Sex differences in the association between dual-energy x-ray absorptiometry-measured body composition and periodontitis

Peijun Zhu, An Li, Qingqing Cai, Yuntao Chen, Yang Liu, Harriët Jager-Wittenaar, Geerten-Has E Tjakkes, Shulan Xu

Research output: Contribution to journalArticlepeer-review


BACKGROUND: A positive association between obesity based on body mass index (BMI) and periodontitis has been reported. Fat tissue-related systemic inflammation acts as the link to periodontal comorbidities of obesity. However, the BMI is unable to distinguish fat and fat-free tissues. More precise measures are required to evaluate body composition, including fat and fat-free tissues. This study aimed to determine the sex differences in the association between dual-energy x-ray absorptiometry (DXA)-measured body composition (i.e., fat mass and muscle mass) and phenotypes with periodontitis.

METHODS: Cross-sectional data of 3892 participants from the National Health and Nutrition Examination Survey (NHANES) study 2011-2014 were analyzed. Adiposity indices (fat mass index [FMI] and percentage body fat [%BF]) and muscle mass index (MMI) were calculated. The participants were categorized by the quintiles of FMI, MMI, and %BF. Body composition phenotypes were categorized as: low adiposity-low muscle (LA-LM), low adiposity-high muscle (LA-HM), high adiposity-low muscle (HA-LM), or high adiposity-high muscle (HA-HM), respectively. Periodontitis was defined by the CDC/AAP (Centers for Disease Control and Prevention/American Academy of Periodontology) criteria. Multivariable logistic regression analysis was conducted, stratified by sex. We further adjusted for white blood cell (WBC) counts in the sensitivity analysis.

RESULTS: Restricted cubic splines revealed non-linear associations between body composition indices and periodontitis risk. Women with a higher FMI (odds ratio for Q5 vs. Q1 [ORQ5vs1 ] = 1.787, 95% confidence interval: 1.209-2.640) or %BF (ORQ5vs1 = 2.221, 1.509-3.268) had increased odds of periodontitis. In addition, women with HA-LM phenotype were more likely to develop periodontitis (OR = 1.528, 1.037-2.252). Interestingly, the WBC count, a systemic inflammatory biomarker, attenuated these associations. No statistically significant associations were found in men.

CONCLUSIONS: The association between DXA-measured body composition and phenotypes with periodontitis differs per sex. Only in women higher adiposity indices and HA-LM phenotype were associated with an increased risk of periodontitis.

Original languageEnglish
Pages (from-to)219-232
Number of pages14
JournalJournal of Periodontology
Issue number3
Early online date28 Jul 2023
Publication statusPublished - Mar 2024

Bibliographical note

© 2023 American Academy of Periodontology.


Dive into the research topics of 'Sex differences in the association between dual-energy x-ray absorptiometry-measured body composition and periodontitis'. Together they form a unique fingerprint.

Cite this