Influence of Unhealthy Diet and Sedentary Behavior on the Oral Health-Related Quality of Life of 12-Year-Old Adolescents

Influence of Unhealthy Diet and Sedentary Behavior on the Oral Health-Related Quality of Life of 12-Year-Old Adolescents | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Influence of Unhealthy Diet and Sedentary Behavior on the Oral Health-Related Quality of Life of 12-Year-Old Adolescents Jhenyffer Andrade Viana Cabral, Rafael Aiello Bomfim This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4667778/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 27 Nov, 2024 Read the published version in Scientific Reports → Version 1 posted 11 You are reading this latest preprint version Abstract This study analyzed the factors associated with the oral health-related quality of life (OHRQOL) of 12-year-old adolescents and their relationship with unhealthy eating and sedentary behavior. Data were collected from 615 adolescents from the five largest cities in Mato Grosso do Sul, Brazil. The theoretical framework of the social determinants of oral health guided all analyses and the measurement instrument was OIDP (impact of oral health on daily performance). Multilevel logistic and negative binomial regressions were performed to test the association of OHRQOL with unhealthy eating, sedentary behavior, sociodemographic characteristics and health behaviours. Considering the sample weights, 43% of the adolescents reported some impact on OHRQOL. In the adjusted models, higher consumption of unhealthy foods (moderate and high) was associated with a prevalence of impact on OHRQOL [OR = 3.59 (95%CI 1.99; 6.46)] and higher OHRQOL severity [RR = 2.05 (95%CI 1.43; 2.94)] compared to their counterparts. Those who had sedentary behaviour were associated with the prevalence of impact on OHRQOL [OR = 1.52 (95%CI 1.22; 1.89)] and greater severity [RR = 1.21 (95%CI 1.07; 1.37)] compared to those who did not have sedentary behaviour. Unhealthy food consumption and sedentary behavior were associated with OHRQOL. Intersectoral health public policies for healthy eating and for reducing sedentary behavior on the internet and electronic games can help in the quality of life of adolescents. Health sciences/Health care/Public health/Epidemiology Health sciences/Health care/Dentistry/Dental public health Family health strategy Unhealthy eating habits Sedentary behavior Quality of life INTRODUCTION Studying sedentary behavior, unhealthy eating, and oral health is crucial for understanding and mitigating the risks associated with chronic diseases and adverse health conditions. Sedentary behaviour, characterized by very low energy expenditure and prolonged periods of inactivity, has been associated with an increased risk of cardiovascular diseases, obesity, type 2 diabetes, and certain types of câncer( 1 ). In turn, unhealthy eating, rich in saturated fats, added sugars, and salt significantly contributes to the development of these same conditions, as well as problems such as hypertension and dyslipidemia ( 2 ). Oral health, often less emphasized but equally important, is intrinsically linked to diet and overall lifestyle, affecting not only the oral cavity but also having systemic implications, including cardiovascular diseases and diabetes ( 3 ). Therefore, integrating these fields of study offers an opportunity for more holistic preventive and therapeutic approaches, emphasizing the importance of active lifestyles, balanced diets, and regular oral health care as fundamental components for health promotion and disease prevention. In health promotion and prevention, adolescence is a phase of significant physical and behavioural changes in an individual's life. Therefore, modifying patterns considered unhealthy is essential and should be encouraged, as they influence the routine and quality of life of these adolescents ( 4 ). According to the 2019 National School Health Survey (PeNSE), conducted to monitor risk and protective factors for the health of school-aged adolescents, the dietary pattern of ninth-grade students showed that 32.6% reported consuming snacks five days a week or more. Additionally, the proportions of consumption, on the day before the survey, of sweets (38.5%) and sodas (46.0%) were also significant (IBGE,2019). According to the World Health Organization (WHO), overweight and obesity are significant risk factors for the development of chronic diseases, including diabetes and cardiovascular diseases ( 2 ). The relationship between unhealthy eating and sedentary behaviour has been assessed in previous studies, demonstrating that sedentary activities such as watching television promote the consumption of ultra-processed foods like snacks and sugary foods( 4 , 5 ). According to the NOVA Classification, ultra-processed foods are a group of industrial formulations manufactured using various ingredients and a series of processes. They are energy-dense, rich in unhealthy types of fats, refined starches, free sugars, and salt, and poor sources of protein, dietary fibre, and micronutrients. Ultra-processed products are designed to be hyperpalatable and attractive, with a long shelf life. Most of these products contain little or no whole foods( 6 ). The increase in consumption of ultra-processed foods is associated with an increase in body fat and diagnoses of obesity in children and adolescents ( 7 ). Another finding showed a higher risk of cardiovascular disease, cerebrovascular disease, and depression( 8 ). Furthermore, evidence suggests an association between the consumption of ultra-processed foods and the experience of dental caries in adolescents( 9 ). Such unhealthy dietary habits are often associated with sedentary behaviour or lifestyle, such as spending time in front of computers and video games and lack of physical activity practice( 8 ). Sedentary behavior is increasingly prevalent in the population, as technological advances create everyday situations that make people more sedentary. In Brazilian adolescents, 57.2% reported spending more than three hours daily engaging in seated activities, and 36% reported spending more than two hours daily watching television (IBGE,2019). Therefore, the pattern of unhealthy dietary consumption and low physical activity directly influences the quality of life of adolescents, as these foods have low nutritional value, affecting their growth and development( 10 ). Seeking to measure the influence of such behaviours on the routine of these adolescents, Oral Health-Related Quality of Life allows the assessment of various symptoms and experiences that represent the individual's subjective perspective. Recognizing that health and well-being are not merely medical concepts but encompass the biopsychosocial model, taking into account the individual's perception of their position in life, and recognizing their goals, expectations, and concerns( 11 ). In light of this, this study analyzed whether unhealthy eating and sedentary behavior are associated with oral health-related quality of life (OHRQoL) in 12-year-old adolescents. The hypothesis to be tested is that unhealthy eating and sedentary behavior would be associated with oral health-related quality of life. METHODS The data presented is a subset of the epidemiological survey called SBMS, conducted in the five largest cities in the state of Mato Grosso do Sul, with over 80,000 inhabitants. These cities are Campo Grande, Corumbá, Dourados, Ponta Porã, and Três Lagoas. The survey was conducted from April 2018 to February 2019. The presented data pertain to oral health-related quality of life, consumption of unhealthy foods, and sedentary behavior. The sampling plan was designed using a conglomerate in two stages of probability proportional to the population size. These five cities were the Primary Sampling Units, and municipal public elementary schools were the Secondary Sampling Units. In 2018, the total number of public elementary schools in the five cities was 182. Further information can be found in Bomfim et al. (2020)( 5 , 12 , 13 ), 32 schools were selected in the two largest cities (Campo Grande and Dourados), and all schools in the remaining cities were included: 26 schools in Corumbá, 17 in Três Lagoas, and 8 in Ponta Porã. Participants in the survey The participants are 12-year-old adolescents enrolled in public schools in the five largest cities in the state of Mato Grosso do Sul. In 2018, Campo Grande had a population of 860,000 inhabitants, Dourados had 220,925 inhabitants, Corumbá had 119,465 inhabitants, Três Lagoas had 119,464 inhabitants, and Ponta Porã had 92,526 inhabitants, together representing more than half of the state's population (IBGE). The inclusion criterion was enrollment in a public educational institution, regardless of gender ( 5 , 13 , 14 ). Data Collection/Recording Instrument The examinations were conducted by five teams in each city, totalling 25 dentists and 25 calibrated recorders. The professionals received 32 hours of practical training. The intra- and inter-examiner reliability tests showed a Kappa coefficient of 0.73. Oral health-related quality of life (OHRQoL) was assessed using the OIDP-PT questionnaire( 15 ), which measured the impact of oral conditions on the ability of these adolescents to perform daily activities through frequency and severity( 16 ). Sedentary behaviour was assessed using the HELENA questionnaire, based on weekdays and weekends in four main domains (TV, internet, video