Center for Clinical Research and Health Promotion, University of Puerto Rico Medical Sciences Campus, School of Dental Medicine, San Juan, PR, USA; Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA.
Center for Clinical Research and Health Promotion, University of Puerto Rico Medical Sciences Campus, School of Dental Medicine, San Juan, PR, USA.
Nitric Oxide. 2017 Dec 1;71:14-20. doi: 10.1016/j.niox.2017.09.004. Epub 2017 Sep 20.
Over-the-counter mouthwash comprises part of routine oral care for many; however, potential adverse effects of the long-term daily use have not been evaluated. Most mouthwash contain antibacterial ingredients, which could impact oral microbes critical for nitric oxide formation, and in turn predispose to metabolic disorders including diabetes. Our aim was to evaluate longitudinally the association between baseline over-the-counter mouthwash use and development of pre-diabetes/diabetes over a 3-year follow-up.
The San Juan Overweight Adults Longitudinal Study (SOALS) recruited 1206 overweight/obese individuals, aged 40-65, and free of diabetes and major cardiovascular diseases; 945 with complete follow-up data were included in the analyses. We used Poisson regression models adjusting for baseline age, sex, smoking, physical activity, waist circumference, alcohol consumption, pre-hypertension/hypertension status; time between visits was included in the models as an offset.
Many participants (43%) used mouthwash at least once daily and 22% at least twice daily. Participants using mouthwash ≥ twice daily at baseline, had a significantly elevated risk of pre-diabetes/diabetes compared to less frequent users (multivariate IRR = 1.55, 95% CI: 1.21-1.99), or non-users of mouthwash (multivariate IRR = 1.49; 95% CI: 1.13-1.95). The effect estimates were similar after adding income, education, oral hygiene, oral conditions, sleep breathing disorders, diet (processed meat, fruit, and vegetable intake), medications, HOMA-IR, fasting glucose, 2hr post load glucose or CRP to the multivariate models. Both associations were also significant among never-smokers and obese individuals. Mouthwash use lower than twice daily showed no association, suggesting a threshold effect at twice or more daily.
Frequent regular use of over-the-counter mouthwash was associated with increased risk of developing pre-diabetes/diabetes in this population.
非处方漱口水是许多人日常口腔护理的一部分；然而，长期每日使用的潜在不良反应尚未得到评估。大多数漱口水都含有抗菌成分，这些成分可能会影响口腔微生物对一氧化氮形成的关键作用，从而导致代谢紊乱，包括糖尿病。我们的目的是在 3 年的随访中，纵向评估基线时使用非处方漱口水与发展为糖尿病前期/糖尿病之间的关系。
圣胡安超重成年人纵向研究（SOALS）招募了 1206 名超重/肥胖人群，年龄在 40-65 岁之间，无糖尿病和主要心血管疾病；945 名具有完整随访数据的参与者被纳入分析。我们使用泊松回归模型，根据基线年龄、性别、吸烟、体力活动、腰围、饮酒、高血压前期/高血压状态进行调整；访问时间间隔作为模型的偏移量。
许多参与者（43%）每天至少使用一次漱口水，22%的人每天使用两次或更多次。与使用频率较低的使用者（多变量 IRR=1.55，95%CI：1.21-1.99）或不使用漱口水的使用者（多变量 IRR=1.49；95%CI：1.13-1.95）相比，基线时每天使用漱口水≥两次的参与者发生糖尿病前期/糖尿病的风险显著升高。在将收入、教育、口腔卫生、口腔状况、睡眠呼吸障碍、饮食（加工肉类、水果和蔬菜摄入）、药物、HOMA-IR、空腹血糖、2 小时餐后血糖或 CRP 添加到多变量模型后，这些估计值仍然相似。在从不吸烟者和肥胖人群中，这两种关联也很显著。每天使用漱口水少于两次与糖尿病前期/糖尿病的发生无关，表明每天使用两次或更多次存在阈值效应。
在该人群中，频繁使用非处方漱口水与发展为糖尿病前期/糖尿病的风险增加有关。
