Effect of oral health on chronic intestinal diseases and all-cause mortality in US adults: results from the NHANES 2005-2008 database

Effect of oral health on chronic intestinal diseases and all-cause mortality in US adults: results from the NHANES 2005-2008 database | 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 Effect of oral health on chronic intestinal diseases and all-cause mortality in US adults: results from the NHANES 2005-2008 database Kang Li, Xingxing Liu, Taiyu Chen, Yonghua Zeng, Xiaolong Ying, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6726151/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: Oral health and gut health are closely related. Gut flora changes can be modulated via the mouth-gut axis, impacting bowel health. This study aimed to explore the relationship between oral health and the incidence of chronic diarrhea and constipation, as well as its impact on all-cause mortality. Methods: This cross-sectional study used data from the 2005–2008 National Health and Nutrition Examination Survey (NHANES) database. Multivariable logistic regression and subgroup analyses assessed the associations between oral health status, dental pain frequency, and chronic diarrhea/constipation. Multivariable Cox regression evaluated the link between oral health and all-cause mortality in patients with chronic constipation or diarrhea. Results: Chronic constipation was present in 10.37% (957/9231) of participants, and chronic diarrhea in 12.06% (1113/9231). Adjusted multivariable logistic regression models showed that poor oral health and high frequency of dental pain were significantly associated with an increased risk of chronic constipation [odds ratio (OR) = 1.65, 95% confidence interval (CI) 1.28–2.12, P < 0.001; OR = 1.43, 95% CI 1.01–2.02, P = 0.044] and chronic diarrhea (OR = 1.31, 95% CI 1.07–1.71, P = 0.044; OR = 1.69, 95% CI 1.35–2.11, P < 0.001), particularly in smokers, drinkers, and those with a history of neoplasia. Adjusted multivariable Cox regression indicated that poor dental health was linked to all-cause mortality in diarrhea patients (HR = 1.66, 95% CI 1.08–2.54, P = 0.033). Conclusion: Oral health conditions are significantly correlated with chronic intestinal diseases. This discovery highlights the significance of oral factors in the treatment strategies for chronic intestinal diseases. Oral health Toothache Chronic diarrhea Chronic constipation Figures Figure 1 Figure 2 1. Introduction Functional gastrointestinal disorders (FGIDs) represent a prevalent class of digestive diseases globally, characterized primarily by chronic constipation(CC), chronic diarrhea(CD), and abdominal pain. Given their high prevalence, FGIDs have long been a central focus in gastroenterology research. These conditions not only impair daily functioning but also impose a substantial burden on healthcare systems worldwide[ 1 ]. Epidemiological studies estimate that CD affects 1%-5% of adults worldwide, while CC demonstrates significantly higher prevalence, occurring in approximately 16% of the global adult population. In specific populations, particularly older adults, the prevalence of chronic constipation reaches as high as 79%[ 2 , 3 ]. Chronic diarrhea requires > 3 daily bowel movements or > 200g stool output (water content > 85%) persisting > 4 weeks, while chronic constipation is defined by 6 months[ 4 ]. Existing evidence demonstrates that chronic diarrhea and constipation exhibit multifactorial etiology involving obesity, dietary patterns, lifestyle factors, medication use, psychological conditions, and underlying pathologies[ 5 – 8 ]. Chronic diarrhea and constipation significantly compromised patients' holistic health and quality of life while concurrently generating substantial socioeconomic burdens encompassing social isolation, diminished work efficiency, and productivity losses[ 7 , 9 ]. Prior research has extensively examined the roles of physical activity, sleep duration, frailty, and food insecurity in chronic gastrointestinal dysfunction, While the potential influence of oral health remains largely unexplored[ 10 – 13 ]. The oral cavity serves as both the gateway to the human digestive tract and a reservoir of complex microbial communities. These oral microbiota play a critical role in systemic health maintenance by modulating nutrient assimilation, xenobiotic metabolism, and immunomodulatory processes[ 14 ]. In recent years, studies have shown that the oral microbiota not only affects the risk of local periodontal and dental caries, but is also closely related to gastrointestinal, neurological, endocrine, immunological and cardiovascular diseases[ 15 ]. The oral microbiome may regulate distal gastrointestinal function through the gut-oral axis, potentially impacting systemic health[ 16 ]. This mechanism also provides a theoretical basis for exploring the relationship between oral health and chronic gastrointestinal symptoms (such as diarrhea and constipation). Notably, recent evidence indicates that oral health interventions may offer benefits for gut regulation. For instance, Gasmi Benahmed A et al. demonstrated that xylitol, an anti-caries sweetener, could indirectly alter intestinal microbiota composition by suppressing pathogenic streptococci proliferation, thereby promoting intestinal well-being[ 17 ]. In patients with liver cirrhosis, periodontal therapy has been shown to mitigate inflammation and endotoxemia through modulation of the oral-intestinal-liver axis[ 18 ]. Recognizing the significant link between oral and gut health, we analyzed data from the 2005–2008 National Health and Nutrition Examination Survey (NHANES) to investigate how oral health relates to the risk of chronic constipation and diarrhea, and to evaluate its influence on all-cause mortality among patients with abnormal gut function. This study addresses a research gap by offering novel insights into the oral-gut health relationship, which may inform strategies for preventing and treating functional gastrointestinal disorders. Additionally, it provides a scientific foundation for public health initiatives focused on oral health interventions. 2. Methods 2.1. Study Design and Population NHANES is a publicly available research project conducted by the National Center for Health Statistics at the Centers for Disease Control (Atlanta, Georgia, USA). Using a complex, stratified, multistage, whole-population sampling methodology, NHANES ensures representative estimates of the noninstitutionalized population of the United States. The survey collects a wide range of data, including demographic information, physical examination findings, and laboratory specimens, through household interviews and visits to screening centers. All data and guidelines are available to the public on the National Center for Health Statistics website ( https://www.cdc.gov/nchs/nhanes/ index. htm). Each cycle of NHANES was approved by the National Center for Health Statistics Research Ethics Review Board, and all participants provided written informed consent. Data from two cycles (2005–2008) were analyzed. All participants with a total of 20,497 cases from 2005 to 2008 were included, with the exception of those with incomplete gut health data (N = 11,141), missing oral health data (N = 37), or missing significant covariates (N = 88) (Fig. 1 ). In total, 9,231 patients were analyzed. 2.2 Variables for evaluating oral health and gut health The oral health assessment utilized the results of a questionnaire for self-assessment through the following question:“Overall, how would you rate the health of your teeth and gums?”The answers were as follows: excellent, very good, good, fair and poor[ 19 ]. We also studied the frequency of dental pain, self-assessed by the questionnaire, “How often did you have oral pain in the last year?” The answers were: often, fairly often, occasionally, almost never, never. The oral health questionnaire was completed at home before the physical examination using a computer-assisted personal interview CAPI) system. The Bowel Health Questionnaire was used to assess bowel health. A computer-assisted personal interview system administered by an interviewer was used at a mobile testing center. The questionnaire covered fecal incontinence, stool characteristics and bowel frequency. Stool consistency was measured using the Bristol Stool Form Scale (BSFS), together with questions about bowel frequency (e.g. "How many times a week do you usually have a bowel movement?"). Chronic constipation was defined as BSFS type 1 or 2 or fewer than 3 bowel movements per week, and chronic diarrhea was defined as BSFS type 6 or 7 or 21 or more bowel movements per week. BSFS types 3, 4, and 5 and other bowel frequency were classified as no bowel symptoms[ 20 ]. Assessing bowel health by considering the frequency and consistency of bowel movements is considered to be more reasonable and valid than using a single parameter[ 21 ]. 2.3. covariates We conducted a comprehensive analysis of demographic and laboratory data and questionnaires from the NHANES database. Important covariates included age, sex, race, education, marital status, household income to poverty income ratio, smoking, alcohol use, hypertension, diabetes, coronary artery disease, history of neoplasm, body mass index (BMI), albumin, cholesterol, urea nitrogen, creatinine, Mortal State, and duration of follow-up. Race/ethnicity was categorized as non-Hispanic white, non-Hispanic black, Mexican-American, and other. Marital status was categorized as married versus other. Educational attainment was categorized as less than 9 years of education, 9 to 12 years of education, and more than 12 years of education. Household income was categorized by poverty income ratio (PIR) into three groups: low (PIR ≤ 1.3), medium (PIR > 1.3 to 3.5), and high (PIR > 3.5). Smoking was defined as having smoked at least 100 cigarettes during lifetime. Alcohol consumption was defined as having had at least 12 drinks of any type of alcoholic beverage in a year. Preexisting conditions (hypertension, diabetes, coronary artery disease) were determined by a questionnaire asking whether the doctor had been informed of the condition in the past. BMI was calculated using a standardized technique based on weight and height. Albumin, cholesterol, urea nitrogen, and creatinine were analyzed using the Beckman Synchron LX20.Mortality status and cause of death for NHANES participants were ascertained through linkage with the National Death Index death certificate records. All-cause mortality served as the primary endpoint, with follow-up continuing through December 2019. 2.4. Statistical method Continuous variables were described using mean ± standard deviation (SD) for normal distributions and median (interquartile range, IQR) for non-normal distributions. Categorical variables were presented as frequencies and percentages [n (%)]. Group comparisons for continuous variables were performed using t-tests or Mann-Whitney U tests, while chi-square tests were used for categorical variables. To examine the relationship between oral health and chronic diarrhea/constipation, three multivariable logistic regression models were constructed: Model 1 (unadjusted), Model 2 (adjusted for age, sex, race, education, marital status, and family income-to-poverty ratio), and Model 3 (further adjusted for hypertension, diabetes, coronary heart disease, cancer history, and albumin). Results were expressed as odds ratios (ORs) with 95% confidence intervals (95% CIs). Subgroup analyses were conducted to evaluate the associations between oral health and chronic diarrhea/constipation risk across different population characteristics. To further investigate all-cause mortality in individuals with abnormal gut health (chronic diarrhea or constipation), three Cox proportional hazards models were constructed. Model 4 and 5 were adjusted for the same covariates as Models 1 and 2, while Model 6 included additional adjustments for smoking, alcohol consumption, coronary heart disease, body mass index (BMI), serum creatinine, and total cholesterol(TC) based on Model 2. Additionally, multiple imputation was used to handle missing data and reduce bias. All statistical analyses were two-sided, with P < 0.05 indicating statistical significance. Statistical analyses were performed using R version 4.3.2 and Fengrui Statistics version 2.1. 