Abstract
BACKGROUND AND AIM: Metabolic health is closely related to periodontal health. Obesity, metabolic syndrome and diabetes mellitus are bidirectionally associated with periodontitis. The triglycerides-to-high-density lipoprotein cholesterol ratio (Ty/HDLc ratio) has emerged as a novel biomarker that can predict the risk of several chronic metabolic diseases. We conducted this systematic review to consolidate the available evidence regarding the association between the Ty/HDLc ratio and periodontitis. METHODS: We systematically searched PubMed, SCOPUS, Embase, and Web of Science databases for studies that assessed the Ty/HDLc ratio and its association with periodontitis till May 2025. No date or language restrictions were applied. We included all observational studies in adults and adolescents and excluded interventional studies, case reports, and animal studies. Study quality was assessed using the Joanna Briggs Institute critical appraisal checklist. RESULTS: Systematic screening of the search results yielded 7 studies that met our eligibility criteria. Sample sizes varied from 69 to 13,584 individuals aged 17 to 53 years across diverse population groups from Brazil, Mexico, South Korea, and Taiwan. All included studies were rated as having a low risk of bias. Despite demographic differences, all studies found a consistent positive association between the Ty/HDLc ratio and periodontitis prevalence and/or severity. CONCLUSION: The findings of this review suggest that the serum Ty/HDLc ratio is positively associated with periodontitis prevalence and could be a promising biomarker that is simple, practical, cost-effective, routinely measured, and easily calculable, and holds the potential to be an indirect risk marker for periodontitis. Future research should focus on establishing the temporal relationship and establishing a definitive, gender-specific cut-off for periodontal risk assessment.