{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T02:57:49Z","timestamp":1790909869641,"version":"4.1.0"},"reference-count":46,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2018,6,14]],"date-time":"2018-06-14T00:00:00Z","timestamp":1528934400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100006580","name":"Office of the Chief Scientist, Ministry of Health","doi-asserted-by":"publisher","award":["3-0000010435"],"award-info":[{"award-number":["3-0000010435"]}],"id":[{"id":"10.13039\/501100006580","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background and Aims: Diabetes and dysglycemia increase the risk of frailty and decreased physical abilities. Adherence to the Mediterranean Diet (MD) may reduce this risk. We hypothesized that adherence to the MD is associated with physical function in older type-2 diabetic patients and that the association is stratified by age. Methods and Results: We recruited type-2 diabetes patients aged &gt;60 years at the Center for Successful Aging with Diabetes at Sheba Medical Center. Health status and demographic data were obtained from medical records. Food Frequency Questionnaire was used for nutritional assessment and calculation of MD score. Physical function indices were determined by a physiotherapist and included: Berg Balance test, Timed Get-Up-and-Go, 6-min walk (6 MW), 10-m walk (10 MW), Four Square Step Test, 30-s chair stand and Grip strength, and activities and instrumental activities of daily living. Among 117 participants (age 70.6 \u00b1 6.5), high adherence to MD was associated with better score on functional tests (low vs. high MD adherence: 9.7% vs. 25%, ANOVA p = 0.02). A significant age by MD interaction was found: a higher adherence to MD was associated with a better 6 MW (low vs. high: 387 \u00b1 35 m vs. 483 \u00b1 26 m; p = 0.001) and higher 10 MW (low vs. high: 1.8 \u00b1 0.16 m\/s vs. 2.0 \u00b1 0.13 m\/s; p = 0.02) in participants aged &gt;75 years. These associations remained significant after controlling for gender, age, BMI, and physical activity. Conclusion: In the current study, we showed relationships between strength, physical performance, and MD among older diabetic patients. Future studies are needed to confirm this association and establish temporal relationships.<\/jats:p>","DOI":"10.3390\/nu10060767","type":"journal-article","created":{"date-parts":[[2018,6,14]],"date-time":"2018-06-14T11:06:06Z","timestamp":1528974366000},"page":"767","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":22,"title":["The Association between Mediterranean Diet and the Risk of Falls and Physical Function Indices in Older Type 2 Diabetic People Varies by Age"],"prefix":"10.3390","volume":"10","author":[{"given":"Sigal","family":"Tepper","sequence":"first","affiliation":[{"name":"Department of Nutritional Sciences, Tel Hai Academic College, Upper Galilee 1220800, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amit","family":"Alter Sivashensky","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danit","family":"Rivkah Shahar","sequence":"additional","affiliation":[{"name":"The S. Daniel Abraham Center for Health and Nutrition, Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 8443944, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diklah","family":"Geva","sequence":"additional","affiliation":[{"name":"Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 8443944, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tali","family":"Cukierman-Yaffe","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel"},{"name":"The Center for Successful Aging with Diabetes, Endocrinology Institute, Sheba Medical Center, Ramat Gan 52621, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2018,6,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2460","DOI":"10.1007\/s00125-005-0023-4","article-title":"Cognitive Decline and Dementia in diabetes\u2014Systematic Overview of Prospective Observational Studies","volume":"48","author":"Cukierman","year":"2005","journal-title":"Diabetologia"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"184","DOI":"10.1016\/S1474-4422(08)70021-8","article-title":"Cognition and Diabetes: A Lifespan Perspective","volume":"7","author":"Biessels","year":"2008","journal-title":"Lancet