Relationship between urinary and water fluoride with cardiovascular risk factors in children and adolescents in Yazd city

Relationship between urinary and water fluoride with cardiovascular risk factors in children and adolescents in Yazd city | 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 Relationship between urinary and water fluoride with cardiovascular risk factors in children and adolescents in Yazd city Habibeh Nasab, Majid Hashemi, Arash Dalvand, Seyedeh Mahdieh Namayandeh, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7724665/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 6 You are reading this latest preprint version Abstract Background Although the prevalence of cardiovascular diseases is low during childhood and adolescence, behavioral and biological risk factors and lifestyle associated with noncommunicable diseases are formed during this period and persist into adulthood. The present study aimed to investigate urinary fluoride levels and their relationship with risk factors for cardiovascular diseases in children and adolescents in Yazd city in 2024. Methods This cross-sectional study was conducted on 161 children and adolescents aged 6 to 18 years in Yazd city. Water fluoride was measured at 56 points of the drinking water network. Demographic information, physical activity, and fluoride exposure factors were collected through a questionnaire. Physical examinations included measurements of height, weight, body mass index (BMI), waist circumference, and systolic blood pressure (SBP) and diastolic blood pressure (DBP). Blood samples were taken from participants to measure lipid profiles (TC, HDL, LDL, and TG), fasting blood sugar (FBS), magnesium, and calcium, and urine samples were taken to measure fluoride and creatinine. Urinary fluoride was measured using an ion-selective electrode. Results The mean age of the participants was 11.95 ± 3.74 years, and the largest age group was adolescents aged 12 to 18 years (50.9%). The mean urinary fluoride (mg/L) was reported to be 0.49 ± 0.29. Lack of calcium supplementation was significantly associated with higher urinary fluoride (mg/g cr) levels (p = 0.004). Water fluoride was associated with a decrease in BMI in the total participants, especially in adolescents, and an increase in SBP and DBP z-score in the total participants. Urinary fluoride was significantly associated with a decrease in BMI and SBP z-score in children, a decrease in BMI and waist circumference in the general population, and a decrease in TC, HDL, and TG in the general population and adolescents. These results showed changes after adjustment for demographic, behavioral, nutritional, and metabolic factors, which indicates the importance of considering moderating variables in examining the effect of fluoride exposure. Conclusion The study findings showed that water and urine fluoride levels are associated with some anthropometric indices and cardiovascular risk factors in children and adolescents. Longitudinal studies are necessary to confirm these findings and determine the causal relationship between fluoride exposure and cardiovascular risk factors. Health sciences/Diseases Health sciences/Health care Health sciences/Medical research Health sciences/Risk factors Children Adolescents Urinary fluoride Water fluoride Cardiovascular Obesity 1. Introduction The prevalence of obesity among children and adolescents in developing countries is increasing rapidly. Due to the decline in traditional food consumption and increasing urbanization, industrialization, and the increase in the consumption of fatty foods and fast foods, obesity in children and adolescents is increasing in many countries ( 1 ). People who are overweight and obese in childhood are more likely to develop obesity and cardiovascular diseases in adulthood ( 2 ). Despite advances in science in the prevention of cardiovascular diseases, these diseases remain the leading cause of death among adults. Risk factors for cardiovascular diseases, such as high blood pressure, diabetes, and hyperlipidemia, can be exacerbated by certain lifestyle behaviors such as diet, physical activity, and environmental pollutants ( 3 , 4 ). Fluoride is a halogen element found in nature as the fluoride ion. Its abundance in the Earth's crust is 0.06 to 0.09% ( 5 ). Fluoride exposure occurs through several major sources, including drinking water, food, toothpaste, mouthwash, agricultural fertilizers, industrial materials, and air ( 6 , 7 ). Exposure to fluoride through the air is high in areas adjacent to phosphate fertilizer and coal ash industries. However, in non-industrial areas, the concentration of fluoride in the air is usually very low, ranging from 0.05 to 1.9 (µg/m3). Fluoride is used in some toothpastes and mouthwashes to prevent tooth decay, and this amount is potentially higher in children due to the increased use of fluoride-containing dental products and ingestion of toothpaste. Fluoride is present in almost all foods, with the highest levels of fluoride found in vegetables, including kale, which contains 40 (mg/kg), and chicory, 0.28 to 0.3 (mg/kg). Fluoride levels in fish are 0.1 to 30 (mg/kg), and high concentrations are found in tea. The average fluoride level in dry tea is 100 (mg/kg), and the use of fluoridated water for preparing food and tea can increase fluoride intake ( 5 , 8 ). The highest exposure to fluoride is mainly through drinking water. The amount of water consumed by each person is influenced by various factors, including air temperature and humidity, physical activity, health status of the person, and diet. Fluoride is present in all water sources, but its highest amount has been reported in groundwater ( 5 ). Studies show that the fluoride level in Iranian drinking water is 0.51 (mg/L), and the minimum and maximum fluoride levels have been reported to be 0.02 to 6 mg/L ( 9 ). This indicates that, on average, each person is exposed to 1 mg/L of fluoride daily through drinking water ( 9 ). Iran is one of the 20 countries with high fluoride concentrations in soil and aquatic environments ( 10 ). Fluoride has beneficial effects on teeth at low concentrations, but excessive exposure to fluoride through water and other sources can lead to adverse health effects ( 5 ). Exposure to high levels of fluoride may alter the structure of mineral tissues and cause dental fluorosis or even skeletal fluorosis. On the other hand, some studies have shown that exposure to levels below the standard limits in water can cause dental fluorosis ( 11 ). Studies also show that exposure to low levels of fluoride is associated with some adverse effects, such as neurotoxicity, reduced IQ scores in children, and changes in sleep-wake cycle regulation and sleep behaviors ( 11 , 12 ). The US National Research Council has shown that fluoride may affect the endocrine system, especially thyroid function ( 8 ). Animal studies have also shown that fluoride can directly disrupt lipid metabolism and lipogenesis ( 6 ), such that fluoride may increase cholesterol, low-density lipoprotein (LDL), and triglycerides, and decrease high-density lipoprotein (HDL) cholesterol ( 13 ). Studies have also shown that fluoride can have potential effects on body weight, which may be related to changes in thyroid hormones, estrogen and androgen levels, or glucose tolerance and insulin resistance ( 6 ). Fluoride has also been associated with an increased risk of hypertension in humans ( 13 ). Indeed, excessive fluoride exposure reduces the elastic properties of the aorta and leads to impaired cardiac function. This mechanism may be due to inflammation and oxidative stress induced by fluoride toxicity, but the cause of the impairment of the elastic properties of the aorta is not fully understood. The possible mechanism for these findings is that excess fluoride reduces glutathione peroxidase levels, which causes systemic inflammation and endothelial activation ( 14 ). Fluoride is mainly absorbed through the gastrointestinal tract. Fluoride metabolism is pH-dependent and is absorbed in the acidic conditions of the stomach as hydrogen fluoride (HF), and its absorption decreases with increasing gastric pH. Fluoride absorption in the intestine is not affected by pH and is reduced in the presence of cations, especially calcium, magnesium, and aluminum cations. Fluoride reaches the bones and tooth enamel through the circulatory system, where it is deposited in the form of a crystal lattice ( 15 , 16 ). Renal excretion of fluoride is high compared to other halogens and is directly related to urinary pH ( 15 ). Direct assessment of total fluoride exposure in a population can be difficult and costly. Estimating total fluoride intake in a population is particularly challenging due to exposure to multiple dietary and non-dietary sources of fluoride, as well as the difficulty in measuring unintentional toothpaste ingestion by children. Since many factors, such as age (skeletal development), dose and form of fluoride, renal insufficiency, physical activity, nutrition, and genetics, can affect fluoride metabolism and lead to changes in fluoride intake and excretion, and the implementation of fluoride interventions varies considerably across countries, the combination of all these factors complicates direct assessment of fluoride exposure ( 17 ). Fluoride is excreted mainly in the urine, with only a small amount excreted in sweat and feces. Approximately 60% of ingested fluoride is excreted in the urine ( 18 ). Although urinary excretion of ingested fluoride is rapid (half-life in the circulation is about 5 hours), frequent consumption of drinking water, water-based beverages, and foods prepared with water, and its presence in other food sources, results in relatively constant exposure ( 8 ). Measurement of urinary fluoride levels has been suggested as a useful method for estimating fluoride exposure in populations ( 17 ). Since urine is the major metabolic pathway for fluoride excretion from the body, it can be a useful biomarker for estimating fluoride exposure ( 17 ). Behavioral and biological risk factors, lifestyle, especially dietary habits and physical activity, associated with noncommunicable diseases are formed during childhood and adolescence and persist into adulthood ( 19 ). Although cardiovascular disease does not appear until adulthood and is not associated with significant adverse health outcomes during childhood and adolescence, growing evidence suggests a link between cardiovascular risk factors and the association between childhood and adolescent dyslipidemia and the development of atherosclerosis and its consequences in adulthood ( 20 ). Prevention and control of cardiovascular risk factors, including dyslipidemia, from early life may serve as primary or secondary prevention. To address this issue, we need scientific evidence on various aspects of the epidemiology of the disorder. Several studies worldwide have investigated the prevalence of dyslipidemia in children and adolescents and have reported a wide range of variation across regions ( 21 ). The results of a study on the prevalence of dyslipidemia in Iranian adolescents showed that the prevalence of dyslipidemia was 45.7%, the most common of which were low HDL (24.8%) and hypertriglyceridemia (24.5%), followed by hypercholesterolemia (6.4%) and high LDL (6.3%) ( 21 , 22 ). Since implementing preventive programs from the beginning of life may be considered a priority for the health system to reduce the burden of chronic diseases ( 21 ) and since so far, limited studies have been conducted in Iran to investigate the relationship between environmental pollutants and their effects on cardiovascular disease risk factors at different ages, especially childhood and adolescence ( 23 – 25 ), the present study aimed to investigate the relationship between cardiovascular disease risk factors and urinary fluoride in children and adolescents in Yazd in 1403. 2. Materials and Methods 2.1. Study Population The study was approved by the Ethics Committee of Shahid Sadoughi University of Medical Sciences, Yazd, Iran (approval code: IR.SSU.SPH.REC.1402.170). All methods were carried out in accordance with relevant guidelines and regulations (Declaration of Helsinki). The present cross-sectional study was conducted in Yazd in 2024. 161 children and adolescents aged 6 to 18 years living in Yazd were randomly selected. The inclusion criteria for the study were being 6–18 years old and living in Yazd for at least one year, not having a chronic disease (cardiovascular disease, diabetes, kidney, and thyroid disorders), and not taking medication in the long term. The exclusion criteria for the study were non-cooperation in all stages of the study ( 26 ). Sampling was conducted from November 2023 to March 2024. Sampling was performed on a voluntary basis through a public call, including sending text message invitations and installing banners across the city to recruit volunteers. In addition, participants were also selected from individuals who attended the Yazd Central Laboratory for routine check-ups and had no known disease. 2.2. Questionnaire After obtaining written Informed consent from the parents of the children and adolescents in the study, a questionnaire was completed by the parents in collaboration with the researchers. This questionnaire included demographic information (age, gender, parental education and income, and exposure to cigarette smoke). In addition, data on the use of dietary supplements (zinc and calcium), physical activity, number of baths per week, number of times toothbrushes were brushed per day and week, amount of mouthwash used, daily tea and water consumption, type of water consumed (urban tap water or purified domestic water), and consumption patterns of fluoride-containing food sources (daily, weekly, or monthly) including cauliflower, broccoli, peanuts, spinach, and fish were collected. Finally, participation in the National Varnish Program over the past year was also assessed ( 13 ). 2.3. Physical examinations Physical examinations were performed on the subjects, including height, weight, waist circumference, BMI, and BMI z-score calculation, and blood pressure measurement. The subjects' weight was measured using a digital scale while wearing light clothing and without shoes. Height was measured in a standing position with three points of the body (back of the head, buttocks, and heels) touching the wall using a tape measure. Waist circumference was recorded in a natural breathing position and from the deepest part of the waist at the distance between the chest and pelvis using a tape measure. Body mass index (BMI) was also calculated using the formula weight (kg) divided by height (m) squared. BMI z-score was calculated based on age and sex using the WHO Anthro Plus software. Also, the waist circumference z-score was calculated based on the Caspian study reference values ( 27 ). Blood pressure was measured in the sitting position and after at least 5 minutes of rest, using a digital sphygmomanometer using a pediatric-appropriate cuff on the right arm ( 13 , 26 ). In addition, systolic and diastolic blood pressure z-scores were calculated based on the Caspian study reference values ( 28 ). 3.3. Blood tests After fasting for at least 8 hours, approximately 2 mL of fasting blood samples were collected from the subjects. These samples were used to measure the blood lipid profile, including total cholesterol (TC), low-density lipoprotein (LDL), high-density lipoprotein (HDL), and triglyceride (TG), fasting blood sugar (FBS), as well as magnesium and calcium levels. All tests were performed using a Hitachi 704 autoanalyzer (Hitachi, Tokyo, Japan) ( 13 , 26 ). In addition, z-scores of blood lipid profile indices (TC, LDL, HDL, and TG) and FBS were calculated based on the Caspian study reference values ( 27 , 29 ). 3.4. Fluoride measurement Also, to measure the amount of fluoride in urine and urine creatinine, at least 25 ml of urine sample will be taken from the study subjects on a fasting basis. The samples were stored in a closed Falcon in a freezer at -20°C until the test was performed. Then, to measure urine fluoride, the urine samples were first removed from the freezer and thawed at room temperature. Fluoride concentration in the samples was measured using a HQ440d multi (Hach, USA) equipped with an Intellical ISEF121 fluoride ion selective electrode. The instrument was calibrated using fluoride standard solutions with concentrations of 0.5, 1.0, and 2.0 mg/L, and the electrode potential (mV) values ​​corresponding to each standard were recorded at a temperature of about 25°C. A calibration curve was prepared based on these data, and the electrode slope was in the range of 73.55 mV/px (equivalent to 124% of the theoretical Nernst response), and the instrument detection limit (LOD) was 0.1651 mg/L. According to the instructions, the limit of quantification (LOQ) was calculated as three times the LOD value. During sample preparation, one pack of Fluoride Ionic Strength Adjustor (ISA) Powder Pillows, 25 mL, Pack of 100 (Hach, USA) was added to 25 mL of each sample to stabilize ionic conditions and reduce possible interferences. Then, the samples were placed on a magnetic stirrer, and the electrode was placed inside them. Fluoride values ​​were read after the signal stabilized. Between each reading, the electrode was washed with deionized water and dried with a lint-free cloth. All preparation, calibration, and measurement steps were performed according to the Hach Company instructions (Method 8323) and in compliance with the USEPA standard. Urine creatinine was measured using the Kinetic Jaffe method. Urinary creatinine concentration was measured in milligrams per deciliter (mg/dL). Then, to determine urinary fluoride in terms of creatinine, creatinine values ​​were first converted to grams per liter (g/L) to standardize units. Next, to reduce the effect of dilute or concentrated urine samples, fluoride concentrations were corrected and measured as milligrams per gram of creatinine (mg/g Cr) according to Eq. 1. This method adjusts for the effects of urine volume and daily fluid intake and provides a more accurate indicator of individual fluoride exposure ( 30 ). \(\:\text{F}\text{l}\text{u}\text{o}\text{r}\text{i}\text{d}\text{e}\:\text{c}\text{o}\text{n}\text{c}\text{e}\text{n}\text{t}\text{r}\text{a}\text{t}\text{i}\text{o}\text{n}(mg/g.cr)=\frac{Urinary\:fluoride\:(mg/L)}{Urinary\:creatinine\:(g/L)}\) ( 1 ) Information on 56 fluoride sampling points in the drinking water network of Yazd city in 1403 was received from the city health center. Using geographic information system (GIS) software, the closest sampling point to each participant's residence was identified. Then, the fluoride concentration measured at that point during 1403 was considered as an indicator of individual exposure level. 