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The Relationship between Meal Regularity and Oral Health and Metabolic Syndrome of Adults in Single Korean Households
J Dent Hyg Sci 2021;21:185-97
Published online September 30, 2021;  https://doi.org/10.17135/jdhs.2021.21.3.185
© 2021 Korean Society of Dental Hygiene Science.

Jin-Ah Jung1 , Hye-Won Cheon2 ,†, and On-Ju Ju3

1Department of Dental Hygiene, Gwangyang Health Sciences University, Gwangyang 57764, 2Department of Dental Hygiene, Howon University, Gunsan 54058, 3Department of Dental Hygiene, Wonkwang Health Sciences University, Iksan 54538, Korea
Correspondence to: Hye-Won Cheon, https://orcid.org/0000-0003-4205-0199
Department of Dental Hygiene, Howon University, 64, Howondae 3-gil, Impi-myeon, Gunsan 54058, Korea
Tel: +82-63-450-7773, Fax: +82-63-450-7779, E-mail: hyewon@howon.ac.kr
Received August 23, 2021; Revised September 15, 2021; Accepted September 23, 2021.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background: This study aimed at investigating the meal regularity, health, and oral health habits of single Korean households to understand the impact of these factors on the risk of metabolic syndrome, in addition to preventing and managing metabolic syndrome.
Methods: Using raw data from the 8th Korea National Health and Nutrition Examination Survey (2019), 274 study subjects, aged 19 to 64, were selected primarily from single adult households. Complex sample statistical analysis was performed using the Predictive Analytics Software Statistics ver. 18.0 program.
Results: Regarding the meal regularity in single-person households in Korea, the younger group outperformed the middle-aged group, and those who drank more than once a month performed better than those who drank less than once a month. In terms of oral health, regardless of the age and the income level, participants who ate three meals a day had a higher rate of speech problems and chewing difficulties than those who ate irregularly or regularly on a regular day. Factors influencing the risk of developing metabolic syndrome were age, speech problems, and frequency of toothbrushing. Compared to the younger group, there were 0.361 times more people in the middle-aged group; and compared to those without speech problems, there were 1.161 more people with speech problem. Compared to those who tooth brushed more than four times a day, there were 1.284 more people who tooth brushed 2 to 3 times a day and there were 5.673 times more people who tooth brushed less than once.
Conclusion: Based on the study results, it is necessary to implement a program that can plan and apply customized management measures and prevent metabolic syndrome by improving and correcting the health and oral health behaviors of single-person households in Korea. Therefore, active mediation measures, such as support and publicity at the local or national level, should be planned.
Keywords : Meal regularity, Metabolic syndrome, Oral health, Single-person households
Introduction

Due to rapid socioeconomic development and the improvement of national income levels, lifestyle, and dietary culture has changed dramatically in response to the pursuit of convenience in life. The number of single-person households is increasing to the point where new terms such as “solo economy” have been coined1). As of 2019, 6.148 million single-person households accounted for 30.2% of all households, with 20’s accounting for 18.2% of all single-person households2). The increase in single- person households is also driving up the consumption and delivery of instant and fast foods3) in addition to a high intake of calories, fat, and sodium, which can lead to obesity, high blood pressure, diabetes, stroke, and cancer1).

Among chronic diseases, metabolic syndrome is a disease that is diagnosed with three or more cases of abdominal obesity, cholesterol, triglycerides, diabetes, and high blood pressure4), which triples the risk of developing heart disease and increases the risk of diabetes by six times5). Therefore, metabolic syndrome has been reported to be closely related to dietary habits and balanced nutrition6). Previous studies on dietary and metabolic syndrome have revealed an association between dietary patterns and metabolic syndrome and are recommended for the prevention and management of metabolic syndrome when consuming hybrid grain and healthy foods with added vegetables and fruit7). Moreover metabolic syndrome has been reported to be lower in people who eat regularly and eat out less frequently than those who usually overeat and dine out8). Studies on the dietary habits of single- person households and the prevalence of metabolic syndrome indicate that eating regularly after menopause reduces the risk of metabolic syndrome in both men and women9).

As concern regarding a healthy quality of life increases, oral health is becoming closely related to overall health-related quality of life as well as general health10). Therefore, oral health is an important indicator in health care, and it is an essential element of health because it is highly related to general health in nutrition intake and digestion11). The results of a previous study on the risk factors for oral health and metabolic syndrome show that the risk of metabolic syndrome impacting the waist circumference, triglyceride, and blood pressure was higher in those who did use a dental clinic and performed less frequent brushing12).

