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

Abstract

Aim: To investigate the association between dietary inflammatory potential and poor periodontal health.

Material and methods: A cross-sectional analysis of a nationally representative sample of participants was performed. NHANES 2011-2014 (n = 7081) and NHANES 2001-2004 (n = 5098) were used as discovery and validation datasets, respectively. The energy-adjusted dietary inflammatory index (E-DII) score was calculated for each participant based on 24-h dietary recalls to assess diet-associated inflammation. Periodontitis was defined by the CDC/AAP using clinical periodontal parameters. Natural cubic spline was applied to identify any non-linear associations of the E-DII score with moderate/severe periodontitis. Furthermore, interaction analyses were performed by age, gender, and race/ethnicity to explore the moderating roles of these factors.

Results: In the discovery dataset, a non-linear positive relationship with periodontitis was identified for the E-DII score (p_{non-linearity} < .001) after adjustment for potential confounders. Compared with those individuals in the lowest tertile of E-DII, participants in the highest tertile who consumed a pro-inflammatory diet were 53% more likely to be periodontitis (OR _tertile3vs1 = 1.53, 95% CI: 1.33-1.77). The validation dataset showed similar associations. Relatively stronger associations were seen in older adults and males.

Conclusion: Consuming a pro-inflammatory diet indicated by the E-DII score is associated with periodontal disease in the U.S. general adult population.

Keywords: NHANES; dietary inflammatory index; inflammation; periodontal health.

FIGURE 1

Flow chart indicating the discovery and validation datasets of participants included for the analysis from the National Health and Nutrition Examination Survey 2011–2014 and 2001–2004 dataset

FIGURE 2

Natural spline curve indicates the non‐linear association between the E‐DII score and moderate/severe periodontitis in participants aged >30 years in the discovery dataset (NHANES 2011–2014, n = 7081). The red hollow‐circle line and dotted lines represent the estimated values and their corresponding 95% CI. Odds ratios are based on logistic regression models adjusted for age, gender, race/ethnicity, education, income, smoking habit, alcohol consumption, physical activity, dental visit, abdominal adiposity, obesity, hypertension, dyslipidaemia, dysglycaemia, WBC count, cardiovascular disease, arthritis, total energy intake, and the number of teeth present. Periodontitis was defined by CDC/AAP case definition. Knots are at the 33.3th and 66.7th percentiles for the E‐DII score. Abbreviations: AAP, American Academy of Periodontology; CDC, Centers for Disease Control and Prevention; CI, confidence interval; E‐DII, energy‐adjusted dietary inflammatory index; NHANES, National Health and Nutrition Examination Survey; OR, odds ratio; WBC, white blood cell

FIGURE 3

Associations between the tertiles of E‐DII and moderate/severe periodontitis in participants aged >30 years in the discovery dataset (NHANES 2011–2014, n = 7081) and the validation dataset (NHANES 2001–2004, n = 5098). Association is deemed significant if the 95% CI does not include zero. All p values were calculated with a two‐sided significance level of .05. A multivariable logistic regression model was adjusted for potential confounders (see legend of Figure 2). Periodontitis was defined by CDC/AAP case definition. Abbreviations: E‐DII, energy‐adjusted dietary inflammatory index; NHANES, National Health and Nutrition Examination Survey; CI, confidence interval; OR, odds ratio; CDC, Centers for Disease Control and Prevention; AAP, American Academy of Periodontology