A case-control study on the relationship between Periodontitis and adherence to the Mediterranean dietary pattern, salivary IL-6 and oral impacts on daily performances

A case-control study on the relationship between Periodontitis and adherence to the Mediterranean dietary pattern, salivary IL-6 and oral impacts on daily performances | 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 Research Article A case-control study on the relationship between Periodontitis and adherence to the Mediterranean dietary pattern, salivary IL-6 and oral impacts on daily performances Zahra Goharfar, Faezeh Ghalichi, Nesa Rasouli, Kosar Rostamlou, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8906374/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Periodontitis, is defined as a chronic multifactorial inflammatory disease and the most advanced form of periodontal diseases. The aim of the present study was to assess the relationship between adherence to the Mediterranean diet (MD), oral impacts on daily performances (OIDP), level of salivary interleukin (IL)-6, dietary intake, anthropometric indices and periodontitis. Methods: A total of 120 individuals were included in the case-control study (n=60). Dietary intake was assessed via a validated food frequency questionnaire (FFQ). Furthermore, MD adherence was evaluated by the Mediterranean Diet Adherence Screener (MEDAS). A full periodontal examination was administered for examining clinical manifestations of periodontitis. Participant’s weight and height were measured and the body mass index was calculated. Crude and adjusted odds ratios (ORs) [95% confidence interval] were calculated to evaluate the association between MD adherence, and periodontitis, OIDP and salivary IL-6. Results: Findings indicated that adherence to the MD was significantly lower 1.34 [1.08 to 1.66, p=0.008] among periodontitis individuals. Significant association between vitamin D 0.44 [0.30 to 0.66, p<0.001], fiber 1.02 [1.00 to 1.03, p=0.004], folate 1.00 [1.00 to 1.00, p=0.017], legumes 1.01 [1.00 to 1.02, p=0.001], dairy intake 0.99 [0.99 to 0.99, p=0.027], and OIDP 0.74 [0.63 to 0.85, p<0.001] and periodontitis. Conclusions: The lower adherence to the Mediterranean Diet among periodontitis cases, compared to healthy cases alongside declined OIDP, enhances the important of antioxidants in the prevention and treatment of periodontitis and subsequent adverse effects. Periodontitis Mediterranean diet Oral health inflammation antioxidant Figures Figure 1 1. Introduction Periodontitis as a significant global health concern, is amongst the top chronic non-communicable diseases, which obstructs quality of life and overall health status ( 1 ). According to estimates, it effects 10.8% of the adult population worldwide, approximately 743 million people ( 2 ). Periodontitis, is defined as a chronic multifactorial immune-inflammatory disease affecting the supportive structures of a tooth and the polymicrobial plaque biofilm adjacent as the main etiology ( 3 ). Inflammation is the results of the interaction of oral microorganisms and periodontal tissues causing progressive destruction of the tooth-supportive tissues, resulting in tooth loss and loss of function in the oral cavity ( 4 ). The composition of the oral microbiome is affected by genetics and behavioral and environmental risk factors such as diet composition, lifestyle habits, oral hygiene approaches, medications, hormones, dental prosthesis and presence of chronic systemic inflammatory disorders ( 5 ) such as diabetes mellitus ( 6 ), cardiovascular disorders ( 7 ), obesity ( 8 ), metabolic syndrome ( 9 ), respiratory disease ( 10 ), cancer ( 11 ), chronic kidney disease ( 12 ), and rheumatoid arthritis ( 13 ). Healthy dietary pattern is among the most modifiable environmental risk factors mentioned for the risk of inflammation and periodontal diseases ( 14 ). Thus, an immune-inflammatory modulatory diet may be efficient in periodontal management. Dietary antioxidants including omega 3 fatty acids and vitamins C and D have been mentioned efficient in declining periodontal inflammatory parameters ( 15 ). Also, diets rich in fiber and reduced amounts of saturated fats are efficient in improving markers of periodontitis in high-risk subjects ( 16 ). Although the beneficial features of dietary antioxidant nutrients are persistently reported, adherence to an anti-inflammatory diet, such as the Mediterranean diet (MD), which generally involves eating plant-based foods, such as fruits and vegetables, whole grains, fish, olive oil, lean protein, low fat dairy is a beneficial approach for declining systemic inflammation and maintaining periodontal health ( 17 ). The high fiber content of the MD, is efficient in declining systemic and local inflammation in periodontal tissues and the abundant amount of dietary antioxidants is beneficial for declining oxidative stress ( 18 ). Periodontitis or tissue destruction is irreversible; thus, proper care and treatment prior to this stage is an invasive approach for declining overall inflammation and related adverse effects. Modulating the diet composition and adding beneficial antioxidant nutrients is an efficient procedure for preventing and treating periodontitis. Therefore, the aim of the present case-control study was to assess the relationship between adherence to the MD, oral impacts on daily performances (OIDP), level of saliva interleukin (IL) 6, dietary intake, anthropometric indices and periodontitis. 2. Materials and Methods 2. 1. Study design The current study is informed according to the Strengthening the Reporting of Observational studies in Epidemiology (STROBE) guidelines for case-control studies ( 19 ). The research protocol was confirmed by the Iran National Committee for Ethics in Biomedical Research, Menistry of Health and Medical Education and received the registration number of ethics research (IR.MARAGHEHPHC.REC.1403.053). 2.2. Setting and participants All consecutive patients attending the unit of periodontology at the Urmia university of medical sciences were screened between November 2024 and August 2025; the inclusion criteria were: willing to participate in the study, 30–60 years old men and women, and diagnosed with periodontitis by a periodontist. Exclusion criteria were pregnant and/or lactating woman, individuals diagnosed with other systemic inflammatory disorders, those on certain anti- inflammatory diets, consuming anti-inflammatory or non-steroid anti-inflammatory drugs and/or having significant intentional or non-intentional weight loss during the past six months. The diagnosis of periodontitis was performed, as previously described ( 20 ), by 1) having a number of teeth ≥ 16; 2) having at least 40% of periodontal sites with full-mouth bleeding score (FMBS), a probing pocket depth (PPD) ≥ 4 mm and clinical attachment level (CAL) ≥ 2 mm ( 21 ); 3) having ≥ 2 mm of interdental alveolar bone loss verified through Rinn radiographs. Healthy subjects, matched for gender and age, had no systemic disease, took no drugs, and presented good oral health and no sites with PPD ≥ 4 mm or CAL ≥ 4 mm were considered as controls. Written informed consent was obtained from all individuals, in accordance with the Declaration of Helsinki. 2.3. Variables 2.3.1. Sociodemographic characteristics Individuals’ age, sex, occupation and education level, smoking, oral hygiene habits such as frequency of brushing teeth and using dental floss, and anthropometric indices were gathered. Patients were weighed on a balance scale with 0.1-kg precision (Seca, Birmingham, UK) and height was measured to the nearest 0.1 cm using a stadiometer. The body mass index (BMI) was calculated as weight (kg)/height (m 2 ). 2.3.2. Dietary assessment A validated 147-item food frequency questionnaire (FFQ) to measure the study population’s frequency of food intake was administered by two examiners (K.R., N.R.). The validity and reliability of the questionnaire was evaluated in a previous study ( 22 ). In order to facilitate the interpretation of dietary habit data, all items were divided into six food groups: cereals, milk and dairy products, meats, vegetables, fruits, and oils. Adherence to the Mediterranean diet was assessed using the 14- item Mediterranean Diet Adherence Screener (MEDAS) questionnaire ( 23 ). The reliability and validity of the questionnaire was previously confirmed among the Iranian high risk population ( 24 ). Each question was scored 0 or 1. If a respondent adhered to the condition described in each question, he/she would score one. Therefore, the total score of the questionnaire ranged from 0 to 14. Higher MEDAS score indicated higher adherence to the Mediterranean diet and lower scores revealed limited adherence. 2.3.3. Physical activity assessment Physical activity (PA) was evaluated using the validated short form of the International Physical Activity Questionnaire-short form (IPAQ-SF). Two examiners (K.R., N.R.) administered the seven-item questionnaire, which records the frequency and duration of vigorous activity, moderate activity, walking, and sedentary behavior during one week. Responses were converted to Metabolic Equivalent Task minutes per week (MET-min/week). Individuals with physical activity 600 MET-min/week was considered as moderate and > 3000 MET-min/week as sever ( 25 ). 2.3.4. Oral impacts on Daily Performances assessment The Oral Impacts on Daily Performances (OIDP) measure is a commonly used oral health-related quality of life indicator. It focuses on the assessment of the impacts caused by oral conditions on the person's abilities to perform activities and behaviors of daily life ( 26 ). Subjects answered the Persian version of the OIDP questionnaire in face-to-face interviews conducted by one trained interviewer. The OIDP questionnaire is related to oral impacts in relation to self-statement general health, self-statement oral health, self-statement dental care and sense of pain. For each reported oral impact, a score between 0–5 was given and the sum of score exhibited total quality of oral health ( 27 ). 2.3.4. Periodontal examination All participants received a full periodontal chart by two trained and calibrated examiners (Z. G, N. R). Subsequently, PPD was recorded with a standardized periodontal probe six sites per tooth, third molars excluded ( 28 ). Additionally, CAL was documented as PPD plus the presence of gingival recession, using the cementoenamel junction as a reference. Also, FMPS was recorded dichotomously (presence/absence of plaque) on six sites per tooth and was then calculated as the percentage of total tooth surfaces that revealed the presence of plaque ( 28 ). Full-mouth bleeding score (FMBS) was recorded by the appearance of gingival bleeding after probing up to 30 seconds during PPD assessment ( 29 ). 2.3.4. Interleukin-6 measurement Non-stimulated whole expectorated saliva was collected (3 ml) from each subject into sterile tubes according to methods described ( 30 ). Subjects were refrained from eating, drinking, and oral hygiene for 2 hours prior to saliva collection. Saliva samples were immediately placed on ice and aliquoted prior to freezing at -80C. Samples were thawed and analyzed within 6 months of collection. Salivary IL-6 levels were obtained using an enzyme-linked immunoassay (ELISA) kit and expressed in picogram per deciliter (pg/dl). 2.4. Statistical analysis 2.4.1. Sample size calculation Considering 95% confidence interval and 90% power, based on findings of previous studies ( 31 ), the sample size was calculated as 120 subjects. Hence, 60 periodontal cases and 60 healthy individuals were selected in the current case-control study. 