Prospective study of obesity and periodontal disease

描述(由申请人提供)：在过去的25年里，美国人口中被归类为肥胖(身体质量指数(BMI)为30公斤/平方米或更高)的人数翻了一番，约占成年男性和女性的三分之一。另有34%的人超重(体重指数e25，但不超过30公斤/平方米)。最近发表的研究表明，与超重或理想体重的人相比，肥胖者的牙周病患病率更高。然而，所有关于这种联系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。一种提出的这种联系的模型是炎症性模型，在该模型中，脂肪组织产生的促炎细胞因子与口腔病原体感染时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发挥关键作用。现在需要进行前瞻性研究。这项前瞻性研究建议对退伍军人事务部牙科纵向研究中1025名男性进行了40多年的跟踪调查，对可用的口腔健康、体脂、实验室和饮食数据进行二次数据分析。这些人不是退伍军人事务部的患者，而是从私营部门接受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的发生率是否会增加牙周病的发生和进展的风险，并控制年龄、吸烟和糖尿病发病等重要的混杂因素。队列中每颗牙齿每3年测量一次的牙周病指数包括牙槽骨X光片丢失、探诊袋深度和附着物丢失。在同一时间间隔内可以进行多种肥胖测量，包括体重、体重指数、腰围和臀围。在540名男性中，有一部分人可以重复测量生物电阻抗分析。第二个目标是确定减肥是否会对随后的牙周病风险产生影响，以及高敏感性C反应蛋白(炎症状态的标志)的长期变化是否更多地受到牙周病、体重(或体脂百分比)或糖耐量受损的影响。第三个目的是检查饮食质量和白细胞介素型和肿瘤坏死因子-α基因变异对肥胖和牙周病相关性的进一步影响。存档的血液和血清样本将被分析C-反应蛋白和基因类型。这些目标将通过多变量比例风险回归模型来实现，这些模型控制重要的混杂因素，并检查牙周病主要预测因素之间的相互作用。这项拟议的流行病学研究是一种及时且具有成本效益的方法，有助于回答肥胖是否会增加牙周病风险以及类似的机制是什么。 与公共健康相关：在过去的25年里，美国人口中肥胖症的患病率翻了一番。最近的横断面研究表明，与正常或超重相比，牙周病在肥胖者中更常见。这项在一群老年男性中进行的前瞻性研究的结果将有助于确定肥胖是否是预测牙周病发展或进展的独立风险因素。

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.