games, and sitting activities). Each response option had seven categories: from 0 minutes to more than 4 hours per day( 17 ). The measurement of unhealthy eating was conducted by assessing the weekly frequency of consumption of unhealthy foods using an instrument recommended by the Brazilian Ministry of Health, the SISVAN. This instrument consists of five food items, self-reported by the adolescent. Each item assessed the frequency of consumption of a specific unhealthy food on a continuous scale from 0 to 7 times per week. The unhealthy foods investigated were as follows: a) French fries and fried snacks; b) Hamburgers and sausages (sausage, salami, ham sausage, etc.); c) Salted biscuits; d) Sweet biscuits or sandwiches with filling, cookies, candies, and chocolates (in bars or bonbons); e) Regular consumption of soft drinks. The stratification of weekly consumption of unhealthy foods was defined as follows: Low consumption: up to 2 times per week (0); Moderate consumption: from 2 to 4 times per week ( 1 ); High consumption: more than 4 times per week ( 2 ) ( 5 , 12 , 13 ). Organization and analysis of data The data were organized into spreadsheets according to the variables mentioned above. Data analysis was performed using Stata software version 14.2 (StataCorp LP, College Station, United States) using the survey module, which considers the effects of stratification and clustering in estimating indicators and their measures of precision. Absolute and relative frequencies, with their respective 95% confidence intervals (95% CI), were calculated for all variables. Sensitivity analysis Sensitivity analysis with the e-value is a statistical technique used to assess to what extent an unmeasured confounder could influence the observed associations in epidemiological studies. The e-value, or E-value, quantifies the minimum strength of association that an unmeasured confounder would need to have with both the exposure and the outcome simultaneously to completely explain the observed association, assuming that the statistical model is correctly specified. This measure provides a way to interpret the robustness of the results in the face of potential confounding by variables not included in the model. A high e-value suggests that a very strong unmeasured confounder would be needed to nullify the observed association, lending greater credibility to the study's findings. This approach has been widely discussed and recommended by VanderWeele and Ding (2017)( 18 ). Ethical Aspects This project was submitted to the Ethics Committee of the Federal University of Mato Grosso do Sul, after authorization from the Municipal Department of Education of Campo Grande, MS, and submission to the Brazil Platform under the ethical protocol CAAE: 85647518.4.0000.0021. It includes an Informed Consent Form for parents/guardians of minors and an Informed Assent Form for adolescents. All methods were carried out in accordance with relevant guidelines and regulation and all experimental protocols were approved by Federal University of Mato Grosso do Sul. All materials will be kept on file, under the custody and responsibility of the lead researcher, for at least 5 years, following Resolution CNS No. 466/2012. RESULTS The sample consisted of 615 adolescent students from public schools in the state of Mato Grosso do Sul. The ethnic-racial characterization was mostly composed of white individuals 43.9% (n = 270) and mixed-race individuals 43.3% (n = 266). Black individuals represented 5.3% (n = 32), Asians 3.9% (n = 24), and Indigenous people 0.8% (n = 6). According to Table 1 , 67.3% of adolescents showed consumption of foods indicative of unhealthy eating habits between 2 to 7 times per week, considered in this study as a moderate to high pattern of consumption. Table 1 Descriptive characteristics and proportions. SBMS 2018-19 Study, 12 years old (n = 615). Individual variations n = 615 % (95%CI) QoL (OIDP = 0) OIDP % (95%CI) Significance (95%CI) Ethnicity White 270 43.9(40.0-47.9) 66.7 (60.1–72.6) 1.01 (0.70–1.32) Brown 266 43.3(39.4–47.2) 46.2 (38.2–54.4) 2.11 (1.57–2.66) Asian 24 3.9 (2.6–5.8) 41.8 (16.7–71.9) 1.68 (0.63–2.71) Black 32 5.3 (3.7–7.3) 29.4 (12.9–53.9) 3.49 (1.52–5.46) Indigenous 6 0.9 (0.4–2.1) 0.0 6.93 (3.75–10.1) No response 17 2.8(1.7–4.4) 25.0 (9.8–50.9) 2.75 (1.28–4.21) Gender Female 315 51.2 (47.3–55.2) 53.6 (46.5–60.5) 1.81 (1.38–2.26) Male 300 48.8(44.8–52.7) 59.8 (52.7–66.5) 1.34 (0.95–1.73) Parental education 1 to 4 years 381 62.0 (58.0-65.7) 36.6 (28.7–45.3) 1.58 (1.21–1.95) Above years 234 38.0 (34.3–42.0) 62.6(56.7–68.1) 1.57 (1.28–1.86) Consumption of unhealthy foods Low (up to 1 time per week) 168 27.3(23.9–31.0) 83.9(76.9–89.0) 0.59 (0.27–0.90) Moderate (2–4 times per week), 197 32.0(28.5–35.8) 45.5(36.9–54.4) 2.02 (1.43–2.61) High (5–7 times per week) 217 35.3(31.6–39.2) 29.8(22.5–38.4) 2.58(1.98–3.18) No response 33 5.4(3.8–7.5) 30.1 (12.7–60.0) 2.10 (0.31–2.90) Sedentary behavior (≥ 2 hours per day) No 338 55.0 (50.9–58.9) 75.8(70.1–80.7) 1.08(0.75–1.43) Yes (internet, games, sitting, or TV) 251 40.8 (35.9–46.5) 30.0(23.2–37.8) 2.34 (1.82–2.87) No response 26 4.2 (2.9–6.1) 14.5(4.7–36.4) 3.48 (1.86–5.10) In adjusted models, higher consumption of unhealthy foods (moderate and high) was associated with the prevalence of impact on OHRQoL (OIDP ≥ 1) with an Odds Ratio of [OR = 3.59 (95% CI 1.99; 6.46)], indicating 3.59 times higher odds of at least one question being answered positively resulting in an impact on the adolescent's quality of life. The impact on oral health-related quality of life was reported by 43% of the sample; Table 2 presents the prevalence and severity of the impact on the adolescent's life. Table 2 Multilevel negative binomial and logistic regressions between prevalence and severity of adolescents' quality of life. SBMS study of adolescents (n = 615). Prevalence of impacts on Quality of Life Sevirity of impacts on Quality of Life Unadjusted Adjusted* Unadjusted Adjusted* Covariates OR (95%CI) OR (95%CI) RR (95%CI) RR (95%CI) Sedentary behavior No 1 1 1 1 Yes 2.00 (1.65; 2.39) 1.64 (1.32; 2.03) 1.22 (1.09; 1.37) 1.21 (1.07; 1.37) E-value** 2.66 (CI 1.97) 1.71 (CI 1.34) Unhealthy eating Low 1 1 1 1 Moderate/high 5.06 (3.23; 7.90) 3.78 (2.15; 6.66) 2.53 (1.84; 3.48) 2.05 (1.51; 2.79) E-value*** 7.02(CI 3.72) 3.51(CI 2.39) VPC 7.0 (1.8; 23.0) 2.0 (0.8; 15.0) 5.0 (1.0; 12.3) 1.8 (0.8; 10.0) * Adjusted for gender, parental education level, and racial groups. VPC = Percentual Variation Coefficient (% of variation at the city level) ** Sensitivity analyses with E-values (unmeasured confounders), only associations above RR/OR > 1.71 could change the association of sedentary behavior with the outcome. *** Sensitivity analyses with E-values (unmeasured confounders), only associations above RR/OR > 3.51 could change the association of dietary consumption with the outcome. When assessing the severity of the impact, which is the sum of the questionnaire responses, it was observed that adolescents with moderate to high unhealthy dietary patterns had a quality of life impact twice as high as those with low unhealthy consumption. The risk ratio (RR) was 2.05 (95% CI 1.43; 2.94), indicating a significant association between an unhealthy dietary pattern and poorer OHRQoL among adolescents. In the analysis of the impact on the quality of life (QoL) of adolescents with sedentary behaviour, a prevalence of impact of 52% was observed, with an odds ratio (OR) of 1.52 (95% CI 1.22; 1.89). Additionally, a greater severity of impact, corresponding to 21%, was identified, with a relative risk (RR) of 1.21 (95% CI 1.07; 1.37), when compared to adolescents without sedentary behaviour. These results highlight the association between sedentary behavior and lower quality of life among adolescents. DISCUSSION This study yielded two main findings. First, it highlighted that both sedentary behavior and unhealthy eating were associated with a higher prevalence and greater severity of impact on oral health-related quality of life among adolescents. Second, sensitivity analyses using e-values confirmed the relationships found between sedentary behavior and unhealthy eating with oral health-related quality of life. Controlling for social determinants, only a very strong unmeasured confounder would tend to alter the associations found. The strengths of the study are related to its scope, as it was conducted in the five largest cities in the state, providing representative data of the population in question. Additionally, another important strength is particularly related to the strong presence of agriculture as the main economic activity. This specific economic characteristic may influence not only oral health patterns but also the dietary habits of the population. A weakness of the study is its cross-sectional nature, which implies that we cannot establish causal inference in the results, limiting the ability to determine the direction of the relationship between variables. The tested hypothesis was confirmed: adolescents with sedentary behavior (< 2 hrs/day watching TV, internet, playing video games, and other sedentary activities) and moderate to high unhealthy dietary consumption reported a greater impact on quality of life. Sedentary behaviour was associated with a higher CPO-D index in the evaluated adolescents when mediated by moderate to high unhealthy dietary consumption( 5 ). The OIDP questionnaire assesses dimensions of