title: Periodontitis and Systemic Disease: Association or Causality?
abstract: OBJECTIVE
  The aim was to assess recent evidence that diabetes, metabolic syndrome (MetS) and obesity impact the progression of periodontitis.
  
  
  RESULTS
  Electronic searches using Embase, Medline, and Web of Science were carried out for epidemiological studies on humans, published between 2014 and 2016. A small number of prospective studies and systematic reviews were identified that in general provide further support for the hypothesis that diabetes, metabolic syndrome and obesity can adversely affect the periodontal condition.
  
  
  CONCLUSIONS
  Confounding remains the most challenging issue in the interpretation of the associations found between diabetes, MetS, obesity and periodontal disease. Recent research applying a Mendelian randomisation approach concluded that the association between obesity and periodontitis is confounded and questioned a role for obesity in causation. Further studies are warranted to assess the issue of causality.
authors.affiliation: Centre for Public Health, School of Medicine Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK.
authors.forename: Lewis
authors.initials: L
authors.lastname: Winning
authors.affiliation: Centre for Public Health, School of Medicine Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK.|School of Dentistry, Queen's University, Grosvenor Road, Belfast, BT12 6BP UK.
authors.forename: Gerard J
authors.initials: GJ
authors.lastname: Linden
keywords: Diabetes; Mendelian randomisation; Metabolic syndrome; Obesity; Periodontitis