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 Table of Contents  
Year : 2017  |  Volume : 7  |  Issue : 2  |  Page : 106-109

To determine the correlation between anthropometric variable of obesity and periodontitis among Mid-Western population of Nepal

1 Department of Physiology, gunj Medical College, gunj, Nepal
2 Department of Pharmacology, gunj Medical College, gunj, Nepal

Date of Web Publication28-Dec-2017

Correspondence Address:
Dr. Bhawana Neupane Pant
Department of Physiology, Nepalgunj Medical College, Nepalgunj
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijmd.ijmd_38_17

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Purpose: Periodontitis qualifies as a major public health problem owing to its high prevalence and incidence in all regions of the world. Among many predisposing factors of periodontitis such as age, hygiene, gender, socioeconomic status, and tobacco consumption, obesity also has significant impact. Although a lot of progress has been achieved in past decade on accessibility and awareness about oral health, the obesity still remains impending and burgeoning health concern in Nepal. With this trend, we can foresee that the body mass index (BMI), one of the commonly used indirect measure of obesity, might potentially turn out to be one of the leading factors of periodontitis.
Materials and Methodology: We screened 300 healthy controls and divided into two groups – Group I (BMI >30) and Group II (BMI <30) to study the correlation between BMI and periodontal status.
Results: Our result showed that periodontitis is significantly correlated with BMI (P = 0.023) in Group I whereas no such correlation was seen in Group II (P = 0.22). The prevalence of periodontal disease was more in Group I (43.1%) as compared to Group II (5.3%) persons (Odds ratio = 11.826 and 95% confidence interval 5.415–21.828).
Conclusion: Our data suggest that the BMI can be a good predictor of periodontitis.

Keywords: Anthropometric variable; body mass index; community periodontal index; gingivitis; periodontitis

How to cite this article:
Pant BN, Goit RK, Bhargava P, Neupane GP. To determine the correlation between anthropometric variable of obesity and periodontitis among Mid-Western population of Nepal. Indian J Multidiscip Dent 2017;7:106-9

How to cite this URL:
Pant BN, Goit RK, Bhargava P, Neupane GP. To determine the correlation between anthropometric variable of obesity and periodontitis among Mid-Western population of Nepal. Indian J Multidiscip Dent [serial online] 2017 [cited 2021 Sep 25];7:106-9. Available from: https://www.ijmdent.com/text.asp?2017/7/2/106/221765

  Introduction Top

The prevalence of obesity is rising in developed and developing nations. The negative effects of obesity on health are beyond dispute, and it is cited as an important risk factor for early mortality.[1] Moreover, obesity is associated with disability and poor perceived health.[2] Besides being a risk factor for cardiovascular disease, certain cancers, and type II diabetes, obesity has also been associated with oral diseases, including periodontitis.[3] The rapidly changing lifestyle as well as disease pattern makes it very important for periodontitis predisposition. Due to remarkable improvement in accessibility and awareness, obesity might potentially turn out to be the leading factor of periodontitis. Body mass index (BMI) is a statistical measure of body size based on an individual's weight and height.[4]

Destruction of the peritooth structure that supports the teeth is referred as periodontal disease.[5] The chronic destruction of these structures such as the gingiva, periodontal ligament, cementum, and alveolar bone can lead to the partial or complete loss of teeth.[5] According to the World Health Organization (WHO) Global Oral Data Bank, more than two-thirds of the world's population suffer from one of the chronic forms of periodontal disease.[6] Therefore, periodontitis qualifies as a major public health problem owing to its high prevalence and incidence in all regions of the world. Among many predisposing factors of periodontitis such as age, hygiene, gender, diabetes, genetics, smoking, and socioeconomic status, obesity has also significant impact.[7] In fact, the burgeoning prevalence of periodontitis despite improvement in public awareness about oral hygiene and accessibility to dental care providers also indicates that the changing lifestyle and obesity are significantly associated with periodontitis. Age is one important factor for the periodontal disease and its severity increases with age.[8],[9] Periodontal diseases can be controlled in younger populations by controlling the other risk factors. It has been suggested that obesity contributes to an overall systemic inflammatory state through its effect on metabolic and immune parameters, thereby increasing susceptibility to periodontal disease.[10] Normally host secrets, both anti-inflammatory and proinflammatory mediators, but in obese person, the amount of proinflammatory cytokines and hormones are highly because secreted adipose tissues which are involved in the overall inflammatory process including the periodontitis.[10] Since BMI is a predictor for obesity and obesity is a risk factor for periodontitis, BMI and periodontitis are related.

Recent studies show that the incidence of overweight and obesity is increasing even in the developing countries like Nepal.[11] Number of studies has associated periodontitis and obesity; however, no such studies have been reported in Mid-Western population of Nepal. Although the general association of obesity and periodontitis is important, it is better to have population-specific association. Therefore, the study aims to determine this association by studying correlation between BMI (one of the commonly used indirect measure of obesity) and periodontitis.

