臺灣博碩士論文加值系統

衰弱症特色為身體功能及多項系統衰退，其生理儲備能力和對抗壓力事件的抵抗能力下降，與跌倒、認知衰退、失能、住院、入住機構與死亡風險有關。老年人飲食品質較佳，可改善或降低衰弱症及死亡風險，然飲食品質良好的衰弱症老年人是否有較低死亡風險仍然未知。以國際營養及老化協會所提出的FRAIL量表作為衰弱判斷標準，臺灣2014-2016年國民營養健康調查中65歲以上老年人衰弱症盛行率為4.9%。為進一步探討飲食多樣性與衰弱症對死亡風險之聯合影響，本研究分為橫斷面與前瞻性世代研究。以24小時飲食回憶計算營養素攝取量及飲食多樣性分數 (Dietary diversity score, DDS；範圍0-6分)，分數愈高，飲食品質愈佳；食物項目攝取頻率則來自飲食頻率問卷。本研究以FRAIL量表作為判斷衰弱標準。橫斷面研究使用 2005-2008年臺灣營養健康狀況變遷調查資料庫中968名65歲及以上的社區老年人為研究對象，結果指出，相較於正常老人，衰弱老人攝取較低的熱量及營養素，麵食製品、菇蕈類、茶及咖啡的攝取頻率也顯著較低。前瞻性世代研究共330名參與者有身分證字號，以其串聯至衛生福利部死因統計檔至2020年1月31日止。經過中位數11.7年的追蹤後，衰弱症與衰弱症前期且DDS分數較低者，其死亡風險較高 (調整之HR: 2.30，95% CI: 1.11–4.75)；反之DDS分數較高者，死亡風險較低。多樣化飲食有助於降低衰弱症或衰弱症前期老年人的死亡風險。

Frailty is characterized by a decline in physical function and multiple systems, associated with a decline in physiological reserves and resistance to stressors and an increased risk of falls, cognitive decline, disability, hospitalization, institutionalization, and mortality. Better dietary quality in the elderly can improve or reduce the risk of frailty and death, yet it remains unknown whether elderly individuals with frailty who have good dietary quality have a lower mortality risk. Using the FRAIL scale proposed by the International Association of Nutrition and Aging for frailty assessment, the prevalence of frailty among the elderly was 4.9% in the Nutrition Health Survey in Taiwan (NAHSIT) from 2014 to 2016. This study consists of a cross-sectional and a prospective cohort study to investigate the combined effect of dietary diversity and frailty on mortality risk. Nutrient intake and dietary diversity scores (DDS; range 0-6 points) were calculated based on 24-hour dietary recalls, with higher scores indicating better dietary quality; food item intake frequency was derived from a food frequency questionnaire. The cross-sectional study used data from 968 community-dwelling individuals aged 65 and over from the 2005-2008 NAHSIT Database, indicated that, compared to their non-frail counterparts, frail elderly individuals consumed lower amounts of calories and nutrients, and had significantly lower intake frequencies of grain products, mushrooms, tea, and coffee. The prospective cohort study included 330 participants with national identification numbers, which was linked to the Ministry of Health and Welfare’s Data Science Center until January 31, 2020. After a median follow-up of 11.7 years, those with frailty or pre-frailty and lower DDS had a higher risk of death (adjusted HR: 2.30, 95% CI: 1.11–4.75); conversely, those with higher DDS had a lower risk of mortality. We conclude that a diversified diet may reduce the risk of mortality in elderly people with frailty or pre-frailty.

目錄
中文摘要 V
Abstract VII
第一章 緒論 1
第一節 研究背景與重要性 1
第二節 研究目的 5
第二章 文獻回顧 6
第一節 衰弱症之流行病學 6
一、 衰弱症的概念與研究 6
二、 衰弱症評估工具 31
第二節 飲食營養與衰弱症 40
一、 飲食營養與衰弱症 40
二、 飲食評估方法 45
三、 飲食型態與飲食品質 52
四、 研究假說 57
第三章 研究方法 58
第一節 研究設計 58
第二節 資料來源及研究對象 58
第三節 研究工具 60
第四節 統計分析 63
第四章 結果 67
第一節 橫斷研究 67
第二節 前瞻性世代研究 70
第五章 討論 73
第一節 橫斷研究 73
第二節 前瞻性世代研究 87
第六章 研究優勢與限制 93
第七章 結論 94
第八章 政策建議 95
參考文獻 96


 
表目錄
Participants in a cross-sectional study
Table 1. Variable definition in statistical analysis 118
Table 2. Baseline characteristics by frailty severity among NAHSIT 2005–2008 older adults (n = 968). 119
Table 3. Compared to DDS, food intake frequency among frailty severity in the NAHSIT 2005-2008 older adults (n = 968). 122
Table 4. Comparisons of nutrient intakes among frailty severity in the NAHSIT 2005-2008 older adults (n=966). 125
Table 5. Comparison of nutrient density among frailty severity in the NAHSIT 2005-2008 older adults (n = 966). 128
Table 6. Baseline characteristics by DDS among NAHSIT 2005-2008 older adults (n = 966). 131
Table 7. Food intake frequency by DDS among the NAHSIT 2005-2008 older adults (n = 966). 135
Table 8. Compared DDS and nutrient intakes among the NAHSIT 2005-2008 older adults (n = 966) 136

Comparing cross-sectional study tables based on sex
Table 2A Baseline characteristics by frailty severity among NAHSIT 2005–2008 older men (n = 482). 120
Table 2B. Baseline characteristics by frailty severity among NAHSIT 2005–2008 older women (n = 486). 121
Table 3A. Compared to dietary diversity score (DDS), food intake frequency among frailty severity in the NAHSIT 2005-2008 older men (n = 482). 123
Table 3B. Compared to dietary diversity score (DDS), food intake frequency among frailty severity in the NAHSIT 2005-2008 older women (n = 486). 124
Table 4A. Comparison of nutrient intakes among frailty severity in the NAHSIT 2005-2008 older men (n = 482). 126
Table 4B. Comparison of nutrient intakes among frailty severity in the NAHSIT 2005-2008 older women (n = 486). 127
Table 5A. Comparison of nutrient density among frailty severity in the NAHSIT 2005-2008 older men (n = 482). 129
Table 5B. Comparison of nutrient density among frailty severity in the NAHSIT 2005-2008 older women (n = 486). 130
¶Cognitive impairment was defined by a SPMSQ with ≥3 errors.Table 6A. Baseline characteristics by DDS among NAHSIT 2005-2008 older men (n = 481). 132
Table 6B. Baseline characteristics by DDS among NAHSIT 2005-2008 older women (n = 485). 134

Participants in a prospective cohort study
Table 9. Compared the demographic characteristics with the ID card numbers and the original database. 137
Table 10. Baseline characteristics by frailty severity among NAHSIT 2005–2008 older adults (n = 330). 138
Table 11. Comparisons of dietary diversity score (DDS), and food intake frequency among frailty severity in the NAHSIT 2005-2008 (n=330). 139
Table 12. Food intake frequency by DDS among NAHSIT 2005–2008 older adults (n = 329). 140
Table 13. Association between frailty severity and risk of all-cause mortality in 2005–2008 NAHSIT older adults (n = 330). 141
Table 14. Association between prefrailty and frailty stratified by DDS and all-cause mortality in 2005–2008 NAHSIT older adults (n = 329). 141
Table 15. Sensitivity analysis of frailty status stratified by DDS and all-cause mortality in 2005-2008 NAHSIT older adult (n = 319). 142

1.WHO. Ageing and health. [Internet]. 2018. Available from: https://www.who.int/news-room/fact-sheets/detail/ageing-and-health.