3. Results 3.1Baseline characteristics of the participants According to their chronic intestinal symptoms, Table 1 summarizes the clinical baseline characteristics of all participants. In a total of 9231 participants, 10.37% (957/9231) of patients with chronic constipation and 12.06% (1113/9231) of patients with chronic diarrhea were included. The mean age of all participants was 49.08 ± 18.08 years, with 49% male. Compared with the healthy group, patients with chronic constipation and diarrhea showed statistically significant lower education, poverty, lower albumin, poorer oral health, frequent/occasional toothache (all P < 0.05). Supplementary table 1 shows the baseline characteristics of patients grouped by oral health. It reveals that among the participants whose oral condition is self-evaluated as poor, the proportion of chronic diarrhea and constipation is higher ( P < 0.001), and the percentage of deaths is higher(p < 0.001) with statistical differences. Table 1 Baseline characteristics of overall participants according to Different chronic intestinal symptoms variables Control N = 7161 Constipation N = 957 p-value Diarrhea N = 1113 p-value Age 46.33± (16.56) 44.15± (17.52) < 0.001 48.87± (15.58) < 0.001 Gender < 0.001 0.867 male 3,700 (51%) 259 (24%) 556 (52%) female 3,461 (49%) 698 (76%) 557 (48%) Race < 0.001 < 0.001 Non-Hispanic white 3,645 (73%) 417 (66%) 475 (67%) Non-Hispanic black 1,423 (10.0%) 267 (17%) 269 (13%) Mexican American 1,306 (7.8%) 164 (7.9%) 242 (10%) Others 787 (9.1%) 109 (9.3%) 127 (9.8%) Education level (year), n (%) < 0.001 < 0.001 12 3,549 (59%) 371 (47%) 456 (52%) Marrired 0.002 0.480 Married/Partner 4,512 (66%) 538 (59%) 673 (65%) single 2,649 (34%) 419 (41%) 440 (35%) PIR, n (%) 3.5 2,460 (47%) 229 (34%) 308 (41%) BMI (kg/m2) 28.50± (6.48) 27.77± (6.70) 0.002 30.37± (8.04) < 0.001 TC(mg/dL), Mean ± SD 197.74± (41.22) 199.16± (42.65) 0.714 200.96± (42.01) 0.008 BUN(mg/dL), Mean ± SD 12.76± (5.13) 12.24± (5.30) < 0.001 12.98± (5.35) 0.396 ALB(g/dL), Mean ± SD 4.26± (0.34) 4.17± (0.37) < 0.001 4.21± (0.35) 0.012 Cr(mg/dL), Mean ± SD 0.90± (0.31) 0.85± (0.33) < 0.001 0.91± (0.34) 0.802 Diabetes, n (%) 0.518 < 0.001 NO 6,401 (93%) 853 (92%) 939 (88%) YES 760 (7.3%) 104 (7.9%) 174 (12%) Hypertension, n (%) 0.080 < 0.001 NO 4,776 (70%) 692 (73%) 635 (62%) YES 2,385 (30%) 265 (27%) 478 (38%) coronary heart disease, n (%) 0.138 0.243 NO 6,866 (97%) 923 (97%) 1,073 (97%) YES 295 (3.4%) 34 (2.5%) 40 (2.6%) Cancer, n (%) 0.447 0.016 NO 6,543 (92%) 870 (91%) 988 (89%) YES 618 (8.2%) 87 (9.1%) 125 (11%) Current smoking status 0.002 0.003 NO 3,711 (52%) 568 (59%) 531 (46%) YES 3,450 (48%) 389 (41%) 582 (54%) Alcohol consumption, n(%) < 0.001 0.071 NO 1,977 (23%) 395 (37%) 366 (27%) YES 5,184 (77%) 562 (63%) 747 (73%) teeth ach < 0.001 < 0.001 Hardly ever/Never 495 (6.2%) 102 (10%) 113 (10%) Occasionally 1,084 (14%) 190 (18%) 189 (16%) Very often/Fairly often 5,582 (80%) 665 (71%) 811 (74%) Condition of teeth < 0.001 < 0.001 Excellent/ Very good 2,242 (37%) 258 (30%) 302 (32%) Good 2,331 (33%) 312 (34%) 321 (31%) Fair 1,549 (19%) 211 (19%) 277 (22%) Poor 1,039 (11%) 176 (17%) 213 (15%) Median (IQR) for continuous variables; N (%) for categorical variables; Abbreviations: PIR: Ratio of household income to poverty, BMI: Body mass index, TC: Total cholesterol, BUN: Blood Urea Nitrogen, ALB: Albumin, Cr: Creatinine 3.2 Relationships between the oral health and Bowel Health The relationship between oral health, frequency of toothache and chronic diarrhea and constipation is shown in Table 2 . We found a positive correlation between poor oral health and an increase in chronic constipation. In Model 2 of the multivariable logistic regression analysis adjusting for demographic covariates (age, gender, race, education, marital status, and poverty-income ratio), the adjusted odds ratio (OR) was 1.65 (95% CI:1.30–2.09; P < 0.001). After further adjustment for clinical comorbidities (hypertension, diabetes, coronary heart disease, cancer history) and albumin levels in Model 3, the association strengthened (OR = 1.65, 95% CI: 1.28–2.12; P < 0.001). The persistent relationship remained statistically significant across progressive adjustment models. Similarly, the multivariable analysis demonstrated a dose-dependent association between deteriorating oral health status and chronic diarrhea incidence (OR = 1.61, 95% CI: 1.25–2.07; P < 0.001). Following full adjustment for demographic, socioeconomic and clinical confounders, oral health maintained significant association with chronic diarrhea (OR = 1.31, 95% CI: 1.07–1.71; P = 0.044). Further analysis revealed elevated risks of both constipation (Model 2 OR = 1.50, 95% CI:1.22–1.85; Model 3 aOR = 1.87, 1.35–2.59) and chronic diarrhea (OR = 1.76, 1.41–2.20) with frequent toothache episodes (all P < 0.001). These associations persisted across progressively adjusted models. Table 2 Association between chronic constipation, chronic constipation, and oral health Characteristic Model 1 Model 2 Model 3 OR (95% CI) P OR (95% CI) P OR (95% CI) P Chronic constipation Condition of teeth Excellent/ Very good 1(Ref) 1(Ref) 1(Ref) Good 1.26(1.01,1.58) 0.041 1.30 (1.01,1.68) 0.046 1.30(1.00,1.70) 0.052 Fair 1.23(0.92,1.65) 0.15 1.13(0.82,1.55) 0.4 1.12(0.81,1.56) 0.5 Poor 1.97(1.60,2.42) < 0.001 1.65(1.30, 2.09) < 0.001 1.65(1.28, 2.12) < 0.001 P for Trend < 0.001 0.002 0.003 Teethach Hardly ever/Never 1(Ref) 1(Ref) 1(Ref) Occasionally 1.50 (1.22,1.85) < 0.001 1.37 (1.12,1.69) 0.004 1.37 (1.11,1.68) 0.006 Very often/Fairly often 1.87 (1.35,2.59) < 0.001 1.43 (1.02,1.99) 0.038 1.43 (1.01,2.02) 0.044 P for Trend < 0.001 0.038 0.044 Chronic diarrhea Condition of teeth Excellent/ Very good 1(Ref) 1(Ref) 1(Ref) Good 1.09(0.89,1.34) 0.4 1.04 (0.84,1.29) 0.7 1.05(0.84,1.31) 0.7 Fair 1.39(1.09,1.77) 0.01 1.24(0.95,1.61) 0.1 1.24(0.94, 1.62) 0.11 Poor 1.61(1.25,2.07) < 0.001 1.32(1.03,1.70) 0.032 1.31(1.01, 1.71) 0.044 P for Trend < 0.001 0.013 0.02 Teethach Hardly ever/Never 1(Ref) 1(Ref) 1(Ref) Occasionally 1.26(0.99,1.60) 0.06 1.23 (0.95,1.60) 0.11 1.22(0.94,1.60) 0.12 Very often/Fairly often 1.76 (1.41,2.20) < 0.001 1.72 (1.39,2.14) < 0.001 1.69(1.35, 2.11) < 0.001 P for Trend < 0.001 < 0.001 < 0.001 95% CI: 95% confidence interval a Model 1: no covariates were adjusted b Model 2: adjusted for Age、Gender、Race、Education level、Marrired、PIR c Model 3: Based on model 2, further adjusted for Hypertension、Diabetes、CH、Cancer、ALB Figure 2 reveals the results of stratifying participants according to gender, age, BMI, diabetes mellitus, hypertension, coronary heart disease, history of tumors, smoking status, and alcohol consumption. Stratification analysis of the association between poor oral health and chronic constipation revealed that the association is stronger among those aged 40–60 years, those with BMI < 25, diabetes, hypertension, history of cancer, smokers, drinkers. (Fig. 2 A). Figure 2 B shows that in the stratified analysis of the correlation between poor oral health status and chronic diarrhea, the association was more pronounced in BMI 25–30, history of tumor, smokers and drinkers. Stratified analyses further identified a significant relationship between toothache frequency and chronic bowel symptoms. Specifically, in individuals with a BMI of < 25, coronary heart disease, history of oncology, smoking, and alcohol consumption, frequent toothache was associated with a higher risk of chronic diarrhea and constipation ( Supplementary table 2 and Supplementary table 3 ) 3.3 Relationships between oral health and all-cause mortality of participants with chronic diarrhea. We further analyzed the relationship between oral health status and mortality in a population with diarrhea and constipation. Baseline characteristics of the diarrhea and constipation populations according to oral health are displayed in Supplementary table 4 and Supplementary table 5 , respectively. Multivariable Cox regression showed no significant association between oral health status and all-cause mortality among participants with constipation(p > 0.05). However, further multivariable Cox regression analyses demonstrated that poor oral health status was significantly associated with increased all-cause mortality among participants with chronic diarrhea population (Model 4 adjusted HR = 2.79, 95% CI:1.64 ~ 4.75, P < 0.001). These associations persisted after sequential adjustment for important demographic, clinical covariates. (Model 6 adjusted HR = 1.66, 95% CI: 1.08 ~ 2.54, P = 0.039) (Table 3 ) Table 3 Association between Condition of Oral health and all-cause mortality of participants with Chronic Diarrhea Characteristic Model 1 a Model 2 b Model 3 c HR (95% CI) P -Value HR (95% CI) P -Value HR (95% CI) P -Value Condition of Oral health Excellent/ Very good 1(Ref) < 0.001 1(Ref) 0.030 1(Ref) 0.039 Good 1.79(1.17 ~ 2.75) 1.58(1.06 ~ 2.36) 1.60 (1.09 ~ 2.34) Fair 1.61 (1.05 ~ 2048) 1.57 (0.91 ~ 2.69) 1.69 (0.99 ~ 2.88) Poor 2.79(1.64 ~ 4.75) 1.78 (1.16 ~ 2.73) 1.66 (1.08 ~ 2.54) P for Trend < 0.001 0.023 0.0331 HR: Hazard Ratio 95% CI: 95% confidence interval a Model 1: no covariates were adjusted b Model 2: adjusted for Age、Gender、Race、Education level、Marrired、PIR c Model 3: Based on model 2, further adjusted for Smoke、Alcohol、CH、BMI、BUN、TC 4. Discussion Our analysis revealed a significant association between poor oral health, including increased frequency of dental pain, and Occurrence of functional bowel symptoms (CC and CD). It is worth noting that this correlation remains stable after gradually adjusting for confounding covariates from Model 1 to Model 3. Stratified analyses further showed that this association was even more marked in those who smoked, drank alcohol, and had a history of tumors. Furthermore, survival analyses suggested that poor oral health was correlated with higher all-cause mortality in participants with CD. Oral health and intestinal health are both important factors that affect human health and quality of life, and have attracted more and more attention in recent years. First, the link between bowel and oral health may stem from shared influencing factors such as diet, sleep, cardiovascular aspects, and physical activity. Movahed E et al. found a significant positive correlation between sleep disorders and oral health, potentially linked to the impact of sleep disorders on the immune system and systemic inflammation[ 22 ]. In addition, both prolonged and short sleep durations have been associated with a higher risk of chronic diarrhea and constipation[ 23 ].Animal studies have confirmed that sleep deprivation can lead to increased secretion of pro-inflammatory cytokines, activation of inflammation-related signaling pathways, and reduced gut microbiota diversity[ 24 , 25 ]. Cardiovascular health is known to be directly related to a variety of pathologies, including hypertension, hyperlipidemia, diabetes, atherosclerosis and obesity. The impact of these pathologies on overall health is often interrelated. A large cross-sectional study identified a link between poor oral health, periodontal disease, and hypertension prevalence[ 26 ].Mechanisms such as oxidative stress, inactivation of prostacyclin and nitric oxide (NO), and increased peripheral vascular resistance may underlie this association. Yu et al. demonstrated that maintaining cardiovascular health (CVH) at the population level was associated with reduced incidence and mortality of CD and CC[ 20 ]. Additionally, prolonged sedentary behavior is known to cause constipation but has no clear link to diarrhea. A study also found that high sedentary behavior (over 7.5 hours/day) is linked to a higher chance of periodontal disease[ 27 ]. The oral cavity and bowel are part of the same digestive tract, jointly involved in food digestion and absorption. Different dietary patterns have different effects on the oral and intestinal health. Gluten-free diet may help maintain high oral health standards, delay gum disease in some celiacs[ 28 ]. On the other hand, it may worsen bowel permeability and inflammation by reducing beneficial gut bacteria (e.g. Bifidobacterium bifidum and Lactobacillus) and lowering levels of short-chain fatty acids (SCFAs)[ 29 , 30 ]. Studies show that compared with a high-fat diet, a high-fiber diet can not only restore the diversity of the intestinal flora and improve metabolic disorders related to obesity[ 31 ], but also reduces plaque by regulating the oral flora[ 32 ]. The ectopic colonization of the flora and the modulation of inflammatory mediators may be a central mechanism underlying the link between the health of the oral and the bowel health. Kitamoto S et al.