Metabolic Syndrome and Periodontitis

描述（由申请人提供）：代谢综合征是一组代谢异常，包括血清甘油三酯升高、低水平高密度脂蛋白、高血压、大腰围、微量白蛋白尿和糖耐量受损。在美国，超过一半的老年人受到影响。这种综合征的定义是有3种或3种以上的异常，它会增加患慢性疾病的风险，尤其是心血管疾病。最近的横断面研究将该综合征与较高的牙周病患病率联系起来。需要前瞻性研究来进一步了解代谢综合征与牙周病之间的关系。代谢综合征是一种进行性疾病。虽然阳性诊断必须有3个或更多的成分，但并非所有成分都必须同时出现。此外，该协会的方向性尚未确立；代谢综合征可能是牙周病的前兆或并发症。我们认为，不同代谢综合征组成部分的出现顺序和持续时间，而不是一个是/否诊断，需要检查与牙周病发病率和进展的关系。本研究拟对现有的口腔健康、体脂、医学检查、实验室和饮食数据进行二次数据分析，这些数据来自退伍军人事务部牙科纵向研究中750名男性的独特队列，随访时间长达30年。这些人不是退伍军人管理局的病人，而是接受私营部门医疗和牙科护理的志愿者。我们将检查的主要牙周病指标是x线摄影牙槽骨丢失、探测袋深度和临床附着丧失，这些指标大约每3年对每颗牙齿进行一次测量。其他口腔卫生措施包括探牙出血、牙齿活动、牙菌斑、牙石和每颗牙齿的蛀牙/修复。在同一时间段内，每3年测量一次血脂、空腹血糖、体重指数和腰围。主要的纵向统计分析将使用广义线性混合模型进行，该模型将各种代谢综合征成分的持续时间纳入自变量，以预测牙周病并控制重要的混杂因素。为了解决这种关联的方向性，我们将以牙周病测量为结果的模型与以代谢综合征为结果的模型进行比较。在广义线性混合模型之后，将使用结构方程模型来估计连接代谢综合征和牙周病的途径中每个潜在步骤的相对贡献。对于我们的第三个目标，我们将研究与目前的综合征定义相比，添加或替代牙周病状态是否可以改善心血管疾病风险的预测。本流行病学研究是了解牙周病与代谢综合征关系的及时、有效的方法。

DESCRIPTION (provided by applicant): Metabolic syndrome is a group of metabolic abnormalities that includes elevated serum triglycerides, low level of high-density lipoprotein, high blood pressure, large waist circumference, microalbuminuria and impaired glucose tolerance. It affects more than half of older adults in the U.S. The syndrome, defined as having 3 or more of the abnormalities, increases the risk of chronic diseases, most notably cardiovascular disease. Recent cross-sectional studies link the syndrome to higher periodontal disease prevalence. Prospective studies are needed to further understand the relationship between metabolic syndrome and periodontal disease. Metabolic syndrome is a progressive disorder. Although 3 or more components must be present for a positive diagnosis, not all components will necessarily develop at the same time. Furthermore, the directionality of the association has not been established; metabolic syndrome may be a predictor or a complication of periodontal disease. We maintain that the sequence of appearance and duration of the different metabolic syndrome components, rather than a yes/no diagnosis, need be examined in relation to periodontal disease incidence and progression. This study proposes to perform secondary data analyses of available oral health, body fatness, medical examination, laboratory and dietary data from a unique cohort of 750 men who have been followed up to 30 years in the Department of Veterans Affairs Dental Longitudinal Study. The men are not VA patients, but are volunteers who receive medical and dental care from the private sector. The key periodontal disease indices we will examine are radiographic alveolar bone loss, probing pocket depth, and clinical attachment loss, which have been measured on each tooth approximately every 3 years. Additional oral health measures include bleeding on probing, tooth mobility, plaque, calculus and decay/restorations on each tooth. Serum lipids, fasting serum glucose, body mass index and waist circumference were also measured every 3 years over the same time period. The primary longitudinal statistical analyses will be performed with generalized linear mixed models that incorporate duration of the various metabolic syndrome components into the independent variables to predict periodontal disease and control for important confounding factors. To address the directionality of the association, we will compare models with periodontal disease measures as the outcomes to models with metabolic syndrome as the outcome. The generalized linear mixed models will be followed up with structural equation models to estimate the relative contribution of each potential step in pathways linking metabolic syndrome and periodontal disease. For our third aim, we will examine whether the addition or substitution of periodontal disease status for one or more of the metabolic syndrome components improves the prediction of cardiovascular disease risk compared to the current syndrome definition. This proposed epidemiologic study is a timely and cost-effective means to better understand the relationship between periodontal disease and the metabolic syndrome.