The interaction among obesity, Type 2 diabetes mellitus, and periodontitis in Vietnamese patients

Shared genetic architecture between periodontal disease and type 2 diabetes: a large scale genome-wide cross-trait analysis

PURPOSE

To investigate the relationship between abnormal glucose metabolism, type 2 diabetes (T2D), and periodontal disease (PER) independent of Body Mass Index (BMI), we employed a genome-wide cross-trait approach to clarify the association.

METHODS

Our study utilized the most extensive genome-wide association studies conducted for populations of European ancestry, including PER, T2D, fasting glucose, fasting insulin, 2-hour glucose after an oral glucose challenge, HOMA-β, HOMA-IR (unadjusted or adjusted for BMI) and HbA1c.

RESULTS

With this approach, we were able to identify pleiotropic loci, establish expression-trait associations, and quantify global and local genetic correlations. There was a significant positive global genetic correlation between T2D (rg = 0.261, p = 2.65 × 10-13), HbA1c (rg = 0.182, p = 4.14 × 10-6) and PER, as well as for T2D independent of BMI (rg = 0.158, p = 2.34 × 10-6). A significant local genetic correlation was also observed between PER and glycemic traits or T2D. We also identified 62 independent pleiotropic loci that impact both PER and glycemic traits, including T2D. Nine significant pathways were identified between the shared genes between T2D, glycemic traits and PER. Genetically liability of HOMA-βadjBMI was causally associated with the risk of PER.

CONCLUSION

Our research has revealed a genetic link between T2D, glycemic traits, and PER that is influenced by biological pleiotropy. Notably, some of these links are not related to BMI. Our research highlights an underlying link between patients with T2D and PER, regardless of their BMI.

Visceral adipose tissue increases the risk of periodontal disease: Results from the 2011-2014 National Health and Nutrition Examination Survey and Mendelian randomization analysis

AIM

This study aimed to investigate the relationship and potential causal effect of visceral adipose tissue (VAT) on periodontal disease (PD). Despite prior research on this, there has been no definitive conclusion. Therefore, this study aimed to provide additional insight into these associations.

MATERIALS AND METHODS

This study used data from the National Health and Nutrition Examination Survey 2011-2014 to examine the association between VAT and PD in a cross-sectional study design. Various analytical methods were employed, such as multivariable logistic regression, restricted cubic spline analysis, and p-value for trend. Additionally, two-sample Mendelian randomization (MR) analysis was performed to evaluate the potential causal effect of VAT on PD risk. These methods enabled us to evaluate the association between VAT and PD and to establish whether VAT could be a causal factor in PD development.

RESULTS

The study examined a sample of 3535 participants, and the findings suggested that higher VAT levels were associated with an increased risk of PD. In addition, multivariable regression analysis conducted in six models revealed a statistically significant association between VAT and PD risk. Restricted cubic spline analysis showed an inverted U-shaped association between VAT and PD, with a turning point at 733 g of VAT. Finally, a two-sample MR analysis provided evidence for a potential causal relationship between VAT and PD risk, with an odds ratio of 1.16 (95% confidence interval: 1.02-1.33, p = .027) per kg increase in genetically predicted VAT.

CONCLUSIONS

The results of this study suggest that there is a significant association between VAT and PD and that VAT could be a potential causal factor in PD risk. Our results also suggest that although there is a potential link between VAT levels and PD risk, the effect size is modest. Therefore, interventions designed to reduce VAT levels should not be considered a primary strategy for PD risk reduction but could be one of many strategies used in a comprehensive approach to PD risk management.

Nonsurgical periodontal treatment improved the type 2 diabetes mellitus status in smokers: A randomized controlled trial

AIM

Type 2 diabetes mellitus (T2D) and periodontal disease have bilateral associations. The effect of periodontal treatment on T2D patients who smoke is scarce. This study aimed to assess the effect of nonsurgical periodontal treatment (NSPT) in periodontitis smokers with T2D for a duration of 6 months of follow-up.

MATERIALS AND METHODS

Forty moderate to severe periodontitis smokers with T2D were randomly distributed into two different treatment groups: the test group (NSPT including oral hygiene instructions, scaling and root planing; and 0.05% Chlorhexidine mouthrinse) and the control group (treatment including oral hygiene instructions, supragingival removal of plaque and calculus and 0.05% Chlorhexidine mouthrinse). Periodontal parameters including plaque index (PI), gingival index (GI), bleeding on probing (BOP), periodontal probing depth (PPD) and clinical attachment loss (CAL) were examined. Metabolic parameters, including fasting plasma glucose (FPG) and glycated hemoglobin (HbA1c), and high-sensitivity C-reactive protein (hs-CRP) were evaluated at baseline and at 1, 3, and 6 months of follow-up.

RESULTS

The test group significantly improved all periodontal parameters and reduced metabolic parameters and hs-CRP, whereas improvements in PI and GI were observed in the control group at 1, 3 and 6 months of follow-up. However, the PPD, CAL, metabolic parameters and hs-CRP increased in the control group at 3 and 6 months of follow-up, but the differences were not significant.

