THE LEPTİN LEVELS OF OBESE AND NORMAL WEİGHT ADOLESCENTS WİTH HEALTHY GİNGİVA AND GİNGİVİTİS: EFFECTS OF PERİODONTAL THERAPY ON THE PARAMETERS

Year 2020, Volume: 30 Issue: 2, 226 - 232, 15.04.2020

Meltem Zihni Korkmaz , Recep Orbak Sevda Kurt , Çağlar Bulut Uncu

https://doi.org/10.17567/ataunidfd.651688

Abstract

Aim: The purpose of our study was to assess the role of leptin, a hormone secreted by adipose tissue, in the association of obesity and periodontal disease.
Material and Methods: Fifty-six adolescents volunteered to participate in this study. The participants were divided into two groups (obese / normal) and each group was then divided into two subgroups (gingivitis / healthy gingiva). All of the adolescents were measured for clinical indexes such as plaque index (PI) and gingival index (GI). Levels of leptin in the gingival crevicular fluid (GCF) samples and serum leptin levels were determined in blood samples by enzyme linked immune sorbent assay (ELISA).
Results: Blood leptin concentration (BLC) was higher in obese subjects than normal weight subjects (p<0.001). Although not statistically significant, BLC was higher in subjects with gingivitis (p=0.68) and decreased after periodontal therapy (p=0.90). GCF leptin concentration (GLC) levels were also higher in subjects with healthy gingiva (p=0.003) and the obese group (p=0.78), and it increased significantly after periodontal therapy (p<0.001). PI was positively correlated with BLC, PI and GI was negatively correlated with GLC, BLC and GLC were negatively correlated.
Conclusion: While the periodontal disease progressed, there was a decrease in GCF leptin concentration and an increase in blood leptin concentration. This observation suggests that leptin may be a protective agent for gingiva. Greater decrease of GCF leptin concentration in obese subjects with gingivitis than in normal weight subjects with gingivitis can be evidence that disease can be more severe in obese subjects.
Key words: Obesity, gingivitis, gingival crevicular fluid

Periodontal Olarak Sağlıklı ve Gingivitisli Obez ve Normal Kilolu Adolesanlarda Leptin Seviyeleri: Periodontal Tedavinin Bu Değerler Üzerine Etkileri
ÖZ
Amaç: Çalışmamızın amacı yağ dokusu tarafından salgılanan bir hormon olan leptinin obezite ve periodontal hastalık ilişkisindeki rolününün değerlendirilmesidir.
Gereç ve Yöntem: Çalışmamıza gönüllü olarak 56 adolesan birey katıldı. Bireyler vücut kitle indeksine göre obez ve normal kilolu olarak iki gruba; her bir grup, kendi arasında gingivitisli ve periodontal sağlıklı dişetine sahip olanlar şeklinde iki alt gruba ayrıldı. Çalışmaya dahil edilen bütün bireylerin plak indeksi (PI) ve gingival indek (GI) gibi klinik indeksleri kaydedildi. Dişeti oluğu sıvısı (DOS) ve kan serumu leptin seviyeleri enzyme linked immune sorbent assay (ELISA) testi ile değerlendirildi.
Bulgular: Obez bireylerin kan leptin konsantrasyonunun (KLK) normal kilolu bireylerin KLK’sından daha yüksek olduğu tespit edildi (p<0.001). İstatistiksel olarak fark olmamasına rağmen gingivitisli bireylerin KLK’sı daha yüksekti (p=0.68) ve periodontal tedaviden sonra azaldı (p=0.90). Dişeti oluğu sıvısı leptin konsantrasyonu (DLK) periodontal sağlıklı dişetine sahip bireylerde (p=0.003) ve obez grupta (p=0.78) daha yüksekti ve periodontal tedavi sonrası istatistiksel anlamlı şekilde arttı (p<0.001). PI, KLK ile pozitif; PI ve GI, DKL ile negatif korelasyon gösterdi. KLK ve DLK arasında ise negatif korelasyon tespit edildi.
Sonuç: Dişetinde sağlıktan hastalığa doğru gidildikçe DLK düşerken, KLK yükselme eğilimi göstermektedir. Bu durum leptinin dişetinde koruyucu bir ajan olabileceğini düşündürmektedir. Obez gingivitisli bireylerde normal kilolu bireylere göre DLK’nun daha çok düşmesi, hastalığın daha ağır seyredebileceğine dair bir kanıt olabilir.
Anahtar Kelimeler: Obezite, Gingivitis, Dişeti oluğu sıvısı

