Rivier Cyprien A, Renedo Daniela, de Havenon Adam, Gill Thomas M, Payabvash Sam, Sheth Kevin N, Falcone Guido J
Department of Neurology, Yale University School of Medicine, New Haven, CT, USA.
Yale Center for Brain and Mind Health, New Haven, CT, USA.
medRxiv. 2023 Mar 18:2023.03.18.23287435. doi: 10.1101/2023.03.18.23287435.
Poor oral health is a modifiable risk factor that is associated with a variety of health outcomes. However, the relationship between oral and brain health is not well understood.
To test the hypothesis that poor oral health is associated with worse neuroimaging brain health profiles in persons without stroke or dementia.
We conducted a 2-stage cross-sectional neuroimaging study using data from the UK Biobank (UKB). First, we tested for association between self-reported poor oral health and MRI neuroimaging markers of brain health. Second, we used Mendelian Randomization (MR) analyses to test for association between genetically-determined poor oral health and the same neuroimaging markers.
Ongoing population study in the United Kingdom. The UKB enrolled participants between 2006 and 2010. Data analysis was performed from September 1, 2022, to January 10, 2023.
40,175 persons aged 40 to 70 enrolled between 2006 to 2010 who underwent a dedicated research brain MRI between 2012 and 2013.
During MRI assessment, poor oral health was defined as the presence of dentures or loose teeth. As instruments for the MR analysis, we used 116 independent DNA sequence variants known to significantly increase the composite risk of decayed, missing, or filled teeth and dentures.
As neuroimaging markers of brain health, we assessed the volume of white matter hyperintensities (WMH), as well as aggregate measures of fractional anisotropy (FA) and mean diffusivity (MD), two metrics indicative of white matter tract disintegrity obtained through diffusion tensor imaging. These measurements were evaluated across 48 distinct brain regions, with FA and MD values for each region also considered as individual outcomes for the MR method.
Among study participants, 5,470 (14%) had poor oral health. We found that poor oral health was associated with a 9% increase in WMH volume (beta = 0.09, standard deviation (SD) = 0.014, p P< 0.001), a 10% change in the aggregate FA score (beta = 0.10, SD = 0.013, P < 0.001), and a 5% change in the aggregate MD score (beta = 0.05, SD = 0.013, P < 0.001). Genetically-determined poor oral health was associated with a 30% increase in WMH volume (beta = 0.30, SD = 0.06, P < 0.001), a 43% change in aggregate FA score (beta = 0.42, SD = 0.06, P < 0.001), and an 10% change in aggregate MD score (beta = 0.10, SD = 0.03, P = 0.01).
Among middle age Britons without stroke or dementia enrolled in a large population study, poor oral health was associated with worse neuroimaging brain health profiles. Genetic analyses confirmed these associations, supporting a potential causal association. Because the neuroimaging markers evaluated in the current study are established risk factors for stroke and dementia, our results suggest that oral health may be a promising target for interventions focused on improving brain health.
口腔健康不佳是一个可改变的风险因素，与多种健康结果相关。然而，口腔健康与大脑健康之间的关系尚未得到充分理解。
检验口腔健康不佳与无中风或痴呆症患者较差的神经影像学脑健康状况相关这一假设。
我们使用英国生物银行（UKB）的数据进行了一项两阶段横断面神经影像学研究。首先，我们测试了自我报告的口腔健康不佳与脑健康的MRI神经影像学标志物之间的关联。其次，我们使用孟德尔随机化（MR）分析来测试基因决定的口腔健康不佳与相同神经影像学标志物之间的关联。
英国正在进行的一项人群研究。UKB在2006年至2010年期间招募了参与者。数据分析于2022年9月1日至2023年1月10日进行。
2006年至2010年期间招募的40175名年龄在40至70岁之间的人，他们在2012年至2013年期间接受了专门的脑部MRI研究。
在MRI评估期间，口腔健康不佳被定义为存在假牙或牙齿松动。作为MR分析的工具，我们使用了116个独立的DNA序列变异，已知这些变异会显著增加龋齿、缺牙或补牙以及假牙的综合风险。
作为脑健康的神经影像学标志物，我们评估了白质高信号（WMH）的体积，以及分数各向异性（FA）和平均扩散率（MD）的综合测量指标，这两个指标是通过扩散张量成像获得的指示白质束完整性的指标。这些测量在48个不同的脑区进行评估，每个区域的FA和MD值也被视为MR方法的个体结局。
在研究参与者中，5470人（14%）口腔健康不佳。我们发现，口腔健康不佳与WMH体积增加9%（β = 0.09，标准差（SD）= 0.014，P < 0.001）、FA综合评分变化10%（β = 0.10，SD = 0.013，P < 0.001）以及MD综合评分变化5%（β = 0.05，SD = 0.013，P < 0.001）相关。基因决定的口腔健康不佳与WMH体积增加30%（β = 0.30，SD = 0.06，P < 0.001）、FA综合评分变化43%（β = 0.42，SD = 0.06，P < 0.001）以及MD综合评分变化10%（β = 0.10，SD = 0.03，P = 0.01）相关。
在一项大型人群研究中纳入的无中风或痴呆症的中年英国人中，口腔健康不佳与较差的神经影像学脑健康状况相关。基因分析证实了这些关联，支持了潜在的因果关系。由于本研究中评估的神经影像学标志物是中风和痴呆症的既定风险因素，我们的结果表明口腔健康可能是改善脑健康干预措施的一个有前景的目标。
