Nutrition and Oral Medicine (Nutrition and Health)

132 Part III / Nutrition and Oral Healthmised dentitions (21–24). The design of the first NHANES, a large cross-sectional studyof 13,479 adults aged 18–74 yr, included a 24-h dietary recall and collected informationabout tooth loss. Controlling for multiple variables, results indicated edentulous adultshad significantly lower intakes of vitamin C, protein, and iron, and a lower consumptionof fruits and vegetables compared to adults with teeth (23).The Health Professionals Follow-Up Study collected information from 49,501 subjectsto assess the nutritional consequences of tooth loss (25). Data collected included demographicand behavioral traits, number of teeth, medical history, and the estimated intakefrequency of 131 food items over a 1-yr period. This approach was validated by collectingdetailed 2-wk recalls from 127 subjects and showed Pearson correlation coefficients rangingfrom r = 0.64–0.77 for various nutrients. The nature of the population facilitated validdata and, in addition, the investigators adjusted for total calorie intake and other potentialconfounders. Edentulous subjects consumed, on average, significantly less dietary fiber,carotene, vegetables, fresh apples, pears, and carrots, and consumed more saturated fat andcholesterol compared to subjects with 25 or more teeth. The actual differences in intakebetween these two groups were relatively small, ranging from 2 to 13%, although, becauseof the higher SES and access to dental care of the patient population studied, the differencesin the general population are likely to be higher. Papas et al. (26) studied nutritionand dentition status in 691 subjects in New England. All were over 60 yr old and thepopulation was 95% white. Individuals who reported difficulty biting, chewing, andswallowing were more likely (80 vs 60% in males, 75 vs 66% in females) to wear dentures.Denture wearers had lower intakes of calories, protein, and folate than nonwearers.In a cohort of 490 British seniors, the nutrient intake was associated with dental status(27). Nutritional intake was measured by 4-d recall and hematologic and biochemicalmeasurement of various nutrients. Confounding factors were controlled by multivariateanalysis. Edentulous independently living subjects consumed fewer calories, protein,intrinsic and milk sugars, fiber, calcium, nonheme iron, niacin, and vitamin C comparedto dentate subjects. Only plasma nutrient levels of vitamin C and retinol were significantlyreduced in the edentulous group. Fiber and sugar intake was significantly associatedwith both the number of teeth and occluding pairs of posterior teeth.The health-related consequences of the nutritional differences in intake because ofdentition status in the previously cited studies suggest that edentulous persons may be athigher risk for cardiovascular or GI diseases and cancer, along with increased associatedmorbidity and mortality. Persons with deficient masticatory function were shown to bemore likely to have GI disorders, as concluded in a study of 367 elderly noninstitutionalizedpeople, linking poor masticatory performance to a significantly increased prevalencein the use of medications to treat GI disorders (10). In a study evaluating the relationshipsbetween a functional measure of dental status, a nutritional intake profile, and mortalityin a cohort of 1189 elderly community subjects in Italy, the authors concluded that dentalstatus is among the major nutritional predictors of long-term mortality (28).Although eating ability may impact food choices, the reported relationships betweendentition status and nutrition status and diet adequacy has been variable for many reasons.A primary consideration not often cited is behavior patterns relative to food choices,which are difficult to change (18). Individuals with compromised dentition adjust theireating habits over time; once new dentures are placed, despite instructions, they may relyon previous eating habits, food preferences, and patterns because it has been typical