# Mediating Effects of Systemic Inflammation on the Association Between Body Roundness Index and Periodontitis in US Adults

## TL;DR

Higher body roundness index is linked to increased periodontitis risk, partly due to systemic inflammation.

## Contribution

This study reveals systemic inflammation partially mediates the link between BRI and periodontitis.

## Key findings

- Higher BRI quartiles correlate with increased odds of periodontitis.
- BRI outperforms BMI in predicting periodontitis risk.
- Systemic inflammation markers SII and SIRI partially mediate the BRI-periodontitis association.

## Abstract

Periodontitis is a highly prevalent chronic inflammatory disease affecting periodontal tissues. While the Body Roundness Index (BRI), has emerged as a novel anthropometric measure for evaluating obesity-related health risks, its relationship with periodontal health remains unexplored. Although systemic inflammation is recognized as a key role in both obesity and periodontitis. However, whether BRI affects periodontitis, the mediating role of systemic inflammation in BRI-related periodontitis has not been elucidated.

Data were derived from the National Health and Nutrition Examination Survey (NHANES) 2009-2014, comprising 8415 participants aged ≥18 years. We analysed BRI's correlation with periodontal disease using binary logistic regression models. Restricted Cubic Spline (RCS) modelling explored nonlinear patterns. The predictive performance of BRI for periodontitis was compared with traditional anthropometric indices using Receiver Operating Characteristic (ROC) curves. Mediation models assessed how systemic inflammation (SII, SIRI) bridges the BRI-periodontitis link.

In the fully adjusted model, participants in higher BRI quartiles showed progressively increased odds of periodontitis compared with those in the lowest quartile (Q1), with odds ratios of 1.33 (95% CI: 1.07-1.65, P = .010) for Q2, 1.48 (95% CI: 1.16-1.88, P = .004) for Q3, and 1.70 (95% CI: 1.20-2.40, P = .010) for Q4. RCS analysis indicated a linear relationship between BRI and periodontitis risk (nonlinearity P = .201). ROC curves revealed that BRI demonstrated superior predictive performance for periodontitis compared to BMI. The mediation analysis indicated that SII (5.37%, 95% CI: 0.86%-15.02%, P < .001) and SIRI (8.92%, 95% CI: 2.73%-22.13%, P < .05) partially mediated the BRI-periodontitis association.

Our study demonstrates that elevated BRI is positive associated with an increased risk of periodontitis. Systemic inflammation, as reflected by SII and SIRI, partially mediates this relationship.

Body Roundness Index (BRI), has emerged as a novel anthropometric indicator that more precisely estimates visceral adiposity and body fat percentage. Obesity, particularly the dysfunction of adipose tissue in visceral obesity, leads to the secretion of many pro-inflammatory factors, triggering systemic inflammatory responses. Systemic inflammation is recognized as a key role in both obesity and periodontitis. However, whether BRI affects periodontitis, the mediating role of systemic inflammation in BRI-related periodontitis has not been elucidated. This study supports that BRI is significantly associated with an increased risk of periodontitis, and systemic inflammation partially mediates this relationship. These findings highlight the importance of addressing obesity and systemic inflammation as part of periodontal disease prevention and management strategies.