oral health's impact on daily activities, and these activities were not elucidated in this analysis. However, a study conducted in Rio de Janeiro with adolescents in the same age group found that 88.7% of the students experienced an impact of oral problems on at least one of the daily performances evaluated by the OIDP. The activities that had the greatest impact were eating (81.3%), cleaning the mouth (40.5%), and smiling (32.2%), the average OIDP index was 7.1 with a 95% CI of 6.2 to 8.1( 19 ). In Rio Grande do Norte, school adolescents aged 15–19 years, 51.16% reported some impact on oral health-related quality of life, with the main cause being the position of the teeth and activities such as eating, mouth hygiene, and smiling ( 20 ). Additionally, 40% of adolescents exhibited sedentary behavior (≥ 2 hrs/day, TV, internet, video games, and sitting activities), of whom 70% reported some impact on oral health-related quality of life. Adolescents from Cuiabá-MT, attended by the Family Health Strategy, had a prevalence of sedentary behavior of 55% ( 21 ). The differentiation by gender of unhealthy dietary patterns and sedentary behaviour was not assessed in this study. However, when examining the association of physical activity levels and dietary habits with anthropometric and lipid profiles in adolescents, girls were found to have higher odds of having altered cholesterol and LDL-C levels ( 22 ). The Modified Canadian Aerobic Fitness Test (mCAFT) found that 31.5% of adolescents aged 15 to 17 in Florianópolis have low levels of aerobic fitness, with a higher prevalence in boys (49.2%) compared to girls (20.6%). Girls with sedentary behaviour, overweight, and high body fat percentage were the groups most likely to have inadequate aerobic fitness( 23 ). Parental education proved to be an important factor, exerting influence on dietary patterns and quality of life. 63.4% of adolescents with parents who had 1 to 4 years of formal education experienced some impact on oral health-related quality of life. Adolescents from public schools in João Pessoa-PB showed higher adherence to a dietary pattern classified as "snacks" (consumption of bread, butter and margarine, cheeses, processed meats, and coffee) when their mothers had lower levels of education and socioeconomic status ( 24 ). When analyzing children and adolescents with overweight and obesity, it is noted that the mother's education level of these adolescents ranges from ten to twelve years of schooling, with a percentage of 30.71% for overweight and 36.80% for obesity( 25 ). Maternal education of less than four years presents a higher risk for short stature, with a decrease as maternal education increases ( 26 ). In Europe, a higher prevalence of overweight/obesity is associated with low family wealth. This led to the formulation of a strategy for implementing the promotion of healthy nutrition and physical activity for children and adolescents( 2 ). The relationship between sedentary behavior, unhealthy eating, and the development of dental caries is complex and multifactorial, highlighting the interconnection between lifestyle and oral health. Sedentary behaviours, such as spending long hours in front of the television or computer, often coincide with the consumption of snacks rich in sugars and fermentable carbohydrates, which are known to contribute to dental caries( 27 ). Estudos indicate that diets high in simple sugars not only increase the risk of obesity and chronic diseases but are also one of the main dietary factors in the development of caries, as sugars serve as substrates for acidogenic bacteria in dental plaque, leading to demineralization of tooth enamel ( 28 ). Furthermore, a sedentary lifestyle may reduce the frequency of healthy oral hygiene habits, exacerbating the risk of caries. Therefore, promoting an active lifestyle along with a balanced diet low in free sugars is essential for preventing dental caries and maintaining oral and overall health( 29 ). Bomfim et al. (2021) highlight how sedentary lifestyles and diets rich in processed sugars and carbohydrates significantly contribute to the increased prevalence of dental caries. Additionally, the study, through structural equation models, showed that sedentary behaviour may be indirectly associated with less rigorous oral hygiene, and higher unhealthy dietary consumption, thus favouring the experience of caries among adolescents. This reinforces the need for integrated approaches promoting active lifestyles and balanced diets while minimizing sugar consumption as an essential strategy in preventing dental caries and promoting oral health( 5 ). According to data from the National School Health Survey of 2015, high prevalences of daily consumption of at least one group of ultra-processed foods and sedentary behaviour > 2 hours per day were identified. Out of every ten Brazilian adolescents, four exhibit regular consumption of ultra-processed foods, and seven have sedentary behaviour ( 30 ). Regarding cultural and behavioural explanations, the increasing use of social media and easy access to electronic devices justify sedentary behaviour. In a study conducted by Lucena et al. in 2013, analyzing the relationship between sedentary behaviour, dietary habits, indicators of quality of life, and health in adolescents, screen time was associated with lower levels of HRQoL for physical well-being and school environment, respectively ( 31 ). CONCLUSION Unhealthy dietary consumption and sedentary behavior were significantly associated with oral health-related quality of life. Intersectoral public health policies promoting healthy eating and reducing sedentary behavior on the internet and electronic games among adolescents can contribute to an improvement in their quality of life. Strengthening educational measures related to oral health should be encouraged. Declarations Ethical Approval This project was submitted to the Ethics Committee of the Federal University of Mato Grosso do Sul, after authorization from the Municipal Department of Education of Campo Grande, MS, and submission to the Brazil Platform under the ethical opinion protocol CAAE: 85647518.4.0000.0021. It includes an Informed Consent Form for parents/guardians of minors and an Informed Assent Form for adolescents Funding: This study was partially financed by the Federal University of Mato Grosso do Sul (UFMS). Conflict of interest: None Author Contribution JAVC contributed to the conception, design, and data interpretation, and drafted and critically revised the manuscriptRAB contributed to the conception, and design, performed all statistical analyses, and data interpretation, and drafted and critically revised the manuscript. All authors reviewed the manuscript. Data Availability The data that support the findings of this study are openly upon request. 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Comportamento sedentário e consumo de alimentos ultraprocessados entre adolescentes brasileiros: Pesquisa Nacional de Saúde do Escolar (PeNSE), 2015. Cadernos de Saúde Pública. 2018;34(3). Farias Júnior JCD, Silva KSD. Sobrepeso/obesidade em adolescentes escolares da cidade de João Pessoa - PB: prevalência e associação com fatores demográficos e socioeconômicos. Revista Brasileira de Medicina do Esporte. 2008;14(2):104–8. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 27 Nov, 2024 Read the published version in Scientific Reports → Version 1 posted Editorial decision: Revision requested 15 Oct, 2024 Reviews received at journal 14 Oct, 2024 Reviewers agreed at journal 10 Oct, 2024 Reviews received at journal 13 Sep, 2024 Reviewers agreed at journal 02 Sep, 2024 Reviewers agreed at journal 19 Jul, 2024 Reviewers invited by journal 14 Jul, 2024 Editor assigned by journal 14 Jul, 2024 Editor invited by journal 04 Jul, 2024 Submission checks completed at journal 04 Jul, 2024 First submitted to journal 01 Jul, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4667778","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":329111993,"identity":"86d9950b-bb2c-41d7-be05-a5a7310adf75","order_by":0,"name":"Jhenyffer Andrade Viana Cabral","email":"","orcid":"","institution":"Federal University of Mato Grosso do Sul","correspondingAuthor":false,"prefix":"","firstName":"Jhenyffer","middleName":"Andrade Viana","lastName":"Cabral","suffix":""},{"id":329111994,"identity":"15963301-00e5-402e-af51-35e88b672ccb","order_by":1,"name":"Rafael Aiello Bomfim","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA/ElEQVRIie2QsYoCMRCGJwTWZmHbVPoKEUE48E2uSR4gXHFNCpVUa+MDWIi+wtlsPRLINYIPcMXFN9jutjS7gtis4bqDy1cMP8N8ZCYAicRfhAJB3wUE8LoN1MQUQNGGLFRxajskosCjIss2RZRiRRGFhreipBcvd4vXYhWURle9CrOZwLDPy8ZlEy6rT7WxxJD16av/GZtzDPtw+DZTJiunTFAoKfuVkS3qThm5wU8jt07tYwq3OXQKd/kUpJmrj5gythkPtzA+dvk7Ew7VISjHZ7cMz/biaz3jQzc41PV8qXZne/SNfnL+DXb/ja5ibP6R5W+GE4lE4p9wBX6cXnnRqOfSAAAAAElFTkSuQmCC","orcid":"","institution":"Federal University of Mato Grosso do Sul","correspondingAuthor":true,"prefix":"","firstName":"Rafael","middleName":"Aiello","lastName":"Bomfim","suffix":""}],"badges":[],"createdAt":"2024-07-01 11:42:55","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4667778/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4667778/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1038/s41598-024-81293-2","type":"published","date":"2024-11-27T15:56:58+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":70381864,"identity":"eb590b6c-0e64-4fdd-8d68-6a7a42be3e4a","added_by":"auto","created_at":"2024-12-02 16:15:27","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":526845,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4667778/v1/ea6105bb-afb0-448f-8208-cdcd545d9549.