2.4.2. Descriptive and inferential statistics Statistical Package for Social Sciences (SPSS) (version 25.0, Chicago, IL, USA) and STATA were used for statistical analyzing of the data. Normality of data was evaluated using the Kolmogorov-Smirnov and Shapiro-Wilk test. Continuous variables were reported as mean and standard deviation (SD); binomial and categorical data were expressed as frequency (percent). After verification of data distribution, Independent t-test and Chi-square test were used for comparing patients’ characteristics among two groups. A P-value < 0.05 was considered to be statistically significant. 2.4.3. Logistic regression models Univariate and multivariate logistic regression analyses were performed to compute the association between periodontitis and MEDAS score, OIDP, PA, anthropometric indices, dietary intake and IL-6. Findings were expressed as expressed as crude and adjusted odds ratios (ORs). Indeed, ORs were adjusted for parameters that could affect periodontitis phenotype (i.e., age, sex, BMI, and PA). 3. Results 3.1. Participant characteristics A total of 120 participants were included in the present study. Subjects’ general characteristics is reported in Table 1. The majority of the participants were female (75% in the case group and 73.3% in the control group). The mean age range was 33 years and the individuals were mainly normal weight or overweight. Comparing the baseline characteristics of participants in the case and control group indicated significant differences between education level, chewing gum habits, frequency of brushing teeth, using dental floss, frequency of using dental floss, and BMI. 3.2. Outcome data 3.2.1. Dietary intake and Periodontitis Comparing the dietary intake of the participants between two groups indicated significant differences for vitamin D. Assessing the association between dietary intake and periodontitis, exhibited significant association between vitamin D and periodontitis after adjusting for age, sex, BMI, and PA. Also significant association was observed between vitamin B9 and fiber and periodontitis after adjusting for confounding factors (Table 2). Table 3 shows the association between food group intake among both groups and periodontitis. As can be seen, significant differences were observed for legumes and dairy intake between two groups and significant associations with periodontitis. Comparing the association between periodontitis and OIDP, vitamin D 0.44 [0.30 to 0.66, p<0.001], folate 1.00 [1.00 to 1.00, p=0.017], fiber 1.02 [1.00 to 1.03, p=0.004], legumes 1.01 [1.00 to 1.02, p=0.001] and dairy 0.99 [0.99 to 0.99, p=0.027] intake indicated that higher vitamin D intake had a more beneficial effect against periodontal disease (figure 1). 3.2.2. Association between adherence to MD and periodontitis Assessing the association between adherence to MD and clinical manifestations of periodontitis, exhibited significant associations between CAL and adherence to MD. This relationship remained significant after adjusting for confounding factors (Table 4). 3.2.3. Comparison of adherence to MD, OIPD and IL-6 between two groups and their association with periodontitis Table 5 compares the adherence to MD, OIPD and IL-6 between two groups and their association with periodontitis. As can be seen, significant associations were observed among adherence to MD 1.34 [1.08, 1.66. p=0.008] and OIPD 0.74 [0.63, 0.85, p<0.001] and periodontitis. 4. Discussion 4.1. Summary of findings The findings of the current case-control study indicated that adherence to the MD was significantly lower among periodontitis individuals, this was also confirmed by their significant higher BMI. In fact, significant association was observed between MD adherence and CAL. Moreover, assessing participants OIDP also confirmed lower quality of life among periodontal cases. Additionally, findings showed significant association between vitamin D, fiber, folate, legumes, and dairy intake and periodontitis. 4.2. Dietary intake and physical activity assessment In the current study, adherence to the MD was significantly lower among periodontitis individuals. A similar study revealed that lower MD scores were in leaner relationship with periodontal indices deterioration among patients attending a public university hospital. This was mainly because approximately 70% of those with low MD adherence were in the severe stages of periodontitis ( 31 ). Nevertheless, other studies showed no associations between periodontal indices and higher MD adherence among a population of young adults ( 32 ). One cross-sectional study revealed a significant association between higher adherence to the DASH diet and MD and lower odds of obtaining periodontal diseases ( 33 ). Another recent cross-sectional study indicated that low adherence to MD and higher red meat consumption may be associated with severity of periodontal disease ( 34 ). Thus, diets rich in plant-based foods such as the MD are associated with lower levels of various inflammatory markers which decline gum disease and systemic inflammation ( 34 ). Findings also showed significant association between vitamin D, fiber, folate, legumes, and dairy intake and periodontitis. The results of a systematic review and meta-analysis of human intervention studies on the role of dietary fiber in managing periodontal diseases showed that fiber-rich dietary interventions decline inflammatory biomarkers of periodontal diseases ( 5 ). One cohort study reported significant association between low fiber consumption and moderate to severe periodontitis ( 35 ). Similarly, other studies claimed that higher levels of fiber and lower levels of fat in the diet improved markers of periodontitis in high-risk subjects ( 16 ). Generally, due to the tremendous health promoting features of fiber in declining periodontal inflammatory biomarkers, a fiber-rich daily diet may be efficient in controlling periodontal diseases ( 5 ). A pilot study also showed that treatment with a high-fiber, low-fat diet for 8 weeks effectively improved periodontal markers ( 36 ). The beneficial effects of fiber in periodontal diseases is related to modulating effects of fiber on gut microbiota and its metabolites such as short chain fatty acids (SCFA). Additionally, fiber declines the gene expression of pro-inflammatory markers such as tumor necrosis factor-α (TNF- α), interleukin (IL)-1β, IL-10, transforming growth factor-β (TGF-β), and interferon-gamma (IFN-γ) ( 4 ). In this study, although salivary IL-6 was higher among patients, there were no statistically significant differences between two groups and there were no statistical association between IL-6 and periodontitis among patients. This may be because the population was newly diagnosed periodontitis cases. Also, comparing the two groups dietary intake indicates that there were no statistical differences in participant’s antioxidant or total nutrient intake, indicating that the level of inflammation was high among healthy cases as well, which may be related to the Iranians dietary habits and high pro-inflammatory nutrient intake ( 37 ). Various vitamin D polymorphisms have been associated with chronic and aggressive periodontitis ( 38 ). Despite vitamin D’s tremendous function in cancer prevention, immunity and cardiovascular regulation, the active form of vitamin D, 1,25(OH)2D3 exhibits physiological and pharmacological effects by activating the vitamin D receptor (VDR), a transcription factor of the nuclear receptor superfamily. In fact, 1,25(OH)2D3 plays a crucial role in maintaining oral health through its effects on bone and mineral metabolism and innate immunity ( 39 ). The proposed mechanisms by which vitamin D may protect against periodontal disease involve two key biological pathways: the antimicrobial pathway and the anti-inflammatory pathway ( 40 ). In the antimicrobial pathway, vitamin D exerts its effects when 1,25(OH)2D3 binds to the VDR/VDRE complex. This interaction triggers the production of antimicrobial peptides such as cAMP, β-defensin-2, and β-defensin-3 in macrophages, monocytes, gingival epithelial cells, and periodontal ligament cells. These peptides help reduce the oral microbial load, thereby limiting the exposure of periodontal tissues to harmful microbial byproducts ( 41 ). The anti-inflammatory pathway, on the other hand, involves the suppression of pro-inflammatory cytokines like IL-6 and TNF-α. This is achieved through the inhibition of NF-κB activity and the up-regulation of MAPK signaling pathways, ultimately contributing to reduced inflammation in periodontal tissues. Thus, evidence from multiple studies suggests that adequate levels of vitamin D support periodontal health ( 42 ). The findings of the current case-control study regarding dairy and legumes intake were also in accordance with previous studies ( 44 – 47 ). Dairy foods are good sources of various nutrients including calcium, magnesium, phosphorus, potassium, vitamin D, and proteins which may have beneficial effects on periodontal health by enhancing alveolar bone density ( 48 ). Additionally, high calcium intake from dairy foods may prevent bone loss by inhibiting the secretion of parathyroid hormone, which contributes to bone resorption ( 49 ). Legumes are good sources of fiber, minerals such as calcium, magnesium, phosphorus and protein, which also exhibit potential protective effects against periodontal diseases ( 51 ). Findings also showed that periodontal patients had a significant lower OIDP than healthy controls. This indicates that unhealthy dietary pattern significantly effects patient’s daily performance, and amplifies the necessity of diets with abundant amounts of antioxidants and fiber-rich sources. Overall, dental condition effects food choices and nutrient intake. These individuals tend to prefer soft and processed foods, and avoid fruits, vegetables and meats. Subsequently, periodontal disease and tooth loss can have an adverse impact on systemic health, which can lead to progressive atherosclerosis and cardiovascular disease ( 51 ). 4.3. Strengths and limitations The current study provided a thorough investigation regarding the relationship between adherence to MD and clinical manifestations of periodontitis, PA, salivary IL-6, anthropometric indices, and dietary intake. Participants demographic factors and oral hygiene habits were gathered and several inclusion and exclusion factors were implied to include periodontal cases without any systematic inflammation. Furthermore, the case-control design of the study allowed investigating associations between variables and generating hypotheses regarding potential causes. Assessing associations between variables and adjusting confounding factors provides further strength to the study. Several limitations are attributed to the present study as well. First, the dietary intake of individuals was gathered via FFQ. Although FFQ is a pragmatic and cost-effective instrument for assessing habitual dietary intake in epidemiological studies, its susceptibility to recall bias and tendency towards social desirability bias. Furthermore, the instrument's reliance on fixed food lists and crude portion size estimates compromises its ability to capture dietary diversity, precise quantities, and specific preparation methods, resulting in substantial inaccuracies in estimating absolute intake. Second, given that the study population was selected among patients coming to a public unit of periodontology, the risk of selection bias could not be ruled out. Third, it would have been superior if other biochemical inflammatory factors been measured to truly assess the inflammatory status of the population. 