Diet quality trajectories and musculoskeletal health among the oldest old: Findings from the Hertfordshire Cohort Study
Diet quality trajectories and musculoskeletal health among the oldest old: Findings from the Hertfordshire Cohort Study
Background: few studies have examined changes in diet quality into old age, and related these changes to musculoskeletal outcomes. We examined this among Hertfordshire Cohort Study participants.
Methods: in total, 178 individuals provided diet quality scores derived in 1998–2004, 2011 and 2017 (median age 64.0, 74.7 and 80.7) using principal component analysis of food frequency questionnaires; higher scores indicated healthier diets (more fruit and vegetables, oily fish and wholemeal bread, and less white bread, added sugar, full-fat dairy products, chips and processed meat). Pearson correlations between diet quality scores at each time-point were computed. Group-based trajectory modelling of diet quality scores was implemented; trajectory groups as predictors of musculoskeletal outcomes (history of hip/knee replacement, osteoporosis, fall in previous year, low grip strength, low gait speed) in 2017 were examined using logistic regression with age and sex included as covariates.
Results: diet quality showed moderate stability over time (0.64 < r < 0.74). Three trajectory groups were identified: low (29%), medium (51%), and high diet quality (20%). A higher diet quality group was related to greater odds (95% CI) of hip/knee replacement (1.85 (1.05, 3.26) per higher category); associations with other musculoskeletal outcomes were weak (p > 0.17).
Conclusions: weak associations were observed between diet quality trajectories and musculoskeletal outcomes. However, higher diet quality was related to increased likelihood of hip/knee joint replacement, potentially due to confounding by socioeconomic position. The stability of diet quality suggests individuals with poorer diets around age 65 are likely to maintain these patterns into old age and may benefit from targeted interventions.
Dennison, Elaine M.
ee647287-edb4-4392-8361-e59fd505b1d1
Laskou, Faidra
ea7e7a54-092d-4baf-8b18-e0d62c47b878
Patel, Harnish P.
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Fuggle, Nicholas
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Ward, Kate A.
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Bevilacqua, Gregorio
e93e3b18-7d1e-4da5-9fcd-e6b4637e1c2e
Westbury, Leo D.
5ed45df3-3df7-4bf9-bbad-07b63cd4b281
8 February 2026
Dennison, Elaine M.
ee647287-edb4-4392-8361-e59fd505b1d1
Laskou, Faidra
ea7e7a54-092d-4baf-8b18-e0d62c47b878
Patel, Harnish P.
e1c0826f-d14e-49f3-8049-5b945d185523
Fuggle, Nicholas
9ab0c81a-ac67-41c4-8860-23e0fdb1a900
Ward, Kate A.
39bd4db1-c948-4e32-930e-7bec8deb54c7
Bevilacqua, Gregorio
e93e3b18-7d1e-4da5-9fcd-e6b4637e1c2e
Westbury, Leo D.
5ed45df3-3df7-4bf9-bbad-07b63cd4b281
Dennison, Elaine M., Laskou, Faidra, Patel, Harnish P., Fuggle, Nicholas, Ward, Kate A., Bevilacqua, Gregorio and Westbury, Leo D.
(2026)
Diet quality trajectories and musculoskeletal health among the oldest old: Findings from the Hertfordshire Cohort Study.
Nutrients, 18 (4).
(doi:10.3390/nu18040569).
Abstract
Background: few studies have examined changes in diet quality into old age, and related these changes to musculoskeletal outcomes. We examined this among Hertfordshire Cohort Study participants.
Methods: in total, 178 individuals provided diet quality scores derived in 1998–2004, 2011 and 2017 (median age 64.0, 74.7 and 80.7) using principal component analysis of food frequency questionnaires; higher scores indicated healthier diets (more fruit and vegetables, oily fish and wholemeal bread, and less white bread, added sugar, full-fat dairy products, chips and processed meat). Pearson correlations between diet quality scores at each time-point were computed. Group-based trajectory modelling of diet quality scores was implemented; trajectory groups as predictors of musculoskeletal outcomes (history of hip/knee replacement, osteoporosis, fall in previous year, low grip strength, low gait speed) in 2017 were examined using logistic regression with age and sex included as covariates.
Results: diet quality showed moderate stability over time (0.64 < r < 0.74). Three trajectory groups were identified: low (29%), medium (51%), and high diet quality (20%). A higher diet quality group was related to greater odds (95% CI) of hip/knee replacement (1.85 (1.05, 3.26) per higher category); associations with other musculoskeletal outcomes were weak (p > 0.17).
Conclusions: weak associations were observed between diet quality trajectories and musculoskeletal outcomes. However, higher diet quality was related to increased likelihood of hip/knee joint replacement, potentially due to confounding by socioeconomic position. The stability of diet quality suggests individuals with poorer diets around age 65 are likely to maintain these patterns into old age and may benefit from targeted interventions.
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Accepted/In Press date: 24 January 2026
Published date: 8 February 2026
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Local EPrints ID: 509900
URI: http://eprints.soton.ac.uk/id/eprint/509900
ISSN: 2072-6643
PURE UUID: 71f6246f-aecb-4e68-a417-f0663b3a1ff5
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Date deposited: 10 Mar 2026 17:51
Last modified: 11 Mar 2026 03:05
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Author:
Faidra Laskou
Author:
Harnish P. Patel
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Gregorio Bevilacqua
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