{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:46:18Z","timestamp":1787028378196,"version":"build-2736575974"},"reference-count":26,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2025,11,26]],"date-time":"2025-11-26T00:00:00Z","timestamp":1764115200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001807","name":"FAPESP","doi-asserted-by":"crossref","award":["2023\/00037-3"],"award-info":[{"award-number":["2023\/00037-3"]}],"id":[{"id":"10.13039\/501100001807","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Background: Oral health problems, particularly tooth loss, may impair nutrition and reduce oral health-related quality of life (OHRQoL) in older adults. However, the pathways linking these conditions remain unclear. Methods: We analyzed data from 112 older adults (\u226560 years). We measured OHRQoL using the Geriatric Oral Health Assessment Index (GOHAI) and nutritional status using the Mini Nutritional Assessment (MNA), and used tooth loss as a clinical indicator. Bivariate analyses used Spearman\u2019s correlation, and structural equation modeling (SEM) with robust estimation was applied to assess direct and indirect pathways. Mediation was evaluated with bootstrap resampling. Results: The prevalence of impaired OHRQoL (GOHAI &gt; 0) was 25.9% (95% CI: 18.6 to 34.9). Tooth loss correlated with worse nutrition (\u03c1 = \u22120.32; 95% CI: \u22120.48 to \u22120.15), and poorer nutrition was associated with worse OHRQoL (\u03c1 = \u22120.22; 95% CI: \u22120.40 to \u22120.03). SEM showed that tooth loss negatively affected nutrition (\u03b2 = \u22120.21; 95% CI: \u22120.43 to 0.00) and that nutrition was directly associated with OHRQoL (\u03b2 = \u22120.21; 95% CI: \u22120.34 to \u22120.08). Bootstrap analyses confirmed a direct effect of tooth loss on OHRQoL (\u03b2 = 0.19; 95% CI: 0.02 to 0.36), while the indirect pathway through nutrition did not reach statistical significance. Conclusions: Tooth loss and poor nutrition independently reduce OHRQoL in older adults. Although mediation by nutrition was not statistically significant, the findings highlight the interdependence of oral and general health and support integrated public health strategies for aging populations.<\/jats:p>","DOI":"10.3390\/ijerph22121793","type":"journal-article","created":{"date-parts":[[2025,11,27]],"date-time":"2025-11-27T10:25:16Z","timestamp":1764239116000},"page":"1793","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Tooth Loss, Nutrition, and Oral Health-Related Quality of Life in Older Adults: Evidence from a Structural Equation Model"],"prefix":"10.3390","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1325-6086","authenticated-orcid":false,"given":"Beatriz","family":"Della Terra Mouco Garrido","sequence":"first","affiliation":[{"name":"Department of Pediatric Dentistry, Orthodontics, and Public Health, Universidade de S\u00e3o Paulo, Bauru 17012-901, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-4366-4775","authenticated-orcid":false,"given":"Patr\u00edcia Soares Silva","family":"Pereira","sequence":"additional","affiliation":[{"name":"Department of Pediatric Dentistry, Orthodontics, and Public Health, Universidade de S\u00e3o Paulo, Bauru 17012-901, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kamilly","family":"Foloni","sequence":"additional","affiliation":[{"name":"Department of Pediatric Dentistry, Orthodontics, and Public Health, Universidade de S\u00e3o Paulo, Bauru 17012-901, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heloisa Dalberto","family":"Pegoraro","sequence":"additional","affiliation":[{"name":"Department of Pediatric Dentistry, Orthodontics, and Public Health, Universidade de S\u00e3o Paulo, Bauru 17012-901, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabelle Rold\u00e3o","family":"Souza","sequence":"additional","affiliation":[{"name":"Department of Pediatric Dentistry, Orthodontics, and Public Health, Universidade de S\u00e3o Paulo, Bauru 17012-901, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9 Roberto Magalh\u00e3es","family":"Bastos","sequence":"additional","affiliation":[{"name":"Department of Pediatric Dentistry, Orthodontics, and Public Health, Universidade de S\u00e3o Paulo, Bauru 17012-901, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4760-8948","authenticated-orcid":false,"given":"Gerson Aparecido","family":"Foratori-J\u00fanior","sequence":"additional","affiliation":[{"name":"Department of Pediatric Dentistry, Orthodontics, and Public Health, Universidade de S\u00e3o Paulo, Bauru 