Periodontal Disease as a Marker of Malnutrition Risk in Community-Dwelling Older Adults

Vittorio Dibello; Silvano Quarto; Raffaele Cavalcanti; Madia Lozupone; Claudio Pace; Antonio Daniele; Vittorio Dibello; Hélio José Coelho Júnior; Francesco Panza; Vincenzo Solfrizzi

doi:10.1016/j.jamda.2026.106135

Periodontal Disease as a Marker of Malnutrition Risk in Community-Dwelling Older Adults

Vittorio Dibello
, Silvano Quarto
, Raffaele Cavalcanti
, Madia Lozupone
, Claudio Pace
, Antonio Daniele
, Vittorio Dibello
, Hélio José Coelho Júnior
, Francesco Panza^*
, Vincenzo Solfrizzi

^*Corresponding author for this work

Orofacial Pain and Dysfunction

Research output: Contribution to Journal › Article › Academic › peer-review

Abstract

Objective Periodontal disease (PD), a prevalent condition in older adults, may impair nutritional status through reduced masticatory function, systemic inflammation, and altered dietary intake. However, few studies have examined the relationship between clinically assessed PD and validated nutritional risk metrics, that is, the Geriatric Nutritional Risk Index (GNRI). In the present study, we examined the association of PD severity with GNRI-defined malnutrition risk in a nationally representative sample of the US National Health and Nutrition Examination Survey (NHANES).

Design A cross-sectional analysis from the NHANES 2009–2014.

Setting and participants From the 30,468 NHANES subjects, we included 2806 participants aged ≥60 years with available PD and GNRI data, corresponding to approximately 32.64 million noninstitutionalized US individuals aged 60 years and older.

Methods PD was classified according to Centers for Disease Control and Prevention/American Academy of Periodontology case definitions using full-mouth clinical examinations. Nutritional status was assessed using the GNRI calculated from serum albumin and weight-to-ideal weight ratios. GNRI scores were dichotomized as high (<98) or low (≥98) nutritional risk. Survey-weighted logistic regression models evaluated associations between PD severity and GNRI-defined malnutrition, adjusting for demographics, socioeconomics, behavioral factors, and multimorbidity.

Results Severe PD was significantly associated with increased odds of being at nutritional risk. In the fully adjusted model, individuals with severe PD had 2.59 times greater odds of low GNRI scores (higher nutritional risk) compared with those with none/mild PD (OR, 2.59; 95% CI, 1.52–4.42; P < .01). No significant association was observed for moderate PD.

Conclusions and Implications The present findings supported integrating oral health evaluation into nutritional screening in older age and geriatric comprehensive assessment, highlighting the need for interdisciplinary strategies to promote healthy aging.

Original language	English
Article number	106135
Pages (from-to)	1-9
Number of pages	9
Journal	Journal of the American Medical Directors Association
Volume	27
Issue number	4
Early online date	2 Mar 2026
DOIs	https://doi.org/10.1016/j.jamda.2026.106135
Publication status	Published - Apr 2026

Bibliographical note

Publisher Copyright:
© 2026 Post-Acute and Long-Term Care Medical Association.

Funding

This paper was produced with the co-funding of the European Union – Next Generation EU , in the context of The National Recovery and Resilience Plan, Investment Partenariato Esteso PE8, Mission 4, C2, Intervention 1.3 ″Conseguenze e sfide dell'invecchiamento", Project Age-It (Ageing Well in an Ageing Society, PE0000015). This paper was also supported by the Project “Development of an ensemble learning-based, multidimensional sensory impairment score to predict cognitive impairment in an elderly cohort of Southern Italy” funded by the European Union – Next Generation EU – NRRP M6C2 – Investment 2.1 Enhancement and Strengthening of NHS biomedical research (Grant Agreement PNRR-MAD-2022-12376656). The views and opinions expressed are only those of the authors and do not necessarily reflect those of the European Union or the European Commission. Neither the European Union nor the European Commission can be held responsible for them.

Funders	Funder number
European Commission	PNRR-MAD-2022-12376656

Keywords

frailty
malnutrition
multimorbidity
Oral health
periodontal disease
prevention

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title = "Periodontal Disease as a Marker of Malnutrition Risk in Community-Dwelling Older Adults",

abstract = "Objective Periodontal disease (PD), a prevalent condition in older adults, may impair nutritional status through reduced masticatory function, systemic inflammation, and altered dietary intake. However, few studies have examined the relationship between clinically assessed PD and validated nutritional risk metrics, that is, the Geriatric Nutritional Risk Index (GNRI). In the present study, we examined the association of PD severity with GNRI-defined malnutrition risk in a nationally representative sample of the US National Health and Nutrition Examination Survey (NHANES).Design A cross-sectional analysis from the NHANES 2009–2014.Setting and participants From the 30,468 NHANES subjects, we included 2806 participants aged ≥60 years with available PD and GNRI data, corresponding to approximately 32.64 million noninstitutionalized US individuals aged 60 years and older.Methods PD was classified according to Centers for Disease Control and Prevention/American Academy of Periodontology case definitions using full-mouth clinical examinations. Nutritional status was assessed using the GNRI calculated from serum albumin and weight-to-ideal weight ratios. GNRI scores were dichotomized as high (<98) or low (≥98) nutritional risk. Survey-weighted logistic regression models evaluated associations between PD severity and GNRI-defined malnutrition, adjusting for demographics, socioeconomics, behavioral factors, and multimorbidity.Results Severe PD was significantly associated with increased odds of being at nutritional risk. In the fully adjusted model, individuals with severe PD had 2.59 times greater odds of low GNRI scores (higher nutritional risk) compared with those with none/mild PD (OR, 2.59; 95\% CI, 1.52–4.42; P < .01). No significant association was observed for moderate PD.Conclusions and Implications The present findings supported integrating oral health evaluation into nutritional screening in older age and geriatric comprehensive assessment, highlighting the need for interdisciplinary strategies to promote healthy aging.",

