Adams School of Dentistry, University North Carolina at Chapel Hill, Chapel Hill, NC, USA.
National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD, USA.
J Dent Res. 2019 Oct;98(11):1219-1226. doi: 10.1177/0022034519866442. Epub 2019 Aug 1.
The US prevalence of nonalcoholic fatty liver disease (NAFLD) is 30.6% and increasing. NAFLD shares some risk factors with periodontitis and dental caries. We explored the association between NAFLD and several oral conditions among US adults, using data from the cross-sectional, nationally representative National Health and Nutrition Examination Survey (NHANES), 1988 to 1994. NAFLD was assessed with ultrasonography (USON), the screening gold standard not available in the more recent NHANES, and the noninvasive Fibrosis Score (FS), Fatty Liver Index (FLI), and US Fatty Liver Index (US-FLI) as other screening alternatives. There were 5,421 eligible dentate adults aged 21 to 74 y with complete relevant data, with transferrin levels ≤50%, without hepatitis B or C, who were not heavy drinkers. Multivariable models were developed to examine the independent effects of moderate-severe periodontitis, untreated dental caries, caries experience, and tooth loss (<20 teeth) on NAFLD while controlling for clinical, biological, and sociodemographic factors. Weighted estimates for odds ratios (ORs) and 95% CIs were calculated with logistic regression. Between 17% and 24% of adults had NAFLD depending on the classification criteria. In adjusted models, as compared with those with better oral health, adults with <20 teeth were more likely to have NAFLD depending on the measure (USON: OR = 1.50, 95% CI = 1.11 to 2.02; FS: OR = 4.36, 95% CI = 3.47 to 5.49; FLI: OR = 1.99, 95% CI = 1.52 to 2.59; US-FLI: OR = 2.32, 95% CI = 1.79 to 3.01). People with moderate-severe periodontitis were more likely to have NAFLD (USON: OR = 1.54, 95% CI = 1.06 to 2.24; FS: OR = 3.10, 95% CI = 2.31 to 4.17; FLI: OR = 1.61, 95% CI = 1.13 to 2.28; US-FLI: OR = 2.21, 95% CI = 1.64 to 2.98). People with any untreated caries were more likely to have NAFLD (USON: OR = 1.51, 95% CI = 1.20 to 1.90; FLI: OR = 1.80, 95% CI = 1.33 to 2.44). NAFLD was associated with tooth loss, periodontitis, and, for some NAFLD measures, untreated dental caries but not overall caries experience after controlling for several key sociodemographic and behavioral factors. Results suggest that further evaluation is needed to better understand this health-oral health interrelationship and potential opportunities for medical-dental integration.
非酒精性脂肪性肝病（NAFLD）在美国的流行率为 30.6%，且呈上升趋势。NAFLD 与牙周炎和龋齿有些共同的危险因素。我们利用来自横断面、全国代表性的国家健康和营养检查调查（NHANES）的数据，研究了美国成年人中 NAFLD 与几种口腔状况之间的关系，该调查于 1988 年至 1994 年进行。使用超声（USON）评估 NAFLD，这是最近的 NHANES 中不可用的筛查金标准，还使用非侵入性纤维化评分（FS）、脂肪肝指数（FLI）和美国脂肪肝指数（US-FLI）作为其他筛查替代方法。共有 5421 名年龄在 21 至 74 岁、有完整相关数据、转铁蛋白水平≤50%、无乙型肝炎或丙型肝炎、非重度饮酒者符合条件。建立多变量模型以检查中度至重度牙周炎、未经治疗的龋齿、龋齿经历和牙齿缺失（<20 颗）对 NAFLD 的独立影响，同时控制临床、生物学和社会人口统计学因素。使用逻辑回归计算优势比（OR）和 95%CI 的加权估计值。根据分类标准，17%至 24%的成年人患有 NAFLD。在调整后的模型中，与口腔健康状况较好的成年人相比，牙齿缺失<20 颗的成年人更有可能患有 NAFLD（根据 USON：OR=1.50，95%CI=1.11-2.02；FS：OR=4.36，95%CI=3.47-5.49；FLI：OR=1.99，95%CI=1.52-2.59；US-FLI：OR=2.32，95%CI=1.79-3.01）。患有中度至重度牙周炎的成年人更有可能患有 NAFLD（USON：OR=1.54，95%CI=1.06-2.24；FS：OR=3.10，95%CI=2.31-4.17；FLI：OR=1.61，95%CI=1.13-2.28；US-FLI：OR=2.21，95%CI=1.64-2.98）。有任何未经治疗的龋齿的成年人更有可能患有 NAFLD（USON：OR=1.51，95%CI=1.20-1.90；FLI：OR=1.80，95%CI=1.33-2.44）。NAFLD 与牙齿缺失、牙周炎有关，对于某些 NAFLD 测量值，与未经治疗的龋齿有关，但与控制了几个关键的社会人口统计学和行为因素后的总体龋齿经历无关。结果表明，需要进一步评估以更好地了解这种健康-口腔健康的相互关系和潜在的医疗-牙科整合机会。
