{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T13:24:38Z","timestamp":1788009878845,"version":"build-2784847793"},"reference-count":43,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2023,8,28]],"date-time":"2023-08-28T00:00:00Z","timestamp":1693180800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["aap.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Periodontology"],"published-print":{"date-parts":[[2024,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>A positive association between obesity based on body mass index (BMI) and periodontitis has been reported. Fat tissue\u2010related systemic inflammation acts as the link to periodontal comorbidities of obesity. However, the BMI is unable to distinguish fat and fat\u2010free tissues. More precise measures are required to evaluate body composition, including fat and fat\u2010free tissues. This study aimed to determine the sex differences in the association between dual\u2010energy x\u2010ray absorptiometry (DXA)\u2010measured body composition (i.e., fat mass and muscle mass) and phenotypes with periodontitis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Cross\u2010sectional data of 3892 participants from the National Health and Nutrition Examination Survey (NHANES) study 2011\u20122014 were analyzed. Adiposity indices (fat mass index [FMI] and percentage body fat [%BF]) and muscle mass index (MMI) were calculated. The participants were categorized by the quintiles of FMI, MMI, and %BF. Body composition phenotypes were categorized as: low adiposity\u2010low muscle (LA\u2010LM), low adiposity\u2010high muscle (LA\u2010HM), high adiposity\u2010low muscle (HA\u2010LM), or high adiposity\u2010high muscle (HA\u2010HM), respectively. Periodontitis was defined by the CDC\/AAP (Centers for Disease Control and Prevention\/American Academy of Periodontology) criteria. Multivariable logistic regression analysis was conducted, stratified by sex. We further adjusted for white blood cell (WBC) counts in the sensitivity analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Restricted cubic splines revealed non\u2010linear associations between body composition indices and periodontitis risk. Women with a higher FMI (odds ratio for Q5 vs. Q1 [OR<jats:sub>Q5vs1<\/jats:sub>]\u00a0=\u00a01.787, 95% confidence interval: 1.209\u20132.640) or %BF (OR<jats:sub>Q5vs1<\/jats:sub>\u00a0=\u00a02.221, 1.509\u20133.268) had increased odds of periodontitis. In addition, women with HA\u2010LM phenotype were more likely to develop periodontitis (OR\u00a0=\u00a01.528, 1.037\u20132.252). Interestingly, the WBC count, a systemic inflammatory biomarker, attenuated these associations. No statistically significant associations were found in men.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The association between DXA\u2010measured body composition and phenotypes with periodontitis differs per sex. Only in women higher adiposity indices and HA\u2010LM phenotype were associated with an increased risk of periodontitis.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jper.23-0162","type":"journal-article","created":{"date-parts":[[2023,7,28]],"date-time":"2023-07-28T11:11:29Z","timestamp":1690542689000},"page":"219-232","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Sex differences in the association between dual\u2010energy x\u2010ray absorptiometry\u2010measured body composition and periodontitis"],"prefix":"10.1002","volume":"95","author":[{"given":"Peijun","family":"Zhu","sequence":"first","affiliation":[{"name":"Center of Oral Implantology Stomatological Hospital School of Stomatology Southern Medical University  Guangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5750-526X","authenticated-orcid":false,"given":"An","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Periodontology Stomatological Hospital School of Stomatology Southern Medical University  Guangzhou China"},{"name":"Department of Periodontology Center for Dentistry and Oral Hygiene University Medical Center Groningen University of Groningen  Groningen The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qingqing","family":"Cai","sequence":"additional","affiliation":[{"name":"Division of Nephrology Nanfang Hospital Southern Medical University National Clinical Research Center of Kidney Disease  Guangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2536-3524","authenticated-orcid":false,"given":"Yuntao","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Public Health University College London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yang","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Oral Medicine Stomatological Hospital School of Stomatology Southern Medical University  Guangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harri\u00ebt","family":"Jager\u2010Wittenaar","sequence":"additional","affiliation":[{"name":"Research Group Healthy Ageing Allied Health Care and Nursing Hanze University of Applied Sciences  Groningen The Netherlands"},{"name":"Department of Oral and Maxillofacial Surgery University of Groningen University Medical Center Groningen  Groningen The Netherlands"},{"name":"Research Unit Experimental Anatomy Faculty of Physical Education and Human Anatomy Vrije Universiteit Brussel  Brussels Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geerten\u2010Has","family":"E. 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