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Article(id=1322608093087781638, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1322608013010120712, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202504371, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1745337600000, receivedDateStr=2025-04-23, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1793263942262, onlineDateStr=2026-10-29, pubDate=1762704000000, pubDateStr=2025-11-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793263942262, onlineIssueDateStr=2026-10-29, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793263942262, creator=13701087609, updateTime=1793263942262, updator=13701087609, issue=Issue{id=1322608013010120712, tenantId=1146029695717560320, journalId=1227665162245664772, year='2025', volume='52', issue='21', pageStart='3841', pageEnd='4032', issueExtLink='null', onlineDate='null', pubDate='1762704000000', pubDateStr='2025-11-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793263923169, creator='13701087609', updateTime=1793264266929, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1322609454932149086, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1322608013010120712, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1322609454932149087, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1322608013010120712, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=3963, endPage=3967, ext={EN=ArticleExt(id=1322608093280719623, articleId=1322608093087781638, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=The impact of tooth loss on cognitive level in the elderly and the chain mediating role of dietary diversity and social participation, columnId=1228016572892119056, journalTitle=Modern Preventive Medicine, columnName=Primary Health Services, runingTitle=null, highlight=null, articleAbstract=
Objective

To explore the relationship between tooth loss and cognitive level in the elderly, and to verify the mediating roles of dietary diversity and social participation.

Methods

This paper used the data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) in 2018, and screened out 5 774 eligible research subjects. Spearman correlation analysis was used to explore the correlations among tooth loss, dietary diversity, social participation and cognitive level in the elderly.The chain mediating effects of dietary diversity and social participation between tooth loss and cognitive level in the elderly were analyzed using Model 6 of the Process 4.1 add-in in SPSS.

Results

The direct effect of tooth loss on cognitive level in the elderly was significant (β=-0.298, P<0.01). Dietary diversity and social participation significantly influenced the cognitive level of the elderly (β=0.059, P<0.05; β=0.063, P<0.01). The mediating effects of dietary diversity and social participation between tooth loss and cognitive level in the elderly were -0.016 (95% CI: -0.005~-0.030) and -0.04 (95% CI: -0.016~-0.065), respectively, and the chain mediating effect was -0.011 (95% CI: -0.006~-0.017).

Conclusion

Tooth loss in older adults can directly affect their cognitive level, and can also influence cognitive function through the independent or chain mediating effects of dietary diversity and social participation. In the future, attention should be paid to the tooth loss situation of older adults, and their nutritional intake and social participation should be ensured to reduce the risk of cognitive impairment and achieve healthy aging.

, authors=Yu LEI, Shu-hui SUN, authorsList=Yu LEI, Shu-hui SUN, authorCompany=null, correspAuthors=Shu-hui SUN, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1322608096711660312, articleId=1322608093087781638, tenantId=1146029695717560320, journalId=1227665162245664772, language=CN, title=老年人牙齿缺失对认知水平的影响及膳食多样性与社会参与度的链式中介作用, columnId=1228016573533847611, journalTitle=现代预防医学, columnName=基层卫生服务, runingTitle=null, highlight=null, articleAbstract=
目的

探究老年人牙齿缺失与认知水平之间的关系，并验证膳食多样性与社会参与度的中介作用。

方法

使用中国老年人健康长寿影响因素调查（CLHLS）2018年数据，筛选出符合要求的研究对象5 774人，运用Spearman相关性分析探究老年人牙齿缺失、膳食多样性、社会参与度和认知水平之间的相关性，使用SPSS中Process 4.1插件模型6分析膳食多样性、社会参与度的链式中介效应

结果

老年人牙齿缺失对认知水平的直接影响显著（β=-0.298，P<0.01）；膳食多样性和社会参与度显著影响老年人的认知水平（β=0.059，P<0.05；β=0.063，P<0.01）；膳食多样性和社会参与度在老年人牙齿缺失与认知之间的中介效应分别为-0.016（95% CI：-0.005～-0.030）和-0.04（95% CI：-0.016～-0.065）、链式中介效应为-0.011（95% CI：-0.006～-0.017）。

结论

老年人牙齿缺失可以直接影响其认知水平，也可以通过膳食多样性和社会参与度的单独或链式中介影响其认知水平。在未来，应关注老年人牙齿缺失情况，保障老年人营养摄入和社会参与，从而降低认知障碍风险，实现健康老龄化。