[ 33 ] found that oral pathogenic bacteria are enriched in the gut of colitis patients, exacerbating intestinal inflammation. They propose that periodontitis may amplify oral pathogens, when ingested and translocated to the gut, activate inflammasomes in colonic mononuclear phagocytes, thereby triggering inflammation. Additionally, periodontitis drives the production of reactive Th17 cells in the oral cavity. When activated by translocated oral pathogens, these cells further exacerbate intestinal inflammation. Another study suggests that oral Porphyromonas gingivalis, a typical periodontal bacterium, alters the gut microbiome, increasing the risk of bowel disease[ 34 ]. Even some oral commensal bacteria, such as Klebsiella, may induce a Th1 immune response in the gut after translocation via the oral-intestinal axis, leading to intestinal inflammation and diarrhoea[ 35 ]. Clostridium perfringens is a common oral commensal that is strongly associated with colorectal cancer. As an opportunistic pathogen, it can exacerbate colorectal cancer lesions by binding to Gal-GalNAc receptors in the intestinal epithelium through the adhesin Fap2, activating the NF-kB pathway, and releasing IL-8 and TNF-α[ 36 ]. The interaction between bowel health and oral health needs to be further substantiated by future advances in flora research. Lifestyle and health factors may play a mediating role in the connection between the gastrointestinal tract and other organs of the body. In this study, we revealed that the association between poor oral health and intestinal symptoms (CC and CD) was more pronounced among participants who differed in smoking and drinking and a history of tumors. Consistent with these findings, several studies have shown that smoking is not only a risk factor for increased incidence and progression of periodontitis, but also tends to induce oxidative stress, producing reactive oxygen species that can directly damage intestinal epithelial cells, triggering diarrhoea[ 37 , 38 ]. Alcohol consumption exerts direct effects on oral and intestinal health and may aggravate inflammatory responses and tissue damage through metabolites such as acetaldehyde. However, drinking certain types of alcohol in moderation may be good for gut health because they contain antioxidants and other beneficial components[ 39 ]. In addition, the mechanisms regarding the association of tumor history on both oral and intestinal health are still unclear. Evidence suggests a potential link between oral health and pancreatic cancer. Specific oral bacteria may increase pancreatic cancer risk. And Gut microbiota modulates immune responses and promotes tumor growth, playing a key role in pancreatic cancer development[ 40 ]. Therefore, we hypothesize that Cancer history may influence oral and gut microbiota, thereby indirectly affecting overall health. Poor oral health indicators, such as tooth loss, dental plaque, and periodontitis, compromise physical health and have been associated with elevated all-cause and cardiovascular mortality in multiple studies in recent years[ 41 – 43 ]. Meanwhile, Treatment of periodontal disease has been shown to reduce systemic inflammation and improve patient prognosis[ 44 ]. In the present study, the findings indicated that poor oral health exhibited a significant correlation with all-cause mortality in the population suffering from diarrhea; however, this association was not observed in the population experiencing constipation. This indicates that poor oral health may negatively impact the prognosis of patients with abnormal bowel symptoms, which may be attributed to several underlying mechanisms:(1)Poor oral health impairs chewing function, reducing food chewing efficiency and nutrient intake[ 45 ]. Chronic diarrhea patients often suffer from nutrient absorption issues due to intestinal dysfunction. Oral problems can worsen nutrient intake and digestion, affecting organ function and repair capacity, and may lead to poorer health and higher all-cause mortality. (2) Oral immunity normally suppresses pathogens. Poor oral health promotes dysbiosis and pathogen overgrowth. In chronic diarrhea patients, intestinal dysbiosis enables oral pathogens to colonize the gut, causing infection and inflammation[ 46 ]. This worsens diarrhea and forms a life-threatening cycle. (3) Oral diseases like periodontitis are chronic inflammatory conditions. In poor oral health, inflammatory mediators such as interleukin-6 and tumor necrosis factor-alpha enter the circulation, driving systemic inflammation[ 47 ]. In patients with diarrhea, this heightened systemic inflammation can further impair organ function and boost mortality risk. Our study has several strengths. First, we assessed overall oral health using both oral health status and the frequency of dental pain, which provides a more comprehensive evaluation than single-factor assessments. Second, our sample was derived from the NHANES database, which uses standardized testing methods and a nationally representative sample, enhancing the generalizability of our findings. Additionally, we performed subgroup analyses to evaluate the relationship between oral health and chronic diarrhea/constipation across different population characteristics. These analyses offer a theoretical basis for developing future oral health screening and intervention strategies. Our study also has some limitations. First, this was a cross-sectional study, which did not allow us to test the causal relationship between oral health and chronic diarrhea and constipation. Second, both oral health and intestinal health status were obtained through questionnaires, which may be subject to recall bias. In addition, the population of our study was focused on the US population, which lacks comparisons with other populations, and the findings may not be generalizable to other populations. Despite these limitations, to the best of our knowledge, this is the first study to assess the relationship between oral health and chronic diarrhea and constipation. It provides important insights into the association between oral health, diarrhea, and constipation, which may be used to reduce chronic diarrhea and constipation by improving oral health. 5. Conclusion Our study indicates that adults with poor oral health and frequent toothaches are more likely to develop chronic diarrhea and constipation, particularly among smokers, drinkers, and individuals with a tumor history. Poor oral health is also linked to a worse prognosis in patients with chronic diarrhea, suggesting a connection between oral and intestinal health. Further prospective studies are needed to confirm this relationship and explore its underlying mechanisms. Abbreviations FGIDs Functional gastrointestinal disorders CC Chronic Constipation CD Chronic Diarrhea NHANES National Health and Nutrition Examination Survey CAPI Computer-assisted Personal Interview BSFS Bristol Stool Form Scale NO Nitric Oxide CVH Cardiovascular Health SCFAs Short-chain Fatty Acids Declarations Acknowledgments We are appreciative of the founders and participants in the NHANES program. Author contributions Kang Li collected data, analyzed relevant information, and drafted the manuscript, Xingxing Liu and Taiyu Chen collected data, analyzed relevant information. Xiaolong Ying and Yonghua Zeng checked the content for errors. Chunyan Zeng, Yixing Luo and Xu Shu designed the article, revised the manuscript, and approved the final submission. * Kang Li, Xingxing Liu and Taiyu Chen are equal primary authors. Funding This work was supported by the Double-Thousand Plan of Jiangxi Province (No. jxsq2023201044). Data availability All the data used in the study can be accessed through the National Center for Health Statistics website(https://wwwn.cdc.gov/nchs/nhanes/). Conflicts of Interest The authors declare no competing interests. References Sperber AD, Bangdiwala SI, Drossman DA, Ghoshal UC, Simren M, Tack J, et al. Worldwide Prevalence and Burden of Functional Gastrointestinal Disorders, Results of Rome Foundation Global Study. Gastroenterology. 2021;160:99–e1143. Mugie SM, Benninga MA, Di Lorenzo C. Epidemiology of constipation in children and adults: a systematic review. Best Pract Res Clin Gastroenterol. 2011;25:3–18. Burgers K, Lindberg B, Bevis ZJ. Chronic Diarrhea in Adults: Evaluation and Differential Diagnosis. Am Fam Physician. 2020;101:472–80. Drossman DA. Functional Gastrointestinal Disorders: History, Pathophysiology, Clinical Features and Rome IV. Gastroenterology 2016;:S0016-5085(16)00223-7. Matsumoto Y, Nadatani Y, Otani K, Higashimori A, Ominami M, Fukunaga S, et al. Prevalence and risk factor for chronic diarrhea in participants of a Japanese medical checkup. JGH Open. 2022;6:69–75. Webster LR, Nalamachu S, Morlion B, Reddy J, Baba Y, Yamada T, et al. Long-term use of naldemedine in the treatment of opioid-induced constipation in patients with chronic noncancer pain: a randomized, double-blind, placebo-controlled phase 3 study. Pain. 2018;159:987–94. Schiller LR, Pardi DS, Sellin JH. Chronic Diarrhea: Diagnosis and Management. Clin Gastroenterol Hepatol. 2017;15:182–e1933. Rao SSC, Rattanakovit K, Patcharatrakul T. Diagnosis and management of chronic constipation in adults. Nat Rev Gastroenterol Hepatol. 2016;13:295–305. Ballou S, Katon J, Singh P, Rangan V, Lee HN, McMahon C, et al. Chronic Diarrhea and Constipation Are More Common in Depressed Individuals. Clin Gastroenterol Hepatol. 2019;17:2696–703. Wang D, Li Y, Shi Y, Hu Z. U-shaped association between sleep duration with chronic constipation and diarrhea: A population-based study. Chronobiol Int. 2022;39:1656–64. Wilson PB. Associations between physical activity and constipation in adult Americans: Results from the National Health and Nutrition Examination Survey. Neurogastroenterol Motil. 2020;32:e13789. Liu X, Wang Y, Shen L, Sun Y, Zeng B, Zhu B, et al. Association between frailty and chronic constipation and chronic diarrhea among American older adults: National Health and Nutrition Examination Survey. BMC Geriatr. 2023;23:745. Li Y, Chen Y, Yu Z, Bai X, Ruan G, Sun Y, et al. Exploring the Association Between Food Insecurity, Bowel Health, and All-Cause Mortality in the United States: Insights from NHANES 2005–2010. J Gastroenterol Hepatol. 2025;40:653–65. Gao L, Xu T, Huang G, Jiang S, Gu Y, Chen F. Oral microbiomes: more and more importance in oral cavity and whole body. Protein Cell. 2018;9:488–500. Si J, Lee C, Ko G. Oral Microbiota: Microbial Biomarkers of Metabolic Syndrome Independent of Host Genetic Factors. Front Cell Infect Microbiol. 2017;7:516. Tortora SC, Agurto MG, Martello LA. The oral-gut-circulatory axis: from homeostasis to colon cancer. Front Cell Infect Microbiol. 2023;13:1289452. Gasmi Benahmed A, Gasmi A, Arshad M, Shanaida M, Lysiuk R, Peana M, et al. Health benefits of xylitol. Appl Microbiol Biotechnol. 2020;104:7225–37. Bajaj JS, Matin P, White MB, Fagan A, Deeb JG, Acharya C, et al. Periodontal therapy favorably modulates the oral-gut-hepatic axis in cirrhosis. Am J Physiol Gastrointest Liver Physiol. 2018;315:G824–37. Hung M, Moffat R, Gill G, Lauren E, Ruiz-Negrón B, Rosales MN, et al. Oral health as a gateway to overall health and well-being: Surveillance of the geriatric population in the United States. Spec Care Dentist. 2019;39:354–61. Yu Z, Guo M, Bai X, Ruan G, Sun Y, Han W, et al. Exploring the association between cardiovascular health and bowel health. Sci Rep. 2024;14:11819. Peng X, Li J, Wu Y, Dai H, Lynn HS, Zhang X. Association of Stool Frequency and Consistency with the Risk of All-Cause and Cause-Specific Mortality among U.S. Adults: Results from NHANES 2005–2010. Healthcare (Basel). 2022;11. Movahed E, Moradi S, Mortezagholi B, Shafiee A, Moltazemi H, Hajishah H, et al. Investigating oral health among US adults with sleep disorder: a cross-sectional study. BMC Oral Health. 2023;23:996. Zhang G, Wang S, Ma P, Wang T, Sun X, Zhang X, et al. Association of habitual sleep duration with abnormal bowel symptoms: a cross-sectional study of the 2005–2010 national health and nutrition examination survey. J Health Popul Nutr. 2024;43:125. Voigt RM, Summa KC, Forsyth CB, Green SJ, Engen P, Naqib A, et al. The Circadian Clock Mutation Promotes Intestinal Dysbiosis. Alcohol Clin Exp Res. 2016;40:335–47. Dong L, Xie Y, Zou X. Association between sleep duration and depression in US adults: A cross-sectional study. J Affect Disord. 2022;296:183–8. Li Y, Yuan X, Zheng Q, Mo F, Zhu S, Shen T, et al. The association of periodontal disease and oral health with hypertension, NHANES 2009–2018. BMC Public Health. 2023;23:1122. Almohamad M, Krall Kaye E, Mofleh D, Spartano NL. The association of sedentary behaviour and physical activity with periodontal disease in NHANES 2011–2012. J Clin Periodontol. 2022;49:758–67. Cervino G, Fiorillo L, Laino L, Herford AS, Lauritano F, Giudice GL, et al. Oral Health Impact Profile in Celiac Patients: Analysis of Recent Findings in a Literature Review. Gastroenterol Res Pract. 