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GERODONTOLOGY
ASSOCIATION BETWEEN SERUM RESISTIN LEVEL AND PERIODONTAL CONDITION
Original Article
CHANGE AMONG ELDERLY PEOPLE
Hiroshi Ogawa1a*, Teerasak Damrongrungruang2b, Reiko Furugen3c, Hideaki Hayashida3d, Toshiyuki Saito3e,
Akihiro Yoshihara1f, Hideo Miyazaki1g
1
Division of Preventive Dentistry, Department of Oral Health Science, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
2
Department of Oral Diagnosis, Faculty of Dentistry, Khon Kaen University, Muang, Khon Kaen, Thailand
3
Department of Oral Health, Unit of Social Medicine, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
a
DDS, MDSc, PhD, Associate Professor
b
DDS, PhD, Associate Professor
c
DDS, PhD, Assistant Professor
d
DDS, PhD, Lecturer
e,f,g
DDS, PhD, Professor
ABSTRACT DOI: 10.25241/stomaeduj.2018.5(1).art.2
Aim: This study aimed to compare periodontal condition in four years of Japanese OPEN ACCESS This is an Open Ac-
elderly between high and low serum resistin levels. cess article under the CC BY-NC 4.0 license.
Peer-Reviewed Article
Materials and methods: One hundred and thirty-two dentate community-dwelling
participants enrolled in this cohort study. At baseline, blood sample were drawn for Citation: Ogawa H, Damrongrungruang T,
Furugen R, Hayashida H, Saito T, Yoshihara A,
serum resistin and other adipokines/cytokines measurements. The participants were Miyazaki H. Association between serum resistin
then divided into 2 groups; low resistin (LR, resistin < 5.3 ng/mL) group (n = 84) and level and periodontal condition change among
elderly people. Stoma Edu J. 2018;5(1):24-30.
high resistin (HR, resistin ≥ 5.3 ng/mL) group (n = 48). At baseline and after four years,
all participants were subjected to periodontal examination (assessment pocket depth; Academic Editor: Poul Erik Petersen, DDS,
Dr Odont, BA, MSc, Professor, WHO Senior
PD and bleeding on probing; BOP). Annual general/oral health questionnaires were Consultant, University of Copenhagen,
Copenhagen, Denmark
also performed. Intergroup comparisons of periodontal parameters and categorical
variables were accomplished by t-test and Chi-square test, respectively. Association Received: January 26, 2018
Revised: February 02, 2018
between baseline serum resistin level and periodontal condition alteration after four Acccepted: February 28, 2018
years in each group were analyzed by a multiple linear regression analysis. Published: March 02, 2018
Results: At baseline, HR group had more sites with PD ≥ 4 mm concomitant BOP than *Corresponding author: Associate Professor
those of LR group (5.8±9.0 vs. 2.8±4.8 sites). High serum resistin concentration and Hiroshi Ogawa, DDS, MDSc, PhD, Division of
Preventive Dentistry, Department of Oral Health
number of tooth loss markedly associated with reduction of sites with PD ≥ 4 mm and Science, Graduate School of Medical and Dental
PD ≥ 4 mm concomitant BOP. Sciences, Niigata University, 2-5274, Gakkocho-
Dori, Chuo-ku, Niigata, 951-8514 Japan Tel: +81
Conclusion: High serum resistin level might negatively be associated to periodontal 25 227 2857, Fax: +81 25 227 0807, e-mail:
ogahpre@dent.niigata-u.ac.jp
disease progression.
Keywords: adipokine, elderly, inflammation, periodontitis, resistin. Copyright: © 2018 the Editorial Council for
the Stomatology Edu Journal.
