{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T12:40:13Z","timestamp":1793018413201,"version":"4.5.0"},"reference-count":43,"publisher":"Elsevier BV","issue":"6","license":[{"start":{"date-parts":[[2026,12,1]],"date-time":"2026-12-01T00:00:00Z","timestamp":1796083200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2026,12,1]],"date-time":"2026-12-01T00:00:00Z","timestamp":1796083200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T00:00:00Z","timestamp":1785974400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82571161"],"award-info":[{"award-number":["82571161"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.jp","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["International Dental Journal"],"published-print":{"date-parts":[[2026,12]]},"DOI":"10.1016\/j.identj.2026.111126","type":"journal-article","created":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T22:53:45Z","timestamp":1789080825000},"page":"111126","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":0,"title":["Periodontitis and Advanced Cardiovascular-Kidney-Metabolic Syndrome: Mediation and Machine Learning-Based Stratification"],"prefix":"10.1016","volume":"76","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-1700-0650","authenticated-orcid":false,"given":"Dan","family":"Luo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Songlin","family":"An","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing","family":"Sun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kun","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hui","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xi","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yue","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li","family":"Gao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rui","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"key":"10.1016\/j.identj.2026.111126_bib0001","doi-asserted-by":"crossref","first-page":"1636","DOI":"10.1161\/CIR.0000000000001186","article-title":"A synopsis of the evidence for the science and clinical management of cardiovascular-kidney-metabolic (ckm) syndrome: a scientific statement from the American Heart Association","volume":"148","author":"Ndumele","year":"2023","journal-title":"Circulation"},{"issue":"16","key":"10.1016\/j.identj.2026.111126_bib0002","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.124.034996","article-title":"Social risk profile and cardiovascular-kidney-metabolic syndrome in US adults","volume":"13","author":"Li","year":"2024","journal-title":"J Am Heart Assoc"},{"key":"10.1016\/j.identj.2026.111126_bib0003","doi-asserted-by":"crossref","DOI":"10.4093\/dmj.2025.0366","article-title":"Association between the life\u2019s essential 8 health behaviors score and mortality risk in US adults with cardiovascular-kidney-metabolic syndrome stage 0\u20133","author":"Zhang","year":"2025","journal-title":"Diabetes Metab J"},{"key":"10.1016\/j.identj.2026.111126_bib0004","doi-asserted-by":"crossref","DOI":"10.1016\/j.jad.2025.119429","article-title":"Association between depressive symptoms and mortality in patients with cardiovascular-kidney-metabolic syndrome: the mediating role of inflammatory biomarkers","volume":"386","author":"Wang","year":"2025","journal-title":"J Affect Disord"},{"key":"10.1016\/j.identj.2026.111126_bib0005","doi-asserted-by":"crossref","DOI":"10.3389\/fendo.2025.1660319","article-title":"Osteoarthritis as a clinical marker of cardiovascular-kidney-metabolic multimorbidity: a population-based cohort study in China","volume":"16","author":"Zou","year":"2025","journal-title":"Front Endocrinol (Lausanne)"},{"key":"10.1016\/j.identj.2026.111126_bib0006","doi-asserted-by":"crossref","first-page":"1858","DOI":"10.1001\/jama.2024.6892","article-title":"Prevalence of cardiovascular-kidney-metabolic syndrome stages in US adults, 2011-2020","volume":"331","author":"Aggarwal","year":"2024","journal-title":"JAMA"},{"key":"10.1016\/j.identj.2026.111126_bib0007","doi-asserted-by":"crossref","DOI":"10.1016\/j.diabres.2025.112437","article-title":"Periodontitis, accelerated biological aging, and advanced stages in cardiovascular-kidney-metabolic syndrome in U.S. adults: a mediation analysis","volume":"228","author":"Qi","year":"2025","journal-title":"Diabetes Res Clin Pract"},{"key":"10.1016\/j.identj.2026.111126_bib0008","doi-asserted-by":"crossref","first-page":"604","DOI":"10.1111\/jcpe.13769","article-title":"Prevalence of