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Background Depression and anxiety are the leading mental health problems worldwide; depression is ranked as the leading cause of global disability with anxiety disorders ranked sixth. Preventive strategies based on the identification of modifiable factors merit exploration. The aim of the present study was to investigate the associations of handgrip strength (HGS) with incident depression and anxiety and to explore how these associations differ by socio‐demographic, lifestyle, and health‐related factors. Methods The analytic sample comprised 162 167 participants (55% women), aged 38–70 years, from the UK Biobank prospective cohort study. HGS was assessed at baseline using dynamometry. Depression and anxiety were extracted from primary care and hospital admission records. Cox proportional models were applied, with a 2 year landmark analysis, to investigate the associations between HGS and incident depression and anxiety. Results Of the 162 167 participants included, 5462 (3.4%) developed depression and 6614 (4.1%) anxiety, over a median follow‐up period of 10.0 years (inter‐quartile range: 9.3–10.8) for depression and 9.9 (inter‐quartile range: 9.0–10.8) for anxiety. In the fully adjusted model, a 5 kg lower HGS was associated with a 7% (HR: 1.07 [95% CI: 1.05, 1.10]; P < 0.001) and 8% (HR: 1.08 [95% CI: 1.06, 1.10]; P < 0.001) higher risk of depression and anxiety, respectively. Compared with participants in the sex and age‐specific highest tertiles of HGS, those in the medium and lowest tertiles had an 11% (HR: 1.11 [95% CI: 1.04, 1.19]; P = 0.002) and 24% (HR: 1.24 [95% CI: 1.16, 1.33]; P < 0.001) higher risk of depression and 13% (HR: 1.13 [95% CI: 1.06, 1.20]; P < 0.001) and 27% (HR: 1.27 [95% CI: 1.19, 1.35]; P < 0.001) higher risk of anxiety, respectively. The association of HGS with depression was stronger among participants with average or brisk walking pace (vs. slow walking pace; Pinteraction < 0.001). The association with anxiety was stronger in those participants aged ≥58 years (vs. ≤58 years; Pinteraction = 0.002) and those living in more affluent areas (vs. deprived; Pinteraction = 0.001). Conclusions Handgrip strength was inversely associated with incident depression and anxiety. Because HGS is a simple, non‐invasive, and inexpensive measure, it could be easily used in clinical practice to stratify patients and identify those at elevated risk of mental health problems. However, future research should assess if resistance training aimed at increasing HGS can prevent the occurrence of mental health conditions.

Background The Mediterranean diet and other dietary patterns rich in fruits and vegetables have been linked to lower risk of frailty in older adults. However, not all plant‐based diets are necessarily healthful, and no previous study has evaluated the role of the quality of plant‐based dietary patterns in frailty risk. Our aim was to assess the association between plant‐based diet quality and risk of frailty. Methods Prospective cohort consisted with 82 234 women aged ≥60 years from the Nurses' Health Study, who were followed from 1990 through 2014. The dates of analysis were April 14 to June 23, 2021. Dietary data were collected every 4 years using a validated semi‐quantitative food frequency questionnaire. The plant‐based diet quality was assessed with two indices (range 18–90 points): (a) healthful plant‐based diet index (hPDI), where healthy plant foods (whole grains, fruits, vegetables, nuts, legumes, vegetable oils and tea/coffee) received positive scores, while less healthy plant foods (fruit juices, sweetened beverages, refined grains, potatoes, and sweets/desserts) and animal foods received reverse scores; and (b) unhealthful plant‐based diet index (uPDI) where positive scores were given to less healthy plant foods and reverse scores to healthy plant foods and animal foods. Frailty incidence was assessed every 4 years, being defined as having three or more of the following five criteria from the FRAIL scale: fatigue, low strength, reduced aerobic capacity, having ≥5 illnesses and weight loss ≥5%. Multivariable‐adjusted Cox proportional‐hazards models were used to estimate hazard ratios (HRs) and their 95% confidence interval (CI). Results We identified 12 910 incident cases of frailty over 1 176 401 person‐year follow‐up. In the multivariable analysis, the hPDI was inversely associated with the risk of frailty (hazard ratio [HR] for the highest vs. lowest quintile: 0.77, 95% confidence interval: 0.72–0.81; P trend <0.001). In addition, a 10‐unit increment in the hPDI was associated with a relative 15% lower risk of frailty. Conversely, a direct association was found between the uPDI and risk of frailty (HR highest vs. lowest quintile: 1.24 [1.17, 1.32], P trend <0.001). These associations were consistent for each frailty criterion, among participants with no frailty criteria at baseline, after excluding participants with diabetes, cancer and cardiovascular disease at baseline, for alternative versions of the plant‐based diet indices (PDIs), in subgroup analysis by categories of potential confounders, and in latency analysis. Conclusions A healthful plant‐based diet was associated with lower risk of frailty whereas an unhealthful plant‐based diet was associated with higher risk.

