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    An article connecting obesity with periodontal health. All credits to the original author.

    Copyright:

    © All Rights Reserved
    Download as PDF or read online from Scribd
    Flag for inappropriate content
    6 views6 pages

    Obesity Periodontal Desease

    Uploaded by

    Ashwin Thejaswi
    An article connecting obesity with periodontal health. All credits to the original author.

    Copyright:

    © All Rights Reserved
    Download as PDF or read online from Scribd
    Flag for inappropriate content
    of 6
    Volune 74 + Number 5 Obesity and Periodontal Disease in Young, Middle-Aged, and Older Adults Mohammad §. Al-Zahrani,*t Nabil F, Bissada,” and Elaine A, Borawski? Background: The growing prevalence of increased body ‘welght and obesity in the United States has raised significant public health concems. Obesity has been implicated as a risk factor for several chronic health conditions, as well as being Recently, on association between obesity and periodontal disease was found in a Japan- ese population. The purposc of the present study is to cxamine the relation between body weight and periodontal disease in a representative United States sample. "Methods: Participants in the third National Health and Nutri- tion Examination Survey (NHANES Il) who were 218 years and had undergone © periodontal examination were selected for the analysis (n = 13.665). Body mass index (Bl) and waist cir- cumference (WC) were used as meosures of overall and abdom- inal fet content, respectively. Univariable and multivariable logis- lic regression models were used to estimate the association between increased body weight and periodontal disease. BMA and WC were assessed independently in a multivariable logistic model containing the following variables: gender, race, education, poverty index, smoking, diabetes, and time elapsed since last dental vist. Significant interections with age were found ond analyses were then stratified by age: younger (18 to 34 years old), middle-aged (35 to 59 years old), and older (60 to 90 years old) adults. Results: A significant association between the measures of body fat and periodontal disease was found among the younger adults, but not middle or older adults. The adjusted odds ratios (OR) for having periodontal disease were 0.21 (0,080 to 0.565), 41.00 (0.705 to 1.407), and 1.76 (1.187 to 2.612) for subjects with BM! <18.5 ka/m?, 23-29.9 kg/m?, and 230 ka/m®, respec- tively. Young subjects with high WC had an adjusted OR of 2.27 (1.480 to 3.487) for having periodontal disease. Conclusions: in a younger population, overall and abdorni- nal obesity are associated with increased prevalence of perio- 2 months of age.!2 The survey consisted of a home interview followed by @ ‘comprehensive medical and dental examination. A total of 31,311 subjects were exernined, 30,818 in a ‘mobile examination center and 493 in their homes. ‘Subjects who were 213 yeats (n= 19,610) were eligl- ble for the periodontal examination, For the current study, only subjects who were 216 years and had ‘undergone the perlodontal examination were included (n= 13,665). a8 was the case in similar studies.">"+ Outcome Variable Periodontal disease was defined based on the pres- ence of one or more periodontal sites with both an attachment loss (AL) of 23 mm and probing depth PD of 24 mm. The use of these criterla was based on pre- vious studies utillaing NHANES Ill data.8-13.4 Com- ining PD and AL has the advantage of classifying those subjects with true periodontal pockets as dis- ‘eased and those with recession only as non-diseased, Furthermore, Tomar and Asma" reported that the use of this definition elimineted age confounding. Perl- odontal examination for NHANES Ill was performed around the teeth of a randomly assigned half-mouth, one upper and one lower quadrant. Third molars, par- tiolly erupted teeth, and retained roots were excluded. ‘The distance from the free gingival margin to the bot- tom of the sulcus (probing depth) and the distance from the free gingival margin to the cemento-enamel junction (CEJ) were recorded at the mesto-facial and mid-facial aspects of each tooth, The level of the peri- ‘odontal attachment was computed from the above measurements to represent the distance from the CEJ to the bottom of the sulcus (attachment loss). Obesity ‘Two indicators of obesity were used: body mass index and waist circumference, BM), used 8s an indicator of overall adiposity, was computed from weight in kilo- crams divided by square height in meters, and divided into 4 categories: underweight (<18.5 kg/m?), normal (18.5 to 24.9 ka/m?), overweight (25 t0 29.9 kg/m?), ‘and obese (230 kg/m?), Weist circumference (WC), used