Association of metabolic syndrome and chronic periodontitis in Colombians

Effects of probiotics in rats with experimental metabolic syndrome and periodontitis: An investigation of the intestine-adipose tissue axis

BACKGROUND

This study evaluated the systemic (intestine and adipose tissue) and local (periodontal tissues) impact of probiotic therapy in rats with metabolic syndrome (MS) associated or not with periodontitis (PE).

METHODS

Forty-eight rats received a high-fat diet for induction of MS for 16 weeks. They were subdivided into groups with (+) and without (-) PE, receiving (*) or not (**) receiving probiotics (PROB): MS (-**), MSP (-*), MSPE (+**), and MSPEP (+*). PROB administration (Bifidobacterium animalis subsp. lactis HN019) started on the 8th week of the study and PE was induced on the 14th week by placing ligature on the animals' lower first molars. Euthanasia occurred in the 16th week. Biomolecular, immunoenzymatic assays, and histomorphometric analyses were performed. The data obtained were statistically analyzed (ANOVA, Tukey, p < 0.05).

RESULTS

The MSPEP group exhibited reduced alveolar bone loss when compared with the MSPE group, as well as lower levels of hepatic steatosis and proteinuria (p < 0.05). In the intestinal environment, the MSPE group exhibited significantly lower villus height and crypt depth, as well as a greater increase in Bacillota when compared with the MSPEP group (p < 0.05). The MSPEP group showed lower adipokine gene expression (LEPR, NAMPT, and FABP4) in adipose tissue than the MSPE group (p < 0.05).

CONCLUSION

The probiotic B. lactis HN019 reduced the severity of experimental periodontitis and modulated the expression of lipogenic genes and intestinal morphological and microbiological parameters in rats with MS.

Periodontal treatment and microbiome-targeted therapy in management of periodontitis-related nonalcoholic fatty liver disease with oral and gut dysbiosis

A growing body of evidence from multiple areas proposes that periodontal disease, accompanied by oral inflammation and pathological changes in the microbiome, induces gut dysbiosis and is involved in the pathogenesis of nonalcoholic fatty liver disease (NAFLD). A subgroup of NAFLD patients have a severely progressive form, namely nonalcoholic steatohepatitis (NASH), which is characterized by histological findings that include inflammatory cell infiltration and fibrosis. NASH has a high risk of further progression to cirrhosis and hepatocellular carcinoma. The oral microbiota may serve as an endogenous reservoir for gut microbiota, and transport of oral bacteria through the gastro-intestinal tract can set up a gut microbiome dysbiosis. Gut dysbiosis increases the production of potential hepatotoxins, including lipopolysaccharide, ethanol, and other volatile organic compounds such as acetone, phenol and cyclopentane. Moreover, gut dysbiosis increases intestinal permeability by disrupting tight junctions in the intestinal wall, leading to enhanced translocation of these hepatotoxins and enteric bacteria into the liver through the portal circulation. In particular, many animal studies support that oral administration of Porphyromonas gingivalis, a typical periodontopathic bacterium, induces disturbances in glycolipid metabolism and inflammation in the liver with gut dysbiosis. NAFLD, also known as the hepatic phenotype of metabolic syndrome, is strongly associated with metabolic complications, such as obesity and diabetes. Periodontal disease also has a bidirectional relationship with metabolic syndrome, and both diseases may induce oral and gut microbiome dysbiosis with insulin resistance and systemic chronic inflammation cooperatively. In this review, we will describe the link between periodontal disease and NAFLD with a focus on basic, epidemiological, and clinical studies, and discuss potential mechanisms linking the two diseases and possible therapeutic approaches focused on the microbiome. In conclusion, it is presumed that the pathogenesis of NAFLD involves a complex crosstalk between periodontal disease, gut microbiota, and metabolic syndrome. Thus, the conventional periodontal treatment and novel microbiome-targeted therapies that include probiotics, prebiotics and bacteriocins would hold great promise for preventing the onset and progression of NAFLD and subsequent complications in patients with periodontal disease.

