2010年06月12日

その1

A Cohort Study on the Association Between Periodontal Disease and the Development of Metabolic Syndrome

Toyoko Morita,*† Yoji Yamazaki,† Ayae Mita,† Koji Takada,† Misae Seto,‡ Norihide Nishinoue,‡Yoshiyuki Sasaki,§ Masafumi Motohashi,* and Masao Maeno*

Background:

An association between periodontal disease and metabolic syndrome based on cross-sectional and casecontrol studieswas recently reported, but their causal relationship has not been fully clarified. The objective of this cohort study is to investigate the association between periodontal disease and changes in metabolic-syndrome components to accumulate evidence of the causal relationship between the two conditions.

Methods:

The study subjects consisted of 1,023 adult employees (727 males and 296 females; mean age: 37.3 years) who underwent medical and dental checkups between 2002 and 2006 and in whom all metabolic-syndrome components were within the standard values in 2002.

The association between the presence of periodontal pockets and the positive conversion of metabolic-syndrome components was investigated using multiple logistic-regression analysis, odds ratios (ORs), and 95% confidence intervals (CIs).

Results:

The presence of periodontal pockets was associated with a positive conversion of one or more metabolic components during the 4-year observation period (OR: 1.6; 95% CI: 1.1 to 2.2).

The ORs for a positive conversion of one component and two or more components were 1.4 (95% CI: 1.0 to 2.1) and 2.2 (95% CI: 1.1 to 4.1), respectively, and the difference was significant for two or more positive components.

Of the metabolic-syndrome components, positive conversions of blood pressure and the blood-lipid index were significantly associated with the presence of periodontal pockets.

Conclusion:

The presence of periodontal pockets was associated with a positive conversion of metabolic-ndromecomponents, suggesting that preventing periodontal disease may prevent metabolic syndrome.

J Periodontol 2010;81:512-519.

Kew words

Cohort study; hyperglycemia; hypertension; lipid metabolism; obesity; periodontal disease.

===============

* Department of Oral Health Sciences, Nihon university School of Dentistry, Tokyo, Japan.

† The Lion Foundation for Dental Health, Tokyo, Japan.

‡ Health Care Center, Lion Corporation, Tokyo, Japan.

§ Center for Education and Research in Oral Health Care, Faculty of Dentistry, Tokyo Medical and Dental University, Tokyo, Japan.

===============

Metabolic syndrome is a complex collection of components that are thought to arise from a visceral fat-type obesity involving hypertension and abnormal glucose and lipid metabolism.

Preventing metabolic syndrome is of great medical importance because the presence of multiple components increases the risk of developing cardiovascular disease.

1,2 Numerous studies3-13 linked periodontal disease with several serious risk factors for metabolic syndrome, including type 2 diabetes,3,4 obesity among community residents,5,6 lipid abnormalities in patients with periodontal disease7-11 and community residents, 12 and elevated blood-pressure levels.

13 Studies on the association between periodontal disease and metabolic syndrome in Japanese-community residents and adults in Northern Jordan and China14-16 and analysis of results from the United States National Health and Nutrition Examination Survey III17 were reported, and Morita et al.

18 described the association in industrial workers.

Previous studies14-18 of the association of periodontal disease and metabolic syndrome were cross-sectional or case-control studies.

The results provided by these study designs is relatively weaker than in cohort studies.

Elevated blood levels of inflammatory markers, such as C-reactive protein (CRP) and interleukin (IL)-6 were reported in patients with periodontal disease,19,20 suggesting that periodontal disease is amild chronic inflammatory disease affecting the systemic condition.

21,22 Aggravation of glucose tolerance in people with deep periodontal pockets was also shown epidemiologically, suggesting that infection with periodontal disease pathogens enhances tumor necrosis factor-alpha (TNF-a) production, induces the prediabetic condition, and leads to abnormal glucose tolerance.

23 Furthermore, negative influences by lipopolysaccharide (LPS) and cytokines produced by inflammation, such as TNF-a and IL-1, on lipid metabolism were reported,24 suggesting that Gram-negative anaerobe- induced periodontal disease has some influence on lipid metabolism.

Considering these findings, it is possible that periodontal disease increases the risk of developing metabolic syndrome as a Gram-negative anaerobeinduced mild chronic inflammatory disease.

