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Association between Human Body Composition and Periodontal Disease
Yagoub Salekzamani,1 Adileh Shirmohammadi,2 Mohammad Rahbar,1 Seyed-kazem Shakouri,1 andFarough Nayebi11Physical Medicine and Rehabilitation Research Center, Tabriz University of Medical Sciences, Golgasht Street, Tabriz 51666-14691, Iran2Department of Periodontics, Dental Faculty, Tabriz University of Medical Sciences, Tabriz 51666-14711, IranReceived 9 August 2011; Accepted 11 September 2011Academic Editor: O. MosesCopyright © 2011 Yagoub Salekzamani et al. This is an open access article distributed under theCreative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Obesity in humans might increase the risk of periodontitis. The aim of the present study was to examine the relationship between body composition of males and their periodontal status. AS total of 150 males (aged 30–60) were selected: 31 were periodontally healthy, 45 had gingivitis, 39 had initial periodontitis, and 35 suffered from established periodontitis. BMI (body mass index), WC (waist circumference), and body composition parameters (consisting of body water, body fat, and skeletal muscle and bone mass) were measured. After adjusting for age, history of diabetes, smoking, physical activity status, and socioeconomic status, statistically significant correlations were found between periodontitis and BMI, WC, and body composition. There was only a statistically significant difference between the periodontal health and established periodontitis; that is, periodontal disease in mild forms (gingivitis) and initial periodontitis do not influence these variables (BMI, WC, and body composition parameters) and only the severe form of the disease influences the variables. These data suggest that there is a considerable association between severe forms of periodontal disease in males and their body composition, but this preliminary finding needs to be confirmed in more extensive studies.
1. Introduction
Obesity has been associated with many serious, life-threatening medical conditions, including cardiovascular disease [1], various cancers [2], and diabetes [3] as well as endocrine [4] and musculoskeletal diseases [5]. Central obesity is a risk factor for metabolic syndrome, a group of conditions or risk factors that increase a subject’s risk for cardiovascular disease [6].Being overweight or obese has also been associated with an increased risk for periodontal disease [7]. Periodontal disease is a common infectious disease associated with gram-negative anaerobic bacteria, characterized by inflammation and destruction of periodontal tissues [8].Studies have described an association between periodontal disease and obesity [7], increased body mass index (BMI) [9], and increased waist circumference [10]. In addition, Shimazaki et al. [11] reported that metabolic syndrome increases the risk for periodontitis, while increased levels of serum resistin, an adipokine secreted from adipose tissues, was significantly associated with periodontitis in a population of Japanese women [12].Although a large number of studies have evaluated the effect of periodontal disease on obesity, no studies have, so far, focused on the association between the severity of this chronic disease and body composition. Therefore, the present study was undertaken to determine the influence of body composition on periodontal disease in males.The main objective of the present study was to evaluate a hypothesis: body composition can have a detrimental effect on severity of periodontal disease.In case of an association between these two, future studies can evaluate this hypothesis.
2. Methods
2.1. Design
The present study was an analytical cross-sectional study.
2.2. Study Population
The study population consisted of men aged 30 to 60, who had referred to the Faculty of Dentistry, Tabriz University of Medical Sciences from April to November 2010. Exclusion criteria included systemic conditions such as diabetes, cardiovascular disorders, or environmental factors such as tobacco use, poor or severe physical activity and men who had received periodontal treatment during the previous 3 months.A total of 150 men met the criteria for participation in the study, and a census procedure was carried out in order to acquire and record data from the subjects during the period of the study. The study design was approved by the Ethics Committee and supported by the Research Deputy of Tabriz Medical Faculty. The nature of this investigation was explained to the patients in detail, and the patients signed an informed consent form.