periodontitis in dentate people between 2011 and 2020: a systematic review and meta-analysis of epidemiological studies","volume":"50","author":"Trindade","year":"2023","journal-title":"J Clin Periodontol"},{"key":"10.1016\/j.identj.2026.111126_bib0009","doi-asserted-by":"crossref","first-page":"842","DOI":"10.1111\/jcpe.13767","article-title":"The association between respiratory diseases and periodontitis: a systematic review and meta-analysis","volume":"50","author":"Molina","year":"2023","journal-title":"J Clin Periodontol"},{"issue":"3","key":"10.1016\/j.identj.2026.111126_bib0010","doi-asserted-by":"crossref","first-page":"3151","DOI":"10.1007\/s11357-026-02101-5","article-title":"Longitudinal association of chronic periodontitis with all-cause dementia, alzheimer disease, vascular dementia, and mild cognitive impairment: a distributed network analysis","volume":"48","author":"Hwang","year":"2026","journal-title":"Geroscience"},{"issue":"6","key":"10.1016\/j.identj.2026.111126_bib0011","doi-asserted-by":"crossref","first-page":"e73","DOI":"10.1161\/CIR.0000000000001390","article-title":"Periodontal disease and atherosclerotic cardiovascular disease: a scientific statement from the American heart association","volume":"153","author":"Tran","year":"2026","journal-title":"Circulation"},{"issue":"89","key":"10.1016\/j.identj.2026.111126_bib0012","first-page":"114","article-title":"Association between periodontitis and chronic kidney disease","volume":"2022","author":"Parsegian","year":"2000","journal-title":"Periodontol"},{"key":"10.1016\/j.identj.2026.111126_bib0013","doi-asserted-by":"crossref","DOI":"10.3390\/ijms241613011","article-title":"Periodontal disease and its association with metabolic syndrome-a comprehensive review","volume":"24","author":"Aizenbud","year":"2023","journal-title":"Int J Mol Sci"},{"issue":"1","key":"10.1016\/j.identj.2026.111126_bib0014","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1186\/s12882-026-04843-y","article-title":"Bridging systems: oral-kidney connections-pathophysiological links, clinical implications, and health system integration-a narrative review","volume":"27","author":"Gudsoorkar","year":"2026","journal-title":"BMC Nephrol"},{"key":"10.1016\/j.identj.2026.111126_bib0015","doi-asserted-by":"crossref","first-page":"e262","DOI":"10.1016\/S1470-2045(19)30149-4","article-title":"Big data and machine learning algorithms for health-care delivery","volume":"20","author":"Ngiam","year":"2019","journal-title":"Lancet Oncol"},{"issue":"1","key":"10.1016\/j.identj.2026.111126_bib0016","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1038\/s41698-026-01448-4","article-title":"A machine learning-driven framework integrating cell death and senescence signatures for multi-target drug design and immunotherapy optimization in ovarian cancer","volume":"10","author":"Yu","year":"2026","journal-title":"NPJ Precis Oncol"},{"key":"10.1016\/j.identj.2026.111126_bib0017","doi-asserted-by":"crossref","DOI":"10.1016\/j.brat.2025.104749","article-title":"Predictors of smartphone addiction in adolescents with depression: combing the machine learning and moderated mediation model approach","volume":"189","author":"Zhou","year":"2025","journal-title":"Behav Res Ther"},{"key":"10.1016\/j.identj.2026.111126_bib0018","doi-asserted-by":"crossref","first-page":"1449","DOI":"10.1902\/jop.2012.110664","article-title":"Update of the case definitions for population-based surveillance of periodontitis","volume":"83","author":"Eke","year":"2012","journal-title":"J Periodontol"},{"key":"10.1016\/j.identj.2026.111126_bib0019","doi-asserted-by":"crossref","DOI":"10.1016\/j.redox.2025.103588","article-title":"Role of oxidative balance score in staging and mortality risk of cardiovascular-kidney-metabolic syndrome: insights from traditional and machine learning approaches","volume":"81","author":"Chen","year":"2025","journal-title":"Redox Biol"},{"key":"10.1016\/j.identj.2026.111126_bib0020","article-title":"Machine learning with decision curve analysis evaluates nutritional metabolic biomarkers for cardiovascular-kidney-metabolic risk: an NHANES analysis","volume":"12","author":"Huang","year":"2025","journal-title":"Front Nutr"},{"key":"10.1016\/j.identj.2026.111126_bib0021","doi-asserted-by":"crossref","DOI":"10.3389\/fnut.2025.1661826","article-title":"Association of SII and SIRI with incidence of cardiovascular disease in cardiovascular-kidney-metabolic syndrome: a prospective cohort