, authors=雷雨, 孙淑慧, authorsList=雷雨, 孙淑慧, authorCompany=null, correspAuthors=孙淑慧, authorNote=

雷雨（1996—），女，硕士在读，研究方向：卫生管理

, correspAuthorsNote=
孙淑慧，E-mail：
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雷雨（1996—），女，硕士在读，研究方向：卫生管理

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雷雨（1996—），女，硕士在读，研究方向：卫生管理

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Journal of Nutrition Health & Aging, 2025, 29 (4): 100518., articleTitle=Impact of energy intake on the association between protein intake and the prevalence of frailty in older Korean adults: The Korea National Health and Nutrition Examination Survey,2014-2018, refAbstract=null)], funds=[Fund(id=1322608100817883962, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322608093087781638, awardId=20SFB4064, language=CN, fundingSource=司法部法治建设与法学理论研究部级科研项目(20SFB4064), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1322608096988484377, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322608093087781638, xref=null, ext=[AuthorCompanyExt(id=1322608096996872986, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322608093087781638, companyId=1322608096988484377, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=School of Management, Shandong Second Medical University, Weifang, Shandong 261053, China), AuthorCompanyExt(id=1322608097005261595, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322608093087781638, companyId=1322608096988484377, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=山东第二医科大学管理学院，山东　潍坊　261053)])], figs=[ArticleFig(id=1322608099907719984, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322608093087781638, language=EN, label=Figure 1, caption=Chain mediation model of dietary diversity and social participation between tooth loss and cognitive level, figureFileSmall=AuZ914bo6cwSnjy6XK0Nuw==, figureFileBig=N5k87LeWOiocJWHPfs9YVQ==, tableContent=null), ArticleFig(id=1322608099987411761, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322608093087781638, language=CN, label=图1, caption=膳食多样性与社会参与度在牙齿缺失情况与认知水平间的链式中介模型, figureFileSmall=AuZ914bo6cwSnjy6XK0Nuw==, figureFileBig=N5k87LeWOiocJWHPfs9YVQ==, tableContent=null), ArticleFig(id=1322608100163572530, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322608093087781638, language=EN, label=Table 1, caption=

Sociodemographic disparities in cognitive level［（），n（%）］

, figureFileSmall=null, figureFileBig=null, tableContent=
变量统计描述认知水平得分t值P值
年龄（岁）79.27±9.90
性别7.799<0.001
男3 123（54.10）28.41±2.53
女2 651（45.90）27.82±3.08
居住地3.1730.115
城市1 821（31.50）28.31±2.79
乡村3 953（68.50）28.06±2.82
婚姻状况16.518<0.001
在婚3 375（58.50）28.68±2.09
不在婚2 399（41.50）27.37±3.45
受教育年限（年）5.13±4.64
牙齿缺失情况-17.958<0.001
天然牙齿不少于20颗2 127（36.80）
天然牙齿小于20颗3 647（63.20）
膳食多样性得分5.10±2.02
社会参与度得分13.87±7.01
), ArticleFig(id=1322608100251652915, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322608093087781638, language=CN, label=表1, caption=

认知水平在社会人口学特征方面的差异［（），n（%）］

, figureFileSmall=null, figureFileBig=null, tableContent=
变量统计描述认知水平得分t值P值
年龄（岁）79.27±9.90
性别7.799<0.001
男3 123（54.10）28.41±2.53
女2 651（45.90）27.82±3.08
居住地3.1730.115
城市1 821（31.50）28.31±2.79
乡村3 953（68.50）28.06±2.82
婚姻状况16.518<0.001
在婚3 375（58.50）28.68±2.09
不在婚2 399（41.50）27.37±3.45
受教育年限（年）5.13±4.64
牙齿缺失情况-17.958<0.001
天然牙齿不少于20颗2 127（36.80）
天然牙齿小于20颗3 647（63.20）
膳食多样性得分5.10±2.02
社会参与度得分13.87±7.01
), ArticleFig(id=1322608100318761780, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322608093087781638, language=EN, label=Table 2, caption=

Correlation analysis of tooth loss, dietary diversity, social participation, and cognitive level（r）

, figureFileSmall=null, figureFileBig=null, tableContent=
变量 牙齿缺失情况膳食多样性社会参与度认知水平
牙齿缺失情况0.63±0.4821.00
膳食多样性5.1±2.017-0.068***1.00
社会参与度13.87±7.007-0.057***0.186***1.00
认知水平28.14±2.812-0.063***0.073***0.163***1.00
), ArticleFig(id=1322608100394259253, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322608093087781638, language=CN, label=表2, caption=

