Sex differences in the association between dual-energy x-ray absorptiometry-measured body composition and periodontitis

Peijun Zhu; An Li; Qingqing Cai; Yuntao Chen; Yang Liu; Harriët Jager-Wittenaar; Geerten-Has E Tjakkes; Shulan Xu

doi:10.1002/JPER.23-0162

Sex differences in the association between dual-energy x-ray absorptiometry-measured body composition and periodontitis

J Periodontol. 2024 Mar;95(3):219-232. doi: 10.1002/JPER.23-0162. Epub 2023 Aug 28.

Authors

Peijun Zhu¹, An Li^{2

3}, Qingqing Cai⁴, Yuntao Chen⁵, Yang Liu⁶, Harriët Jager-Wittenaar^{7

8

9}, Geerten-Has E Tjakkes³, Shulan Xu¹

Affiliations

¹ Center of Oral Implantology, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, China.
² Department of Periodontology, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, China.
³ Department of Periodontology, Center for Dentistry and Oral Hygiene, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
⁴ Division of Nephrology, Nanfang Hospital, Southern Medical University, National Clinical Research Center of Kidney Disease, Guangzhou, China.
⁵ Department of Epidemiology and Public Health, University College London, London, UK.
⁶ Department of Oral Medicine, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, China.
⁷ Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands.
⁸ Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
⁹ Research Unit Experimental Anatomy, Faculty of Physical Education and Human Anatomy, Vrije Universiteit Brussel, Brussels, Belgium.

PMID: 37505475
DOI: 10.1002/JPER.23-0162

Abstract

Background: A positive association between obesity based on body mass index (BMI) and periodontitis has been reported. Fat tissue-related systemic inflammation acts as the link to periodontal comorbidities of obesity. However, the BMI is unable to distinguish fat and fat-free tissues. More precise measures are required to evaluate body composition, including fat and fat-free tissues. This study aimed to determine the sex differences in the association between dual-energy x-ray absorptiometry (DXA)-measured body composition (i.e., fat mass and muscle mass) and phenotypes with periodontitis.

Methods: Cross-sectional data of 3892 participants from the National Health and Nutrition Examination Survey (NHANES) study 2011‒2014 were analyzed. Adiposity indices (fat mass index [FMI] and percentage body fat [%BF]) and muscle mass index (MMI) were calculated. The participants were categorized by the quintiles of FMI, MMI, and %BF. Body composition phenotypes were categorized as: low adiposity-low muscle (LA-LM), low adiposity-high muscle (LA-HM), high adiposity-low muscle (HA-LM), or high adiposity-high muscle (HA-HM), respectively. Periodontitis was defined by the CDC/AAP (Centers for Disease Control and Prevention/American Academy of Periodontology) criteria. Multivariable logistic regression analysis was conducted, stratified by sex. We further adjusted for white blood cell (WBC) counts in the sensitivity analysis.

Results: Restricted cubic splines revealed non-linear associations between body composition indices and periodontitis risk. Women with a higher FMI (odds ratio for Q5 vs. Q1 [OR_Q5vs1] = 1.787, 95% confidence interval: 1.209-2.640) or %BF (OR_Q5vs1 = 2.221, 1.509-3.268) had increased odds of periodontitis. In addition, women with HA-LM phenotype were more likely to develop periodontitis (OR = 1.528, 1.037-2.252). Interestingly, the WBC count, a systemic inflammatory biomarker, attenuated these associations. No statistically significant associations were found in men.

Conclusions: The association between DXA-measured body composition and phenotypes with periodontitis differs per sex. Only in women higher adiposity indices and HA-LM phenotype were associated with an increased risk of periodontitis.

Keywords: body composition; cross‐sectional study; dual‐energy x‐ray absorptiometry; periodontitis; sex difference.

MeSH terms

Absorptiometry, Photon
Adiposity
Body Composition / physiology
Body Mass Index
Cross-Sectional Studies
Female
Humans
Male
Nutrition Surveys
Obesity / complications
Obesity / epidemiology
Periodontitis* / complications
Periodontitis* / diagnostic imaging
Sex Characteristics*

Abstract

MeSH terms

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