to assess visceral adiposity, was divided into 2 categories using the cutoff point of >102 em for men ‘and 588 cm for women. The cutoff points for both BM and WC were based on the guidelines of the National Heart, Lung, and Blood Institute and World Health ‘Organization (WHO) #16 Covariates Socio-demographic variables and periodontal disease Fisk factors were selected as covariates. The selected variables were age, race, gender. poverty index. edu- cation, time elapsed since the last dental visit, srmok- ing, and diabetes. Race was obtained from the NHANES Il examination fle variable race-ethnicity, which iden- tifies the following categories: non-Hispanic white, non- Hispanic black, Mexican American, and others.!2 The poverty index in NHANES lll represents the family income divided by the poverty threshold, For our analy. sis, it was categorized into high (>2.75 to 11.89), medium (71.29 to 2.75), and low (0 to 1.29) income. ‘Smoking status was defined as current smoker, former smoker, or never smoker. History of diabetes was ‘obtained from the household adult file variable “have ‘you ever been told by a doctor that you have diabetes ‘or suger diabetes.” Women who reported to have dia- betes only during pregnancy were considered non-dia- betics, Educetion attainment was osscascd os 3 cate- gories, those who have less than, equal to or greater than 12 years of schooling. The time elapsed since last dental visit was categorized into 4 categories (<1 year, 2 to 3 years, >3 yeers, and never visited). Data Analysts Data analyses entalled basic descriptive approaches using statistical software,* and estimation and testing utilizing a specialized statistical package that adjusts for complex sample design. The final sample weight variable for the mobile examination center and the replicate weights provided by the NCHS were used to produce nationally representative estimates, The assoclation between the exposure variables (BMI and WC) and periodontal disease was assessed using 2 separate multi-variable logistic regression models. ‘The full model included BMI or WC and all the covari- ates, as well as the 2-way interaction between the expo- ‘sure variables and 3 demographic covariates: age, gen- der, and race. The interaction terms were removed one by one from the model if their significance level was >0.1. The main effect terms were kept in the model regardless of their effects on the P value or on the odds ratio for exposure variables. RESULTS ‘There were 17,752 subjects in the NHANES Ill exam- ination data file aged 218 years. OF these, 13,669 sub- jects had pcriodontol examination, 1,342 were excluded ‘from periodontal exam for medical reasons, and 2745 subjects had no information on their periodontal con- dition, Our analysis was limited to those NHANES sub- {ects 218 years old who had the periodontal assessment (n= 13,665). ‘Characteristics of the study population and preva- lence of periodontal disease are shown in Table 1. Based ‘on our weighted sample, 42.4% of the participants were 18 to 34 years old (young), 42.4% were 35 to 59 yeers: ‘old (middle-aged), and 15.2% were 60 to 90 years $985, Yeon 8.2, SAS nutter, CarY NE Neste FC, Yeon #0, Wenn ne: Roche, MD, en *, Qbaaity and Periodontal Dienase Volare 74 + Number 5 Tablet. Characteristics of the Study Population by Periodontal Disease Status (n = 13,665)" 1096 @¢i9) 1671 (0938) 216 4876075) 898 0532) 296° 73340467) 15.40 0.056) 20760136) 12886 96300181) 1332 0673) 370181) SUISIL9 p25. ‘si year 8179 6834(079) N84 744) 23 years 169512550538) 1448. (0930) 23 years 3118 1705 (0497) 2053 (1339) Newer 589-207 @171) 1716720) 7981. 6391 (0604) 11.69.0799) 1744 (0887) 12 (older). Fity one percent of the partic- ipante were females. A majority of the study population were non-Hispanic whites (74%). Neoly half of the sub- jects had never smoked. More than 78% Of the subjects had 12 years or more of schooling, Less than 4% were diabetic. ‘Two percent had never been toe den- tist or a dental hygienist and 17% had not had a dental visit for more than 3 ‘years. More than half ofthe study pop- Ulation was either obese or overweight (BMI 225) and 36% had high WC. Prevalence of periodontal disease was 14% in the totel population (8% in the young. 