Impact of Intermittent Fasting on Metabolic Syndrome and Periodontal Disease-A Suggested Preventive Strategy to Reduce the Public Health Burden

Metabolic syndrome (MetS) prevalence continues to climb significantly worldwide in today's ad libitum society. MetS has tremendous societal and economic ramifications, making it imperative to develop effective strategies for preventing and controlling it to alleviate this growing burden. Periodontal disease and MetS are associated with several risk factors. Studies in the past have demonstrated that obesity, cardiovascular illness, and type 2 diabetes mellitus have a negative effect on the severity of the periodontal disease. Patients with metabolic syndrome have elevated serum levels of proinflammatory mediators such as tumor necrosis factor-alpha interleukin-6 and C-reactive protein. Similar inflammatory mediators, such as interleukin-6, tumor necrosis factor-alpha, and C-reactive protein, are increased in patients with severe periodontal disease. Remarkably, intermittent fasting is underpinned by scientific evidence, claiming to be the most effective non-pharmacological, potential therapeutic alternative for combating a wide range of metabolic, inflammatory, and lifestyle-related diseases. Nonetheless, an insufficient investigation has been performed to determine whether intermittent fasting has therapeutic benefits on periodontal inflammation and diseases. Here, we show the interrelationship between metabolic syndrome and periodontal disease and contextualize the beneficial impact of intermittent fasting in modulating the chronic metabolic and periodontal inflammatory response. We also anticipate that this review paves the way for further exploration of intermittent fasting as a unique research paradigm representing a cost-effective alternative strategy to conventional disease management in patients with periodontal diseases and metabolic syndrome which may serve as the foundation for an integrative vision relevant to primary, diagnostic, and therapeutic purposes.

Patients with obstructive sleep apnea can favor the predisposing factors of periodontitis by the presence of P. melaninogenica and C. albicans, increasing the severity of the periodontal disease

Objective

The aim of this study was to analyze the cultivable oral microbiota of patients with obstructive sleep apnea (OSA) and its association with the periodontal condition.

Methods

The epidemiology profile of patients and their clinical oral characteristics were determined. The microbiota was collected from saliva, subgingival plaque, and gingival sulcus of 93 patients classified into four groups according to the periodontal and clinical diagnosis: Group 1 (n = 25), healthy patients; Group 2 (n = 17), patients with periodontitis and without OSA; Group 3 (n = 19), patients with OSA and without periodontitis; and Group 4 (n = 32), patients with periodontitis and OSA. Microbiological samples were cultured, classified, characterized macroscopically and microscopically, and identified by MALDI-TOF-MS. The distribution of complexes and categories of microorganisms and correlations were established for inter- and intra-group of patients and statistically evaluated using the Spearman r test (p-value <0.5) and a multidimensional grouping analysis.

Result

There was no evidence between the severity of OSA and periodontitis (p = 0.2813). However, there is a relationship between the stage of periodontitis and OSA (p = 0.0157), with stage III periodontitis being the one with the highest presence in patients with severe OSA (prevalence of 75%; p = 0.0157), with more cases in men. The greatest distribution of the complexes and categories was found in oral samples of patients with periodontitis and OSA (Group 4 P-OSA); even Candida spp. were more prevalent in these patients. Periodontitis and OSA are associated with comorbidities and oral conditions, and the microorganisms of the orange and red complexes participate in this association. The formation of the dysbiotic biofilm was mainly related to the presence of these complexes in association with Candida spp.

Conclusion

Periodontopathogenic bacteria of the orange complex, such as Prevotella melaninogenica, and the yeast Candida albicans, altered the cultivable oral microbiota of patients with periodontitis and OSA in terms of diversity, possibly increasing the severity of periodontal disease. The link between yeasts and periodontopathogenic bacteria could help explain why people with severe OSA have such a high risk of stage III periodontitis. Antimicrobial approaches for treating periodontitis in individuals with OSA could be investigated in vitro using polymicrobial biofilms, according to our findings.

Association between components of metabolic syndrome and periodontitis: a systematic review and meta-analysis

OBJECTIVES

To evaluate the role of metabolic syndrome (MetS) components in the association with periodontitis (PE) (#CRD42020218310).

MATERIALS AND METHODS

A systematic electronic search was performed in PUBMED, Scielo and Lilacs databases up to April 2022. Cross-sectional, case-control, and cohort studies presenting data on the association between MetS and PE in the adult and elderly populations were included. A random effect meta-analysis was performed to determine association effect estimates. Results interpretation followed the assessment of methodological quality (Joana Briggs Institute tool) together with the certainty of evidence (GRADE approach).