2.衛生福利部。2025衛生政策福利白皮書(2016年1月公告)。[Internet]. Available from: http://tagv.mohw.gov.tw/TAGVResources/upload/Resources/2017/4/2025%E8%A1%9B%E7%94%9F%E7%A6%8F%E5%88%A9%E6%94%BF%E7%AD%96%E7%99%BD%E7%9A%AE%E6%9B%B8.pdf.
3.WHO. Decade of healthy ageing 2020–2030. 2017.
4.Abrams AP, Thompson LA. Physiology of aging of older adults: Systemic and oral health considerations. Dent Clin North Am 2014;58:729-738.
5.Chen LK, Woo J, Assantachai P, et al. Asian working group for sarcopenia: 2019 consensus update on sarcopenia diagnosis and treatment. J Am Med Dir Assoc 2020;21:300-307.e302.
6.Jeremy D Walston M. Frailty. [Internet]. 2018. Available from: https://www.uptodate.com/contents/frailty/print?search=frailty,%20nutrition&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1.
7.Dominguez LJ, Barbagallo M. The relevance of nutrition for the concept of cognitive frailty. Curr Opin Clin Nutr Metab Care 2017;20:61-68.
8.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:M146-156.
9.Morley JE, Vellas B, van Kan GA, et al. Frailty consensus: A call to action. J Am Med Dir Assoc 2013;14:392-397.
10.Song X, Mitnitski A, Rockwood K. Prevalence and 10-year outcomes of frailty in older adults in relation to deficit accumulation. J Am Geriatr Soc 2010;58:681-687.
11.Ofori-Asenso R, Chin KL, Mazidi M, et al. Global incidence of frailty and prefrailty among community-dwelling older adults: A systematic review and meta-analysis. JAMA Netw Open 2019;2:e198398.
12.Chang SF. Frailty is a major related factor for at risk of malnutrition in community-dwelling older adults. J Nurs Scholarsh 2017;49:63-72.
13.Hsieh TJ, Su SC, Chen CW, et al. Individualized home-based exercise and nutrition interventions improve frailty in older adults: A randomized controlled trial. Int J Behav Nutr Phys Act 2019;16:119.
14.Lee MS, Huang YC, Su HH, Lee MZ, Wahlqvist ML. A simple food quality index predicts mortality in elderly Taiwanese. J Nutr Health Aging 2011;15:815-821.
15.Hengeveld LM, Wijnhoven HAH, Olthof MR, et al. Prospective associations of diet quality with incident frailty in older adults: The health, aging, and body composition study. J Am Geriatr Soc 2019;67:1835-1842.
16.Lee MS, Huang YC, Wahlqvist ML. Chewing ability in conjunction with food intake and energy status in later life affects survival in Taiwanese with the metabolic syndrome. J Am Geriatr Soc 2010;58:1072-1080.
17.Donini LM, Poggiogalle E, Piredda M, et al. Anorexia and eating patterns in the elderly. PLoS One 2013;8:e63539.
18.Kimura Y, Ogawa H, Yoshihara A, et al. Evaluation of chewing ability and its relationship with activities of daily living, depression, cognitive status and food intake in the community-dwelling elderly. Geriatr Gerontol Int 2013;13:718-725.
19.Gu Y, Wu W, Bai J, et al. Association between the number of teeth and frailty among Chinese older adults: A nationwide cross-sectional study. BMJ Open 2019;9:e029929.
20.Bartali B, Frongillo EA, Bandinelli S, et al. Low nutrient intake is an essential component of frailty in older persons. The journals of gerontology Series A, Biological sciences and medical sciences 2006;61:589-593.
21.Lo YT, Wahlqvist ML, Chang YH, Kao S, Lee MS. Dietary diversity predicts type of medical expenditure in elders. Am J Manag Care 2013;19:e415-423.
22.Motokawa K, Watanabe Y, Edahiro A, et al. Frailty severity and dietary variety in Japanese older persons: A cross-sectional study. J Nutr Health Aging 2018;22:451-456.
23.Wahlqvist ML, Xiu L, Lee MS, et al. Dietary diversity no longer offsets the mortality risk of hyperhomocysteinaemia in older adults with diabetes: A prospective cohort study. Asia Pac J Clin Nutr 2016;25:414-423.
24.Gümüşsoy M, Atmış V, Yalçın A, et al. Malnutrition-sarcopenia syndrome and all-cause mortality in hospitalized older people. Clin Nutr 2021;40:5475-5481.
25.Chen RC, Chang YH, Lee MS, Wahlqvist ML. Dietary quality may enhance survival related to cognitive impairment in Taiwanese elderly. Food Nutr Res 2011;55.
