Association between high-density lipoprotein-related inflammation index and periodontitis: insights from NHANES 2009-2014

Abstract

Background: Periodontitis, a persistent inflammatory condition, significantly impairs individuals' overall quality of life. Lymphocyte-to-high-density lipoprotein cholesterol ratio (LHR), monocyte-to-high-density lipoprotein cholesterol ratio (MHR), neutrophil-to-high-density lipoprotein cholesterol ratio (NHR), and platelet-to-high-density lipoprotein cholesterol ratio (PHR) are new convenient and economical biomarkers. However, whether the above high-density lipoprotein-related inflammatory biomarkers are associated with periodontitis has rarely been investigated. Therefore, the research endeavor focused on uncovering potential relationships.

Methods: The research encompassed a diverse and extensive sample, comprising 9,470 participants, selected from the National Health and Nutrition Examination Survey spanning the years 2009 to 2014. The association between high-density lipoprotein-related inflammatory biomarkers and periodontitis was explored utilizing a multivariable logistic regression model with weighted analysis. Additionally, the study employed smoothed curve fitting to explore potential nonlinear relationships. Further stratified analyses and interaction tests were performed.

Results: This study indicated no apparent association between MHR and PHR with periodontitis, whereas LHR and NHR demonstrated a statistically significant positive relationship with the prevalence of periodontitis. In the fully adjusted model, participants belonging to the highest tertile of both LHR and NHR showed a notably higher likelihood of having periodontitis compared to those in the lowest tertile (LHR: OR = 1.22, 95% CI: 1.06, 1.39; NHR: OR = 1.27, 95% CI: 1.09, 1.49). Furthermore, smooth curve fitting was employed to investigate the potential nonlinear relationship between LHR, NHR, and periodontitis. The results indicated that there was a significant increase in the occurrence of periodontitis when Log₂ (LHR) exceeded 1.01 and Log₂(NHR) surpassed 2.16 (Log₂(LHR): OR = 1.42; 95% CI: 1.19, 1.69; Log₂(NHR): OR = 1.40; 95% CI: 1.15, 1.71). The subgroup analysis revealed that the associations between periodontitis and either LHR or NHR, separately, were more pronounced among individuals under the age of 50 and those without hypertension.

Conclusions: This cross-sectional study revealed a positive relationship between LHR、NHR and periodontitis, particularly when these indicators exceeded their thresholds. LHR and NHR may serve as potential inflammatory markers for identifying periodontitis, thereby facilitating early warning for both patients and dentists, and enabling early intervention in the oral environment. Besides, extensive prospective cohort investigations are essential to confirm and solidify this observation.

Keywords: High-density lipoprotein-related inflammatory biomarkers; NHANES; Periodontitis.

Fig. 1

Study population selection (N = 9,470)

Fig. 2

Smooth curve fitting analysis of the association between Log₂(LHR), Log₂(NHR) and the prevalence of periodontitis (Adjusted for all covariables, including sex, age, race, education background, marital condition, PIR, smoking, alcohol consumption, diabetes, hypertension, and BMI). (A) Smooth curve fitting for Log₂(LHR) and periodontitis; (B) Smooth curve fitting for Log₂(NHR) and periodontitis

Fig. 3

Subgroup analysis of the association between Log₂(LHR), Log₂(NHR) and the prevalence of periodontitis