Obezite-periodontal hastalık ilişkisi ve rol oynayan olası mekanizmalar

“Sağlığı bozacak ölçüde vücutta anormal veya aşırı miktarda yağ birikimi’’ olarak tanımlanan obezite kronik, inflamatuar, multifaktöriyel bir hastalıktır. Sedanter yaşam tarzı ve yüksek yağlı diyet tüketiminin yol açtığı obezite tüm yaş gruplarında hızla artarak küresel bir sorun ve halk sağlığı problemi haline gelmiştir. Birçok kronik inflamatuar hastalık ve kanser gelişimi için temel risk faktörü olduğu belirlenen obezitenin periodontitise duyarlılığı da arttırdığı ileri sürülmüştür. Periodontal hastalık, birçok faktör tarafından modifiye edilebilen, dişleri destekleyen dokuların kronik inflamatuar, multifaktöriyel hastalığıdır. Hem obezite hem de periodontitis sistemik inflamasyonla ilişkili olduğundan, bu iki durumun ortak bir patofizyoloji ile bağlantılı olduğu söylenebilir. Obezite ile periodontitis arasındaki ilişkiyi araştıran çalışmalar, aşırı kilolu / obez kişilerde artmış periodontitis riskinin görüldüğünü bildirmişlerdir. Bu ilişkideki patofizyolojik mekanizmalar belirsiz olsa da, kronik inflamatuar durum ve oksidatif stresin sonucu olarak insülin direnci gelişiminin obezite ile periodontitis arasındaki ilişkide rol oynayabileceği belirtilmiştir. Bu derlemede mevcut literatürün ışığı altında, obezite-periodontal hastalık ilişkisi ve bu ilişkide rol oynayan olası mekanizmalar özetlenmektedir.

Obesity-periodontal disease relationship and mechanisms involved

Obesity defined as ‘‘abnormal or excessive fat accumulation in the body that may impair health’’ is a chronic, inflammatory, multifactorial disease. Obesity, caused by sedentary lifestyle and high-fat diet, has increased rapidly in all age groups and has become a global issue and a public health problem. It has been suggested that obesity, which was identified as a major risk factor for the development of many chronic inflammatory diseases and cancer, also increases susceptibility to periodontitis. Periodontitis is a chronic inflammatory, multifactorial disease of tissues supporting teeth, which can be modified by many factors. Since both obesity and periodontitis are associated with systemic inflammation, these two diseases were thought to be connected by a common pathophysiology. Studies investigating the relationship between obesity and periodontitis have reported an increased risk of periodontitis in overweight / obese individuals. Although the pathophysiological mechanisms in this relationship are uncertain, it has been stated that the development of insulin resistance as a result of chronic inflammatory condition and oxidative stress may play a role in the relationship between obesity and periodontitis. In this review, in the light of current literature, the relationship between obesity and periodontal disease and the possible mechanisms involved in this relationship are summarized.

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1. World Health Organization. Obesity. http://www.who. int/topics/obesity/en/ Son erişim tarihi: 20.06.2019.
2. Falagas ME, Kompoti M. Obesity and infection. Lancet Infect Dis 2006; 6: 438-446.
3. Obezite Tanı ve Tedavi Kılavuzu. Türkiye Endokrinoloji ve Metabolizma Derneği 2019.
4. Lundin M, Yucel-Lindberg T, Dahllöf G, Marcus C, Modéer T. Correlation between TNFa in gingival crevicular fluid and body mass index in obese subjects. Acta Odontol Scand 2004; 62: 273-277.
5. Genco RJ, Grossi SG, Ho A, Nishimura F, Murayama Y. A proposed model linking inflammation to obesity, diabetes, and periodontal infections. J Periodontol 2005; 76(11-s): 2075-84.
6. Zuza EP, Barroso EM, Carrareto ALV, Pires JR, Carlos IZ, et al. The role of obesity as a modifying factor in patients undergoing non-surgical periodontal therapy. J Periodontol 2011; 82: 676-682.
7. Zimmermann GS, Bastos MF, Dias Goncalves TE, Chambrone L, Duarte PM. Local and circulating levels of adipocytokines in obese and normal weight individuals with chronic periodontitis. J Periodontol 2013; 84: 624- 633.
8. Armitage, GC. Periodontal diagnoses and classification of periodontal diseases. Periodontol 2000 2004; 34: 9-21.
9. Loesche WJ, Grossman NS. Periodontal disease as a specific, albeit chronic, infection: diagnosis and treatment. Clin Microbiol Rev 2001; 14: 727-752.
10. NCD-RisC. Trends in adult body-mass index in 200 countries from 1975 to 2014: a pooled analysis of 1698 population-based measurement studies with 19.2 million participants. NCD Risk Factor Collaboration (NCD-RisC). Lancet 2016; 387: 1377-1396.
11. Kassebaum NJ, Bernabe E, Dahiya M, Bhandari B, Murray CJ, et al. Global burden of severe periodontitis in 1990-2010: a systematic review and meta-regression. J Dent Res 2014; 93: 1045-1053.
