Nutritional Pearls: A More-Robust Later Life Is Within Reach

Paula is a 51-year-old woman whose diet includes 2 to 3 sugar sweetened beverages per day. She knows sweetened beverages aren’t good for her and asks you what kind of impact this could have on her health. 

How would you advise your patient?

(Answer and discussion on next page)

Dr. Gourmet is the definitive health and nutrition web resource for both physicians and patients with evidence-based resources including special diets for warfarin users, patients with GERD/acid reflux, celiac disease, type 2 diabetes, low-sodium diets (1500 mg/d), and lactose intolerance.

Timothy S. Harlan, MD, is a board-certified internist and professional chef who translates the Mediterranean diet for the American kitchen with familiar, healthy recipes. He is an assistant dean for clinical services, executive director of The Goldring Center for Culinary Medicine, associate professor of medicine at Tulane University in New Orleans, and faculty chair of the Certified Culinary Medicine Specialist program.

Answer: Artificially and sugar-sweetened beverages have been linked to negative health effects. 

Frailty is probably not something you have thought much about, yet it is a serious risk to elderly patient’s health. The Oxford English Dictionary defines frailty as "the condition of being weak and delicate."

The Royal College of Nursing1 offers a simple clinical description: “If on assessment of an older patient you can identify 3 out of the 5 following indicators as being present–– unintentional weight loss, feelings of exhaustion, weakness, slow walking speed, and low levels of physical activity–– then you can identify the patient as being frail.

An additional clinical indication of frailty is the presence of 5 or more illnesses, including diabetes, high blood pressures, congestive heart failure, type 2 diabetes, stroke, asthma, arthritis, Parkinson Disease, and others.

So how might this condition affect elderly patients’ health? Those aged more than 65 years who are diagnosed as frail are at a higher risk of falls, hospitalizations, disability, and death.

The Research

There has been research into the preventive effects of different dietary factors, from fruit and protein intake to overall dietary patterns, but a team of researchers at Harvard as well as in Madrid, Spain, thought to look at what foods might increase the risk of frailty.2

The authors analyzed data gathered for the Nurses' Health Study (NHS), a large scale, long term study that began recruitment in 1976 with the enrollment of over 121,000 women aged 30 to 55 years.

Every 2 years the participants respond to questionnaires on their medical history and lifestyle, and the study continues through the present. Between 1990 and 2010 the participants also responded to 6 dietary questionnaires, that among other food items, assessed their consumption of sugar-sweetened beverages.

To assess frailty, the authors identified those women who responded positively to 3 questions indicating moderate to severe fatigue, poor physical strength, and reduced aerobic capacity–– weight loss of at least 5% within 2 years–– and the diagnosis of at least 5 illnesses (as mentioned above).

Women aged 60 years at the start of the study in 1976 were included in the authors' analysis, with additional participants added to the study as they also turned 60 years, up to 2014 when the authors began assessing the data. Eventually the participants included over 71,000 women.

The participants' consumption of sweetened beverages was grouped into 6 increasing levels: 1 to 3 servings per month, 1 serving per week, 2 to 6 servings per week, 1 to 2 servings per day, and 2 or more servings per day. Further, the authors differentiated between sugar-sweetened beverages, artificially sweetened beverages, and fruit juices.

The Results

Compared with those who "never or almost never" consumed sugar-sweetened beverages, women who drank at least 2 sugar-sweetened beverages per day were 32% more likely to become frail. Interestingly, those who drank artificially sweetened beverages didn't do much better, with a 28% greater risk of becoming frail.

Every additional serving of sugar-sweetened beverages increased a woman's risk of frailty by 12%, and each additional serving of artificially sweetened beverages increased the risk by 9%.

Those who drank fruit juices such as apple juice, apple cider, grapefruit juice, prune juice, or unspecified other juices did not fare much better, with those drinking juices other than orange juice seeing their risk rise by 15%. On the other hand, those who drank at least one serving of orange juice every day were 18% less likely to become frail.

The authors considered not only Body Mass Index, demographic information, and lifestyle factors such as exercise, but also diet quality and medication use.

What’s the Take Home?

Why was orange juice associated with a lower risk of frailty? The authors of this paper theorize that it may have to do with the high levels of antioxidants, which may help reduce oxidative stress and inflammation.

The take-home message, however, is that once again artificially- and sugar-sweetened beverages have been linked to negative health effects. You'll likely be more robust later in life if you cut them out of your diet.


  1. Frailty in older people. Royal College of Nursing. Updated March 25, 2021. Accessed August 2, 2021.
  2. Struijk EA, Rodríguez-Artalejo F, Fung TT, Willett WC, Hu FB, Lopez-Garcia E. Sweetened beverages and risk of frailty among older women in the Nurses' Health Study: A cohort study. PLoS Med. 2020;17(12):e1003453. doi:10.1371/journal.pmed.1003453