3.5. Data analysis Data analysis was performed using SPSS software (version 27). The analyses were conducted in both descriptive and analytical categories. Descriptive statistics were used to present demographic characteristics. Independent t-test and chi-square test were applied to compare categorical and continuous variables between children and adolescents. To assess the associations of urinary and water fluoride levels with anthropometric indices, blood pressure, and lipid profile, univariate linear regression models were applied by age groups (children, adolescents, and total population). Multivariable linear regression analyses were further performed in two models: Model 1 adjusted for age and sex, and Model 2 adjusted for a broader set of demographics, behavioral, dietary, anthropometric, and metabolic covariates. A p-value < 0.05 was considered statistically significant. 3. Results Table 1 presents the distribution of demographic information of the participants based on age. The results showed that the mean age of the participants was 11.95 ± 3.74. The results showed that the largest number of participants were adolescents aged 12 to 18 years (50.9%). Also, most of the participants were girls (77.64%), and the majority of them had no history of exposure to cigarette smoke (77.4%). Most of the participants' parents had non-academic education (70.2% and 59.6%), and this group was mainly adolescents (59.4%), and this difference was statistically significant (p = 0.019). The majority of the participants had an average family income (66.5%). Also, most of them had at least 30 minutes of physical activity between 3 and 7 days a week (38.5%), and this group was mainly adolescents (51.7%); this difference was also reported to be significant (p = 0.024). The mean urinary fluoride (mg/L) in participants was 0.49 ± 0.29, which was reported to be higher in adolescents than in children (0.54 ± 0.32), and this difference was statistically significant (p = 0.016). The mean urinary fluoride (mg/g.cr) was 0.93 ± 1.6.3, and the mean water fluoride (mg/L) was 0.53 ± 0.15. Table 1 Distribution of demographic information participants according to age Variables Total Children (6–11 years) Adolescents (12–18 years) p-value* N (%) Gender Girls 125(77.64) 57(72.2) 68(82.9) 0.101 Boys 36(22.36) 22(27.8) 14(17.1) Total 161(100) 79(49.1) 82(50.9) Smoker family Smokers 36(22.4) 15(19.0) 21(25.6) 0.313 Non-Smokers 125(77.6) 64(81.0) 61(74.4) Father education Illiterate 10(6.2) 2(2.5) 8(9.8) 0.163 Non-academic 113(70.2) 58(73.4) 55(67.1) Academic 38(23.6) 19(24.1) 19(23.2) Mother education Illiterate 7(4.3) 3(3.8) 4(4.9) 0.019 Non-academic 96(59.6) 39(49.4) 57(69.5) Academic 58(36.0) 37(46.8) 21(25.6) Household income * Low 40(24.8) 20(25.3) 20(24.4) 0.887 Moderate 107(66.5) 53(67.1) 54(65.9) High 14(8.7) 6(7.6) 8(9.8) Physical activity (years/week) None 38(23.8) 12(15.4) 26(31.7) 0.024 < 3 60(37.5) 29(37.2) 31(37.8) 3–7 62(38.8) 37(47.4) 25(30.5) Mean ± SD Age (year) 11.95 ± 3.74 8.69 ± 1.76 15.08 ± 2.12 < 0.001 Urinary fluoride (mg/L) 0.49 ± 0.29 0.43 ± 0.24 0.54 ± 0.32 0.016 Urinary fluoride (mg/g.cr) 0.93 ± 1.6.3 1.05 ± 2.05 0.82 ± 1.07 0.371 Water fluoride (mg/L) 0.53 ± 0.15 0.52 ± 0.15 0.53 ± 0.14 0.812 a Physical Activity: low = less than 5 minutes, moderate = 5 to 30 minutes, high = more than 30 minutes a. chi-square test, independent T-test b. Children = 6–11 years, Adolescent = 12–18 years * Low: ≤192 $ , Moderate: 192–384 $ and High: ≥384 $ Table 2 shows the mean urinary fluoride (mg/L and mg/g.cr) based on health and nutritional factors. The results showed that the majority of participants did not use mouthwash (88.19%), and their mean urinary fluoride (mg/L) was 0.49 ± 0.29. The majority of the study population did not use calcium supplements, and their mean oral fluoride (mg/g.cr) was 0.49 ± 0.36, and this difference was significant (p = 0.004). The results showed that people who consumed Cabbage at least 1 to 2 times a week had a higher mean urinary fluoride (mg/g.cr) of 1.45 ± 2.93, and this difference was significant (p = 0.046). Also, people who consumed Soy at least 1 to 2 times a week had a higher mean oral fluoride (mg/g.cr) of 1.32 ± 2.51, and this difference was significant (p = 0.058). Also, regarding fish consumption, the results showed that people who did not consume any fish during the month had a higher mean urinary fluoride (mg/L) than other people, 0.55 ± 0.34, and this difference was significant (p = 0.021). Table 2 Mean urinary fluoride (mg/L and mg/g.cr) based on health and nutritional factors Variables Urinary fluoride (mg/L) Urinary fluoride (mg/g.cr) N Mean ± SD p-value Mean ± SD p-value Toothbrush (day) 1 85 0.48 ± 0.28 0.884 0.81 ± 0.82 0.172 2 19 0.53 ± 0.29 0.55 ± 0.26 2–3 39 0.50 ± 0.31 1.41 ± 2.95 Never 18 0.47 ± 0.28 0.86 ± 1.11 Mouthwash (month) Never 142 0.49 ± 0.29 0.729 0.99 ± 1.72 0.004 1–3 19 0.47 ± 0.26 0.50 ± 0.33 Varnish Yes 72 0.49 ± 0.28 0.995 0.90 ± 1.16 0.852 No 89 0.49 ± 0.30 0.95 ± 1.93 Water Type Tap 109 0.50 ± 0.27 0.402 1.01 ± 1.92 0.390 purified 52 0.46 ± 0.31 0.77 ± 0.68 Tea (Cup) Never 81 0.45 ± 0.22 0.197 0.80 ± 0.73 0.496 1–2 Cup 69 0.54 ± 0.35 1.11 ± 2.34 > 2 Cup 11 0.49 ± 0.25 0.77 ± 0.69 Amount of drinking water (Cup) Never 6 0.58 ± 0.29 0.557 0.87 ± 0.68 0.903 2–4 85 0.51 ± 0.30 0.99 ± 1.99 4–8 54 0.48 ± 0.26 0.94 ± 1.27 > 8 15 0.41 ± 0.26 0.64 ± 0.36 Ca Supplement Yes 17 0.39 ± 0.31 0.139 0.49 ± 0.36 0.004 No 144 0.50 ± 0.28 0.98 ± 1.71 Zn Supplement Yes 26 0.51 ± 0.30 0.643 0.88 ± 1.04 0.875 No 135 0.48 ± 0.28 0.94 ± 1.72 Cabbage Never 82 0.48 ± 0.28 0.443 0.73 ± 0.59 0.046 1–2 (day/week) 43 0.54 ± 0.30 1.45 ± 2.93 months 36 0.46 ± 0.28 0.75 ± 0.73 Soy Never 62 0.51 ± 0.33 0.142 0.75 ± 0.68 0.058 1–2 (day/week) 60 0.52 ± 0.29 1.32 ± 2.51 months 39 0.41 ± 2.51 0.62 ± 0.46 Broccoli Never 128 0.50 ± 0.29 0.453 1.02 ± 1.79 0.411 1-(day/week) 9 0.42 ± 0.23 0.46 ± 0.46 monthly 24 0.44 ± 0.26 0.58 ± 0.58 Peanut Never 68 0.51 ± 0.32 0.298 0.89 ± 1.17 0.461 1–2 (day/week) 38 0.53 ± 0.33 1.20 ± 2.87 monthly 55 0.44 ± 0.20 0.78 ± 0.64 Spinach Never 100 0.49 ± 0.31 0.327 0.81 ± 0.84 0.481 1–2 (day/week) 18 0.57 ± 0.30 1.16 ± 1.84 monthly 43 0.45 ± 0.22 1.12 ± 2.64 Fish Never 45 0.55 ± 0.34 * 1.35 ± 1.35 1–2 (day/week) 41 0.54 ± 0.28 0.021 1.27 ± 2.74 0.138 monthly 75 0.42 ± 0.24 0.66 ± 0.66 Table 3 shows the association of urinary fluoride mg/L and mg/g.cr and water fluoride mg/L with cardiovascular risk factors based on age. The results showed that the mean water fluoride mg/L was significantly associated with a decrease in BMI in the general population and especially in adolescents (β=-7.16, P = 0.006). Also, BMI z-score in children showed a significant decrease with water fluoride mg/L (β=-3.10, P = 0.006) and in adolescents, urinary fluoride mg/L showed a significant decrease (β=-1.01, P = 0.04). Urinary fluoride in mg/g.cr was significantly associated with a decrease in waist circumference in the general population (β=-2.50, P = 0.038). Urinary fluoride mg/L in children was associated with a significant decrease in SBP z-score (β=-1.52, P = 0.032). Also, water fluoride mg/L was significantly associated with increased SBP z-score in the total population (β = 1.57, P = 0.032). Water fluoride mg/L was significantly associated with increased DBP z-score in the total population (β = 1.20, P = 0.044) and in adolescents (β = 1.78, P = 0.044). Urinary fluoride in mg/g.cr was significantly associated with decreased TC in the total population and adolescents (β=-3.34, P = 0.018 and β=-5.96, P = 0.049), also urinary fluoride mg/L was significantly associated with decreased TC z-score in adolescents (β=-2.07, P < 0.001). Urinary fluoride mg/g.cr was significantly associated with decreased HDL in the total population (β=-1.98, P = 0.045). Urinary fluoride mg/g.cr was significantly associated with TG reduction in the total population (β=-8.14, P = 0.048). Table 3 Relationship between Urinary and Water Fluoride Levels and Cardiovascular Risk Factors by Age Group Variables Urinary fluoride (mg/L) Urinary fluoride (mg/g.cr) Water fluoride (mg/L) Total Children Adolescents Total Children Adolescents Total Children Adolescents β(SE) β(SE) β(SE) BMI -1.24(1.39) -0.33(1.75) -3.52(1.93) -0.24(0.24) 0.02(0.20) -0.87(0.58) -3.51(2.63) -7.16(2.58)* -0.02(4.25) BMI z-score -0.59(0.42) 0.17(0.77) -1.01(0.49)* 0.004(0.07) 0.07(0.09) -0.24(0.14) -1.47(0.79) -3.10(1.13)* 0.26(1.09) WC (cm) -2.13(3.27) -2.32(4.89) -6.54(4.07) -0.87(0.58) -0.18(0.58) -2.50(1.20)* -4.48(6.20) -1.62(7.55) -8.61(8.84) WC z-score (cm) -0.43(0.39) -0.65(0.57) -0.39(0.57) -0.04(0.07) 0.01(0.06) -0.25(0.16) -0.59(0.75) 0.51(0.88) -1.79(1.22) SBP (mmHg) -0.70(2.99) -1.92(4.42) 0.31(4.22) 0.15(0.53) 0.43(0.52) -0.91(1.26) -5.07(5.66) -3.95(6.81) -6.18(9.07) SBP z-score (mmHg) -0.26(0.39) -1.52(0.71)* 0.35(0.44) -0.04(0.06) 0.07(0.08) 0.06(0.13) 1.57(0.73)* 1.40(1.11) 1.74(0.94) DBP (mmHg) -0.34(2.85) -6.45(4.71) 3.32(3.66) -0.24(0.50) 0.07(0.56) -1.45(1.09) 5.49(5.38) 4.18(7.33) 6.98(7.88) DBP z-score (mmHg) 0.29(0.33) 0.78(0.56) -0.16(0.42) -0.04(0.06) -0.02(0.06) -0.07(0.12) 1.20(0.63)* 0.62(0.88) 1.78(0.88)* FBS (mg/100 mL) -9.81(9.19) -11.82(21.29) -5.32(4.95) 0.45(1.64) 0.85(2.52) -1.65(1.48) 3.76(17.47) 2.62(32.84) 5.95(10.70) FBS z-score (mg/100 mL) 0.13(0.89) -0.01(0.67) -0.13(1.49) -0.02(0.15) 0.07(0.07) -0.29(0.44) 0.39(1.68) 0.61(1.03) 0.08(3.21) TC (mg/100 mL) -6.17(8.03) 4.35(13.44) -9.92(10.29) -3.34(1.40)* -2.73(1.56) -5.96(3.02)* 3.80(15.23) -9.52(20.69) 18.62(22.18) TC z-score (mg/100 mL) -1.16(0.64) 1.05(1.29) -2.07(0.59)* -0.09(0.11) 0.08(0.15) -0.17(0.19) 0.02(1.23) -1.40(1.99) 1.65(1.36) HDL (mg/100 mL) -2.54(5.62) -9.47(8.62) -0.76(7.70) -1.98(0.99)* -1.46(1.01) -3.52(2.27) 6.42(10.65) 20.19(13.18) -8.74(16.54) HDL z-score (mg/100 mL) 0.58(0.59) 0.84(1.07) 0.36(0.71) 0.03(0.10) 0.11(0.12) -0.24(0.21) -0.26(1.13) 0.23(1.65) -0.81(1.53) LDL (mg/100 mL) -1.97(5.34) 9.64(8.37) -5.76(7.10) -1.21(0.94) -1.29(0.98) -1.48(2.12) -4.98(10.11) -19.54(12.81) 11.23(15.28) LDL z-score (mg/100 mL) -0.07(0.25) 0.42(0.45) -0.20(0.30) -0.03(0.04) -0.05(0.05) 0.004(0.09) -0.45(0.48) -0.47(0.70) -0.40(0.65) TG (mg/100 mL) -1.94(11.54) 22.21(20.36) -14.76(13.96) -2.30(2.04) -0.68(2.42) -8.14(4.11)* 12.91(21.84) -2.63(31.58) 29.65(30.08) TG z-score (mg/100 mL) -0.09(0.29) -0.11(0.58) 0.11(0.29) -0.02(0.05) -0.04(0.06) 0.01(0.08) -0.26(0.56) -0.75(0.90) 0.29(0.62) * p-value is significant at the 0.05 level Table 4 presents the results of a multivariate regression analysis to examine the effect of cardiovascular risk factors on urinary and water fluoride levels. Model 1 was adjusted for age and sex only, while Model 2 was adjusted for a broad set of demographic, nutritional, and behavioral variables, including smoking, calcium and zinc supplement use, fluoride varnish, type and amount of tea consumption, weekly physical activity, frequency of bathing, oral hygiene (toothbrush and mouthwash), amount and type of water consumption, consumption of fluoride-containing foods (cabbage, broccoli, soybeans, peanuts, spinach, and fish), calcium and magnesium levels, anthropometric indices (BMI, Z-BMI, waist circumference), systolic and diastolic blood pressure, fasting blood glucose, and lipid profile (TC, HDL, LDL, and TG). The findings showed that in model 2, an increase in waist circumference was associated with a significant decrease in urinary fluoride concentration (mg/L) (β=-5.66; p = 0.004), and an increase in diastolic blood pressure was associated with a significant decrease in urinary fluoride in mg/g.cr (β=-2.06; p = 0.002). In addition, in model 1, an increase in total cholesterol was associated with a decrease in urinary fluoride in mg/g.cr (β=-3.45; p = 0.014), while in model 2, an increase in TC was associated with a significant increase in water fluoride (β = 31.12; p < 0.001). The results of model 2 also showed that both an increase in HDL and LDL were associated with a significant decrease in water fluoride (β=-18.64; p < 0.001 and β=-20.86; p < 0.001, respectively). On the other hand, an increase in triglycerides in model 2 was associated with a significant increase in urinary fluoride (mg/L) (β = 1.15; p = 0.010). Table 4 Multivariable Regression Analysis of the Effect of Cardiovascular Risk Factors on Urinary and Water Fluoride Levels Variables Urinary fluoride (mg/L) Urinary fluoride (mg/g.cr) Water fluoride (mg/L) β(95%CI) p-value β(95%CI) p-value β(95%CI) p-value BMI Model 1 -2.36(-4.88, 0.16) 0.067 -0.134(-0.58, 0.31) 0.561 -3.02(-7.78, 1.73) 0.212 Model 2 -1.59(-3.38, 0.19) 0.081 -0.23(-0.61, 0.15) 0.235 2.73(-1.64, 7.11) 0.221 BMI z-score Model 1 -0.59(-1.42, 0.24) 0.167 -0.005(-0.15, 0.14) 0.946 -1.50(-3.06, 0.04) 0.058 Model 2 0.32(-0.18, 0.84) 0.213 0.07(-0.03, 0.18) 0.169 -0.71(-1.96, 0.53) 0.261 WC (cm) Model 1 -5.11(-10.66, 0.44) 0.071 -0.63(-1.62, 0.36) 0.212 -3.29(-13.78, 7.19) 0.538 Model 2 -5.66(-9.47, -1.85) 0.004 -0.82(-1.66, 0.02) 0.056 -0.94(-10.88, 8.99) 0.853 SBP (mmHg) Model 1 -0.32(-6.26, 5.61) 0.915 0.10(-0.94, 1.15) 0.846 -5.28(-16.37, 5.79) 0.350 Model 2 1.22(-6.64, 9.09) 0.760 -0.22(0.85, -1.89) 0.788 -8.62(-27.46, 10.20) 0.369 DBP (mmHg) Model 1 0.04(-5.59, 5.69) 0.986 -0.28(-1.28, 0.71) 0.577 5.35(-5.17, 15.87) 0.319 Model 2 -0.78(-7.38, 5.81) 0.815 -2.06(-3.33, -0.78) 0.002 -12.08(-27.65, 3.48) 0.128 FBS (mg/100 mL) Model 1 -8.95(-27.05, 9.15) 0.332 0.19(-3.02, 3.41) 0.906 2.85(-31.12, 36.83) 0.869 Model 2 3.07(-5.64, 11.79) 0.490 1.38(-0.42, 3.20) 0.134 12.78(-8.03, 33.60) 0.229 TC (mg/100 mL) Model 1 -5.35(-21.25, 10.53) 0.509 -3.45(-6.23, -0.68) 0.014 3.47(-26.31, 33.26) 0.819 Model 2 0.77(-6.27, 7.82) 0.830 -1.02(-2.49, 0.44) 0.171 31.12(16.62, 45.62) < 0.001 HDL (mg/100 mL) Model 1 -4.07(-15.05, 6.90) 0.467 -1.92(-3.84, 0.006) 0.051 6.95(-13.60, 27.50) 0.508 Model 2 2.09(-2.81, 6.99) 0.403 0.54(-0.49, 1.57) 0.304 -18.64(-29.33, -7.95) < 0.001 LDL (mg/100 mL) Model 1 -0.80(-11.26, 9.65) 0.880 -1.31(-3.15, 0.53) 0.164 -5.40(-24.97, 14.15) 0.588 Model 2 0.89(-3.75, 5.55) 0.705 0.64(-0.32, 1.61) 0.191 -20.86(-30.39, -11.33) < 0.001 TG (mg/100 mL) Model 1 -2.59(-25.50, 20.30) 0.824 -2.30(-6.35, 1.74) 0.264 13.14(-29.68, 55.97) 0.548 Model 2 1.15(0.27, 2.02) 0.010 -0.71(-5.43, 4.00) 0.766 4.12(-49.54, 57.79) 0.880 a. Model 1: adjusted by age, gender b. Model 2: adjusted by Sex, Age, Smoking, Calcium supplement, Zinc supplement, Fluoride varnish, Type of tea, Physical activity-week, Bathing, Toothbrush, Mouthwash, tea consumed, Amount of drinking water, Type of water used, Cabbage, Broccoli, Soybean, Peanut, Spinach, Fish, Ca, Mg, BMI, Z_BMI, WC, SBP, DBP, FBS, TC, HDL, LDL, TG * p-value is significant at the 0.05 level 4. Discussion The present study investigated the association of urinary and drinking water fluoride with cardiovascular risk factors in children and adolescents. To date, limited studies have examined the association of fluoride with blood pressure. The results of this study showed that urinary fluoride was inversely associated with SBP z-score, while drinking water fluoride was positively associated with SBP z-score and DBP z-score. Furthermore, after adjusting for a wide range of confounding factors, including demographic characteristics, lifestyle, dietary patterns, supplement use, and anthropometric and metabolic indices (Model 2), the direction of the association of urinary fluoride with DBP changed and appeared inverse. These findings indicate that moderating factors can significantly affect the magnitude and direction of the relationships between fluoride exposure and blood pressure. Therefore, in analyzing the association of fluoride with cardiovascular risk factors, it is of particular importance to consider background and confounding variables. In contrast to the present study, Yun Liu et al. observed a positive association with SBP z-score and DBP z-score ( 13 ). Consistent with the present study, the results of the study by Koh et al. also showed an inverse association between fluoride in drinking water and systolic blood pressure while adjusting for the effects of age, gender, race, and income among the study population ( 31 ). The results of the study by Guo et al. also observed an inverse association between fluoride in drinking water and plasma fluoride with systolic blood pressure in the population of children and adolescents ( 32 ). Also, in the study by Sun L et al., an inverse association was observed between fluoride in water and SBP in the population of children and adolescents, and in this study, they did not observe any association between plasma fluoride and SBP ( 33 ). However, the studies by Yousefi et al. showed a positive association of fluoride concentration in water with blood pressure, which is consistent with the results of fluoride in water ( 34 ). Based on evidence from experimental animal studies, exposure to high concentrations of fluoride can lead to significant changes in the composition of the liver lipid membrane and disruption of thyroid hormone levels in animal models such as mice. Furthermore, data show that fluoride can exacerbate inflammatory cytokine responses in rabbit aorta, while simultaneously increasing lipid peroxidation and cardiotoxicity ( 35 ). The results of the present study showed an inverse relationship between urinary fluoride and water fluoride with BMI Z-score in the studied individuals. The results also showed an inverse relationship between fluoride mg/g.cr with WC. Studies conducted on adults have not observed any relationship between the amount of fluoride consumed in water and anthropometric parameters ( 34 , 35 ). In contrast to the results of the present study, the results of the study by Liu et al., which examined the blood fluoride level of Mexican children aged 7 to 13 years in areas with different levels of water fluoride, showed a significant positive relationship between urinary fluoride and BMI Z-score. They also showed that the level of the father's education and gender can affect this relationship after adjusting for confounding factors ( 6 ). The results of the study by Yun Liu et al., which examined the blood fluoride level in Mexican children and adolescents aged 10 to 18 years, showed a significant positive relationship with anthropometric indices in girls ( 13 ). The results of the study by Tingting Hao et al. also showed a positive relationship between urinary fluoride and blood fluoride with BMI and WC in children and adolescents ( 36 ). The conflicting findings in different studies may be due to differences in gender, age, and race distributions. In addition, these discrepancies could be due to differences in fluoride exposure levels, population sensitivity and vulnerabilities, as well as long-term cumulative effects of fluoride ( 23 , 37 ). The exact mechanism by which fluoride affects overweight and obesity is not yet fully understood; however, evidence from rodent studies suggests that fluoride can lead to increased serum lipid concentrations by disrupting lipid metabolism and lipogenesis. In addition, fluoride's effects on liver function and endocrine glands, including the thyroid and parathyroid, may play an important role in causing metabolic changes and ultimately the occurrence of overweight ( 6 ). The results of the present study showed that urinary fluoride was inversely associated with TC and HDL, and directly associated with TG. These results indicate the disruptive role of fluoride on lipid metabolism. Also, in the present study, the results showed that after adjusting for a wide range of confounding variables (including demographic factors, lifestyle, diet, supplements, and anthropometric and metabolic indices) in Model 2, the magnitude and direction of some associations changed; such that the association of urinary fluoride with TG became more positive and the association of water fluoride with TC also became positive. This indicates that the presence of modulating factors can affect the interpretation of the association between fluoride exposure and cardiovascular risk factors, and special attention should be paid to these variables in the analyses. Previous studies have also reported largely similar results. In a study of 20–60-year-old patients with endemic fluorosis in Punjab, India, exposure to drinking water containing high fluoride (5.9–24.5 mg/L) was associated with decreased TC and HDL and increased TG, which is consistent with the findings of the present study ( 38 ). Also, in an animal model, long-term exposure to fluoride in rabbits increased TC and LDL-C and exacerbated hypercholesterolemia along with increased oxidative stress indices ( 39 ). These results also confirm the negative effect of fluoride on lipid metabolism. On the other hand, a study by Dionizio et al. on rats showed that the effect of fluoride depends on the duration of exposure and the type of diet, such that short-term consumption under normal diet conditions can have protective effects, but long-term exposure or in the presence of NAFLD disrupts the lipid profile ( 40 ). However, not all studies have observed a negative effect; For example, Yun Liu's study in children and adolescents reported no association between blood lipid profiles and plasma fluoride ( 13 ). Overall, a review of the available evidence suggests that although in some short-term settings and in certain age groups, no significant effect may be observed, chronic and long-term exposure to fluoride is often associated with impaired lipid metabolism and increased cardiovascular risk factors. The findings of the present study showed that urinary fluoride was associated with decreased total cholesterol (TC) and high-density lipoprotein (HDL) levels and increased triglyceride (TG) levels in the blood. These results are consistent with the known mechanisms of fluoride's effects on lipid metabolism. Fluoride can reduce cholesterol production by inhibiting key enzymes in cholesterol synthesis, such as HMG-CoA reductase ( 40 , 41 ). Fluoride can also lead to lipid degradation and decreased HDL levels by increasing oxidative stress and free radical production ( 42 ). On the other hand, increased TG levels may be due to stimulation of lipogenesis (new fat synthesis) or decreased fatty acid oxidation ( 43 ). The results of the present study showed that short-term consumption of some vegetables, such as cabbage and soybeans, was associated with increased urinary fluoride levels in mg/g.cr. Regarding fish consumption, contrary to expectations and existing evidence that fish is a source of fluoride, in the present study, individuals without fish consumption had higher urinary fluoride levels. This result may be due to differences in the amount of fluoride in the fish consumed, preparation and cooking methods, or the interaction of other dietary and environmental sources. Therefore, although dietary sources containing fluoride can affect the total body fluoride burden, the contradictory results for fish indicate that a more detailed examination of the type, amount, and pattern of its consumption is necessary in future studies. The results of this study also showed that participants who did not use calcium supplements had higher urinary fluoride levels. These findings suggest that calcium consumption may reduce the level of fluoride excreted in the urine by reducing the absorption or accumulation of fluoride in the body. Estimating total fluoride intake in the population is challenging due to exposure to multiple dietary and non-dietary sources of fluoride, as well as the difficulty of measuring unintentional toothpaste ingestion by young children ( 17 ). Fluoride biomarkers, such as urine, directly correlate with fluoride exposure from various sources such as water, fluoride supplements, and foods ( 44 , 45 ). Many factors can alter fluoride metabolism and thus alter the relationship between fluoride intake and excretion, including age (skeletal growth), dose and form of fluoride, as well as acid-base disturbances (e.g., altitude), renal impairment, physical activity, nutritional status, dietary composition and genetics, and implementation of fluoride interventions, cultural and geographic variations. The combination of all these potential fluoride carriers, with the complex availability of fluoride, can affect fluoride excretion ( 17 , 46 ). The present study had several important strengths. First, the target population included children and adolescents, who are considered a vulnerable group in terms of sensitivity to fluoride exposure. In addition, in this study, water fluoride and urinary fluoride were simultaneously measured as valid biomarkers, and related dietary consumption patterns were also considered. The use of biological measurements increased the validity of the results, and controlling for a wide range of confounding factors, including demographic variables, lifestyle, diet, supplement use, and anthropometric and metabolic indices, improved the accuracy of the analyses. In addition, the study results were compared with evidence from numerous domestic and international studies, which enriched the discussion and added to the scientific validity of the findings. However, the present study also had limitations. Its cross-sectional design prevented inferences of cause-and-effect relationships. Also, dietary fluoride intake was estimated indirectly through a questionnaire, which increases the possibility of recall or reporting errors. For some food sources, such as fish, unexpected results may have been due to heterogeneity in the type of fish consumed and differences in cooking and preparation methods. In addition, fluoride intake through unintentional ingestion of toothpaste and other environmental sources was not accurately measured. On the other hand, changes in fluoride levels and their effects over time were not assessed due to the lack of longitudinal follow-up. Finally, specific characteristics of the study population may limit the generalizability of the results to other age groups or regions. 5. Conclusion The present study showed that urinary fluoride and water fluoride levels were associated with some cardiovascular risk factors in children and adolescents. Specifically, water fluoride was more associated with decreased BMI and increased blood pressure (DBP and SBP), and urinary fluoride was associated with positive changes in waist circumference, cholesterol, and triglycerides. These results may indicate that fluoride has a different effect on cardiovascular risk factors depending on the source of exposure and age group. After adjusting for confounders, the direction and magnitude of some relationships changed: the association of urinary fluoride with DBP was reversed, the association of urinary fluoride with TG was stronger, and the association of water fluoride with TC was positive. These changes indicate that moderating factors can have a significant impact on the magnitude and direction of the relationships between fluoride exposure and cardiovascular risk factors. In addition, the findings showed that short-term consumption of vegetables such as cabbage and soybeans was associated with increased urinary fluoride levels. However, contrary to expectations and previous evidence regarding the role of fish as a source of fluoride, in the present study, non-consumption of fish was associated with higher urinary fluoride levels. The results also showed that non-consumption of calcium supplements was associated with increased urinary fluoride levels. These results emphasize the role of dietary sources and supplements in the body's fluoride load and its excretion through urine. Overall, the present study shows that the effects of fluoride on cardiovascular health and lipid metabolism are multifaceted and influenced by environmental and nutritional factors. Given the cross-sectional nature of this study, longitudinal studies are necessary to confirm these findings and determine the causal relationship between fluoride exposure and cardiovascular risk factors. Declarations Ethical approval The present study has the code of ethics IR.SSU.SPH.REC.1402.170 of Shahid Sadoughi University of Medical Sciences, Yazd. Consent to participate The study was approved by the Ethics Committee of Shahid Sadoughi University of Medical Sciences, Yazd, Iran (approval code: IR.SSU.SPH.REC.1402.170). All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. All methods were carried out in accordance with relevant guidelines and regulations. Competing interests The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Funding This study was funded by Shahid Sadoughi University of Medical Sciences, Yazd, Iran, and the National Institute for Medical Research Development (NIMAD), Iran. Author Contribution All authors contributed to the study's conception and design. Material preparation, data collection, and analysis were performed by **H.N., A.D, M.H., S.M.N., H.F., and M.H.E.** The first draft of the manuscript was written by **H.N.,** and all authors commented on the previous versions of the manuscript. All authors read and approved the final manuscript. Conceptualization was performed by **H.N., A.D, M.H., S.M.N., H.F., M.H.E.** ; Methodology by **A.D, H.N., M.H., S.M.N., M.H.E.** ; Formal analysis and investigation by **H.N., H.F.** ; Writing-original draft preparation by **H.N.** Writing-review and editing by **A.D, M.H., S.M.N., H.F., M.H.E.** Acknowledgements The authors would like to gratefully acknowledge the research deputy of Shahid Sadoughi University of Medical Sciences, Yazd, and the National Institute for Medical Sciences Research Development (NIMAD). Data Availability The supporting data are available from the corresponding authors upon reasonable request. References Hamidi, A. et al. 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An assessment of the relationship between excess fluoride intake from drinking water and essential hypertension in adults residing in fluoride endemic areas. Sci. Total Environ. 443 , 864–869 (2013). Yousefi, M. et al. Association of hypertension, body mass index, and waist circumference with fluoride intake; water drinking in residents of fluoride endemic areas, Iran. Biol. Trace Elem. Res. 185 (2), 282–288 (2018). Aldana, S. I. et al. Longitudinal associations between early-life fluoride exposures and cardiometabolic outcomes in school-aged children. Environ. Int. 183 , 108375 (2024). Hao, T. et al. Association Between Fluoride Exposure and BMI, WWI in Children and Adolescents: A Cross-Sectional Study. Clin. Pediatr. :00099228251339210. (2025). Nasab, H., Mirzaee, M., Hashemi, M. & Rajabi, S. Measurement of Urinary Triclocarban and 2, 4-Dichlorophenol Concentration and Their Relationship with Obesity and Predictors of Cardiovascular Diseases among Children and Adolescents in Kerman, Iran. J. Environ. Public. Health . 2022 (1), 2939022 (2022). Bhardwaj, M. & Shashi, A. Dose effect relationship between high fluoride intake and biomarkers of lipid metabolism in endemic fluorosis. Biomed. Prev. Nutr. 3 (2), 121–127 (2013). Sun, L., Gao, Y., Zhang, W., Liu, H. & Sun, D. Effect of high fluoride and high fat on serum lipid levels and oxidative stress in rabbits. Environ. Toxicol. Pharmacol. 38 (3), 1000–1006 (2014). Dionizio, A. et al. Effect of duration of exposure to fluoride and type of diet on lipid parameters and de novo lipogenesis. Biol. Trace Elem. Res. 190 (1), 157–171 (2019). Lavanya, S., Shree, K. H. & Ramani, P. Fluoride effect on renal and hepatic functions: A comprehensive decade review of In vitro and In vivo studies. J. Oral Biology Craniofac. Res. 14 (6), 735–745 (2024). Pereira, H. A. B. S. et al. Fluoride intensifies hypercaloric diet-induced ER oxidative stress and alters lipid metabolism. PLoS One . 11 (6), e0158121 (2016). Wu, J. et al. Fluoride exposure and its interaction with ATP2B1 polymorphism in the alteration of lipid metabolism in adults. Int. J. Environ. Health Res. :1–10. (2025). Villa, A., Cabezas, L., Anabalón, M. & Garza, E. The fractional urinary fluoride excretion of adolescents and adults under customary fluoride intake conditions, in a community with 0.6-mg F/L in its drinking water. Community Dent. Health . 21 (1), 11–18 (2004). Till, C. et al. Community water fluoridation and urinary fluoride concentrations in a national sample of pregnant women in Canada. Environ. Health Perspect. 126 (10), 107001 (2018). Castiblanco-Rubio, G. A., Baston, M., Hernandez, F. M., Martinez-Mier, E. A. & Cantoral, A. Associations between Dietary Patterns, Fluoride Intake and Excretion in Women Exposed to Fluoridated Salt: A Preliminary Study. Nutrients 16 (19), 3404 (2024). Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 23 Oct, 2025 Reviewers invited by journal 23 Oct, 2025 Editor assigned by journal 16 Oct, 2025 Editor invited by journal 14 Oct, 2025 Submission checks completed at journal 12 Oct, 2025 First submitted to journal 06 Oct, 2025 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. We do this by developing innovative software and high quality services for the global research community. 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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-7724665","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":538732702,"identity":"29bccc0d-984b-4b50-8fba-81af63ef6cd2","order_by":0,"name":"Habibeh Nasab","email":"","orcid":"","institution":"Shahid Sadoughi University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Habibeh","middleName":"","lastName":"Nasab","suffix":""},{"id":538732703,"identity":"59c7ce44-b0ac-4680-b867-f5bd8c58f911","order_by":1,"name":"Majid Hashemi","email":"","orcid":"","institution":"Kerman University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Majid","middleName":"","lastName":"Hashemi","suffix":""},{"id":538732704,"identity":"b9beb97e-80cd-4b13-98ac-2a3cc7f650fb","order_by":2,"name":"Arash Dalvand","email":"","orcid":"","institution":"Shahid Sadoughi University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Arash","middleName":"","lastName":"Dalvand","suffix":""},{"id":538732705,"identity":"956c8adc-1700-424f-930f-20b3e73ea1b8","order_by":3,"name":"Seyedeh Mahdieh Namayandeh","email":"","orcid":"","institution":"Shahid Sadoughi University of Medical Sciences, Yazd Shahid Sadoughi University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Seyedeh","middleName":"Mahdieh","lastName":"Namayandeh","suffix":""},{"id":538732706,"identity":"ca46a01e-cd4f-44de-b3f6-ca0dbc5eb38c","order_by":4,"name":"Hossien Fallahzadeh","email":"","orcid":"","institution":"Shahid Sadoughi University of Medical 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16:37:44","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1410026,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7724665/v1/f5a19461-6ec9-423e-a812-301c5bedea54.