1. Introduction expression [7] and induced anti-inflammatory cytokine
Adipose tissue, in current view, is not only an inert organ IL-10 and IL1R in human leukocytes [8]. Furthermore, its
for energy storage, but it is able to mediate signals level is slightly decreased in periodontitis [9].
to play important roles in a number of physiological Resistin is an 144-amino-acid adipokine which was
responses, for instance activation of secretory process previously said to be predominantly expressed
from endocrine and reproductive system, modulation in adipocytes [10-11]. However, recent evidence
of bone metabolism and controlling inflammatory demonstrated that resistin expressed mainly from
processes [1]. It is well established knowledge in macrophages and bone marrow cells and is linked to
recent years that increase in metabolic overload relates the inflammatory cascade [12] as well as an immune
to more frequent obesity and is closely associated response [1]. It was found that lipopolysaccharides from
with higher systemic inflammations [1]. Adipocytes pathogenic bacteria in human volunteers stimulated
produce a number of adipokine such as adiponectin, secretion of circulating serum resistin levels [13]. On the
resistin and leptin as well as cytokine including tumor contrary, the NF-κB inhibitor could counteract the pro-
necrosis factor alpha (TNF-α) and interleukin-6 (IL- inflammatory properties of resistin, thus demonstrating
6). These factors play a pivotal role in inflammation the interplay of the NF-κB in the resistin–induced
and immune reaction [1,2]. TNF-α and IL-6, two major modulation of the inflammatory cascades [14]. Previous
inflammatory cytokines, were shown to overexpress in reports found that resistin was positively correlated with
adipose tissue of obese mice and human, which clearly obesity and insulin resistance and glucose-lowering
showed the link between obesity, diabetes and chronic therapies reduced resistin gene expression [15].
inflammation [3-5]. Additionally, soluble molecules Periodontitis, a multifactor chronic inflammatory
from adipocytes played a complex interaction with the disease caused mainly by intraoral pathogens, is
immune cells [6]. Adiponectin, one of a well-studied strongly linked to the immune system [16,17]. Obesity
adipokines, acts as an anti-inflammatory factor due has also been suggested to be linked to periodontitis
to it inhibited TNF-α-induced adhesion molecule in the way that periodontitis was exacerbated by some
24 Stoma Edu J. 2018;5(1): 24-30 http://www.stomaeduj.com
ASSOCIATION BETWEEN SERUM RESISTIN LEVEL AND PERIODONTAL CONDITION CHANGE
AMONG ELDERLY PEOPLE
conditions associated with obesity e.g. insulin resistance
Original Article
Table 1. Basic characteristics, HbA1c and periodontal characteristics of
[18]. It was suggested that increased serum resistin levels the study participants at baseline
were correlated with developed periodontitis in elderly
Resistin
Japanese [9]. Furthermore, non-surgical periodontal
Characteristics Overall
treatment slightly decreased circulating resistin level LR (<5.3 ng/ HR (≥5.3 ng/
[19]. Bleeding on probing is generally known parameter mL) N = 84 mL) N = 48
that directly reflects inflammatory condition and General characteristics
is considered as a predictor of periodontal disease Male/female 64/68 40/44 24/24
progression in elderly [20]. We hypothesized that serum
Number of
resistin level but not adiponectin might relate to the present teeth
20.53 ± 5.87 20.36 ± 5.67 20.83 ± 6.21
progression of periodontitis by the changing of bleeding
Alcoohol
on probing sites. However, this hypothesis has never drinking (%)
64.12 64.29 63.83
been proved yet.
