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Wu Y, He B, Chen Q, Yu R, Wu Y, Yang H, Yu Y, Yan F, Li Y, Chen F. Association between Mediterranean diet and periodontitis among US adults: The mediating roles of obesity indicators. J Periodontal Res 2024; 59:32-41. [PMID: 37842947 DOI: 10.1111/jre.13195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 09/04/2023] [Accepted: 10/01/2023] [Indexed: 10/17/2023]
Abstract
OBJECTIVE This study aimed to assess the association between the Mediterranean diet (MedDiet) and periodontitis in US adults and to further explore the mediating roles of obesity indicators in this association. BACKGROUND DATA The relationship between MedDiet and periodontitis is controversial. And it is unclear whether obesity indicators are potential mediators of this relationship. METHODS Using data derived from the National Health and Nutrition Examination Survey (2009-2014). Weighted binary logistic regression and restricted cubic spline were used to assess the association between MedDiet and periodontitis. Weighted ordinal logistic regression was performed to evaluate the relationship between MedDiet and periodontitis severity. The mediating roles of body mass index (BMI) and waist circumference in the relationship between the MedDiet and periodontitis were explored. Association analyses were further performed using mean clinical attachment loss (CAL) or mean periodontal probing depth (PPD) as dependent variables. The false discovery rate method was used to correct the p-values in the regression analyses. RESULTS A total of 8290 eligible participants (4159 participants with periodontitis and 4131 without periodontitis) were included. A negative association between the MedDiet adherence score and periodontitis was observed in the binary logistic regression model (adjusted odds ratio = 0.94, 95% confidence interval: 0.90-0.97, p = .001). Restricted cubic spline regression revealed a dose-response relationship between the MedDiet adherence score and periodontitis. BMI and waist circumference significantly mediate this association, with mediation proportions of 9.7% (p = .032) and 9.3% (p = .012), respectively. Multivariable ordinal logistic regression showed that the MedDiet adherence score was negatively associated with the severity of periodontitis (all p < .05). Additionally, the MedDiet adherence score was negatively associated with mean PPD or mean CAL (all p < .05). CONCLUSIONS This study suggests a significant negative association between adherence to the MedDiet and periodontitis and a possible mediating role of obesity indicators in this association. Furthermore, studies are still warranted to confirm our findings.
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Affiliation(s)
- Yuying Wu
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, China
| | - Baochang He
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, China
| | - Qiansi Chen
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, China
| | - Rong Yu
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, China
| | - Yuxuan Wu
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, China
| | - Han Yang
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, China
| | - Yiming Yu
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, China
| | - Fuhua Yan
- Department of Periodontology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Yanfen Li
- Department of Periodontology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Fa Chen
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, China
- Clinical Research Unit, The Second Affiliated Hospital, Fujian Medical University, Quanzhou, China
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Lu Z, Li Y, Chowdhury N, Yu H, Syn WK, Lopes-Virella M, Yilmaz Ö, Huang Y. The Presence of Periodontitis Exacerbates Non-Alcoholic Fatty Liver Disease via Sphingolipid Metabolism-Associated Insulin Resistance and Hepatic Inflammation in Mice with Metabolic Syndrome. Int J Mol Sci 2023; 24:8322. [PMID: 37176029 PMCID: PMC10179436 DOI: 10.3390/ijms24098322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 04/27/2023] [Accepted: 05/03/2023] [Indexed: 05/15/2023] Open
Abstract
Clinical studies have shown that periodontitis is associated with non-alcoholic fatty liver disease (NAFLD). However, it remains unclear if periodontitis contributes to the progression of NAFLD. In this study, we generated a mouse model with high-fat diet (HFD)-induced metabolic syndrome (MetS) and NAFLD and oral P. gingivalis inoculation-induced periodontitis. Results showed that the presence of periodontitis increased insulin resistance and hepatic inflammation and exacerbated the progression of NAFLD. To determine the role of sphingolipid metabolism in the association between NAFLD and periodontitis, we also treated mice with imipramine, an inhibitor of acid sphingomyelinase (ASMase), and demonstrated that imipramine treatment significantly alleviated insulin resistance and hepatic inflammation, and improved NAFLD. Studies performed in vitro showed that lipopolysaccharide (LPS) and palmitic acid (PA), a major saturated fatty acid associated with MetS and NAFLD, synergistically increased the production of ceramide, a bioactive sphingolipid involved in NAFLD progression in macrophages but imipramine effectively reversed the ceramide production stimulated by LPS and PA. Taken together, this study showed for the first time that the presence of periodontitis contributed to the progression of NAFLD, likely due to alterations in sphingolipid metabolism that led to exacerbated insulin resistance and hepatic inflammation. This study also showed that targeting ASMase with imipramine improves NAFLD by reducing insulin resistance and hepatic inflammation.