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eInfluence of Unhealthy Diet and Sedentary Behavior on the Oral Health-Related Quality of Life of 12-Year-Old Adolescents\u003c/p\u003e","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eStudying sedentary behavior, unhealthy eating, and oral health is crucial for understanding and mitigating the risks associated with chronic diseases and adverse health conditions. Sedentary behaviour, characterized by very low energy expenditure and prolonged periods of inactivity, has been associated with an increased risk of cardiovascular diseases, obesity, type 2 diabetes, and certain types of c\u0026acirc;ncer(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). In turn, unhealthy eating, rich in saturated fats, added sugars, and salt significantly contributes to the development of these same conditions, as well as problems such as hypertension and dyslipidemia (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Oral health, often less emphasized but equally important, is intrinsically linked to diet and overall lifestyle, affecting not only the oral cavity but also having systemic implications, including cardiovascular diseases and diabetes (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Therefore, integrating these fields of study offers an opportunity for more holistic preventive and therapeutic approaches, emphasizing the importance of active lifestyles, balanced diets, and regular oral health care as fundamental components for health promotion and disease prevention. In health promotion and prevention, adolescence is a phase of significant physical and behavioural changes in an individual's life. Therefore, modifying patterns considered unhealthy is essential and should be encouraged, as they influence the routine and quality of life of these adolescents (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAccording to the 2019 National School Health Survey (PeNSE), conducted to monitor risk and protective factors for the health of school-aged adolescents, the dietary pattern of ninth-grade students showed that 32.6% reported consuming snacks five days a week or more. Additionally, the proportions of consumption, on the day before the survey, of sweets (38.5%) and sodas (46.0%) were also significant (IBGE,2019). According to the World Health Organization (WHO), overweight and obesity are significant risk factors for the development of chronic diseases, including diabetes and cardiovascular diseases (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe relationship between unhealthy eating and sedentary behaviour has been assessed in previous studies, demonstrating that sedentary activities such as watching television promote the consumption of ultra-processed foods like snacks and sugary foods(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). According to the NOVA Classification, ultra-processed foods are a group of industrial formulations manufactured using various ingredients and a series of processes. They are energy-dense, rich in unhealthy types of fats, refined starches, free sugars, and salt, and poor sources of protein, dietary fibre, and micronutrients. Ultra-processed products are designed to be hyperpalatable and attractive, with a long shelf life. Most of these products contain little or no whole foods(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). The increase in consumption of ultra-processed foods is associated with an increase in body fat and diagnoses of obesity in children and adolescents (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Another finding showed a higher risk of cardiovascular disease, cerebrovascular disease, and depression(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Furthermore, evidence suggests an association between the consumption of ultra-processed foods and the experience of dental caries in adolescents(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Such unhealthy dietary habits are often associated with sedentary behaviour or lifestyle, such as spending time in front of computers and video games and lack of physical activity practice(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSedentary behavior is increasingly prevalent in the population, as technological advances create everyday situations that make people more sedentary. In Brazilian adolescents, 57.2% reported spending more than three hours daily engaging in seated activities, and 36% reported spending more than two hours daily watching television (IBGE,2019). Therefore, the pattern of unhealthy dietary consumption and low physical activity directly influences the quality of life of adolescents, as these foods have low nutritional value, affecting their growth and development(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSeeking to measure the influence of such behaviours on the routine of these adolescents, Oral Health-Related Quality of Life allows the assessment of various symptoms and experiences that represent the individual's subjective perspective. Recognizing that health and well-being are not merely medical concepts but encompass the biopsychosocial model, taking into account the individual's perception of their position in life, and recognizing their goals, expectations, and concerns(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn light of this, this study analyzed whether unhealthy eating and sedentary behavior are associated with oral health-related quality of life (OHRQoL) in 12-year-old adolescents. The hypothesis to be tested is that unhealthy eating and sedentary behavior would be associated with oral health-related quality of life.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cp\u003eThe data presented is a subset of the epidemiological survey called SBMS, conducted in the five largest cities in the state of Mato Grosso do Sul, with over 80,000 inhabitants. These cities are Campo Grande, Corumb\u0026aacute;, Dourados, Ponta Por\u0026atilde;, and Tr\u0026ecirc;s Lagoas. The survey was conducted from April 2018 to February 2019. The presented data pertain to oral health-related quality of life, consumption of unhealthy foods, and sedentary behavior.\u003c/p\u003e \u003cp\u003eThe sampling plan was designed using a conglomerate in two stages of probability proportional to the population size. These five cities were the Primary Sampling Units, and municipal public elementary schools were the Secondary Sampling Units. In 2018, the total number of public elementary schools in the five cities was 182. Further information can be found in Bomfim et al. (2020)(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e), 32 schools were selected in the two largest cities (Campo Grande and Dourados), and all schools in the remaining cities were included: 26 schools in Corumb\u0026aacute;, 17 in Tr\u0026ecirc;s Lagoas, and 8 in Ponta Por\u0026atilde;.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eParticipants in the survey\u003c/h2\u003e \u003cp\u003e The participants are 12-year-old adolescents enrolled in public schools in the five largest cities in the state of Mato Grosso do Sul. In 2018, Campo Grande had a population of 860,000 inhabitants, Dourados had 220,925 inhabitants, Corumb\u0026aacute; had 119,465 inhabitants, Tr\u0026ecirc;s Lagoas had 119,464 inhabitants, and Ponta Por\u0026atilde; had 92,526 inhabitants, together representing more than half of the state's population (IBGE). The inclusion criterion was enrollment in a public educational institution, regardless of gender (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eData Collection/Recording Instrument\u003c/h2\u003e \u003cp\u003eThe examinations were conducted by five teams in each city, totalling 25 dentists and 25 calibrated recorders. The professionals received 32 hours of practical training. The intra- and inter-examiner reliability tests showed a Kappa coefficient of 0.73.\u003c/p\u003e \u003cp\u003eOral health-related quality of life (OHRQoL) was assessed using the OIDP-PT questionnaire(\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e), which measured the impact of oral conditions on the ability of these adolescents to perform daily activities through frequency and severity(\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSedentary behaviour was assessed using the HELENA questionnaire, based on weekdays and weekends in four main domains (TV, internet, video games, and sitting activities). Each response option had seven categories: from 0 minutes to more than 4 hours per day(\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe measurement of unhealthy eating was conducted by assessing the weekly frequency of consumption of unhealthy foods using an instrument recommended by the Brazilian Ministry of Health, the SISVAN. This instrument consists of five food items, self-reported by the adolescent. Each item assessed the frequency of consumption of a specific unhealthy food on a continuous scale from 0 to 7 times per week. The unhealthy foods investigated were as follows: a) French fries and fried snacks; b) Hamburgers and sausages (sausage, salami, ham sausage, etc.); c) Salted biscuits; d) Sweet biscuits or sandwiches with filling, cookies, candies, and chocolates (in bars or bonbons); e) Regular consumption of soft drinks. The stratification of weekly consumption of unhealthy foods was defined as follows: Low consumption: up to 2 times per week (0); Moderate consumption: from 2 to 4 times per week (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e); High consumption: more than 4 times per week (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eOrganization and analysis of data\u003c/h2\u003e \u003cp\u003eThe data were organized into spreadsheets according to the variables mentioned above. Data analysis was performed using Stata software version 14.2 (StataCorp LP, College Station, United States) using the survey module, which considers the effects of stratification and clustering in estimating indicators and their measures of precision. Absolute and relative frequencies, with their respective 95% confidence intervals (95% CI), were calculated for all variables.