{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T02:07:43Z","timestamp":1788228463447,"version":"build-2803163510"},"reference-count":48,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2023,8,9]],"date-time":"2023-08-09T00:00:00Z","timestamp":1691539200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Department of Science and Technology (DECIT\/Brazilian Ministry of Health)","award":["17617\/2017-29"],"award-info":[{"award-number":["17617\/2017-29"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>(1) Background: To investigate the grouping of obesity and insulin resistance with caries and periodontitis from a syndemic perspective through pathways of socioeconomic inequalities, smoking, alcohol, and high sugar consumption in adolescence. (2) Methods: The population-based RPS Cohort study, S\u00e3o Lu\u00eds, Brazil, in ages 18\u201319 years (n = 2515) was used. The outcomes were the grouping of pbesity and Insulin Resistance Phenotype (latent variable formed by Triglycerides\/HDL ratio, TyG index, and VLDL) and the Chronic Oral Disease Burden (latent variable comprising caries, bleeding on probing, probing depth \u2265 4 mm, clinical attachment level \u2265 3 mm, and visible plaque index \u2265 15%). Socioeconomic Inequalities influencing the Behavioral Risk Factors (latent variable formed by added sugar, smoking, and alcohol) were analyzed using structural equation modeling. (3) Results: Socioeconomic Inequalities were associated with the Chronic Oral Disease Burden [Standardized Coefficient (SC) = 0.222, p &lt; 0.001]. Behavioral Risk Factors were associated with increased Chronic Oral Disease Burden (SC = 0.103; p = 0.013). Obesity was associated with the Insulin Resistance Phenotype (SC = 0.072; p &lt; 0.001) and the Chronic Oral Disease Burden (SC = 0.066; p = 0.005). The Insulin Resistance Phenotype and the Chronic Oral Disease Burden were associated (SC = 0.053; p = 0.032). (4) Conclusion: The grouping of obesity and early events of diabetes with caries and periodontitis call for a syndemic approach in adolescence.<\/jats:p>","DOI":"10.3390\/nu15163512","type":"journal-article","created":{"date-parts":[[2023,8,9]],"date-time":"2023-08-09T10:21:50Z","timestamp":1691576510000},"page":"3512","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":29,"title":["Obesity, Insulin Resistance, Caries, and Periodontitis: Syndemic Framework"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6718-4356","authenticated-orcid":false,"given":"Lorena L\u00facia Costa","family":"Ladeira","sequence":"first","affiliation":[{"name":"Postgraduate Program of Dentistry, Federal University of Maranh\u00e3o, S\u00e3o Lu\u00eds 65085-580, MA, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4288-6300","authenticated-orcid":false,"given":"Gustavo Giacomelli","family":"Nascimento","sequence":"additional","affiliation":[{"name":"National Dental Research Institute Singapore, National Dental Centre Singapore, Singapore 168938, Singapore"},{"name":"Oral Health Academic Clinical Programme (ORH ACP), Duke-NUS Medical School, Singapore 169857, Singapore"},{"name":"Section for Periodontology, Department of Dentistry and Oral Health, Aarhus University, 8000 Aarhus, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8053-4517","authenticated-orcid":false,"given":"F\u00e1bio Renato Manzolli","family":"Leite","sequence":"additional","affiliation":[{"name":"National Dental Research Institute Singapore, National Dental Centre Singapore, Singapore 168938, Singapore"},{"name":"Oral Health Academic Clinical Programme (ORH ACP), Duke-NUS Medical School, Singapore 169857, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7982-5301","authenticated-orcid":false,"given":"Silas","family":"Alves-Costa","sequence":"additional","affiliation":[{"name":"Postgraduate Program of Dentistry, Federal University of Maranh\u00e3o, S\u00e3o Lu\u00eds 65085-580, MA, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jana\u00edna Maiana Abreu","family":"Barbosa","sequence":"additional","affiliation":[{"name":"Postgraduate Program of Public Health, Federal University of Maranh\u00e3o, S\u00e3o Lu\u00eds 65020-070, MA, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia Maria Coelho","family":"Alves","sequence":"additional","affiliation":[{"name":"Postgraduate Program of Dentistry, Federal University of Maranh\u00e3o, S\u00e3o Lu\u00eds 65085-580, MA, Brazil"},{"name":"Postgraduate Program of Public Health, Federal University of Maranh\u00e3o, S\u00e3o Lu\u00eds 65020-070, MA, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4156-4067","authenticated-orcid":false,"given":"Erika Barbara Abreu Fonseca","family":"Thomaz","sequence":"additional","affiliation":[{"name":"Postgraduate Program of Dentistry, Federal University of Maranh\u00e3o, S\u00e3o Lu\u00eds 65085-580, MA, Brazil"},{"name":"Postgraduate Program of Public