A study on the relationship between metabolic syndrome and periodontitis revealed a high community periodontal index prevalence in patients with metabolic syndrome13), moreover, inflammation and metabolic markers tend to increase the number of periodontal pockets14). This suggests that metabolic syndrome and periodontal disease are related. Factors affecting periodontal disease were discomfort in chewing, throbbing or pain, and bleeding gums15), and the greatest risk of periodontal disease was chewing difficulty16). In addition, periodontal disease was found to be high in patients with poor oral conditions, chewing difficulty, and speech problems17). Therefore, it is thought that chewing difficulty and speech problems are also related to metabolic syndrome.

According to the findings of a study on the prevalence of metabolic syndrome based on oral health behavior, the prevalence of metabolic syndrome was highest among those who brushed their teeth less than once and when regular dental examinations were not conducted18). A study of patients with metabolic syndrome on the relevance of oral health knowledge, attitudes, and behaviors to the oral health impact index, the quality of life related to oral health is poor if they say they have had a dental experience in the past year19). As a result of reviewing these literatures, oral health behavior is thought to be related to the occurrence of metabolic syndrome, including eating habits and lifestyle, and studies on the relationship between dietary rules and oral health and metabolic syndrome in adults in single-person households are lacking.

Therefore, this study was conducted to understand the dietary rules, in addition to the health and oral health behaviors of single-person households and to examine their relationship with metabolic syndrome risk factors. By improving health and oral health of single-person households, this study presents the basic data for the prevention and management of metabolic syndrome.

Materials and Methods

1.Study subjects

This study used raw data20) from the 8th Korea National Health and Nutrition Examination Survey (KNHANES) conducted in 2019.

The study subjects were 433 adults aged 19 to 64 who responded to the survey, 32 people diagnosed with cancer, 1 patient who had been sick for 15 days or more, and 126 people with missing values. A total of 274 people who answered all the questions were selected as the final subjects, and the model for selecting he study subjects is presented in Fig. 1.

Fig. 1. Research subject selection model. KNHANES: Korea National Health and Nutrition Examination Survey.

2.Study method

In this study, the variables of the health survey, nutrition survey, and oral examination data of the 8th KNHANES (2019) were converted and used. Metabolic syndrome was the dependent variable, and the independent variables were general characteristics, dietary rules, and oral health.

1) Diagnosis of metabolic syndrome

The data of this study were based on the 8th period (2019) of the KNHANES. The diagnosis of metabolic syndrome was defined according to the NCEP-ATP (National Cholesterol Education Program-Adult Treatment Panel) III diagnostic criteria and the Korea Obesity Society criteria. Metabolic syndrome is defined as metabolic syndrome when three or more of the following five factors are present: abdominal obesity (above 90 cm waist circumference for men, over 85 cm for women), hyper-triglyceridemia (over 150 mg/dl for blood), HDL- cholesterol (under 40 mg/dl for men, <50 mg/dl for women), hypertension (over 140 mmHg for contractor blood pressure, or over 90 mmHg for relaxation blood pressure), impaired fasting glucose (fasting glucose 100 mg/dl or more, people who took insulin injections and diabetes drugs for diabetes blood glucose care)4,20).

2) General characteristics

The general characteristics were sex, age, education level, income level, smoking status, and drinking status. Sex was divided into male and female, and the age groups were categorized as young people (19∼39) and middle- aged people (40∼64). The education level was categorized as below high school and above college and the income level was divided into low, middle-low, middle-high, high for one-generation households and single-person households. In the category for smoking status those who smoked less than 5 packs (100 cigarettes) and more than 5 packs (more than 100 cigarettes) in their lifetime were classified as smokers and those who had never smoked were classified as non-smokers. Alcohol consumption was classified as those who consumed alcohol less than once a month and those who consumed alcohol more than once a month over a span of one year.

3) Meal regularity

The weekly meal information (0∼7 breakfast, lunch, and dinner frequency according to the weekly unit) was collected and divided into irregular or regular meals, regular groups of two meals, and regular groups of three meals.

4) Oral health

Oral health variables used in this study were perceived oral health, speech problems, chewing difficulty, toothache experience, frequency of toothbrushing per day, and oral examinations for one year. Perceived oral health categories like “very good,” “good,” “moderate,” “poor, and “very poor” were reclassified into three levels: “good,” “moderate,” and “poor.” Speech problem and chewing difficulty categories like “very uncomfortable,” “discomfort,” “neutral,” “not uncomfortable,” and “not at all un-comfortable” were reclassified as: “yes,” “neutral,” and “no.” The experience of toothache in the past year was divided into “yes” and “no.” Frequency of toothbrushing per day was reclassified into “less than once,” “2∼3 times,” and “more than 4 times.”

