Oral microbiota mediates the association of healthy dietary patterns with lower risk of advanced cardiovascular-kidney-metabolic syndrome.

OBJECTIVES

Existing evidence links diet and the oral microbiota to individual cardiovascular, kidney, and metabolic conditions, but these relationships have not been extended to the progressive stages of cardiovascular-kidney-metabolic (CKM) syndrome. We therefore investigated the associations among dietary patterns, the oral microbiome, and CKM stages.

METHODS

This cross-sectional study included 2051 representative US adults. Oral microbiota was characterized via 16S rRNA gene sequencing of oral rinse samples. Dietary patterns were assessed using multiple dietary indexes derived from 24-h dietary recalls. CKM stages were defined according to American Heart Association criteria. MaAsLin3 analysis and ordinal logistic regression were used to evaluate the associations of dietary indexes and oral microbiota with CKM stages. Mediation analysis was used to assess the mediating role of oral microbiota in the associations between various dietary indexes and CKM stages.

RESULTS

As CKM stages advanced, the oral microbial community tended to exhibit gradient shifts, primarily characterized by a potentially progressive reduction in the relative abundance of Pseudomonadota. Neisseria and Lautropia within Pseudomonadota, together with Gemella and Bergeyella, were negatively associated with CKM stages, whereas Lactobacillus was positively associated. Pseudomonadota-dominated salivatypes were associated with the lowest risk of advanced CKM stages. Higher healthy dietary indexes were associated with lower likelihood of advanced CKM stages and with higher abundance of Pseudomonadota taxa, particularly Neisseria. Notably, Neisseria and its higher taxonomies predominantly mediated the associations between dietary indexes and CKM stages.

CONCLUSION

This study suggests that Neisseria-related taxa are predominant mediators linking dietary patterns to CKM stages. Modulation of the diet-microbiome axis may represent a complementary strategy for promoting health and potentially influencing CKM-associated outcomes, but our cross-sectional data should not be interpreted as establishing a causal protective role.