Du Mi, Deng Ke, Yin Jiawei, Wu Chenkai, Hu Shixian, Guo Linxu, Luo Zhixin, Tonetti Maurizio, Tjakkes Geerten-Has E, Visser Anita, Ge Shaohua, Li An
School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Provincial Clinical Research Center for Oral Diseases, Jinan, China.
Division of Periodontology and Implant Dentistry, Faculty of Dentistry, The University of Hong Kong, Pok Fu Lam, Hong Kong SAR, China.
J Clin Periodontol. 2025 May;52(5):695-706. doi: 10.1111/jcpe.14122. Epub 2025 Jan 12.
Masticatory dysfunction due to tooth loss is a potentially modifiable risk for mortality, but the pathway behind that remains to be investigated. This prospective study aimed to examine the role of diet and ageing in the associations between chewing capacity and long-term mortality.
Data were obtained from participants (aged ≥ 20) in the National Health Nutritional and Health Survey (NHANES 1999-2010, n = 22,900). The mortality follow-up ended on 31 December 2019. Chewing capacity was determined by the number of functional tooth units (FTUs). Diet information in NHANES was collected using a 24-h-recall questionnaire, and diet quality was measured by three index-based dietary patterns, namely the nutrition index (NI), energy-adjusted dietary inflammatory index (E-DII) and healthy eating index-2015 (HEI-2015). The biological ageing process was reflected using phenotypic age acceleration (PhenoAgeAccel) and frailty index. Mediation analyses were conducted to assess the role of diet quality in the association between FTUs and ageing, as well as the role of ageing in the association between impaired chewing capacity (ICC) and mortality.
Participants with more FTUs were found to have a slower biological ageing process. Diet quality scores were estimated to mediate 9.0%-23.0% of the association between chewing capacity and biological ageing. Multivariable Cox proportional hazards regression models found a positive association between ICC and all-cause mortality (hazard ratio = 1.282 [95% confidence interval: 1.189-1.382]). Also, ICC was significantly associated with a 28.9% higher risk of mortality due to cardiovascular disease (CVD) and a 32.7% higher risk of mortality due to cancer. Mediation analyses indicated that PhenoAgeAccel mediated the effect of ICC on all-cause, CVD and cancer mortality with proportions of 18.1%, 17.3% and 12.5%, respectively. Similar mediating proportions were observed in the frailty index (range: 11.6%-23.5%).
ICC was associated with poorer diet quality and accelerated ageing, resulting in higher mortality risk. Therefore, it is plausible that dietary interventions and oral rehabilitation would promote healthy longevity, although further investigations are needed.
牙齿缺失导致的咀嚼功能障碍是一种潜在的可改变的死亡风险，但其背后的机制仍有待研究。这项前瞻性研究旨在探讨饮食和衰老在咀嚼能力与长期死亡率之间的关联中所起的作用。
数据来自美国国家健康与营养检查调查（NHANES 1999 - 2010，n = 22,900）中年龄≥20岁的参与者。死亡率随访于2019年12月31日结束。咀嚼能力通过功能性牙单位（FTU）的数量来确定。NHANES中的饮食信息通过24小时回忆问卷收集，饮食质量通过三种基于指数的饮食模式来衡量，即营养指数（NI）、能量调整饮食炎症指数（E - DII）和健康饮食指数 - 2015（HEI - 2015）。使用表型年龄加速（PhenoAgeAccel）和衰弱指数来反映生物衰老过程。进行中介分析以评估饮食质量在FTU与衰老之间关联中的作用，以及衰老在咀嚼能力受损（ICC）与死亡率之间关联中的作用。
发现FTU数量较多的参与者生物衰老过程较慢。估计饮食质量得分在咀嚼能力与生物衰老之间的关联中起到9.0% - 23.0%的中介作用。多变量Cox比例风险回归模型发现ICC与全因死亡率之间存在正相关（风险比 = 1.282 [95%置信区间：1.189 - 1.382]）。此外，ICC与心血管疾病（CVD）导致的死亡风险显著高28.9%以及癌症导致的死亡风险高32.7%显著相关。中介分析表明，PhenoAgeAccel分别以18.1%、17.3%和12.5%的比例介导了ICC对全因、CVD和癌症死亡率的影响。在衰弱指数中也观察到类似的中介比例（范围：11.6% - 23.5%）。
ICC与较差的饮食质量和加速衰老相关，导致更高的死亡风险。因此，饮食干预和口腔修复可能促进健康长寿，尽管还需要进一步研究。