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eSensitivity analysis\u003c/h2\u003e \u003cp\u003eSensitivity analysis with the e-value is a statistical technique used to assess to what extent an unmeasured confounder could influence the observed associations in epidemiological studies. The e-value, or E-value, quantifies the minimum strength of association that an unmeasured confounder would need to have with both the exposure and the outcome simultaneously to completely explain the observed association, assuming that the statistical model is correctly specified. This measure provides a way to interpret the robustness of the results in the face of potential confounding by variables not included in the model. A high e-value suggests that a very strong unmeasured confounder would be needed to nullify the observed association, lending greater credibility to the study's findings. This approach has been widely discussed and recommended by VanderWeele and Ding (2017)(\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eEthical Aspects\u003c/h2\u003e \u003cp\u003e This project was submitted to the Ethics Committee of the Federal University of Mato Grosso do Sul, after authorization from the Municipal Department of Education of Campo Grande, MS, and submission to the Brazil Platform under the ethical protocol CAAE: 85647518.4.0000.0021. It includes an Informed Consent Form for parents/guardians of minors and an Informed Assent Form for adolescents.\u003c/p\u003e \u003cp\u003e All methods were carried out in accordance with relevant guidelines and regulation and all experimental protocols were approved by Federal University of Mato Grosso do Sul. All materials will be kept on file, under the custody and responsibility of the lead researcher, for at least 5 years, following Resolution CNS No. 466/2012.\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003eThe sample consisted of 615 adolescent students from public schools in the state of Mato Grosso do Sul. The ethnic-racial characterization was mostly composed of white individuals 43.9% (n\u0026thinsp;=\u0026thinsp;270) and mixed-race individuals 43.3% (n\u0026thinsp;=\u0026thinsp;266). Black individuals represented 5.3% (n\u0026thinsp;=\u0026thinsp;32), Asians 3.9% (n\u0026thinsp;=\u0026thinsp;24), and Indigenous people 0.8% (n\u0026thinsp;=\u0026thinsp;6).\u003c/p\u003e \u003cp\u003eAccording to Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, 67.3% of adolescents showed consumption of foods indicative of unhealthy eating habits between 2 to 7 times per week, considered in this study as a moderate to high pattern of consumption.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDescriptive characteristics and proportions. SBMS 2018-19 Study, 12 years old (n\u0026thinsp;=\u0026thinsp;615).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eIndividual variations\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;615\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e% (95%CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eQoL (OIDP\u0026thinsp;=\u0026thinsp;0)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOIDP\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e% (95%CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSignificance (95%CI)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEthnicity\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhite\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e270\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43.9(40.0-47.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e66.7 (60.1\u0026ndash;72.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.01 (0.70\u0026ndash;1.32)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBrown\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e266\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43.3(39.4\u0026ndash;47.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e46.2 (38.2\u0026ndash;54.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.11 (1.57\u0026ndash;2.66)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAsian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.9 (2.6\u0026ndash;5.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e41.8 (16.7\u0026ndash;71.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.68 (0.63\u0026ndash;2.71)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlack\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.3 (3.7\u0026ndash;7.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e29.4 (12.9\u0026ndash;53.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.49 (1.52\u0026ndash;5.46)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIndigenous\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.9 (0.4\u0026ndash;2.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e6.93 (3.75\u0026ndash;10.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo response\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.8(1.7\u0026ndash;4.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e25.0 (9.8\u0026ndash;50.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.75 (1.28\u0026ndash;4.21)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e315\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e51.2 (47.3\u0026ndash;55.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e53.6 (46.5\u0026ndash;60.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.81 (1.38\u0026ndash;2.26)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e300\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e48.8(44.8\u0026ndash;52.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e59.8 (52.7\u0026ndash;66.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.34 (0.95\u0026ndash;1.73)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eParental education\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1 to 4 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e381\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e62.0 (58.0-65.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e36.6 (28.7\u0026ndash;45.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.58 (1.21\u0026ndash;1.95)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAbove years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e234\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38.0 (34.3\u0026ndash;42.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e62.6(56.7\u0026ndash;68.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.57 (1.28\u0026ndash;1.86)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eConsumption of unhealthy foods\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLow (up to 1 time per week)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e168\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27.3(23.9\u0026ndash;31.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e83.9(76.9\u0026ndash;89.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.59 (0.27\u0026ndash;0.90)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerate (2\u0026ndash;4 times per week),\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e197\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32.0(28.5\u0026ndash;35.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e45.5(36.9\u0026ndash;54.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.02 (1.43\u0026ndash;2.61)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh (5\u0026ndash;7 times per week)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e217\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35.3(31.6\u0026ndash;39.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e29.8(22.5\u0026ndash;38.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.58(1.98\u0026ndash;3.18)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo response\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.4(3.8\u0026ndash;7.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e30.1 (12.7\u0026ndash;60.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.10 (0.31\u0026ndash;2.90)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSedentary behavior (\u0026ge;\u0026thinsp;2 hours per day)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e338\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e55.0 (50.9\u0026ndash;58.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e75.8(70.1\u0026ndash;80.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.08(0.75\u0026ndash;1.43)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes (internet, games, sitting, or TV)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e251\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40.8 (35.9\u0026ndash;46.