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Relationship between urinary and water fluoride with cardiovascular risk factors in children and adolescents in Yazd city","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eThe prevalence of obesity among children and adolescents in developing countries is increasing rapidly. Due to the decline in traditional food consumption and increasing urbanization, industrialization, and the increase in the consumption of fatty foods and fast foods, obesity in children and adolescents is increasing in many countries (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). People who are overweight and obese in childhood are more likely to develop obesity and cardiovascular diseases in adulthood (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Despite advances in science in the prevention of cardiovascular diseases, these diseases remain the leading cause of death among adults. Risk factors for cardiovascular diseases, such as high blood pressure, diabetes, and hyperlipidemia, can be exacerbated by certain lifestyle behaviors such as diet, physical activity, and environmental pollutants (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eFluoride is a halogen element found in nature as the fluoride ion. Its abundance in the Earth's crust is 0.06 to 0.09% (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Fluoride exposure occurs through several major sources, including drinking water, food, toothpaste, mouthwash, agricultural fertilizers, industrial materials, and air (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Exposure to fluoride through the air is high in areas adjacent to phosphate fertilizer and coal ash industries. However, in non-industrial areas, the concentration of fluoride in the air is usually very low, ranging from 0.05 to 1.9 (\u0026micro;g/m3). Fluoride is used in some toothpastes and mouthwashes to prevent tooth decay, and this amount is potentially higher in children due to the increased use of fluoride-containing dental products and ingestion of toothpaste. Fluoride is present in almost all foods, with the highest levels of fluoride found in vegetables, including kale, which contains 40 (mg/kg), and chicory, 0.28 to 0.3 (mg/kg). Fluoride levels in fish are 0.1 to 30 (mg/kg), and high concentrations are found in tea. The average fluoride level in dry tea is 100 (mg/kg), and the use of fluoridated water for preparing food and tea can increase fluoride intake (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe highest exposure to fluoride is mainly through drinking water. The amount of water consumed by each person is influenced by various factors, including air temperature and humidity, physical activity, health status of the person, and diet. Fluoride is present in all water sources, but its highest amount has been reported in groundwater (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Studies show that the fluoride level in Iranian drinking water is 0.51 (mg/L), and the minimum and maximum fluoride levels have been reported to be 0.02 to 6 mg/L (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). This indicates that, on average, each person is exposed to 1 mg/L of fluoride daily through drinking water (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Iran is one of the 20 countries with high fluoride concentrations in soil and aquatic environments (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eFluoride has beneficial effects on teeth at low concentrations, but excessive exposure to fluoride through water and other sources can lead to adverse health effects (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Exposure to high levels of fluoride may alter the structure of mineral tissues and cause dental fluorosis or even skeletal fluorosis. On the other hand, some studies have shown that exposure to levels below the standard limits in water can cause dental fluorosis (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Studies also show that exposure to low levels of fluoride is associated with some adverse effects, such as neurotoxicity, reduced IQ scores in children, and changes in sleep-wake cycle regulation and sleep behaviors (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). The US National Research Council has shown that fluoride may affect the endocrine system, especially thyroid function (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Animal studies have also shown that fluoride can directly disrupt lipid metabolism and lipogenesis (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e), such that fluoride may increase cholesterol, low-density lipoprotein (LDL), and triglycerides, and decrease high-density lipoprotein (HDL) cholesterol (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Studies have also shown that fluoride can have potential effects on body weight, which may be related to changes in thyroid hormones, estrogen and androgen levels, or glucose tolerance and insulin resistance (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Fluoride has also been associated with an increased risk of hypertension in humans (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Indeed, excessive fluoride exposure reduces the elastic properties of the aorta and leads to impaired cardiac function. This mechanism may be due to inflammation and oxidative stress induced by fluoride toxicity, but the cause of the impairment of the elastic properties of the aorta is not fully understood. The possible mechanism for these findings is that excess fluoride reduces glutathione peroxidase levels, which causes systemic inflammation and endothelial activation (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eFluoride is mainly absorbed through the gastrointestinal tract. Fluoride metabolism is pH-dependent and is absorbed in the acidic conditions of the stomach as hydrogen fluoride (HF), and its absorption decreases with increasing gastric pH. Fluoride absorption in the intestine is not affected by pH and is reduced in the presence of cations, especially calcium, magnesium, and aluminum cations. Fluoride reaches the bones and tooth enamel through the circulatory system, where it is deposited in the form of a crystal lattice (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). Renal excretion of fluoride is high compared to other halogens and is directly related to urinary pH (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eDirect assessment of total fluoride exposure in a population can be difficult and costly. Estimating total fluoride intake in a population is particularly challenging due to exposure to multiple dietary and non-dietary sources of fluoride, as well as the difficulty in measuring unintentional toothpaste ingestion by children. Since many factors, such as age (skeletal development), dose and form of fluoride, renal insufficiency, physical activity, nutrition, and genetics, can affect fluoride metabolism and lead to changes in fluoride intake and excretion, and the implementation of fluoride interventions varies considerably across countries, the combination of all these factors complicates direct assessment of fluoride exposure (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eFluoride is excreted mainly in the urine, with only a small amount excreted in sweat and feces. Approximately 60% of ingested fluoride is excreted in the urine (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Although urinary excretion of ingested fluoride is rapid (half-life in the circulation is about 5 hours), frequent consumption of drinking water, water-based beverages, and foods prepared with water, and its presence in other food sources, results in relatively constant exposure (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Measurement of urinary fluoride levels has been suggested as a useful method for estimating fluoride exposure in populations (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). Since urine is the major metabolic pathway for fluoride excretion from the body, it can be a useful biomarker for estimating fluoride exposure (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eBehavioral and biological risk factors, lifestyle, especially dietary habits and physical activity, associated with noncommunicable diseases are formed during childhood and adolescence and persist into adulthood (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). Although cardiovascular disease does not appear until adulthood and is not associated with significant adverse health outcomes during childhood and adolescence, growing evidence suggests a link between cardiovascular risk factors and the association between childhood and adolescent dyslipidemia and the development of atherosclerosis and its consequences in adulthood (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). Prevention and control of cardiovascular risk factors, including dyslipidemia, from early life may serve as primary or secondary prevention. To address this issue, we need scientific evidence on various aspects of the epidemiology of the disorder. Several studies worldwide have investigated the prevalence of dyslipidemia in children and adolescents and have reported a wide range of variation across regions (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). The results of a study on the prevalence of dyslipidemia in Iranian adolescents showed that the prevalence of dyslipidemia was 45.7%, the most common of which were low HDL (24.8%) and hypertriglyceridemia (24.5%), followed by hypercholesterolemia (6.4%) and high LDL (6.3%) (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eSince implementing preventive programs from the beginning of life may be considered a priority for the health system to reduce the burden of chronic diseases (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e) and since so far, limited studies have been conducted in Iran to investigate the relationship between environmental pollutants and their effects on cardiovascular disease risk factors at different ages, especially childhood and adolescence (\u003cspan additionalcitationids=\"CR24\" citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e), the present study aimed to investigate the relationship between cardiovascular disease risk factors and urinary fluoride in children and adolescents in Yazd in 1403.\u003c/p\u003e"},{"header":"2. Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003e2.1. Study Population\u003c/h2\u003e\u003cp\u003e The study was approved by the Ethics Committee of Shahid Sadoughi University of Medical Sciences, Yazd, Iran (approval code: IR.SSU.SPH.REC.1402.170). All methods were carried out in accordance with relevant guidelines and regulations (Declaration of Helsinki). The present cross-sectional study was conducted in Yazd in 2024. 161 children and adolescents aged 6 to 18 years living in Yazd were randomly selected. The inclusion criteria for the study were being 6\u0026ndash;18 years old and living in Yazd for at least one year, not having a chronic disease (cardiovascular disease, diabetes, kidney, and thyroid disorders), and not taking medication in the long term. The exclusion criteria for the study were non-cooperation in all stages of the study (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). Sampling was conducted from November 2023 to March 2024. Sampling was performed on a voluntary basis through a public call, including sending text message invitations and installing banners across the city to recruit volunteers. In addition, participants were also selected from individuals who attended the Yazd Central Laboratory for routine check-ups and had no known disease.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\u003ch2\u003e2.2. Questionnaire\u003c/h2\u003e\u003cp\u003e After obtaining written Informed consent from the parents of the children and adolescents in the study, a questionnaire was completed by the parents in collaboration with the researchers. This questionnaire included demographic information (age, gender, parental education and income, and exposure to cigarette smoke). In addition, data on the use of dietary supplements (zinc and calcium), physical activity, number of baths per week, number of times toothbrushes were brushed per day and week, amount of mouthwash used, daily tea and water consumption, type of water consumed (urban tap water or purified domestic water), and consumption patterns of fluoride-containing food sources (daily, weekly, or monthly) including cauliflower, broccoli, peanuts, spinach, and fish were collected. Finally, participation in the National Varnish Program over the past year was also assessed (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003e2.3. Physical examinations\u003c/h2\u003e\u003cp\u003ePhysical examinations were performed on the subjects, including height, weight, waist circumference, BMI, and BMI z-score calculation, and blood pressure measurement. The subjects' weight was measured using a digital scale while wearing light clothing and without shoes. Height was measured in a standing position with three points of the body (back of the head, buttocks, and heels) touching the wall using a tape measure. Waist circumference was recorded in a natural breathing position and from the deepest part of the waist at the distance between the chest and pelvis using a tape measure. Body mass index (BMI) was also calculated using the formula weight (kg) divided by height (m) squared. BMI z-score was calculated based on age and sex using the WHO Anthro Plus software. Also, the waist circumference z-score was calculated based on the Caspian study reference values (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). Blood pressure was measured in the sitting position and after at least 5 minutes of rest, using a digital sphygmomanometer using a pediatric-appropriate cuff on the right arm (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). In addition, systolic and diastolic blood pressure z-scores were calculated based on the Caspian study reference values (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003e3.3. Blood tests\u003c/h2\u003e\u003cp\u003eAfter fasting for at least 8 hours, approximately 2 mL of fasting blood samples were collected from the subjects. These samples were used to measure the blood lipid profile, including total cholesterol (TC), low-density lipoprotein (LDL), high-density lipoprotein (HDL), and triglyceride (TG), fasting blood sugar (FBS), as well as magnesium and calcium levels. All tests were performed using a Hitachi 704 autoanalyzer (Hitachi, Tokyo, Japan) (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). In addition, z-scores of blood lipid profile indices (TC, LDL, HDL, and TG) and FBS were calculated based on the Caspian study reference values (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003e3.4. Fluoride measurement\u003c/h2\u003e\u003cp\u003eAlso, to measure the amount of fluoride in urine and urine creatinine, at least 25 ml of urine sample will be taken from the study subjects on a fasting basis. The samples were stored in a closed Falcon in a freezer at -20\u0026deg;C until the test was performed. Then, to measure urine fluoride, the urine samples were first removed from the freezer and thawed at room temperature. Fluoride concentration in the samples was measured using a HQ440d multi (Hach, USA) equipped with an Intellical ISEF121 fluoride ion selective electrode. The instrument was calibrated using fluoride standard solutions with concentrations of 0.5, 1.0, and 2.0 mg/L, and the electrode potential (mV) values ​​corresponding to each standard were recorded at a temperature of about 25\u0026deg;C. A calibration curve was prepared based on these data, and the electrode slope was in the range of 73.55 mV/px (equivalent to 124% of the theoretical Nernst response), and the instrument detection limit (LOD) was 0.1651 mg/L. According to the instructions, the limit of quantification (LOQ) was calculated as three times the LOD value. During sample preparation, one pack of Fluoride Ionic Strength Adjustor (ISA) Powder Pillows, 25 mL, Pack of 100 (Hach, USA) was added to 25 mL of each sample to stabilize ionic conditions and reduce possible interferences. Then, the samples were placed on a magnetic stirrer, and the electrode was placed inside them. Fluoride values ​​were read after the signal stabilized. Between each reading, the electrode was washed with deionized water and dried with a lint-free cloth. All preparation, calibration, and measurement steps were performed according to the Hach Company instructions (Method 8323) and in compliance with the USEPA standard. Urine creatinine was measured using the Kinetic Jaffe method. Urinary creatinine concentration was measured in milligrams per deciliter (mg/dL). Then, to determine urinary fluoride in terms of creatinine, creatinine values ​​were first converted to grams per liter (g/L) to standardize units. Next, to reduce the effect of dilute or concentrated urine samples, fluoride concentrations were corrected and measured as milligrams per gram of creatinine (mg/g Cr) according to Eq.\u0026nbsp;1. This method adjusts for the effects of urine volume and daily fluid intake and provides a more accurate indicator of individual fluoride exposure (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\text{F}\\text{l}\\text{u}\\text{o}\\text{r}\\text{i}\\text{d}\\text{e}\\:\\text{c}\\text{o}\\text{n}\\text{c}\\text{e}\\text{n}\\text{t}\\text{r}\\text{a}\\text{t}\\text{i}\\text{o}\\text{n}(mg/g.cr)=\\frac{Urinary\\:fluoride\\:(mg/L)}{Urinary\\:creatinine\\:(g/L)}\\)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)\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\u003eInformation on 56 fluoride sampling points in the drinking water network of Yazd city in 1403 was received from the city health center. Using geographic information system (GIS) software, the closest sampling point to each participant's residence was identified. Then, the fluoride concentration measured at that point during 1403 was considered as an indicator of individual exposure level.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003e3.5. Data analysis\u003c/h2\u003e\u003cp\u003eData analysis was performed using SPSS software (version 27). The analyses were conducted in both descriptive and analytical categories. Descriptive statistics were used to present demographic characteristics. Independent t-test and chi-square test were applied to compare categorical and continuous variables between children and adolescents. To assess the associations of urinary and water fluoride levels with anthropometric indices, blood pressure, and lipid profile, univariate linear regression models were applied by age groups (children, adolescents, and total population). Multivariable linear regression analyses were further performed in two models: Model 1 adjusted for age and sex, and Model 2 adjusted for a broader set of demographics, behavioral, dietary, anthropometric, and metabolic covariates. A p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e\u003c/div\u003e"},{"header":"3. Results","content":"\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e presents the distribution of demographic information of the participants based on age. The results showed that the mean age of the participants was 11.95\u0026thinsp;\u0026plusmn;\u0026thinsp;3.74. The results showed that the largest number of participants were adolescents aged 12 to 18 years (50.9%). Also, most of the participants were girls (77.64%), and the majority of them had no history of exposure to cigarette smoke (77.4%). Most of the participants' parents had non-academic education (70.2% and 59.6%), and this group was mainly adolescents (59.4%), and this difference was statistically significant (p\u0026thinsp;=\u0026thinsp;0.019). The majority of the participants had an average family income (66.5%). Also, most of them had at least 30 minutes of physical activity between 3 and 7 days a week (38.5%), and this group was mainly adolescents (51.7%); this difference was also reported to be significant (p\u0026thinsp;=\u0026thinsp;0.024). The mean urinary fluoride (mg/L) in participants was 0.49\u0026thinsp;\u0026plusmn;\u0026thinsp;0.29, which was reported to be higher in adolescents than in children (0.54\u0026thinsp;\u0026plusmn;\u0026thinsp;0.32), and this difference was statistically significant (p\u0026thinsp;=\u0026thinsp;0.016). The mean urinary fluoride (mg/g.cr) was 0.93\u0026thinsp;\u0026plusmn;\u0026thinsp;1.6.3, and the mean water fluoride (mg/L) was 0.53\u0026thinsp;\u0026plusmn;\u0026thinsp;0.15.