Oral Health, Diet, and Frailty at Baseline of the Canadian Longitudinal Study on Aging

Abstract

OBJECTIVES: Poor diet due to poor oral health was proposed as a potential mediator of the association between poor oral health and frailty. This study explores the cross-sectional associations between poor oral health, poor diet, and frailty in Canadian adults, aged 45 to 85 years, and then tests whether the expected oral health-frailty association is changed by taking into account the pathway through poor diet. DESIGN: Cross-sectional study. SETTING: The baseline wave of the Canadian Longitudinal Study on Aging, a nationally representative population study. PARTICIPANTS: Data from 28 738 community-dwelling participants, aged 45 to 85 years. MEASUREMENTS: We characterized poor oral health (cumulative count of 24 items of oral health problems), poor diet (scale of poor food consumption from 7 healthy foods groups), and frailty (cumulative frailty index of 76 items). Regression-based path analyses were used to investigate associations between poor oral health, poor diet, and frailty, adjusted for age group, sex, income, smoking, living alone, education, physical activity, social support, and dental visit. RESULTS: Poorer oral health was associated with low income, smoking, low physical activity, low social support, and no dental visit. There were associations between poorer oral health and poorer diet (effect size β adjusted = .40; 95% confidence interval [CI] = .20-.61) and between poorer oral health and increased frailty (β adjusted = .85; 95% CI = .68-1.02). The indirect effect through the path of poor diet was approximately 0.01 (95% CI = 0.01-0.02) (ie, explaining 1% of the effect of poor oral health on frailty). CONCLUSIONS: Poor oral health was associated with poor diet and frailty. Each additional oral health problem was associated with an increase of approximately 1 frailty index point, even after full adjustment for poor diet. The indirect effect of poor oral health through poor diet was modest. Though poor oral health was associated with poorer diet quality, a more direct effect of poor oral health on increasing frailty may be indicated. J Am Geriatr Soc 68:959-966, 2020.

Self‐rated oral health and frailty index among older Americans

“…Previous studies that assessed the association between oral health and frailty index used a self-reported number of teeth, 21 and the count of self-reported oral health problems. 22 Both studies found significant associations with frailty index.…”

“…To our knowledge, this is the first study to assess the association between self‐rated oral health and frailty index among older adults using a national representative sample. Previous studies that assessed the association between oral health and frailty index used a self‐reported number of teeth, 21 and the count of self‐reported oral health problems 22 . Both studies found significant associations with frailty index.…”

“…The most plausible mechanism that links oral health and frailty is the nutritional pathway, as oral health has a great impact on food selection, nutritional intake and ultimately nutritional status. 9 Previous reports found that poor diet (based on the consumption of essential food groups) 22 and inadequate nutritional intake (based on micronutrient intake) 23 have modest mediating effects on the association between oral health and frailty index.…”

“…The most plausible mechanism that links oral health and frailty is the nutritional pathway, as oral health has a great impact on food selection, nutritional intake and ultimately nutritional status 9 . Previous reports found that poor diet (based on the consumption of essential food groups) 22 and inadequate nutritional intake (based on micronutrient intake) 23 have modest mediating effects on the association between oral health and frailty index. In a previous report, we demonstrated that clinical indicators of oral health namely, number of teeth and, to a lesser degree, periodontal disease are associated with frailty index among older Americans after adjusting for inadequate nutritional intake and important covariates similar to the results observed with self‐rated oral health in this study 23 .…”

A Two-Year Longitudinal Study of the Association between Oral Frailty and Deteriorating Nutritional Status among Community-Dwelling Older Adults

“…Previous studies have demonstrated that older adults with poor oral health had less intake of proteins, vitamins, and fiber [6,37,38]. In addition, poor oral health has been associated with poor diet quality [39] and a less varied diet [40]. Poor quantity and quality of diet can contribute to malnutrition [41].…”