Periodontitis and prevalence of elevated aminotransferases in the Hispanic Community Health Study/Study of Latinos

Periodontal diseases, potential mediators and development of liver fat content: a community-based large cohort

Background

A high level of liver fat content (LFC) is a key indicator of steatotic liver disease (SLD), reflecting its pathological essence. Periodontal disease (PD) recognized as a chronic inflammatory condition and cause a widespread adverse health impact. This study aims to investigate the relationship between PD and LFC development.

Methods

In the UK Biobank, PD were gathered through a digital questionnaire, including gum pain, gum bleed, or teeth loose. LFC was measured by Fatty Liver Index (>60 indicates SLD) in cross-sectional analysis and by magnetic resonance imaging (quantified by Proton Density Fat Fraction, PDFF) in longitudinal analysis. Multivariable logistic and linear regression models were conducted to investigate the association of PD and LFC.

Results

In cross-sectional analysis, 164,150 (37.4%) individuals were diagnosed with SLD, and PD showed a significant association with SLD (odds ratio: 1.104, 95% CI: 1.075-1.132). In prospective analysis, a total of 39,656 participants with a median follow-up of 10.3 years were included. PD showed an arithmetic mean difference of 0.091 in PDFF (95% CI: 0.047-0.139), with males exhibiting a stronger association than females (P for interaction <0.05). Significant mediating effects were observed for body mass index (19.58%), C-reactive protein (11.61%), blood glucose (6.70%), and healthy diet score (5.99%) between PD and PDFF (P for all <0.001).

Conclusion

There was a pronounced correlation between PD and LFC, with males predominantly driving this link. This correlation may be partially mediated by body fat, inflammation, dietary habit, and insulin resistance.

Bioactive Zn-V-Si-Ca Glass Nanoparticle Hydrogel Microneedles with Antimicrobial and Antioxidant Properties for Bone Regeneration in Diabetic Periodontitis

Periodontitis is a chronic inflammatory condition affecting the periodontal tissue. This condition worsens in diabetic patients due to oxidative stress and inflammation. Herein, we investigated a treatment using bioactive Zn-V-Si-Ca glass nanoparticle hydrogel microneedles. The microneedles contain bioactive glass nanoparticles codoped with zinc and vanadium ions. They also include gallic acid and oxidized methacrylated hyaluronic acid. These microneedles address bacterial dysbiosis and oxidative stress in diabetic periodontitis. They provide antibacterial and antioxidant effects. The microneedles deliver therapeutic agents directly into the gingival tissue. This enhances drug retention and absorption by penetrating the mucosal barrier. In vitro studies demonstrated biocompatibility, excellent antioxidant properties, and acceptable mechanical properties. Meanwhile, the microneedle patches demonstrated antibacterial properties effective against a Gram-negative periodontal pathogen as well as a Gram-positive oral bacterium. In vivo experiments were performed using a diabetic rat model with periodontitis. Results showed significant improvement in alveolar bone regeneration. The hydrogel modulated the inflammatory microenvironment effectively. Ribonucleic acid sequencing revealed downregulation of JAK-STAT and NF-κB inflammation signaling pathways. This work presents a distinctive approach to suppressing the inflammatory response and modulate immune responses for the purpose of treating diabetic periodontitis early.

Non-alcoholic fatty liver disease and periodontal disease: A systematic review and meta-analysis of cross-sectional studies

Non-alcoholic fatty liver disease (NAFLD) is a chronic liver disease, comprising hepatic steatosis, and non-alcoholic steatohepatitis. Periodontal disease (PD) may be a risk factor for the evolution of liver cirrhosis. This study aimed to evaluate the association between NAFLD and PD.We searched in Pubmed, Scopus, Cochrane, and Lilacs databases with descriptors (Non-alcoholic Fatty Liver Disease OR (non-alcoholic AND Fatty Liver AND disease) OR Nonalcoholic Steatohepatitis) AND (Periodontal Disease OR Gingivitis OR Periodontitis) from January 2021 to September 2021. We selected, by the abstract, cross-sectional, cohort (prospective and retrospective), and case-control studies that address periodontal disease in patients with Non-alcoholic Fatty Liver Disease, and aged ≥ 18 years. The search was without the restriction of language and publication time.The search resulted in 954 articles. After applying the selection criteria, five cross-sectional studies remained. A metanalysis combined the study estimates of periodontal disease in NAFLD, by using the random effects. The Odds Ratio (1.91; 95% CI 1.21-3.02; P = 0.006) indicates that the chance of presenting Periodontal disease is 91% higher in individuals with NAFLD when compared with individuals without NAFLD. There are few studies with appropriate methodology to produce sound evidence about the causal relationship between the use of NAFLD and PD, however, studies support the association. So, dental staff must be aware of this association for better management of periodontal disease in patients with NAFLD.

