01 June 2023

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Dental condition, diet and glycemic control

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Background

Research evidence collected from cross-sectional and cohort studies supports a bidirectional relationship between periodontitis and diabetes. Adults with diabetes were found to experience more generalized and severe forms of periodontal disease as compared to individuals without diabetes. Conversely, adults with periodontal disease, especially in its severe forms, exhibited poor glycemic control and increased risk of diabetes.

The link between periodontal disease and glycemic control has also been demonstrated in the nondiabetic population. Among a diabetes-free sample in Pomerania, people with advanced forms of periodontitis had five times higher increase in hemoglobin A1c (HbA1c) levels over five years in contrast to individuals without periodontitis.

Objectives

A bidirectional relationship between periodontitis and diabetes has been reported. Its mechanisms are yet to be elucidated. This study examines the interplays amongst dental conditions (periodontitis and functional dentition), diet, and glycemic control of adults.

Methods

This study, using the data of National Health and Nutrition Examination Survey (NHANES) 2011–2014, aimed to investigate the associations between dental conditions (periodontitis and functional dentition) and glycemic control of adults, the associations between dental conditions and dietary intake, and the mediation effect of diet in the association between dental conditions and glycemic control.

Relevant data of the NHANES surveys (2011–2012 and 2013–2014) (n = 6076) were extracted, including dental examination for generalized severe periodontitis (GSP) and functional dentition, laboratory tests for hemoglobin A1c (HbA1c), and 24-hour dietary recall. Multiple regressions and path analysis were conducted to assess the association between dental conditions and glycemic control and the mediation effect of diet.

Results

Higher HbA1c value was associated with GSP (coef: 0.34; 95% CI: 0.10 to 0.58) and nonfunctional dentition (coef: 0.12; 95% CI: 0.01 to 0.24). Associations were also found between lower fiber intake (g/1000 kcal) with GSP (coef: −1.16; 95% CI: −1.61 to −0.72) and nonfunctional dentition (coef: −0.80; 95% CI: −1.18 to −0.42). Mediation effect of diet (% energy from carbohydrate and energy-adjusted fiber intake) for the association between dental conditions and glycemic control was not significant.

Conclusions

Periodontitis and functional dentition are significantly associated with fiber intake and glycemic control in adults. Dietary intake, however, does not mediate the association between dental conditions and glycemic control.

Glenn Chun Hwee Lee, Mary Foong-Fong Chong, Xiaoli Gao, "Dental Condition, Diet, and Glycaemic Control: Analysis of NHANES 2011–2014," International Dental Journal, May 2023, ISSN 0020-6539, https://doi.org/10.1016/j.identj.2023.04.001.