牙齿缺失、膳食多样性、社会参与度、认知水平相关性分析（r）

, figureFileSmall=null, figureFileBig=null, tableContent=
变量 牙齿缺失情况膳食多样性社会参与度认知水平
牙齿缺失情况0.63±0.4821.00
膳食多样性5.1±2.017-0.068***1.00
社会参与度13.87±7.007-0.057***0.186***1.00
认知水平28.14±2.812-0.063***0.073***0.163***1.00
), ArticleFig(id=1322608100457173814, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322608093087781638, language=EN, label=Table 3, caption=

Regression analysis results of the mediating model of dietary diversity and social participation between tooth loss and cognitive level

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常量模型1：膳食多样性模型2：社会参与度模型3：认知水平
β t值P值β t值P值β t值P值
常量6.8090.27824.467<0.00128.5591.00428.436<0.00132.8130.44473.877<0.001
年龄（岁）0.0100.0033.462<0.05-0.2280.010-22.671<0.001-0.0670.004-15.520<0.001
性别-0.0860.051-1.6850.0920.4750.1762.708<0.05-0.3890.073-5.342<0.001
居住地-1.3710.057-23.986<0.001-0.4950.206-2.404<0.050.1390.0851.6270.104
婚姻状况-0.2500.056-4.460<0.001-0.3160.193-1.6360.102-0.1930.080-2.416<0.05
受教育时间0.0880.00614.462<0.0010.2140.02110.079<0.0010.0560.0096.272<0.001
牙齿缺失情况-0.2750.053-5.175<0.001-0.6350.183-3.475<0.05-0.2980.076-3.931<0.001
膳食多样性0.6380.04514.107<0.0010.0590.0193.093<0.05
社会参与度0.0630.00511.522<0.001
R-sq0.2140.2310.182
), ArticleFig(id=1322608100545254199, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322608093087781638, language=CN, label=表3, caption=

膳食多样性与社会参与度在牙齿缺失情况与认知水平间中介模型的回归分析结果

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常量模型1：膳食多样性模型2：社会参与度模型3：认知水平
β t值P值β t值P值β t值P值
常量6.8090.27824.467<0.00128.5591.00428.436<0.00132.8130.44473.877<0.001
年龄（岁）0.0100.0033.462<0.05-0.2280.010-22.671<0.001-0.0670.004-15.520<0.001
性别-0.0860.051-1.6850.0920.4750.1762.708<0.05-0.3890.073-5.342<0.001
居住地-1.3710.057-23.986<0.001-0.4950.206-2.404<0.050.1390.0851.6270.104
婚姻状况-0.2500.056-4.460<0.001-0.3160.193-1.6360.102-0.1930.080-2.416<0.05
受教育时间0.0880.00614.462<0.0010.2140.02110.079<0.0010.0560.0096.272<0.001
牙齿缺失情况-0.2750.053-5.175<0.001-0.6350.183-3.475<0.05-0.2980.076-3.931<0.001
膳食多样性0.6380.04514.107<0.0010.0590.0193.093<0.05
社会参与度0.0630.00511.522<0.001
R-sq0.2140.2310.182
), ArticleFig(id=1322608100637528888, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322608093087781638, language=EN, label=Table 4, caption=

Tests of mediating effects of dietary diversity and social participation between tooth loss and cognitive level

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路径效应值（95% CI） 百分比（%）
总效应-0.365（-0.515～-0.215）0.077100.0
直接效应-0.298（-0. 446～-0. 149）0.07681.6
总中介效应-0.067（-0.097～-0.039）0.01518.4
路径1-0.016（-0.029～-0.005）0.0064.4
路径2-0.040（-0.065～-0.016）0.01311.0
路径3-0.011（-0.017～-0.006）0.0033.0
), ArticleFig(id=1322608100700443449, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322608093087781638, language=CN, label=表4, caption=

