Association Between Nutritional Status, Body Mass Index, and Oral Health Among Older Adults in Primary Health Care

Objective: We aimed to analyze factors associated with body mass index and nutritional status, including oral health, among older adults in Primary Health Care. Methods: We conducted a cross-sectional study of community-dwelling older adults aged ≥ 60 years, selected from five Health Units in a Brazilian city. A questionnaire was applied to collect the following data: sociodemographic data, anthropometric status assessed by Body Mass Index (BMI) (weight and height), oral health (number of teeth and self-perceived chewing ability: good, fair, or poor), cognition assessed using the 10-Point Cognitive Screener (10-CS), nutritional status using the Mini Nutritional Assessment (MNA), health literacy using the 14-item Health Literacy Scale (HLS-14), sarcopenia risk using the SARC-F questionnaire plus calf circumference (SARC-F + CC), and frailty using the Clinical Functional Vulnerability Index-20 (CFVI-20). The outcomes were Body Mass Index (BMI)-defined anthropometric status, dichotomized as non-excess weight (underweight/normal weight) vs. excess weight (overweight/obese), and nutritional status assessed by the Mini Nutritional Assessment (MNA), dichotomized into normal nutritional status vs. nutritional risk or malnutrition. Descriptive, bivariate (Chi-square test), and multiple binary logistic regression analyses were performed for each outcome (p < 0.05). Results: A total of 211 older adults participated in the study. The sample was 72% female, with a mean age of 70.41 (±7.45) years. In the adjusted regression analysis, the use of four or more medications (OR = 2.12; 95% CI: 1.08–4.17), sedentary behavior (OR = 3.09; 95% CI: 1.58–6.04), and absence of sarcopenia risk (OR = 4.99; 95% CI: 2.02–12.34) were associated with higher odds of overweight/obesity. Conversely, usual attendance at the neighborhood PHC unit (OR = 0.23; 95% CI: 0.07–0.72) and possible cognitive impairment (OR = 0.30; 95% CI: 0.08–0.98) were inversely associated with overweight/obesity. Nutritional risk or malnutrition was associated with edentulism (OR = 2.10; 95% CI: 1.05–4.23), poor chewing ability (OR = 2.48; 95% CI: 1.06–5.82), fair chewing ability (OR = 2.88; 95% CI: 1.29–6.47), and the presence of feelings of discouragement, sadness, or hopelessness (OR = 3.52; 95% CI: 1.78–6.96). Among participants with overweight/obesity, 28.4% were also classified as being at nutritional risk or malnourished according to the MNA. Conclusions: Among older adults in Primary Health Care, nutritional risk or malnutrition was associated with oral health and psychosocial characteristics, whereas overweight/obesity was associated with distinct clinical, healthcare-use, behavioral, cognitive, and functional characteristics, even after adjustment for sociodemographic, clinical, functional, and psychosocial characteristics. These findings support the importance of comprehensive multidisciplinary assessment and care to address the heterogeneous and coexisting nutritional challenges of aging.