Associations between Mediterranean diet adherence and body composition and metabolic outcomes in older adults at risk of sarcopenic obesity

Background Sarcopenic obesity (SO) is prevalent in older adults and is associated with metabolic dysfunction and adverse health outcomes. Lifestyle factors including diet may influence SO development and associated metabolic perturbations. This study examined associations between MedDiet adherence and body composition and metabolic outcomes in community-dwelling older adults at risk of SO and explored links between individual food groups and these outcomes. Methods This cross-sectional study included adults aged ≥ 60 years at risk of SO (BMI ≥ 30 kg/m ² , SARC-F score ≥ 2). Diet was assessed via 24-hour recall, and MedDiet measured using Mediterranean Diet Score (range 0–45). Body composition was measured by dual-energy X-ray absorptiometry. Results Among 116 participants (mean ± SD age 66.5 ± 4.1 years; MDS 23.1 ± 5.0), higher MedDiet adherence was not associated with body composition [fat mass (β= -0.01; 95%CI: -1.93, 1.90), percentage body fat (β= -0.39; 95%CI: -1.17, 0.40), lean soft tissue mass (β = 1.00; 95%CI: -0.28, 2.29), visceral fat (β = 5.56; 95%CI: -60.72, 71.84), appendicular lean mass (β= -0.01; 95%CI: -0.18, 0.17)]. In exploratory analysis, higher fish intake was associated with lower waist-to-hip ratio (β= -0.0053; 95%CI: -0.01, -0.0005), higher poultry intake with higher high-density lipoprotein (β = 0.05; 95%CI: 0.01, 0.08) and lower diastolic blood pressure (β= -1.39; 95%CI: -2.71, -0.08), and higher grains intake with lower low-density lipoprotein (β= -0.14; 95%CI: -0.28, -0.01) in fully adjusted models. Conclusions In older adults at risk of SO, MedDiet adherence showed no associations with body composition and limited associations with metabolic outcomes, though higher fish, poultry and grains intake had modest associations with anthropometric and metabolic outcomes. Trial registration (ANZCTR): ACTRN12621000236897. Date of registration: 05/03/2021.