\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\u003eDistribution of demographic information participants according to age\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" 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=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eChildren\u003c/p\u003e\u003cp\u003e(6\u0026ndash;11 years)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eAdolescents\u003c/p\u003e\u003cp\u003e(12\u0026ndash;18 years)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003ep-value*\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e\u003cp\u003eN (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGender\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGirls\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e125(77.64)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e57(72.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e68(82.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.101\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBoys\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e36(22.36)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e22(27.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e14(17.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e161(100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e79(49.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e82(50.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSmoker family\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSmokers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e36(22.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e15(19.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e21(25.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.313\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNon-Smokers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e125(77.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e64(81.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e61(74.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFather education\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIlliterate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10(6.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2(2.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e8(9.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.163\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNon-academic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e113(70.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e58(73.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e55(67.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAcademic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e38(23.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e19(24.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e19(23.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMother education\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIlliterate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7(4.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3(3.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4(4.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.019\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNon-academic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e96(59.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e39(49.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e57(69.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAcademic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e58(36.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e37(46.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e21(25.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHousehold income\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLow\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e40(24.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e20(25.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e20(24.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.887\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eModerate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e107(66.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e53(67.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e54(65.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHigh\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14(8.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6(7.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e8(9.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePhysical activity (years/week)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNone\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e38(23.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12(15.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e26(31.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.024\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e60(37.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e29(37.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e31(37.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3\u0026ndash;7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e62(38.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e37(47.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e25(30.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge (year)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11.95\u0026thinsp;\u0026plusmn;\u0026thinsp;3.74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8.69\u0026thinsp;\u0026plusmn;\u0026thinsp;1.76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e15.08\u0026thinsp;\u0026plusmn;\u0026thinsp;2.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUrinary fluoride (mg/L)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.49\u0026thinsp;\u0026plusmn;\u0026thinsp;0.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.43\u0026thinsp;\u0026plusmn;\u0026thinsp;0.24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.54\u0026thinsp;\u0026plusmn;\u0026thinsp;0.32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.016\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUrinary fluoride (mg/g.cr)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.93\u0026thinsp;\u0026plusmn;\u0026thinsp;1.6.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.05\u0026thinsp;\u0026plusmn;\u0026thinsp;2.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.82\u0026thinsp;\u0026plusmn;\u0026thinsp;1.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.371\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWater fluoride (mg/L)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.53\u0026thinsp;\u0026plusmn;\u0026thinsp;0.15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.52\u0026thinsp;\u0026plusmn;\u0026thinsp;0.15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.53\u0026thinsp;\u0026plusmn;\u0026thinsp;0.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.812\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e\u003cp\u003e\u003csup\u003e\u003cem\u003ea\u003c/em\u003e\u003c/sup\u003e \u003cem\u003ePhysical Activity: low\u0026thinsp;=\u0026thinsp;less than 5 minutes, moderate\u0026thinsp;=\u0026thinsp;5 to 30 minutes, high\u0026thinsp;=\u0026thinsp;more than 30 minutes\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e\u003cp\u003e\u003csup\u003e\u003cem\u003ea.\u003c/em\u003e\u003c/sup\u003e \u003cem\u003echi-square test, independent T-test\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003csup\u003e\u003cem\u003eb.\u003c/em\u003e\u003c/sup\u003e \u003cem\u003eChildren\u0026thinsp;=\u0026thinsp;6\u0026ndash;11 years, Adolescent\u0026thinsp;=\u0026thinsp;12\u0026ndash;18 years\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e*\u003c/em\u003e Low: \u0026le;192\u003cspan\u003e$\u003c/span\u003e, Moderate: 192\u0026ndash;384\u003cspan\u003e$\u003c/span\u003e and High: \u0026ge;384\u003cspan\u003e$\u003c/span\u003e\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\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e shows the mean urinary fluoride (mg/L and mg/g.cr) based on health and nutritional factors. The results showed that the majority of participants did not use mouthwash (88.19%), and their mean urinary fluoride (mg/L) was 0.49\u0026thinsp;\u0026plusmn;\u0026thinsp;0.29. The majority of the study population did not use calcium supplements, and their mean oral fluoride (mg/g.cr) was 0.49\u0026thinsp;\u0026plusmn;\u0026thinsp;0.36, and this difference was significant (p\u0026thinsp;=\u0026thinsp;0.004). The results showed that people who consumed Cabbage at least 1 to 2 times a week had a higher mean urinary fluoride (mg/g.cr) of 1.45\u0026thinsp;\u0026plusmn;\u0026thinsp;2.93, and this difference was significant (p\u0026thinsp;=\u0026thinsp;0.046). Also, people who consumed Soy at least 1 to 2 times a week had a higher mean oral fluoride (mg/g.cr) of 1.32\u0026thinsp;\u0026plusmn;\u0026thinsp;2.51, and this difference was significant (p\u0026thinsp;=\u0026thinsp;0.058). Also, regarding fish consumption, the results showed that people who did not consume any fish during the month had a higher mean urinary fluoride (mg/L) than other people, 0.55\u0026thinsp;\u0026plusmn;\u0026thinsp;0.34, and this difference was significant (p\u0026thinsp;=\u0026thinsp;0.021).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eMean urinary fluoride (mg/L and mg/g.cr) based on health and nutritional factors\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"8\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" 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=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003eUrinary fluoride (mg/L)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003eUrinary fluoride (mg/g.cr)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eN\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eToothbrush (day)\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\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.48\u0026thinsp;\u0026plusmn;\u0026thinsp;0.28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e0.884\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.81\u0026thinsp;\u0026plusmn;\u0026thinsp;0.82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e0.172\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.53\u0026thinsp;\u0026plusmn;\u0026thinsp;0.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.55\u0026thinsp;\u0026plusmn;\u0026thinsp;0.26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u0026ndash;3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.50\u0026thinsp;\u0026plusmn;\u0026thinsp;0.31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.41\u0026thinsp;\u0026plusmn;\u0026thinsp;2.95\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNever\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.47\u0026thinsp;\u0026plusmn;\u0026thinsp;0.28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.86\u0026thinsp;\u0026plusmn;\u0026thinsp;1.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMouthwash (month)\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\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNever\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e142\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.49\u0026thinsp;\u0026plusmn;\u0026thinsp;0.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.729\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.99\u0026thinsp;\u0026plusmn;\u0026thinsp;1.72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.004\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u0026ndash;3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.47\u0026thinsp;\u0026plusmn;\u0026thinsp;0.26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.50\u0026thinsp;\u0026plusmn;\u0026thinsp;0.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVarnish\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\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.49\u0026thinsp;\u0026plusmn;\u0026thinsp;0.28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.995\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.90\u0026thinsp;\u0026plusmn;\u0026thinsp;1.16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.852\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\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=\"left\" colname=\"c2\"\u003e\u003cp\u003e89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.49\u0026thinsp;\u0026plusmn;\u0026thinsp;0.30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.95\u0026thinsp;\u0026plusmn;\u0026thinsp;1.93\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWater Type\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\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTap\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e109\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.50\u0026thinsp;\u0026plusmn;\u0026thinsp;0.27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.402\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.01\u0026thinsp;\u0026plusmn;\u0026thinsp;1.92\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.390\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003epurified\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.46\u0026thinsp;\u0026plusmn;\u0026thinsp;0.31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.77\u0026thinsp;\u0026plusmn;\u0026thinsp;0.68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTea (Cup)\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\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNever\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.45\u0026thinsp;\u0026plusmn;\u0026thinsp;0.22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.197\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.80\u0026thinsp;\u0026plusmn;\u0026thinsp;0.73\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.496\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u0026ndash;2 Cup\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.54\u0026thinsp;\u0026plusmn;\u0026thinsp;0.35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.11\u0026thinsp;\u0026plusmn;\u0026thinsp;2.34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;2 Cup\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.49\u0026thinsp;\u0026plusmn;\u0026thinsp;0.25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.77\u0026thinsp;\u0026plusmn;\u0026thinsp;0.69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAmount of drinking water (Cup)\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\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNever\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.58\u0026thinsp;\u0026plusmn;\u0026thinsp;0.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e0.557\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.87\u0026thinsp;\u0026plusmn;\u0026thinsp;0.68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e0.903\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u0026ndash;4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.51\u0026thinsp;\u0026plusmn;\u0026thinsp;0.30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.99\u0026thinsp;\u0026plusmn;\u0026thinsp;1.99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4\u0026ndash;8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.48\u0026thinsp;\u0026plusmn;\u0026thinsp;0.26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.94\u0026thinsp;\u0026plusmn;\u0026thinsp;1.27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;8\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.41\u0026thinsp;\u0026plusmn;\u0026thinsp;0.26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.64\u0026thinsp;\u0026plusmn;\u0026thinsp;0.36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCa Supplement\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\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.39\u0026thinsp;\u0026plusmn;\u0026thinsp;0.31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.139\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.49\u0026thinsp;\u0026plusmn;\u0026thinsp;0.36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.004\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\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=\"left\" colname=\"c2\"\u003e\u003cp\u003e144\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.50\u0026thinsp;\u0026plusmn;\u0026thinsp;0.28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.98\u0026thinsp;\u0026plusmn;\u0026thinsp;1.71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eZn Supplement\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\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.51\u0026thinsp;\u0026plusmn;\u0026thinsp;0.30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.643\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.88\u0026thinsp;\u0026plusmn;\u0026thinsp;1.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.875\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\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=\"left\" colname=\"c2\"\u003e\u003cp\u003e135\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.48\u0026thinsp;\u0026plusmn;\u0026thinsp;0.28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.94\u0026thinsp;\u0026plusmn;\u0026thinsp;1.72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCabbage\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\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNever\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.48\u0026thinsp;\u0026plusmn;\u0026thinsp;0.28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.443\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.73\u0026thinsp;\u0026plusmn;\u0026thinsp;0.59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.046\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u0026ndash;2 (day/week)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.54\u0026thinsp;\u0026plusmn;\u0026thinsp;0.30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.45\u0026thinsp;\u0026plusmn;\u0026thinsp;2.93\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003emonths\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.46\u0026thinsp;\u0026plusmn;\u0026thinsp;0.28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.75\u0026thinsp;\u0026plusmn;\u0026thinsp;0.73\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSoy\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\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNever\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.51\u0026thinsp;\u0026plusmn;\u0026thinsp;0.