Background Frailty and sarcopenia are age‐associated syndromes that have been associated with the risk of several adverse events, mainly functional decline and death, that usually coexist. However, the potential role of one of them (sarcopenia) in modulating some of those adverse events associated to the other one (frailty) has not been explored. The aim of this work is to assess the role of sarcopenia within the frailty transitions and mortality in older people. Methods Data from the Toledo Study of Healthy Aging (TSHA) were used. TSHA is a cohort of community‐dwelling older adults ≥65. Frailty was assessed according with the Frailty Phenotype (FP) and the Frailty Trait Scale‐5 (FTS5) at baseline and at follow‐up. Basal sarcopenia status was measured with the standardized Foundation for the National Institutes of Health criteria. Fisher's exact test and logistic regression model were used to determine if sarcopenia modified the transition of frailty states (median follow‐up of 2.99 years) and Cox proportional hazard model was used for assessing mortality. Results There were 1538 participants (74.73 ± 5.73; 45.51% men) included. Transitions from robustness to prefrailty and frailty according to FP were more frequent in sarcopenic than in non‐sarcopenic participants (32.37% vs. 15.18%, P ≤ 0.001; 5.76% vs. 1.12%; P ≤ 0.001, respectively) and from prefrailty‐to‐frailty (12.68% vs. 4.27%; P = 0.0026). Improvement from prefrail‐to‐robust and remaining robust was more frequent in non‐sarcopenic participants (52.56% vs. 33.80%, P ≤ 0.001; 80.18% vs 61.15%, P ≤ 0.001, respectively). When classified by FTS5, this was also the case for the transition from non‐frail‐to‐frail (25.91% vs. 4.47%, P ≤ 0.001) and for remaining stable as non‐frail (91.25% vs. 70.98%, P ≤ 0.001). Sarcopenia was associated with an increased risk of progression from robustness‐to‐prefrailty [odds ratio (OR) 2.34 (95% confidence interval, CI) (1.51, 3.63); P ≤ 0.001], from prefrailty‐to‐frailty [OR(95% CI) 2.50 (1.08, 5.79); P = 0.033] (FP), and from non‐frail‐to‐frail [OR(95% CI) 4.73 (2.94, 7.62); P‐value ≤ 0.001]. Sarcopenia does not seem to modify the risk of death associated with a poor frailty status (hazard ratios (HR, 95%) P > 0.05). Conclusions Transitions within frailty status, but not the risk of death associated to frailty, are modulated by the presence of sarcopenia.