5. Conclusion The findings of this case-control study demonstrated a significant inverse association between adherence to the MD and periodontitis. Participants with periodontitis exhibited significantly lower MD adherence, a finding corroborated by higher intakes of vitamin D, dietary fiber, folate, legumes, and dairy products. Future studies should focus on conducting well-designed randomized clinical trials implementing MD or other healthy antioxidant diets that could beneficially decline inflammation progression among potential cases. Declarations Acknowledgment This research received no specific grants from funding agencies in the public, commercial, or not-for-profit sectors. We are grateful for the financial support of Maragheh university of medical sciences. The authors declare no conflict of interest. Ethics Approval Declaration: The research protocol was confirmed by the Iran National Committee for Ethics in Biomedical Research, Ministry of Health and Medical Education and received the registration number of ethics research (IR.MARAGHEHPHC.REC.1403.053). Data Availability Statement The data that support the findings of this study are available upon reasonable request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions. Funding Declaration No funding Consent to participate declaration Human ethics and consent to participate was considered for all participants. 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Zhu K, Prince RL. Calcium and bone. Clinical biochemistry. 2012;45(12):936-42. Maphosa Y, Jideani VA. The role of legumes in human nutrition. Functional food-improve health through adequate food. 2017;1:13. do Nascimento MA, Francelino VCM, de Souza Porcelli IC, Yokoyama MF, Poli-Frederico RC, Fracasso MdLC, et al. Relationship between tooth loss, nutritional status and consumption of macro and micronutrients in elderly people from southern Brazil. Acta Scientiarum Health Sciences. 2022;44. Tables Table 1 . Demographic characteristics of study population Variable Case N (%) Control N (%) P-value* Sex Male Female 15 (25) 45 (75) 16 (26.7) 44 (73.3) 0.835 Education College Undergraduate Graduate PhD 29 (48.3) 21 (35) 5 (8.3) 5 (8.3) 2 (3.3) 10 (16.17) 45 (75) 3 (5) <0.001 Chewing Gum Yes No 29 (48.3) 31 (51.7) 40 (66.7) 20 (33.3) 0.042 Frequency of chewing Gum Never Daily Weekly Monthly 31 (51.7) 7 (11.7) 12 (20) 10 (16.7) 19 (31.7) 6 (10) 23 (38.3) 12 (20) 0.086 Brushing teeth Yes No 55 (91.7) 5 (8.3) 57 (95) 3 (5) 0.464 Frequency of Brushing teeth Never Once daily Twice daily weekly 9 (15) 34 (56.7) 7 (11.7) 10 (16.7) 2 (3.3) 39 (65) 18 (30) 1 (1.7) 0.001 Using dental floss Yes No 25 (41.7) 35 (58.3) 45 (75) 15 (25) <0.001 Frequency of using dental floss Never Daily Weekly 34 (56.7) 9 (15) 17 (28.3) 16 (26.7) 17 (28.3) 27 (45) 0.004 Smoking Yes No 4 (6.7) 56 (93.3) 2 (3.3) 58 (96.7) 0.402 Breathing difficulties Yes No 7 (11.7) 53 (88.3) 2 (3.3) 58 (96.7) 0.083 IPAQ Mild Moderate Severe 23 (38.3) 31 (51.7) 6 (10) 12 (20) 40 (66.7) 8 (13.3) 0.087 MEDAS adherence Yes No 4 (6.7) 56 (93.3) 2 (3.3) 58 (96.7) 0.402 Variable Mean (SD) Mean (SD) P-value** Age 33.12 (7.05) 33.78 (5.22) 0.557 Weight 74.55 (12.77) 70.43 (11.94) 0.071 BMI 27.52 (4.19) 24.5 (3.18) <0.001 N: number; SD: standard deviation; IPAQ: International Physical Activity Questionnaires; BMI: Body Mass Index p-value*: Chi-squared test p-value**: Independent t-test Table 2 . Dietary and antioxidant intake of the study population Variable Case Mean (SD) Control Mean (SD) P-value a Odds ratio (95% CI) P-value b Adjusted β (95% CI) P-value c Energy (kcal) 3397.53 (1150.72) 4427.70 (9244.93) 0.393 0.99 (0.99, 1.00) 0.488 0.99 (0.99, 1.00) 0.550 Carbohydrate (kcal) 1951.93 (729.05) 2737.62 (6937.53) 0.385 0.99 (0.99, 1.00) 0.493 0.99 (0.99, 1.00) 0.667 Protein (kcal) 503.69 (203.02) 658.69 (203.02) 0.418 0.99 (0.99, 1.00) 0.492 1.00 (0.99, 1.00) 0.157 Fat (kcal) 1035.39 (398.08) 1188.71 (1441.22) 0.429 0.99 (0.99, 1.00) 0.470 1.00 (0.99, 1.00) 0.956 Vitamin A (mg) 964.79 (773.61) 784.94 (352.86) 0.104 1.00 (0.99, 1.00) 0.128 1.00 (0.99, 1.00) 0.060 Vitamin D (mg) 1.66 (1.17) 3.03 (1.65) <0.001 0.47 (0.34, 0.66) <0.001 0.44 (0.30, 0.66) <0.001 Vitamin E (mg) 15.06 (6.13) 18.17 (34.62) 0.494 0.99 (0.97, 1.01) 0.529 1.02 (0.94, 1.11) 0.574 Vitamin C (mg) 162.78 (121.36) 171.73 (87.49) 0.644 0.99 (0.99, 1.00) 0.642 0.99 (0.99, 1.00) 0.442 Selenium (mg) 198.43 (92.45) 346.95 (1384.67) 0.409 0.99 (0.99, 1.00) 0.501 1.00 (0.99, 1.00) 0.484 Vitamin B9 (mg) 975.21 (411.38) 1066.32 (1886.59) 0.715 0.99 (0.99, 1.00) 0.718 1.00 (1.00, 1.00) 0.017 Fiber (g) 101.14 (54.91) 107.13 (259.22) 0.861 0.99 (0.99, 1.00) 0.861 1.02 (1.00, 1.03) 0.004 Zinc (mg) 18.20 (7.19) 26.32 (71.65) 0.384 0.99 (0.98, 1.00) 0.490 1.06 (0.96, 1.16) 0.195 SFA (g) 32.82 (14.76) 36.71 (34.98) 0.430 0.99 (0.97, 1.00) 0.452 1.00 (0.96, 1.04) 0.750 PUFA (g) 26.89 (12.39) 29.08 (39.16) 0.681 0.99 (0.98, 1.00) 0.684 1.02 (0.98, 1.07) 0.249 MUFA (g) 36.48 (14.82) 43.68 (64.73) 0.403 0.99 (0.98, 1.00) 0.463 1.00 (0.96, 1.05) 0.716 SD: standard deviation; CI: confidence interval; SFA: saturated fatty acid; PUFA: poly unsaturated fatty acid; MUFA: mono unsaturated fatty acid P-value a : Independent t-test P-value b : ANCOVA P-value c : ANCOVA adjusted for age, sex, BMI, and physical activity Table 3. Food group intake of the study population Variable Case Mean (SD) Control Mean (SD) P-value a Odds ratio (95% CI) P-value b Adjusted β (95% CI) P-value c Grains (g) 692.7 (336.86) 1131.20 (3778.52) 0.372 0.99 (0.99, 1.00) 0.501 0.99 (0.99, 1.00) 0.503 Legumes (g) 134.71 (117.53) 75.46 (49.12) <0.001 1.01 (1.00, 1.01) 0.001 1.01 (1.00, 1.02) 0.001 Meat (g) 140.59 (111.01) 157.02 (79.85) 0.354 0.99 (0.99, 1.00) 0.356 0.99 (0.99, 1.00) 0.726 Dairy (g) 298.59 (184.19) 413.74 (266.88) 0.007 0.99 (0.99, 0.99) 0.010 0.99 (0.99, 0.99) 0.027 Vegetable (g) 319.89 (227.47) 270.96 (164.70) 0.180 1.01 (0.99, 1.00) 0.187 1.00 (0.99, 1.00) 0.457 Fruit (g) 318.28 (293.37) 393.23 (247.90) 0.133 0.99 (0.99, 1.00) 0.139 0.99 (0.99, 1.00) 0.093 Fats (g) 29.93 (26.99) 27.15 (16.97) 0.502 1.00 (0.98, 1.02) 0.500 1.00 (0.98, 1.02) 0.584 Seeds (g) 25.81 (30.47) 29.01 (54.31) 0.691 0.99 (0.98, 1.00) 0.692 1.00 (0.99, 1.01) 0.655 SD: standard deviation; CI: confidence interval P-value a : Independent t-test P-value b : ANCOVA P-value c : ANCOVA adjusted for age, sex, BMI, and physical activity Table 4. Association between adherence to Mediterranean Diet and Periodontitis Variable Mean (SD) β (95% CI) P-value a Adjusted β (95% CI) P-value b FMP 50.04 (17.79) -0.68 (-3.32, 1.95) 0.604 -0.66 (-3.42, 2.09) 0.631 FMB 37.69 (19.19) -1.56 (-4.38, 1.26) 0.273 -1.44 (-4.38, 1.49) 0.329 PPD 2.11 (0.71) -0.06 (-0.17, 0.03) 0.195 -0.08 (-0.18, 0.02) 0.138 CAL 1.34 (0.90) 0.14 (0.02, 0.27) 0.026 0.15 (0.01, 0.28) 0.028 SD: standard deviation; CI: confidence interval P-value a : ANCOVA P-value b : ANCOVA adjusted for age, sex, BMI, and physical activity Table 5. Comparison between adherence to MD, OIPD, and IL-6 and Periodontitis Variable Mean (SD) Mean (SD) P-value a Odds ratio (95% CI) P-value b MEDAS score 4.23 (1.76) 3.32 (1.79) 0.006 1.34 (1.08, 1.66) 0.008 OIPD 16.43 (3.29) 18.92 (2.49) <0.001 0.74 (0.63, 0.85) <0.001 IL-6 (pg/dl) 454.33 (278.90) 428.14 (256.23) 0.593 1.00 (0.99, 1.00) 0.590 SD: standard deviation; CI: confidence interval; OIPD: Oral Impact on Daily Performance; IL: Interleukin P-value a : Independent t-test P-value b : ANCOVA Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8906374","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":604722147,"identity":"f5d63b30-f55c-463c-9666-8b10b14f67b5","order_by":0,"name":"Zahra Goharfar","email":"","orcid":"","institution":"Urmia University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Zahra","middleName":"","lastName":"Goharfar","suffix":""},{"id":604722151,"identity":"627ec8de-fb06-497b-baed-a7348fcf4dc7","order_by":1,"name":"Faezeh Ghalichi","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABCUlEQVRIiWNgGAWjYBAC9gYgwQgkDBiYGw4wNkjIMTDw4NfCcwCuhRGsxZg0LSCU2EBQC/vhwx8+7mCw285+sPHAzx0W6RuOnz344AODnZxuAw4tPGkJhjPPMCTv7ElsONh7RiJ3w5m8ZMMZDMnGZgewa7FnyDFI5m1jSDY4kNhwmLENqOVAjpk0D8OBxG04tPDwv/9w+C9Iy/mHYC3pBuffENAikcPYzNjGYGdwA2JLgsENQrZIPDNm7AWrfAj0S5uE4cwbb4wNZxjg9gsPf/LjDz/bbOwNzicfBjLq5PnO5xg++FBhJ4dLCxRIAKMDChTAKg3wKgcDezhLvgG3qlEwCkbBKBiZAACmu2XzEKwc4AAAAABJRU5ErkJggg==","orcid":"","institution":"Maragheh University of Medical Sciences","correspondingAuthor":true,"prefix":"","firstName":"Faezeh","middleName":"","lastName":"Ghalichi","suffix":""},{"id":604722152,"identity":"5587e36b-7442-4fdc-9897-05f00e61d424","order_by":2,"name":"Nesa Rasouli","email":"","orcid":"","institution":"Urmia University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Nesa","middleName":"","lastName":"Rasouli","suffix":""},{"id":604722153,"identity":"5fe07e39-a1d4-495d-9280-7b0676572d7f","order_by":3,"name":"Kosar Rostamlou","email":"","orcid":"","institution":"Maragheh University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Kosar","middleName":"","lastName":"Rostamlou","suffix":""},{"id":604722154,"identity":"4b981fad-9ab5-48ba-bb24-e4ffa42daea9","order_by":4,"name":"Ebrahim Mazloumi","email":"","orcid":"","institution":"Urmia University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Ebrahim","middleName":"","lastName":"Mazloumi","suffix":""},{"id":604722155,"identity":"d54a8447-f107-46ec-9be1-f9b923258424","order_by":5,"name":"Neda Gilani","email":"","orcid":"","institution":"Tabriz University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Neda","middleName":"","lastName":"Gilani","suffix":""}],"badges":[],"createdAt":"2026-02-18 06:38:18","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8906374/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8906374/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":104557400,"identity":"3d9f3c21-bfe8-4f46-93c4-d859f0620998","added_by":"auto","created_at":"2026-03-13 09:27:32","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":65295,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eComparison of associations between periodontitis and OIPD and dietary intake\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8906374/v1/e26a7579c392cb7b971c825b.png"},{"id":106326372,"identity":"a08ae1ef-eeb7-4863-9a18-c7e519a2b2db","added_by":"auto","created_at":"2026-04-07 13:13:33","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1701015,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8906374/v1/c401f160-b15d-48d9-bc68-031c23310cb0.