A Mediation Analysis of Oral Health, Anthropometric Characteristics and Frailty Among Community-Dwelling Mexican Older Adults.

INTRODUCTION: Frailty has been associated with oral health, a broad and heterogeneous construct. Due to its complexity and multi-dimensional nature, clarifying the role of oral health in the development of frailty remains challenging; potential mediating factors are being examined to improve its comprehension. This study aims to examine the relationship between frailty and oral deficits, considering biological age as a potential mediator using samples of Mexicans aged over 60. METHODS: This study is a secondary analysis of the Cohort of Obesity, Sarcopenia and Frailty of Older Mexican Adults (COSFOMA), a cohort of Mexican older adults starting at age 60. We analysed pre-pandemic data from 2019, including questionnaires, anthropometric measures, oral health evaluations and physical performance tests. Frailty was assessed using a standard Frailty Index, constructed from health-related deficits. Oral health was evaluated with the New Oral Health Index and the Geriatric Oral Health Assessment Index (GOHAI). Accelerated aging was estimated using AnthropoAge. Associations between frailty, oral health and biological aging were examined using generalised linear models (GLMs) with bootstrapped standard errors. RESULTS: The analytical sample comprised 1657 participants. We found that women had higher scores in BMI categories, use of prostheses, while men had higher scores of dental biofilm, gingivitis, caries and number of missing teeth. Values were higher among those with oral health deficits. A sex-stratified sub-analysis was performed; among men, no statistically significant average causal mediation effect (ACME) was found. However, among women, the direct effect of oral health deficits on frailty was not statistically significant, indicating associational evidence about mediation by accelerated aging. The proportion was 51.86%. DISCUSSION: Oral health deficits were associated with frailty, evidence consistent with an indirect pathway through accelerated aging. Among women, this indirect association was primarily observed in aging profiles characterised by disproportionate fat distribution and reduced lean mass. These findings highlight potential pathways linking oral health and frailty that warrant further investigation.