Adherence to the Mediterranean Diet and frailty criteria in an old population with metabolic syndrome: A cross-sectional analysis

Abstract

Objectives Frailty has emerged as a key indicator of biological aging. This study aimed to assess the relationship between MedDiet adherence and frailty prevalence in the context of metabolic syndrome (MetS). Design Cross-sectional study. Baseline data from PREDIMED-Plus trial Setting Primary care health, 23 recruitment sites (2013–2016). Participants A total of 6874 participants with overweight/obesity and ≥3 MetS components. Measurements Adherence to the MedDiet: 17-item MedDiet score. Frailty and prefrailty (3 or 1–2 criteria): modified Fried Frailty Index (FFI), considering exhaustion, physical activity and functional capacity. Main independent variable was analysed: as a continuous variable (range: 0–17); in quartiles of adherence using univariate and multivariate logistic regression models adjusted for potential confounders. Results Prefrailty and frailty prevalence were 49.7% and 2.9%, respectively. Compared to those with the lowest MedDiet adherence (0–6), participants with the highest adherence (11–17) had significantly lower odds of meeting frailty criteria. Fully adjusted models showed ORs of 0.479 (p = 0.097) for frailty, 0.705 (p = 0.001) for prefrailty, and 0.694 (p = 0.001) for frailty or prefrailty in participants with higher/greater MedDiet adherence. Each 1-point increase in the 17-item score was associated with an OR ranging from 0.878 to 0.977 (p < 0.05 for all comparisons, except functional capacity: p = 0.100). When adherence was dichotomized, the adjusted ORs ranged from 0.406 to 0.834 (p < 0.05 for all comparisons). Conclusions Higher adherence to MedDiet was associated with a lower prevalence of frailty and prefrailty in older adults with overweight/obesity and MetS, reinforcing its potential role in promoting healthy aging despite cardiometabolic comorbidities.