Impact of behavioural dietary intervention coupled with oral rehabilitation on the health and nutritional status of older adults: A systematic review and meta-analysis

L McGowan, L McCrum, S Watson, C Cardwell, B McGuinness, H Rutherford, V Paice, C Moore, P R Brocklehurst, J V Woodside, G McKenna

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Introduction: The ageing population represents significant nutritional challenges; where vulnerabilities to obesity, malnutrition and age-related diseases are exacerbated by impaired dental and oral health status. As natural teeth are lost, many older adults choose softer, more manageable foods lacking in essential micronutrients and fibre, yet replacing missing natural teeth alone does not positively influence diet. This systematic review synthesised literature relating to oral rehabilitation coupled with dietary intervention in adults. The primary outcome was diet/nutritional status; secondary outcomes pertained to health status (e.g. body mass index (BMI)), oral health and dietary intervention characteristics including: theoretical basis, intervention delivery and behaviour change techniques (BCTs). Methods: MEDLINE, Web of Science, PubMed and CENTRAL were searched systemically, alongside hand-searching reference lists and contacting authors. Studies were eligible if they replaced missing teeth in edentate/partially dentate adults and included a dietary intervention, reporting diet/nutritional outcomes. Results: Nine studies were included. Study designs were heterogeneous (three RCTs; five single-arm; one parallel-groups) involving 526 participants. Narrative synthesis identified improvements in all studies for least one aspect of patients' oral health (i.e. chewing) alongside at least one positive diet/nutrition outcome post-intervention (including some plasma biomarkers). Dietary outcomes included increased fruit/vegetable (F/V), protein and fibre intake. F/V results were pooled for three studies using meta-analysis techniques resulting in a standardised mean difference (SMD) of 0.29 [CI -0.54, 1.12], p = 0.49, but with marked heterogeneity (p = 0.0007). Five of nine studies reported BMI at baseline (three reported average BMI values of 22.5-22.9 kg/m2; two reported average BMI values of 26.8-27.4 kg/m2). Despite positive dietary changes in four of these studies, BMI did not change significantly post-intervention (reported in two studies with overweight participants only). Few interventions were theory- based with intervention components and delivery poorly described. Identifiable BCTs ranged from one to nine; five interventions tailored dietary information, and the most common BCT was giving information on the health consequences of diet. Conclusion: Narrative synthesis indicated support for dietary intervention coupled with oral rehabilitation on improving intake. Impact on BMI from dietary intervention was unclear from the limited results reported. Meta-analysis of F/V intake was only possible with three studies, highlighting limitations. Further research with large-scale, appropriately designed and described trial methodologies is needed.
Original languageEnglish
Publication statusPublished - 07 May 2019
Event26th European Congress on Obesity - United Kingdom , Glasgow,
Duration: 28 Apr 201901 May 2019


Conference26th European Congress on Obesity


  • Medline
  • Web of Science
  • adult
  • aged
  • behavior change
  • biological marker
  • body mass
  • conference abstract
  • diet therapy
  • female
  • fruit vegetable
  • health status
  • human
  • human tissue
  • male
  • malnutrition
  • mastication
  • meta analysis
  • narrative
  • nutritional status
  • obesity
  • parallel design
  • periodontal disease
  • plasma
  • synthesis
  • systematic review
  • theoretical study


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