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、血压和体脂稳态共存异常的疾病，影响超过一半的55岁及以上的美国成年人。Metsyn是一个假定的因素，修改宿主免疫反应和加速牙周炎。体力活动和体重减轻可以改善某些Metsyn相关并发症的风险，但尚不清楚这是否会扩展到牙周病。为了响应NIDCR PAR-09-182，我们提出了一个广泛的二手数据分析现有的前瞻性数据，以检查协会的Metsyn，体力活动和身体形态与牙周病的患病率和进展的措施，在一个队列的绝经后妇女。我们假设，美泰生将与更高的牙周病患病率和更大的进展;更高的体力活动水平和更低的体脂水平将修改美泰生和牙周病之间的关联;更高的胰岛素敏感性和更低的全身炎症，部分是通过更高的体力活动和更低的体脂修改美泰生和牙周炎之间的关联的潜在机制。这项研究包括660名绝经后妇女参加了在布法罗（纽约）妇女健康倡议中心进行的牙周病/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查措施和牙槽嵴高度（ACH）的口腔X线片;骨密度和身体成分的双能X线吸收测定法（DXA）;生活习惯，口腔卫生和病史的问卷调查;静息血压;以及精心收集，处理和冷冻的空腹血液样本，这些样本已测量相关生物标志物。我们的主要因变量是基于ACH的变化，其他牙周的结果也将进行探讨。Metsyn将由国家胆固醇教育计划标准定义，使用腰围和/或BMI、血压和空腹血糖、甘油三酯和HDL-C的测量值。胰岛素、C-反应蛋白和白细胞介素-6的浓度将用于定义 胰岛素敏感性和全身性炎症。优势是前瞻性设计和系列标准化的口腔检查，使用校准的考官，绝经后妇女的明确定义的样本，身体成分的DXA测量，并测量血清生物标志物。这提供了优于流行病学研究的优势，在流行病学研究中，暴露和结果仅使用问卷进行评估，血液生物标志物不可用，或者暴露和结果评估的时间顺序不适合病因学假设检验。广泛的数据库允许检查相关变量的混杂和相互作用，包括吸烟，药物治疗和日常牙科护理。拟议的研究符合NIDCR战略计划，整合分子，临床和人口工作，以改善诊断和健康结果。用于这种二级数据分析的现有资源提供了一个前所未有的具有成本效益的机会，可以在这一重要的公共卫生领域的既定工作基础上再接再厉，扩大知识。

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.