3.Data analysis

Using the raw data of the 8th KNHANES (2019) used in this study, a planned file was generated considering the distributed estimation layer, survey, health survey, and the weight of the nutrition survey to ensure that the data results were representative and subsequently a complex sample analysis was performed. A complex sample chi- square test was performed to investigate the differences in (1) meal regularity and oral health according to general characteristics; (2) metabolic syndrome according to general characteristics; and (3) meal regularity and metabolic syndrome according to oral health. Complex sample logistic regression analysis was performed to determine whether it affected the metabolic syndrome. The collected data were subjected to complex sample statistical analyses using Predictive Analytics Software (PASW) Statistics ver. 18.0 (IBM Corp., Armonk, NY, USA), and the statistical significance level was p<0.05.

Results

1.Meal regularity according to the general characteristics of single-person households

The results of analyzing the differences in meal regularity according to the general characteristics of single-person households are presented in Table 1. There was a statistically significant difference in the meal regularity according to age and alcohol intake. In the middle-aged group, 9.7% made up the irregular or regular one-meal group, and 25.0% made up the irregular or regular one-meal group in the youth group, displaying a higher difference than the middle-aged group, which was statistically significant (F=11.053, p<0.001). Subjects who drank less than once a month made up 17.8% of the irregular or regular one-meal group, while those who drank more than once a month made up 23.4% of the irregular or regular one meal group, which was statistically significant (F=3.601, p=0.031).

Meal Regularity according to General Characteristics

VariableDivisionTotalMeal regularity

≤One time regularityTwo times regularityThree times regularityt or F(p)
SexMale154 (62.2)26 (18.2)87 (58.3)41 (23.4)0.151 (0.854)
Female120 (37.8)23 (18.4)57 (55.0)40 (26.6)
AgeYoung adult128 (55.9)32 (25.0)77 (61.1)19 (13.9)11.053 (<0.001)
Middle-aged146 (44.1)17 (9.7)67 (52.1)62 (38.2)
Education≤High school161 (52.1)28 (17.4)75 (53.4)58 (29.1)1.178 (0.307)
≥College113 (47.9)21 (19.2)69 (61.1)23 (19.7)
IncomeLow91 (29.5)18 (18.2)42 (51.9)31 (29.9)1.397 (0.228)
Middle-low72 (25.3)14 (21.2)29 (47.1)29 (31.6)
Middle-high55 (22.2)12 (23.1)35 (65.2)8 (11.7)
High56 (23.0)5 (10.6)38 (66.9)13 (22.5)
SmokingNon-smoker119 (38.3)21 (17.3)58 (55.7)40 (27.0)0.251 (0.776)
Current smoker155 (61.7)28 (18.9)86 (58.0)41 (23.1)
Alcohol intake<1 time/month32 (9.4)42 (17.8)134 (59.5)66 (22.7)3.601 (0.031)
≥1 time/month242 (90.6)7 (23.4)10 (33.8)15 (42.8)

Values are presented as unweighted count (weighted %).

F: Rao–Scott test.



2.Oral health according to general characteristics of single-person households and meal regularity

Table 2 shows the differences in oral health according to the general characteristics and meal regularity of single- person households. The analysis revealed a statistically significant difference in perceived oral health according to sex. In terms of sex, the perceived oral health for female was divided as 14.3% (good), 34.7% (moderate), and 51.0% (poor); and the perceived oral health for male was 8.3% (good), 54.1 % (moderate), and 37.7% (poor), which was statistically significant (F=3.489, p=0.024). There was a statistically significant difference between speech problems and chewing difficulty according to age. Speech problems (F=11.379, p=0.005) and chewing difficulty (F=26.108, p<0.001) made up 0.6% and 5.9% in the young group and in the middle-aged group, they made up 4.9% and 23.8% respectively, which was higher than the younger age group, and statistical significance was noted.

Oral Health according to General Characteristics and Meal Regularity

VariablePerceived oral healthSpeech problemChewing difficultyToothache experienceFrequency of toothbrushingOral examination






