Table 1 Characteristics of the included studies in the meta-analysis

Chapple (2007) [16]

America (North America)

Cross-sectional study

Both, > 20

11480 (609)

Blood sample

 ≥ 2 mesiobuccal sites with CAL ≥ 5mm and ≥ 1 mesiobuccal sites with PD ≥ 4mm

A: 0.92(0.85–1.00)

C:0.76(0.69–0.84)

E:0.97(0.90–1.05)

age, gender, race/ethnicity, cigarette smoking, oral contraceptives /hormone replacement therapy use, diabetes, poverty-income ratio, and education

Yu (2007) [17]

America (North America)

Cross-sectional study

Both, > 60

844 (125)

Blood sample

 ≥ 10% of sites with CAL ≥ 4mm and ≥ 10% sites with PD ≥ 3mm

Folate: 0.74(0.59–0.93)

age, sex, race, educational level, body mass index, bleeding on probing and probing sites

Alshouibi (2013) [18]

America (North America)

Cross-sectional study

Men, 62,9

562 (98)

FFQ

 ≥ 2 sites with CAL ≥ 6mm and ≥ 1 sites with PD ≥ 5 mm(not on same tooth)

D:0.97(0.96–0.98)

age, sex, race, educational level, body mass index, bleeding on probing and probing sites

Millen (2013) [32]

America (North America)

Cross-sectional study

Women, 66.6

920 (612)

Blood sample

 ≥ 2 interproximal sites with CAL ≥ 4mm (not on same tooth) or ≥ 2 interproximal sites with PD ≥ 5mm (not on same tooth), alveolar crest height and tooth loss

D:0.67(0.47–0.95)

age, frequency of dental visits, and body mass index

Lee (2015) [20]

Korea (Asia)

Cross-sectional study

Both, > 19

6011, 1938

Blood sample

(CPI) ≥ 1 sites with PD ≥ 3.5mm

D:0.98(0.79–1.22)

age, gender, educational level, and household income, use of floss, use of interproximal toothbrush, alcohol consumption, diabetes, obesity, and dietary conditions

Antonoglou (2015) [19]

Finland (Europe)

Case–control study

Both, -

85 (55)

Blood sample

PD ≥ 4mm and CAL ≥ 4mm

D:0.97(0.95–1.00)

age, plaque, smoking, high-density lipoprotein cholesterol, body mass index, and gender

Antonoglou (2015) [33]

Finland (Europe)

Cross-sectional study

Both, 30–49

1205 (32)

Blood sample

PD ≥ 4mm

D:0.99(0.99–1.00)

gender, age, education, presence of dental plaque, number of teeth, dental attendance pattern, tooth brushing frequency, lipid medication, body mass index and alcohol consumption

Abreu (2016) [21]

America (North America)

Case–control study

Both, 35–64

48 (24)

Blood sample

 ≥ 2 interproximal sites with CAL ≥ 4mm or ≥ 2 interproximal sites with PD ≥ 5mm

D:0.885(0.785–0.997)

age, gender, and body mass index

Adegboye (2016) [34]

Danish (Europe)

Cross-sectional study

Both, 18–95

3287 (316)

FFQ

 ≥ 2 interproximal sites with CAL ≥ 6mm and ≥ 1 interproximal sites with PD ≥ 5mm

D:0.85(0.66–1.01)

age, gender, education, smoking, sucrose intake, alcohol consumption, number of teeth, daily brushing, regular visits to the dentist, and chronic illness.

Huang (2017) [22]

America (North America)

Cross-sectional study

Both, -

754 (173)

24-hDR

BOP and ≥ 2 sites with CAL ≥ 4mm

D:0.979(0.964–0.995)

age, gender, smoking status, and physical activity

Park (2017) [24]

Korea (Asia)

Cross-sectional study

Both, 19–39

2049 (279)

24-hDR

(CPI) ≥ 1 sites with PD ≥ 3.5mm

A: 0.85(0.61–1.21)

C: 0.77(0.55–1.08)

age, gender, household income, education, daily frequency of tooth brushing, use of floss /interdental brush, smoking status and pack-years, diabetes mellitus and obesity

Lee (2017) [9]

Korea (Asia)

Cross-sectional study

Both, > 19

10930

24-hDR

(CPI) PD ≥ 3.5mm

C: 0.86(0.77–0.96)

age, sex, income, tooth brushing, use of floss, dental visit, alcohol drinking, smoking, diabetes, hypercholesterolemia, hypertension and obesity

Laky (2017) [23]

Austria (Europe)

Case–control study

Both, 35.4

58 (29)

Blood sample

 ≥ 5 teeth with PD ≥ 5mm

D: 0.68(0.50–0.88)

E: 0.53(0.28–0.99)

age, gender, and smoking

Yoon (2017) [25]

Korea (Asia)

