nutrients Article Dietary Patterns and Risk Factors of Frailty in Lebanese Older Adults Nathalie Yaghi 1 , Cesar Yaghi 2,3 , Marianne Abifadel 4 , Christa Boulos 1 and Catherine Feart 5, *   Citation: Yaghi, N.; Yaghi, C.; Abifadel, M.; Boulos, C.; Feart, C. Dietary Patterns and Risk Factors of Frailty in Lebanese Older Adults. Nutrients 2021, 13, 2188. https:// doi.org/10.3390/nu13072188 Academic Editor: Rosa Casas Received: 16 May 2021 Accepted: 22 June 2021 Published: 25 June 2021 Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affil- iations. Copyright: © 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/). 1 Department of Nutrition & Dietetics, Faculty of Pharmacy, Saint Joseph University of Beirut, P.O. Box 17-5208 Mar Mikhael, Beirut 1104 2020, Lebanon; nathalie.yaghi@usj.edu.lb (N.Y.); christa.boulos@usj.edu.lb (C.B.) 2 Department of Gastroenterology, Faculty of Medicine, Saint Joseph University of Beirut, P.O. Box 17-5208 Mar Mikhael, Beirut 1104 2020, Lebanon; cesar.yaghi@usj.edu.lb 3 Hotel-Dieu de France of Beirut University Hospital, P.O. Box 166830, Alfred Naccache Blvd, Beirut, Lebanon 4 Laboratory of Biochemistry and Molecular Therapeutics, Faculty of Pharmacy, Pôle Technologie-Santé, Saint Joseph University of Beirut, P.O. Box 17-5208 Mar Mikhael, Beirut 1104 2020, Lebanon; marianne.abifadel@usj.edu.lb 5 LEHA team, INSERM U1219, Université de Bordeaux, F-33000 Bordeaux, France * Correspondence: catherine.feart-couret@u-bordeaux.fr; Tel.: +33-(0)5-47-304-204 Abstract: Factors associated with frailty, particularly dietary patterns, are not fully understood in Mediterranean countries. This study aimed to investigate the association of data-driven dietary patterns with frailty prevalence in older Lebanese adults. We conducted a cross-sectional national study that included 352 participants above 60 years of age. Sociodemographic and health-related data were collected. Food frequency questionnaires were used to elaborate dietary patterns via the K-mean cluster analysis method. Frailty that accounted for 15% of the sample was twice as much in women (20%) than men (10%). Identified dietary patterns included a Westernized-type dietary pattern (WDP), a high intake/Mediterranean-type dietary pattern (HI-MEDDP), and a moderate intake/Mediterranean-type dietary pattern (MOD-MEDDP). In the multivariate analysis, age, waist to height ratio, polypharmacy, age-related conditions, and WDP were independently associated with frailty. In comparison to MOD-MEDDP, and after adjusting for covariates, adopting a WDP was strongly associated with a higher frailty prevalence in men (OR = 6.63, 95% (CI) (1.82–24.21) and in women (OR = 11.54, 95% (CI) (2.02–65.85). In conclusion, MOD-MEDDP was associated with the least prevalence of frailty, and WDP had the strongest association with frailty in this sample. In the Mediterranean sample, a diet far from the traditional one appears as the key deleterious determinant of frailty. Keywords: frailty; dietary pattern; malnutrition; food groups; Mediterranean dietary pattern; West- ernized dietary pattern; older adults; cross-sectional study 1. Introduction The frailty phenotype is a multifactorial syndrome associated with aging, charac- terized by unintentional weight loss, self-reported exhaustion, muscular weakness, slow walking speed, and low physical activity [1]. Physical frailty is also recognized as a risk factor for mortality, increased morbidity [2], malnutrition [2], and falls [3,4]. If not managed, frailty can lead to disability and dependency [5,6], and become a burden to the individual, caregivers, and public health authorities. This process, which moves from robustness to frailty, disability, then dependency, is preventable, and could even improve in some aspects, if addressed in the early stages (i.e., in the prefrail state) [7–10]. Frailty, being a multifactorial condition, is related to several sociodemographic-, lifestyle-, and health-related factors. Associations were found between frailty risk and marital status [11], education [12], depression [13], polypharmacy [14], and nutritional status [2,15]. Nutrients 2021, 13, 2188. https://doi.org/10.3390/nu13072188 https://www.mdpi.com/journal/nutrients