Background There is emerging evidence of the role of certain nutrients as risk factors for frailty. However, people eat food, rather than nutrients, and no previous study has examined the association between dietary patterns empirically derived from food consumption and the risk of frailty in older adults. Methods This is a prospective cohort study of 1,872 non-institutionalized individuals aged ≥60 years recruited between 2008 and 2010. At baseline, food consumption was obtained with a validated diet history and, by using factor analysis, two dietary patterns were identified: a ‘prudent’ pattern, characterized by high intake of olive oil and vegetables, and a ‘Westernized’ pattern, with a high intake of refined bread, whole dairy products, and red and processed meat, as well as low consumption of fruit and vegetables. Participants were followed-up until 2012 to assess incident frailty, defined as at least three of the five Fried criteria (exhaustion, weakness, low physical activity, slow walking speed, and unintentional weight loss). Results Over a 3.5-year follow-up, 96 cases of incident frailty were ascertained. The multivariate odds ratios (95% confidence interval) of frailty among those in the first (lowest), second, and third tertile of adherence to the prudent dietary pattern were 1, 0.64 (0.37–1.12), and 0.40 (0.2–0.81), respectively; P -trend = 0.009. The corresponding values for the Westernized pattern were 1, 1.53 (0.85–2.75), and 1.61 (0.85–3.03); P -trend = 0.14. Moreover, a greater adherence to the Westernized pattern was associated with an increasing risk of slow walking speed and weight loss. Conclusions In older adults, a prudent dietary pattern showed an inverse dose-response relationship with the risk of frailty while a Westernized pattern had a direct relationship with some of their components. Clinical trials should test whether a prudent pattern is effective in preventing or delaying frailty.

To examine the stratified and joint associations of physical activity (PA) and the number of chronic conditions on long-term all-cause mortality. We used data from a cohort of 3967 individuals representative of the noninstitutionalized population 60 years and older in Spain (2000/2001). Information on self-reported PA (inactive, occasionally, monthly, weekly) and 11 chronic conditions diagnosed by a physician and reported by the study participants were recorded. Associations are summarized using hazard ratios (HRs) and Cox regression, after adjustment for covariates. At baseline, 43.2%, 37.5%, 14.4%, and 4.9% of participants had 0, 1, 2, and 3 or more chronic conditions, respectively. Mean follow-up was 8.9 years (median, 10.8 years; range, 0.02-11.28 years), with 1483 deaths. The HRs (95% CIs) for all-cause mortality in participants with 1, 2, and 3 or more chronic conditions compared with those with none were 1.26 (1.05-1.39), 1.78 (1.51-2.09), and 2.27 (1.79-2.86), respectively. Being physically active (ie, doing any PA) was associated with a mortality reduction (95% CI) of 30% (14%-43%), 33% (18%-45%), 35% (16%-50%), and 47% (18%-66%) in participants with 0, 1, 2, and 3 or more chronic conditions, respectively. Compared with those with 0 chronic conditions who were physically active, participants with 2 (HR=2.63; 95% CI, 2.09-3.31) and 3 or more (HR=3.26; 95% CI, 2.42-4.38) chronic conditions who were physically inactive had the highest mortality risk. Physical activity is associated with a reduction in increased risk of death associated with multimorbidity (ie, coexistence of ≥2 chronic conditions) in older individuals.

Background There is evidence that an overall healthy diet is associated with lower risk of frailty. However, the effect of diet composition, specifically the role of protein intake on frailty, is mostly unclear. The aim of this study was to evaluate the intake of protein, including total, plant, animal, and dairy protein, in relation to frailty incidence in a large cohort of older women. Methods We analysed data from 85 871 women aged ≥60 participating in the Nurses' Health Study. Intake of protein was measured nine times during follow‐up from 1980 until 2010. Frailty was defined as having at least three of the following five criteria from the Fatigue, Resistance, Ambulation, Illnesses and Loss of Weight (FRAIL) scale: fatigue, low strength, reduced aerobic capacity, having ≥5 illnesses, and weight loss of ≥5%. The occurrence of frailty was assessed every 4 years from 1992 up to 2014. Results During follow‐up, we identified 13 279 incident cases of frailty. Women with a higher intake of plant protein had a lower risk of developing frailty after adjustment for all relevant confounders [relative risks across quintiles of consumption: 1.00, 0.94, 0.89, 0.86, and 0.86; P‐trend < 0.001]. In contrast, those with a higher intake of animal protein intake had a higher risk of frailty [relative risks across quintiles of consumption: 1.00, 0.98, 0.99, 1.00, and 1.07; P‐trend 0.04]. The intake of total and dairy protein showed no significant association with frailty in the full model. Substituting 5% of energy from plant protein intake at the expense of animal protein, dairy protein, or non‐dairy animal protein was associated with 38% (29%, 47%), 32% (21%, 42%), and 42% (33%, 50%) reduced risk of frailty. Conclusions A higher intake of plant protein, but not animal or dairy protein, was associated with a lower risk of frailty. Substitution of plant protein for animal protein, especially non‐dairy animal protein, was associated with lower risk of frailty.

