Association between obesity and periodontitis in Australian adults: A single mediation analysis

BACKGROUND Obesity and periodontitis are conditions with high burden and cost. This study aimed to unfold "the proposed pathways through which the effect of obesity in the presence of health behaviours (dental visiting behaviour and diabetes) increases the risk of periodontitis?" METHODS The effect decomposition analysis using potential outcome approach was used to determine obesity related periodontits risk using the Australian National Survey of Adult Oral Health 2004-06. A single mediation analysis for exposure "physical-inactivity induced obesity, mediator "dental visiting behaviour (a de facto measure of healthy behaviours)", outcome "periodontitis", and confounders "age, sex, household income, level of education, self-reported diabetes, alcohol-intake and smoking" was constructed for subset of 3715 participants, ≥30years. Proposed pathways were set independently for each risk factor and in synergy. The STATA 15 Paramed library was used for analysis. Sensitivity analysis was conducted to detect unmeasured confounding using nonparametric approach. RESULTS The average treatment effect of physical inactivity induced obesity to periodontitis is 14%. Pathway effect analysis using potential outcomes illustrated that the effect of obesity on periodontitis that was not mediated through poor dental visiting behaviour was 13%. Indirect effect of obesity-mediated through poor dental visiting behaviour on periodontitis was 3%. CONCLUSION The direct effect of physical inactivity induced obesity on periodontitis was higher than the indirect effect of obesity on periodontitis through dental visiting behaviour. CLINICAL IMPLICATIONS Establishing a pathway of causal relationship for obesity and periodontitis could help in developing management strategies that focuses on mediators. This article is protected by copyright. All rights reserved.