Periodontal treatment and microbiome-targeted therapy in management of periodontitis-related nonalcoholic fatty liver disease with oral and gut dysbiosis

A growing body of evidence from multiple areas proposes that periodontal disease, accompanied by oral inflammation and pathological changes in the microbiome, induces gut dysbiosis and is involved in the pathogenesis of nonalcoholic fatty liver disease (NAFLD). A subgroup of NAFLD patients have a severely progressive form, namely nonalcoholic steatohepatitis (NASH), which is characterized by histological findings that include inflammatory cell infiltration and fibrosis. NASH has a high risk of further progression to cirrhosis and hepatocellular carcinoma. The oral microbiota may serve as an endogenous reservoir for gut microbiota, and transport of oral bacteria through the gastro-intestinal tract can set up a gut microbiome dysbiosis. Gut dysbiosis increases the production of potential hepatotoxins, including lipopolysaccharide, ethanol, and other volatile organic compounds such as acetone, phenol and cyclopentane. Moreover, gut dysbiosis increases intestinal permeability by disrupting tight junctions in the intestinal wall, leading to enhanced translocation of these hepatotoxins and enteric bacteria into the liver through the portal circulation. In particular, many animal studies support that oral administration of Porphyromonas gingivalis, a typical periodontopathic bacterium, induces disturbances in glycolipid metabolism and inflammation in the liver with gut dysbiosis. NAFLD, also known as the hepatic phenotype of metabolic syndrome, is strongly associated with metabolic complications, such as obesity and diabetes. Periodontal disease also has a bidirectional relationship with metabolic syndrome, and both diseases may induce oral and gut microbiome dysbiosis with insulin resistance and systemic chronic inflammation cooperatively. In this review, we will describe the link between periodontal disease and NAFLD with a focus on basic, epidemiological, and clinical studies, and discuss potential mechanisms linking the two diseases and possible therapeutic approaches focused on the microbiome. In conclusion, it is presumed that the pathogenesis of NAFLD involves a complex crosstalk between periodontal disease, gut microbiota, and metabolic syndrome. Thus, the conventional periodontal treatment and novel microbiome-targeted therapies that include probiotics, prebiotics and bacteriocins would hold great promise for preventing the onset and progression of NAFLD and subsequent complications in patients with periodontal disease.

The Triangle of Nonalcoholic Fatty Liver Disease, Metabolic Dysfunction, and Periodontitis: Analysis of the Dental, Oral, Medical and Epidemiological (DOME) Records-Based Nationwide Research

This study aimed to analyze the associations of nonalcoholic fatty liver disease (NAFLD) with dental parameters, while controlling for socio-demographics, health-related habits, and each of the metabolic syndrome (MetS) components, consequences, and related conditions among a nationally representative sample of young and middle-aged adults. To that end, we analyzed data from the dental, oral, medical epidemiological (DOME) cross-sectional records-based study that combined comprehensive socio-demographic, medical, and dental databases of a nationally representative sample of military personnel. Included were 132,529 subjects aged 18-50 who attended military dental clinics for one year. The prevalence of NAFLD in the study population was 0.7% (938/132,529). The following parameters maintained a statistically positive association with NAFLD in the multivariate analysis (from highest to lowest OR): male sex (OR = 3.91 (2.29-6.66)), hyperlipidemia (OR = 3.69 (2.75-4.95)), diabetes Type 2 (OR = 3.14 (2.21-4.46)), hypertension (OR = 1.67 (1.30-2.14)), periodontitis (OR = 1.42 (1.06-1.89)), body mass index (BMI) (OR = 1.15 (1.13-1.18)), and age (OR = 1.08 (1.06-1.09)). The multivariate analysis established a profile of the "patient vulnerable to NAFLD", including older age, male sex, and other MetS components, including diabetes type 2, hypertension, hyperlipidemia, BMI, and periodontitis. This profile aligns with the current new definition of metabolic dysfunction-associated fatty liver disease (MAFLD). We also analyzed the associations of the sum of the standard dental unit (SDU) scores of planned (SDU-P) and delivered (SDU-D) dental procedures per patient with NAFLD using receiver operating characteristic (ROC) analysis. The SDU-P (planned) score exhibited excellent discrimination for NAFLD (area under the curve (AUC) = 0.718 (0.703-0.734)). Overall, the results confirmed the hypothesis of this research, i.e., that NAFLD is associated with dental morbidity, particularly with periodontitis.