keywords = "frailty, malnutrition, multimorbidity, Oral health, periodontal disease, prevention",

author = "Vittorio Dibello and Silvano Quarto and Raffaele Cavalcanti and Madia Lozupone and Claudio Pace and Antonio Daniele and Vittorio Dibello and \{Coelho J{\'u}nior\}, \{H{\'e}lio Jos{\'e}\} and Francesco Panza and Vincenzo Solfrizzi",

note = "Publisher Copyright: {\textcopyright} 2026 Post-Acute and Long-Term Care Medical Association.",

year = "2026",

month = apr,

doi = "10.1016/j.jamda.2026.106135",

language = "English",

volume = "27",

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T1 - Periodontal Disease as a Marker of Malnutrition Risk in Community-Dwelling Older Adults

AU - Dibello, Vittorio

AU - Quarto, Silvano

AU - Cavalcanti, Raffaele

AU - Lozupone, Madia

AU - Pace, Claudio

AU - Daniele, Antonio

AU - Dibello, Vittorio

AU - Coelho Júnior, Hélio José

AU - Panza, Francesco

AU - Solfrizzi, Vincenzo

PY - 2026/4

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N2 - Objective Periodontal disease (PD), a prevalent condition in older adults, may impair nutritional status through reduced masticatory function, systemic inflammation, and altered dietary intake. However, few studies have examined the relationship between clinically assessed PD and validated nutritional risk metrics, that is, the Geriatric Nutritional Risk Index (GNRI). In the present study, we examined the association of PD severity with GNRI-defined malnutrition risk in a nationally representative sample of the US National Health and Nutrition Examination Survey (NHANES).Design A cross-sectional analysis from the NHANES 2009–2014.Setting and participants From the 30,468 NHANES subjects, we included 2806 participants aged ≥60 years with available PD and GNRI data, corresponding to approximately 32.64 million noninstitutionalized US individuals aged 60 years and older.Methods PD was classified according to Centers for Disease Control and Prevention/American Academy of Periodontology case definitions using full-mouth clinical examinations. Nutritional status was assessed using the GNRI calculated from serum albumin and weight-to-ideal weight ratios. GNRI scores were dichotomized as high (<98) or low (≥98) nutritional risk. Survey-weighted logistic regression models evaluated associations between PD severity and GNRI-defined malnutrition, adjusting for demographics, socioeconomics, behavioral factors, and multimorbidity.Results Severe PD was significantly associated with increased odds of being at nutritional risk. In the fully adjusted model, individuals with severe PD had 2.59 times greater odds of low GNRI scores (higher nutritional risk) compared with those with none/mild PD (OR, 2.59; 95% CI, 1.52–4.42; P < .01). No significant association was observed for moderate PD.Conclusions and Implications The present findings supported integrating oral health evaluation into nutritional screening in older age and geriatric comprehensive assessment, highlighting the need for interdisciplinary strategies to promote healthy aging.

AB - Objective Periodontal disease (PD), a prevalent condition in older adults, may impair nutritional status through reduced masticatory function, systemic inflammation, and altered dietary intake. However, few studies have examined the relationship between clinically assessed PD and validated nutritional risk metrics, that is, the Geriatric Nutritional Risk Index (GNRI). In the present study, we examined the association of PD severity with GNRI-defined malnutrition risk in a nationally representative sample of the US National Health and Nutrition Examination Survey (NHANES).Design A cross-sectional analysis from the NHANES 2009–2014.Setting and participants From the 30,468 NHANES subjects, we included 2806 participants aged ≥60 years with available PD and GNRI data, corresponding to approximately 32.64 million noninstitutionalized US individuals aged 60 years and older.Methods PD was classified according to Centers for Disease Control and Prevention/American Academy of Periodontology case definitions using full-mouth clinical examinations. Nutritional status was assessed using the GNRI calculated from serum albumin and weight-to-ideal weight ratios. GNRI scores were dichotomized as high (<98) or low (≥98) nutritional risk. Survey-weighted logistic regression models evaluated associations between PD severity and GNRI-defined malnutrition, adjusting for demographics, socioeconomics, behavioral factors, and multimorbidity.Results Severe PD was significantly associated with increased odds of being at nutritional risk. In the fully adjusted model, individuals with severe PD had 2.59 times greater odds of low GNRI scores (higher nutritional risk) compared with those with none/mild PD (OR, 2.59; 95% CI, 1.52–4.42; P < .01). No significant association was observed for moderate PD.Conclusions and Implications The present findings supported integrating oral health evaluation into nutritional screening in older age and geriatric comprehensive assessment, highlighting the need for interdisciplinary strategies to promote healthy aging.

KW - frailty

KW - malnutrition

KW - multimorbidity

KW - Oral health

KW - periodontal disease

KW - prevention

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U2 - 10.1016/j.jamda.2026.106135

DO - 10.1016/j.jamda.2026.106135

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Periodontal Disease as a Marker of Malnutrition Risk in Community-Dwelling Older Adults

Abstract

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Keywords

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