Association between metal exposures and periodontitis among U.S. adults: the potential mediating role of biological aging

Abstract

Abstract Background This study aimed to investigate the associations between metal exposures and periodontitis among U.S. adults, as well as the mediated effect of biological aging. Methods Using data from the National Health and Nutrition Examination Survey (NHANES) 2009–2014, we explored the single and mixed impacts of metal exposures on periodontitis through adjusted weighted logistic regression, robust Poisson regression, restricted cubic spline regression, and Bayesian kernel machine regression models. This study included 2,393 participants, with 46.9% experiencing periodontitis. Concentrations of nine urinary metals, including barium (Ba), cadmium (Cd), cobalt (Co), cesium (Cs), molybdenum (Mo), lead (Pb), thallium (Tl), tungsten (Tu), and uranium (Ur), were measured using inductively coupled plasma-mass spectrometry. In addition, we analyzed the association between metals and periodontitis, stratified by age, body mass index, gender, and smoking status. Mediation models were also applied to investigate the mediated effects of biological aging between metal exposures and periodontitis. Results Weighted logistic and robust Poisson regression identified positive associations between Cd, Pb and periodontitis (P < 0.05). BKMR analyses indicated that mixed metal exposures were significantly associated with periodontitis, particularly among smokers, second-hand smokers, and males, with Cd, Pb, Tl, and Ba contributing the most. Furthermore, subgroup analyses observed a modifying effect on the associations between urinary Cd, Pb and periodontitis in stratified gender and BMI subgroups in robust Poisson regression. Phenotype age was found to mediate the association between metals and periodontitis. Conclusions This study identified significant positive associations between metal exposures and periodontitis in the U.S. adults. In addition, the association between metal exposures and periodontitis could vary in different gender, BMI and smoking subgroups. These associations were likely partly mediated by biological aging, suggesting that metals may potentially increase the risk of periodontitis by promoting cell senescence and overall aging of the body. Graphical Abstract