Periodontal disease could be a potential risk factor for non-alcoholic fatty liver disease: An 11-year retrospective follow-up study

OBJECTIVE

This study aimed to evaluate the association of periodontal disease with non-alcoholic fatty liver disease (NAFLD).

MATERIALS AND METHODS

A retrospective follow-up study using the National Health Insurance Service-National Sample Cohort was performed from 2002 to 2015 in the Korean population. A total of 165,032 subjects were followed up for incident NAFLD during 11 years. Periodontal disease and NAFLD were defined by a diagnosis using the International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD-10) codes. Periodontal status was used as the severity of periodontal status and the number of dental visit due to PD.

RESULTS

Periodontitis was associated with a 4% increase in risk for NAFLD after adjusting for socio-demographic factor, health behaviors, and systemic diseases (adjusted hazard ratio [aHR] = 1.04, 95% CI = 1.01 to 1.07). Between the number of dental visit due to PD and the risk for NAFLD was observed a dose-effect association (aHR = 1.02, 95% CI = 0.99 to 1.05 for once; aHR = 1.10, 95% CI = 1.06 to 1.15 for two times; aHR = 1.14, 95% CI = 1.06 to 1.24 for three times).

CONCLUSIONS

Our data confirmed that periodontitis showed an association with a higher incidence of NAFLD.

CLINICAL RELEVANCE

Prevention and management of periodontal disease could be beneficial for reducing the risk of NAFLD.

Association of hepatic and systemic inflammation with localized stage II/III periodontitis in young males: The CHIEF oral health study

AIM

To clarify the association between systemic and hepatic inflammation and localized periodontitis which has been reported to vary among races.

MATERIALS AND METHODS

The study included 1112 military males, aged 18-40 years, in Taiwan. Participants were classified as periodontally healthy/stage I (n = 796) or stage II/III periodontitis (n = 316), according to the 2017 world workshop criteria. Systemic and hepatic inflammation were defined by the highest tertiles of blood leukocyte counts (7.51 × 103 /μl) and alanine aminotransferase (30 U/L), respectively. Multiple logistic regression analysis with adjustments for age, metabolic syndrome, betel nut consumption and smoking was carried out.

RESULTS

There was a significant association between high systemic inflammation, irrespective of hepatic inflammation severity, and localized stage II/III periodontitis (odds ratio [OR], 1.62 [1.09-2.42] and 1.47 [1.00-2.15], respectively, in the presence of high or no hepatic inflammation. However, no significant association was found among participants with low systemic inflammation, irrespective of the severity of hepatic inflammation (OR, 1.31 [0.91-1.91]).

CONCLUSIONS

An association between hepatic inflammation and localized periodontitis in Taiwanese was observed only if systemic inflammation coexisted, possibly accounting for the reported differences in the association between Japanese and non-Asian populations in prior studies.

Increasing risk factors of non-alcoholic fatty liver disease, a look into chronic periodontitis and insulin resistance

Non-alcoholic fatty liver disease (NAFLD) is marked by the excessive intrusion of triglycerides into hepatocytes without any role of alcohol consumption. Various risk factors have been attributed to this disease pathogenesis which involves metabolic disorders, immune response, and even an intricate relationship between the two. The role of insulin resistance (IR) in NAFLD has long been known; however, the molecular basis of disease progression under this metabolic backdrop is still being investigated. Similarly, the periodontitis-mediated immune response is another major factor involved in NAFLD manifestation which has generated huge interest. The prevalence of pathogenic bacteria elicits a strong immune response which according to studies shows a strong correlation with NAFLD state. Such pre-existing conditions have a strong probability of explaining the disease onset. Additionally, increasing reports of inflammatory response and its links to insulin resistance have further increased the scope of understanding NAFLD. Through this review, we aim to elaborate on these factors explaining their role in the disease progression.

