The association between serum folate levels and periodontal disease in older adults: Data from the National Health and Nutrition Examination Survey 2001/02

OBJECTIVES: To assess the relationship between serum folate levels and periodontal disease in older adults. DESIGN: Population-based cross-sectional study. SETTING: National Health and Nutritional Examination Survey 2001/02. PARTICIPANTS: Eight hundred forty-four dentate elderly subjects aged 60 and older (mean age 70.6) who completed a periodontal examination and laboratory test for serum folate levels. MEASUREMENTS: Periodontal examination, including probing depth and attachment loss, was performed. Periodontal disease was defined as having at least 10% of sites with clinical attachment loss of more than 4 mm and at least 10% sites with probing depth of more than 3 mm. Serum folate levels were measured using a commercially available radioprotein binding assay kit. RESULTS: After controlling for demographics, educational level, body mass index, bleeding on probing, and probing sites, the odds ratio for periodontal disease was 0.74 (95% confidence interval=0.59-0.93) for each standard deviation increase in natural-log-transformed folate levels. After additionally controlling for levels of vitamin B-12 and homocysteine, chronic diseases (hypertension, diabetes mellitus, heart disease, and stroke), and health behaviors (smoking status and alcohol consumption), the negative association between folate level and periodontal disease remained statistically significant and essentially unchanged. There was no effect modification of sex on the association between serum folate levels and periodontal disease. CONCLUSION: A low serum folate level was independently associated with periodontal disease in older adults. The results suggest that serum folate levels, important indicators of periodontal disease in older adults, may provide an important clinical target for intervention to promote oral health.