RESULTS

This review included 52 studies, totalling 140,434 participants, and 38 studies were meta-analyzed. Association between PE and MetS was observed (OR_adj from 1.27 to 1.90; PR_ajd = 1.19; RR_adj from 1.10 to 1.37) (low and very low certainty of evidence). Hyperglycaemia (OR = 1.18), HDL (OR = 1.16), obesity (OR = 1.08), and hypertension (OR = 1.11) were associated with PE, except triglycerides (low and very low certainty of evidence). There was a dose-response gradient between the number of MetS components and PE, with a gradual increase in the effect magnitude for 1 (OR = 1.14), 2 (OR = 1.52), 3 or more (OR = 1.79), and 4 or 5 components (OR = 2.02) (low to high certainty of evidence).

CONCLUSIONS

MetS was associated with PE, with a dose-response gradient between the number of MetS components and the occurrence of PE, with an increasing effect magnitude according to an increasing number of components.

CLINICAL RELEVANCE

Periodontal examination should be part of a comprehensive propaedeutic approach of MetS patients, particularly those presenting a great number of components.

Association Between Periodontitis and Metabolic Syndrome in Females: A Systematic Review and Meta-analysis

Background:

Metabolic syndrome (MetS) and periodontal diseases (PDs) have shown a bidirectional and vice versa relationship. Hence, this study aimed to identify the extent and magnitude between MetS and PDs in females.

Materials and Methods:

A published literature was explored by considering case–control, cross-sectional, and cohort studies that involved patients with measurements of MetS and PD. Ovid MEDLINE, EMBASE, LILACS, and Cochrane Library databases were used for the search. This study examined the relationship between the MetS and PD among females.

Results:

Of the initial 4150 titles screened, a total of 37 reported papers were eligible for quantitative review. A gender-wise analysis of the findings revealed a crude odds ratio (OR) of 1.385 [95% confidence interval (CI): 1.043–1.839, I² = 94.61%, P < 0.001] for the females relative to the average OR of 1.54 (95% CI: 1.39–1.71, I² = 90.95%, P < 0.001). Further subgroup analysis for directionality in females revealed the crude ORs of 1.28 (95% CI: 0.91–1.79, I² = 96.44%, P < 0.001) for the relationship between PD and MetS, whereas an OR of 2.12 (95% CI: 0.78–5.73, I² = 88.31%, P < 0.001) was found between MetS and PDs.

Conclusion:

This study lacks convincing proof of a link between MetS and PDs in females when compared with an overall association between MetS and PDs. Directionality indicated higher odds of linking between MetS and PD than PD and MetS among females. Further longitudinal and treatment trials are needed to confirm the association among females.

Association between metabolic syndrome and periodontitis: The role of lipids, inflammatory cytokines, altered host response, and the microbiome

Periodontitis has been associated with many systemic diseases and conditions, including metabolic syndrome. Metabolic syndrome is a cluster of conditions that occur concomitantly and together they increase the risk of cardiovascular disease and double the risk of type 2 diabetes. In this review, we focus on the association between metabolic syndrome and periodontitis; however, we also include information on diabetes mellitus and cardiovascular disease, since these two conditions are significantly intertwined with metabolic syndrome. With regard to periodontitis and metabolic syndrome, to date, the vast majority of studies point to an association between these two conditions and also demonstrate that periodontitis can contribute to the development of, or can worsen, metabolic syndrome. Evaluating the effect of metabolic syndrome on the salivary microbiome, data presented herein support the hypothesis that the salivary bacterial profile is altered in metabolic syndrome patients compared with healthy patients. Considering periodontitis and these three conditions, the vast majority of human and animal studies point to an association between periodontitis and metabolic syndrome, diabetes, and cardiovascular disease. Moreover, there is evidence to suggest that metabolic syndrome and diabetes can alter the oral microbiome. However, more studies are needed to fully understand the influence these conditions have on each other.

The Dental, Oral, Medical Epidemiological (DOME) Study: Protocol and Study Methods

OBJECTIVES

To develop and present the methods utilized for the Dental, Oral, Medical Epidemiological (DOME) study.

