Periodontitis, Edentulism, and Risk of Metabolic Syndrome, Obesity, and Dyslipidemia: A Systematic Review With Meta-Analyses

Abstract

Aim: This systematic review (SR) aimed to investigate the risk of metabolic syndrome (MetS) and its single components in individuals with and without periodontitis/edentulism. Methods: The protocol was registered in the PROSPERO database (CRD420261301248). The focused PECOS question was: “Is the risk of metabolic syndrome and its single components (obesity and dyslipidemia) increased among individuals with periodontitis/edentulism compared to those without periodontitis/edentulism?” Results were reported according to the PRISMA statement. Electronic and manual searches were conducted to identify longitudinal studies. Effect estimates expressed as RRs for MetS, obesity, and dyslipidemia were the outcomes of interest. Random-effects meta-analyses were conducted. Results: Ten longitudinal studies were included (584 590 participants), of which four were rated as having a low risk of bias. Follow-up ranged from 1 to 18 years. Newly diagnosed MetS ranged from 10.5% to 23%, obesity from 1.2% to 7.1%, and dyslipidemia from 6.7% to 14.3%. The risk of developing ≥ 1 MetS component was higher in individuals with periodontitis (RR: 1.18 [95% CI 1.04–1.35], p = 0.01; I2 = 28%) than in those without periodontitis, whereas the risk of a new MetS diagnosis, defined as ≥ 3 components (RR: 1.17 [95% CI 0.97–1.42], p = 0.10; I2 = 46%), did not differ between groups. The RR for severe periodontitis compared with no periodontitis was 1.34 [95% CI 1.10–1.64], p = 0.004; I2 = 0%. The risk ratio for obesity was statistically significant (RR: 1.30 [95% CI 1.05–1.62], p = 0.02; I2 = 73%), but subgroup analyses did not confirm this significance. The risk ratio for dyslipidemia was not significant (RR: 1.08 [95% CI 0.94–1.24], p = 0.29; I2 = 16%). Meta-Analyses for edentulism were not considered appropriate. Conclusion: Within the limits of this SR, periodontitis was associated with the development of ≥ 1 MetS component, but the association was not significant for a new MetS diagnosis defined as ≥ 3 components. The association may be stronger for severe periodontitis. The impact of edentulism remains unclear. Further prospective longitudinal studies using homogeneous definitions of periodontitis, reporting data on dental care exposure, and including ≥ 10 years of follow-up are strongly encouraged to further investigate these associations.