The aim of this cohort study is to evaluate the influence of periodontal disease on the development of metabolic syndrome in industrial workers. In this study, exposure was the presence of a periodontal pocket ‡4 mm, and the outcome was a positive conversion of metabolic-syndrome components.

========
Materials and methods

The subjects were industrial employees of a company that manufacturers household products in Tokyo, Japan.

The subjects underwent periodic health and dental checkups that were independently performed by a health-insurance association in 2002 and 2006.

In 2002, 99.9% of the employees underwent systemic medical checkups, 88.4% of them had dental examinations, and 2,796 received both checkups.

There were 2,078 employees who had checkups in 2002 and 2006 and gave written informed consent to participate in the present study.

The study subjects included 1,023 industrial workers in whom all components of metabolic syndrome were within the standard values at baseline in 2002 (727 males and 296 females; age range: 20 to 56 years; mean age: 37.3 years).

The remaining 1,055 workers were excluded from the study because one or more metabolic syndrome components were not within standard values in 2002.

The presence of periodontal disease at the initiation of follow-up was assessed according to the criteria of the World Health Organization (WHO) Community Periodontal Index (CPI) criteria.

25 Dental hygienists (AM et al.) examined 10 representative teeth in six sextants under the supervision of dentists (Yoko Ogawa et al.).

Oral examinations were carried out using standardWHOprobes after calibration of the pressure (<20 g) of the probe using a sensor probe.

The subjects were divided into two groups: individualswith CPI codes £2 (without a periodontal pocket) and the other individuals with at least one sextant with a CPI code ‡3 (periodontal pocket ‡4 mm), and their relationships with the positive conversion of each metabolic-syndrome component were analyzed.

Additionally, oral examination was carried out by dentists to assess dental caries experience and periodontal disease excluding third molars.

Blood pressure was measured with an automatic hemomanometer while the patients were in a sitting position.

Blood pressure was measured twice for only those subjects with an abnormal value at the first measurement.

The data of blood pressure used in the present study were based upon the first measurement only for consistency in data collection across subjects.

After fasting from 9:00 pm to the following morning, blood samples were collected from an arm vein.

Triglyceride, high-density lipoprotein (HDL) cholesterol, total cholesterol, and fasting blood glucose levels were measured from these samples.

The body mass index (BMI) was calculated from the heights and body weights of each participant.

The test values of hypertension, lipid abnormality, and hyperglycemia were based on the definition and diagnostic criteria for metabolic syndrome in Japan;26,27 a ‡130-mm/Hg systolic or ‡85-mm/Hg diastolic blood pressure was equated with hypertension, ‡150 mg/dl triglycerides or <40 mg/dl HDL cholesterol was considered an abnormal lipid profile, and ‡110 mg/dl fasting blood glucose was deemed positive for hyperglycemia.

A BMI ‡25 kg/m2 was regarded as positive for a metabolic disorder.

The health habits described by Belloc and Breslow28 were surveyed using a self-completed questionnaire.

The items on the questionnaire were: ‘‘Do you have a smoking habit?,’’ ‘‘Are you doing physical exercise regularly?,’’ and ‘‘Are you controlling consumption of food between meals?’’ Subjects answered the questions by selecting ‘‘yes’’ or ‘‘no.’’ Periodontal pockets, age, gender, and smoking habit were determined at the baseline of the observational period.

This study was approved by the ethics committee of the Nihon University School of Dentistry.

======
Statistical Methods

Multiple logistic regression analysis was used to evaluate the association between the presence of periodontal pocket and the number of positively changed components during 4 years (positive components) and between the presence of periodontal pocket and positive components.

Dependent variable was the positivity of each component and explanatory variables were the presence of periodontal pockets, carious teeth, and missing teeth representing the oral condition in 2002.

Odds ratios (ORs) and confidence intervals (CIs) were calculated with adjustments for age, gender, cigarette smoking, exercise, eating between meals, and the maintenance of a healthy body weight J Periodontol • April 2010 Morita, Yamazaki, Mita, et al. 513 in 2002.

Statistical analysis softwarei was used, and the significance level was set at £5%.

However, >3,000 employeeswork for the company, indicating that the data may be generalized in terms of industrial workers.

