto9, Kazuko Ishikawa-Takata1, Hiroyuki Sagayama10, Naoyuki Ebine6, Hisamine Kobayashi11, Misaka Kimura3,5, Yosuke Yamada1,3,5. 1. National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Tokyo, Japan. 2. Department of Pharmacology, St. Marianna University School of Medicine, Kanagawa, Japan. 3. Laboratory of Applied Health Sciences, Kyoto Prefectural University of Medicine, Kyoto, Japan. 4. Senior Citizen's Welfare Section, Kameoka City Government, Kyoto, Japan. 5. Institute for Active Health, Kyoto University of Advanced Science, Kyoto, Japan. 6. Faculty of Health and Sports Science, Doshisha University, Kyoto, Japan. 7. Department of Data Science, Shiga University, Shiga, Japan. 8. Department of Health, Sports and Nutrition, Faculty of Health and Welfare, Kobe Women's University, Hyogo, Japan. 9. Department of Health and Nutrition, Faculty of Health and Human Life, Nagoya Bunri University, Aichi, Japan. 10. Faculty of Health and Sport Sciences, University of Tsukuba, Ibaraki, Japan. 11. Ajinomoto Co., Inc., Tokyo, Japan.
Abstract
BACKGROUND: Appropriate energy intake (EI) is essential to prevent frailty. Because self-reported EI is inaccurate and has systematic errors, adequate biomarker calibration is required. This study examined the association between doubly labeled water (DLW)-calibrated EI and the prevalence of frailty among community-dwelling older adults. METHOD: A cross-sectional study was performed using baseline data of 7,022 older adults aged ≥65 years in the Kyoto-Kameoka Study. EI was evaluated using a validated food frequency questionnaire (FFQ), and calibrated EI was obtained from a previously established equation using the DLW method. Physical and comprehensive frailty were defined by the Fried phenotype (FP) model and the Kihon Checklist (KCL), respectively. We used multivariable-adjusted restricted cubic spline logistic regression analysis. RESULTS: The prevalence of physical frailty was 14.8% and 13.6% in women and men, respectively. The spline models showed significant reverse J-shaped or U-shaped relationships between the prevalence of physical or comprehensive frailty against the DLW-calibrated EI, respectively. The lowest prevalence of both types of frailty was found at 1,900-2,000 kcal/d in women and 2,400-2,500 kcal/d in men, which corresponded to approximately 40 kcal/d/kg IBW (ideal body weight = 22 × height2) with DLW-calibrated EI. Uncalibrated EI underestimated approximately 20% compared with calibrated EI; underestimated EI were attenuated by calibration approach. CONCLUSIONS: This study suggests that low EI has a greater detrimental effect compared with excessive EI, particularly on physical frailty. Using biomarkers to calibrate EI holds promise for providing accurate energy requirements to establish guidelines used in public health and clinical nutrition.
BACKGROUND: Appropriate energy intake (EI) is essential to prevent frailty. Because self-reported EI is inaccurate and has systematic errors, adequate biomarker calibration is required. This study examined the association between doubly labeled water (DLW)-calibrated EI and the prevalence of frailty among community-dwelling older adults. METHOD: A cross-sectional study was performed using baseline data of 7,022 older adults aged ≥65 years in the Kyoto-Kameoka Study. EI was evaluated using a validated food frequency questionnaire (FFQ), and calibrated EI was obtained from a previously established equation using the DLW method. Physical and comprehensive frailty were defined by the Fried phenotype (FP) model and the Kihon Checklist (KCL), respectively. We used multivariable-adjusted restricted cubic spline logistic regression analysis. RESULTS: The prevalence of physical frailty was 14.8% and 13.6% in women and men, respectively. The spline models showed significant reverse J-shaped or U-shaped relationships between the prevalence of physical or comprehensive frailty against the DLW-calibrated EI, respectively. The lowest prevalence of both types of frailty was found at 1,900-2,000 kcal/d in women and 2,400-2,500 kcal/d in men, which corresponded to approximately 40 kcal/d/kg IBW (ideal body weight = 22 × height2) with DLW-calibrated EI. Uncalibrated EI underestimated approximately 20% compared with calibrated EI; underestimated EI were attenuated by calibration approach. CONCLUSIONS: This study suggests that low EI has a greater detrimental effect compared with excessive EI, particularly on physical frailty. Using biomarkers to calibrate EI holds promise for providing accurate energy requirements to establish guidelines used in public health and clinical nutrition.