Even several lines of evidence support the higher level Smocking (%) 44.70 46.43 41.67
of serum resistin in periodontitis patients, but recent HbA1c (%) 5.22 ± 0.70 5.27 ± 0.81 5.13 ± 0.46
reports concluded that there were almost no differences BMI (kg/m2) 22.69 ± 2.62 22.75 ± 2.69 22.59 ± 2.51
of serum resistin levels between normal VS periodontitis Serological parameters
patients [21-22]. Whether they influence the alteration of
periodontal conditions in a long-term period still has not Adiponectin
11.09 ± 4.82 11.17 ± 4.80 10.97 ± 4.88
(µg/mL)
yet been reported. The aim of the present study was to
investigate whether serum resistin levels associate to the TNF-α (pg/mL) 0.97 ± 1.59 0.94 ± 1.80 1.03 ± 1.14
long term periodontal condition alteration. IL-6 (pg/mL) 0.75 ± 1.89 0.75 ± 1.97 0.76 ± 1.75
Data expressed as mean ± standard deviation
BMI = body mass index, HbA1c = glycated hemoglobin, HR = high serum resistin,
2. Materials and Methods IL-6 = interleukin-6. LR = low serum resitin, TNF-α = tumor necrosis factor alpha
2.1. Study design and participants
The present cohort, parallel design study was the manufacturer. All serological parameters were
performed as part of the Niigata elderly study. A total measured once at the baseline period.
of 161 Japanese elderly residing in Niigata, Japan and
aged 76 at baseline participated during the entire 2.4. Health Status Interview
period of the present study. Our inclusion criteria At baseline and at 4th-year, the participants were asked
were healthy individuals and the exclusion criteria to participate in an annual health examination which
included any severe systemic disease(s) or disability includes a general health check-up and the oral health
condition(s). Ethical approval was obtained from the questionnaires. We included the questions about
Niigata University Review Board (21-R13-09-08) and all receiving dental (including periodontal) treatment and
procedures were undergone in the Niigata University recent tooth loss in the questionnaires as well in order to
Hospital. After the participants signed the informed evaluate the oral health maintenance manner of subjects.
consent, they were asked to answer the general/oral
health questionnaires. The diagnosis of periodontitis 2.5. Statistical Analysis
was based on the criteria as designed by the American For continuous variables, the t-test was used for
Academy of Periodontology in 1999 [23]. intergroup comparisons. Categorical variables
comparisons between groups were conducted using
2.2. Periodontal Examination Chi-square test. For association between baseline
Four trained dentists were involved in this study and serum resistin level and periodontal condition after 4
were calibrated for periodontal examination until years, multiple linear regression models were used to
the kappa value for probing pocket depth ≥0.8 was predict changes of sites with PD≥4 mm and sites with
reached. All remaining teeth were subjected to 6 sites/ PD≥4 mm concomitant BOP by the influence of serum
tooth examination. The measurements of the probing resistin, adiponectin, IL-6, TNF-α level and number
pocket depth (PD) were based on nearest millimeter of tooth loss. The P-value<0.05 was determined as
intervals and all sites with bleeding on probing (BOP) statistically significant. All statistical analyses were
were also recorded. Periodontal examinations were conducted using the STATA software package (Stata
conducted at baseline and at the 4th-year follow-up Corp., www.stata.com).
examinations. Analyses were performed by another
dentist who was not involved in the patient clinical
outcome measurements. 3. Results
A total of 132 participants (64 male and 68 female) were
2.3. Biological measurement included in the present study because 29 participants
Blood samples were taken and kept at -70°C until were totally edentulous individuals. Almost all participants
subsequent measurements of HbA1c, adiponectin, were non-diabetic because the average HbA1c at
resistin, IL-6 and TNF-α by KHP0041, KHP0051, KHC0064 baseline was 5.22 ± 0.70%. Only 5 participants (3.8%) had
and KHC3014 ELISA kits (Biosource International Inc., HbA1c level more than 6.7% (a cut-off point of increased
CA, USA), respectively. Before measurements, the risk of hypoglycemia according to the Japanese Diabetes
validation of the method was performed by fabrication Diagnostic Criteria (1999) [24]. Of these, 84 participants
of standard curve following the instruction from were classified into a low resistin group (LR), (with an
Stomatology Edu Journal 25
ASSOCIATION BETWEEN SERUM RESISTIN LEVEL AND PERIODONTAL CONDITION CHANGE
AMONG ELDERLY PEOPLE
individual having a serum resistin level <5.3 ng/mL, and
Original Article 48 participants were in a high resistin group (HR), or who
Table 2. Comparison of periodontal conditions between low (LR) and
high (HR) serum resistin
had serum resistin from 5.3 ng/mL. This categorization
Resistin
was according to a previous study [9].