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"A case-control study on the relationship between Periodontitis and adherence to the Mediterranean dietary pattern, salivary IL-6 and oral impacts on daily performances","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003ePeriodontitis as a significant global health concern, is amongst the top chronic non-communicable diseases, which obstructs quality of life and overall health status (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). According to estimates, it effects 10.8% of the adult population worldwide, approximately 743\u0026nbsp;million people (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Periodontitis, is defined as a chronic multifactorial immune-inflammatory disease affecting the supportive structures of a tooth and the polymicrobial plaque biofilm adjacent as the main etiology (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Inflammation is the results of the interaction of oral microorganisms and periodontal tissues causing progressive destruction of the tooth-supportive tissues, resulting in tooth loss and loss of function in the oral cavity (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe composition of the oral microbiome is affected by genetics and behavioral and environmental risk factors such as diet composition, lifestyle habits, oral hygiene approaches, medications, hormones, dental prosthesis and presence of chronic systemic inflammatory disorders (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e) such as diabetes mellitus (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e), cardiovascular disorders (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e), obesity (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e), metabolic syndrome (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e), respiratory disease (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e), cancer (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e), chronic kidney disease (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e), and rheumatoid arthritis (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Healthy dietary pattern is among the most modifiable environmental risk factors mentioned for the risk of inflammation and periodontal diseases (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Thus, an immune-inflammatory modulatory diet may be efficient in periodontal management. Dietary antioxidants including omega 3 fatty acids and vitamins C and D have been mentioned efficient in declining periodontal inflammatory parameters (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Also, diets rich in fiber and reduced amounts of saturated fats are efficient in improving markers of periodontitis in high-risk subjects (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). Although the beneficial features of dietary antioxidant nutrients are persistently reported, adherence to an anti-inflammatory diet, such as the Mediterranean diet (MD), which generally involves eating plant-based foods, such as fruits and vegetables, whole grains, fish, olive oil, lean protein, low fat dairy is a beneficial approach for declining systemic inflammation and maintaining periodontal health (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). The high fiber content of the MD, is efficient in declining systemic and local inflammation in periodontal tissues and the abundant amount of dietary antioxidants is beneficial for declining oxidative stress (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e).\u003c/p\u003e \u003cp\u003ePeriodontitis or tissue destruction is irreversible; thus, proper care and treatment prior to this stage is an invasive approach for declining overall inflammation and related adverse effects. Modulating the diet composition and adding beneficial antioxidant nutrients is an efficient procedure for preventing and treating periodontitis. Therefore, the aim of the present case-control study was to assess the relationship between adherence to the MD, oral impacts on daily performances (OIDP), level of saliva interleukin (IL) 6, dietary intake, anthropometric indices and periodontitis.\u003c/p\u003e"},{"header":"2. Materials and Methods","content":"\u003cp\u003e \u003cb\u003e2. 1. Study design\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe current study is informed according to the Strengthening the Reporting of Observational studies in Epidemiology (STROBE) guidelines for case-control studies (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). The research protocol was confirmed by the Iran National Committee for Ethics in Biomedical Research, Menistry of Health and Medical Education and received the registration number of ethics research (IR.MARAGHEHPHC.REC.1403.053).\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.2. Setting and participants\u003c/h2\u003e \u003cp\u003eAll consecutive patients attending the unit of periodontology at the Urmia university of medical sciences were screened between November 2024 and August 2025; the inclusion criteria were: willing to participate in the study, 30\u0026ndash;60 years old men and women, and diagnosed with periodontitis by a periodontist. Exclusion criteria were pregnant and/or lactating woman, individuals diagnosed with other systemic inflammatory disorders, those on certain anti- inflammatory diets, consuming anti-inflammatory or non-steroid anti-inflammatory drugs and/or having significant intentional or non-intentional weight loss during the past six months. The diagnosis of periodontitis was performed, as previously described (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e), by 1) having a number of teeth\u0026thinsp;\u0026ge;\u0026thinsp;16; 2) having at least 40% of periodontal sites with full-mouth bleeding score (FMBS), a probing pocket depth (PPD)\u0026thinsp;\u0026ge;\u0026thinsp;4 mm and clinical attachment level (CAL)\u0026thinsp;\u0026ge;\u0026thinsp;2 mm (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e); 3) having\u0026thinsp;\u0026ge;\u0026thinsp;2 mm of interdental alveolar bone loss verified through Rinn radiographs. Healthy subjects, matched for gender and age, had no systemic disease, took no drugs, and presented good oral health and no sites with PPD\u0026thinsp;\u0026ge;\u0026thinsp;4 mm or CAL\u0026thinsp;\u0026ge;\u0026thinsp;4 mm were considered as controls.\u003c/p\u003e \u003cp\u003e Written informed consent was obtained from all individuals, in accordance with the Declaration of Helsinki.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.3. Variables\u003c/h2\u003e \u003cdiv id=\"Sec5\" class=\"Section3\"\u003e \u003ch2\u003e2.3.1. Sociodemographic characteristics\u003c/h2\u003e \u003cp\u003eIndividuals\u0026rsquo; age, sex, occupation and education level, smoking, oral hygiene habits such as frequency of brushing teeth and using dental floss, and anthropometric indices were gathered. Patients were weighed on a balance scale with 0.1-kg precision (Seca, Birmingham, UK) and height was measured to the nearest 0.1 cm using a stadiometer. The body mass index (BMI) was calculated as weight (kg)/height (m\u003csup\u003e2\u003c/sup\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section3\"\u003e \u003ch2\u003e2.3.2. Dietary assessment\u003c/h2\u003e \u003cp\u003eA validated 147-item food frequency questionnaire (FFQ) to measure the study population\u0026rsquo;s frequency of food intake was administered by two examiners (K.R., N.R.). The validity and reliability of the questionnaire was evaluated in a previous study (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). In order to facilitate the interpretation of dietary habit data, all items were divided into six food groups: cereals, milk and dairy products, meats, vegetables, fruits, and oils. Adherence to the Mediterranean diet was assessed using the 14- item Mediterranean Diet Adherence Screener (MEDAS) questionnaire (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). The reliability and validity of the questionnaire was previously confirmed among the Iranian high risk population (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). Each question was scored 0 or 1. If a respondent adhered to the condition described in each question, he/she would score one. Therefore, the total score of the questionnaire ranged from 0 to 14. Higher MEDAS score indicated higher adherence to the Mediterranean diet and lower scores revealed limited adherence.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section3\"\u003e \u003ch2\u003e2.3.3. Physical activity assessment\u003c/h2\u003e \u003cp\u003ePhysical activity (PA) was evaluated using the validated short form of the International Physical Activity Questionnaire-short form (IPAQ-SF). Two examiners (K.R., N.R.) administered the seven-item questionnaire, which records the frequency and duration of vigorous activity, moderate activity, walking, and sedentary behavior during one week. Responses were converted to Metabolic Equivalent Task minutes per week (MET-min/week). Individuals with physical activity\u0026thinsp;\u0026lt;\u0026thinsp;600 MET-min/week was classified as low, \u0026gt;\u0026thinsp;600 MET-min/week was considered as moderate and \u0026gt;\u0026thinsp;3000 MET-min/week as sever (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section3\"\u003e \u003ch2\u003e2.3.4. Oral impacts on Daily Performances assessment\u003c/h2\u003e \u003cp\u003e The Oral Impacts on Daily Performances (OIDP) measure is a commonly used oral health-related quality of life indicator. It focuses on the assessment of the impacts caused by oral conditions on the person's abilities to perform activities and behaviors of daily life (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). Subjects answered the Persian version of the OIDP questionnaire in face-to-face interviews conducted by one trained interviewer. The OIDP questionnaire is related to oral impacts in relation to self-statement general health, self-statement oral health, self-statement dental care and sense of pain. For each reported oral impact, a score between 0\u0026ndash;5 was given and the sum of score exhibited total quality of oral health (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section3\"\u003e \u003ch2\u003e2.3.4. Periodontal examination\u003c/h2\u003e \u003cp\u003eAll participants received a full periodontal chart by two trained and calibrated examiners (Z. G, N. R). Subsequently, PPD was recorded with a standardized periodontal probe six sites per tooth, third molars excluded (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). Additionally, CAL was documented as PPD plus the presence of gingival recession, using the cementoenamel junction as a reference. Also, FMPS was recorded dichotomously (presence/absence of plaque) on six sites per tooth and was then calculated as the percentage of total tooth surfaces that revealed the presence of plaque (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). Full-mouth bleeding score (FMBS) was recorded by the appearance of gingival bleeding after probing up to 30 seconds during PPD assessment (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section3\"\u003e \u003ch2\u003e2.3.4. Interleukin-6 measurement\u003c/h2\u003e \u003cp\u003eNon-stimulated whole expectorated saliva was collected (3 ml) from each subject into sterile tubes according to methods described (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). Subjects were refrained from eating, drinking, and oral hygiene for 2 hours prior to saliva collection. Saliva samples were immediately placed on ice and aliquoted prior to freezing at -80C. Samples were thawed and analyzed within 6 months of collection. Salivary IL-6 levels were obtained using an enzyme-linked immunoassay (ELISA) kit and expressed in picogram per deciliter (pg/dl).\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e2.4. Statistical analysis\u003c/h2\u003e \u003cdiv id=\"Sec12\" class=\"Section3\"\u003e \u003ch2\u003e2.4.1. Sample size calculation\u003c/h2\u003e \u003cp\u003eConsidering 95% confidence interval and 90% power, based on findings of previous studies (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e), the sample size was calculated as 120 subjects. Hence, 60 periodontal cases and 60 healthy individuals were selected in the current case-control study.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section3\"\u003e \u003ch2\u003e2.4.2. Descriptive and inferential statistics\u003c/h2\u003e \u003cp\u003eStatistical Package for Social Sciences (SPSS) (version 25.0, Chicago, IL, USA) and STATA were used for statistical analyzing of the data. Normality of data was evaluated using the Kolmogorov-Smirnov and Shapiro-Wilk test. Continuous variables were reported as mean and standard deviation (SD); binomial and categorical data were expressed as frequency (percent). After verification of data distribution, Independent t-test and Chi-square test were used for comparing patients\u0026rsquo; characteristics among two groups. A P-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered to be statistically significant.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section3\"\u003e \u003ch2\u003e2.4.3. Logistic regression models\u003c/h2\u003e \u003cp\u003eUnivariate and multivariate logistic regression analyses were performed to compute the association between periodontitis and MEDAS score, OIDP, PA, anthropometric indices, dietary intake and IL-6. Findings were expressed as expressed as crude and adjusted odds ratios (ORs). Indeed, ORs were adjusted for parameters that could affect periodontitis phenotype (i.e., age, sex, BMI, and PA).