Neurol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"563","DOI":"10.1037\/a0040455","article-title":"Neurocognitive Consequences of Diabetes","volume":"71","author":"Ryan","year":"2016","journal-title":"Am. Psychol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1069","DOI":"10.2337\/diacare.24.6.1069","article-title":"The Prevalence of Comorbid Depression in Adults with Diabetes: A Meta-Analysis","volume":"24","author":"Anderson","year":"2001","journal-title":"Diabetes Care"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1539","DOI":"10.1093\/gerona\/60.12.1539","article-title":"Risk Factors for Falls in Older Disabled Women with Diabetes: The Women\u2019s Health and Aging Study","volume":"60","author":"Volpato","year":"2005","journal-title":"J. Gerontol. Ser. A Biol. Sci. Med. Sci."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"61","DOI":"10.2337\/diacare.25.1.61","article-title":"Diabetes and Incidence of Functional Disability in Older Women","volume":"25","author":"Gregg","year":"2002","journal-title":"Diabetes Care"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"763","DOI":"10.1093\/ajcn\/nqy026","article-title":"Mediterranean Diet and Risk of Frailty Syndrome among Women with Type 2 Diabetes","volume":"107","author":"Hagan","year":"2018","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"824","DOI":"10.1007\/s11892-013-0424-6","article-title":"Physical Disability in the Elderly with Diabetes: Epidemiology and Mechanisms","volume":"13","author":"Bianchi","year":"2013","journal-title":"Curr. Diabetes Rep."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1672","DOI":"10.2337\/dc11-2202","article-title":"Role of Muscle Mass and Muscle Quality in the Association between Diabetes and Gait Speed","volume":"35","author":"Volpato","year":"2012","journal-title":"Diabetes Care"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1993","DOI":"10.2337\/dc09-0264","article-title":"Excessive Loss of Skeletal Muscle Mass in Older Adults with Type 2 Diabetes","volume":"32","author":"Park","year":"2009","journal-title":"Diabetes Care"},{"key":"ref_11","unstructured":"Calderon, R., Manor, O., Abu-Ahmad, W., Ben-Yehuda, A., Horowitz, E., Wolff-Sagy, Y., Paltiel, O., Kriger, M., and Shmueli, A. (2017). National Program for Quality Indicators in Community Healthcare 2014\u20132016 Report, The Israel National Institute for Health Policy Research. Available online: www.israelhpr.org.il\/h\/1\/&mod=download&me_id=2398."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"819","DOI":"10.1016\/S2213-8587(14)70034-8","article-title":"Age-Related and Disease-Related Muscle Loss: The Effect of Diabetes, Obesity, and Other Diseases","volume":"2","author":"Kalyani","year":"2014","journal-title":"Lancet Diabetes Endocrinol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1881","DOI":"10.1111\/j.1532-5415.2012.04167.x","article-title":"Adherence to Mediterranean Diet and Decline in Walking Speed Over 8 Years in Community-Dwelling Older Adults","volume":"60","author":"Shahar","year":"2012","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_14","first-page":"333","article-title":"Mediterranean Dietary Patterns and Impaired Physical Function in Older Adults","volume":"73","author":"Struijk","year":"2018","journal-title":"J. Gerontol. Ser. A Biomed. Sci. Med. Sci."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"625","DOI":"10.1097\/MCO.0b013e32833e337d","article-title":"Nutritional Determinants of Mobility","volume":"13","author":"Milaneschi","year":"2010","journal-title":"Curr. Opin. Clin. Nutr. Metab. Care"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s12603-017-0922-3","article-title":"Aging and Adherence to the Mediterranean Diet: Relationship with Cardiometabolic Disorders and Polypharmacy","volume":"22","author":"Vicinanza","year":"2018","journal-title":"J. Nutr. Health Aging"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1016\/j.exger.2010.11.030","article-title":"Mediterranean Diet and Mobility Decline in Older Persons","volume":"46","author":"Milaneschi","year":"2011","journal-title":"Exp. Gerontol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1007\/s12603-016-0808-9","article-title":"Adherence to the