26.Huang YC, Wahlqvist ML, Lee MS. Appetite predicts mortality in free-living older adults in association with dietary diversity. A NAHSIT cohort study. Appetite 2014;83:89-96.
27.Markle-Reid M, Browne G. Conceptualizations of frailty in relation to older adults. J Adv Nurs 2003;44:58-68.
28.Lally F, Crome P. Understanding frailty. Postgrad Med J 2007;83:16-20.
29.He B, Ma Y, Wang C, et al. Prevalence and risk factors for frailty among community-dwelling older people in China: A systematic review and meta-analysis. J Nutr Health Aging 2019;23:442-450.
30.中華民國內政部. 歷年簡易生命表. 2020.
31.衛生福利部社會及家庭署。高齡社會白皮書。 [Internet]. 2020. Available from: https://www.sfaa.gov.tw/SFAA/Pages/Detail.aspx?nodeid=1372&pid=11419. 32.Hoogendijk EO, Afilalo J, Ensrud KE, et al. Frailty: Implications for clinical practice and public health. Lancet 2019;394:1365-1375.
33.Farooqi M, Papaioannou A, Bangdiwala S, Rangarajan S, Leong D. How regional versus global thresholds for physical activity and grip strength influence physical frailty prevalence and mortality estimates in pure: A prospective multinational cohort study of community-dwelling adults. BMJ Open 2023;13:e066848.
34.Collard RM, Boter H, Schoevers RA, Oude Voshaar RC. Prevalence of frailty in community-dwelling older persons: A systematic review. J Am Geriatr Soc 2012;60:1487-1492.
35.Siriwardhana DD, Hardoon S, Rait G, Weerasinghe MC, Walters KR. Prevalence of frailty and prefrailty among community-dwelling older adults in low-income and middle-income countries: A systematic review and meta-analysis. BMJ Open 2018;8:e018195.
36.Lo YL, Hsieh YT, Hsu LL, et al. Dietary pattern associated with frailty: Results from nutrition and health survey in Taiwan. J Am Geriatr Soc 2017;65:2009-2015.
37.Rezaei-Shahsavarloo Z, Atashzadeh-Shoorideh F, Gobbens RJJ, Ebadi A, Ghaedamini Harouni G. The impact of interventions on management of frailty in hospitalized frail older adults: A systematic review and meta-analysis. BMC Geriatr 2020;20:526.
38.Lee IC, Yang YH, Ho PS, Lee IC. Chewing ability, nutritional status and quality of life. J Oral Rehabil 2014;41:79-86.
39.Mann T, Heuberger R, Wong H. The association between chewing and swallowing difficulties and nutritional status in older adults. Aust Dent J 2013;58:200-206.
40.Turner MD, Ship JA. Dry mouth and its effects on the oral health of elderly people. J Am Dent Assoc 2007;138 Suppl:15s-20s.
41.Lo YT, Wahlqvist ML, Chang YH, Lee MS. Combined effects of chewing ability and dietary diversity on medical service use and expenditures. J Am Geriatr Soc 2016;64:1187-1194.
42.Navaratnarajah A, Jackson SHD. The physiology of ageing. Medicine 2016;45:6-10.
43.Britton E, McLaughlin JT. Ageing and the gut. Proceedings of the Nutrition Society 2013;72:173-177.
44.Bhutto A, Morley JE. The clinical significance of gastrointestinal changes with aging. Curr Opin Clin Nutr Metab Care 2008;11:651-660.
45.Chuang SY, Chang HY, Lee MS, Chia-Yu Chen R, Pan WH. Skeletal muscle mass and risk of death in an elderly population. Nutr Metab Cardiovasc Dis 2014;24:784-791.
46.Remelli F, Vitali A, Zurlo A, Volpato S. Vitamin D deficiency and sarcopenia in older persons. Nutrients 2019;11.
47.Nishikawa H, Fukunishi S, Asai A, et al. Pathophysiology and mechanisms of primary sarcopenia (review). Int J Mol Med 2021;48.
48.Zamboni M, Rubele S, Rossi AP. Sarcopenia and obesity. Curr Opin Clin Nutr Metab Care 2019;22:13-19.
49.Rietman ML, van der AD, van Oostrom SH, et al. The association between BMI and different frailty domains: A u-shaped curve? J Nutr Health Aging 2018;22:8-15.
50.Stenholm S, Strandberg TE, Pitkala K, et al. Midlife obesity and risk of frailty in old age during a 22-year follow-up in men and women: The mini-finland follow-up survey. J Gerontol A Biol Sci Med Sci 2014;69:73-78.
51.Yuan L, Chang M, Wang J. Abdominal obesity, body mass index and the risk of frailty in community-dwelling older adults: A systematic review and meta-analysis. Age Ageing 2021;50:1118-1128.
52.van der Valk ES, van den Akker ELT, Savas M, et al. A comprehensive diagnostic approach to detect underlying causes of obesity in adults. Obes Rev 2019;20:795-804.
53.Colleluori G, Villareal DT. Aging, obesity, sarcopenia and the effect of diet and exercise intervention. Exp Gerontol 2021;155:111561.
54.van Dam CS, Labuschagne HA, van Keulen K, et al. Polypharmacy, comorbidity and frailty: A complex interplay in older patients at the emergency department. Eur Geriatr Med 2022;13:849-857.
55.Di Ciaula A, Portincasa P. The environment as a determinant of successful aging or frailty. Mech Ageing Dev 2020;188:111244.
56.Huang Q, Zhong W, Chen Z, et al. Associations between specific diets, dietary diversity, and cognitive frailty in older adults - China, 2002-2018. China CDC Wkly 2023;5:872-876.
57.Wu SY, Cheng YY, Chang HY, et al. Efficacy of dietary intervention with group activities on dietary intakes, frailty status, and working memory: A cluster-randomized controlled trial in community strongholds. Nutrients 2023;15.
58.Huang TY, Chou MY, Liang CK, et al. Physical activity plays a crucial role in multidomain intervention for frailty prevention. Aging Clin Exp Res 2023;35:1283-1292.
59.Aghjayan SL, Lesnovskaya A, Esteban-Cornejo I, et al. Aerobic exercise, cardiorespiratory fitness, and the human hippocampus. Hippocampus 2021;31:817-844.
