# Correlation of alternative healthy eating index with risk of frailty among metabolic syndrome individuals: a cross-sectional study

## TL;DR

This study shows that better diet quality, as measured by the Alternative Healthy Eating Index, is linked to a lower risk of frailty in people with metabolic syndrome.

## Contribution

The study demonstrates a novel association between AHEI scores and reduced frailty risk in metabolic syndrome patients using NHANES data.

## Key findings

- Higher AHEI scores are significantly associated with reduced frailty risk (OR = 0.99, P = 0.022).
- Individuals in the highest AHEI quartile had a 32% lower frailty risk compared to those in the lowest quartile.
- The negative association between AHEI and frailty remained consistent across all subgroup analyses.

## Abstract

Mounting evidence identifies diet quality as a frailty modifying factor. Individuals suffering from metabolic syndrome (MetS) are more likely to be affected by frailty. Therefore, our research sought to explore the relationship of Alternative Healthy Eating Index (AHEI) with frailty risk among patients with MetS.

National Health and Nutrition Examination Survey (NHANES) data from 2005 to 2018 were gathered. Frailty Index (FI) was utilized for assessment of frailty status. Weighted multivariate logistic regression model was adopted for investigating the association of AHEI with frailty among patients with MetS. Subgroup analysis, interaction test and restricted cubic spline (RCS) test were also performed in this study.

When the covariates considered were entirely adjusted for, higher AHEI scores exhibited significant association with reduced frailty risk (OR = 0.99,95%CI = 0.981–0.998, P = 0.022). Relative to the frailty risk among participants belonging to the lowest AHEI quartile(Q1), that of individuals in the highest AHEI quartile(Q4) decreased by 32% (OR = 0.68, 95% CI = 0.51–0.92, P = 0.01). Additionally, the negative association of AHEI with frailty persisted for all subgroup analyses, which also indicates the reliability of the relationship.

For patients with MetS, higher AHEI scores reduce the risk of developing frailty. This investigation provides valuable knowledge that could be utilized for treating MetS patients clinically and guiding healthy eating program development.

The online version contains supplementary material available at 10.1007/s40520-025-02992-y.