Keywords

Obesity, gingivitis

References

• 1. Kinane DF. Causation and pathogenesis of periodontal disease. Periodontol 2000 2001; 25(1): 8-20.
• 2. Karthikeyan B, Pradeep A. Leptin levels in gingival crevicular fluid in periodontal health and disease. J Periodontal Res 2007; 42(4): 300-304.
• 3. Karthikeyan B, Pradeep A. Gingival crevicular fluid and serum leptin: their relationship to periodontal health and disease. J Clin Periodontol 2007; 34(6): 467-472.
• 4. Johnson R, Serio F. Leptin within healthy and diseased human gingiva. J Periodontol 2001; 72(9): 1254-1257.
• 5. Trayhurn P, Wood IS. Adipokines: inflammation and the pleiotropic role of white adipose tissue. Br J Nutr 2004;92(3):347-355.
• 6. Klok M, Jakobsdottir S, Drent M. The role of leptin and ghrelin in the regulation of food intake and body weight in humans: a review. Obes Rev 2007;8(1):21-34.
• 7. Friedman JM, Halaas JL. Leptin and the regulation of body weight in mammals. Nature 1998; 395(6704):763-770.
• 8. Fantuzzi G, Faggioni R. Leptin in the regulation of immunity, inflammation, and hematopoiesis. J leukoc biol 2000; 68(4): 437-446.
• 9. Aronne LJ, Segal KR. Adiposity and fat distribution outcome measures: assessment and clinical implications. Obesity 2002; 10.
• 10. Martinez JA. Body-weight regulation: causes of obesity. Proc Nutr Soc 2000; 59(3): 337-345.
• 11. Greenberg AS, Obin MS. Obesity and the role of adipose tissue in inflammation and metabolism. Am J Clin Nutr 2006; 83(2): 461S-465S.
• 12. Ritchie CS. Obesity and periodontal disease. Periodontol 2000 2007;44(1): 154-163.
• 13. Martens L, Smet S, Yusof MYPM, Rajasekharan S. Association between overweight/obesity and periodontal disease in children and adolescents: a systematic review and meta-analysis. Eur Arch Paediatr Dent 2017; 2(18): 69-82.
• 14. Ay ZY, Çağlar DF. Obezite Ve Periodontal Durum Arasındaki İlişkinin Antropometrik Ve Biyoelektrik İmpedans Yöntemlerle İncelenmesi. Atatürk Üniversitesi Diş Hekimliği Fakültesi Dergisi 2010; 3: 139-144.
• 15. Perlstein MI, Bissada NF. Influence of obesity and hypertension on the severity of periodontitis in rats. Oral Surg Oral Med Oral Pathol 1977; 43(5): 707-719.
• 16. Fadel HT, Pliaki A, Gronowitz E, Marild S, Ramberg P, Dahlèn G, Yucel-Lindberg T, Heijl L, Birkhed D. . Clinical and biological indicators of dental caries and periodontal disease in adolescents with or without obesity. Clin oral investig 2014; 18(2): 359.
• 17. Al-Zahrani MS, Bissada NF, Borawski EA. Obesity and periodontal disease in young, middle-aged, and older adults. J Periodontol 2003; 74(5): 610-615.
• 18. Reeves AF, Rees JM, Schiff M, Hujoel P. Total body weight and waist circumference associated with chronic periodontitis among adolescents in the United States. Arch Pediatr Adolesc Med 2006; 160(9): 894-899.
• 19. Pischon N, Heng N, Bernimoulin J-P, Kleber B-M, Willich SN, Pischon T. Obesity, inflammation, and periodontal disease. J Dent Res 2007; 86(5): 400-409.
• 20. Khosravi R, Tran SD, Lambert M,O'Loughlin J, Ka Khady, Feine JS, Caron C, Tremblay A, Nicolau B.. Adiposity and gingival crevicular fluid tumour necrosis factor‐α levels in children. J Clin Periodontol 2009; 36(4): 301-307.
• 21. Kershaw EE, Flier JS. Adipose tissue as an endocrine organ. J Clin Endocrinol Metab 2004; 89(6): 2548-2556.
• 22. Bastard J-P, Maachi M, Lagathu C, Kim MJ, Caron M, Vidal H, Capeau J, Bruno F.. Recent advances in the relationship between obesity, inflammation, and insulin resistance. European Cytokine Network 2006; 17(1): 4-12.
• 23. Ahima RS, Flier JS. Leptin. Annual review of physiology. 2000; 62(1): 413-437.
• 24. Gualillo O, Eiras S, Lago F, Dieguez C, Casanueva FF.. Elevated serum leptin concentrations induced by experimental acute inflammation. Life Sciences 2000; 67(20): 2433-2441.
• 25. Barbier M, Vidal H, Desreumaux P, Dubuquoy L, Bourreille A, Colombel JF, Cherbut C, Galmiche JP. Overexpression of leptin mRNA in mesenteric adipose tissue in inflammatory bowel diseases. Gastroenterol Clin Biol 2003; 27: 987-991.
• 26. Gangadhar V, Ramesh A, Thomas B. Correlation between leptin and the health of the gingiva: a predictor of medical risk. Indian J Dent Res 2011; 22(4): 537.
• 27. 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(5): 624-633.