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e30.0(23.2\u0026ndash;37.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.34 (1.82\u0026ndash;2.87)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo response\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.2 (2.9\u0026ndash;6.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e14.5(4.7\u0026ndash;36.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.48 (1.86\u0026ndash;5.10)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eIn adjusted models, higher consumption of unhealthy foods (moderate and high) was associated with the prevalence of impact on OHRQoL (OIDP\u0026thinsp;\u0026ge;\u0026thinsp;1) with an Odds Ratio of [OR\u0026thinsp;=\u0026thinsp;3.59 (95% CI 1.99; 6.46)], indicating 3.59 times higher odds of at least one question being answered positively resulting in an impact on the adolescent's quality of life. The impact on oral health-related quality of life was reported by 43% of the sample; Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e presents the prevalence and severity of the impact on the adolescent's life.\u003c/p\u003e\u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eMultilevel negative binomial and logistic regressions between prevalence and severity of adolescents\u0026apos; quality of life. SBMS study of adolescents (n\u0026thinsp;=\u0026thinsp;615).\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colspan=\"2\" style=\"width: 9.7236%;\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\" style=\"width: 13.7764%;\"\u003e\n \u003cp\u003ePrevalence of impacts on Quality of Life\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\" style=\"width: 18.8249%;\"\u003e\n \u003cp\u003eSevirity of impacts on Quality of Life\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" style=\"width: 0.7779%;\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" style=\"width: 9.0235%;\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" style=\"width: 7.6233%;\"\u003e\n \u003cp\u003eUnadjusted\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" style=\"width: 15.7911%;\"\u003e\n \u003cp\u003eAdjusted*\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" style=\"width: 12.0573%;\"\u003e\n \u003cp\u003eUnadjusted\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" style=\"width: 6.7676%;\"\u003e\n \u003cp\u003eAdjusted*\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" style=\"width: 0.7779%;\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" style=\"width: 9.0235%;\"\u003e\n \u003cp\u003eCovariates\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" style=\"width: 7.6233%;\"\u003e\n \u003cp\u003eOR (95%CI)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" style=\"width: 15.7911%;\"\u003e\n \u003cp\u003eOR (95%CI)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" style=\"width: 12.0573%;\"\u003e\n \u003cp\u003eRR (95%CI)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" style=\"width: 6.7676%;\"\u003e\n \u003cp\u003eRR (95%CI)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 9.7236%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSedentary behavior\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.6233%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.7911%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 12.0573%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.7676%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 0.7779%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.0235%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.6233%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.7911%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 12.0573%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.7676%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 0.7779%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.0235%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.6233%;\"\u003e\n \u003cp\u003e2.00 (1.65; 2.39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.7911%;\"\u003e\n \u003cp\u003e1.64 (1.32; 2.03)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 12.0573%;\"\u003e\n \u003cp\u003e1.22 (1.09; 1.37)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.7676%;\"\u003e\n \u003cp\u003e1.21 (1.07; 1.37)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 0.7779%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.0235%;\"\u003e\n \u003cp\u003eE-value**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.6233%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.7911%;\"\u003e\n \u003cp\u003e2.66 (CI 1.97)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 12.0573%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.7676%;\"\u003e\n \u003cp\u003e1.71 (CI 1.34)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 9.7236%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUnhealthy eating\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.6233%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.7911%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 12.0573%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.7676%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 0.7779%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.0235%;\"\u003e\n \u003cp\u003eLow\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.6233%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.7911%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 12.0573%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.7676%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 0.7779%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.0235%;\"\u003e\n \u003cp\u003eModerate/high\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.6233%;\"\u003e\n \u003cp\u003e5.06 (3.23; 7.90)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.7911%;\"\u003e\n \u003cp\u003e3.78 (2.15; 6.66)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 12.0573%;\"\u003e\n \u003cp\u003e2.53 (1.84; 3.48)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.7676%;\"\u003e\n \u003cp\u003e2.05 (1.51; 2.79)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 0.7779%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.0235%;\"\u003e\n \u003cp\u003eE-value***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.6233%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.7911%;\"\u003e\n \u003cp\u003e7.02(CI 3.72)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 12.0573%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.7676%;\"\u003e\n \u003cp\u003e3.51(CI 2.39)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 0.7779%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.0235%;\"\u003e\n \u003cp\u003eVPC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.6233%;\"\u003e\n \u003cp\u003e7.0 (1.8; 23.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.7911%;\"\u003e\n \u003cp\u003e2.0 (0.8; 15.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 12.0573%;\"\u003e\n \u003cp\u003e5.0 (1.0; 12.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.7676%;\"\u003e\n \u003cp\u003e1.8 (0.8; 10.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"4\" style=\"width: 34.7716%;\"\u003e\n \u003cp\u003e* Adjusted for gender, parental education level, and racial groups.\u003c/p\u003e\n \u003cp\u003eVPC\u0026thinsp;=\u0026thinsp;Percentual Variation Coefficient (% of variation at the city level)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 12.0573%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.7676%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"6\" style=\"width: 53.5964%;\"\u003e\n \u003cp\u003e** Sensitivity analyses with E-values (unmeasured confounders), only associations above RR/OR\u0026thinsp;\u0026gt;\u0026thinsp;1.71 could change the association of sedentary behavior with the outcome.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"6\" style=\"width: 53.5964%;\"\u003e\n \u003cp\u003e*** Sensitivity analyses with E-values (unmeasured confounders), only associations above RR/OR\u0026thinsp;\u0026gt;\u0026thinsp;3.51 could change the association of dietary consumption with the outcome.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e \u003cp\u003eWhen assessing the severity of the impact, which is the sum of the questionnaire responses, it was observed that adolescents with moderate to high unhealthy dietary patterns had a quality of life impact twice as high as those with low unhealthy consumption. The risk ratio (RR) was 2.05 (95% CI 1.43; 2.94), indicating a significant association between an unhealthy dietary pattern and poorer OHRQoL among adolescents.\u003c/p\u003e \u003cp\u003eIn the analysis of the impact on the quality of life (QoL) of adolescents with sedentary behaviour, a prevalence of impact of 52% was observed, with an odds ratio (OR) of 1.52 (95% CI 1.22; 1.89). Additionally, a greater severity of impact, corresponding to 21%, was identified, with a relative risk (RR) of 1.21 (95% CI 1.07; 1.37), when compared to adolescents without sedentary behaviour. These results highlight the association between sedentary behavior and lower quality of life among adolescents.\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis study yielded two main findings. First, it highlighted that both sedentary behavior and unhealthy eating were associated with a higher prevalence and greater severity of impact on oral health-related quality of life among adolescents. Second, sensitivity analyses using e-values confirmed the relationships found between sedentary behavior and unhealthy eating with oral health-related quality of life. Controlling for social determinants, only a very strong unmeasured confounder would tend to alter the associations found.