***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Obesity is a strong risk factor for type 2 diabetes . However , few studies have compared the predictive power of overall obesity with that of central obesity . The cutoffs for  waist circumference ( WC  ) and  waist-to-hip ratio ( WHR ) as measures of abdominal adiposity remain controversial . OBJECTIVE The objective was to compare  body mass index ( BMI ) , WC , and WHR  in predicting type 2 diabetes . DESIGN A prospect i ve cohort study ( Health Professionals Follow-Up Study ) of 27 270 men was conducted .  WC , WHR , and BMI were assessed at baseline . Covariates and potential confounders were assessed repeatedly during the follow-up . RESULTS During 13 y of follow-up , we documented 884 incident type 2 diabetes cases . Age-adjusted relative risks ( RRs ) across quintiles of WC were 1.0 , 2.0 , 2.7 , 5.0 , and 12.0 ; those of WHR were 1.0 , 2.1 , 2.7 , 3.6 , and 6.9 ; and those of BMI were 1.0 , 1.1 , 1.8 , 2.9 , and 7.9 ( P for trend < 0.0001 for all ) . Multivariate adjustment for diabetes risk factors only slightly attenuated these RRs . Adjustment for BMI substantially attenuated RRs for both WC and WHR . The receiver operator characteristic curve analysis indicated that WC and BMI were similar and were better than WHR in predicting type 2 diabetes . The cumulative proportions of type 2 diabetes cases identified according to medians of BMI ( > /=24.8 ) , WC ( > /=94 cm ) , and WHR ( > /=0.94 ) were 82.5 % , 83.6 % , and 74.1 % , respectively . The corresponding proportions were 78.9 % , 50.5 % , and 65.7 % according to the recommended cutoffs . CONCLUSIONS Both overall and abdominal adiposity strongly and independently predict risk of type 2 diabetes . WC is a better predictor than is WHR . The currently recommended cutoff for WC of 102 cm for men may need to be reevaluated ; a lower cutoff may be more appropriate OBJECTIVE Our purpose was to measure the agreement , reliability , construct validity , and feasibility of a measurement tool to assess  systematic review s ( AMSTAR ) . STUDY DESIGN AND SETTING We r and omly selected 30 systematic review s from a data base . Each was assessed by two review ers using : ( 1 ) the enhanced quality assessment question naire ( Overview of Quality Assessment Question naire [ OQAQ ] ) ; ( 2 ) Sacks ' instrument ; and ( 3 ) our newly developed measurement tool ( AMSTAR ) . We report on reliability ( interobserver kappas of the 11 AMSTAR items ) , intraclass correlation coefficients ( ICCs ) of the sum scores , construct validity ( ICCs of the sum scores of AMSTAR compared with those of other instruments ) , and completion times . RESULTS The interrater agreement of the individual items of AMSTAR was substantial with a mean kappa of 0.70 ( 95 % confidence interval [ CI ] : 0.57 , 0.83 ) ( range : 0.38 - 1.0 ) . Kappas recorded for the other instruments were 0.63 ( 95 % CI : 0.38 , 0.78 ) for enhanced OQAQ and 0.40 ( 95 % CI : 0.29 , 0.50 ) for the Sacks ' instrument . The ICC of the total score for AMSTAR was 0.84 ( 95 % CI : 0.65 , 0.92 ) compared with 0.91 ( 95 % CI : 0.82 , 0.96 ) for OQAQ and 0.86 ( 95 % CI : 0.71 , 0.94 ) for the Sacks ' instrument . AMSTAR proved easy to apply , each review taking about 15 minutes to complete . CONCLUSIONS AMSTAR has good agreement , reliability , construct validity , and feasibility . These findings need confirmation by a broader range of assessors and a more diverse range of review The aim of the present cross-sectional retrospective study was to compare the peri-implant clinical and radiographic inflammatory parameters and whole salivary destructive inflammatory cytokine profile among obese and non-obese men . Thirty-five obese and 37 non-obese men were included . Information regarding age , obesity , systemic health status , and habits was collected using a question naire . Clinical examination to evaluate peri-implant parameters and radiographic examination to assess marginal bone loss were conducted . Levels of interleukin (IL)-6 and IL-1β in collected un-stimulated whole saliva were measured using enzyme-linked immunosorbent assay . Data was statistically analyzed using Kruskal Wallis test . The mean scores of