BACKGROUND: Unhealthy diet may increase the risk of impaired physical functioning in older age. Although poor diet and limited physical functioning both seem to be particularly common in Eastern Europe, no previous study has assessed the relationship between these two factors in this region. The current analysis examined the association between overall diet quality and physical functioning in Eastern European populations. METHODS: We used data on 25,504 persons (aged 45-69 years at baseline) who participated in the Health Alcohol and Psychosocial factors in Eastern Europe (HAPIEE) study. Dietary assessment at baseline used food frequency questionnaire, and the overall diet quality was evaluated by the Mediterranean diet score (MDS). Physical functioning (PF) was measured by the physical functioning subscale (PF-10) of the 36-item Short-Form Health Survey at baseline and three subsequent occasions over a 10-year period. The cross-sectional and longitudinal relationships between the MDS and PF were examined simultaneously using growth curve models. RESULTS: Men and women with higher adherence to the Mediterranean diet had significantly better PF at baseline; after multivariable adjustment, the regression coefficient per 1-unit increase in the MDS was 0.39 (95% CI: 0.25, 0.52) in men and 0.50 (0.36, 0.64) in women. However, we found no statistically significant link between baseline MDS and the subsequent slope of PF decline in neither gender; the coefficients were -0.02 (-0.04, 0.00) in men and -0.01 (-0.03, 0.02) in women. DISCUSSION: Our results do not support the hypothesis that the Mediterranean diet has a substantial impact on the trajectories of physical functioning, although the differences existing at baseline may be related to dietary habits in earlier life.

Department of Epidemiology and Population Studies Jagiellonian University Collegium Medicum Krakow Poland

Department of Epidemiology and Public Health University College London London United Kingdom

Department of Preventive Medicine and Public Health School of Medicine Universidad Autónoma de Madrid IdiPaz and CIBERESP Madrid Spain

Institute of Internal and Preventive Medicine Siberian Branch of the Russian Academy of Medical Sciences Novosibirsk Russia

Max Planck Institute for Demographic Research Rostock Germany

National Institute of Public Health Prague Czech Republic

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Cosco TD, Prina AM, Perales J, Stephan BC, Brayne C. Operational definitions of successful aging: a systematic review. Int Psychogeriatr. 2014;26:373–381. 10.1017/S1041610213002287 PubMed DOI

Christensen K, Doblhammer G, Rau R, Vaupel JW. Ageing populations: the challenges ahead. Lancet. 2009;374:1196–1208. 10.1016/S0140-6736(09)61460-4 PubMed DOI PMC

Artaud F, Dugravot A, Sabia S, Singh-Manoux A, Tzourio C, Elbaz A. Unhealthy behaviours and disability in older adults: three-City Dijon cohort study. BMJ. 2013;347:f4240 10.1136/bmj.f4240 PubMed DOI

Semba RD, Blaum C, Guralnik JM, et al. Carotenoid and vitamin E status are associated with indicators of sarcopenia among older women living in the community. Aging Clin Exp Res. 2003;15:482–487. PubMed

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. 10.1093/ajcn.81.2.515 PubMed DOI

Vercambre MN, Boutron-Ruault MC, Ritchie K, Clavel-Chapelon F, Berr C. Long-term association of food and nutrient intakes with cognitive and functional decline: a 13-year follow-up study of elderly French women. Br J Nutr. 2009;102:419–427. 10.1017/S0007114508201959 PubMed DOI PMC

Milaneschi Y, Tanaka T, Ferrucci L. Nutritional determinants of mobility. Curr Opin Clin Nutr Metab Care. 2010;13:625–629. 10.1097/MCO.0b013e32833e337d PubMed DOI PMC

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. 10.3945/jn.115.227900 PubMed DOI PMC

Hu FB. Dietary pattern analysis: a new direction in nutritional epidemiology. Curr Opin Lipidol. 2002;13:3–9. PubMed

Kant AK. Dietary patterns and health outcomes. J Am Diet Assoc. 2004;104:615–635. 10.1016/j.jada.2004.01.010 PubMed DOI

Tucker KL. Dietary patterns, approaches, and multicultural perspective. Appl Physiol Nutr Metab. 2010;35:211–218. 10.1139/H10-010 PubMed DOI

Slattery ML. Analysis of dietary patterns in epidemiological research. Appl Physiol Nutr Metab. 2010;35:207–210. 10.1139/H10-006 PubMed DOI

Bloomfield HE, Koeller E, Greer N, MacDonald R, Kane R, Wilt TJ. Effects on health outcomes of a Mediterranean diet with no restriction on fat intake: A Systematic Review and Meta-analysis. Ann Intern Med. 2016. 10.7326/M16-0361 PubMed DOI