A Qualitative Analysis of Mexican-Origin Men's Knowledge and Cultural Attitudes Toward Non-Alcoholic Fatty Liver Disease and Interest in Risk Reduction

Mexican-origin men are at increased risk of developing non-alcoholic fatty liver disease (NAFLD). The purpose of this qualitative research was to assess Mexican-origin men’s knowledge and cultural attitudes toward NAFLD and their interest in risk reduction. Semi-structured interviews were conducted with 11 Spanish-speaking Mexican-origin men who were considered high-risk of having NAFLD according to transient elastography (FibroScan®) continuous attenuation parameter (CAP) scores (≥280). Audio recordings of these interviews were transcribed and interpreted in their respective language to facilitate data analysis using NVivo 12. A thematic codebook was developed, from which the research team identified emerging themes. Findings demonstrated limited knowledge about NAFLD and in general chronic liver disease among Mexican-origin men. Cultural attitudes appeared to both enhance and mitigate their perceived risk for NAFLD. Interviews also revealed high interest levels for reducing NAFLD risk, with family and loved ones acting as the main motivators for engagement in healthier behaviors. Inclination toward family-based interventions was reported as a subject of interest for this high-risk population. This qualitative study suggests that the development of a NAFLD-specific intervention approach for Mexican-origin men may be feasible and should consider a familial and cultural context centered in improving lifestyle health behaviors.

Periodontal disease-related nonalcoholic fatty liver disease and nonalcoholic steatohepatitis: An emerging concept of oral-liver axis

Periodontal disease, a chronic inflammatory disease of the periodontal tissues, is not only a major cause of tooth loss, but it is also known to exacerbate/be associated with various metabolic disorders, such as obesity, diabetes, dyslipidemia, and cardiovascular disease. Recently, growing evidence has suggested that periodontal disease has adverse effects on the pathophysiology of liver disease. In particular, nonalcoholic fatty liver disease, a hepatic manifestation of metabolic syndrome, has been associated with periodontal disease. Nonalcoholic fatty liver disease is characterized by hepatic fat deposition in the absence of a habitual drinking history, viral infections, or autoimmune diseases. A subset of nonalcoholic fatty liver diseases can develop into more severe and progressive forms, namely nonalcoholic steatohepatitis. The latter can lead to cirrhosis and hepatocellular carcinoma, which are end‐stage liver diseases. Extensive research has provided plausible mechanisms to explain how periodontal disease can negatively affect nonalcoholic fatty liver disease and nonalcoholic steatohepatitis, namely via hematogenous or enteral routes. During periodontitis, the liver is under constant exposure to various pathogenic factors that diffuse systemically from the oral cavity, such as bacteria and their by‐products, inflammatory cytokines, and reactive oxygen species, and these can be involved in disease promotion of nonalcoholic fatty liver disease and nonalcoholic steatohepatitis. Also, gut microbiome dysbiosis induced by enteral translocation of periodontopathic bacteria may impair gut wall barrier function and promote the transfer of hepatotoxins and enterobacteria to the liver through the enterohepatic circulation. Moreover, in a population with metabolic syndrome, the interaction between periodontitis and systemic conditions related to insulin resistance further strengthens the association with nonalcoholic fatty liver disease. However, most of the pathologic links between periodontitis and nonalcoholic fatty liver disease in humans are provided by epidemiologic observational studies, with the causal relationship not yet being established. Several systematic and meta‐analysis studies also show conflicting results. In addition, the effect of periodontal treatment on nonalcoholic fatty liver disease has hardly been studied. Despite these limitations, the global burden of periodontal disease combined with the recent nonalcoholic fatty liver disease epidemic has important clinical and public health implications. Emerging evidence suggests an association between periodontal disease and liver diseases, and thus we propose the term periodontal disease–related nonalcoholic fatty liver disease or periodontal disease–related nonalcoholic steatohepatitis. Continued efforts in this area will pave the way for new diagnostic and therapeutic approaches based on a periodontologic viewpoint to address this life‐threatening liver disease.

Periodontal Disease and Incident CKD in US Hispanics/Latinos: The Hispanic Community Health Study/Study of Latinos

Rationale & Objective

Recent studies suggest that periodontal disease may be associated with incident chronic kidney disease (CKD). However, studies have focused on older populations, and US Hispanics/Latinos were not well represented.

Study Design

Observational cohort.

