British Journal of Nutrition

Full Papers

Dietary Surveys and Nutritional Epidemiology

Lower nutritional status and higher food insufficiency in frail older US adults

Ellen Smita1 c1, Kerrie M. Winters-Stonea2, Paul D. Loprinzia3, Alice M. Tanga4 and Carlos J. Crespoa5

a1 School of Biological and Population Health Sciences, Oregon State University, Waldo 316, Corvallis, OR 97331, USA

a2 Oregon Health & Science University, School of Nursing Portland Campus, 3455 SW US Veterans Road, SN-ORD, Portland, OR 97239, USA

a3 Department of Exercise Science, Donna & Allan Lansing School of Nursing and Health Sciences, Bellarmine University, 2001 Newburg Road, Louisville, KY 40205, USA

a4 Department of Public Health and Community Medicine, Tufts School of Medicine, 136 Harrison Avenue, Jaharis 265, Boston, MA 02111, USA

a5 School of Community Health, Portland State University, Urban Center, Suite 450, 506 SW Mill Street, Portland, OR 97201, USA


Frailty is a state of decreased physical functioning and a significant complication of ageing. We examined frailty, energy and macronutrient intake, biomarkers of nutritional status and food insufficiency in US older adult (age ≥ 60 years) participants of the Third National Health and Nutrition Examination Survey (n 4731). Frailty was defined as meeting ≥ 2 and pre-frailty as meeting one of the following four-item criteria: (1) slow walking; (2) muscular weakness; (3) exhaustion and (4) low physical activity. Intake was assessed by 24 h dietary recall. Food insufficiency was self-reported as ‘sometimes’ or ‘often’ not having enough food to eat. Analyses were adjusted for sex, race, age, smoking, education, income, BMI, other co-morbid conditions and complex survey design. Prevalence of frailty was highest among people who were obese (20·8 %), followed by overweight (18·4 %), normal weight (16·1 %) and lowest among people who were underweight (13·8 %). Independent of BMI, daily energy intake was lowest in people who were frail, followed by pre-frail and highest in people who were not frail (6648 (se 130), 6966 (se 79) and 7280 (se 84) kJ, respectively, P< 0·01). Energy-adjusted macronutrient intakes were similar in people with and without frailty. Frail (adjusted OR (AOR) 4·7; 95 % CI 1·7, 12·7) and pre-frail (AOR 2·1; 95 % CI 0·8, 5·8) people were more likely to report being food insufficient than not frail people. Serum albumin, carotenoids and Se levels were lower in frail adults than not frail adults. Research is needed on targeted interventions to improve nutritional status and food insufficiency among frail older adults, while not necessarily increasing BMI.

(Received January 23 2012)

(Revised July 26 2012)

(Accepted September 03 2012)

(Online publication November 01 2012)

Key Words:

  • Frailty;
  • Nutritional status;
  • Food insufficiency


c1 Corresponding author: E. Smit, email


  Abbreviations: InCHIANTI, Invecchiare in Chianti; NHANES III, Third National Health and Nutrition Examination Survey