Correspondence

Obesity and Periodontitis

N Engl J Med 1998; 339:482-483August 13, 1998

Article

To the Editor:

We recently noted a relation between obesity, which is a risk factor for various diseases, and periodontitis, which is a major cause of tooth loss in adults. We studied 241 apparently healthy dentulous Japanese subjects, 20 to 59 years of age (172 women and 69 men), who attended a health promotion program at Fukuoka Health Promotion Center from May 1995 to April 1997. Periodontal status was estimated by the Community Periodontal Index of Treatment Needs (CPITN).1 Among the subjects, 145 had no periodontitis (normal gums or gingivitis, CPITN code 0 to 2; probing depth, ≤3.5 mm), and 96 had periodontitis (CPITN code 3 or 4; probing depth, ≥4 mm).

The subjects were divided into four groups according to their body-mass index (the weight in kilograms divided by the square of the height in meters): <20 (lean, 47 subjects), 20 to 24.9 (normal, 150), 25 to 29.9 (overweight, 36), and ≥30 (obese, 8). The subjects completed a questionnaire about oral hygiene, smoking, and known risk factors for periodontal disease and had measurements taken of blood glucose while fasting, glycosylated hemoglobin, serum high-density lipoprotein (HDL) cholesterol, and body fat (by dual-energy x-ray absorptiometry).

The relative risk of periodontitis, after adjustment for age, sex, oral-hygiene status, and smoking history, was 1.7 in the group with body-mass indexes of 20 to 24.9 as compared with <20, 3.4 in those with body-mass indexes of 25 to 29.9, and 8.6 in those with body-mass indexes of ≥30 (P=0.02) (Table 1Table 1Relative Risk of Periodontitis Associated with the Body-Mass Index in Japanese Subjects.). The adjusted relative risk of periodontitis for each 5 percent increase in body fat was 1.3 (95 percent confidence interval, 1.0 to 1.6; P=0.02). Type 2 diabetes mellitus is a risk factor for periodontitis2,3 and is associated with obesity. However, neither the subjects' glycosylated hemoglobin values (range, 3.4 to 6.3 percent) nor their fasting blood glucose concentrations (73 to 131 mg per deciliter [4.1 to 7.3 mmol per liter]) were correlated with the incidence of periodontitis. However, periodontitis was more common in the subjects with serum HDL cholesterol concentrations <60 mg per deciliter (1.6 mmol per liter). We conclude that obesity and periodontitis are related and that the latter may be exacerbated by some conditions associated with obesity — for example, “the metabolic syndrome,” a clustering of dyslipidemia and insulin resistance.

Toshiyuki Saito, D.D.S., Ph.D.
Yoshihiro Shimazaki, D.D.S., Ph.D.
Kyushu University, Fukuoka 812-8582, Japan

Masako Sakamoto, M.D.
Fukuoka Health Promotion Foundation, Fukuoka 810-0073, Japan

3 References

1. 1

   Ainamo J, Barmes D, Beagrie G, Cutress T, Martin J, Sardo-Infirri J. Development of the World Health Organization (WHO) community periodontal index of treatment needs (CPITN). Int Dent J 1982;32:281-291
   Web of Science | Medline

2. 2

   Grossi SG, Zambon JJ, Ho AW, et al. Assessment of risk for periodontal disease. I. Risk indicators for attachment loss. J Periodontol 1994;65:260-267
   CrossRef | Web of Science | Medline

3. 3

   Salvi GE, Lawrence HP, Offenbacher S, Beck JD. Influence of risk factors on the pathogenesis of periodontitis. Periodontology 2000;14:173-201
   CrossRef | Web of Science

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10. 10

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13. 13

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14. 14

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15. 15

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16. 16

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17. 17

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18. 18

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19. 19

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    CrossRef

42. 42

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43. 43

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48. 48

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