\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003cp\u003e\u003cstrong\u003e3.1. Participant characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 120 participants were included in the present study. Subjects\u0026rsquo; general characteristics is reported in Table 1. The majority of the participants were female (75% in the case group and 73.3% in the control group). The mean age range was 33 years and the individuals were mainly normal weight or overweight. Comparing the baseline characteristics of participants in the case and control group indicated significant differences between education level, chewing gum habits, frequency of brushing teeth, using dental floss, frequency of using dental floss, and BMI.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.2. Outcome data\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.2.1. Dietary intake and Periodontitis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eComparing the dietary intake of the participants between two groups indicated significant differences for vitamin D. Assessing the association between dietary intake and periodontitis, exhibited significant association between vitamin D and periodontitis after adjusting for age, sex, BMI, and PA. Also significant association was observed between vitamin B9 and fiber and periodontitis after adjusting for confounding factors (Table 2). Table 3 shows the association between food group intake among both groups and periodontitis. As can be seen, significant differences were observed for legumes and dairy intake between two groups and significant associations with periodontitis. Comparing the association between periodontitis and OIDP, vitamin D 0.44 [0.30 to 0.66, p\u0026lt;0.001], folate 1.00 [1.00 to 1.00, p=0.017], fiber 1.02 [1.00 to 1.03, p=0.004], legumes 1.01 [1.00 to 1.02, p=0.001] and dairy 0.99 [0.99 to 0.99, p=0.027] intake indicated that higher vitamin D intake had a more beneficial effect against periodontal disease (figure 1). \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.2.2. Association between adherence to MD and periodontitis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAssessing the association between adherence to MD and clinical manifestations of periodontitis, exhibited significant associations between CAL and adherence to MD. This relationship remained significant after adjusting for confounding factors (Table 4).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.2.3. Comparison of adherence to MD, OIPD and IL-6 between two groups and their association with periodontitis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 5 compares the adherence to MD, OIPD and IL-6 between two groups and their association with periodontitis. As can be seen, significant associations were observed among adherence to MD 1.34 [1.08, 1.66. p=0.008] and OIPD 0.74 [0.63, 0.85, p\u0026lt;0.001] and periodontitis.\u0026nbsp;\u003c/p\u003e"},{"header":"4. Discussion","content":"\u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003e4.1. Summary of findings\u003c/h2\u003e \u003cp\u003eThe findings of the current case-control study indicated that adherence to the MD was significantly lower among periodontitis individuals, this was also confirmed by their significant higher BMI. In fact, significant association was observed between MD adherence and CAL. Moreover, assessing participants OIDP also confirmed lower quality of life among periodontal cases. Additionally, findings showed significant association between vitamin D, fiber, folate, legumes, and dairy intake and periodontitis.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003e4.2. Dietary intake and physical activity assessment\u003c/h2\u003e \u003cp\u003eIn the current study, adherence to the MD was significantly lower among periodontitis individuals. A similar study revealed that lower MD scores were in leaner relationship with periodontal indices deterioration among patients attending a public university hospital. This was mainly because approximately 70% of those with low MD adherence were in the severe stages of periodontitis (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). Nevertheless, other studies showed no associations between periodontal indices and higher MD adherence among a population of young adults (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). One cross-sectional study revealed a significant association between higher adherence to the DASH diet and MD and lower odds of obtaining periodontal diseases (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e). Another recent cross-sectional study indicated that low adherence to MD and higher red meat consumption may be associated with severity of periodontal disease (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). Thus, diets rich in plant-based foods such as the MD are associated with lower levels of various inflammatory markers which decline gum disease and systemic inflammation (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFindings also showed significant association between vitamin D, fiber, folate, legumes, and dairy intake and periodontitis. The results of a systematic review and meta-analysis of human intervention studies on the role of dietary fiber in managing periodontal diseases showed that fiber-rich dietary interventions decline inflammatory biomarkers of periodontal diseases (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). One cohort study reported significant association between low fiber consumption and moderate to severe periodontitis (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e). Similarly, other studies claimed that higher levels of fiber and lower levels of fat in the diet improved markers of periodontitis in high-risk subjects (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). Generally, due to the tremendous health promoting features of fiber in declining periodontal inflammatory biomarkers, a fiber-rich daily diet may be efficient in controlling periodontal diseases (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). A pilot study also showed that treatment with a high-fiber, low-fat diet for 8 weeks effectively improved periodontal markers (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e). The beneficial effects of fiber in periodontal diseases is related to modulating effects of fiber on gut microbiota and its metabolites such as short chain fatty acids (SCFA). Additionally, fiber declines the gene expression of pro-inflammatory markers such as tumor necrosis factor-α (TNF- α), interleukin (IL)-1β, IL-10, transforming growth factor-β (TGF-β), and interferon-gamma (IFN-γ) (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). In this study, although salivary IL-6 was higher among patients, there were no statistically significant differences between two groups and there were no statistical association between IL-6 and periodontitis among patients. This may be because the population was newly diagnosed periodontitis cases. Also, comparing the two groups dietary intake indicates that there were no statistical differences in participant\u0026rsquo;s antioxidant or total nutrient intake, indicating that the level of inflammation was high among healthy cases as well, which may be related to the Iranians dietary habits and high pro-inflammatory nutrient intake (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eVarious vitamin D polymorphisms have been associated with chronic and aggressive periodontitis (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e). Despite vitamin D\u0026rsquo;s tremendous function in cancer prevention, immunity and cardiovascular regulation, the active form of vitamin D, 1,25(OH)2D3 exhibits physiological and pharmacological effects by activating the vitamin D receptor (VDR), a transcription factor of the nuclear receptor superfamily. In fact, 1,25(OH)2D3 plays a crucial role in maintaining oral health through its effects on bone and mineral metabolism and innate immunity (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e). The proposed mechanisms by which vitamin D may protect against periodontal disease involve two key biological pathways: the antimicrobial pathway and the anti-inflammatory pathway (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e). In the antimicrobial pathway, vitamin D exerts its effects when 1,25(OH)2D3 binds to the VDR/VDRE complex. This interaction triggers the production of antimicrobial peptides such as cAMP, β-defensin-2, and β-defensin-3 in macrophages, monocytes, gingival epithelial cells, and periodontal ligament cells. These peptides help reduce the oral microbial load, thereby limiting the exposure of periodontal tissues to harmful microbial byproducts (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e). The anti-inflammatory pathway, on the other hand, involves the suppression of pro-inflammatory cytokines like IL-6 and TNF-α. This is achieved through the inhibition of NF-κB activity and the up-regulation of MAPK signaling pathways, ultimately contributing to reduced inflammation in periodontal tissues. Thus, evidence from multiple studies suggests that adequate levels of vitamin D support periodontal health (\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe findings of the current case-control study regarding dairy and legumes intake were also in accordance with previous studies (\u003cspan additionalcitationids=\"CR45 CR46\" citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e). Dairy foods are good sources of various nutrients including calcium, magnesium, phosphorus, potassium, vitamin D, and proteins which may have beneficial effects on periodontal health by enhancing alveolar bone density (\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e). Additionally, high calcium intake from dairy foods may prevent bone loss by inhibiting the secretion of parathyroid hormone, which contributes to bone resorption (\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e). Legumes are good sources of fiber, minerals such as calcium, magnesium, phosphorus and protein, which also exhibit potential protective effects against periodontal diseases (\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFindings also showed that periodontal patients had a significant lower OIDP than healthy controls. This indicates that unhealthy dietary pattern significantly effects patient\u0026rsquo;s daily performance, and amplifies the necessity of diets with abundant amounts of antioxidants and fiber-rich sources. Overall, dental condition effects food choices and nutrient intake. These individuals tend to prefer soft and processed foods, and avoid fruits, vegetables and meats. Subsequently, periodontal disease and tooth loss can have an adverse impact on systemic health, which can lead to progressive atherosclerosis and cardiovascular disease (\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec23\" class=\"Section2\"\u003e \u003ch2\u003e4.3. Strengths and limitations\u003c/h2\u003e \u003cp\u003eThe current study provided a thorough investigation regarding the relationship between adherence to MD and clinical manifestations of periodontitis, PA, salivary IL-6, anthropometric indices, and dietary intake. Participants demographic factors and oral hygiene habits were gathered and several inclusion and exclusion factors were implied to include periodontal cases without any systematic inflammation. Furthermore, the case-control design of the study allowed investigating associations between variables and generating hypotheses regarding potential causes. Assessing associations between variables and adjusting confounding factors provides further strength to the study. Several limitations are attributed to the present study as well. First, the dietary intake of individuals was gathered via FFQ. Although FFQ is a pragmatic and cost-effective instrument for assessing habitual dietary intake in epidemiological studies, its susceptibility to recall bias and tendency towards social desirability bias. Furthermore, the instrument's reliance on fixed food lists and crude portion size estimates compromises its ability to capture dietary diversity, precise quantities, and specific preparation methods, resulting in substantial inaccuracies in estimating absolute intake. Second, given that the study population was selected among patients coming to a public unit of periodontology, the risk of selection bias could not be ruled out. Third, it would have been superior if other biochemical inflammatory factors been measured to truly assess the inflammatory status of the population.