Consumption of sugar-sweetened beverages (SSBs) has been consistently associated with a higher risk of obesity, type 2 diabetes, cardiovascular disease, and premature mortality, whereas evidence for artificially sweetened beverages (ASBs) and fruit juices on health is less solid. The aim of this study was to evaluate the consumption of SSBs, ASBs, and fruit juices in association with frailty risk among older women. We analyzed data from 71,935 women aged ≥60 (average baseline age was 63) participating in the Nurses' Health Study (NHS), an ongoing cohort study initiated in 1976 among female registered nurses in the United States. Consumption of beverages was derived from 6 repeated food frequency questionnaires (FFQs) administered between 1990 and 2010. Frailty was defined as having at least 3 of the following 5 criteria from the FRAIL scale: fatigue, poor strength, reduced aerobic capacity, having ≥5 chronic illnesses, and weight loss ≥5%. The occurrence of frailty was assessed every 4 years from 1992 to 2014. During 22 years of follow-up, we identified 11,559 incident cases of frailty. Consumption of SSBs was associated with higher risk of frailty after adjustment for diet quality, body mass index (BMI), smoking status, and medication use, specifically, the relative risks (RRs) and 95% confidence interval (95% CI) for ≥2 serving/day versus no SSB consumption was 1.32 (1.10, 1.57); p-value <0.001. ASBs were also associated with frailty [RR ≥2 serving/day versus no consumption: 1.28 (1.17, 1.39); p-value <0.001]. Orange juice was associated with lower risk of frailty [RR ≥1 serving/day versus no consumption: 0.82 (0.76, 0.87); p-value <0.001], whereas other juices were associated with a slightly higher risk [RR ≥1 serving/day versus no consumption: 1.15 (1.03, 1.28); p-value <0.001]. A limitation of this study is that, due to self-reporting of diet and frailty, certain misclassification bias cannot be ruled out; also, some residual confounding may persist. In this study, we observed that consumption of SSBs and ASBs was associated with a higher risk of frailty. However, orange juice intake showed an inverse association with frailty. These results need to be confirmed in further studies using other frailty definitions.

Background Red meat is a nutrient‐dense source of protein fundamental for older adults; however, red meat is also high in detrimental components, including saturated fat. It is unclear whether habitual red meat consumption is associated with risk of frailty. This study aimed to examine the prospective association between the consumption of total, unprocessed, and processed red meat and the risk of frailty in older adults. Methods We analysed data from 85 871 women aged ≥60 participating in the Nurses' Health Study. Consumption of total, unprocessed, and processed red meat was obtained from repeated food frequency questionnaires administered between 1980 and 2010. Frailty was defined as having at least three of the following five criteria from the FRAIL scale: fatigue, low strength, reduced aerobic capacity, having ≥5 chronic illnesses, and unintentional weight loss ≥5%. The occurrence of frailty was assessed every four years from 1992 to 2014. Results During 22 years of follow‐up (median follow‐up 14 years), we identified 13 279 incident cases of frailty. Women with a higher intake of red meat showed an increased risk of frailty after adjustment for lifestyle factors, medication use, and dietary factors. The relative risk (95% confidence interval) for one serving/day increment in consumption was 1.13 (1.08, 1.18) for total red meat, 1.08 (1.02, 1.15) for unprocessed red meat, and 1.26 (1.15, 1.39) for processed red meat. When each component of the frailty syndrome was individually examined, each of them was positively associated with total red meat consumption, except for the weight loss criterion. Replacing one serving/day of unprocessed red meat with other protein sources was associated with significantly lower risk of frailty; the risk reduction estimates were 22% for fish and 14% for nuts, while for replacement of processed red meat, the percentages were 33% for fish, 26% for nuts, 13% for legumes, and 16% for low‐fat dairy. Conclusions Habitual consumption of unprocessed and processed red meat was associated with a higher risk of frailty. Replacement of red meat by other protein sources might reduce the risk of frailty. These findings are in line with dietary guidelines promoting diets that emphasize plant‐based sources of protein.

