Supplementary Material for: Behavior Risk Factors for Non-Communicable Diseases and Caries in Adolescents: A Population Study

Introduction: Caries is the most widespread non-communicable disease (NCD) globally and can predict fatality NCDs in the future, such as diabetes and cardiovascular diseases. Therefore, we hypothesized that the behavioral risk factors for those NCDs may be present in adolescents with caries. Objective: To analyze the association of unhealthy diet, tabagism, and alcohol with caries in adolescents. Methods: This population-based study with a cross-sectional design used data from 2515 adolescents aged 18-19 yo, born in São Luís-MA, Brazil, and part of the RPS Cohort Consortium. The exposures were the latent variables of the Unhealthy Diet Pattern (sugars, fast foods, and salty snacks) and Addictive Behaviors (tabagism and risk of alcohol dependence). The outcome was the number of decayed teeth. The model adjustment considered the Socioeconomic Status (head of household education, adolescent education, economic class, and monthly family income) as a distal determinant and the oral biofilm as a mediator between the exposures and the outcome, analyzed by Structural Equation Modeling (SEM), using the Mplus 8.0 software. Results: Unhealthy Diet Pattern was associated with a higher number of decayed teeth directly (SC=0.092, p≤0.001) and indirectly via dental biofilm (SC=0.020, p≤0.001). Addictive Behaviors were associated with a higher number of decayed teeth indirectly via dental biofilm (SC=0.019, p=0.013). The Unhealthy Diet Pattern and Addictive Behaviors were associated with each other (CP=0,199; p<0,001). Conclusion: Besides sugars, other behavioral risk factors for NCDs underlie caries, emphasizing the importance of comprehensive adolescent health care.

引言：龋齿是全球范围内最普遍的非传染性疾病（non-communicable disease, NCD），且可预测未来致命性NCD的发生，例如糖尿病与心血管疾病。因此，我们假设这些NCD的行为危险因素可能存在于患有龋齿的青少年中。
目标：分析不健康饮食、吸烟（tabagism）与饮酒和青少年龋齿之间的关联。
方法：本研究为基于人群的横断面研究，使用了来自巴西马拉尼昂州圣路易斯市出生的2515名18-19岁青少年的数据，这些青少年属于RPS队列联盟（RPS Cohort Consortium）的一部分。暴露因素为不健康饮食模式（含糖食物、快餐及咸味零食）和成瘾行为（吸烟（tabagism）及酒精依赖风险）的潜变量。结局指标为龋齿数。模型调整将社会经济地位（Socioeconomic Status）（户主教育程度、青少年教育程度、经济阶层及家庭月收入）视为远端决定因素，并将口腔生物膜作为暴露因素与结局之间的中介变量，采用结构方程模型（Structural Equation Modeling, SEM）通过Mplus 8.0软件进行分析。
结果：不健康饮食模式与龋齿数增加直接相关（SC=0.092，p≤0.001），并通过口腔生物膜间接相关（SC=0.020，p≤0.001）。成瘾行为通过口腔生物膜与龋齿数增加间接相关（SC=0.019，p=0.013）。不健康饮食模式与成瘾行为之间存在关联（CP=0.199；p<0.001）。
结论：除含糖食物外，其他NCD行为危险因素也是龋齿的潜在原因，这强调了青少年综合健康护理的重要性。