Associated Factors Of Metabolic Syndrome And The Role Of Oral Health Among 50 And Older Adults: from the 6th KNHANES

Article History:Received:11 november 2020; Accepted: 27 December 2020; Published online: 05 April 2021 Abstract: The study on relationship between metabolic syndrome and oral health, is rare. We investigated to find out the correlation of metabolic syndrome and oral health. We investigated to find out the correlation of metabolicsyndrome and oral health with the data from the 6th KoreaNationalHealth and NutritionExaminationSurvey. This is the crosssectional designed study. 2433 subjects (aged 50 ≤) were included. Metabolicsyndrome was defined as NCEP-ATP (NationalCholesterolEducationProgram-AdultTreatmentPanel III). To analyze influencing factors of metabolic syndrome, multi-variablelogisticregression was used. Our results showed that gender(male) (OR 1.86; 95%CI: 1.27-2.72; p<.05) and not taking dietary supplements (OR 1.74; 95%CI: 1.22-2.48; p<.05) factors were the most influencing factors of metabolic syndrome. And then, presence of stress(OR1.59; 95%CI: 1.28-1.98; p<.05), lowest education level(elementary)(OR1.48; 95%CI: 0.98-2.21; p=.05), and oral health(periodontitis) (OR1.39; 95%CI: 1.09-1.78; p<.05) factors were showed as the next strong factors of metabolic syndrome in order. While chewing ability was not related with metabolic syndrome. We highlighted on the impact of oral health in metabolic syndrome including chewing difficulty as well as periodontitis. And to prevent metabolic syndrome cause of serious disability and lowering quality of life, we tried to find out the influencing factors of metabolic syndrome considering of this study with diverse view point such as adding the dietary supplements as dietary habit, stress as psychological value, and sedentary time as health-related factors. The government and public health associates should do urgently preparing the policies and strategies focusing on gender disparities, dietary supplements and oral health to prevent metabolic syndrome among ageing population.


Introduction
Metabolic syndrome was prevalent and increasing worldwide. Metabolic syndrome, the serious health problem resulted in cardiovascular disease, consists of hypertension, glucose intolerance, abdominal obesity, hypertriglyceridemia and low HDL cholesterol. Recently oral health factors, the major indicator of quality of life (Cervino, G., et al, 2019), were reported to being associated with metabolic-syndrome (Kim, J. S., et al, 2019; Kaur, K. K. et al, 2019). And gender disparities were also reported to be related with metabolic syndrome (Kim, J. S., et al, 2019) as well as the relationship between metabolic syndrome and healthy life style factors (Hoyas, I., &Leon-Sanz, M. 2019; Lin, W. T., et al, 2019). And coping style and occupational stress were reported to be associated with periodontitis among workers by the cross-sectional study(Islam, M. M., et al, 2019). Also, circulation microparticles in metabolic syndrome with cardiovascular risks were reported to be associated with oxidative stress (Zahran, A. M., et al, 2019). And posttraumatic stress was reported to be related with metabolic syndrome especially in women(LIhua, M., et al, 2020).In current evidence on natural agents, they were reported to be on thoughtful perspective in oral health including periodontitis (Jaramillo Flores, M. E. , 2019). It was reported on the links that serum vitamin C and antioxidant levels were related with periodontitis (Isola, G., et al, 2019; Van der Veldena, U., 2020). Especially, the relationship between vitamin D level and metabolic syndrome was suggested as important one in obese patient as well as general people for reducing metabolic disease and increasing longevity (Moukayed, M., & Grant, W. B.,2019). And dietary nitrate was also reported to be associated with activating of metabolic pathways and reducing of oxidative stress (Lundberg, J. O.,2018). Dietary supplements such as botanical oil and fish oil was reported to be related with metabolic syndrome as well as type-2 diabetes ( Lee, T. C. et al, 2014). In addition to that, dietary supplementation of watermelon juice was reported to being ameliorating the metabolic syndromes in obese animals (Wu, G., Collins, et al, 2007) though it has kinds of some limitation in animal subjects. And more, oral health was reported to be closely connected with improving of overall health especially among adults (Onubogu, U., et al, 2019; Ismail, F., et al, 2019; Rawal, I., et al, 2019). In addition to that, number of teeth, as the important indicator of oral health, was reported to increase the risk of metabolic syndrome among elderly (PEDRO, R. E. L., et al, 2019). Additionally, diabetes and smoking were closely associated with poor oral health such as tooth loss by recent cohort study ( Kim, Y. T., et al, 2019). Through reviewing of current studies, we investigated to find out the major influencing factors of metabolic syndrome and impacting factors of oral-health of 50 and older aged Koreans using nationally representative data of 6th KNHANES. Considering potential impact on subjects and lifestyle, we included demographic, socioeconomic, health related and oral health factors.

