The mediating role of body mass index in the association of the dietary index for gut microbiota and frailty: NHANES 2007-2020

Jiawei Lei^1*Tingting Feng¹Tian Tian¹Ziyun Zhuang²Guilei Zhang¹Ying Liu¹Zhenrong Yang¹Yuting Wang¹Xin Zhang^3*Wei Sun^1*Jiahe Wang^1*

• ¹Sheng Jing Hospital Affiliated, China Medical University, Shenyang, China
• ²College of Medicine, Shantou University, Shantou, Guangdong Province, China
• ³The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China

The Dietary Index for Gut Microbiota (DI-GM), a newly introduced metric, indicates gut microbiota diversity. However, its correlation with frailty remains unexplored.A total of 25,320 individuals were included in the 2007-2020 National Health and Nutrition Examination Survey (NHANES). Dietary recall data were calculated by averaging intake values from two separate 24-hour dietary recall interviews. Frailty was assessed using the 49-item frailty index. The relationship between DI-GM and the frailty phenomenon was examined by applying a weighted logistic regression model. A comprehensive sensitivity analysis was undertaken, incorporating restricted cubic splines for modeling non-linear effects, stratified subgroup analyses to explore effect modification, and multiple imputation techniques to address potential missing data concerns.Higher DI-GM scores and gut microbiota-beneficial dietary components were significantly associated with reduced prevalence of frailty (Frailty Index: OR = 0.987, 95% CI: 0.977-0.997, P = 0.014; Frailty: OR = 0.941, 95% CI: 0.902-0.980, P =0.004). Restricted cubic spline analysis revealed a non-linear relationship between DI-GM and frailty. Body Mass Index (BMI) mediated this relationship, accounting for 17.57% of the association.We concluded that a higher DI-GM score is associated with a lower risk of frailty, partly via BMI mediation. Future research should validate these findings using longitudinal studies.