METHODS

The DOME is an electronic record-based cross-sectional study, that was conducted to measure the dental, periodontal, and oral morbidities and their associations with systemic morbidities, among a nationally representative sample of young to middle-aged adults military personnel from the IDF (Israel Defense Forces). To that end, we developed a strict protocol including standardized terminology, data collection, and handling.

RESULTS

Data for the DOME study was derived simultaneously from three electronic records of the IDF: (1) a central demographic database, (2) the dental patient record (DPR), and (3) the medical computerized patient record (CPR). The established DOME repository includes socio-demographic, dental and medical records of 132,354 young to middle-age military personnel from the IDF, who attended the dental clinics during the year 2015. Records of general military personnel (N > 50,000), with no recorded dental visits during the study period, served as a control group regarding all other parameters except dental. The DOME study continues and is currently collecting longitudinal data from the year 2010 until 2020. The IDF employs a standardized uniform administrative and clinical work-up and treatment protocols as well as uniform computerized codes. We describe the standardized definitions for all the parameters that were included: socio-demographics, health-related habits, medical and dental attendance patterns, and general and dental health status. Multicollinearity analysis results of the sociodemographic and medical study parameters are presented.

CONCLUSION

Standardized work-up and definitions are essential to establish the centralized DOME data repository to study the extent of dental and systemic morbidities and their associations.

Association of Periodontitis With Metabolic Syndrome: A Case-Control Study

Aim:

This study was undertaken to assess the association between periodontitis and metabolic syndrome.

Materials and Methods:

A case-control study was designed among 100 cases as patients with metabolic syndrome aged 35–74 years, and age- and sex-matched 100 controls as apparently healthy relatives or friends accompanying the cases visiting the diabetic outpatient department at Victoria Hospital, Bengaluru, Karnataka, India, using convenience sampling method. Information related to diabetes, hypertension, and oral hygiene practices was collected. Periodontal health status was measured using community periodontal index. Metabolic syndrome was diagnosed based on the criteria of National Cholesterol Education Program Adult Treatment Panel III. Chi-square test and logistic regression were used for analysis.

Results:

Significantly more number of cases had shallow pockets 4–5 mm, deep pockets ≥ 6 mm, and also more number of loss of attachment code 1, code 2, code 3, and code 4 compared to controls. Bivariate analysis showed significant association between metabolic syndrome and body mass index, smoking, and tobacco chewing. The association between periodontitis and metabolic syndrome was significant with increased risk of developing metabolic syndrome among the subjects with community periodontal index code 3 and code 4 (odds ratio [OR] = 17) and among the subjects having loss of attachment code 1, code 2, code 3, and code 4 (OR = 12). Association remained significant even after adjustment with other variables (adjusted OR = 6).

Conclusion:

This study showed significant association between periodontitis and metabolic syndrome. Further prospective and randomized control trials are recommended to assess causal association between these two diseases.

Strategies for the prevention of periodontal disease and its impact on general health in Latin America. Section III: Prevention

Dental plaque removal and the understanding of risk factors, risk indicators and social determinants are important components in the prevention of periodontal disease. Periodontal diseases and dental caries are largely preventable conditions, but require a "common risk factor approach" with non-communicable diseases with the purpose of improving their prevention and control, and positive impact on health. The aim of this consensus was to identify the evidence and gaps in periodontal prevention in Latin American, and to propose individual and collective recommendations for the population, health professionals, dental practice and government. The prevention of periodontal diseases in Latin America has mainly been focused on oral hygiene instruction, use of toothbrushes and interproximal devices, but in some patients, it is necessary to use adjuncts to these measures, such as antimicrobial and/or probiotic products that are backed by broad scientific evidence. Some evidence has shown that there are inadequate knowledge, attitudes and practices among patients, dentist and other health professionals. The prevention of periodontal diseases and caries should be adopted as a healthy lifestyle routine, because of their local and systemic effects. Recently, new empowerment strategies have been proposed in order to generate behavioral changes. Periodontal diseases can often be prevented, or controlled by joined efforts between government health systems, scientific associations, universities, health professionals, private companies and communities. In conclusion, the relations between periodontal diseases, caries, healthy lifestyles and NCD's offer an ideal opportunity to change Latin American prevention strategies at both the individual level and population levels.