Mediterranean Diet and all-Cause Mortality Risk in an Elderly Italian Population: Data from the ILSA Study","volume":"21","author":"Limongi","year":"2017","journal-title":"J. Nutr. Health Aging"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1007\/s12603-014-0003-9","article-title":"Mediterranean Diet and Functional Indicators among Older Adults in Non-Mediterranean and Mediterranean Countries","volume":"18","author":"Zbeida","year":"2014","journal-title":"J. Nutr. Health Aging"},{"key":"ref_20","unstructured":"WHO (World Health Organisation) (2018, May 01). Health Statistics and Information Systems. Proposed Working Definition of an Older Person in Africa for the MDS Project, 2002. Available online: http:\/\/www.Who.int\/healthinfo\/survey\/ageingdefnolder\/en\/."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"855","DOI":"10.1023\/A:1025634020718","article-title":"Development of a Semi-Quantitative Food Frequency Questionnaire (FFQ) to Assess Dietary Intake of Multiethnic Populations","volume":"18","author":"Shahar","year":"2003","journal-title":"Eur. J. Epidemiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"3625","DOI":"10.1093\/jn\/133.11.3625","article-title":"Development of a Food Frequency Questionnaire (FFQ) for an Elderly Population Based on a Population Survey","volume":"133","author":"Shahar","year":"2003","journal-title":"J. Nutr."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"573","DOI":"10.1093\/jn\/135.3.573","article-title":"Dietary Evaluation and Attenuation of Relative Risk: Multiple Comparisons between Blood and Urinary Biomarkers, Food Frequency, and 24-h Recall Questionnaires: The DEARR Study","volume":"135","author":"Shai","year":"2005","journal-title":"J. Nutr."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"745","DOI":"10.1079\/PHN2004599","article-title":"Selection of Food Items for Inclusion in a Newly Developed Food-Frequency Questionnaire","volume":"7","author":"Shai","year":"2007","journal-title":"Public Health Nutr."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"186","DOI":"10.1016\/j.jclinepi.2007.04.016","article-title":"Gait Velocity and the Timed-Up-and-Go Test were Sensitive to Changes in Mobility in Frail Elderly Patients","volume":"61","author":"Munneke","year":"2008","journal-title":"J. Clin. Epidemiol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"556","DOI":"10.1177\/0269215507085378","article-title":"Mobility beyond the Clinic: The Effect of Environment on Gait and its Measurement in Community-Ambulant Stroke Survivors","volume":"22","author":"Donovan","year":"2008","journal-title":"Clin. Rehabil."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1007\/s00391-004-0176-7","article-title":"Systematic Review of Quantitative Clinical Gait Analysis in Patients with Dementia","volume":"37","author":"Hoefsloot","year":"2004","journal-title":"Z. Gerontol. Geriatr."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1016\/j.apmr.2006.10.031","article-title":"The Effect of Cognitive Dual Tasks on Balance during Walking in Physically Fit Elderly People","volume":"88","author":"Ribbers","year":"2007","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1053\/apmr.2001.9396","article-title":"Validity and Reliability Comparison of 4 Mobility Measures in Patients Presenting with Neurologic Impairment","volume":"82","author":"Rossier","year":"2001","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_30","first-page":"S7","article-title":"Measuring Balance in the Elderly: Validation of an Instrument","volume":"83","author":"Berg","year":"1992","journal-title":"Can. J. Public Health"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"857","DOI":"10.1097\/00002060-200211000-00010","article-title":"Development of a Clinical Measure of Turning for Older Adults","volume":"81","author":"Dite","year":"2002","journal-title":"Am. J. Phys. Med. Rehabil."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1080\/02701367.1999.10608028","article-title":"A 30-s Chair-Stand Test as a Measure of Lower Body Strength in Community-Residing Older Adults","volume":"70","author":"Jones","year":"1999","journal-title":"Res. Q. Exerc. Sport"},{"key":"ref_33","first-page":"830","article-title":"Association between Hand grip\/body Weight Ratio and Disability Pension due to Musculoskeletal Disorders: A Population-Based Cohort Study of 1 Million Swedish Men","volume":"39","author":"Ropponen","year":"2011","journal-title":"Scand. J. Soc. Med."