Clinically Assessed Tooth Loss and Malnutrition Risk in U.S. Older Adults

Background: Tooth loss is common in older adults and a recognized risk factor for malnutrition, compromising chewing ability and restricting food choices. The Geriatric Nutritional Risk Index (GNRI), based on serum albumin and body weight, provides an objective and validated measure for malnutrition, yet its relationship with clinically assessed remaining teeth has not been fully explored. Objectives: The objective of this study was to examine the association between clinically assessed remaining teeth and GNRI-defined malnutrition risk in a large cohort of older adults. Results: We analysed data from 3717 subjects aged≥ 60 years in the 2009-2014 National Health and Nutrition Examination Survey, representing approximately 42.37 million non-institutionalized U.S. individuals in this age group. Dentition status was determined by standardized dental examinations, and nutritional risk was classified using GNRI (< 98 vs. ≥ 98). Weighted logistic regression models assessed associations, adjusting for demographics, socioeconomic status, lifestyle, and multimorbidity. Tooth loss was consistently associated with higher malnutrition risk. In unadjusted models, participants with 10-19 teeth odds ratio (OR):1.75, 95% confidence interval (CI):1.14-2.69, 1-9 teeth (OR:2.24, 95% CI:1.43-3.51), and edentulism (OR:2.45, 95% CI:1.77-3.39) had significantly greater odds of low GNRI compared with those with ≥ 20 teeth. After full adjustment, the association remained significant for edentulous individuals (OR:1.72, 95% CI:1.11-2.66). Conclusion: Complete tooth loss appeared to be a robust marker of nutritional vulnerability in older age, underscoring the need to integrate oral health into geriatric nutrition screening. Preserving or restoring dentition may play a critical role in preventing malnutrition and supporting healthy aging.