Metabolic syndrome was defined as an obesity (waist circumference)-based condition with three or more of the following conditions: obesity, hypertension, lipid abnormality, and hyperglycemia in Japan by the Japanese Society of Internal Medicine in 2005;26,27 whereas the American Heart Association and United States National Heart, Lung, and Blood Institute regard persons with three or more of the following conditions: obesity (waist circumference) and abnormal levels of triglycerides, HDL cholesterol, blood pressure, and fasting blood glucose as those with metabolic syndrome.

29 This definition is not obesity based because the presence of nonobese cases with insulin resistance and other metabolic risk factors was recognized, and placing special emphasis on a single pathology, visceral obesity, was considered inadequate.

We considered obesity as an index to investigate whether the presence of periodontal pockets was associated with the development of metabolic syndrome and surveyed positive conversions of obesity, hypertension, lipid abnormality, and hyperglycemia to investigate their associations with periodontal disease.

The BMI was adopted as the obesity index because the waistcircumference measurement specified for metabolic syndrome was not performed on health checkups in 2002 and 2006.

The metabolic-syndrome criteria26,27 regard conditions with three or more positive components as metabolic syndrome, but subjects with two or more positive components were collectively handled in the analysis because only 0.8% of subjects became positive for three or more components, whereas 18.2% and 4.0% became positive for one and two components, respectively.

The positive rate for any one of the metabolicsyndrome components was significantly higher in subjects with periodontal pockets than in subjects without periodontal pockets in 2002(OR: 1.6),even after adjustments for age, gender, and habits (cigarette smoking, exercise, eating between meals, and the maintenance of a healthy body weight).

18,30-32 These findings indicate that the maintenance of a healthy oral cavity to prevent periodontal pocket formation is effective for maintaining metabolic-syndrome components within standard values.

After 4 years, the OR rose as the number of positive components increased, and the difference was significant for two or more positive components (OR: 2.2), thus clarifying that the risk of becoming positive for metabolic-syndrome components is higher in subjects with periodontal pockets.

Previous cross-sectional14,17,18 and case-control15,16 studies showed the presence of a close association between periodontal disease and metabolic syndrome, and that patients with metabolic syndrome may be at a higher risk for periodontal disease.

Furthermore, the present cohort study suggests that people with periodontal pockets are at a higher risk for developing metabolic syndrome even when all metabolic-syndrome components are within standard values.

Periodontal disease is considered a mild chronic inflammatory condition caused by Gram-negative anaerobes inhabiting periodontal pockets,21,22 and the elevation of the blood levels of cytokines, such as CRP and IL-6, has been reported.

19,20 These inflammatory substances induced by periodontal disease may influence the whole body and act toward the positive conversion of metabolic-syndrome components.

In contrast, a report33 found that the level of CRP increases in the person with the metabolic syndrome.

Therefore, an increase of CRP due to periodontitis is related to the progression of the metabolic syndrome.

Positive conversions of hypertension and lipid abnormality were significantly associated with the presence of periodontal pockets.

Negative influences of a Gram-negative bacterial cell component, LPS, and cytokines, such as TNF-a and IL-1, on lipid metabolism were reported, 24 suggesting that the OR for the development of lipid abnormality increases through these substances in subjects with periodontal pockets.

Although an association between hypertension and periodontal disease was reported,34 the reason for this association has not been clarified.

However, thrombus formation caused by Porphyromonas gingivalis from aggregating platelets,35 the elevation of risks of hypertension and coronary arterial heart disease because of an elevated CRP level,36-38 and elevated CRP levels in patients with periodontal disease19,21 were reported.

It is quite possible that periodontal disease influences the development of hypertension through inflammatory substances, such as CRP, which supports our finding that the presence of periodontal pockets increases the risk of developing hypertension.

In contrast, there was no significant association between the presence of periodontal pockets and a positive conversion of obesity or hyperglycemia, but obesity showed a tendency toward an association (P = 0.056); P value was approximated to P = 0.05.

It was reported that LPS stimulated fat deposition in the liver and adipose tissue in mice, which led to a weight increase.

39 This result and our findings suggest that periodontal disease affects obesity.

A reduction in blood glucose levels after periodontal treatment in patients with diabetes was reported in studies40,41 on periodontal disease and diabetes intervention.

