Sarcopenia and physical frailty are associated with progressive disability and predictive of negative health outcomes. Dietary interventions are considered the cornerstone in the management of sarcopenic symptomology and physical frailty. However few studies have investigated preventative strategies. Moreover, most studies have focused on the efficacy of individual nutrients or supplements rather than dietary patterns. The Mediterranean Diet (MedDiet) is a dietary pattern that provides evidence for an association between diet quality, healthy ageing and disease prevention. The purpose of this paper was to examine, synthesise and develop a narrative review of the current literature, investigating the potential benefits associated with adherence to a MedDiet and attenuation of physical frailty and sarcopenic symptomology in older adults. We also explored the underlying mechanisms underpinning the potential benefits of the MedDiet on ameliorating physical frailty and sarcopenic symptomology. Synthesis of the reviewed literature is suggestive of a decreased risk of physical frailty and sarcopenic symptomology with greater adherence to a MedDiet. We identified the anti-inflammatory and high antioxidant components of the MedDiet as two potential biological mechanisms involved. Due to a lack of evidence from RCTs to support the proposed physiological mechanisms, we suggest investigating these observations in older adults with type 2 diabetes (T2DM) whom are vulnerable to physical frailty and disability. A number of biological mechanisms describing the pathway to disability in older adults with T2DM have been postulated with many of these mechanisms potentially mitigated with dietary interventions involving the MedDiet. Exploring these mechanisms with the use of well-designed, longer-term dietary intervention studies in older adults with an increased vulnerability to physical frailty and sarcopenia is warranted.

The prevalence of smoking amongst a group of 77 diabetic teenagers aged 11-18 years attending two paediatric clinics was determined using a questionnaire and urine cotinine assay. Five individuals were identified as definite smokers with two further individuals being probable smokers, all of whom were aged 15 years or more. This low prevalence (9%) is in contrast to a 48% prevalence in a young adult diabetic clinic. Many diabetic teenagers appear to acquire a regular smoking habit after leaving the paediatric clinic so it is important that health education is targeted at this group.

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The relationship between adherence to a Mediterranean diet (MedDiet) and health-related quality of life (HRQoL) is unclear, particularly in vulnerable older adults. This cross-sectional analysis explored the association between adherence to a MedDiet and subscales of HRQoL in two independent cohorts of overweight and obese middle-aged to older adults with and without type 2 diabetes mellitus (T2DM). Both cohorts were community-dwelling (T2DM aged ≥50 years; non-T2DM aged ≥60 years) with a BMI ≥25kg/m2. Adherence to a MedDiet was assessed using the Mediterranean Diet Adherence Screener (MEDAS), and HRQoL was determined using the 36-item short-form health survey (SF-36). Multiple regression analysis was used to examine the association between adherence to a MedDiet and HRQoL subscales. A total of n = 152 middle-aged to older adults were included (T2DM: n = 87, 71.2 ± 8.2 years, BMI: 29.5 ± 5.9kg/m2; non-T2DM: n = 65, 68.7 ± 5.6 years, BMI: 33.7 ± 4.9kg/m2). Mean adherence scores for the entire cohort were 5.3 ± 2.2 (T2DM cohort: 5.6 ± 2.3; non-T2DM cohort: 4.9 ± 2.0). In the adjusted model, using pooled data from both study cohorts, adherence to a MedDiet was significantly associated with the general health subscale of HRQoL (β = 0.223; 95% CI: 0.006-0.044; P = 0.001). Similar findings were also observed in the T2DM cohort (β = 0.280; 95% CI: 0.007-0.054; P = 0.001). However, no additional significant associations between adherence to a MedDiet and HRQoL subscales were observed. We showed that adherence to a MedDiet was positively associated with the general health subscale of HRQoL in middle-aged to older adults with T2DM. However, larger longitudinal data in older adults with a wider range of adherence scores, particularly higher adherence, is required to better understand the direction of this relationship.

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