PADRÃO DE DIETA NÃO-SAUDÁVEL, OBESIDADE E DOENÇA PERIODONTAL EM ADOLESCENTES: COORTE RPS- SÃO LUÍS. BRASIL

Abstract

Introduction: The mechanisms explaining the link between an unhealthy diet and periodontal disease have not yet been fully elucidated. Thus, the present study aimed to model the association between an "unhealthy dietary pattern" and "initial periodontal disease" in adolescents, analyzing mediation pathways through oral biofilm (local mechanism) and obesity (systemic mechanism), using Structural Equation Modeling (SEM). Method: This was a population-based, cross-sectional study that used data from adolescents aged 18 to 19 years (n=2515) from the RPS Cohort Consortium (Ribeirão Preto, Pelotas, and São Luís), specifically the São Luís cohort, Brazil. The exposure of interest, the "unhealthy dietary pattern," was a latent variable constructed by Exploratory Factor Analysis (EFA), composed of the consumption of sugar-sweetened beverages, salty snacks, and fast foods, obtained through a validated 106-item food frequency questionnaire. The outcome, the latent variable "initial periodontal disease," was formed by the indicators: probing depth (PD ≥ 4 mm), clinical attachment loss (CAL ≥ 4 mm), and bleeding on probing (BOP). The models were adjusted for socioeconomic status (a latent variable formed by family income, head of household's education, adolescent's education, and economic class), abusive alcohol use (assessed by the AUDIT questionnaire), and smoking. Data were analyzed using SEM, with the Mplus software version 7.0. Subgroup analyses were performed by sex. Model consistency was tested for a latent variable of "severe periodontal disease," formed by the indicators: PD ≥ 5 mm, CAL ≥ 5 mm, and BOP. Results: The "Unhealthy Dietary Pattern" was associated with "initial periodontal disease" through the indirect path mediated by oral biofilm (Standardized Coefficient - SC = 0.078, Standard Error - SE = 0.022, p <0.001). In boys, the Unhealthy Dietary Pattern showed a direct association with "initial periodontal disease" (SC = 0.096, SE = 0.049, p = 0.049) and also an indirect association via oral biofilm (SC = 0.041, p=0.027). Additionally, in boys, obesity was associated with "initial periodontal disease" (SC=0.195, SE = 0.062, p = 0.002). In girls, no association was observed between the Unhealthy Dietary Pattern and "initial periodontal disease." In the consistency analysis, the "Unhealthy Dietary Pattern" was associated with "severe periodontal disease" via oral biofilm (SC= 0.074, SE = 0.021, p<0.001); these associations were observed in both boys (SC= 0.102, SE = 0.031, p=0.001) and girls (SC= 0.051, SE = 0.023, p=0.027). Conclusion: The Unhealthy Dietary Pattern was associated with periodontal disease through a path mediated by oral biofilm, suggesting a predominantly local mechanism. The direct association of the Unhealthy Dietary Pattern with more severe periodontal disease, independent of obesity and observed only in men, may suggest a systemic effect.