This study was planned to establish if chronic periodontitis is associated with BMI in young Nepali adults attending dental outpatient department (OPD) in medical college teaching hospital and a private dental clinic in Mid-Western region of Nepal. This will lead us to determine the relationship between this measure and the periodontal disease and thus to identify their effectiveness in screening the individuals with periodontal disease.

  Materials and Methodology Top

This cross-sectional prospective study was conducted in patients attending dental OPD at medical college and in a private dental clinic in Mid-Western region of Nepal, from August 3, 2015, to October 8, 2016. A total of 300 individuals of age group between 30 and 50 years of either sex were taken and divided into two groups:

  • Group I – BMI >30 kg/m2 – 150 individuals – study group
  • Group II – BMI <30 kg/m2 – 150 individuals – control group.

All the healthy controls of age range 30–50 years who gave the consent were included in the study. Individuals who were not in the age group of 30–50 years and those individuals who were under medication of any kind of severe illness, smokers, tobacco chewers, and pregnant were excluded.

The anthropometric measurements were measured by standard procedures. The height was measured by stadiometer with individuals having their shoes removed and was recorded to the nearest 0.1 cm.[12] The body weights of the individuals were measured with weighing machine in light clothing, without shoes.[12] BMI was determined by dividing weight in kilogram (kg) by height in square meter (m2).[4] According to guidelines adopted by WHO in 1997, 18.5≤ BMI <25 is classified as normal, 25≤ BMI <30 is overweight, and BMI ≥30 is obese.[13]

Oral examination was performed which included dental bacterial plaque, calculus, bleeding on probing, and periodontal pocket depth for determining community periodontal index (CPI). The mouth was divided into six parts (sextants). The examination was done by special periodontal probe (WHO probe). The score was identified by examination of specified index teeth: upper right first molar, upper right central incisor, upper left first molar, lower right first molar, lower left central incisor, and lower left first molar.[14] CPI was scored as: 0 = no disease; 1 = bleeding on probing; 2 = calculus with plaque seen or felt by probing; 3 = pathological pocket 4–5 mm; 4 = pathological pocket 6 mm or more; x = when only 1 tooth or no tooth is present.[14]

Data were analyzed using SPSS 16 (Statistical Package for Social Science). BMI was compared with CPI using Pearson correlation coefficient test. Any possible association of BMI with periodontitis was examined in a series of logistic regression analysis, and the odds ratio (OR) and 95% confidence interval (CI) were calculated. The data analysis was considered significant at P < 0.05.

  Results Top

The frequency percentage for the severe gingivitis (CPI score 2) was highest in Group I as well as Group II with 46.7% and 28.7%, respectively. The frequency percentage of periodontitis was 43.1% and 5.3%, respectively, in Group I and Group II (CPI score 3 and 4 [severe gingival recession and mobility]). About 18% of Group I and 4% of Group II were found to have CPI score 4 (P = 0.032). The result also revealed that the BMI was positively correlated with CPI in the Group I (r = 0.1.86, P = 0.023) but was not correlated with the Group II (r = −0.10, P = 0.22). In Group II, 4.7% had severe periodontitis, 0.7% had moderate periodontitis, and 95.3% had no periodontitis. Among these 95% of Group II, 40.7% were with normal gingiva and 59.3% were with gingivitis. When evaluation was done for the prevalence of periodontal disease according to BMI in Group I and Group II, the prevalence of periodontal disease was significantly (P = 0.03) more in Group I (43.1%) than in Group II (5.3%) individuals (OR = 11.826 and 95% CI 5.415–21.828).

  Discussion Top

Epidemiological studies have suggested a constant association between chronic periodontitis and various components of metabolic syndrome.[15],[16] The relationship between chronic periodontitis and metabolic syndrome could be bidirectional.[16] Periodontal disease prevalence is greater among obese people, and an increased BMI may be a potential risk factor for periodontitis.[14] Past studies have included either young or old individuals or used a wide range of age as the periodontal status was assessed using the CPI, and data from those studies on both the young and adult individuals had suggested that periodontal status deteriorates with BMI.[15]

The present study was done in a group of patients in the age group of 30–50 years as shown in [Table 1]. This age group was considered because systemic diseases are much more common with the older age group and the dental indices would be affected by aging in older individuals. Al-Zaharani et al.[3] assessed the association of BMI and periodontal disease among adults aged 18–34 years and observed that the prevalence of periodontitis was 88% higher among obese individuals. Moreover, it is evident that the BMI increases with age.[17],[18]
Table 1: Demographic representation of the individuals among the 300 patients examined (age 30-55 years); females were 151 and the males were 149 in number