Setting & Participants

We analyzed data from the Hispanic Community Health Study/Study of Latinos who completed a baseline visit with a periodontal examination and a follow-up visit, and did not have CKD at baseline.

Predictors

Predictors included ≥30% of sites with clinical attachment loss ≥3 mm, ≥30% of sites with probing depth ≥4 mm, percentage of sites with bleeding on probing, and absence of functional dentition (<21 permanent teeth present).

Outcomes

Outcomes were incident low estimated glomerular filtration rate (eGFR) (eGFR <60 mL/min/1.73 m² and decline in eGFR ≥1 mL/min/year); incident albuminuria (urine albumin:creatinine ratio [ACR] ≥30 mg/g); and change in eGFR and ACR.

Analytic Approach

Poisson and linear regression.

Results

For the sample (n = 7.732), baseline mean age was 41.5 years, 45.2% were male, 11.7% had ≥30% of sites with clinical attachment loss ≥3 mm, 5.1% had ≥30% of sites with probing depth ≥4 mm, 30.7% had ≥50% of sites with bleeding on probing, and 16.2% had absent functional dentition. During a median follow-up of 5.9 years, 149 patients developed low eGFR and 415 patients developed albuminuria. On multivariable analysis, presence versus absence of ≥30% of sites with probing depth ≥4 mm and absence of functional dentition were each associated with increased risk for incident low eGFR (incident density ratio, 2.31; 95% CI, 1.14-4.65 and 1.65, 95% CI, 1.01-2.70, respectively). None of the other predictors were associated with outcomes.

Limitations

Only a single kidney function follow-up measure.

Conclusions

In this cohort of US Hispanics/Latinos, we found that select measures of periodontal disease were associated with incident low eGFR. Future work is needed to assess whether the treatment of periodontal disease may prevent CKD.

Relationship between NAFLD and Periodontal Disease from the View of Clinical and Basic Research, and Immunological Response

Periodontal disease is an inflammatory disease caused by pathogenic oral microorganisms that leads to the destruction of alveolar bone and connective tissues around the teeth. Although many studies have shown that periodontal disease is a risk factor for systemic diseases, such as type 2 diabetes and cardiovascular diseases, the relationship between nonalcoholic fatty liver disease (NAFLD) and periodontal disease has not yet been clarified. Thus, the purpose of this review was to reveal the relationship between NAFLD and periodontal disease based on epidemiological studies, basic research, and immunology. Many cross-sectional and prospective epidemiological studies have indicated that periodontal disease is a risk factor for NAFLD. An in vivo animal model revealed that infection with periodontopathic bacteria accelerates the progression of NAFLD accompanied by enhanced steatosis. Moreover, the detection of periodontopathic bacteria in the liver may demonstrate that the bacteria have a direct impact on NAFLD. Furthermore, Porphyromonas gingivalis lipopolysaccharide induces inflammation and accumulation of intracellular lipids in hepatocytes. Th17 may be a key molecule for explaining the relationship between periodontal disease and NAFLD. In this review, we attempted to establish that oral health is essential for systemic health, especially in patients with NAFLD.

Periodontitis Prevalence, Severity, and Risk Factors: A Comparison of the AAP/CDC Case Definition and the EFP/AAP Classification

BACKGROUND

This cross-sectional study evaluated the utility of the 2018 European Federation of Periodontology/American Academy of Periodontology (EFP/AAP) classifications of epidemiological studies in terms of periodontitis severity, prevalence and associated risk factors and the 2012 American Academy of Periodontology/Centers for Disease Control and Prevention (AAP/CDC) case definitions.

METHODS

We included 488 participants aged 35-74 years. Measurements were recorded at six sites per tooth by two qualified examiners. The evaluated parameters included pocket depth (PD), clinical attachment loss (CAL) and bleeding on probing (BOP). Periodontitis prevalence and severity were reported using the 2018 EFP/AAP classification and the AAP/CDC case definitions. The data were stratified by recognized risk factors (age, diabetes and smoking status).

RESULTS

The 2018 EFP/AAP classification indicated that all patients suffered from periodontitis. When CAL served as the main criterion, the frequency of patients with severe (Stages III-IV) periodontitis was 54%. When the AAP/CDC case definitions were applied, the prevalence of periodontitis was 61.9% and that of severe periodontitis 16.8%. Age was the most significant risk factor, regardless of the chosen case definition.

