Diet-borne systemic inflammation is associated with prevalent tooth loss

Georgios A. Kotsakis, Vanessa Chrepa, Nitin Shivappa, Michael Wirth, James Hébert, Ai Koyanagi, Stefanos Tyrovolas

Research output: Journal article publicationJournal articleAcademic researchpeer-review

31 Citations (Scopus)


Background & aims: The deleterious effect of cariogenic dietary patterns on tooth loss is well characterized, but the contribution of diet-borne systemic inflammation to loss of teeth remains uncharted. Recent efforts have unveiled a protective role of single nutrients to periodontal health. However, the assessment of overall diet as a modifiable risk factor for oral health remains elusive. Thus, the aim of this study was to assess the association between diet-borne systemic inflammation and tooth loss in a representative sample of the US adult non-institutionalized population. Methods: A cross-sectional analysis of a sample of participants of the 2009–2010 and 2011–2012 continuous NHANES receiving an oral exam and providing dietary recall data was performed. Dietary inflammatory potential was assessed by the Dietary Inflammatory Index (DII), a composite measure computed based on the association between nutrients and systemic pro-inflammatory cytokine levels. The outcome measure was prevalent tooth loss. Numbers of missing teeth were regressed across quartiles of the DII using multivariable linear regression models. Results: 6887 eligible NHANES participants were included in the analysis; participants in the highest quartile of the DII index (pro-inflammatory diet) had an average [95% CI] of 0.84 [0.24, 1.45] additional more teeth lost as compared to those in the lowest quartile of DII (anti-inflammatory diet) (p = 0.015), after adjusting for known confounders. This significant association remained in subgroup analyses, including the lowest tertiles of energy-adjusted carbohydrate intake, and in persons aged ≥50 years. Conclusions: Adherence to an anti-inflammatory diet is associated with fewer missing teeth. These results suggest protective dietary patterns as a modifiable protective factor for tooth loss in the US adult population and support the incorporation of tooth loss prevention in the agenda of dietary public health interventions to prevent chronic inflammatory diseases.

Original languageEnglish
Pages (from-to)1306-1312
Number of pages7
JournalClinical Nutrition
Issue number4
Publication statusPublished - Aug 2018
Externally publishedYes


  • Diet
  • Inflammation
  • Nutrition
  • Periodontal diseases
  • Tooth loss

ASJC Scopus subject areas

  • Nutrition and Dietetics
  • Critical Care and Intensive Care Medicine


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