12. Ritchie CS. Obesity and periodontal disease. Periodontol 2000 2007; 44: 154-163.
13. Fantuzzi G. Adipose tissue, adipokines, and inflammation. J Allergy Clin Immunol 2005; 115: 911-919.
14. Medzhitov R. Inflammation 2010: new adventures of an old flame. Cell 2010; 140: 771-776.
15. Pischon N, Heng N, Bernimoulin J-P, Kleber B-M, Willich S, et al. Obesity, inflammation, and periodontal disease. J Dent Res 2007; 86: 400-409.
16. Perlstein MI, Bissada NF. Influence of obesity and hypertension on the severity of periodontitis in rats. Oral Surg Oral Med Oral Pathol 1977; 43: 707-719.
17. Saito T, Shimazaki Y, Sakamoto M. Obesity and periodontitis. N Engl J Med 1998; 339: 482-483.
18. Al-Zahrani MS, Bissada NF, Borawskit EA. Obesity and periodontal disease in young, middle-aged, and older adults. J Periodontol 2003; 74: 610-615.
19. Dalla Vecchia CF, Susin C, Rosing CK, Oppermann RV, Albandar JM. Overweight and obesity as risk indicators for periodontitis in adults. J Periodontol 2005; 76: 1721- 1728.
20. Saito T, Shimazaki Y, Koga T, Tsuzuki M, Ohshima A. Relationship between upper body obesity and periodontitis. J Dent Res 2001; 80: 1631-1636.
21. Torrungruang K, Tamsailom S, Rojanasomsith K, Sutdhibhisal S, Nisapakultorn K, et al. Risk indicators of periodontal disease in older Thai adults. J Periodontol 2005; 76: 558-565.
22. Wood N, Johnson RB, Streckfus CF. Comparison of body composition and periodontal disease using nutritional assessment techniques: Third National Health and Nutrition Examination Survey (NHANES III). J Clin Periodontol 2003; 30: 321-327.
23. Suvan JE, Finer N, D'Aiuto F. Periodontal complications with obesity. Periodontol 2000 2018; 78: 98-128.
24. Saxlin T, Ylostalo P, Suominen-Taipale L, Mannisto S, Knuuttila M. Association between periodontal infection and obesity: results of the Health 2000 Survey. J Clin Periodontol 2011; 38: 236-242.
25. Kim YS, Kim JH. Body mass index and oral health status in Korean adults: the Fifth Korea National Health and Nutrition Examination Survey. Int J Dent Hyg 2017; 15: 172-178.
26. Martinez-Herrera M, Silvestre FJ, Silvestre-Rangil J, Banuls C, Rocha M, et al. Involvement of insulin resistance in normoglycaemic obese patients with periodontitis: A cross-sectional study. J Clin Periodontol 2017; 44: 981- 988.
27. Nascimento GG, Peres KG, Mittinty MN, Mejia GC, Silva DA, et al. Obesity and periodontal outcomes: a population-based cohort study in Brazil. J Periodontol 2017; 88: 50-58.
28. Morita I, Okamoto Y, Yoshii S, Nakagaki H, Mizuno K, et al. Five-year incidence of periodontal disease is related to body mass index. J Dent Res 2011; 90: 199-202.
29. Chaffee BW, Weston SJ. Association between chronic periodontal disease and obesity: a systematic review and meta-analysis. J Periodontol 2010; 81: 1708-1724.
30. Suvan J, D'Aiuto F, Moles DR, Petrie A, Donos N. Association between overweight/obesity and periodontitis in adults. A systematic review. Obes Rev 2011; 12: 381-404.
31. Keller A, Rohde JF, Raymond K, Heitmann BL. Association Between Periodontal Disease and Overweight and Obesity: A Systematic Review. J Periodontol 2015; 86: 766-76.
32. Papageorgiou SN, Reichert C, Jäger A, Deschner J. Effect of overweight/obesity on response to periodontal treatment: systematic review and a meta‐analysis. J Clin Periodontol 2015; 42: 247-61.
33. Gerber FA, Sahrmann P, Schmidlin OA, Heumann C, Beer JH, et al. Influence of obesity on the outcome of non-surgical periodontal therapy-a systematic review. BMC Oral Health 2016; 16: 90.
34. Akram Z, Abduljabbar T, Abu Hassan MI, Javed F, Vohra F. Cytokine profile in chronic periodontitis patients with and without obesity: a systematic review and meta-analysis. Dis Markers 2016; 2016: 1-12.
35. Akram Z, Safii SH, Vaithilingam RD, Baharuddin NA, Javed F, et al. Efficacy of non-surgical periodontal therapy in the management of chronic periodontitis among obese and non-obese patients: a systematic review and meta-analysis. Clin Oral Investig 2016; 20: 903-914.
