Association between triglyceride-glucose-related indices and all-cause and cause-specific mortality among individuals with periodontitis: A population-based study.

ObjectiveThis 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.MethodsThis 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.ResultsOver 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.ConclusionsTriglyceride-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.