Association between overweight/ obesity and increased risk of periodontitis Suvan JE, Petrie A, Nibali L, Darbar U, Rakmanee T, Donos N, D’Aiuto F. Association between overweight/obesity and increased risk of periodontitis. J Clin Periodontol 2015; 42: 733–739. doi:10.1111/jcpe.12421. Abstract Objective: To investigate periodontitis as a co-morbidity of overweight/obesity in an age-matched sample of periodontitis cases or periodontally healthy controls. Methods: Participants were periodontally assessed using whole mouth clinical periodontal measures. Multivariable conditional logistic regression was used to calculate the odds ratio for diagnosis of periodontitis when body mass index (kg/m 2 ), overweight (BMI 25–29.99 kg/m 2 , or obese BMI ≥ 30 kg/m 2 ) were the explanatory variables. A receiver operating characteristic (ROC) curve was gener- ated of all possible BMI (kg/m 2 ) cut-off points discriminating individuals for diagnosis of periodontitis. Results: The study comprised 286 participants. BMI showed a dose–response association with increased odds (1.12 per increase of 1 kg/m 2 , 95% CI 1.05–1.20, p = 0.001) of being a case compared to a control independent of gender, ethnic- ity, smoking status and dental plaque level. Similarly overweight/obese were inde- pendently associated with increased odds of diagnosis of periodontitis for overweight (OR = 2.56, 95% CI 1.210–5.400, p = 0.014) and for obese (OR = 3.11, 95% CI 1.052–6.481, p = 0.015) compared to normal weight individ- uals. The ROC curve analysis confirmed diagnosis of periodontitis was 1.6 times more likely in an individual with the BMI ≥ 24.32 kg/m 2 . Conclusions: Overweight/obese individuals are more likely to suffer from peri- odontitis compared to normal weight individuals in this case–control sample. Jean E. Suvan 1 , Aviva Petrie 2 , Luigi Nibali 1 , Ulpee Darbar 3 , Thanasak Rakmanee 4 , Nikos Donos 1 and Francesco D’Aiuto 1 1 Unit of Periodontology, University College London (UCL), Eastman Dental Institute, London, UK; 2 Biostatistics Unit, UCL Eastman Dental institute, London, UK; 3 University College London Hospitals NHS Trust (UCLH), Eastman Dental Hospital, London, UK; 4 Faculty of Dentistry, Thammasat University, Patumthani, Thailand Key words: body mass index; obesity; overweight; periodontitis Accepted for publication 2 June 2015 Obesity is a highly prevalent condi- tion worldwide especially in devel- oped countries (WHO 2006). It is a metabolic condition occurring due to an energy imbalance (intake > con- sumption), which subsequently leads to an increase in adipose tissue deposits (Bray 2007). As adipocytes exert a number of endocrine func- tions, increased adiposity is associ- ated with a state of low-grade inflammation and insulin resistance (Bray 2004, Gimeno & Klaman 2005). Periodontitis is a chronic inflam- matory disease driven by bacterial pathogens and is one of the most common oral infections worldwide (WHO 2004). The host response to periodontal pathogens represents a crucial determinant of the individ- ual’s susceptibility to periodontitis. Several pro-inflammatory molecules and processes implicated in the path- ogenesis of periodontitis, including cytokines (e.g. Interleukin-IL-6), chemokines and T-cell function, could be altered by obesity (Falagas & Kompoti 2006). An altered (delayed and sustained) inflamma- tory state, such as that found both in animal experimental conditions (Amar et al. 2007) and in obese individuals, could predispose individ- uals to increased periodontal tissue Conflict of interest and sources of funding: The authors declare no conflicts of interest. This work was undertaken at UCLH/UCL who received a proportion of funding from the Department of Health’s NIHR Bio- medical Research Centres funding scheme. Francesco D’Aiuto holds a Clinical Senior Lectureship Award supported by the UK Clinical Research Collaboration. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd 733 J Clin Periodontol 2015; 42: 733–739 doi: 10.1111/jcpe.12421