Higher adherence to a Mediterranean-type diet is linked to lower risk of mortality, cardiovascular disease and Alzheimer’s disease while its association with disability has never been assessed. The aim of the study was to investigate the relation between adherence to a Mediterranean diet (MeDi) and disability in activities of daily living. The study sample consisted of 1,410 individuals from Bordeaux, France, included in 2001–2002 in the Three-City Study and re-examined at least once over 5 years. Adherence to a MeDi (scored as 0–9) was computed from a food frequency questionnaire and 24H recall. Disability in Basic and Instrumental ADL (B-IADL) was evaluated on the Lawton–Brody and Katz scales. Statistical analyses were stratified by gender and adjusted for potential confounders. No association between MeDi adherence and baseline disability in B-IADL was highlighted in men or in women in multivariate models. Risk of onset of disability in B-IADL over time was not significantly associated with MeDi adherence in men. In women, MeDi adherence was inversely associated with the risk of incident disability in B-IADL (HR = 0.90, 95% Confidence Interval 0.82–0.98 for 1 point of the score). Women with the highest MeDi adherence (score 6–8) had a 50% (22–68%) relative risk reduction of incident disability in B-IADL over time than women in the lowest MeDi category (score 0–3). In addition to its well-documented beneficial effects on health, adherence to a Mediterranean-type diet could contribute to slow down the disablement process in women.
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Fried LP, Ferrucci L, Darer J, Williamson JD, Anderson G. Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care. J Gerontol A Biol Sci Med Sci. 2004;59:255–63.
Keeler E, Guralnik JM, Tian H, Wallace RB, Reuben DB. The impact of functional status on life expectancy in older persons. J Gerontol A Biol Sci Med Sci. 2010;65:727–33.
Seeman TE, Merkin SS, Crimmins EM, Karlamangla AS. Disability trends among older Americans: National Health And Nutrition Examination Surveys, 1988–1994 and 1999–2004. Am J Public Health. 2010;100:100–7.
Verbrugge LM, Jette AM. The disablement process. Soc Sci Med. 1994;38:1–14.
Alley DE, Chang VW. The changing relationship of obesity and disability, 1988–2004. JAMA. 2007;298:2020–7.
Guralnik JM, Ferrucci L. Underestimation of disability occurrence in epidemiological studies of older people: is research on disability still alive? J Am Geriatr Soc. 2002;50:1599–601.
Stuck AE, Walthert JM, Nikolaus T, Bula CJ, Hohmann C, Beck JC. Risk factors for functional status decline in community-living elderly people: a systematic literature review. Soc Sci Med. 1999;48:445–69.
Schroll M. Aging, food patterns and disability. Forum Nutr. 2003;56:256–8.
Houston DK, Stevens J, Cai J, Haines PS. Dairy, fruit, and vegetable intakes and functional limitations and disability in a biracial cohort: the atherosclerosis risk in communities study. Am J Clin Nutr. 2005;81:515–22.
Bartali B, Semba RD, Frongillo EA, et al. Low micronutrient levels as a predictor of incident disability in older women. Arch Intern Med. 2006;166:2335–40.
Ortega RM, Manas LR, Andres P, et al. Functional and psychic deterioration in elderly people may be aggravated by folate deficiency. J Nutr. 1996;126:1992–9.
Sharkey JR, Branch LG, Giuliani C, Zohoori M, Haines PS. Nutrient intake and BMI as predictors of severity of ADL disability over 1 year in homebound elders. J Nutr Health Aging. 2004;8:131–9.
Tomey KM, Sowers MR, Crandall C, Johnston J, Jannausch M, Yosef M. Dietary intake related to prevalent functional limitations in midlife women. Am J Epidemiol. 2008;167:935–43.
Karlamangla AS, Sarkisian CA, Kado DM, et al. Light to moderate alcohol consumption and disability: variable benefits by health status. Am J Epidemiol. 2009;169:96–104.
Vercambre MN, Boutron-Ruault MC, Ritchie K, Clavel-Chapelon F, Berr C. Long-term association of food and nutrient intakes with cognitive and functional decline: a 13-year follow-up study of elderly French women. Br J Nutr. 2009;102:419–27.
Kant AK. Dietary patterns and health outcomes. J Am Diet Assoc. 2004;104:615–35.
Milaneschi Y, Tanaka T, Ferrucci L. Nutritional determinants of mobility. Curr Opin Clin Nutr Metab Care. 2010;13:625–9.
Sofi F, Cesari F, Abbate R, Gensini GF, Casini A. Adherence to Mediterranean diet and health status: meta-analysis. BMJ. 2008;337:a1344.
