Association between the Mediterranean Diet Index and self-reported Gingival Health Status Indicators in a population of Chilean adults: a cross-sectional study

Abstract Despite the recognized impact of diet on non-communicable diseases, the association between the Mediterranean diet and periodontal diseases is still uncertain. This study aimed to determine the association between adherence to the Mediterranean Diet Index (MDI) and self-reported gingival health status in Chilean adults, exploring the feasibility of using validated web-based survey questionnaires. Methodology Cross-sectional data were collected from a representative sample of a population of Chilean adults (18-60 years old) using a low-cost and time-saving methodology. By the PsyToolkit platform, anonymous survey data were downloaded and analyzed in bivariate (crude) and backward stepwise selection multivariate logistic regression models adjusted for sociodemographic determinants, smoking, and dental attendance using STATA 17. Odds ratios (OR) [95% confidence intervals] were estimated. Results In total, 351 complete statistical data were mostly obtained from female university students who had never smoked and reported having visited a dentist in the previous year. Multivariate regression models showed an association between MDI and very good/good gingival health status (OR 1.18 [95% CI 1.04-1.34], p=0.013), absence of bleeding on toothbrushing (OR 1.12 [95% CI 1.01-1.25], p=0.035), and absence of clinical signs of gingival inflammation (OR 1.24 [95% CI 1.10-1.40], p<0.001), after controlling for age, sex, educational level, smoking, and dental attendance. Conclusions We associated adherence to the Mediterranean diet with better self-reported gingival health status in a population of Chilean adults in an entirely web-based research environment. Longitudinal studies with random sampling are required to establish the effect of diet on gingival and periodontal health. Nevertheless, this evidence could contribute to the design of low-cost surveillance programs to reduce the burden of periodontal disease and related “common risk factors”.

摘要 尽管饮食对非传染性疾病的影响已得到学界公认，但地中海饮食与牙周疾病之间的关联仍未明确。本研究旨在明确智利成年人群对地中海饮食指数（Mediterranean Diet Index, MDI）的依从程度与自我报告的牙龈健康状况之间的关联，并探讨使用经过验证的网络问卷调查的可行性。

研究方法 本研究采用低成本且省时的研究方案，从智利18~60岁成年人群的代表性样本中收集横断面数据。通过PsyToolkit平台下载匿名调查数据，并使用STATA 17软件开展双变量（粗模型）分析，以及针对社会人口学特征、吸烟状况及牙科就诊情况进行校正的向后逐步选择多元logistic回归分析，最终估算比值比（OR）[95%置信区间]。

结果 本研究共获取351份完整统计数据，研究对象多为从未吸烟且自述过去一年曾就诊牙医的女性大学生。多元回归分析结果显示，在校正年龄、性别、受教育程度、吸烟状况及牙科就诊情况后，MDI依从性与极佳/良好的牙龈健康状况（OR=1.18，95%CI：1.04~1.34，p=0.013）、刷牙时无牙龈出血症状（OR=1.12，95%CI：1.01~1.25，p=0.035）以及无牙龈炎症临床体征（OR=1.24，95%CI：1.10~1.40，p<0.001）均存在显著关联。

结论 本研究在完全基于网络的研究环境中，证实智利成年人群的地中海饮食依从性与更佳的自我报告牙龈健康状况存在关联。未来需开展采用随机抽样的纵向研究，以明确饮食对牙龈及牙周健康的具体影响。尽管如此，本研究结果可为设计低成本监测项目以减轻牙周疾病及其相关“共同危险因素”的疾病负担提供参考依据。