Cross-sectional study

Both, > 65

1021 (446)

Blood sample

(CPI) PD ≥ 4mm

D: 0.58(0.34–0.98)

gender, education, income, living area, the frequency of tooth-brushing, use of oral hygiene, oral health check-ups, missing teeth, drinking, smoking experience, body mass index, regular physical activity, and walking practice

Luo (2018) [26]

America (North America)

Cross-sectional study

Both, ≥ 30

6415 (2950)

24-hDR

 ≥ 2 interproximal sites with CAL ≥ 4mm (not on same tooth) or ≥ 2 interproximal sites with PD ≥ 5mm (not on same tooth)

A: 0.56(0.44–0.72)

B1: 0.75(0.58–0.97)

B2: 0.83(0.64–1.07)

B6: 0.89(0.71–1.12)

Folate:

0.80(0.64–1.00)

B12: 0.90(0.71–1.15)

C: 0.71(0.58–0.89)

D: 0.86(0.68–1.10)

E: 0.63(0.49–0.82)

age, gender, ethnicity, education, income-to-poverty ratio, smoking, history of diabetes mellitus, hypertension, smoking, days per week using floss, and body mass index

Ketharanathan (2019) [7]

Norway (Europe)

Case–control study

Both, 30–70

92 (48)

Blood sample

 ≥ 2 sites with CAL ≥ 6mm and ≥ 1 sites with PD ≥ 5mm

D: 0.96(0.94–0.99)

age and race

Kim (2020) [27]

Korea (Asia)

Cross-sectional study

Both, ≥ 50

5405 (1289)

Blood sample

 ≥ 2 sites with CAL ≥ 6mm and ≥ 1 sites with PD ≥ 5mm

D: 0.66(0.42–1.05)

age, sex, month of blood collection, body mass index, smoking status, alcohol consumption status, regular exercise, antihypertensive medication, and antidiabetic medication

Alzahrani (2021) [28]

Saudi (Asia)

Case–control study

Both, 30–48

123 (60)

Blood sample

 ≥ 2 interproximal sites with CAL ≥ 4mm (not on same tooth) or ≥ 2 interproximal sites with PD ≥ 5mm (not on same tooth)

D: 0.964(0.931–0.999)

age, gender, and body mass index

Zhou (2021) [29]

America (North America)

Cross-sectional study

Both, 50

2928 (301)

Blood sample

 ≥ 2 interproximal sites with CAL ≥ 6mm (not on same tooth) and ≥ 1 interproximal site with PD ≥ 5mm (not on same tooth)

D: 0.75(0.63- 0.89)

gender, hypertension, direct HDL-Cholesterol, age, race/Hispanic origin, glycohemoglobin, education level, diabetes mellitus, body mass index, marital status, creatinine, health insurance, smoking status, and ratio of family income to poverty

Hosoda (2021) [10]

Japan (Asia)

Cross-sectional study

Both, 20.4

120 (49)

DHQ

(CPI)PD ≥ 4mm

Folate:

0.99(0.97–1.01)

C: 1.03(0.99–1.07)

E: 0.53(0.28–0.99)

body mass index, presence of snacks, and dietary hardness

Li (2022) [30]

America (North America)

Cross-sectional study

Both, ≥ 30

5530 (3994)

24-hDR

 ≥ 2 interproximal sites with CAL ≥ 4mm or ≥ 2 interproximal sites with PD ≥ 5mm

A: 0.835(0.694–1.004)

B1: 1.084(0.977–1.203)

B2: 0.916(0.841–0.999)

C: 1.130(1.039–1.228)

E: 0.968(0.953–0.984)

age, gender, educational level, income, body mass index, diabetes, hyperlipidemia and hypertension

Li (2022) [31]

America (North America)

Cross-sectional study

Both, ≥ 30

5145 (-)

24-hDR

 ≥ 2 interproximal sites with CAL ≥ 3mm (not on the same tooth), and ≥ 2 interproximal sites with PD ≥ 4mm or one site with PD ≥ 5mm (not on same tooth)

C: 0.93(0.78–1.12)

age, sex, race, had at least 12 alcohol drinks/one year, body mass index, hypertension, hyperlipidemia, education level, marital status, annual household income, diabetes history, general health condition, number of flossing / weeks, sleep disorder, smoked at least 100 cigarettes in life and energy

Watson (2022) [8]

America (North America)

Cross-sectional study

Both, 56.2

9476 (1634)

24-hDR

painful gums and/or bleeding gums and/or loose teeth

B6: 0.83(0.71–0.96)

Folate:

0.81(0.69–0.94)

B12: 0.83(0.71–0.97)

C: 0.77(0.66–0.90)

D: 0.89(0.77–1.04)

E: 0.63(0.69–0.94)

age, sex, ethnicity, Townsend Deprivation Index, body mass index, smoking status, and alcohol drinking status