Risk Factors of Periodontitis: Evidence From Two-Sample Mendelian Randomization and Meta-Analysis

Mendelian randomization is a more appropriate tool for causal inference, as the main suspected risk factors for periodontitis are difficult to test by randomized controlled trials due to ethical or feasibility issues. This study aimed to evaluate potential causal relationships between 50 known and suspected factors and periodontitis risk by a two-sample Mendelian randomization study and meta-analysis.

By utilizing the databases of the Gene-Lifestyle Interactions at Dental Endpoints (GLIDE) consortium and the Finnish Genetics (FinnGen) consortium, 25 obesity-related indicators (BMI, birth weight, weight, height, waist-hip ratio, waist circumference, hip circumference, 18 body fat percentage or fat-free mass factors), eight hormone-related indicators (estradiol levels, total testosterone levels, sex hormone-binding globulin, age at menarche, age at menopause, three bone mineral density factors), five lifestyle factors (smoking, alcohol drinking, sleep duration, morning/evening chronotype, years of schooling), three dietary factors (coffee, tea, fruit), six blood biomarkers (fasting glucose, high-density lipoprotein cholesterol [HDL cholesterol], low-density lipoprotein cholesterol [LDL cholesterol], total cholesterol, serum 25-hydroxyvitamin D levels, hemoglobin A1c [HbA1c]), and three diseases (hypertension, type 2 diabetes, COVID-19). The odds ratios (ORs) and 95% confidence intervals (CIs) associated with the risk of periodontitis were estimated for each trait using the inverse variance weighting (IVW) method. A meta-analysis was conducted to analyze the causal associations from these databases.

Among the 50 potential risk factors, the IVW analyses revealed significant associations with the risk of periodontitis for 22 and two traits (FDR-corrected p < 0.05) in the GLIDE database as well as the FinnGen database, respectively. The meta-analyses revealed that 23 traits maintained statistically significant associations with periodontitis risk. Noteworthy associations included 20 obesity-related indicators with ORs ranging from 1.11 to 1.25, smoking (OR = 1.74), and hemoglobin A1c (OR = 1.07), which were associated with an increased risk of periodontitis. Conversely, increased years of education (OR = 0.81) were identified as potential mitigators of periodontitis risk. The sensitivity analyses utilizing five additional methods further bolstered the robustness of these findings.

This comprehensive study provides evidence for the potential causal association of several modifiable risk factors with periodontitis, highlighting the importance of addressing these factors in preventive strategies for periodontal health.