GoodModeratePoorYesNeutralNoYesNeutralNoYesNo≤12~3≥4YesNo
Sex
Male12 (8.3)80 (54.1)62 (37.7)3 (1.8)17 (10.1)134 (88.1)16 (10.1)33 (19.7)105 (70.2)40 (25.3)114 (74.7)10 (5.8)122 (79.1)22 (15.1)49 (31.1)105 (68.9)
Female18 (14.3)44 (34.7)58 (51.0)6 (3.8)12 (11.7)102 (84.6)28 (19.9)21 (18.8)71 (61.3)43 (34.5)77 (65.5)1 (0.5)97 (83.5)22 (16.0)37 (31.5)83 (68.5)
t(p)3.489 (0.024)1.285 (0.589)5.272 (0.132)2.697 (0.104)2.709 (0.075)0.003 (0.956)
Age
Young adult12 (9.2)65 (51.9)51 (38.9)1 (0.6)8 (6.8)119 (92.6)8 (5.9)21 (15.2)99 (78.8)31 (25.5)97 (74.5)6 (3.8)101 (79.2)21 (17.0)41 (30.1)87 (69.9)
Middle-aged18 (12.2)59 (40.2)69 (47.5)8 (4.9)21 (15.7)117 (79.4)36 (23.8)33 (24.5)77 (51.7)52 (32.9)94 (67.1)5 (3.9)118 (82.7)23 (13.4)45 (32.8)101 (67.2)
t(p)1.426 (0.243)11.379 (0.005)26.108 (<0.001)1.858 (0.176)0.255 (0.763)0.154 (0.696)
Education
≤High school18 (10.3)71 (44.2)72 (45.5)2 (1.6)6 (6.3)105 (92.1)36 (19.5)34 (22.9)91 (57.5)55 (33.1)106 (66.9)7 (5.0)130 (80.7)24 (14.3)44 (26.9)117 (73.1)
≥College12 (10.8)53 (49.6)48 (39.7)7 (3.4)23 (14.8)131 (81.9)8 (7.6)20 (15.5)85 (77.0)28 (24.1)85 (75.9)4 (2.5)89 (80.8)20 (16.7)42 (36.0)71 (64.0)
t(p)0.525 (0.589)6.225 (0.118)12.930 (0.013)2.975 (0.088)0.548 (0.560)2.120 (0.149)
Income
Low9 (10.1)39 (42.2)43 (47.7)7 (7.0)12 (12.7)72 (80.3)25 (26.1)13 (12.4)53 (61.5)34 (32.9)57 (67.1)1 (1.1)75 (84.4)15 (14.5)19 (23.6)72 (76.4)
Middle-low8 (11.4)33 (46.9)31 (41.7)1 (1.3)6 (6.8)65 (91.9)10 (12.1)13 (18.5)49 (69.4)20 (27.8)52 (72.2)5 (7.7)59 (81.5)8 (10.9)24 (29.5)48 (70.5)
Middle-high4 (7.8)28 (52.2)23 (40.0)1 (0.6)8 (17.4)46 (82.0)6 (6.6)16 (30.2)33 (63.2)18 (29.7)37 (70.3)2 (2.7)42 (77.6)11 (19.6)16 (27.2)39 (72.8)
High9 (12.7)24 (47.2)23 (40.1)0 (0.0)3 (6.0)53 (94.0)3 (6.8)12 (18.8)41 (74.4)11 (23.6)45 (76.4)3 (4.0)43 (78.4)10 (17.6)27 (47.1)29 (52.9)
F(p)0.331 (0.897)15.708 (0.027)20.412 (0.012)0.447 (0.713)0.950 (0.441)2.699 (0.054)
Smoking
Non-smoker15 (10.7)57 (48.9)47 (40.4)2 (1.3)15 (13.8)102 (85.0)14 (9.2)23 (20.0)82 (70.8)29 (24.3)90 (75.7)5 (2.7)92 (81.0)22 (16.3)37 (32.0)82 (68.0)
Current smoker15 (10.4)67 (45.4)73 (44.1)7 (3.3)14 (8.8)134 (87.9)30 (16.6)31 (18.9)94 (64.4)54 (31.5)101 (68.5)6 (4.5)127 (80.6)22 (14.9)49 (30.8)106 (69.2)
t(p)0.202 (0.813)2.593 (0.303)3.003 (0.228)1.868 (0.175)0.279 (0.756)0.037 (0.848)
Alcohol intake
<1 time/month3 (8.1)9 (31.7)20 (60.2)3 (11.6)4 (9.1)25 (79.2)8 (24.4)6 (14.5)18 (61.1)14 (41.1)18 (58.9)2 (3.3)25 (77.3)5 (19.4)7 (23.8)25 (76.2)
≥1 time/month27 (10.8)115 (48.3)100 (40.9)6 (1.6)25 (10.9)211 (87.6)36 (12.7)48 (19.8)158 (67.4)69 (27.5)173 (72.5)9 (3.9)194 (81.1)39 (15.0)79 (32.1)163 (67.9)
t(p)1.962 (0.144)9.630 (0.005)2.815 (0.174)2.197 (0.142)0.197 (0.789)0.561 (0.456)
Meal regularity/day
≤One time regularity2 (6.6)23 (46.8)24 (46.6)2 (2.0)2 (2.5)45 (95.5)5 (8.2)6 (7.0)38 (84.8)21 (41.4)28 (58.6)1 (1.8)41 (83.9)7 (14.3)10 (17.3)39 (82.7)
Two times regularity18 (10.1)65 (48.3)61 (41.6)2 (1.0)14 (11.2)128 (87.8)20 (11.4)34 (24.1)90 (64.5)38 (25.0)106 (75.0)6 (4.6)119 (83.5)19 (11.9)49 (34.5)95 (65.5)
Three times regularity10 (14.4)36 (43.3)35 (42.3)5 (6.6)13 (15.6)63 (77.8)19 (23.6)14 (17.3)48 (59.0)24 (28.2)57 (71.8)4 (3.5)59 (72.1)18 (24.4)27 (34.2)54 (65.8)
F(p)0.391 (0.777)11.697 (0.021)15.624 (0.003)2.656 (0.078)1.373 (0.246)2.190 (0.121)

Values are presented as unweighted count (weighted %).