• 28. Bundak R, Furman A, Gunoz H, Darendeliler F, Bas F, Neyzi O. Body mass index references for Turkish children. Acta Paediatr 2006; 95(2): 194-198.
• 29. Löe H, Silness J. Periodontal disease in pregnancy I. Prevalence and severity. Acta Odontol Scand 1963; 21(6): 533-551.
• 30. Silness J, Löe H. Periodontal disease in pregnancy II. Correlation between oral hygiene and periodontal condition. Acta Odontol Scand 1964; 22 (1):121-135.
• 31. Farooq R, Lutfullah S, Ahmed M. Serum leptin levels in obese infertile men and women. Pak J Pharm Sci 2014; 27(1).
• 32. Saito T, Shimazaki Y, Sakamoto M. Obesity and periodontitis. N Engl J Med 1998; 339(7): 482-483.
• 33. Keller A, Rohde JF, Raymond K, Heitmann B.Association between periodontal disease and overweight and obesity: a systematic review. J Periodontol 2015; 86(6): 766-776.
• 34. 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: 2075-2084.
• 35. Ekuni D, Yamamoto T, Koyama R, Tsuneishi M, Naito K, Tobe K. Relationship between body mass index and periodontitis in young Japanese adults. J Periodontal Res 2008; 43(4): 417-421.
• 36. Ylöstalo P, Suominen‐Taipale L, Reunanen A, Knuuttila M.Association between body weight and periodontal infection. J Clin Periodontol 2008; 35(4): 297-304.
• 37. Suvan JE, Petrie A, Nibali L, Garbar U, Rakmanee T, Donos N, D'Aiuto F.Association between overweight/obesity and increased risk of periodontitis. J Clin Periodontol 2015; 42(8): 733-739.
• 38. Wallace AM. Measurement of leptin and leptin binding in the human circulation. Ann Clin Biochem 2000; 37(3): 244-252.
• 39. McConway M, Johnson D, Kelly A, Griffin D, Smith J, Wallace AM.. Differences in circulating concentrations of total, free and bound leptin relate to gender and body composition in adult humans. Ann Clin Biochem 2000; 37(5): 717-723.
• 40. Hellström L, Wahrenberg H, Hruska K, Reynisdottir S, Arner P. Mechanisms behind gender differences in circulating leptin levels. J İntern Med 2000; 247(4): 457-462.
• 41. Lönnqvist F, Nordfors L, Jansson M, Thörne A, Schalling M, Arner P. Leptin secretion from adipose tissue in women. Relationship to plasma levels and gene expression. J Clin Invest 1997; 99(10): 2398.
• 42. Teles FR, Teles RP, Martin L, Socransky SS, Haffajee AD. Relationships among interleukin-6, tumor necrosis factor-α, adipokines, vitamin D, and chronic periodontitis. J Periodontol 2012; 83(9): 1183-1191.
• 43. Sarraf P, Frederich RC, Turner EM, Ma Grace, Jaskowiak NT, Rivet DJ, Flier JS, Lowell BB, Fraker DL, Alexander HR. Multiple cytokines and acute inflammation raise mouse leptin levels: potential role in inflammatory anorexia. J Expl Med 1997; 185 (1): 171-176.
• 44. Grunfeld C, Zhao C, Fuller J, Pollack A, Moser A, Friedman J, Feingold KR.. Endotoxin and cytokines induce expression of leptin, the ob gene product, in hamsters. J Clin Invest 1996; 97(9): 2152.
• 45. Purwar P, Khan M, Mahdi AA, Pandey S, Singh B, Dixit J, Sareen S. . Salivary and serum leptin concentrations in patients with chronic periodontitis. J Periodontol 2015; 86(4): 588-594.
• 46. Shi D, Liu Y-Y, Li W, Zhang X, Sun X-J, Xu L, Zhang L, Chen Z-B, Meng H-X.. Association between plasma leptin level and systemic inflammatory markers in patients with aggressive periodontitis. Chin Med J 2015; 128(4): 528.
• 47. Bozkurt FY, Yetkin Ay Z, Sütçü R, Delibaş N, Demirel R. Gingival crevicular fluid leptin levels in periodontitis patients with long-term and heavy smoking. J Periodontol 2006; 77(4): 634-640.
• 48. Selvarajan S, Perumalsamy R, Emmadi P, Thiagarajan R, Namasivayam A.. Association between gingival crevicular fluid leptin levels and periodontal status–A biochemical study on Indian patients. J Clin Diagn Res 2015; 9(5): ZC48.
• 49. Shimada Y, Komatsu Y, Ikezawa-Suzuki I, Tai H, Sugita N, Yoshie H. The effect of periodontal treatment on serum leptin, interleukin-6, and C-reactive protein. J Periodontol 2010; 81(8): 1118-1123.
• 50. Kardeşler L, Buduneli N, Çetinkalp Ş, Kinane DF. Adipokines and inflammatory mediators after initial periodontal treatment in patients with type 2 diabetes and chronic periodontitis. J Periodontol 2010; 81(1): 24-33.
• 51. Gonçalves TED, Zimmermann GS, Figueiredo LC, Soza MC, Cruz DF, Bastos MF, Silva HDP, Duarte PM. Local and serum levels of adipokines in patients with obesity after periodontal therapy: one‐year follow‐up. J Clin Periodontol 2015; 42(5): 431-439.