title: Abdominal obesity modifies long-term associations between periodontitis and markers of systemic inflammation.
abstract: OBJECTIVE
  Periodontitis is considered to promote atherosclerosis and cardiovascular diseases through increased low-grade systemic inflammation. However, there is no information on the long-term impact of periodontitis on systemic inflammation from cohort studies. Thus, this study aims to assess the impact of periodontitis on systemic inflammation (fibrinogen and white blood cells (WBC)) in a population-based longitudinal survey in north-eastern Germany.
  
  
  METHODS
  The study sample comprised 2622 subjects from the Study of Health in Pomerania with complete 5- and 11-year follow-ups. Periodontitis was assessed by probing depth and clinical attachment level. Multilevel regression analyses were applied to evaluate associations between periodontitis measures and i) fibrinogen/WBC count using 11-year follow-up data and ii) respective z-scores of fibrinogen/WBC count using 5- and 11-year follow-up data. We adjusted for common cardiovascular risk factors and stratified analyses by abdominal obesity (P for interaction <0.10).
  
  
  RESULTS
  In lean subjects, beta-coefficients of mean probing depth were B = 0.13 (0.08-0.019; P < 0.001) for fibrinogen and B = 0.50 (0.37-0.64; P < 0.001) for WBC count using 11-year follow-up data only. For lean subjects, models using z-scores confirmed that increased mean probing depths were associated with increased fibrinogen z-scores (B = 0.14 (0.09-0.18; P < 0.001)) and increased WBC z-scores (B = 0.16 (0.11-0.20; P < 0.001)). Consistent results were found for mean clinical attachment levels. For abdominally obese subjects, relations between periodontitis measures and levels of inflammation markers were less pronounced or non-significant.
  
  
  CONCLUSIONS
  Modified by abdominal obesity, periodontitis affected systemic inflammation in a significant dose-dependent manner. Results contribute to the discussion on how periodontitis is linked to atherosclerosis and cardiovascular diseases.
authors.affiliation: Unit of Periodontology, Department of Restorative Dentistry, Periodontology, and Endodontology, University Medicine Greifswald, Ernst Moritz Arndt University of Greifswald, Greifswald, Germany.
authors.forename: Christiane
authors.initials: C
authors.lastname: Gocke
authors.affiliation: Unit of Periodontology, Department of Restorative Dentistry, Periodontology, and Endodontology, University Medicine Greifswald, Ernst Moritz Arndt University of Greifswald, Greifswald, Germany.
authors.forename: Birte
authors.initials: B
authors.lastname: Holtfreter
authors.affiliation: Unit of Periodontology, Department of Restorative Dentistry, Periodontology, and Endodontology, University Medicine Greifswald, Ernst Moritz Arndt University of Greifswald, Greifswald, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Meisel
authors.affiliation: Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Ernst Moritz Arndt University of Greifswald, Greifswald, Germany.
authors.forename: Anne
authors.initials: A
authors.lastname: Grotevendt
authors.affiliation: Unit of Periodontology, Department of Restorative Dentistry, Periodontology, and Endodontology, University Medicine Greifswald, Ernst Moritz Arndt University of Greifswald, Greifswald, Germany.
authors.forename: Lukasz
authors.initials: L
authors.lastname: Jablonowski
authors.affiliation: Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Ernst Moritz Arndt University of Greifswald, Greifswald, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Nauck
authors.affiliation: Department Study of Health in Pomerania/Clinical-Epidemiological Research, Institute for Community Medicine, University Medicine Greifswald, Ernst Moritz Arndt University of Greifswald, Greifswald, Germany.
authors.forename: Marcello Ricardo Paulista
authors.initials: MR
authors.lastname: Markus
authors.affiliation: Unit of Periodontology, Department of Restorative Dentistry, Periodontology, and Endodontology, University Medicine Greifswald, Ernst Moritz Arndt University of Greifswald, Greifswald, Germany. Electronic address: kocher@uni-greifswald.de.
authors.forename: Thomas
authors.initials: T
authors.lastname: Kocher
mesh_terms: D000328:Adult; D050197:Atherosclerosis / Q000209:etiology*; D002318:Cardiovascular Diseases / Q000209:etiology*; D005260:Female; D005858:Germany; D006801:Humans; D007249:Inflammation / Q000097:blood; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D056128:Obesity, Abdominal; D010518:Periodontitis / Q000150:complications*; D012307:Risk Factors
keywords: Cohort study; Fibrinogen; Obesity; Periodontitis; Study of health in Pomerania; Systemic inflammation; White blood cell count