17% in middle-aged, and 20% in the older adults). Peridontal disease was more prevaient among males, non-Hispanic blacks (foliowed by Mexican Americans), current smok. ‘ers (compared to former or non-smok- ets), individuals with less education, and diabetics. Prevalence also increased based on the time since last dental visit (highest among those who had never visited 2 dental office or whose last visit ‘was more than 3 years ago). Prevalence was highest among persons with a BM of 230 kg/m? and increased with increasing BMI. Eighteen percent of the population with high WC had peri ‘odontal disease compared to 12% with a smaller WC. BMI >30 kg/m? and high WC were found to be associated with the preva- lence of periodontal disease in both univariable and multivariable ogistic regression models (Table 2). Only the interaction between age and the expo- sure variables were significant. For this reason, age-stratified analyses are resented, ‘As show in Tables 3 and 4, respec- tively, body mass index >30 kg/m? and high WC were crudely associated with prevalence of periodontal disease in persons aged 18 to 34, but not in the other age groups. A negative associa- tion between being underweight and the prevalence of periodontal disease was also observed in this age group. The estimate of the association be- ‘tween prevalence of periodontal dis- ‘ease in young adults and obesity wes slightly attenuated (rom 1.85 to 1.76) by adjusting for all the covariates, but |LPetodonal = May 2003 Table 2. Crude and Adjusted Odds Ratios and 95% Confidence Interval of Body Mass Index (BMI) and Waist Circumference (WC), and Periodontal Disease in Study Population © 13E (1301514) 64 (137541960) Table 3. Crude and Adjusted Odds Ratios and 95% Confidence Interval of Body Mass Index and Periodontal Disease Stratified by Age prevalence of periodontal disease in persons 18 to 34 was slightly increased (from 2.14 to 2.27) by adjusting for the covariates and remained statistically significant (P <0.001). In the other age categories, no association was found between periodontal disease and WC or BMI, ‘To confirm that the association between obesity and periodontitis was not due to residual age confounding, wwe further categorized the younger group into 16 to 24 years and 25 to 34 years. The association between WC ‘and periodontitis remained strong and signéicont; the adjusted OR and 95% CL were 2.20 (1.131 to 4.291) and 2.10 (1.281 to 3.432) for persons aged 18 to 24 and 25 to 34, respectively. DISCUSSION sity and prevalence of peri- odontal disease, only among individuals aged 18 to 34 years. The prevalence of peri- ‘odontal disease is 76% higher young obese (BMAI>30 glee) ddan han ‘young, but normal weight indi- viduals. Also young persons with high WC @102 em in ‘men; >88.cm in women) have 2.27 times greater odds of hhoving periodontal disease than in those with smaller WC. eis 1938096) 127(0445.663) 108 (0350.3998) Furthermore, young under- (e529 15691255) Retrence Fefeence weight individuals were 80% 25.289 17.14.(1.356), 1.09 (0908-1315) 0.98 (0812-1.191) less likely to have periodontal (09261573) Doma. aa 5 Aarti ocernyetingpo ewe aac FSi Sabor Pol remained significant (P <0.01). The negative associa- tion between underweight and prevalence of perio- dontal disease remained strong and significant in the final multivariable model for persons aged 16 to 34 (OR = 0.21 and 95% confidence interval (Cl) 0.08 to 0.57). The OR for the association between WC and 128 (0973-1680), disesse than young, but nor- mal weight individuals. No significant assecistion was found between body ‘weight and periodontal dis- ‘ease in the middle and older lage groups. These findings ‘ace consistent with other pre- vious reports that found @ stronger association between obesity and mortalty and chronic diseases other than periodontitis in younger age groups.?.!7- Several explanations for the association between obesity and periodontal disease in younger edults, and not older adults are plausible. Research has shown that early-onset obesity thet continues in adult- 69 Obesity and Perlodontal Disease Table 4. Crude and Adjusted Odds Ratios and 95% Confidence Interval of Waist Circumference and Periodontal Disease Stratified by Age 1655 (1319) Reference 1837 (1325) aon Spb! WTO os * Cutof pint 102 em er men and 285 cm fo waren, + Rated for ance, roe, moka, poverty nex, edocetn, dabens, and tie since at dena st. tera eprenertalive esses. hood may be more harmful than obesity that appears 1m adulthood.”? Since aging is associated with an increase in body fat mass, it is reasonable to assume that most of the obesity in younger age groups started earlier in life while some of the older obese Participants gain some welght as part of the aging process. If this is true, the association of obesity and periodontal disease would be more pronounced among younger than older adults, due to the confounding ‘metabolic changes in later life. ‘A second explanation could be due to the dilution of the effect of obesity in the older age groups. It may be that the influence of obesity on the periodontal condition of older participants was mosked by pres. ence of stronger risk factors (such as age). Thus, more non-obese individuals would develop periodontal dis- cease