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Added Sugars from Diet Linked to Frailty in Older Adults

by Lewis Chang, PhD

Frailty, characterized by exhaustion, reduced physical activity capacity, slow gait speed, unintentional weight loss, and muscle weakness, is a major health concern associated with aging that increases the risk of disability, institutionalization, and death in older adults.1 It is important to identify modifiable risk factors associated with frailty so that prevention or early intervention strategies can be implemented accordingly.

According to epidemiological evidence, certain dietary patterns or dietary components can influence the risk of frailty.2 However, it is unclear whether added sugars in the diet play an important role. This question was the focus of a new research study recently published in American Journal of Clinical Nutrition.3

Participants of this study consisted of nearly 2000 Spanish adults 60 years and older from the ENRICA Study, a cohort representative of the noninstitutionalized adult population of Spain. Detailed habitual dietary information was obtained by trained staff, and the amount of added sugars in the diet was calculated. Study participants were followed up the next 3 years to assess the development of frailty.3

The study investigators found that:3

  • There was a 2.48-fold greater odds of frailty in individuals consuming ≥36 g/day added sugars than individuals consuming <15 g/day added sugars
  • The specific frailty components “reduced physical activity capacity” and “unintentional weight loss” were associated with added sugars in a dose-dependent manner
  • Sugars added during production (such as sugar-sweetened beverages, pastries and cookies) were more closely associated with frailty, whereas sugars naturally present in foods (such as fruits, vegetables and milk) were not associated with frailty

Higher amounts of added sugars in the diet may reflect an increased consumption of processed foods which is linked to worse diet quality,4 and poor diet quality is linked to physical decline and frailty.5 Whether sugars also directly contribute the development of frailty requires further investigation.

Why is this Clinically Relevant?

  • Not only is increased consumption of sugar-sweetened beverages and added sugars in the diet linked to obesity, cardiovascular disease, diabetes, and other chronic diseases,6-10 it is also associated with frailty in older adults3
  • Higher intakes of added sugars may be an indicator of unhealthy lifestyle and poor dietary patterns such as increased intake of processed foods
  • Frailty status may be reversible with proper exercise programs and improvements in nutritional status1. This is even more imperative since ~5-13% of adults, 60-70 years old are affected by sarcopenia,11 which is one of the main physical drivers of frailty.

View the abstract


  1. Buckinx F, Rolland Y, Reginster JY, Ricour C, Petermans J, Bruyere O. Burden of frailty in the elderly population: perspectives for a public health challenge. Arch Public Health. 2015;73(1):19.
  2. Yannakoulia M, Ntanasi E, Anastasiou CA, Scarmeas N. Frailty and nutrition: From epidemiological and clinical evidence to potential mechanisms. Metabolism. 2017;68:64-76.
  3. Laclaustra M, Rodriguez-Artalejo F, Guallar-Castillon P, et al. Prospective association between added sugars and frailty in older adults. Am J Clin Nutr. 2018;107(5):772-779.
  4. Livingstone MB, Rennie KL. Added sugars and micronutrient dilution. Obes Rev. 2009;10 Suppl 1:34-40.
  5. Leon-Munoz LM, Garcia-Esquinas E, Lopez-Garcia E, Banegas JR, Rodriguez-Artalejo F. Major dietary patterns and risk of frailty in older adults: a prospective cohort study. BMC Med. 2015;13:11.
  6. Yang Q, Zhang Z, Gregg EW, Flanders WD, Merritt R, Hu FB. Added sugar intake and cardiovascular diseases mortality among US adults. JAMA Intern Med. 2014;174(4):516-524.
  7. Te Morenga LA, Howatson AJ, Jones RM, Mann J. Dietary sugars and cardiometabolic risk: systematic review and meta-analyses of randomized controlled trials of the effects on blood pressure and lipids. Am J Clin Nutr. 2014;100(1):65-79.
  8. Malik VS, Pan A, Willett WC, Hu FB. Sugar-sweetened beverages and weight gain in children and adults: a systematic review and meta-analysis. Am J Clin Nutr. 2013;98(4):1084-1102.
  9. Malik VS, Popkin BM, Bray GA, Despres JP, Willett WC, Hu FB. Sugar-sweetened beverages and risk of metabolic syndrome and type 2 diabetes: a meta-analysis. Diabetes Care. 2010;33(11):2477-2483.
  10. Imamura F, O’Connor L, Ye Z, et al. Consumption of sugar sweetened beverages, artificially sweetened beverages, and fruit juice and incidence of type 2 diabetes: systematic review, meta-analysis, and estimation of population attributable fraction. Br J Sports Med. 2016;50(8):496-504.
  11. von Haehling S, Morley JE, Anker SD. An overview of sarcopenia: facts and numbers on prevalence and clinical impact. J Cachexia Sarcopenia Muscle. 2010;1(2):129-133.



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