Associations between single and multiple dietary vitamins and the risk of periodontitis: results from NHANES 2009-2014

Abstract

Background: Periodontitis is a prevalent inflammatory periodontal disease that has an impact on the overall quality of life. Although several studies have indicated an association between individual vitamin intake and periodontitis risk, the associations of the multivitamins with periodontitis risk remain unclear.

Aim: This study aimed to explore the joint effect of multivitamins (including vitamin A, vitamin B₁, vitamin B₂, vitamin B₆, vitamin B₁₂, vitamin C, vitamin D, vitamin E, and vitamin K) on periodontitis.

Methods: For this cross-sectional study, data were collected from participants aged ≥ 30 years in the National Health and Nutrition Examination Surveys 2009-2014 (n = 9,820). We employed weighted multivariate logistic regression models to evaluate the single association between individual vitamin intakes and periodontitis, and Bayesian kernel machine regression (BKMR), weighted quantile sum (WQS) regression, and quantile g-computation (qgcomp) models to assess the joint effect of nine vitamins on periodontitis.

Results: The overall prevalence of periodontitis was approximately 35.97%. After adjustment of covariates, vitamin B₆ [odds ratio (OR) = 0.82, 95% confidence interval (CI): 0.72-0.94] and vitamin E (OR = 0.79, 95%CI: 0.69-0.92) were negatively related to the likelihood of developing periodontitis, respectively. The result of three models indicated that, mixture of vitamin A, vitamin B₁, vitamin B₂, vitamin B₆, vitamin B₁₂, vitamin C, vitamin D, vitamin E, and vitamin K had a significant negative combined effect on the risk of periodontitis. In the BKMR model, when all remaining vitamins were at their median levels, the periodontitis risk decreased with increased concentration levels of vitamin E and vitamin B₂. WQS analysis indicated the highest weighted chemical was vitamin E, followed by vitamin B₁₂ and vitamin D. In the qgcomp model, vitamin E received the highest negative weights for the periodontitis risk, followed by vitamin B₂ and vitamin D, respectively.

Conclusion: Both dietary vitamin B₆ and vitamin E were associated with decreased odds of periodontitis. Additionally, the mixture-exposed analyses consistently showed the negative correlations between nine dietary vitamins mixtures and periodontitis.

Keywords: Bayesian kernel machine regression; multiple vitamins co-exposure; periodontitis; quantile g-computation model; weighted quantile sum.