17012-901, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0886-4407","authenticated-orcid":false,"given":"Monica","family":"Yamauti","sequence":"additional","affiliation":[{"name":"Department of Restorative Dentistry, Graduate School of Dental Medicine, Hokkaido University, Sapporo 060-8586, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8897-9345","authenticated-orcid":false,"given":"Raquel Concei\u00e7\u00e3o","family":"Ferreira","sequence":"additional","affiliation":[{"name":"Department of Community and Preventive Dentistry, Federal University of Minas Gerais, Belo Horizonte 31270-901, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roosevelt Silva","family":"Bastos","sequence":"additional","affiliation":[{"name":"Department of Pediatric Dentistry, Orthodontics, and Public Health, Universidade de S\u00e3o Paulo, Bauru 17012-901, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Atanda, A.J., Livinski, A.A., London, S.D., Boroumand, S., Weatherspoon, D., Iafolla, T.J., and Dye, B.A. (2022). Tooth retention, health, and quality of life in older adults: A scoping review. BMC Oral Health, 22.","DOI":"10.1186\/s12903-022-02210-5"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1111\/jphd.12072","article-title":"Socioeconomic and racial\/ethnic oral health disparities among US older adults: Oral health quality of life and dentition","volume":"75","author":"Huang","year":"2015","journal-title":"J. Public Health Dent."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1186\/s12955-019-1078-0","article-title":"Number of remaining teeth and health-related quality of life: The Korean National Health and Nutrition Examination Survey 2010\u20132012","volume":"17","author":"Park","year":"2019","journal-title":"Health Qual. Life Outcomes"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"408","DOI":"10.1177\/00220345010800020201","article-title":"The relationship among dental status, nutrient intake, and nutritional status in older people","volume":"80","author":"Sheiham","year":"2001","journal-title":"J. Dent. Res."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"680","DOI":"10.1002\/j.0022-0337.1990.54.11.tb02481.x","article-title":"Development of the Geriatric Oral Health Assessment Index","volume":"54","author":"Atchison","year":"1990","journal-title":"J. Dent. Educ."},{"key":"ref_6","first-page":"e88","article-title":"Validation of the Brazilian versions of two inventories for measuring oral health-related quality of life of edentulous subjects","volume":"29","author":"Terada","year":"2012","journal-title":"Gerodontology"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Rodakowska, E., Mierzy\u0144ska, K., Bagi\u0144ska, J., and Jamio\u0142kowski, J. (2014). Quality of life measured by OHIP-14 and GOHAI in elderly people from Bialystok, north-east Poland. BMC Oral Health, 14.","DOI":"10.1186\/1472-6831-14-106"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2155","DOI":"10.2147\/CIA.S273671","article-title":"The Effects of Dental Status and Chewing Efficiency on the Oral-Health-Related Quality of Life of Nursing-Home Residents","volume":"15","author":"Ehret","year":"2020","journal-title":"Clin. Interv. Aging"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"434","DOI":"10.1590\/S1415-790X2010000300007","article-title":"Oral health status and nutritional deficit in noninstitutionalized older adults in Londrina, Brazil","volume":"13","author":"Mesas","year":"2010","journal-title":"Rev. Bras. Epidemiol."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Benksim, A., Ait Addi, R., Khalloufi, E., Habibi, A., and Cherkaoui, M. (2021). Self-reported morbidities, nutritional characteristics, and associated factors in institutionalized and non-institutionalized older adults. BMC Geriatr., 21.","DOI":"10.1186\/s12877-021-02067-3"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1007\/s12603-017-0887-2","article-title":"Oral Health Indicators for Risk of Malnutrition in Elders","volume":"22","author":"Wu","year":"2018","journal-title":"J. Nutr. Health Aging"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1111\/ger.12317","article-title":"Tooth loss and its relationship with protein intake by elderly Brazilians-A structural equation modelling approach","volume":"35","author":"Bomfim","year":"2018","journal-title":"Gerodontology"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1016\/j.adaj.2018.09.010","article-title":"Tooth loss among older adults according to poverty status in the United States from 1999 through 2004 and 2009 through 2014","volume":"150","author":"Dye","year":"2019","journal-title":"J. Am. Dent. Assoc."