Adherence to the Eatwell Guide and associations with markers of physical function: A prospective analysis within the UK Biobank cohort

Abstract

Background: The Eatwell Guide represents the UKs principal healthy eating model and understanding whether adherence to UK dietary recommendations can attenuate age-related functional decline is essential to inform healthy ageing strategies. Methods: In up to 157,457 participants from the UK Biobank, we explored cross-sectional and prospective associations between adherence to the Eatwell Guide and markers of physical function (grip strength, fat-free mass percentage, self-reported walking pace, and falls). Eatwell Guide adherence scores were derived from 24-hour dietary recall data (Oxford WebQ), and quantified using a graded, food-based scoring system. Differences between population subgroups including by age, sex, physical activity, and protein intake level were explored. Results: Higher Eatwell Guide adherence was cross-sectionally associated with higher grip strength, greater fat-free mass percentage, higher odds of brisk walking pace, and lower odds of falls (all p<0.001). Prospectively, greater adherence was associated with attenuated fat-free mass decline ({beta}=0.02, SE=0.001, p<0.001) and slower grip strength decline ({beta}=0.01, SE=0.002, p<0.01). Higher adherence was also prospectively associated with greater odds of brisk walking pace (OR=1.02, 95% CI: 1.017-1.021, p<0.01), though this advantage attenuated over follow-up (EWG*Time: OR=0.998, 95% CI: 0.997-0.999, p=0.002). Higher adherence was prospectively associated with lower falls risk (OR=0.996, 95% CI: 0.995-0.998, p<0.001), with this protective association remaining stable over time (EWG*Time: p=0.89). Conclusions: Higher Eatwell Guide adherence was associated with preserved muscle mass, modest attenuation of grip strength decline over time, and a reduced risk of falls, supporting its relevance for musculoskeletal health and physical function in ageing populations. Key words: Diet, Muscle mass, Grip Strength