F: Rao–Scott test.



There was a statistically significant difference in chewing difficulty according to education level. The chewing difficulty was 7.6% for college graduates or higher, 19.5% for high school graduates or lower, which was higher than that of college graduates or higher and was statistically significant (F=12.930, p=0.013). There is a statistically significant difference between speech problems and chewing difficulty according to income level. The lower the income, the higher the speech problem (F=15.708, p=0.027) and chewing difficulty (F=20.142, p=0.012), which was statistically significant. There was a statistically significant difference in speech problems according to alcohol intake. Subjects who drank more than once a month and had speech problems made up 1.6%, and those who drank less than once a month and had speech problem made up 11.6%, which was higher than those who drank more than once a month, which was statistically significant (F=9.630, p=0.005). There was a statistically significant difference between speech problems and chewing difficulty according to the meal regularity. In the three times regularity group, speech problems (F=11.697, p=0.021) and chewing difficulty (F=15.624, p=0.003) were higher at 6.6% and 23.6%, respectively, than in the group who ate less than twice the regularity and was statistically significant.

3.Metabolic syndrome according to general characteristics of single-person households and meal regularity

Table 3 shows the differences in metabolic syndrome according to the general characteristics of single-person households and meal regularity. There was a statistically significant difference in metabolic syndrome according to age. In the youth group, the metabolic syndrome was abnormal in 12.4% of the study subjects, and in the middle-aged group, it was 28.2%, which was higher than that of the younger age group and was statistically significant (F=6.652, p=0.012).

Metabolic Syndrome according to General Characteristics and Meal Regularity

VariableDivisionMetabolic syndrome

NormalAbnormalt or F(p)
SexMale120 (77.8)34 (22.2)2.520 (0.116)
Female98 (85.2)22 (14.8)
AgeYoung adult113 (87.6)15 (12.4)6.652 (0.012)
Middle-aged105 (71.8)41 (28.2)
Education≤High school128 (80.3)33 (19.7)0.015 (0.904)
≥College90 (80.9)23 (19.1)
IncomeLow73 (80.1)18 (19.9)0.224 (0.861)
Middle-low61 (83.4)11 (16.6)
Middle-high39 (77.2)16 (22.8)
High45 (81.6)11 (18.4)
SmokingNon-smoker96 (81.4)23 (18.6)0.063 (0.803)
Current smoker122 (80.1)33 (19.9)
Alcohol intake<1 time/month25 (84.6)7 (15.4)0.373 (0.543)
≥1 time/month193 (80.2)49 (19.8)
Meal regularity/day≤One time regularity40 (79.6)9 (20.4)0.129 (0.869)
Two times regularity112 (79.9)32 (20.1)
Three times regularity66 (83.0)15 (17.0)

Values are presented as unweighted count (weighted %).

F: Rao–Scott test.



4.Metabolic syndrome according to oral health of single-person households

Table 4 shows the results of analyzing the differences in metabolic syndrome according to the oral health of single-person households. There was a statistically significant difference in metabolic syndrome according to speech problems, chewing difficulty, and frequency of toothbrushing. In the case of no speech problem, metabolic syndrome was abnormal in 83.4%, and in those with speech problems it was 85.4%, which was higher than that of the non-speech problem, indicating statistical significance (F=11.731, p=0.002). In the case of no chewing difficulty, the metabolic syndrome was abnormal (66.8%) and in the case of chewing difficulty the metabolic syndrome was 85.3%, which was higher and was thus statistically significant (F=8.553, p=0.034). In addition, when the frequency of toothbrushing was 2 to 3 times and 4 times or more, the metabolic syndrome was abnormal by 18.7% and 15.2%, respectively, and in the case of less than one frequency of toothbrushing, the metabolic syndrome was abnormal at 50.4%, which was higher and was therefore statistically significant (F=2.770, p=0.047).