Characteristics p value
Table 1 shows the characteristic of the participants LR (<5.3 ng/ HR (≥5.3 ng/
at baseline. Based on general data, 44.7 % (59 out of mL) N = 84 mL) N = 48
132) of participants were smokers. With respect to Periodontal conditions (Baseline)
the drinking habit, one participant who was in the Sites with PD ≥
HR group refused to answer the questionnaire so we 9.91 ± 11.98 15.62 ± 17.02 0.026
4 mm
excluded this participant in the analysis of the drinking Sites with PD ≥
habit and we found that 64.1 % (84 out of 131) of 1.69 ± 3.11 2.75 ± 5.17 0.144
6 mm
participants drank alcohol. There was no difference Sites with PD ≥ 4
regarding the number of drinkers or smokers between mm concomitant 2.82 ± 4.84 5.75 ± 8.97 0.016
the groups. The distribution of serum resistin ranged BOP
from 1.2 to 17.9 ng/mL with an average of 5.38 ± 3.24 Sites with PD ≥ 6
ng/mL. The average BMI of participants in the present mm concomitant 0.60 ± 1.69 1.02 ± 2.07 0.216
BOP
study were in the normal weight range based on the
WHO classification for Asians [25]. Six participants (5 in Number of
20.36 ± 5.67 20.83 ± 6.25 0.664
LR and 1 in HR group, data not shown) were classified present teeth
as obese (BMI ≥ 27.5). With respect to the adipokine/ Periodontal conditions (4 years follow-up)
cytokines data at baseline, there were no differences Sites with PD ≥
7.11 ± 12.08 7.16 ± 8.10 0.980
between the groups in all these parameters (Table 1). 4 mm
Intergroup comparisons of periodontal parameters are Sites with PD ≥
shown in Table 2. At baseline, the HR group had sites 0.89 ± 0.30 0.87 ± 1.23 0.969
6 mm
with PD≥4 mm, and sites with PD≥4 mm concomitant Sites with PD ≥ 4
BOP 1.58. This was 2 times higher than those of the LR mm concomitant 0.36 ± 0.48 0.43 ± 0.50 0.442
group, respectively. BOP
There were statistically significant differences at p = Sites with PD ≥ 6
0.026 and 0.016, respectively. Interestingly, after 4 years mm concomitant 0.21 ± 0.85 0.22 ± 0.55 0.913
BOP
all these parameters were improved in all participants.
Alteration of above parameters were markedly detected Number of
19.09 ± 6.56 19.02 ± 6.68 0.950
present teeth
in the HR group for both sites with PD ≥ 4 mm and sites
with PD ≥ 4 mm concomitant BOP which were reduced Periodontal conditions (alteration)
by 54.2% and 92.5% after 4 years, respectively while in Sites with PD ≥
-2.79 ± 11.02 -8.45 ± 12.44 0.000
the LR group, these parameters decreased only by 28.3% 4 mm
and 87.2%, respectively from baseline. No significant Sites with PD ≥
-0.79 ± 4.06 -1.87 ± 4.72 0.170
difference was found between groups regarding PD ≥ 6 mm
6 mm, and PD ≥ 6 mm concomitant BOP. The average Sites with PD ≥ 4
number of tooth loss was only 1.1 teeth (5.0% loss from mm concomitant -1.15 ± 4.98 -4.27 ± 7.34 0.004
baseline) in the LR group, and 1.62 teeth (7.8% loss from BOP
baseline) in the HR group. Sites with PD ≥ 6
Multiple linear regression analyses (Table 3 and 4) were mm concomitant -0.39 ± 1.86 -0.79 ± 1.97 0.250
BOP
performed using alteration in the number of sites with
PD≥4 mm, and these sites concomitant BOP during Number of
1.10 ± 2.17 1.62 ± 2.60 0.224
present teeth
4 years as a dependent variable, and all adipokines/
Data expressed as mean ± standard deviation
cytokines level at baseline as well as the number
HbA1c = glycated hemoglobin, PD = probing pocket depth, BOP = bleeding on
of tooth loss in 4 years as independent variables. It probing
was found that serum resistin levels had a significant t test was used to analysed
contribution effect on the improvement of sites with PD
≥ 4 mm (correlation coefficient = -0.49; p = 0.080), and individuals, respectively. When we compared the
also inflammation shown by the reduction of sites with groups, there were no statistically significant differences
PD ≥ 4 mm concomitant BOP (correlation coefficient between groups in participants who received scaling
= -0.41, p = 0.009). The other cytokines and adipokine, or those who received scaling with root planning (p =
however, appeared to have no such relationship. 0.862 and p = 0.894, respectively).
