Periodontitis and Risk of Diabetes in the Atherosclerosis Risk in Communities (ARIC) Study: A BMI-Modified Association

Shaoping Zhang, Kamaira H. Philips, Kevin Moss, Di Wu, Hamdi S. Adam, Elizabeth Selvin, Ryan T. Demmer, Faye L. Norby, Indra Z. Mustapha, James D. Beck

Research output: Contribution to journalArticlepeer-review


Purpose: To determine whether periodontal disease is positively associated with incident diabetes across the continuum of body mass levels (BMI) and test the hypothesis that the periodontal risk for incident diabetes is modified by BMI. Methods: We included 5569 diabetes-free participants from Visit 4 (1996-1998) of the Atherosclerosis Risk in Communities study and followed them until 2018. Periodontal disease status was classified by periodontal profile class (PPC)-Stages, and incident diabetes was based on participant report of physician diagnosis. We estimated the hazard ratios (HR) for diabetes using a competing risk model for each PPC-Stage. We assessed multiplicative interactions between periodontal disease and BMI (as a continuous variable) on risk of diabetes. Results: During a median time of 19.4 years of follow-up, 1348 incident diabetes cases and 1529 deaths occurred. Compared to the "Health/Incidental Disease"stage, participants with PPC "Severe Periodontal Disease"or "Severe Tooth Loss"stage and lower BMI had elevated risk for diabetes adjusting for demographic, smoking, education, and biological variables when accounting for death as a competing risk with HRs of 1.76 (95% CI 1.10-2.80) and 2.11 (95% CI 1.46-3.04), respectively. The interaction between PPC-Stages and BMI was significant (P = 0.01). No significant associations of PPC-Stages with incident diabetes were present when BMI was above 31 kg/m2. Conclusion: Periodontal disease was associated with incident diabetes, especially in nonobese participants. Dentists should be aware that periodontal disease is associated with incident diabetes but the association may be modified for patient's at higher BMI levels.

Original languageEnglish (US)
Pages (from-to)E3546-E3558
JournalJournal of Clinical Endocrinology and Metabolism
Issue number9
StatePublished - Sep 1 2021


  • body mass index
  • diabetes
  • periodontal disease
  • periodontal-systemic disease interaction

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Biochemistry
  • Endocrinology
  • Clinical Biochemistry
  • Biochemistry, medical


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