膳食多样性与社会参与度在牙齿缺失情况与认知水平间的中介效应检验

, figureFileSmall=null, figureFileBig=null, tableContent=
路径效应值（95% CI） 百分比（%）
总效应-0.365（-0.515～-0.215）0.077100.0
直接效应-0.298（-0. 446～-0. 149）0.07681.6
总中介效应-0.067（-0.097～-0.039）0.01518.4
路径1-0.016（-0.029～-0.005）0.0064.4
路径2-0.040（-0.065～-0.016）0.01311.0
路径3-0.011（-0.017～-0.006）0.0033.0
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老年人牙齿缺失对认知水平的影响及膳食多样性与社会参与度的链式中介作用
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雷雨 , 孙淑慧
现代预防医学 | 基层卫生服务 2025,52(21): 3963-3967
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现代预防医学 |基层卫生服务 2025 , 52 (21) : 3963 -3967
老年人牙齿缺失对认知水平的影响及膳食多样性与社会参与度的链式中介作用
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雷雨（1996—），女，硕士在读，研究方向：卫生管理

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雷雨（1996—），女，硕士在读，研究方向：卫生管理

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雷雨, 孙淑慧
作者信息
  • 山东第二医科大学管理学院，山东　潍坊　261053
通讯作者:
孙淑慧，E-mail：
作者简介:

雷雨（1996—），女，硕士在读，研究方向：卫生管理

The impact of tooth loss on cognitive level in the elderly and the chain mediating role of dietary diversity and social participation
Yu LEI, Shu-hui SUN
Affiliations
  • School of Management, Shandong Second Medical University, Weifang, Shandong 261053, China
出版时间: 2025-11-10 doi: 10.20043/j.cnki.MPM.202504371
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摘要
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目的

探究老年人牙齿缺失与认知水平之间的关系，并验证膳食多样性与社会参与度的中介作用。

方法

使用中国老年人健康长寿影响因素调查（CLHLS）2018年数据，筛选出符合要求的研究对象5 774人，运用Spearman相关性分析探究老年人牙齿缺失、膳食多样性、社会参与度和认知水平之间的相关性，使用SPSS中Process 4.1插件模型6分析膳食多样性、社会参与度的链式中介效应

结果

老年人牙齿缺失对认知水平的直接影响显著（β=-0.298，P<0.01）；膳食多样性和社会参与度显著影响老年人的认知水平（β=0.059，P<0.05；β=0.063，P<0.01）；膳食多样性和社会参与度在老年人牙齿缺失与认知之间的中介效应分别为-0.016（95% CI：-0.005～-0.030）和-0.04（95% CI：-0.016～-0.065）、链式中介效应为-0.011（95% CI：-0.006～-0.017）。

结论

老年人牙齿缺失可以直接影响其认知水平，也可以通过膳食多样性和社会参与度的单独或链式中介影响其认知水平。在未来，应关注老年人牙齿缺失情况，保障老年人营养摄入和社会参与，从而降低认知障碍风险，实现健康老龄化。

老年人  /  牙齿缺失  /  膳食多样性  /  认知水平  /  社会参与度
Objective

To explore the relationship between tooth loss and cognitive level in the elderly, and to verify the mediating roles of dietary diversity and social participation.

Methods

This paper used the data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) in 2018, and screened out 5 774 eligible research subjects. Spearman correlation analysis was used to explore the correlations among tooth loss, dietary diversity, social participation and cognitive level in the elderly.The chain mediating effects of dietary diversity and social participation between tooth loss and cognitive level in the elderly were analyzed using Model 6 of the Process 4.1 add-in in SPSS.

Results

The direct effect of tooth loss on cognitive level in the elderly was significant (β=-0.298, P<0.01). Dietary diversity and social participation significantly influenced the cognitive level of the elderly (β=0.059, P<0.05; β=0.063, P<0.01). The mediating effects of dietary diversity and social participation between tooth loss and cognitive level in the elderly were -0.016 (95% CI: -0.005~-0.030) and -0.04 (95% CI: -0.016~-0.065), respectively, and the chain mediating effect was -0.011 (95% CI: -0.006~-0.017).

Conclusion

Tooth loss in older adults can directly affect their cognitive level, and can also influence cognitive function through the independent or chain mediating effects of dietary diversity and social participation. In the future, attention should be paid to the tooth loss situation of older adults, and their nutritional intake and social participation should be ensured to reduce the risk of cognitive impairment and achieve healthy aging.

