{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T14:41:06Z","timestamp":1783435266079,"version":"3.54.6"},"reference-count":38,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,4,16]],"date-time":"2025-04-16T00:00:00Z","timestamp":1744761600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Nutr."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Frailty is a prevalent geriatric syndrome marked by diminished physiological reserves and heightened vulnerability to stressors, leading to adverse health outcomes and imposing significant economic burdens on healthcare systems.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This study investigates the relationship between the Dietary Index for Gut Microbiota (DI-GM) and the risk of frailty in middle-aged and older adults, using data from the National Health and Nutrition Examination Survey (NHANES) collected from 2007 to 2018. Weighted logistic regression, subgroup analysis, and restricted cubic splines (RCS) were performed to evaluate the relationship between DI-GM and frailty risk. Additionally, a mediation analysis was conducted to investigate the influence of relevant inflammatory parameters from complete blood count, including leukocyte count, neutrophil count, the neutrophil to lymphocyte ratio (NLR), and the systemic inflammatory response index (SIRI), to elucidate how DI-GM may influence the onset and progression of frailty.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In this cross-sectional analysis of 8,695 participants with a mean age of 65.56\u202fyears, 3,173 individuals were classified as frail. After adjusting for all covariates, a significant inverse relationship was observed between DI-GM and the risk of frailty. Quartile analysis revealed that participants in the highest quartile of DI-GM had significantly lower odds of frailty compared to those in the lowest quartile (OR: 0.80, 95% CI: 0.65\u20130.99, <jats:italic>p<\/jats:italic>\u202f=\u202f0.04). Trend analyses across all models demonstrated a consistent inverse relationship between higher DI-GM quartiles and frailty odds (<jats:italic>p<\/jats:italic>\u202f&amp;lt;\u202f0.0001 for the crude model; <jats:italic>p<\/jats:italic>\u202f=\u202f0.001 for Model 1; <jats:italic>p<\/jats:italic>\u202f=\u202f0.04 for Model 2). Subgroup analyses confirmed the stability of the impact of DI-GM on frailty risk across various subgroups. RCS showed that the risk of frailty decreased linearly with increasing DI-GM levels. Mediation analysis indicated significant effects for leukocyte count, neutrophil count, NLR, and SIRI, with mediation proportions of 5.7, 7.9, 4.4, and 5.5%, respectively (all <jats:italic>p<\/jats:italic>\u202f&amp;lt;\u202f0.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The levels of DI-GM are inversely associated with the risk of frailty, with part of this association mediated by inflammatory parameters.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fnut.2025.1553467","type":"journal-article","created":{"date-parts":[[2025,4,16]],"date-time":"2025-04-16T04:10:47Z","timestamp":1744776647000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":6,"title":["Inflammatory parameters mediates the relationship between dietary index for gut microbiota and frailty in middle-aged and older adults in the United States: findings from a large-scale population-based study"],"prefix":"10.3389","volume":"12","author":[{"given":"Qijiang","family":"Yang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoyun","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinlan","family":"Duan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yiyin","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tianrui","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,4,16]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"127","DOI":"10.1684\/pnv.2021.0924","article-title":"Fragility and quality of life, the benefits of physical activity for the elderly","volume":"19","author":"Vejux","year":"2021","journal-title":"Geriatr Psychol Neuropsychiatr Vieil"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"341","DOI":"10.1007\/s40520-022-02302-w","article-title":"Early physical rehabilitation effectiveness in frail older patients hospitalized for community-acquired pneumonia: analysis of a nationwide database in Japan","volume":"35","author":"Shimizu","year":"2023","journal-title":"Aging Clin Exp Res"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"376","DOI":"10.1016\/j.clinthera.2019.01.006","article-title":"Review of interventions for the frailty syndrome and the role of metformin as a potential pharmacologic agent for frailty prevention","volume":"41","author":"Espinoza","year":"2019","journal-title":"Clin Ther"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"505","DOI":"10.1093\/gerona\/glaa277","article-title":"Adherence to the mediterranean diet and physical resilience in older adults: the seniors-enrica cohort","volume":"76","author":"Sotos-Prieto","year":"2021","journal-title":"J Gerontol A Biol Sci Med Sci"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1097\/MCO.0000000000000266","article-title":"Nutrition, gut microbiota and child health