2018;2018:7848735. Matera M, Guandalini S. How the Microbiota May Affect Celiac Disease and What We Can Do. Nutrients. 2024;16. De Angelis M, Vannini L, Di Cagno R, Cavallo N, Minervini F, Francavilla R, et al. Salivary and fecal microbiota and metabolome of celiac children under gluten-free diet. Int J Food Microbiol. 2016;239:125–32. Klingbeil EA, Cawthon C, Kirkland R, de La Serre CB. Potato-Resistant Starch Supplementation Improves Microbiota Dysbiosis, Inflammation, and Gut-Brain Signaling in High Fat-Fed Rats. Nutrients. 2019;11. Swarnamali H, Medara N, Chopra A, Spahr A, Jayasinghe TN. Role of Dietary Fibre in Managing Periodontal Diseases-A Systematic Review and Meta-Analysis of Human Intervention Studies. Nutrients. 2023;15. Atarashi K, Suda W, Luo C, Kawaguchi T, Motoo I, Narushima S, et al. Ectopic colonization of oral bacteria in the intestine drives T(H)1 cell induction and inflammation. Science. 2017;358:359–65. Rubinstein MR, Wang X, Liu W, Hao Y, Cai G, Han YW. Fusobacterium nucleatum promotes colorectal carcinogenesis by modulating E-cadherin/β-catenin signaling via its FadA adhesin. Cell Host Microbe. 2013;14:195–206. Hu J, Zou H, Qiao X, Wang Y, Lv M, Zhang K, et al. The relationship between oxidative balance scores and chronic diarrhea and constipation: a population-based study. BMC Public Health. 2024;24:1366. Leite FRM, Nascimento GG, Scheutz F, López R. Effect of Smoking on Periodontitis: A Systematic Review and Meta-regression. Am J Prev Med. 2018;54:831–41. Haber J. Smoking is a major risk factor for periodontitis. Curr Opin Periodontol. 1994;:12–8. Cervino G, Fiorillo L, Laino L, Herford AS, Lauritano F, Giudice GL, et al. Oral Health Impact Profile in Celiac Patients: Analysis of Recent Findings in a Literature Review. Gastroenterol Res Pract. 2018;2018:7848735. Subramanian SK, Brahmbhatt B, Bailey-Lundberg JM, Thosani NC, Mutha P. Lifestyle Medicine for the Prevention and Treatment of Pancreatitis and Pancreatic Cancer. Diagnostics (Basel). 2024;14. Tu Y-K, Galobardes B, Smith GD, McCarron P, Jeffreys M, Gilthorpe MS. Associations between tooth loss and mortality patterns in the Glasgow Alumni Cohort. Heart. 2007;93:1098–103. Liu J, Zong X, Vogtmann E, Cao C, James AS, Chan AT, et al. Tooth count, untreated caries and mortality in US adults: a population-based cohort study. Int J Epidemiol. 2022;51:1291–303. Falcao A, Bullón P. A review of the influence of periodontal treatment in systemic diseases. Periodontol 2000. 2019;79:117–28. De Angelis M, Vannini L, Di Cagno R, Cavallo N, Minervini F, Francavilla R, et al. Salivary and fecal microbiota and metabolome of celiac children under gluten-free diet. Int J Food Microbiol. 2016;239:125–32. Okada M, Hama Y, Futatsuya R, Sasaki Y, Noritake K, Yamaguchi K et al. Association between Masticatory Performance, Nutritional Intake, and Frailty in Japanese Older Adults. Nutrients. 2023;15. Catalan EA, Seguel-Fuentes E, Fuentes B, Aranguiz-Varela F, Castillo-Godoy DP, Rivera-Asin E et al. Oral Pathobiont-Derived Outer Membrane Vesicles in the Oral-Gut Axis. Int J Mol Sci. 2024;25. Li L, Zhang Y-L, Liu X-Y, Meng X, Zhao R-Q, Ou L-L, et al. Periodontitis Exacerbates and Promotes the Progression of Chronic Kidney Disease Through Oral Flora, Cytokines, and Oxidative Stress. Front Microbiol. 2021;12:656372. Li L, Zhang Y-L, Liu X-Y, Meng X, Zhao R-Q, Ou L-L, et al. Periodontitis Exacerbates and Promotes the Progression of Chronic Kidney Disease Through Oral Flora, Cytokines, and Oxidative Stress. Front Microbiol. 2021;12:656372. Additional Declarations No competing interests reported. Supplementary Files file.docx 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. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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-6726151","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":473449391,"identity":"1a73fc86-776c-4d15-9cad-00f6e299a7e9","order_by":0,"name":"Kang Li","email":"","orcid":"","institution":"First Affiliated Hospital of Nanchang University","correspondingAuthor":false,"prefix":"","firstName":"Kang","middleName":"","lastName":"Li","suffix":""},{"id":473449392,"identity":"4d1ae26d-631f-4cbe-8d31-49bb7e510ecc","order_by":1,"name":"Xingxing Liu","email":"","orcid":"","institution":"First Affiliated Hospital of Nanchang University","correspondingAuthor":false,"prefix":"","firstName":"Xingxing","middleName":"","lastName":"Liu","suffix":""},{"id":473449393,"identity":"d32131d5-a7a2-4709-ad10-026740761208","order_by":2,"name":"Taiyu Chen","email":"","orcid":"","institution":"First Affiliated Hospital of Nanchang University","correspondingAuthor":false,"prefix":"","firstName":"Taiyu","middleName":"","lastName":"Chen","suffix":""},{"id":473449394,"identity":"86ca2669-8cee-4f0e-b97b-e027ebba20ab","order_by":3,"name":"Yonghua Zeng","email":"","orcid":"","institution":"First Affiliated Hospital of Nanchang University","correspondingAuthor":false,"prefix":"","firstName":"Yonghua","middleName":"","lastName":"Zeng","suffix":""},{"id":473449395,"identity":"5ae731c3-aab5-4b09-95d3-49f55f441ac6","order_by":4,"name":"Xiaolong Ying","email":"","orcid":"","institution":"First Affiliated Hospital of Nanchang University","correspondingAuthor":false,"prefix":"","firstName":"Xiaolong","middleName":"","lastName":"Ying","suffix":""},{"id":473449396,"identity":"7b7db27e-0f4f-4c6a-ba5a-5d39fb77eb09","order_by":5,"name":"Chunyan Zeng","email":"","orcid":"","institution":"Jiangxi Province Hospital of Integrated Chinese and Western Medicine","correspondingAuthor":false,"prefix":"","firstName":"Chunyan","middleName":"","lastName":"Zeng","suffix":""},{"id":473449397,"identity":"1db08cfb-5372-4ce3-916d-aa1ac8df7797","order_by":6,"name":"Yixing Luo","email":"","orcid":"","institution":"First Affiliated Hospital of Nanchang University","correspondingAuthor":false,"prefix":"","firstName":"Yixing","middleName":"","lastName":"Luo","suffix":""},{"id":473449398,"identity":"4f444368-8643-4baf-b956-3b053bb2938f","order_by":7,"name":"Xu Shu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAtElEQVRIiWNgGAWjYBACxgYIIcfG3nyANC3GfDzHEkizKnGeRI4CcaqZZ2SnSf7ccTi9jSGHgeFHxTYiLOg5u02a90xabhvD2QOMPWduE6GlvXebNGObTW4bY18CM2MbMVqaebdJ/myTSGdj5jEgUgvQFgneNpsENjaitfSc3WzN25Zm2MbDlnCQKL8YzsjdePNn22F5+fmPDz74UUGMlgYkzgHC6oFAnihVo2AUjIJRMLIBAAoPOfNxDHgTAAAAAElFTkSuQmCC","orcid":"","institution":"First Affiliated Hospital of Nanchang University","correspondingAuthor":true,"prefix":"","firstName":"Xu","middleName":"","lastName":"Shu","suffix":""}],"badges":[],"createdAt":"2025-05-22 14:53:22","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6726151/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6726151/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":85175964,"identity":"cbfe680e-eaa1-42b8-a494-749aa5b4f675","added_by":"auto","created_at":"2025-06-23 06:32:40","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":128955,"visible":true,"origin":"","legend":"\u003cp\u003eFlowchart of participants.\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-6726151/v1/1cde1ea73e8eae9aa28bb76d.jpeg"},{"id":85175966,"identity":"8b1b1947-7681-4f20-90b2-895c9a78d267","added_by":"auto","created_at":"2025-06-23 06:32:40","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":210211,"visible":true,"origin":"","legend":"\u003cp\u003eShows that in the stratified analysis of the correlation between oral health status and chronic constipation and chronic diarrhea.\u003cstrong\u003e Fig. 2A. \u003c/strong\u003eStratified analysis of chronic constipation across poor oral health; \u003cstrong\u003eFig. 2B. \u003c/strong\u003eStratified analysis of chronic diarrhea across poor oral health.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-6726151/v1/6471bc0bd452f6ecd9b2848a.png"},{"id":91332450,"identity":"ab0498e4-6fa6-4508-9707-7560be4469f2","added_by":"auto","created_at":"2025-09-15 11:11:55","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1472317,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6726151/v1/209b3b38-45b9-4525-8ba5-e69363114f7b.pdf"},{"id":85175965,"identity":"ee73e9fa-d360-4ffc-8b55-554222b779c8","added_by":"auto","created_at":"2025-06-23 06:32:40","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":99691,"visible":true,"origin":"","legend":"","description":"","filename":"file.docx","url":"https://assets-eu.researchsquare.com/files/rs-6726151/v1/c1e5a48bb0cfe54593fa1429.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Effect of oral health on chronic intestinal diseases and all-cause mortality in US adults: results from the NHANES 2005-2008 database","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eFunctional gastrointestinal disorders (FGIDs) represent a prevalent class of digestive diseases globally, characterized primarily by chronic constipation(CC), chronic diarrhea(CD), and abdominal pain. Given their high prevalence, FGIDs have long been a central focus in gastroenterology research. These conditions not only impair daily functioning but also impose a substantial burden on healthcare systems worldwide[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Epidemiological studies estimate that CD affects 1%-5% of adults worldwide, while CC demonstrates significantly higher prevalence, occurring in approximately 16% of the global adult population. In specific populations, particularly older adults, the prevalence of chronic constipation reaches as high as 79%[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Chronic diarrhea requires\u0026thinsp;\u0026gt;\u0026thinsp;3 daily bowel movements or \u0026gt;\u0026thinsp;200g stool output (water content\u0026thinsp;\u0026gt;\u0026thinsp;85%) persisting\u0026thinsp;\u0026gt;\u0026thinsp;4 weeks, while chronic constipation is defined by \u0026lt;\u0026thinsp;3 weekly defecations with hard stools (Bristol 1\u0026ndash;2) and/or straining, lasting\u0026thinsp;\u0026gt;\u0026thinsp;6 months[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Existing evidence demonstrates that chronic diarrhea and constipation exhibit multifactorial etiology involving obesity, dietary patterns, lifestyle factors, medication use, psychological conditions, and underlying pathologies[\u003cspan additionalcitationids=\"CR6 CR7\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Chronic diarrhea and constipation significantly compromised patients' holistic health and quality of life while concurrently generating substantial socioeconomic burdens encompassing social isolation, diminished work efficiency, and productivity losses[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Prior research has extensively examined the roles of physical activity, sleep duration, frailty, and food insecurity in chronic gastrointestinal dysfunction, While the potential influence of oral health remains largely unexplored[\u003cspan additionalcitationids=\"CR11 CR12\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e The oral cavity serves as both the gateway to the human digestive tract and a reservoir of complex microbial communities. These oral microbiota play a critical role in systemic health maintenance by modulating nutrient assimilation, xenobiotic metabolism, and immunomodulatory processes[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. In recent years, studies have shown that the oral microbiota not only affects the risk of local periodontal and dental caries, but is also closely related to gastrointestinal, neurological, endocrine, immunological and cardiovascular diseases[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. The oral microbiome may regulate distal gastrointestinal function through the gut-oral axis, potentially impacting systemic health[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. This mechanism also provides a theoretical basis for exploring the relationship between oral health and chronic gastrointestinal symptoms (such as diarrhea and constipation). Notably, recent evidence indicates that oral health interventions may offer benefits for gut regulation. For instance, Gasmi Benahmed A et al. demonstrated that xylitol, an anti-caries sweetener, could indirectly alter intestinal microbiota composition by suppressing pathogenic streptococci proliferation, thereby promoting intestinal well-being[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. In patients with liver cirrhosis, periodontal therapy has been shown to mitigate inflammation and endotoxemia through modulation of the oral-intestinal-liver axis[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Recognizing the significant link between oral and gut health, we analyzed data from the 2005\u0026ndash;2008 National Health and Nutrition Examination Survey (NHANES) to investigate how oral health relates to the risk of chronic constipation and diarrhea, and to evaluate its influence on all-cause mortality among patients with abnormal gut function. This study addresses a research gap by offering novel insights into the oral-gut health relationship, which may inform strategies for preventing and treating functional gastrointestinal disorders. Additionally, it provides a scientific foundation for public health initiatives focused on oral health interventions.