Periodontal Infection and Cardiorespiratory Fitness in Younger Adults: Results from Continuous National Health and Nutrition Examination Survey 1999–2004 Ashley Thai 1. , Panos N. Papapanou 2 , David R. Jacobs Jr. 3,4 , Moı¨se Desvarieux 1,5 , Ryan T. Demmer 1 * . 1 Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, United States of America, 2 Division of Periodontics, Section of Oral and Diagnostic Sciences, College of Dental Medicine, Columbia University, New York, New York, United States of America, 3 Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, United States of America, 4 Department of Nutrition, University of Oslo, Oslo, Norway, 5 Centre de recherche Epide ´miologies et Biostatistique, INSERM U1153, Equipe: Me ´thodes en e ´valuation the ´rapeutique des maladies chroniques, Paris, France Abstract Objective: Previous studies report associations between periodontal infection and cardiorespiratory fitness but no study has examined the association among younger adults. Our objective was to study the association between clinical measures of periodontal infection and cardiorespiratory fitness levels among a population-based sample of younger adults. Methods: The Continuous National Health and Nutrition Examination Survey 1999–2004 enrolled 2,863 participants (46% women) who received a partial-mouth periodontal examination and completed a submaximal treadmill test for the assessment of estimated VO 2 max(eVO 2 max ). Participants were mean6SD age 3369 years (range = 20–49 years), 30% Hispanic, 48% White, 19% Black, and 3% other. Mean eVO 2 max (mL/kg/minute) as well as eVO 2 max#32 mL/kg/minute (20th percentile) were regressed across quartiles of mean probing depth and mean attachment loss in multivariable linear and logistic regression models. Results: After multivariable adjustment, mean eVO 2 max levels6SE across quartiles of attachment loss were 39.7260.37, 39.6460.34, 39.5960.36, and 39.8560.39 (P = 0.99). Mean eVO 2 max6SE across quartiles of probing depth were 39.5760.32, 39.7860.38, 39.1960.25, and 40.3760.53 (P = 0.28). Similarly, multivariable adjusted mean eVO 2 max values were similar between healthy participants vs. those with moderate/severe periodontitis: 39.7060.21 vs. 39.7060.90 (P = 1.00). The odds ratio (OR) for low eVO 2 max comparing highest vs. lowest quartile of attachment loss = 0.89[95% CI 0.64–1.24]. The OR for comparing highest vs. lowest probing depth quartile = 0.77[95% CI 0.51–1.15]. Conclusion: Clinical measures of periodontal infection were not related to cardiorespiratory fitness in a sample of generally healthy younger adults. Citation: Thai A, Papapanou PN, Jacobs DR Jr, Desvarieux M, Demmer RT (2014) Periodontal Infection and Cardiorespiratory Fitness in Younger Adults: Results from Continuous National Health and Nutrition Examination Survey 1999–2004. PLoS ONE 9(3): e92441. doi:10.1371/journal.pone.0092441 Editor: Michael Glogauer, University of Toronto, Canada Received November 6, 2013; Accepted February 21, 2014; Published March 24, 2014 Copyright: ß 2014 Thai et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Funding: This research was supported by NIH grants R00 DE-018739 and R21 DE-022422 to Dr. Demmer. Additional funding support was provided by a Pilot & Feasibility Award to Dr. Demmer from the Diabetes and Endocrinology Research Center, College of Physicians and Surgeons, Columbia University (DK-63608); a Chair in Chronic Disease, E ´ cole des Hautes E ´ tudes en Sante ´ Publique, France (Dr. Desvarieux); Dr. Desvarieux is also supported by R01 DE-13094. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing Interests: The authors have declared that no competing interests exist. * E-mail: rtd2106@columbia.edu . These authors contributed equally to this work. Introduction Healthcare costs in the U.S arising from elevated cardiometa- bolic risk factors were estimated to be $80 billion in 2005 [1] and a 2012 report by the Centers for Disease Control listed cardiometa- bolic diseases including hypertension, coronary heart disease, stroke and diabetes among the top seven causes of death in the U.S [2]. Therefore, research that can provide further insight into cardiometabolic disease mechanisms are important because they could inform future prevention efforts and improve population health. Periodontal infections have been hypothesized as a possible risk factor for cardiometabolic diseases and several studies have reported periodontal disease to be associated with increased risk of incident stroke [3–6], coronary heart disease [7], carotid artery atherosclerosis [8–10] and type 2 diabetes [11–13]. These associations are generally believed to exist independent of traditional risk factors common to both periodontal disease and cardiometabolic disease including low socio-economic status (SES), adverse health behaviors such as smoking, poor diet and reduced physical activity levels. However, the causal nature of these associations remains uncertain and there are currently no PLOS ONE | www.plosone.org 1 March 2014 | Volume 9 | Issue 3 | e92441