ASSOCIATION BETWEEN SERUM RESISTIN LEVEL AND PERIODONTAL CONDITION CHANGE AMONG ELDERLY PEOPLE

Table 3 . Multiple linear regression analysis and associated p-value using change in sites with PD ≥ 4 mm as a dependent variable

Independent variables

Resisitin ( ng / mL )

Adiponectin (µ g / mL )

TNF-α ( pg / mL )

Dependent variable : changes in sites with PD ≥ 4 mm

Coefficient S . E . t 95 % CI p-value

-0.49 0.28 -1.76 -1.05 – 0.06 0.080

-0.01 0.19 -0.04 -0.38 – 0.36 0.967

0.39 0.56 0.70 -0.72 – 1.52 0.487

IL-6 ( pg / mL ) -0.05 0.48 0.11 -0.90 – 1.00 0.915

Number of tooth loss

-2.48 0.39 -6.23 -3.27 – 1.69 0.000

Constant 0.70 2.93 0.24 -5.09 – 6.51 0.240

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

Table 4 . Multiple linear regression analysis and associated p-value using change in sites with PD ≥ 4 mm concomitant BOP as a dependent variable

Independent variables

Resisitin ( ng / mL )

Adiponectin (µ g / mL )

TNF-α ( pg / mL )

Dependent variable : changes in sites with PD ≥ 4 mm , concomitant BOP

Coefficient S . E . t 95 % CI p-value

-0.41 0.15 -2.66 -0.72 – 0.10 0.009

-0.02 0.10 -0.28 -0.23 – 0.17 0.777

0.31 0.31 0.99 -0.30 – 0.93 0.323

IL-6 ( pg / mL ) -0.01 0.26 -0.07 -0.54 – 0.50 0.945

Number of tooth loss

-0.78 0.21 -3.55 -1.21 – -0.34 0.001

Constant 1.00 1.61 0.62 -2.19 – 4.20 0.536

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

Table 5 . Comparison of number and percentages of participants who received periodontal treatment between low and high serum resistin group during study period

Type of periodontal treatment received

LR (< 5.3 ng / mL ) N = 84

Resistin

HR ( ≥5.3 ng / mL ) N = 48 p value

of inflammatory-related periodontal parameters . We demonstrated that the high serum resistin levels seemed more sensitive to contribute to the other factors-mediated improved periodontal condition more than those in the low resistin counterpart . The association between the other serological parameters at baseline as well as the number of teeth lost in 4 years , and the alteration of the periodontal condition were the secondary outcome variables . The participants in the present study were in a relatively good periodontal condition ( at baseline average sites with PD≥4 mm , and those concomitant BOP were 11.99 sites and 3.88 sites , respectively ). Basically , periodontal disease activity can be measured by many parameters such as probing pocket depth , clinical attachment level , radiographic bone level , and bleeding on probing . Among these parameters , bleeding on probing is a reliable indicator that can be used to monitor periodontal disease activity in clinical situation [ 26 ], especially when focusing on inflammation as a primary outcome . This is the reason why we emphasized the analysis of the sites with periodontal pocket depth ≥ 4mm concomitant BOP in our study . Our results indicated that the periodontal disease activity in our participants were much lower than in the previous report [ 20 ]. Two meta-analyses [ 27,28 ] have demonstrated that individuals who were obese or had high body mass index ( BMI ) seemed susceptible to periodontitis more than normal weight individuals . And the high resistin levels were observed in obese individuals with periodontitis . The participants in the precedent study had normal BMI , but in individuals with relatively high BMI or the obese ones we did not observe this tendency suggesting that obesity modulates resistin independent of periodontitis . A previous cross-sectional study by Furugen et al . [ 9 ] indicated that serum resistin levels were significantly correlated with BOP , and leukocyte counts , but weakly correlated with average PD . The present study also similarly found a significant correlation of sites with PD≥4 mm as well as sites with PD≥4 mm concomitant BOP at baseline with serum resistin level . These results support the previous report that resistin play an important role in inflammation [ 12 ]. But since all previous studies were cross-sectional studies ; causality-effect relationship could not be obtained . It is noteworthy that for long term association of serum resistin level and periodontal parameters , high serum resistin level at baseline appeared to influence more profoundly the effect of the periodontal condition alteration . The 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 periodontal examination and oral hygiene instruction . These led most of the participants to receive extensive periodontal treatment by themselves elsewhere over the period of the present study . However , the percentages of participants who received periodontal treatment in both groups are almost the same ( Table 5 ). Nonetheless , the periodontal conditions of the high resistin group remained more improved than the low resistin group . These results were probably due to resistin significantly correlated only to severe systemic inflammation condition such as in angina patient [ 29 ], but in case of mild or localized inflammation such as stable angina and mild periodontitis , which is not severe enough to sense signaling to activate resistin , resulting in almost no positive relationship between the serum resistin level and the periodontal condition [ 14,19,30 ]. Our results were somehow different from these studies because we demonstrated the inverse association between serum resistin level and long-term periodontitis progression in a fashion that the higher the serum resistin levels the better the sensitivity to periodontal treatment effectiveness . Moreover , resistin plays a role not only in the peripheral area , but it also functions in a central nervous system . It was found that resistin inhibits dopamine and norepinerphrine in rat hypothalamus [ 31 ]. Furthermore , an increase in

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