Assessing Nutrition as a Mediator between Oral and General Health

Objective: To evaluate the association of oral health on general health and whether food intake mediates the relationship. Method: Data were collected in 2004–06 in a representative sample of Australian adults from NSW and Queensland, using a three-stage, stratified clustered sample, involving a computer-assisted telephone interview (CATI), followed by an oral examination, mailed questionnaire and a food frequency questionnaire (FFQ). Self-rated general health was the outcome, and self-rated oral health, periodontal status, oral health impact (OHIP) and missing-teeth were explanatory variables, and food groups (dairy, bread-cereal, meat-fish-eggs, sweet foods-snacks, mixed-vegetables, vegetables and fruits) were mediators. Age, gender, smoking-status, brushing-habits, diabetes, alcohol-consumption and social-support were the control variables. For mediation analysis Baron and Kenny’s mediation analysis was initially performed, followed by Sobel’s test. Lastly bootstrapping for standard-error and Structural Equation Modelling (SEM) were conducted to assess the consistency of the mediation model. Result: A total of n =14,123 adults responded to the CATI (49% response rate), and n =5505 were examined. In the nutrition sub-study, a total of n = 1218 persons were approached, with n =1129 responding (92.7% response rate). Among them, there were 752 respondents who were aged 45 years or more. From multivariate linear regression analysis, It has been found that adults with better self-rated dental health rated their general health better (β=0.408, p<0.001). Worse oral health was associated with worse general health (for OHIP and missing-teeth, β= -0.027 and -0.01, p<0.001). Adults with none/mild and moderate periodontal problems compared to severe problems rated their general health better (β1=0.13, p<0.001 and β2=0.09, p<0.001). Baron and Kenny, and Sobel tests showed the associations between oral health (OHIP and missing-teeth) were partially mediated by food intake (Sobel test: for all mediators, p<0.001). The associations between periodontal status and self- rated general health were partially mediated by food intake (Sobel test: for all mediators, p<0.05). The association between self-rated dental health and general health was partially mediated by food intake (Sobel test: for all mediators, p<0.01). For all four explanatory variables, periodontitis, number of missing-teeth, OHIP-score and self-rated dental health, Bootstrap results showed zero in the bias-corrected confidence intervals for mediators, indicative of no mediation. SEM analysis for mediation between periodontal status and general health showed p= 0.76, p=0.045, p=0.050, p=0.015, p=0.73, p=0.42 and p= 0.30 for dairy, bread-cereal, meat-fish-eggs, sweet foods-snacks, mixed-vegetables, vegetables and fruits. SEM analysis for mediation showed p= 0.95, p=0.34, p=0.44, p=0.40; p= 0.04 and p=0.58 for dairy, bread-cereal, meat-fish-eggs, sweet foods-snacks, mixed-vegetables, vegetables and fruits respectively for OHIP and p>0.05 for dairy, bread-cereal, meat-fish-eggs, sweet foods-snacks, mixed-vegetables, vegetables and fruits for missing-teeth. SEM analysis for mediation between self-rated dental and general health showed p>0.05 for dairy, bread-cereal, meat-fish-eggs, sweet foods-snacks, mixed-vegetables, vegetables and fruits. Conclusion: SEM indicated the association between periodontitis and self-rated general health was partially mediated by bread-cereal, meat-fish-eggs and sweet-snacks. But the association between self-rated dental health, OHIP-Score or number of missing-teeth and self- rated general health was not mediated by any of these food items.

Author dc:creator

• Islam, Saima

Advisor dc:contributor.advisor

• Brennan, David S.

• Oral health
• General health
• Nutrition, Mediation analysis
• Mediation analysis
• Structural Equation Modelling (SME)

Language dc:language.iso

en

Handle dc:identifier.uri

http://hdl.handle.net/2440/122294

OAI identifier oai:identifier

oai:digital.library.adelaide.edu.au:2440/122294