Ch. 18: Nutrition, Inflammation, and Perio Disease

Question 1

Obesity

Answer 1

excess body fat in proportion to lean body mass; BMI of 30 or greater

Question 2

Adipose Tissue

Answer 2

complex, metabolically active endocrine organ; secrete numerous immunomodulatory factors

Question 3

Functions of Adipose Tissue

Answer 3

Plays major role in regulating metabolic and vascular biology
Obese individuals have elevated levels of circulating proinflammatory cytokines

Question 4

Adipocytes

Answer 4

makes up adipose tissue; extensive distribution throughout body
Increased numbers and size in obesity

Question 5

Functions of Adipocytes

Answer 5

Secretes hormones, growth factors, cytokines, enzymes; can affect systemic inflammation and insulin sensitivity
Releases both harmful and beneficial cytokines

Question 6

Adiponectin

Answer 6

hormone secreted only be adipose tissue; involved in glucose and lipid metabolism

Question 7

Role of Adiponectin

Answer 7

stimulating hunger through the hypothalamus and decreasing inflammation by acting on macrophages to suppress TNF-a production and release IL-10

Question 8

Levels of Adiponectin in obese individulas

Answer 8

Decreased levels in obese individuals; low levels associated w/ increased systemic inflammation

Question 9

Leptin

Answer 9

suppresses appetite and enhancing inflammation; signal to brain that person is satiated/full
Levels gradually increase as person eats

Question 10

Effects of Leptin

Answer 10

Multiple proinflammatory roles: activates monocytes and macrophages, promotes immune cell chemotaxis, regulates activity of immune cells, produces cytokines

Question 11

Levels of Leptin in obese individuals

Answer 11

Elevated in obese individuals, resulting in greater resistance to its effects

Question 12

Perio-Obesity Link

Answer 12

positive correlation between BMI and severity of perio attachment loss
Higher prevalence of perio disease in overweight young individuals
More overweight and obese individuals have periodontitis than individuals of normal weight

Question 13

Cytokines in adipose tissue

Answer 13

Release of proinflammatory cytokines from adipose tissue; continuous release in obese individuals may lead to systemic inflammatory overload

Question 14

Obesity Associated TNF-a

Answer 14

secreted by adipocytes and macrophages in the adipose tissue
Greatest contributor to systemic circulation is from adipose tissue
Highly implicated in insulin resistance
Elevated levels in periodontitis

Question 15

Interleukin-6 (IL-6)

Answer 15

30% in circulation comes from adipose tissue; obesity stimulates secretion
Elevated levels associated w/ coronary heart disease, periodontal inflammation, alveolar bone loss

Question 16

Plasminogen Activator Inhibitor-1 (PAI-1)

Answer 16

increases in circulation as adipose tissue increases
Involved in fibrinolysis, contributes to atherosclerosis, elevated in perio disease

Question 17

Reactive Oxygen Species (ROS)

Answer 17

chemically reactive molecules containing oxygen

Question 18

Low levels of ROS

Answer 18

cell signaling, tissue homeostasis, cellular proliferation, differentiation, metabolism, growth of cells
(beneficial)

Question 19

High levels of ROS

Answer 19

Elevated in obesity and periodontal disease
Higher concentrations can lead to tissue damage, including perio tissue (generated through cytokines, bacteria, tobacco)

Question 20

Antioxidant Molecules

Answer 20

can prevent or reduce damage to periodontal tissue
Prevents formation of ROS or converts them to less reactive forms

Question 21

ROS-Antioxidant Imbalance

Answer 21

can lead to periodontal disease
Inflammation may result from depletion of antioxidant levels
Levels of antioxidants in crevicular fluid lower in patients w/ perio disease

Question 22

Micronutrients

Answer 22

needed in very small amounts; vitamins and minerals

Question 23

Macronutrients

Answer 23

provide energy, ingested in larger quantities; proteins, lipids, carbohydrates

Question 24

Oxidation

Answer 24

oxidations occurs when oxygens interacts w/ cells, produces some type of change
Free radicals cause oxidative stress, ROS most significant form, cause damage in cells, sources inside and outside of body
ROS produced by PMN’s during phagocytosis, can damage proteins (causing fragmentation, peroxidation of lipids, strand breakage of DNA)

Question 25

Antioxidants

Answer 25

counteracts damaging effects of oxidation Influences perio disease and wound healing, downregulation of proinflammatory responses

Question 26

Most common water soluble vitamin antioxidant

Answer 26

Vitamin C

Question 27

Common fat soluble vitamin antioxidant

Answer 27

Vitamin E

Question 28

Vitamin C (Ascorbic Acid)

Answer 28

water soluble, cannot be stored in body, curative effect on scurvy

Question 29

Effects of Vit C

Answer 29

Helps in maintaining integrity of cell membrane and protection from ROS inflammatory responses Lower intake increases risk of perio disease in current and former smokers Mature collagen fibers fail to develop in scurvy

Question 30

Rebound scurvy

Answer 30

rare, can occur after abruptly stopping vit C intake after period of excessive doses; high risk for newborns whose mothers taken large doses during pregnancy

Question 31

Ascorbic Acid Deficiency Gingivitis

Answer 31

inflammatory response to biofilm exaggerated by low vit C levels Bright red, swollen, ulcerated gingiva that bleeds easily

Question 32

Vitamin A

Answer 32

fat soluble, needed for epithelial cell differential, bone remotely, immunity, anti-inflammatory response (key role in epithelial maintenance) No significant relationship with risk for periodontitis Primarily in animal fats and fish oils at retinoids

Question 33

Vitamin D

Answer 33

diet or sun exposure, enhances calcium and phosphate absorption, maintains blood calcium levels Aids calcification of teeth and osseous tissues Acts as anti-inflammatory agent

Question 34

Vitamin E

Answer 34

protects cell membrane from oxidative damage, reduces prostaglandin E2 from macrophages Can aid in gingival inflammation Supplementation shown to have positive effect on immune response

Question 35

Folic Acid

Answer 35

B-complex group, DNA synthesis Deficiency may reduce ability of gingival tissues to act as barrier to bacteria

Question 36

Calcium

Answer 36

calcification process, RDA 1,000mg (adults 19-50) Formation and maintenance of alveolar bone Higher intake may reduce risk for tooth loss

Question 37

Magnesium

Answer 37

found in all cells, in mitochondria Supplementation may improve perio health for people 40 years or older

Question 38

Proteins main function

Answer 38

build new and repair old body tissue

Question 39

Proteins (Cont.)

Answer 39

Deficiency can impair defense Perio disease more prevalent and severe in undernourished individuals

Question 40

Refined Carbs and Lipids

Answer 40

excessive intake associated w/ obesity and periodontitis Can affect immune response, cause rapid release of glucose, oxidative damage, progression of perio disease

Question 41

polyunsaturated lipids (omega-3 fatty acids)

Answer 41

show anti-inflammatory properties Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) Associated w/ lower levels of periodontitis