Additionally, the number of teeth lost during the 4-year
period also had a significantly positive effect on the
reduction of sites with PD ≥ 4 mm and sites with PD ≥ 4. Discussion
4 mm concomitant BOP (correlation coefficient = -2.48; To our knowledge, this is the first longitudinal
p = 0.000 and correlation coefficient = -0.78; p = 0.001, observational study to compare the potential of low
respectively). and high serum resistin level at baseline to predict
Most of participants received periodontal treatment the periodontal condition alteration of community-
during the study period. Table 5 shows the numbers dwelling elderly in a 4-year period. The primary
of participants who received scaling and scaling with outcome variable was the association between
root planning which were 109 (82.6%) and 56 (42.4%) the baseline serum resistin level and the alteration
26 Stoma Edu J. 2018;5(1): 24-30 http://www.stomaeduj.com
ASSOCIATION BETWEEN SERUM RESISTIN LEVEL AND PERIODONTAL CONDITION CHANGE
AMONG ELDERLY PEOPLE
and bleeding on probing. Among these parameters,
Original Article
Table 3. Multiple linear regression analysis and associated p-value using
change in sites with PD ≥ 4 mm as a dependent variable bleeding on probing is a reliable indicator that can
Dependent variable: changes in sites with PD ≥ 4 be used to monitor periodontal disease activity in
Independent mm clinical situation [26], especially when focusing on
variables
Coefficient S.E. t 95% CI p-value
inflammation as a primary outcome. This is the reason
why we emphasized the analysis of the sites with
Resisitin
(ng/mL)
-0.49 0.28 -1.76 -1.05 – 0.06 0.080 periodontal pocket depth ≥ 4mm concomitant BOP
in our study. Our results indicated that the periodontal
Adiponectin
(µg/mL)
-0.01 0.19 -0.04 -0.38 – 0.36 0.967 disease activity in our participants were much lower
than in the previous report [20].
TNF-α (pg/
mL)
0.39 0.56 0.70 -0.72 – 1.52 0.487 Two meta-analyses [27,28] have demonstrated that
individuals who were obese or had high body mass
IL-6 (pg/mL) -0.05 0.48 0.11 -0.90 – 1.00 0.915
index (BMI) seemed susceptible to periodontitis
Number of
tooth loss
-2.48 0.39 -6.23 -3.27 – 1.69 0.000 more than normal weight individuals. And the high
resistin levels were observed in obese individuals with
Constant 0.70 2.93 0.24 -5.09 – 6.51 0.240
periodontitis. The participants in the precedent study
R-square = 0.281, PD = probing pocket depth, S.E. = standard error, t = t test statistic, had normal BMI, but in individuals with relatively
CI = confidence interval, TNF-α = tumor necrosis factor alpha, IL-6 = interleukin-6
high BMI or the obese ones we did not observe this
Table 4. Multiple linear regression analysis and associated p-value using tendency suggesting that obesity modulates resistin
change in sites with PD ≥ 4 mm concomitant BOP as a dependent independent of periodontitis.