To examine the association between physical activity (PA) and the risk for metabolically unhealthy obesity (MUO) or metabolically healthy obesity (MHO) in Asian adults. Data were obtained from 205,745 healthy individuals 18 years or older. Individuals were classified as inactive, lower or upper insufficiently active, active, and high active. Metabolically unhealthy was defined as having 1 or more of the metabolic syndrome criteria, excluding the abdominal obesity criterion. The percentages of metabolically healthy normal-weight (MHNW), metabolically healthy overweight (MHOW), MHO, and MUO in our cohort were 30.8% (63,408 of 205,745), 5.8% (12,002 of 205,745), 4.1% (8329 of 205,745), and 20.7% (42,564 of 205,745), respectively. During a mean follow-up of 6 (range, 0.5-19) years, among 63,408 MHNW participants, 1890 (3.0%) and 1174 (1.9%) developed MUO and MHO, respectively. Among 12,002 MHOW participants, 3404 (28.4%) developed MUO and 2734 (22.8%) developed MHO. A total of 5506 of 8329 (66.1%) participants moved from MHO to MUO, and 5675 of 42,564 (13.3%) moved from MUO to MHO. Compared with being inactive, MHNW individuals who were active or high active showed lower risk for MUO. Among those with MHOW, being high active was associated with reduced risk for MUO and MHO. Although among MHO participants, PA was not associated with incident MUO, being active or high active was linked to a greater likelihood of moving from MUO to MHO. PA may prevent the development of both MHO and MUO. PA also helps increase the transition from MUO to MHO, which may contribute to reduce the subsequent development of type 2 diabetes mellitus and major cardiovascular disease complications.

Background There is mounting evidence that the Mediterranean diet prevents type 2 diabetes, but little is known about the role of Mediterranean lifestyles other than diet and among non-Mediterranean populations. This work aimed to examine the association between a comprehensive Mediterranean-type lifestyle and type 2 diabetes incidence in a British adult population. Methods We used data from 112,493 individuals free of cardiovascular disease and type 2 diabetes mellitus, aged 40–69 years, from the UK Biobank cohort, who were followed from 2009 to 2010 to 2021. The Mediterranean lifestyle was assessed through the 25-item MEDLIFE index, which comprises three blocks: (a) “Mediterranean food consumption”, (b) “Mediterranean dietary habits”, (c) “Physical activity, rest, social habits, and conviviality”. Diabetes incidence was obtained from clinical records. Cox proportional-hazards regression models were used to analyze associations and adjusted for the main potential confounders. Results After a median follow-up of 9.4 years, 2,724 cases of type 2 diabetes were ascertained. Compared to the first quartile of MEDLIFE adherence, the hazard ratios (95% confidence interval) for increasing quartiles of adherence were 0.90 (0.82–0.99), 0.80 (0.72–0.89) and 0.70 (0.62–0.79) ( p -trend < 0.001). All three blocks of MEDLIFE were independently associated with lower risk of diabetes. Conclusions Higher adherence to the MEDLIFE index was associated with lower risk of type 2 diabetes in the UK Biobank. A Mediterranean-type lifestyle, culturally adapted to non-Mediterranean populations, could help prevent diabetes.