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      Mediterranean diet and physical functioning trajectories in Eastern Europe: Findings from the HAPIEE study

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          Abstract

          Background

          Unhealthy diet may increase the risk of impaired physical functioning in older age. Although poor diet and limited physical functioning both seem to be particularly common in Eastern Europe, no previous study has assessed the relationship between these two factors in this region. The current analysis examined the association between overall diet quality and physical functioning in Eastern European populations.

          Methods

          We used data on 25,504 persons (aged 45–69 years at baseline) who participated in the Health Alcohol and Psychosocial factors in Eastern Europe (HAPIEE) study. Dietary assessment at baseline used food frequency questionnaire, and the overall diet quality was evaluated by the Mediterranean diet score (MDS). Physical functioning (PF) was measured by the physical functioning subscale (PF-10) of the 36-item Short-Form Health Survey at baseline and three subsequent occasions over a 10-year period. The cross-sectional and longitudinal relationships between the MDS and PF were examined simultaneously using growth curve models.

          Results

          Men and women with higher adherence to the Mediterranean diet had significantly better PF at baseline; after multivariable adjustment, the regression coefficient per 1-unit increase in the MDS was 0.39 (95% CI: 0.25, 0.52) in men and 0.50 (0.36, 0.64) in women. However, we found no statistically significant link between baseline MDS and the subsequent slope of PF decline in neither gender; the coefficients were -0.02 (-0.04, 0.00) in men and -0.01 (-0.03, 0.02) in women.

          Discussion

          Our results do not support the hypothesis that the Mediterranean diet has a substantial impact on the trajectories of physical functioning, although the differences existing at baseline may be related to dietary habits in earlier life.

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          Most cited references26

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          Risk factors for functional status decline in community-living elderly people: a systematic literature review.

          To lay the groundwork for devising, improving and implementing strategies to prevent or delay the onset of disability in the elderly, we conducted a systematic literature review of longitudinal studies published between 1985 and 1997 that reported statistical associations between individual base-line risk factors and subsequent functional status in community-living older persons. Functional status decline was defined as disability or physical function limitation. We used MEDLINE, PSYCINFO, SOCA, EMBASE, bibliographies and expert consultation to select the articles, 78 of which met the selection criteria. Risk factors were categorized into 14 domains and coded by two independent abstractors. Based on the methodological quality of the statistical analyses between risk factors and functional outcomes (e.g. control for base-line functional status, control for confounding, attrition rate), the strength of evidence was derived for each risk factor. The association of functional decline with medical findings was also analyzed. The highest strength of evidence for an increased risk in functional status decline was found for (alphabetical order) cognitive impairment, depression, disease burden (comorbidity), increased and decreased body mass index, lower extremity functional limitation, low frequency of social contacts, low level of physical activity, no alcohol use compared to moderate use, poor self-perceived health, smoking and vision impairment. The review revealed that some risk factors (e.g. nutrition, physical environment) have been neglected in past research. This review will help investigators set priorities for future research of the Disablement Process, plan health and social services for elderly persons and develop more cost-effective programs for preventing disability among them.
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            Adherence to Mediterranean Diet Reduces Incident Frailty Risk: Systematic Review and Meta-Analysis

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              Mediterranean diet and mobility decline in older persons.