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.142\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.75\u0026thinsp;\u0026plusmn;\u0026thinsp;0.68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.058\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u0026ndash;2 (day/week)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.52\u0026thinsp;\u0026plusmn;\u0026thinsp;0.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.32\u0026thinsp;\u0026plusmn;\u0026thinsp;2.51\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003emonths\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.41\u0026thinsp;\u0026plusmn;\u0026thinsp;2.51\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.62\u0026thinsp;\u0026plusmn;\u0026thinsp;0.46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBroccoli\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\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNever\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e128\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.50\u0026thinsp;\u0026plusmn;\u0026thinsp;0.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.453\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.02\u0026thinsp;\u0026plusmn;\u0026thinsp;1.79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.411\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1-(day/week)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.42\u0026thinsp;\u0026plusmn;\u0026thinsp;0.23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.46\u0026thinsp;\u0026plusmn;\u0026thinsp;0.46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003emonthly\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.44\u0026thinsp;\u0026plusmn;\u0026thinsp;0.26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.58\u0026thinsp;\u0026plusmn;\u0026thinsp;0.58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePeanut\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\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNever\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.51\u0026thinsp;\u0026plusmn;\u0026thinsp;0.32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.298\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.89\u0026thinsp;\u0026plusmn;\u0026thinsp;1.17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.461\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u0026ndash;2 (day/week)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.53\u0026thinsp;\u0026plusmn;\u0026thinsp;0.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.20\u0026thinsp;\u0026plusmn;\u0026thinsp;2.87\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003emonthly\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.44\u0026thinsp;\u0026plusmn;\u0026thinsp;0.20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.78\u0026thinsp;\u0026plusmn;\u0026thinsp;0.64\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSpinach\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\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNever\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.49\u0026thinsp;\u0026plusmn;\u0026thinsp;0.31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.327\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.81\u0026thinsp;\u0026plusmn;\u0026thinsp;0.84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.481\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u0026ndash;2 (day/week)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.57\u0026thinsp;\u0026plusmn;\u0026thinsp;0.30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.16\u0026thinsp;\u0026plusmn;\u0026thinsp;1.84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003emonthly\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.45\u0026thinsp;\u0026plusmn;\u0026thinsp;0.22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.12\u0026thinsp;\u0026plusmn;\u0026thinsp;2.64\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFish\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\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNever\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.55\u0026thinsp;\u0026plusmn;\u0026thinsp;0.34\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.35\u0026thinsp;\u0026plusmn;\u0026thinsp;1.35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u0026ndash;2 (day/week)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.54\u0026thinsp;\u0026plusmn;\u0026thinsp;0.28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.021\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.27\u0026thinsp;\u0026plusmn;\u0026thinsp;2.74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.138\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003emonthly\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.42\u0026thinsp;\u0026plusmn;\u0026thinsp;0.24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.66\u0026thinsp;\u0026plusmn;\u0026thinsp;0.66\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e shows the association of urinary fluoride mg/L and mg/g.cr and water fluoride mg/L with cardiovascular risk factors based on age. The results showed that the mean water fluoride mg/L was significantly associated with a decrease in BMI in the general population and especially in adolescents (β=-7.16, P\u0026thinsp;=\u0026thinsp;0.006). Also, BMI z-score in children showed a significant decrease with water fluoride mg/L (β=-3.10, P\u0026thinsp;=\u0026thinsp;0.006) and in adolescents, urinary fluoride mg/L showed a significant decrease (β=-1.01, P\u0026thinsp;=\u0026thinsp;0.04). Urinary fluoride in mg/g.cr was significantly associated with a decrease in waist circumference in the general population (β=-2.50, P\u0026thinsp;=\u0026thinsp;0.038). Urinary fluoride mg/L in children was associated with a significant decrease in SBP z-score (β=-1.52, P\u0026thinsp;=\u0026thinsp;0.032). Also, water fluoride mg/L was significantly associated with increased SBP z-score in the total population (β\u0026thinsp;=\u0026thinsp;1.57, P\u0026thinsp;=\u0026thinsp;0.032). Water fluoride mg/L was significantly associated with increased DBP z-score in the total population (β\u0026thinsp;=\u0026thinsp;1.20, P\u0026thinsp;=\u0026thinsp;0.044) and in adolescents (β\u0026thinsp;=\u0026thinsp;1.78, P\u0026thinsp;=\u0026thinsp;0.044). Urinary fluoride in mg/g.cr was significantly associated with decreased TC in the total population and adolescents (β=-3.34, P\u0026thinsp;=\u0026thinsp;0.018 and β=-5.96, P\u0026thinsp;=\u0026thinsp;0.049), also urinary fluoride mg/L was significantly associated with decreased TC z-score in adolescents (β=-2.07, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Urinary fluoride mg/g.cr was significantly associated with decreased HDL in the total population (β=-1.98, P\u0026thinsp;=\u0026thinsp;0.045). Urinary fluoride mg/g.cr was significantly associated with TG reduction in the total population (β=-8.14, P\u0026thinsp;=\u0026thinsp;0.048).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eRelationship between Urinary and Water Fluoride Levels and Cardiovascular Risk Factors by Age Group\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"12\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" 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=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003eUrinary fluoride (mg/L)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e\u003cp\u003eUrinary fluoride (mg/g.cr)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c12\" namest=\"c10\"\u003e\u003cp\u003eWater fluoride (mg/L)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eChildren\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAdolescents\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eChildren\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eAdolescents\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c10\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c11\"\u003e\u003cp\u003eChildren\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c12\"\u003e\u003cp\u003eAdolescents\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003eβ(SE)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e\u003cp\u003eβ(SE)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c12\" namest=\"c9\"\u003e\u003cp\u003eβ(SE)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBMI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-1.24(1.39)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-0.33(1.75)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-3.52(1.93)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-0.24(0.24)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.02(0.20)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-0.87(0.58)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e-3.51(2.63)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e-7.16(2.58)*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e-0.02(4.25)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBMI z-score\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.59(0.42)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.17(0.77)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-1.01(0.49)*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.004(0.07)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.07(0.09)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-0.24(0.14)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e-1.47(0.79)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e-3.10(1.13)*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e0.26(1.09)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWC (cm)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-2.13(3.27)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-2.32(4.89)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-6.54(4.07)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-0.87(0.58)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-0.18(0.58)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-2.50(1.20)*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e-4.48(6.20)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e-1.62(7.55)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e-8.61(8.84)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWC z-score (cm)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.43(0.39)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-0.65(0.57)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-0.39(0.57)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-0.04(0.07)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.01(0.06)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-0.25(0.16)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e-0.59(0.75)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0.51(0.88)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e-1.79(1.22)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSBP (mmHg)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.70(2.99)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-1.92(4.42)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.31(4.22)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.15(0.53)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.43(0.52)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-0.91(1.26)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e-5.07(5.66)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e-3.95(6.81)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e-6.18(9.07)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSBP z-score (mmHg)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.26(0.39)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-1.52(0.71)*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.35(0.44)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-0.04(0.06)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.07(0.08)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.06(0.13)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e1.57(0.73)*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e1.40(1.11)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e1.74(0.94)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDBP (mmHg)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.34(2.85)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-6.45(4.71)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.32(3.66)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-0.24(0.50)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.07(0.56)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-1.45(1.09)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e5.49(5.38)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e4.18(7.33)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e6.98(7.88)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDBP z-score (mmHg)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.29(0.33)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.78(0.56)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-0.16(0.42)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-0.04(0.06)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-0.02(0.06)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-0.07(0.12)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e1.20(0.63)*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0.62(0.88)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e1.78(0.88)*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFBS (mg/100 mL)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-9.81(9.19)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-11.82(21.29)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-5.32(4.95)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.45(1.64)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.85(2.52)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-1.65(1.48)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e3.76(17.47)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e2.62(32.84)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e5.95(10.70)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFBS z-score (mg/100 mL)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.13(0.89)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-0.01(0.67)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-0.13(1.49)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-0.02(0.15)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.07(0.07)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-0.29(0.44)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.39(1.68)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0.61(1.03)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e0.08(3.21)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTC (mg/100 mL)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-6.17(8.03)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.35(13.44)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-9.92(10.29)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-3.34(1.40)*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-2.73(1.56)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-5.96(3.02)*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e3.80(15.23)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e-9.52(20.69)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e18.62(22.18)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTC z-score (mg/100 mL)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-1.16(0.64)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.05(1.29)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-2.07(0.59)*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-0.09(0.11)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.08(0.15)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-0.17(0.19)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.02(1.23)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e-1.40(1.99)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e1.65(1.36)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHDL (mg/100 mL)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-2.54(5.62)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-9.47(8.62)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-0.76(7.70)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-1.98(0.99)*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-1.46(1.01)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-3.52(2.27)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e6.42(10.65)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e20.19(13.18)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e-8.74(16.54)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHDL z-score (mg/100 mL)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.58(0.59)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.84(1.07)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.36(0.71)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.03(0.10)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.11(0.12)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-0.24(0.21)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e-0.26(1.13)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0.23(1.65)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e-0.81(1.53)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLDL (mg/100 mL)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-1.97(5.34)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9.64(8.37)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-5.76(7.10)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-1.21(0.94)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-1.29(0.98)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-1.48(2.12)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e-4.98(10.11)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e-19.54(12.81)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e11.23(15.28)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLDL z-score (mg/100 