Periodontics Department, College of Dentistry, University of Iowa, Iowa City, IA, USA.
Division of Oral and Craniofacial Health Sciences, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
J Clin Endocrinol Metab. 2021 Aug 18;106(9):e3546-e3558. doi: 10.1210/clinem/dgab337.
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.
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.
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.
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.
确定牙周病是否与体重水平（BMI）连续体上的新发糖尿病呈正相关，并检验牙周病新发糖尿病风险是否受 BMI 影响的假设。
我们纳入了动脉粥样硬化风险社区研究（Atherosclerosis Risk in Communities study）第 4 次访视（1996-1998 年）中 5569 例无糖尿病的参与者，并随访至 2018 年。牙周病状况通过牙周档案分类（PPC）-阶段进行分类，新发糖尿病则根据参与者报告的医生诊断确定。我们使用竞争风险模型估算了每个 PPC 阶段的糖尿病发病风险比（HR）。我们评估了牙周病和 BMI（作为连续变量）之间的乘法交互作用对糖尿病风险的影响。
在中位随访时间为 19.4 年期间，发生了 1348 例新发糖尿病病例和 1529 例死亡事件。与“健康/偶发疾病”阶段相比，PPC“重度牙周病”或“重度牙齿缺失”阶段且 BMI 较低的参与者发生糖尿病的风险增加，调整了人口统计学、吸烟、教育和生物学变量，同时将死亡作为竞争风险因素，HR 分别为 1.76（95%CI 1.10-2.80）和 2.11（95%CI 1.46-3.04）。PPC 阶段和 BMI 之间的交互作用具有统计学意义（P=0.01）。当 BMI 超过 31 kg/m2 时，PPC 阶段与新发糖尿病之间无显著关联。
牙周病与新发糖尿病相关，尤其是在非肥胖参与者中。牙医应意识到牙周病与新发糖尿病相关，但该关联可能会因患者 BMI 水平较高而发生改变。