The OR for subjects with periodontal pockets becoming hyperglycemic was 1.4, but the association was not significant.

In the 2006 National Nutrition Survey, 42 the rate of people between 20 and 69 years of age strongly suspected of having diabetes and in whom the possibility of diabetes could not be ruled out increased with advancing age, and the difference between age groups classified as patients with and suspected of having diabetes for 10 years was 3.0% to 9.5%.

However, the rate of subjects who became positive for hyperglycemia within the next 4 years was only 1% of all subjects, and this may have been the reason for the absence of a significant difference.

The present study shows that adult employees, ranging in age from 20 to 56 years, with periodontal pockets were at a higher risk for the positive conversion of metabolic-syndrome components.

Accordingly, the prevention of periodontal disease may consequently prevent metabolic syndrome, and the maintenance of a healthy oral cavity from a young age may be important to maintain the health of the entire body.

However, there is a limitation for the findings of this study.

Periodontal disease and metabolic syndrome are considered to be related to a complex lifestyle.

To exclude confounding factors, habits (cigarette smoking, exercise, eating between meals, and the maintenance of a healthy body weight) that are assumed to affect periodontal disease and metabolic syndrome18,30-32 were adopted for adjustment, in addition to age and gender.

However, it cannot be ruled out that habits not investigated in this study may affect metabolic syndrome.

Interventional studies on periodontal treatment-induced changes in the condition of metabolic syndrome in patients with periodontal disease and metabolic syndrome may be necessary to further clarify the causal relationship between periodontal disease and metabolic syndrome.

============
Conclusion

The presence of periodontal pockets was associated with positive conversions of metabolic-syndrome components, suggesting that the prevention of periodontal disease consequently prevents metabolic syndrome.

=============
Acknowledgments

This work was supported by the Promotion and Mutual Aid Corporation for Private Schools of Japan,Tokyo, Japan. The authors report no conflicts of interest related to this study.

===========
Refferences

1.
Isomaa B, Almgren P, Tuomi T, et al.
Cardiovascular morbidity and mortality associated with the metabolic syndrome.
Diabetes Care 2001;24:683-689.

2.
Lakka HM, Laaksonen DE, Lakka TA, et al.
The metabolic syndrome and total and cardiovascular disease mortality in middle-aged men.
JAMA 2002;288:2709-2716.

3.
Page RC, Offenbacher S, Schroeder HE, Seymour GJ, Kornman KS.
Advances in the pathogenesis of periodontitis:Summary of developments, clinical implications and future directions.
Periodontol 2000 1997;14:216-248.

4.
Nelson RG, Shlossman M, Budding LM, et al.
Periodontal disease and NIDDM in Pima Indians.
Diabetes Care 1990;13:836-840.

5. Saito T, Shimazaki Y, Koga T, Tsuzuki M, Ohshima A.
Relationship between upper body obesity and periodontitis.
J Dent Res 2001;80:1631-1636.

6.
Saito T, Shimazaki Y, Kiyohara Y, et al.
Relationship between obesity, glucose tolerance, and periodontal disease in Japanese women: The Hisayama study.
J Periodontal Res 2005;40:346-353.

7.
Lo¨sche W, Karapetow F, Pohl A, Pohl C, Kocher T.
Plasma lipid and blood glucose levels in patients with destructive periodontal disease.
J Clin Periodontol 2000;27:537-541.

8.
Noack B, Jachmann I, Roscher S, et al.
Metabolic diseases and their possible link to risk indicators of periodontitis.
J Periodontol 2000;71:898-903.

9.
Katz J, Flugelman MY, Goldberg A, Heft M.
Association between periodontal pockets and elevated cholesterol and low density lipoprotein cholesterol levels.
J Periodontol 2002;73:494-500.

10.
Katz J, Chaushu G, Sharabi Y.
On the association between hypercholesterolemia, cardiovascular disease and severe periodontal disease.
J Clin Periodontol 2001;28:865-868.

11.
Moeintaghavi A, Haerian-Ardakani A, Talebi-Ardakani M, Tabatabaie I.
Hyperlipidemia in patients with periodontitis.
J Contemp Dent Pract 2005;6:78-85.

