Association between the Prevalence of Frailty and Doubly Labeled Water-Calibrated Energy Intake among Community-Dwelling Older Adults

Daiki Watanabe, Tsukasa Yoshida, Hinako Nanri, Yuya Watanabe, Heiwa Date, Aya Itoi, Chiho Goto, Kazuko Ishikawa-Takata, Hiroyuki Sagayama, Naoyuki Ebine, Hisamine Kobayashi, Misaka Kimura, Yosuke Yamada*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

21 Citations (Scopus)


Background: Appropriate energy intake (EI) is essential to prevent frailty. Because self-reported EI is inaccurate and has systematic errors, adequate biomarker calibration is required. This study examined the association between doubly labeled water (DLW)-calibrated EI and the prevalence of frailty among community-dwelling older adults. Method: A cross-sectional study was performed using baseline data of 7,022 older adults aged ≥65 years in the Kyoto-Kameoka Study. EI was evaluated using a validated food frequency questionnaire (FFQ), and calibrated EI was obtained from a previously established equation using the DLW method. Physical and comprehensive frailty were defined by the Fried phenotype (FP) model and the Kihon Checklist (KCL), respectively. We used multivariable-adjusted restricted cubic spline logistic regression analysis. Results: The prevalence of physical frailty was 14.8% and 13.6% in women and men, respectively. The spline models showed significant reverse J-shaped or U-shaped relationships between the prevalence of physical or comprehensive frailty against the DLW-calibrated EI, respectively. The lowest prevalence of both types of frailty was found at 1,900-2,000 kcal/d in women and 2,400-2,500 kcal/d in men, which corresponded to approximately 40 kcal/d/kg IBW (ideal body weight = 22 × height2) with DLW-calibrated EI. Uncalibrated EI underestimated approximately 20% compared with calibrated EI; underestimated EI were attenuated by calibration approach. Conclusions: This study suggests that low EI has a greater detrimental effect compared with excessive EI, particularly on physical frailty. Using biomarkers to calibrate EI holds promise for providing accurate energy requirements to establish guidelines used in public health and clinical nutrition.

Original languageEnglish
Pages (from-to)876-884
Number of pages9
JournalJournals of Gerontology - Series A Biological Sciences and Medical Sciences
Issue number5
Publication statusPublished - 2021 May 1
Externally publishedYes


  • Doubly labeled water-calibrated approach
  • Energy intake
  • Food frequency questionnaires
  • Frailty
  • Restricted cubic spline model

ASJC Scopus subject areas

  • Ageing
  • Geriatrics and Gerontology


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