60.Clegg ME, Godfrey A. The relationship between physical activity, appetite and energy intake in older adults: A systematic review. Appetite 2018;128:145-151.
61.Kadariya S, Gautam R, Aro AR. Physical activity, mental health, and wellbeing among older adults in south and southeast asia: A scoping review. Biomed Res Int 2019;2019:6752182.
62.Garber CE, Blissmer B, Deschenes MR, et al. American college of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: Guidance for prescribing exercise. Med Sci Sports Exerc 2011;43:1334-1359.
63.Byrne T, Cooke J, Bambrick P, McNeela E, Harrison M. Circulating inflammatory biomarker responses in intervention trials in frail and sarcopenic older adults: A systematic review and meta-analysis. Exp Gerontol 2023;177:112199.
64.Marcos-Pérez D, Sánchez-Flores M, Proietti S, et al. Association of inflammatory mediators with frailty status in older adults: Results from a systematic review and meta-analysis. Geroscience 2020;42:1451-1473.
65.Soysal P, Isik AT, Carvalho AF, et al. Oxidative stress and frailty: A systematic review and synthesis of the best evidence. Maturitas 2017;99:66-72.
66.Brioche T, Lemoine-Morel S. Oxidative stress, sarcopenia, antioxidant strategies and exercise: Molecular aspects. Curr Pharm Des 2016;22:2664-2678.
67.Fernandez-Sanchez A, Madrigal-Santillan E, Bautista M, et al. Inflammation, oxidative stress, and obesity. Int J Mol Sci 2011;12:3117-3132.
68.吳雅汝、周怡君、詹鼎正。文獻回顧-肌少症與衰弱症。內科學誌 2014;25:131-136.
69.Kregel KC, Zhang HJ. An integrated view of oxidative stress in aging: Basic mechanisms, functional effects, and pathological considerations. Am J Physiol Regul Integr Comp Physiol 2007;292:R18-36.
70.Valentini L, Pinto A, Bourdel-Marchasson I, et al. Impact of personalized diet and probiotic supplementation on inflammation, nutritional parameters and intestinal microbiota - the "ristomed project": Randomized controlled trial in healthy older people. Clin Nutr 2015;34:593-602.
71.Sato R, Vatic M, da Fonseca GWP, von Haehling S. Sarcopenia and frailty in heart failure: Is there a biomarker signature? Curr Heart Fail Rep 2022;19:400-411.
72.Yoo JI, Ha YC, Lee YK, Koo KH. High levels of heavy metals increase the prevalence of sarcopenia in the elderly population. J Bone Metab 2016;23:101-109.
73.Chen CH, Huang LY, Lee KY, et al. Effects of pm(2.5) on skeletal muscle mass and body fat mass of the elderly in Taipei, Taiwan. Sci Rep 2019;9:11176.
74.Kim YM, Yang N, Kim K. Effects of perceived food store environment on malnutrition and frailty among the food-insecure elderly in a metropolitan city. Nutrients 2021;13.
75.Youn HM, Lee HJ, Lee DW, Park EC. The impact of poverty transitions on frailty among older adults in South Korea: Findings from the Korean longitudinal study of ageing. BMC Geriatr 2020;20:139.
76.Gale CR, Westbury L, Cooper C. Social isolation and loneliness as risk factors for the progression of frailty: The English longitudinal study of ageing. Age Ageing 2018;47:392-397.
77.Davies K, Maharani A, Chandola T, Todd C, Pendleton N. The longitudinal relationship between loneliness, social isolation, and frailty in older adults in England: A prospective analysis. Lancet Healthy Longev 2021;2:e70-e77.
78.Cobb S. Presidential address-1976. Social support as a moderator of life stress. Psychosom Med 1976;38:300-314.
79.Pan C, Cao N. Patterns of social isolation and low social support and frailty trajectories among Chinese older adults. J Appl Gerontol 2023;42:2325-2334.
80.Wang Y, Li J, Fu P, et al. Social support and subsequent cognitive frailty during a 1-year follow-up of older people: The mediating role of psychological distress. BMC Geriatr 2022;22:162.
81.Vaughan L, Corbin AL, Goveas JS. Depression and frailty in later life: A systematic review. Clin Interv Aging 2015;10:1947-1958.
82.Soysal P, Veronese N, Thompson T, et al. Relationship between depression and frailty in older adults: A systematic review and meta-analysis. Ageing Res Rev 2017;36:78-87.
83.Andreescu C, Lee S. Anxiety disorders in the elderly. Adv Exp Med Biol 2020;1191:561-576.
84.Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K. Frailty in elderly people. Lancet 2013;381:752-762.
85.Lorbergs AL, Prorok JC, Holroyd-Leduc J, et al. Nutrition and physical activity clinical practice guidelines for older adults living with frailty. J Frailty Aging 2022;11:3-11.
86.Campbell AJ, Buchner DM. Unstable disability and the fluctuations of frailty. Age Ageing 1997;26:315-318.
87.Bouillon K, Kivimaki M, Hamer M, et al. Measures of frailty in population-based studies: An overview. BMC Geriatr 2013;13:64.
88.Rockwood K, Song X, MacKnight C, et al. A global clinical measure of fitness and frailty in elderly people. Cmaj 2005;173:489-495.
89.Pulok MH, Theou O, van der Valk AM, Rockwood K. The role of illness acuity on the association between frailty and mortality in emergency department patients referred to internal medicine. Age Ageing 2020;49:1071-1079.
90.Chou YC, Tsou HH, Chan DD, et al. Validation of clinical frailty scale in Chinese translation. BMC Geriatr 2022;22:604.
91.Searle SD, Mitnitski A, Gahbauer EA, Gill TM, Rockwood K. A standard procedure for creating a frailty index. BMC Geriatr 2008;8:24.
92.Stolz E, Mayerl H, Godin J, et al. Reliability of the frailty index among community-dwelling older adults. J Gerontol A Biol Sci Med Sci 2024;79.
93.Abellan van Kan G, Rolland YM, Morley JE, Vellas B. Frailty: Toward a clinical definition. J Am Med Dir Assoc 2008;9:71-72.
