Skip to main content

The Alternative Healthy Eating Index and Physical Function Impairment in Men

The journal of nutrition, health & aging volume 23, pages 459–465 (2019)Cite this article

Abstract

Objectives

Physical function is increasingly recognized as integral to healthy aging, in particular as a core component of mobility and independent living in older adults. Thus, it is important to identify strategies for the prevention of physical function decline.

Design

Longitudinal cohort study.

Setting and Participants

A total of 12,658 men from the Health Professionals Follow-Up Study were followed from 2008–2012.

Measurements

We examined the association between the Alternative Healthy Eating Index-2010 (AHEI), a measure of diet quality combining 11 dietary components (vegetables, fruits, nuts and legumes, red and processed meats, sugar-sweetened beverages and fruit juices, alcohol, whole grains, omega-3 fatty acids, polyunsaturated fatty acids, trans fatty acids, sodium), and impairment in physical function, as measured by the SF-36. Multivariable logistic regression models were used to estimate the odds ratios (OR) and 95% confidence intervals (CI) of impairment in physical function.

Results

In the multivariable-adjusted model, each 10-point increase in total AHEI score was associated with a 10% lower odds of impairment in physical function (OR=0.90, 95% CI: 0.86,0.95), and in the categorical analysis, men with AHEI scores in the top quintile had a 26% lower odds (OR=0.74, 95% CI:0.63,0.86) compared with men in the bottom quintile. For individual AHEI components, higher intake of vegetables (p-trend=0.01), nuts and legumes (p-trend<0.01), polyunsaturated fatty acids (p-trend<0.01) and lower intake of red and processed meats (p-trend=0.03) and sugar-sweetened beverages (p-trend=0.01) were significantly associated with lower odds of physical impairment. For specific foods, higher consumption of lettuce, broccoli, blueberries, peanuts, walnuts and other nuts were associated with lower odds of impairment.

Conclusions

In this large cohort of older men, better overall diet quality was significantly associated with a lower odds of impairment in physical function. Given the value of physical function to healthy aging and quality of life, this may represent a particularly compelling public health rationale for older men to improve their diet.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Abbreviations

AHEI:

Alternative Healthy Eating Index-2010

BMI:

Body Mass Index

CI:

Confidence Interval

FFQ:

Food Frequency Questionnaire

HPFS:

Health Professionals Follow-Up Study

OR:

Odds Ratio

SF-36:

Medical Outcomes Short Form-36

References

  1. Motl RW, McAuley E. Physical activity, disability, and quality of life in older adults. Phys Med Rehabil Clin N Am 2010;21:299–308.

    Article  PubMed  Google Scholar 

  2. Beswick AD, Rees K, Dieppe P, Ayis S, Gooberman–Hill R, Horwood J, Ebrahim S. Complex interventions to improve physical function and maintain independent living in elderly people: a systematic review and meta–analysis. Lancet 2008;371:725–735.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Guralnik JM, Simonsick EM, Ferrucci L, Glynn RJ, Berkamn LF, Blazer DG, Scherr PA, Wallace RB. A short physical performance battery assessing lower extremity function: association with self–reported disability and prediction of mortality and nursing home admission. J Gerontol 1994;49:M85–94.

    Article  CAS  PubMed  Google Scholar 

  4. Cesari M, Onder G, Zamboni V, Manini T, Shorr RI, Russo A, Bernabei R, Pahor M, Landi F. Physical function and self–rated health status as predictors of mortality: results from longitudinal analysis in the ilSIRENTE study. BMC Geriatr 2008;8:34.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Satariano WA, Guralnik JM, Jackson RJ, Marottoli RA, Phelan EA, Prohaska TR. Mobility and aging: new directions for public health action. Am J Public Health 2012;102:1508–1515.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Hagan KA, Chiuve SE, Stampfer MJ, Katz JN, Grodstein F. Greater Adherence to the Alternative Healthy Eating Index Is Associated with Lower Incidence of Physical Function Impairment in the Nurses’ Health Study. J Nutr 2016;146:1341–1347.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Beckett LA, Brock DB, Lemke JH, Mendes de Leon CF, Guralnik JM, Fillenbaum GG, Branch LG, Wetle TT, Evans DA. Analysis of change in self–reported physical function among older persons in four population studies. Am J Epidemiol 1996;143:766–778.

    Article  CAS  PubMed  Google Scholar 

  8. Leveille SG, Penninx BW, Melzer D, Izmirlian G, Guralnik JM. Sex differences in the prevalence of mobility disability in old age: the dynamics of incidence, recovery, and mortality. J Gerontol B Psychol Sci Soc Sci 2000;55:S41–50.