Estruch R, Ros E, Salas-Salvadó J Covas MI, Corella D, Arós F et al. Primary prevention of cardiovascular disease with a Mediterranean diet supplemented with extra-virgin olive oil or nuts. N Engl J Med. 2018;378:e34 10.1056/NEJMoa1800389 PubMed DOI

Lourida I, Soni M, Thompson-Coon J, Purandare N, Lang IA, Ukoumunne OC, et al. Mediterranean diet, cognitive function, and dementia: a systematic review. Epidemiology. 2013;24:479–489. 10.1097/EDE.0b013e3182944410 PubMed DOI

van de Rest O, Berendsen AA, Haveman-Nies A, de Groot LC. Dietary patterns, cognitive decline, and dementia: a systematic review. Adv Nutr. 2015;6:154–168. 10.3945/an.114.007617 PubMed DOI PMC

Milaneschi Y, Bandinelli S, Corsi AM, Lauretani F, Paolisso G, Dominguez LJ, et al. Mediterranean diet and mobility decline in older persons. Exp Gerontol. 2011;46:303–308. 10.1016/j.exger.2010.11.030 PubMed DOI PMC

Shahar DR, Houston DK, Hue TF, Lee JS, Sahyoun NR, Tylavsky FA, et al. Adherence to Mediterranean diet and decline in walking speed over 8 years in community-dwelling older adults. J Am Geriatr Soc. 2012;60:1881–1888. 10.1111/j.1532-5415.2012.04167.x PubMed DOI PMC

Struijk EA, Guallar-Castillón P, Rodríguez-Artalejo F, López-García E. Mediterranean Dietary Patterns and Impaired Physical Function in Older Adults. J Gerontol A Biol Sci Med Sci. 2018;73:333–339. 10.1093/gerona/glw208 PubMed DOI

Barrea L, Muscogiuri G, Di Somma C, Tramontano G, De Luca V, Illario M et al. Association between Mediterranean diet and hand grip strength in older adult women. Clin Nutr. 2018. April 3. [Epub ahead of print] PubMed

Kojima G, Avgerinou C, Iliffe S, Walters K. Adherence to Mediterranean Diet Reduces Incident Frailty Risk: Systematic Review and Meta-Analysis. J Am Geriatr Soc. 2018;66:783–788. 10.1111/jgs.15251 PubMed DOI

Ginter E. Cardiovascular disease prevention in eastern Europe. Nutrition. 1998;14:452–457. PubMed

Pomerleau J, Lock K, McKee M. The burden of cardiovascular disease and cancer attributable to low fruit and vegetable intake in the European Union: differences between old and new Member States. Public Health Nutr. 2006;9:575–583. PubMed

Zatoński WA, HEM project team. Epidemiological analysis of health situation development in Europe and its causes until 1990. Ann Agric Environ Med. 2011;18:194–202. PubMed

Bobak M, Kristenson M, Pikhart H, Marmot M. Life span and disability: a cross sectional comparison of Russian and Swedish community based data. BMJ. 2004;329:767 10.1136/bmj.38202.667130.55 PubMed DOI PMC

Trichopoulou A, Martínez-González MA, Tong TY, Forouhi NG, Khandelwal S, Prabhakaran D, et al. Definitions and potential health benefits of the Mediterranean diet: views from experts around the world. BMC Med. 2014;12:112 10.1186/1741-7015-12-112 PubMed DOI PMC

Stefler D, Malyutina S, Kubinova R, Pajak A, Peasey A, Pikhart H, et al. Mediterranean diet score and total and cardiovascular mortality in Eastern Europe: the HAPIEE study. Eur J Nutr. 2017;56(1):421–429. 10.1007/s00394-015-1092-x PubMed DOI PMC

Peasey A, Bobak M, Kubinova R, Malyutina S, Pajak A, Tamosiunas A, et al. Determinants of cardiovascular disease and other non-communicable diseases in Central and Eastern Europe: Rationale and design of the HAPIEE study. BMC Public Health. 2006;6:255 10.1186/1471-2458-6-255 PubMed DOI PMC

Bobak M, Room R, Pikhart H, Kubinova R, Malyutina S, Pajak A, et al. Contribution of drinking patterns to differences in rates of alcohol related problems between three urban populations. J Epidemiol Community Health. 2004;58:238–242. 10.1136/jech.2003.011825 PubMed DOI PMC

Raczek AE, Ware JE, Bjorner JB, Gandek B, Haley SM, Aaronson NK, et al. Comparison of Rasch and summated rating scales constructed from SF-36 physical functioning items in seven countries: Results from the IQOLA Project. J Clin Epidemiol. 1998;51:1203–1214. PubMed

Boylan S, Welch A, Pikhart H, Malyutina S, Pajak A, Kubinova R, et al. Dietary habits in three Central and Eastern European countries: the HAPIEE study. BMC Public Health. 2009;9:439 10.1186/1471-2458-9-439 PubMed DOI PMC

European Food Safety Authority (EFSA). The food classification and description system FoodEx 2 (draft-revision 1). Report No.: 215. Parma, 2011.