94.Kojima G. Frailty defined by frail scale as a predictor of mortality: A systematic review and meta-analysis. J Am Med Dir Assoc 2018;19:480-483.
95.Dong L, Qiao X, Tian X, et al. Cross-cultural adaptation and validation of the frail scale in Chinese community-dwelling older adults. J Am Med Dir Assoc 2018;19:12-17.
96.Ensrud KE, Ewing SK, Taylor BC, et al. Comparison of 2 frailty indexes for prediction of falls, disability, fractures, and death in older women. Arch Intern Med 2008;168:382-389.
97.Ensrud KE, Ewing SK, Cawthon PM, et al. A comparison of frailty indexes for the prediction of falls, disability, fractures, and mortality in older men. J Am Geriatr Soc 2009;57:492-498.
98.Kapagan T, Yavuzer H, Ferhatoglu F, Erdincler DS, Camcıoglu AE. Validity and reliability of study of osteoporotic fractures index in the diagnosis of sarcopenia in Turkish geriatric patients. European Journal of Geriatrics & Gerontology 2023;5.
99.Yamaguchi M, Yamada Y, Nanri H, et al. Association between the frequency of protein-rich food intakes and kihon-checklist frailty indices in older Japanese adults: The Kyoto-Kameoka study. Nutrients 2018;10.
100.Arai H, Satake S. English translation of the kihon checklist. Geriatr Gerontol Int 2015;15:518-519.
101.Sentandreu-Mañó T, Cezón-Serrano N, Cebrià IIMA, et al. Kihon checklist to assess frailty in older adults: Some evidence on the internal consistency and validity of the spanish version. Geriatr Gerontol Int 2021;21:262-267.
102.Organization WH. Integrated care for older people (‎ICOPE)‎: Guidance for person-centred assessment and pathways in primary care. 2019.
103.Buta BJ, Walston JD, Godino JG, et al. Frailty assessment instruments: Systematic characterization of the uses and contexts of highly-cited instruments. Ageing Res Rev 2016;26:53-61.
104.Liang H, Li X, Lin X, Ju Y, Leng J. The correlation between nutrition and frailty and the receiver operating characteristic curve of different nutritional indexes for frailty. BMC Geriatr 2021;21:619.
105.陳慧君、黃素華、鄭金寶、楊榮森。年老衰弱症的營養處置。台灣醫學 2015;19:534-541.
106.Coelho-Junior HJ, Rodrigues B, Uchida M, Marzetti E. Low protein intake is associated with frailty in older adults: A systematic review and meta-analysis of observational studies. Nutrients 2018;10.
107.Bauer J, Biolo G, Cederholm T, et al. Evidence-based recommendations for optimal dietary protein intake in older people: A position paper from the PROT-AGE study group. J Am Med Dir Assoc 2013;14:542-559.
108.Wu SY, Yeh NH, Chang HY, et al. Adequate protein intake in older adults in the context of frailty: Cross-sectional results of the nutrition and health survey in Taiwan 2014-2017. Am J Clin Nutr 2021;114:649-660.
109.Park Y, Choi JE, Hwang HS. Protein supplementation improves muscle mass and physical performance in undernourished prefrail and frail elderly subjects: A randomized, double-blind, placebo-controlled trial. Am J Clin Nutr 2018;108:1026-1033.
110.Bhasin S, Apovian CM, Travison TG, et al. Effect of protein intake on lean body mass in functionally limited older men: A randomized clinical trial. JAMA Intern Med 2018;178:530-541.
111.Roschel H, Hayashi AP, Fernandes AL, et al. Supplement-based nutritional strategies to tackle frailty: A multifactorial, double-blind, randomized placebo-controlled trial. Clin Nutr 2021;40:4849-4858.
112.Zhou J, Huang P, Liu P, et al. Association of vitamin D deficiency and frailty: A systematic review and meta-analysis. Maturitas 2016;94:70-76.
113.Latham NK, Anderson CS, Lee A, et al. A randomized, controlled trial of quadriceps resistance exercise and vitamin D in frail older people: The frailty interventions trial in elderly subjects (fitness). J Am Geriatr Soc 2003;51:291-299.
114.Bauer JM, Verlaan S, Bautmans I, et al. Effects of a vitamin D and leucine-enriched whey protein nutritional supplement on measures of sarcopenia in older adults, the provide study: A randomized, double-blind, placebo-controlled trial. J Am Med Dir Assoc 2015;16:740-747.
115.Cai Y, Wanigatunga AA, Mitchell CM, et al. The effects of vitamin D supplementation on frailty in older adults at risk for falls. BMC Geriatr 2022;22:312.
116.Bislev LS, Grove-Laugesen D, Rejnmark L. Vitamin D and muscle health: A systematic review and meta-analysis of randomized placebo-controlled trials. J Bone Miner Res 2021;36:1651-1660.
117.Simopoulos AP. Omega-3 fatty acids in inflammation and autoimmune diseases. J Am Coll Nutr 2002;21:495-505.
118.Del Brutto OH, Mera RM, Ha JE, et al. Dietary oily fish intake and frailty. A population-based study in frequent fish consumers living in rural coastal Ecuador (the Atahualpa project). J Nutr Gerontol Geriatr 2020;39:88-97.
119.Imai E, Tsubota-Utsugi M, Kikuya M, et al. Animal protein intake is associated with higher-level functional capacity in elderly adults: The ohasama study. J Am Geriatr Soc 2014;62:426-434.
120.Guerville F, de Souto Barreto P, Giudici KV, Rolland Y, Vellas B. Association of 3-year multidomain intervention and omega-3 supplementation with frailty incidence. J Am Geriatr Soc 2019;67:1700-1706.
121.Sandoval-Insausti H, Pérez-Tasigchana RF, López-García E, et al. Macronutrients intake and incident frailty in older adults: A prospective cohort study. J Gerontol A Biol Sci Med Sci 2016;71:1329-1334.
122.Yokoyama Y, Nishi M, Murayama H, et al. Association of dietary variety with body composition and physical function in community-dwelling elderly Japanese. J Nutr Health Aging 2016;20:691-696.
123.Lorenzo-Lopez L, Maseda A, de Labra C, et al. Nutritional determinants of frailty in older adults: A systematic review. BMC Geriatr 2017;17:108.