\u003c/p\u003e \u003c/div\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eThe findings of this case-control study demonstrated a significant inverse association between adherence to the MD and periodontitis. Participants with periodontitis exhibited significantly lower MD adherence, a finding corroborated by higher intakes of vitamin D, dietary fiber, folate, legumes, and dairy products. Future studies should focus on conducting well-designed randomized clinical trials implementing MD or other healthy antioxidant diets that could beneficially decline inflammation progression among potential cases.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research received no specific grants from funding agencies in the public, commercial, or not-for-profit sectors. We are grateful for the financial support of Maragheh university of medical sciences. The authors declare no conflict of interest.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics Approval Declaration:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe research protocol was confirmed by the Iran National Committee for Ethics in Biomedical Research, Ministry of Health and Medical Education and received the registration number of ethics research (IR.MARAGHEHPHC.REC.1403.053).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study are available upon reasonable request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding Declaration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funding\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participate declaration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHuman ethics and consent to participate was considered for all participants. In this regard, written informed consent was obtained from all individuals, in accordance with the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Publish Declaration:\u0026nbsp;\u003c/strong\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interest declaration:\u003c/strong\u003e No competing interest\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003ePihlstrom BL, Michalowicz BS, Johnson NW. Periodontal diseases. 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The plaque control record. J periodontol. 1972;43:38.\u003c/li\u003e\n\u003cli\u003eAinamo J, Bay I. Problems and proposals for recording gingivitis and plaque. International dental journal. 1975;25(4):229-35.\u003c/li\u003e\n\u003cli\u003eNavazesh M. Methods for collecting saliva. Annals of the New York Academy of Sciences. 1993;694(1):72-7.\u003c/li\u003e\n\u003cli\u003eMarruganti C, Traversi J, Gaeta C, Ferrari Cagidiaco E, Parrini S, Discepoli N, et al. Adherence to Mediterranean diet, physical activity level, and severity of periodontitis: results from a university‐based cross‐sectional study. Journal of periodontology. 2022;93(8):1218-32.\u003c/li\u003e\n\u003cli\u003eIwasaki M, Ennibi OK, Bouziane A, Erraji S, Lakhdar L, Rhissassi M, et al. Association between periodontitis and the Mediterranean diet in young Moroccan individuals. Journal of periodontal research. 2021;56(2):408-14.\u003c/li\u003e\n\u003cli\u003eAltun E, Walther C, Borof K, Petersen E, Lieske B, Kasapoudis D, et al. Association between dietary pattern and periodontitis\u0026mdash;A cross-sectional study. Nutrients. 2021;13(11):4167.\u003c/li\u003e\n\u003cli\u003eMainas G, Grosso G, Di Giorgio J, Hurley J, Alamri MM, Isola G, et al. Relationship between Mediterranean diet and periodontal inflammation in a UK population: A cross‐sectional study. Journal of Periodontology. 2025.\u003c/li\u003e\n\u003cli\u003eNielsen SJ, Trak-Fellermeier MA, Joshipura K, Dye BA. Dietary fiber intake is inversely associated with periodontal disease among US adults. The Journal of nutrition. 2016;146(12):2530-6.\u003c/li\u003e\n\u003cli\u003eKondo K, Ishikado A, Morino K, Nishio Y, Ugi S, Kajiwara S, et al. A high-fiber, low-fat diet improves periodontal disease markers in high-risk subjects: a pilot study. Nutrition Research. 2014;34(6):491-8.\u003c/li\u003e\n\u003cli\u003eEsmaillzadeh A, Kimiagar M, Mehrabi Y, Azadbakht L, Hu FB, Willett WC. Dietary patterns and markers of systemic inflammation among Iranian women. The Journal of nutrition. 2007;137(4):992-8.\u003c/li\u003e\n\u003cli\u003eLu EMC. The role of vitamin D in periodontal health and disease. Journal of periodontal research. 2023;58(2):213-24.\u003c/li\u003e\n\u003cli\u003eAmano Y, Komiyama K, Makishima M. Vitamin D and periodontal disease. Journal of oral science. 2009;51(1):11-20.\u003c/li\u003e\n\u003cli\u003eDragonas P, El-Sioufi I, Bobetsis YA, Madianos PN. Association of Vitamin D With Periodontal Disease: A Narrative Review. Oral Health Prev Dent. 2020;18(2):103-14.\u003c/li\u003e\n\u003cli\u003eLiu PT, Stenger S, Li H, Wenzel L, Tan BH, Krutzik SR, et al. Toll-like receptor triggering of a vitamin D-mediated human antimicrobial response. Science 2006;311(5768):1770\u0026ndash;1773.\u003c/li\u003e\n\u003cli\u003eCohen-Lahav M, Shany S, Tobvin D, Chaimovitz C, Douvdevani A. Vitamin D decreases NFkappaB activity by increasing I\u0026kappa;B\u0026alpha; levels. Nephrol Dial Transplant 2006;21:889\u0026ndash;897.\u003c/li\u003e\n\u003cli\u003eBonnet C, Rabbani R, Moffatt ME, Kelekis-Cholakis A, Schroth RJ. The relation between periodontal disease and vitamin D. J Can Dent Assoc. 2019;84:j4.\u003c/li\u003e\n\u003cli\u003eLee K, Kim J. Dairy food consumption is inversely associated with the prevalence of periodontal disease in Korean adults. Nutrients. 2019;11(5):1035.\u003c/li\u003e\n\u003cli\u003eShimazaki Y, Shirota T, Uchida K, Yonemoto K, Kiyohara Y, Iida M, et al. Intake of dairy products and periodontal disease: the Hisayama Study. Journal of periodontology. 2008;79(1):131-7.\u003c/li\u003e\n\u003cli\u003eAl‐Zahrani MS. Increased intake of dairy products is related to lower periodontitis prevalence. Journal of periodontology. 2006;77(2):289-94.\u003c/li\u003e\n\u003cli\u003eAdegboye AR, Christensen LB, Holm-Pedersen P, Avlund K, Boucher BJ, Heitmann BL. Intake of dairy products in relation to periodontitis in older Danish adults. Nutrients. 2012;4(9):1219-29.\u003c/li\u003e\n\u003cli\u003eIntini G, Katsuragi Y, Kirkwood K, Yang S. Alveolar bone loss: mechanisms, potential therapeutic targets, and interventions. Advances in dental research. 2014;26(1):38-46.\u003c/li\u003e\n\u003cli\u003eZhu K, Prince RL. Calcium and bone. Clinical biochemistry. 2012;45(12):936-42.\u003c/li\u003e\n\u003cli\u003eMaphosa Y, Jideani VA. The role of legumes in human nutrition. Functional food-improve health through adequate food. 2017;1:13.\u003c/li\u003e\n\u003cli\u003edo Nascimento MA, Francelino VCM, de Souza Porcelli IC, Yokoyama MF, Poli-Frederico RC, Fracasso MdLC, et al. Relationship between tooth loss, nutritional status and consumption of macro and micronutrients in elderly people from southern Brazil. Acta Scientiarum Health Sciences. 2022;44.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003cstrong\u003e. Demographic characteristics of study population\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv align=\"Left\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"503\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCase\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eN (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eControl\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eN (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e15 (25)\u003c/p\u003e\n \u003cp\u003e45 (75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e16 (26.7)\u003c/p\u003e\n \u003cp\u003e44 (73.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.835\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducation\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eCollege\u003c/p\u003e\n \u003cp\u003eUndergraduate\u003c/p\u003e\n \u003cp\u003eGraduate\u003c/p\u003e\n \u003cp\u003ePhD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e29 (48.3)\u003c/p\u003e\n \u003cp\u003e21 (35)\u003c/p\u003e\n \u003cp\u003e5 (8.3)\u003c/p\u003e\n \u003cp\u003e5 (8.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2 (3.3)\u003c/p\u003e\n \u003cp\u003e10 (16.17)\u003c/p\u003e\n \u003cp\u003e45 (75)\u003c/p\u003e\n \u003cp\u003e3 (5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eChewing Gum\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e29 (48.3)\u003c/p\u003e\n \u003cp\u003e31 (51.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e40 (66.7)\u003c/p\u003e\n \u003cp\u003e20 (33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.042\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency of chewing Gum\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eNever\u003c/p\u003e\n \u003cp\u003eDaily\u003c/p\u003e\n \u003cp\u003eWeekly\u003c/p\u003e\n \u003cp\u003eMonthly\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e31 (51.7)\u003c/p\u003e\n \u003cp\u003e7 (11.7)\u003c/p\u003e\n \u003cp\u003e12 (20)\u003c/p\u003e\n \u003cp\u003e10 (16.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e19 (31.7)\u003c/p\u003e\n \u003cp\u003e6 (10)\u003c/p\u003e\n \u003cp\u003e23 (38.3)\u003c/p\u003e\n \u003cp\u003e12 (20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.086\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eBrushing teeth\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e55 (91.7)\u003c/p\u003e\n \u003cp\u003e5 (8.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e57 (95)\u003c/p\u003e\n \u003cp\u003e3 (5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.464\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency of Brushing teeth\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eNever\u003c/p\u003e\n \u003cp\u003eOnce daily\u003c/p\u003e\n \u003cp\u003eTwice daily\u003c/p\u003e\n \u003cp\u003eweekly\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e9 (15)\u003c/p\u003e\n \u003cp\u003e34 (56.7)\u003c/p\u003e\n \u003cp\u003e7 (11.7)\u003c/p\u003e\n \u003cp\u003e10 (16.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2 (3.3)\u003c/p\u003e\n \u003cp\u003e39 (65)\u003c/p\u003e\n \u003cp\u003e18 (30)\u003c/p\u003e\n \u003cp\u003e1 (1.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eUsing dental floss\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e25 (41.7)\u003c/p\u003e\n \u003cp\u003e35 (58.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e45 (75)\u003c/p\u003e\n \u003cp\u003e15 (25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency of using dental floss\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eNever\u003c/p\u003e\n \u003cp\u003eDaily\u003c/p\u003e\n \u003cp\u003eWeekly\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e34 (56.7)\u003c/p\u003e\n \u003cp\u003e9 (15)\u003c/p\u003e\n \u003cp\u003e17 (28.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e16 (26.7)\u003c/p\u003e\n \u003cp\u003e17 (28.3)\u003c/p\u003e\n \u003cp\u003e27 (45)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.004\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSmoking\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e4 (6.7)\u003c/p\u003e\n \u003cp\u003e56 (93.