Do YoungJoo

Gyeongsang National University College of Nursing, South Korea

Abstract Title: Unpacking the Nutrition-Frailty Pathway: Appetite and Physical Function as Sequential Mediators Linking Nutritional Status to Intrinsic Capacity in Urban-Rural Older Adults

Biography:

Juhee Seo is a doctoral student in Nursing at Gyeongsang National University, South Korea. She is a researcher on the DREAMS (Digital Rural-urban Ecosystem for Active Management & Successful Aging) project funded by the National Research Foundation of Korea, which aims to develop and implement innovative digital-based approaches to support active management and successful aging across rural and urban settings.
Heekyung Chang is a professor of Nursing at Gyeongsang National University, South Korea, and serves as the principal investigator of the DREAMS project.
Minji Park and Youngjoo Do are doctoral students in Nursing and researchers on the DREAMS project, contributing substantially to study design, data collection, and data analysis.

Research Interest:

Background: Poor nutritional status predicts frailty in older adults, yet the sequential mechanisms remain unclear. Purpose: This study tested appetite, physical function, and intrinsic capacity as sequential mediators in the nutrition–frailty pathway and compared these mechanisms between urban and rural older adults. Methods: A cross-sectional study included 464 community-dwelling older adults (urban n = 268; rural n = 196) in South Korea. Serial mediation was tested using PROCESS macro(Model 6) with 10,000 bias-corrected bootstrap samples, adjusting for covariates. Multi-group structural equation modeling compared pathway coefficients between residential contexts. Results: The total effect of nutritional status on frailty was significant (β = −0.164, 95% CI [−0.214, −0.114]), with 57.9% mediated indirectly. Appetite emerged as a gateway mediator: the X → M1 → Y (β = −0.040, 24.4%), X → M3 → Y (β = −0.031, 18.9%), and serial X → M1 → M3 → Y (β = −0.020, 12.2%) pathways were significant, while physical function did not independently mediate. Multi-group analysis revealed comparable total effects across settings (urban β = −0.111 vs. rural β = −0.127, p = .74) but qualitatively distinct mechanisms. Urban older adults exhibited a multi-step cascade with all path coefficients significant, whereas rural older adults showed a shortened, appetite-dominant pathway with non-significant M1 → M2 and M2 → M3 links. All four individual path coefficients differed significantly between groups (p = .001–.041). Conclusions: Appetite functions as an upstream gateway initiating frailty. Equivalent nutritional risk produces equivalent frailty outcomes through distinct mechanisms—a cumulative cascade in urban versus an appetite-dominant pathway in rural settings—warranting context-tailored prevention strategies prioritizing appetite screening.

Keywords: Frailty; Nutritional status; Appetite; Intrinsic capacity; Older adults