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1. Study Design and Population\u003c/h2\u003e \u003cp\u003eNHANES is a publicly available research project conducted by the National Center for Health Statistics at the Centers for Disease Control (Atlanta, Georgia, USA). Using a complex, stratified, multistage, whole-population sampling methodology, NHANES ensures representative estimates of the noninstitutionalized population of the United States. The survey collects a wide range of data, including demographic information, physical examination findings, and laboratory specimens, through household interviews and visits to screening centers. All data and guidelines are available to the public on the National Center for Health Statistics website (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.cdc.gov/nchs/nhanes/\u003c/span\u003e\u003cspan address=\"https://www.cdc.gov/nchs/nhanes/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e index. htm). Each cycle of NHANES was approved by the National Center for Health Statistics Research Ethics Review Board, and all participants provided written informed consent. Data from two cycles (2005\u0026ndash;2008) were analyzed. All participants with a total of 20,497 cases from 2005 to 2008 were included, with the exception of those with incomplete gut health data (N\u0026thinsp;=\u0026thinsp;11,141), missing oral health data (N\u0026thinsp;=\u0026thinsp;37), or missing significant covariates (N\u0026thinsp;=\u0026thinsp;88) (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). In total, 9,231 patients were analyzed.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Variables for evaluating oral health and gut health\u003c/h2\u003e \u003cp\u003eThe oral health assessment utilized the results of a questionnaire for self-assessment through the following question:\u0026ldquo;Overall, how would you rate the health of your teeth and gums?\u0026rdquo;The answers were as follows: excellent, very good, good, fair and poor[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. We also studied the frequency of dental pain, self-assessed by the questionnaire, \u0026ldquo;How often did you have oral pain in the last year?\u0026rdquo; The answers were: often, fairly often, occasionally, almost never, never. The oral health questionnaire was completed at home before the physical examination using a computer-assisted personal interview CAPI) system.\u003c/p\u003e \u003cp\u003eThe Bowel Health Questionnaire was used to assess bowel health. A computer-assisted personal interview system administered by an interviewer was used at a mobile testing center. The questionnaire covered fecal incontinence, stool characteristics and bowel frequency. Stool consistency was measured using the Bristol Stool Form Scale (BSFS), together with questions about bowel frequency (e.g. \"How many times a week do you usually have a bowel movement?\"). Chronic constipation was defined as BSFS type 1 or 2 or fewer than 3 bowel movements per week, and chronic diarrhea was defined as BSFS type 6 or 7 or 21 or more bowel movements per week. BSFS types 3, 4, and 5 and other bowel frequency were classified as no bowel symptoms[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Assessing bowel health by considering the frequency and consistency of bowel movements is considered to be more reasonable and valid than using a single parameter[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3. covariates\u003c/h2\u003e \u003cp\u003eWe conducted a comprehensive analysis of demographic and laboratory data and questionnaires from the NHANES database. Important covariates included age, sex, race, education, marital status, household income to poverty income ratio, smoking, alcohol use, hypertension, diabetes, coronary artery disease, history of neoplasm, body mass index (BMI), albumin, cholesterol, urea nitrogen, creatinine, Mortal State, and duration of follow-up. Race/ethnicity was categorized as non-Hispanic white, non-Hispanic black, Mexican-American, and other. Marital status was categorized as married versus other. Educational attainment was categorized as less than 9 years of education, 9 to 12 years of education, and more than 12 years of education. Household income was categorized by poverty income ratio (PIR) into three groups: low (PIR\u0026thinsp;\u0026le;\u0026thinsp;1.3), medium (PIR\u0026thinsp;\u0026gt;\u0026thinsp;1.3 to 3.5), and high (PIR\u0026thinsp;\u0026gt;\u0026thinsp;3.5). Smoking was defined as having smoked at least 100 cigarettes during lifetime. Alcohol consumption was defined as having had at least 12 drinks of any type of alcoholic beverage in a year. Preexisting conditions (hypertension, diabetes, coronary artery disease) were determined by a questionnaire asking whether the doctor had been informed of the condition in the past. BMI was calculated using a standardized technique based on weight and height. Albumin, cholesterol, urea nitrogen, and creatinine were analyzed using the Beckman Synchron LX20.Mortality status and cause of death for NHANES participants were ascertained through linkage with the National Death Index death certificate records. All-cause mortality served as the primary endpoint, with follow-up continuing through December 2019.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.4. Statistical method\u003c/h2\u003e \u003cp\u003eContinuous variables were described using mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (SD) for normal distributions and median (interquartile range, IQR) for non-normal distributions. Categorical variables were presented as frequencies and percentages [n (%)]. Group comparisons for continuous variables were performed using t-tests or Mann-Whitney U tests, while chi-square tests were used for categorical variables. To examine the relationship between oral health and chronic diarrhea/constipation, three multivariable logistic regression models were constructed: Model 1 (unadjusted), Model 2 (adjusted for age, sex, race, education, marital status, and family income-to-poverty ratio), and Model 3 (further adjusted for hypertension, diabetes, coronary heart disease, cancer history, and albumin). Results were expressed as odds ratios (ORs) with 95% confidence intervals (95% CIs). Subgroup analyses were conducted to evaluate the associations between oral health and chronic diarrhea/constipation risk across different population characteristics. To further investigate all-cause mortality in individuals with abnormal gut health (chronic diarrhea or constipation), three Cox proportional hazards models were constructed. Model 4 and 5 were adjusted for the same covariates as Models 1 and 2, while Model 6 included additional adjustments for smoking, alcohol consumption, coronary heart disease, body mass index (BMI), serum creatinine, and total cholesterol(TC) based on Model 2. Additionally, multiple imputation was used to handle missing data and reduce bias. All statistical analyses were two-sided, with \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 indicating statistical significance. Statistical analyses were performed using R version 4.3.2 and Fengrui Statistics version 2.1.\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e3.1Baseline characteristics of the participants\u003c/h2\u003e \u003cp\u003eAccording to their chronic intestinal symptoms, Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e summarizes the clinical baseline characteristics of all participants. In a total of 9231 participants, 10.37% (957/9231) of patients with chronic constipation and 12.06% (1113/9231) of patients with chronic diarrhea were included. The mean age of all participants was 49.08\u0026thinsp;\u0026plusmn;\u0026thinsp;18.08 years, with 49% male. Compared with the healthy group, patients with chronic constipation and diarrhea showed statistically significant lower education, poverty, lower albumin, poorer oral health, frequent/occasional toothache (all \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). \u003cb\u003eSupplementary table \u003cspan refid=\"MOESM1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003c/b\u003e shows the baseline characteristics of patients grouped by oral health. It reveals that among the participants whose oral condition is self-evaluated as poor, the proportion of chronic diarrhea and constipation is higher (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and the percentage of deaths is higher(p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) with statistical differences.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline characteristics of overall participants according to Different chronic intestinal symptoms\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003evariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl \u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;7161\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eConstipation \u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;957\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eDiarrhea \u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;1113\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e46.33\u0026plusmn; (16.56)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44.15\u0026plusmn; (17.52)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e48.87\u0026plusmn; (15.58)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.867\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003emale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3,700 (51%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e259 (24%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e556 (52%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003efemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3,461 (49%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e698 (76%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e557 (48%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRace\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-Hispanic white\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3,645 (73%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e417 (66%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e475 (67%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-Hispanic black\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,423 (10.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e267 (17%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e269 (13%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMexican American\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,306 (7.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e164 (7.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e242 (10%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e787 (9.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e109 (9.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e127 (9.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducation level (year), n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;9\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e790 (5.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e131 (7.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e184 (9.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e9\u0026ndash;12\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2,822 (36%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e455 (45%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e473 (38%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e\u0026gt;\u0026thinsp;12\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3,549 (59%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e371 (47%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e456 (52%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarrired\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.480\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried/Partner\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4,512 (66%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e538 (59%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e673 (65%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003esingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2,649 (34%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e419 (41%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e440 (35%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePIR, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.009\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;1.