mL)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.07(0.25)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.42(0.45)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-0.20(0.30)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-0.03(0.04)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-0.05(0.05)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.004(0.09)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e-0.45(0.48)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e-0.47(0.70)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e-0.40(0.65)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTG (mg/100 mL)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-1.94(11.54)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e22.21(20.36)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-14.76(13.96)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-2.30(2.04)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-0.68(2.42)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-8.14(4.11)*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e12.91(21.84)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e-2.63(31.58)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e29.65(30.08)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTG z-score (mg/100 mL)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.09(0.29)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-0.11(0.58)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.11(0.29)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-0.02(0.05)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-0.04(0.06)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.01(0.08)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e-0.26(0.56)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e-0.75(0.90)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e0.29(0.62)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"12\" nameend=\"c12\" namest=\"c1\"\u003e\u003cp\u003e\u003cem\u003e* p-value is significant at the 0.05 level\u003c/em\u003e\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\u003eTable\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e presents the results of a multivariate regression analysis to examine the effect of cardiovascular risk factors on urinary and water fluoride levels. Model 1 was adjusted for age and sex only, while Model 2 was adjusted for a broad set of demographic, nutritional, and behavioral variables, including smoking, calcium and zinc supplement use, fluoride varnish, type and amount of tea consumption, weekly physical activity, frequency of bathing, oral hygiene (toothbrush and mouthwash), amount and type of water consumption, consumption of fluoride-containing foods (cabbage, broccoli, soybeans, peanuts, spinach, and fish), calcium and magnesium levels, anthropometric indices (BMI, Z-BMI, waist circumference), systolic and diastolic blood pressure, fasting blood glucose, and lipid profile (TC, HDL, LDL, and TG). The findings showed that in model 2, an increase in waist circumference was associated with a significant decrease in urinary fluoride concentration (mg/L) (β=-5.66; p\u0026thinsp;=\u0026thinsp;0.004), and an increase in diastolic blood pressure was associated with a significant decrease in urinary fluoride in mg/g.cr (β=-2.06; p\u0026thinsp;=\u0026thinsp;0.002). In addition, in model 1, an increase in total cholesterol was associated with a decrease in urinary fluoride in mg/g.cr (β=-3.45; p\u0026thinsp;=\u0026thinsp;0.014), while in model 2, an increase in TC was associated with a significant increase in water fluoride (β\u0026thinsp;=\u0026thinsp;31.12; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The results of model 2 also showed that both an increase in HDL and LDL were associated with a significant decrease in water fluoride (β=-18.64; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001 and β=-20.86; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, respectively). On the other hand, an increase in triglycerides in model 2 was associated with a significant increase in urinary fluoride (mg/L) (β\u0026thinsp;=\u0026thinsp;1.15; p\u0026thinsp;=\u0026thinsp;0.010).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eMultivariable Regression Analysis of the Effect of Cardiovascular Risk Factors on Urinary and Water Fluoride Levels\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"9\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" 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=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eUrinary fluoride (mg/L)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003eUrinary fluoride (mg/g.cr)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e\u003cp\u003eWater fluoride (mg/L)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eβ(95%CI)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eβ(95%CI)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eβ(95%CI)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBMI\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\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eModel 1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-2.36(-4.88, 0.16)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.067\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-0.134(-0.58, 0.31)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.561\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-3.02(-7.78, 1.73)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.212\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eModel 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-1.59(-3.38, 0.19)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.081\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-0.23(-0.61, 0.15)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.235\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e2.73(-1.64, 7.11)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.221\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBMI z-score\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\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eModel 1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.59(-1.42, 0.24)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.167\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-0.005(-0.15, 0.14)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.946\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-1.50(-3.06, 0.04)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.058\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eModel 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.32(-0.18, 0.84)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.213\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.07(-0.03, 0.18)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.169\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-0.71(-1.96, 0.53)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.261\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWC (cm)\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\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eModel 1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-5.11(-10.66, 0.44)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.071\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-0.63(-1.62, 0.36)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.212\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-3.29(-13.78, 7.19)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.538\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eModel 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-5.66(-9.47, -1.85)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.004\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-0.82(-1.66, 0.02)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.056\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-0.94(-10.88, 8.99)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.853\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSBP (mmHg)\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\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eModel 1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.32(-6.26, 5.61)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.915\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.10(-0.94, 1.15)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.846\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-5.28(-16.37, 5.79)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.350\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eModel 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.22(-6.64, 9.09)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.760\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-0.22(0.85, -1.89)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.788\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-8.62(-27.46, 10.20)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.369\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDBP (mmHg)\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\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eModel 1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.04(-5.59, 5.69)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.986\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-0.28(-1.28, 0.71)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.577\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e5.35(-5.17, 15.87)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.319\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eModel 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.78(-7.38, 5.81)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.815\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-2.06(-3.33, -0.78)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.002\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-12.08(-27.65, 3.48)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.128\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFBS (mg/100 mL)\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\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eModel 1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-8.95(-27.05, 9.15)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.332\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.19(-3.02, 3.41)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.906\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e2.85(-31.12, 36.83)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.869\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eModel 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.07(-5.64, 11.79)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.490\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.38(-0.42, 3.20)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.134\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e12.78(-8.03, 33.60)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.229\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTC (mg/100 mL)\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\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eModel 1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-5.35(-21.25, 10.53)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.509\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-3.45(-6.23, -0.68)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.014\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e3.47(-26.31, 33.26)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.819\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eModel 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.77(-6.27, 7.82)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.830\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-1.02(-2.49, 0.44)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.171\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e31.12(16.62, 45.62)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHDL (mg/100 mL)\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\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eModel 1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-4.07(-15.05, 6.90)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.467\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-1.92(-3.84, 0.006)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.051\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e6.95(-13.60, 27.50)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.508\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eModel 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.09(-2.81, 6.99)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.403\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.54(-0.49, 1.57)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.304\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-18.64(-29.33, -7.95)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLDL (mg/100 mL)\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\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eModel 1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.80(-11.26, 9.65)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.880\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-1.31(-3.15, 0.53)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.164\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-5.40(-24.97, 14.15)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.588\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eModel 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.89(-3.75, 5.55)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.705\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.64(-0.32, 1.61)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.191\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-20.86(-30.39, -11.33)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTG (mg/100 mL)\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\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eModel 1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-2.59(-25.50, 20.30)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.824\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-2.30(-6.35, 1.74)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.264\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e13.14(-29.68, 55.97)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.548\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eModel 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.15(0.27, 2.02)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.010\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-0.71(-5.43, 4.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.766\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e4.12(-49.54, 57.79)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.880\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"9\" nameend=\"c9\" namest=\"c1\"\u003e\u003cp\u003e\u003csup\u003e\u003cem\u003ea.\u003c/em\u003e\u003c/sup\u003e \u003cem\u003eModel 1: adjusted by age, gender\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003csup\u003e\u003cem\u003eb.\u003c/em\u003e\u003c/sup\u003e \u003cem\u003eModel 2: adjusted by Sex, Age, Smoking, Calcium supplement, Zinc supplement, Fluoride varnish, Type of tea, Physical activity-week, Bathing, Toothbrush, Mouthwash, tea consumed, Amount of drinking water, Type of water used, Cabbage, Broccoli, Soybean, Peanut, Spinach, Fish, Ca, Mg, BMI, Z_BMI, WC, SBP, DBP, FBS, TC, HDL, LDL, TG\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e* p-value is significant at the 0.05 level\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eThe present study investigated the association of urinary and drinking water fluoride with cardiovascular risk factors in children and adolescents. To date, limited studies have examined the association of fluoride with blood pressure. The results of this study showed that urinary fluoride was inversely associated with SBP z-score, while drinking water fluoride was positively associated with SBP z-score and DBP z-score. Furthermore, after adjusting for a wide range of confounding factors, including demographic characteristics, lifestyle, dietary patterns, supplement use, and anthropometric and metabolic indices (Model 2), the direction of the association of urinary fluoride with DBP changed and appeared inverse. These findings indicate that moderating factors can significantly affect the magnitude and direction of the relationships between fluoride exposure and blood pressure. Therefore, in analyzing the association of fluoride with cardiovascular risk factors, it is of particular importance to consider background and confounding variables. In contrast to the present study, Yun Liu et al. observed a positive association with SBP z-score and DBP z-score (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Consistent with the present study, the results of the study by Koh et al. also showed an inverse association between fluoride in drinking water and systolic blood pressure while adjusting for the effects of age, gender, race, and income among the study population (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). The results of the study by Guo et al. also observed an inverse association between fluoride in drinking water and plasma fluoride with systolic blood pressure in the population of children and adolescents (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). Also, in the study by Sun L et al., an inverse association was observed between fluoride in water and SBP in the population of children and adolescents, and in this study, they did not observe any association between plasma fluoride and SBP (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e). However, the studies by Yousefi et al. showed a positive association of fluoride concentration in water with blood pressure, which is consistent with the results of fluoride in water (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). Based on evidence from experimental animal studies, exposure to high concentrations of fluoride can lead to significant changes in the composition of the liver lipid membrane and disruption of thyroid hormone levels in animal models such as mice. Furthermore, data show that fluoride can exacerbate inflammatory cytokine responses in rabbit aorta, while simultaneously increasing lipid peroxidation and cardiotoxicity (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe results of the present