Summary: Middle-aged and older adults with depression may be more vulnerable to the effects of dietary inflammation, increasing the risk of frailty and other health disorders.
Source: Hebrew SeniorLife Hinda and Arthur Marcus Institute for Aging Research
A new study published in The Journal of Gerontology: Medical Sciences found a link between depression, diet, and the development of frailty.
Frailty, defined as a recognizable state of increased vulnerability resulting from a decline in function across multiple physiological systems, affects 10-15% older adults and often co-occurs with other health conditions, like depression. Diet is thought to be a major contributor to frailty development.
While previous studies established a link between an inflammatory diet – including artificial trans fats (like partially hydrogenated oil), refined carbohydrates, and saturated fats – and the risk of development frailty, this is one of the first studies to try to understand the impact of depression on dietary inflammation and frailty.
Titled, “Association of pro-inflammatory diet with frailty onset among adults with and without depressive symptoms: results from the Framingham Offspring Study,” the study attempted to determine if individuals with depressive symptoms are more vulnerable to frailty development in response to dietary inflammation.
The study utilized data from the Framingham Heart Study Offspring cohort. The 1,701 non-frail participants reported their diet and depressive symptoms at baseline and were followed for ~11 years when frailty status was reassessed.
The study found an association between inflammatory diet and increased odds of frailty appeared somewhat stronger among those with depressive symptoms.
The researchers hypothesize that since individuals with depressive symptoms typically have higher levels of inflammation, adding dietary inflammation on top of that accelerates the development of frailty.
Courtney L Millar, Ph.D., Post-Doctoral Fellow, Marcus Institute of Aging Research, Hebrew SeniorLife, and Harvard Medical School, is the lead author. “This study found that depressive symptoms may exacerbate the development of frailty in response to consuming an inflammatory diet. This suggests that consuming a diet rich in anti-inflammatory compounds (e.g., fiber and plant-based compounds called flavonoids) may help prevent the development of frailty,” Dr. Millar said.
“Our exploratory data also suggests that when middle-aged and older adults consume a pro-inflammatory diet, they are more likely to newly develop depressive symptoms and frailty at the same time rather than develop either condition alone,” she added.
This research follows two prior studies conducted by Dr. Millar, one published in May in the American Journal of Clinical Nutrition that showed that consuming a Mediterranean-style diet may prevent the development of frailty, and one published in February in the American Journal of Clinical Nutrition that showed a pro-inflammatory diet increased the risk of frailty development.
“This study contributes to the understanding of the relationship between dietary inflammation, depression, and frailty,” Dr. Millar said.
“For those with depression, it may be even more important to increase their intake of fruits and vegetables that are rich in fiber, flavonoids as well as other dietary antioxidants.”
The Framingham Heart Study, Massachusetts General Hospital, and the University of South Carolina collaborated on this observational study.
Funding: This study was primarily funded by the National Institute of Aging (NIA) (grant no. T32-AG023480), the Beth and Richard Applebaum Research Fund, as well as the Boston Claude D. Pepper Center OAIC (OAIC; 1P30AG031679).
Other authors included: Alyssa B. Dufour, Ph.D., Assistant Scientist II, Hinda and Arthur Marcus Institute for Aging Research; James R. Hebert, D.Sc. Health Sciences Distinguished Professor and Director, South Carolina Statewide Cancer Prevention and Control Program, the Department of Epidemiology and Biostatistics and the Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, SC and Department of Nutrition, Connecting Health Innovations LLC, Columbia, SC; Nitin Shivappa, M.B.B.S., M.P.H., Ph.D., Adjunct Assistant Professor, Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC; Olivia I. Okereke, M.D., M.S., Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School and Department of Epidemiology, Harvard TH Chan School of Public Health; Douglas P. Kiel, M.D., M.P.H., Director, Musculoskeletal Research Center and Senior Scientist, Hinda and Arthur Marcus Institute for Aging Research; Marian T. Hannan, D.Sc., M.P.H., Co-Director, Musculoskeletal Research Center and Senior Scientist, Hinda and Arthur Marcus Institute for Aging Research; and Shivani Sahni, Ph.D., Director, Nutrition Program and Associate Scientist, Hinda and Arthur Marcus Institute for Aging Research.
Association of pro-inflammatory diet with frailty onset among adults with and without depressive symptoms: results from the Framingham Offspring Study
Dietary inflammation is associated with increased risk of frailty. Those with depressive symptoms may be at higher risk of frailty onset since they typically have higher levels of inflammation. The study objective was to determine the association between a pro-inflammatory diet and frailty onset in those with and without clinically relevant depressive symptoms.
This prospective study included 1,701 non-frail individuals with self-reported baseline (1998-2001) data available for the evaluation of energy-adjusted dietary inflammatory index (E-DII TM) (calculated from food frequency questionnaires), depressive symptoms (from the Center for Epidemiologic Studies Depression; CES-D), and follow-up frailty measurements (2011-2014). Frailty was defined as fulfilling ≥3 Fried frailty criteria. Results are presented by baseline CES-D scores <16 or ≥16 points, which denotes the absence or presence of clinically relevant depressive symptoms, respectively. Logistic regression estimated odds ratios (OR) and 95% confidence intervals (95% CI) between E-DII and frailty onset, adjusting for confounders.
In all study participants, mean (standard deviation; SD) age was 58(8) years and E-DII was -1.95 (2.20; range: -6.71 to +5.40, higher scores denote a more pro-inflammatory diet), and 45% were male. In those without clinically relevant depressive symptoms, one-unit higher E-DII score was associated with 14% increased odds (95% CI :1.05-1.24) of frailty. In those with depressive symptoms, one-unit higher E-DII score was associated with 55% increased odds of frailty (95% CI: 1.13-2.13).
The association between inflammatory diet and increased odds of frailty appeared somewhat stronger among those with depressive symptoms. This preliminary finding warrants further investigation.