Relationship between Metabolic Syndrome Components and Periodontal Disease in a Japanese General Population: the Suita Study

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.

Identifying metabolic parameters related to severity and extent of periodontitis in down syndrome patients

BACKGROUND AND OBJECTIVE

Systemic metabolic status and periodontitis can be related in patients with Down syndrome (DS). The objective of this study was to identify metabolic indicators (anthropometric measurements, blood pressure, and serum markers) related to severity and extent of periodontitis in DS patients.

METHODS

A cross-sectional study was conducted with 49 patients with DS. Periodontal evaluation included the periodontal probing depth (PPD), clinical attachment level (CAL), gingival bleeding index (GBI), and visible plaque index (VPI). Periodontitis severity was classified by the stages system. The extent of periodontitis was assessed as the percentage of sites with CAL ≥3 mm, CAL ≥4 mm, PPD ≥4 mm, and PPD ≥5 mm. The metabolic condition of the participants was determined by analyzing anthropometric parameters, blood pressure, and serum markers. Data were analyzed using the Mann-Whitney test, Spearman's correlation coefficient, and multivariate regression analysis.

RESULTS

Periodontitis stage 3/4 was detected in 32.7% of patients, with high values of VPI (54.6 ± 35.8) and GBI (42.4 ± 33.3). The severity of periodontitis was related to higher mean corpuscular hemoglobin (β = .291, p = .028) and mean corpuscular volume values (β = .293, p = .046). Arm circumference measurements were inversely related to CAL ≥3 mm (β = -.408, p = .023), PPD ≥4 mm (β = -.475, p = .006), and PPD ≥5 mm (β = -.443, p = .010).

CONCLUSIONS

The findings suggest that the severity and extent of periodontitis may be related to some metabolic parameters in DS patients.

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.

Screening for a Decreased Masticatory Function by a Color-changeable Chewing Gum Test in Patients with Metabolic Disease

Objective This study aimed to reveal the screening performance of a color-changeable chewing gum test for a decreased masticatory function in the assessment of oral hypofunction in patients with metabolic diseases. Methods We analyzed 1,000 patients with metabolic diseases, including diabetes, dyslipidemia, hypertension, and hyperuricemia. A decreased masticatory function was diagnosed by a gummy jelly test. Patients were asked to chew a test gum, which changed from green to red by thorough mastication, 60 times for 1 minute. The color change was visually evaluated using the color scale, from 1 (green-dominant) to 10 points (red-dominant), and was colorimetrically quantified as delta E in the L*a*b* color space. The screening performance for a decreased masticatory function was evaluated with the receiver operating characteristic (ROC) curve. Results Seventy-seven patients (7.7%) were diagnosed with a decreased masticatory function. The mean color scale and delta E of the gum test were 6.7±1.8 points and 42.9±6.7 units, respectively. The area under the ROC curve was 0.822 (95% confidence interval, 0.768-0.872) for the color scale and 0.838 (0.781-0.890) for delta E (p=0.41). The optimal cut-off point of the color scale was 5.5 (5.0-6.5) points, whereas that of delta E was 37.7 (35.5-38.8) units. The optimal cut-off points were not significantly different between the subgroups divided by clinical characteristics. Conclusions A color-changeable chewing gum test using the color scale as well as delta E would be a useful tool for screening patients with metabolic diseases for a decreased masticatory function in the assessment of oral hypofunction.

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.

Relationship between periodontal diseases and newly-diagnosed metabolic syndrome components in a sub-Saharan population: a cross sectional study

Background

Oral health is a frequently ignored aspect of global health in sub-Saharan patients. Periodontitis, a very frequent oral disease has been proven to be associated to development of the metabolic syndrome. This study aims to evaluate the relationship between periodontal disease and metabolic syndrome components in a sub-Saharan population.

Methods

We performed a cross sectional study in 3 Yaounde hospitals. Consenting adults aged 21 years and above were recruited. Participants who presented with a tooth loss of at least 50% or any condition which could alter values of biological and periodontal parameters (tobacco smoking, pregnancy, chronic kidney disease, cancer) were excluded. Metabolic syndrome elements (glycaemia, arterial pressure, HDL cholesterol, abdominal circumference, triglycerides) and periodontal variables were recorded (plaque and gingival index of Silness and Loe, periodontal pocket depth and clinical attachment loss). These variables were compared using Fisher’s exact Test and odds ratio calculated with 95% confidence intervals.