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2 (3.3)\u003c/p\u003e\n \u003cp\u003e58 (96.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.402\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eBreathing difficulties\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e7 (11.7)\u003c/p\u003e\n \u003cp\u003e53 (88.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2 (3.3)\u003c/p\u003e\n \u003cp\u003e58 (96.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.083\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eIPAQ\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eMild\u003c/p\u003e\n \u003cp\u003eModerate\u003c/p\u003e\n \u003cp\u003eSevere\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e23 (38.3)\u003c/p\u003e\n \u003cp\u003e31 (51.7)\u003c/p\u003e\n \u003cp\u003e6 (10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e12 (20)\u003c/p\u003e\n \u003cp\u003e40 (66.7)\u003c/p\u003e\n \u003cp\u003e8 (13.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.087\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMEDAS adherence\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e4 (6.7)\u003c/p\u003e\n \u003cp\u003e56 (93.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2 (3.3)\u003c/p\u003e\n \u003cp\u003e58 (96.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.402\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean (SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean (SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value**\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e33.12 (7.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e33.78 (5.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.557\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eWeight\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e74.55 (12.77)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e70.43 (11.94)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.071\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eBMI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e27.52 (4.19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e24.5 (3.18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eN: number; SD: standard deviation; IPAQ: International Physical Activity Questionnaires; BMI: Body Mass Index\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;p-value*: Chi-squared test\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;p-value**: Independent t-test\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003cstrong\u003e. Dietary and antioxidant intake of the study population\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv align=\"Left\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"728\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCase\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eMean (SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eControl\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eMean (SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value \u003csup\u003ea\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOdds ratio\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value \u003csup\u003eb\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdjusted \u0026beta;\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value \u003csup\u003ec\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEnergy (kcal)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e3397.53 (1150.72)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e4427.70 (9244.93)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.393\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e0.99 (0.99, 1.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.488\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e0.99 (0.99, 1.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.550\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCarbohydrate (kcal)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e1951.93 (729.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e2737.62 (6937.53)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.385\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e0.99 (0.99, 1.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.493\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e0.99 (0.99, 1.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.667\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eProtein (kcal)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e503.69 (203.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e658.69 (203.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.418\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e0.99 (0.99, 1.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.492\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e1.00 (0.99, 1.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.157\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFat (kcal)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e1035.39 (398.08)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e1188.71 (1441.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.429\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e0.99 (0.99, 1.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.470\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e1.00 (0.99, 1.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.956\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVitamin A (mg)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e964.79 (773.61)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e784.94 (352.86)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.104\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e1.00 (0.99, 1.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.128\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e1.00 (0.99, 1.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.060\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVitamin D (mg)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e1.66 (1.17)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e3.03 (1.65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e0.47 (0.34, 0.66)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e0.44 (0.30, 0.66)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVitamin E (mg)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e15.06 (6.13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e18.17 (34.62)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.494\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e0.99 (0.97, 1.01)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.529\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e1.02 (0.94, 1.11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.574\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVitamin C (mg)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e162.78 (121.36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e171.73 (87.49)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.644\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e0.99 (0.99, 1.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.642\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e0.99 (0.99, 1.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.442\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSelenium (mg)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e198.43 (92.45)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e346.95 (1384.67)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.409\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e0.99 (0.99, 1.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.501\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e1.00 (0.99, 1.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.484\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVitamin B9 (mg)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e975.21 (411.38)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e1066.32 (1886.59)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.715\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e0.99 (0.99, 1.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.718\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e1.00 (1.00, 1.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.017\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFiber (g)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e101.14 (54.91)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e107.13 (259.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.861\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e0.99 (0.99, 1.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.861\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e1.02 (1.00, 1.03)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.004\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eZinc (mg)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e18.20 (7.19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e26.32 (71.65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.384\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e0.99 (0.98, 1.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.490\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e1.06 (0.96, 1.16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.195\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSFA (g)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e32.82 (14.76)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e36.71 (34.98)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.430\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e0.99 (0.97, 1.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.452\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e1.00 (0.96, 1.04)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.750\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePUFA (g)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e26.89 (12.39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e29.08 (39.16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.681\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e0.99 (0.98, 1.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.684\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e1.02 (0.98, 1.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.249\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMUFA (g)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e36.48 (14.82)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e43.68 (64.73)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.403\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e0.99 (0.98, 1.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.463\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e1.00 (0.96, 1.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.716\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eSD: standard deviation; CI: confidence interval; SFA: saturated fatty acid; PUFA: poly unsaturated fatty acid; MUFA: mono unsaturated fatty acid\u003c/p\u003e\n\u003cp\u003eP-value \u003csup\u003ea\u003c/sup\u003e: Independent t-test\u003c/p\u003e\n\u003cp\u003eP-value \u003csup\u003eb\u003c/sup\u003e: ANCOVA\u003c/p\u003e\n\u003cp\u003eP-value \u003csup\u003ec\u003c/sup\u003e: ANCOVA adjusted for age, sex, BMI, and physical activity\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3. Food group intake of the study population\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv align=\"Left\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"775\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCase\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eMean (SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eControl\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eMean (SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value \u003csup\u003ea\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOdds ratio (95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value \u003csup\u003eb\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdjusted \u0026beta; (95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value \u003csup\u003ec\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGrains (g)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e692.7 (336.86)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e1131.20 (3778.52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.372\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e0.99 (0.99, 1.