Avaliação do impacto da gastroplastia na microbiota salivar e status de saúde bucal em pacientes com obesidade mórbida
Data
2022-04-19
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
A gastroplastia é considerada uma terapia efetiva para a obesidade mórbida, capaz de
melhorar ou reverter comorbidades, embora o conhecimento sobre o impacto na saúde
bucal seja restrito. O objetivo foi avaliar as condições de saúde bucal, marcadores
salivares inflamatórios e microbiota salivar em pacientes submetidos à gastroplastia (by pass; grupo Gastroplastia), comparando-os com um grupo Controle que recebeu
aconselhamento dietético por 6 meses. Material e Métodos: 30 mulheres e 10 homens
com obesidade mórbida (IMC≥40 kg/m2
) e idades entre 23 e 44 anos compuseram a
amostra (n=20 em cada grupo pareado para o sexo). Foram coletados dados do histórico
médico e dentário e consumo alimentar. O exame clínico incluiu o índice de cárie
(CPOD), índice periodontal comunitário (IPC) e medidas antropométricas e coleta de
saliva para determinação do fluxo, capacidade tampão, citocinas inflamatórias e ácido
úrico. A análise microbiológica salivar foi realizada por sequenciamento 16S rRNA para
avaliação da abundância relativa de gênero, espécie e alfa-diversidade. Os dados foram
analisados por análise de cluster K-means e ANOVA modelo misto de duas vias.
Resultados: Uma associação entre condição de saúde bucal, razão cintura/quadril e alfa diversidade bacteriana salivar foi observada ao baseline. A massa corporal e IMC
diminuíram significativamente no grupo Gastroplastia. Embora observada discreta
melhora nos marcadores de consumo alimentar, o número de dentes obturados e o índice
CPOD aumentaram em ambos os grupos (p<0,001). Uma discreta piora no IPC foi
observada no grupo Gastroplastia aos 3 meses, enquanto no grupo Controle observou-se
leve melhora no status periodontal aos 3 meses, que voltou a piorar até os 6 meses. O
fluxo salivar, capacidade tampão e concentrações de TNFα e ácido úrico não se alteraram
no período avaliado. As concentrações de IFNγ e IL10 reduziram significativamente no
grupo Gastroplastia até os 3 meses, enquanto no grupo Controle a diminuição ocorreu
após 3 meses de acompanhamento dietético; as concentrações de IL6 diminuíram em
ambos os grupos. Alterações significativas na abundância relativa de gêneros e espécies
foram observadas, com destaque para Actinomyces, Atopobium, Campylobacter e
Veillonella e Prevotella tannerae, Prevotella nigrescens e Porphyromonas endodontalis,
respectivamente, e na alfa-diversidade bacteriana salivar. Conclusão: A perda de peso e
a melhora no quadro inflamatório foi evidenciada pelas alterações nas concentrações de
citocinas salivares após a gastroplastia, concomitante a uma modulação na microbiota
salivar ao nível de gênero, espécie e alfa-diversidade em ambos os grupos. Embora
observada discreta melhora nos marcadores de consumos alimentar, o índice de cárie
aumentou e não foi encontrada melhora clinicamente significativa no status periodontal
6 meses após a gastroplastia.
