Ultra-processed foods, unprocessed/minimally processed foods and risk of frailty in a cohort of U.S. females

Background Ultra-processed foods (UPF) and poor diet quality have been associated with frailty but existing studies had relatively short follow-up time. It is also unclear if the association of UPF was primarily due to its correlation with poorer diet quality. Objective We examined the association between unprocessed/minimally processed foods (UMF) and UPF and risk of frailty, and explored if the association with UPF was mainly driven by poor diet quality. Methods 63,743 non-frail females aged 60+ from the Nurses’ Health Study (cohort study) were followed for up to 26 years. Diet was assessed every 4 years by Food Frequency Questionnaires. UPF and UMF intakes were calculated using the Nova classification. Diet quality was estimated with the Alternate-Healthy Eating Index-2010 (AHEI-2010). The association of UMF and UPF with risk of frailty was examined with multivariable adjusted Cox proportional hazard model. Results During the follow-up period, we recorded 15187 incident cases of frailty. The hazard ratio (HR) of frailty for the highest versus lowest quintile of UMF (servings/d) was 0.86 (95% CI=0.83, 0.95, p trend <0.001). However, this was no longer statistically significant after adjustment for AHEI-2010. UPF(servings/d) was directly associated with the risk of frailty, even after adjustment for AHEI-2010 (1.31 95% CI=1.23, 1.39, p trend <0.001). Among those at the highest category of the AHEI-2010, UPF remained directly associated with frailty (HR comparing top to bottom quintile = 1.40, 95% CI=1.24, 1.57, p trend <0.001). For UPF components, we found a higher frailty risk with each serving/day of artificial and sugar sweetened beverages; fat, spreads and condiments; yogurt and dairy based desserts; and other UPF. However, processed whole grains were not associated with frailty. Conclusion Higher intake of UPF was associated with a higher risk of frailty in olderfemales. This was not explained by a lower diet quality contributed by UPF.