Dietary patterns and root caries risk

描述（由申请人提供）：美国人口正在老龄化，与前几代人相比，人们在老年时保留更多的牙齿。这些趋势表明，牙根龋的发病率和治疗费用将继续上升。需要更多的研究来更好地了解饮食如何影响牙根龋病的风险。我们对龋齿的饮食风险因素的大部分知识，特别是糖，来自对冠状（牙釉质）龋齿的研究，主要是在儿童中进行的，并且是在氟化物广泛使用之前进行的。目前尚不清楚这些研究与当前老年人牙根龋问题的相关性。牙根龋比冠状龋在酸性较低的环境中发展。老年人往往比年轻人摄入更少的糖。因此，需要检查其他饮食因素的作用，无论是致癌因素还是保护因素。饮食和牙根龋病的研究是复杂的，因为各种营养素的摄入量是高度相关的。饮食模式分析是一种研究饮食和其他慢性疾病的方法。本研究的目的是利用来自两个研究人群的现有数据，调查与牙根龋风险相关的饮食模式。第一个人群是成年男性的前瞻性VA牙科纵向研究（DLS），该研究收集了20年来关于牙根龋病和修复、饮食和其他口腔健康、生活方式和医学变量的数据。这些人不是退伍军人管理局的病人，而是退伍军人管理局一项研究的志愿者，他们从私营部门接受医疗和牙科护理。对563名在过去20年中参加过两次或两次以上牙科检查的DLS受试者进行牙根龋患病率和发病率的估计。我们的主要假设是，在遵循高水果、蔬菜、低脂乳制品和全谷物饮食模式的老年男性中，即使在摄入适量糖的情况下，牙根龋的患病率、发病率和严重程度也会降低。为了解决这一假设，我们将使用聚类分析从DLS的食物频率问卷中确定与降低牙根龋风险相关的饮食模式。我们将使用多变量逻辑分析、生存和泊松回归分析来估计与饮食模式相关的原发性和继发性牙根龋患病率、发病率和严重程度。所有模型都将控制重要的混杂因素。这种饮食模式将在第二组人群中得到验证，这是2003-04年NHANES进行的横断面调查。在这项调查中，5122名成年人接受了牙齿检查，并填写了食物频率问卷。虽然NHANES仅提供牙根龋患病率的测量，但样本权重可用于得出具有全国代表性的整体人口以及特定性别和种族亚组的疾病估计。这项研究的一个重要结果是有可能为患者和公众建立一套一致的饮食建议，将口腔健康纳入整体健康促进战略。

DESCRIPTION (provided by applicant): The US population is aging and individuals are keeping more of their teeth into old age compared to previous generations. These trends suggest the prevalence of root caries and expenditures to treat them will continue to rise. More research is needed to better understand how diet affects root caries risk. Most of our knowledge about dietary risk factors for caries, particularly sugars, comes from studies of coronal (enamel) caries, primarily in children, and conducted prior to the widespread availability of fluoride. It is not clear how relevant these studies are to the current problem of root caries in older adults. Root caries can develop in a less acidic environment than coronal caries. Older adults tend to consume less sugar than younger age groups. Therefore, the roles of other dietary factors, both cariogenic and protective, need to be examined. The study of diet and root caries is complex because intakes of various nutrients are highly correlated. Analysis of dietary patterns is a methodological approach that has been used in the study of diet and other chronic diseases. The aim of this research is to investigate dietary patterns that are associated with root caries risk using existing data from two study populations. The first population is the prospective VA Dental Longitudinal Study (DLS) of adult men which has collected 2 decades of data on root caries and restorations, diet, and other oral health, lifestyle, and medical variables. The men are not VA patients, but are volunteers in a VA study who receive medical and dental care from the private sector. Root caries prevalence and incidence will be estimated from 563 DLS subjects who have participated in two or more dental examinations in the past 20 years. Our primary hypothesis is that root caries prevalence, incidence and severity are reduced among older men who follow a dietary pattern that is high in fruits, vegetables, low-fat dairy and whole grains, even in the presence of moderate sugar intake. To address this hypothesis, we will use cluster analysis to identify dietary patterns from food frequency questionnaires in the DLS that are associated with reduced risk of root caries. We will use multivariable logistic, survival and Poisson regression analyses to estimate the primary and secondary root caries prevalence, incidence and severity associated with the dietary patterns. All models will control for important confounders. The dietary patterns will be validated in the second population, the cross-sectional NHANES survey conducted in 2003-04. In this survey, 5122 adults received dental examinations and completed food frequency questionnaires. Although NHANES only provides measures of root caries prevalence, sample weights can be used to derive nationally representative estimates of disease in the population as a whole and in gender- and ethnic-specific subgroups. An important result of this research is the potential for creating a consistent set of dietary recommendations for patients and the public that integrates oral health into overall health promotion strategies. PUBLIC HEALTH RELEVANCE: Root decay is expected to be a growing problem among older adults in the US as people live longer and keep more of their teeth. This study will identify dietary patterns that are associated with root decay in a group of older men and in a nationally representative sample of adult men and women. The findings may help to define healthy eating patterns that reduce the risk of root decay.