12.
Takami Y, Nakagaki H, Morita I, et al.
Blood test values and Community Periodontal Index scores in medical checkup recipients.
J Periodontol 2003;74:1778-1784.

13.
Joss A, Adler R, Lang NP.
Bleeding on probing: A parameter for monitoring periodontal conditions in clinical practice.
J Clin Periodontol 1994;21:402-408.

14.
Shimazaki Y, Saito T, Yonemoto K, Kiyohara Y, Iida M,Yamashita Y.
Relationship of metabolic syndrome to periodontal disease in Japanese women: The Hisayama study.
J Dent Res 2007;86:271-275.

15.
Khader Y, Khassawneh B, Obeidat B, et al.
Periodontal status of patients with metabolic syndrome compared to those without metabolic syndrome.
J Periodontol 2008;79:2048-2053.

16.
Li P, He L, Sha YQ, Luan QX.
Relationship of metabolic syndrome to chronic periodontitis.
J Periodontol2009;80:541-549.

17.
D’Aiuto F, Sabbah W, Netuveli G, et al.
Association of the metabolic syndrome with severe periodontitis in a large U.S. population-based survey.
J Clin Endocrinol Metab 2008;93:3989-3994.

18.
Morita T, Ogawa Y, Takada K, et al.
Association between periodontal disease and metabolic syndrome.
J Public Health Dent 2009;69:248-253.

19.
Saito T, Murakami M, Shimazaki Y, Oobayashi K,Matsumoto S, Koga T.
Association between alveolar bone loss and elevated serum C-reactive protein in Japanese men.
J Periodontol 2003;74:1741-1746.

20.
Loos BG, Craandijk J, Hoek FJ, Wertheim-van Dillen PM, Van der Velden U.
Elevation of systemic markers related to cardiovascular diseases in the peripheral blood of periodontitis patients.
J Periodontol 2000;71:1528-1534.

21.
Nishimura F, Soga Y, Iwamoto Y, Kudo C, Murayama Y.
Periodontal disease as part of the insulin resistance syndrome in diabetic patients.
J Int Acad Periodontol 2005;7:16-20.

22.
Slade GD, Ghezzi EM, Heiss G, Beck JD, Riche E, Offenbacher S.
Relationship between periodontal disease and C-reactive protein among adults in the Atherosclerosis Risk in Communities study.
Arch Intern Med 2003;163:1172-1179.

23.
Saito T, Shimazaki Y, Kiyohara Y, et al.
The severity of periodontal disease is associated with the development of glucose intolerance in non-diabetics: The Hisayama study.
J Dent Res 2004;83:485-490.

24.
Hardardo´ ttir I, Gru¨nfeld C, Feingold KR.
Effects of endotoxin and cytokines on lipid metabolism.
Curr Opin Lipidol 1994;5:207-215.

25.
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.

26.
Matsuzawa Y.
Metabolic syndrome – Definition and diagnostic criteria in Japan.
J Atheroscler Thromb 2005;12:301.

27.
Aizawa Y, Kamimura N, Watanabe H, et al.
Cardiovascular risk factors are really linked in the metabolic syndrome:
This phenomenon suggests clustering rather than coincidence.
Int J Cardiol 2006;109:213-218.

28.
Belloc NB, Breslow L. Relationship of physical health status and health practices.
Prev Med 1972;1:409-421.

29.
Grundy SM, Cleeman JI, Daniels SR, et al.
Diagnosis and management of the metabolic syndrome:
An American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement.
Circulation 2005;112:2735-2752.

30.
Ntandou G, Delisle H, Agueh V, Fayomi B.
Abdominal obesity explains the positive rural-urban gradient in the prevalence of the metabolic syndrome in Benin, West Africa.
Nutr Res 2009;29:180-189.

31.
Toornvliet AC, Pijl H, Tuinenburg JC, et al.
Psychological and metabolic responses of carbohydrate craving obese patients to carbohydrate, fat and protein-rich meals.
Int J Obes Relat Metab Disord 1997;21:860-864.

32.
Horne J.
Short sleep is a questionable risk factor for obesity and related disorders: Statistical versus clinical significance.
Biol Psychol 2008;77:266-276.

33.
Ford ES.
The metabolic syndrome and C-reactive protein, fibrinogen, and leukocyte count:
Findings from the Third National Health and Nutrition Examination Survey.
Atherosclerosis 2003;168:351-358.