\u003c/p\u003e \u003cp\u003eThe strengths of the study are related to its scope, as it was conducted in the five largest cities in the state, providing representative data of the population in question. Additionally, another important strength is particularly related to the strong presence of agriculture as the main economic activity. This specific economic characteristic may influence not only oral health patterns but also the dietary habits of the population.\u003c/p\u003e \u003cp\u003eA weakness of the study is its cross-sectional nature, which implies that we cannot establish causal inference in the results, limiting the ability to determine the direction of the relationship between variables.\u003c/p\u003e \u003cp\u003eThe tested hypothesis was confirmed: adolescents with sedentary behavior (\u0026lt;\u0026thinsp;2 hrs/day watching TV, internet, playing video games, and other sedentary activities) and moderate to high unhealthy dietary consumption reported a greater impact on quality of life. Sedentary behaviour was associated with a higher CPO-D index in the evaluated adolescents when mediated by moderate to high unhealthy dietary consumption(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). The OIDP questionnaire assesses dimensions of oral health's impact on daily activities, and these activities were not elucidated in this analysis. However, a study conducted in Rio de Janeiro with adolescents in the same age group found that 88.7% of the students experienced an impact of oral problems on at least one of the daily performances evaluated by the OIDP. The activities that had the greatest impact were eating (81.3%), cleaning the mouth (40.5%), and smiling (32.2%), the average OIDP index was 7.1 with a 95% CI of 6.2 to 8.1(\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). In Rio Grande do Norte, school adolescents aged 15\u0026ndash;19 years, 51.16% reported some impact on oral health-related quality of life, with the main cause being the position of the teeth and activities such as eating, mouth hygiene, and smiling (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). Additionally, 40% of adolescents exhibited sedentary behavior (\u0026ge;\u0026thinsp;2 hrs/day, TV, internet, video games, and sitting activities), of whom 70% reported some impact on oral health-related quality of life. Adolescents from Cuiab\u0026aacute;-MT, attended by the Family Health Strategy, had a prevalence of sedentary behavior of 55% (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe differentiation by gender of unhealthy dietary patterns and sedentary behaviour was not assessed in this study. However, when examining the association of physical activity levels and dietary habits with anthropometric and lipid profiles in adolescents, girls were found to have higher odds of having altered cholesterol and LDL-C levels (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). The Modified Canadian Aerobic Fitness Test (mCAFT) found that 31.5% of adolescents aged 15 to 17 in Florian\u0026oacute;polis have low levels of aerobic fitness, with a higher prevalence in boys (49.2%) compared to girls (20.6%). Girls with sedentary behaviour, overweight, and high body fat percentage were the groups most likely to have inadequate aerobic fitness(\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eParental education proved to be an important factor, exerting influence on dietary patterns and quality of life. 63.4% of adolescents with parents who had 1 to 4 years of formal education experienced some impact on oral health-related quality of life. Adolescents from public schools in Jo\u0026atilde;o Pessoa-PB showed higher adherence to a dietary pattern classified as \"snacks\" (consumption of bread, butter and margarine, cheeses, processed meats, and coffee) when their mothers had lower levels of education and socioeconomic status (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). When analyzing children and adolescents with overweight and obesity, it is noted that the mother's education level of these adolescents ranges from ten to twelve years of schooling, with a percentage of 30.71% for overweight and 36.80% for obesity(\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). Maternal education of less than four years presents a higher risk for short stature, with a decrease as maternal education increases (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). In Europe, a higher prevalence of overweight/obesity is associated with low family wealth. This led to the formulation of a strategy for implementing the promotion of healthy nutrition and physical activity for children and adolescents(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe relationship between sedentary behavior, unhealthy eating, and the development of dental caries is complex and multifactorial, highlighting the interconnection between lifestyle and oral health. Sedentary behaviours, such as spending long hours in front of the television or computer, often coincide with the consumption of snacks rich in sugars and fermentable carbohydrates, which are known to contribute to dental caries(\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). Estudos indicate that diets high in simple sugars not only increase the risk of obesity and chronic diseases but are also one of the main dietary factors in the development of caries, as sugars serve as substrates for acidogenic bacteria in dental plaque, leading to demineralization of tooth enamel (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). Furthermore, a sedentary lifestyle may reduce the frequency of healthy oral hygiene habits, exacerbating the risk of caries. Therefore, promoting an active lifestyle along with a balanced diet low in free sugars is essential for preventing dental caries and maintaining oral and overall health(\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eBomfim et al. (2021) highlight how sedentary lifestyles and diets rich in processed sugars and carbohydrates significantly contribute to the increased prevalence of dental caries. Additionally, the study, through structural equation models, showed that sedentary behaviour may be indirectly associated with less rigorous oral hygiene, and higher unhealthy dietary consumption, thus favouring the experience of caries among adolescents. This reinforces the need for integrated approaches promoting active lifestyles and balanced diets while minimizing sugar consumption as an essential strategy in preventing dental caries and promoting oral health(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAccording to data from the National School Health Survey of 2015, high prevalences of daily consumption of at least one group of ultra-processed foods and sedentary behaviour\u0026thinsp;\u0026gt;\u0026thinsp;2 hours per day were identified. Out of every ten Brazilian adolescents, four exhibit regular consumption of ultra-processed foods, and seven have sedentary behaviour (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). Regarding cultural and behavioural explanations, the increasing use of social media and easy access to electronic devices justify sedentary behaviour. In a study conducted by Lucena et al. in 2013, analyzing the relationship between sedentary behaviour, dietary habits, indicators of quality of life, and health in adolescents, screen time was associated with lower levels of HRQoL for physical well-being and school environment, respectively (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e).\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eUnhealthy dietary consumption and sedentary behavior were significantly associated with oral health-related quality of life. Intersectoral public health policies promoting healthy eating and reducing sedentary behavior on the internet and electronic games among adolescents can contribute to an improvement in their quality of life. Strengthening educational measures related to oral health should be encouraged.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003cstrong\u003eEthical Approval\u003c/strong\u003e \u003cp\u003e This project was submitted to the Ethics Committee of the Federal University of Mato Grosso do Sul, after authorization from the Municipal Department of Education of Campo Grande, MS, and submission to the Brazil Platform under the ethical opinion protocol CAAE: 85647518.4.0000.0021. It includes an Informed Consent Form for parents/guardians of minors and an Informed Assent Form for adolescents\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding:\u003c/h2\u003e \u003cp\u003eThis study was partially financed by the Federal University of Mato Grosso do Sul (UFMS).\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConflict of interest:\u003c/strong\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eJAVC contributed to the conception, design, and data interpretation, and drafted and critically revised the manuscriptRAB contributed to the conception, and design, performed all statistical analyses, and data interpretation, and drafted and critically revised the manuscript. All authors reviewed the manuscript.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe data that support the findings of this study are openly upon request. Contact the corresponding author.