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Affiliation(s)
- Zhongyang Lu
- Division of Endocrinology, Diabetes and Metabolic Diseases, Department of Medicine, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Yanchun Li
- Division of Endocrinology, Diabetes and Metabolic Diseases, Department of Medicine, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Nityananda Chowdhury
- Department of Oral Health Sciences, The James B. Edwards College of Dental Medicine, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Hong Yu
- Department of Oral Health Sciences, The James B. Edwards College of Dental Medicine, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Wing-Kin Syn
- Division of Gastroenterology and Hepatology, Saint Louis University School of Medicine, Saint Louis, MI 63110, USA
- Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, SC 29425, USA
- Department of Physiology, Faculty of Medicine and Nursing, University of the Basque Country, Universidad del Pa S Vasco/Euskal Herriko Univertsitatea (UPV/EHU), 48940 Leioa, Spain
| | - Maria Lopes-Virella
- Division of Endocrinology, Diabetes and Metabolic Diseases, Department of Medicine, Medical University of South Carolina, Charleston, SC 29425, USA
- Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC 29401, USA
| | - Özlem Yilmaz
- Department of Oral Health Sciences, The James B. Edwards College of Dental Medicine, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Yan Huang
- Division of Endocrinology, Diabetes and Metabolic Diseases, Department of Medicine, Medical University of South Carolina, Charleston, SC 29425, USA
- Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC 29401, USA
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Association of Diet-Related Systemic Inflammation with Periodontitis and Tooth Loss: The Interaction Effect of Diabetes. Nutrients 2022; 14:nu14194118. [PMID: 36235769 PMCID: PMC9572370 DOI: 10.3390/nu14194118] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 09/27/2022] [Accepted: 09/28/2022] [Indexed: 11/16/2022] Open
Abstract
Diet is an important factor that can affect inflammatory processes. Diet-related systemic inflammation is closely linked to periodontitis and tooth loss. However, the role that systemic conditions play in influencing this association remains unclear. A cross-sectional analysis was conducted using the National Health and Nutrition Examination Survey (NHANES) from 2009 to 2014. Diet-related systemic inflammation was assessed by the Dietary Inflammatory Index (DII). Multivariate Cox regression models were used to investigate the association between DII and periodontal results, including total periodontitis, tooth loss, severe tooth loss, and the number of teeth lost. The interaction effects between DII and established covariates were tested. Higher DII scores, corresponding to a higher pro-inflammatory potential of the diet, were associated with an increased risk of periodontitis and tooth loss among the 10,096 eligible participants. There was an interaction between diabetes and DII on total periodontitis (p = 0.0136). No significant interaction effect was detected between DII and other established covariates. Participants who consumed an anti-inflammatory diet, and did not have diabetes, experienced the lowest risks of periodontitis and tooth loss. However, in the context of diabetes, the efficacy of such a diet may be weakened or even eliminated. Dietary interventions to manage oral health problems may need to take the individual's metabolic condition into account.