CONCLUSIONS

NSPT improves the periodontal status of smokers with T2D, has a favorable effect on glycemic control and reduces pro-inflammatory mediators, which may limit complications due to T2D in these patients.

Association between clinical measures of gingival inflammation and obesity in adults: systematic review and meta-analyses

OBJECTIVE

This study aimed to systematically review the literature about the association between clinical measures of gingival inflammation and obesity in adults.

MATERIAL AND METHODS

Searches for studies were performed in five databases (Medline-PubMed, Scopus, Web of Science, Cochrane Library, and Embase) to compile studies of any design that evaluated the association between clinical measures of gingival inflammation and obesity in adults. Selection of studies, data extraction and risk of bias analysis were performed independently by two reviewers, and a third researcher was involved to resolve disagreements. Meta-analyses were performed for measures of gingival inflammation as compared to body mass index (BMI). Independent analyses were performed for studies involving periodontitis, gingivitis, and population-based/studies that did not provide a periodontal diagnosis. Standard mean deviation (SMD) and its 95% confidence interval (95%CI) were estimated.

RESULTS

Ninety studies were included (cross-sectional/clinical trials [n=82], case-control [n=3], cohorts [n=5]). Most of the studies demonstrated no significant difference in the measures of gingival inflammation regardless of the comparison performed. However, meta-analysis showed that among individuals with periodontitis, significantly higher levels of gingival inflammation are observed in those with obesity (n of individuals=240) when compared to those who were not obese (n of individuals=574) (SMD:0.26; 95%CI:0.07-0.44). When considering population-based/those studies that did not provide periodontal diagnosis, significantly higher measures of gingival inflammation were observed in the groups with higher BMI.

CONCLUSIONS

Within the limitations of the present study, it was concluded that higher measures of gingival inflammation may be expected for those with higher BMI.

CLINICAL RELEVANCE

Clinicians must be aware that higher measures of gingival inflammation may be expected for individuals with higher BMI. However, there is a necessity for further longitudinal studies regarding the association between obesity and gingival inflammation.

Evaluation of gingival and periodontal status in obese and non-obese type II diabetic patients - a cross sectional study

Objective

The aim of this study was to evaluate gingival and periodontal status in obese and non-obese type II Diabetic Patients.

Methods

The study population comprised of 75 subjects visiting the outpatient department of our institution, divided into three different groups, group 1 (obese diabetic), group 2 (non-obese diabetic), and group 3 (obese, non-diabetic). Diabetic status was assessed with HbA1c values and obesity status was assessed by body mass index (BMI) score greater than or equal to 30 kg/m². Gingival and periodontal status were assessed using the Gingival Index (GI) and Community Periodontal Index (CPI) respectively.

Results

The mean gingival index score in group 1, group 2, and group 3 were 1.58, 1.54, and 1.25, respectively. Gingival status was poor among obese and non-obese diabetic subjects (Groups 1 and 2) when compared with obese non-diabetic patients (Group 3). The periodontal status showed that periodontal pockets were increased in diabetic obese group (15.4%), followed by diabetic non obese (4.66%), and non-diabetic obese (2%) group respectively and loss of attachment was severe in diabetic obese group (60.7%), followed by diabetic non obese (45.9%) and non-diabetic obese (15.3%) respectively.

Conclusion

Gingival and periodontal status was poor in the obese diabetic group compared to non-obese diabetic and obese non diabetic group. Hence, the risk of gingivitis and periodontitis in obese diabetic patients should be addressed earlier to prevent further complications and achieve a good oral health status.

Role of Cluster of Differentiation 163 in Diabetes-Periodontitis Interplay

Background

The aim of the present study was to assess and quantify cluster of differentiation 163 (CD163) protein levels and CD163 messenger RNA (mRNA) gene expression in subgingival plaque samples of generalized chronic periodontitis subjects with and without type II diabetes mellitus (DM).

Materials and methods

Eighty chronic periodontitis subjects were selected and divided into 40 systemically healthy, generalized chronic periodontitis subjects (Group I) and 40 generalized chronic periodontitis subjects diagnosed with type II diabetes mellitus (Group II). Age, body mass index (BMI), income, plaque index (PI), bleeding on probing (BOP), probing pocket depth (PPD), and clinical attachment level (CAL) were recorded. CD163 protein and gene expressions were quantified and compared between the groups.

Results 

The mean age, BMI, income, PI, BOP %, and CD163 protein and gene expression were higher in Group II (p< 0.05) as compared to Group I. In Group I, CD163 protein levels showed a negative correlation with respect to BMI and PI, and this was statistically significant. In Group II, all the periodontal parameters showed a positive correlation with CD163 protein levels. Overall, PI and BOP % were significantly correlated with CD163 protein levels. Both CD163 protein and gene expression showed a negative correlation with each other (p= 0.001).

Conclusion

The elevated protein levels of CD163 in the subgingival plaque samples of generalized chronic periodontitis individuals with type II diabetes mellitus signify the involvement of CD163 in the pathogenesis of both periodontitis and diabetes mellitus. CD163 can play a challenging role as a diagnostic, as well as a prognostic biomarker, in both these inflammatory diseases.