              We examined whether adherence to a Mediterranean-style diet has positive effects on mobility assessed over a 9-year follow-up in a representative sample of older adults. This research is part of the InCHIANTI Study, a prospective population-based study of older persons in Tuscany, Italy. The sample for this analysis included 935 women and men aged 65 years and older. Adherence to the Mediterranean diet was assessed at baseline by the standard 10-unit Mediterranean diet score (MDS). Lower extremity function was measured at baseline, and at the 3-, 6- and 9-year follow-up visits using the short physical performance battery (SPPB). At baseline, higher adherence to Mediterranean diet was associated with better lower body performance. Participants with higher adherence experienced less decline in SPPB score, which was of 0.9 points higher (p<.0001) at the 3-year-follow, 1.1 points higher (p=0.0004) at the 6-year follow-up and 0.9 points higher (p=0.04) at the 9-year follow-up compared to those with lower adherence. Among participants free of mobility disability at baseline, those with higher adherence had a lower risk (HR=0.71, 95% CI=0.51-0.98, p=0.04) of developing new mobility disability. High adherence to a Mediterranean-style diet is associated with a slower decline of mobility over time in community-dwelling older persons. If replicated, this observation is highly relevant in terms of public health. Copyright © 2010 Elsevier Inc. All rights reserved.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: MethodologyRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: Data curationRole: Formal analysisRole: MethodologyRole: SoftwareRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: Funding acquisitionRole: InvestigationRole: Project administrationRole: ResourcesRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: Funding acquisitionRole: InvestigationRole: Project administrationRole: ResourcesRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: Funding acquisitionRole: InvestigationRole: Project administrationRole: ResourcesRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: Funding acquisitionRole: InvestigationRole: Project administrationRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: Funding acquisitionRole: InvestigationRole: Project administrationRole: Writing – review & editing
                Role: ConceptualizationRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: Project administrationRole: SupervisionRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                12 July 2018
                2018
                : 13
                : 7
                : e0200460
                Affiliations
                [1 ] Department of Epidemiology and Public Health, University College London, London, United Kingdom
                [2 ] Max Planck Institute for Demographic Research, Rostock, Germany
                [3 ] Institute of Internal and Preventive Medicine, Siberian Branch of the Russian Academy of Medical Sciences, Novosibirsk, Russia
                [4 ] Department of Epidemiology and Population Studies, Jagiellonian University Collegium Medicum, Krakow, Poland
                [5 ] National Institute of Public Health, Prague, Czech Republic
                [6 ] Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/IdiPaz and CIBERESP, Madrid, Spain
                CUNY, UNITED STATES
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                http://orcid.org/0000-0002-4482-148X
                Article
                PONE-D-17-10614
                10.1371/journal.pone.0200460
                6042732
                30001406
                d18bc639-a47a-46bf-8699-fee223a11139
                © 2018 Stefler et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 17 March 2017
                : 24 June 2018
                Page count
                Figures: 2, Tables: 4, Pages: 14
                Funding
                Funded by: funder-id http://dx.doi.org/10.13039/100004440, Wellcome Trust;
                Award ID: WT064947
                Award Recipient :
                Funded by: funder-id http://dx.doi.org/10.13039/100004440, Wellcome Trust;
                Award ID: WT081081
                Award Recipient :
                Funded by: National Institute of Aging (US)
                Award ID: 1RO1AG23522
                Award Recipient :
                Funded by: Russian Scientific Foundation
                Award ID: 14-45-00030
                Award Recipient :
                Funded by: MacArthur Foundation Initiative on Social Upheaval and Health
                Award Recipient :
                Funded by: European Union Horizon 2020 Research and Innovation Program (ATHLOS Project)
                Award ID: 635316
                Award Recipient :
                The HAPIEE study was supported by the Wellcome Trust [grant numbers WT064947, WT081081], the US National Institute of Aging [grant number 1RO1AG23522] and the MacArthur Foundation Initiative on Social Upheaval and Health. The current analysis was partly supported by the Russian Scientific Foundation [grant number 14-45-00030]. This work was also supported by the ATHLOS Project, a European Union Horizon 2020 Research and Innovation Program [grant number 635316]. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Biology and Life Sciences
                Nutrition
                Diet
                Medicine and Health Sciences
                Nutrition
                Diet
                People and Places
                Geographical Locations
                Europe
                Research and Analysis Methods
                Research Design
                Cohort Studies
                People and places
                Geographical locations
                Europe
                European Union
                Poland
                People and Places
                Geographical Locations
                Asia
                Russia
                People and Places
                Geographical Locations
                Europe
                Russia
                People and Places
                Population Groupings
                Ethnicities
                European People
                Slavic People
                Russian People
                People and places
                Geographical locations
                Europe
                European Union
                Czech Republic
                Social Sciences
                Economics
                Human Capital
                Economics of Training and Education
                Custom metadata
                Data are from the HAPIEE study, and are available on request from Professor Martin Bobak ( m.bobak@ 123456ucl.ac.uk ) and/or UCL Research Ethics Committee ( ethics@ 123456ucl.ac.uk ), who will jointly seek approval by the HAPIEE Study Steering Committee and the Research Ethics Committee at UCL and participating centres.

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