34.
Engstro¨m S, Gahnberg L, Ho¨gberg H, Sva¨rdsudd K.
Association between high blood pressure and deep periodontal pockets:
A nested case-referent study.
Ups J Med Sci 2007;112:95-103.

35.
Imamura T, Travis J, Potempa J.
The biphasic virulence activities of gingipains:
Activation and inactivation of host proteins.
Curr Protein Pept Sci 2003; 4:443-450.

36.
Vidal F, Figueredo CM, Cordovil I, Fischer RG.
Periodontal therapy reduces plasma levels of interleukin-6, C-reactive protein, and fibrinogen in patients with severe periodontitis and refractory arterial hypertension.
J Periodontol 2009;80:786-791.

37.
Lakoski SG, Cushman M, Palmas W, Blumenthal R, D’Agostino RB Jr., Herrington DM.
The relationship between blood pressure and C-reactive protein in the Multi-Ethnic Study of Atherosclerosis (MESA).
J Am Coll Cardiol 2005;46:1869-1874.

38.
Sesso HD, Wang L, Buring JE, Ridker PM, Gaziano JM.
Comparison of interleukin-6 and C-reactive protein for the risk of developing hypertension in women.
Hypertension 2007;49:304-310.

39.
Cani PD, Amar J, Iglesias MA, et al.
Metabolic endotoxemia initiates obesity and insulin resistance.
Diabetes 2007;56:1761-1772.

40.
Janket SJ, Wightman A, Baird AE, Van Dyke TE, Jones JA.
Does periodontal treatment improve glycemic control in diabetic patients?
A meta-analysis of intervention studies.
J Dent Res 2005;84:1154-1159.

41.
Grossi SG, Skrepcinski FB, DeCaro T, et al.
Treatment of periodontal disease in diabetics reduces glycated hemoglobin.
J Periodontol 1997;68:713-719.

42.
The National Health and Nutrition Survey in Japan.Tokyo:
Office for Life-Style Related Diseases Control General Affairs Division Health Service Bureau Ministry of Health, Labour, and Welfare; 2006:72-73.
Correspondence:
Dr. Masafumi Motohashi,
Department of Oral Health Sciences, Nihon University School of Dentistry,
1-8-13 Kanda-Surugadai, Chiyoda-ku, Tokyo 101-8310,
Japan. Fax: 81-3-3219-8138;
e-mail: motohashi@dent.nihon-u.ac.jp.
Submitted October 23, 2009;
accepted for publication December 11, 2009.

==========
Table 1.
Association Between One or More Positivity of Metabolic-Syndrome Components in 2006 and Oral Condition in 2002

====
Subjects in 2006 (n [%])
Oral Condition
in 2002
No Positive
Components
(n = 788 [77.0%])
One or More
Positive Components
(n = 235 [23.0%]) OR (95% CI)*
Periodontal pockets
Without pockets 656 (80.2) 162 (19.8) 1
With pockets 132 (64.4) 73 (35.6) 1.6 (1.1 to 2.2)†
Missing teeth
None 656 (78.2) 183 (21.8) 1
One or more 132 (71.7) 52 (28.3) 1.0 (0.6 to 2.0)
Carious teeth
None 739 (77.1) 219 (22.9) 1
One or more 49 (75.4) 16 (24.6) 1.1 (0.7 to 1.6)
* Adjusted for age, gender, smoking habit, exercise, eating between meals, and healthy body weight.
† P <0.05

===========
Table 2.
Association Between Each Number of Positive Components of Metabolic Syndrome in 2006 and Oral Condition in 2002

