Periodontitis Linked to Higher Mortality Risk in MASLD Patients, NHANES Study Reveals

The study found that individuals with metabolic dysfunction-associated steatotic liver disease (MASLD) who also had moderate to severe periodontitis faced a 29% higher risk of all-cause mortality and a 41% greater risk of cardiovascular-related death compared to those with no or mild gum disease. Interestingly, cancer-related mortality remained unaffected.

The findings, published in BMC Oral Health, suggest that incorporating routine oral health assessments into the management of MASLD could play a meaningful role in improving long-term survival outcomes.

Previous research has identified periodontitis as a potential risk factor for MASLD, a common liver condition linked to metabolic disorders such as obesity and insulin resistance. Given the shared inflammatory pathways between the two conditions, there is growing interest in understanding how poor oral health may influence disease progression and outcomes in individuals with MASLD.

Against this backdrop, Guanhui Chen, Department of Stomatology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, PR China, and colleagues aimed to examine the association between periodontitis and mortality in patients with MASLD, specifically focusing on all-cause and cause-specific mortality.

For this purpose, the researchers included 11,019 individuals with metabolic dysfunction-associated steatotic liver disease from the National Health and Nutrition Examination Survey (NHANES). They used multivariable Cox proportional hazards models to assess the hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause and cause-specific mortality based on the severity of periodontitis.

To further examine the dose-response relationship, restricted cubic spline (RCS) curves were applied using clinical attachment level (CAL) and pocket probing depth (PPD) as indicators. A series of sensitivity and stratified analyses was also performed to ensure the reliability and robustness of the findings.

The key findings of the study were as follows:

• Moderate to severe periodontitis was associated with a 29% higher risk of all-cause mortality in MASLD participants (HR 1.29).
• The risk of cardiovascular disease-related mortality increased by 41% in MASLD individuals with moderate to severe periodontitis (HR 1.41).
• No significant association was found between periodontal status and cancer-related mortality in MASLD participants.

In the large, nationally representative study, the authors found that moderate to severe periodontitis was linked to significantly higher all-cause and cardiovascular-related mortality in individuals with metabolic dysfunction-associated steatotic liver disease. Higher levels of clinical attachment loss and pocket probing depth were also associated with increased risk, highlighting the prognostic value of periodontitis in MASLD.

As the first study of its kind, the authors emphasized the need for further research to confirm these findings and explore causality. They also noted limitations, including baseline data collection and variability in periodontitis classification methods compared to other studies.

Reference:

Zhang, Z., Zheng, Q., Liu, Y. et al. Association between periodontitis and mortality in participants with metabolic dysfunction-associated steatotic liver disease: results from NHANES. BMC Oral Health 25, 567 (2025). https://doi.org/10.1186/s12903-025-05959-7