The relationship between obesity and periodontal disease (PD) in adults is well known (1). However, PD is much less frequent in pediatric populations, although gingivitis is often documented. Untreated gingivitis may progress to a more complex destructive chronic PD later in life (2). Children who are obese (OB) or overweight (OWt) may also present other comorbidities such as dyslipidemia and/or insulin resistance (IR), which may also contribute to the development of inflammatory processes observed in PD. We studied the occurrence of gingival inflammation related to excess body fat, dyslipidemia, and IR in 90 white healthy Argentinean children/adolescents. Children/adolescents were referred to the outpatient Nutrition Clinic, Hospital José de San Martin, School of Medicine, University of Buenos Aires, for assessment and treatment of obesity. The ethical committees of the hospital and the university approved the study. Excess body fat was defined according to BMI z score with cutoff points established by the World Health Organization in 2007. Gingival inflammation was evaluated by the gingival inflammatory index (GI) (3). Serum lipids were determined. IR was evaluated by the HOMA-IR index. An HOMA-IR index ≥3 was considered an indicator of IR. The demographic information; the frequencies of dyslipidemia, IR, and positive GI; and the associations of positive GI and dyslipidemia or IR related to excess body fat are shown in Table 1.
Characteristics of the population and frequencies of dyslipidemia, IR, and GI related to excess body weight
| Characteristics . | OWt (n = 20) . | OB (n = 70) . | P . |
|---|---|---|---|
| Age, years (mean ± SD) | |||
| Boys (10.40 ± 1.75) (n = 40) | 10.25 ± 2.22 (n = 4) | 10.42 ± 1.73 (n = 36) | 0.8567 |
| Girls (10.62 ± 1.76) (n = 50) | 10.56 ± 1.82 (n = 16) | 10.65 ± 1.76 (n = 34) | 0.8630 |
| Sex | |||
| Boys (n = 40) | 20.0 (9.7–43.7) (n = 4) | 51.4 (39.3–63.4) (n = 36) | 0.011 |
| Girls (n = 50) | 80.0 (56.3–94.3) (n = 16) | 48.6 (33.6–60.7) (n = 34) | |
| Frequency of dyslipidemia and IR | |||
| Triglyceridemia (≥110 mg/dL) (n = 22) | 15.0 (3.2–37.9) (n = 3) | 27.1 (17.5–39.3) (n = 19) | 0.209 |
| HDL cholesterol (≤40 mg/dL) (n = 28) | 25.0 (8.7–49.1) (n = 5) | 32.9 (22.4–45.2) (n = 23) | 0.353 |
| Cholesterolemia (≥200 mg/dL) (n = 5) | 10.0 (1.2–31.7) (n = 2) | 4.3 (0.9–2.0) (n = 3) | 0.307 |
| LDL cholesterol (≥130 mg/dL) (n = 4) | 5.0 (0.1–24.9) (n = 1) | 4.3 (0.9–2.0) (n = 3) | 0.641 |
| HOMA-IR (≥3) (n = 43) | 30.0 (11.9–54.3) (n = 6) | 52.9 (40.6–64.8) (n = 37) | 0.059 |
| Frequency of positive GI | |||
| GI (>1) (n = 86) | 85.0 (62.1–96.8) (n = 17) | 98.6 (92.3–100.0) (n = 69) | 0.030 |
| Frequency of positive GI in patients with dyslipidemia | |||
| Hypertriglyceridemia and positive GI (n = 21) | 10.0 (1.2–31.7) (n = 2) | 27.1 (17.5–39.3) (n = 19) | 0.09 |
| Low HDL cholesterol and positive GI (n = 26) | 15.0 (3.2–37.9) (n = 3) | 32.9 (22.4–45.2) (n = 23) | 0.09 |
| Hypercholesterolemia and positive GI (n = 5) | 10.0 (1.2–31.7) (n = 2) | 4.3 (0.9–2.0) (n = 3) | 0.307 |
| High LDL cholesterol and positive GI (n = 4) | 10.0 (1.2–31.7) (n = 2) | 2.9 (0.3–9.9) (n = 2) | 0.213 |
| Frequency of positive GI in patients with IR | |||
| IR and positive GI (n = 41) | 20.0 (5.7–43.7) (n = 4) | 52.9 (40.6–64.8) (n = 37) | 0.008 |
| Characteristics . | OWt (n = 20) . | OB (n = 70) . | P . |
|---|---|---|---|
| Age, years (mean ± SD) | |||
| Boys (10.40 ± 1.75) (n = 40) | 10.25 ± 2.22 (n = 4) | 10.42 ± 1.73 (n = 36) | 0.8567 |
| Girls (10.62 ± 1.76) (n = 50) | 10.56 ± 1.82 (n = 16) | 10.65 ± 1.76 (n = 34) | 0.8630 |
| Sex | |||
| Boys (n = 40) | 20.0 (9.7–43.7) (n = 4) | 51.4 (39.3–63.4) (n = 36) | 0.011 |
| Girls (n = 50) | 80.0 (56.3–94.3) (n = 16) | 48.6 (33.6–60.7) (n = 34) | |
| Frequency of dyslipidemia and IR | |||
| Triglyceridemia (≥110 mg/dL) (n = 22) | 15.0 (3.2–37.9) (n = 3) | 27.1 (17.5–39.3) (n = 19) | 0.209 |
| HDL cholesterol (≤40 mg/dL) (n = 28) | 25.0 (8.7–49.1) (n = 5) | 32.9 (22.4–45.2) (n = 23) | 0.353 |
| Cholesterolemia (≥200 mg/dL) (n = 5) | 10.0 (1.2–31.7) (n = 2) | 4.3 (0.9–2.0) (n = 3) | 0.307 |
