title: Added sugars and periodontal disease in young adults: an analysis of NHANES III data.
abstract: BACKGROUND
  Added sugar consumption seems to trigger a hyperinflammatory state and may result in visceral adiposity, dyslipidemia, and insulin resistance. These conditions are risk factors for periodontal disease. However, the role of sugar intake in the cause of periodontal disease has not been adequately studied.
  
  
  OBJECTIVE
  We evaluated the association between the frequency of added sugar consumption and periodontal disease in young adults by using NHANES III data.
  
  
  METHODS
  Data from 2437 young adults (aged 18-25 y) who participated in NHANES III (1988-1994) were analyzed. We estimated the frequency of added sugar consumption by using food-frequency questionnaire responses. We considered periodontal disease to be present in teeth with bleeding on probing and a probing depth ≥3 mm at one or more sites. We evaluated this outcome as a discrete variable in Poisson regression models and as a categorical variable in multinomial logistic regression models adjusted for sex, age, race-ethnicity, education, poverty-income ratio, tobacco exposure, previous diagnosis of diabetes, and body mass index.
  
  
  RESULTS
  A high consumption of added sugars was associated with a greater prevalence of periodontal disease in middle [prevalence ratio (PR): 1.39; 95% CI: 1.02, 1.89] and upper (PR: 1.42; 95% CI: 1.08, 1.85) tertiles of consumption in the adjusted Poisson regression model. The upper tertile of added sugar intake was associated with periodontal disease in ≥2 teeth (PR: 1.73; 95% CI: 1.19, 2.52) but not with periodontal disease in only one tooth (PR: 0.85; 95% CI: 0.54, 1.34) in the adjusted multinomial logistic regression model.
  
  
  CONCLUSIONS
  A high frequency of consumption of added sugars is associated with periodontal disease, independent of traditional risk factors, suggesting that this consumption pattern may contribute to the systemic inflammation observed in periodontal disease and associated noncommunicable diseases.
authors.affiliation: From the Departments of Public Health (ECOL and AAMS) and Dentistry (CCCR and CMCA), Federal University of Maranhão, São Luís, Brazil, and the Department of Preventive and Social Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil (FNH).
authors.forename: Estevam C O
authors.initials: EC
authors.lastname: Lula
authors.affiliation: From the Departments of Public Health (ECOL and AAMS) and Dentistry (CCCR and CMCA), Federal University of Maranhão, São Luís, Brazil, and the Department of Preventive and Social Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil (FNH).
authors.forename: Cecilia C C
authors.initials: CC
authors.lastname: Ribeiro
authors.affiliation: From the Departments of Public Health (ECOL and AAMS) and Dentistry (CCCR and CMCA), Federal University of Maranhão, São Luís, Brazil, and the Department of Preventive and Social Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil (FNH).
authors.forename: Fernando N
authors.initials: FN
authors.lastname: Hugo
authors.affiliation: From the Departments of Public Health (ECOL and AAMS) and Dentistry (CCCR and CMCA), Federal University of Maranhão, São Luís, Brazil, and the Department of Preventive and Social Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil (FNH).
authors.forename: Cláudia M C
authors.initials: CM
authors.lastname: Alves
authors.affiliation: From the Departments of Public Health (ECOL and AAMS) and Dentistry (CCCR and CMCA), Federal University of Maranhão, São Luís, Brazil, and the Department of Preventive and Social Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil (FNH).
authors.forename: Antônio A M
authors.initials: AA
authors.lastname: Silva
mesh_terms: D000293:Adolescent; D000328:Adult; D015992:Body Mass Index; D004040:Dietary Carbohydrates / Q000008:administration & dosage* / Q000009:adverse effects*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D009749:Nutrition Surveys; D010510:Periodontal Diseases / Q000453:epidemiology* / Q000209:etiology; D015995:Prevalence; D012307:Risk Factors; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D004040:Dietary Carbohydrates