124.Chan R, Leung J, Woo J. Dietary patterns and risk of frailty in Chinese community-dwelling older people in Hong Kong: A prospective cohort study. Nutrients 2015;7:7070-7084.
125.Brennan DS, Singh KA, Liu P, Spencer A. Fruit and vegetable consumption among older adults by tooth loss and socio-economic status. Aust Dent J 2010;55:143-149.
126.Chi SH, Wang JY, Tsai AC. Combined association of leisure-time physical activity and fruit and vegetable consumption with depressive symptoms in older Taiwanese: Results of a national cohort study. Geriatr Gerontol Int 2016;16:244-251.
127.Chuang SY, Lo YL, Wu SY, Wang PN, Pan WH. Dietary patterns and foods associated with cognitive function in Taiwanese older adults: The cross-sectional and longitudinal studies. J Am Med Dir Assoc 2019;20:544-550.e544.
128.McCullough ML, Feskanich D, Stampfer MJ, et al. Diet quality and major chronic disease risk in men and women: Moving toward improved dietary guidance. Am J Clin Nutr 2002;76:1261-1271.
129.Mithal A, Bonjour JP, Boonen S, et al. Impact of nutrition on muscle mass, strength, and performance in older adults. Osteoporos Int 2013;24:1555-1566.
130.Tamaki K, Kusunoki H, Tsuji S, et al. The relationship between dietary habits and frailty in rural Japanese community-dwelling older adults: Cross-sectional observation study using a brief self-administered dietary history questionnaire. Nutrients 2018;10:1982.
131.Tanaka T, Takahashi K, Hirano H, et al. Oral frailty as a risk factor for physical frailty and mortality in community-dwelling elderly. J Gerontol A Biol Sci Med Sci 2017.
132.Kwon SH, Park HR, Lee YM, et al. Difference in food and nutrient intakes in Korean elderly people according to chewing difficulty: Using data from the Korea National Health and Nutrition Examination Survey 2013 (6th). Nutr Res Pract 2017;11:139-146.
133.Baranowski T, Willett W. 4924-hour recall and diet record methods. Edtion ed. Nutritional epidemiology: Oxford University Press, 2012:0.
134.Bogle M, Stuff J, Davis L, et al. Validity of a telephone-administered 24-hour dietary recall in telephone and non-telephone households in the rural lower Mississippi delta region. J Am Diet Assoc 2001;101:216-222.
135.Foster E, Lee C, Imamura F, et al. Validity and reliability of an online self-report 24-h dietary recall method (intake24): A doubly labelled water study and repeated-measures analysis. J Nutr Sci 2019;8:e29.
136.Pan W-H, Chang Y-H, Chen J-Y, et al. Nutrition and health survey in Taiwan (NAHSIT) 1993-1996: Dietary nutrient intakes assessed by 24-hour recall. 中華民國營養學會雜誌 1999;24:11-39.
137.Byers T, Sedjo RL, Willett W. 344nutrition monitoring and surveillance. Edtion ed. Nutritional epidemiology: Oxford University Press, 2012:0.
138.Huang YC, Lee MS, Pan WH, Wahlqvist ML. Validation of a simplified food frequency questionnaire as used in the nutrition and health survey in Taiwan (NAHSIT) for the elderly. Asia Pac J Clin Nutr 2011;20:134-140.
139.Kye S, Kwon SO, Lee SY, et al. Under-reporting of energy intake from 24-hour dietary recalls in the Korean national health and nutrition examination survey. Osong Public Health Res Perspect 2014;5:85-91.
140.Willett W, Willett W. Food frequency methods. Edtion ed. Nutritional epidemiology: Oxford University Press, 2012:0.
141.Lim HX, Toh JY, Tan KH, et al. Validation of a semi-quantitative FFQ for 18-month-old toddlers: The growing up in Singapore towards healthy outcomes (GUSTO) study. Public Health Nutr 2019;22:1990-2000.
142.YUN S-H, Shim J-S, Kweon S, Oh K. Development of a food frequency questionnaire for the Korea National Health and Nutrition Examination Survey: Data from the fourth Korea National Health and Nutrition Examination Survey (KNHANES IV). The Korean Journal of Nutrition 2013:186-196.
143.Cade J, Thompson R, Burley V, Warm D. Development, validation and utilisation of food-frequency questionnaires - a review. Public Health Nutr 2002;5:567-587.
144.Lyu LC, Lin CF, Chang FH, et al. Meal distribution, relative validity and reproducibility of a meal-based food frequency questionnaire in Taiwan. Asia Pac J Clin Nutr 2007;16:766-776.
145.Toorang F, Sasanfar B, Esmaillzadeh A, Ebrahimpour-Koujan S, Zendehdel K. Comparison of validity of the food frequency questionnaire and the diet history questionnaire for assessment of energy and nutrients intakes in an Iranian population. East Mediterr Health J 2020;26:1062-1069.
146.Ortega RM, Pérez-Rodrigo C, López-Sobaler AM. Dietary assessment methods: Dietary records. Nutr Hosp 2015;31 Suppl 3:38-45.
147.黃伯超、游素玲、李淑美等人。 Dietary survey in Taiwan area, 1980-81. 中華民國營養學會雜誌, v 8 1983:1-20.
148.Organization WH. World Health Organization. Global action plan for the prevention and control of NCDs 2013-2020. [Internet]. 2013. Available from: http://www.who.int/nmh/events/ncd_action_plan/en/.
149.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.
150.Stewart RAH. Primary prevention of cardiovascular disease with a Mediterranean diet supplemented with extra-virgin olive oil or nuts. N Engl J Med 2018;379:1388.
151.Hoffmann K, Schulze MB, Schienkiewitz A, Nöthlings U, Boeing H. Application of a new statistical method to derive dietary patterns in nutritional epidemiology. Am J Epidemiol 2004;159:935-944.
152.Devlin UM, McNulty BA, Nugent AP, Gibney MJ. The use of cluster analysis to derive dietary patterns: Methodological considerations, reproducibility, validity and the effect of energy mis-reporting. Proc Nutr Soc 2012;71:599-609.
153.Shan Z, Guo Y, Hu FB, Liu L, Qi Q. Association of low-carbohydrate and low-fat diets with mortality among us adults. JAMA Intern Med 2020;180:513-523.