Trichopoulou A, Bamia C, Trichopoulos D. Anatomy of health effects of Mediterranean diet: Greek EPIC prospective cohort study. BMJ. 2009;338:b2337.
Sofi F, Abbate R, Gensini GF, Casini A. Accruing evidence on benefits of adherence to the Mediterranean diet on health: an updated systematic review and meta-analysis. Am J Clin Nutr. 2010;92:1189–96.
Scarmeas N, Luchsinger JA, Schupf N, et al. Physical activity, diet, and risk of Alzheimer disease. JAMA. 2009;302:627–37.
Feart C, Samieri C, Rondeau V, et al. Adherence to a Mediterranean diet, cognitive decline, and risk of dementia. JAMA. 2009;302:638–48.
Feart C, Samieri C, Barberger-Gateau P. Mediterranean diet and cognitive function in older adults. Curr Opin Clin Nutr Metab Care. 2010;13:14–8.
The 3C Study Group. Vascular factors and risk of dementia: design of the three-city study and baseline characteristics of the study population. Neuroepidemiology. 2003;22:316–325.
Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist. 1969;9:179–86.
Katz S, Downs TD, Cash HR, Grotz RC. Progress in development of the index of ADL. Gerontologist. 1970;10:20–30.
Spector WD, Fleishman JA. Combining activities of daily living with instrumental activities of daily living to measure functional disability. J Gerontol B Psychol Sci Soc Sci. 1998;53:S46–57.
Feart C, Jutand MA, Larrieu S, et al. Energy, macronutrient and fatty acid intake of French elderly community dwellers and association with socio-demographic characteristics: data from the Bordeaux sample of the three-city study. Br J Nutr. 2007;98:1046–57.
Samieri C, Jutand MA, Feart C, Capuron L, Letenneur L, Barberger-Gateau P. Dietary patterns derived by hybrid clustering method in older people: association with cognition, mood, and self-rated health. J Am Diet Assoc. 2008;108:1461–71.
Trichopoulou A, Costacou T, Bamia C, Trichopoulos D. Adherence to a Mediterranean diet and survival in a Greek population. N Engl J Med. 2003;348:2599–608.
Folstein MF, Folstein SE, McHugh PR. Mini mental state: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12:189–98.
Berkman LF, Berkman CS, Kasl S, et al. Depressive symptoms in relation to physical health and functioning in the elderly. Am J Epidemiol. 1986;124:372–88.
Radloff LS. The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Meas. 1977;1:385–401.
Commenges D, Letenneur L, Joly P, Alioum A, Dartigues JF. Modelling age-specific risk: application to dementia. Stat Med. 1998;17:1973–88.
Newman AB, Brach JS. Gender gap in longevity and disability in older persons. Epidemiol Rev. 2001;23:343–50.
Murtagh KN, Hubert HB. Gender differences in physical disability among an elderly cohort. Am J Public Health. 2004;94:1406–11.
Willett WC, Sacks F, Trichopoulou A, et al. Mediterranean diet pyramid: a cultural model for healthy eating. Am J Clin Nutr. 1995;61:1402S–6S.
Bartali B, Frongillo EA, Guralnik JM, et al. Serum micronutrient concentrations and decline in physical function among older persons. JAMA. 2008;299:308–15.
Cesari M, Pahor M, Bartali B, et al. Antioxidants and physical performance in elderly persons: the Invecchiare in Chianti (InCHIANTI) study. Am J Clin Nutr. 2004;79:289–94.
Snowdon DA, Gross MD, Butler SM. Antioxidants and reduced functional capacity in the elderly: findings from the Nun Study. J Gerontol A Biol Sci Med Sci. 1996;51:M10–6.
Fried LP, Tangen CM, Walston J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56:M146–56.
Bach-Faig A, Geleva D, Carrasco JL, Ribas-Barba L, Serra-Majem L. Evaluating associations between Mediterranean diet adherence indexes and biomarkers of diet and disease. Public Health Nutr. 2006;9:1110–7.
Dai J, Jones DP, Goldberg J, et al. Association between adherence to the Mediterranean diet and oxidative stress. Am J Clin Nutr. 2008;88:1364–70.
Giugliano D, Esposito K. Mediterranean diet and metabolic diseases. Curr Opin Lipidol. 2008;19:63–8.
Wray LA, Blaum CS. Explaining the role of sex on disability: a population-based study. Gerontologist. 2001;41:499–510.
Fried LP, Guralnik JM. Disability in older adults: evidence regarding significance, etiology, and risk. J Am Geriatr Soc. 1997;45:92–100.
