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Li Y, Xia X, Wu W, Tian X, Hu Y, Dong B, Wang Y. The Mediating Effects of Nutritional Status on the Relationship between Number of Residual Teeth and Cognitive Function among Older Adults: A Cross-Sectional Multicenter Study. Nutrients 2023; 15:3089. [PMID: 37513507 PMCID: PMC10384863 DOI: 10.3390/nu15143089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 07/07/2023] [Accepted: 07/08/2023] [Indexed: 07/30/2023] Open
Abstract
The underlying mechanisms of the relationship between the number of teeth and cognition is still unclear. We aimed to construct a mediation model between the number of residual teeth and cognitive function, using nutritional status as a mediating factor. This study was completed using the West China Health and Aging Trend cohort. A total of 6634 multi-ethnic older adults, aged 50 years or older, were included. This study measured cognitive function using the Short-Portable Mental Status Questionnaire, and nutritional status was assessed using the Mini Nutritional Assessment-Short Form. The mediation analysis examined the potential mediating role of nutritional status. The pathway analysis was supplemented and validated using the structural equation modelling framework. Multiple linear regression demonstrated that a higher number of residual teeth was correlated with enhanced cognitive function (β = -0.15; 95% CI: -0.19 to -0.111). The mediation model, from the number of residual teeth to cognitive impairment, was partially mediated by nutritional status (β = -0.0608; 95% CI: -0.0762 to -0.0461). The proportion of the mediating effect, expressed as a percentage, was 40.66%. Furthermore, the estimated coefficients for the number of residual teeth and nutritional status varied across ethnic groups. This study indicated that enhancing the nutrition of older adults could reduce the adverse effects of the number of residual teeth on cognitive function among older adults.
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Affiliation(s)
- Yun Li
- West China School of Nursing, West China Hospital, Sichuan University, Chengdu 610041, China; (Y.L.); (Y.H.)
| | - Xin Xia
- National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu 610041, China;
| | - Wenwen Wu
- West China School of Nursing, Innovation Center of Nursing Research, Nursing Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu 610041, China;
| | - Xin Tian
- West China School of Nursing, West China Hospital, Sichuan University, Chengdu 610041, China; (Y.L.); (Y.H.)
| | - Yuexia Hu
- West China School of Nursing, West China Hospital, Sichuan University, Chengdu 610041, China; (Y.L.); (Y.H.)
| | - Birong Dong
- National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu 610041, China;
| | - Yanyan Wang
- Nursing Key Laboratory of Sichuan Province, National Clinical Research Center for Geriatrics, Science and Technology Department, West China Hospital, Sichuan University, Chengdu 610041, China
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Luo H, Wu B, González H, Stickel A, Kaste L, Tarraf W, Daviglus M, Sanders A, Cai J. Tooth Loss, Periodontal Disease, and Mild Cognitive Impairment Among Hispanic/Latino Immigrants: The Moderating Effects of Age at Immigration. J Gerontol A Biol Sci Med Sci 2023; 78:949-957. [PMID: 36049219 PMCID: PMC10235192 DOI: 10.1093/gerona/glac178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The objectives were to assess (a) the association between poor oral health and mild cognitive impairment (MCI) in Hispanic/Latino immigrants and (b) potential modification effects on this association by age at immigration. METHODS Data were from the Hispanic Community Health Study/Study of Latinos and its ancillary study-the Study of Latinos-Investigation of Neurocognitive Aging. MCI, a binary outcome variable, defined by the National Institute on Aging-Alzheimer's Association criteria. The main exposure was significant tooth loss (STL), defined as a loss of 8 or more teeth, and periodontitis, classified using the Centers for Disease Control and Prevention and American Academy of Periodontology case classification. Multiple logistic regression was used to assess the association between STL/periodontitis and MCI and test moderation effects of age at immigration. The analytical sample comprised 5 709 Hispanic/Latino adult immigrants. RESULTS Hispanic/Latino immigrants with STL (adjusted odds ratio [AOR] = 1.36, 95% confidence interval [CI]: 1.01-1.85) were more likely to have MCI than those with greater tooth retention. Overall, migration to the United States after age 18 was associated with greater odds of MCI than migration at a younger age. A significant interaction effect between STL and age at immigration revealed that the effect of STL on MCI is even higher in those who immigrated to the United States at ages 35-49 years. CONCLUSIONS STL is a significant risk factor for MCI and age at immigration had a modification effect on the association between STL and MCI. Better access to dental care, health education on risk factors of MCI, and promotion of good oral health may mitigate the burden of cognitive impairment in Hispanics/Latinos.