variable A previous cross-sectional study by Furugen et al. [9]
Dependent variable: changes in sites with PD ≥ 4 indicated that serum resistin levels were significantly
Independent mm, concomitant BOP correlated with BOP, and leukocyte counts, but weakly
variables
Coefficient S.E. t 95% CI p-value correlated with average PD. The present study also
similarly found a significant correlation of sites with
Resisitin
(ng/mL)
-0.41 0.15 -2.66 -0.72 – 0.10 0.009 PD≥4 mm as well as sites with PD≥4 mm concomitant
BOP at baseline with serum resistin level. These results
Adiponectin
(µg/mL)
-0.02 0.10 -0.28 -0.23 – 0.17 0.777 support the previous report that resistin play an
TNF-α (pg/
important role in inflammation [12]. But since all previous
mL)
0.31 0.31 0.99 -0.30 – 0.93 0.323 studies were cross-sectional studies; causality-effect
IL-6 (pg/mL) -0.01 0.26 -0.07 -0.54 – 0.50 0.945
relationship could not be obtained. It is noteworthy
that for long term association of serum resistin level
Number of
tooth loss
-0.78 0.21 -3.55 -1.21 – -0.34 0.001 and periodontal parameters, high serum resistin level
at baseline appeared to influence more profoundly
Constant 1.00 1.61 0.62 -2.19 – 4.20 0.536
the effect of the periodontal condition alteration. The
R-square = 0.281, PD = probing pocket depth, S.E. = standard error, t = t test statistic,
CI = confidence interval, TNF-α = tumor necrosis factor alpha, IL-6 = interleukin-6 possible explanation of these findings is based on the
fact that all participants were aware of their periodontal
condition mainly because they were subjected to
Table 5. Comparison of number and percentages of participants who
received periodontal treatment between low and high serum resistin periodontal examination and oral hygiene instruction.
group during study period These led most of the participants to receive extensive
periodontal treatment by themselves elsewhere
Type of Resistin
periodontal over the period of the present study. However, the
LR (<5.3 ng/ HR (≥5.3 ng/ p value percentages of participants who received periodontal
treatment
received mL) N = 84 mL) N = 48 treatment in both groups are almost the same (Table
Scaling only (%) 69 (82.14) 40 (83.33) 0.862 5). Nonetheless, the periodontal conditions of the high
resistin group remained more improved than the low
Scaling and root
planing (%)
36 (42.86) 20 (41.67) 0.894 resistin group. These results were probably due to
The p-values were calculated by Chi-square test
resistin significantly correlated only to severe systemic
inflammation condition such as in angina patient [29],
of inflammatory-related periodontal parameters. We but in case of mild or localized inflammation such as
demonstrated that the high serum resistin levels seemed stable angina and mild periodontitis, which is not
more sensitive to contribute to the other factors-mediated severe enough to sense signaling to activate resistin,
improved periodontal condition more than those in the resulting in almost no positive relationship between
low resistin counterpart. The association between the other the serum resistin level and the periodontal condition
serological parameters at baseline as well as the number of [14,19,30]. Our results were somehow different from
teeth lost in 4 years, and the alteration of the periodontal these studies because we demonstrated the inverse
condition were the secondary outcome variables. association between serum resistin level and long-term
The participants in the present study were in a periodontitis progression in a fashion that the higher
relatively good periodontal condition (at baseline the serum resistin levels the better the sensitivity to
average sites with PD≥4 mm, and those concomitant periodontal treatment effectiveness. Moreover, resistin
BOP were 11.99 sites and 3.88 sites, respectively). plays a role not only in the peripheral area, but it also
Basically, periodontal disease activity can be measured functions in a central nervous system. It was found
by many parameters such as probing pocket depth, that resistin inhibits dopamine and norepinerphrine
clinical attachment level, radiographic bone level, in rat hypothalamus [31]. Furthermore, an increase in
Stomatology Edu Journal 27
ASSOCIATION BETWEEN SERUM RESISTIN LEVEL AND PERIODONTAL CONDITION CHANGE
AMONG ELDERLY PEOPLE
serum resistin levels is related to the inhibition of the pockets. Based on theoretical and clinical knowledge such
Original Article parasympathetic nervous system [32]. To date, there is teeth would be extracted. The data of the present study
still a lack of promising data in humans. This is because showed that approximately 5.1 – 7.8% of teeth were lost
there is a striking difference in terms of biological during the 4 years in LR and HR group, respectively. This
responses between humans and rodents. Hence, was considered an important factor that dramatically
we postulated that high serum resistin at baseline in reduced the sites with PD ≥ 4 mm and these sites PO ≥
our subjects might be a signaling factor to activate 4 concomitant BOP, which collectively improved the
the central nervous system regulating an extensive periodontal condition as shown in the study population.