154.Ntanasi E, Yannakoulia M, Kosmidis MH, et al. Adherence to Mediterranean diet and frailty. J Am Med Dir Assoc 2018;19:315-322.e312.
155.Hernandez-Galiot A, Goni I. Adherence to the Mediterranean diet pattern, cognitive status and depressive symptoms in an elderly non-institutionalized population. Nutr Hosp 2017;34:338-344.
156.Appel LJ, Moore TJ, Obarzanek E, et al. A clinical trial of the effects of dietary patterns on blood pressure. Dash collaborative research group. N Engl J Med 1997;336:1117-1124.
157.Castro-Barquero S, Ruiz-León AM, Sierra-Pérez M, Estruch R, Casas R. Dietary strategies for metabolic syndrome: A comprehensive review. Nutrients 2020;12.
158.Juraschek SP, Miller ER, 3rd, Weaver CM, Appel LJ. Effects of sodium reduction and the dash diet in relation to baseline blood pressure. Journal of the American College of Cardiology 2017;70:2841-2848.
159.Kennedy ET, Ohls J, Carlson S, Fleming K. The healthy eating index: Design and applications. J Am Diet Assoc 1995;95:1103-1108.
160.Haines PS, Siega-Riz AM, Popkin BM. The diet quality index revised: A measurement instrument for populations. J Am Diet Assoc 1999;99:697-704.
161.Lee MS, Lai CJ, Yang FY, et al. A global overall dietary index: Odi-r revised to emphasize quality over quantity. Asia Pac J Clin Nutr 2008;17 Suppl 1:82-86.
162.李孟璋。台灣地區老人之飲食多樣性與其營養健康狀況關係之探討。公共衛生學研究所。台北市：國防醫學院，2004:118.
163.Kant AK, Schatzkin A, Harris TB, Ziegler RG, Block G. Dietary diversity and subsequent mortality in the first national health and nutrition examination survey epidemiologic follow-up study. Am J Clin Nutr 1993;57:434-440.
164.Tu SH, Chen C, Hsieh YT, et al. Design and sample characteristics of the 2005-2008 nutrition and health survey in Taiwan. Asia Pac J Clin Nutr 2011;20:225-237.
165.Chen JY, Wu SJ, Tzeng MS, Kao MD. Nutrition and health survey in Taiwan (NAHSIT) 1993-1996: Dietary nutrient intakes assessed by 24-hour recall. Nutr Sci J 1999;24:11-39.
166.Woo J, Leung J, Morley JE. Comparison of frailty indicators based on clinical phenotype and the multiple deficit approach in predicting mortality and physical limitation. J Am Geriatr Soc 2012;60:1478-1486.
167.Schafer JL. Multiple imputation: A primer. Stat Methods Med Res 1999;8:3-15.
168.中華民國內政部。全國人口資料庫統計地圖。 [Internet]. Available from: https://gis.ris.gov.tw/dashboard.html?key=B02.
169.Balomenos V, Ntanasi E, Anastasiou CA, et al. Association between sleep disturbances and frailty: Evidence from a population-based study. J Am Med Dir Assoc 2021;22:551-558.e551.
170.Pourmotabbed A, Boozari B, Babaei A, et al. Sleep and frailty risk: A systematic review and meta-analysis. Sleep Breath 2020;24:1187-1197.
171.Liu X, Wang C, Qiao X, Si H, Jin Y. Sleep quality, depression and frailty among Chinese community-dwelling older adults. Geriatr Nurs 2021;42:714-720.
172.Harttgen K, Kowal P, Strulik H, Chatterji S, Vollmer S. Patterns of frailty in older adults: Comparing results from higher and lower income countries using the survey of health, ageing and retirement in Europe (SHARE) and the study on global ageing and adult health (SAGE). PLoS One 2013;8:e75847.
173.Hubbard RE, Rockwood K. Frailty in older women. Maturitas 2011;69:203-207.
174.Roubenoff R. Sarcopenic obesity: The confluence of two epidemics. Obes Res 2004;12:887-888.
175.Uchai S, Andersen LF, Hopstock LA, Hjartåker A. Body mass index, waist circumference and pre-frailty/frailty: The tromsø study 1994-2016. BMJ Open 2023;13:e065707.
176.Afonso C, Sousa-Santos AR, Santos A, et al. Frailty status is related to general and abdominal obesity in older adults. Nutr Res 2021;85:21-30.
177.Carcaillon L, García-García FJ, Tresguerres JA, et al. Higher levels of endogenous estradiol are associated with frailty in postmenopausal women from the Toledo study for healthy aging. J Clin Endocrinol Metab 2012;97:2898-2906.
178.Li G, Compston JE, Leslie WD, et al. Relationship between obesity and risk of major osteoporotic fracture in postmenopausal women: Taking frailty into consideration. J Bone Miner Res 2020;35:2355-2362.
179.Li B, Li Y, Zhang Y, et al. Visceral fat obesity correlates with frailty in middle-aged and older adults. Diabetes Metab Syndr Obes 2022;15:2877-2884.
180.Monteil D, Walrand S, Vannier-Nitenberg C, Van Oost B, Bonnefoy M. The relationship between frailty, obesity and social deprivation in non-institutionalized elderly people. J Nutr Health Aging 2020;24:821-826.
181.Boutin E, Natella PA, Schott AM, et al. Interrelations between body mass index, frailty, and clinical adverse events in older community-dwelling women: The EPIDOS cohort study. Clin Nutr 2018;37:1638-1644.
182.Hernández Morante JJ, Gómez Martínez C, Morillas-Ruiz JM. Dietary factors associated with frailty in old adults: A review of nutritional interventions to prevent frailty development. Nutrients 2019;11.
183.Wu SJ, Pan WH, Yeh NH, Chang HY. Trends in nutrient and dietary intake among adults and the elderly: From NAHSIT 1993-1996 to 2005-2008. Asia Pac J Clin Nutr 2011;20:251-265.
184.Wu SY, Lee SC, Yeh NH, et al. Dietary characteristics of elders with frailty and with mild cognitive impairment: Cross-sectional findings and implications from the nutrition and health survey in Taiwan 2014-2017. Nutrients 2022;14.
