Abstract
Background: Increased physical activity improves insulin sensitivity and glucose metabolism, and may therefore affect incidence of periodontitis. Methods: We studied the association of physical activity, walking and periodontitis in 39,461 male, US based, health professionals, 40–75 years old at baseline, more than half of whom were dentists, being followed up continuously since 1986. Participants were free of periodontitis, coronary heart disease and stroke at the start of follow-up. Physical activity and periodontitis were measured by validated questionnaires (expressed in metabolic equivalents – METs); the first report of professionally diagnosed periodontitis was considered a case. Results: Periodontitis risk decreased by 3% for every 10-MET increase in average physical activity after adjustment for age, smoking, diabetes, BMI, alcohol consumption and total calories (RR = 0.97; 95% CI: 0.95–0.99). The inverse trend remained significant in the categorical analysis. Compared to men in the lowest quintile of physical activity, those in the highest quintile had a 13% lower risk of periodontitis (RR = 0.87; 95% CI: 0.76–1.01, p-value, test for trend = 0.02). In a sub-sample of men with radiographs (n = 137) the physically active had less average bone loss (β = −0.29, p-value = 0.03) after multivariate adjustment compared to those inactive. Conclusions: In this large-scale prospective study, we found an inverse, linear association between sustained physical activity and periodontitis independent of known risk factors. The benefits of a physically active lifestyle may extend to periodontal health.
References
Albandar JM, Brunelle JA, Kingman A. Destructive periodontal disease in adults 30 years of age and older in the United States, 1988-1994. J Periodontol 1999; 70: 13–29.
Position paper: Epidemiology of periodontal diseases. American Academy of Periodontology. J Periodontol 1996; 67: 935–945.
Lalla E, Lamster IB, Schmidt AM. Enhanced interaction of advanced glycation end products with their cellular receptor RAGE: Implications for the pathogenesis of accelerated periodontal disease in diabetes. Ann Periodontol 1998; 3: 13–19.
Lalla E, Lamster IB, Feit M, et al. Blockade of RAGE suppresses periodontitis-associated bone loss in diabetic mice. J Clin Invest 2000; 105: 1117–1124.
Evans DJ, Hoffmann RG, Kalkhoff RK, Kissebah AH. Relationship of body fat topography to insulin sensitivity and metabolic profiles in premenopausal women. Metabolism 1984; 33: 68–75.
Nishikawa T, Edelstein D, Brownlee M. The missing link: A single unifying mechanism for diabetic complications. Kidney Int 2000; 58(Suppl 77): S26–S30.
Saito T, Shimazaki Y, Sakamoto M. Obesity and periodontitis. N Engl J Med 1998; 339: 482–483.
Saito T, Shimazaki Y, Koga T, Tsuzuki M, Ohshima A. Relationship between upper body obesity and periodontitis. J Dent Res 2001; 80: 1631–1636.
Goodyear LJ, Kahn BB. Exercise, glucose transport, and insulin sensitivity. Annu Rev Med 1998; 49: 235–261.
Borghouts LB, Keizer HA. Exercise and insulin sensitivity: A review. Int J Sports Med 2000; 21: 1–12.
Rimm EB, Giovannucci EL, Willett WC, et al. Prospective study of alcohol consumption and risk of coronary disease in men. Lancet 1991; 338: 464–468.
Stampfer MJ, Willett WC, Speizer FE, et al. Test of the National Death Index. Am J Epidemiol 1984; 119: 837–839.
Manson JE, Hu FB, Rich-Edwards JW, et al. A prospective study of walking as compared with vigorous exercise in the prevention of coronary heart disease in women. N Engl J Med 1999; 341: 650–658.
Ainsworth BE, Haskell WL, Leon AS, et al. Compendium of physical activities: Classification of energy costs of human physical activities. Med Sci Sports Exerc 1993; 25: 71–80.
Wolf AM, Hunter DJ, Colditz GA, et al. Reproducibility and validity of a self-administered physical activity questionnaire. Int J Epidemiol 1994; 23: 991–999.
Joshipura KJ, Douglass CW, Garcia RI, Valachovic R, Willett WC. Validity of a self-reported periodontal disease measure. J Public Health Dent 1996; 56: 205–212.
Joshipura KP, Douglass, CW. Validation of self-reported periodontal measures among health professionals. J Public Health Dent, in press.
Hu FB, Stampfer MJ, Rimm E, et al. Dietary fat and coronary heart disease: A comparison of approaches for adjusting for total energy intake and modeling repeated dietary measurements. Am J Epidemiol 1999; 149: 531–540.
Rothman KJ, Greenland S. Modern Epidemiology. 2nd ed. Philadelphia: Lippincott-Raven Publishers, 1998.
D'Agostino RB, Lee ML, Belanger AJ, Cupples LA, Anderson K, Kannel WB. Relation of pooled logistic regression to time dependent Cox regression analysis: The Framingham Heart Study. Stat Med 1990; 9: 1501–1515.
Willett WC, Howe GR, Kushi LH. Adjustment for total energy intake in epidemiologic studies. Am J Clin Nutr 1997; 65 1220S–1228S; discussion 1229S-1231S.
Durrleman S, Simon R. Flexible regression models with cubic splines. Stat Med 1989; 8: 551–561.
Greenland S, Michels KB, Robins JM, Poole C, Willett WC. Presenting statistical uncertainty in trends and dose-response relations. Am J Epidemiol 1999; 149: 1077–1086.
Merchant A, Pitiphat W, Douglass CW, Crohin C, Joshipura K. Oral hygiene practices and periodontitis in health care professionals. J Periodontal 2002; 73: 531–553.
Gortmaker SL, Dietz WH Jr, Cheung LW. Inactivity, diet, and the fattening of America. J Am Diet Assoc 1990; 90: 1247–1252, 1255.
Ching PL, Willett WC, Rimm EB, Colditz GA, Gortmaker SL, Stampfer MJ. Activity level and risk of overweight in male health professionals. Am J Public Health 1996; 86: 25–30.
Sakki TK KM, Vimpari SS, Hartikainen MS. Association of lifestyle with periodontal health. Cummunity Dent Oral Epidemiol 1995; 23: 155–158.
Wakai K, Kawamura T, Umemura O, et al. Associations of medical status and physical fitness with periodontal disease. J Clin Periodontol 1999; 26: 664–672.
Hu FB, Sigal RJ, Rich-Edwards JW, et al. Walking compared with vigorous physical activity and risk of type 2 diabetes in women: A prospective study. JAMA 1999; 282: 1433–1439.
Coakley EH, Rimm EB, Colditz G, Kawachi I, Willett W. Predictors of weight change in men: Results from the Health Professionals Follow-up Study. Int J Obes Relat Metab Disord 1998; 22: 89–96.
Manson JE, Nathan DM, Krolewski AS, Stampfer MJ, Willett WC, Hennekens CH. A prospective study of exercise and incidence of diabetes among US male physicians. JAMA 1992; 268: 63–67.
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Merchant, A.T., Pitiphat, W., Rimm, E.B. et al. Increased physical activity decreases periodontitis risk in men. Eur J Epidemiol 18, 891–898 (2003). https://doi.org/10.1023/A:1025622815579
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DOI: https://doi.org/10.1023/A:1025622815579