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.501\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0.99 (0.99, 1.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.503\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLegumes (g)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e134.71 (117.53)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e75.46 (49.12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e1.01 (1.00, 1.01)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1.01 (1.00, 1.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMeat (g)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e140.59 (111.01)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e157.02 (79.85)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.354\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e0.99 (0.99, 1.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.356\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0.99 (0.99, 1.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.726\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDairy (g)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e298.59 (184.19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e413.74 (266.88)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.007\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e0.99 (0.99, 0.99)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.010\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0.99 (0.99, 0.99)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.027\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVegetable (g)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e319.89 (227.47)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e270.96 (164.70)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.180\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e1.01 (0.99, 1.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.187\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1.00 (0.99, 1.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.457\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFruit (g)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e318.28 (293.37)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e393.23 (247.90)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.133\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e0.99 (0.99, 1.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.139\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0.99 (0.99, 1.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.093\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFats (g)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e29.93 (26.99)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e27.15 (16.97)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.502\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e1.00 (0.98, 1.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.500\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1.00 (0.98, 1.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.584\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSeeds (g)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e25.81 (30.47)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e29.01 (54.31)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.691\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e0.99 (0.98, 1.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.692\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1.00 (0.99, 1.01)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.655\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eSD: standard deviation; CI: confidence interval\u003c/p\u003e\n\u003cp\u003eP-value \u003csup\u003ea\u003c/sup\u003e: Independent t-test\u003c/p\u003e\n\u003cp\u003eP-value \u003csup\u003eb\u003c/sup\u003e: ANCOVA\u003c/p\u003e\n\u003cp\u003eP-value \u003csup\u003ec\u003c/sup\u003e: ANCOVA adjusted for age, sex, BMI, and physical activity\u003c/p\u003e\n\u003cp\u003eTable 4. Association between adherence to Mediterranean Diet and Periodontitis\u003c/p\u003e\n\u003cdiv align=\"Left\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean (SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026beta; (95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value \u003csup\u003ea\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdjusted \u0026beta; (95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value \u003csup\u003eb\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFMP\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e50.04 (17.79)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-0.68 (-3.32, 1.95)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.604\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-0.66 (-3.42, 2.09)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.631\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFMB\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e37.69 (19.19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-1.56 (-4.38, 1.26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.273\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-1.44 (-4.38, 1.49)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.329\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePPD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2.11 (0.71)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-0.06 (-0.17, 0.03)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.195\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-0.08 (-0.18, 0.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.138\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCAL\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.34 (0.90)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.14 (0.02, 0.27)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.026\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.15 (0.01, 0.28)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.028\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; SD: standard deviation; CI: confidence interval\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; P-value \u003csup\u003ea\u003c/sup\u003e: ANCOVA\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; P-value \u003csup\u003eb\u003c/sup\u003e: ANCOVA adjusted for age, sex, BMI, and physical activity\u003c/p\u003e\n\u003cp\u003eTable 5. Comparison between adherence to MD, OIPD, and IL-6 and Periodontitis\u003c/p\u003e\n\u003cdiv align=\"Left\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean (SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean (SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value \u003csup\u003ea\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eOdds ratio (95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value \u003csup\u003eb\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMEDAS score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.23 (1.76)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.32 (1.79)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.006\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.34 (1.08, 1.66)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.008\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eOIPD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e16.43 (3.29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e18.92 (2.49)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.74 (0.63, 0.85)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eIL-6 (pg/dl)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e454.33 (278.90)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e428.14 (256.23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.593\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.00 (0.99, 1.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.590\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; SD: standard deviation; CI: confidence interval; OIPD: Oral Impact on Daily Performance; IL: Interleukin\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; P-value \u003csup\u003ea\u003c/sup\u003e: Independent t-test\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; P-value \u003csup\u003eb\u003c/sup\u003e: ANCOVA\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"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":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Periodontitis, Mediterranean diet, Oral health, inflammation, antioxidant","lastPublishedDoi":"10.21203/rs.3.rs-8906374/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8906374/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003ePeriodontitis, is defined as a chronic multifactorial inflammatory disease and the most advanced form of periodontal diseases. The aim of the present study was to assess the relationship between adherence to the Mediterranean diet (MD), oral impacts on daily performances (OIDP), level of salivary interleukin (IL)-6, dietary intake, anthropometric indices and periodontitis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eA total of 120 individuals were included in the case-control study (n=60). Dietary intake was assessed via a validated food frequency questionnaire (FFQ). Furthermore, MD adherence was evaluated by the Mediterranean Diet Adherence Screener (MEDAS). A full periodontal examination\u003cstrong\u003e \u003c/strong\u003ewas administered for examining clinical manifestations of periodontitis. Participant’s weight and height were measured and the body mass index was calculated. Crude and adjusted odds ratios (ORs) [95% confidence interval] were calculated to evaluate the association between MD adherence, and periodontitis, OIDP and salivary IL-6.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eFindings indicated that adherence to the MD was significantly lower 1.34 [1.08 to 1.66, p=0.008] among periodontitis individuals. Significant association between vitamin D 0.44 [0.30 to 0.66, p\u0026lt;0.001], fiber 1.02 [1.00 to 1.03, p=0.004], folate 1.00 [1.00 to 1.00, p=0.017], legumes 1.01 [1.00 to 1.02, p=0.001], dairy intake 0.99 [0.99 to 0.99, p=0.027], and OIDP 0.74 [0.63 to 0.85, p\u0026lt;0.001] and periodontitis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003eThe\u003cstrong\u003e \u003c/strong\u003elower adherence to the Mediterranean Diet among periodontitis cases, compared to healthy cases alongside declined OIDP, enhances the important of antioxidants in the prevention and treatment of periodontitis and subsequent adverse effects.\u003c/p\u003e","manuscriptTitle":"A case-control study on the relationship between Periodontitis and adherence to the Mediterranean dietary pattern, salivary IL-6 and oral impacts on daily performances","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-13 09:24:03","doi":"10.21203/rs.3.rs-8906374/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"0d086c78-2961-4bbc-894f-b705033805c4","owner":[],"postedDate":"March 13th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-04-07T13:11:50+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-13 09:24:03","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8906374","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8906374","identity":"rs-8906374","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}