Qi Xiang, Sui Junyu, Yang Zhongfang, Dahlen Alex, Zhang Kai, Wu Bei
Rory Meyers College of Nursing, New York University, New York, NY 10010, USA.
Rory Meyers College of Nursing, New York University, New York, NY 10010, USA; Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ 85004, USA.
Diabetes Res Clin Pract. 2025 Aug 25;228:112437. doi: 10.1016/j.diabres.2025.112437.
Cardiovascular-Kidney-Metabolic (CKM) syndrome is a five-stage framework integrating cardiovascular, renal, and metabolic health. Periodontitis may contribute to multi-system conditions like CKM syndrome, but its overall impact and mechanisms remain unclear.
We analyzed 3,102 U.S. adults (30-79 years) from NHANES 2009-2014. Periodontal status was classified as none, mild, moderate, or severe; CKM stage (0-4) was determined by clinical criteria. Biological age was estimated via the Klemera-Doubal Method (KDMAge) and Phenotypic Age (PhenoAge) algorithms. Ordinal and binary logistic regression assessed periodontitis-CKM associations, adjusting for sociodemographic and lifestyle factors. Mediation analysis quantified the proportion of this association explained by biological age acceleration (BAA).
Advanced CKM (stage 3-4) affected 17.8 % of participants. Severe periodontitis versus none/mild was associated with 1.50-fold higher odds of a more advanced CKM stage (95 % CI: 1.15-1.96) and 2.05-fold higher odds of advanced CKM in binary models (95 % CI: 1.50-2.80). Severe periodontitis corresponded to + 1.1 years of KDMAge acceleration and + 1.2 years of PhenoAge acceleration (p < 0.001). BAA mediated 20.1 % of the effect via KDMAge and 13.9 % via PhenoAge (p < 0.001).
These findings underscore the importance of integrating oral health into cardiometabolic care, suggesting that addressing periodontal inflammation and BAA could improve CKM outcomes.
心血管-肾脏-代谢（CKM）综合征是一个整合心血管、肾脏和代谢健康的五阶段框架。牙周炎可能导致如CKM综合征等多系统疾病，但其总体影响和机制仍不清楚。
我们分析了来自2009 - 2014年美国国家健康与营养检查调查（NHANES）的3102名美国成年人（30 - 79岁）。牙周状况分为无、轻度、中度或重度；CKM阶段（0 - 4）由临床标准确定。通过克莱梅拉-杜巴尔方法（KDMAge）和表型年龄（PhenoAge）算法估计生物学年龄。有序和二元逻辑回归评估牙周炎与CKM的关联，并对社会人口统计学和生活方式因素进行调整。中介分析量化了生物学年龄加速（BAA）所解释的这种关联的比例。
晚期CKM（3 - 4期）影响了17.8%的参与者。与无/轻度牙周炎相比，重度牙周炎与CKM更晚期阶段的几率高1.50倍相关（95%置信区间：1.15 - 1.96），在二元模型中与晚期CKM的几率高2.05倍相关（95%置信区间：1.50 - 2.80）。重度牙周炎对应KDMAge加速 + 1.1年和PhenoAge加速 + 1.2年（p < 0.001）。BAA通过KDMAge介导了20.1%的效应，通过PhenoAge介导了13.9%的效应（p < 0.001）。
这些发现强调了将口腔健康纳入心脏代谢护理的重要性，表明解决牙周炎症和BAA可能改善CKM结局。
