Nutrition-based interventions for frailty conducted to date

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Nutrient intake and dietary patterns

Measuring nutrition in scientific studies can be not only done through nutrient intake, but also dietary patterns. Using dietary patterns is helpful as it is holistic and does not look into single nutrients but the outcomes of interactions between multiple nutrients and constituents of food such as the increased absorption of iron when vitamin C is present (146). The physiological effect of a single nutrient may be too specific to be detected but together with other nutrients in the form of food the effect may be adequately sized to be registered (146). There are two approaches when analysing dietary patterns in nutrition science: a priori and a posteriori. The first one uses an established pattern that is known to impact disease such as the Healthy Eating Index or the Mediterranean diet to test the degree of conformity to that pattern (148). The latter uses statistical factor or cluster analyses to identify changes in food patterns found in the population at hand and can be used to test the differences between groups or changes after an intervention (148). Increasingly, dietary patterns have been used in research to complement the findings of nutrient changes (148). To identify trends however, it is easiest to use nutrient intake.
The focus of this thesis’ research is to test the changes in nutrition intake before and after a cooking and nutrition programme, not necessarily the impact of nutrition on frailty. Due to this focus and the availability of short-term follow-up post-intervention assessment, nutrient intake was analysed to detect specific changes that help form a basis for dietary pattern analysis in the future when longer-term follow-up results are available. Furthermore, dietary pattern analyses are more suitable when assessing the long-term changes that participants may have after a nutritional intervention as behavioural changes generally take months to years to develop.
Though dietary patterns will not be used in this study, the current research conducted on dietary patterns in the literature is useful to identify the interactions of foods that are commonly consumed together that have impact on frailty status. An example of this was explored earlier identifying alcohol intake with foods of the Mediterranean pattern like F&V which may interact to synergistically prevent frailty (95). Another example is the increased absorption of fat-soluble vitamins such as vitamin A, D and E when fat is consumed together with foods high in these (128). This helps future studies to focus on specific components of the favourable or unfavourable dietary pattern in determining targets for frailty prevention.

The relationship between dietary patterns and frailty

As seen in Table 2-4, researchers have identified both a priori and a posteriori dietary patterns have been implicated in frailty outcomes in OA. This following section describes the main features of the favourable and unfavourable patterns and potential implications on underlying nutrient intake.
Favourable dietary patterns Many of the favourable patterns in reducing the risk of frailty outcomes in OA had the common denominator of high F&V intake, whole grains, legumes, more fish and less red meats, and generally less saturated fat, sodium and added sugars from processed foods.
The Mediterranean dietary pattern has been extensively studied and offers the strongest evidence for a positive impact on frailty. Alongside the aforementioned common denominators: it also includes a moderate alcohol intake with meals (17,149-151). In support of the pattern, León-Muñoz et al. (152) coined the favourable pattern they identified, the ‘Prudent’ pattern characterised similarly to the Mediterranean diet by a high olive oil and vegetable intake.
Houston et al. (80) identified that OA who consumed a pattern of high protein from both animal and vegetable sources were less likely to lose lean mass as those who had lower intakes. Tomata et al. (153) identified a ‘Japanese’ pattern that was associated with low risk of developing incident functional disability. The major contributors to this pattern were fish, fruits and vegetables, inclusive of mushroom, potato, seaweed, pickles and soybean which contain a high variety of micronutrients, healthy fats and protein.
The Diet Quality index revised (DQI-R), though not necessarily a dietary pattern, serves as a reflection of dietary guidelines calculated out of 100 points (127,154). It scores the contribution to energy from saturated fat and total fat, and cholesterol intake (generally from animal products), and as well as accounting for variety of foods. The Healthy Eating index (HEI), also called the Healthy Dietary Pattern, is similarly based on dietary guidelines (154,155). Criticism of these indices has been on their arbitrary criteria where upon testing in association studies, prediction of clinical outcomes were not any better than testing individual dietary components (156). Despite this, these indices again support the association for a balanced diet with plenty of micronutrients from a variety of fruits and vegetables in frailty prevention.

1 INTRODUCTION 
2 LITERATURE REVIEW 
2.1 Frailty
2.2 A place for nutrition-based interventions
2.3 Nutrition-based interventions for frailty conducted to date .
2.4 Cooking and nutrition programmes
2.5 Summary
3 METHODOLOGY
3.1 Study Design .
3.2 Sampling
3.3 Recruitment .
3.4 Data collection
3.5 Statistical Analysis
4 RESULTS 
4.1 Participant profile ..
4.2 Nutrient intake
5 DISCUSSION
5.1 Main findings..
5.2 Intakes compared to guidelines .
5.3 Behavioural and learning theory
5.4 Important considerations
5.5 Strengths and limitations
5.6 Study implications
6 CONCLUSION

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The impact of a nutrition and cooking programme on energy and nutrient intake to prevent frailty in pre-frail communitydwelling older adults