This paper evaluates neck circumference as a metabolic risk marker. Overweight/obese, nondiabetic Hispanics, 40–65 years old, who are free of major cardiovascular diseases, were recruited for the San Juan Overweight Adults Longitudinal Study (SOALS). Baseline exams were completed by 1,206 participants. Partial correlation coefficients (r) and logistic models adjusted for age, gender, smoking status, and physical activity were computed. Neck circumference was significantly correlated with waist circumference (r = 0.64), BMI (r = 0.66), and body fat % (r = 0.45). Neck circumference, highest (compared to lowest) tertile, had higher association with prediabetes: multivariable OR = 2.30 (95% CI: 1.71–3.06) compared to waist circumference OR = 1.97 (95% CI: 1.48–2.66) and other anthropometric measures. Neck circumference showed higher associations with HOMA, low HDL-C, and triglycerides, multivariable OR = 8.42 (95% CI: 5.43–13.06), 2.41 (95% CI: 1.80–3.21), and 1.52 (95% CI: 1.14–2.03), but weaker associations with hs-CRP and hypertension, OR = 3.61 (95% CI: 2.66–4.90) and OR = 2.58 (95% CI: 1.90–3.49), compared to waist circumference. AIC for model fit was generally similar for neck or waist circumference. Neck circumference showed similar or better associations with metabolic factors and is more practicable than waist circumference. Hence, neck circumference may be a better alternative to waist circumference.

There is no association between periodontitis and risk of prediabetes/diabetes in this longitudinal study.

Frequent regular use of over-the-counter mouthwash was associated with increased risk of developing pre-diabetes/diabetes in this population.

The effects of lipid-lowering agents (LLA) on reducing systemic and oral inflammation have not been evaluated. Objective To assess the association of LLA use with high-sensitivity C-reactive protein (hs-CRP) and oral inflammation. Design Cross-sectional analysis using baseline data from 1,300 overweight/obese participants aged 40–65 years, recruited for the ongoing San Juan Overweight Adults Longitudinal Study. Serum hs-CRP was measured by ELISA, gingival/periodontal inflammation was evaluated as bleeding upon probing (BOP), and LLA was self-reported. Separate logistic models were performed for systemic and oral inflammation. Results 24% participants reported history of dyslipidemia, of which, 50.3% self-reported LLA use. Sixty percent of the participants had elevated hs-CRP (>3 mg/dL) and 50% had high BOP (defined as at or above the median: 21%). After adjusting for age, gender, smoking, HDL-C, physical activity, diabetes, blood pressure medications, and percent body fat composition, LLA users had significantly lower odds of elevated hs-CRP compared to LLA non-users (OR=0.58; 95% CI: 0.39–0.85). After adjusting for age, gender, smoking status, educational level, mean plaque index, and percent body fat, LLA users had significantly lower odds of high BOP compared to LLA non-users (OR= 0.62; 95% CI: 0.42–0.91). Conclusions Lipid-lowering agents may reduce both systemic and oral inflammatory responses.

Aim We assessed the longitudinal association between tooth loss and peripheral arterial disease (PAD) within the Nurses’ Health Study. Materials and Methods After excluding participants with prior cardiovascular diseases, 277 out of 79,663 women were confirmed as PAD cases during 16-years of follow-up. Number of teeth and recent tooth loss were reported initially in 1992. Subsequent tooth loss was recorded in 1996 and in 2000. We evaluated the associations of baseline number of teeth and recent tooth loss with risk of PAD, adjusting for age, smoking, diabetes, hypertension, high cholesterol, aspirin use, family history of myocardial infarction, BMI, alcohol consumption, physical activity, post-menopausal hormone use, and use of vitamin E, vitamin D, multivitamin, and calcium. Results Incident tooth loss during follow-up was significantly associated with higher hazard of PAD (HR=1.31 95% CI: 1.00–1.71). However, the association appeared inverse among never smokers. There was no dose-response relationship between baseline number of teeth and PAD. Conclusions Tooth loss showed a modest association with PAD, but no dose-response relationship was observed.

Objectives Evaluate whether insulin resistance (IR) predicts the risk of oral inflammation, assessed as the number of sites with bleeding on probing (BOP) and number of teeth with probing pocket depths (PPD) ≥ 4 mm and BOP. Methods Data on 870 overweight/obese diabetes free adults, aged 40-65 years from the San Juan Overweight Adults Longitudinal Study over a three-year period, was analyzed. Baseline IR, assessed using the Homeostasis Model Assessment of IR (HOMA-IR) index, was divided into tertiles. BOP was assessed at buccal and lingual sites, and PPD at six sites per tooth. Negative binomial regression was used to estimate the risk ratios (RRs) for oral inflammation adjusted for baseline age, gender, smoking status, alcohol intake, education, physical activity, waist circumference, mean plaque index, and baseline number of sites with BOP, or number of teeth with PPD≥4 mm and BOP. The potential impact of tertiles of serum TNF-α and adiponectin on the IR-oral inflammation association was also assessed in a subsample of 597 participants. Results Participants in the highest HOMA-IR tertile at baseline, had significantly higher numbers of sites with BOP [RR=1.19, 95% confidence interval (CI): 1.03-1.36] and number of teeth with PPD≥4 mm and BOP (RR=1.39, 95% CI: 1.09 - 1.78) at follow-up, compared with individuals in the lower two HOMA-IR tertiles. Neither TNF-α nor adiponectin confounded the associations. Conclusion IR significantly predicts gingival/periodontal inflammation in this population.

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Short-term blood pressure variability is associated with pre-diabetes/diabetes cross-sectionally, but there are no longitudinal studies evaluating this association. The objective of this study is to evaluate the association between within-visit systolic and diastolic blood pressure variability and development of pre-diabetes/diabetes longitudinally. The study was conducted among eligible participants from the San Juan Overweight Adults Longitudinal Study (SOALS), who completed the three-year follow-up exam. Participants were Hispanics, 40–65 years of age, and free of diabetes at baseline. Within-visit systolic and diastolic blood pressure variability was defined as the maximum difference between three measures, taken a few minutes apart, of systolic and diastolic blood pressure respectively. Diabetes progression was defined as development of pre-diabetes/diabetes over the follow-up period. We computed multivariate incidence rate ratios adjusting for baseline age, gender, smoking, physical activity, waist circumference and hypertension status. Participants with systolic blood pressure variability ≥10 mm Hg compared to those with <10 mm Hg, showed higher progression to pre-diabetes/diabetes (RR=1.77, 95% CI: 1.30–2.42). The association persisted among never smokers. Diastolic blood pressure variability ≥ 10 mm Hg (compared to < 10 mm Hg) did not show an association with diabetes status progression (RR=1.20, 95% CI: 0.71–2.01). Additional adjustment of baseline glycemia, C- reactive protein, and lipids (reported dyslipidemia or baseline HDL or triglycerides) did not change the estimates. Systolic blood pressure variability may be a novel independent risk factor and an early predictor for diabetes, which can be easily incorporated into a single routine outpatient visit at none to minimal additional cost.