{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T09:56:36Z","timestamp":1791280596149,"version":"4.1.0"},"reference-count":28,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T00:00:00Z","timestamp":1791244800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T00:00:00Z","timestamp":1791244800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Public Health Dent"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To quantify how much of the association between tooth loss and cognitive performance is statistically attributable to dietary quality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Cross\u2010sectional causal mediation analysis of 2600 adults aged 60\u201380\u2009years (NHANES 2011\u20132014). Functional tooth loss (&lt;\u200920 natural teeth) was the exposure, dietary quality (Healthy Eating Index 2020; HEI\u20102020) the mediator, and a composite cognitive\n                      <jats:italic>z<\/jats:italic>\n                      \u2010score (processing speed, episodic memory, semantic fluency) the outcome. Survey\u2010weighted models estimated the total effect; mediation quantities were estimated from unweighted models with 1000 bootstrap replicates.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Severe tooth loss was associated with lower cognitive\n                      <jats:italic>z<\/jats:italic>\n                      \u2010scores (survey\u2010weighted\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u2009=\u2009\u22120.167 SD; 95% CI: \u22120.226, \u22120.107) and lower dietary quality (\u22122.8 HEI\u20102020 points; 95% CI: \u22123.7, \u22122.0). Dietary quality accounted for 8.9% of the association (95% CI: 3.8%\u201316.9%). The mediated effect was small in absolute terms (\u22120.012 SD, \u22480.2 Digit Symbol points) and fragile: it would be nullified by unmeasured mediator\u2013outcome 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%\u201332.6%;\n                      <jats:italic>p<\/jats:italic>\n                      = 0.047).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Dietary quality accounted for a small share of the cross\u2010sectional tooth loss\u2013cognition association. Because exposure, mediator, and outcome were measured contemporaneously and the estimate was sensitive to plausible confounding, these findings are consistent with\u2014but do not establish\u2014a dietary mediating pathway. The robust association between tooth loss and poorer diet nonetheless supports nutritional screening in dental care of older adults.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jphd.70087","type":"journal-article","created":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T09:33:46Z","timestamp":1791279226000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Dietary Quality and the Association Between Tooth Loss and Cognitive Performance in Older Adults: A Causal Mediation Analysis of\n                    <scp>NHANES<\/scp>\n                    2011\u20132014"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0574-4220","authenticated-orcid":false,"given":"Kuan\u2010Yu","family":"Chu","sequence":"first","affiliation":[{"name":"School of Dentistry and Graduate Institute of Dental Science, College of Oral Medicine National Defense Medical University  Taipei Taiwan"},{"name":"Department of Health and Welfare University of Taipei  Taipei Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,6]]},"reference":[{"key":"e_1_2_12_2_1","volume-title":"World Alzheimer Report 2023","author":"Alzheimer's Disease International","year":"2023"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(20)32205-4"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(24)01296-0"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1177\/2380084416633102"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamda.2021.05.009"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.13190"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jnha.2025.100620"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1093\/gerona\/glaf213"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.physbeh.2015.07.017"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clnu.2017.03.014"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.14219\/jada.archive.1996.0237"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jalz.2014.11.009"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/ana.20854"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.14922"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0012244"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.3390\/nu8020068"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.1152\/physrev.00018.2018"},{"key":"e_1_2_12_19_1","doi-asserted-by":"publisher","DOI":"10.1214\/10-STS321"},{"key":"e_1_2_12_20_1","first-page":"1","article-title":"National Health and Nutrition Examination Survey: Plan and Operations, 1999\u20132010","volume":"56","author":"Zipf G.","year":"2013","journal-title":"Vital and Health Statistics Series 1"},{"key":"e_1_2_12_21_1","volume-title":"NHANES Analytic Guidelines, 2011\u20132014 and 2015\u20132016","author":"NCHS","year":"2021"},{"key":"e_1_2_12_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jand.2023.05.015"},{"key":"e_1_2_12_23_1","unstructured":"T.Lumley \u201csurvey: Analysis of Complex Survey Samples\u201dR Package Version 4.4. 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