Health, Federal University of Maranh\u00e3o, S\u00e3o Lu\u00eds 65020-070, MA, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1529-0165","authenticated-orcid":false,"given":"Rosangela Fernandes Lucena","family":"Batista","sequence":"additional","affiliation":[{"name":"Postgraduate Program of Public Health, Federal University of Maranh\u00e3o, S\u00e3o Lu\u00eds 65020-070, MA, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cecilia Claudia Costa","family":"Ribeiro","sequence":"additional","affiliation":[{"name":"Postgraduate Program of Dentistry, Federal University of Maranh\u00e3o, S\u00e3o Lu\u00eds 65085-580, MA, Brazil"},{"name":"Postgraduate Program of Public Health, Federal University of Maranh\u00e3o, S\u00e3o Lu\u00eds 65020-070, MA, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,8,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"941","DOI":"10.1016\/S0140-6736(17)30003-X","article-title":"Syndemics and the Biosocial Conception of Health","volume":"389","author":"Singer","year":"2017","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"951","DOI":"10.1016\/S0140-6736(17)30402-6","article-title":"Non-Communicable Disease Syndemics: Poverty, Depression, and Diabetes among Low-Income Populations","volume":"389","author":"Mendenhall","year":"2017","journal-title":"Lancet"},{"key":"ref_3","unstructured":"Network, Global Burden of Disease Collaborative (2023, June 01). Global Burden of Disease Study 2019 (GBD 2019); Institute of Health Metrics and Evaluation (IHME). Available online: http:\/\/ghdx.healthdata.org\/gbd-results-tool."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1016\/S0140-6736(19)31146-8","article-title":"Oral Diseases: A Global Public Health Challenge","volume":"394","author":"Peres","year":"2019","journal-title":"Lancet"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"508","DOI":"10.1177\/0022034517745326","article-title":"Added Sugar Consumption and Chronic Oral Disease Burden among Adolescents in Brazil","volume":"97","author":"Carmo","year":"2018","journal-title":"J. Dent. Res."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1710953","DOI":"10.1080\/20002297.2019.1710953","article-title":"Integrated Hypothesis of Dental Caries and Periodontal Diseases","volume":"12","author":"Nyvad","year":"2020","journal-title":"J. Oral Microbiol."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Aragno, M., and Mastrocola, R. (2017). Dietary Sugars and Endogenous Formation of Advanced Glycation Endproducts: Emerging Mechanisms of Disease. Nutrients, 9.","DOI":"10.20944\/preprints201702.0047.v1"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"580","DOI":"10.1111\/jcpe.13625","article-title":"Investigating Oral and Systemic Pathways between Unhealthy and Healthy Dietary Patterns to Periodontitis in Adolescents: A Population-Based Study","volume":"49","author":"Costa","year":"2022","journal-title":"J. Clin. Periodontol."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Phillips, C.M., Chen, L.W., Heude, B., Bernard, J.Y., Harvey, N.C., Duijts, L., Mensink-Bout, S.M., Polanska, K., Mancano, G., and Suderman, M. (2019). Dietary Inflammatory Index and Non-Communicable Disease Risk: A Narrative Review. Nutrients, 11.","DOI":"10.3390\/nu11081873"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"490","DOI":"10.1016\/j.cyto.2018.05.031","article-title":"Serum Levels of Proinflammatory Cytokines Are High in Early Childhood Caries","volume":"111","author":"Lima","year":"2018","journal-title":"Cytokine"},{"key":"ref_11","unstructured":"WHO (2015). Guideline: Sugars Intake for Adults and Children, World Health Organ."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1007\/s40368-017-0272-1","article-title":"Association between Overweight\/Obesity and Periodontal Disease in Children and Adolescents: A Systematic Review and Meta-Analysis","volume":"18","author":"Martens","year":"2017","journal-title":"Eur. Arch. Paediatr. Dent."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"532","DOI":"10.1111\/ipd.12292","article-title":"Overweight, Obese, Underweight, and Frequency of Sugar Consumption as Risk Indicators for Early Childhood Caries in Brazilian Preschool Children","volume":"27","author":"Ribeiro","year":"2017","journal-title":"Int. J. Paediatr. Dent."},{"key":"ref_14","first-page":"1","article-title":"Pathways in the Association between Added Sugar Consumption, Obesity in Mother-Child Dyads, and Chronic Oral Disease Burden in Early Childhood","volume":"130","author":"Costa","year":"2022","journal-title":"Eur. J. Oral Sci."