Sofi F, Macchi C, Abbate R, Gensini GF, Casini A. Mediterranean diet and health status: an updated meta-analysis and a proposal for a literature-based adherence score. Public Health Nutr. 2014;17:2769–82. 10.1017/S1368980013003169 PubMed DOI PMC

Graham JW. Missing data analysis: Making it work in the real world. Annu Rev Psychol 2009;60:549–576. 10.1146/annurev.psych.58.110405.085530 PubMed DOI

White IR, Royston P, Wood AM. Multiple imputation using chained equations: Issues and guidance for practice. Stat Med 2011;30:377–399. 10.1002/sim.4067 PubMed DOI

Singer JD, Willett JB. Growth curve modelling In: Everitt BS, Howell DC, eds. Encyclopedia of Statistics in Behavioral Science. Chichester: John Wiley & Sons, 2005.

Stoel RD, van Den Wittenboer G, Hox J. Analyzing longitudinal data using multilevel regression and latent growth curve analysis. Metodologia de las Ciencas Compartamiento 2003;5:21–42.

Wu W, West SG, Taylor AB. Evaluating model fit for growth curve models: Integration of fit indices from SEM and MLM frameworks. Psychol Methods 2009;14:183–201. 10.1037/a0015858 PubMed DOI

Mirowsky J, Kim JY. Graphing age trajectories: vector graphs, synthetic and virtual cohort projections, and cross-sectional profiles of depression. Sociol Method Res 2007;35:497–541.

Mirowsky J, Ross CE. Education and self-rated health: cumulative advantage and its rising importance. Res Aging 2008;30:93–122.

Féart C, Pérès K, Samieri C, Letenneur L, Dartigues JF, Barberger-Gateau P. Adherence to a Mediterranean diet and onset of disability in older persons. Eur J Epidemiol 2011;26:747–756. 10.1007/s10654-011-9611-4 PubMed DOI

Zbeida M, Goldsmith R, Shimony T, Vardi H, Naggan L, Shahar DR. Mediterranean diet and functional indicators among older adults in non-Mediterranean and Mediterranean countries. J Nutr Health Aging 2014;18:411–418. 10.1007/s12603-014-0003-9 PubMed DOI

Pérez-Tasigchana RF, León-Muñoz LM, López-García E, Banegas JR, Rodríguez-Artalejo F, Guallar-Castillón P. Mediterranean diet and health-related quality of life in two cohorts of community-dwelling older adults. PLoS One 2016;11:e0151596 10.1371/journal.pone.0151596 PubMed DOI PMC

Hu Y, Pikhart H, Kubinova R, Malyutina S, Pajak A, Besala A, et al. Alcohol consumption and longitudinal trajectories of physical functioning in Central and Eastern Europe: A 10-Year Follow-up of HAPIEE Study. J Gerontol A Biol Sci Med Sci. 2016;71(8):1063–1068. 10.1093/gerona/glv233 PubMed DOI PMC

Gilmore A, Pomerleau J, McKee M, Rose R, Haerpfer CW, Rotman D, et al. Prevalence of smoking in 8 countries of the former Soviet Union: results from the living conditions, lifestyles and health study. Am J Public Health. 2004;94:2177–2187. PubMed PMC

Tomkins S, Collier T, Oralov A, Saburova L, McKee M, Shkolnikov V, et al. Hazardous alcohol consumption is a major factor in male premature mortality in a typical Russian city: prospective cohort study 2003–2009. PLoS One. 2012;7:e30274 10.1371/journal.pone.0030274 PubMed DOI PMC

Stuck AE, Walthert JM, Nikolaus T Bula CJ, Hohmann C, Beck JC. Risk factors for functional status decline in community-living elderly people: a systematic literature review. Soc Sci Med. 1999;48:445–469. PubMed

Imamura F, Micha R, Khatibzadeh S, Fahimi S, Shi P, Powles J et al. Dietary quality among men and women in 187 countries in 1990 and 2010: a systematic assessment. Lancet Glob Health. 2015;3:e132–42. 10.1016/S2214-109X(14)70381-X PubMed DOI PMC