Association Between the Prevalence of Frailty and Doubly Labeled Water-Calibrated Energy Intake Among Community-Dwelling Older Adults

Background: Appropriate energy intake (EI) is essential to prevent frailty. Because self-reported El is inaccurate and has systematic errors, adequate biomarker calibration is required. This study examined the association between doubly labeled water (DLW)-calibrated El 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 265 years in the Kyoto-Kameoka Study. El 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 DIW-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 x height(2)) with DLW-calibrated EL Uncalibrated El underestimated approximately 20% compared with calibrated EI; underestimated EI were attenuated by calibration approach. Conclusions: This study suggests that low Fl has a greater detrimental effect compared with excessive EI, particularly on physical frailty. Using biomarkers to calibrate El holds promise for providing accurate energy requirements to establish guidelines used in public health and clinical nutrition.

Automated summary

The study highlights the importance of appropriate energy intake in preventing frailty among older adults, and the use of DLW-calibrated energy intake for accurate assessment of frailty prevalence. Additionally, it suggests that uncalibrated self-reported energy intake may lead to underestimation, emphasizing the need for biomarker calibration.