    Article  CAS  PubMed  Google Scholar 

  9. Newman AB, Brach JS. Gender gap in longevity and disability in older persons. Epidemiol Rev 2001;23:343–350.

    Article  CAS  PubMed  Google Scholar 

  10. Rimm EB, Giovannucci EL, Stampfer MJ, Colditz GA, Litin LB, Willett WC. Reproducibility and validity of an expanded self–administered semiquantitative food frequency questionnaire among male health professionals. Am J Epidemiol 1992;135:1114–1136.

    Article  CAS  PubMed  Google Scholar 

  11. Feskanich D, Rimm EB, Giovannucci EL, Colditz GA, Stampfer MJ, Litin LB, Willett WC. Reproducibility and validity of food intake measurements from a semiquantitative food frequency questionnaire. J Am Diet Assoc 1993;93:790–796.

    Article  CAS  PubMed  Google Scholar 

  12. Chiuve SE, Fung TT, Rimm EB, Hu FB, McCullough ML, Wang M, Stampfer MJ, Willett WC. Alternative dietary indices both strongly predict risk of chronic disease. J Nutr 2012;142:1009–1018.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Brazier JE, Harper R, Jones NM, O’Cathain A, Thomas KJ, Usherwood T, Westlake L. Validating the SF–36 health survey questionnaire: new outcome measure for primary care. BMJ 1992;305:160–164.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. McHorney CA, Ware JE, Jr., Raczek AE. The MOS 36–Item Short–Form Health Survey (SF–36): II. Psychometric and clinical tests of validity in measuring physical and mental health constructs. Med Care 1993;31:247–263.

    CAS  PubMed  Google Scholar 

  15. Haley SM, McHorney CA, Ware JE, Jr. Evaluation of the MOS SF–36 physical functioning scale (PF–10): I. Unidimensionality and reproducibility of the Rasch item scale. J Clin Epidemiol 1994;47:671–684.

    CAS  PubMed  Google Scholar 

  16. Ware JE. SF–36 Health Survey: Manual and Interpretation Guide. Boston: The Health Institute, New England Medical Center, 1993.

    Google Scholar 

  17. Lin J, Curhan GC. Kidney function decline and physical function in women. Nephrol Dial Transplant 2008;23:2827–2833.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Friedman B, Heisel MJ, Delavan RL. Psychometric properties of the 15–item geriatric depression scale in functionally impaired, cognitively intact, community–dwelling elderly primary care patients. J Am Geriatr Soc 2005;53:1570–1576.

    Article  PubMed  Google Scholar 

  19. Stefler D, Hu Y, Malyutina S, Pajak A, Kubinova R, Peasey A, Pikhart H, Rodriguez–Artalejo F, Bobak M. Mediterranean diet and physical functioning trajectories in Eastern Europe: Findings from the HAPIEE study. PloS One 2018;13:e0200460.

    Article  CAS  Google Scholar 

  20. León–Muñoz LM, Guallar–Castillón P, López–García E, Rodríguez–Artalejo F. Mediterranean diet and risk of frailty in community–dwelling older adults. J Am Med Dir Assoc 2014;15:899–903.

    Article  PubMed  Google Scholar 

  21. Milaneschi Y, Bandinelli S, Corsi AM, Lauretani F, Paolisso G, Dominguez LJ, Semba RD, Tanaka T, Abbatecola AM, Talegawkar SA, Guralnik JM, Ferrucci L. Mediterranean diet and mobility decline in older persons. Exp Gerontol 2011;46:303–308.

    Article  PubMed  Google Scholar 

  22. Shikany JM, Barrett–Connor E, Ensrud KE, Cawthon PM, Lewis CE, Dam TT, Shannon J, Redden DT; Osteoporotic Fractures in Men (MrOS) Research Group. Macronutrients, diet quality, and frailty in older men. J Gerontol A Biol Sci Med Sci 2014;69:695–701.

    Article  CAS  PubMed  Google Scholar 

  23. Robinson SM, Jameson KA, Syddall HE, Dennison EM, Cooper C, Aihie Sayer A; Hertfordshirt Cohort Study Group. Clustering of lifestyle risk factors and poor physical function in older adults: the Hertfordshire cohort study. J Am Geriatr Soc 2013;61:1684–1691.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Xu B, Houston DK, Locher JL, Ellison KJ, Gropper S, Buys DR, Zizza CA. Higher Healthy Eating Index–2005 scores are associated with better physical performance. J Gerontol A Bio Sci Med Sci 2012;67:93–99.