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,928 (17%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e338 (26%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e371 (23%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1.3\u0026ndash;3.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2,773 (36%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e390 (40%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e434 (37%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;3.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2,460 (47%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e229 (34%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e308 (41%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI (kg/m2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28.50\u0026plusmn; (6.48)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27.77\u0026plusmn; (6.70)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e30.37\u0026plusmn; (8.04)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTC(mg/dL), Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e197.74\u0026plusmn; (41.22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e199.16\u0026plusmn; (42.65)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.714\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e200.96\u0026plusmn; (42.01)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.008\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBUN(mg/dL), Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12.76\u0026plusmn; (5.13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12.24\u0026plusmn; (5.30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12.98\u0026plusmn; (5.35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.396\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eALB(g/dL), Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.26\u0026plusmn; (0.34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.17\u0026plusmn; (0.37)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.21\u0026plusmn; (0.35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.012\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCr(mg/dL), Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.90\u0026plusmn; (0.31)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.85\u0026plusmn; (0.33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.91\u0026plusmn; (0.34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.802\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.518\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6,401 (93%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e853 (92%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e939 (88%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e760 (7.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e104 (7.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e174 (12%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.080\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4,776 (70%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e692 (73%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e635 (62%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2,385 (30%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e265 (27%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e478 (38%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ecoronary heart disease, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.138\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.243\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6,866 (97%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e923 (97%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1,073 (97%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e295 (3.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34 (2.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e40 (2.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCancer, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.447\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.016\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6,543 (92%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e870 (91%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e988 (89%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e618 (8.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e87 (9.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e125 (11%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCurrent smoking status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3,711 (52%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e568 (59%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e531 (46%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3,450 (48%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e389 (41%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e582 (54%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlcohol consumption,\u003c/p\u003e \u003cp\u003en(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.071\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,977 (23%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e395 (37%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e366 (27%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5,184 (77%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e562 (63%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e747 (73%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eteeth ach\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHardly ever/Never\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e495 (6.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e102 (10%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e113 (10%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOccasionally\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,084 (14%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e190 (18%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e189 (16%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVery often/Fairly often\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5,582 (80%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e665 (71%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e811 (74%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCondition of teeth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExcellent/ Very good\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2,242 (37%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e258 (30%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e302 (32%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGood\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2,331 (33%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e312 (34%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e321 (31%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFair\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,549 (19%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e211 (19%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e277 (22%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePoor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,039 (11%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e176 (17%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e213 (15%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eMedian (IQR) for continuous variables;\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eN (%) for categorical variables;\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eAbbreviations: PIR: Ratio of household income to poverty, BMI: Body mass index, TC: Total cholesterol, BUN: Blood Urea Nitrogen, ALB: Albumin, Cr: Creatinine\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e3.2 Relationships between the oral health and Bowel Health\u003c/h2\u003e \u003cp\u003eThe relationship between oral health, frequency of toothache and chronic diarrhea and constipation is shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. We found a positive correlation between poor oral health and an increase in chronic constipation. In Model 2 of the multivariable logistic regression analysis adjusting for demographic covariates (age, gender, race, education, marital status, and poverty-income ratio), the adjusted odds ratio (OR) was 1.65 (95% CI:1.30\u0026ndash;2.09; \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). After further adjustment for clinical comorbidities (hypertension, diabetes, coronary heart disease, cancer history) and albumin levels in Model 3, the association strengthened (OR\u0026thinsp;=\u0026thinsp;1.65, 95% CI: 1.28\u0026ndash;2.12; \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The persistent relationship remained statistically significant across progressive adjustment models. Similarly, the multivariable analysis demonstrated a dose-dependent association between deteriorating oral health status and chronic diarrhea incidence (OR\u0026thinsp;=\u0026thinsp;1.61, 95% CI: 1.25\u0026ndash;2.07; \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Following full adjustment for demographic, socioeconomic and clinical confounders, oral health maintained significant association with chronic diarrhea (OR\u0026thinsp;=\u0026thinsp;1.31, 95% CI: 1.07\u0026ndash;1.71; \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.044). Further analysis revealed elevated risks of both constipation (Model 2 OR\u0026thinsp;=\u0026thinsp;1.50, 95% CI:1.22\u0026ndash;1.85; Model 3 aOR\u0026thinsp;=\u0026thinsp;1.87, 1.35\u0026ndash;2.59) and chronic diarrhea (OR\u0026thinsp;=\u0026thinsp;1.76, 1.41\u0026ndash;2.20) with frequent toothache episodes (all \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). These associations persisted across progressively adjusted models.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAssociation between chronic constipation, chronic constipation, and oral health\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eModel 1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eModel 2\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eModel 3\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eOR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eChronic constipation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCondition of teeth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExcellent/ Very good\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1(Ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1(Ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1(Ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGood\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.26(1.01,1.58)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.041\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.30 (1.01,1.68)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.046\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.30(1.00,1.70)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.052\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFair\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.23(0.92,1.65)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.13(0.82,1.55)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.12(0.81,1.56)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePoor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.97(1.60,2.42)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.65(1.30, 2.09)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.65(1.28, 2.12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e for Trend\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTeethach\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHardly ever/Never\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1(Ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1(Ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1(Ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOccasionally\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.50 (1.22,1.85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.37 (1.12,1.69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.37 (1.11,1.68)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.006\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVery often/Fairly often\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.87 (1.35,2.59)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.43 (1.02,1.99)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.038\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.43 (1.01,2.02)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.044\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e for Trend\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.038\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.044\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eChronic diarrhea\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCondition of teeth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExcellent/ Very good\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1(Ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1(Ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1(Ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGood\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.09(0.89,1.34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.04 (0.84,1.29)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.05(0.84,1.31)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFair\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.39(1.09,1.77)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.24(0.95,1.61)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.24(0.94, 1.62)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePoor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.61(1.25,2.07)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.32(1.03,1.70)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.032\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.31(1.01, 1.71)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.044\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e for Trend\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.013\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTeethach\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHardly ever/Never\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1(Ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1(Ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1(Ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOccasionally\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.26(0.99,1.60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.23 (0.95,1.60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.22(0.94,1.60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVery often/Fairly often\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.76 (1.41,2.20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.72 (1.39,2.14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.69(1.35, 2.11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e for Trend\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e95% CI: 95% confidence interval\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e\u003csup\u003ea\u003c/sup\u003e Model 1: no covariates were adjusted\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e\u003csup\u003eb\u003c/sup\u003e Model 2: adjusted for Age、Gender、Race、Education level、Marrired、PIR\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e\u003csup\u003ec\u003c/sup\u003e Model 3: Based on model 2, further adjusted for Hypertension、Diabetes、CH、Cancer、ALB\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eFigure \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e reveals the results of stratifying participants according to gender, age, BMI, diabetes mellitus, hypertension, coronary heart disease, history of tumors, smoking status, and alcohol consumption. Stratification analysis of the association between poor oral health and chronic constipation revealed that the association is stronger among those aged 40\u0026ndash;60 years, those with BMI\u0026thinsp;\u0026lt;\u0026thinsp;25, diabetes, hypertension, history of cancer, smokers, drinkers. (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eA).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eFigure \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eB shows that in the stratified analysis of the correlation between poor oral health status and chronic diarrhea, the association was more pronounced in BMI 25\u0026ndash;30, history of tumor, smokers and drinkers. Stratified analyses further identified a significant relationship between toothache frequency and chronic bowel symptoms. Specifically, in individuals with a BMI of \u0026lt;\u0026thinsp;25, coronary heart disease, history of oncology, smoking, and alcohol consumption, frequent toothache was associated with a higher risk of chronic diarrhea and constipation (\u003cb\u003eSupplementary table 2 and Supplementary table 3\u003c/b\u003e)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e3.3 Relationships between oral health and all-cause mortality of participants with chronic diarrhea.\u003c/h2\u003e \u003cp\u003eWe further analyzed the relationship between oral health status and mortality in a population with diarrhea and constipation. Baseline characteristics of the diarrhea and constipation populations according to oral health are displayed in \u003cb\u003eSupplementary table 4 and Supplementary table 5\u003c/b\u003e, respectively. Multivariable Cox regression showed no significant association between oral health status and all-cause mortality among participants with constipation(p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). However, further multivariable Cox regression analyses demonstrated that poor oral health status was significantly associated with increased all-cause mortality among participants with chronic diarrhea population (Model 4 adjusted HR\u0026thinsp;=\u0026thinsp;2.79, 95% CI:1.64\u0026thinsp;~\u0026thinsp;4.75, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). These associations persisted after sequential adjustment for important demographic, clinical covariates. (Model 6 adjusted HR\u0026thinsp;=\u0026thinsp;1.66, 95% CI: 1.08\u0026thinsp;~\u0026thinsp;2.54, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.039) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAssociation between Condition of Oral health and all-cause mortality of participants with Chronic Diarrhea\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eModel 1\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eModel 2 \u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eModel 3 \u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHR (95% CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e-Value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHR (95% CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e -Value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eHR (95% CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e -Value\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCondition of Oral health\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eExcellent/ Very good\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(Ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1(Ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.030\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1(Ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.039\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGood\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.79(1.17\u0026thinsp;~\u0026thinsp;2.75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.58(1.06\u0026thinsp;~\u0026thinsp;2.36)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.60 (1.09\u0026thinsp;~\u0026thinsp;2.34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFair\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.61 (1.05\u0026thinsp;~\u0026thinsp;2048)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.57 (0.91\u0026thinsp;~\u0026thinsp;2.69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.69 (0.99\u0026thinsp;~\u0026thinsp;2.88)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePoor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.79(1.64\u0026thinsp;~\u0026thinsp;4.75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.78 (1.16\u0026thinsp;~\u0026thinsp;2.73)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.66 (1.08\u0026thinsp;~\u0026thinsp;2.54)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e for Trend\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.0331\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003eHR: Hazard Ratio\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003e95% CI: 95% confidence interval\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003e\u003csup\u003ea\u003c/sup\u003e Model 1: no covariates were adjusted\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003e\u003csup\u003eb\u003c/sup\u003e Model 2: adjusted for Age、Gender、Race、Education level、Marrired、PIR\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003e\u003csup\u003ec\u003c/sup\u003e Model 3: Based on model 2, further adjusted for Smoke、Alcohol、CH、BMI、BUN、TC\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003e Our analysis revealed a significant association between poor oral health, including increased frequency of dental pain, and Occurrence of functional bowel symptoms (CC and CD). It is worth noting that this correlation remains stable after gradually adjusting for confounding covariates from Model 1 to Model 3. Stratified analyses further showed that this association was even more marked in those who smoked, drank alcohol, and had a history of tumors. Furthermore, survival analyses suggested that poor oral health was correlated with higher all-cause mortality in participants with CD.\u003c/p\u003e \u003cp\u003eOral health and intestinal health are both important factors that affect human health and quality of life, and have attracted more and more attention in recent years. First, the link between bowel and oral health may stem from shared influencing factors such as diet, sleep, cardiovascular aspects, and physical activity. Movahed E et al. found a significant positive correlation between sleep disorders and oral health, potentially linked to the impact of sleep disorders on the immune system and systemic inflammation[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. In addition, both prolonged and short sleep durations have been associated with a higher risk of chronic diarrhea and constipation[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].Animal studies have confirmed that sleep deprivation can lead to increased secretion of pro-inflammatory cytokines, activation of inflammation-related signaling pathways, and reduced gut microbiota diversity[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Cardiovascular health is known to be directly related to a variety of pathologies, including hypertension, hyperlipidemia, diabetes, atherosclerosis and obesity. The impact of these pathologies on overall health is often interrelated. A large cross-sectional study identified a link between poor oral health, periodontal disease, and hypertension prevalence[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].Mechanisms such as oxidative stress, inactivation of prostacyclin and nitric oxide (NO), and increased peripheral vascular resistance may underlie this association. Yu et al. demonstrated that maintaining cardiovascular health (CVH) at the population level was associated with reduced incidence and mortality of CD and CC[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Additionally, prolonged sedentary behavior is known to cause constipation but has no clear link to diarrhea. A study also found that high sedentary behavior (over 7.5 hours/day) is linked to a higher chance of periodontal disease[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. The oral cavity and bowel are part of the same digestive tract, jointly involved in food digestion and absorption. Different dietary patterns have different effects on the oral and intestinal health. Gluten-free diet may help maintain high oral health standards, delay gum disease in some celiacs[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. On the other hand, it may worsen bowel permeability and inflammation by reducing beneficial gut bacteria (e.g. Bifidobacterium bifidum and Lactobacillus) and lowering levels of short-chain fatty acids (SCFAs)[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Studies show that compared with a high-fat diet, a high-fiber diet can not only restore the diversity of the intestinal flora and improve metabolic disorders related to obesity[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e], but also reduces plaque by regulating the oral flora[\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe ectopic colonization of the flora and the modulation of inflammatory mediators may be a central mechanism underlying the link between the health of the oral and the bowel health. Kitamoto S et al.