Periodontal Diseases and the Risk of Metabolic Syndrome: An Updated Systematic Review and Meta-Analysis

Background: Periodontitis and metabolic syndrome (MetS) are two major global health problems that are widely prevalent in the world, although the former is a common infection in developing countries and the latter is a non-infectious but prevalent disease in developed countries. This study aims to provide an updated review on the existence and magnitude of the relationship between periodontal disease and the risk of MetS. Methods: We searched the PubMed, Web of Science, ScienceDirect, Chinese National Knowledge Infrastructure, and Wanfang databases for original studies assessing the association between periodontitis and MetS published before August 2019. We calculated the pooled crude and adjusted odds ratios (ORs) together with the 95% confidence intervals (95% CIs) to estimate the strength of this association. Subgroup analysis was performed by considering the diagnostic method or the country where the studies were performed. Results: We identified 43 potentially eligible articles for this systematic review, including 32 cross-sectional studies, eight case-control studies, and three cohort studies. Among them, 39 articles presented enough information to be included in the meta-analysis. The pooled crude and adjusted ORs were 1.99 (95% CI: 1.75-2.25) and 1.46 (95% CI: 1.31-1.61), respectively. Subgroup analysis showed a consistent relation stratified by either the diagnostic method or the country where the studies were performed. The pooled OR was 1.68 (95% CI: 1.41-2.00) for Japan, 1.75 (95% CI: 1.31-2.34) for the USA, 1.81 (95% CI: 1.35-2.42) for Korea, and 2.29 (95% CI: 1.53-3.41) for China. Conclusion: Our results provide compelling evidence for the association between periodontitis and MetS. Patients with periodontal disease are a critical screening population for MetS. We also recommend that people exhibiting components of MetS should receive a periodontal check-up and pay attention to their oral health.

Oral microbiota-induced periodontitis: a new risk factor of metabolic diseases

It has recently become evident that the periodontium (gingiva, desmodontal ligament, cementum and alveolar bone) and the associated microbiota play a pivotal role in regulating human health and diseases. The oral cavity is the second largest microbiota in the body with around 500 different bacterial species identified today. When disruption of oral cavity and dysbiosis occur, the proportion of strict anaerobic Gram-negative bacteria is then increased. Patients with periodontitis present 27 to 53% more risk to develop diabetes than the control population suggesting that periodontitis is an aggravating factor in the incidence of diabetes. Moreover, dysbiosis of oral microbiota is involved in both periodontal and metabolic disorders (cardiovascular diseases, dyslipidaemia …). The oral diabetic dysbiosis is characterized by a specific bacteria Porphyromonas, which is highly expressed in periodontal diseases and could exacerbate insulin resistance. In this review, we will address the nature of the oral microbiota and how it affects systemic pathologies with a bidirectional interaction. We also propose that using prebiotics like Akkermansia muciniphila may influence oral microbiota as novel therapeutic strategies. The discovery of the implication of oral microbiota for the control of metabolic diseases could be a new way for personalized medicine.

Associations between caries experience, dietary habits, and metabolic syndrome in Japanese adults

Dental caries could be a risk factor for metabolic syndrome (MetS); however, there is limited evidence of such a relationship in the literature. This cross-sectional study investigated the relationships among dental caries experience, dietary habits, and MetS in Japanese adults. A total of 937 participants aged 40-74 years underwent a health check, including dental examination. Decayed, missing, and filled teeth (DMFT) were used as an index of caries experience. The mean DMFT score was 14, and 12% of the participants had MetS in this study. Multivariate logistic regression analyses showed that the prevalence of MetS was significantly related to DMFT (first vs. fourth quartile, odds ratio [OR] = 1.80; P < 0.05). In addition, the OR of DMFT for MetS was found to be greater in each successively higher DMFT quartile. The prevalence of MetS was significantly related to daily coffee consumption (OR = 0.51, P < 0.01), and the relationship between DMFT and MetS was noted after adjusting for daily coffee consumption. There appears to be a positive association between caries experience and MetS in Japanese adults. This relationship increased with the increase in DMFT regardless of dietary habits.

Where periodontitis meets metabolic syndrome-The role of common health-related risk factors

OBJECTIVES

To analyse and compare associations between metabolic syndrome (MetS) and its components in periodontitis compared to control patients.