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Affiliation(s)
- Huabin Luo
- Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, North Carolina, USA
| | - Bei Wu
- Rory Meyers College of Nursing, New York University, New York City, New York, USA
| | - Hector M González
- Department of Neurosciences and Shiley-Marcos Alzheimer’s Disease Research Center, University of California, San Diego, San Diego, California, USA
| | - Ariana Stickel
- Department of Neurosciences, University of California, San Diego, San Diego, California, USA
| | - Linda M Kaste
- Department of Pediatric Dentistry, College of Dentistry, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Wassim Tarraf
- Department of Healthcare Sciences, Wayne State University, Institute of Gerontology, Detroit, Michigan, USA
| | - Martha L Daviglus
- Institute for Minority Health Research, University of Illinois at Chicago, College of Medicine, Chicago, Illinois, USA
| | - Anne E Sanders
- Division of Pediatric and Public Health, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jianwen Cai
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Chen HM, Li KY, Li TL, Kwong EYL, Wong GHY, McGrath C, Chen H. The Association between Tooth Loss and Cognitive Decline in the Aged Population: the Mediating Role of HDL-cholesterol. J Dent 2023:104570. [PMID: 37263408 DOI: 10.1016/j.jdent.2023.104570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/19/2023] [Accepted: 05/30/2023] [Indexed: 06/03/2023] Open
Abstract
OBJECTIVE Tooth loss and its impact on cognitive impairment have become a heated topic over the past decade as the global population continues to age. Despite the proliferation of research in this area, the underlying mechanism linking tooth loss and cognitive decline remains poorly understood. Limited investigation has been conducted to explore the potential role of lipid metabolism and its impact on the association between tooth loss and cognitive function. This study endeavored to identify the role of high-density lipoprotein cholesterol (HDL-C) concentration among older adults and its contribution to the link between tooth loss and cognitive impairment. METHODS Data were retrieved from a public database, namely, the National Health and Nutrition Examination Survey (NHANES). Among 1,124 included participants who were aged above 60 years old, linear regression was performed to determine the association between tooth loss (moderate and severe tooth loss) and cognitive function [Consortium to Establish a Registry for Alzheimer's Disease-Immediate Recall (CERAD-IR), Delayed Recall (CERAD-DR), Animal Fluency Test (AFT), and Digit Symbol Substitution Test (DSST)]. Mediation analysis was used to test the effect of HDL-C on the association of tooth numbers and four cognitive tests. RESULTS Participants with moderate and severe tooth loss had lower scores on cognitive performance (p<0.001) and lower levels of HDL-C (p<0.05). The HDL-C levels were highly correlated with CERAD-IR and DSST, which mediated 2.11% to 5.24% of the total effect between tooth numbers and cognitive function. CONCLUSION Tooth loss was negatively associated with cognitive function which was mediated by serum HDL-C levels.
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Affiliation(s)
- Hui Min Chen
- Department of Restorative Dental Sciences, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, PR China
| | - Kar Yan Li
- Clinical Research Centre, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, PR China
| | - Tian Le Li
- Department of Restorative Dental Sciences, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, PR China
| | - Elaine Yee Lan Kwong
- Department of Chinese and Bilingual Studies, The Hong Kong Polytechnic University; Research Institute for Smart Ageing, The Hong Kong Polytechnic University
| | - Gloria Hoi Yan Wong
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong SAR, PR China
| | - Colman McGrath
- Department of Dental Public Health, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China.
| | - Hui Chen
- Department of Restorative Dental Sciences, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, PR China.
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Dental Prosthetic Rehabilitation Interventions in Elderly Patients Hospitalized in the Nursing Homes of the Lombardy Region: A Retrospective Study. Healthcare (Basel) 2022; 10:healthcare10112328. [DOI: 10.3390/healthcare10112328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 11/14/2022] [Accepted: 11/16/2022] [Indexed: 11/22/2022] Open
Abstract
Background: The difficulty of frail, non-self-sufficient or non-ambulatory collaborating elderly residents in nursing homes to eat due to a lack of teeth or the absence of a dental prosthesis leads to an increasingly evident increase in the patients’ systemic pathological state, particularly in older patients who take a lot of medications. Total or partial edentulousness that is not filled with dental prostheses or that is filled with inadequate prostheses, associated with socioeconomic factors, depression, impaired motor functions, heart disease and a large number of chronic diseases including excessive use of drugs, often affects elderlies’ feeding. Aim: In this study, prosthetic rehabilitation was performed on some frail elderly residents in 10 nursing homes in the Lombardy district, and, subsequently, meal behavior and social activity were examined in two information questionnaires through compilation. Methods: The research was conducted on only 67 patients, 26 men and 41 women, aged between 75 and 99, who were guests in 10 health facilities (nursing homes) in the Lombard district; only 8 residents did not undergo prosthetic rehabilitation, as they did not cooperate. All the patients who were visited underwent oral prosthetic rehabilitation, and, subsequently, some aspects such as nutrition and socialization were assessed with other residents through the aid of two information dossiers. Results: the results showed that all the residents, despite difficulties in chewing with the new prosthesis, were fed and did not refuse more consistent foods; in addition, there was an improvement in social activity among the residents. Only 19.3% of men and 22% of women continued to eat little; there was an improvement in the participation in social activities among the residents, with a percentage of 73% of men and 88% of women; in particular, during meals 35 residents conversed with the other residents. Discussion: The dental problems of elderly people residing in social welfare homes are increasingly evident when other systemic pathologies are present. It would be desirable to introduce telemedicine in residences for the elderly for the monitoring of dental problems. Conclusions: From the information obtained and from the evaluation of the change in the elderly, it can be concluded that it would be desirable to include specific dental protocols to create a network, including a telematic one, to monitor and perform more dental checks in nursing homes.
