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

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.