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The aim of the present study was to correlate the BMI to oral health of the individuals as determined by CPI score. In the present study, the deposition of plaque was higher in Group II (data not shown). The higher plaque deposition may be due to the excess in calorie consumption and dietary habits. This agrees with the findings of Saito et al.[19] who concluded that obesity may negatively affect oral hygiene measures. Result presented in [Table 2] indicates that the frequency and percentage for the severe gingivitis (CPI score 2) were highest in Group I (46.7%) as well as Group II (28.7%). There is a link between obesity and periodontal disease, gingival disease being one of them.
Table 2: The frequency and percentage of different phases of community periodontal index for study group and control group, respectively

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Our results as shown in [Table 2] also indicate that the mean CPI in the present study was more in Group I as compared to Group II. On correlation between CPI and BMI, our result revealed a statistically significant correlation in Group I (P = 0.023) and no such correlation was seen in Group II (P = 0.22). The possible reason may be that in persons with obesity, adipose tissue actively secretes a variety of cytokines and hormones which are responsible for overall inflammatory processes and in similar way involved for the loss of periodontal attachment.[3] This result agrees with the results of Saito et al.[19] in their cross-sectional study which suggested that there is a strong relation linking obesity to chronic inflammatory periodontal diseases.

In this study, percentage of periodontal disease was higher in Group I (42.7%) compared to Group II (5.3%). This finding agrees with the study conducted by Mathur et al.[20] and Linden et al.[21] Family history of dental disease and poor oral hygiene habits can be a contributing factor for the development of periodontal disease in Group II. Some studies observed to have no association of obesity with periodontal disease; a study done by Kim et al.[22] found no association between BMI and periodontitis, but a significant association between abdominal obesity and periodontitis was found. Ylostalo et al.[23] detected a weak exposure association of BMI with deepened periodontal pocket.

When evaluation was done for the prevalence of periodontal disease according to BMI in persons with obesity and nonobese, the prevalence of periodontal disease was significantly (P = 0.03) more in Group I (43.1%) than in Group II (5.3%) individuals (OR = 11.826 and 95% CI). Obese persons are at high risk (about 12 times) for periodontal disease.

  Conclusion Top

Thus, our study shows that persons with obesity and with higher BMI are at high risk for periodontal disease as compared to persons with normal weight. Relevant anthropometric index can serve as excellent indicators if used based on scientific validation.

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Conflicts of interest

There are no conflicts of interest.

  References Top

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Lahti-Koski M. Body Mass Index and Obesity among Adults in Finland 2001; 09 November. Available from: http://www.ethesis.helsinki.fi/julkaisut/laa/kansa/vk/lahti-koski/bodymass.pdf. [Last accessed on 2013 Dec 21].  Back to cited text no. 2
Al-Zaharani MS, Bissada NF, Borawskit EA. Obesity and periodontal disease in young, middle aged and older adults. J Periodontal 2003;74:610-5.  Back to cited text no. 3
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Altay U, Gürgan CA, Aǧbaht K. Changes in inflammatory and metabolic parameters after periodontal treatment in patients with and without obesity. J Periodontol 2013;84:13-23.  Back to cited text no. 10
Vaidya A, Shakya S, Krettek A. Obesity prevalence in Nepal: Public health challenges in a low-income nation during an alarming worldwide trend. Int J Environ Res Public Health 2010;7:2726-44.  Back to cited text no. 11
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BMI Classification World Health Organization. Global Database on Body Mass Index; 2004. Available from: http://www.apps.who.int/bmi/index.jsp?introPage=intro_3.html. [Last accessed on 2017 Jul 24].  Back to cited text no. 13
Cutress TW, Ainamo J, Sardo-Infirri J. The community periodontal index of treatment needs (CPITN) procedure for population groups and individuals. Int Dent J 1987;37:222-33.  Back to cited text no. 14
Gaurav AN. The association of periodontitis and metabolic syndrome. Dent Res J (Isfahan) 2014;11:1-10.  Back to cited text no. 15
Kim J, Amar S. Periodontal disease and systemic conditions: A bidirectional relationship. Odontology 2006;94:10-21.  Back to cited text no. 16
Yanai M, Kon A, Kumasaka K, Kawano K. Body mass index variations by age and sex, and prevalence of overweight in Japanese adults. Int J Obes Relat Metab Disord 1997;21:484-8.  Back to cited text no. 17
Mungreiphy NK, Kapoor S, Sinha R. Association between BMI, blood pressure, and age: Study among Tangkhul Naga Tribal Males of Northeast India. J Anthropol 2011;2011;1-6.  Back to cited text no. 18
Saito T, Shimazaki Y, Koga T, Tsuzuki M, Ohshima A. Relationship between upper body obesity and periodontitis. J Dent Res 2001;80:1631-6.  Back to cited text no. 19
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[PUBMED]  [Full text]  
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Kim EJ, Jin BH, Bae KH. Periodontitis and obesity: A study of the Fourth Korean National Health and Nutrition Examination Survey. J Periodontol 2011;82:533-42.  Back to cited text no. 22
Ylostalo P, Suominen-Taipale L, Reunanen A, Knuuttila M. Association between body weight and periodontal infection. J Clin Periodontol 2008;35:297-304.  Back to cited text no. 23


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