Barberger-Gateau P, Fabrigoule C, Rouch I, Letenneur L, Dartigues JF. Neuropsychological correlates of self-reported performance in instrumental activities of daily living and prediction of dementia. J Gerontol B Psychol Sci Soc Sci. 1999;54:P293–303.
Peres K, Helmer C, Amieva H, et al. Natural history of decline in instrumental activities of daily living performance over the 10 years preceding the clinical diagnosis of dementia: a prospective population-based study. J Am Geriatr Soc. 2008;56:37–44.
Cunnane SC, Plourde M, Pifferi F, Begin M, Feart C, Barberger-Gateau P. Fish, docosahexaenoic acid and Alzheimer’s disease. Prog Lipid Res. 2009;48:239–56.
Gillette Guyonnet S, Abellan Van Kan G, Andrieu S, et al. IANA task force on nutrition and cognitive decline with aging. J Nutr Health Aging. 2007;11:132–52.
Feart C, Torres MJ, Samieri C, et al. Adherence to a Mediterranean diet and plasma fatty acids: data from the Bordeaux sample of the three-city study. Br J Nutr. 2011;106:149–58.
Letenneur L, Gilleron V, Commenges D, Helmer C, Orgogozo JM, Dartigues JF. Are sex and educational level independent predictors of dementia and Alzheimer’s disease? Incidence data from the PAQUID project. J Neurol Neurosurg Psychiatry. 1999;66:177–83.
Sauvel C, Barberger-Gateau P, Dequae L, Letenneur L, Dartigues JF. Factors associated with a 1-year development in the functional autonomy of elderly persons living at home. Rev Epidemiol Sante Publique. 1994;42:13–23.
Deschamps V, Astier X, Ferry M, Rainfray M, Emeriau JP, Barberger-Gateau P. Nutritional status of healthy elderly persons living in Dordogne, France, and relation with mortality and cognitive or functional decline. Eur J Clin Nutr. 2002;56:305–12.
Bach A, Serra-Majem L, Carrasco JL, et al. The use of indexes evaluating the adherence to the Mediterranean diet in epidemiological studies: a review. Public Health Nutr. 2006;9:132–46.
Willett WC, Howe GR, Kushi LH. Adjustment for total energy intake in epidemiologic studies. Am J Clin Nutr. 1997;65:1220S–1228S; discussion 1229S–1231S.
Balzi D, Lauretani F, Barchielli A, et al. Risk factors for disability in older persons over 3-year follow-up. Age Ageing. 2010;39:92–8.
Covinsky KE, Yaffe K, Lindquist K, Cherkasova E, Yelin E, Blazer DG. Depressive symptoms in middle age and the development of later-life functional limitations: the long-term effect of depressive symptoms. J Am Geriatr Soc. 2010;58:551–6.
Schillerstrom JE, Royall DR, Palmer RF. Depression, disability and intermediate pathways: a review of longitudinal studies in elders. J Geriatr Psychiatry Neurol. 2008;21:183–97.
Paterson DH, Warburton DE. Physical activity and functional limitations in older adults: a systematic review related to Canada’s physical activity guidelines. Int J Behav Nutr Phys Act. 2010;7:38.
Funding/Support The Three-City Study is conducted under a partnership agreement between the Institut National de la Santé et de la Recherche Médicale (INSERM), the Institut de Santé Publique et Développement of the Victor Segalen Bordeaux 2 University, and Sanofi-Aventis. The Fondation pour la Recherche Médicale funded the preparation and initiation of the study. The 3C Study is also supported by the Caisse Nationale Maladie des Travailleurs Salariés, Direction Générale de la Santé, Mutuelle Générale de l’Education Nationale, Institut de la Longévité, Regional Governments of Aquitaine and Bourgogne, Fondation de France, and Ministry of Research—INSERM Programme “Cohortes et collections de données biologiques.” Financial support for 3C-COGINUT project was provided by the French National Research Agency (ANR-06-PNRA-005). C. Féart was funded by the French National Research Agency (ANR-06-PNRA-005). C. Samieri was funded by the Institut Carnot Lisa (Lipides pour l’Industrie et la santé, Lipids for Industry, Safety and Health). Study sponsors played no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript.
Conflict of Interest
P. Barberger-Gateau received fees for conferences from Danone, Lesieur, Bauch&Lomb and Aprifel and benefits from research grants from Danone and Lesieur. The other authors declared no support from any institution for the submitted work.
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Féart, C., Pérès, K., Samieri, C. et al. Adherence to a Mediterranean diet and onset of disability in older persons. Eur J Epidemiol 26, 747–756 (2011). https://doi.org/10.1007/s10654-011-9611-4