Background: Frailty significantly impacts healthy aging, yet lifestyle interventions may reduce its prevalence. This study investigated the association between a comprehensive lifestyle score, comprising eight modifiable factors (diet, physical activity, smoking, sleep, body mass index [BMI], non-HDL cholesterol, blood glucose, and blood pressure), and frailty risk in older adults, identifying key components for targeted interventions.

Using data from the National Health and Nutrition Examination Survey (NHANES, 2005–2018), we analyzed 10,065 adults aged ≥60 years (mean age: 69.61, 54.97 % female). Each lifestyle factor was scored from 0 to 100, and frailty was defined using a 49-item index (>0.21). Weighted logistic regression assessed individual associations, restricted cubic spline (RCS) analysis explored dose-response relationships, and quantile g-computation evaluated joint effects.

Higher scores for dietary score (OR=0.69, 95 % CI: 0.52–0.90, score 100 vs. 0), non-smoking (OR=0.62, 95 % CI: 0.51–0.75), sleep (OR=0.29, 95 % CI: 0.17–0.49), blood glucose (OR=0.27, 95 % CI: 0.17–0.44), and blood pressure (OR=0.43, 95 % CI: 0.30–0.61, score 25 vs. 0) were associated with lower frailty risk (all P < .05). Diet and non-HDL cholesterol showed no linear association; smoking, BMI, blood glucose, and blood pressure exhibited non-linear patterns (P<.05). A simultaneous one-level increase in all lifestyle factors reduced frailty risk by 94 % (95 % CI: 92–95 %), with physical activity, blood glucose, and sleep as primary contributors.

These findings highlighted the association between specific lifestyle factors and reduced frailty risk, underscoring the need for prospective studies to prioritize interventions for frailty prevention.