Table 1.
Human observational studies included in the systematic review.
| Sl no | Author/Year Country/Study Design |
Study Subjects | Age Range (Mean) Male/Female | Body Composition Criteria (BMI) | Definition of Periodontitis Used | Secondary Parameters (Tooth Loss, BOP) |
Sampling Method | Inclusion of Smokers/Diabetics | Main Observations |
|---|---|---|---|---|---|---|---|---|---|
| 1 | Dalla et al. 2005 [35] Brazil Cross-sectional study |
706 individuals (131 normal/ 134 overweight/ 64 obese |
30–65 years 329 males 377 females |
* Four BMI categories (WHO criteria) |
Individuals with ≥30% teeth with attachment loss ≥5 mm | Not mentioned | Multistage probability sampling method |
Smokers and Diabetes (self-reported) |
Higher risk of periodontitis among obese females than normal females (OR = 2.1). There is no significant association between overweight and periodontitis among females and the age group above 35 years—more pronounced association of BMI and periodontitis in non-smokers. |
| 2 | Sarlati et al. 2008 [43] Iran Case-control study |
80 young volunteers (40 normal/40 overweight/obese) | 18–34 years; obese individuals (29.1 + 4.7 years) and normal individuals (24 + 5 years) 10 males 70 females |
* Four BMI categories (WHO criteria) |
PPD and CAL | Not mentioned | Not mentioned | Smokers and Diabetes (self-reported) |
Positive correlations between BMI and PPD (R = 0.33) BMI and CAL (R = 0.39). Not adjusted for confounding. |
| 3 | Khader et al. 2009 [36] Jordan Cross-sectional study |
340 persons (13 underweight/108 normal/115 overweight/104 obese) |
18–70 years 168 males 172 females |
* Two BMI categories (WHO criteria) obese and overweight |
Four or more teeth with one or more sites with PPD ≥4 mm, CAL ≥ 3 mm. | Obese patients had a significantly higher average of GI. | Systematic random sampling | Smokers and Diabetes (self-reported) |
Higher risk of periodontitis in obese patients (OR = 2.9; CI 1.3, 6.1). Insignificant association between smoking and the prevalence of periodontal disease. |
| 4 | Amin 2010 [37] Egypt Cross-sectional study |
380 adults (92 normal/161 overweight/127 obese) |
20–26 years 170 males 210 females |
* 3 BMI categories (WHO criteria) normal weight, overweight, obese | CAL, GI, and CPI | Significant correlation between BMI and G.I. | Not mentioned | No | High correlation between CAL and BMI (r = 0.9, p < 0.01) in young females than in males. |
| 5 | Pataro et al. 2012 [42] Brazil Cross-sectional study |
594 females (352 normal/54 overweight/48 obesity level I/56 obesity level II/74 obesity level III) |
18–65 years; 39.7 ± 17.35 years 594 females |
Normal weight (BMI 20–24.99 kg/m2) overweight (BMI 25–29.99 kg/m2), ** obesity level I, obesity level II and obesity level III (WHO 1997) |
Proximal CAL ≥ 4 mmin two or more teeth, or proximal PD ≥ 5 mm in two or more teeth (Page et al. 2007) | BOP was more prevalent in the obese group III (34.8%, p < 0.001) | Convenience sampling | Both were included but unclear how it was evaluated. | Statistically significant differences in BOP, PPD, CAL ≥ 4 mm (p < 0.05) among obese and overweight women as compared to women with normal BMI. BMI > 30 kg/m2 interacted with diabetes (4.03), and smoking (15.79) (p < 0.03). The association was more evident as obesity increased. |
| 6 | Budduneli et al. 2014 [44] Turkey Case-control study |
91 females (31 normal and 60 obese) |
43.10 ± 10.87 years 91 females only |
Obesity is diagnosed based on the WHO criteria (not specified) | Not clearly defined. PPD, CAL, and dichotomous BOP (present or absent within 10 s after probing) recorded | Not mentioned | Not mentioned | Smokers (self-reported). Diabetes excluded. |
BMI did not correlate to clinical periodontal parameters in the obese group (but correlated with serum levels of inflammatory molecules (p < 0.05). Smokers (obese and non-obese) did not show significant differences in P.D., BOP, and PI (p > 0.05). Obese non-smokers had higher periodontitis CAL, BOP and PI (p < 0.05). PD was the same in obese and control groups of non-smokers. |
| 7 | Gaio et al. 2016 [45] Brazil Cohort study |
583 individuals (297 normal/177 overweight/108 obese) |
36.02 ± 14.97 years 333 males 249 females |
* Four BMI categories (WHO criteria) |
Proximal PAL ≥ 3 mm in ≥ 4 teeth over the 5 years of follow-up. | Not mentioned | Multistage probability sampling strategy |
Smokers (self-reported) Diabetes excluded. |
Higher risk of PAL in obese females than normal weight females (R.R. = 1.64, 95% CI = 1.11–2.43) and males. No statistically significant associations were observed between obesity and PAL progression for never or ever smokers. |
| 8 | Deshpande and Amrutiya 2017 [38] India Cross-sectional study |
100 patients with chronic generalized periodontitis/gingivitis (50 normal/50 obese) |