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Ueno Y, Iwasaki M, Kimura Y, Kakuta S, Masaki C, Wada T, Sakamoto R, Ishimoto Y, Fujisawa M, Okumiya K, Ansai T, Matsubayashi K, Hosokawa R. Periodontal status is associated with oral function in community-dwelling older adults, independent of dentition status. J Periodontal Res 2022; 57:1139-1147. [PMID: 36059203 DOI: 10.1111/jre.13051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 08/10/2022] [Accepted: 08/22/2022] [Indexed: 10/14/2022]
Abstract
OBJECTIVE To determine whether periodontal status is associated with oral function, including masticatory performance and occlusal force, among community-dwelling older adults. BACKGROUND Although a potential association between periodontal status and oral function has been reported, variations in the root surface area (RSA) of each tooth have not been considered. METHODS We used data from a population-based study involving community-dwelling older adults. The RSA with periodontal ligament (RSA-PL), which quantifies the RSA attached to the periodontal ligament and alveolar bone, was calculated based on full-mouth periodontal examination. Masticatory performance was assessed using spectrophotometric measurement of the color (a* value) of color-changing chewing gum. The bilateral maximal occlusal force (MOF) was measured using a pressure-sensitive sheet and dedicated software. The associations of the RSA-PL, a quantitative marker of periodontal tissue support, with the a* value and MOF were assessed using linear regression models. RESULTS The analyses included data from 250 adults [60.8% women; age, mean (standard deviation) 82.5 (5.0) years]. On average, the study participants had an RSA-PL of 26.3 cm2 , a* value of 25.0, and an MOF value of 555.1 N. After adjustments for potential confounders, including dentition status, age, sex, dental visit regularity, smoking status, physical activity level, depressive symptoms, a history of stroke or diabetes mellitus, and body mass index, the RSA-PL was found to be associated with the a* value [coefficient (per 1 cm2 increase): 0.16, 95% confidence interval (CI) 0.10-0.22)] and MOF (coefficient: 9.2, 95% CI 5.3-13.1). CONCLUSION This study demonstrated that greater amounts of remaining tooth-supporting structures, indicated by higher RSA-PL values, were associated with better masticatory performance and a higher occlusal force among community-dwelling older adults.
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Affiliation(s)
- Yui Ueno
- Division of Oral Reconstruction and Rehabilitation, Kyushu Dental University, Kitakyushu City, Japan
| | | | - Yumi Kimura
- Graduate School of Human Sciences, Osaka University, Suita City, Japan
| | - Satoko Kakuta
- Division of Community Oral Health Development, Kyushu Dental University, Kitakyushu City, Japan
| | - Chihiro Masaki
- Division of Oral Reconstruction and Rehabilitation, Kyushu Dental University, Kitakyushu City, Japan
| | - Taizo Wada
- Center for Southeast Asian Studies, Kyoto University, Kyoto City, Japan
| | - Ryota Sakamoto
- Center for Southeast Asian Studies, Kyoto University, Kyoto City, Japan
| | - Yasuko Ishimoto
- Department of Health and Sports Science, Faculty of Health Science and Technology, Kawasaki University of Medical Welfare, Kitakyushu City, Japan
| | - Michiko Fujisawa
- Center for Southeast Asian Studies, Kyoto University, Kyoto City, Japan
| | - Kiyohito Okumiya
- Center for Southeast Asian Studies, Kyoto University, Kyoto City, Japan
| | - Toshihiro Ansai
- Division of Community Oral Health Development, Kyushu Dental University, Kitakyushu City, Japan
| | - Kozo Matsubayashi
- Center for Southeast Asian Studies, Kyoto University, Kyoto City, Japan
| | - Ryuji Hosokawa
- Division of Oral Reconstruction and Rehabilitation, Kyushu Dental University, Kitakyushu City, Japan
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