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Lee YC, Lee JW, Kwon YJ. Comparison of the triglyceride glucose (TyG) index, triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio, and metabolic score for insulin resistance (METS-IR) associated with periodontitis in Korean adults. Ther Adv Chronic Dis 2022; 13:20406223221122671. [PMID: 36120508 PMCID: PMC9478708 DOI: 10.1177/20406223221122671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 08/10/2022] [Indexed: 11/30/2022] Open
Abstract
Background: Periodontitis is one of the most common diseases associated with the oral
cavity. Previous studies have suggested that there is an association between
periodontitis and metabolic dysfunction. Recently, the triglyceride glucose
(TyG) index, high-density lipoprotein cholesterol (TG/HDL-C) ratio, and
metabolic score for insulin resistance (METS-IR) index have been identified
as useful markers for assessing insulin resistance. Objective: This study aimed to evaluate the relationship between periodontitis and
non-insulin-based insulin resistance (IR) indices and compare the predictive
values of these indices in the Korean population. Design: This is a cross-sectional study. Methods: A total of 13,584 participants were included in the 2013–2015 Korean National
Health and Nutrition Examination Survey data. A community periodontal index
score⩾3 was used to define periodontitis. Participants were divided into
quartiles according to each index. Odds ratios (ORs) and 95% confidence
intervals (CIs) for the prevalence of periodontitis and the TyG index,
TG/HDL-C ratio, and METS-IR index quartiles were calculated using multiple
logistic regression analysis. We estimated the areas under the receiver
operating characteristic curves (AUCs) of the indices to compare the
predictive values of the three indices. Results: Compared with quartile 1, the fourth quartile ORs (95% CIs) for periodontitis
were 1.23 (1.01–1.49) for the TyG index, 1.23 (1.02–1.48) for the TG/HDL-C
ratio, and 1.53 (1.25–1.88) for the METS-IR index after adjustment for
confounders. The AUC (95% CIs) was 0.608 (0.598–0.618) for the TyG index,
0.600 (0.590–0.610) for the TG/HDL-C ratio, and 0.617 (0.608–0.627) for the
METS-IR index to identify periodontitis. The predictive power of METS-IR was
significantly higher than that of the TyG index and TG/HDL-C. Conclusion: Higher TG/HDL-C ratio, TyG, and METS-IR indices are associated with a higher
prevalence of periodontitis. The METS-IR index is a more powerful predictor
of periodontitis prevalence than the TyG index and TG/HDL-C ratio.
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Affiliation(s)
- Yea-Chan Lee
- Department of Medicine, Graduate School of Medicine, Yonsei University, Seoul, Republic of Korea.,The 3rd Air and Missile Defense Brigade, Air & Missile Defense Command, Republic of Korea Air Force, Seoul, Republic of Korea
| | - Ji-Won Lee
- Department of Family Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yu-Jin Kwon
- Professor, Department of Family Medicine, Yonsei University College of Medicine, Yongin Severance Hospital, 363, Dongbaekjukjeon-daero, Giheung-gu, Yongin-si 16995, Gyeonggi-do, Republic of Korea
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Thalla S, Kamaraj R, Kavitha A. Increasing risk factors of non-alcoholic fatty liver disease, a look into chronic periodontitis and insulin resistance. Endocr Metab Immune Disord Drug Targets 2022; 22:807-814. [PMID: 34983354 DOI: 10.2174/1871530322666220104095534] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 10/21/2021] [Accepted: 10/27/2021] [Indexed: 11/22/2022]
Abstract
Non-alcoholic fatty liver disease (NAFLD) is marked by the excessive intrusion of triglycerides into hepatocytes without any role of alcohol consumption. Various risk factors have been attributed to this disease pathogenesis which involves metabolic disorders, immune response, and even an intricate relationship between the two. The role of insulin resistance (IR) in NAFLD has long been known; however, the molecular basis of disease progression under this metabolic backdrop is still being investigated. Similarly, the periodontitis-mediated immune response is another major factor involved in NAFLD manifestation which has generated huge interest. The prevalence of pathogenic bacteria elicits a strong immune response which according to studies shows a strong correlation with NAFLD state. Such pre-existing conditions have a strong probability of explaining the disease onset. Additionally, increasing reports of inflammatory response and its links to insulin resistance have further increased the scope of understanding NAFLD. Through this review, we aim to elaborate on these factors explaining their role in the disease progression.