========
Subjects in 2006 (n [%]) OR (95% CI)*
Oral Condition
in 2002
No Positive
Components
(n = 788 [ 77.0%])
One Positive
Component
(n = 186 [18.2%])
Two Positive
Components
(n = 41 [4.0%])
Three Positive
Components
(n = 8 [0.8%])
One
Positive
Component
Two or More
Positive
Components
Periodontal pockets
Without pockets 656 (80.2) 132 (16.1) 27 (3.3) 3 (0.4) 1 1
With pockets 132 (64.4) 54 (26.3) 14 (6.8) 5 (2.5) 1.4 (1.0 to 2.1) 2.2 (1.1 to 4.1)†
Missing teeth
None 656 (78.2) 146 (17.4) 30 (3.6) 7 (0.8) 1 1
One or more 132 (71.7) 40 (21.7) 11 (6.0) 1 (0.6) 1.0 (0.6 to 1.5) 1.2 (0.4 to 3.6)
Carious teeth
None 739 (77.1) 174 (18.2) 37 (3.9) 8 (0.8) 1 1
One or more 49 (75.4) 12 (18.5) 4 (6.1) 0 (0) 1.3 (0.4 to 3.6) 1.1 (0.5 to 2.1)
* Adjusted

=========
Table 3.
Association Between Obesity in 2006 and Oral Condition in 2002

========

Subjects in 2006 (n [%])
Oral Condition
in 2002
Non-Obese
(n = 950 [92.9%])
Obese
(n = 73 [ 7.1%])
OR
(95% CI)*
Periodontal pockets
Without pockets 767 (93.8) 51 (6.2) 1
With pockets 183 (89.3) 22 (10.7) 1.7 (1.0 to 3.0)
Missing teeth
None 779 (92.9) 60 (7.1) 1
One or more 171 (92.9) 13 (7.1) 1.2 (0.6 to 2.3)
Carious teeth
None 891 (93.0) 67 (7.0) 1
One or more 59 (90.8) 6 (9.2) 1.3 (0.5 to 3.0)
* Adjusted for age, gender, smoking habit, exercise, eating between meals, and healthy body
weight

============
Table 4.
Association Between Hypertension in 2006 and Oral Condition in 2002

======
Subjects in 2006 (n [%])
Oral Condition
in 2002
Non-Hypertensive
(n = 883 [86.3%])
Hypertensive
(n = 140 [13.7%])
OR
(95% CI)*
Periodontal pockets
Without pockets 726 (88.8) 92 (11.3) 1
With pockets 157 (76.6) 48 (23.4) 1.5 (1.0 to 2.3)†
Missing teeth
None 736 (87.7) 103 (12.3) 1
One or more 147 (79.9) 37 (20.1) 1.3 (0.8 to 2.0)
Carious teeth
None 826 (86.2) 132 (13.8) 1
One or more 57 (87.7) 8 (12.3) 1.1 (0.5 to 2.7)
* Adjusted for age, gender, smoking habit, exercise, eating between meals, and healthy body
weight.
† P <0.05.

========

Table 5.
Association Between Lipid Abnormality in 2006 and Oral Condition in 2002

===
Subjects in 2006 (n [%])
Oral Condition
in 2002


No Lipid
Abnormality
(n = 954 [93.3%])
With Lipid
Abnormality
(n = 69 [6.7%]) OR (95% CI)*
Periodontal pockets
Without pockets 774 (94.6) 44 (5.4) 1
With pockets 180 (87.8) 25 (12.2) 1.9 (1.1 to 3.2)†
Missing teeth
None 782 (93.2) 57 (6.8) 1
One or more 172 (93.5) 12 (6.5) 1.4 (0.7 to 2.9)
Carious teeth
None 893 (93.2) 65 (6.8) 1
One or more 61 (93.9) 4 (6.2) 1.3 (0.5 to 4.3)
* Adjusted for age, gender, smoking habit, exercise, eating between meals, and healthy body weight.
† P <0.05.

=========

Table 6.
Association Between Hyperglycemia in 2006 and Oral Condition in 2002

=======
Subjects in 2006 (n[%])
Oral Condition
in 2002
Non-Hyperglycemic
(n = 1,013 [99.0%])
Hyperglycemic
(n = 10 [1.0%]) OR (95% CI)*
Periodontal pockets
Without pockets 810 (99.0) 8 (1.0) 1
With pockets 203 (99.0) 2 (1.0) 1.4 (1.0 to 2.1)
Missing teeth
None 832 (99.2) 7 (0.8) 1
One or more 181 (98.4) 3 (1.6) 1.0 (0.6 to 1.5)
Carious teeth
None 950 (99.2) 8 (0.8) 1
One or more 63 (96.9) 2 (3.1) 4.6 (0.7 to 20.6)
* Adjusted for
=========
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