Intersecting burdens: oral health, dietary patterns, food security and their impact on cardiometabolic risk and mental health in Ghana

The nutrition transition and persistent food insecurity in Ghana and similar low- and middle-income countries pose significant challenges to both physical and mental health. Emerging evidence suggests that oral health may be implicated in these associations. This study examines the associations between oral health, dietary patterns, food insecurity and their associations with cardiometabolic and psychological distress outcomes. This study employed a cross-sectional design, recruiting 100 participants in March 2025. Data on sociodemographic characteristics and dietary patterns were taken using standard questionnaires, while cardiometabolic risk factors were assessed using standard procedures. Mental Health was assessed using Kessler’s Psychological Distress scale, while food security was assessed using the USDA Household Food Security Questionnaire. Four distinct dietary patterns were identified: Sweet Tooth, Traditional Ghanaian Staples, Animal-Based Protein, and Street Food. The Sweet Tooth pattern was significantly associated with poorer cardiometabolic health (β = 0.412, p = 0.031), while food insecurity showed a strong positive association with psychological distress (β = 0.594, p < 0.001). The Animal Protein Dominant Pattern was also linked to increased psychological distress (β = 0.174, p = 0.047). Oral health exhibited a marginal association with cardiometabolic health (β = -0.101, p = 0.075) but was not linked to psychological distress. Mediation analysis revealed that the relationship between food insecurity and psychological distress was partially mediated by increased consumption of street foods (β = 0.103, p = 0.014). This study highlights the detrimental impact of a sugary, energy-dense dietary pattern on cardiometabolic health and shows food insecurity as a key driver of psychological distress in Ghana. The partial mediation by street food consumption suggests that food environments contribute to mental health disparities among food-insecure populations. Public health interventions that use an integrated approach targeting food security, promotion of healthy diets and mental support are essential to address the dual burden of cardiometabolic and psychological disorder.