outcomes","volume":"19","author":"Videhult","year":"2016","journal-title":"Curr Opin Clin Nutr Metab Care"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"494","DOI":"10.3389\/fmicb.2014.00494","article-title":"Diet and the development of the human intestinal microbiome","volume":"5","author":"Voreades","year":"2014","journal-title":"Front Microbiol"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"2365","DOI":"10.1007\/s00394-017-1509-9","article-title":"Dietary patterns and changes in frailty status: the Rotterdam study","volume":"57","author":"De Haas","year":"2018","journal-title":"Eur J Nutr"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"283","DOI":"10.1146\/annurev-food-072023-034458","article-title":"How diet and lifestyle can fine-tune gut microbiomes for healthy aging","volume":"15","author":"Tamayo","year":"2024","journal-title":"Annu Rev Food Sci Technol"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"1045","DOI":"10.3390\/nu16071045","article-title":"The development and evaluation of a literature-based dietary index for gut microbiota","volume":"16","author":"Kase","year":"2024","journal-title":"Nutrients"},{"key":"ref10","doi-asserted-by":"publisher","DOI":"10.1007\/s00406-024-01912-x","article-title":"Association of the newly proposed dietary index for gut microbiota and depression: the mediation effect of phenotypic age and body mass index","author":"Zhang","year":"2024","journal-title":"Eur Arch Psychiatry Clin Neurosci"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"16","DOI":"10.3390\/nu16234164","article-title":"The mediating role of body mass index in the association between dietary index for gut microbiota and biological age: a study based on nhanes 2007-2018","volume":"16","author":"An","year":"2024","journal-title":"Nutrients"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"1458","DOI":"10.1039\/d4fo04649h","article-title":"Dietary index for gut microbiota is associated with stroke among us adults","volume":"16","author":"Liu","year":"2025","journal-title":"Food Funct"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"1529373","DOI":"10.3389\/fnut.2025.1529373","article-title":"Association of the newly proposed dietary index for gut microbiota and constipation: a cross-sectional study from nhanes","volume":"12","author":"Zhang","year":"2025","journal-title":"Front Nutr"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1186\/s13098-025-01589-9","article-title":"The association between the dietary index for gut microbiota and metabolic dysfunction-associated fatty liver disease: a cross-sectional study","volume":"17","author":"Zheng","year":"2025","journal-title":"Diabetol Metab Syndr"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"613","DOI":"10.1007\/s12603-018-1020-x","article-title":"Adherence to the mediterranean diet and the risk of frailty in old people: a systematic review and meta-analysis","volume":"22","author":"Wang","year":"2018","journal-title":"J Nutr Health Aging"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"793","DOI":"10.1007\/s40520-023-02353-7","article-title":"Association between b-vitamins intake and frailty among patients with chronic obstructive pulmonary disease","volume":"35","author":"Cheng","year":"2023","journal-title":"Aging Clin Exp Res"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"3103","DOI":"10.1111\/j.1582-4934.2009.00733.x","article-title":"Inflammation and frailty measures in older people","volume":"13","author":"Hubbard","year":"2009","journal-title":"J Cell Mol Med"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"121","DOI":"10.3945\/an.115.009258","article-title":"Update on nhanes dietary data: focus on collection, release, analytical considerations, and uses to inform public policy","volume":"7","author":"Ahluwalia","year":"2016","journal-title":"Adv Nutr"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"559","DOI":"10.1016\/j.jamda.2020.07.023","article-title":"Association between oral health and frailty among american older adults","volume":"22","author":"Hakeem","year":"2021","journal-title":"J Am Med Dir Assoc"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"1377408","DOI":"10.3389\/fpubh.2024.1377408","article-title":"Association of two novel systemic inflammatory biomarkers and frailty based on NHANES 2007-2018","volume":"12","author":"Zhang","year":"2024","journal-title":"Front Public Health"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"745","DOI":"10.1186\/s12877-023-04438-4","article-title":"Association between frailty and chronic constipation and chronic diarrhea among american older adults: national health and nutrition examination survey","volume":"23","author":"Liu","year":"2023","journal-title":"BMC Geriatr"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"1362194","DOI":"10.3389\/fendo.2024.1362194","article-title":"The association between the weight-adjusted-waist index and frailty in us older adults: a cross-sectional study of nhanes 2007-2018","volume":"15","author":"Jia","year":"2024","journal-title":"Front Endocrinol"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"105","DOI":"10.1007\/s40520-024-02745-3","article-title":"The association between circadian syndrome and frailty in