Nutritional Risk Profiles and Poor Self-Perceived Oral Health in Hungarian Adults: A Population-Based Study with Monte Carlo Population-Attributable Fraction Estimation.

BACKGROUND

Oral diseases remain a major public health challenge globally and in Hungary, where untreated caries, periodontal disease, and edentulism are highly prevalent. Diet is a key modifiable determinant of oral health, yet the cumulative impact of multiple unfavorable nutritional behaviors on self-perceived oral health has not been assessed at the national level in Hungary, nor have population-attributable fraction (PAF) estimates been reported.

METHODS

This cross-sectional study analyzed data from 5146 adults in the 2019 Hungarian European Health Interview Survey. A six-component nutritional-risk score was constructed from self-reported dietary behaviors (fruit intake, vegetable intake, sugary soft drink consumption, sweets consumption, processed meat consumption, and water intake). Survey-weighted logistic regression estimated associations between nutritional-risk categories and poor self-perceived oral health, adjusting for sociodemographic, lifestyle, and health-related covariates. Counterfactual PAFs with 95% Monte Carlo uncertainty intervals (1000 bootstrap replications) were estimated for three nutritional-risk scenarios.

RESULTS

The weighted prevalence of poor self-perceived oral health was 19.2%. Compared with participants with 0-1 unfavorable nutritional factors, those with 3 factors (OR = 1.37; 95% CI: 1.09-1.73) and 4-6 factors (OR = 1.46; 95% CI: 1.15-1.85) had significantly higher odds of poor oral health. Low water intake was independently associated with poor oral health (OR = 1.38; 95% CI: 1.16-1.64). The main counterfactual PAF analysis estimated that 16.1% (Monte Carlo 95% UI: 5.93-26.48%) of poor oral health burden was attributable to unfavorable nutritional profiles. High nutritional risk was also associated with active caries, gum bleeding, and tooth loss.

CONCLUSIONS

Cumulative nutritional risk is independently associated with poor self-perceived oral health in Hungarian adults. Integrating dietary improvements into oral health prevention strategies may substantially reduce the population-level burden of oral disease.