The elderly  /  Tooth loss  /  Dietary diversity  /  Cognitive level  /  Social participation
雷雨, 孙淑慧. 老年人牙齿缺失对认知水平的影响及膳食多样性与社会参与度的链式中介作用. 现代预防医学, 2025 , 52 (21) : 3963 -3967 . DOI: 10.20043/j.cnki.MPM.202504371
Yu LEI, Shu-hui SUN. The impact of tooth loss on cognitive level in the elderly and the chain mediating role of dietary diversity and social participation[J]. Modern Preventive Medicine, 2025 , 52 (21) : 3963 -3967 . DOI: 10.20043/j.cnki.MPM.202504371
正文
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根据第七次全国人口普查数据，我国60岁以上老年人口已达2.64亿，其中65岁以上人口占该群体的72.19%（占总人口13.5%），标志着我国已进入深度老龄化社会[1]。同时，老年人健康水平已成为影响经济发展与民生质量的关键因素，健康老龄化也成为推进人口高质量发展的首要条件。《中国健康老年人标准》中明确将“认知水平正常”列为核心指标[2]，但认知功能衰退正随老龄化加剧成为重大公共卫生问题。研究发现，老年人牙齿数量与认知水平显著相关，老年人牙齿缺失会导致认知水平下降[3]。老年人牙齿数量减少会通过降低膳食多样性影响营养的摄入[4]，进而影响认知水平[5]。老年人牙齿缺失会影响老年人的社会心理状态[6]，从而降低其社会参与程度[7]。而社会参与度高的老年人认知疾病患病率更低[8]。此外，膳食多样性与社会参与程度也呈正相关，老年人通过均衡膳食摄入足够营养，提高身体机能[9]，提高老年人参与家庭和社会活动的意愿与能力[10]。综上，既往研究多针对上述两个或三个变量，缺乏对“牙齿缺失-膳食多样性-社会参与度-认知水平”四变量链式中介效应的探讨。因此，本研究利用中国老年健康影响因素跟踪调查（CLHLS）数据，探讨老年人牙齿缺失对认知水平的影响及膳食多样性和社会参与度的链式中介机制。
本文假设如下：
H1：老年人牙齿缺失直接影响其认知水平。
H2：老年人牙齿缺失通过膳食多样性的中介作用影响其认知水平。
H3：老年人牙齿缺失通过社会参与度的中介作用影响其认知水平。
H4：老年人牙齿缺失通过膳食多样性及社会参与度的链式中介影响其认知水平。
1　对象与方法
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1.1　对象
本研究将中国老年健康影响因素跟踪调查（Chinese Longitudinal Healthy Longevity Survey,CLHLS）2018年数据库作为数据源，该数据已获得北京大学生物医学伦理委员会（IRB00001052—13074）批准,所有调查参与者均签署知情同意书。该数据库覆盖全国23个省市自治区的500余个样本点地区，调查对象涵盖各年龄层次，采集信息维度丰富，涉及老年人生理健康指标、饮食行为模式、心理健康状态、认知功能水平以及家庭基本结构、生活环境特征和社会参与状况等多方面内容。作为我国自1998年起持续追踪至今的长周期老年人研究数据库之一，此样本具有全国范围内的典型代表性和科学性。本研究基于CLHLS 2018年数据集的15 874例原始样本，遵循以下筛选标准：排除 65 岁以下个体及关键变量缺失的样本（n=15 771），最终纳入符合条件的5 774例受试者数据进行分析。
1.2　变量选取
1.2.1　牙齿缺失情况
根据既往研究，天然牙齿数量是否不少于20颗是衡量口腔功能健康和美学的重要标准[11]。根据CLHLS生理健康模块中的问题“请问您有几颗牙（不包括假牙）？”将牙齿数量分为“0”或“1”，分别代表“天然牙齿数量不少于20颗”“天然牙齿数量小于20颗”，以此代表老年人的牙齿缺失情况。
1.2.2　膳食多样性评分
参考先前研究，从CLHLS生活方式问卷中选取水果、蔬菜、肉、蛋、鱼、豆、奶制品、坚果、茶9种食物的食用频率，按照9种食物的得分之和计算膳食多样性评分（DDS）[12]。其中，新鲜水果、新鲜蔬菜的摄入频率若为“每天/几乎每天吃”和“经常吃”，评为1分，否则评为0分；其他7种食物的摄入频率若为“几乎每天吃”和“至少每周一次”，评为1分，否则评为0分。根据相加计算，九种食物的总分范围为0～9分，分数越高代表膳食多样性越好。本量表的Chronbach α=0.631，KMO=0.746。