Metabolic Syndrome according to Oral Health

VariableDivisionTotalMetabolic syndrome

NormalAbnormalt or F(p)
Perceived oral healthGood30 (10.5)22 (78.9)8 (21.1)0.228 (0.792)
Moderate124 (46.8)102 (82.5)22 (17.5)
Poor120 (42.7)94 (79.0)26 (21.0)
Speech problemYes9 (2.5)2 (14.6)7 (85.4)11.731 (0.002)
Neutral29 (10.7)12 (43.0)17 (57.0)
No236 (86.8)42 (16.6)194 (83.4)
Chewing difficultyYes44 (13.8)15 (14.7)29 (85.3)8.553 (0.034)
Neutral54 (19.3)13 (25.7)41 (74.3)
No176 (66.9)28 (33.2)148 (66.8)
Toothache experienceYes83 (28.8)63 (75.8)20 (24.2)1.268 (0.263)
No191 (71.2)155 (82.6)36 (17.4)
Frequency of toothbrushing/day≤111 (3.8)7 (49.6)4 (50.4)2.770 (0.047)
2∼3219 (80.8)173 (81.3)46 (18.7)
≥444 (15.4)38 (84.8)6 (15.2)

Values are presented as unweighted count (weighted %).

F: Rao–Scott test.



5.Factors affecting metabolic syndrome in single-person households

To identify the factors affecting metabolic syndrome in single-person households, a complex sample logistic regression analysis was performed using general character-istics, meal regularity, and oral health as independent variables, as shown in Table 5. The factors influencing metabolic syndrome were age, speech problems, and frequency of toothbrushing. The risk of metabolic syndrome was significantly higher in the middle-aged group than in the young group by 0.361 times (95% confidence interval [CI], 0.162∼0.806; p=0.014); and 1.161 times (95% CI, 0.193∼6.985; p=0.018) in the case of difficulty in speech problems compared to the case of no speech problem, which was significantly higher. In addition, compared to subjects with a frequency of toothbrushing more than four times a day, the risk of metabolic syndrome in those with a frequency of toothbrushing less than once a day was 5.673 times (95% CI, 1.148∼28.038; p=0.034) and those who had a toothbrushing frequency of 2 to 3 times the risk was 1.284 times (95% CI, 0.422∼3.911; p=0.027), which was significantly higher.

Factors affecting Metabolic Syndrome

VariableDivisionOR95% CIp-value
SexFemale1.0
Male1.6450.879∼3.0780.118
AgeYoung adult1.0
Middle-aged0.3610.162∼0.8060.014
Education≤High school1.0410.541∼2.0040.904
≥College1.0
IncomeLow1.3020.421∼4.0240.829
Middle-low0.8810.286∼2.7190.700
Middle-high1.1010.455∼2.6600.630
High1.0
SmokingNon-smoker1.0
Current smoker1.0840.573∼2.0490.803
Alcohol intake<1 time/month1.0
≥1 time/month1.3500.507∼3.5990.544
Meal regularity/day≤One time regularity1.0200.377∼2.7610.691
Two times regularity1.2540.406∼3.8750.588
Three times regularity1.0
Perceived oral healthGood1.0
Moderate0.7930.280∼2.2440.988
Poor0.9920.353∼2.7920.554
Speech problemNo1.0
Neutral0.2640.116∼0.5990.493
Yes1.1610.193∼6.9850.018
Chewing difficultyNo1.0
Neutral0.3470.144∼0.8330.869
Yes0.4970.213∼1.1600.095
Toothache experienceNo1.0
Yes1.5140.726∼3.1570.265
Frequency of toothbrushing/day≤15.6731.148∼28.0380.034
2∼31.2840.422∼3.9110.027
≥41.0

CI: confidence interval, OR: odds ratio.

By complex sample logistic regression analysis.


Discussion

While rapid changes in the population structure are causing fundamental changes in society, economy, and culture, the increase in single-person households has led to drastic changes in daily life, such as residential environment, consumption structure, and dietary habits21). Risk factors overlap22), and substantial health-care assistance is necessary due to the poor living conditions of single-person households, which have relatively poor lifestyles compared to multi-person households. Thus, this study was conducted to examine the oral health in single-person households with metabolic syndrome, which has been linked to various lifestyle factors, including dietary habits23) and to determine their effect on the risk of developing metabolic syndrome.

According to a study of meal regularity in single Korean households, there were statistically significant differences between age and alcohol intake, with young people in irregular or regular meal groups outnumbering middle-aged people, and middle-aged people outnumbering young people in regular three meal groups. Middle-aged people tend to eat three meals regularly due to their health concerns, on the other hand, income and employment instability are high and economic activities are often required to maintain a livelihood, affecting the dietary habit of young people24), which can be attributed to the prevalence of one meal. In the case of single-person households, 90.6% of those who skipped meals or drink more than once a month and consumed instant food25) are found to drink because they do not have the time or are lazy and there was a significant difference in the meal regularity. In addition, those who eat one meal a day and those who eat three meals a day, both indicated a higher rate of metabolic syndrome when they drank more than once a month. Thus, the living conditions of single-person households proved to be highly unstable and the need for health care is emphasized. Therefore, it is necessary to improve health-related lifestyles and strengthen policy support for psychological health.