Results

The prevalence of periodontitis and metabolic syndrome were 43.4% and 10.8% respectively. Age (37.75 ± 13.25, P < 0.001) and poor accessory brushing methods were associated risk factors for development of periodontal disease. Sub-Saharan sindividuals with periodontitis had increased odds of having obesity (OR 11.1 [95% CI 3.97–31.03], P < 0.001) and low HDL (OR 4.58 [95% CI 1.79–11.70], P = 0.001)

Conclusion

Our findings suggest an association between periodontal disease and metabolic syndrome in Sub-Saharan subjects. Increasing age and poor accessory brushing methods are associated risk indicators.

Accuracy of a salivary examination kit for the screening of periodontal disease in a group medical check-up (Japanese-specific health check-up)

The purpose of the present study was to investigate the accuracy of a screening method using salivary tests to screen for periodontal disease.In total, 1888 individuals older than 30 years in 2017 and 2296 in 2018 who underwent medical check-ups for metabolic syndrome agreed to participate and simultaneously underwent a dental examination by dentists and salivary tests. Salivary occult blood, protein, and ammonia levels and white blood cell counts were evaluated in salivary tests using commercially available kits. The relationship between the results of the salivary tests and dental examination was examined and classification performance was analyzed.The prevalence of periodontal disease was 69.9% in 2017 and 66.8% in 2018. Salivary ammonia showed the highest classification performance in both years (sensitivity 83.5 and 83.1%, precision 73.0 and 69.3%, F-measure 0.779 and 0.756). Occult blood, which was assessed using a monoclonal antibody to human hemoglobin, also showed good performance (sensitivity 69.5%, precision 70.6%, F-measure 0.701). Questions regarding self-reported gingival bleeding were not sufficient to screen for periodontitis. The present results suggest that screening tests using salivary samples may detect periodontal disease in approximately 70% to 80% of subjects in a large population.Conclusion: Salivary ammonia and hemoglobin have potential as salivary markers in the screening of periodontal disease.

Correlations between the properties of saliva and metabolic syndrome: A prospective observational study

Saliva tests, which are easy to perform and non-invasive, can be used to monitor both oral disease (especially periodontal disease) and physical conditions, including metabolic syndrome (MetS). Therefore, in the present study the associations between saliva test results and MetS were investigated based on medical health check-up data for a large population. In total, 1,888 and 2,296 individuals underwent medical check-ups for MetS and simultaneous saliva tests in 2017 and 2018, respectively. In the saliva tests, the buffer capacity of saliva, salivary pH, the salivary white blood cell count, the number of cariogenic bacteria in saliva, salivary occult blood, protein, and ammonia levels were tested using a commercially available kit. The relationships between the results of the saliva tests and MetS components were examined in cross-sectional and longitudinal multivariate analyses. Significant relationships were detected between salivary protein levels and serum HbA1c levels or blood pressure levels and between the buffer capacity of saliva and serum triglyceride levels. In addition, salivary pH was increased irreversibly by impaired renal function. This study suggested that saliva tests conducted during health check-ups of large populations might be a useful screening tool for periodontal disease and MetS/MetS components.

Relationship between periodontitis and subclinical risk indicators for chronic non-communicable diseases

In view of the epidemiological relevance of periodontal disease and chronic noncommunicable diseases, the study aimed to evaluate the relationship between them through subclinical indicators of systemic risk in a population group with healthy habits, including alcohol and tobacco abstinence. A complete periodontal examination of six sites per tooth was performed in a sample of 420 participants from the Advento study (Sao Paulo), submitted to anthropometric and laboratory evaluation. Periodontitis was defined and classified based on the Community Periodontal Index score 3 (periodontal pocket = 4-5 mm) and score 4 (periodontal pocket ≥ 6 mm). The prevalence of mild/moderate and severe periodontitis was 20% and 8.2%, respectively. Both categories of periodontal disease had significantly higher levels of triglycerides, C-reactive protein, calcium score, and calcium percentile, whereas blood glucose after tolerance test was significantly higher among people with severe periodontitis and HDL-c levels were lower (p < 0.05). Young adults with severe periodontitis had significantly higher prevalence of obesity, pre-diabetes, hypertension, and metabolic syndrome. Besides these conditions, the older adults with severe periodontitis had significantly higher prevalence of dyslipidemia and subclinical atherosclerosis. The group with periodontitis had also a higher coronary heart disease risk based on the PROCAM score (p < 0.05). The results indicated associations of periodontitis with several systemic indicators for chronic noncommunicable diseases, and highlighted the need for multiprofessional measures in the whole care of patients.

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.

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.

The association between periodontal disease severity and metabolic syndrome in Vietnamese patients

OBJECTIVE

To investigate the association between periodontal disease severity and metabolic syndrome (MetS) in a group of Vietnamese patients.

