Department of Public Health, Federal University of Maranhão, São Luís, Maranhão, Brazil.
Department of Dentistry, Federal University of Alagoas, Maceió, Alagoas, Brazil.
Sci Rep. 2024 Oct 30;14(1):26170. doi: 10.1038/s41598-024-75813-3.
This study aimed to evaluate the association between ultra-processed food (UPF) and dental caries, considering muscle mass (MM), bone mineral density (BMD), and oral hygiene habits (OHH) as mediators. This study has an analytical cross-sectional design with 2,515 adolescents (18-19 years). The main exposure - the UPF intake ratio - was established using the food frequency questionnaire. The outcome was the number of decayed teeth, according to the DMFT index. The model adjustment included socio-economic status (SES), frequency of physical activity, and concurrent risk habits (CRH) as potential confounders. Three latent variables were considered: SES (family income, economic class, household head, and adolescent education), OHH (gingival bleeding on probing index and visible plaque index), and CRH (alcohol and tobacco dependence). The analyses used structural equation modeling, estimating the standardized coefficient (SC) in three models: lumbar BMD(1), femoral BMD(2), and total BMD(3). UPF consumption had a direct (SC=0.071, SC=0.072, SC=0.071; p < 0.05) and total (SC=0.067, SC=0.068, SC=0.068; p < 0.05) effect on the number of decayed teeth. BMD and MM did not mediate the association between UPF and dental caries, but the indirect association mediated by OHH was significant in all analyses (p < 0.05). Dental Caries was explained in other specific pathways: SES→UPF→Dental Caries (SCmodel = 0.009, SCmodel = 0.008, SCmodel = 0.009); SES→OHH→Dental Caries (SCmodel = 0.033, SCmodel = 0.033, SCmodel = 0.034); CRH→UPF→Dental Caries (SCmodel = 0.009, SCmodel = 0.008, SCmodel = 0.008); CRH→OHH→Dental Caries (SCmodel = 0.029, SCmodel = 0.027, SCmodel = 0.027). Dental caries prevention should include encouraging good OHH, healthy eating, and developing equitable public policies in middle and low-income countries like Brazil.
本研究旨在评估超加工食品（UPF）与龋齿之间的关联，并考虑肌肉质量（MM）、骨矿物质密度（BMD）和口腔卫生习惯（OHH）作为中介因素。本研究采用分析性横断面设计，纳入 2515 名青少年（18-19 岁）。主要暴露因素——UPF 摄入量比——使用食物频率问卷进行评估。结果为根据 DMFT 指数评估的龋齿数。模型调整包括社会经济地位（SES）、体力活动频率和同时存在的风险习惯（CRH）作为潜在混杂因素。考虑了三个潜在变量：SES（家庭收入、经济阶层、家庭户主和青少年教育）、OHH（探诊出血指数和可见菌斑指数）和 CRH（酒精和烟草依赖）。分析采用结构方程模型，在三个模型中估计标准化系数（SC）：腰椎 BMD（1）、股骨 BMD（2）和总 BMD（3）。UPF 消费对龋齿数量有直接（SC=0.071、SC=0.072、SC=0.071；p<0.05）和总（SC=0.067、SC=0.068、SC=0.068；p<0.05）效应。BMD 和 MM 并未介导 UPF 与龋齿之间的关联，但在所有分析中，由 OHH 介导的间接关联均具有统计学意义（p<0.05）。龋齿还通过其他特定途径解释：SES→UPF→龋齿（SCmodel=0.009、SCmodel=0.008、SCmodel=0.009）；SES→OHH→龋齿（SCmodel=0.033、SCmodel=0.033、SCmodel=0.034）；CRH→UPF→龋齿（SCmodel=0.009、SCmodel=0.008、SCmodel=0.008）；CRH→OHH→龋齿（SCmodel=0.029、SCmodel=0.027、SCmodel=0.027）。在巴西等中低收入国家，龋齿预防应包括鼓励良好的 OHH、健康饮食和制定公平的公共政策。
