Impact of Non-surgical Periodontal Treatment on Cytokines/Adipocytokines Levels Among Periodontitis Patients with or without Obesity: A Systematic Review and Meta-analysis

Abstract

Aim The objective of this systematic review and meta-analysis was to provide scientific evidence for clinical practice on the impact of non-surgical periodontal therapy (NSPT) on cytokines/adipocytokines (IL-6, TNF-a, CRP/hs-CRP, resistin, adiponectin, leptin and RBP4) among periodontitis patients with or without obesity. Materials & Methods of Study Selection The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement (PRISMA) has been followed. The study was registered (CRD42022375331) in the International prospective register of systematic reviews (PROSPERO). The literature search was conducted via eight databases. Both randomized-controlled trials (RCTs) and controlled clinical trials (CCTs) were screened from searches up to December 2022 to evaluate the effect of NSPT on inflammatory-related cytokines/adipocytokines. The selection, extraction of data and risk of bias assessment were performed in duplicate with consensus while quality was assessed via the Cochrane Collaboration’s risk assessment tool and the Methodological Index for non-randomized studies (MINORS). Meta-analysis was carried out using random-effect model in subgroups’ analyses with mean difference (MD) and 95% confidence intervals (CI) provided. Results Seventeen references were included for the systematic analysis and sixteen were further incorporated for meta-analysis. Meta-analysis demonstrated that the interleukin (IL) -6 in periodontitis individuals with obesity decreased three months after NSPT at serum levels (MD = -0.54, CI = -0.62 – -0.46) and at gingival crevicular fluid (GCF) levels (MD = -2.70, CI = -4.77 – -0.63); the C-reactive protein/ high-sensitivity-C-reactive protein (CRP/hs-CRP) decreased three months after NSPT at serum levels (MD = -0.31, CI = -0.54 – -0.07) and adiponectin improved three months after NSPT at GCF levels (MD = 2.37, CI = 0.29–4.45) both in periodontitis individuals without obesity. Most results displayed the higher level of pro-inflammatory biomarkers in obesity object rather than normal weight object at baseline. Incorporated studies are presented with low risk of bias. Conclusions NSPT has the impact on the redistribution of specific pro-inflammatory mediators and anti- inflammatory mediators in biological fluids within obesity or non-obesity individually or between the two groups. Wherein, NSPT could contribute to the reduction of serum and GCF IL-6 level together with the serum RBP4 level in obesity individuals at 3-month, NSPT also could contribute to the rise of GCF adiponectin level in normal weight individuals at 3-month, which implies the potential ideal follow-up interval and sensitive biomarkers for clinical bioanalysis.