Association between the quality of plant‐based diets and periodontitis in the U.S. general population

Abstract

Aim: To investigate the relationship between plant-based diet indices (PDIs) and periodontitis and serum IgG antibodies against periodontopathogens in the U.S. population. Materials and Methods:We analysed cross-sectional data on 5651 participants ≥40 years of age from the Third National Health and Nutrition Examination Survey.Food frequency questionnaire data were used to calculate the overall PDI, healthy plant-based diet index (hPDI), and unhealthy plant-based diet index (uPDI). Periodontitis was defined using a half-reduced Centers for Disease Control and Prevention and American Academy of Periodontology case definition. Serum antibodies against 19 periodontopathogens were used to classify the population into two subgroups using hierarchical clustering. Survey-weighted multivariable logistic regressions were applied to assess the associations of PDI/hPDI/uPDI z-scores with periodontitis and hierarchical clusters after adjusting for potential confounders.Results: A total of 2841 (50.3%) participants were defined as having moderate/ severe periodontitis. The overall PDI z-score was not significantly associated with the clinical and bacterial markers of periodontitis. By considering the healthiness of plant foods, we observed an inverse association between hPDI z-score and periodontitis (odds ratio [OR] = 0.925, 95% confidence interval [CI]: 0.860-0.995). In contrast, higher uPDI z-score (adherence to unhealthful plant foods) might increase the risk of periodontitis (OR = 1.100; 95% CI: 1.043-1.161). Regarding antibodies against periodontopathogens, the participants in cluster 2 had higher periodontal antibodies than those in cluster 1. The hPDI z-score was positively associated with cluster 2 (OR = 1.192; 95% CI: 1.112-1.278). In contrast, an inverse association between uPDI z-score and cluster 2 was found (OR = 0.834; 95% CI: 0.775-0.896).Conclusions: Plant-based diets were associated with periodontitis, depending on their quality. A healthy plant-based diet was inversely related to an increased risk of periodontitis but positively related to elevated antibody levels against periodontopathogens. For an unhealthy plant-based diet, the opposite trends were observed.An Li and Bingjiang Qiu share the first authorship.

The potential causal path between periodontitis stage diagnosis and vegetable consumption is mediated by loss of posterior functional tooth units and masticatory function

“…Additionally, it seems to be consistent across age groups, a known determinant of food choices (Pirlich & Lochs, 2001; Yannakoulia et al, 2018) with a complex relationship with periodontitis and tooth loss (Kassebaum et al, 2014; Machtei et al, 1994). These results are significant, as emerging evidence from population studies has shown a potential two‐way relationship between food choices/nutrition and periodontal health status (Alhassani et al, 2021; Li et al, 2022, 2023; Machado et al, 2021; O'Keeffe et al, 2019; Shen et al, 2023). Although these studies have been unable to establish the directionality of the association, biological plausibility speaks for a contributory role of food choices/nutrition in the onset and progression of periodontitis, particularly so through the consumption of a pro‐inflammatory diet (Li et al, 2021; Machado et al, 2021).…”

“…This study's main aim was to identify any potential cause-effect relationship between periodontitis stage and dietary choices, particularly Additionally, it seems to be consistent across age groups, a known determinant of food choices (Pirlich & Lochs, 2001;Yannakoulia et al, 2018) with a complex relationship with periodontitis and tooth loss (Kassebaum et al, 2014;Machtei et al, 1994). These results are significant, as emerging evidence from population studies has shown a potential two-way relationship between food choices/nutrition and periodontal health status (Alhassani et al, 2021;Li et al, 2022Li et al, , 2023Machado et al, 2021;O'Keeffe et al, 2019;Shen et al, 2023).…”

Associations of dietary antioxidant intake with periodontal health among US adults: An exploratory mediation analysis via mitochondrial function

“…According to a recent population‐based study, healthy plant‐based diets (e.g. antioxidant‐rich fruits and vegetables) can promote host immunity, benefitting periodontal health (Li et al, 2023). A healthy diet has been reported to suppress oxidative stress and ameliorate oxidative damage in chronic metabolic diseases (Jiang et al, 2021).…”

Empirically derived dietary patterns in relation to periodontitis and number of teeth among Norwegian adults

“…the Dietary Inflammatory Index (mainly nutrient-based) ( 6 , 7 ) and anti-inflammatory dietary score (based on nine food groups) ( 11 ) , as well as indices that measure adherence to established evidence-based dietary patterns for chronic disease prevention, e.g. the Dietary Approaches to Stop Hypertension and the Mediterranean Diet Score ( 9 , 12 ) , plant-based diet indices ( 13 ) and food groups according to the degree of processing ( 14 ) . Most studies of a priori indices reported lower adherence to the anti-inflammatory/healthier diet in individuals with periodontitis ( 6 , 7 , 9 , 11 , 13 , 14 ) .…”

“…the Dietary Approaches to Stop Hypertension and the Mediterranean Diet Score ( 9 , 12 ) , plant-based diet indices ( 13 ) and food groups according to the degree of processing ( 14 ) . Most studies of a priori indices reported lower adherence to the anti-inflammatory/healthier diet in individuals with periodontitis ( 6 , 7 , 9 , 11 , 13 , 14 ) . However, hypothesis-driven approaches neither reflect overall dietary patterns nor consider the correlated structure of the dietary components and nutrients ( 15 ) .…”