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.

研究背景：龋病（Caries）是全球范围内最普遍的非传染性疾病（non-communicable disease, NCD），还可预测未来致死性非传染性疾病的发生，例如糖尿病与心血管疾病。据此，本研究提出假设：龋病青少年群体中可能存在上述非传染性疾病的行为危险因素。
研究目的：分析青少年不良饮食、吸烟行为与饮酒行为和龋病的关联。
研究方法：本研究为基于人群的横断面研究，数据来源于巴西圣路易斯-马拉尼昂州（São Luís-MA）出生的2515名18~19岁青少年，该群体属于RPS队列联盟（RPS Cohort Consortium）。本研究的暴露因素为不良饮食模式（包含糖类、快餐及咸味零食）与成瘾行为（吸烟行为及酒精依赖风险）的潜变量；结局指标为龋坏牙齿数量。模型校正环节将社会经济地位（户主受教育程度、青少年自身受教育程度、经济阶层及家庭月收入）作为远端决定因素，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Mplus 8.0软件通过结构方程模型（Structural Equation Modeling, SEM）进行数据分析。
研究结果：不良饮食模式可直接（标准化系数SC=0.092，P≤0.001）以及通过口腔生物膜间接（SC=0.020，P≤0.001）与更多的龋坏牙齿数量呈正相关。成瘾行为可通过口腔生物膜间接与更多龋坏牙齿数量呈正相关（SC=0.019，P=0.013）。不良饮食模式与成瘾行为之间存在显著关联（CP=0.199，P<0.001）。
研究结论：除糖类外，龋病的发生还存在其他与非传染性疾病相关的行为危险因素，凸显了青少年综合健康照护的重要性。