Supplemental Material for: Oral microbiome alpha diversity and cardiovascular-kidney-metabolic syndrome in US adults: evidence from the NHANES 2009-2012

This cross-sectional study used data from the National Health and Nutrition Examination Survey (NHANES), conducted with Mexican American, Non-Hispanic White, Non-Hispanic Black, and other racial and/or ethnic groups between 2009 and 2012, involving 5,225 participants with oral microbiome measurements. The richness of the amplicon sequence variants (ASV) in the oral microbiome was quantified using 16S rRNA gene sequencing of oral rinse samples to assess alpha diversity.

We examined the prevalence of CKM syndrome and its severity, assessed as an ordinal stage score ranging from 0 to 4.</p><p dir="ltr">Results: Participants’ (men 54.1%) mean±SD age was 41.1±14.9 years. Each 1-SD decrement in ASV richness was associated with higher odds of CKM syndrome stage ≥1 (odds ratio [OR]=1.14, 95% confidence interval [CI]=1.02-1.28), stage ≥2 (OR=1.24, 95% CI=1.13-1.37), and the severity of CKM syndrome (OR=1.22, 95% CI=1.12-1.33).

With sex, racial and/or ethnic groups, and dietary fiber intake interactions, the association of ASV richness with CKM syndrome was observed in men and women, Non-Hispanic White and Non-Hispanic Black adults, and those with inadequate fiber intake.</p><p dir="ltr">Conclusion: Reduced oral microbiome alpha diversity is associated with a greater burden of CKM syndrome, with these associations potentially varying by sex, racial and/or ethnic groups, and dietary fiber intake.</p>