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"442","DOI":"10.3143\/geriatrics.49.442","article-title":"Predictors of Frailty Development in a General Population of Older Adults in Japan using the Frailty Index for Japanese Elderly Patients","volume":"49","author":"Yoshida","year":"2012","journal-title":"Jpn. J. Geriatr."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"10","DOI":"10.3109\/09638289509166622","article-title":"The Functional Independence Measure: A Comparative Validity and Reliability Study","volume":"17","author":"Kidd","year":"1995","journal-title":"Disabil. Rehabil."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1173","DOI":"10.1161\/01.STR.24.8.1173","article-title":"The Frenchay Activities Index. Assessment of Functional Status in Stroke Patients","volume":"24","author":"Schuling","year":"1993","journal-title":"Stroke"},{"key":"ref_37","unstructured":"Soper, D.S. (2018, May 01). A-Priori Sample Size Calculator for Multiple Regression [Software]. Available online: http:\/\/www.Danielsoper.com\/statcalc."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1001\/jama.2010.1923","article-title":"Gait Speed and Survival in Older Adults","volume":"305","author":"Studenski","year":"2011","journal-title":"JAMA J. Am. Med. Assoc."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"2018","DOI":"10.1001\/jama.295.17.2018","article-title":"Association of Long-Distance Corridor Walk Performance with Mortality, Cardiovascular Disease, Mobility Limitation, and Disability","volume":"295","author":"Newman","year":"2006","journal-title":"JAMA J. Am. Med. Assoc."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Manas, L.R., and Sinclair, A.J. (2017). Diabetes and Functional Limitation: The Emergence of Frailty and Disability. Diabetes in Old Age, John Wiley and Sons.","DOI":"10.1002\/9781118954621.ch16"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"949","DOI":"10.1016\/j.jamda.2016.07.013","article-title":"Frailty as a Major Factor in the Increased Risk of Death and Disability in Older People with Diabetes","volume":"17","author":"Carnicero","year":"2016","journal-title":"J. Am. Med. Dir. Assoc."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1016\/S2213-8587(13)70046-9","article-title":"Diabetes and Risk of Physical Disability in Adults: A Systematic Review and Meta-Analysis","volume":"1","author":"Wong","year":"2013","journal-title":"Lancet Diabetes Endocrinol."},{"key":"ref_43","first-page":"381","article-title":"Measuring the Impact of Diabetes on Life Expectancy and Disability-Free Life Expectancy among Older Adults in Mexico","volume":"65","author":"Andrade","year":"2009","journal-title":"J. Gerontol. Ser. B Psychol. Sci. Soc. Sci."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"21525","DOI":"10.3390\/ijms141121525","article-title":"Oxidative Stress in Diabetes: Implications for Vascular and Other Complications","volume":"14","author":"Pitocco","year":"2013","journal-title":"Int. J. Mol. Sci."},{"key":"ref_45","first-page":"1567","article-title":"The Association of New Inflammatory Markers with Type 2 Diabetes Mellitus and Macrovascular Complications: A Preliminary Study","volume":"18","author":"Zhang","year":"2014","journal-title":"Eur. Rev. Med. Pharmacol. Sci."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1084","DOI":"10.1016\/j.amjmed.2007.07.028","article-title":"Oxidative Stress and Severe Walking Disability among Older Women","volume":"120","author":"Semba","year":"2007","journal-title":"Am. J. Med."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/10\/6\/767\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T15:08:39Z","timestamp":1760195319000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/10\/6\/767"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,6,14]]},"references-count":46,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2018,6]]}},"alternative-id":["nu10060767"],"URL":"https:\/\/doi.org\/10.3390\/nu10060767","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,6,14]]}}}