us adults: a cross-sectional study of nhanes data from 2007 to 2018","volume":"36","author":"Sun","year":"2024","journal-title":"Aging Clin Exp Res"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"100171","DOI":"10.1016\/j.jnha.2024.100171","article-title":"Association of dietary live microbe intake with frailty in us adults: evidence from nhanes","volume":"28","author":"Huo","year":"2024","journal-title":"J Nutr Health Aging"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"185","DOI":"10.1111\/ger.12513","article-title":"Self-rated oral health and frailty index among older Americans","volume":"38","author":"Hakeem","year":"2021","journal-title":"Gerodontology"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"143","DOI":"10.1186\/s12877-019-1149-4","article-title":"Body weight, frailty, and chronic pain in older adults: a cross-sectional study","volume":"19","author":"Chen","year":"2019","journal-title":"BMC Geriatr"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"1323174","DOI":"10.3389\/fimmu.2024.1323174","article-title":"Association between systemic immune inflammation index, systemic inflammation response index and adult psoriasis: evidence from NHANES","volume":"15","author":"Ma","year":"2024","journal-title":"Front Immunol"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"1338025","DOI":"10.3389\/fimmu.2024.1338025","article-title":"Systemic inflammatory response index (SIRI) is associated with all-cause mortality and cardiovascular mortality in population with chronic kidney disease: evidence from NHANES (2001-2018)","volume":"15","author":"Gu","year":"2024","journal-title":"Front Immunol"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"102238","DOI":"10.1016\/j.arr.2024.102238","article-title":"Therapeutic effect of dietary ingredients on cellular senescence in animals and humans: a systematic review","volume":"95","author":"Guan","year":"2024","journal-title":"Ageing Res Rev"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"1234549","DOI":"10.3389\/fnut.2023.1234549","article-title":"A personalized diet intervention improves depression symptoms and changes microbiota and metabolite profiles among community-dwelling older adults","volume":"10","author":"Magzal","year":"2023","journal-title":"Front Nutr"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"1430722","DOI":"10.3389\/fnut.2024.1430722","article-title":"Cognitive frailty in relation to vitamin b12 and 25-hydroxyvitamin d in an elderly population: a cross-sectional study from nhanes","volume":"11","author":"Pan","year":"2024","journal-title":"Front Nutr"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"159","DOI":"10.1016\/j.semnephrol.2016.12.006","article-title":"Prehabilitation for the frail patient approaching ESRD","volume":"37","author":"Sheshadri","year":"2017","journal-title":"Semin Nephrol"},{"key":"ref33","doi-asserted-by":"publisher","DOI":"10.1038\/s41430-024-01525-6","article-title":"The role of dietary inflammatory index in metabolic diseases: the associations, mechanisms, and treatments","author":"Xu","year":"2024","journal-title":"Eur J Clin Nutr"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"8779","DOI":"10.1002\/fsn3.4550","article-title":"Exploring the relationship between gut microbiota and sarcopenia based on gut-muscle axis","volume":"12","author":"Li","year":"2024","journal-title":"Food Sci Nutr"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"1249","DOI":"10.1038\/s43587-024-00678-0","article-title":"Gut microbial features and circulating metabolomic signatures of frailty in older adults","volume":"4","author":"Pu","year":"2024","journal-title":"Nat Aging"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"111955","DOI":"10.1016\/j.exger.2022.111955","article-title":"Do neutrophil to lymphocyte ratio and platelet to lymphocyte ratio associate with frailty in elderly inpatient with comorbidity?","volume":"169","author":"Guan","year":"2022","journal-title":"Exp Gerontol"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"101","DOI":"10.18999\/nagjms.84.1.101","article-title":"Evaluation of frailty and neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios relationship in elderly people","volume":"84","author":"Asik","year":"2022","journal-title":"Nagoya J Med Sci"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"931","DOI":"10.1017\/S0007114520001853","article-title":"Dietary inflammatory potential in relation to the gut microbiome: results from a cross-sectional study","volume":"124","author":"Zheng","year":"2020","journal-title":"Br J Nutr"}],"container-title":["Frontiers in Nutrition"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnut.2025.1553467\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,16]],"date-time":"2025-04-16T04:10:48Z","timestamp":1744776648000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnut.2025.1553467\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,16]]},"references-count":38,"alternative-id":["10.3389\/fnut.2025.1553467"],"URL":"https:\/\/doi.org\/10.3389\/fnut.2025.1553467","relation":{},"ISSN":["2296-861X"],"issn-type":[{"value":"2296-861X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,16]]},"article-number":"1553467"}}