Frontiers in Nutrition · Nov 5, 2026
Dietary Diversity, Frailty Transitions, and Frailty-State Life Expectancy in Chinese Older Adults: A 10-Year Multistate Analysis of the CLHLS
By Lin Zhou, Daoze Ke, Junru Li et al.
er recoverBackground: Dietary diversity has been linked to incident frailty, but it remains unclear whether it is associated with specific transitions along the frailty continuum and with the number of later-life years spent in healthier states. We examined dietary diversity in relation to frailty transitions and frailty-state life expectancy in Chinese older adults. Methods: We analyzed 2008–2018 data from the Chinese Longitudinal Healthy Longevity Survey. Frailty was classified as robust, prefrail, or frail using a graded deficit-accumulation frailty index (FI), and dietary diversity was assessed with a repeated 0–18 dietary diversity score (DDS). Multistate models estimated transition intensity ratios (IRs) with 95% confidence intervals (CIs) for transitions among frailty states and death, and a previous-wave analysis separated dietary assessment from subsequent transitions. Frailty-state life expectancy was estimated at ages 65, 70, 75, and 80 years. Results: The primary analysis included 22,804 person-period observations from 13,427 individuals. In the previous-wave analysis, each 2-point higher DDS was associated with lower robust-to-prefrail transition intensity (IR 0.892, 95% CI 0.835–0.953), whereas the interval-start DDS estimate within the same 9,464 intervals was 0.982 (0.922–1.046). The lagged association was similar under FI threshold and dietary-component sensitivity analyses. Under model-standardized age-65 scenarios, DDS 11 versus DDS 7 corresponded to +0.45 robust years (95% uncertainty interval [UI] +0.23 to +0.70), whereas the +0.23 non-frail and +0.20 total-year contrasts had UIs including zero. Life-expectancy contrasts depended on the fitted model and standardization assumptions. Conclusions: Higher DDS recorded at the preceding wave was associated with a lower subsequent intensity of early frailty deterioration. Model-standardized higher-DDS scenarios showed more years in the robust state; at age 65, uncertainty intervals for differences in total and non-frail years included zero. The observational results do not establish that dietary changes prevent frailty or preferentially affect deterioration over recovery. y.