36. Martinez-Herrera M, Silvestre-Rangil J, Silvestre FJ. Association between obesity and periodontal disease. A systematic review of epidemiological studies and controlled clinical trials. Med Oral Patol Oral Cir Bucal 2017; 22: 708-715.
37. Nascimento GG, Leite FR, Correa MB, Peres MA, Demarco FF. Does periodontal treatment have an effect on clinical and immunological parameters of periodontal disease in obese subjects? A systematic review and meta-analysis. Clin Oral Investig 2016; 20: 639-647.
38. Amar S, Zhou Q, Shaik-Dasthagirisaheb Y, Leeman S. Diet-induced obesity in mice causes changes in immune responses and bone loss manifested by bacterial challenge. Proc Natl Acad Sci USA 2007; 104: 20466-20471.
39. Maciel SS, Feres M, Goncalves TE, Zimmermann GS, da Silva HD, et al. Does obesity influence the subgingival microbiota composition in periodontal health and disease? J Clin Periodontol 2016; 43: 1003-1012.
40. Reaven GM. The insulin resistance syndrome: definition and dietary approaches to treatment. Annu Rev Nutr 2005; 25: 391-406.
41. Gemmell E, Seymour GJ. Cytokine profiles of cells extracted from humans with periodontal diseases. J Dent Res 1998; 77: 16-26.
42. Nishimura F, Iwamoto Y, Mineshiba J, Shimizu A, Soga Y, et al. Periodontal disease and diabetes mellitus: the role of tumor necrosis factor-alpha in a 2-way relationship. J Periodontol 2003; 74: 97-102.
43. Matsuzawa-Nagata N, Takamura T, Ando H, Nakamura S, Kurita S, et al. Increased oxidative stress precedes the onset of high-fat diet-induced insulin resistance and obesity. Metabolism 2008; 57: 1071-1077.
44. Suresh S, Mahendra J, Sudhakar U, Pradeep AR, Singh G. Evaluation of plasma reactive oxygen metabolites levels in obese subjects with periodontal disease. Indian J Dent Res 2016; 27: 155-159.
45. Atabay VE, Lutfioglu M, Avci B, Sakallioglu EE, Aydogdu A. Obesity and oxidative stress in patients with different periodontal status: a case-control study. J Periodontal Res 2017; 52: 51-60.
46. Iikuni N, Lam QL, Lu L, Matarese G, La CA. Leptin and inflammation. Curr Immunol Rev 2008; 4: 70-79.
47. Thanakun S, Pornprasertsuk-Damrongsri S, Izumi Y. Increased oral inflammation, leukocytes, and leptin, and lower adiponectin in overweight or obesity. Oral Dis 2017; 23: 956-965.
48. Kanoriya D, Pradeep AR, Mallika A, Singhal S, Garg V. Correlation of crevicular fluid and serum levels of retinol-binding protein 4 and leptin in chronic periodontitis and obesity. Clin Oral Investig 2016; 21: 2319-2325.
49. Cury EZ, Santos VR, Maciel SDS, Gonçalves TED, Zimmermann GS, et al. Lipid parameters in obese and normal weight patients with or without chronic periodontitis. Clin Oral Investig 2017; 22: 161-167.
50. Zuza EP, Barroso EM, Fabricio M, Carrareto AL, Toledo BE, et al. Lipid profile and high-sensitivity C-reactive protein levels in obese and non-obese subjects undergoing non-surgical periodontal therapy. J Oral Sci 2016; 58: 423-430.
51. Endo Y, Tomofuji T, Ekuni D, Irie K, Azuma T, et al. Experimental periodontitis induces gene expression of proinflammatory cytokines in liver and white adipose tissues in obesity. J Periodontol 2010; 81: 520-526.
52. O’Neill LA, Sheedy FJ, McCoy CE. MicroRNAs: the fine-tuners of Toll-like receptor signalling. Nat Rev Immunol 2011; 11: 163-175.
53. Hennessy EJ, Sheedy FJ, Santamaria D, Barbacid M, O’Neill LA. Toll-like receptor-4 (TLR4) down-regulates microRNA-107, increasing macrophage adhesion via cyclin-dependent kinase 6. J Biol Chem 2011; 286: 531-539.
54. Wendlandt EB, Graff JW, Gioannini TL, McCaffrey AP, Wilson ME. The role of microRNAs miR-200b and miR-200c in TLR4 signaling and NF-kappaB activation. Innate Immun 2012; 18: 846-855.
55. Luan X, Zhou X, Trombetta-eSilva J, Francis M, Gaharwar AK, et al. MicroRNAs and periodontal homeostasis. J Dent Res 2017; 96: 491-500.
56. Grimble RF. Inflammatory status and insulin resistance. Curr Opin Clin Nutr Metab Care 2002; 5: 551-559.
57. Jentsch HFR, Arnold N, Richter V, Deschner J, Kantyka T, et al. Salivary, gingival crevicular fluid and serum levels of ghrelin and chemerin in patients with periodontitis and overweight. J Periodontal Res 2017; 52: 1050-1057.