Alcohol consumption, periodontal disease and plasma homocysteine levels
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BACKGROUND: In the US 47.2% of adults have periodontitis. Alcohol affects the host response, impairs immune function, has toxic effects on the liver and affects with protein metabolism, and therefore may increase the risk of periodontitis. Alcohol may also interfere with homocysteine (Hcy) metabolism and result in hyperhomocysteinemia (HHcy), a risk factor for inflammatory diseases such as cardiovascular disease and possibly periodontal disease. Understanding the exact relationship between alcohol consumption, HHcy and periodontitis is incomplete. OBJECTIVES: To add to our understanding of the alcohol-periodontitis, periodontitis-Hcy and alcohol-Hcy associations longitudinally by addressing methodological issues that confound past research. Methods: The study used existing data from 562 male participants in the VA Dental Longitudinal Study (DLS) who answered food frequency questionnaires (FFQ), underwent periodontal examinations and had plasma . Hcy measurements (N=469). Periodontitis was defined using the CDC case definition (Eke et al., 2009) and categorized into none/mild/moderate or severe disease. HHcy was defined as Hcy ≥10.2 umol/L based on Spence et al., 2001. Alcohol intake was categorized as none, ≤ 1 drink/day, >1 but <2 drinks/day, or ≥ 2 drinks/day. RESULTS: In longitudinal analyses, the risk of developing severe periodontitis among alcohol consumers was 10-17% higher over a period of 19-years compared to non-drinkers after controlling for age, smoking, diabetes, education, and number of teeth present. These estimates were higher still among men with lower than average vitamin B6 or B12 intakes. However, these results were not statistically significant The analyses suggested that men with mild, moderate or severe periodontitis had greater hazards of developing HHcy compared to disease-free participants after adjusting for covariates, but these results were not statistically significant. Consuming more than 2 drinks of alcohol per day significantly increased the risk of developing HHcy by 76% (p= 0.037). SUMMARY: Our findings suggest that alcohol consumption may increase the hazards of developing severe periodontal disease especially if vitamin B complex intakes are low. These results also suggest that periodontal disease and alcohol consumption each increases the hazards of hyperhomocysteinemia. We believe this is the first prospective cohort study to examine associations among periodontitis, homocysteine and alcohol consumption.