Non-alcoholic fatty liver and periodontal disease in the adult population: Overview of systematic reviews
DOI:
https://doi.org/10.56294/saludcyt2024.1016Keywords:
Non-alcoholic Fatty Liver Disease, Periodontitis, Periodontal Diseases, Porphyromonas gingivalis, Quality of lifeAbstract
Introduction: Periodontal disease is a chronic inflammatory condition affecting the periodontal supporting tissues. In addition to dental loss, it has been associated with various metabolic disorders, including obesity, diabetes, dyslipidemia, and non-alcoholic fatty liver disease (NAFLD). This study aimed to analyze the effects of periodontal disease on the prevention and treatment of NAFLD in the adult population. Method: An electronic search of systematic reviews published between 2019 and 2024 was conducted in the Medline, Scopus, and Web of Science databases, as well as in the Epistemonikos meta-search engine. The search strategy was "Non-alcoholic Fatty Liver Disease AND Periodontitis". A total of 47 articles were identified, of which three systematic reviews with meta-analyses were analyzed. Results: The results indicated a potential association between periodontal disease and NAFLD, with an odds ratio (OR) of 1.48 (95% CI: 1.15 to 1.89; I² = 92%) and 1.91 (95% CI: 1.21 to 3.02; I² = 95%). However, this link has not been definitively proven, as heterogeneity decreases and the number of patients increases, resulting in an OR of 1.04 (95% CI: 0.97 to 1.12; I² = 58%). Conclusion: It is suggested that systemic inflammation and pro-inflammatory markers may play a significant role in the pathophysiology of both conditions. Nonetheless, further studies are needed to clarify this relationship and explore the common metabolic parameters.
References
Wijarnpreecha K, Panjawatanan P, Cheungpasitporn W, et al. The Association between Periodontitis and Nonalcoholic Fatty Liver Disease: A Systematic Review and Meta-analysis. J Gastrointestin Liver Dis. 2020;29(2):211-217. doi:10.15403/jgld-841.
Shin H-S. Association between periodontal status and non-alcoholic fatty liver disease in a Korean adult population: A nationwide cross-sectional study. J Periodontol. 2020;91:524–532. https://doi.org/10.1002/JPER.19-0291
Yoneda M, Kobayashi T, Iwaki M, Nogami A, Saito S, Nakajima A. Nonalcoholic Fatty Liver Disease as a Systemic Disease and the Need for Multidisciplinary Care. Gut Liver. 2023;17(6):843-852. doi:10.5009/gnl220545
Kuraji R, Sekino S, Kapila Y, Numabe Y. Periodontal disease-related nonalcoholic fatty liver disease and nonalcoholic steatohepatitis: An emerging concept of oral-liver axis. Periodontol 2000. 2021;87(1):204-240. doi:10.1111/prd.12387
Younossi ZM, Koenig AB, Abdelatif D, Fazel Y, Henry L, Wymer M. Global epidemiology of nonalcoholic fatty liver disease-Meta-analytic assessment of prevalence, incidence, and outcomes. Hepatology. 2016;64(1):73-84. doi:10.1002/hep.28431
Akinkugbe AA, Barritt AS, Cai J, et al. Periodontitis and prevalence of elevated aminotransferases in the Hispanic Community Health Study/Study of Latinos. J Periodontol. 2018;89(8):949-958. doi:10.1002/JPER.17-0579
Caetano VDS, de Andrade RSB, França LFC, et al. Food restriction reduces hepatic alterations associated with experimental periodontitis. J Periodontol. 2022;93(1):156-165. doi:10.1002/JPER.20-0772
Yao C, Lan D, Li X, Wang Y, Qi S. Porphyromonas gingivalis triggers inflammation in hepatocyte depend on ferroptosis via activating the NF-κB signaling pathway. Oral Dis. 2024;30(3):1680-1694. doi:10.1111/odi.14537
Nagasaki A, Sakamoto S, Arai T, et al. Elimination of Porphyromonas gingivalis inhibits liver fibrosis and inflammation in NASH. J Clin Periodontol. 2021;48(10):1367-1378. doi:10.1111/jcpe.13523
Liu L, Geng Y, Xiong C. Impact of Porphyromonas gingivalis-odontogenic infection on the pathogenesis of non-alcoholic fatty liver disease. Ann Med. 2023;55(2):2255825. doi:10.1080/07853890.2023.2255825
Kuraji R, Shiba T, Dong TS, Numabe Y, Kapila YL. Periodontal treatment and microbiome-targeted therapy in management of periodontitis-related nonalcoholic fatty liver disease with oral and gut dysbiosis. World J Gastroenterol. 2023;29(6):967-996. doi:10.3748/wjg.v29.i6.967
Xu F, Tang J. Is There An Association Between Periodontitis And Non-Alcoholic Fatty Liver Disease? A Systematic Review and Meta-Analysis. Community Dent Health. 2023;40(1):47-52. doi:10.1922/CDH_00180Xu06
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71. Disponible en: https://doi.org/10.1136/bmj.n71.
