Zhang HuanRui, Tian Wen, Qi GuoXian, Zhou BaoSen, Sun YuJiao
Department of Geriatric, The First Hospital of China Medical University, No. 155 Nanjing North Street, Heping Ward, Shenyang, 110001, China.
Department of Clinical Epidemiology and Evidence-Based Medicine, The First Hospital of China Medical University, No. 155 Nanjing North Street, Heping Ward, Shenyang, 110001, China.
Nutr J. 2025 Sep 7;24(1):135. doi: 10.1186/s12937-025-01201-w.
This study analyzed data from the US population to examine how oral microbiome diversity and diet quality individually and synergistically affect frailty.
This study included 6,283 participants aged 20 years or older from the 2009-2010 and 2011-2012 NHANES cycles. A frailty index (FI) consisting of 36 items was developed, with items related to nutritional status excluded. The diversity of the oral microbiome was assessed using α-diversity, including observed ASVs, the Shannon-Weiner index, Faith's phylogenetic diversity (PD), and the Simpson index. Dietary quality was assessed using Dietary Inflammatory Index (DII), Dietary Approaches to Stop Hypertension (DASH), Mediterranean Diet Score (MED), and Alternate Healthy Eating Index (AHEI). Multivariable logistic models were employed to examine the separate and combined associations of oral microbiome diversity and four dietary quality scores with FI, with interaction effects were explored. Several subgroup analyses and sensitivity analyses were conducted to assess the robustness of our findings. Furthermore, the mediation analysis was used to explore oral microbiome diversity as a mediator in the relationship between dietary scores and FI.
Both oral microbiome diversity and dietary quality scores showed significant individual associations with FI. Jointly, those in the highest tertile of oral microbiome diversity and the lowest tertile of DII had lower FI [β (95% CI) = -2.544(-3.678,-1.411); β (95% CI) = -2.688(-3.783,-1.593); β (95% CI) = -2.359(-3.333,-1.386); β (95% CI) = -1.93(-2.879,-0.981)], compared to participants in the lowest tertile of oral microbiome diversity and the highest tertile of DII. A significant interaction between oral microbiome diversity (Observed ASVs and Faith's PD) and DII in relation to FI reduction was found (P for interaction = 0.032, P for interaction = 0.014). Other dietary scores showed similar joint associations of oral microbiome diversity with FI, but no significant interactions were observed. Further mediation analysis indicated that the proportion of DII's effect on FI mediated through Observed ASVs, Faith's PD, and the Shannon-Weiner index was 8.7%, 7.5%, and 3.4%, respectively.
This study demonstrates that a high-quality diet and greater α-diversity of oral microbiota are significantly associated with a reduced risk of frailty. Notably, the interaction between DII and the diversity of the oral microbiota exerts a particularly substantial influence on frailty risk.
本研究分析了美国人群的数据，以探讨口腔微生物群多样性和饮食质量如何单独及协同影响衰弱。
本研究纳入了2009 - 2010年和2011 - 2012年美国国家健康与营养检查调查（NHANES）周期中6283名20岁及以上的参与者。开发了一个由36项组成的衰弱指数（FI），排除了与营养状况相关的项目。使用α多样性评估口腔微生物群的多样性，包括观察到的扩增子序列变异（ASVs）、香农 - 韦纳指数、费思系统发育多样性（PD）和辛普森指数。使用饮食炎症指数（DII）、终止高血压饮食方法（DASH）、地中海饮食评分（MED）和替代健康饮食指数（AHEI）评估饮食质量。采用多变量逻辑模型来检验口腔微生物群多样性和四个饮食质量评分与FI的单独及联合关联，并探索交互作用。进行了多项亚组分析和敏感性分析以评估我们研究结果的稳健性。此外，中介分析用于探索口腔微生物群多样性在饮食评分与FI关系中的中介作用。
口腔微生物群多样性和饮食质量评分均与FI显示出显著的单独关联。共同来看，口腔微生物群多样性处于最高三分位数且DII处于最低三分位数的参与者，其FI较低[β（95%置信区间）= -2.544（-3.678，-1.411）；β（95%置信区间）= -2.688（-3.783，-1.593）；β（95%置信区间）= -2.359（-3.333，-1.386）；β（95%置信区间）= -1.93（-2.879，-0.981）]，相比之下，口腔微生物群多样性处于最低三分位数且DII处于最高三分位数的参与者。发现口腔微生物群多样性（观察到的ASVs和费思的PD）与DII在降低FI方面存在显著交互作用（交互作用P = 0.032，交互作用P = 0.014）。其他饮食评分显示出与FI类似的口腔微生物群多样性联合关联，但未观察到显著交互作用。进一步的中介分析表明，DII对FI的影响通过观察到的ASVs、费思的PD和香农 - 韦纳指数介导的比例分别为8.7%、7.5%和3.4%。
本研究表明，高质量饮食和口腔微生物群更高的α多样性与降低衰弱风险显著相关。值得注意的是，DII与口腔微生物群多样性之间的相互作用对衰弱风险产生了特别显著的影响。