study showed an inverse relationship between urinary fluoride and water fluoride with BMI Z-score in the studied individuals. The results also showed an inverse relationship between fluoride mg/g.cr with WC. Studies conducted on adults have not observed any relationship between the amount of fluoride consumed in water and anthropometric parameters (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e). In contrast to the results of the present study, the results of the study by Liu et al., which examined the blood fluoride level of Mexican children aged 7 to 13 years in areas with different levels of water fluoride, showed a significant positive relationship between urinary fluoride and BMI Z-score. They also showed that the level of the father's education and gender can affect this relationship after adjusting for confounding factors (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). The results of the study by Yun Liu et al., which examined the blood fluoride level in Mexican children and adolescents aged 10 to 18 years, showed a significant positive relationship with anthropometric indices in girls (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). The results of the study by Tingting Hao et al. also showed a positive relationship between urinary fluoride and blood fluoride with BMI and WC in children and adolescents (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e). The conflicting findings in different studies may be due to differences in gender, age, and race distributions. In addition, these discrepancies could be due to differences in fluoride exposure levels, population sensitivity and vulnerabilities, as well as long-term cumulative effects of fluoride (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e). The exact mechanism by which fluoride affects overweight and obesity is not yet fully understood; however, evidence from rodent studies suggests that fluoride can lead to increased serum lipid concentrations by disrupting lipid metabolism and lipogenesis. In addition, fluoride's effects on liver function and endocrine glands, including the thyroid and parathyroid, may play an important role in causing metabolic changes and ultimately the occurrence of overweight (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe results of the present study showed that urinary fluoride was inversely associated with TC and HDL, and directly associated with TG. These results indicate the disruptive role of fluoride on lipid metabolism. Also, in the present study, the results showed that after adjusting for a wide range of confounding variables (including demographic factors, lifestyle, diet, supplements, and anthropometric and metabolic indices) in Model 2, the magnitude and direction of some associations changed; such that the association of urinary fluoride with TG became more positive and the association of water fluoride with TC also became positive. This indicates that the presence of modulating factors can affect the interpretation of the association between fluoride exposure and cardiovascular risk factors, and special attention should be paid to these variables in the analyses. Previous studies have also reported largely similar results. In a study of 20\u0026ndash;60-year-old patients with endemic fluorosis in Punjab, India, exposure to drinking water containing high fluoride (5.9\u0026ndash;24.5 mg/L) was associated with decreased TC and HDL and increased TG, which is consistent with the findings of the present study (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e). Also, in an animal model, long-term exposure to fluoride in rabbits increased TC and LDL-C and exacerbated hypercholesterolemia along with increased oxidative stress indices (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e). These results also confirm the negative effect of fluoride on lipid metabolism. On the other hand, a study by Dionizio et al. on rats showed that the effect of fluoride depends on the duration of exposure and the type of diet, such that short-term consumption under normal diet conditions can have protective effects, but long-term exposure or in the presence of NAFLD disrupts the lipid profile (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e). However, not all studies have observed a negative effect; For example, Yun Liu's study in children and adolescents reported no association between blood lipid profiles and plasma fluoride (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Overall, a review of the available evidence suggests that although in some short-term settings and in certain age groups, no significant effect may be observed, chronic and long-term exposure to fluoride is often associated with impaired lipid metabolism and increased cardiovascular risk factors. The findings of the present study showed that urinary fluoride was associated with decreased total cholesterol (TC) and high-density lipoprotein (HDL) levels and increased triglyceride (TG) levels in the blood. These results are consistent with the known mechanisms of fluoride's effects on lipid metabolism. Fluoride can reduce cholesterol production by inhibiting key enzymes in cholesterol synthesis, such as HMG-CoA reductase (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e). Fluoride can also lead to lipid degradation and decreased HDL levels by increasing oxidative stress and free radical production (\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e). On the other hand, increased TG levels may be due to stimulation of lipogenesis (new fat synthesis) or decreased fatty acid oxidation (\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe results of the present study showed that short-term consumption of some vegetables, such as cabbage and soybeans, was associated with increased urinary fluoride levels in mg/g.cr. Regarding fish consumption, contrary to expectations and existing evidence that fish is a source of fluoride, in the present study, individuals without fish consumption had higher urinary fluoride levels. This result may be due to differences in the amount of fluoride in the fish consumed, preparation and cooking methods, or the interaction of other dietary and environmental sources. Therefore, although dietary sources containing fluoride can affect the total body fluoride burden, the contradictory results for fish indicate that a more detailed examination of the type, amount, and pattern of its consumption is necessary in future studies. The results of this study also showed that participants who did not use calcium supplements had higher urinary fluoride levels. These findings suggest that calcium consumption may reduce the level of fluoride excreted in the urine by reducing the absorption or accumulation of fluoride in the body. Estimating total fluoride intake in the population is challenging due to exposure to multiple dietary and non-dietary sources of fluoride, as well as the difficulty of measuring unintentional toothpaste ingestion by young children (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). Fluoride biomarkers, such as urine, directly correlate with fluoride exposure from various sources such as water, fluoride supplements, and foods (\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e). Many factors can alter fluoride metabolism and thus alter the relationship between fluoride intake and excretion, including age (skeletal growth), dose and form of fluoride, as well as acid-base disturbances (e.g., altitude), renal impairment, physical activity, nutritional status, dietary composition and genetics, and implementation of fluoride interventions, cultural and geographic variations. The combination of all these potential fluoride carriers, with the complex availability of fluoride, can affect fluoride excretion (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe present study had several important strengths. First, the target population included children and adolescents, who are considered a vulnerable group in terms of sensitivity to fluoride exposure. In addition, in this study, water fluoride and urinary fluoride were simultaneously measured as valid biomarkers, and related dietary consumption patterns were also considered. The use of biological measurements increased the validity of the results, and controlling for a wide range of confounding factors, including demographic variables, lifestyle, diet, supplement use, and anthropometric and metabolic indices, improved the accuracy of the analyses. In addition, the study results were compared with evidence from numerous domestic and international studies, which enriched the discussion and added to the scientific validity of the findings. However, the present study also had limitations. Its cross-sectional design prevented inferences of cause-and-effect relationships. Also, dietary fluoride intake was estimated indirectly through a questionnaire, which increases the possibility of recall or reporting errors. For some food sources, such as fish, unexpected results may have been due to heterogeneity in the type of fish consumed and differences in cooking and preparation methods. In addition, fluoride intake through unintentional ingestion of toothpaste and other environmental sources was not accurately measured. On the other hand, changes in fluoride levels and their effects over time were not assessed due to the lack of longitudinal follow-up. Finally, specific characteristics of the study population may limit the generalizability of the results to other age groups or regions.\u003c/p\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eThe present study showed that urinary fluoride and water fluoride levels were associated with some cardiovascular risk factors in children and adolescents. Specifically, water fluoride was more associated with decreased BMI and increased blood pressure (DBP and SBP), and urinary fluoride was associated with positive changes in waist circumference, cholesterol, and triglycerides. These results may indicate that fluoride has a different effect on cardiovascular risk factors depending on the source of exposure and age group. After adjusting for confounders, the direction and magnitude of some relationships changed: the association of urinary fluoride with DBP was reversed, the association of urinary fluoride with TG was stronger, and the association of water fluoride with TC was positive. These changes indicate that moderating factors can have a significant impact on the magnitude and direction of the relationships between fluoride exposure and cardiovascular risk factors. In addition, the findings showed that short-term consumption of vegetables such as cabbage and soybeans was associated with increased urinary fluoride levels. However, contrary to expectations and previous evidence regarding the role of fish as a source of fluoride, in the present study, non-consumption of fish was associated with higher urinary fluoride levels. The results also showed that non-consumption of calcium supplements was associated with increased urinary fluoride levels. These results emphasize the role of dietary sources and supplements in the body's fluoride load and its excretion through urine. Overall, the present study shows that the effects of fluoride on cardiovascular health and lipid metabolism are multifaceted and influenced by environmental and nutritional factors. Given the cross-sectional nature of this study, longitudinal studies are necessary to confirm these findings and determine the causal relationship between fluoride exposure and cardiovascular risk factors.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003ch2\u003eEthical approval\u003c/h2\u003e\u003cp\u003e The present study has the code of ethics IR.SSU.SPH.REC.1402.170 of Shahid Sadoughi University of Medical Sciences, Yazd.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConsent to participate\u003c/strong\u003e\u003cp\u003eThe study was approved by the Ethics Committee of Shahid Sadoughi University of Medical Sciences, Yazd, Iran (approval code: IR.SSU.SPH.REC.1402.170). All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. All methods were carried out in accordance with relevant guidelines and regulations.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003ch2\u003eCompeting interests\u003c/h2\u003e\u003cp\u003eThe authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e\u003cp\u003eThis study was funded by Shahid Sadoughi University of Medical Sciences, Yazd, Iran, and the National Institute for Medical Research Development (NIMAD), Iran.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAll authors contributed to the study's conception and design. Material preparation, data collection, and analysis were performed by **H.N., A.D, M.H., S.M.N., H.F., and M.H.E.** The first draft of the manuscript was written by **H.N.,** and all authors commented on the previous versions of the manuscript. All authors read and approved the final manuscript. Conceptualization was performed by **H.N., A.D, M.H., S.M.N., H.F., M.H.E.** ; Methodology by **A.D, H.N., M.H., S.M.N., M.H.E.** ; Formal analysis and investigation by **H.N., H.F.** ; Writing-original draft preparation by **H.N.** Writing-review and editing by **A.D, M.H., S.M.N., H.F., M.H.E.**\u003c/p\u003e\u003ch2\u003eAcknowledgements\u003c/h2\u003e\u003cp\u003eThe authors would like to gratefully acknowledge the research deputy of Shahid Sadoughi University of Medical Sciences, Yazd, and the National Institute for Medical Sciences Research Development (NIMAD).\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe supporting data are available from the corresponding authors upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eHamidi, A. et al. 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Associations between Dietary Patterns, Fluoride Intake and Excretion in Women Exposed to Fluoridated Salt: A Preliminary Study. \u003cem\u003eNutrients\u003c/em\u003e \u003cb\u003e16\u003c/b\u003e (19), 3404 (2024).\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":false,"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":"Children, Adolescents, Urinary fluoride, Water fluoride, Cardiovascular, Obesity","lastPublishedDoi":"10.21203/rs.3.rs-7724665/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7724665/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eAlthough the prevalence of cardiovascular diseases is low during childhood and adolescence, behavioral and biological risk factors and lifestyle associated with noncommunicable diseases are formed during this period and persist into adulthood. The present study aimed to investigate urinary fluoride levels and their relationship with risk factors for cardiovascular diseases in children and adolescents in Yazd city in 2024.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eThis cross-sectional study was conducted on 161 children and adolescents aged 6 to 18 years in Yazd city. Water fluoride was measured at 56 points of the drinking water network. Demographic information, physical activity, and fluoride exposure factors were collected through a questionnaire. Physical examinations included measurements of height, weight, body mass index (BMI), waist circumference, and systolic blood pressure (SBP) and diastolic blood pressure (DBP). Blood samples were taken from participants to measure lipid profiles (TC, HDL, LDL, and TG), fasting blood sugar (FBS), magnesium, and calcium, and urine samples were taken to measure fluoride and creatinine. Urinary fluoride was measured using an ion-selective electrode.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThe mean age of the participants was 11.95\u0026thinsp;\u0026plusmn;\u0026thinsp;3.74 years, and the largest age group was adolescents aged 12 to 18 years (50.9%). The mean urinary fluoride (mg/L) was reported to be 0.49\u0026thinsp;\u0026plusmn;\u0026thinsp;0.29. Lack of calcium supplementation was significantly associated with higher urinary fluoride (mg/g cr) levels (p\u0026thinsp;=\u0026thinsp;0.004). Water fluoride was associated with a decrease in BMI in the total participants, especially in adolescents, and an increase in SBP and DBP z-score in the total participants. Urinary fluoride was significantly associated with a decrease in BMI and SBP z-score in children, a decrease in BMI and waist circumference in the general population, and a decrease in TC, HDL, and TG in the general population and adolescents. These results showed changes after adjustment for demographic, behavioral, nutritional, and metabolic factors, which indicates the importance of considering moderating variables in examining the effect of fluoride exposure.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eThe study findings showed that water and urine fluoride levels are associated with some anthropometric indices and cardiovascular risk factors in children and adolescents. Longitudinal studies are necessary to confirm these findings and determine the causal relationship between fluoride exposure and cardiovascular risk factors.\u003c/p\u003e","manuscriptTitle":"Relationship between urinary and water fluoride with cardiovascular risk factors in children and adolescents in Yazd city","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-04 18:55:51","doi":"10.21203/rs.3.rs-7724665/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"2746496143455388762672852802909544557","date":"2025-10-23T16:08:56+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-10-23T15:49:32+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-10-16T06:47:22+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-10-14T06:32:24+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-10-13T03:37:25+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2025-10-06T12:06:31+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":"b78b5d33-5e0e-4e7d-ba39-7f10b6e6849b","owner":[],"postedDate":"November 4th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[{"id":57295614,"name":"Health sciences/Diseases"},{"id":57295615,"name":"Health sciences/Health care"},{"id":57295616,"name":"Health sciences/Medical research"},{"id":57295617,"name":"Health sciences/Risk factors"}],"tags":[],"updatedAt":"2025-11-04T18:55:51+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-04 18:55:51","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7724665","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7724665","identity":"rs-7724665","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}