The Triangle of Nonalcoholic Fatty Liver Disease, Metabolic Dysfunction, and Periodontitis: Analysis of the Dental, Oral, Medical and Epidemiological (DOME) Records-Based Nationwide Research

Abstract

This study aimed to analyze the associations of nonalcoholic fatty liver disease (NAFLD) with dental parameters, while controlling for socio-demographics, health-related habits, and each of the metabolic syndrome (MetS) components, consequences, and related conditions among a nationally representative sample of young and middle-aged adults. To that end, we analyzed data from the dental, oral, medical epidemiological (DOME) cross-sectional records-based study that combined comprehensive socio-demographic, medical, and dental databases of a nationally representative sample of military personnel. Included were 132,529 subjects aged 18–50 who attended military dental clinics for one year. The prevalence of NAFLD in the study population was 0.7% (938/132,529). The following parameters maintained a statistically positive association with NAFLD in the multivariate analysis (from highest to lowest OR): male sex (OR = 3.91 (2.29–6.66)), hyperlipidemia (OR = 3.69 (2.75–4.95)), diabetes Type 2 (OR = 3.14 (2.21–4.46)), hypertension (OR = 1.67 (1.30–2.14)), periodontitis (OR = 1.42 (1.06–1.89)), body mass index (BMI) (OR = 1.15 (1.13–1.18)), and age (OR = 1.08 (1.06–1.09)). The multivariate analysis established a profile of the “patient vulnerable to NAFLD”, including older age, male sex, and other MetS components, including diabetes type 2, hypertension, hyperlipidemia, BMI, and periodontitis. This profile aligns with the current new definition of metabolic dysfunction-associated fatty liver disease (MAFLD). We also analyzed the associations of the sum of the standard dental unit (SDU) scores of planned (SDU-P) and delivered (SDU-D) dental procedures per patient with NAFLD using receiver operating characteristic (ROC) analysis. The SDU-P (planned) score exhibited excellent discrimination for NAFLD (area under the curve (AUC) = 0.718 (0.703–0.734)). Overall, the results confirmed the hypothesis of this research, i.e., that NAFLD is associated with dental morbidity, particularly with periodontitis.

Obstructive Sleep Apnea, Metabolic Dysfunction, and Periodontitis—Machine Learning and Statistical Analyses of the Dental, Oral, Medical Epidemiological (DOME) Big Data Study

“…This study is a part of the Dental, Oral, Medical Epidemiological (DOME) record-based big data study [ 25 , 28 , 29 , 30 , 31 , 32 , 33 , 34 ]. These previous publications have used and described the DOME study, including a paper dedicated to the describe the protocol and study methods of the DOME [ 28 ].…”

“…Other medical diagnoses and axillary tests related to MetS: Other medical diagnoses related to MetS served as independent variables and were also based on the ICD-9-CM, as previously mentioned [ 25 , 28 , 32 , 33 , 34 ], and include diabetes mellitus, impaired glucose tolerance (IGT), hyperlipidemia, hypertension, cardiovascular disease, obesity (BMI > 30 kg/m 2 ), obstructive sleep apnea (OSA), S/P (status post) transient ischemic attack (TIA), and S/P stroke [ 28 , 32 , 34 ].…”

“…Auxiliary Test Results: Results were also obtained from the CPR included tests used in the evaluation of MetS components, as mentioned previously [ 28 , 32 , 34 ], and were continuous variables: weight (in kilograms), body mass index—BMI (weight/height 2 (kg/m 2 )), C reactive protein-CRP (mg/L), glycated hemoglobin-HbA1c (%), fasting glucose (mg/dL), cholesterol (mg/dL), high-density lipoprotein-HDL (mg/dL), low-density lipoprotein-LDL (mg/dL), triglycerides (mg/dL), very-low-density lipoprotein-VLDL (mg/dL), and non-HDL cholesterol (mg/dL).…”

“…The DPR was used to retrieve the delivered treatments (i.e., dental treatments that were carried out) which included: fillings, endodontic treatments and retreatments, regular and surgical extractions, direct and indirect post and core, and crowns [ 28 ]. In addition, records of periodontal disease and a count of missing teeth (apart from wisdom teeth) were also retrieved from the DPR and included in the study as described previously [ 28 , 34 ].…”

Statistical Methods and Machine Learning Algorithms for Investigating Metabolic Syndrome in Temporomandibular Disorders: A Nationwide Study

“…This investigation forms a part of the Dental, Oral, Medical Epidemiological (DOME) big data record-based research project [23][24][25][26][27][28][29][30]. Previous publications have extensively utilized and elucidated the DOME initiative, with a singular paper devoted to outlining the procedural framework and research methodologies of the DOME project [23].…”