    Article  Google Scholar 

  25. Gopinath B, Russell J, Flood VM, Burlutsky G, Mitchell P. Adherence to dietary guidelines positively affects quality of life and functional status of older adults. J Acad Nutr Diet 2014;114:220–229.

    Article  PubMed  Google Scholar 

  26. Neville CE, Young IS, Gilchrist SE, McKinley MC, Gibson A, Edgar JD, Woodside JV. Effect of increased fruit and vegetable consumption on physical function and muscle strength in older adults. Age (Dordr) 2013;35:2409–2422.

    Article  CAS  Google Scholar 

  27. Jin Y, Tanaka T, Ma Y, Bandinelli S, Ferrucci L, Talegawkar SA. Cardiovascular Health Is Associated With Physical Function Among Older Community Dwelling Men and Women. J Gerontol A Biol Sci Med Sci 2017;72:1710–1716.

    Article  PubMed  PubMed Central  Google Scholar 

  28. 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;81:515–522.

    Article  CAS  PubMed  Google Scholar 

  29. 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;167:935–943.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Lopez–Garcia E, Schulze MB, Fung TT, Meigs JB, Rifai N, Manson JE, Hu FB. Major dietary patterns are related to plasma concentrations of markers of inflammation and endothelial dysfunction. Am J Clin Nutr 2004;80:1029–1035.

    Article  PubMed  Google Scholar 

  31. Diaz MN, Frei B, Vita JA, Keaney JF, Jr. Antioxidants and atherosclerotic heart disease. N Engl J Med 1997;337:408–416.

    Article  CAS  PubMed  Google Scholar 

  32. Coyle JT, Puttfarcken P. Oxidative stress, glutamate, and neurodegenerative disorders. Science 1993;262:689–695.

    Article  CAS  Google Scholar 

  33. Estruch R, Ros E, Salas–Salvadó J, Covas MI, Corella D, Arós F, Gómez–Garcia E, Ruiz–Guitérrez V, Fiol M, Lapetra J, et al. Primary prevention of cardiovascular disease with a Mediterranean diet supplemented with extra–virgin olive oil or nuts. N Engl J Med 2013;378:e34.

    Article  Google Scholar 

  34. Cesari M, Pahor M, Bartali B, Cherubini A, Pennix BW, Williams GR, Atkinson H, Martin A, Guralnik JM, Ferrucci L. Antioxidants and physical performance in elderly persons: the Invecchiare in Chianti (InCHIANTI) study. Am J Clin Nutr 2004;79:289–294.

    Article  CAS  PubMed  Google Scholar 

  35. Meydani M. Dietary antioxidants modulation of aging and immune–endothelial cell interaction. Mech Ageing Dev 1999;111:123–132.

    Article  CAS  PubMed  Google Scholar 

  36. Syddall HE, Martin HJ, Harwood RH, Cooper C, Aihie Sayer A. The SF–36: a simple, effective measure of mobility–disability for epidemiological studies. J Nurt Health Aging 2009;13:57–62.

    Article  CAS  Google Scholar 

  37. Alison JA, Kenny P, King MT, McKinley S, Aitken LM, Leslie GD, Elliott D. Repeatability of the six–minute walk test and relation to physical function in survivors of a critical illness. Phys Ther 2012;92:1556–1563.

    Article  PubMed  Google Scholar 

  38. Moriello C, Mayo NE, Feldman L, Carli F. Validating the six–minute walk test as a measure of recovery after elective colon resection surgery. Arch Phys Med Rehabil 2008;89:1083–1089.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Channing Division of Network Medicine, Department of Medicine, Brigham & Women’s Hospital and Harvard Medical School, Boston, MA, USA

    Kaitlin A. Hagan & F. Grodstein

  2. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA

    Kaitlin A. Hagan & F. Grodstein

  3. 181 Longwood Ave, 3rd Floor, Boston, MA, 02115, USA

    Kaitlin A. Hagan

Authors
  1. Kaitlin A. Hagan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. F. Grodstein
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kaitlin A. Hagan.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Hagan, K.A., Grodstein, F. The Alternative Healthy Eating Index and Physical Function Impairment in Men. J Nutr Health Aging 23, 459–465 (2019). https://doi.org/10.1007/s12603-019-1185-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12603-019-1185-y

Key words

  • Diet Quality
  • physical function
  • aging
  • longitudinal cohort study
  • epidemiology