Socioeconomic status, dietary pattern, and frailty in older adults in rural China: A prospective longitudinal study

This study explored the association between dietary patterns and frailty, and the mediating role of diet in the socioeconomic status (SES)-frailty relationship among rural Chinese older adults.

Data came from the Shandong Rural Elderly Health Cohort Survey (2019-2022). Longitudinal associations between dietary patterns and frailty were analyzed using generalized estimating equations. Mediation pathways were examined using Hayes' PROCESS macro to determine how dietary patterns influence the socioeconomic gradient in frailty.

Of 1903 participants, 12.3 % developed frailty over 3-year follow-up, with significant differences across education and household income levels (P < 0.001). After adjustment of confounders (age, sex, marital status, education level, occupation, physical activity, smoking status, drinking status, household income, BMI, and chronic diseases), adherence to a milk-bean-egg-fruit dietary pattern was associated with a lower risk of frailty, with OR in Q2, Q3, and Q4 of 0.69 (95 % CI: 0.53‒0.91), 0.62 (95 % CI: 0.47‒0.81), and 0.53 (95 % CI: 0.40‒0.70), respectively, compared with Q1. Notably, this dietary pattern significantly mediated the associations of household income and education level with frailty risk, explaining 28.33 % and 15.58 % of the respective total effects.

The milk-bean-egg-fruit dietary pattern exerts a protective effect against frailty and mediates the association between socioeconomic status and frailty risk. The current findings underscore the importance of educational and socioeconomic support initiatives in rural areas as well as promoting healthier dietary habits among older adults through targeted nutritional interventions to reduce frailty risk.