METABOLIC SYNDROME AND PERIODONTITIS IN POSTMENOPAUSAL WOMEN

描述（由申请人提供）：代谢综合征（Metsyn）是一种葡萄糖、脂质、血压和体脂平衡共存异常的疾病，影响了超过一半的55岁及以上的美国成年人。Metsyn被认为是改变宿主免疫反应和加速牙周炎的一个因素。体育活动和体重减轻可改善某些metsyn相关并发症的风险，但尚不清楚这是否适用于牙周病。为了响应NIDCR PAR-09-182，我们提出对现有前瞻性数据进行广泛的二次数据分析，以检查绝经后妇女队列中Metsyn、体力活动和身体习惯与牙周病患病率和进展的关系。我们假设Metsyn与更高的牙周病患病率和更大的进展有关；较高的体力活动水平和较低的体脂水平将改变Metsyn与牙周病之间的联系；更高的胰岛素敏感性和更低的全身性炎症，在某种程度上，是更高的身体活动和更低的身体脂肪改变Metsyn和牙周炎之间关系的潜在机制。该研究包括660名绝经后妇女，她们参加了纽约州布法罗妇女健康倡议中心的牙周病/骨质疏松症研究。在基线和5年复查时，评估包括标准化口腔探探测量和牙槽嵴高度（ACH）的口腔x线片；双能x线骨密度和身体成分测定仪（DXA）；生活习惯、口腔卫生、病史问卷调查；静息血压；以及精心收集、处理和冷冻的空腹血液样本，并测量了相关的生物标志物。我们的主要因变量是基于ACH的变化；其他牙周结果也将被探讨。Metsyn将根据国家胆固醇教育计划标准定义，使用腰围和/或BMI，血压，空腹血糖，甘油三酯和HDL-C的测量。胰岛素、c反应蛋白和白细胞介素-6的浓度将用于确定

DESCRIPTION (provided by applicant): Metabolic syndrome (Metsyn) is a condition of coexisting abnormalities in glucose, lipid, blood pressure, and body fat homeostasis, that affects more than half of U.S. adults 55 years and older. Metsyn is a putative factor for modified host immune response and acceleration of periodontitis. Physical activity and weight loss ameliorate risk of certain Metsyn-related complications, but it is unknown if this extends to periodontal disease. In response to NIDCR PAR-09-182, we propose an extensive secondary data analysis on existing prospective data to examine associations of Metsyn, physical activity and body habitus with measures of prevalence and progression of periodontal disease in a cohort of postmenopausal women. We hypothesize that Metsyn will be associated with higher periodontal disease prevalence and greater progression; that higher physical activity levels and lower body fat levels will modify the association between Metsyn and periodontal disease; and that greater insulin sensitivity and lower systemic inflammatory are, in part, potential mechanisms through which higher physical activity and lower body fat modify the association between Metsyn and periodontitis. The study includes 660 postmenopausal women enrolled in a periodontal disease/osteoporosis study at the Buffalo (NY) center of the Women's Health Initiative. At baseline and at a 5-year reexamination, assessments included standardized oral probing measures and oral radiographs for alveolar crestal height (ACH); dual energy x-ray absorptiometry (DXA) for bone density and body composition; questionnaires on lifestyle habits, oral hygiene and medical history; resting blood pressure; and a fasting blood sample meticulously collected, processed and frozen, that have had relevant biomarkers measured. Our primary dependent variable is based on ACH changes; other periodontal outcomes also will be explored. Metsyn will be defined by National Cholesterol Education Program criteria, using measures of waist girth and/or BMI, blood pressure, and fasting glucose, triglyceride and HDL-C. Concentrations of insulin, and of C-reactive protein and interleukin-6, will be used in defining insulin sensitivity and systemic inflammation, respectively. Strengths are the prospective design and serial standardized oral examinations using calibrated examiners, the well-defined sample of postmenopausal women, DXA measures of body composition, and measured serum biomarkers. This offers advantages over epidemiological studies in which exposures and outcomes are assessed using only questionnaires, blood biomarkers are not available, or the temporal sequence of exposure and outcome assessment is not suitable for etiological hypothesis testing. The extensive database permits examination of confounding and interaction by relevant variables including smoking, medications, and usual dental care. The proposed study aligns with the NIDCR Strategic Plan to integrate molecular, clinical and population work to improve diagnostics and health outcomes. The existing resources for this secondary data analysis provide an unprecedented cost- efficient opportunity to build on established work and expand knowledge in this important area of public health. PUBLIC HEALTH RELEVANCE: The aim of this study is to examine associations of metabolic syndrome, physical activity and body fat, blood measures of inflammation and insulin resistance with the prevalence and progression of periodontal disease in 660 well-characterized postmenopausal women. The cost-efficient work will utilize extensive available data from a clinical dental examination and measures of body habitus to expand our scientific understanding of the how metabolic syndrome influences postmenopausal periodontal disease, and how activity and body fat effect this relationship. Study findings could lead to future intervention trals aimed at lowering the risk progressive periodontal disease, and ultimately could enhance not only oral healthcare, but also the role dental professionals have in impacting and improving systemic health.