peri-implant bleeding on probing ( P<0.05 ) and peri-implant probing depth ( P<0.05 ) were significantly higher among obese compared with non-obese individuals . The mean marginal bone loss was also statistically significantly higher among individuals in the test-group compared with the control-group ( P<0.05 ) . Whole salivary IL-1β ( P<0.001 ) and IL-6 ( P<0.001 ) levels were significantly higher among individuals in the test-group compared with the control-group . Clinical and radiographic peri-implant inflammatory parameters were worse , and whole salivary IL-6 and IL-1β were higher in obese than non-obese subjects . Obese patients are at greater risk of peri-implant inflammation than non-obese healthy subjects . It is highly recommended that clinicians should educate obese patients seeking implant treatment regarding the association between obesity and peri-implant inflammation . In addition , obese patients with osseointegrated implants must follow strict oral hygiene regimen to prevent inflammation and maintain optimum peri-implant tissue health Background : Anthropometric-based classification schemes for excess adiposity do not include direct assessment of obesity-related comorbidity and functional status and thus have limited clinical utility . We examined the ability of the Edmonton obesity staging system , a 5-point ordinal classification system that considers comorbidity and functional status , in predicting mortality in a nationally representative US sample . Methods : We analyzed data from the National Health and Human Nutrition Examination Surveys ( NHANES ) III ( 1988–1994 ) and the NHANES 1999–2004 , with mortality follow-up through to the end of 2006 . Adults ( age ≥ 20 yr ) with overweight or obesity who had been r and omized to the morning session at the mobile examination centre were scored according to the Edmonton obesity staging system . We examined the relationship between staging system scores and mortality , and Cox proportional hazards models were adjusted for the presence of the metabolic syndrome or hypertriglyceridemic waist . Results : Over 75 % of the cohort with overweight or obesity were given scores of 1 or 2 . Scores of 4 could not be reliably assigned because specific data elements were lacking . Survival curves clearly diverged when stratified by scores of 0–3 , but not when stratified by obesity class alone . Within the data from the NHANES 1988–1994 , scores of 2 ( hazard ratio [ HR ] 1.57 ; 95 % confidence interval [ CI ] 1.16 to 2.13 ) and 3 ( HR 2.69 ; 95 % CI 1.98 to 3.67 ) were associated with increased mortality compared with scores of 0 or 1 , even after adjustment for body mass index and the metabolic syndrome . We found similar results after adjusting for hypertriglyceridemic waist ( i.e. , waist circumference ≥ 90 cm and a triglyceride level ≥ 2 mmol/L for men ; the corresponding values for women were ≥ 85 cm and ≥ 1.5 mmol/L ) , as well as in a cohort eligible for bariatric surgery . Interpretation : The Edmonton obesity staging system independently predicted increased mortality even after adjustment for contemporary methods of classifying adiposity . The Edmonton obesity staging system may offer improved clinical utility in assessing obesity-related risk and prioritizing treatment Summary Background The main associations of body-mass index ( BMI ) with overall and cause-specific mortality can best be assessed by long-term prospect i ve follow-up of large numbers of people . The Prospect i ve Studies Collaboration aim ed to investigate these associations by sharing data from many studies . Methods Collaborative analyses were undertaken of  baseline BMI versus mortality  in 57 prospect i ve studies with 894 576 participants , mostly in western Europe and North America ( 61 % [ n=541 452 ] male , mean recruitment age 46 [ SD 11 ] years , median recruitment year 1979 [ IQR 1975–85 ] , mean BMI 25 [ SD 4 ] kg/m2 ) . The analyses were adjusted for age , sex , smoking status , and study . To limit reverse causality , the first 5 years of follow-up were excluded , leaving 66 552 deaths of known cause during a mean of 8 ( SD 6 ) further years of follow-up ( mean age at death 67 [ SD 10 ] years ) : 30 416 vascular ; 