Abstract
Purpose: To determine whether periodontal disease is positively associated with incident diabetes across the continuum of body mass levels (BMI) and test the hypothesis that the periodontal risk for incident diabetes is modified by BMI. Methods: We included 5569 diabetes-free participants from Visit 4 (1996-1998) of the Atherosclerosis Risk in Communities study and followed them until 2018. Periodontal disease status was classified by periodontal profile class (PPC)-Stages, and incident diabetes was based on participant report of physician diagnosis. We estimated the hazard ratios (HR) for diabetes using a competing risk model for each PPC-Stage. We assessed multiplicative interactions between periodontal disease and BMI (as a continuous variable) on risk of diabetes. Results: During a median time of 19.4 years of follow-up, 1348 incident diabetes cases and 1529 deaths occurred. Compared to the "Health/Incidental Disease"stage, participants with PPC "Severe Periodontal Disease"or "Severe Tooth Loss"stage and lower BMI had elevated risk for diabetes adjusting for demographic, smoking, education, and biological variables when accounting for death as a competing risk with HRs of 1.76 (95% CI 1.10-2.80) and 2.11 (95% CI 1.46-3.04), respectively. The interaction between PPC-Stages and BMI was significant (P = 0.01). No significant associations of PPC-Stages with incident diabetes were present when BMI was above 31 kg/m2. Conclusion: Periodontal disease was associated with incident diabetes, especially in nonobese participants. Dentists should be aware that periodontal disease is associated with incident diabetes but the association may be modified for patient's at higher BMI levels.
Original language | English (US) |
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Pages (from-to) | E3546-E3558 |
Journal | Journal of Clinical Endocrinology and Metabolism |
Volume | 106 |
Issue number | 9 |
DOIs | |
State | Published - Aug 18 2021 |
Bibliographical note
Funding Information:The Atherosclerosis Risk in Communities study has been funded in whole or in part with federal funds from the National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, under contract nos. HHSN268201700001I, HHSN268201700002I, HHSN268201700003I, HHSN268201700005I, and HHSN268201700004I. This study was also partially supported by an National Institute of Dental and Craniofacial Research (NIDCR) R00 grant (4R00DE027086) awarded to SZ.
Publisher Copyright:
© 2021 The Author(s). Published by Oxford University Press on behalf of the Endocrine Society. All rights reserved.
Keywords
- body mass index
- diabetes
- periodontal disease
- periodontal-systemic disease interaction