185.Huang CH, Martins BA, Okada K, et al. A 3-year prospective cohort study of dietary patterns and frailty risk among community-dwelling older adults. Clin Nutr 2021;40:229-236.
186.Ghosh TS, Rampelli S, Jeffery IB, et al. Mediterranean diet intervention alters the gut microbiome in older people reducing frailty and improving health status: The nu-age 1-year dietary intervention across five European countries. Gut 2020;69:1218-1228.
187.Kenđel Jovanović G, Mrakovcic-Sutic I, Pavičić Žeželj S, et al. The efficacy of an energy-restricted anti-inflammatory diet for the management of obesity in younger adults. Nutrients 2020;12.
188.Pan WH, Wu SY, Yeh NH, Hung SY. Healthy Taiwanese eating approach (TEA) toward total wellbeing and healthy longevity. Nutrients 2022;14.
189.Gängler S, Steiner H, Gagesch M, et al. Adherence to the Mediterranean diet and incidence of pre-frailty and frailty in community-dwelling adults 70+: The 3-year do-health study. Nutrients 2022;14.
190.Sotos-Prieto M, Struijk EA, Fung TT, et al. Association between the quality of plant-based diets and risk of frailty. J Cachexia Sarcopenia Muscle 2022;13:2854-2862.
191.Shiau MH, Lee MC, Lin FL, Hurng BS, Yeh CJ. Cross-sectional, short-, medium-, and long-term effects of dietary pattern on frailty in Taiwan. Int J Environ Res Public Health 2021;18.
192.León-Muñoz LM, García-Esquinas E, López-García E, Banegas JR, Rodríguez-Artalejo F. Major dietary patterns and risk of frailty in older adults: A prospective cohort study. BMC Med 2015;13:11.
193.Dehghan M, Mente A, Rangarajan S, et al. Ultra-processed foods and mortality: Analysis from the prospective urban and rural epidemiology study. Am J Clin Nutr 2023;117:55-63.
194.Shi SM, Olivieri-Mui B, McCarthy EP, Kim DH. Changes in a frailty index and association with mortality. J Am Geriatr Soc 2021;69:1057-1062.
195.Sandoval-Insausti H, Blanco-Rojo R, Graciani A, et al. Ultra-processed food consumption and incident frailty: A prospective cohort study of older adults. J Gerontol A Biol Sci Med Sci 2020;75:1126-1133.
196.Chesson P. Predator-prey theory and variability. Annual Review of Ecology and Systematics 1978;9:323-347.
197.Tsutsumimoto K, Doi T, Makizako H, et al. Aging-related anorexia and its association with disability and frailty. J Cachexia Sarcopenia Muscle 2018;9:834-843.
198.Li H, Ding F, Xiao L, et al. Food-derived antioxidant polysaccharides and their pharmacological potential in neurodegenerative diseases. Nutrients 2017;9.
199.Liguori I, Russo G, Curcio F, et al. Oxidative stress, aging, and diseases. Clin Interv Aging 2018;13:757-772.
200.Picca A, Coelho-Junior HJ, Calvani R, Marzetti E, Vetrano DL. Biomarkers shared by frailty and sarcopenia in older adults: A systematic review and meta-analysis. Ageing Res Rev 2022;73:101530.
201.McKenna G, Allen PF, O'Mahony D, et al. Comparison of functionally orientated tooth replacement and removable partial dentures on the nutritional status of partially dentate older patients: A randomised controlled clinical trial. J Dent 2014;42:653-659.
202.Hanlon P, Nicholl BI, Jani BD, et al. Frailty and pre-frailty in middle-aged and older adults and its association with multimorbidity and mortality: A prospective analysis of 493 737 UK biobank participants. Lancet Public Health 2018;3:e323-e332.
203.Tanaka T, Takahashi K, Hirano H, et al. Oral frailty as a risk factor for physical frailty and mortality in community-dwelling elderly. J Gerontol A Biol Sci Med Sci 2018;73:1661-1667.
204.Gomes MJ, Martinez PF, Pagan LU, et al. Skeletal muscle aging: Influence of oxidative stress and physical exercise. Oncotarget 2017;8:20428-20440.
205.Lo YC, Wahlqvist ML, Huang YC, et al. Medical costs of a low skeletal muscle mass are modulated by dietary diversity and physical activity in community-dwelling older Taiwanese: A longitudinal study. Int J Behav Nutr Phys Act 2017;14:31.
206.Lo YT, Wahlqvist ML, Huang YC, Lee MS. Elderly Taiwanese who spend more on fruits and vegetables and less on animal-derived foods use less medical services and incur lower medical costs. Br J Nutr 2016;115:823-833.
207.Jayanama K, Theou O, Godin J, et al. Relationship between diet quality scores and the risk of frailty and mortality in adults across a wide age spectrum. BMC Med 2021;19:64.
208.Spence C, Okajima K, Cheok AD, Petit O, Michel C. Eating with our eyes: From visual hunger to digital satiation. Brain Cogn 2016;110:53-63.
209.Shimizu A, Fujishima I, Maeda K, et al. Texture-modified diets are associated with poor appetite in older adults who are admitted to a post-acute rehabilitation hospital. J Am Med Dir Assoc 2021;22:1960-1965.
210.Hubner S, Boron JB, Koehler K. The effects of exercise on appetite in older adults: A systematic review and meta-analysis. Front Nutr 2021;8:734267.
211.Wijnhoven HA, van der Meij BS, Visser M. Variety within a cooked meal increases meal energy intake in older women with a poor appetite. Appetite 2015;95:571-576.
212.van der Meij BS, Wijnhoven HA, Finlayson GS, Oosten BS, Visser M. Specific food preferences of older adults with a poor appetite. A forced-choice test conducted in various care settings. Appetite 2015;90:168-175.
213.Mikami Y, Motokawa K, Shirobe M, et al. Relationship between eating alone and poor appetite using the simplified nutritional appetite questionnaire. Nutrients 2022;14.
214.Scheufele P, Rappl A, Visser M, Kiesswetter E, Volkert D. Characterisation of community-dwelling older adults with poor appetite. Eur J Nutr 2023;62:1991-2000.