ArticleFrontiers in nutrition2026
The role of diet and periodontitis in preserved ratio impaired spirometry: a mediation analysis.
Article in Frontiers in nutrition, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Preserved ratio impaired spirometry (PRISm) is an early form of lung dysfunction linked to systemic inflammation and oxidative stress. While diet and periodontitis independently affect pulmonary health, their interrelationship and potential mediating pathways remain unclear. Objective: To explore the cross-sectional associations between dietary inflammatory indices, periodontitis, and PRISm, and to examine whether periodontitis statistically accounts for part of the diet-PRISm association. An external validation analysis was conducted to assess reproducibility rather than to confirm causality or definitive generalizability. Methods: This cross-sectional analysis used data from the National Health and Nutrition Examination Survey (NHANES, 2009-2012), including 3,540 participants aged ≥30 years with complete periodontal, spirometric, dietary, laboratory, and covariate information. The Dietary Inflammatory Index (DII) and Oxidative Balance Score (OBS) were used to assess dietary inflammatory potential and oxidative balance, while periodontitis was defined according to CDC/AAP criteria. PRISm was identified based on spirometry results. Mediation analysis was performed as an exploratory statistical decomposition of associations, not as evidence of temporal or causal mediation. An external hospital-based cohort of 1,126 participants from the Health Examination Center of the Second Affiliated Hospital of Shandong First Medical University, Shandong Province, China, was used to evaluate the reproducibility of the main findings. Results: In NHANES, higher DII values were associated with greater odds of PRISm (OR = 1.17, 95% CI: 1.06-1.29), while higher OBS values were associated with lower odds of PRISm (OR = 0.96, 95% CI: 0.93-0.99). Periodontitis was independently associated with PRISm (OR = 1.61, 95% CI: 1.04-2.50). Mediation analysis suggested that periodontitis accounted for only a small statistical proportion of the DII-PRISm association (6.46%) and the OBS-PRISm association (9.58%). In the external validation cohort, OBS remained inversely associated with PRISm (OR = 0.92, 95% CI: 0.84-0.99), whereas the DII-PRISm association was directionally positive but not statistically significant (OR = 1.18, 95% CI: 0.93-1.49). Conclusions: Pro-inflammatory diets, lower oxidative balance, and periodontitis were associated with PRISm odds in NHANES, and periodontitis accounted for a small statistical proportion of the observed diet-PRISm associations. The external cohort supported the OBS pattern, whereas DII-related findings were not statistically significant and should not be considered externally confirmed.
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