2.3. Data Collection
Clinical histories were taken by one of the authors to ensure that none of the aforementioned exclusion criteria was present. Periodontal measurements were taken by AS classification on the basis of gingival and plaque indices (Ainamo and Bay [13]) and means of attachment loss. In this index, bleeding from the gingival margin and visible plaque has a score of “1,” while absence of bleeding and no visible plaque have a score of “0.”Attachment loss (the distance from the CEJ to the base of pocket) was measured with a Williams periodontal probe (PWD, Hu-Friedy Immunity, USA) for all the existing teeth on four surfaces (buccal, mesial, distal, and palatal or lingual), and the means were calculated. Based on the results, the subjects were divided into 4 groups as follows.Group 1: normal with no gingival inflammation (gingival plaque index, GPI = 0) and no attachment loss.Group 2: simple gingivitis with gingival inflammation (GPI = 1) and no attachment loss.Group 3: initial periodontitis with gingival inflammation (GPI = 1) and attachment loss of <2 mm.Group 4: established periodontitis with gingival inflammation (GPI = 1) and attachment loss of >2 mm.Weight was measured in kilograms (kg), height in centimeters (cm), and BMI in kg/m2. Waist circumference measurements were taken at the level of the umbilicus in centimeters (cm).Fat mass and skeletal muscle mass were determined from the impedance and conductance measures of the bioelectrical impedance analysis (BIA). Because fat-free mass is composed of water, proteins, and electrolytes, conductivity is greater in fat-free mass than in fat mass [14]. Resistance and reactance are used to estimate body water, fat and skeletal muscle, and bone mass. These parameters were measured with Diagnostic Scale-Beurer BG 56.
2.4. Statistical Analysis
Means of these variables were calculated for each group and compared using one-way ANOVA. If there were statistically significant differences between the groups, post hoc tests were used for further analysis. A ݑü/tspan> value of <0.05 was considered significant.
3. Results
A total of 150 men (aged 30–60) participated in the present study, of which 31 were periodontally healthy, 45 had gingivitis, 39 had initial periodontitis, and 35 suffered from established periodontitis. ANOVA indicated no significant differences in the age of the subjects between the four groups (ݑü/tspan> > 0 . 0 5).Statistical analysis using one-way ANOVA demonstrated statistically significant associations between BMI, waist circumference, body water, fat mass, skeletal muscle mass and bone mass, and the periodontal status of patients from normal periodontium and gingivitis, to initial periodontitis, and to established periodontitis. Table 1 summarizes the values relating to BMI, waist circumference, body water, body fat, and skeletal muscle and bone mass in relation to patients’ periodontal status.Table 1: BMI, waist circumference, and body composition based on patient’s periodontal condition (mean ± SD).A post hoc Tukey test revealed that there was only a statistically significant difference between periodontal health and established periodontitis; that is, periodontal disease in mild forms (gingivitis) and initial periodontitis do not influence these variables and only the severe form of the disease influences the variables (Table 2).Table 2: Comparison between normal periodontal status and various stages of periodontal disease, related variables (data are expressed in ݑü/tspan> value).
4. Discussion
This study was designed to determine the relationship between periodontal disease of males and their BMI, WC, and body composition after adjusting for age, history of diabetes, smoking, physical activity, and socioeconomic status.In the periodontitis groups (initial and established forms), the average BMI was significantly greater than the healthy and gingivitis groups, which is consistent with the results of a systematic review by Chaffee and Weston [15]. His study suggested a greater mean clinical attachment loss among obese individuals, a higher mean body mass index (BMI) among periodontal patients, and a trend of increasing odds of prevalent periodontal disease with increasing BMI. However, Kim et al. [16] showed no association between BMI and periodontitis. Obese people with BMI ≥25 had an adjusted odds ratio (OR) of 0.991 (0.806 to 1.220) for having periodontitis. This discrepancy might be attributed to the age of the participants. Participants in Kim et al. study were younger than those in ours.Our study showed higher waist circumferences in periodontitis patients compared to healthy and gingivitis groups, which is consistent with the results reported by Khader et al. [17], who s
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