Prospective study of obesity and periodontal disease

描述（由申请人提供）：美国人口中被归类为肥胖的人数（体重指数（BMI）为30 kg/m2或更高）在过去25年中翻了一番，约占成年男性和女性的三分之一。另有34%的人超重（BMI为e25，但<30 kg/m2）。最近发表的研究表明，与超重或理想体重的人相比，肥胖人群的牙周病患病率更高。然而，所有关于这种关联的研究都是横断面的，因此无法确定肥胖是否在牙周病的发展或进展中起因果作用。这一联系的一个被提出的模型是炎症性的，其中脂肪组织产生的促炎细胞因子与口腔病原体感染反应中产生的局部细胞因子相互作用。糖尿病和不良饮食也可能在疾病过程中起关键作用。现在需要前瞻性研究。这项前瞻性研究提出对现有的口腔健康、体脂、实验室和饮食数据进行二次数据分析，这些数据来自一个独特的队列，由1025名男性组成，他们在退伍军人事务部牙科纵向研究中被跟踪了40多年。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。这项研究的第一个目的是确定肥胖是否会增加牙周病的发病率和进展，控制重要的混杂因素，如年龄、吸烟和糖尿病的发病。在队列中每3年测量每颗牙齿的牙周病指标包括x线片显示的牙槽骨丢失、探诊袋深度和附着物丢失。在同一时间间隔内，有多种肥胖测量方法，包括体重、身体质量指数、腰围和臀围。对540名男性进行了生物电阻抗分析的重复测量。第二个目的是确定体重减轻是否会影响随后的牙周病风险，以及炎症状态的标志——高敏感性c反应蛋白的长期变化是否更多地受到牙周病、体重（或体脂百分比）或糖耐量受损的变化的影响。第三个目的是研究饮食质量和白细胞介素和肿瘤坏死因子- α基因型的变化对肥胖-牙周病相关性的进一步影响。将对存档的血液和血清样本进行c反应蛋白和基因型分析。目标将通过多变量比例风险回归模型来解决，该模型控制重要的混杂因素并检查牙周病主要预测因子之间的相互作用。这项提出的流行病学研究是一个及时和经济有效的方法来帮助回答肥胖是否会增加牙周病的风险以及一些类似的机制。

DESCRIPTION (provided by applicant): The number of persons in the US population classified as obese (body mass index (BMI) of 30 kg/m2 or greater) has doubled in the past 25 years to approximately one-third of adult men and women. An additional 34% were overweight (BMI e25 but <30 kg/m2). Recently published studies suggest that periodontal disease prevalence is higher among obese persons compared to those who are overweight or ideal weight. However, all the studies on this association have been cross-sectional, making it impossible to determine if obesity has a causal role in the development or advancement of periodontal disease. A proposed model for the link is an inflammatory one in which pro-inflammatory cytokines produced by fat tissue interact with local cytokines produced in response to infection by oral pathogens. Diabetes and poor diet may also have key roles in the disease process. Prospective studies are now needed. This prospective study proposes to perform secondary data analyses of available oral health, body fatness, laboratory and dietary data from a unique cohort of 1,025 men who have been followed for more than 40 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 first aim of the study is to determine if incidence of obesity increases the risk of periodontal disease incidence and progression, controlling for important confounding factors such as age, smoking and diabetes onset. Periodontal disease indices that have been measured on each tooth every 3 years in the cohort include alveolar bone loss from radiographs, probing pocket depth, and attachment loss. Multiple adiposity measures over the same time interval are available, including weight, body mass index, and waist and hip circumferences. Repeated measures of bio-electrical impedance analysis are available in a subset of 540 men. A second aim is to determine if weight loss impacts on subsequent periodontal disease risk and whether long-term changes in high sensitivity c-reactive protein, a marker of inflammatory status, are influenced more by changes in periodontal disease, weight (or %body fat) or impaired glucose tolerance. The third aim is to examine the further effects of dietary quality and variation in the interleukin and tumor necrosing factor- alpha genotypes on the obesity-periodontal disease association. Archived blood and serum samples will be analyzed for c-reactive protein and genotypes. The aims will be addressed with multivariate proportional hazards regression models that control for important confounders and examine interactions among the main predictors of periodontal disease. This proposed epidemiologic study is a timely and cost-effective means to help answer the questions of whether obesity increases the risk of periodontal disease and what are some like mechanisms. PUBLIC HEALTH RELEVANCE: The prevalence of obesity has doubled in the US population in the past 25 years. Recent cross-sectional studies suggest periodontal disease is more common in obese persons compared to normal or overweight. The findings from this prospective study in a cohort of older men will help determine if obesity is an independent risk factor that predicts the development or progression of periodontal disease.