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Affiliation(s)
- Sreenu Thalla
- Department of Pharmacology, SRM College of Pharmacy, SRMIST, Kattankalathur, Tamil Nadu - 603203
| | - Kamaraj R
- SRM College of Pharmacy, SRMIST, Kattankalathur, Tamil Nadu - 603203
| | - Kavitha A
- Department of Gastroenterology, Guntur Medical College & Government General Hospital, Guntur, Andhra Pradesh - 522004
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Qureshi A, Haque Z, Qureshi H, Farooqui WA. Effects of Metronidazole as an Adjunct to Non-Surgical Periodontal Therapy on Insulin Resistance in Type 2 Diabetics. Antibiotics (Basel) 2021; 10:antibiotics10111400. [PMID: 34827338 PMCID: PMC8615120 DOI: 10.3390/antibiotics10111400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 11/07/2021] [Accepted: 11/08/2021] [Indexed: 12/18/2022] Open
Abstract
Treating periodontitis with metronidazole (MET) as an adjunct to scaling root planing (SRP) is suggested to have inconsistent effects on insulin resistance (IR) in type 2 diabetes mellitus (T2DM). This paper will present the effects of MET, in addition to SRP, on the homeostatis model assessment of IR (HOMA-IR). A three-arm clinical trial was conducted and analyses were performed on T2DM participants with periodontitis (n = 74) who completed follow-up visits at 3 and 6 months after the intervention. The observed between-group and within-group mean changes in IR were found using ANOVA with repeated measures, followed by a post-hoc analysis, and a p-value of ≤0.05 was considered significant. Between-group analyses showed no difference in the HOMA-IR at 3 months, but at 6 months the difference was significant (p = 0.046). Within-group analyses showed that the HOMA-IR was significantly reduced in both test groups (p ≤ 0.05) over the period of time. Adjunct use of MET may result in a sudden short-term lowering of the HOMA-IR level within 3 months that may not be retained over 6 months when compared to the sustained lowering of the HOMA-IR levels in T2DM when intervened with SRP without MET.
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Affiliation(s)
- Ambrina Qureshi
- Department of Community & Preventive Dentistry, Dow University of Health Sciences, Karachi 74200, Pakistan
- Correspondence: ; Tel.: +92-33-3346-3585
| | - Zeba Haque
- Department of Biochemistry, Dow International Medical College, Dow University of Health Sciences, Karachi 74200, Pakistan;
| | - Hina Qureshi
- Department of Pathology, The Kidney Center Postgraduate Institute, Karachi 75260, Pakistan;
| | - Waqas Ahmed Farooqui
- School of Public Health, Dow University of Health Sciences, Karachi 74200, Pakistan;
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Machado V, Botelho J, Viana J, Pereira P, Lopes LB, Proença L, Delgado AS, Mendes JJ. Association between Dietary Inflammatory Index and Periodontitis: A Cross-Sectional and Mediation Analysis. Nutrients 2021; 13:nu13041194. [PMID: 33916342 PMCID: PMC8066166 DOI: 10.3390/nu13041194] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 04/01/2021] [Accepted: 04/02/2021] [Indexed: 01/08/2023] Open
Abstract
Inflammation-modulating elements are recognized periodontitis (PD) risk factors, nevertheless, the association between dietary inflammatory index (DII) and PD has never been appraised. We aimed to assess the association between DII and PD and the mediation effect of DII in the association of PD with systemic inflammation. Using the National Health and Nutrition Examination Survey 2009–2010, 2011–2012 and 2013–2014, participants who received periodontal exam and provided dietary recall data were included. The inflammatory potential of diet was calculated via DII. PD was defined according to the 2012 case definition. White blood cells (WBC), segmented neutrophils and C-reactive protein (CRP) were used as proxies for systemic inflammation. The periodontal measures were regressed across DII values using adjusted multivariate linear regression and adjusted mediation analysis. Overall, 10,178 participants were included. DII was significantly correlated with mean periodontal probing depth (PPD), mean clinical attachment loss (CAL), thresholds of PPD and CAL, WBC, segmented neutrophils and DII (p < 0.01). A linear regression logistic adjusted for multiple confounding variables confirmed the association between DII and mean PPD (B = 0.02, Standard Error [SE]: 0.02, p < 0.001) and CAL (B = −0.02, SE: 0.01, p < 0.001). The association of mean PPD and mean CAL with both WBC and segmented neutrophils were mediated by DII (from 2.1 to 3.5%, p < 0.001). In the 2009–2010 subset, the association of mean CAL with serum CRP was mediated by DII (52.0%, p < 0.01). Inflammatory diet and PD may be associated. Also, the inflammatory diet significantly mediated the association of leukocyte counts and systemic inflammation with PD.
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Affiliation(s)
- Vanessa Machado
- Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz–Cooperativa de Ensino Superior, 2829-511 Almada, Portugal; (V.M.); (J.V.); (L.B.L.); (A.S.D.); (J.J.M.)