METHODS

This 7-year cross-sectional study retrospectively analysed medical records of 504 individuals aged 18-90 who attended the student dental clinic between 2008 and 2014. Demographics, smoking habits, blood pressure, waist circumference, as well as presence of: periodontitis, MetS, diabetes, hypertension, hyperlipidaemia, stroke, heart disease, cancer and psychiatric disorders were recorded.

RESULTS

The study population composed of 231 (45.8%) males and 273 (54.2%) females, with an average age of 55.79 ± 16.91 years. A patient profile associated with periodontitis was identified and included male sex, older age, smoking, higher smoking pack-years, abdominal obesity, higher systolic and diastolic blood pressures, the presence of MetS or its components, hypertension, hyperlipidaemia, diabetes or diseases associated with its consequences such as ischaemic heart disease and stroke. Following multivariate logistic regression analysis, age and smoking retained a significant association with periodontitis, whereas the systemic disorders did not.

CONCLUSIONS

The association between periodontitis and MetS may be explained by shared common profile and risk factors. An appropriate risk factors management approach should be adopted by both dental and general health clinicians and health authorities, to control common high-risk behaviours.

Finding diseases associated with amyotrophic lateral sclerosis: a total population-based case-control study

OBJECTIVE

To investigate diseases associated with amyotrophic lateral sclerosis (ALS) by using a total population-based medical database.

METHODS

This study included 705 ALS patients aged older than 15 years diagnosed from January 1, 2007, to December 31, 2013, along with 14,100 controls matching in sex, age, residence, and insurance premium. Data from the National Health Insurance Research Database (NHIRD) and Serious Disabling Diseases (SDD) database in Taiwan were used to conduct a total population-based case-control study. Prior diseases were categorized as being diagnosed 1, 3, 5, 7, or 9 years before first ALS diagnosis. Chi-square or t test was used to examine differences in demographic characteristics between the new patients with ALS and controls. Previous diseases were screened using a conditional logistic regression model. Multivariate analysis was performed using stepwise selection to evaluate the association between these diseases and the risk of ALS. The path analysis was conducted to analyze the pathway between prior diseases and ALS.

RESULTS

In total, 28 diseases were associated with ALS, including 17 positive associations and 11 negative associations. The path analysis revealed that the 11 negatively associated diseases could be attributed to diabetes mellitus and its comorbidities. The 17 positively associated diseases could be categorized as metabolic syndrome, neuroinflammation, head trauma, sports injuries, infections, and their comorbidities.

CONCLUSIONS

Our results support the hypothesis that diseases developing prior to ALS diagnoses are hypermetabolic disorders. Hypometabolic disorders may have a beneficial effect on ALS incidence. Defective energy metabolism may play a role in ALS pathogenesis.

Association between metabolic syndrome and periodontitis: a systematic review and meta-analysis

The aim of the present study was to evaluate the association between metabolic syndrome (MS) and periodontitis (PD), through a systematic review and meta-analysis. Original observational studies assessing the association between MS and PD in adults, published before May 11th (2017), were identified through electronic searches of MEDLINE, EMBASE and Cochrane Library databases. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guideline was used. For studies to be included, they had to mention the criteria used to diagnose MS and to have used at least one clinical measure to diagnose PD. There was no language restriction. Three reviewers independently identified eligible studies for possible inclusion in the systematic review and meta-analysis. The quality of the studies was evaluated by the Newcastle-Ottawa scale for observational studies. A random model meta-analysis was conducted. The strategies used to investigate heterogeneity were sequential analysis, subgroup analysis, univariate meta-regression and sensitivity analysis. Thirty-three studies met the inclusion criteria for the systematic review, and 26 had enough information to be included in the meta-analysis, totaling 52,504 patients. MS and PD were associated with an odds ratio of 1.38 (95%CI 1.26-1.51; I2 = 92.7%; p < 0.001). Subgroup analysis showed that complete periodontal examination (I2 = 70.6%; p < 0.001) partially explained the variability between studies. The present findings suggest an association between MS and PD. Individuals with MS are 38% more likely to present PD than individuals without this condition. Prospective studies should be conducted to establish cause and effect relations between MS and PD.