1.2.3　社会参与度
参考先前研究，本文提取CLHLS问卷中社会参与类问题赋分计算，指标包括：广场舞或串门等户外活动、阅读书报、看电视听广播、打牌或者打麻将、参加有组织的社会活动、做饭带孩子等家务、种花养宠物、饲养家禽[13]。按照参与频率，将“不参加”“不是每月但有时”“每月一次”“每周一次”“几乎每天”分别赋值为0～4分，得分越高代表社会参与度越好。本量表的Chronbach α=0.581，KMO= 0.708。
1.2.4　认知水平
本文将中文版简易智能精神状态检查量表（mini-mental state examination, MMSE）作为受试者认知水平的评估标准。按照MMSE量表测定标准，抽取问卷中与认知相关五大模块（定向能力、记忆能力、注意力、计算能力以及语言能力）的24个问题，其中，记忆能力分值取值范围为0～7，其他能力测试问题答对计1分，答错计0分。最终得分在0～30分之间，得分越高代表认知水平越高。本量表的Chronbach α=0.712，KMO=0.863。
1.2.5　控制变量
本文根据研究对象的一般人口学特征选取控制变量，包括性别、居住地、婚姻状况、年龄和受教育年限。
1.3　统计学分析
本研究相关变量的统计学分析通过SPSS 25.0软件实现。对连续变量和分类变量分别采用（均值±标准差）和频数进行统计学描述。不同组别认知水平的差异通过独立样本t检验比较。对牙齿缺失情况、膳食多样性、社会参与度与认知水平之间的关系，使用Spearman相关性分析，验证四者之间的双变量相关程度。运用SPSS插件PROCESS的模型6，利用偏差矫正的非参数百分位bootstrap法，重复抽样5 000次，构建95%置信区间，验证中介效应是否显著。
2　结果
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2.1　研究对象基本情况
在性别、婚姻状况、牙齿缺失情况上，不同组别的老年人认知水平差异具有统计学意义（P<0.05），而居住地差异不显著（P=0.115）。见表1。
2.2　相关性分析
为控制混杂变量的影响，本研究采用偏相关分析法分析变量之间的相关关系，牙齿缺失情况与膳食多样性呈负相关，牙齿缺失情况与社会参与程度呈负相关，牙齿缺失情况与认知水平呈负相关，膳食多样性与社会参与程度呈正相关，膳食多样性与认知水平呈正相关，社会参与程度与认知水平呈正相关。见表2。
2.3　链式中介效应分析
将性别、年龄、居住地、婚姻状况及受教育年限等作为控制变量，以牙齿缺失情况为自变量，认知水平为因变量，膳食多样性和社会参与度作为中介变量构建链式中介模型。
链式中介模型回归分析结果显示，牙齿缺失情况不仅对膳食多样性（β=-0.275，P<0.001）和社会参与度（β=-0.635，P<0.05）有负影响，也对认知水平（β=-0.298，P<0.001）有负影响；膳食多样性对社会参与度（β=0.638，P<0.001）和认知水平（β=0.059，P<0.05）有正影响；社会参与度对认知水平（β=0.063，P<0.001）有正影响。见表3，图1。
中介效应结果显示，牙齿缺失情况对认知水平的直接效应显著（β=-0.298,95% CI：-0.446～-0.149）；中介效应的三条路径效应都显著。见表4。
3　讨论
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3.1　老年人牙齿缺失情况直接影响其认知水平
本研究结果显示，老年人牙齿缺失情况直接影响其认知水平，研究结果与张宇蝶等人[14]一致，老年人天然牙齿数量过少会导致认知水平下降。天然牙齿数量作为衡量口腔健康情况的重要因素，将天然牙齿数量维持在20颗及以上对老年人口腔健康十分重要[15]。牙齿数量不足20颗会影响牙齿咬合能力进而降低咀嚼能力[16]，咀嚼能刺激口腔受体向大脑发送大量信息，激活大脑与记忆和学习相关的区域，而咀嚼功能降低会损害记忆与学习能力，从而造成认知功能受损[17]。提倡老年人保留至少20颗天然牙齿，对维护老年人口腔健康、预防认知功能疾病至关重要。政府应建立老年人口腔健康标准，重点推动60岁以上人群实现保留20颗功能牙目标，通过科普宣传牙齿缺失的危害。医疗机构需进行老年人牙齿缺失情况排查，将认知水平评估及认知功能疾病干预纳入老年人常规诊疗，加强口腔科与神经科协作，定期开展“口腔-认知”联合门诊，提供预防、评估、干预一体化的综合医疗服务。
3.2　老年人牙齿缺失通过膳食多样性的中介作用影响其认知水平