Materials and Methods
Associated factors of Metabolic Syndrome and the role of Oral health among 50 and older adults: from the 6th KNHANES Using derived from nationally representative data from 6th Knhanes (Korea-National-Health and Nutrition-Examination-Survey), of stratified sampling one, after exclusion of missing and not available one, this study was analyzed. The standards of NCEP-ATPⅢ (National-Cholesterol-Education-Program -Adult-Treatment-Panel) for the criteria of metabolic-syndrome was used for the study. This study is a cross-sectional-designed one.

Study-subjects
This study was conducted to find-out on relationship between oral health and metabolic-syndrome of 2433 consented participants, 50 aged and older, using complex-sampling-methods by multiple-logistic-regressions with SPSS (ver. 21.0).

Study-analysis
This study was analyzed by complex sampling methods. For the general characteristic of the 2433 subjects of aged 50 and over, demographic statistics methods were used. And chi-square test was used for analyzing prevalence of association between metabolic-syndrome and determinant factors. To investigate influencing factors of metabolic-syndrome and impact of oral health, multi-variable logistic regression methods with SPSS (ver. 21.0) were used. The significance-level was (p<.05).

Results and Discussion
Out of 2433 participants, 42.0% were men [  These findings suggest that men compared to women, not taking of dietary supplements, much stress, lower education level and periodontitis, as the indicator of oral health, were the major determinants of metabolic syndrome with analyzing 2433 participants aged 50 and older participants of the 6th Korea-National-Health and Nutrition-Examination-Survey. The prevalence of metabolic-syndrome was 13.6%. And this prevalence of metabolic syndrome result was low compared to that of another study (Kim, Y. H., et al, 2018) and these results were thought to be due to the total prevalence regardless of gender. Regarding gender (male), which was found to be the strongest factor of metabolic syndrome in this study, was mainly having , 2018) despite of common results in the aspects of education level and they seem to be cause of gender difference by study design. The strength of this study was based on the nationally representative data with stratified survey in the point of reliability and validity. Major consideration of this study was including and dealing with the importance of the oral health variables such as chewing level and periodontitis as the critical role of potential and influencing on general health of middle-older-adults. The limitation of this study is in cross-sectional nature design. To conclude, gender(male), not taking of dietary supplements, stress as the psychological factor, lower education level and periodontitis as the indicator of oral health were the influencing major determinants of metabolic syndrome. So, public health professionals might be needed to manage the education strategies considering age, gender disparities, education level and promoting oral health to prevent metabolic syndrome. Further researches might be necessary to explore the mechanisms for validity between metabolic syndrome and oral health by gender to prepare early public and nursing interventions in this population.

Conclusion
In conclusion, it was suggested that gender(male) and not taking of dietary supplements were the major determinants of metabolic syndrome. And then, the next determinant factors were stress of the psychological status, elementary school in lowest education level and periodontitis in oral health were the important determinants of metabolic syndrome respectively. Therefore, public health and nursing professionals might urgently consider managing the public education strategies heightening on age, gender disparities, dietary habits and improving oral health as well as including to prevent metabolic syndrome. Continued researches should be accomplished to find out the links and associations of metabolic syndrome and dietary habits, psychological areas as well as oral health by gender for the future successful ageing.