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eOwen N, Healy GN, Matthews CE, Dunstan DW. Too Much Sitting: The Population Health Science of Sedentary Behavior. Exercise and sport sciences reviews. 2010;38(3):105\u0026ndash;13.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWorld Health Organization. Regional Office for E. Situation of child and adolescent health in Europe. Copenhagen: World Health Organization. Regional Office for Europe; 2018 2018.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePetersen PE, Baehni PC. Periodontal health and global public health. Periodontology 2000. 2012;60(1):7\u0026ndash;14.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAgath\u0026atilde;o BT, Reichenheim ME, Moraes CLd. Qualidade de vida relacionada \u0026agrave; sa\u0026uacute;de de adolescentes escolares. 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Cobertura e vigil\u0026acirc;ncia da fluoreta\u0026ccedil;\u0026atilde;o das \u0026aacute;guas nos munic\u0026iacute;pios com mais de 50 mil habitantes da regi\u0026atilde;o Centro-Oeste. 2018. p. 174\u0026ndash;84.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGodinho GF, Cavalheiro A, Lu\u0026iacute;s HS, Mexia R. Valida\u0026ccedil;\u0026atilde;o do Oral Impacts on Daily Performances para a popula\u0026ccedil;\u0026atilde;o portuguesa. Ci\u0026ecirc;ncia \u0026amp; Sa\u0026uacute;de Coletiva. 2018;23(12):4351\u0026ndash;60.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVera C, Moreno X, Rivera D. Adaptation and validation of Child Oral Impact on Daily Performance index in 11-14-year-old Chilean school children. Journal of oral research. 2013;2(3):119\u0026ndash;24.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRey-L\u0026oacute;pez JP, Ruiz JR, Ortega FB, Verloigne M, Vicente-Rodriguez G, Gracia-Marco L, et al. Reliability and validity of a screen time-based sedentary behaviour questionnaire for adolescents: The HELENA study. European Journal of Public Health. 2012;22(3):373\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVanderweele TJ, Ding P. Sensitivity Analysis in Observational Research: Introducing the E-Value. Annals of Internal Medicine. 2017;167(4):268.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCastro RdAL, Portela MC, Le\u0026atilde;o AT, de Vasconcellos MTL. Oral health-related quality of life of 11- and 12-year-old public school children in Rio de Janeiro: Oral health-related quality of life in Rio de Janeiro. Community dentistry and oral epidemiology. 2011;39(4):336\u0026ndash;44.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFilgueira ACG, Machado FCDA, Do Amaral BA, De Lima KC, De Assun\u0026ccedil;\u0026atilde;o IV. SA\u0026Uacute;DE BUCAL DE ADOLESCENTES ESCOLARES. HOLOS. 2016;1:161\u0026thinsp;\u0026ndash;\u0026thinsp;72.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlexandre M, Silva A, Coelho-Ravagnani C. Comportamento sedent\u0026aacute;rio em adolescentes atendidos pela Estrat\u0026eacute;gia de Sa\u0026uacute;de da Fam\u0026iacute;lia em Cuiab\u0026aacute;, Brasil. Revista Brasileira de Atividade F\u0026iacute;sica \u0026amp; Sa\u0026uacute;de. 2016;21(4).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGuimar\u0026atilde;es RDF, Silva MPD, Mazzardo O, Martins RV, Campos WD. Atividade f\u0026iacute;sica e alimenta\u0026ccedil;\u0026atilde;o associadas aos perfis antropom\u0026eacute;trico e lip\u0026iacute;dico em adolescentes. ConScientiae Sa\u0026uacute;de. 2014;13(3):340\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSilva DAS, Tremblay MS, Pelegrini A, Silva JMFDL, Petroski EL. Low aerobic fitness in Brazilian adolescents. 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Estado nutricional e fatores associados ao d\u0026eacute;ficit de estatura em crian\u0026ccedil;as atendidas por uma unidade de ensino b\u0026aacute;sico de tempo integral. Journal of Human Growth and Development. 2009;19(1):54.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSheiham A, James WPT. Diet and Dental Caries: The Pivotal Role of Free Sugars Reemphasized. Journal of dental research. 2015;94(10):1341\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMoynihan PJ, Kelly SAM. Effect on Caries of Restricting Sugars Intake: Systematic Review to Inform WHO Guidelines. Journal of dental research. 2014;93(1):8\u0026ndash;18.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBull FC, Al-Ansari SS, Biddle S, Borodulin K, Buman MP, Cardon G, et al. World Health Organization 2020 guidelines on physical activity and sedentary behaviour. British Journal of Sports Medicine. 2020;54(24):1451\u0026ndash;62.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCosta CDS, Flores TR, Wendt A, Neves RG, Assun\u0026ccedil;\u0026atilde;o MCF, Santos IS. Comportamento sedent\u0026aacute;rio e consumo de alimentos ultraprocessados entre adolescentes brasileiros: Pesquisa Nacional de Sa\u0026uacute;de do Escolar (PeNSE), 2015. Cadernos de Sa\u0026uacute;de P\u0026uacute;blica. 2018;34(3).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFarias J\u0026uacute;nior JCD, Silva KSD. Sobrepeso/obesidade em adolescentes escolares da cidade de Jo\u0026atilde;o Pessoa - PB: preval\u0026ecirc;ncia e associa\u0026ccedil;\u0026atilde;o com fatores demogr\u0026aacute;ficos e socioecon\u0026ocirc;micos. Revista Brasileira de Medicina do Esporte. 2008;14(2):104\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Family health strategy, Unhealthy eating habits, Sedentary behavior, Quality of life","lastPublishedDoi":"10.21203/rs.3.rs-4667778/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4667778/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThis study analyzed the factors associated with the oral health-related quality of life (OHRQOL) of 12-year-old adolescents and their relationship with unhealthy eating and sedentary behavior. Data were collected from 615 adolescents from the five largest cities in Mato Grosso do Sul, Brazil. The theoretical framework of the social determinants of oral health guided all analyses and the measurement instrument was OIDP (impact of oral health on daily performance). Multilevel logistic and negative binomial regressions were performed to test the association of OHRQOL with unhealthy eating, sedentary behavior, sociodemographic characteristics and health behaviours. Considering the sample weights, 43% of the adolescents reported some impact on OHRQOL. In the adjusted models, higher consumption of unhealthy foods (moderate and high) was associated with a prevalence of impact on OHRQOL [OR\u0026thinsp;=\u0026thinsp;3.59 (95%CI 1.99; 6.46)] and higher OHRQOL severity [RR\u0026thinsp;=\u0026thinsp;2.05 (95%CI 1.43; 2.94)] compared to their counterparts. Those who had sedentary behaviour were associated with the prevalence of impact on OHRQOL [OR\u0026thinsp;=\u0026thinsp;1.52 (95%CI 1.22; 1.89)] and greater severity [RR\u0026thinsp;=\u0026thinsp;1.21 (95%CI 1.07; 1.37)] compared to those who did not have sedentary behaviour. Unhealthy food consumption and sedentary behavior were associated with OHRQOL. Intersectoral health public policies for healthy eating and for reducing sedentary behavior on the internet and electronic games can help in the quality of life of adolescents.\u003c/p\u003e","manuscriptTitle":"Influence of Unhealthy Diet and Sedentary Behavior on the Oral Health-Related Quality of Life of 12-Year-Old Adolescents","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-29 10:29:59","doi":"10.21203/rs.3.rs-4667778/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-10-15T04:04:34+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-10-14T16:19:46+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"289514098744008818981823552112176985877","date":"2024-10-10T20:53:00+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-09-13T19:54:42+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"225724073283250373224492090607884391542","date":"2024-09-02T17:53:13+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"8846232930248211580801867530610123090","date":"2024-07-19T10:55:15+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-07-14T07:13:59+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-07-14T07:10:41+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-07-04T06:22:57+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-07-04T06:18:13+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2024-07-01T11:41:38+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f394ab38-6178-4fd9-939d-af0397034cd2","owner":[],"postedDate":"July 29th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":35268979,"name":"Health sciences/Health care/Public health/Epidemiology"},{"id":35268980,"name":"Health sciences/Health care/Dentistry/Dental public health"}],"tags":[],"updatedAt":"2024-12-02T15:59:31+00:00","versionOfRecord":{"articleIdentity":"rs-4667778","link":"https://doi.org/10.1038/s41598-024-81293-2","journal":{"identity":"scientific-reports","isVorOnly":false,"title":"Scientific Reports"},"publishedOn":"2024-11-27 15:56:58","publishedOnDateReadable":"November 27th, 2024"},"versionCreatedAt":"2024-07-29 10:29:59","video":"","vorDoi":"10.1038/s41598-024-81293-2","vorDoiUrl":"https://doi.org/10.1038/s41598-024-81293-2","workflowStages":[]},"version":"v1","identity":"rs-4667778","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4667778","identity":"rs-4667778","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}