amelioration of the local inflammation. In contrast, a Additionally, it is useful to include other age groups, the
low serum resistin level might not provide an adequate leukocyte related parameters e.g. leukocyte count, and
signal to stimulate the reduction of the peripheral genetic information to clarify the general resistin function.
inflammation. The exact mechanism to explain this Especially from a genetic point of view, although there
finding, however, has not yet been fully elucidate. is no clear association, some Finnish [48] and Japanese
Furthermore, resistin may respond differently [49] study subjects suggested that single nucleotides
depending on the age of the patients because it was polymorphism (SNP) in the promoter region of the
found that resistin levels in children had no correlation resistin gene (RETN -420C>G, rs1862513) associated with
with metabolic parameters. However, they correlated obesity and diabetes, which may be a link to the increase
only with the onset of pubertal development [33]. of the inflammatory reaction. Based on the fact that all
Thus, resistin in the elderly probably exerts different participants were non-diabetic and almost classified
effects than in the adults. Additionally, the serum resistin into normal BMI individuals, the majority of our subjects
level is also affected by many other factors such as probably might not have this SNP locus.
lipopolysaccharides form oral pathogens [13], insulin The present study has some limitations that should be
level [10,34], cardiovascular disease condition [35], and carefully taken into consideration when interpreting
chronic kidney disease [36]. All these factors might the results. First, because of the observational nature
exert an effect on serum resistin levels more than local of our study, we could not discourage individuals
inflammation occurring in mild/moderate periodontitis. from receiving periodontal treatment, thus improving
Conversely to the effect of serum resistin on the of individual periodontal condition. This might have
alteration of the periodontal condition, serum IL-6 in part contributed to the observed effect of the
and adiponectin level were hardly associated with the periodontal treatment they received. Furthermore, as
change of the periodontal condition (data not shown). aforementioned almost all participants were relatively
For IL-6, the results are somewhat supported by the in a good periodontal condition from the beginning of
previous reports [37-39] in which these molecules were the study, therefore detecting the association between
produced mainly only during the early inflammation severe periodontitis and the serum resistin level could
event and were probably synthesized only in low level in not be achieved. Finally, we had no data on the serum
elderly. Therefore, in the long-term observation and with resistin level as well as the other serological parameters
a relatively low level of localized inflammation such as in at the follow-up period to re-evaluate the relationship
the present study, we could not observe any effect of IL-6 of serum resistin level and other adipokines/cytokines,
on the periodontal condition changes. For adiponectin, and periodontal condition in a low inflammatory state.
previous studies suggested that periodontal treatment Monitoring the level of adipokines/cytokines at the
had minimally influenced the serum adiponectin level end of study should be included in the future studies.
[9,39-42]. The present study added up this relationship,
in which serum adiponectin level was relatively
minimally influenced by the alteration of the periodontal 5. Conclusion
condition. Indeed, adiponectin is said to be an anti- The present results provide evidence that high
inflammatory molecule that can be impaired by resistin serum resistin levels are associated with a dramatic
[43]. Regarding TNF-α, we demonstrated that the TNF-α improvement in the long-term periodontal condition
level at baseline slightly positively affected periodontal especially when considering bleeding on probing
disease progression (regression coefficient of 0.39 and in the Japanese elderly. There was also a finding that
0.31 for change of sites with PD ≥ 4 mm, and sites with resistin plays an important role in inflammation.