While considering oral health according to the general characteristics of single-person households and meal regularity, in the case of women, more respondents answered that their perceived oral health was poorer than good, and in the case of male, more subjects answered it was moderate than poor. Although female perceived their oral health more negatively than male, as the self- evaluation method of oral health is subjective, it is thought that the response may vary depending on the level of interest in oral health, and objective indicators for evaluating oral health should be prepared in the future.

Middle-aged individuals had higher rate speech problems (4.9%) and chewing difficulty (23.8%) than the younger individuals, and the older they were, the more difficult it was to speak and chew. According to Kim26), the older the age, the more uncomfortable it was to chew and pronounce and thus the prevalence was higher in the middle-aged compared to the younger group, which is consistent with the findings of this study. Mastication, pronunciation, and swallowing are important functions of the oral cavity. The tongue, which plays an important role in pronunciation and assists in mastication, plays a key role in swallowing and swallowing food27). Therefore, it is necessary to check the functions of mastication, pro-nunciation, and tongue simultaneously. However, as the relevant factors were omitted from the data of the KNHANES, it is necessary to supplement and investigate these factors.

If such oral functions become problematic, it is another cause of deteriorating health, as well as a major cause of deteriorating oral health-related quality of life, therefore multidimensional support such as social welfare support should be provided to maintain oral health even as people age. In addition, the lower the educational level, the higher was the chewing difficulty. This is in line with research by Kang and Yu28) who studied metabolic syndrome and oral disease, and found that the lower the educational level, the higher the periodontitis and the lower the educational level, the higher the missing value. In addition, the study by Hawg et al.29) proved that the lower the education level, the more chewing difficulty was, which is consistent with the results of this study. In addition, when examining meal regularity and oral health, speech problems and chewing difficulty were higher in the subjects who ate three meals a day than those who ate irregularly or regularly. This is consistent with the results of the study, which showed that middle-aged adults had more three meals a day than the young, and the results of this study also established that speaking and chewing were more difficult as the age increased. The oral cavity is the first gateway for food intake and is part of the digestive system30). If oral health cannot be maintained with increasing age and teeth are lost due to oral disease, chewing ability may be reduced, which may eventually lead to an imbalance in nutritional supply. In addition, it can lead to sunken lips and cheeks, loss of occlusal support due to a decrease in vertical height, and wrinkles, which can change facial expressions and affect pronunciation, leading to speech problems31). Therefore, to maintain a healthy life, a systematic strategy is required to prevent oral diseases, which in turn can be resolved through regular oral care. Thus, improving the quality of life, and promoting and maintaining oral health.

According to the general characteristics of single-person households and meal regularity, there were 218 normal people and 56 people with metabolic syndrome, 34 male (22.2%) and 22 female (14.8%) with metabolic syndrome, which was higher in male than in women. The study of Song et al.9) using the 7th KNHANES was similar to this study with 23.7% male and 13.4% female with metabolic syndrome. and In a study by Kim et al.32) using the KNHANES in the 2nd year of the 6th period (2014) and the 1st year of the 7th period (2016), 30.3% male and 18.3% female has metabolic syndrome, however, the differences between male and female were similar. It can be considered that the prevalence rate was low due to the difference in the samples of the KNHANES data. Compared to multi households, single-person households have a relatively low healthy eating behavior index and a high rate of accompanying metabolic syndrome due to poor lifestyle33). Research is needed to reduce the risk of metabolic syndrome by subdividing various lifestyles and meal regularity.

Abnormal metabolic syndrome was higher in the middle-aged group than in the young group. This was almost the same as the result of Kwon and Lee34), who studied metabolic syndrome-related factors and environmental factors in Korean adults, with the highest prevalence among the middle-aged, who were between 45 and 54 years of age, than the young. It is thought that the high prevalence in the elderly is the result of the characteristics of the metabolic syndrome rather than the influence of social and environmental factors. Detailed and specialized research is needed in the future by classifying them by age group. Meanwhile, in this study, smoking and drinking did not have a significant effect on metabolic syndrome, which was consistent with the study results of Kim26) and An and Son35). However, in a study by Kwon and Lee34), these disparities were attributed to the fact that the characteristics of each factor for smoking and drinking were not considered. However, as smoking is reported to increase the risk of metabolic syndrome26), even if it does not cause immediate health problems, intervention through correction of health behavior is necessary as a long-term preventive aspect.

