The sex paradox in the interplay between periodontitis, obesity, and serum C-reactive protein: Data from a general population.

Abstract

Women are generally periodontally healthier than men but they exhibit higher systemic levels of inflammatory markers. Our aim is to evaluate whether this paradox may be explained by different ramifications of adiposity or body shape. In 3,268 subjects from the Study of Health in Pomerania, we determined anthropometric and periodontal parameters, C-reactive protein (CRP), and fibrinogen as markers of inflammation. Behavioural and environmental risk factors and hand grip strength were assessed as factors interfering with the outcomes in question. We evaluated sex-specific associations of adiposity characteristics and periodontal variables such as probing depth (PD) with CRP and fibrinogen. After adjusting for age, waist-to-hip ratio (WHR), glycated hemoglobin, smoking, education, and grip strength, the opposite sex role of periodontitis and obesity on CRP levels were confirmed. WHR and body mass index (BMI) were associated with CRP in both men and women (P<0.001). CRP was associated with PD in men (P=0.001) but not in women (P=0.11). When adjusted for BMI this association was attenuated in men by 15% (P=0.002) but in women by 70% (P=0.58). PD was related to plaque and bleeding on probing (P<0.001) in both sexes and also to WHR in women (P=0.026) and men (P=0.002). BMI attenuated this association in women but not in men. HbA1c contributed significantly to PD in women (P=0.013) but not in men (P=0.76). Systemic CRP concentrations are affected by periodontitis and obesity in men. In women adiposity is more significant than in men overriding the impact of periodontal measures.