Association between triglyceride–glucose–related indices and all-cause and cause-specific mortality among individuals with periodontitis: A population-based study
5 affiliations
- 1Department of General Dentistry, School and Hospital of Stomatology, China Medical University, Liaoning Province Key Laboratory of Oral Disease, P.R. China
- 2Department of Periodontal and Oral Mucosal Diseases, Wuxi Stomatological Hospital, P.R. China
- 3Liaoning Province Key Laboratory of Oral Disease, School and Hospital of Stomatology, China Medical University, P.R. China
- 4Department of Prosthodontics, School and Hospital of Stomatology, China Medical University, Liaoning Province Key Laboratory of Oral Disease, P.R. China
- 5Department of Oroamxillofacial-Head and Neck Surgery, School and Hospital of Stomatology, China Medical University, Liaoning Province Key Laboratory of Oral Disease, P.R. China
Abstract
Objective: This study aimed to investigate the associations of triglyceride–glucose–related indices with all-cause, cardiovascular disease–related, and cancer-related mortality in US adults with periodontitis.
Methods: This study included individuals with periodontitis from the National Health and Nutrition Examination Survey datasets covering the periods, 1988–1994, 1999–2004, and 2009–2014. The triglyceride–glucose index and its combinations with body mass index, waist circumference, and waist-to-height ratio, was calculated. Mortality data were obtained by linking participants to the National Death Index records, with follow-up extending through 31 December 2019. Periodontitis was defined using partial-mouth periodontal examination based on clinical attachment loss and probing pocket depth. Models were adjusted for demographic, socioeconomic, lifestyle, cardiometabolic, and cohort-period covariates. Multivariate Cox proportional hazards models were used to investigate the associations of triglyceride–glucose–related indices with all-cause and cause-specific mortality.
Results: Over a median follow-up period of 14.46 years, 6789 adult participants with periodontitis were included. During follow-up, 2883 all-cause deaths and 983 cardiovascular-related deaths were documented. In fully adjusted Cox models, triglyceride–glucose, triglyceride–glucose–waist circumference, and triglyceride–glucose–waist-to-height ratio were significantly associated with all-cause mortality in continuous analyses. The corresponding hazard ratios were 1.15 (95% confidence interval: 1.04–1.28; p = 0.009) for triglyceride–glucose, 1.05 (95% confidence interval: 1.00–1.09; p = 0.033) per 100-unit increase in the triglyceride–glucose–waist circumference, and 1.11 (95% confidence interval: 1.03–1.19; p = 0.006) for the triglyceride–glucose–waist-to-height ratio. For cardiovascular disease–related mortality, triglyceride–glucose and triglyceride–glucose–waist-to-height ratio remained significantly associated with increased risk, with hazard ratios of 1.23 (95% confidence interval: 1.03–1.47; p = 0.025) and 1.15 (95% confidence interval: 1.01–1.32; p = 0.035), respectively. Triglyceride–glucose–body mass index was not significantly associated with all-cause, cardiovascular disease–related, or cancer-related mortality. In quartile analyses, no significant increasing trend was observed across quartiles of triglyceride–glucose–related indices.
Conclusions: Triglyceride–glucose–waist-to-height ratio demonstrated the most consistent association with mortality outcomes among US adults with periodontitis, being associated with all-cause and cardiovascular disease–related mortality in continuous analyses. Triglyceride–glucose was also associated with all-cause and cardiovascular disease–related mortality, whereas triglyceride–glucose–waist circumference was associated only with all-cause mortality. In contrast, triglyceride–glucose–body mass index demonstrated no significant association with mortality outcomes. Given the multiple related comparisons and the observational design, these findings warrant cautious interpretation and require confirmation in independent populations.
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BibTeX
@article{cen2026association,
title = {{Association between triglyceride–glucose–related indices and all-cause and cause-specific mortality among individuals with periodontitis: A population-based study}},
author = {Dongdong Cen and Zhe Wang and Negin Toufani and Tian Li and Shanfeng Lin},
journal = {The Journal of International Medical Research},
year = {2026},
month = sep,
doi = {10.1177/03000605261489330},
url = {https://doi.org/10.1177/03000605261489330},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Association between triglyceride–glucose–related indices and all-cause and cause-specific mortality among individuals with periodontitis: A population-based study
AU - Dongdong Cen
AU - Zhe Wang
AU - Negin Toufani
AU - Tian Li
AU - Shanfeng Lin
PY - 2026
DA - 2026/09/20
JO - The Journal of International Medical Research
DO - 10.1177/03000605261489330
UR - https://doi.org/10.1177/03000605261489330
AB - Objective: This study aimed to investigate the associations of triglyceride–glucose–related indices with all-cause, cardiovascular disease–related, and cancer-related mortality in US adults with periodontitis. Methods: This study included individuals with periodontitis from the National Health and Nutrition Examination Survey datasets covering the periods, 1988–1994, 1999–2004, and 2009–2014. The triglyceride–glucose index and its combinations with body mass index, waist circumference, and waist-to-height ratio, was calculated. Mortality data were obtained by linking participants to the National Death Index records, with follow-up extending through 31 December 2019. Periodontitis was defined using partial-mouth periodontal examination based on clinical attachment loss and probing pocket depth. Models were adjusted for demographic, socioeconomic, lifestyle, cardiometabolic, and cohort-period covariates. Multivariate Cox proportional hazards models were used to investigate the associations of triglyceride–glucose–related indices with all-cause and cause-specific mortality. Results: Over a median follow-up period of 14.46 years, 6789 adult participants with periodontitis were included. During follow-up, 2883 all-cause deaths and 983 cardiovascular-related deaths were documented. In fully adjusted Cox models, triglyceride–glucose, triglyceride–glucose–waist circumference, and triglyceride–glucose–waist-to-height ratio were significantly associated with all-cause mortality in continuous analyses. The corresponding hazard ratios were 1.15 (95% confidence interval: 1.04–1.28; p = 0.009) for triglyceride–glucose, 1.05 (95% confidence interval: 1.00–1.09; p = 0.033) per 100-unit increase in the triglyceride–glucose–waist circumference, and 1.11 (95% confidence interval: 1.03–1.19; p = 0.006) for the triglyceride–glucose–waist-to-height ratio. For cardiovascular disease–related mortality, triglyceride–glucose and triglyceride–glucose–waist-to-height ratio remained significantly associated with increased risk, with hazard ratios of 1.23 (95% confidence interval: 1.03–1.47; p = 0.025) and 1.15 (95% confidence interval: 1.01–1.32; p = 0.035), respectively. Triglyceride–glucose–body mass index was not significantly associated with all-cause, cardiovascular disease–related, or cancer-related mortality. In quartile analyses, no significant increasing trend was observed across quartiles of triglyceride–glucose–related indices. Conclusions: Triglyceride–glucose–waist-to-height ratio demonstrated the most consistent association with mortality outcomes among US adults with periodontitis, being associated with all-cause and cardiovascular disease–related mortality in continuous analyses. Triglyceride–glucose was also associated with all-cause and cardiovascular disease–related mortality, whereas triglyceride–glucose–waist circumference was associated only with all-cause mortality. In contrast, triglyceride–glucose–body mass index demonstrated no significant association with mortality outcomes. Given the multiple related comparisons and the observational design, these findings warrant cautious interpretation and require confirmation in independent populations.
SN - 0300-0605
SN - 1473-2300
ER -