Metabolic syndrome due to oral health was significantly higher in cases where there were speech problems, chewing difficulty, and less than one frequency of toothbrushing per day. If the oral functional problems, which causes chewing difficulty, leads to a problem of digestive function, then the intake of food is restricted, sufficient intake of nutrients cannot be achieved, which will act as a negative factor for health. Therefore, if chewing and speaking, which are important functions of the oral cavity, become difficult, it will be necessary to study whether it acts as a risk factor for metabolic syndrome. To add a comprehensive oral function, it is necessary to discuss policy methods for oral health and health promotion. In addition, a study by Ku and Kim12) showed that the fewer times a person brushes in a day, the higher the metabolic syndrome and it is in the same vein as a study that reported a high risk of periodontal disease in the presence of metabolic syndrome14). In addition, another study reported that the inflammatory state caused by periodontal disease was related to metabolic syndrome13). These results support a study that reported that periodontal condition deterioration and periodontal disease risk36), and tooth loss37) were high among the components of metabolic syndrome in the hypertensive, diabetic, and low HDL cholesterol groups. In other words, difficulty in chewing and speaking are usually caused by poor oral health, so there is a possibility that tooth loss and weakened support layer may have had an effect38). Toothbrushing can lower the overall dental plaque index in the oral cavity and increase resistance to infection from inflammatory diseases. In addition, by improving the periodontal condition and reducing the prevalence of periodontal disease, thus reducing the risk of tooth loss, the oral health condition is improved, thereby solving the problem of chewing difficulty and speech. Furthermore, it is thought that it may affect not only oral health but also chronic diseases related to metabolic syndrome.

Therefore, for the management of risk factors of metabolic syndrome, regular and professional oral hygiene care should be recommended to reduce the incidence of oral diseases. As part of the national policy, it is necessary to develop and disseminate continuous and systematic programs such as preventive treatment education and specialized dental plaque management for the prevention of oral diseases.

As a result of complex sample logistic regression analysis to identify factors affecting metabolic syndrome in single-person households, metabolic syndrome was 0.361 times higher in the middle-aged group than in the youth group, 1.161 times higher in the case of difficulty in speech problems than in the case of no speech problems. In addition, compared to the frequency of toothbrushing more than four times a day, it was 5.673 times higher than in the case of brushing less than once a day, and 1.284 times higher in the case of 2 to 3 times. In particular, the frequency of toothbrushing per day was found to be highly related to metabolic syndrome. A study by Kim26) in single-person households found that older people are more affected by metabolic syndrome and have a relatively higher proportion of regular meals, but as a result of adverse eating habits or lifestyle influences on the occurrence of metabolic syndrome and in relation to dietary habits, it is thought that it is necessary to specifically confirm the interval between meal times or the metabolically unfavorable meal pattern. The older the person, the higher the percentage of regular meals, however, it is thought that specific checks on eating time intervals and metabolic patterns are essential if poor eating or lifestyle influences metabolic syndrome.

Oral health is a major component of overall health and affects the quality of life. Therefore, it is necessary to discuss concrete practical methods to reach a healthy old age and improve the quality of life. In this study, metabolic syndrome was found to be highly related to the frequency of toothbrushing, which is essential for oral health, confirming that there is a close relationship between metabolic syndrome and oral health. Less frequent brushing causes oral diseases, which reduce oral functions such as mastication and pronunciation, which leads to poor oral health. When the amount of activity is reduced, it leads to poor overall health results.

As a result of the above, the health risks faced by single-person households in Korea are corrected through the correction of lifestyle and oral health behaviors, and active intervention measures such as support and publicity at the local or national level should be prepared so that a customized care plan for single-person households can be prevented, and programs that can be applied can be implemented.

As a limitation of this study, the KNHANES data used in this study did not specifically identify the health behavior or oral health behavior of each person in a single- person household using a cross-sectional survey. Therefore, in future studies, the implementation of a longitudinal study requires detailed association with metabolic syndrome, along with clinical data related to various dietary, lifestyle, oral, and systemic health. Nevertheless, this study aims to use the most recent data to identify the risk factors of metabolic syndrome in single Korean households that can be viewed as a universal social phenomenon through big data analysis.

Acknowledgments

This research was supported by funds of Howon University.

Conflict of Interest

No potential conflict of interest relevant to this article was reported.

Ethical Approval

This study was approved by the Research Ethics Review Committee of the Korea Centers for Disease Control and Prevention (2018-01-03-C-A) and the exemption approval of the Research Ethics Review Committee of Howon University (IRB No: 1041585-202105-HR-003-01).

Author contributions

Conceptualization: Hye-Won Cheon. Data acquisition: Jin-Ah Jung. Formal analysis: Jin-Ah Jung. Funding: Hye-Won Cheon. Supervision: Jin-Ah Jung. Writing—original draft: Jin-Ah Jung, Hye-Won Cheon, and On-Ju Ju. Writing—review & editing: Jin-Ah Jung, Hye-Won Cheon, and On-Ju Ju.

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