| LDL cholesterol (≥130 mg/dL) (n = 4) | 5.0 (0.1–24.9) (n = 1) | 4.3 (0.9–2.0) (n = 3) | 0.641 |
| HOMA-IR (≥3) (n = 43) | 30.0 (11.9–54.3) (n = 6) | 52.9 (40.6–64.8) (n = 37) | 0.059 |
| Frequency of positive GI | |||
| GI (>1) (n = 86) | 85.0 (62.1–96.8) (n = 17) | 98.6 (92.3–100.0) (n = 69) | 0.030 |
| Frequency of positive GI in patients with dyslipidemia | |||
| Hypertriglyceridemia and positive GI (n = 21) | 10.0 (1.2–31.7) (n = 2) | 27.1 (17.5–39.3) (n = 19) | 0.09 |
| Low HDL cholesterol and positive GI (n = 26) | 15.0 (3.2–37.9) (n = 3) | 32.9 (22.4–45.2) (n = 23) | 0.09 |
| Hypercholesterolemia and positive GI (n = 5) | 10.0 (1.2–31.7) (n = 2) | 4.3 (0.9–2.0) (n = 3) | 0.307 |
| High LDL cholesterol and positive GI (n = 4) | 10.0 (1.2–31.7) (n = 2) | 2.9 (0.3–9.9) (n = 2) | 0.213 |
| Frequency of positive GI in patients with IR | |||
| IR and positive GI (n = 41) | 20.0 (5.7–43.7) (n = 4) | 52.9 (40.6–64.8) (n = 37) | 0.008 |
Data are % (95% CI), unless otherwise indicated. OWt was defined as having a BMI ≥1 to 1.99 SD above the mean, and obesity was defined as having a BMI ≥2 SD, both adjusted for age and sex. HOMA-IR index is defined as fasting levels of insulin (μU/mL) multiplied by fasting glycemia (mmol/mL) divided by 22.5, and HOMA-IR index ≥3 was considered an indicator of IR. Student t test was used for comparing age; P < 0.05 was taken to indicate statistical significance. Fisher exact tests were applied to compare OWt/OB children/adolescents as a dependent variable, with sex, serum lipids, IR, and positive GI as independent variables.
The results of the current study showed that there were more children who were OB than OWt. Sex differences were observed; being OWt was more prevalent among girls (P = 0.01). There was no significant difference for dyslipidemia among OB and OWt subjects. However, IR had a tendency to be significant (P = 0.059). Associations between positive GI among OB and OWt (P = 0.03) and positive GI, IR, and excess body fat (P = 0.008) were found.
Obesity, considered a global epidemic by the World Health Organization, represents one of the most serious health problems in both children and adults (4). In Argentina, OB and OWt prevalence in childhood and adolescence has increased in the last decades to 34.6% of school children (5). Excess body fat was associated with an inflammatory state; the secretion of inflammatory cytokines by adipose tissue could lead to hepatic dyslipidemia and reduction in insulin sensitivity. Given the evidence of the association of IR with the development of PD (6), our results reinforce the importance of addressing IR early in life and of being alert to gingival inflammation in children/adolescents with excess body fat. Oral health status should also be considered in the assessment of obesity and its comorbidities, principally because oral alterations are amenable to primary care prevention and treatment measures. Thus, OB children require a comprehensive multidisciplinary approach that should include both medical and dental health care professionals.
Article Information
Acknowledgments. The authors thank Marcela Pandolfo and Anabella Caamaño from the Biochemical Central Lab, Clinical Hospital José de San Martin, School of Medicine, University of Buenos Aires, for the biochemical determinations and Maria Eugenia Antona (Department of Biochemistry, School of Dentistry, University of Buenos Aires, Buenos Aires, Argentina) for the dental technical support.
Funding. The study was supported by the University of Buenos Aires grants 20020130100506 and 20720130100017BA. Pediatric Sunshine Academics, Inc., supported F.L.
Duality of Interest. No potential conflicts of interest relevant to this article were reported.
Author Contributions. P.L.C. and L.S.R. researched data. F.L. contributed to the discussion and reviewed and edited the manuscript. M.M.G.C. assessed oral parameters. N.B. contributed to the discussion. P.M.B. wrote the manuscript. P.N.R. wrote the manuscript and researched data. S.M.F. designed the protocol, wrote the manuscript, and contributed to the discussion. S.M.F. is the guarantor of this work and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
