Association between diet and periodontitis: a cross-sectional study of 10,000 NHANES participants

Abstract

Background Periodontitis is a major cause of tooth loss globally. Risk factors include age, smoking, and diabetes. Intake of specific nutrients has been associated with periodontitis risk but there has been little research into the influence of overall diet, potentially more relevant when formulating dietary recommendations. Objectives We aimed to investigate potential associations between diet and periodontitis using novel statistical techniques for dietary pattern analysis. Methods Two 24-h dietary recalls and periodontal examination data from the cross-sectional US NHANES, 2009–2014 (n = 10,010), were used. Dietary patterns were extracted using treelet transformation, a data-driven hierarchical clustering and dimension reduction technique. Associations between each pattern [treelet component (TC)] and extent of periodontitis [proportion of sites with clinical attachment loss (CAL) ≥ 3 mm] were estimated using robust logistic quantile regression, adjusting for age, sex, ethnicity, education level, smoking, BMI, and diabetes. Results Eight TCs explained 21% of the variation in diet, 1 of which (TC1) was associated with CAL extent. High TC1 scores represented a diet rich in salad, fruit, vegetables, poultry and seafood, and plain water or tea to drink. There was a substantial negative gradient in CAL extent from the lowest to the highest decile of TC1 (median proportion of sites with CAL ≥ 3 mm: decile 1 = 19.1%, decile 10 = 8.1%; OR, decile 10 compared with decile 1: 0.67; 95% CI: 0.46, 0.99). Conclusions Most dietary patterns identified were not associated with periodontitis extent. One pattern, however, rich in salad, fruit, and vegetables and with plain water or tea to drink, was associated with lower CAL extent. Treelet transformation may be a useful approach for calculating dietary patterns in nutrition research.

Dietary inflammatory potential is associated with poor periodontal health: A population‐based study

“…In contrast, an anti‐inflammatory pattern is characterized by frequent intake of vegetables and fruits, whole grains, legumes, nuts, and fish (Ahluwalia et al, 2013). Using a data‐driven approach in the NHANES population, the dietary pattern (rich in salad, fruit and vegetables, poultry, and seafood) was negatively associated with the extent of periodontitis (Wright et al, 2020). These epidemiological studies reported that periodontal status might be affected by inflammatory eating patterns defined using principal components analysis (Alhassani et al, 2021) and treelet transformation analysis (Wright et al, 2020).…”

“…Using a data‐driven approach in the NHANES population, the dietary pattern (rich in salad, fruit and vegetables, poultry, and seafood) was negatively associated with the extent of periodontitis (Wright et al, 2020). These epidemiological studies reported that periodontal status might be affected by inflammatory eating patterns defined using principal components analysis (Alhassani et al, 2021) and treelet transformation analysis (Wright et al, 2020). Both analyses derive a summary score for each pattern through statistical modelling of dietary data at hand (e.g.…”

“…A dietary index can be used to identify the synergistic effects among various nutrients and determine the overall healthy qualities of an individual's nutritional patterns (Hu, 2002; Liese et al, 2015; Schwingshackl et al, 2018), which is distinct from focusing solely on a specific macronutrient or micronutrient. Recent studies on various dietary indices have shown that unhealthy dietary patterns are associated with gingival bleeding and periodontal disease, including the Mediterranean diet, the Western diet, the Healthy Eating Index (HEI), and the Alternative HEI (Bawadi et al, 2011; Salazar et al, 2018; Laiola et al, 2020; Wright et al, 2020; Alhassani et al, 2021). Nevertheless, these index‐based dietary patterns were not designed to capture the inflammatory potential of diets.…”

Periodontal Inflammation and Systemic Diseases: An Overview

“…For instance, it has been argued that a so-called industrialized western diet rich in processed carbohydrates like sugar, white flour, and processed fatty acids like trans fats and poor in micronutrients promotes gingival and periodontal inflammation (Woelber and Tennert, 2020 ). A cross-sectional study in 10,000 participants in the NHANES cohort, on the other hand, revealed the effects of a protective diet (Wright et al, 2020 ). In some instances, associations have been also revealed with factors such as the composition of the oral microbiota (Jockel-Schneider et al, 2021 ; Li et al, 2021 ).…”

Association between periodontitis and the Mediterranean diet in young Moroccan individuals

“…Although the mechanism is not fully understood, diet has been reported to be significantly associated with periodontitis, 9‐13 with healthier dietary patterns or better diet quality having a protective effect on periodontal health. The Mediterranean diet (MedDiet) is the traditional healthy dietary pattern of people living in countries bordering the Mediterranean Sea.…”