Shea BJ, Reeves BC, Wells G, Thuku M, Hamel C, Moran J, et al. AMSTAR-2: herramienta de evaluación crítica de revisiones sistemáticas de estudios de intervenciones de salud. BMJ. 2017;358:j4008.
Alakhali MS, Al-Maweri SA, Al-Shamiri HM, Al-Haddad K, Halboub E. The potential association between periodontitis and non-alcoholic fatty liver disease: a systematic review. Clin Oral Investig. 2018;22(9):2965-2974. doi:10.1007/s00784-018-2726-1
Thalla S, R K, A K. Increasing Risk Factors for Non-Alcoholic Fatty Liver Disease; an Insight into Chronic Periodontitis and Insulin Resistance. Endocr Metab Immune Disord Drug Targets. 2022;22(8):807-814. doi:10.2174/1871530322666220104095534
Kobayashi T, Iwaki M, Nogami A, et al. Involvement of Periodontal Disease in the Pathogenesis and Exacerbation of Nonalcoholic Fatty Liver Disease/Nonalcoholic Steatohepatitis: A Review. Nutrients. 2023;15(5):1269. doi:10.3390/nu15051269
Kuraji R, Shiba T, Dong TS, Numabe Y, Kapila YL. Periodontal treatment and microbiome-targeted therapy in management of periodontitis-related nonalcoholic fatty liver disease with oral and gut dysbiosis. World J Gastroenterol. 2023;29(6):967-996. doi:10.3748/wjg.v29.i6.967
Hatasa M, Yoshida S, Takahashi H, et al. Relationship between NAFLD and Periodontal Disease from the View of Clinical and Basic Research, and Immunological Response. Int J Mol Sci. 2021;22(7):3728. doi:10.3390/ijms22073728
Liu L, Geng Y, Xiong C. Impact of Porphyromonas gingivalis-odontogenic infection on the pathogenesis of non-alcoholic fatty liver disease. Ann Med. 2023;55(2):2255825. doi:10.1080/07853890.2023.2255825
Mei EH, Yao C, Chen YN, Nan SX, Qi SC. Multifunctional role of oral bacteria in the progression of non-alcoholic fatty liver disease. World J Hepatol. 2024;16(5):688-702. doi:10.4254/wjh.v16.i5.688
Albuquerque-Souza E, Sahingur SE. Periodontitis, chronic liver diseases, and the emerging oral-gut-liver axis. Periodontol 2000. 2022;89(1):125-141. doi:10.1111/prd.12427
Aguiar ILS, Santos-Lins LS, Brasil-Oliveira R, Cotrim HP, Lins-Kusterer L. Non-alcoholic fatty liver disease and periodontal disease: A systematic review and meta-analysis of cross-sectional studies. Arab J Gastroenterol. 2023;24(4):198-203. doi:10.1016/j.ajg.2023.09.005
Reis C, DA Costa AV, Guimarães JT, et al. Clinical improvement following therapy for periodontitis: Association with a decrease in IL-1 and IL-6. Exp Ther Med. 2014;8(1):323-327. doi:10.3892/etm.2014.1724
Hajishengallis G. Periodontitis: from microbial immune subversion to systemic inflammation. Nat Rev Immunol. 2015;15(1):30-44. doi:10.1038/nri3785
Kim JY, Park YM, Lee GN, et al. Association between toothbrushing and non-alcoholic fatty liver disease. PLoS One. 2021;16(5):e0243686. doi:10.1371/journal.pone.0243686
Cardoso EM, Reis C, Manzanares-Céspedes MC. Chronic periodontitis, inflammatory cytokines, and interrelationship with other chronic diseases. Postgrad Med. 2018;130(1):98-104. doi:10.1080/00325481.2018.1396876
Butt K, Butt R, Sharma P. The burden of periodontal disease. Dental Update. 2019;46(10):907–13
Manuzza MA, Brito G, Echegaray NS, López LB. Glycemic index and glycemic load: their value in treatment and prevention of noncommunicable chronic diseases. Diaeta. 2018;36(162):29-38.
Orlandi M, Muñoz Aguilera E, Marletta D, Petrie A, Suvan J, D'Aiuto F. Impact of the treatment of periodontitis on systemic health and quality of life: A systematic review. J Clin Periodontol. 2022;49 Suppl 24:314-327. doi:10.1111/jcpe.13554
Kim JY, Lee GN, Song HC, Park YM, Ahn YB, Han K, et al. Association between Fatty Liver Index and Periodontitis: the Korea National Health and Nutrition Examination Survey. Sci Rep. 2020;10(1):3805.
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Copyright (c) 2024 Héctor Fuentes-Barría, Blanca Klahn-Acuña, Denisse Sepúlveda-Toro , Najarett Galaz-Cáceres, Raúl Aguilera-Eguía, Miguel Alarcón-Rivera (Author)

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