Ultra-processed food (upf) and frailty: Findings from a pro-spective cohort study and the case for reform in upf research

Authors: KONIECZYNSKI, ELSA - Friedman School Of Nutrition; SAHNI, SHIVANI - Harvard Medical School; JACQUES, PAUL - Jean Mayer Human Nutrition Research Center On Aging At Tufts University; NAUMOVA, ELENA - Friedman School Of Nutrition

Submitted to: Nutrients
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 8/8/2025
Publication Date: 8/14/2025
Citation: Konieczynski, E.M., Sahni, S., Jacques, P.F., Naumova, E.N. 2025. Ultra-processed food (upf) and frailty: Findings from a pro-spective cohort study and the case for reform in upf research. Nutrients. Volume 17, Issue 16. https://doi.org/10.3390/nu17162631.
DOI: https://doi.org/10.3390/nu17162631

Interpretive Summary: Ultra-processed foods (UPFs), which make up a growing portion of the older adult diet, tend to be high in added sugars, sodium, saturated and trans fats, and energy while providing low amounts of fiber, protein, and essential micronutrients necessary for a balanced diet and healthy aging. While we know little about the role of UPF in the development of frailty, it is plausible that the poor nutritional quality makes UPFs a plausible pro-inflammatory factor that may link UPF intake to musculoskeletal decline and frailty development. The objective of the present study was to examine the association of UPF intake with frailty development. The study findings suggest that UPF intake is not related to frailty but may be related to worsening muscle strength and function.

Technical Abstract: Background: Ultra-processed foods (UPFs) make up a growing share of older adults' diets and may contribute to frailty through pro-inflammatory pathways. The objective of this study was to examine the association of UPF intake with frailty development, and with annual changes in select frailty components. Methods: This prospective cohort study used data from 2,547 participants in the Framingham Offspring Cohort. UPF intake was assessed using a food frequency questionnaire and frailty was defined by the Fried frailty phenotype. We used cumulative and mixed logistic regression models to examine the association between UPF intake and odds of developing frailty, adjusting for baseline age, education, energy intake, multivitamin use, smoking, self-rated health, history of diabetes, cancer, cardiovascular disease, and diet quality. For the frailty component analysis, we used cumulative linear regression models to assess the association between UPF intake and annual changes in grip strength, gait speed, and weight, further adjusting for BMI and physical activity. We also evaluated potential effect modification by sex and baseline age (<60 vs. =60 years). Results: The study population was 55.1% female, with a mean age of 60.3 +- 8.9 years. Over an average follow-up of 10.8 years, 233 participants (9.2%) developed frailty. UPF intake was not associated with frailty development in either the cumulative or mixed regression models. However, UPF intake was inversely associated with annual change in gait speed, and with annual change in grip strength in men only. UPF intake was not associated with annual weight change. Conclusion: Our findings contribute preliminary evidence that in middle-aged and older adults, UPF intake is not related to frailty but may be related to worsening muscle strength and function. Further research on the topic of UPF intake and aging muscle, and a more granular approach to UPF classification, is required to translate these findings to practical recommendations and to clarify their clinical significance.