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"731","DOI":"10.1902\/jop.2017.160607","article-title":"Prediction of Periodontitis Occurrence: Influence of Classification and Sociodemographic and General Health Information","volume":"88","author":"Leite","year":"2017","journal-title":"J. Periodontol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1373","DOI":"10.2337\/dc08-0026","article-title":"Periodontal Disease and Incident Type 2 Diabetes: Results from the First National Health and Nutrition Examination Survey and Its Epidemiologic Follow-up Study","volume":"31","author":"Demmer","year":"2008","journal-title":"Diabetes Care"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Ladeira, L.L.C., Leite, F.R.M., Nascimento, G.G., Saraiva, M.D.C., Brondani, M.A., Moreira, A.R.O., and Ribeiro, C.C.C. (2022). Precursors of Insulin Resistance Underlying Periodontitis in Adolescents Aged 17\u201318 Years. Oral Dis.","DOI":"10.1111\/odi.14283"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1291","DOI":"10.1093\/ije\/dyac072","article-title":"Tooth Count, Untreated Caries and Mortality in US Adults: A Population-Based Cohort Study","volume":"51","author":"Liu","year":"2022","journal-title":"Int. J. Epidemiol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"452","DOI":"10.1111\/jcpe.13761","article-title":"Chronic Oral Diseases Burden: The Confluence of Caries and Periodontitis throughout Life","volume":"50","author":"Costa","year":"2023","journal-title":"J. Clin. Periodontol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1186\/s12933-022-01724-0","article-title":"Insulin Resistance Phenotype Is Associated with Vascular Risk Phenotype at the End of the Second Decade of Life: A Population-Based Study","volume":"21","author":"Barbosa","year":"2022","journal-title":"Cardiovasc. Diabetol."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Confortin, S.C., Ribeiro, M.R.C., Barros, A.J.D., Menezes, A.M.B., Horta, B.L., Victora, C.G., Barros, F.C., Gon\u00e7alves, H., Bettiol, H., and Dos Santos, I.S. (2021). RPS Brazilian Birth Cohort Consortium (Ribeir\u00e3o Preto, Pelotas and S\u00e3o Lu\u00eds): History, Objectives and Methods. Cad. Saude Publica, 37.","DOI":"10.1590\/0102-311x00093320"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1590\/S0102-311X2011000300010","article-title":"Adapta\u00e7\u00e3o e Valida\u00e7\u00e3o Do Alcohol Use Disorder Identification Test (AUDIT) Para Popula\u00e7\u00e3o Ribeirinha Do Interior Da Amaz\u00f4nia, Brasil","volume":"27","year":"2011","journal-title":"Cad. Saude Publica"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1590\/1980-5497201600020017","article-title":"Desenho de Um Question\u00e1rio de Frequ\u00eancia Alimentar Digital Autoaplicado Para Avaliar o Consumo Alimentar de Adolescentes e Adultos Jovens: Coortes de Nascimentos de Pelotas, Rio Grande Do Sul","volume":"19","author":"Schneider","year":"2016","journal-title":"Rev. Bras. Epidemiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e1017","DOI":"10.1161\/CIR.0000000000000439","article-title":"Added Sugars and Cardiovascular Disease Risk in Children: A Scientific Statement From the American Heart Association","volume":"135","author":"Vos","year":"2017","journal-title":"Circulation"},{"key":"ref_25","unstructured":"WHO (2000). Obesity: Preventing and Managing the Global Epidemic: Report of a WHO Consultation, WHO."},{"key":"ref_26","first-page":"229","article-title":"Problems and Proposals for Recording Gingivitis and Plaque","volume":"25","author":"Ainamo","year":"1975","journal-title":"Int. Dent. J."},{"key":"ref_27","unstructured":"Kline, R.B. (2011). Principles and Practice of Structural Equation Modeling, The Gilford Press. [3rd ed.]."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"655","DOI":"10.1002\/JPER.18-0483","article-title":"Metabolic Syndrome and Periodontitis: A Structural Equation Modeling Approach","volume":"90","author":"Nascimento","year":"2019","journal-title":"J. Periodontol."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Ladeira, L.L.C., Nascimento, G.G., Leite, F.R.M., Alves-Costa, S., Alves, C.M.C., Thomaz, E.B.A.F., and Cury, J.A. (Oral Dis., 2022). Sugar Intake above International Recommendations Is Associated with a Heavy Oral Disease Burden, Oral Dis., ahead of print.","DOI":"10.1111\/odi.14464"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1638","DOI":"10.1053\/j.gastro.2016.12.051","article-title":"Adolescent Obesity and Insulin Resistance: Roles of Ectopic Fat Accumulation and Adipose Inflammation","volume":"152","author":"Caprio","year":"2017","journal-title":"Gastroenterology"},{"key":"ref_31","first-page":"87","article-title":"Dental Plaque Biofilm in Oral Health and Disease","volume":"14","author":"Seneviratne","year":"2011","journal-title":"Chin. J. Dent. Res."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1111\/cdoe.12367","article-title":"Methodological Issues in Assessing the Association between Periodontitis and Caries among Adolescents","volume":"46","author":"Nascimento","year":"2018","journal-title":"Community Dent. Oral Epidemiol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"983","DOI":"10.1007\/s00784-020-03387-1","article-title":"Higher Sugar Intake Is Associated with Periodontal Disease in Adolescents","volume":"25","author":"Moreira","year":"2021","journal-title":"Clin. Oral Investig."