study","volume":"12","author":"Pengfei","year":"2025","journal-title":"Front Nutr"},{"issue":"1","key":"10.1016\/j.identj.2026.111126_bib0022","doi-asserted-by":"crossref","first-page":"174","DOI":"10.1007\/s12026-025-09707-5","article-title":"Myeloid inflammation thresholds stratify mortality risk in early-stage cardiovascular-kidney-metabolic syndrome: MLR-driven findings from NHANES","volume":"73","author":"Qu","year":"2025","journal-title":"Immunol Res"},{"issue":"1","key":"10.1016\/j.identj.2026.111126_bib0023","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1186\/s12944-025-02589-4","article-title":"Obesity indicators mediate the association between the aggregate index of systemic inflammation (AISI) and type 2 diabetes mellitus (T2DM)","volume":"24","author":"Su","year":"2025","journal-title":"Lipids Health Dis"},{"issue":"1","key":"10.1016\/j.identj.2026.111126_bib0024","doi-asserted-by":"crossref","first-page":"1253","DOI":"10.1186\/s40001-025-03634-9","article-title":"Negative association between oxidative balance score and stroke prevalence in US adults with metabolic syndrome: mediating roles of HDL-C and NHHR","volume":"30","author":"Gao","year":"2025","journal-title":"Eur J Med Res"},{"issue":"2","key":"10.1016\/j.identj.2026.111126_bib0025","doi-asserted-by":"crossref","first-page":"660","DOI":"10.1016\/j.identj.2024.10.022","article-title":"Association between neutrophil percentage-to-albumin ratio and periodontitis: a cross-sectional study","volume":"75","author":"Zhou","year":"2025","journal-title":"Int Dent J"},{"issue":"1","key":"10.1016\/j.identj.2026.111126_bib0026","doi-asserted-by":"crossref","first-page":"1248","DOI":"10.1186\/s40001-025-03560-w","article-title":"Neutrophil percentage to albumin ratio and advanced cardiovascular-kidney-metabolic syndrome in diabetes: a machine learning approach","volume":"30","author":"Zhuang","year":"2025","journal-title":"Eur J Med Res"},{"key":"10.1016\/j.identj.2026.111126_bib0027","doi-asserted-by":"crossref","DOI":"10.3389\/fimmu.2021.706432","article-title":"Serum c-reactive protein and periodontitis: a systematic review and meta-analysis","volume":"12","author":"Machado","year":"2021","journal-title":"Front Immunol"},{"issue":"1","key":"10.1016\/j.identj.2026.111126_bib0028","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1177\/00220345251388340","article-title":"Understanding the periodontitis-diabetes linkage: mechanisms and evidence","volume":"105","author":"Graves","year":"2026","journal-title":"J Dent Res"},{"key":"10.1016\/j.identj.2026.111126_bib0029","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1111\/prd.12379","article-title":"Association between metabolic syndrome and periodontitis: the role of lipids, inflammatory cytokines, altered host response, and the microbiome","volume":"87","author":"Pirih","year":"2021","journal-title":"Periodontol 2000"},{"issue":"1","key":"10.1016\/j.identj.2026.111126_bib0030","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1186\/s12872-025-04935-x","article-title":"Association of neutrophil-to-albumin ratio with all-cause and cardiovascular mortality in community-dwelling individuals with chronic kidney disease: evidence from the NHANES 1999\u20132018","volume":"25","author":"Han","year":"2025","journal-title":"BMC Cardiovasc Disord"},{"key":"10.1016\/j.identj.2026.111126_bib0031","doi-asserted-by":"crossref","DOI":"10.1016\/j.identj.2025.03.017","article-title":"Association between serum albumin and periodontitis across disease subgroups: a cross-sectional study","volume":"75","author":"Xiang","year":"2025","journal-title":"Int Dent J"},{"key":"10.1016\/j.identj.2026.111126_bib0032","doi-asserted-by":"crossref","first-page":"456","DOI":"10.1111\/jcpe.12732","article-title":"Impact of the global burden of periodontal diseases on health, nutrition and wellbeing of mankind: a call for global action","volume":"44","author":"Tonetti","year":"2017","journal-title":"J Clin Periodontol"},{"key":"10.1016\/j.identj.2026.111126_bib0033","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1016\/j.ejim.2022.05.004","article-title":"Low serum albumin: a neglected predictor in patients with cardiovascular disease","volume":"102","author":"Manolis","year":"2022","journal-title":"Eur J Intern Med"},{"issue":"1","key":"10.1016\/j.identj.2026.111126_bib0034","doi-asserted-by":"crossref","first-page":"815","DOI":"10.1186\/s12872-025-05109-5","article-title":"Association between systemic