Gastroplasty is considered an effective therapy for morbid obesity, able of improving or reversing comorbidities, although knowledge about the impact on oral health is limited. The objective was to evaluate oral health status, salivary inflammatory markers and salivary microbiota in patients undergoing gastroplasty (by-pass; Gastroplasty group), comparing them with a Control group that received dietary advice for 6 months. Material and Methods: 30 women and 10 men with morbid obesity (BMI≥40 kg/m2) and aged between 23 and 44 years comprised the sample (n = 20 in each gender-matched group). Data on medical and dental history and food consumption were collected. Clinical examination included caries index (DMFT), community periodontal index (CPI), anthropometric measurements and saliva collection to determine flow, buffering capacity, inflammatory cytokines and uric acid. Salivary microbiological analysis was performed by 16S rRNA sequencing to assess relative abundance of genus, species and alphadiversity. Data were analyzed by K-means Cluster analysis and two-way mixed model ANOVA. Results: An association between oral health status, waist-to-hip ratio and salivary bacterial alpha-diversity was observed at baseline. Weight and BMI decreased significantly in the Gastroplasty group. Although there was a slight improvement in food consumption markers, the number of filled teeth and the DMFT index increased in both groups (p<0.001). A slight worsening in IPC was observed in the Gastroplasty group at 3 months, while in the Control group there was a slight improvement in periodontal status at 3 months, which worsened again until 6 months. Salivary flow, buffering capacity and concentrations of TNFα and uric acid did not change during this period. The concentrations of IFNγ and IL10 significantly reduced in the Gastroplasty group up to 3 months, while in the Control group the decrease occurred after 3 months of dietary followup; IL6 concentrations decreased in both groups. Significant alterations in the relative abundance of genera and species were observed, especially for Actinomyces, Atopobium, Campylobacter and Veillonella and Prevotella tannerae, Prevotella nigrescens and Porphyromonas endodontalis, respectively, and in salivary bacterial alpha-diversity. Conclusion: Weight loss and improvement in the inflammatory condition was evidenced by changes in salivary cytokine concentrations after gastroplasty, concomitant with a modulation in the salivary microbiota at the level of gender, species and alpha-diversity in both groups. Although a slight improvement was observed in food consumption markers, the caries index increased and no clinically improvement in periodontal status was found 6 months after gastroplasty.
Gastroplasty is considered an effective therapy for morbid obesity, able of improving or reversing comorbidities, although knowledge about the impact on oral health is limited. The objective was to evaluate oral health status, salivary inflammatory markers and salivary microbiota in patients undergoing gastroplasty (by-pass; Gastroplasty group), comparing them with a Control group that received dietary advice for 6 months. Material and Methods: 30 women and 10 men with morbid obesity (BMI≥40 kg/m2) and aged between 23 and 44 years comprised the sample (n = 20 in each gender-matched group). Data on medical and dental history and food consumption were collected. Clinical examination included caries index (DMFT), community periodontal index (CPI), anthropometric measurements and saliva collection to determine flow, buffering capacity, inflammatory cytokines and uric acid. Salivary microbiological analysis was performed by 16S rRNA sequencing to assess relative abundance of genus, species and alphadiversity. Data were analyzed by K-means Cluster analysis and two-way mixed model ANOVA. Results: An association between oral health status, waist-to-hip ratio and salivary bacterial alpha-diversity was observed at baseline. Weight and BMI decreased significantly in the Gastroplasty group. Although there was a slight improvement in food consumption markers, the number of filled teeth and the DMFT index increased in both groups (p<0.001). A slight worsening in IPC was observed in the Gastroplasty group at 3 months, while in the Control group there was a slight improvement in periodontal status at 3 months, which worsened again until 6 months. Salivary flow, buffering capacity and concentrations of TNFα and uric acid did not change during this period. The concentrations of IFNγ and IL10 significantly reduced in the Gastroplasty group up to 3 months, while in the Control group the decrease occurred after 3 months of dietary followup; IL6 concentrations decreased in both groups. Significant alterations in the relative abundance of genera and species were observed, especially for Actinomyces, Atopobium, Campylobacter and Veillonella and Prevotella tannerae, Prevotella nigrescens and Porphyromonas endodontalis, respectively, and in salivary bacterial alpha-diversity. Conclusion: Weight loss and improvement in the inflammatory condition was evidenced by changes in salivary cytokine concentrations after gastroplasty, concomitant with a modulation in the salivary microbiota at the level of gender, species and alpha-diversity in both groups. Although a slight improvement was observed in food consumption markers, the caries index increased and no clinically improvement in periodontal status was found 6 months after gastroplasty.