A Proposed Model Linking Inflammation to Obesity, Diabetes, and Periodontal Infections

Background: Obesity is an important risk factor for diabetes, cardiovascular disease, and periodontal dis-ease. Adipocytes appear to secrete proinflammatory cytokines which may be the molecules linking the path-ogenesis of these diseases. We evaluated the relationship between obesity, periodontal disease, and diabetes mellitus insulin resistance as well as the plasma levels of tumor necrosis factor alpha (TNFa) and its soluble receptors (sTNFa) to assess the relationship of inflammation to obesity, diabetes, and periodontal infections. Methods: The relationship between periodontal disease, obesity, and insulin resistance was examined in the Third National Health and Nutrition Examination Survey (NHANES III). In a population of 12,367 non-diabetic subjects, the variable body mass index (BMI) was used as an assessment of obesity and periodontal disease was assessed by mean clinical attachment loss. The plasma levels of TNFa and sTNFa were assessed in sub-sets of 1,221 adults from Erie County, New York, who represented the highest and lowest quartile of BMI. These subjects had extensive periodontal and medical evaluations. Results: In the NHANES III portion of the study, BMI was positively related to severity of periodontal attach-ment loss (P <0.001). Weighted multiple logistic regressions showed that this relationship is likely mediated by insulin resistance, since overweight individuals (with BMI ‡27 kg/m2) with high levels of insulin resistance (IR) exhibited an odds ratio of 1.48 (95 % confidence interval 1.13- 1.93) for severe periodontal disease as com