本研究结果显示，老年人牙齿缺失和认知水平之间存在膳食多样性这条中介路径，这与既往研究结果一致[18]。牙齿缺失是影响老年人咀嚼功能的常见因素之一，保留至少20颗功能牙，不仅是维持有效咀嚼的生理基础，也是保证营养摄入的生物学前提[19]。老年人咀嚼能力的下降，会使其倾向于选择更易咀嚼的柔软食物，这样的选择会让老年人减少水果、坚果等食物的摄入，影响老年人的饮食结构，破坏膳食平衡，导致膳食纤维摄入量不足、营养不合理[20]。同时，营养状况与认知水平相关，营养不均衡会导致老年人认知水平的下降[21] 。因此，要注重完善老年人的膳食结构，通过科普宣传等方式提高老年人的饮食科学性，尤其对于天然牙齿数量不足20颗的老年人，更应该关注其日常饮食搭配，以此避免因牙齿缺失、膳食结构不合理导致的认知水平下降。
3.3　老年人牙齿缺失通过社会参与度的中介作用影响其认知水平
研究结果表明，牙齿缺失能通过社会参与度影响老年人的认知水平。这与张虹等[22]学者的研究结果一致。牙齿数量是衡量口腔健康的重要指标之一[23]。口腔健康水平的高低会对老年人的社交活动和社会参与程度产生不同的影响。比如，牙齿缺失能通过牙齿功能和面部美学影响老年人的社会心理状态[24]，老年人牙齿缺失还影响身体机能，老年人牙齿缺失会提高心血管疾病、老年综合征以及慢性共病的患病概率[25]，社会心理状态和身体机能不佳会导致老年人社会参与度降低，而与社会隔绝的老年人由于群体活动不足更容易出现认知功能障碍[26]。因此，应当加大对老年人口腔健康的关注，比如组织免费的口腔检查，及时发现老年人的口腔健康问题，避免老年人牙齿脱落，此举可以提高老年人的社会参与，预防认知功能障碍类疾病。
3.4　老年人牙齿缺失通过膳食多样性及社会参与度的链式中介影响其认知水平
研究结果显示，膳食多样性和社会参与度先后在老年人牙齿缺失和认知水平之间存在链式中介效应。老年人牙齿缺失会影响其膳食多样性，导致营养摄入不足，比如，钙和维生素摄入不足会提高骨质疏松症发病率[27]；蛋白质摄入不足会提高老年人虚弱[28]的患病率。这些疾病会阻碍老年人参与家庭、社会活动，进而影响其认知水平。相反，牙齿数量更多的老年人可以摄入更多类型的食物，提高营养水平，降低抑郁症的患病风险，更多的参与家庭、社会活动[27]，激发老年人思维，提高其认知水平[26]。因此，要引导帮助老年人关注自身的牙齿缺失情况，保有更多的天然牙齿数量，提高老年人饮食的多样性，满足老年人的营养需求和生活质量，老年人家属也应该多关注老年人的认知状态，多方位提高老年人的认知水平，让老年人拥有高质量的健康老年生活。
综上，老年人牙齿缺失情况对老年人的认知水平有显著影响。未来，我们应给予老年人的口腔健康更多关注，将牙齿缺失状况列为衡量老年人认知水平的重要指标。通过避免牙齿缺失来保障老年人的饮食营养，在提升老年人社会参与度与夯实健康基础方面具有关键意义，这有利于降低老年人罹患认知功能障碍类疾病的风险，实现健康老龄化的目标。但本研究仍存在不足：一是本研究为横断面研究，因果推断存在一定局限性；二是受数据限制，可能存在未完全控制的混杂因素。
基金
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  • 司法部法治建设与法学理论研究部级科研项目(20SFB4064)
文献
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2025年第52卷第21期
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doi: 10.20043/j.cnki.MPM.202504371
  • 接收时间：2025-04-23
  • 首发时间：2026-10-29
  • 出版时间：2025-11-10
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  • 收稿日期：2025-04-23
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司法部法治建设与法学理论研究部级科研项目(20SFB4064)
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    山东第二医科大学管理学院，山东　潍坊　261053

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孙淑慧，E-mail：
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2种不同金属材料的力学参数
科
Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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