Nutritional Risk Profiles and Poor Self-Perceived Oral Health in Hungarian Adults: A Population-Based Study with Monte Carlo Population-Attributable Fraction Estimation.

BACKGROUND: Oral diseases remain a major public health challenge globally and in Hungary, where untreated caries, periodontal disease, and edentulism are highly prevalent. Diet is a key modifiable determinant of oral health, yet the cumulative impact of multiple unfavorable nutritional behaviors on self-perceived oral health has not been assessed at the national level in Hungary, nor have population-attributable fraction (PAF) estimates been reported. METHODS: This cross-sectional study analyzed data from 5146 adults in the 2019 Hungarian European Health Interview Survey. A six-component nutritional-risk score was constructed from self-reported dietary behaviors (fruit intake, vegetable intake, sugary soft drink consumption, sweets consumption, processed meat consumption, and water intake). Survey-weighted logistic regression estimated associations between nutritional-risk categories and poor self-perceived oral health, adjusting for sociodemographic, lifestyle, and health-related covariates. Counterfactual PAFs with 95% Monte Carlo uncertainty intervals (1000 bootstrap replications) were estimated for three nutritional-risk scenarios. RESULTS: The weighted prevalence of poor self-perceived oral health was 19.2%. Compared with participants with 0-1 unfavorable nutritional factors, those with 3 factors (OR = 1.37; 95% CI: 1.09-1.73) and 4-6 factors (OR = 1.46; 95% CI: 1.15-1.85) had significantly higher odds of poor oral health. Low water intake was independently associated with poor oral health (OR = 1.38; 95% CI: 1.16-1.64). The main counterfactual PAF analysis estimated that 16.1% (Monte Carlo 95% UI: 5.93-26.48%) of poor oral health burden was attributable to unfavorable nutritional profiles. High nutritional risk was also associated with active caries, gum bleeding, and tooth loss. CONCLUSIONS: Cumulative nutritional risk is independently associated with poor self-perceived oral health in Hungarian adults. Integrating dietary improvements into oral health prevention strategies may substantially reduce the population-level burden of oral disease.