Abstract
ABSTRACT
Objectives
To quantify how much of the association between tooth loss and cognitive performance is statistically attributable to dietary quality.
Methods
Cross‐sectional causal mediation analysis of 2600 adults aged 60–80 years (NHANES 2011–2014). Functional tooth loss (z
‐score (processing speed, episodic memory, semantic fluency) the outcome. Survey‐weighted models estimated the total effect; mediation quantities were estimated from unweighted models with 1000 bootstrap replicates.
Results
Severe tooth loss was associated with lower cognitive
z
‐scores (survey‐weighted
β
= −0.167 SD; 95% CI: −0.226, −0.107) and lower dietary quality (−2.8 HEI‐2020 points; 95% CI: −3.7, −2.0). Dietary quality accounted for 8.9% of the association (95% CI: 3.8%–16.9%). The mediated effect was small in absolute terms (−0.012 SD, ≈0.2 Digit Symbol points) and fragile: it would be nullified by unmeasured mediator–outcome confounding only 1.5 times that implied by race/ethnicity, and was of borderline significance after periodontal adjustment in the dentate subsample (7.7%; 95% CI: 0.1%–32.6%;
p
= 0.047).
Conclusions
Dietary quality accounted for a small share of the cross‐sectional tooth loss–cognition association. Because exposure, mediator, and outcome were measured contemporaneously and the estimate was sensitive to plausible confounding, these findings are consistent with—but do not establish—a dietary mediating pathway. The robust association between tooth loss and poorer diet nonetheless supports nutritional screening in dental care of older adults.