A nationally representative analysis suggests that insufficient dietary lycopene intake could be associated with a higher likelihood of severe periodontitis among older US adults, with notable differences by race and sex.
In the study, investigators analyzed data from the National Health and Nutrition Examination Survey (NHANES) to assess whether lycopene, a carotenoid commonly found in tomatoes and other red fruits, may play a role in periodontal health disparities.
Periodontitis affects more than 70% of US adults aged 65 years and older and has been linked to systemic conditions, including cardiovascular disease and diabetes. Prior research has documented racial disparities in periodontal disease prevalence, particularly between non-Hispanic White and non-Hispanic Black adults. While age, sex, and race are nonmodifiable risk factors, dietary intake represents a potentially modifiable target for prevention.
The investigators evaluated 1,227 adults aged 65 to 79 years who participated in NHANES between 2009 and 2014. Dietary lycopene intake was evaluated using 2-day dietary recall interviews, with intake of at least 8,000 µg per day defined as sufficient. Periodontitis status was determined through standardized oral examinations conducted in mobile examination centers and categorized as severe or nonsevere.
Overall, 48.7% of the participants had some degree of periodontitis, and 77.9% reported insufficient dietary lycopene intake. Severe periodontitis was less common among individuals with sufficient lycopene intake compared with those with insufficient intake (2.4% vs 6.5%). After adjustment for age, race, sex, smoking status, education, and other covariates, adequate lycopene intake was associated with a significantly lower likelihood of severe periodontitis.
Racial and sex-based differences were also observed. non-Hispanic Black participants were nearly three times more likely to have severe periodontitis compared with non-Hispanic White participants. Women had a substantially lower risk of severe disease compared with men, and among non-Hispanic White participants specifically, women were less likely than men to have severe periodontitis. In stratified analyses, sufficient lycopene intake was strongly associated with a reduced likelihood of severe periodontitis among non-Hispanic White participants, but this association wasn't observed among non-Hispanic Black participants.
Smoking remained a major risk factor. Current smokers had a markedly higher prevalence of severe periodontitis compared with former and never-smokers. Lead study author Katherine Kwong, of the Department of Human Development at Connecticut College, and her colleagues noted that behavioral, biological, and social factors may contribute to the observed disparities.
The investigators emphasized several limitations, including the cross-sectional design, which precluded causal inference. NHANES doesn't capture dental insurance coverage or routine preventive dental care, and lycopene intake was assessed as total dietary consumption without distinguishing between food and supplement sources. Additionally, the number of participants with severe periodontitis was relatively small, which may have affected some subgroup analyses.
Despite these limitations, the findings suggested that dietary lycopene intake may be an important, modifiable factor associated with periodontal health in older adults, particularly among NHW individuals. The investigators concluded that future prevention strategies for periodontitis may benefit from race- and sex-specific dietary approaches and called for longitudinal and randomized clinical trials to determine whether increasing lycopene intake can prevent or slow disease progression.
