Flavonol-rich foods like apples and blackberries can lower chances of developing frailty

Eating plant-based foods that contain dietary compounds called flavonols can lower your chances of developing frailty.


Foods like apples and blackberries that contain flavonoids called quercetin may be the most important for frailty prevention.


Approximately 10% to 15% of older adults experience frailty, a geriatric syndrome that leads to a greater risk of falls, fractures, disability, hospitalization, and mortality.  Current dietary recommendations for frailty prevention primarily focus on protein intake. However there are many other foods that may have health benefits


“There may be some validity to the old saying, an apple a day keeps the doctor (or frailty) away,” said the authors. “Our findings suggest that for every 10 mg higher intake of flavonols per day, the odds of frailty were reduced by 20%. Individuals can easily consume 10 mg of flavonols intake per day since one medium sized apple has about 10 mg of flavonols.”


“Although there was no significant association between total flavonoid intake and frailty, higher flavonols intake (one of the subclasses of flavonoids) was associated with lower odds of developing frailty. Specifically, higher quercetin intake was the flavonoid that had the strongest association with frailty prevention. This data suggests that there may be particular subclasses of flavonoids that have the most potential as a dietary strategy for frailty prevention,” said coauthor Shivani Sahni, PhD, of Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, and the Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife; and Courtney L. Millar, PhD, of the Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, and the Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife.


The authors suggest that future research should focus on dietary interventions of flavonols or quercetin for the treatment of frailty. Research is also needed in racially and ethnically diverse participants.


The findings were published in the American Journal of Clinical Nutrition article, “Higher Intake Of Dietary Flavonols, Specifically Dietary Quercetin, Is Associated With Lower Odds Of Frailty Onset Over 12-Years Of Follow-Up Among Adults In The Framingham Heart Study.”  This is one of the first community-based studies that comprehensively examined the role of dietary flavonoids for frailty prevention.


Authors are Steven Oei, MSc1,2*, Courtney L. Millar, PhD2,3*, Thuy Nga Nguyen, RN, BSN4, Kenneth J. Mukamal, MD, MPH2, Douglas P. Kiel, MD, MPH2,3, Lewis A. Lipsitz, MD2,3, Marian T. Hannan, DSc, MPH2,3, Shivani Sahni, PhD2,3 .

1Division of Human Nutrition and Health, Wageningen University, Wageningen, the Netherlands (SO).

2Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (SO, CLM, KJM, DPK, LAL, MTH, SS).  

3Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA (CLM, DPK, LAL, MTH, SS).

4University of Arizona, Tucson, AZ (TNN).

*Co-first authors.


Detailed description of the research


This study utilizes data from the Framingham Heart Study – Offspring Cohort to determine the association between flavonoid intake and frailty onset. There were 1,701 individuals included in this analysis. All were free of frailty at baseline and followed from ~12 years to evaluate frailty status (evaluated by the Fried Frailty Phenotype). After ~12 years, 13.2% of the participants developed frailty. Total flavonoids intake was not significantly associated with frailty onset. However, flavonols intake (a type of flavonoid, in particular quercetin) was associated with lower odds of frailty onset.


Funding information or grantor requirements


This study was funded by the National Institute on Aging (NIA) grant number R01 AG051728, the National Heart, Lung and Blood Institute’s Framingham Heart Study (contract numbers HHSN268201500001I and N01-HC 25195). Dr. Millar was supported by the NIA/NIH T32-AG023480 and the Beth and Richard Applebaum Research Fund. Ms. Nguyen was supported by the NIA through the Medical Student Training in Aging Research (MSTAR) Program. DPK was funded by R01 AR041398 and R01 AR061445. Dr. Lipsitz was supported by R21 AG073886 from the NIA. He also holds the Irving and Edyth S. Usen Chair in geriatric medicine at Hebrew SeniorLife. Dr. Mukamal was supported by K24 AG065525.


Conflict of interest statement


Dr. Kiel has received grant funding from Amgen and Solarea Bio. He serves on the scientific advisory board of Solarea Bio Inc., Reneo, and Pfizer, and on a Data Monitoring Committee for Agnovos, and receives royalties for publication by Wolters Kluwer. Dr. Lipsitz is the Editor-in-Chief of the Journal of Gerontology Medical Sciences. Dr. Hannan has received funding to her institution from Amgen, Inc for work unrelated to this project. Drs. Mukamal and Sahni have received grant funding from the United States Highbush Blueberry Council for research unrelated to this project. Dr. Sahni further reports institutional grants from Dairy Management Inc. (ended September 2022) and Solarea Bio Inc. (ended March 2022), has reviewed grants for the American Egg Board’s Egg Nutrition Center and National Dairy Council. Dr. Millar, Mr. Oei and Ms. Nguyen have no conflicts of interest to report related to this current work.


About Hebrew SeniorLife

Hebrew SeniorLife, an affiliate of Harvard Medical School, is a national senior services leader uniquely dedicated to rethinking, researching, and redefining the possibilities of aging. Hebrew SeniorLife cares for more than 3,000 seniors a day across six campuses throughout Greater Boston. Locations include: Hebrew Rehabilitation Center-Boston and Hebrew Rehabilitation Center-NewBridge in Dedham; NewBridge on the Charles, Dedham; Orchard Cove, Canton; Simon C. Fireman Community, Randolph; Center Communities of Brookline, Brookline; and Jack Satter House, Revere. Founded in 1903, Hebrew SeniorLife also conducts influential research into aging at the Hinda and Arthur Marcus Institute for Aging Research, which has a portfolio of more than $85 million, making it one of the largest gerontological research facilities in the U.S. in a clinical setting. It also trains more than 1,000 geriatric care providers each year. For more information about Hebrew SeniorLife, visit our website or follow us on our blog, Facebook, Instagram, Twitter, and LinkedIn.


About the Hinda and Arthur Marcus Institute for Aging Research

Scientists at the Marcus Institute seek to transform the human experience of aging by conducting research that will ensure a life of health, dignity, and productivity into advanced age. The Marcus Institute carries out rigorous studies that discover the mechanisms of age-related disease and disability; lead to the prevention, treatment, and cure of disease; advance the standard of care for older people; and inform public decision-making.

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