- Evidence-Based Hub, Clinical Research Unit, Centro de Investigação Interdisciplinar Egas Moniz, 2829-511 Almada, Portugal;
| | - João Botelho
- Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz–Cooperativa de Ensino Superior, 2829-511 Almada, Portugal; (V.M.); (J.V.); (L.B.L.); (A.S.D.); (J.J.M.)
- Evidence-Based Hub, Clinical Research Unit, Centro de Investigação Interdisciplinar Egas Moniz, 2829-511 Almada, Portugal;
- Correspondence: ; Tel.: +351-212-946-800
| | - João Viana
- Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz–Cooperativa de Ensino Superior, 2829-511 Almada, Portugal; (V.M.); (J.V.); (L.B.L.); (A.S.D.); (J.J.M.)
| | - Paula Pereira
- Grupo de Estudos em Nutrição Aplicada (GENA), CiiEM, Egas Moniz–Cooperativa de Ensino Superior, 2829-511 Almada, Portugal;
| | - Luísa Bandeira Lopes
- Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz–Cooperativa de Ensino Superior, 2829-511 Almada, Portugal; (V.M.); (J.V.); (L.B.L.); (A.S.D.); (J.J.M.)
| | - Luís Proença
- Evidence-Based Hub, Clinical Research Unit, Centro de Investigação Interdisciplinar Egas Moniz, 2829-511 Almada, Portugal;
- Quantitative Methods for Health Research (MQIS), CiiEM, Egas Moniz–Cooperativa de Ensino Superior, 2829-511 Almada, Portugal
| | - Ana Sintra Delgado
- Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz–Cooperativa de Ensino Superior, 2829-511 Almada, Portugal; (V.M.); (J.V.); (L.B.L.); (A.S.D.); (J.J.M.)
| | - José João Mendes
- Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz–Cooperativa de Ensino Superior, 2829-511 Almada, Portugal; (V.M.); (J.V.); (L.B.L.); (A.S.D.); (J.J.M.)
- Evidence-Based Hub, Clinical Research Unit, Centro de Investigação Interdisciplinar Egas Moniz, 2829-511 Almada, Portugal;
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Tian J, Liu C, Zheng X, Jia X, Peng X, Yang R, Zhou X, Xu X. Porphyromonas gingivalis Induces Insulin Resistance by Increasing BCAA Levels in Mice. J Dent Res 2020; 99:839-846. [PMID: 32176550 DOI: 10.1177/0022034520911037] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Insulin resistance is one of the critical pathogeneses of type 2 diabetes mellitus (T2DM). Elevated levels of plasma branched-chain amino acids (BCAAs) are associated with insulin resistance. Recent studies have demonstrated the role of Porphyromonas gingivalis in the development of insulin resistance. However, the mechanisms by which P. gingivalis induces insulin resistance are still unclear. The purpose of this study was to investigate whether P. gingivalis induces insulin resistance through BCAA biosynthesis. We established a murine model of periodontitis by infecting mice with P. gingivalis. Alveolar bone loss, insulin sensitivity, and the plasma level of BCAAs were measured. A P. gingivalis BCAA aminotransferase-deficient strain (∆bcat) was constructed, and its kinetic growth, biofilm formation, and in vivo colonization were compared with its wild-type strain. Alveolar bone loss, insulin sensitivity, and the plasma level of BCAAs of the mice infected with either wild-type strain or ∆bcat strain were further measured. We found that periodontal infection with P. gingivalis significantly upregulated the plasma level of BCAAs and aggravated the high-fat diet (HFD)-induced insulin resistance. Bcat deletion did not alter the growth, biofilm formation, and in vivo colonization of P. gingivalis. More important, the ∆bcat strain was unable to upregulate the plasma level of BCAAs and induce insulin resistance in HFD-fed mice. These findings suggest that the BCAA biosynthesis of P. gingivalis plays a critical role in the development of insulin resistance in the HFD-fed mice. The BCAA biosynthesis pathways may provide a potential target for the disruption of linkage between periodontitis and T2DM.
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Affiliation(s)
- J Tian
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - C Liu
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Periodontology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - X Zheng
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - X Jia
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Pediatric Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - X Peng
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - R Yang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Pediatric Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - X Zhou
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - X Xu
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
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