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. 2025 May;96(5):490-498.
doi: 10.1002/JPER.24-0171. Epub 2024 Jul 7.

Association between nonalcoholic fatty liver disease scores and chronic periodontitis: A retrospective cohort study

Kwangmin Joo  1 , Yeo Wool Kang  2 , Sang Yi Moon  2   3 , Yang Hyun Baek  2 , Minkook Son  3   4
Affiliations

Association between nonalcoholic fatty liver disease scores and chronic periodontitis: A retrospective cohort study

Kwangmin Joo et al. J Periodontol. 2025 May.

Abstract

Background: Although several studies have demonstrated a bidirectional relationship between nonalcoholic fatty liver disease (NAFLD) and chronic periodontitis, few studies have reported that NAFLD causes chronic periodontitis, especially in the Asian population.

Methods: This study was conducted on 129,087 individuals, and the NAFLD score was assessed using the Fatty Liver Index (FLI), Hepatic Steatosis Index (HSI), and Framingham Steatosis Index (FSI). The incidence of chronic periodontitis was defined as a diagnostic code with dental procedures. Multi-variable adjusted Cox proportional hazard regression analysis was performed with hazard ratio (HR) and 95% confidence intervals (CIs).

Results: Nine thousand one hundred and twenty-eight chronic periodontitis cases (7.1%) were identified during a mean 7.4 years follow-up period. Each NAFLD score was related to chronic periodontitis. In the FLI score, HR and 95% CIs for the incidence of chronic periodontitis compared with a low FLI group were as follows: indeterminate FLI: 1.19 (1.12-1.26), high FLI: 1.32 (1.18-1.47). In the HSI and FSI scores, HR and 95% CIs for the incidence of chronic periodontitis were 1.13 (1.05-1.22) and 1.23 (1.05-1.31), respectively.

Conclusions: All NAFLD scores were associated with chronic periodontitis in the Korean population. As chronic periodontitis can aggravate the liver status, patients with NAFLD may need regular dental visits.

Plain language summary: Several studies have shown a link between nonalcoholic fatty liver disease (NAFLD) and chronic periodontitis, but few have explored if NAFLD causes chronic periodontitis, especially in Asians. This study investigated the relationship between NAFLD and chronic periodontitis in Koreans. NAFLD was measured using different indexes (Fatty Liver Index, Hepatic Steatosis Index, and Framingham Steatosis Index), and chronic periodontitis was identified through medical records and dental procedures. The results showed that higher NAFLD scores were significantly associated with an increased risk of developing chronic periodontitis. These findings suggest a positive association between NAFLD and the incidence of chronic periodontitis in Korean population.

Keywords: chronic periodontitis periodontal diseases; non‐alcoholic fatty liver disease; retrospective studies.

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