Adherence to the dietary guidelines and prevalence of periodontal disaese: The Buffalo osteoperio study
MetadataShow full item record
Background: Nutrition has been hypothesized to play a role in periodontal disease risk through numerous proposed mechanisms which include diet's influence on oxidative stress, inflammation, wound healing and glycemic control. The majority of previous studies examining associations between nutrition and periodontal disease have examined single nutrients or foods with respect to periodontal disease risk. Overall dietary patterns, rather than measure of single nutrients and foods, may better reflect overall nutritional status, however, few studies have examined the association between diet quality and periodontal disease. Purpose: We examined the cross-sectional relationship between diet quality, scored using the Healthy Eating Index-2005 (HEI-2005), and periodontal disease prevalence among postmenopausal women in the Buffalo Osteoporosis and Periodontal Disease (OsteoPerio) study, an ancillary study of the Women's Health Initiative Observational Study (WHI OS). Methods: Diet quality was collected using a modified Block food frequency questionnaire self-administered at WHI OS baseline (1993-1997), and scored according to the HEI-2005. Measures of periodontal disease (clinical attachment loss (CAL) and pocket depth (PD)) were collected at OsteoPerio Study baseline (1997-2001), which coincided with the WHI OS three year follow-up. Prevalent disease was defined using the Centers of Disease Control and Prevention/American Academy of Periodontology (CDC/AAP) classification. Logistic regression was used to calculate odds ratios (OR) and 95% confidence intervals (CI) for moderate/severe, moderate, and severe periodontal disease compared to no/mild periodontal disease by quartiles of the HEI-2005 diet score. Linear regression models were used to analyze the relationship between quartiles of HEI-2005 score and continuous outcome measures of whole-mouth mean and worst-site CAL and PD. Beta-coefficients (β) and standard errors (SE) for the outcome measures of CAL and PD corresponding to quartile of HEI-2005 diet quality score were estimated. Both logistic and linear regression models were adjusted for age, income, recreational physical activity, and frequency of flossing. Results: A moderate association was observed between diet quality and periodontal disease defined by the CDC/AAP classification. The adjusted odds of moderate/severe periodontal disease was 18% less for those in HEI-2005 diet Quartile 4 compared to those in Quartile 1, but this result was not statistically significant (OR= 0.82 (0.56, 1.21), p-trend= 0.175). Results were similar when we examined the adjusted models for the odds of moderate or severe periodontal disease. Further adjustment for hypothesized variables in the causal pathway (e.g. total energy intake, body mass index, waist circumference, and waist to hip ratio) did not change the results. Linear regression analyses with continuous measures of CAL and PD showed that women in HEI-2005 Quartile 4 had on average 0.13 mm (p-value=0.02) lower whole-mouth CAL and 0.07 mm (p-value=0.02) lower whole-mouth mean PD as compared to Quartile 1. This relationship was not observed for worst site CAL or PD. Conclusions: In this cross sectional study of postmenopausal women, we observed a moderate association between diet quality, defined with the HEI-2005, and prevalence of periodontal disease defined using the CDC/AAP definition. Differently, continuous whole-mean mouth measures of CAL and PD were significantly associated with diet quality, while worst-site measures were not.