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"S135","DOI":"10.1111\/jcpe.12681","article-title":"Dental caries and periodontal diseases in the ageing population: Call to action to protect and enhance oral health and well-being as an essential component of healthy ageing-Consensus report of group 4 of the joint EFP\/ORCA workshop on the boundaries between caries and periodontal diseases","volume":"44","author":"Tonetti","year":"2017","journal-title":"J. Clin. Periodontol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"777","DOI":"10.1590\/S0004-282X2003000500014","article-title":"Suggestions for utilization of the mini-mental state examination in Brazil]","volume":"61","author":"Brucki","year":"2003","journal-title":"Arq. Neuropsiquiatr."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2513","DOI":"10.1590\/1413-81232018247.20862017","article-title":"Cognitive assessment instruments used in elderly Brazilians in the last five years","volume":"24","author":"Martins","year":"2019","journal-title":"Cienc. Saude Coletiva"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1111\/idj.12104","article-title":"The caries assessment spectrum and treatment (CAST) instrument: Its reproducibility in clinical studies","volume":"64","author":"Bronkhorst","year":"2014","journal-title":"Int. Dent. J."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1034\/j.1600-0528.2001.290305.x","article-title":"Prevalence of impacts of dental and oral disorders and their effects on eating among older people; a national survey in Great Britain","volume":"29","author":"Sheiham","year":"2001","journal-title":"Community Dent. Oral Epidemiol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"135","DOI":"10.2209\/tdcpublication.46.135","article-title":"Relationship between number of present teeth and nutritional intake in institutionalized elderly","volume":"46","author":"Suzuki","year":"2005","journal-title":"Bull. Tokyo Dent. Coll."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1899","DOI":"10.1590\/1413-81232021265.11962019","article-title":"The impacts of oral health-related quality of life of elderly people living at home: A cross-sectional study","volume":"26","author":"Bastos","year":"2021","journal-title":"Cienc. Saude Coletiva"},{"key":"ref_21","first-page":"217","article-title":"The Eating Experience: Adaptive and Maladaptive Strategies of Older Adults with Tooth Loss","volume":"4","author":"Zelig","year":"2019","journal-title":"JDR Clin. Transl. Res."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"253","DOI":"10.4314\/ejhs.v24i3.9","article-title":"Comparison of chewing ability, oral health related quality of life and nutritional status before and after insertion of complete denture amongst edentulous patients in a Dental College of Pune","volume":"24","author":"Madhuri","year":"2014","journal-title":"Ethiop. J. Health Sci."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"146S","DOI":"10.1177\/0022034513504948","article-title":"Do implant overdentures improve dietary intake? A randomized clinical trial","volume":"92","author":"Hamdan","year":"2013","journal-title":"J. Dent. Res."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e139","DOI":"10.1590\/1807-3107bor-2021.vol35.0139","article-title":"Frailty and oral health-related quality of life in community-dwelling older adults: A cross-sectional study","volume":"35","author":"Bastos","year":"2021","journal-title":"Braz. Oral Res."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"105809","DOI":"10.1016\/j.jdent.2025.105809","article-title":"Nutrition and Oral Health in Care Homes: A qualitative study of stakeholder perspectives","volume":"159","author":"Bradwel","year":"2025","journal-title":"J. Dent."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Ferreira, R.C., Vargas, A.M.D., Moura, R.N.V., Fonseca, M.L.V., Gomes, V.E., Pinheiro, E.L., Cartaxo, S.C.A., and Pinto, R.S. (2025). Caries and edentulism trends among Brazilian older adults: A comparative analysis of 2003, 2010, and 2023 surveys. Braz. Oral Res., 39.","DOI":"10.1590\/1807-3107bor-2025.vol39.0050"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/22\/12\/1793\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,28]],"date-time":"2025-11-28T05:13:09Z","timestamp":1764306789000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/22\/12\/1793"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,26]]},"references-count":26,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["ijerph22121793"],"URL":"https:\/\/doi.org\/10.3390\/ijerph22121793","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,26]]}}}