2070 diabetic , renal or hepatic ; 22 592 neoplastic ; 3770 respiratory ; 7704 other . Findings In both sexes , mortality was lowest at about 22·5–25 kg/m2 . Above this range , positive associations were recorded for several specific causes and inverse associations for none , the absolute excess risks for higher BMI and smoking were roughly additive , and each 5 kg/m2 higher BMI was on average associated with about 30 % higher overall mortality ( hazard ratio per 5 kg/m2 [ HR ] 1·29 [ 95 % CI 1·27–1·32 ] ) : 40 % for vascular mortality ( HR 1·41 [ 1·37–1·45 ] ) ; 60–120 % for diabetic , renal , and hepatic mortality ( HRs 2·16 [ 1·89–2·46 ] , 1·59 [ 1·27–1·99 ] , and 1·82 [ 1·59–2·09 ] , respectively ) ; 10 % for neoplastic mortality ( HR 1·10 [ 1·06–1·15 ] ) ; and 20 % for respiratory and for all other mortality ( HRs 1·20 [ 1·07–1·34 ] and 1·20 [ 1·16–1·25 ] , respectively ) . Below the range 22·5–25 kg/m2 , BMI was associated inversely with overall mortality , mainly because of strong inverse associations with respiratory disease and lung cancer . These inverse associations were much stronger for smokers than for non-smokers , despite cigarette consumption per smoker varying little with BMI . Interpretation Although other anthropometric measures ( eg , waist circumference , waist-to-hip ratio ) could well add extra information to BMI , and BMI to them , BMI is in itself a strong predictor of overall mortality both above and below the apparent optimum of about 22·5–25 kg/m2 . The progressive excess mortality above this range is due mainly to vascular disease and is probably largely causal . At 30–35 kg/m2 , median survival is reduced by 2–4 years ; at 40–45 kg/m2 , it is reduced by 8–10 years ( which is comparable with the effects of smoking ) . The definite excess mortality below 22·5 kg/m2 is due mainly to smoking-related diseases , and is not fully explained . Funding UK Medical Research Council , British Heart Foundation , Cancer Research UK , EU BIOMED programme , US National Institute on Aging , and Clinical Trial Service Unit ( Oxford , UK ) Alcohol consumption impairs neutrophil , macrophage , and T-cell functions , increasing the likelihood of infections . We examined the association between alcohol consumption and  periodontitis  , prospect ively , among 39,461 male health professionals aged 40 to 75 years and free of periodontitis at the start of follow-up .  Alcohol intake was assessed at baseline and up date d every 4 years by a food-frequency question naire .  Periodontal disease status was self-reported and vali date d against radiographs . Multivariate analysis was adjusted for age , smoking , diabetes , body-mass index , physical activity , time period , and caloric intake . During 406,160 person-years of follow-up , there were 2125 cases of periodontitis . Compared with non-drinkers , the relative risk ( 95 % confidence interval ) among men reporting usual alcohol intake of 0.1 - 4.9 g/day was 1.24 ( 1.09 , 1.42 ) ; 5.0 to 14.9 g/day , 1.18 ( 1.04 , 1.35 ) ; 15 to 29.9 g/day , 1.18 ( 1.01 , 1.38 ) ; and > 30 g/day , 1.27 ( 1.08 , 1 
    Output:
    
Eight review s reported on cross-sectional studies investigating the association of obesity and periodontal diseases , 4 included longitudinal studies , 5 addressed response to periodontal therapy , 5 reported on studies investigating biomarkers , and only 2 were related to pediatric population sample s. Systematic review summaries in the various study design domains ( cross-sectional , longitudinal and experimental ) report that obese individuals are more likely to have periodontal diseases , with more severe periodontal conditions , than nonobese individuals , with cross-sectional evidence congruent with longitudinal studies showing that obesity or weight gain increases the risk of periodontitis onset and progression .
Published research on the effect of obesity on responses to periodontal therapy  , or systemic or local biomarkers of inflammation , is variable and therefore inconclusive based on the evidence currently available , which suggests that overweight/obesity contributes to periodontal complications independently of other risk factors , such as age , gender , smoking , or ethnicity .