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  The Liver Meeting
Digital Experience
November 13 - 16 - 2020
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Periodontitis is associated with chronic liver
disease in a population-based cohort of US adults

  Gum Infection Tied to Worse Liver Fibrosis in Nationwide US Cohort
AASLD The Liver Meeting Digital Experience, November 13-16, 2020
Mark Mascolini
Periodontal disease (gum infection), especially severe periodontal disease, independently boosted odds of a high fibrosis score, a marker of chronic liver disease, in an 11,909-person US analysis [1]. Because good oral hygiene can prevent or delay periodontitis, the findings may mean gum disease could be a modifiable risk factor for liver disease.
University of North Carolina (UNC) researchers who conducted this study reminded colleagues that chronic liver disease prevalence and resulting death continue to climb across the United States. Periodontal inflammation and gum destruction already raise chances of heart disease and diabetes [2]. The UNC team wondered whether periodontal disease also affects risk of liver fibrosis and thus chronic liver disease.
The researchers focused on 2009-2014 participants in the National Health and Nutrition Examination Survey (NHANES). Analyzing NHANES dental records, the investigators selected adults at least 30 years old who had periodontal exams. Using standard definitions, they grouped participants into those with no, mild/moderate, or severe periodontitis They used a noninvasive method, the FIB-4 score, to rank participants by fibrosis status: low (below 1.30), intermediate (1.30 to 2.67), or high (above 2.67) likelihood of significant fibrosis. The UNC team assessed the impact of periodontitis on chances of severe fibrosis in a logistic regression model that adjusted for age, sex, race/ethnicity, body mass index, income above versus below 130% of the poverty level, smoking status, unhealthy alcohol use, and diabetes.
The analysis focused on 11,909 people participating in NHANES in 2009-2014, including 2521 with no periodontitis, 8189 with mild/moderate periodontitis, and 1199 with severe periodontitis. Compared with people who had no periodontal disease, those with mild/moderate periodontitis, and severe periodontitis, proved more likely to be older, male (37%, 51%, 72%), non-Hispanic black (7%, 11%, 20%), below 130% of the poverty level (14%, 25%, 38%), a current smoker (11%, 18%, 38%), and a person with metabolic syndrome (44%, 51%, 60%).
Significant fibrosis (FIB-4 above 2.67) affected 1% with no periodontitis, 4% with mild/moderate periodontitis, and 6% with severe periodontitis. Adjusted logistic regression analysis determined that mild/moderate periodontal disease versus no periodontal disease almost doubled the odds of a FIB-4 score above 2.67 versus below 1.30 (adjusted odds ratio [aOR] 1.7, 95% confidence interval [CI] 1.1 to 2.8), while severe periodontitis almost tripled the odds (aOR 2.8, 95% CI 1.5 to 5.3).
The UNC researchers believe their findings suggest that periodontitis "could be a modifiable risk factor for chronic liver disease" and that "monitoring of periodontal health may provide a tool for risk stratifying patients at high risk of liver disease progression." They suggested that regular periodontal exams and therapy could help avert development of significant fibrosis or worsening fibrosis in people who already have chronic liver disease.
1. Moon A, Galanko JA, Barrit SA IV, et al. Periodontitis is associated with chronic liver disease in a population-based cohort of US adults. AASLD The Liver Meeting Digital Experience, November 13-16, 2020. Abstract 180.
2. National Health Service UK (NHS). The health risks of gum disease. https://www.nhs.uk/live-well/healthy-body/health-risks-of-gum-disease/