| Objective:With the acceleration of the aging process and people’s increasing attention to oral health,as well as the close association between periodontitis and systemic diseases,periodontitis has become an important issue in global health.The tissue damage of periodontitis is mainly caused by an exacerbated host immune-inflammatory response,and trace mineral imbalance may be one of the factors.In recent years,with the changes of global environment and diet,scholars have begun to pay attention to the intake and content of trace minerals in the human body and their effects on chronic diseases,including the role of trace minerals in periodontitis.The purpose of this study is to explore the association between trace minerals levels(selenium,manganese,lead,cadmium,mercury)and periodontitis,and the difference of this association in different subgroups,so as to provide scientific basis for controlling the levels of trace minerals and reducing the risk of periodontitis.Methods:This study was based on the National Health and Nutrition Survey(NHANES)2011-2014 database,using questionnaire interviews combined with physical examination and laboratory testing to complete the data collection and conduct a crosssectional study.Clinical attachment loss(CAL)and periodontitis grading were used to measure the severity of periodontitis.1.The social demographic characteristics and health status of the participants were analyzed by descriptive research methods.2.Linear regression models were used to evaluate the association between trace minerals and mean CAL,and stratified analysis and trend test were carried out.3.Further subgroup analysis were conducted to explore the relationship between blood lead,blood cadmium,blood selenium and mean CAL in people of different age,sex,race/ethnicity and history of diabetes.4.The dose-response relationship between blood lead,blood cadmium,blood selenium and mean CAL were analyzed by generalized additive model and smooth curve fitting,and the dose-response relationship of different subgroups were analyzed.5.The relationship between trace minerals and periodontitis grading were evaluated by multinomial logistic regression models.Results:1.A total of 4,964 participants were enrolled in our study,of whom 2,509 met the criteria for periodontitis.Of all participants,the mean age was 51.04 ± 13.52 years old,48.99% were males.There were significant differences in age,sex,race/ethnicity,vitamin D,smoking,diabetes,weekly use of dental floss and mouthwash,periodontal therapy,hypertension,heart attack,congestive heart failure,calcium intake,coronary heart disease,angina pectoris,physical activity,stroke,bone mineral density,education and poverty impact ratio between people with and without periodontitis.2.In the fully adjusted model 3,there were significant positive associations between blood lead and cadmium levels and mean CAL [0.6081(0.321,0.8950);0.0266(0.0213,0.0318)],and a significant negative association between blood selenium level and mean CAL [-0.1056(-0.1647,-0.0465)].There were no significant associations between blood mercury,blood manganese levels and mean CAL [-0.0015(-0.0035,0.0003);0.0002(-0.0001,0.0006)].3.Among females,non-Hispanic whites,non-Hispanic blacks,people aged 75 years and older,and diabetic group,the β value between blood lead level and mean CAL were higher.Among males,Mexican-American,people aged 60-74 years old and diabetic group,the β value between blood cadmium level and mean CAL were higher.Among males,other races,people aged 30-44 years old and non-diabetic group,the βvalue between blood selenium level and mean CAL were higher.4.There was a non-linear relationship between blood cadmium level and mean CAL.When the blood cadmium level reached 4.03 μmol/L,the mean CAL began to increase with the increase of blood cadmium concentration [0.0889(0.0550 0.1228)].After the blood cadmium level reached 10.32 μmol/L,the β value decreased greatly[0.0178(0.0073,0.0284)].Among people aged 45-59 years old,mean CAL increased with the increase of blood lead [2.9057(0.7422,5.0692)] until the turning point(0.065μmol/L).Among non-Hispanic blacks,the relationship between blood cadmium level and mean CAL followed an inverted U-shaped curve.When blood cadmium level<12.99 μmol/L,the mean CAL increased with the increase of blood cadmium [0.0508(0.0222,0.0794)].When the blood cadmium level >12.99 μmol/L,blood cadmium level was negatively associated with mean CAL,but it was not statistically significant[-0.0130(-0.0431,0.0171)].5.In model 3,blood lead and cadmium levels had statistical significance on periodontitis grading.Compared with people without periodontitis,for every unit increase in blood lead,the risk of moderate periodontitis increased by 3.143 times[4.143(1.233,13.921)],and the risk of severe periodontitis increased by 27.145 times[28.145(7.112,111.376)].For every unit increase in blood cadmium,the incidence of severe periodontitis was 1.058 times higher than that of non-periodontitis [1.058(1.036,1.08)].Conclusions:1.Blood lead and cadmium levels were positively associated with periodontitis,and blood selenium level was negatively associated with periodontitis;However,blood mercury and blood manganese levels were not significantly associated with periodontitis.2.The association between trace minerals levels and mean CAL were more significant in males,the elderly,and diabetic people.3.There was a threshold effect between blood cadmium level and mean CAL.Among the non-Hispanic blacks,the relationship between blood cadmium level and mean CAL followed an inverted U-shaped curve.There was a saturation effect between the blood lead level and the mean CAL in people aged 45-59 years. |
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