inflammation response index and advanced stages in U.S. cardiovascular-kidney-metabolic syndrome patients: a cross-sectional study using NHANES 2015\u20132020 data","volume":"25","author":"Zhang","year":"2025","journal-title":"BMC Cardiovasc Disord"},{"issue":"4","key":"10.1016\/j.identj.2026.111126_bib0035","doi-asserted-by":"crossref","first-page":"532","DOI":"10.1111\/joim.13180","article-title":"Is systemic inflammation a missing link between periodontitis and hypertension? Results from two large population-based surveys","volume":"289","author":"Aguilera","year":"2021","journal-title":"J Intern Med"},{"key":"10.1016\/j.identj.2026.111126_bib0036","doi-asserted-by":"crossref","first-page":"793","DOI":"10.1111\/jre.12266","article-title":"Serum creatinine and alkaline phosphatase levels are associated with severe chronic periodontitis","volume":"50","author":"Ca\u00fala","year":"2015","journal-title":"J Periodontal Res"},{"key":"10.1016\/j.identj.2026.111126_bib0037","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1038\/nrneph.2017.60","article-title":"Alkaline phosphatase: a novel treatment target for cardiovascular disease in CKD","volume":"13","author":"Haarhaus","year":"2017","journal-title":"Nat Rev Nephrol"},{"key":"10.1016\/j.identj.2026.111126_bib0038","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1080\/10408363.2020.1857681","article-title":"Potential value and impact of data mining and machine learning in clinical diagnostics","volume":"58","author":"Saberi-Karimian","year":"2021","journal-title":"Crit Rev Clin Lab Sci"},{"issue":"1","key":"10.1016\/j.identj.2026.111126_bib0039","doi-asserted-by":"crossref","DOI":"10.1038\/s41598-024-82789-7","article-title":"Identification of the shared gene signatures in retinoblastoma and osteosarcoma by machine learning","volume":"14","author":"Ye","year":"2024","journal-title":"Sci Rep"},{"issue":"1","key":"10.1016\/j.identj.2026.111126_bib0040","doi-asserted-by":"crossref","DOI":"10.1016\/j.identj.2025.109352","article-title":"Risk prediction of edentulism in Chinese adults: insights from the China Health and Retirement Longitudinal Study (CHARLS)","volume":"76","author":"Wang","year":"2026","journal-title":"Int Dent J"},{"key":"10.1016\/j.identj.2026.111126_bib0041","doi-asserted-by":"crossref","DOI":"10.1016\/j.suronc.2026.102455","article-title":"Exploring osteoporosis risk in breast cancer patients after comprehensive treatment via explainable artificial intelligence algorithms","volume":"67","author":"Zhang","year":"2026","journal-title":"Surg Oncol"},{"issue":"1","key":"10.1016\/j.identj.2026.111126_bib0042","article-title":"Machine learning and SHAP value interpretation for predicting the response to neoadjuvant chemotherapy and long-term clinical outcomes in Chinese female breast cancer","volume":"57","author":"Yuan","year":"2025","journal-title":"An Med (Helsinki)"},{"issue":"5","key":"10.1016\/j.identj.2026.111126_bib0043","doi-asserted-by":"crossref","DOI":"10.1016\/j.identj.2025.100921","article-title":"Associations between thyroid function and periodontitis: a machine learning approach using NHANES","volume":"75","author":"Wang","year":"2025","journal-title":"Int Dent J"}],"container-title":["International Dental Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S002065392601717X?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S002065392601717X?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T12:21:38Z","timestamp":1793017298000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S002065392601717X"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,12]]},"references-count":43,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2026,12]]}},"alternative-id":["S002065392601717X"],"URL":"https:\/\/doi.org\/10.1016\/j.identj.2026.111126","relation":{},"ISSN":["0020-6539"],"issn-type":[{"value":"0020-6539","type":"print"}],"subject":[],"published":{"date-parts":[[2026,12]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Periodontitis and Advanced Cardiovascular-Kidney-Metabolic Syndrome: Mediation and Machine Learning-Based Stratification","name":"articletitle","label":"Article Title"},{"value":"International Dental Journal","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.identj.2026.111126","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2026 The Authors. Published by Elsevier Inc. on behalf of FDI World Dental Federation.","name":"copyright","label":"Copyright"}],"article-number":"111126"}}