PD ≥ 4 mm concomitant BOP, respectively). TNF-α is a
well-recognized cytokine related to the inflammatory
process, and this molecule could be secreted by Author contributions
adipocytes [44], and immune cells [45]. Some studies Conceptualization: HO. Methodology: HO and TD.
have shown the positive association between serum Investigation: HO, RF and HH. Writing: HO and TD.
TNF-α and periodontitis [46,47]. Our study is in line with Funding: TS and HM. Resources: AY.
these studies and contributes to the establishment of
the role of the TNF-α in inflammatory enhancement.
Regarding the number of tooth loss which had a strong Acknowledgement
association with the reduction of the sites with PD ≥ 4 We would like to thank all study participants for their
mm in 4 years, it is a common phenomenon that teeth kind co-operation. This study was supported by Grant-
which had been diagnosed on the basis of periodontal in-Aids from the Japan Society for the Promotion of
etiology/criteria, as having a poor prognosis in the elderly, Science (09470469) from the Ministry of Education,
on the basis of periodontal etiology/criteria, were the Culture, Sports, Science and Technology of Japan.
main sources of multiple, and relatively deep periodontal The author declares no conflict of interest related to this
28 Stoma Edu J. 2018;5(1): 24-30 http://www.stomaeduj.com
ASSOCIATION BETWEEN SERUM RESISTIN LEVEL AND PERIODONTAL CONDITION CHANGE
AMONG ELDERLY PEOPLE
study. There are no conflicts of interest and no financial 19. Devanoorkar A, Dwarakanath CD, Gundanavar G, et al.
Original Article
Evaluation of serum resistin levels in periodontal health and disease
interests to be disclosed. and effects of non surgical periodontal therapy on its levels. Dis
Markers. 2012;32(5):289-294. doi: 10.3233/DMA-2012-0891.
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Hiroshi OGAWA
DDS, MDSc, PhD, Associate Professor
Division of Preventive Dentistry, Department of Oral Health Science
Graduate School of Medical and Dental Sciences, Niigata University
Niigata, Japan
CV
Dr Hiroshi Ogawa acquired his dentist qualifications at the Nihon University in Japan in 1994, his Masters in Public Health
Dentistry at the University of Sydney in Australia and his PhD in Preventive Dentistry at Niigata University in Japan. He has been
Associate Professor at the Graduate School of Medical and Dental Sciences and also Vice-Director of WHO Collaborating Centre
for Translation of Oral Health Sciences at Niigata University. For several years he served at the WHO HQ-Geneva as Dental
Officer of the Global Oral Health Programme.
His major interest is global oral health promotion in public health perspective and also clinical research to strengthen evidence
for the integration of oral and general health.
Questions
1. What is the major inflammatory cytokine shown to overexpress in adipose
tissue?
qa. Adiponectine;
qb. Resistin;
qc. TNF-alpha;
qd. Leptin.
2. Individuals with impaired fasting glucose and diabetes mellitus,
qa. often have degrees of periodontal inflammation;
qb. often have degrees of oral carcinoma;
qc. often have degrees of root caries;
qd. often have degrees of dysphagia.
3. Periodontal disease could be described as,
qa. non-multifactor chronic inflammatory disease;
qb. integrated to immune system;
qc. caused only by intraoral pathogen;
qd. caused mainly by undernutrition.
4. Level of adipokine could be influenced by,
qa. fluoride gel application;
qb. intake of Vitamin supplement;
qc. professional mechanical tooth cleaning;
qd. smoking habit.
30 Stoma Edu J. 2018;5(1): 24-30 http://www.stomaeduj.com