CONCLUSION

It is essential to employ a globalized standard case definition when monitoring periodontitis and associated risk factors.

The prevalence and severity of periodontal disease in Mainland China: Data from the Fourth National Oral Health Survey (2015-2016)

AIM

To evaluate periodontal conditions in adults in mainland China based on data from the 4th National Oral Health Survey.

MATERIALS AND METHODS

Data of adult subjects (35- to 44-year-old group [N = 4409], 55- to 64-year-old group [N = 4622], and 65- to 74-year-old group [N = 4428]) were analysed. Demographic, socio-economic, personal habit, dental history, and health attitude data were obtained using a questionnaire. Periodontal condition was assessed using the standardized case definitions of the 2018 classification scheme. A multivariate analysis was performed to investigate the relationship between periodontitis severity and age, smoking status, gender, and region using generalized additive models after adjusting for confounders.

RESULTS

The frequency of subjects with periodontitis was 52.8%, 69.3%, and 64.6% in the three age groups, respectively. The frequency of subjects with severe periodontitis (stage III or IV) was 10.6%, 37.3%, and 43.5% in the three age groups, respectively. The severity of periodontal disease was positively associated with age. Current and former smokers exhibited significantly greater disease severity than non-smokers after adjustment for confounders. No significant difference of severity was found between males and females.

CONCLUSION

Within the limitations of the study, the prevalence of periodontitis is very high among adults in mainland China. Periodontal status is associated with age and smoking status.

Association between periodontal disease, tooth loss and liver diseases risk

AIM

The purpose of this study is to assess the associations between periodontal disease, tooth loss and liver diseases.

MATERIALS AND METHODS

PubMed and Embase databases were utilized to search eligible studies. Odds ratio (OR) with 95% confidence interval (CI) was used as effect size to assess the associations between periodontal disease, tooth loss and liver diseases risk.

RESULTS

Our results indicated positive associations between periodontal disease and non-alcoholic fatty liver disease (NAFLD) (OR = 1.19, 95% CI = 1.06-1.33), liver cirrhosis (OR = 2.28, 95% CI = 1.50-3.48) and elevated transaminase level risk (OR = 1.08, 95% CI = 1.02-1.15). Moreover, tooth loss could increase NAFLD (OR = 1.33, 95% CI = 1.12- 1.56) and liver cancer risk (OR = 1.34, 95% CI = 1.04-1.74), and every five increment in tooth loss was associated with 5% increased liver cancer risk (OR = 1.05, 95% CI = 1.01 - 1.10) with a linear relationship. In addition, tooth loss had a positive tendency towards liver cirrhosis risk (OR = 2.03, 95% CI = 0.85-4.85) although there was no statistical significance.

CONCLUSION

Periodontal disease and tooth loss are positively associated with liver diseases including NAFLD, elevated transaminase level, liver cirrhosis and liver cancer.

Association between periodontal status and non-alcoholic fatty liver disease in a Korean adult population: A nationwide cross-sectional study

BACKGROUND

The objective of this study was to investigate the association between periodontal status and non-alcoholic fatty liver disease (NAFLD) indicators in a representative Korean population.

METHODS

A cross-sectional study was conducted on 4061 participants >19 years of age using the 2010 Korea National Health and Nutrition Examination Survey data. Periodontal status was assessed by trained dentists using the community periodontal index. To identify the presence of NAFLD, biochemical data were defined using two validated indicators: the fatty liver index (FLI) and the hepatic steatosis index (HSI). The associations of the presence of periodontal pockets with FLI and HSI were evaluated by multivariable logistic regression analysis after adjusting for age, income, education level, smoking status, alcohol consumption, physical activity, diabetes mellitus, obesity, hypertension, and hypercholesterolemia.

RESULTS

The adjusted means in the FLI indicator increased in the presence of periodontal pockets, whereas there was no significant difference in the HSI (P = 0.005 for FLI; P = 0.142 for HSI). Periodontal pockets were consistently associated with the two NAFLD indicators in the sequential logistic models for women throughout the adjustment process. (OR = 1.77, 95% CI = 1.05 to 2.98 for FLI, OR = 1.64, 95% CI = 1.08 to 2.51 for HSI).

CONCLUSIONS

Our findings showed that the presence of periodontal pockets may be independently associated with NAFLD indicators. Further study will be clarified by well-designed longitudinal studies.