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"725460","DOI":"10.3389\/froh.2021.725460","article-title":"Non-Communicable Diseases and Oral Health: An Overview","volume":"2","author":"Wolf","year":"2021","journal-title":"Front. Oral Health"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"2337","DOI":"10.1016\/S0140-6736(21)01169-7","article-title":"Spatial, Temporal, and Demographic Patterns in Prevalence of Smoking Tobacco Use and Attributable Disease Burden in 204 Countries and Territories, 1990\u20132019: A Systematic Analysis from the Global Burden of Disease Study 2019","volume":"397","author":"Reitsma","year":"2021","journal-title":"Lancet"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"416","DOI":"10.1111\/cdoe.12468","article-title":"Social Inequality in Tooth Loss, the Mediating Role of Smoking and Alcohol Consumption","volume":"47","author":"Hach","year":"2019","journal-title":"Community Dent. Oral Epidemiol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1011","DOI":"10.1161\/CIRCULATIONAHA.109.192627","article-title":"Dietary Sugars Intake and Cardiovascular Health a Scientific Statement from the American Heart Association","volume":"120","author":"Johnson","year":"2009","journal-title":"Circulation"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1111\/cdoe.12616","article-title":"Socioeconomic Status and Oral Health-related Quality of Life: A Systematic Review and Meta-analysis","volume":"49","author":"Knorst","year":"2021","journal-title":"Community Dent. Oral Epidemiol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"2491","DOI":"10.1007\/s11136-019-02229-2","article-title":"Socioeconomic Inequalities in Oral Health-Related Quality of Life in Adolescents: A Cohort Study","volume":"28","author":"Sfreddo","year":"2019","journal-title":"Qual. Life Res."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1s","DOI":"10.1590\/s01518-8787.2016050006685","article-title":"ERICA: Prevalences of Hypertension and Obesity in Brazilian Adolescents","volume":"50","author":"Bloch","year":"2016","journal-title":"Rev. Saude Publica"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1182","DOI":"10.3945\/ajcn.114.089656","article-title":"Added Sugars and Periodontal Disease in Young Adults: An Analysis of NHANES III Data","volume":"100","author":"Lula","year":"2014","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"831","DOI":"10.1016\/j.amepre.2018.02.014","article-title":"Effect of Smoking on Periodontitis: A Systematic Review and Meta-Regression","volume":"54","author":"Leite","year":"2018","journal-title":"Am. J. Prev. Med."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"572","DOI":"10.1111\/jcpe.12556","article-title":"Alcohol Consumption and Risk of Periodontitis: A Meta-Analysis","volume":"43","author":"Wang","year":"2016","journal-title":"J. Clin. Periodontol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"553","DOI":"10.1016\/j.jneb.2021.04.004","article-title":"Sugar-Sweetened Beverage Consumption, Perceptions, and Disparities in Children and Adolescents","volume":"53","author":"Roesler","year":"2021","journal-title":"J. Nutr. Educ. Behav."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1944","DOI":"10.1093\/eurheartj\/ehw152","article-title":"Fasting Is Not Routinely Required for Determination of a Lipid Profile: Clinical and Laboratory Implications Including Flagging at Desirable Concentration Cut-Points-a Joint Consensus Statement from the European Atherosclerosis Society and European Federa","volume":"37","author":"Nordestgaard","year":"2016","journal-title":"Eur. Heart J."},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"American Diabetes Association 2 (2021). Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes-2021. Diabetes Care, 44, S15\u2013S33.","DOI":"10.2337\/dc21-S002"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1637","DOI":"10.1016\/j.jacc.2017.08.006","article-title":"A Test in Context: Lipid Profile, Fasting Versus Nonfasting","volume":"70","author":"Nordestgaard","year":"2017","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_48","unstructured":"WHO (2017). Adolescents and Mental Health, World Health Organization."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/15\/16\/3512\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T20:29:42Z","timestamp":1760128182000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/15\/16\/3512"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,8,9]]},"references-count":48,"journal-issue":{"issue":"16","published-online":{"date-parts":[[2023,8]]}},"alternative-id":["nu15163512"],"URL":"https:\/\/doi.org\/10.3390\/nu15163512","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,8,9]]}}}