METHODS

A total of 412 participants (114 males, 298 females, average age 57.8 ± 5.7 years) including 206 patients with MetS and 206 participants without MetS were selected for this study. Information on sociodemographic characteristics, dental behaviours and smoking status was collected from a self-administrated questionnaire. Periodontal status including plaque index (PI), gingival index (GI) pocket depth (PD) and clinical attachment level (CAL) was recorded. Logistic regression analyses were used to evaluate the association between severity of periodontal disease and MetS with adjustments for related confounders.

RESULTS

The prevalence of moderate and severe periodontitis assessed by GI, PD and CAL was all significantly higher in the MetS group than in the control group and was significantly increased by a number of MetS components. Logistic regression, adjusted for confounders, showed that people with mean PI ≥2.51 or GI ≥1.01 or number of teeth with bleeding on probing of ≥20 teeth or PD ≥3.66 or CAL ≥3.66 showed a significant association with greater OR for MetS compared to counterparts (P < .05). The OR for MetS was 4.06 (95% CI 2.11-7.84) in severe periodontitis patients compared to non-periodontitis participants (P < .001).

CONCLUSION

Much severe and extensive periodontal disease was found in MetS participants and increased with number of MetS components. Participants with higher periodontal parameters had a higher risk of MetS.

Prevalence and Risk Factors for Periodontitis Among Patients with Metabolic Syndrome

BACKGROUND

The incidence of periodontitis is higher when metabolic syndrome (MS) is present. However, only few Korean studies have compared the risk factors for MS and periodontitis. Therefore, this study aimed to investigate the prevalence and risk factors for periodontitis relative to the presence of MS.

METHODS

The data collected from 13,196 respondents of the 2010-2015 Korea National Health and Nutrition Examination Survey in South Korea, which include periodontitis and MS parameters, were analyzed after propensity score matching of sex and age.

RESULTS

A total of 29% of the participants had periodontitis. The periodontitis group had more males (53%), lower number of participants who had a high educational level (66.6%), and higher body mass index (24.3 ± 3.2) and waist circumference (83.8 ± 9.2) than the nonperiodontitis group. Moreover, the periodontitis group exhibited higher systolic blood pressure and fasting plasma glucose and plasma triglyceride levels, but lower high-density lipoprotein cholesterol levels than the nonperiodontitis group (P < 0.001). Several patients in the periodontitis group had hypertension (43.3%) and diabetes mellitus (17.3%), but only few had chronic kidney disease (3.4%). Multiple regression analysis showed that the risk of periodontitis increased when MS, diabetes mellitus, and smoking history were present. Particularly, the risk of periodontitis increased as the number of MS components increased (P < 0.001).

CONCLUSIONS

Patients with MS had 1.12-fold higher risk of periodontitis than those without. Additionally, patients who had diabetes mellitus and were smokers had a particularly high risk of periodontitis. The risk of periodontitis increased as the number of MS components increased.

Rationale and Descriptive Analysis of Specific Health Guidance: the Nationwide Lifestyle Intervention Program Targeting Metabolic Syndrome in Japan

AIM

All health insurers in Japan are mandated to provide Specific Health Checkups and Specific Health Guidance (SHG) focusing on metabolic syndrome (MetS) in middle-aged adults, beginning in 2008; intensive HG for individuals who have abdominal obesity and two or more additional MetS risk factors, and motivational HG for individuals with one risk factor. The aim of this study is to describe medium-term changes in health indexes for intensive and motivational HG groups using the National Database.

METHODS

We compared changes of risk factors and initiation of pharmacological therapy over 3 yr between participants (n=31,790) and nonparticipants (n=189,726) who were eligible for SHG in 2008.

RESULTS

Body weight reduction in intensive HG was 1.98 kg (participants) vs 0.42 kg (nonparticipants) in men (p＜0.01) and 2.25 vs 0.68 kg in women (p＜0.01) after 1 yr. In motivational HG, the respective reduction was 1.40 vs 0.30 kg in men (p＜0.01) and 1.53 vs 0.42 kg in women (p＜0.01). Waist circumference reduction was also greatest among participants in intensive HG (2.34 cm in men and 2.98 cm in women). These reductions were fairly unchanged over 3 yr and accompanied greater improvements in MetS risk factors in participants. We also detected significantly smaller percentages of SHG participants who initiated pharmacological therapy compared with nonparticipants.

CONCLUSION

Participants in SHG showed greater improvements in MetS profiles with proportionally smaller pharmacological treatment initiations than did nonparticipants for 3 yr. Although selection bias may be present, this study suggests SHG would be a feasible strategy to prevent MetS and its sequelae.