[\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e] found that oral pathogenic bacteria are enriched in the gut of colitis patients, exacerbating intestinal inflammation. They propose that periodontitis may amplify oral pathogens, when ingested and translocated to the gut, activate inflammasomes in colonic mononuclear phagocytes, thereby triggering inflammation. Additionally, periodontitis drives the production of reactive Th17 cells in the oral cavity. When activated by translocated oral pathogens, these cells further exacerbate intestinal inflammation. Another study suggests that oral Porphyromonas gingivalis, a typical periodontal bacterium, alters the gut microbiome, increasing the risk of bowel disease[\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Even some oral commensal bacteria, such as Klebsiella, may induce a Th1 immune response in the gut after translocation via the oral-intestinal axis, leading to intestinal inflammation and diarrhoea[\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. Clostridium perfringens is a common oral commensal that is strongly associated with colorectal cancer. As an opportunistic pathogen, it can exacerbate colorectal cancer lesions by binding to Gal-GalNAc receptors in the intestinal epithelium through the adhesin Fap2, activating the NF-kB pathway, and releasing IL-8 and TNF-α[\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. The interaction between bowel health and oral health needs to be further substantiated by future advances in flora research.\u003c/p\u003e \u003cp\u003eLifestyle and health factors may play a mediating role in the connection between the gastrointestinal tract and other organs of the body. In this study, we revealed that the association between poor oral health and intestinal symptoms (CC and CD) was more pronounced among participants who differed in smoking and drinking and a history of tumors. Consistent with these findings, several studies have shown that smoking is not only a risk factor for increased incidence and progression of periodontitis, but also tends to induce oxidative stress, producing reactive oxygen species that can directly damage intestinal epithelial cells, triggering diarrhoea[\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. Alcohol consumption exerts direct effects on oral and intestinal health and may aggravate inflammatory responses and tissue damage through metabolites such as acetaldehyde. However, drinking certain types of alcohol in moderation may be good for gut health because they contain antioxidants and other beneficial components[\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. In addition, the mechanisms regarding the association of tumor history on both oral and intestinal health are still unclear. Evidence suggests a potential link between oral health and pancreatic cancer. Specific oral bacteria may increase pancreatic cancer risk. And Gut microbiota modulates immune responses and promotes tumor growth, playing a key role in pancreatic cancer development[\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. Therefore, we hypothesize that Cancer history may influence oral and gut microbiota, thereby indirectly affecting overall health.\u003c/p\u003e \u003cp\u003ePoor oral health indicators, such as tooth loss, dental plaque, and periodontitis, compromise physical health and have been associated with elevated all-cause and cardiovascular mortality in multiple studies in recent years[\u003cspan additionalcitationids=\"CR42\" citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]. Meanwhile, Treatment of periodontal disease has been shown to reduce systemic inflammation and improve patient prognosis[\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]. In the present study, the findings indicated that poor oral health exhibited a significant correlation with all-cause mortality in the population suffering from diarrhea; however, this association was not observed in the population experiencing constipation. This indicates that poor oral health may negatively impact the prognosis of patients with abnormal bowel symptoms, which may be attributed to several underlying mechanisms:(1)Poor oral health impairs chewing function, reducing food chewing efficiency and nutrient intake[\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]. Chronic diarrhea patients often suffer from nutrient absorption issues due to intestinal dysfunction. Oral problems can worsen nutrient intake and digestion, affecting organ function and repair capacity, and may lead to poorer health and higher all-cause mortality. (2) Oral immunity normally suppresses pathogens. Poor oral health promotes dysbiosis and pathogen overgrowth. In chronic diarrhea patients, intestinal dysbiosis enables oral pathogens to colonize the gut, causing infection and inflammation[\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]. This worsens diarrhea and forms a life-threatening cycle. (3) Oral diseases like periodontitis are chronic inflammatory conditions. In poor oral health, inflammatory mediators such as interleukin-6 and tumor necrosis factor-alpha enter the circulation, driving systemic inflammation[\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e]. In patients with diarrhea, this heightened systemic inflammation can further impair organ function and boost mortality risk.\u003c/p\u003e \u003cp\u003eOur study has several strengths. First, we assessed overall oral health using both oral health status and the frequency of dental pain, which provides a more comprehensive evaluation than single-factor assessments. Second, our sample was derived from the NHANES database, which uses standardized testing methods and a nationally representative sample, enhancing the generalizability of our findings. Additionally, we performed subgroup analyses to evaluate the relationship between oral health and chronic diarrhea/constipation across different population characteristics. These analyses offer a theoretical basis for developing future oral health screening and intervention strategies.\u003c/p\u003e \u003cp\u003eOur study also has some limitations. First, this was a cross-sectional study, which did not allow us to test the causal relationship between oral health and chronic diarrhea and constipation. Second, both oral health and intestinal health status were obtained through questionnaires, which may be subject to recall bias. In addition, the population of our study was focused on the US population, which lacks comparisons with other populations, and the findings may not be generalizable to other populations. Despite these limitations, to the best of our knowledge, this is the first study to assess the relationship between oral health and chronic diarrhea and constipation. It provides important insights into the association between oral health, diarrhea, and constipation, which may be used to reduce chronic diarrhea and constipation by improving oral health.\u003c/p\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eOur study indicates that adults with poor oral health and frequent toothaches are more likely to develop chronic diarrhea and constipation, particularly among smokers, drinkers, and individuals with a tumor history. Poor oral health is also linked to a worse prognosis in patients with chronic diarrhea, suggesting a connection between oral and intestinal health. Further prospective studies are needed to confirm this relationship and explore its underlying mechanisms.\u003c/p\u003e"},{"header":"Abbreviations","content":" \u003cp\u003eFGIDs Functional gastrointestinal disorders\u003c/p\u003e \u003cp\u003eCC Chronic Constipation\u003c/p\u003e \u003cp\u003eCD Chronic Diarrhea\u003c/p\u003e \u003cp\u003eNHANES National Health and Nutrition Examination Survey\u003c/p\u003e \u003cp\u003eCAPI Computer-assisted Personal Interview\u003c/p\u003e \u003cp\u003eBSFS Bristol Stool Form Scale\u003c/p\u003e \u003cp\u003eNO Nitric Oxide\u003c/p\u003e \u003cp\u003eCVH Cardiovascular Health\u003c/p\u003e \u003cp\u003eSCFAs Short-chain Fatty Acids\u003c/p\u003e "},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe are appreciative of the founders and participants in the NHANES program.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eKang Li collected data, analyzed relevant information, and drafted the manuscript, Xingxing Liu and Taiyu Chen collected data, analyzed relevant information. Xiaolong Ying and Yonghua Zeng checked the content for errors. Chunyan Zeng, Yixing Luo and Xu Shu designed the article, revised the manuscript, and approved the final submission.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e*\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eKang Li, Xingxing Liu and Taiyu Chen are equal primary authors.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by the Double-Thousand Plan of Jiangxi Province (No. jxsq2023201044).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll the data used in the study can be accessed through the National Center for Health Statistics website(https://wwwn.cdc.gov/nchs/nhanes/).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of Interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSperber AD, Bangdiwala SI, Drossman DA, Ghoshal UC, Simren M, Tack J, et al. 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Front Microbiol. 2021;12:656372.\u003c/span\u003e\u003c/li\u003e\u003c/ol\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":"Oral health, Toothache, Chronic diarrhea, Chronic constipation","lastPublishedDoi":"10.21203/rs.3.rs-6726151/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6726151/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground:\u003c/h2\u003e \u003cp\u003eOral health and gut health are closely related. Gut flora changes can be modulated via the mouth-gut axis, impacting bowel health. This study aimed to explore the relationship between oral health and the incidence of chronic diarrhea and constipation, as well as its impact on all-cause mortality.\u003c/p\u003e\u003ch2\u003eMethods:\u003c/h2\u003e \u003cp\u003eThis cross-sectional study used data from the 2005\u0026ndash;2008 National Health and Nutrition Examination Survey (NHANES) database. Multivariable logistic regression and subgroup analyses assessed the associations between oral health status, dental pain frequency, and chronic diarrhea/constipation. Multivariable Cox regression evaluated the link between oral health and all-cause mortality in patients with chronic constipation or diarrhea.\u003c/p\u003e\u003ch2\u003eResults:\u003c/h2\u003e \u003cp\u003eChronic constipation was present in 10.37% (957/9231) of participants, and chronic diarrhea in 12.06% (1113/9231). Adjusted multivariable logistic regression models showed that poor oral health and high frequency of dental pain were significantly associated with an increased risk of chronic constipation [odds ratio (OR)\u0026thinsp;=\u0026thinsp;1.65, 95% confidence interval (CI) 1.28\u0026ndash;2.12, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001; OR\u0026thinsp;=\u0026thinsp;1.43, 95% CI 1.01\u0026ndash;2.02, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.044] and chronic diarrhea (OR\u0026thinsp;=\u0026thinsp;1.31, 95% CI 1.07\u0026ndash;1.71, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.044; OR\u0026thinsp;=\u0026thinsp;1.69, 95% CI 1.35\u0026ndash;2.11, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), particularly in smokers, drinkers, and those with a history of neoplasia. Adjusted multivariable Cox regression indicated that poor dental health was linked to all-cause mortality in diarrhea patients (HR\u0026thinsp;=\u0026thinsp;1.66, 95% CI 1.08\u0026ndash;2.54, P\u0026thinsp;=\u0026thinsp;0.033).\u003c/p\u003e\u003ch2\u003eConclusion:\u003c/h2\u003e \u003cp\u003e Oral health conditions are significantly correlated with chronic intestinal diseases. This discovery highlights the significance of oral factors in the treatment strategies for chronic intestinal diseases.\u003c/p\u003e","manuscriptTitle":"Effect of oral health on chronic intestinal diseases and all-cause mortality in US adults: results from the NHANES 2005-2008 database","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-23 06:24:35","doi":"10.21203/rs.3.rs-6726151/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":"f879d3c9-aebb-42b6-941e-3119a9010b77","owner":[],"postedDate":"June 23rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-09-15T05:08:45+00:00","versionOfRecord":[],"versionCreatedAt":"2025-06-23 06:24:35","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6726151","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6726151","identity":"rs-6726151","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}