Zuk Aleksandra M, Quiñonez Carlos R, Saarela Olli, Demmer Ryan T, Rosella Laura C
Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
Discipline of Dental Public Health, Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada.
BMJ Open Diabetes Res Care. 2018 Jul 23;6(1):e000535. doi: 10.1136/bmjdrc-2018-000535. eCollection 2018.
Periodontitis is strongly associated with diabetes and is increasingly shown to be associated with other glycemic abnormalities. Vitamin D is postulated to have both anti-inflammatory and antimicrobial activity. Therefore, our aim was to investigate the joint effects of both serum 25-hydroxyvitamin D and total 25-hydroxyvitamin D with periodontitis on homeostatic model assessment for insulin resistance (HOMA-IR), pre-diabetes, and type 2 diabetes.
Using data from the 2009-2010 National Health and Nutrition Examination Survey, the sample was restricted to adults over 30 years of age, who were eligible for oral health examination, and had vitamin D, fasting glucose and insulin measures. The analytic sample includes those with (n=1631) and without (n=1369) type 2 diabetes. Using survey logistic multivariable regression analysis, we examined the following joint effects: (1) vitamin D insufficiency (<50 nmol/L) and moderate to severe periodontitis (VD+PD+); (2) vitamin D insufficiency and mild to no periodontitis (VD+PD-); and (3) vitamin D sufficiency ) (>50 nmol/L) and periodontitis (VD-PD+), and compared these groups with the doubly unexposed reference group (VD-PD-).
Consistently, the joint effects of vitamin D insufficiency and total vitamin D insufficiency with periodontitis (VD+PD+) were significantly associated with diabetes: OR=2.83 (95% CI 1.34 to 5.96) and OR=1.98 (95% CI 1.04 to 3.76), respectively. However, the joint effects of vitamin D insufficiency and periodontitis were attenuated for HOMA-IR 4.17: OR=1.57 (95% CI 0.97 to 2.55). Pre-diabetes was not associated with either joint effects.
In this cross-sectional, nationally representative sample, the joint effects of vitamin D and periodontitis appear to differ for HOMA-IR, pre-diabetes and diabetes.
牙周炎与糖尿病密切相关，且越来越多地被证明与其他血糖异常有关。据推测，维生素D具有抗炎和抗菌活性。因此，我们的目的是研究血清25-羟维生素D和总25-羟维生素D与牙周炎对胰岛素抵抗稳态模型评估（HOMA-IR）、糖尿病前期和2型糖尿病的联合影响。
利用2009 - 2010年美国国家健康和营养检查调查的数据，样本仅限于30岁以上符合口腔健康检查条件且有维生素D、空腹血糖和胰岛素测量值的成年人。分析样本包括患有2型糖尿病（n = 1631）和未患有2型糖尿病（n = 1369）的人群。使用调查逻辑多变量回归分析，我们研究了以下联合影响：（1）维生素D不足（<50 nmol/L）和中重度牙周炎（VD + PD +）；（2）维生素D不足和轻度至无牙周炎（VD + PD -）；（3）维生素D充足（>50 nmol/L）和牙周炎（VD - PD +），并将这些组与双重未暴露的参考组（VD - PD -）进行比较。
一致地，维生素D不足和总维生素D不足与牙周炎（VD + PD +）的联合影响与糖尿病显著相关：OR分别为2.83（95%CI 1.34至5.96）和1.98（95%CI 1.04至3.76）。然而，维生素D不足和牙周炎对HOMA-IR的联合影响减弱：OR = 1.57（95%CI 0.97至2.55）。糖尿病前期与任何一种联合影响均无关联。
在这个具有全国代表性的横断面样本中，维生素D和牙周炎对HOMA-IR、糖尿病前期和糖尿病的联合影响似乎有所不同。
