Association of ultra-processed foods and dental health—results from Bandare-Kong cohort: structural equation modeling

Ultra-processed foods (UPFs) have become a major component of modern diets and have been linked to adverse health outcomes. However, evidence regarding their association with dental health in adults remains limited. This cross-sectional study analyzed baseline data from 3947 adults (35-75 years old, 57.8% females), enrolled in the Bandare-Kong Non-Communicable Disease (BKNCD) cohort. Dietary intake was assessed using a validated food frequency questionnaire, and UPFs consumption was classified according to the NOVA system. Dental health was evaluated through clinical examinations measuring the number of teeth, missing teeth, decayed teeth, and filled teeth. Structural equation modeling (SEM) was employed to assess the relationships, incorporating age and gender as a potential mediating variables. UPFs intake across tertiles was 14.2, 28.9, and 49.2% of total intake. Age and gender partially mediated the associations between UPFs consumption and dental health. Higher UPFs intake (NOVA T3 vs. T1) was linked to more decayed teeth in females 35-50 years (β = 0.521) and to fewer total teeth (β = - 0.976), more missing teeth (β = 0.987), and more decayed teeth (β = 0.536) in females 50-75 years. Among males, higher UPFs intake was associated with more missing teeth in those 35-50 years (β = 0.387) and with fewer teeth (β = - 0.937), more missing teeth (β = 0.911), and more decayed teeth (β = 0.754) in older males. This study highlights significant associations between greater UPFs consumption and poorer dental health among Iranian adults. A longitudinal study is required.