18–63 years Mean age 34.14 ± 11.70 (non-obese) and 34.02 ± 9.03 (obese) 63 males 37 females |
Obese (BMI > 30) Non-obese (BMI < 30) |
PPD and CAL | Not mentioned | Convenience sampling | Unclear | Higher prevalence of periodontitis in obese patients than in the control group (p < 0.05 for PPD, and p < 0.031 for CAL). |
| 9 | Nascimento et al. 2017 [47] Brazil Cohort study |
1076 individuals | 20–59 years 463 males 603 females |
Obese (BMI ≥ 25 Kg/m2) | Combination of CAL and BOP | Tooth loss was mentioned but not mentioned if due to periodontal disease | Not mentioned | Smokers and diabetes (self-reported) | A higher risk of attachment loss and BOP in obese patients presented (RR 1.45 for AL and BOP in different teeth; RR 1.84 for AL and BOP in the same tooth). |
| 10 | Santos et al. 2019 [40] Brazil Cross-sectional study |
236 individuals (156 normal/ 69 overweight 80 obese |
18–34; 35 and above 52 males 184 females |
* Two BMI categories (WHO criteria) overweight, obese. |
Based on CDC-AAP case classification | Not mentioned | Not mentioned | Smokers (self-reported) Diabetes excluded. |
Positive association between severe periodontitis and obesity (OR = 3.25, 95% CI = 1.27–8.31, p = 0.01) but not with overweight (p = 0.59). |
| 11 | Gulati et al. 2020 [39] India Cross-sectional study |
317 individuals (52 overweight/ 251 obesity I/ 9 obesity II 5 obesity III) |
25–70 years 203 males 114 females |
** Obese Class I, Class II, Class III | Four or more teeth with one site or more with PPD ≥ 4 mm and CAL ≥ 3 mm was present. | Not mentioned | Not mentioned | Unclear | Deeper PD was significantly associated with obesity determinants, especially among Class 2 and Class 3 obese individuals with chronic periodontitis. |
| 12 | Maulani et al. 2021 [41] Indonesia Cross-sectional study |
262 individuals (135 normal/ 127 overweight or obese) |
18–66 years 105 males 157 females |
* Four BMI categories (WHO criteria by the Asia-Pacific perspective) | CAL 5 mm and PD 6 mm were cut-off measurements between mild and severe periodontitis | Yes; not associated with increased BMI | Consecutive sampling | Yes, but unclear how it was recorded | Increased BMI showed a positive correlation with periodontitis of all severity. (aOR = 1.88, 95%CI 1.05-3.37; p < 0.05). Lower BMI is found in smokers than in non-smokers. |
| 13 | Carneiro et al. 2022 [34] Brazil Cross-sectional study |
345 individuals (133 normal/ 106 obese) |
49.08 years (±) 14.26 92 males 253 females |
* Six BMI categories (WHO criteria) low weight, normal weight, overweight, ** obese I, obese II, obese III |
CDC/AAP criteria | Not mentioned | Not mentioned | Smokers (self-reported) Unclear how diabetes was recorded. |
Females and younger participants showed a positive association between obesity and periodontitis. |
| 14 | Cetin et al. 2022 [48] Turkey Retrospective study |
142 with periodontitis (59 normal/62 overweight/21 obese) |
above 18; 57.24 ± 8.78 82 males 60 females |
* Three BMI categories (WHO criteria) normal weight, overweight, obese |
interdental CAL at the site of greatest loss (staging and grading) | number of remaining teeth | not mentioned | Smokers (self-reported) Diabetic status obtained from the ‘patient’s hospital records. |
CAL (p < 0.001), PPD (p < 0.05), PI (p < 0.05)), stage and grade of periodontitis (p < 0.05) were higher overweight and obese patients. BMI and smoking status showed no significant association (p = 0.142). Overweight and obese patients were at higher risk of developing stage III–IV periodontitis |
| 15 | Linden et al. 2007 [46] UK. Retrospective cohort study |
1362 males (336 normal/ 728 overweight/ 298 obese) |
60–70 years; 64 ± 2.9 1362 males |
Four BMI categories (WHO criteria) | High-threshold periodontitis was identified when ≥ 15% of all sites measured had a loss of attachment ≥6 mm, and there was at least one site with deep pocketing (≥6 mm). | Tooth loss mentioned | the multistage probability sampling method. | Smokers and Diabetes (self-reported) |
Strong association between BMI and high-threshold periodontitis for heavy smokers (OR 4.21, 95% CI% 2.04–8.72, p 0.0001) and light smokers (OR 3.22, 95% CI% 1.76–5.88, p 0.0001) among older men. High BMI levels in early life did not predict periodontitis in later life in the men studied. |
Clinical attachment loss (CAL); gingival index (GI); Community Periodontal Index (CPI); bleeding on probing (BOP); periodontal attachment loss (PAL); Centers for Disease Control and Prevention-American Academy of Periodontology (CDC-AAP), * BMI categories (WHO criteria)- underweight (BMI < 18.5 kg/m2), normal weight (18.5 to 24.9 kg/m2), overweight (25 to 29.9 kg/m2) and obese (≥30 kg/m2); ** obesity level I (BMI 30–34.99 kg/m2), obesity level II (BMI 35–39.99 kg/m2), obesity level III (BMI ≥ 40 kg/m2); odds ratio (OR); adjusted odds ratio (aOR).