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Abstract
Objective Periodontitis is strongly associated with diabetes and is increasingly shown to be associated with other glycemic abnormalities. Vitamin D is postulated to have both anti-inflammatory and antimicrobial activity. Therefore, our aim was to investigate the joint effects of both serum 25-hydroxyvitamin D3 and total 25-hydroxyvitamin D with periodontitis on homeostatic model assessment for insulin resistance (HOMA-IR), pre-diabetes, and type 2 diabetes.
Research design and methods Using data from the 2009–2010 National Health and Nutrition Examination Survey, the sample was restricted to adults over 30 years of age, who were eligible for oral health examination, and had vitamin D, fasting glucose and insulin measures. The analytic sample includes those with (n=1631) and without (n=1369) type 2 diabetes. Using survey logistic multivariable regression analysis, we examined the following joint effects: (1) vitamin D insufficiency (<50 nmol/L) and moderate to severe periodontitis (VD+PD+); (2) vitamin D insufficiency and mild to no periodontitis (VD+PD−); and (3) vitamin D sufficiency ) (>50 nmol/L) and periodontitis (VD−PD+), and compared these groups with the doubly unexposed reference group (VD−PD−).
Results Consistently, the joint effects of vitamin D3 insufficiency and total vitamin D insufficiency with periodontitis (VD+PD+) were significantly associated with diabetes: OR=2.83 (95% CI 1.34 to 5.96) and OR=1.98 (95% CI 1.04 to 3.76), respectively. However, the joint effects of vitamin D3 insufficiency and periodontitis were attenuated for HOMA-IR 4.17: OR=1.57 (95% CI 0.97 to 2.55). Pre-diabetes was not associated with either joint effects.
Conclusion In this cross-sectional, nationally representative sample, the joint effects of vitamin D and periodontitis appear to differ for HOMA-IR, pre-diabetes and diabetes.
- Vitamin D
- Periodontal Disease
- HOMA-IR
- Pre-Diabetes
- and Type 2 Diabetes.
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Footnotes
Presented at The abstract was previously published as a late breaking abstract and assigned poster presentation (237-LB) in the category 16-F Epidemiology-Other at the American Diabetes Association’s 77th Scientific Sessions.
Contributors AMZ identified the research question, obtained the data, conducted the analysis, interpreted the data, drafted the manuscript, and reviewed and edited the manuscript. AMZ and LCR contributed to the analytic plan. OS provided statistical analysis support. CRQ, OS, RTD, and LCR took part in the conceptualization, provided methodological and content feedback, contributed to discussion, and reviewed and edited the final manuscript.
Funding This research was funded by a Connaught New Researcher Award held by LCR at the University of Toronto (207656).
Competing interests None declared.
Patient consent Not required.
Ethics approval The survey protocol for the NHANES was approved by CDC's National Center for Health Statistics Institutional Research Ethics Review Board.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement NHANES data sets are publicly available through the Centers for Disease Control and Prevention website at https://wwwn.cdc.gov/nchs/nhanes/Default.aspx.