as they age, diluting the effect of obesity toward no association. The previous assumption is supported by our observation of greater increase of periodontal disease prevalence by getting older among normal weight individuals compared to obese. ‘A third explanation may be an observed cohort effect. The present study is cross sectional. Younger and older study participants may have been exposed to different lifestyles. Research in dictory trends has documented a significant shift in the dletary pattern toward less healthy food among U.S, adolescents.” For example, a comparison of dietary pattems of 2 cohorts of adolescents aged 11 to 16 from 1965 and 1977, respectively, cevealed a significant decrease in raw fruit and non-potato vegetables (sources of vit- amin C), a decrease in total calcium intake, and a sharp increase in soft drinks and non-citrus juices among the later cohort.2© This is particularly relevant os 113 888+ 1498) to oral health since low dietary intake of calcium and vitamin ¢ have been associ- ated with periodontal dis ease.*”*® The 11 t0 18 year- ‘ald cohort in 1965 would be >35 years at the time of NHANES ll (1988-1994), while in 1977 the cohort would be <35 years old. ‘Thus, younger persons in our study population may have different. dietary patterns than older study participants, f the cohort effect assump- ton is valid, the association between periodontal disease and obesity is likely to remain strong and significant 4s the younger cohort ages. Finally, the social stigma sseociated with obesity in younger adults may be a greater source of chronic stress than in older adults, where increased body weight is considered more acceptable. Moreover. younger and older individuals may have different coping strate- gies. Stress and inadequate coping behaviors have Doth been found to be associated with risk for pert- codental dizease.%9 The proposed mechanisms by which psychosocial factors may contribute to the pathogen- esis of periodontal discase include physiological alter- ation of blood supply and salivary flow: modification cof the immune response to periodontal pathogens; oF ‘eration of health-related behavior such as smoking, dietary intake, and oral hygiene practice. The primary limitation of our study is its cross- sectional design. Thus, the association between obe- sity and periodontal disease does not imply causal- ity. The study, however, has several strengths: the large sample size, the svellability of information on many of the potential confounders, and its generalizibity to the United States population. Future studies need to address the underlying question of causality to deter- mine If obesity is a true tisk factor for periodontal dis- ‘ease, expecially among the younger population. If this proves to be the case, prevention and management of, ‘obesity may be an adjunctive approach to improving periodontal health. Reference REFERENCES 1. Doll S, Paccaud F, Bovet P, Burnier M, Wiellbach ¥. Body mass index, abdominal adiposity, and biood pres- sure: Consistency oftheir association across developing land developed countries, nt J Obes Relat Metab Disord 22002;26:88-57. 2. Burton BT, Foster WR, Hicech J, Van Italie TB. Health Implications of obesity: An NIH Consensus Development S,Priodonch «May 2003, Conference. int J Odes 1982:9:135-170. 3, Must A, Spadano J, Coakley EH, Field AB, Colditz G, Dietz WH, The disease burden associated with over ‘weight and obesity. JAMA 1999;262:1523-1529. 4, Field AE, Coakley EH, Must A. et al. Impact of over: ‘weight on the risk of developing commen chronic die gests during. 10-yeor period. Ach intern Ped 2001; 161:1583-1 5. Sturm R. The effects of obesity, smoking, and drinking ‘on medical problems and costs. Obesity outrenks both ‘smoking and drinking in its deleterious effects on health and health costs. Health Aff 2002;21:245.253. 6. Flegal KM, Carroll MD, Kucemaraki RJ, Johnson CL. ‘Overweight and obesty in the United States: Prevalence and trends, 1960-1994, Int J Obes Relat Metab Disord 1998:22:38.47. 7. Mokdad AH, Serdula MK, Dietz WH, Bowman BA, Marks ‘JS. Koplan JP. The spread of the obesity epidemic in the United States, 1991-1998. JAMA 1000;282-1519-1522. ©. Albandar JM, Brunelle JA, Kingman A, Destructive periodontal disease in aduRs 30 years of age and older In the United States, 1988-1994. J Periodontol 1999; 70:13-29. 19, Genco Ru. Current view of risk factors for periodontal disenses. J Perlodontol 1996;67-1041-1049. 10, Partin, issade NF. nfunce a bee and hyper. tension on the severity of is in rats, Oral Surg ral Med Oral Pathol 1977:43:701-713. 11, Salto T, Shimazaic Y, Koga 7, Teuzuki M, Ohshima A. Relationship between upper body obesity and perio-

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